Sexual and gender diverse young people face significantly higher rates of depression and anxiety compared to their peers. A recent study published in BMC Psychology provides encouraging evidence that a specialized form of therapy can provide lasting mental health benefits for this vulnerable population.
The Challenge
Research consistently shows that LGBTQ+ adolescents and young adults experience mental health disparities. They are twice as likely to report significant depression and three times more likely to have suicidal thoughts compared to their heterosexual, cisgender counterparts. Among transgender and nonbinary youth, the statistics are even more concerning, with over 75% reporting symptoms of generalized anxiety disorder.
These disparities are largely attributed to minority stress, which refers to the unique stressors that come from having a stigmatized identity. This includes experiences like family rejection, discrimination, bullying, and the constant need to hide or defend one's identity.
The Intervention
Researchers tested an eight week group therapy program called AFFIRM, which adapts traditional cognitive behavioral therapy (CBT) specifically for LGBTQ+ young people aged 14 to 29. Unlike standard CBT, this approach acknowledges and addresses the specific challenges these youth face due to their sexual orientation or gender identity.
The program covers several key areas: understanding how thoughts, feelings, and behaviors are connected; learning to recognize and manage stress (including minority stress); developing healthy coping strategies; building hope for the future; and creating supportive social connections.
What the Study Found
The research followed 202 participants for one full year after they completed the program. The results were promising across multiple measures.
Participants showed significant improvements in both depression and anxiety that persisted throughout the entire year. They also demonstrated positive changes in how they coped with stress, how they viewed stressful situations, and their sense of hope for the future.
Interestingly, the participants who benefited most were those who started the program with the greatest challenges. Young people who initially viewed stress as threatening and had difficulty envisioning a positive future showed the largest improvements over time.
Key Mechanisms of Change
The study identified three main factors that contributed to lasting improvements:
Better Coping Strategies: Participants learned to use more active, problem focused approaches to dealing with challenges rather than avoiding or withdrawing from difficult situations. This "engagement coping" includes strategies like making plans to address problems, seeking emotional support from others, and trying to see challenges in a more positive light.
Changed Stress Appraisal: The therapy helped young people shift how they think about stressful situations. Instead of viewing stress as an overwhelming threat, they learned to see challenges as manageable problems they could work through with the right tools and support.
Increased Hope: Participants developed a stronger sense that they could achieve their goals and that there were multiple pathways to reach them. This future oriented thinking proved crucial for maintaining mental health improvements.
Why This Matters
Traditional therapy approaches don't always address the unique experiences of LGBTQ+ youth. This study demonstrates that when therapy is specifically adapted to acknowledge minority stress and affirm diverse identities, it can produce substantial and lasting benefits.
The fact that improvements persisted for a full year is particularly significant. Many therapy studies only follow participants for a few months, making it unclear whether benefits last. This research suggests that even a relatively brief intervention can have enduring positive effects when it's properly tailored to the population it serves.
The study adds important evidence to support the use of affirmative therapy approaches for LGBTQ+ youth. It suggests that effective treatment should validate young people's experiences of discrimination and stigma while helping them develop practical skills for managing both minority stress and typical life challenges.
For families, educators, and healthcare providers working with LGBTQ+ youth, these findings underscore the importance of affirming approaches to mental health care. Rather than viewing these young people's identities as problems to be solved, effective treatment recognizes that the real issues often stem from societal stigma and discrimination.
The research also highlights that hope and coping skills can be taught and strengthened through appropriate interventions. This offers an optimistic message for LGBTQ+ youth and their families: with the right support, young people can develop resilience and maintain good mental health despite facing minority stress.
While more research is needed to understand exactly how these interventions work and for whom they work best, this study represents an important step forward in developing evidence-based treatments that can genuinely help improve the lives of sexual and gender diverse young people.
Craig, S. L., Leung, V. W., Hui, J. A., Iacono, G., Pascoe, R. V., Dillon, F., ... & Brooks, A. S. (2025). LGBTQ+ Affirmative CBT: a hierarchical linear model of longitudinal outcomes and mechanisms of change. BMC psychology, 13(1), 1006
