Toward Cognitive-Behavioral Therapy for Sexual Minority Women: Voices From Stakeholders and Community Members

Sexual minority women (SMW) experience an elevated risk of mental health problems compared to heterosexual women. However, knowledge gaps remain regarding whether cognitive-behavioral therapy (CBT) interventions meet SMW’s mental health needs. Further, virtually no studies have integrated stakeholder (i.e., researchers with content expertise in SMW’s health and clinical providers who work with SMW) and community member (i.e., SMW) perspectives to identify CBT approaches that address SMW-specific issues. This study used qualitative data gathered from 39 SMW who reported depression, anxiety, suicidality, and heavy drinking in the past 3 months and 16 content experts and clinical providers to obtain information relevant to enhancing CBT for SMW. In addition, we used thematic analysis to identify themes related to the adaptation and delivery of CBT for SMW. Building on prior literature, this study’s findings revealed seven considerations for delivering mental health services to SMW: (1) attending to SMW’s diverse gender identities and expressions; (2) focusing on SMW’s nonbinary stressors; (3) formulating SMW’s gender-based stressors within a feminist framework; (4) applying intersectionality frameworks; (5) incorporating issues of diversity, multiculturalism, and social justice; (6) addressing the role of trauma exposure; and (7) addressing the role of alcohol use in SMW’s lives. These considerations are reviewed in terms of their implications for clinical practice, with a focus on enhancing applications of existing CBT interventions to best respond to the unique needs of this population.     

Minority stress and mental health among Dutch LGBs: examination of differences between sex and sexual orientation

Minority stress is often cited as an explanation for greater mental health problems among lesbian, gay, and bisexual (LGB) individuals than heterosexual individuals. However, studies focusing on sex or sexual orientation differences in level of minority stress and its impact on mental health are scarce, even more so outside the United States. Performing secondary analyses on the data of a Dutch population study on sexual health, the present study examines the robustness of the minority stress model by explaining mental health problems among men and women with mostly or only same-sex sexual attraction, and men and women who are equally attracted to same-sex and opposite-sex partners in the "gay-friendly" Netherlands (N = 389; 118 gay men, 40 bisexual men, 184 lesbian women, and 54 bisexual women). Results showed that minority stress is also related to mental health of Dutch LGBs. Participants with a higher level of internalized homonegativity and those who more often encountered negative reactions from other people on their same-sex sexual attraction reported more mental health problems. Such negative reactions from others, however, had a stronger link with mental health among lesbian/gay than among bisexual participants. Openness about one's sexual orientation was related to better mental health among sexual minority women, but not among their male counterparts. Suggestions for future research, implications for counseling, and other societal interventions are discussed.     

Sexual Minority Identity,Viewing Motivations,and Viewing Frequency of LGB-Inclusive Television Among LGB Viewers

The purpose of this study was to examine the relationships between dimensions of sexual minority identity, viewing motivations, and viewing frequency of lesbian, gay, and bisexual (LGB)-inclusive television (TV) among LGB viewers. Two hundred two LGB adults completed measures regarding sexual minority identity, TV viewing motivations, and frequency of viewing LGB-inclusive TV programs. Analyses revealed that dimensions of sexual minority identity (i.e., internalized homonegativity, acceptance concerns, and identity affirmation) were positively associated with a learning motivation for viewing LGB-inclusive TV. Moreover, a learning motivation mediated the relationship between dimensions of sexual minority identity and frequency of viewing LGB-inclusive TV. These findings have important implications for clinicians, and suggest that engaging with LGB-inclusive TV may represent an important coping strategy for LGB individuals dealing with identity concerns.     

父母消极教养方式对中国性少数心理健康的影响：基于Bifactor模型

中国性少数群体普遍存在严重的心理健康问题，家庭是其最大的压力来源。在性少数压力模型的背景下，本研究基于Bifactor模型探究父母消极教养方式对中国性少数（LGB）心理健康的特殊影响。采用父母教养方式问卷、抑郁-焦虑-压力量表和金赛量表对649名LGB进行网络问卷调查，结果发现：（1）父母消极教养方式的Bifactor模型存在部分差异；（2）对于LGB心理健康，父母消极教养方式的一般因子和拒绝特殊因子具有损害作用，过度保护特殊因子具有保护作用。     

Affirmative Dialectical Behavior Therapy Skills Training With Sexual Minority Veterans

