A Systematic Review of Evidence-Based Cognitive and/or Behavioural Interventions Targeting Mental Health in LGBTQ+ Populations Systematic Reviews and Meta-analyses A Systematic Review of Evidence-Based Cognitive and/or Behavioural Interventions Targeting Mental Health in LGBTQ+ Populations Carina Tudor-Sfetea 1 , Raluca Topciu 1 [1] CEDAR (Clinical Education Development and Research), University of Exeter, Exeter, United Kingdom. Clinical Psychology in Europe, 2024, Vol. 6(3), Article e11323, https://doi.org/10.32872/cpe.11323 Received: 2023-02-13 • Accepted: 2024-05-06 • Published (VoR): 2024-09-30 Handling Editor: Cornelia Weise, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Corresponding Author: Carina Tudor-Sfetea, Washington Singer Laboratories, University of Exeter, Perry Road, Prince of Wales Road, Exeter, EX4 4QG, UK. Telephone number: +447990572937. E-mail: C.Tudor-Sfetea@exeter.ac.uk Supplementary Materials: Data, Materials, Preregistration [see Index of Supplementary Materials] Abstract Background: Despite a minority stress-related higher risk to develop mental health difficulties, and problematic access to and treatment from healthcare providers, research into LGBTQ+ mental health support is limited. The aims of this systematic review were to explore evidence-based cognitive and/or behavioural interventions and adaptations targeting mental health in LGBTQ+ populations, before providing recommendations for future clinical and research directions. Method: Six databases were searched in February-March 2022 and risk of bias evaluated using the Cochrane RoB 2/ROBINS-I tools. A narrative synthesis following the PICOS framework and the review questions was used to examine the results. Results: Sixteen studies met inclusion criteria, including various interventions and adaptations, mental health difficulties, and other emotion- and minority stress-related processes/constructs. Risk of bias was judged as high, and critical/serious, respectively, in all studies. Outcomes included improvements in symptoms of depression (most statistically/clinically significant effects/large effect sizes), and anxiety, emotion regulation, and internalised homophobia in the pre-post studies. Conclusion: Cognitive/behavioural interventions and adaptations for LGBTQ+ populations feature a range of therapeutic modalities and levels of adaptation, with largely positive effects, in the context of limited and heterogenous literature and risk of bias concerns, as well as limitations related to publication bias and inclusion criteria of the current work. Suggestions for future clinical and research directions include a focus on generic therapeutic competencies and This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License, CC BY 4.0, which permits unrestricted use, distribution, and reproduction, provided the original work is properly cited. https://crossmark.crossref.org/dialog/?doi=10.32872/cpe.11323&domain=pdf&date_stamp=2024-09-30 https://orcid.org/0000-0002-5494-4731 https://orcid.org/0000-0002-3242-1200 https://www.psychopen.eu/ https://cpe.psychopen.eu/ https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ metacompetencies, and affirmative, potentially more holistic approaches, as well as more consistency in methodology, more focus on underserved LGBTQ+ populations and intersectionality, and more detailed investigations into mechanisms of change. Keywords LGBTQ+, systematic review, mental health, cognitive behavioural interventions Highlights • Research findings on evidence-based mental health support for LGBTQ+ individuals are positive, but the literature is limited, heterogenous, and there are risk-of-bias concerns. • More work is needed around affirmative approaches, consistency in methodology, mechanisms of change, and underserved LGBTQ+ populations and intersectionality. Rationale LGBTQ+ individuals (who identify as lesbian, gay, bisexual, transgender, queer, or with any other non-heterosexual and/or non-cisgender identity) experience a disproportion­ ately higher rate of mental health difficulties compared to heterosexual and/or cisgen­ der individuals (Pinna et al., 2022; Plöderl & Tremblay, 2015). This disparity has been attributed at least partly to stigma-related stressors, with perhaps the most important framework addressing this being the Minority Stress Theory (Brooks, 1981; Meyer, 1995, 2003; reviewed in Hoy-Ellis, 2023; Tan et al., 2020) alongside its extensions, particularly Hendricks and Testa’s (2012) work exploring gender identity stressors. Herein, distal (external, objective) factors – victimisation, prejudice, and discrimina­ tion, and the likely resulting proximal (internal, subjective) factors – concealment of one’s identity, prejudice- and rejection-related anxiety and expectations, and internalised homo- and transphobia, are thought to contribute to a set of differences in cognitions, emotions, and behaviours which drive and maintain mental health disparities transdiag­ nostically (Meyer, 2003; Nicholson et al., 2022; Pachankis, 2015). The effects of these factors have been widely documented (Gnan et al., 2019; Testa et al., 2017). A complicat­ ing, yet crucial, consideration, is that of the intersection of various sexual identities with other racial, ethnic, social, and gender identities, with individuals with multidimensional minority status facing unique challenges (Balsam et al., 2011; Dale & Safren, 2019). Various mechanisms have been proposed in the context of minority stress. These include: alterations in emotion regulation, social/interpersonal dynamics (e.g., isolation), and cognitive processes (e.g., negative self-schemas; Hatzenbuehler, 2009); disruptions of negative valence systems (avoidance, hypervigilance, loss), positive valence systems (ap­ proach motivation, reward learning – associated with impulsivity/addictive behaviours), social functioning (e.g., disrupted attachment, low agency, poor social communication; LGBTQ+ Mental Health Interventions 2 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ Pachankis, 2015), and anticipatory emotions/behaviours as well as cognitions around the expectation of rejection (Feinstein, 2020). Biological mechanisms (Flentje et al., 2020) and neuroimaging/neural correlates (Nicholson et al., 2022) have also been documented. Despite these significant vulnerabilities, access to and treatment for mental health seems to be problematic for LGTBQ+ populations (e.g., McCann & Sharek, 2014; Steele et al., 2017). While some limited research has documented poorer psychological treatment outcomes for some LGBTQ+ populations (Beard et al., 2017; Rimes et al., 2019), there is generally a paucity of literature (e.g., data pertaining to sexual orientation and gender identity is often omitted in research on psychological interventions for mental health – Heck et al., 2017). This speaks to the need for tailored mental health interventions for this population, and crucially, thorough research into their effectiveness. Others have reviewed interventions targeting mental health and/or health behav­ iour in various LGBTQ+ sub-populations. In their systematic review and meta-analysis, Pantalone et al. (2020) focused on behavioural interventions targeting psychosocial syn­ demics and HIV-related health behaviours for sexual minority men, reporting significant improvements with small effect sizes in mental health, while a systematic review by Melendez-Torres and Bonell (2014) found improvements related to sexual risk behaviour following a CBT (Cognitive Behavioural Therapy) intervention in substance-using men who have sex with men, although the evidence was evaluated to be of moderate quality. Focusing on LGBTQ+ youth mental health, Hobaica et al. (2018) found support for the effectiveness of a range of intervention modes, including in-person, computerised, online, as well as individual and group. Sheinfil et al. (2019) investigated adapted psy­ chotherapeutic interventions for depression, while Van Der Pol-Harney and McAloon (2019) found CBT to be an effective therapeutic framework. Bochicchio et al. (2022) also reported preliminary evidence for effectiveness of a variety of psychotherapeutic interventions. This work has, however, either mainly focused on health behaviour rather than mental health, therefore not including details around intervention components, outcome measures, and their relationship to minority stress (Pantalone et al., 2020); on specific genders or populations known to present with unique challenges (sexual minority men including those HIV-positive or at risk – Pantalone et al., 2020; substance-using sexual minority men – Melendez-Torres & Bonell, 2014; young people – Bochicchio et al., 2022; Hobaica et al., 2018; Van Der Pol-Harney & McAloon, 2019), therefore making generali­ sations limited; or on particular diagnoses rather than more widely/transdiagnostically which would be more in line with minority stress factors and mechanisms (Sheinfil et al., 2019). Few, if any reviews have adopted a wider/more general lens on LGBTQ+ populations of any age, focusing on psychotherapies for mental health and their adaptations, their components, their outcomes, and their relationship to transdiagnostic minority stressors; this review aims to bridge this gap. As CBT has a rich evidence base for several mental Tudor-Sfetea & Topciu 3 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ health difficulties (Hofmann et al., 2012), and importantly, offers a framework by which to understand and explore minority stressors (i.e, relationships among cognition – e.g., negative self-schemas, emotion – e.g., emotion regulation, anxiety, shame, and behaviour – e.g., isolation, avoidance), the review will focus on this psychotherapeutic model. Objectives The aim of this systematic review is to explore the landscape of the scientific literature on evidence-based cognitive and/or behavioural interventions and adaptations targeting mental health in LGBTQ+ populations, by answering the following questions: 1. What evidence-based cognitive and/or behavioural interventions for LGBTQ+ populations exist, and what, if any, specific adaptations do they involve? 2. What are the outcomes of evidence-based cognitive and/or behavioural interventions and adaptations targeting mental health in LGBTQ+ populations? 3. What recommendations could be made in terms of such adaptations in clinical practice? Method Guidelines and Registration This systematic review was carried out in accordance with the updated PRISMA guide­ lines (Page et al., 2021), and registered on PROSPERO (International prospective register of systematic reviews) in April 2022 (CRD42022243466) – please see Tudor-Sfetea and Topciu, 2024S, Appendix A for more information regarding deviations from this preregis­ tration. No ethics approval was required due to the nature of the work. Eligibility Criteria Studies had to be published or in press in peer-reviewed journals, in English; no time limits for publication were enforced. Pre-prints were considered, while other grey litera­ ture was excluded. The studies also had to fulfil the criteria outlined in Table 1, following the PICOS framework (Population, Intervention, Comparison, Outcomes, Study designs, Higgins et al., 2023). Please see more details on these decisions in the Discussion section, and in Tudor-Sfetea & Topciu, 2024S, Appendix B. Information Sources Eligible studies were sourced from: Embase, MEDLINE, PsycINFO, PsychExtra, Web of Science, Cochrane Library (advanced search), via searches between 19.02.2022 and 10.03.2022. LGBTQ+ Mental Health Interventions 4 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ Table 1 Inclusion and Exclusion Criteria According to the PICOS Framework Inclusion Exclusion Population LGBTQ+ individuals or individuals reporting distress over minority stress- related issues, of any age, sex, gender, sexual orientation, race, and ethnicity; including people identifying as gay, lesbian, bisexual, pansexual, demisexual, asexual, queer, transgender, genderqueer, genderfluid, non- binary Studies with HIV-positive participants where no separate results for participants with negative or unclear HIV status were reported, as well as studies with people with substance dependence as a main presenting problem Interventions Evidence-based individual and group-based cognitive behavioural interventions; including Cognitive Behavioural Therapy (CBT), behaviour- based interventions such as exposure or exposure and response prevention (ERP), as well as third-wave CBT interventions, including Acceptance and Commitment Therapy (ACT), Mindfulness-Based Interventions such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), Dialectical Behaviour Therapy (DBT), Behavioural Activation (BA), or Compassion Focused Therapy (CFT); delivered in any settings, including out- and inpatient settings, charity organisations, educational settings, or any other community or home settings; and via any medium, including in person, videoconference, telephone, live-chat Interventions with only a minimal cognitive or behavioural component, and couple-specific interventions; self-help interventions with no direct therapist involvement Comparison Active control (i.e., other interventions for mental health; treatment-as- usual), inactive control (i.e., waitlist), or no control group Outcomes Outcomes in the domain of common mental health difficulties; including studies with outcomes related to, e.g., symptoms of depression, anxiety and any anxiety disorders, obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD), health anxiety, post-traumatic stress disorder (PTSD), and minority stress, as well as psychological flexibility and quality of life/subjective wellbeing, assessed via validated questionnaires