LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach

John E. Pachankis, Mark L. Hatzenbuehler, H. Jonathon Rendina, Steven A. Safren, Jeffrey T. Parsons

Research output: Contribution to journalArticlepeer-review

278 Scopus citations


Objectives: We tested the preliminary efficacy of a transdiagnostic cognitive-behavioral treatment adapted to improve depression, anxiety, and co-occurring health risks (i.e., alcohol use, sexual compulsivity, condomless sex) among young adult gay and bisexual men. Treatment adaptations focused on reducing minority stress processes that underlie sexual orientation-related mental health disparities. Method: Young gay and bisexual men (n = 63; M age = 25.94) were randomized to immediate treatment or a 3-month waitlist. At baseline, 3-month, and 6-month assessments, participants completed self-reports of mental health and minority stress and an interview of past-90-day risk behavior. Results: Compared to waitlist, treatment significantly reduced depressive symptoms (b =-2.43, 95% CI:-4.90, 0.35, p <.001), alcohol use problems (b =-3.79, 95% CI:-5.94,-1.64, p <.001), sexual compulsivity (b =-5.09, 95% CI:-8.78,-1.40, p <.001), and past-90-day condomless sex with casual partners (b =-1.09, 95% CI:-1.80,-0.37, p <.001), and improved condom use self-efficacy (b = 10.08, 95% CI: 3.86, 16.30, p <.001). The treatment yielded moderate and marginally significant greater improvements than waitlist in anxiety symptoms (b =-2.14, 95% CI:-4.61, 0.34, p =.09) and past-90-day heavy drinking (b =-0.32, 95% CI:-0.71, 0.07, p =.09). Effects were generally maintained at follow-up. Minority stress processes showed small improvements in the expected direction. Conclusion: This study demonstrated preliminary support for the first intervention adapted to address gay and bisexual men's co-occurring health problems at their source in minority stress. If found to be efficacious compared to standard evidence-based treatments, the treatment will possess substantial potential for helping clinicians translate LGB-affirmative treatment guidelines into evidence-based practice.

Original languageEnglish (US)
Pages (from-to)875-886
Number of pages12
JournalJournal of consulting and clinical psychology
Issue number5
StatePublished - Oct 1 2015
Externally publishedYes


  • LGB-affirmative
  • cognitive-behavioral therapy (CBT)
  • intervention
  • minority stress
  • stigma

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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