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Critical issues in cognitive behavioural therapy (CBT) with gender and sexual minorities (GSMs)

Published online by Cambridge University Press:  12 January 2022

Sérgio A. Carvalho ,
Paula Castilho ,
Daniel Seabra ,
Céu Salvador ,
Daniel Rijo  and
Carlos Carona
Sérgio A. Carvalho*
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal HEI-Lab: Digital Human-Environment Interaction Lab, School of Psychology and Life Sciences (EPCV), Lusófona University, Lisbon, Portugal
Paula Castilho
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
Daniel Seabra
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
Céu Salvador
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
Daniel Rijo
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
Carlos Carona
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
*
*Corresponding author. Email: sergiocarvalho@fpce.uc.pt
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Abstract

In a cisheteronormative culture, gender and sexual minorities (GSMs) may experience additional challenges that get in the way of a meaningful life. It is crucial that clinicians are mindful of these challenges and cognizant about the specificities of clinical work with GSMs. This article points out how societal structure interferes with mental health, and clarifies what clinicians must take into account when using affirmative cognitive behavioural therapy (CBT) interventions. Knowledge of up-to-date terminology and use of affirmative language are the first steps that contribute to clients’ experience of respect, which is paramount for the development of a good therapeutic relationship. Considering a conceptual framework of minority stress to understand vulnerability in GSM, specificities in formulation and key psychological processes are discussed. Moreover, guidelines and practical tools for intervention are presented within a CBT approach. Some reflections on therapists’ own personal biases are encouraged, in order to increase the efficacy of interventions.

Key learning aims

After reading this article you will be able to:

  1. (1) Recognize the uniqueness of gender and sexual minorities (GSM) stressors in broad and specific contexts, and their impact on mental health.

  2. (2) Identify the underlying key processes and specificities in therapeutic work with GSMs, from a CBT perspective.

  3. (3) Recognize the importance of a culturally sensitive approach in affirmative CBT interventions.

Keywords

affirmativecognitive behavioural therapygender and sexual minoritiesLGBT+minority stress
Type
Empirically Grounded Clinical Guidance Paper
Information
the Cognitive Behaviour Therapist , Volume 15 , 2022 , e3
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

For further information on the American Psychological Association (APA) guidelines for psychological practice with sexual minority persons, see https://www.apa.org/about/policy/psychological-sexual-minority-persons.pdf Google Scholar
For further information on the World Professional Association for Transgender Health (WPATH) standards of care, see https://www.wpath.org/publications/soc Google Scholar
For further reading on contextual behavioural approaches with GSMs, see Skinta, M. D. (2020). Contextual Behavior Therapy for Sexual and Gender Minority Clients: A Practical Guide to Treatment. New York, USA: Routledge. https://doi.org/10.4324/9780429030307.CrossRefGoogle Scholar