Studies with outcomes related solely to sex- related health behaviour, as well as drug use Study designs Quantitative studies or the quantitative aspects of mixed-method studies; including randomised controlled trials (RCTs), controlled/experimental studies such as controlled trials, open trials/studies/pilots, pilot trials/ studies, case-control studies, effectiveness studies without a control group (e.g., pre-post effect size), feasibility or acceptability studies Qualitative studies, as well as published study protocols and reviews Search Strategy Search terms based on the PICOS framework were used to determine MeSH (Medical Subject Heading) terms where applicable, and perform searches using these as well as keyword searches, combined with Boolean logic, OR/AND – a table of the search terms, and a link to the full search strategy/history are available in Tudor-Sfetea and Topciu, 2024S, Appendix C. Tudor-Sfetea & Topciu 5 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ Results were exported into RIS and Microsoft Excel files, before being imported into Covidence (Veritas Health Innovation, 2022), a screening and data extraction tool recommended for Cochrane authors. Selection Process Duplicates were automatically removed in Covidence. Reference titles and abstracts were then screened by the first author and categorised as “Yes”, “No”, “Maybe”, before reviewing the full texts of the “Yes” and “Maybe” references. A second reviewer followed the same process for a randomly-selected subset, at both stages (approximately 20%; n = 51, n = 5 respectively). Disagreements (n = 5 at title and abstract screening stage, none at full text review stage) were resolved by discussion and revisiting/clarification of criteria, with consensus reached throughout. Data Collection Process Data were extracted using customised forms on Covidence, based on the Cochrane Data collection forms for intervention reviews. The forms were piloted on one randomly selected study, and further refined. A subset (12.5%, n = 2) of the extracted data were checked for accuracy by the second reviewer; no disagreements occurred. A link to a more extensive, raw data table is available in Tudor-Sfetea and Topciu, 2024S, Appendix D. Study Risk of Bias Assessment All included studies were assessed for risk of bias. There seems to be no agreed standard to evaluate the quality of psychotherapy outcome research; instead, a heterogeneity of tools are available, with the Cochrane tools or adapted versions thereof more common (Munder & Barth, 2018). Therefore, the Cochrane risk-of-bias tool for randomised trials (RoB 2) (Sterne et al., 2019) for randomised studies, and the Risk of Bias In Non-Rando­ mised Studies - of Interventions (ROBINS-I) tool (Sterne et al., 2016) for non-randomised studies were used, consistent with PRISMA guidelines (Page et al., 2021), and to align to the majority of previous research, encouraging consistency and reproducibility. The tool domains were evaluated categorically as Low, High, or Some concerns (RoB2), or Low, Moderate, Serious, Critical, or No information (ROBINS-I), in line with the sig­ nalling questions and guidance (Sterne et al., 2019; Sterne et al., 2016, respectively). Customised Quality Assessment Templates on Covidence were used. A subset (12.5%, n = 2) of the studies were also evaluated by the second reviewer; no disagreements occurred. Synthesis Methods Due to the limited number of included studies and the heterogeneity of results in terms of study designs and outcomes, following scoping/initial searches, the data were deemed LGBTQ+ Mental Health Interventions 6 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ not appropriate for quantitative synthesis. Therefore, a narrative synthesis considering the “Synthesis without meta-analysis" (SWiM) guidelines (Campbell et al., 2020), as well as tables and figures, were used to summarise and explain the characteristics of the included studies. Results Study Selection A total of 411 records were identified and imported into Covidence, with 152 records au­ tomatically identified as duplicates and removed. Of the remaining 259 records, 231 were excluded following title and abstract screening, resulting in 28 records eligible for full text review. Twelve of these were then excluded as they did not meet the review criteria; see Tudor-Sfetea and Topciu, 2024S, Appendix E for a detailed overview. Therefore, 16 records were included. The PRISMA flow diagram in Figure 1 outlines this process. Study Characteristics Table 2 summarises study and sample characteristics. Studies have been numbered for clarity (chronologically, starting with the oldest, grouped by RCTs, then non-RCTs), and will be referred to by their allocated numbers from now on. Please see Tudor-Sfetea and Topciu, 2024S, Appendix F for a narrative summary of study and sample characteristics. Interventions, Adaptations, and Results Table 3 summarises the interventions, adaptations, and results of each of the included studies. What Evidence-Based Cognitive and/or Behavioural Interventions for LGBTQ+ Populations Exist, and What, if Any, Specific Adaptations Do They Involve? CBT-based interventions: Eleven studies involved CBT-based interventions, five of which featured the ESTEEM (Effective Skills to Empower Effective Men) intervention, or interventions based on it. ESTEEM was adapted via interviews with key stakeholders, including gay and bisexual men with depression and anxiety and expert providers, from Barlow et al.’s (2011) Unified Protocol to improve minority stress coping through emo­ tion regulation, cognitive restructuring, and assertiveness training (identifying minority stress experiences; tracking cognitive, affective, and behavioural reactions to minority stress; attributing distress to minority stress rather than to personal failure; Pachankis, 2014; Pachankis et al., 2015). Tudor-Sfetea & Topciu 7 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ Figure 1 PRISMA Flow Diagram Outlining the Process of Study Selection Figure 1. PRISMA Flow Diagram outlining the process of study selection. Records identified from: Databases (n = 411) Cochrane (n = 62) Embase (n = 138) Medline (n = 64) PsychExtra (n = 15) PsychInfo (n = 48) Web of Science (n = 84) Records removed before screening: Duplicate records removed by automation tools (n = 152) Records screened (n = 259) Records excluded by reviewer (n = 231) Reports sought for retrieval (n = 28) Reports not retrieved (n = 0) Reports assessed for eligibility (n = 28) Reports excluded (n = 12): Did not meet population inclusion/exclusion criteria (n = 3) Conference abstract (n = 2) Unpublished/dissertation (n = 2) Did not meet intervention inclusion/exclusion criteria (n = 2) Not differentiating LGBT (n = 1) Did not meet route of administration inclusion/exclusion criteria (n = 1) Wrong study design (n = 1) Reports included in review (n = 16) Identification of studies via databases and registers LGBTQ+ Mental Health Interventions 8 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ Ta bl e 2 St ud y an d Sa m pl e C ha ra ct er is tic s St ud y; y ea r( s) o f da ta c ol le ct io n; co un tr y/ co un tr ie s of d at a co lle ct io n St ud y de si gn s; C om pa ri so ns Ti m ep oi nt s of ou tc om e co lle ct io n Sa m pl e si ze Pa rt ic ip an ts A ge - M (SD ) / Br ea kd ow n G en de r (% o r N) Se xu al or ie nt at io n (% o r N) Et hn ic it y (% o r N) M en ta l h ea lt h 1 - P ac ha nk is e t a l. (2 01 5) ; 2 01 3- 20 14 ; U SA Ra nd om is ed c on tr ol le d tr ia l (c ro ss ov er - pa rt ic ip an ts w er e ra nd om is ed (s tr at if ie d ac co rd in g to r ac e/ et hn ic ity an d an xi et y/ de pr es si on ) t o ei th er im m ed ia te tr ea tm en t - re ce iv ed tr ea tm en t b et w ee n ba se lin e an d 3- m on th as se ss m en t - , o r w ai tli st - re ce iv ed tr ea tm en t b et w ee n 3- m on th a nd 6 -m on th as se ss m en t - ); In ac tiv e co nt ro l ( w ai tli st ) Im m ed ia te co nd iti on : p re - tr ea tm en t, po st - tr ea tm en t, 3- m on th fo llo w -u p; W ai tli st c on di tio n: 3- m on th p re - tr ea tm en t, pr e- tr ea tm en t, po st - tr ea tm en t 63 (5 4 co m pl et ed a t le as t o ne se ss io n) Im m ed ia te co nd iti on : 2 6. 19 (4 .2 6) ; W ai tli st co nd iti on : 2 5. 69 (4 .2 8) M al e - in cl us io n cr ite ri on ; G ay /q ue er : 3 1; 27 Bi se xu al : 1 ; 4 Im m ed ia te c on di tio n; W ai tli st c on di tio n: A m er ic an In di an /A la sk an N at iv e: 0 ; 1 A si an : 0 ; 3 Bl ac k/ A fr ic an A m er ic an : 6 ; 4 Pa ci fi c Is la nd er : 1 ; 1 W hi te : 1 6; 1 7 O th er /m ix ed : 9 ; 5 H is pa ni c/ La tin o: Y es - 12 ; 1 1; N o - 2 0; 2 0 Im m ed ia te p re -t re at m en t m ea n sc or es (S D ) D ep re ss io n: C ES D - im m ed ia te c on di tio n: 2 7. 69 (1 .8 3) , w ai tli st c on di tio n: 2 3. 19 (2 .1 4) - ab ov e cu t- of f 1 6 O D SI S - i m m ed ia te c on di tio n: 8 .1 6 (0 .7 6) , w ai tli st c on di tio n: 7 .0 8 (0 .8 8) - ju st ab ov e /s lig ht ly b el ow c ut -o ff 8 A nx ie ty : O A SI S - i m m ed ia te c on di tio n: 8 .0 3 (0 .6 6) , w ai tli st c on di tio n: 6 .8 9 (0 .7 8) - ju st a bo ve / sl ig ht ly b el ow c ut -o ff 8 2 - M ill ar , W an g, & Pa ch an ki s (2 01 6) ; 20 13 -2 01 4; U SA A s ab ov e A s ab ov e 63 e nr ol le d, 5 4 co m pl et ed b ot h pr e- a nd p os t- tr ea tm en t as se ss m en ts M = 2 6. 1 (S D = 4 .0 ) M al e - in cl us io n cr ite ri on G ay /q ue er (4 9) , Bi se xu al (4 ) A m er ic an In di an o r A la sk an N at iv e (1 ), A si an (1 ), Bl ac k / A fr ic an A m er ic an (7 ), Pa ci fi c Is la nd er (2 ), W hi te (3 0) , O th er /m ix ed (1 3) H is pa ni c / La tin o - Y es (2 2) , N o (3 2) Pr e- tr ea tm en t m ea n sc or es (S D ) D ep re ss io n: O D SI S - 7 .4 6 (4 .3 0) - be lo w c ut -o ff 8 A nx ie ty : O A SI S - 7 .5 0 (3 .7 6) - be lo w c ut -o ff 8 3 – O ’C le ir ig h et a l. (2 01 9) ; 2 00 7- 20 11 ; U SA Ra nd om is ed c on tr ol le d tr ia l; ac tiv e co nt ro l ( V C T- on ly ) Ba se lin e, e nd o f t he tr ea tm en t p er io d (a pp ro xi m at el y 3- m on th s af te r ra nd om iz at io n) , a nd 6- a nd 9 -m on th fo llo w -u p 43 M = 3 9. 19 (S D = 1 1. 07 ) M al e - in cl us io n cr ite ri on G ay (2 7) , Bi se xu al (1 2) , U ns ur e (4 ) C au ca si an (2 7) , A fr ic an A m er ic an (1 1) , H is pa ni c/ La tin o (3 ), O th er (2 ) Ba se lin e m ea n sc or es (S D ) PT SD : D av id so n Tr au m a Sc al e C on tr ol - 37 .2 0 (2 5. 29 ) - b el ow c ut -o ff 4 0 Tr ea tm en t - 4 7. 09 (2 1. 27 ) - a bo ve c ut -o ff 40 Re po rt a ls o st at es 3 2. 6% o f p ar tic ip an ts m et d ia gn os tic c ri te ri a fo r PT SD Tudor-Sfetea & Topciu 9 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y; y ea r( s) o f da ta c ol le ct io n; co un tr y/ co un tr ie s of d at a co lle ct io n St ud y de si gn s; C om pa ri so ns Ti m ep oi nt s of ou tc om e co lle ct io n Sa m pl e si ze Pa rt ic ip an ts A ge - M (SD ) / Br ea kd ow n G en de r (% o r N) Se xu al or ie nt at io n (% o r N) Et hn ic it y (% o r N) M en ta l h ea lt h 4 - P ac ha nk is e t a l. (2 02 0) ; 2 01 8- 20 19 ; U SA A s Pa ch an ki s et a l. (2 01 5) an d M ill ar , W an g, & Pa ch an ki s (2 01 6) A s Pa ch an ki s et a l. (2 01 5) a nd M ill ar , W an g, & P ac ha nk is (2 01 6) 60 e nr ol le d, 5 8 co m pl et ed a t le as t o ne se ss io n M = 2 5. 58 (S D = 3 .2 6) W om en - in cl us io n cr ite ri on ; ci sg en de r (5 6. 7% ) Q ue er (5 5% ) W hi te (5 8. 3% ), ra ci al o r et hn ic m in or iti es (4 1. 7% ) Im m ed ia te p re -t re at m en t m ea n sc or es (S D ) D ep re ss io n: C ES D - im m ed ia te c on di tio n: 2 9. 70 (1 .8 4) , w ai tli st c on di tio n: 2 6. 86 (1 .9 1) - ab ov e cu t- of f 1 6 O D SI S - i m m ed ia te c on di tio n: 6 .3 0 (0 .8 3) , w ai tli st c on di tio n: 7 .6 9 (0 .7 3) - be lo w c ut - of f 8 A nx ie ty : O A SI S - i m m ed ia te c on di tio n: 8 .8 0 (0 .6 4) , w ai tli st c on di tio n: 8 .0 3 (0 .4 6) - ju st a bo ve cu t- of f 8 5 - M ag ue n, Sh ip he rd , & H ar ri s (2 00 5) ; u nc le ar ye ar s of d at a co lle ct io n; U SA Pr e- po st Pr e, p os t 6 M = 4 7 (S D = 9 .1 6) , ra ng e 32 -5 9 Fe m al e (M tF ) N /A N /A D ep re ss io n: 67 % (4 ) s co re d ab ov e cl in ic al th re sh ol d fo r BD I A nx ie ty : 67 % (4 ) s co re d ab ov e cl in ic al th re sh ol d fo r ST A I 6 - Y ad av ai a & H ay es (2 01 2) ; un cl ea r ye ar s of da ta c ol le ct io n; U SA C on cu rr en t, m ul tip le - ba se lin e, a cr os s- pa rt ic ip an ts de si gn (s ev er al c oo rd in at ed si m pl e ph as e ch an ge s, in w hi ch tr ea tm en t b eg in s fo r sp ec if ic p ar tic ip an ts a t di ff er en t p oi nt s in r ea l t im e an d af te r ba se lin e pe ri od s of di ff er in g le ng th s) ; Pr e- po st Pr e, p os t, 4- w ee k an d 12 -w ee k fo llo w -u p 6 en ro lle d, 5 co m pl et ed A ge 2 1- 24 (3 pa rt ic ip an ts ), ag e >3 0 (1 pa rt ic ip an t) , ag e 56 (1 pa rt ic ip an t) M al e (3 ), Fe m al e (2 ) G ay (2 ), Le sb ia n (1 ), Q ue st io ni ng (1 ) - o ne p pt 's da ta no t r ep or te d du e to pr ef er en ce s A si an /A fr ic an A m er ic an / C au ca si an (1 ), A fr ic an A m er ic an /C au ca si an (1 ), C au ca si an (1 ), N at iv e A m er ic an (1 ) - o ne p pt 's da ta no t r ep or te d du e to pr ef er en ce s M ea n sc or es (S D ) D ep re ss io n: D A SS -D - 14 .4 (8 .2 ) - in di ca tin g m od er at e de pr es si on A nx ie ty : D A SS -A - 5. 2 (3 .9 ) - in di ca tin g no rm al an xi et y 7 - C ra ig & A us tin (2 01 6) ; 2 01 4; O pe n pi lo t, pr e- po st Ba se lin e (< 4 w ee ks be fo re s ta rt o f 30 M = 1 6. 