Minority stress theory posits that unique stressors create an invalidating environment, which places sexual minority individuals at increased risk for psychiatric morbidity. Sexual minority veterans’ experience of minority stressors results in elevated levels of emotion dysregulation, anxiety, depression, and suicidality. Clinical interventions designed to address minority stress and treat emotional dysregulation and related disorders among sexual minority veterans are warranted. Professional guidelines recommend the adaptation of evidence-based treatments to address the unique features of sexual minority and veteran mental health. Dialectical Behavior Therapy (DBT) is a treatment for emotion dysregulation and related problems that addresses an invalidating environment, which is an appropriate framework for sexual minorities. The current research adapts the Emotion Regulation module of DBT Skills Training. This adaptation highlights minority stress as part of the invalidating environment and adds new teaching points to address the unique features of sexual minority mental health to create Affirmative DBT Skills Training. Six sexual minority veterans completed Affirmative DBT Skills Training meeting on a weekly basis for 10 consecutive weeks. Before and after treatment, participants completed measures of emotion regulation, anxiety, and depression as well as assessments of minority stress processes. Affirmative DBT Skills Training was well received in this sample. Results suggest that the intervention was effective in decreasing emotion dysregulation and symptoms of depression. These findings suggest Affirmative DBT Skills Training is a promising treatment, although more research is warranted, particularly given the small sample size and lack of a control group.     

Disclosure Experiences of Sexual Minority College Student Victims of Intimate Partner Violence

Although research on disclosure following intimate partner violence (IPV) victimization is burgeoning, sexual minority young adults’ (lesbian, gay, bisexual, queer, questioning, etc.; LGBQ+) experiences have not received equal attention. The current study employed the minority stress framework to examine disclosure experiences of LGBQ+ college students across the United States reporting physical IPV victimization within their current relationship (n = 77). Participants completed measures assessing minority stress and IPV disclosure, and answered open‐ended questions regarding the most and least helpful persons/responses to disclosure or reasons for non‐disclosure. Results indicated that approximately one‐third (35 %) of victims disclosed to at least one person, with friends being the most common recipients. Thematic analyses indicated that talking or listening to the victim was considered the most helpful response and not understanding the situation least helpful. Reasons for non‐disclosure centered on themes of the victims’ perception that the IPV was not a big deal. Quantitative findings regarding physical IPV disclosure indicated that non‐disclosers experienced greater minority stress than disclosers. The current study suggests the presence of differences between sexual minority (i.e., LGBQ +persons) and non‐sexual minority persons, as well as between LGBQ+ young adults/college students and older adults and presents a theoretical structure (i.e., minority stress framework) through which these differences may be understood.     

Minority stress and intimate partner aggression among male same-sex couples

Intimate partner aggression (IPA) is high among gay, bisexual, queer, and other sexual minority men (SMM), and is strongly linked to minority stress. These links might be further magnified or buffered by communication between partners (i.e., negative and positive communication, respectively). The present study investigated associations of minority stress and IPA, and the moderating role of positive/negative communication, among male couples (N = 932 individuals, 466 couples). Partners completed measures of communication skills, minority stress, and IPA, which were analyzed using moderated actor-partner interdependence models. Results suggested that microaggressions increase one's own (i.e., an actor effect) and one's partner's (i.e., a partner effect) verbal IPA victimization, verbal IPA perpetration, and physical IPA victimization. Positive communication moderated the association between microaggressions and verbal IPA victimization, suggesting that high levels of positive communication may buffer the microaggression-verbal IPA link. Thus, minority stress' detrimental impacts on relationship functioning among male same-sex couples may be reduced by the presence of positive communication (e.g., effective conflict resolution). We discuss structural and clinical innovations to prevent IPA among male couples, with particular emphasis on the absence of positive communication as an aggravating factor.     

Sexual Minority Stress,Coping, and Physical Health Indicators

Sexual minorities experience higher rates of several physical health problems compared to their heterosexual counterparts. The present study uses Meyer's Minority Stress Model (Psychological Bulletin, 129(5): 674-697, 2003) to examine physical health indicators among 250 adults who identified as sexual minorities. Study hypotheses include that sexual minority stress is predictive of two physical health indicators (i.e., engagement in a health-promoting lifestyle and number of physical health problems) and that planning (i.e., problem-focused) and social support coping will partially mediate the relationship between sexual minority stress and each physical health indicator. Results showed that as level of sexual minority stress increased, engagement in a health-promoting lifestyle decreased and the number of physical health problems increased. Planning and social support coping did not mediate these relationships; however, as levels of coping increased, engagement in a health-promoting lifestyle increased. These findings have implications for researchers and healthcare professionals in their efforts to promote the physical health of sexual minorities.     

