基于互联网的 LGBTQ 肯定认知行为疗法对性少数青年心理健康的影响：一种基于少数群体应激处理方法的随机对照试验。
Guided LGBTQ-affirmative internet cognitive-behavioral therapy for sexual minority youth's mental health: A randomized controlled trial of a minority stress treatment approach.
机构信息
Yale School of Public Health, USA.
Yale School of Public Health, USA.
出版信息
Behav Res Ther. 2023 Oct;169:104403. doi: 10.1016/j.brat.2023.104403. Epub 2023 Sep 9.
OBJECTIVE
LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses the adverse impacts of minority stress. However, this treatment has rarely been tested in randomized controlled trials with LGBTQ youth and never using an asynchronous online platform for broad reach. This study examined the feasibility, acceptability, preliminary efficacy, and multi-level stigma moderators of LGBTQ-affirmative internet-based CBT (ICBT).
METHOD
Participants were 120 LGBTQ youth (ages 16-25; 37.5% transgender or non-binary; 75.8% assigned female at birth; 49.2% non-Latino White) living across 38 U.S. states and reporting depression and/or anxiety symptoms. Participants were randomized to receive 10 sessions of LGBTQ-affirmative ICBT or only complete 10 weekly assessments of mental and behavioral health and minority stress; all completed measures of psychological distress, depression, anxiety, suicidal thoughts, alcohol use, and HIV-transmission-risk behavior at baseline and 4 and 8 months post-baseline; 20 LGBTQ-affirmative ICBT participants completed a qualitative interview regarding intervention acceptability.
RESULTS
Participants randomized to LGBTQ-affirmative ICBT completed, on average, 6.08 (SD = 3.80) sessions. Participants reported that LGBTQ-affirmative ICBT was helpful and engaging and provided suggestions for enhancing engagement. Although most outcomes decreased over time, between-group comparisons were small and non-significant. LGBTQ-affirmative ICBT was more efficacious in reducing psychological distress than assessment-only for participants in counties high in anti-LGBTQ bias (b = -1.73, p = 0.001, 95% CI [-2.75, -0.70]). Session dosage also significantly predicted reduced depression and anxiety symptoms.
CONCLUSIONS
LGBTQ-affirmative ICBT represents a feasible and acceptable treatment. Future research can identify more efficacious approaches and modalities for engaging LGBTQ youth, especially those living under stigmatizing conditions, who might benefit most.
目的
同性恋、双性恋、跨性别和酷儿群体（LGBTQ）肯定认知行为疗法（CBT）可解决少数群体压力带来的负面影响。然而，这种治疗方法在 LGBTQ 青少年的随机对照试验中很少得到检验，也从未在广泛传播的异步在线平台上使用过。本研究检验了基于互联网的 LGBTQ 肯定认知行为疗法（ICBT）的可行性、可接受性、初步疗效和多层次污名调节因素。
方法
参与者为 120 名 LGBTQ 青少年（年龄 16-25 岁；37.5%为跨性别或非二元性别；75.8%出生时为女性；49.2%为非拉丁裔白人），分布在美国 38 个州，有抑郁和/或焦虑症状。参与者被随机分配接受 10 次 LGBTQ 肯定 ICBT 或仅完成 10 周的心理健康和行为以及少数群体压力的评估；所有参与者在基线和 4 个月及 8 个月后均完成了心理困扰、抑郁、焦虑、自杀念头、饮酒和 HIV 传播风险行为的测量；20 名接受 LGBTQ 肯定 ICBT 的参与者完成了一项关于干预可接受性的定性访谈。
结果
接受 LGBTQ 肯定 ICBT 的参与者平均完成了 6.08（SD=3.80）次治疗。参与者报告称，LGBTQ 肯定 ICBT 很有帮助且引人入胜，并提出了增强参与度的建议。尽管大多数结果随着时间的推移而下降，但组间比较较小且无统计学意义。对于处于 LGBTQ 偏见较高的县的参与者，LGBTQ 肯定 ICBT 在减少心理困扰方面比仅评估更有效（b=-1.73，p=0.001，95%CI[-2.75，-0.70]）。疗程剂量也显著预测了抑郁和焦虑症状的减轻。
结论
LGBTQ 肯定 ICBT 是一种可行且可接受的治疗方法。未来的研究可以确定更有效的方法和模式，以吸引 LGBTQ 青少年，特别是那些生活在污名化环境中的青少年，他们可能受益最大。
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