8, ra ng e 15 -1 8 Fe m al e (5 4% ), ge nd er Pa ns ex ua l (2 9% ), le sb ia n W hi te E ur op ea n (6 4% ), Bl ac k/ A fr ic an /C ar ib be an M ea n sc or es (S D ) D ep re ss io n: LGBTQ+ Mental Health Interventions 10 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y; y ea r( s) o f da ta c ol le ct io n; co un tr y/ co un tr ie s of d at a co lle ct io n St ud y de si gn s; C om pa ri so ns Ti m ep oi nt s of ou tc om e co lle ct io n Sa m pl e si ze Pa rt ic ip an ts A ge - M (SD ) / Br ea kd ow n G en de r (% o r N) Se xu al or ie nt at io n (% o r N) Et hn ic it y (% o r N) M en ta l h ea lt h un cl ea r co un tr ie s of da ta c ol le ct io n – lik el y C an ad a, po ss ib ly U SA in te rv en tio n) , p os t, 3- m on th fo llo w -u p in de pe nd en t/ no n- bi na ry (2 1% ), m al e (1 8% ), tr an s (1 0% ), an d/ or tw o- sp ir it (8 % ) (2 5% ), qu ee r (2 1% ), bi se xu al (1 8% ), un su re / qu es tio ni ng (1 1% ), ga y (1 1% ), an d/ or po ly se xu al (2 % ) (2 5% ), Ea st /S ou th /S ou th ea st A si an (2 4% ), In di ge no us / Fi rs t N at io ns (1 8% ), an d/ or La tin o/ a (7 % ) BD I- II - 25 .9 5 (1 4. 51 ) - in di ca tin g m od er at e de pr es si on 8 - A us tin , C ra ig , & D ’S ou za (2 01 8) ; 20 14 ; C an ad a Pr e- po st Pr e, p os t, 3- m on th fo llo w -u p 8 A ge 1 6 (1 pa rt ic ip an t) , ag e 17 (1 pa rt ic ip an t) , ag e 18 (6 pa rt ic ip an ts ) N on bi na ry (6 ), Q ue er (5 ), Fe m al e (2 ), Tr an sg en de r (2 ), M al e (1 ), Tw o- sp ir it (1 ), G en de r in de pe nd en t (1 ), O th er - fi gu ri ng th in gs ou t ( 1) Q ue er (5 ), Pa ns ex ua l ( 2) , Q ue st io ni ng (2 ), A se xu al (1 ) W hi te (C an ad ia n, E ur op ea n) (5 ), M ix ed (2 ), A si an (1 ), Bl ac k (A fr ic an , C an ad ia n, C ar ib be an ) ( 1) , I nd ig en ou s, Fi rs t N at io ns , I nu it, M et is (1 ), La tin A m er ic an (1 ) M ea n sc or es (S D ) D ep re ss io n: BD I- II - 37 .5 0 (1 2. 29 ) - in di ca tin g se ve re de pr es si on 9 - J ab so n Tr ee & Pa tt er so n (2 01 9) ; un cl ea r ye ar s of da ta c ol le ct io n; U SA Pr e- po st Pr e, p os t, 12 -w ee k fo llo w -u p 24 e nr ol le d, 1 7 co m pl et ed N /A Fe m al e (1 1) , M al e (6 ) Bi se xu al (1 ), M os tly le sb ia n/ ga y/ ho m os ex ua l ( 2) , O nl y le sb ia n/ ga y/ ho m os ex ua l (1 2) , O th er (2 ) N /A N /A - no m ea su re s re la te d to m en ta l he al th d is or de rs 10 - C oh en e t a l. (2 02 1) ; u nc le ar ye ar s of d at a co lle ct io n; U SA C as e se ri es ; P re -p os t Pr e, p os t 7; 6 c om pl et ed tr ea tm en t N /A N /A Se xu al m in or ity - u nc le ar br ea kd ow n N /A D ep re ss io n: 6 7% (4 ) s co re d ab ov e cl in ic al th re sh ol d fo r PH Q -9 A nx ie ty : 5 0% (3 ) s co re d ab ov e cl in ic al th re sh ol d fo r O A SI S Tudor-Sfetea & Topciu 11 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y; y ea r( s) o f da ta c ol le ct io n; co un tr y/ co un tr ie s of d at a co lle ct io n St ud y de si gn s; C om pa ri so ns Ti m ep oi nt s of ou tc om e co lle ct io n Sa m pl e si ze Pa rt ic ip an ts A ge - M (SD ) / Br ea kd ow n G en de r (% o r N) Se xu al or ie nt at io n (% o r N) Et hn ic it y (% o r N) M en ta l h ea lt h 11 - H ar t e t a l. (2 02 0) ; u nc le ar ye ar s of d at a co lle ct io n; u nc le ar co un tr ie s of d at a co lle ct io n – C an ad a or U SA Pr e- po st p ilo t Ba se lin e, p os t, 3- , an d 6- m on th fo llo w -u p 29 s ta rt er s, 2 1 co m pl et er s M = 3 2. 81 (S D = 8 .9 5) M al e - in cl us io n cr ite ri on G ay (1 8) , Bi se xu al (3 ) W hi te (1 2) , B la ck (2 ), Ea st / So ut he as t A si an (0 ), M id dl e Ea st er n/ N or th A fr ic an (2 ), La tin A m er ic an /H is pa ni c (2 ), M ix ed R ac e (3 ) M ea n sc or es (S D ) So ci al A nx ie ty : Li eb ow itz S oc ia l A nx ie ty S ca le - 62 .8 6 (2 2. 76 ) - in di ca tin g m od er at e so ci al an xi et y SI A S - 4 7. 38 (1 2. 31 ) - a bo ve c ut -o ff 3 4/ 36 SP S - 3 3. 57 (1 8. 81 ) - a bo ve c ut -o ff 2 4 BF N E- S - 3 0. 28 (7 .1 1) - ab ov e cu t- of f 2 5 Re po rt a ls o st at es 9 5% o f p ar tic ip an ts m ee tin g di ag no st ic c ri te ri a fo r so ci al an xi et y D ep re ss io n: C ES D - 25 .8 1 (1 2. 76 ) - a bo ve c ut -o ff 1 6 Re po rt a ls o st at es 2 4% o f p ar tic ip an ts m ee tin g di ag no st ic c ri te ri a fo r m aj or de pr es si ve d is or de r, cu rr en t e pi so de 12 - Bl ut h et a l. (2 02 3) ; 2 02 0- 20 21 (p re su m ed d ue to m en tio n of C ov id -1 9 pa nd em ic an d 20 21 y ea r of pu bl ic at io n) ; un cl ea r co un tr ie s of da ta c ol le ct io n – U SA o r C an ad a Pr e- po st Pr e, p os t, 3- m on th fo llo w -u p 41 M = 1 4. 5 (S D = 1 .4 9) Tr an sg en de r M -F (9 ), Tr an sg en de r F- M (1 8) , N on - bi na ry (1 2) , G en de rf lu id (3 ), Q ue st io ni ng (2 ), A ge nd er (1 ) N /A W hi te (3 3) , B la ck /A fr ic an A m er ic an (4 ), A si an (1 ), H is pa ni c/ La tin o/ a (5 ), O th er : M ix ed (1 ) M ea n sc or es (S D ) p re -i nt er ve nt io n A nx ie ty : ST A I - 5 0. 77 (1 3. 58 ) - a bo ve c ut -o ff 4 0 D ep re ss io n: PH Q -9 - 15 .1 2 (6 .7 7) - ab ov e cu t- of f 1 0 13 - C ra ig e t a l. (2 02 1) ; 2 02 0; un cl ea r co un tr ie s of da ta c ol le ct io n, N on -r an do m is ed ex pe ri m en ta l s tu dy ; i na ct iv e co nt ro l Pr e, p os t 46 c om pl et er s M = 2 1. 17 (S D = 4 .5 2) N on -b in ar y (1 7) , Tr an sg en de r (1 4) , C is w om an (8 ), Q ue er (1 2) , Le sb ia n (1 0) , Bi se xu al (6 ), G ay (6 ), Pa ns ex ua l ( 6) , W hi te (3 5) , A si an (5 ), Bl ac k (4 ), M id dl e Ea st er n (2 ), In di ge no us (1 ), La tin x (0 ), M ul ti- et hn ic /r ac ia l ( 5) , O th er (6 ) M ea n sc or es (S D ) D ep re ss io n: BD I- II - co nt ro l: 19 .4 8 (1 0. 67 ), in te rv en tio n: 1 9. 30 (1 1. 15 ) - in di ca tin g m ild -m od er at e de pr es si on LGBTQ+ Mental Health Interventions 12 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y; y ea r( s) o f da ta c ol le ct io n; co un tr y/ co un tr ie s of d at a co lle ct io n St ud y de si gn s; C om pa ri so ns Ti m ep oi nt s of ou tc om e co lle ct io n Sa m pl e si ze Pa rt ic ip an ts A ge - M (SD ) / Br ea kd ow n G en de r (% o r N) Se xu al or ie nt at io n (% o r N) Et hn ic it y (% o r N) M en ta l h ea lt h lik el y C an ad a or U SA Q ue er (3 ), A ge nd er (2 ), C is m an (1 ), Tw o- sp ir it (0 ), O th er (1 ) A se xu al (3 ), Q ue st io ni ng (2 ), D em i ( 1) , O th er (0 ) 14 - Pa n et a l. (2 02 1) ; u nc le ar ye ar s of d at a co lle ct io n; C hi na Pr e- po st Ba se lin e, 1 -m on th fo llo w -u p 8 A ge 1 6- 20 (2 pa rt ic ip an ts ), ag e 21 -3 0 (3 pa rt ic ip an ts ), ag e >3 0 (3 pa rt ic ip an ts ) M al e - in cl us io n cr ite ri on G ay (6 ), Bi se xu al (2 ) A si an /C hi ne se (a s pe r ar tic le tit le ) Ba se lin e m ea n sc or es (S D ) D ep re ss io n: PH Q -9 - 10 .4 3 (3 .4 6) - ab ov e cu t- of f 1 0 A nx ie ty : G A D -7 - 7. 43 (2 .5 7) - be lo w c ut -o ff 8 15 - Ja ck so n et a l. (2 02 2) ; 2 01 8- 20 19 ; U SA Pr e- po st Ba se lin e, 3 -m on th fo llo w -u p 21 s ta rt er s, 1 7 co m pl et ed th e 3- m on th fo llo w -u p A ge 1 8- 23 (4 pa rt ic ip an ts ), ag e 24 -2 9 (1 1 pa rt ic ip an ts ), ag e 30 -3 5 (6 pa rt ic ip an ts ) M al e - in cl us io n cr ite ri on ; C is ge nd er m an (2 0) , Tr an sg en de r m an (1 ) G ay (1 6) , Bi se xu al (3 ), Q ue er (2 ) La tin o/ La tin x (H is pa ni c) (7 ), W hi te (H is pa ni c) (5 ), Bl ac k (H is pa ni c) 5 , B la ck (n on - H is pa ni c) (4 ) Ba se lin e m ea n sc or es (S D ) D ep re ss io n: C ED S - 2 2. 10 (1 1. 89 ) - a bo ve c ut -o ff 1 6 O D SI S - 1 1 (4 .7 9) - ab ov e cu t- of f 8 A nx ie ty : O A SI S - 1 2. 05 (3 .5 4) - ab ov e cu t- of f 8 16 - Po on e t a l. (2 02 2) ; u nc le ar ye ar s of d at a co lle ct io n; U SA Pr e- po st ; LG BQ -n on -L G BQ Pr e, p os t 39 M = 1 5. 21 (S D = 1 .6 5) Fe m al e (8 6. 8% ) LG BQ (1 6) , H et er os ex ua l (2 3) N on -H is pa ni c W hi te (7 1. 1% ), H is pa ni c (2 2. 9% ), bi - o r m ul tir ac ia l ( 13 .1 % ), A si an , A fr ic an -A m er ic an , o r ot he r (7 .9 % ) Pr et re at m en t m ea n sc or es (S D ) D ep re ss io n: BD I- II - 28 .6 4 (1 4. 61 ) - in di ca tin g m od er at e- se ve re d ep re ss io n Tudor-Sfetea & Topciu 13 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ Ta bl e 3 In te rv en tio ns , A da pt at io ns , a nd R es ul ts St ud y In te rv en ti on s A ny L G BT Q +- sp ec if ic ad ap ta ti on s R el ev an t o ut co m es (c om pl et e na m es an d re fe re nc es in T ud or -S fe te a & To pc iu , 2 02 4S , A pp en di x I) R el ev an t a na ly se s; N um be r of pa rt ic ip an ts in cl ud ed th er ei n R el ev an t r es ul ts s um m ar y 1 - P ac ha nk is e t a l. (2 01 5) C BT : E ST EE M in te rv en tio n - 10 in di vi du al ly -d el iv er ed se ss io ns , b as ed o n Ba rl ow e t al .’s U ni fi ed P ro to co l f or th e Tr an sd ia gn os tic T re at m en t o f Em ot io na l D is or de rs Ye s - f oc us o n th e im pa ct o f m in or ity s tr es s on m en ta l he al th , i nt er pe rs on al fu nc tio ni ng , u nh el pf ul be ha vi ou rs ; a im o f i m pr ov in g m in or ity s tr es s co pi ng th ro ug h em ot io n re gu la tio n, c og ni tiv e re st ru ct ur in g, a ss er tiv en es s tr ai ni ng C en te r fo r Ep id em io lo gi ca l S tu di es D ep re ss io n Sc al e (C ES D ); O ve ra ll D ep re ss io n Se ve ri ty & Im pa ir m en t S ca le (O D SI S) ; O ve ra ll A nx ie ty S ev er ity & Im pa ir m en t Sc al e (O A SI S) ; M ea su re o f G ay -R el at ed S tr es s (M O G S) ; G ay -r el at ed R ej ec tio n Se ns iti vi ty S ca le (G RS ); In te rn al iz ed H om op ho bi a Sc al e (I H S) ; Se xu al O ri en ta tio n C on ce al m en t S ca le (S O C S) ; Ru m in at iv e Re sp on se s Sc al e (R RS ); D iff ic ul tie s of E m ot io n Re gu la tio n Sc al e (D ER S) ; Ra th us A ss er tiv en es s Sc he du le (R A S) Li ne ar m ix ed m od el s w ith m ax im um lik el ih oo d es tim at io n 1) C on di tio n co m pa ri so n 2) G en er al iz ed li ne ar m ix ed m od el s pr ed ic tin g th e od ds o f m ee tin g cl in ic al cu t- of fs o n C ES D , O D SI S, O A SI S 3) P oo le d da ta (p re -t re at m en t m ea su re s fr om th e ba se lin e as se ss m en t f or th e im m ed ia te p ar tic ip an ts a nd th e th re e- m on th a ss es sm en t f or th e w ai tli st pa rt ic ip an ts , a nd p os t- tr ea tm en t m ea su re s fr om th e th re e- m on th a ss es sm en t f or th e im m ed ia te p ar tic ip an ts a nd th e si x- m on th as se ss m en t f or th e w ai tli st p ar tic ip an ts ) - ch an ge c om pa ri so n ac ro ss a ll pa rt ic ip an ts fr om im m ed ia te p re -t re at m en t t o po st - tr ea tm en t 4) F ol lo w -u p as se ss m en t; 63 - in te nt -t o- tr ea t a pp ro ac h 1) S ig ni fi ca nt im pr ov em en ts in d ep re ss iv e sy m pt om s (o n O D SI S, n ot C ES D ), m ar gi na lly s ig ni fi ca nt im pr ov em en ts in an xi et y (O A SI S) in im m ed ia te v s w ai tli st co nd iti on (m ed iu m -l ar ge e ff ec ts s iz es ), no si gn if ic an t c on di tio n - t im e in te ra ct io n ef fe ct s fo r co gn iti ve , a ff ec tiv e, a nd be ha vi ou ra l m in or ity s tr es s pr oc es se s or fo r un iv er sa l p ro ce ss es (s m al l e ff ec t s iz es ) 2) S tr on ge r de cr ea se s in th e pr op or tio n of im m ed ia te v er su s w ai tli st p ar tic ip an ts w ho c on tin ue d to e xc ee d th e cu t- of f a t th re e m on th s (o n C ES D , n ot O D SI S or O A SI S) 3) S ig ni fi ca nt r ed uc tio ns in a ll pr im ar y ou tc om es , s ig ni fi ca nt (a pa rt fr om S O C S) re du ct io ns in a ll m in or ity s tr es s pr oc es se s an d un iv er sa l p ro ce ss es fr om im m ed ia te pr e- tr ea tm en t t o po st -t re at m en t ( la rg e ef fe ct s iz es ) 4) T re at m en t e ff ec ts g en er al ly m ai nt ai ne d at fo llo w -u p, fe w s ig ni fi ca nt d iff er en ce s be tw ee n po st -t re at m en t a nd fo llo w -u p, ru m in at io n sc or es c on tin ui ng to si gn if ic an tly d ec re as e fr om p os t- tr ea tm en t 2 - M ill ar , W an g, & Pa ch an ki s (2 01 6) C BT : E ST EE M in te rv en tio n Ye s - d es cr ib ed a bo ve Se xu al O ri en ta tio n Im pl ic it A ss oc ia tio n Te st ; Li ne ar m ix ed m od el s w ith m ax im um lik el ih oo d es tim at io n, p oo le d da ta a s D ep re ss io n an d an xi et y sh ow ed si gn if ic an t r ed uc tio ns ; LGBTQ+ Mental Health Interventions 14 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y In te rv en ti on s A ny L G BT Q +- sp ec if ic ad ap ta ti on s R el ev an t o ut co m es (c om pl et e na m es an d re fe re nc es in T ud or -S fe te a & To pc iu , 2 02 4S , A pp en di x I) R el ev an t a na ly se s; N um be r of pa rt ic ip an ts in cl ud ed th er ei n R el ev an t r es ul ts s um m ar y In te rn al iz ed H om op ho bi a Sc al e (I H S) ; O ve ra ll D ep re ss io n Se ve ri ty & Im pa ir m en t S ca le (O D SI S) ; O ve ra ll A nx ie ty S ev er ity & Im pa ir m en t Sc al e (O A SI S) ab ov e, tw o se pa ra te m od el s - w ith im pl ic it IH a nd e xp lic it IH , a nd th ei r re sp ec tiv e in te ra ct io ns w ith ti m e; 54 (w ho c om pl et ed p re - a nd p os t- tr ea tm en t a ss es sm en ts ) Pa rt ic ip an ts h ig he r in im pl ic it IH a t ba se lin e sh ow ed n ea rl y th re e tim es gr ea te r re du ct io ns th an th os e lo w er in im pl ic it IH o n de pr es si on a nd a nx ie ty ; A t p os t- tr ea tm en t, th os e hi gh er in im pl ic it IH s ho w ed r ed uc tio ns o n de pr es si on a nd a nx ie ty r ou gh ly eq ui va le nt to o ne s ta nd ar d de vi at io n 3 - O ’C le ir ig h et a l. (2 01 9) C BT : 1 0- se ss io n in te gr at ed C BT fo r Tr au m a an d Se lf- C ar e (C BT -T SC ) i nt er ve nt io n w ith H IV v ol un ta ry c ou ns el in g an d te st in g (V C T ) o r V C T a lo ne (V C T- on ly ) Ye s - p ar tic ip an ts in b