Transgender and Gender Diverse Patients in Intensive Mood Disorder Treatment: A Comparative Examination of Clinical Presentation and Treatment Outcomes

Individuals who are transgender and gender diverse (TGD) are more likely to suffer from and to seek mental health services for mood disorders. Some literature suggests that TGD individuals, because of pervasive and systemic minority stress, may have more complex clinical presentations (i.e., psychiatric conditions and severity of symptoms) and may benefit from empirically based treatments to a lesser degree than their cisgender peers. However, research has yet to examine individuals who are TGD receiving treatment in specialized, intensive mood disorder treatment despite the propensity for them to be diagnosed with and treated for mood disorders. Using a sample of 1,326 adult patients in intensive mood disorder treatment (3.8% TGD), the clinical presentation and treatment outcomes were compared between patients who are TGD and cisgender. Contrary to previous research, TGD patients were largely similar if not healthier than their cisgender counterparts, including similar depression severity, quality of life, emotion dysregulation, and behavioral activation, and less severe rumination at admission. Despite similar to better reported mental health symptoms, TGD patients were diagnosed with more psychiatric conditions overall, including greater prevalence of social anxiety and neurodevelopmental diagnoses. Those who are TGD did not experience attenuated treatment response as predicted. Findings suggest that patients in intensive mood disorder treatment who are TGD may be more resilient than previously assumed, or supports may have increased to buffer effects of stigma on mental health, and emphasize the need to exercise discretion and sensitivity in diagnostic practices to prevent over-diagnosis and pathologizing of TGD individuals.     

Trauma Recovery in the Transgender and Gender Diverse Community: Extensions of the Minority Stress Model for Treatment Planning

Transgender and gender diverse (TGD) populations, including those that do not identify with gender binary constructs (man or woman) are increasingly presenting for treatment of posttrauma sequelae. Providers who offer services for trauma survivors including posttraumatic stress disorder (PTSD) treatment should be knowledgeable about evidence-based care and have some cultural familiarity with TGD experiences. Indeed, the Minority Stress Model suggests that the combination of distal and proximal minority stressors can combine to produce increased mental health symptoms as compared with cisgender peers, though this model has yet to be fully tested. Clients often present with a complicated picture of experiences, which include a variety of minority stressors, microaggressions, discrimination, and traumatic events that can all be related to their identity. However, conceptualizations of trauma treatment in the context of extensive minority stress are lacking. This paper summarizes the existing literature and offers guidance to mental health providers who are well positioned to address stigma, discrimination, violence, and related symptoms that arise from micro-, mezzo- and macro-level spheres of TGD individuals’ experience.     

The Rasch Scaling of Mystical Experiences: Construct Validity and Correlates of the Mystical Experience Scale (MES)

This study evaluated the relationships that exist between the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the mental health of individuals with heterogeneous medical disorders. The participants were 168 individuals with heterogeneous medical disorders (i.e., 61 brain injury, 32 stroke, 25 spinal cord injury, 25 cancer, 25 primary care). The measures were BMMRS subscales (conceptualized as spiritual experiences, religious practices, and congregational support), Medical Outcomes Scale–Short Form 36 General Mental Health scale. Pearson correlations indicated that, in general, mental health is positively correlated with positive spiritual experiences and positive congregational support but negatively correlated with negative spiritual coping and negative congregational support. Mental health was not correlated with private religious practices (e.g., prayer). Hierarchical regressions indicated that congregational support was the only BMMRS scale to predict mental health, explaining 6% of the variance beyond the 14% explained by demographic factors. The mental health of individuals with significant medical conditions appears to be primarily related to positive spiritual beliefs and especially congregational support. Mental health does not appear to be related to religious practices such as prayer, which is likely related to the fact that many individuals with serious medical conditions increase prayer with declining mental health status. These results stress the need for active congregational support and spiritual interventions to improve the mental health of persons with serious medical conditions.     

Lifestyle changes are related to reductions in depression in persons with elevated coronary risk factors

This observational study investigates whether persons with elevated coronary risk factors (CRFs >3 and/or diabetes) and depression [i.e., ≥16 on the Center for Epidemiological Scale – Depression (CES-D)] can make changes in health behaviours over 3 months and improve depressive symptoms and other CRFs. Analyses were based on data from 310 men and 687 women enrolled in the high-risk arm of the Multisite Cardiac Lifestyle Intervention Program, targeting diet (10% fat), exercise (3 h per week) and stress management (7 h per week). As expected, at study entry, depressed persons had a more adverse medical status, consumed more dietary fat and practiced less stress management than non-depressed persons. To examine 3-month changes, participants were grouped into (1) depressed persons who became non-depressed (CES-D ≤ 16, n = 248; 73%), (2) persons who remained or became depressed (CES-D >16, n = 76) and (3) non-depressed persons who remained non-depressed (n = 597). All persons, regardless of group, met program goals. The greatest improvements (i.e., diet, exercise, perceived stress, hostility and mental health) were observed in Group 1 relative to Groups 2 and 3, which did not differ from each other. Comprehensive lifestyle changes appear to be feasible and beneficial for initially depressed persons with elevated CRFs.     