References

Alberti, R. E., & Emmons, M. L. (2017). Your Perfect Right: Assertiveness and Equality in Your Life and Relationships (10th edn). Impact Publisher.Google Scholar
American Psychological Association (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. American Psychologist, 67, 10–42. https://doi.org/10.1037/a0024659 CrossRefGoogle Scholar
Arntz, A., & Weertman, A. (1999). Treatment of childhood memories: theory and practice. Behaviour Research and Therapy, 37, 715–740. https://doi.org/10.1016/S0005-7967(98)00173-9 CrossRefGoogle ScholarPubMed
Austin, A., & Craig, S. L. (2015). Transgender affirmative cognitive behavioral therapy: clinical considerations and applications. In Professional Psychology: Research and Practice (vol. 46, issue 1). https://doi.org/10.1037/a0038642 CrossRefGoogle Scholar
Austin, A., Craig, S. L., & Alessi, E. J. (2016). Affirmative cognitive behavior therapy with transgender and gender nonconforming adults. The Psychiatric Clinics of North America, 40, 141–156.CrossRefGoogle ScholarPubMed
Baams, L., Kiekens, W. J., & Fish, J. N. (2020). The rejection sensitivity model: sexual minority adolescents in context. Archives of Sexual Behavior, 49, 2259–2263.CrossRefGoogle ScholarPubMed
Ball, C. A. (2010). From the Closet to the Courtroom: Five LGBT Rights Lawsuits that have Changed our Nation. Beacon Press.Google Scholar
Balsam, K. F., Rothblum, E. D., & Beauchaine, T. P. (2005). Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings. Journal of Consulting and Clinical Psychology, 73, 477–487. https://doi.org/10.1037/0022-006X.73.3.477 Google ScholarPubMed
Bergfeld, J. R., & Chiu, E. Y. (2017) Mediators in the relationship between minority stress and depression among young same-sex attracted women. Professional Psychology: Research and Practice, 48, 294–300.Google Scholar
Bockting, W., Coleman, E., Deutsch, M. B., Guillamon, A., Meyer, I., Meyer, W., Reisner, S., Sevelius, J., & Ettner, R. (2016). Adult development and quality of life of transgender and gender nonconforming people. Current Opinion in Endocrinology, Diabetes and Obesity, 23, 188–197. https://doi.org/10.1097/MED.0000000000000232 CrossRefGoogle ScholarPubMed
Bockting, W. O., Miner, M. H., Romine, R. E. S., Dolezal, C., Robinson, B. B. E., Rosser, B. R. S., & Coleman, E. (2020). The Transgender Identity Survey: a measure of internalized transphobia. LGTB Health, 7, 15–27. https://doi.org/10.1089/lgbt.2018.0265 Google ScholarPubMed
Bratt, A., Gralberg, I. M., Svensson, I., & Rusner, M. (2020). Gaining the courage to see and accept oneself: group-based compassion-focussed therapy as experienced by adolescent girls. Clinical Child Psychology and Psychiatry, 25, 909–921. https://doi.org/10.1177/1359104520931583 Google ScholarPubMed
Bruce, D., Ramirez-Valles, J., & Campbell, R. T. (2008). Stigmatization, substance use, and sexual risk behavior among Latino gay and bisexual men and transgender persons. Journal of Drug Issues, 38, 235–260. https://doi.org/10.1177/002204260803800111 CrossRefGoogle Scholar
Bullough, V. L. (2019). Homosexuality: A History (From Ancient Greece to Gay Liberation) (2nd edn). Routledge.CrossRefGoogle Scholar
Burton, C. L., Clark, K. A., & Pachankis, J. E. (2020). Risk from within: intraminority gay community stress and sexual risk-taking among sexual minority men. Annals of Behavioral Medicine, 54, 703–712. https://doi.org/10.1093/abm/kaaa014 CrossRefGoogle ScholarPubMed
Bybee, J. A., Sullivan, E. L., Zielonka, E., & Moes, E. (2009). Are gay men in worse mental health than heterosexual men? The role of age, shame and guilt, and coming-out. Journal of Adult Development, 16, 144–154. https://doi.org/10.1007/s10804-009-9059-x Google Scholar
Carona, C., Handford, C., & Fonseca, A. (2020). Socratic questioning put into clinical practice. BJPsych Advances, 27, 1–3. https://doi.org/10.1192/bja.2020.77 Google Scholar
Chakraborty, A., McManus, S., Brugha, T. S., Bebbington, P., & King, M. (2011). Mental health of the non-heterosexual population of England. British Journal of Psychiatry, 198, 143–148. https://doi.org/10.1192/bjp.bp.110.082271 CrossRefGoogle ScholarPubMed