ot h co nd iti on s re ce iv ed H IV /S T I vo lu nt ar y co un se lin g an d te st in g (V C T ) a t b as el in e M in i- In te rn at io na l N eu ro ps yc hi at ri c In te rv ie w (M IN I) - to a ss es s sy m pt om s an d a di ag no si s of P T SD D av id so n PT SD S ca le H LM (H ie ra rc hi ca l L in ea r M od el in g) 43 D av id so n Tr au m a Sc al e Im m ed ia te ly p os t- tr ea tm en t: - S ig ni fi ca nt ly g re at er r ed uc tio ns in po st tr au m at ic s ym pt om s ev er ity fo r th e C BT -T SC c on di tio n fo r th e To ta l S co re an d th e A vo id an ce s ub sc al e - T re nd fo r a di ff er en ce b et w ee n th e co nd iti on s fo r th e In tr us io ns s ub sc al e Fo llo w -u p: - T re nd fo r a st at is tic al ly s ig ni fi ca nt di ff er en ce b et w ee n th e ra nd om iz at io n co nd iti on s on th e To ta l S co re - S ig ni fi ca nt r ed uc tio ns in tr au m a sy m pt om s ev er ity fo r th e A vo id an ce su bs ca le - T re nd fo r a m ea ni ng fu l d iff er en ce be tw ee n th e co nd iti on s fo r th e In tr us io ns su bs ca le 4 - P ac ha nk is e t a l. (2 02 0) C BT : E Q uI P (E m po w er in g Q ue er Id en tit ie s in Ps yc ho th er ap y) , a 1 0- se ss io n in te rv en tio n ad ap te d fo r se xu al m in or ity w om en fr om th e ES T EE M p ro to co l Ye s - a da pt ed fr om th e ES T EE M p ro to co l, de sc ri be d ab ov e, w ith a fo cu s on s ex ua l m in or ity w om en ’s u ni qu e ex pe ri en ce s C en te r fo r Ep id em io lo gi ca l S tu di es D ep re ss io n Sc al e (C ES D ); Br ie f S ym pt om In ve nt or y (B SI ); O ve ra ll D ep re ss io n Se ve ri ty & Im pa ir m en t S ca le (O D SI S) ; A s Pa ch an ki s et a l. (2 01 5) ; 60 (i nt en t- to -t re at ) 1) S ig ni fi ca nt im pr ov em en ts in d ep re ss iv e sy m pt om s (o n C ES D , O D SI S) a nd a nx ie ty (O A SI S) in im m ed ia te v s w ai tli st co nd iti on (l ar ge e ff ec t s iz es ), no si gn if ic an t c on di tio n - t im e in te ra ct io n Tudor-Sfetea & Topciu 15 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y In te rv en ti on s A ny L G BT Q +- sp ec if ic ad ap ta ti on s R el ev an t o ut co m es (c om pl et e na m es an d re fe re nc es in T ud or -S fe te a & To pc iu , 2 02 4S , A pp en di x I) R el ev an t a na ly se s; N um be r of pa rt ic ip an ts in cl ud ed th er ei n R el ev an t r es ul ts s um m ar y O ve ra ll A nx ie ty S ev er ity & Im pa ir m en t Sc al e (O A SI S) ; Se xu al M in or ity W om en 's Re je ct io n Se ns iti vi ty S ca le (S M W -R SS ); Se xu al O ri en ta tio n C on ce al m en t S ca le (S O C S) ; Le sb ia n, G ay , a nd B is ex ua l I de nt ity S ca le - In te rn al iz ed H om on eg at iv ity S ub sc al e; Se xu al O ri en ta tio n Im pl ic it A ss oc ia tio n Te st ; D iff ic ul tie s of E m ot io n Re gu la tio n Sc al e - Sh or t F or m (D ER SS F) ; Ru m in at iv e Re sp on se s Sc al e - B ro od in g Su bs ca le (R RS ); Si m pl e RA S - S ho rt F or m (S RA S- SF ) ef fe ct s fo r m in or ity s tr es s pr oc es se s or fo r un iv er sa l p ro ce ss es (s m al l e ff ec t s iz es ) 2) S tr on ge r de cr ea se s in th e pr op or tio n of im m ed ia te v er su s w ai tli st p ar tic ip an ts w ho c on tin ue d to e xc ee d th e cu t- of f a t th re e m on th s (o n O D SI S, n ot C ES D , a nd on O A SI S) 3) S ig ni fi ca nt im pr ov em en ts in a ll pr im ar y ou tc om es (l ar ge e ff ec t s iz es ), si gn if ic an t i m pr ov em en ts in e m ot io n re gu la tio n di ff ic ul tie s an d ru m in at io n an d m ar gi na lly s ig ni fi ca nt r ed uc tio ns in re je ct io n se ns iti vi ty (s m al l e ff ec t s iz es fo r m in or ity s tr es s pr oc es se s, s m al l- m ed iu m ef fe ct s iz es fo r un iv er sa l p ro ce ss es ) 4) T re at m en t e ff ec ts g en er al ly c on tin ue d to d ec re as e at fo llo w -u p fo r m en ta l a nd be ha vi ou ra l h ea lth o ut co m es , m in or ity st re ss p ro ce ss es , a nd u ni ve rs al p ro ce ss es , BS I a nd r um in at io n co nt in ui ng to si gn if ic an tly d ec re as e fr om p os t- tr ea tm en t 5 - M ag ue n, Sh ip he rd , & H ar ri s (2 00 5) C BT : 1 2 w ee kl y 60 -m in ut e se ss io ns Ye s - s es si on d ed ic at ed to ho rm on e m ai nt en an ce , su rg er ie s, h ea lth c ar e; s es si on de di ca te d to d is cl os ur e, pa ss in g, s oc ia lis at io n; s es si on de di ca te d to b od y is su es a nd in tim at e re la tio ns hi ps e tc . Be ck D ep re ss io n In ve nt or y (B D I) St at e an d Tr ai t A nx ie ty In ve nt or y (S TA I) N et w or k O ri en ta tio n sc al e (N O S) - ut ili si ng s oc ia l s up po rt n et w or ks in ti m es of n ee d Li fe S at is fa ct io n In de x (L SI ) N /A - in di vi du al s co re s; 6 O ve ra ll: - A nx ie ty a nd d ep re ss io n m ea su re s: Im pr ov em en t - S oc ia l s up po rt : I nc re as es in 4 /6 pa rt ic ip an ts - L ife s at is fa ct io n in di ce s: D ec re as ed fo r th e m aj or ity o f p ar tic ip an t, pe rh ap s du e to th e m ul tit ud e of li fe c ha ng es , i nc lu di ng be co m in g un em pl oy ed a nd h om el es s LGBTQ+ Mental Health Interventions 16 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y In te rv en ti on s A ny L G BT Q +- sp ec if ic ad ap ta ti on s R el ev an t o ut co m es (c om pl et e na m es an d re fe re nc es in T ud or -S fe te a & To pc iu , 2 02 4S , A pp en di x I) R el ev an t a na ly se s; N um be r of pa rt ic ip an ts in cl ud ed th er ei n R el ev an t r es ul ts s um m ar y 6 - Y ad av ai a & H ay es (2 01 2) A C T : 6 -1 0 w ee kl y 50 -m in ut e A C T s es si on s Ye s - e xp lic itl y ad dr es si ng s el f- st ig m a ar ou nd s ex ua l or ie nt at io n/ in te rn al is ed ho m op ho bi a Pr im ar y: - D ai ly R at in gs o f T ho ug ht s A bo ut S ex ua l O ri en ta tio n ((a ) t he d eg re e to w hi ch ne ga tiv e th ou gh ts a bo ut s ex ua l or ie nt at io n in te rf er ed in th e pa rt ic ip an t's lif e, (b ) t he d is tr es s as so ci at ed w ith th os e th ou gh ts , ( c) th e be lie va bi lit y of th e th ou gh ts , a nd (d ) t he ir fr eq ue nc y) ; Se co nd ar y: - D ep re ss io n, A nx ie ty , a nd S tr es s Sc al es -2 1 (D A SS -2 1) ; - S ho rt In te rn al iz ed H om on eg at iv ity S ca le (S IH S) ; - L es bi an In te rn al iz ed H om op ho bi a Sc al e (L IH S) ; - W H O Q O L- BR EF (W or ld H ea lth O rg an iz at io n Q ua lit y of L ife - A bb re vi at ed V er si on ); - A A Q -I I ( A cc ep ta nc e an d A ct io n Q ue st io nn ai re -I I) H ie ra rc hi ca l L in ea r M od el in g (H LM ); M ix ed M od el R ep ea te d M ea su re s; 5 D ai ly R at in gs o f T ho ug ht s A bo ut S ex ua l O ri en ta tio n: Im pr ov em en ts in in te rf er en ce a nd d is tr es s fr om b as el in e to th e la te r tim e po in ts in al l p ar tic ip an ts ; s im ila r pa tt er n fo r be lie va bi lit y ra tin gs ; i nc on si st en t a nd sm al le r ch an ge s fo r fr eq ue nc y ra tin gs D ur in g ba se lin e: N o si gn if ic an t t im e ef fe ct s fo r tim e fo r an y of th e ra te d di m en si on s D ur in g tr ea tm en t: Fr eq ue nc y of th ou gh ts di d no t c ha ng e, b ut b el ie va bi lit y de cl in ed si gn if ic an tly , a s di d di st re ss a nd s el f- re po rt ed in te rf er en ce IH : I m pr ov em en t o n SI H S an d LI H S fr om pr e- tr ea tm en t b y po st -t re at m en t ( 23 % ), by th e 4- w ee k fo llo w -u p (3 2% ), an d by th e 12 -w ee k fo llo w -u p (4 0% ) D ep re ss io n, a nx ie ty s tr es s: N o si gn if ic an t ch an ge o n an xi et y (f ro m n or m al r an ge a t ba se lin e) ; s ig ni fi ca nt r ed uc tio n in de pr es si on a nd s tr es s (f ro m m od er at e an d m ild r an ge , r es pe ct iv el y, a t b as el in e) b y fo llo w -u p; im pr ov em en ts in q ua lit y of li fe an d ps yc ho lo gi ca l f le xi bi lit y at 4 -w ee k fo llo w -u p 7 - C ra ig & A us tin (2 01 6) C BT : A FF IR M in te rv en tio n: ei gh t m od ul e, m an ua lis ed af fi rm at iv e co gn iti ve be ha vi ou ra l i nt er ve nt io n Ye s - i nc or po ra tin g af fi rm at iv e pr ac tic es in to tr ad iti on al C BT m od el s Be ck D ep re ss io n In ve nt or y (B D I- II ); St re ss A pp ra is al M ea su re fo r A do le sc en ts (S A M A ) - 3 s ub sc al es (c ha lle ng e, th re at , re so ur ce s) ; Re pe at ed m ea su re s A N O VA - ge ne ra l lin ea r m od el (G LM ); T 1- T 2 = 30 ; T 1- T 3 = 17 D ep re ss io n: S ta tis tic al ly s ig ni fi ca nt re du ct io n fr om T 1 to T 2, a nd fr om T 1 to T 3 Re fle ct iv e co pi ng : N on -s ig ni fi ca nt in cr ea se fr om T I t o T 2; s ig ni fi ca nt di ff er en ce s be tw ee n T 1 an d T 3 Tudor-Sfetea & Topciu 17 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y In te rv en ti on s A ny L G BT Q +- sp ec if ic ad ap ta ti on s R el ev an t o ut co m es (c om pl et e na m es an d re fe re nc es in T ud or -S fe te a & To pc iu , 2 02 4S , A pp en di x I) R el ev an t a na ly se s; N um be r of pa rt ic ip an ts in cl ud ed th er ei n R el ev an t r es ul ts s um m ar y A do le sc en t P ro ac tiv e C op in g In ve nt or y (P C I- A ) - R ef le ct iv e C op in g Su bs ca le (R C S) St re ss a pp ra is al : T hr ea t a pp ra is al : S ig ni fi ca nt d ec re as e fr om T 1 to T 2, p er si st ed to T 3 C ha lle ng e ap pr ai sa l: Si gn if ic an t i nc re as e fr om T I t o T 2, d id n ot r et ai n st at is tic al si gn if ic an ce to T 3 Re so ur ce a pp ra is al : S ig ni fi ca nt in cr ea se fr om T 1 to T 2, d id n ot r et ai n si gn if ic an ce to T 3 8 - A us tin , C ra ig , & D ’S ou za (2 01 8) C BT : 2 -d ay r et re at - A FF IR M , de sc ri be d ab ov e Ye s - d es cr ib ed a bo ve Be ck D ep re ss io n In ve nt or y (B D I- II ); A do le sc en t P ro ac tiv e C op in g In ve nt or y (P C I- A ) - R ef le ct iv e C op in g Su bs ca le (R C S) Pa ir ed -s am pl e t- te st s (T 1- T 2, T 1- T 3, T 2- T 3) ; T 1- T 2 - 8 , T 1- T 3, T 2- T 3 - 6 D ep re ss io n: St at is tic al ly s ig ni fi ca nt r ed uc tio n fr om T 1 to T 2, fr om T 1 to T 3, n on si gn if ic an t re du ct io n fr om T 2 to T 3; M ea n sc or es a t T 2 an d T 3 re m ai ne d in th e BD I- II S ev er e ra ng e C op in g: N o si gn if ic an t d iff er en ce s fr om T 1 to T 2 or fr om T 2 to T 3 9 - J ab so n Tr ee & Pa tt er so n (2 01 9) O nl in e M BS R - 8 w ee ks , pa ra lle le d K ab at -Z in n' s in - pe rs on M BS R N /A Pe rc ei ve d St re ss S ca le (P SS ); D ai ly E xp er ie nc es w ith H et eo se xi sm Q ue st io nn ai re (D EH Q ) 1) P ai re d sa m pl es t- te st s fo r ch an ge s in st re ss fr om b as el in e to p os tp ro gr am a nd ba se lin e to fo llo w -u p 2) R ep ea te d- m ea su re s A N O VA te st ed m ea n va lu es fo r ea ch m ea su re o f s tr es s ag ai ns t o ne a no th er a t t he 3 ti m e po in ts ; 17 W om en : - P er ce iv ed s tr es s (P SS ): Si gn if ic an t de cr ea se p re -p os t a nd p re -f ol lo w -u p - O ve ra ll D EH Q a nd V ig ila nc e su bs ca le : N on -s ig ni fi ca nt d ec re as e pr e- po st , si gn if ic an t d ec re as e pr e- fo llo w -u p - V ic ar io us tr au m a su bs ca le o f t he D EH Q : Si gn if ic an t d ec re as e pr e- po st a nd p re - fo llo w -u p - S im ila r bu t l es s dr am at ic r es ul ts o n IT T an al ys es o ve ra ll M en : - P er ce iv ed s tr es s (P SS ): Si gn if ic an t de cr ea se p re -p os t, bu t n ot p re -f ol lo w -u p, LGBTQ+ Mental Health Interventions 18 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y In te rv en ti on s A ny L G BT Q +- sp ec if ic ad ap ta ti on s R el ev an t o ut co m es (c om pl et e na m es an d re fe re nc es in T ud or -S fe te a & To pc iu , 2 02 4S , A pp en di x I) R el ev an t a na ly se s; N um be r of pa rt ic ip an ts in cl ud ed th er ei n R el ev an t r es ul ts s um m ar y si m ila r bu t l es s dr am at ic r es ul ts o n IT T an al ys es - D EH Q : N o si gn if ic an t d iff er en ce in ei th er p er -p ro to co l o r IT T a na ly se s 10 - C oh en e t a l. (2 02 1) D BT ; O th er : W ee kl y 90 -m in ut e se ss io n ov er 1 0 co ns ec ut iv e w ee ks ; p ar tic ip an ts w er e en ro lle d in in di vi du al ps yc ho th er ap y an d/ or m ed ic at io n m an ag em en t co nc ur re nt ly Ye s - i nc or po ra te s m in or ity st re ss th eo ry a nd a da pt s th e te ac hi ng p oi nt s of e xi st in g D BT s ki lls to c re at e A ff ir m at iv e D BT S ki lls Tr ai ni ng ; i nc lu di ng ps yc ho ed uc at io n on th e m in or ity -s pe ci fi c ps yc ho lo gi ca l p ro ce ss es o f re je ct io n se ns iti vi ty , in te rn al iz ed s tig m a, a nd s ex ua l or ie nt at io n co nc ea lm en t D iff ic ul tie s of E m ot io n Re gu la tio n Sc al e (D ER S) ; O ve ra ll A nx ie ty S ev er ity & Im pa ir m en t Sc al e (O A SI S) ; Pa tie nt H ea lth Q ue st io nn ai re - D ep re ss io n M od ul e (P H Q -9 ); G ay -r el at ed R ej ec tio n Se ns iti vi ty S ca le (G RS ); Se xu al M in or ity W om en 's Re je ct io n Se ns iti vi ty S ca le (S M W -R SS ); In te rn al iz ed H om op ho bi a Sc al e (I H S) ; Se xu al O ri en ta tio n C on ce al m en t S ca le (S O C S) C lin ic al ly s ig ni fi ca nt r el ia bl e ch an ge , w ith no rm at iv e da ta u se d to c al cu la te R C I ac qu ir ed th ro ug h th e sc al es o ri gi na l ar tic le s; RC I n ot c al cu la te d fo r th e G RS , S M W - RS S, IH S, a nd S O C S, a s re le va nt d at a w er e no t a va ila bl e; 6 Em ot io n re gu la tio n: Im pr ov em en ts in 5 /6 pa rt ic ip an ts (s ta tis tic al ly s ig ni fi ca nt fo r ~5 0% o f t he p ar tic ip an ts ); D ep re ss iv e sy m pt om s: Im pr ov em en ts in 4/ 5 of th e pa rt ic ip an ts w ho r ep or te d a cl in ic al le ve l o f d ep re ss io n at b as el in e (s ta tis tic al ly s ig ni fi ca nt fo r ~5 0% o f t he pa rt ic ip an ts ; A nx ie ty s ym pt