Exploring the Effectiveness of a Mixed-Diagnosis Group Cognitive Behavioral Therapy Intervention Across Diverse Populations

Depression and anxiety are the most common mental health disorders seen in clinical practice and they are highly comorbid. Cognitive behavioral therapy (CBT) has been demonstrated as an effective treatment for both depression and anxiety but is often not available to all individuals who could benefit from it. This paper investigates the effectiveness of a mixed-diagnosis group CBT intervention that incorporates mindfulness meditation for individuals presenting with depression and/or anxiety: CBT Basics II. This intervention was evaluated across two distinct mental health programs to determine both if it can demonstrate positive results and if it is feasible to implement in these types of programs. Sample 1 (n = 42 completers) consisted of higher-functioning individuals in a general mental health program. Sample 2 (n = 53 completers) consisted of individuals with more chronic and severe mental health diagnoses. Overall, intent-to-treat analyses revealed improvements in psychiatric symptoms, and increases in CBT knowledge and mindfulness skill across both programs. This indicates that CBT Basics II is effective across diverse mental health populations and shows promise for improving access to CBT.     

Open Workplace Climate and LGB Employees' Psychological Experiences: The Roles of Self‐Concealment and Self‐Acceptance

This study explores how an environmental factor (i.e., a perceived open climate) shapes lesbian, gay, and bisexual (LGB) employees' job satisfaction and job anxiety through the mediating role of self‐concealment. It also investigates the moderating role of self‐acceptance. Results from 315 LGB employees supported the conclusion that a perceived open climate for minority sexuality increased job satisfaction and decreased job anxiety. The open climate–job anxiety relationship was mediated by self‐concealment, and both stages of this mediation process were moderated by self‐acceptance. These findings offer useful insights for counselors and managers to help LGB individuals improve their workplace psychological experiences.     

Prevalence and Predictors of Background Television Among Infants and Toddlers from Low-Income Homes

TV use could be detrimental to children’s development because it may displace enriching activities like shared reading and caregiver-child interaction or disrupt children’s interactions with the adults in their lives by distracting both parties. Some prior research has shown that demographic factors (maternal education, siblings) and maternal mental health (depression risk and parenting stress) may predict household TV, but findings are mixed. Household TV is defined here as whether or how much the TV is on in the home. In the current study, we examine the following research questions: (a) what is the prevalence of household TV (i.e., whether or how much the TV is on) in the homes of infants and toddlers in a sample of families from low-income homes? and (b) do demographic characteristics (i.e., maternal education level and presence of siblings in the home), and maternal mental health (i.e., depression risk and parenting stress) predict household TV (i.e., whether or how much the TV is on)? Mothers (N = 220) reported on their household TV, education level, siblings in the home, depression risk, and parenting stress when children were four to seven months of age and again at 15–19 months of age. Results showed a high level of household TV, especially during infancy. Furthermore, education level, but not siblings, depression risk, or parenting stress, was related to household TV during infancy and toddlerhood. These findings are discussed in relation to prior research and the potential for informing future interventions or education efforts.     

Perspectives of people with mental health problems at hot spots: Attitudes and perceptions of safety,crime, and the police

People who live in places with high levels of crime and disorder are more likely to experience mental illness compared with those who do not live in these types of place (Weisburd et al., 2018; Weisburd & White, 2019). The increased police presence on high crime streets may also increase the likelihood that these individuals will encounter law enforcement. There is a strong body of literature focused on the relationship between neighborhoods and the physical and mental health of residents (e.g. Arcaya et al., 2016; Duncan & Kawachi, 2018; Leventhal & Brooks‐Gunn, 2003), but there are very few studies that look at the perceptions of people with mental illness directly, particularly as they relate to the environment of the street on which they live and attitudes toward the police. In turn, existing studies generally look at the most serious mental health problems (e.g. schizophrenia), ignoring more common mental health concerns such as post‐traumatic stress disorder (PTSD) and depression. This paper uses self‐report data from a large in‐person survey of people who live on crime hot spot and non‐hot spot streets in order to assess attitudes among a broader group of persons with mental health problems. Furthermore, we examine the interaction between living in crime hot spots and non‐hot spots and perceptions of these residents. Our findings in this broader sample confirm earlier studies that identify greater fear and less trust of the police among persons with mental illnesses. At the same time, our findings suggest that fear of crime and perceptions of police are moderated by living in a crime hot spot.     

