An Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth (Project Youth AFFIRM): Protocol for an Implementation Study

Abstract

Background Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential. Objective The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY. Methods SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol. Results Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed. Conclusions AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do ...

Selected pathobiological features and principles of pharmacological pain management

“…61 Cognitive-behavioral therapy, mindfulness/meditation, and physical activity are effective for moderating maladaptive emotions and thoughts, as well as for improving the capacity to cope with chronic pain (Figure 6). 62–65…”

Interrelations between pain, stress and executive functioning

“…Understanding the nature of the dysregulation between thoughts, emotions and behaviour will enable someone experiencing chronic stress/pain to adopt alternative more normative thoughts, emotions and behaviour, lowering their levels of anxiety/depression. 35,48 Cognitive behavioural therapy improves personal communication skills, coping capacity, sense of control over life events and an overall feeling of well-being. 49 This elevated positive effect has the capacity to increase resources of mental energy, further improving cognitive thought processes and social behaviour, thus mitigating the risk of depressive symptoms.…”

Suicide among LGBTQIA+ youth: A review of the treatment literature

“…Several reasons may account for this. First, LGBTQIA+ communities have historically been left out of clinical trials due to skepticism of researchers outside of LGBTQIA+ communities (Craig et al, 2019;Olson-Kennedy et al, 2017;Oransky et al, 2019;. These youth and the providers that treat them have ambivalence about the research community which is further compacted by the proximal and distal stressors outlined in MST.…”

“…Clearly the researchers could do more to build safe and collaborative relationships with this community; however, the problem is also embedded in the established structures for conducting research in our institutions. Second, LGBTQIA+ individuals, particularly TGD youth, rarely seek general community behavioral health services (Craig et al, 2019;Oransky et al, 2019;. They report feeling misunderstood, and unwelcome.…”

“…AFFIRM demonstrated preliminary effectiveness in reducing depression. Recently, Craig et al (2019) designed another study to test the efficacy of AFFIRM on improving the mental health of gender and sexual minority youth. While this implementation study was designed to reduce sexual risk behaviors and psychosocial distress, no suicide outcomes measured.…”