om s: Im pr ov em en ts in 3 /4 of th e pa rt ic ip an ts w ho r ep or te d a cl in ic al le ve l o f a nx ie ty a t b as el in e; G RS /S M W -R SS , I H S, a nd S O C S: Im pr ov em en ts in th e m aj or ity o f pa rt ic ip an ts 11 - H ar t e t a l. (2 02 0) C BT : T en 1 -h ou r, w ee kl y se ss io ns o f C BT fo r tr ea tm en t of s oc ia l a nx ie ty , r el at ed su bs ta nc e us e in s ex ua l si tu at io ns , a nd H IV p re ve nt io n Ye s - f oc us o n pa rt ic ip an ts ' se xu al a nd r el at io ns hi p hi st or y, go al s fo r sa tis fy in g re la tio ns hi ps a nd s ex e tc . T he M in i I nt er na tio na l N eu ro ps yc hi at ri c In te rv ie w v er si on 6 .0 (M IN I 6 .0 ); A nx ie ty D is or de rs In te rv ie w S ch ed ul e- IV - Li fe tim e (A D IS -I V ), So ci al P ho bi a Se ct io n; Li eb ow itz S oc ia l A nx ie ty S ca le (L SA S) ; T he S oc ia l I nt er ac tio n A nx ie ty S ca le (S IA S) a nd S oc ia l P ho bi a Sc al e (S PS ); C en te r fo r Ep id em io lo gi c St ud ie s- D ep re ss io n Sc al e (C ES D ); U C LA L on el in es s Sc al e Ve rs io n 3 (U C LA ); Br ie f F ea r of N eg at iv e Ev al ua tio n Sc al e, St ra ig ht -f or w ar d It em s (B FN E- S) G en er al iz ed e st im at in g eq ua tio ns w ith ro bu st e st im at or s an d un st ru ct ur ed co rr el at io n m at ri x ad dr es si ng no ni nd ep en de nc e of d at a ac ro ss ti m e po in ts ; Be ta e st im at es fo r co nt in uo us m ea su re s an d re la tiv e ri sk r at io s (R R) fo r bi na ry ou tc om es Si m ila r pa tt er n of r es ul ts u si ng b ot h in te nt -t o- tr ea t ( n = 32 ) a nd c om pl et er (n = 21 ) s am pl es ; t he re fo re , r es ul ts o f l at te r re po rt ed So ci al a nx ie ty : - S ig ni fi ca nt r ed uc tio ns in th e pr op or tio n of p ar tic ip an ts w ho m et d ia gn os tic cr ite ri a fo r so ci al a nx ie ty d is or de r fr om ba se lin e to a ll tim ep oi nt s - S ig ni fi ca nt r ed uc tio ns in m ea n sc or es o n th e LS A S, S IA S, S PS , B FN E- S be tw ee n ba se lin e an d al l t im e po in ts D ep re ss io n an d lo ne lin es s: Tudor-Sfetea & Topciu 19 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y In te rv en ti on s A ny L G BT Q +- sp ec if ic ad ap ta ti on s R el ev an t o ut co m es (c om pl et e na m es an d re fe re nc es in T ud or -S fe te a & To pc iu , 2 02 4S , A pp en di x I) R el ev an t a na ly se s; N um be r of pa rt ic ip an ts in cl ud ed th er ei n R el ev an t r es ul ts s um m ar y - S ig ni fi ca nt r ed uc tio n in th e pr op or tio n of p at ie nt s w ith c ur re nt m aj or d ep re ss iv e ep is od es p re -p os t- tr ea tm en t, no n- si gn if ic an t d iff er en ce s fo r 3- a nd 6 -m on th fo llo w -u p; - S ig ni fi ca nt r ed uc tio n in m ea n sc or es o n th e C ES D b et w ee n ba se lin e an d al l tim ep oi nt s; - S ig ni fi ca nt r ed uc tio n in m ea n sc or es o n th e U C LA b et w ee n ba se lin e an d al l tim ep oi nt s 12 - Bl ut h et a l. (2 02 3) M in df ul S el f- C om pa ss io n fo r Te en s (M SC -T ) - 8 x1 .5 h se ss io ns o nl in e, h el d ov er 8 da ys (1 /d ay ) f or th e fi rs t co ho rt , t he n 2x /w ee k fo r 4 w ee ks fo r th e se co nd tw o co ho rt s Ye s - s lig ht m od if ic at io ns to ac co m m od at e th e ne ed s of tr an sg en de r ad ol es ce nt s e. g. , om m is si on o f b od y sc an pr ac tic e Se lf- co m pa ss io n sc al e: Y ou th (S C S- Y) St ud en t l ife s at is fa ct io n sc al e (S LS S) Sp ie lb er ge r St at e A nx ie ty S ca le - Sh or t Fo rm Pa tie nt H ea lth Q ue st io nn ai re -D ep re ss io n M od ul e (P H Q -9 ) In te rp er so na l n ee ds q ue st io nn ai re (I N Q ) Br ie f r es ili en ce s ca le (B RS ) O ne -w ay r ep ea te d m ea su re s A N O VA s; 26 O ve ra ll, m ai n ef fe ct o f t im e fo r al l co ns tr uc ts a cr os s th e st ud y D ep re ss io n: S ig ni fi ca nt d ec re as e pr e- po st an d pr e- 3- m on th fo llo w -u p A nx ie ty : S ig ni fi ca nt d ec re as e pr e- po st (n ot o bs er ve d at 3 -m on th fo llo w -u p) Re si lie nc e: S ig ni fi ca nt in cr ea se p re -p os t (n ot o bs er ve d at 3 -m on th fo llo w -u p) M in df ul ne ss : S ig ni fi ca nt in cr ea se p re -p os t an d pr e- 3- m on th fo llo w -u p Se lf- co m pa ss io n: S ig ni fi ca nt in cr ea se p re - po st a nd p re -3 -m on th fo llo w -u p 13 - C ra ig e t a l. (2 02 1) C BT : A FF IR M , d es cr ib ed a bo ve - O nl in e gr ou ps (e ig ht w ee kl y se ss io ns ) w ith 6 -1 4 di st in ct pa rt ic ip an ts in e ac h ag e- ap pr op ri at e (1 4- 18 , 1 9- 24 , 2 5+ ) gr ou p Ye s - A FF IR M , d es cr ib ed a bo ve Be ck D ep re ss io n In ve nt or y (B D I- II ); Br ie f C O PE In ve nt or y (B C I) ; Pr oa ct iv e C op in g In ve nt or y fo r A do le sc en ts -A (P C I- A )- Re fle ct iv e C op in g Su bs ca le (R C S) ; St re ss A pp ra is al M ea su re fo r A do le sc en ts (S A M A ); H op e Sc al e (H S) Li ne ar m ul til ev el m od el s w ith r es tr ic te d m ax im um li ke lih oo d es tim at io n (R EM L) to te st th e ef fe ct s of T im e, C on di tio n, a nd T im e X C on di tio n fo r al l o ut co m es ; a ge (c en tr ed a t t he m ea n of th e w ho le s am pl e = 22 .3 4) in cl ud ed a s a co va ri at e in th e m od el ; In te rv en tio n (4 6) , C on tr ol (5 0) C om pa re d to w ai tli st c on tr ol , in te rv en tio n co nd iti on p ar tic ip an ts ex pe ri en ce d: - S ig ni fi ca nt ly r ed uc ed d ep re ss io n - S ig ni fi ca nt ly im pr ov ed li ke lih oo d to ap pr ai se s tr es s as c ha lle ng e an d to ap pr ai se th at th ey h ad e no ug h re so ur ce s to d ea l w ith th e st re ss LGBTQ+ Mental Health Interventions 20 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y In te rv en ti on s A ny L G BT Q +- sp ec if ic ad ap ta ti on s R el ev an t o ut co m es (c om pl et e na m es an d re fe re nc es in T ud or -S fe te a & To pc iu , 2 02 4S , A pp en di x I) R el ev an t a na ly se s; N um be r of pa rt ic ip an ts in cl ud ed th er ei n R el ev an t r es ul ts s um m ar y - S ig ni fi ca nt ly im pr ov ed a ct iv e co pi ng , em ot io na l s up po rt , p os iti ve fr am in g, pl an ni ng M ar gi na lly s ig ni fi ca nt d ec re as e in s el f- bl am e; n o si gn if ic an t d iff er en ce s be tw ee n th e in te rv en tio n an d co nt ro l c on di tio ns fo r su bs ta nc e us e an d be ha vi ou ra l di se ng ag em en t - I nc re as es fo r re fle ct iv e co pi ng o r ho pe , bu t n ot s ta tis tic al ly s ig ni fi ca nt 14 - Pa n et a l. (2 02 1) C BT : E ST EE M , a da pt ed fo r ne w c on te xt s or p op ul at io ns Ye s - E ST EE M , d es cr ib ed ab ov e, b ut w ith a d iff er en t (A si an /C hi ne se ) p op ul at io n C hi ne se v er si on o f t he P H Q -9 C hi ne se v er si on o f t he G A D -7 Pa ir ed s am pl e t- te st s; 7 Re du ct io n in th e av er ag e sc or e of de pr es si on a nd a nx ie ty s ym pt om s by ap pr ox im at el y 7 an d 5, r es pe ct iv el y (m ed iu m -t o- la rg e im pr ov em en t) 15 - Ja ck so n et a l. (2 02 2) C BT : W ee kl y 90 -m in g ro up tr ea tm en t s es si on s ov er 1 0 w ee ks Ye s - E ST EE M , d es cr ib ed ab ov e, b ut a da pt ed to re co gn is e th e in te rs ec tio na lit y of r ac is m a nd h om op ho bi a C en te r fo r Ep id em io lo gi ca l S tu di es D ep re ss io n Sc al e (C ES D ); O ve ra ll D ep re ss io n Se ve ri ty & Im pa ir m en t S ca le (O D SI S) ; O ve ra ll A nx ie ty S ev er ity & Im pa ir m en t Sc al e (O A SI S) ; G ay -r el at ed R ej ec tio n Se ns iti vi ty S ca le (G RS ); Se lf- C on ce al m en t S ca le a s pr ev io us ly m od if ie d fo r us e w ith G BM ; In te rn al iz ed H om op ho bi a Sc al e (I H S) ; Pr ol on ge d A ct iv at io n an d A nt ic ip at or y Ra ce -R el at ed S tr es s Sc al e - P sy ch ol og ic al Su bs ca le a nd P er se ve ra tiv e C og ni tiv e Su bs ca le ; Ra ci sm -R el at ed V ig ila nc e Sc al e; H et er os ex is m in R ac ia l E th ni c M in or ity C om m un iti es S ub sc al e of th e LG BT t- te st s - f oc us in g on H ed ge 's g ef fe ct s iz es 21 (b as el in e) , 1 7 (3 -m on th fo llo w -u p) D ep re ss io n sy m pt om s an d se ve ri ty , an xi et y, p sy ch ol og ic al d is tr es s, s ui ci da l id ea tio n: D ec re as e (v er y sm al l e ff ec t si ze s) ; Re je ct io n se ns iti vi ty a nd c on ce al m en t: D ec re as e (s m al l e ff ec t s iz es ), bu t n ot in te rn al is ed h om op ho bi a; Ra ci al m in or ity s tr es s ou tc om es , in cl ud in g de cr ea se d an tic ip at or y st re ss , ra ce -r el at ed r um in at io n, a nd r ac e- re la te d vi gi la nc e, a nd in te rs ec tio na l s tr es s, in cl ud in g ho m op ho bi a w ith in o ne ’s ra ci al /e th ni c co m m un ity , r ac is m w ith in th e LG BT c om m un ity , a nd r ac is m in da tin g an d cl os e re la tio ns hi ps : D ec re as e (v er y sm al l t o sm al l e ff ec t s iz es ) Tudor-Sfetea & Topciu 21 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ St ud y In te rv en ti on s A ny L G BT Q +- sp ec if ic ad ap ta ti on s R el ev an t o ut co m es (c om pl et e na m es an d re fe re nc es in T ud or -S fe te a & To pc iu , 2 02 4S , A pp en di x I) R el ev an t a na ly se s; N um be r of pa rt ic ip an ts in cl ud ed th er ei n R el ev an t r es ul ts s um m ar y Pe op le o f C ol or (P O C ) M ic ro ag gr es si on Sc al e 16 - Po on e t a l. (2 02 2) D BT : 1 8- w ee k co m pr eh en si ve D BT -A (a da pt at io n of D BT m od el fo r ad ol es ce nt s an d th ei r fa m ili es ) o ut pa tie nt pr og ra m o ff er ed to a do le sc en ts be tw ee n th e ag es o f 1 3- 18 , de liv er ed w ith fi de lit y to th e st an da rd m od el , i nc lu di ng a w ee kl y m ul ti fa m ily s ki lls tr ai ni ng g ro up , i nd iv id ua l th er ap y, 2 4/ 7 ph on e co ac hi ng , an d a th er ap is t c on su lta tio n te am N /A D iff ic ul tie s of E m ot io n Re gu la tio n Sc al e (D ER S) ; Be ck D ep re ss io n In ve nt or y (B D I- II ); Be ck A nx ie ty In ve nt or y; T he d ia le ct ic al b eh av io ur th er ap y w ay s of co pi ng c he ck lis t ( D BT -W C C L) ; Bo de rl in e sy m pt om s lis t ( BS L) 1) R ep ea te d- m ea su re s bo ot st ra pp ed t- te st s (t w o- ta ile d 0. 05 p -v al ue s fo r tr ea tm en t ef fe ct s) - fo r LG BQ p ar tic ip an ts o nl y 2) 2 x2 m ix ed -m od el A N O VA to te st g ro up (L G BQ /n on -L G BQ ) e ff ec ts o n th e ou tc om es ; 16 - LG BQ fo r 1) , 1 6 - L G BQ + 23 - no n- LG BQ fo r 2) 1) S ig ni fi ca nt im pr ov em en ts o n al l ou tc om es , a pa rt fr om a nx ie ty (m os tly la rg e ef fe ct s iz es ) 2) N o si gn if ic an t g ro up - tim e in te ra ct io n ef fe ct s on a ny o f t he o ut co m es (c ha ng es ov er ti m e di d no t d iff er b et w ee n LG BQ an d no n- LG BQ p ar tic ip an ts ); st at is tic al ly no ns ig ni fi ca nt , b ut s m al l t o m ed iu m in te ra ct io n ef fe ct s iz es o n th e D ER S, B D I- II , a nd W C C L- Sk ill U se (s ex ua l m in or iti es m ay b en ef it sl ig ht ly m or e fr om D BT -A w ith r es pe ct to e m ot io n re gu la tio n, de pr es si on , a nd e ff ec tiv e sk ill u se ) N ot e. A ll in fo rm at io n w as p re se nt ed a s fo un d in th e re sp ec tiv e re su lts s ec tio ns o f t he p ri m ar y re po rt s; th e sa m e ap pl ie s fo r ev al ua tio ns o f w ha t i s co ns id er ed st at is tic al ly o r cl in ic al ly s ig ni fi ca nt , a nd e ff ec t s iz es (a lth ou gh g en er al ly , s ta tis tic al ly s ig ni fi ca nt p er ta in s to p < .0 5, c lin ic al ly s ig ni fi ca nt p er ta in s to r ed uc tio ns in sc or es th at e ith er d ec re as e to b el ow c lin ic al th re sh ol d of th e re sp ec tiv e sc al e or e xc ee d th e m ea su re m en t e rr or o f t he s ca le s, a nd e ff ec t s iz es a re c on si de re d sm al l (d /g = 0 .2 ), m ed iu m (d /g = 0 .5 ), an d la rg e (d /g ≥ 0 .8 ) a cc or di ng to C oh en (1 96 9) , a nd th e in cl ud ed s tu di es s ee m to h av e ad he re d to th is ). LGBTQ+ Mental Health Interventions 22 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ Interventions based on ESTEEM included EQuiP (Empowering Queer Identities in Psy­ chotherapy), which, following interviews with sexual minority women and expert clini­ cians, revised intervention contents to, for example, focus on sexual minority women’s unique experiences, including the intersection of sexism with other forms of oppression, exposure to sexual assault and harassment, or impact of gender norms (Pachankis et al., 2020). ESTEEM was also adapted to more diverse contexts, populations, and ethnicities, with a view to address cultural contexts such as prioritisation of family needs and limited support from the health system (Pan et al., 2021), or to recognise intersectionality of racism and homophobia (Jackson et al., 2022). Adaptations occurred via key stakehold­ er feedback and by following the Assessment-Decision-Administration-Production-Topi­ cal Experts-Integration-Training-Testing (ADAPT-ITT) model (Wingood & DiClemente, 2008), a prescriptive method for adapting existing evidence-based interventions for new contexts or populations (Pan et al., 2021), as well as based on prior empirically supported group treatments for GBM of colour and guidance on psychotherapy for individuals who are both racial and sexual minorities (Jackson et al., 2022). Three studies featured the AFFIRM intervention, a manualised affirmative cognitive behavioural intervention developed using case studies and community-based research, and participant feedback. AFFIRM targets young people with sexual and/or gender iden­ tity minority identities, focusing on improving coping and reducing depression. This occurs by explicitly acknowledging and validating the unique experiences of these pop­ ulations, providing opportunities to