Academic and Social Integration on Campus Among Sexual Minority Students: The Impacts of Psychological and Experiential Campus Climate

A heterosexist campus climate can increase risk for mental health problems for sexual minority students; however, the relationship between campus climate for sexual minorities and academic outcomes remains understudied. Using a sample of sexual minority respondents extracted from a campus climate survey conducted at a large university in the Midwest, we examine relationships between multiple dimensions of psychological and experiential campus climate for sexual minorities with academic integration (academic disengagement, grade‐point average [GPA]) and social integration (institutional satisfaction, acceptance on campus). We also investigate the protective role of engagement with informal academic and peer‐group systems. Findings suggest campus climate affects sexual minority students’ integration. In multivariate analyses, perceptions of whether lesbian, gay, and bisexual (LGB) people could be open about their sexual identity was positively associated with acceptance on campus; personal heterosexist harassment was positively associated with academic disengagement and negatively with GPA. Students’ informal academic integration (instructor relations) and informal social integration (LGB friends) demonstrated influential main effects but did not moderate any of the climate‐outcome relationships. Researchers should further explore the relationships between climate and academic outcomes among sexual minority students, both collectively and among specific sub‐groups, and address the role of other protective factors.     

Entertain Me Well: An Entertaining,Tailorable, Online Platform Delivering CBT for Depression

Depression prevalence is high, impacting approximately 20% of Americans during their lifetime, and on the rise due to stress and loss associated with the COVID-19 pandemic. Despite the high prevalence of depression, unacceptable treatment access disparities persist. When depression goes untreated, it leads to substantial negative impacts in multiple life domains. Cognitive behavioral therapy (CBT), the gold-standard psychosocial treatment for depression, remains largely unavailable to individuals living with depression, particularly individuals who are members of underrepresented groups in our society. Digital mental health interventions (DMHI) have led to important advances in extending the reach of CBT for depression; however, they are underutilized and treatment engagement remains low. We sought to address some of the current gaps in DMHI by developing an online platform for delivering CBT for depression that is entertaining, simple and straightforward, and tailorable. First, this article introduces our online platform, Entertain Me Well (EMW) and its key innovations, including the use of an engaging, character-driven storyline presented as “episodes” within each session, as well as customizable content that allows for tailoring of text, images, and examples to create content most relevant to the target client population, context, or setting. Next, we describe two EMW depression treatment programs that have been tailored: one for delivery in the rural church setting, called Raising Our Spirits Together, and one tailored for delivery in dialysis centers, called Doing Better on Dialysis. Finally, we discuss future directions for the EMW platform, including the ability to create programs for other common mental health and health conditions, the development of additional character-driven storylines with greater treatment personalization, translation of content in multiple languages, and the use of additional technological innovation, such as artificial intelligence like natural language processing, to enhance platform interactivity.     

Impact of Cyber Aggression and Cyber Victimization on Mental Health and Well-Being of Pakistani Young Adults: The Moderating Role of Gender

The present study was conducted to investigate the impact of cyber aggression and cyber victimization on the mental health and well-being of young adults. The sample consisted of 508 young adults, ages ranging from 18 to 25 years (mean±SD = 20.53 ± 1.77 years, 68.5% female). The data were collected from young adults studying at various universities of Rawalpindi and Islamabad, Pakistan. The participants completed the Cyberbullying and Cyber Victimization Scales, Depression, Anxiety, and Stress Scales (DASS-21), and The Warwick–Edinburgh Mental Well-being Scale (WEMWBS). The results showed a significant effect of cyber victimization on mental health and well-being. After controlling for the effect of age, gender, and residential status (staying at hostel vs. home), the cyber victimization significantly negatively predicted the well-being and significantly positively predicted mental health (i.e., depression, anxiety, and stress). In contrast, cyber aggression appeared to have a nonsignificant impact on both the mental health and well-being of young adults. Furthermore, the moderating role of gender was assessed for the effect of cyber victimization on mental health. The results revealed that the effect of cyber victimization is moderated by gender only on anxiety. Findings suggest that females are more vulnerable to develop anxiety due to cyber victimization as compared to their male counterparts. The findings of the study have important theoretical and practical implications and suggest the inclusion of some gender-specific strategies to develop counseling programs to save young adults from the negative psychological and emotional impacts of cyber victimization.