Efficacy of affirmative cognitive behavioural group therapy for sexual and gender minority adolescents and young adults in community settings in Ontario, Canada

Objective: This study tested the efficacy of AFFIRM, a brief affirmative cognitive-behavioural group intervention tailored to reduce psychosocial distress and improve coping among sexual and gender minority adolescents and young adults (SGMY). Method: SGMY (n = 138; M age = 22.44) were allocated to immediate 8-week AFFIRM intervention delivered at 12 community-based organisations or an 8-week waitlisted control. At baseline, post-intervention or post-waitlist, participants completed self-reported assessments of depression, hope, coping, and stress appraisal. Implementation outcomes of feasibility and acceptability were also assessed. Results: Compared to waitlist, SGMY in the intervention condition significantly reduced their depressive symptoms (b = − 5.79, p =.001) as well as increased reports of hope (agency: b = 0.84, p =.001; pathway: b = 0.79, p =.001), and coping by emotional support (b = 0.59, p <.001), instrumental support (b = 0.67, p <.001), positive framing (b = 0.59, p <.001), humour (b = 0.36, p =.014), planning (b = 0.49, p <.001) as well as reflective coping (b = 0.27, p =.009). Intervention participants were also less likely to perceive stress as a threat (b = − 0.43, p =.001), and more likely to perceive stress as challenge (b = 0.67, p <.001) and have the resources to deal with that stress (b = 0.38, p =.016) in comparison to waitlisted control participants. All outcomes had medium to large effect sizes. AFFIRM participants reported low attrition (8.5%) and high levels of engagement and acceptability (e.g. 99% agreed intervention was relevant to their lives). Over 63% of the community organizations that participated in the training hosted AFFIRM at least once during the study. Conclusions: Results demonstrate efficacy for the community-based implementation of an affirmative clinical intervention designed for SGMY to address depression and foster coping with universal and minority stressors.