understand and modify cognition (self-awareness, identifying risk, e.g., development of realistic alternative ways of thinking and behaving that affirm identities while integrating healthy ways of coping with internal/external stressors), mood (recognising the link between thoughts and feelings, e.g., how partici­ pants have learned to cope with identity-specific stressors), and behaviour (identifying strengths and ways of coping, e.g., connection to peer and adult allies) (Craig & Austin, 2016). Furthermore, one study featured CBT for Trauma and Self-Care (CBT-TSC) including HIV counselling, another featured CBT for social anxiety including a focus on goals for satisfying relationships and sex, and a last study featured CBT with sessions dedicated to transgender-specific issues. DBT, mindfulness, ACT: Two studies used DBT, one adapted by explicitly including minority stress psychoeducation; two studies featured mindfulness-based interventions (MBSR; Mindful Self-Compassion for Teens, MSC-T – with slight modifications to ac­ commodate the needs of transgender adolescents). A final study featured ACT, explicitly addressing self-stigma around sexual orientation/internalised homophobia. See Tudor-Sfetea and Topciu, 2024S, Appendix G for more details. Tudor-Sfetea & Topciu 23 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ What Are the Outcomes of Evidence-Based Cognitive and/or Behavioural Interventions and Adaptations Targeting Mental Health in LGBTQ+ Populations? Condition Differences Post-Intervention — Four studies, three of which were RCTs with inactive controls (#1, #3, #4) and one of which was a non-randomised experimental study (#13), all CBT-based, reported condition differences; #2, although an RCT, focused primarily on the effects of internalised homophobia. Mental Health; Depression and Anxiety — Three studies (#1, #4, #13) reported significant improvements in depressive symptoms – although on different measures, and the two RCTs also at least marginally significant improvements in anxiety, all of which had medium-large effect sizes, maintained at follow-up where available. The fourth study (#3) focused on PTSD and showed significant improvements on all measures related to this, bar one subscale which showed a trend for significant difference; these effects were maintained or were trending towards this at follow-up. Mental Health; Other Processes/Constructs and Minority Stress-Related Processes/Constructs — No significant differences were reported in any of the studies. Pre-Post Differences — The remaining 11 studies reported pre-post intervention dif­ ferences for variables of interest – however, three of the RCTs (#1, #2, #4) and the non-randomised experimental study (#13) also reported pre-post differences. Mental Health; Depression and Anxiety — Fourteen studies reported results related to symptoms of depression, all of which showed improvements on at least one measure, ten of which (#1, #2, #4, #6, #7, #8, #11, #12, #13, #16) statistically or clinically significant, with medium-large effect sizes, generally maintained at follow-up. Ten studies reported results related to symptoms of anxiety, eight of which showed improvements, four of which (#1, #2, #4, #12) were at least marginally statistically or clinically significant, with medium-large effect sizes, of which two maintained the effects at follow-up. The study that focused on social anxiety (#11) showed significant improvements on all measures related to this. Mental Health; Other Processes/Constructs — Two studies reported results related to emo­ tion regulation, one of which (#16) showed significant improvements with large effect sizes, maintained at follow-up. Three studies reported results related to coping, only two of which (#7, #13) showed significant improvements between at least two timepoints, on different measures. Minority Stress-Related Processes/Constructs — Six studies reported results related to in­ ternalised homophobia, three of which reported improvements on at least one analysis, LGBTQ+ Mental Health Interventions 24 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ one of which (#1) was statistically significant, with a large effect size, maintained at follow-up. Four studies reported results on rejection sensitivity, all of which showed improvements, but only one of which (#1) reported a significant result, with a large effect size. Finally, four studies reported results related to sexual orientation concealment, two of which reported improvements, none of which appeared to be significant, with small effect sizes. Risk of Bias in Studies All four RCTs were judged to be at high risk of bias using the RoB 2 (Sterne et al., 2019), particularly due to high risk being identified in the measurement of outcome and missing data domains, respectively. Of the 12 non-randomised studies, nine (#5, #7, #8, #9, #10, #11, #12, #14, #15) were judged to be at critical risk of bias using the ROBINS-I (Sterne et al., 2016), and three (#6, #13, #16) were judged to be at serious risk of bias. This was mostly due to critical scores in the confounding domain, as well as serious scores in the measurement of outcomes domain. Half of the studies also scored as serious on the selection of participants domain. See Figures 2 and 3, generated using the Cochrane visualisation tool - robvis, McGuinness et al., 2021), and further details, in Tudor-Sfetea and Topciu, 2024S, Appendix H. Discussion This review investigated evidence-based cognitive and/or behavioural interventions and adaptations for LGBTQ+ populations, complementing previous work (Bochicchio et al., 2022; Sheinfil et al., 2019; Van Der Pol-Harney & McAloon, 2019) by focusing specifically on cognitive and/or behavioural interventions and broadening the criteria to include participants of any age. Summary and Interpretation of Evidence What Evidence-Based Cognitive and/or Behavioural Interventions for LGBTQ+ Populations Exist, and What, if any, Specific Adaptations Do They Involve? The studies included in the review featured a range of therapeutic modalities (CBT – 11 studies; DBT – two studies; ACT – one study; mindfulness-based interventions – two studies). Of the CBT studies, eight involved versions of two protocolised interven­ tions aimed specifically at LGBTQ+ individuals (ESTEEM, interventions based on it such as EQuiP, or adaptations to more diverse contexts or populations – five studies, and AFFIRM – three studies; see Table 3). Another four studies explicitly referred to LGBTQ+-specific adaptations, including a focus on stigma around sexual orientation, Tudor-Sfetea & Topciu 25 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ incorporating minority stress theory, or slight modifications to accommodate LGBTQ+ needs. What Are the Outcomes of Evidence-Based Cognitive and/or Behavioural Interventions and Adaptations Targeting Mental Health in LGBTQ+ Populations? When considering post-intervention differences between groups, of the four studies (three RCTs, one non-randomised experimental study) which reported this, three repor­ ted significant improvements in depressive symptoms, and the two RCTs also at least marginally significant improvements in anxiety. The fourth study, which focused on PTSD, showed significant improvements on most measures related to this. No significant differences were reported in terms of other mental health or minority stress-related processes/constructs. When considering pre-post differences, these were reported in the remaining 11 studies as well as in three of the RCTs and the non-randomised experimental study. All the 14 studies investigating this showed improvement on at least one measure, ten being statistically/clinically significant. For anxiety, eight out of ten studies showed improve­ ments, four thereof at least marginally statistically/clinically significant. The study that focused on social anxiety showed significant improvements on all measures related to this. Reflections Studies were heterogenous in terms of study designs, outcome measures, and analyses. Although the studies showed general improvements in certain areas such as depression, this is based on a variety of outcome measures (e.g., in some studies, significant improve­ ments are seen on one outcome measure and not another, and viceversa – Pachankis et al., 2015, and Pachankis et al., 2020, respectively), as well as types of analysis (statistical significance, effect sizes, clinically significant reductions). This, together with the limita­ tions of the studies (see below), raises questions about the strength and consistency of the evidence base. The included studies also featured a heterogeneity of LGBTQ+ populations, such that the results cannot be generalised to any specific LGBTQ+ population without discussing the intersection of various identities (sexual, gender, racial, ethnic, social). Indeed, six studies focused on men, of which four included both gay and bisexual men, one included gay and bisexual men of colour, and one included sexual minority men in China. One study only focused specifically on women, three specifically on transgender individuals; moreover, most studies were conducted in North America. Therefore, findings may apply more to particular populations such as sexual minority men in North America, raising the question of whether other populations are the focus of enough relevant research. LGBTQ+ Mental Health Interventions 26 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ Moreover, while a variety of transdiagnostic elements were featured in the studies’ interventions, mechanisms of change are not clearly differentiated such that the role of the minority stress-based adaptations remains largely unclear. Indeed, the most notable effects were observed for depression, while measures of minority stress (that is, proximal factors such as internalised homophobia, concealment, rejection sensitivity) showed less reliable improvements – or were not even explored at all (of the 16 included studies, only seven included such measures). Measures of other processes/constructs proposed to interact with minority stress (e.g., emotion regulation, unhelpful behaviours) were included in some studies, yet again, yielded unreliable results. While some authors (e.g., Pachankis et al., 2015) discuss that larger sample sizes would reveal such effects, it seems that certain components of non-empirically based treatment may also lead to improvements (Van Der Pol-Harney & McAloon, 2019). Findings of this review were consistent with those of previous systematic reviews in that positive effects on mental health were reported, particularly in terms of symp­ toms of depression (Bochicchio et al., 2022; Sheinfil et al., 2019; Van Der Pol-Harney & McAloon, 2019), with comparable results for various modes of administration, including in-person, online, individual, or group (Bochicchio et al., 2022; Hobaica et al., 2018), and particularly for interventions based on CBT (Van Der Pol-Harney & McAloon, 2019). Furthermore, previous reviews also noted the paucity and heterogeneity of existing liter­ ature. However, while the cited reviews only explored interventions for young people, the current review expanded these to all ages, providing some evidence that results can be generalisable to adults as well, yet the intersection of these various characteristics and identities necessitates more in-depth exploration. What Recommendations Could Be Made in Terms of Such Adaptations in Clinical Practice? The heterogeneity in the studies leads to a limited ability to draw more precise con­ clusions about the effects of particular interventions for particular groups. Therefore, generic therapeutic competencies and metacompetencies (e.g., around engagement, ther­ apeutic alliance and grasping clients’ ‘world views’, adapting interventions in response to client feedback, formulating and applying CBT models to the individual client etc., Roth & Pilling, 2007) may be especially important. Indeed, such competencies have been deemed important by some LGBTQ+ populations (McNamara & Wilson, 2020). Applying these competencies to the needs of LGBTQ+ populations may also specifi­ cally mean adopting an affirmative approach, with clinicians being aware of LGBTQ+ issues (O’Shaughnessy & Speir, 2018), including minority stress, and receiving ongoing training on this (Boroughs et al., 2015; McNamara & Wilson, 2020). This may also mean adopting a more holistic approach, as LGBTQ+ individuals may benefit from addressing minority stress regardless of the format and drawing from social support to build resil­ ience or reframe unhelpful beliefs (Alessi, 2014). Tudor-Sfetea & Topciu 27 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ Limitations of Evidence/Summary and Interpretation of Risk of Bias Evaluation Searches yielded only 16 studies despite broad inclusion criteria. Only four studies used an RCT design, with the majority using a pre-post design with no control group, there­ fore not being able to establish a causal effect of the interventions. Moreover, sample sizes varied considerably, with some studies featuring very small sample sizes and some studies relying on the same sample, bringing into question statistical power and the relevance, reliability, and generalisability of results where statistical tests were not even used. Risk of bias was evaluated as high in all four RCTs, and critical in nine of the non-randomised studies, with the remaining three non-randomised studies evaluated as serious. However, due to the nature of psychological interventions, domains regarding blinding participants and study personnel and measuring outcomes are intrinsically restricted. Nonetheless, almost all uncontrolled pre-post studies were evaluated