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Symposia

LGBTQ+

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

4 - (SYM 35) Implementing Lgbtq-affirmative CBT in 90 LGBTQ Community Centers Nationwide: A Comparison of Three Strategies

Saturday, November 22, 2025
10:56 AM - 11:13 AM CST
Location: Bolden 5, Level 2
Keywords: LGBTQ+, Implementation, Community-Based
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.,   ,  
Abstract Body

LGBTQ-affirmative CBT brings minority stress theory to clinical practice and shows efficacy for reducing LGBTQ people’s co-occurring depression, anxiety, and substance use across clinical trials. To identify how to bring LGBTQ-affirmative CBT to LGBTQ people nationwide, this study compares three strategies for training frontline mental health providers working in LGBTQ community centers.



 



LGBTQ community centers (N = 90) in 35 US states were randomized to one of three additive training strategies to support their providers in learning LGBTQ-affirmative CBT: (1) materials only (therapist manual + online training course); (2) live expert training over 12 weeks; and (3) ongoing leadership support, whereby a local supervisor was trained to train and supervise LGBTQ-affirmative CBT. Trained mental health providers (n=771) were mostly Master’s-level counselors (56.3%) and women (63.1%), with 3.4 (SD=4.6) years of experience treating LGBTQ clients, on average. Outcomes included LGBTQ-affirmative CBT knowledge, confidence, and demonstrated practice assessed at baseline and 4-, 8-, and 12-month post-baseline. Providers’ 8- and 12-month follow-up data will be available for analysis, by condition, in August 2025. At this point, we present 4-month outcome data aggregated across conditions.



 



At the 4-month follow-up, providers across conditions demonstrated improved knowledge of (d=0.50), confidence in (d=1.12), and use of (d=0.76) LGBTQ-affirmative CBT compared to baseline. Trained providers indicated delivering LGBTQ-affirmative CBT to a total of 4,348 clients within the first four months after training.  The most common adaptation that providers made when delivering LGBTQ-affirmative CBT in their practice involved delivering only certain modules of the treatment. Providers’ most preferred modules were assertiveness training and case conceptualization.



 



Two million people access services at LGBTQ community centers annually, making these centers an important setting for evidence-based practice implementation at scale. Future research that identifies how providers select which modules to deliver to whom can optimize this treatment when delivered in community settings.