Internalized binegativity (IB), negative attitudes and beliefs about one's own bisexuality, can develop from chronic exposure to binegative discrimination and prejudice and is associated with several negative mental health consequences. We developed and tested an online intervention following the Releasing Internalized Stigma for Empowerment (RISE) model (Lin, Israel, & Ryan, 2018) to reduce IB and to offer a novel means to access and treat bisexual people. We analyzed data from 641 bisexual adults recruited from Amazon Mechanical Turk (MTurk) who were randomly assigned to the intervention or active control condition and asked to complete pretest and posttest measures. Four modules tailored for bisexual people, based on a review of relevant literature and expert feedback, comprised the intervention. The modules included: (a) a true/false quiz that challenged negative bisexual stereotypes with research evidence, (b) an activity where participants identified external sources of their binegative beliefs, (c) a biaffirming video and a writing exercise to express support for a bisexual person, and (d), presentation of positive aspects of being bisexual and biaffirming images. We used a posttest-only randomized controlled design with the intervention as the between-subjects factor. A series of one-way analyses of covariance (ANCOVAs), controlling for covariates of identity concealment and self-esteem, revealed that the intervention was efficacious in reducing IB at a small effect size in addition to influencing related constructs. These results offer a promising contribution to accessible and targeted intervention efforts for reducing bispecific minority stressors. Future directions include examining acceptability, feasibility, implementation, and replication issues. Public Significance StatementResults from our randomized controlled trial demonstrated that 4 online modules-comprised of activities using social psychology principles-conferred statistically significant and practically meaningful (e.g., effect sizes) changes in IB and related constructs compared with a control condition, supporting the efficacy of the intervention. Our findings demonstrate the viability of using online platforms to access and serve bisexual people, as well as the importance of considering bispecific aspects of minority stress when working with this highly vulnerable population.

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Current psychotherapy research with sexual and gender minorities (SGMs) is inadequate to address the health disparities in this population. Psychotherapy can benefit from research demonstrating the unique experiences of SGMs with respect to behavioral health, internalized stigma, coping, and resilience. This article describes research approaches, questions, and measurement that can be employed to study psychotherapy. Given the impact of minority stress and microaggressions on SGM individuals, many of the recommendations provided in this article focus on how these components should be infused throughout a diverse range of psychotherapy interventions. Namely, we provide recommendations for researchers focusing on SGM populations in randomized controlled trials and psychotherapy process research. We also provide 7 specific recommendations that focus on psychotherapy research measurement with SGM populations and how researchers can focus their efforts to reduce disparities for SGM individuals. Finally, we identify additional constructs to consider for future intervention research with SGM individuals. Public Significance StatementThe conclusions of this article are notable for several reasons. First, the lack of psychotherapy research being conducted with sexual and gender minority populations indicates a lack of knowledge regarding best practices and evidence-based treatment with sexual and gender minorities. Second, psychotherapy research has been conceptualized from a hetero and cis-normative point of view; the recommendations in this article will allow for interventions that are more population-appropriate.

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Given the degree of hostility toward transgender people and the pervasiveness of societal messages regarding gender roles, transgender people may internalize negative attitudes and beliefs about being transgender in the form of internalized transnegativity (IT). IT has been shown to contribute to negative behavioral health outcomes including suicide among transgender people (Breslow et al., 2015;Staples, Neilson, Bryan, & George, 2018). In this study, we developed an online intervention designed to reduce IT among transgender people and evaluated its efficacy using a randomized controlled trial. The IT intervention consisted of 4 modules aimed at (a) combatting stereotypes, (b) identifying and rejecting negative messages, (c) reinforcing the rejection of negative messages, and (d) enhancing identity affirmation. We analyzed data from 639 participants recruited with Amazon Mechanical Turk (Mturk) and randomly assigned to the intervention (n ϭ 294) or a control (n ϭ 345) addressing stress management. We measured IT using 2 subscales from the Transgender Identity Survey (TIS; Bockting, Miner, Swinburne Romine, Hamilton, & Coleman, 2013): shame and pride. At posttest, those who received the IT intervention reported significantly lower levels of shame and higher levels of pride when compared to control. The intervention conferred small to medium effects for reducing shame (d ϭ .43) and increasing pride (d ϭ .43). As IT represents a transdiagnostic risk factor for many behavioral health problems among transgender people, our brief online intervention offers a highly promising and accessible means of addressing public health issues in this population. Future research directions include dismantling studies and enhancing generalizability to transgender subpopulations. Public Significance StatementThis randomized controlled trial found that participants who completed this brief online intervention had significantly lower levels of shame and higher levels of pride related to their transgender identity compared to participants in the control condition. The authors discuss the online intervention's potential at increasing accessibility to effective psychological interventions for transgender populations.