as pre­ senting critical risk of confounding, based on the ROBINS-I detailed guidance (Sterne et al., 2016), which recommends this where confounding is “inherently uncontrollable”. This may have led to a flooring effect. Limitations of the Review Process Only English language and peer-reviewed studies were included, which limited the range of articles, potentially raising publication bias (Cuijpers et al., 2010). Our intention was to focus on the “gold standard” (peer-reviewed) literature as a first step, and research has found that “any unpublished studies identified in a given review may be an unrepresen­ tative subset of all the unpublished studies in existence” (Higgins et al., 2023). A funnel plot was considered, but this was not possible, as treatment effects were not available for all included studies. Additionally, we excluded certain populations (e.g., HIV-positive persons) and studies with outcomes related solely to drug use, and did not explicitly address outcomes related to suicidality or eating disorders. These areas were considered beyond the scope of this review due to the added complexity they would have brought. See Tudor-Sfetea and Topciu, 2024S, Appendix B for more details on these decisions. Finally, while our search terms were developed in line with our inclusion/exclusion criteria, using the PICOS framework, and in collaboration with a University of Exeter librarian specialising in with Psychology, as well as via terms identified during the scop­ ing search, we acknowledge that their use in their current form may have led to some potentially eligible studies not being retrieved. This is because terms such as “minority stress” encompass heterogenous sets of constructs which may have led to studies not being retrieved unless the constructs were explicitly part of the search string. This, of LGBTQ+ Mental Health Interventions 28 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ course, may in turn limit the representativeness of the studies and paint a relatively different picture of the landscape of the literature. Our rationale for keeping terms rather broad was to keep a similar “detail level” of terms, one which was most likely to retrieve the most relevant results. Indeed, as dis­ cussed above, our findings are broadly in line with those of previous systematic reviews in the area, suggesting that the retrieved studies were mostly representative of the topic at hand. We provide a more extensive explanation in Tudor-Sfetea and Topciu, 2024S, Appendix B. The limited and heterogeneous nature of the evidence also restricted the possibility of exploring the data via meta-analyses and drawing more robust conclusions. Implications and Future Research Directions To allow for more robust and more generalisable conclusions to be drawn, more consis­ tency in outcome measures and general methodology is needed. This would allow for more meta-analyses to be conducted, and these should consider the impact of publication bias (Cuijpers et al., 2010). However, less strict methodologies may also offer pragmatic information on how interventions are administered and received in a variety of health­ care settings. Moreover, as certain LGBTQ+ populations seem to be focused on more than others in the literature, more research needs to be carried out focusing on other LGBTQ+ popu­ lations, as well as discussing the intersection of various identities. More detailed investi­ gations into specific mechanisms of change could also provide invaluable information as to the role of minority stress-based adaptations and what intervention aspects and therapeutic competencies are most important in producing positive outcomes, allowing for more investment and/or training in those areas. Conclusion The review investigated evidence-based cognitive and/or behavioural interventions and adaptations for LGBTQ+ populations, revealing a range of therapeutic modalities and levels of adaptation. Findings showed largely positive effects, in line with previous systematic reviews – however, in the context of a paucity of the literature, with hetero­ geneity in terms of study designs, outcome measures, and analyses, as well as risk of bias evaluated as high or critical/serious (despite the possibility of a flooring effect). Limitations in terms of included studies and possible publication bias, as well as limited opportunity for generalisability and further exploration of the evidence to draw more robust conclusions are recognised. Suggestions for clinical practice are around the im­ portance of generic therapeutic competencies and metacompetencies, and affirmative, potentially more holistic approaches. Suggestions for future research directions include more consistency in methodology, more focus on underserved LGBTQ+ populations and intersectionality, and more detailed investigations into mechanisms of change. Tudor-Sfetea & Topciu 29 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.psychopen.eu/ Funding: The authors have no funding to report. Acknowledgments: The authors have no additional (i.e., non-financial) support to report. Competing Interests: The authors have declared that no competing interests exist. Social Media Accounts: @cts504 Reporting Guidelines: This systematic review was carried out in accordance with the updated PRISMA guidelines (Page et al., 2021). Preregistration: The work was registered on PROSPERO (International prospective register of systematic reviews) in April 2022 (CRD42022243466) (Tudor-Sfetea & Topciu, 2022S). Data Availability: For this article, a data set is freely available (Tudor-Sfetea, 2023S). Supplementary Materials The Supplementary Materials contain the following items: • The preregistration (Tudor-Sfetea & Topciu, 2022S) • Online Appendices ◦ Appendix A – Further explanation regarding deviations from the PROSPERO protocol (Tudor-Sfetea & Topciu, 2024S) ◦ Appendix B – Further explanation regarding inclusion/exclusion criteria (Tudor-Sfetea & Topciu, 2024S) ◦ Appendix C – Search terms and full search strategy/history (Tudor-Sfetea, 2023S) ◦ Appendix D – Full extracted data table (Tudor-Sfetea, 2023S) ◦ Appendix E – Overview of records excluded at full text review stage (Tudor-Sfetea & Topciu, 2024S) ◦ Appendix F – Narrative summary of study and sample characteristics (Tudor-Sfetea & Topciu, 2024S) ◦ Appendix G – Further details around study session numbers and duration (Tudor-Sfetea & Topciu, 2024S) ◦ Appendix H – Further information regarding risk of bias in studies (Tudor-Sfetea & Topciu, 2024S) ◦ Appendix I – Measures referenced in the data extraction table(s) (Tudor-Sfetea & Topciu, 2024S) Index of Supplementary Materials Tudor-Sfetea, C. (2023S). A systematic review of evidence-based cognitive and/or behavioural interventions targeting mental health in LGBTQ+ populations [Search terms, full search strategy/ history, and full extracted data table]. OSF. https://osf.io/zbu6r LGBTQ+ Mental Health Interventions 30 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://x.com/cts504 https://osf.io/zbu6r https://www.psychopen.eu/ Tudor-Sfetea, C., & Topciu, R. (2022S). A systematic review of evidence-based cognitive and/or behavioural interventions targeting mental health in the LGBT+ community [Preregistration]. PROSPERO. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022243466 Tudor-Sfetea, C., & Topciu, R. (2024S). Supplementary materials to "A systematic review of evidence- based cognitive and/or behavioural interventions targeting mental health in LGBTQ+ populations" [Online appendices]. PsychOpen GOLD. https://doi.org/10.23668/psycharchives.15402 References Note. References marked with an asterisk (*) are the articles included in the systematic review. Alessi, E. J. (2014). A framework for incorporating minority stress theory into treatment with sexual minority clients. Journal of Gay & Lesbian Mental Health, 18(1), 47–66. https://doi.org/10.1080/19359705.2013.789811 *Austin, A., Craig, S. L., & D’Souza, S. A. (2018). An AFFIRMative cognitive behavioral intervention for transgender youth: Preliminary effectiveness. Professional Psychology: Research and Practice, 49(1), 1–8. https://doi.org/10.1037/pro0000154 Balsam, K. F., Molina, Y., Beadnell, B., Simoni, J., & Walters, K. (2011). Measuring multiple minority stress: The LGBT People of Color Microaggressions Scale. Cultural Diversity & Ethnic Minority Psychology, 17(2), 163–174. https://doi.org/10.1037/a0023244 Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2011). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. Oxford University Press. Beard, C., Kirakosian, N., Silverman, A. L., Winer, J. P., Wadsworth, L. P., & Björgvinsson, T. (2017). Comparing treatment response between LGBQ and heterosexual individuals attending a CBT- and DBT-skills-based partial hospital. Journal of Consulting and Clinical Psychology, 85(12), 1171–1181. https://doi.org/10.1037/ccp0000251 *Bluth, K., Lathren, C., Clepper-Faith, M., Larson, L. M., Ogunbamowo, D. O., & Pflum, S. (2023). Improving mental health among transgender adolescents: Implementing mindful self- compassion for teens. Journal of Adolescent Research, 38(2), 271–302. https://doi.org/10.1177/07435584211062126 Bochicchio, L., Reeder, K., Ivanoff, A., Pope, H., & Stefancic, A. (2022). Psychotherapeutic interventions for LGBTQ + youth: A systematic review. Journal of LGBT Youth, 19(2), 152–179. https://doi.org/10.1080/19361653.2020.1766393 Boroughs, M. S., Bedoya, C. A., O’Cleirigh, C., & Safren, S. A. (2015). Toward defining, measuring, and evaluating LGBT cultural competence for psychologists. Clinical Psychology: Science and Practice, 22(2), 151–171. https://doi.org/10.1111/cpsp.12098 Brooks, V. R. (1981). Minority stress and lesbian women. Lexington Books. Campbell, M., McKenzie, J. E., Sowden, A., Katikireddi, S. V., Brennan, S. E., Ellis, S., Hartmann- Boyce, J., Ryan, R., Shepperd, S., Thomas, J., Welch, V., & Thomson, H. (2020). Synthesis Tudor-Sfetea & Topciu 31 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022243466 https://doi.org/10.23668/psycharchives.15402 https://doi.org/10.1080/19359705.2013.789811 https://doi.org/10.1037/pro0000154 https://doi.org/10.1037/a0023244 https://doi.org/10.1037/ccp0000251 https://doi.org/10.1177/07435584211062126 https://doi.org/10.1080/19361653.2020.1766393 https://doi.org/10.1111/cpsp.12098 https://www.psychopen.eu/ Without Meta-Analysis (SWiM) in systematic reviews: Reporting guideline. BMJ, 368, Article i6890. https://doi.org/10.1136/bmj.l6890 Cohen, J. (1969). Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates. *Cohen, J. M., Norona, J. C., Yadavia, J. E., & Borsari, B. (2021). Affirmative dialectical behavior therapy skills training with sexual minority veterans. Cognitive and Behavioral Practice, 28(1), 77–91. https://doi.org/10.1016/j.cbpra.2020.05.008 Covidence. (2022). [Systematic review software]. Veritas Health Innovation, Melbourne, Australia. *Craig, S. L., & Austin, A. (2016). The AFFIRM open pilot feasibility study: A brief affirmative cognitive behavioral coping skills group intervention for sexual and gender minority youth. Children and Youth Services Review, 64, 136–144. https://doi.org/10.1016/j.childyouth.2016.02.022 *Craig, S. L., Leung, V. W. Y., Pascoe, R., Pang, N., Iacono, G., Austin, A., & Dillon, F. (2021). AFFIRM Online: Utilising an affirmative cognitive-behavioural digital intervention to improve mental health, access, and engagement among LGBTQA+ youth and young adults. International Journal of Environmental Research and Public Health, 18(4), Article 1541. https://doi.org/10.3390/ijerph18041541 Cuijpers, P., Smit, F., Bohlmeijer, E., Hollon, S. D., & Andersson, G. (2010). Efficacy of cognitive- behavioural therapy and other psychological treatments for adult depression: Meta-analytic study of publication bias. The British Journal of Psychiatry, 196(3), 173–178. https://doi.org/10.1192/bjp.bp.109.066001 Dale, S. K., & Safren, S. A. (2019). Gendered racial microaggressions predict posttraumatic stress disorder symptoms and cognitions among Black women living with HIV. Psychological Trauma: Theory, Research, Practice, and Policy, 11(7), 685–694. https://doi.org/10.1037/tra0000467 Feinstein, B. A. (2020). The rejection sensitivity model as a framework for understanding sexual minority mental health. Archives of Sexual Behavior, 49(7), 2247–2258. https://doi.org/10.1007/s10508-019-1428-3 Flentje, A., Heck, N. C., Brennan, J. M., & Meyer, I. H. (2020). The relationship between minority stress and biological outcomes: A systematic review. Journal of Behavioral Medicine, 43(5), 673– 694. https://doi.org/10.1007/s10865-019-00120-6 Gnan, G. H., Rahman, Q., Ussher, G., Baker, D., West, E., & Rimes, K. A. (2019). General and LGBTQ-specific factors associated with mental health and suicide risk among LGBTQ students. Journal of Youth Studies, 22(10), 1393–1408. https://doi.org/10.1080/13676261.2019.1581361 *Hart, T. A., Noor, S. W., Vernon, J. R. G., Antony, M. M., Gardner, S., & O’Cleirigh, C. (2020). Integrated cognitive-behavioral therapy for social anxiety and HIV/STI prevention for gay and bisexual men: A pilot intervention trial. Behavior Therapy, 51(3), 503–517. https://doi.org/10.1016/j.beth.2019.09.001 Hatzenbuehler, M. L. (2009). How does sexual minority stigma “Get Under the Skin”? A psychological mediation framework. Psychological Bulletin, 135(5), 707–730. https://doi.org/10.1037/a0016441 Heck, N. C., Mirabito, L. A., LeMaire, K., Livingston, N. A., & Flentje, A. (2017). Omitted data in randomized controlled trials for anxiety and depression: A systematic review of the inclusion LGBTQ+ Mental Health Interventions 32 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://doi.org/10.1136/bmj.l6890 https://doi.org/10.1016/j.cbpra.2020.05.008 