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LGBTQ+
Session Type:: Symposia

Symposium 35 - Implementing LGBTQ-affirmative cognitive behavioral therapy in community settings nationwide: Centering case formulation, provider perspective, and client impact

Saturday, November 22, 2025
10:00 AM - 11:30 AM CST
Location: Bolden 5, Level 2
CE: 1.5

Keywords: LGBTQ+, Implementation, Community-Based
Level of Familiarity: Basic to Moderate
Recommended Readings: Pachankis, J. E., Soulliard, Z. A., Seager van Dyk, I., Layland, E. K., Clark, K. A., Levine, D. S., & Jackson, S. D. (2022). Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers. Journal of Consulting and Clinical Psychology, 90(7), 582.,   Pachankis, J. E., Soulliard, Z. A., Morris, F., & van Dyk, I. S. (2023). A model for adapting evidence-based interventions to be LGBQ-affirmative: Putting minority stress principles and case conceptualization into clinical research and practice. Cognitive and Behavioral Practice, 30(1), 1-17.,   Burger, J., & Pachankis, J. E. (2024). State of the science: LGBTQ-affirmative psychotherapy. Behavior Therapy.,   ,  

As LGBTQ+ people face growing threats to their safety and well-being in the United States, there is an urgent need to rapidly implement affirmative evidence-based practices (EBPs) at scale. However, few EBPs exist to specifically support LGBTQ+ people’s well-being. One promising EBP that can address LGBTQ+ people’s ongoing minority stress experiences and mental health challenges is LGBTQ-affirmative cognitive-behavioral therapy (CBT), a transdiagnostic treatment designed by and for LGBTQ+ people that directs providers to develop case formulations that integrate minority stress theory with cognitive-behavioral principles. After being tested in 6 efficacy trials, LGBTQ-affirmative CBT is now being implemented in 90 LGBTQ+ community centers nationwide in a type 3 hybrid effectiveness-implementation trial. This symposium, which aligns with the convention’s theme to showcase research that promotes rigorous and inclusive affirmative therapies, highlights efforts along the translational pipeline—from efficacy to implementation research—to ensure that LGBTQ-affirmative CBT is supporting LGBTQ+ people’s mental health in the frontline community settings where many seek care.

First, we describe research using natural language processing, a type of artificial intelligence that processes text, to identify minority stress content in LGBTQ-affirmative CBT sessions. We find that in-session discussion of certain minority stress themes predicts treatment outcomes at follow-up.

Next, we leverage baseline data from the hybrid effectiveness-implementation trial to identify LGBTQ+ community center providers’ training in, perceptions of, and routine deployment of minority stress-informed case formulations in usual care. We find that most providers report being trained in case formulation and find developing case formulations with clients helpful, but perceive barriers to routine implementation of case formulation.

Third, we present data on LGBTQ+ community center providers’ perceptions and attitudes towards EBPs, examining multi-level predictors of these perceptions and attitudes. We find that organizational priorities as well as providers’ training and cultural backgrounds are associated with their openness to EBPs.

Fourth, we describe preliminary results from the hybrid effectiveness-implementation trial, finding that providers demonstrate improved knowledge, confidence in, and use of LGBTQ-affirmative CBT following various training strategies in this treatment.

Finally, we discuss LGBTQ+ community center providers’ adaptations of LGBTQ-affirmative CBT, which suggest that providers frequently integrate other treatments into their implementation of LGBTQ-affirmative CBT to personalize care for each client.

