Mini Workshop 8 - Empowering Gender-diverse Youth: Advanced Exposure Therapy Techniques for Social Anxiety

Cognitive Behavioral Therapy (CBT) with exposure is widely recognized as the gold standard treatment for anxiety disorders. However, there is limited research on adaptations of CBT for social anxiety that are culturally responsive to the unique needs of gender-diverse youth (GDY). Given the current political climate in the United States where GDY are targeted in anti-trans legislation, the experiences of gender dysphoria, gender minority stress, and social anxiety among GDY will increase. Consequently, there will be a greater need for exposure therapy practitioners to enhance their cultural sensitivity and consideration of factors related to gender dysphoria.

In this workshop, we highlight assessment and intervention strategies for applying exposure therapy to support GDY experiencing social anxiety and gender dysphoria. To provide gender-affirming CBT for anxiety, practitioners need to have an understanding of the gender dysphoria and gender minority stress, as well as factors contributing to the onset and maintenance of social anxiety, such as the cycle of avoidance. A great deal of nuance is required when assessing whether social anxiety is “out of proportion to the actual threat posed by the social situation and to the sociocultural context” (DSM-5-TR criterion B). Additionally, we aim to address how the experiences of gender dysphoria and internalized transphobia compound the distress felt by GDY in social situations. We also encourage recognition of gender euphoria and adapting the exposure framework to not only increase distress tolerance but also enhance the feelings of self-efficacy and empower youth to seek out affirming experiences. Adaptations to CBT such as de-emphasizing cognitive restructuring around experiences of microaggressions and discrimination, and instead focusing on tools for managing genuine fears will be discussed, along with acceptance-based approaches, distress tolerance and values-oriented action.

Recommended Reading 1: Busa, S., Wernick, J., Kellerman, J., Glaeser, E., McGregor, K., Wu, J., & Janssen, A. (2022). A Descriptive Case Study of a Cognitive Behavioral Therapy Group Intervention Adaptation for Transgender Youth With Social Anxiety Disorder. The Behavior therapist, 45(4), 135.

Recommended Reading 2: Hunter, J., Butler, C., & Cooper, K. (2021). Gender minority stress in trans and gender diverse adolescents and young people. Clinical child psychology and psychiatry, 26(4), 1182-1195.

Hidalgo, M. A., Petras, H., Chen, D., & Chodzen, G. (2019). The Gender Minority Stress and Resilience Measure: Psychometric Validity of an Adolescent Extension. Clinical practice in pediatric psychology, 7(3), 278.

Recommended Reading 3: Chodzen, G., Hidalgo, M. A., Chen, D., & Garofalo, R. (2019). Minority stress factors associated with depression and anxiety among transgender and gender-nonconforming youth. Journal of Adolescent Health, 64(4), 467-471.

Leitch, J., Nguyen, V., & Potter, S. (2024). Beyond dysphoria and stress: a theory of gender euphoria and gender fulfillment. International Journal of Transgender Health, 1-14.