(PS9-73) Transgender and Gender Diverse Perspectives on CBT: A Qualitative Analysis of a Clinical Trial Adapted for Marginalized Communities

Cognitive-behavioral therapy (CBT) is a gold standard treatment for anxiety, depression, and other common outpatient presenting concerns. While there is extensive research on the efficacy of CBT, there is less evidence regarding whether CBT can be successfully utilized with marginalized populations such as transgender and gender diverse (TGD) individuals. The present study highlights the voices of TGD individuals engaging with CBT and explores their perspectives on CBT’s ability to be affirming of and beneficial to TGD individuals.  

Data for the present study comes from an ongoing clinical trial that has currently enrolled 24 TGD adults with an average age of 27.38 (SD = 12.69). Participation in the clinical trial includes 12 weekly sessions of a transdiagnostic CBT protocol that was adapted to be affirming of TGD individuals using the Adaptations to Care (Hope et al., 2022). Participants are randomly assigned to either the immediate treatment or waitlist condition. The participants assigned to the waitlist condition received biweekly check-in phone calls with a member of the team for 12 weeks before beginning the 12-session treatment. All participants are asked to complete semi-structured interviews about their experiences halfway through treatment, after the conclusion of treatment, and three months post-treatment. For the present study, 22 mid-treatment interviews and 20 end-of-treatment interviews were analyzed to ascertain themes across participant experiences. For the final poster, approximately 25 mid-treatment and 25 end of treatment interviews across 25 participants will be analyzed.  

Results of the qualitative analysis indicate that TGD participants’ thoughts on CBT fell into one of two main themes. The first theme was that participants felt positively about the CBT protocol and adaptations implemented in this study because they felt affirmed, validated, and as if they were making measurable progress throughout treatment. The second theme described an overarching feeling of empowerment emerging from the affirming CBT protocol. Within this theme, participants described ways their therapist incorporated considerations of marginalization and resilience into cognitive restructuring and exposures, as well as the unique influences of societal transphobia on exploring core beliefs and negative thought patterns through cognitive restructuring.    

The findings from the present study indicate that when done correctly, CBT can be adapted to be affirming of and beneficial to TGD individuals. Participants continuously described the ways in which considerations and aspects of their gender identity and experiences were infused throughout every element of the standard CBT protocol, which led to a stronger therapeutic alliance and better perceived outcomes than previous therapy experiences. To provide the best mental health services possible, it is essential that psychotherapists acquire the knowledge and skills to seamlessly weave TGD individuals’ identities and experiences into standard treatments such as CBT.