Our discussant is a distinguished scholar who has devoted his career to examining the social determinants of LGBTQ+ people’s mental health, focusing on the biopsychosocial mechanisms through which multi-level determinants (from policies to interpersonal factors to intraindividual factors) shape LGBTQ+ people’s mental health. Our symposium will identify future directions for evidence-based and inclusive clinical science research to support LGBTQ+ people’s well-being at scale.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Identify how LGBTQ-affirmative CBT integrates principles from minority stress and learning theory to support LGBTQ+ people’s mental health.
  2. Discuss how natural language processing can be used as a tool for clinicians to personalize LGBTQ-affirmative CBT and improve client outcomes.
  3. Describe LGBTQ+ community center clinicians’ training in, perceptions of, and routine deployment of case formulation in usual care.
  4. Report preliminary findings from an LGBTQ-affirmative CBT effectiveness-implementation study underway in 90 U.S. LGBTQ+ community centers.
  5. List how LGBTQ+ community center clinicians perceive, adapt, and personalize LGBTQ-affirmative cognitive behavioral therapy.

Presentations:

  • 10:05 AM - 10:22 AM CST
    (SYM 35) Advancing Case Conceptualizations Using Natural Language Processing: A Proof-of-concept Using Lgbtq-affirmative CBT

    Speaker: Julian Burger, Ph.D. (he/him/his) – Yale University

    Co-author: John Pachankis, Ph.D. – Yale University

  • 10:22 AM - 10:39 AM CST
    (SYM 35) Determinants and Use of Evidence-based Case Formulation Across 90 LGBTQ+ Community Centers

    Speaker: Briana Last, Ph.D. (they/them/theirs) – Stony Brook University

    Co-author: Julian Burger, Ph.D. (he/him/his) – Yale University

    Co-author: Hunter Baldwin, BA (they/them/theirs) – Yale University

    Co-author: Rafael Esteva Hache, B.A. – Stony Brook University

    Co-author: Palomi Kurade, BA (they/them/theirs) – Yale University

    Co-author: Danielle Chiaramonte, Ph.D. – Yale School of Public Health

    Co-author: John Pachankis, Ph.D. – Yale University

  • 10:39 AM - 10:56 AM CST
    (SYM 35) LGBTQ Community Mental Health Providers' Attitudes Towards Evidence-based Practice: The Role of Individual and Organizational Characteristics

    Speaker: Hunter Baldwin, BA (they/them/theirs) – Yale University

    Co-author: Lauren Wilkins, BA – Postgraduate Associate

    Co-author: Danielle Chiaramonte, Ph.D. – Yale School of Public Health

    Co-author: Dennis Li, Ph.D. (he/him/his) – Northwestern University

    Co-author: Brian Mustanski, Ph.D. – Northwestern University

    Co-author: John Pachankis, Ph.D. – Yale University

  • 10:56 AM - 11:13 AM CST
    (SYM 35) Implementing Lgbtq-affirmative CBT in 90 LGBTQ Community Centers Nationwide: A Comparison of Three Strategies

    Speaker: John Pachankis, Ph.D. – Yale University

    Co-author: Danielle Chiaramonte, Ph.D. – Yale School of Public Health

    Co-author: Hunter Baldwin, BA (they/them/theirs) – Yale University

    Co-author: Lauren Wilkins, BA – Postgraduate Associate

    Co-author: Xin Zhou, PhD – Yale School of Public Health

    Co-author: Skyler D. Jackson, Ph.D. – Yale School of Public Health

    Co-author: Audrey Harkness, PhD (she/her/hers) – University of Miami

    Co-author: Zachary A. Soulliard, Ph.D. (he/him/his) – Miami University

    Co-author: Em Matsuno, Ph.D. – Arizona State University

    Co-author: Dennis Li, Ph.D. (he/him/his) – Northwestern University

    Co-author: Brian Mustanski, Ph.D. – Northwestern University

  • 11:13 AM - 11:30 AM CST
    (SYM 35) Provider-directed Adaptations to Lgbtq-affirmative CBT in Community Settings

    Speaker: Danielle Chiaramonte, Ph.D. – Yale School of Public Health

    Co-author: Hunter Baldwin, BA (they/them/theirs) – Yale University

    Co-author: Ashley Hagaman, Ph.D. (she/her/hers) – Yale School of Public Health

    Co-author: John Pachankis, Ph.D. – Yale University