Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine.
Department of Psychology, University of Michigan.
J Consult Clin Psychol. 2023 Mar;91(3):150-164. doi: 10.1037/ccp0000799. Epub 2023 Feb 13.
Lesbian, gay, bisexual, and queer (LGBQ)-affirmative cognitive behavioral therapy (CBT) focused on minority stress processes can address gay and bisexual men's transdiagnostic mental and behavioral health concerns. Identifying moderators of treatment outcomes may inform the mechanisms of LGBQ-affirmative CBT and subpopulations who may derive particular benefit.
Data were from a clinical trial in which gay and bisexual men with mental and behavioral health concerns were randomized to receive Effective Skills to Empower Effective Men (ESTEEM; an LGBQ-affirmative transdiagnostic CBT; = 100) or one of two control conditions ( = 154): LGBQ-affirmative community mental health treatment (CMHT) or HIV counseling and testing (HCT). The preregistered outcome was a comorbidity index of depression, anxiety, alcohol/drug problems, and human immunodeficiency virus (HIV) transmission risk behavior at 8-month follow-up (i.e., 4 months postintervention). A two-step exploratory machine learning process was employed for 20 theoretically informed baseline variables identified by study therapists as potential moderators of ESTEEM efficacy. Potential moderators included demographic factors, pretreatment comorbidities, clinical facilitators, and minority stress factors.
Racial/ethnic minority identification, namely as Black or Latino, was the only statistically significant moderator of treatment efficacy ( = -3.23, 95% CI [-5.03, -1.64]), (197) = -3.88, < .001. Racially/ethnically minoritized recipients ( = -0.71, < .001), but not White/non-Latino recipients ( = 0.22, = .391), had greater reductions in comorbidity index scores in ESTEEM compared to the control conditions. This moderation was driven by improvements in anxiety and alcohol/drug use problems.
Black and Latino gay and bisexual men experiencing comorbid mental and behavioral health risks might particularly benefit from a minority stress-focused LGBQ-affirmative CBT. Future research should identify mechanisms for this moderation to inform targeted treatment delivery and dissemination. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
以少数群体压力过程为重点的同性恋、双性恋、双性人和酷儿（LGBQ）肯定认知行为疗法（CBT）可以解决男同性恋和双性恋者的多种精神和行为健康问题。确定治疗结果的调节因素可以为 LGBQ 肯定 CBT 的机制以及可能从中受益的特定亚群提供信息。
数据来自一项临床试验，该试验中，有精神和行为健康问题的男同性恋和双性恋者被随机分配接受有效技能赋能有效男性（ESTEEM；一种 LGBQ 肯定的跨诊断 CBT；n = 100）或两种对照条件之一（n = 154）：LGBQ 肯定的社区心理健康治疗（CMHT）或艾滋病毒咨询和检测（HCT）。预先注册的结果是在 8 个月（即干预后 4 个月）时的抑郁、焦虑、酒精/药物问题和人类免疫缺陷病毒（HIV）传播风险行为的共病指数。采用两步探索性机器学习过程，对治疗师认为可能是 ESTEEM 疗效的 20 个理论上有意义的基线变量进行分析。潜在的调节因素包括人口统计学因素、治疗前共病、临床促进因素和少数群体压力因素。
种族/民族少数群体认同，即黑人或拉丁裔，是治疗效果的唯一具有统计学意义的调节因素（β = -3.23，95%CI [-5.03，-1.64]），（197）= -3.88， <.001）。少数群体中的受治疗者（β = -0.71， <.001），而不是白人/非拉丁裔受治疗者（β = 0.22， =.391），在 ESTEEM 中，与对照条件相比，共病指数得分的降低幅度更大。这种调节作用是由焦虑和酒精/药物使用问题的改善驱动的。
有多种精神和行为健康风险的黑人、拉丁裔男同性恋和双性恋者可能特别受益于以少数群体压力为重点的 LGBQ 肯定认知行为疗法。未来的研究应该确定这种调节的机制，以便为有针对性的治疗提供信息。