https://doi.org/10.1016/j.childyouth.2016.02.022 https://doi.org/10.3390/ijerph18041541 https://doi.org/10.1192/bjp.bp.109.066001 https://doi.org/10.1037/tra0000467 https://doi.org/10.1007/s10508-019-1428-3 https://doi.org/10.1007/s10865-019-00120-6 https://doi.org/10.1080/13676261.2019.1581361 https://doi.org/10.1016/j.beth.2019.09.001 https://doi.org/10.1037/a0016441 https://www.psychopen.eu/ of sexual orientation and gender identity. Journal of Consulting and Clinical Psychology, 85(1), 72–76. https://doi.org/10.1037/ccp0000123 Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research and Practice, 43(5), 460–467. https://doi.org/10.1037/a0029597 Higgins, J. P., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2023). Cochrane handbook for systematic reviews of interventions (Version 6.4; updated August 2023). Cochrane. Available from https://training.cochrane.org/handbook Hobaica, S., Alman, A., Jackowich, S., & Kwon, P. (2018). Empirically based psychological interventions with sexual minority youth: A systematic review. Psychology of Sexual Orientation and Gender Diversity, 5(3), 313–323. https://doi.org/10.1037/sgd0000275 Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1 Hoy-Ellis, C. P. (2023). Minority stress and mental health: A review of the literature. Journal of Homosexuality, 70(5), 806–830. https://doi.org/10.1080/00918369.2021.2004794 *Jabson Tree, J. M., & Patterson, J. G. (2019). A test of feasibility and acceptability of online mindfulness-based stress reduction for lesbian, gay, and bisexual women and men at risk for high stress: Pilot study. JMIR Mental Health, 6(8), Article e15048. https://doi.org/10.2196/15048 *Jackson, S. D., Wagner, K. R., Yepes, M., Harvey, T. D., Higginbottom, J., & Pachankis, J. E. (2022). A pilot test of a treatment to address intersectional stigma, mental health, and HIV risk among gay and bisexual men of color. Psychotherapy, 59(1), 96–112. https://doi.org/10.1037/pst0000417 *Maguen, S., Shipherd, J. C., & Harris, H. N. (2005). Providing culturally sensitive care for transgender patients. Cognitive and Behavioral Practice, 12(4), 479–490. https://doi.org/10.1016/S1077-7229(05)80075-6 McCann, E., & Sharek, D. (2014). Survey of lesbian, gay, bisexual, and transgender people’s experiences of mental health services in Ireland. International Journal of Mental Health Nursing, 23(2), 118–127. https://doi.org/10.1111/inm.12018 McGuinness, L. A., & Higgins, J. P. T. (2021). Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Research Synthesis Methods, 12(1), 55– 61. https://doi.org/10.1002/jrsm.1411 McNamara, G., & Wilson, C. (2020). Lesbian, gay and bisexual individuals experience of mental health services – A systematic review. The Journal of Mental Health Training, Education and Practice, 15(2), 59–70. https://doi.org/10.1108/JMHTEP-09-2019-0047 Melendez-Torres, G. J., & Bonell, C. (2014). Systematic review of cognitive behavioural interventions for HIV risk reduction in substance-using men who have sex with men. International Journal of STD & AIDS, 25(9), 627–635. https://doi.org/10.1177/0956462413515638 Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286 Tudor-Sfetea & Topciu 33 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://doi.org/10.1037/ccp0000123 https://doi.org/10.1037/a0029597 https://training.cochrane.org/handbook https://doi.org/10.1037/sgd0000275 https://doi.org/10.1007/s10608-012-9476-1 https://doi.org/10.1080/00918369.2021.2004794 https://doi.org/10.2196/15048 https://doi.org/10.1037/pst0000417 https://doi.org/10.1016/S1077-7229(05)80075-6 https://doi.org/10.1111/inm.12018 https://doi.org/10.1002/jrsm.1411 https://doi.org/10.1108/JMHTEP-09-2019-0047 https://doi.org/10.1177/0956462413515638 https://doi.org/10.2307/2137286 https://www.psychopen.eu/ Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674 *Millar, B. M., Wang, K., & Pachankis, J. E. (2016). The moderating role of internalized homonegativity on the efficacy of LGB-affirmative psychotherapy: Results from a randomized controlled trial with young adult gay and bisexual men. Journal of Consulting and Clinical Psychology, 84(7), 565–570. https://doi.org/10.1037/ccp0000113 Munder, T., & Barth, J. (2018). Cochrane’s risk of bias tool in the context of psychotherapy outcome research. Psychotherapy Research, 28(3), 347–355. https://doi.org/10.1080/10503307.2017.1411628 Nicholson, A. A., Siegel, M., Wolf, J., Narikuzhy, S., Roth, S. L., Hatchard, T., Lanius, R. A., Schneider, M., Lloyd, C. S., McKinnon, M. C., Heber, A., Smith, P., & Lueger-Schuster, B. (2022). A systematic review of the neural correlates of sexual minority stress: Towards an intersectional minority mosaic framework with implications for a future research agenda. European Journal of Psychotraumatology, 13(1), Article 2002572. https://doi.org/10.1080/20008198.2021.2002572 *O’Cleirigh, C., Safren, S. A., Taylor, S. W., Goshe, B. M., Bedoya, C. A., Marquez, S. M., Boroughs, M. S., & Shipherd, J. C. (2019). Cognitive Behavioral Therapy for Trauma and Self-Care (CBT- TSC) in men who have sex with men with a history of childhood sexual abuse: A randomized controlled trial. AIDS and Behavior, 23(9), 2421–2431. https://doi.org/10.1007/s10461-019-02482-z O’Shaughnessy, T., & Speir, Z. (2018). The state of LGBQ affirmative therapy clinical research: A mixed-methods systematic synthesis. Psychology of Sexual Orientation and Gender Diversity, 5(1), 82–98. https://doi.org/10.1037/sgd0000259 Pachankis, J. E. (2014). Uncovering clinical principles and techniques to address minority stress, mental health, and related health risks among gay and bisexual men. Clinical Psychology: Science and Practice, 21(4), 313–330. https://doi.org/10.1111/cpsp.12078 Pachankis, J. E. (2015). A transdiagnostic minority stress treatment approach for gay and bisexual men’s syndemic health conditions. Archives of Sexual Behavior, 44(7), 1843–1860. https://doi.org/10.1007/s10508-015-0480-x *Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T. (2015). LGB- affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83(5), 875–889. https://doi.org/10.1037/ccp0000037 *Pachankis, J. E., McConocha, E. M., Clark, K. A., Wang, K., Behari, K., Fetzner, B. K., Brisbin, C. D., Scheer, J. R., & Lehavot, K. (2020). A transdiagnostic minority stress intervention for gender diverse sexual minority women’s depression, anxiety, and unhealthy alcohol use: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 88(7), 613–630. https://doi.org/10.1037/ccp0000508 Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., LGBTQ+ Mental Health Interventions 34 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://doi.org/10.1037/0033-2909.129.5.674 https://doi.org/10.1037/ccp0000113 https://doi.org/10.1080/10503307.2017.1411628 https://doi.org/10.1080/20008198.2021.2002572 https://doi.org/10.1007/s10461-019-02482-z https://doi.org/10.1037/sgd0000259 https://doi.org/10.1111/cpsp.12078 https://doi.org/10.1007/s10508-015-0480-x https://doi.org/10.1037/ccp0000037 https://doi.org/10.1037/ccp0000508 https://www.psychopen.eu/ Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., . . . Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, Article 71. https://doi.org/10.1136/bmj.n71 *Pan, S., Sun, S., Li, X., Chen, J., Xiong, Y., He, Y., & Pachankis, J. E. (2021). A pilot cultural adaptation of LGB-affirmative CBT for young Chinese sexual minority men’s mental and sexual health. Psychotherapy, 58(1), 12–24. https://doi.org/10.1037/pst0000318 Pantalone, D. W., Nelson, K. M., Batchelder, A. W., Chiu, C., Gunn, H. A., & Horvath, K. J. (2020). A systematic review and meta-analysis of combination behavioral interventions co-targeting psychosocial syndemics and HIV-related health behaviors for sexual minority men. Journal of Sex Research, 57(6), 681–708. https://doi.org/10.1080/00224499.2020.1728514 Pinna, F., Paribello, P., Somaini, G., Corona, A., Ventriglio, A., Corrias, C., Frau, I., Murgia, R., El Kacemi, S., Galeazzi, G. M., Mirandola, M., Amaddeo, F., Crapanzano, A., Converti, M., Piras, P., Suprani, F., Manchia, M., Fiorillo, A., Carpiniello, B., & Italian Working Group on LGBTQI Mental Health. (2022). Mental health in transgender individuals: A systematic review. International Review of Psychiatry, 34(3-4), 292–359. https://doi.org/10.1080/09540261.2022.2093629 Plöderl, M., & Tremblay, P. (2015). Mental health of sexual minorities: A systematic review. International Review of Psychiatry, 27(5), 367–385. https://doi.org/10.3109/09540261.2015.1083949 *Poon, J., Galione, J. N., Grocott, L. R., Horowitz, K. J., Kudinova, A. Y., & Kim, K. L. (2022). Dialectical behavior therapy for adolescents (DBT-A): Outcomes among sexual minorities at high risk for suicide. Suicide and Life-Threatening Behavior, 52(3), 383–391. https://doi.org/10.1111/sltb.12828 Rimes, K. A., Ion, D., Wingrove, J., & Carter, B. (2019). Sexual orientation differences in psychological treatment outcomes for depression and anxiety: National cohort study. Journal of Consulting and Clinical Psychology, 87(7), 577–589. https://doi.org/10.1037/ccp0000416 Roth, A. D., & Pilling, S. (2007). The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. London, United Kingdom: Department of Health. Sheinfil, A. Z., Foley, J. D., Ramos, J., Antshel, K. M., & Woolf-King, S. E. (2019). Psychotherapeutic depression interventions adapted for sexual and gender minority youth: A systematic review of an emerging literature. Journal of Gay & Lesbian Mental Health, 23(4), 380–411. https://doi.org/10.1080/19359705.2019.1622616 Steele, L. S., Daley, A., Curling, D., Gibson, M. F., Greene, D. C., Williams, C. C., & Ross, L. E. (2017). LGBT identity, untreated depression, and unmet need for mental health services by sexual minority women and trans-identified people. Journal of Women’s Health, 26(2), 116–127. https://doi.org/10.1089/jwh.2015.5677 Sterne, J. A. C., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. D., Viswanathan, M., Henry, D., Altman, D. G., Ansari, M. T., Boutron, I., Carpenter, J. R., Chan, A. W., Churchill, R., Deeks, J. J., Hróbjartsson, A., Kirkham, J., Jüni, P., Loke, Y. K., Pigott, T. D., . . . Higgins, J. P. T. (2016). Tudor-Sfetea & Topciu 35 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://doi.org/10.1136/bmj.n71 https://doi.org/10.1037/pst0000318 https://doi.org/10.1080/00224499.2020.1728514 https://doi.org/10.1080/09540261.2022.2093629 https://doi.org/10.3109/09540261.2015.1083949 https://doi.org/10.1111/sltb.12828 https://doi.org/10.1037/ccp0000416 https://doi.org/10.1080/19359705.2019.1622616 https://doi.org/10.1089/jwh.2015.5677 https://www.psychopen.eu/ ROBINS-I: A tool for assessing risk of bias in non-randomized studies of interventions. BMJ, 355, Article i4919. https://doi.org/10.1136/bmj.i4919 Sterne, J., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H.-Y., Corbett, M. S., Eldridge, S. M., Emberson, J. R., Hernán, M. A., Hopewell, S., Hróbjartsson, A., Junqueira, D. R., Jüni, P., Kirkham, J. J., Lasserson, T., Li, T., . . . Higgins, J. P. T. (2019). RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ, 366, Article i4898. https://doi.org/10.1136/bmj.l4898 Tan, K. K. H., Treharne, G. J., Ellis, S. J., Schmidt, J. M., & Veale, J. F. (2020). Gender minority stress: A critical review. Journal of Homosexuality, 67(10), 1471–1489. https://doi.org/10.1080/00918369.2019.1591789 Testa, R. J., Michaels, M. S., Bliss, W., Rogers, M. L., Balsam, K. F., & Joiner, T. (2017). Suicidal ideation in transgender people: Gender minority stress and interpersonal theory factors. Journal of Abnormal Psychology, 126, 125–136. https://doi.org/10.1037/abn0000234 Van Der Pol-Harney, E., & McAloon, J. (2019). Psychosocial interventions for mental illness among LGBTQIA youth: A PRISMA-based systematic review. Adolescent Research Review, 4(2), 149– 168. https://doi.org/10.1007/s40894-018-0090-7 Wingood, G. M., & DiClemente, R. J. (2008). The ADAPT-ITT model: A novel method of adapting evidence-based HIV interventions. Journal of Acquired Immune Deficiency Syndrome, 47(Suppl 1), S40–S46. https://doi.org/10.1097/QAI.0b013e3181605df1 *Yadavaia, J. E., & Hayes, S. C. (2012). Acceptance and commitment therapy for self-stigma around sexual orientation: A multiple baseline evaluation. Cognitive and Behavioral Practice, 19(4), 545– 559. https://doi.org/10.1016/j.cbpra.2011.09.002 Clinical Psychology in Europe (CPE) is the official journal of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT). PsychOpen GOLD is a publishing service by Leibniz Institute for Psychology (ZPID), Germany. LGBTQ+ Mental Health Interventions 36 Clinical Psychology in Europe 2024, Vol. 6(3), Article e11323 https://doi.org/10.32872/cpe.11323 https://doi.org/10.1136/bmj.i4919 https://doi.org/10.1136/bmj.l4898 https://doi.org/10.1080/00918369.2019.1591789 https://doi.org/10.1037/abn0000234 https://doi.org/10.1007/s40894-018-0090-7 https://doi.org/10.1097/QAI.0b013e3181605df1 https://doi.org/10.1016/j.cbpra.2011.09.002 https://www.psychopen.eu/ LGBTQ+ Mental Health Interventions (Introduction) Rationale Objectives Method Guidelines and Registration Eligibility Criteria Information Sources Search Strategy Selection Process Data Collection Process Study Risk of Bias Assessment Synthesis Methods Results Study Selection Study Characteristics Interventions, Adaptations, and Results Risk of Bias in Studies Discussion Summary and Interpretation of Evidence Limitations of Evidence/Summary and Interpretation of Risk of Bias Evaluation Limitations of the Review Process Implications and Future Research Directions Conclusion (Additional Information) Funding Acknowledgments Competing Interests Social Media Accounts Reporting Guidelines Preregistration Data Availability Supplementary Materials References