LGBTQ-Affirmative Mental Health Treatments & Implementation

LGBTQ individuals disproportionately experience depression, anxiety, and substance use problems compared to heterosexual, cisgender individuals. For gay and bisexual men, these mental health disparities co-occur with risk for HIV/STI infection. One source of these disparities is often assumed to be LGBTQ people’s greater social stress, such as threat-oriented social perceptions and behavioral avoidance. While these tendencies are often adaptive in early development, when held onto throughout life, they can ultimately erode healthy relationships and behaviors.

We are creating and evaluating LGBTQ-affirming psychotherapy programs that undo these maladaptive tendencies and improve LGBTQ individuals’ mental, behavioral, and sexual health. For instance, our ESTEEM intervention reworks gay and bisexual men’s cognitive, behavioral, and emotional experiences to be self-affirming. This intervention has been tested in a small waitlist-controlled trial, as well as a large multi-site trial (in NYC and Miami) which was funded by the National Institute of Mental Health (NIMH).

We created another treatment, EQuIP (Empowering Queer Identities in Psychotherapy), with input from expert mental health providers with expertise treating sexual minority women’s mental health. This treatment, funded by NIMH, the Lesbian Health Fund, and the Yale Fund for Gay and Lesbian Studies, specifically aims to help sexual minority women cope with identity-related stress in order to reduce their depression and alcohol abuse.

Our other LGBTQ-affirmative treatment studies are testing similar interventions in diverse global regions (e.g., Romania, China), in group format (e.g., at the Fair Haven Community Health Center in New Haven), using technologies (e.g., smartphones), and with particularly vulnerable populations (e.g., rural LGBTQ youth, LGBTQ migrants). Recently, we have also embarked on a study in partnership with CenterLink to validate our training procedures for these LGBTQ-affirmative treatments.

• Pachankis, J. E., Clark, K. A., Jackson, S. D., Pereira, K. A., & Levine, D. (in press). Current capacity and future implementation of mental health services in US LGBTQ community centers. Psychiatric Services.
• Pachankis, J. E., McConocha, E. M., Clark, K. A., Wang, K., Behari, K., Fetzner, B. K., ... & Lehavot, K. (2020). A transdiagnostic minority stress intervention for gender diverse sexual minority women’s depression, anxiety, and unhealthy alcohol use: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 88(7), 613.
• Pan, S., Sun, S., Li, X., Chen, J., Xiong, Y., He, Y., & Pachankis, J. E. (2020). A pilot cultural adaptation of LGB-affirmative CBT for young Chinese sexual minority men's mental and sexual health. Psychotherapy (Chicago, Ill.), 10.1037/pst0000318. Advance online publication.
• Pachankis, J. E., Williams, S. L., Behari, K., Job, S., McConocha, E. M., & Chaudoir, S. R. (2020). Brief online interventions for LGBTQ young adult mental and behavioral health: A randomized controlled trial in a high-stigma, low-resource context. Journal of consulting and clinical psychology, 88(5), 429–444.
• Bränström, R., & Pachankis, J. E. (2020). Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. The American journal of psychiatry, 177(8), 727–734.
• Burton, C. L., Wang, K., & Pachankis, J. E. (2019). Psychotherapy for the spectrum of sexual minority stress: Application and technique of the ESTEEM treatment model. Cognitive and Behavioral Practice, 26(2), 285-299
• White Hughto, J. M., Clark, K. A., Altice, F. L., Reisner, S. L., Kershaw, T. S., & Pachankis, J. E. (2017). Improving correctional healthcare providers' ability to care for transgender patients: Development and evaluation of a theory-driven cultural and clinical competence intervention. Social Science & Medicine, 195, 159-169.
• Clark, K. A., White Hughto, J. M., Pachankis, J. E. (2017). "What's the right thing to do?" Correctional healthcare providers' knowledge, attitudes and experiences caring for transgender inmates. Social Science & Medicine, 193, 80-89.
• Millar, B. M., Wang, K., & Pachankis, J. E. (2016). The moderating role of internalized homonegativity on the efficacy of LGB-affirmative psychotherapy: Results from a randomized controlled trial with young adult gay and bisexual men. Journal of Consulting and Clinical Psychology, 84(7), 565-570.
• Chaudoir, S. R., Wang, K., & Pachankis, J. E. (2017). What reduces sexual minority stress? A review of the intervention "toolkit". Journal of Social Issues, 73(3), 586-617.
• Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T. (2015). LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83(5), 875-889.
• Pachankis, J. E. (2015). A transdiagnostic minority stress treatment approach for gay and bisexual men's syndemic health conditions. Archives of Sexual Behavior, 44(7), 1843-1860.
• Bromberg, D., Paltiel, A. D., Busch, S. H., & Pachankis, J. E. (in press). Has depression surpassed HIV as a burden to gay and bisexual men’s health in the United States?: A comparative modeling study. Social Psychiatry and Psychiatric Epidemiology