1 - (SYM 30) Affirmative CBT for Sexual and Gender Minority Youth: Feedback from Pilot Studies in the US and New Zealand

Sexual and gender minority (SGM) youth experience disproportionately high rates of internalizing conditions relative to their cisgender, heterosexual peers. Minority stress theory suggests this phenomenon occurs due to the combined effects of unique SGM stressors (e.g., SGM-related discrimination, internalized stigma) and everyday life stress on SGM youth. However, to date, the evidence base for minority stress-informed psychotherapies for SGM youth is largely limited to people ages 16+ in North American samples, so it is not clear whether the interventions are fit for use in cultural contexts like New Zealand (NZ), where incorporating indigenous values and processes into therapy is considered best practice. We sought to close these gaps by adapting a well-supported intervention for SGM young adults and adults—LGBTQ-affirmative cognitive behavioral therapy (CBT)—for use with youth aged 12-17 and assessing its acceptability across two studies.

First, we will describe the findings from exit interviews conducted with nine American SGM youth (aged 12-16; 78% GM, 100% SM) with anxiety and/or depressive disorders who received a therapist-delivered online, 10-session version of this adapted LGBTQ-affirmative CBT for youth. Caregivers of participants received handouts reviewing treatment materials and were surveyed about their views on and proposed content for a caregiver group. Thematic analysis by two independent coders indicated that the intervention was acceptable, and suggested several future directions, including in-person delivery of 60-minute (vs 90) youth sessions, and the creation of a caregiver group that meets at least 1-2 times, provides caregivers with social support, and covers advocating for SGM youth in schools, and talking with youth about SGM identities, among other topics.

Second, we will describe the translation of these American findings to NZ, where Hwang’s 5-phase formative method for adapting psychotherapy is currently being used to culturally adapt this intervention for SGM youth and their families. In partnership with indigenous advisors, stakeholders (SGM youth, their caregivers, mental health providers, SGM community organizations) are participating in focus groups that seek to: 1) assess the acceptability of American intervention materials in the NZ context; 2) collaboratively determine cultural processes and adaptations that need to be incorporated; and 3) co-create a caregiver group, building on results from the American study. Thematic analysis of focus group data will be presented.