Chaudoir, S. R., Wang, K., & Pachankis, J. E. (2017). What reduces sexual minority stress? A review of the intervention “toolkit.” Journal of Social Issues, 73, 586–617. https://doi.org/10.1111/josi.12233 CrossRefGoogle Scholar
Cheng, F. K. (2018). Overcoming internalised phobia among Buddhist sexual minorities through mindfulness. Contemporary Buddhism, 19, 223–236. https://doi.org/10.1080/14639947.2018.1572326 CrossRefGoogle Scholar
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., Monstrey, S., Adler, R. K., Brown, G. R., Devor, A. H., Ehrbar, R., Ettner, R., Eyler, E., Garofalo, R., Karasic, D. H., … & Zucker, K. (2012). Standards of care for the health of transexual, transgender, and gender-nonconforming people. In World Professional Association for Transgender Health (WPATH) (7th edn). World Professional Association for Transgender Health (WPATH). www.wpath.org Google Scholar
Craig, S. L., Austin, A., & Alessi, E. (2013). Gay affirmative cognitive behavioral therapy for sexual minority youth: a clinical adaptation. Clinical Social Work Journal, 41, 258–266. https://doi.org/10.1007/s10615-012-0427-9 CrossRefGoogle Scholar
Dearing, R. L., & Tangney, J. P. (2011). Shame in the therapy hour. In Shame in the Therapy Hour. American Psychological Association. https://doi.org/10.1037/12326-000 CrossRefGoogle Scholar
Drescher, J. (2015). Out of DSM: depathologizing homosexuality. Behavioral Sciences, 5, 565–575. https://doi.org/10.3390/bs5040565 CrossRefGoogle ScholarPubMed
Ehrensaft, D. (2012). From gender identity disorder to gender identity creativity: true gender self child therapy. Journal of Homosexuality, 59, 337–356. https://doi.org/10.1080/00918369.2012.653303 CrossRefGoogle ScholarPubMed
Felner, J. K., Wisdom, J. P., Williams, T., Katuska, L., Haley, S. J., Jun, H. J., & Corliss, H. L. (2020). Stress, coping, and context: examining substance use among LGBTQ young adults with probable substance use disorders. Psychiatric Services, 71, 112–120. https://doi.org/10.1176/appi.ps.201900029 CrossRefGoogle ScholarPubMed
Finlay-Jones, A., Strauss, P., Perry, Y., Waters, Z., Gilbey, D., Windred, M. an, Murdoch, A., Pugh, C., Ohan, J. L., & Lin, A. (2021). Group mindful self-compassion training to improve mental health outcomes for LGBTQIA+ young adults: rationale and protocol for a randomised controlled trial. Contemporary Clinical Trials, 102, 106268. https://doi.org/10.1016/j.cct.2021.106268 CrossRefGoogle ScholarPubMed
Gilbert, P. (2003). Evolution, social roles, and the differences in shame and guilt. Social Research, 70, 1205–1230+i.Google Scholar
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53, 6–41. https://doi.org/10.1111/bjc.12043 CrossRefGoogle ScholarPubMed
Goud, N. H. (2005). Courage: its nature and development. The Journal of Humanistic Counseling, Education and Development, 44, 102–116. https://doi.org/10.1002/j.2164-490x.2005.tb00060.x CrossRefGoogle Scholar
Hall, W. J., Ruiz Rosado, B., & Chapman, M. V. (2019). Findings from a feasibility study of an adapted cognitive behavioral therapy group intervention to reduce depression among LGBTQ (lesbian, gay, bisexual, transgender, or queer) young people. Journal of Clinical Medicine, 8, 949. https://doi.org/10.3390/jcm8070949 Google ScholarPubMed
Hart, T. A., & Heimberg, R. G. (2005). Social anxiety as a risk factor for unprotected intercourse among gay and bisexual male youth. AIDS and Behavior, 9, 505–512. https://doi.org/10.1007/s10461-005-9021-2 CrossRefGoogle ScholarPubMed
Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive behavioral therapy and the rise of process-based care. World Psychiatry, 16, 245–246. https://doi.org/10.1002/wps.20442 CrossRefGoogle ScholarPubMed
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, 460–467. https://doi.org/10.1037/a0029597 CrossRefGoogle Scholar
Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: insights from a social psychological perspective. Journal of Counseling Psychology, 56, 32–43. https://doi.org/10.1037/a0014672 Google Scholar
Herrick, A. L., Stall, R., Goldhammer, H., Egan, J. E., & Mayer, K. H. (2014). Resilience as a research framework and as a cornerstone of prevention research for gay and bisexual men: Theory and evidence. AIDS and Behavior, 18, 1–9. https://doi.org/10.1007/s10461-012-0384-x Google ScholarPubMed
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, 427–440. https://doi.org/10.1007/s10608-012-9476-1 CrossRefGoogle ScholarPubMed
Hughto, J. M. W., Pachankis, J. E., & Reisner, S. L. (2018). Healthcare mistreatment and avoidance in trans masculine adults: the mediating role of rejection sensitivity. Psychology of Sexual Orientation and Gender Diversity, 5, 471–481. https://doi.org/10.1037/sgd0000296 CrossRefGoogle ScholarPubMed
Kabat-Zinn, J. (2003). Mindfulness-based stress reduction (MBSR). Constructivism in the Human Sciences, 8, 73–83. http://doi.org/10.1016/j.jaci.2012.05.050 Google Scholar
Keyes, C. L. M., & Brim, G. (2002). Keyes and human development program through mem-and lopez. Journal of Health and Social Research, 43, 207–222.Google Scholar
Kidd, S. A., Howison, M., Pilling, M., Ross, L. E., & McKenzie, K. (2016). Severe mental illness in LGBT populations: a scoping review. Psychiatric Services, 67, 779–783. https://doi.org/10.1176/appi.ps.201500209 CrossRefGoogle ScholarPubMed
Lloyd, C. E., Rimes, K. A., & Hambrook, D. G. (2021). LGBQ adults’ experiences of a CBT wellbeing group for anxiety and depression in an Improving Access to Psychological Therapies Service: a qualitative service evaluation. the Cognitive Behaviour Therapist, 13. https://doi.org/10.1017/S1754470X20000598 CrossRefGoogle Scholar
López-Castro, T., Saraiya, T., Zumberg-Smith, K., & Dambreville, N. (2019). Association between shame and posttraumatic stress disorder: a meta-analysis. Journal of Traumatic Stress, 32, 484–495. https://doi.org/10.1002/jts.22411 Google ScholarPubMed
Loshek, E., & Terrell, H. K. (2015). The development of the Sexual Assertiveness Questionnaire (SAQ): a comprehensive measure of sexual assertiveness for women. Journal of Sex Research, 52, 1017–1027. https://doi.org/10.1080/00224499.2014.944970 Google ScholarPubMed
Macbeth, A., & Gumley, A. (2012). Exploring compassion: a meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32, 545–552. https://doi.org/10.1016/j.cpr.2012.06.003 CrossRefGoogle ScholarPubMed
Mahfouda, S., Moore, J. K., Siafarikas, A., Hewitt, T., Ganti, U., Lin, A., & Zepf, F. D. (2019). Gender-affirming hormones and surgery in transgender children and adolescents. The Lancet Diabetes and Endocrinology, 7, 484–498. https://doi.org/10.1016/S2213-8587(18)30305-X CrossRefGoogle ScholarPubMed
Matos, M., Carvalho, S. A., Cunha, M., Galhardo, A., & Sepodes, C. (2017). Psychological flexibility and self-compassion in gay and heterosexual men: how they relate to childhood memories, shame, and depressive symptoms. Journal of LGBT Issues in Counseling, 11, 88–105. https://doi.org/10.1080/15538605.2017.1310007 CrossRefGoogle Scholar
McCambridge, S. A., & Consedine, N. S. (2014). For whom the bell tolls: experimentally-manipulated disgust and embarrassment may cause anticipated sexual healthcare avoidance among some people. Emotion, 14, 407–415. https://doi.org/10.1037/a0035209 Google ScholarPubMed
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. https://doi.org/10.1037/0033-2909.129.5.674 CrossRefGoogle ScholarPubMed
Meyer, I. H. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity, 2, 209–213. https://doi.org/10.1037/sgd0000132 Google Scholar
Meyer, I. H. (2020). Rejection sensitivity and minority stress: a challenge for clinicians and interventionists. Archives of Sexual Behavior, 49, 2287–2289. https://doi.org/10.1007/s10508-019-01597-7 CrossRefGoogle ScholarPubMed
Mink, M. D., Lindley, L. L., & Weinstein, A. A. (2014). Stress, stigma, and sexual minority status: the intersectional ecology model of LGBTQ health. Journal of Gay and Lesbian Social Services, 26, 502–521. https://doi.org/10.1080/10538720.2014.953660 CrossRefGoogle Scholar
Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: a meta-analytic review. Clinical Psychology Review, 30, 1019–1029. https://doi.org/10.1016/j.cpr.2010.07.003 CrossRefGoogle ScholarPubMed
Ogolsky, B. G., Monk, J. K., Rice, T. K. M., & Oswald, R. F. (2019). As the states turned: implications of the changing legal context of same-sex marriage on well-being. Journal of Social and Personal Relationships, 36, 3219–3238. https://doi.org/10.1177/0265407518816883 CrossRefGoogle Scholar
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, 313–330. https://doi.org/10.1111/cpsp.12078 Google ScholarPubMed
Pachankis, J. E. (2018). The scientific pursuit of sexual and gender minority mental health treatments: toward evidence-based affirmative practice. American Psychologist, 73, 1207–1219. https://doi.org/10.1037/amp0000357 CrossRefGoogle ScholarPubMed
Pachankis, J. E., Clark, K. A., Burton, C. L., Hughto, J. M. W., Bränström, R., & Keene, D. E. (2020a). Sex, status, competition, and exclusion: intraminority stress from within the gay community and gay and bisexual men’s mental health. Journal of Personality and Social Psychology, 119, 713–740. https://doi.org/10.1037/pspp0000282 CrossRefGoogle ScholarPubMed
Pachankis, J. E., Goldfried, M. R., & Ramrattan, M. E. (2008). Extension of the rejection sensitivity construct to the interpersonal functioning of gay men. Journal of Consulting and Clinical Psychology, 76, 306–317. https://doi.org/10.1037/0022-006X.76.2.306 Google Scholar
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, 875–886. https://doi.org/10.1037/ccp0000037 CrossRefGoogle ScholarPubMed
Pachankis, J. E., Jackson, S. D., Fetzner, B. K., Mahon, C. P., & Bränström, R. (2020b). Sexual Orientation Concealment and Mental Health: A Conceptual and Meta-Analytic Review, 146, 831–871. https://doi.org/10.1037/bul0000271 Google ScholarPubMed
Padesky, C. A., & Mooney, K. A. (2012). Strengths-based cognitive-behavioural therapy: a four-step model to build resilience. Clinical Psychology and Psychotherapy, 19, 283–290. https://doi.org/10.1002/cpp.1795 CrossRefGoogle ScholarPubMed
Pepping, C. A., Lyons, A., McNair, R., Kirby, J. N., Petrocchi, N., & Gilbert, P. (2017). A tailored compassion-focused therapy program for sexual minority young adults with depressive symotomatology: study protocol for a randomized controlled trial. BMC Psychology, 5, 1–7. https://doi.org/10.1186/s40359-017-0175-2 CrossRefGoogle ScholarPubMed
Perez-Brumer, A., Hatzenbuehler, M. L., Oldenburg, C. E., & Bockting, W. (2015). Individual- and structural-level risk factors for suicide attempts among transgender adults. Behavioral Medicine, 41, 164–171. https://doi.org/10.1080/08964289.2015.1028322 CrossRefGoogle ScholarPubMed
Pinto-Gouveia, J., & Matos, M. (2011). Can shame memories become a key to identity? The centrality of shame memories predicts psychopathology. Applied Cognitive Psychology, 25, 281–290. https://doi.org/10.1002/acp.1689 Google Scholar
Plöderl, M., & Tremblay, P. (2015). Mental health of sexual minorities. A systematic review. International Review of Psychiatry, 27, 367–385. https://doi.org/10.3109/09540261.2015.1083949 Google ScholarPubMed
Puckett, J. A., Woodward, E. N., Mereish, E. H., & Pantalone, D. W. (2015). Parental rejection following sexual orientation disclosure: impact on internalized homophobia, social support, and mental health. LGBT Health, 2, 265–269. https://doi.org/10.1089/lgbt.2013.0024 CrossRefGoogle ScholarPubMed
Roughgarden, J. (2013). Evolution’s rainbow: diversity, gender, and sexuality in nature and people. In Angewandte Chemie International Edition, 6, 951–952. University of California Press.Google Scholar
Ruff, N., Smoyer, A., & Breny, J. (2019). Hope, courage, and resilience in the lives of transgender women of color. The Qualitative Report, 24, 1990–2008. https://doi.org/10.46743/2160-3715/2019.3729 Google Scholar
Scandurra, C., Bochicchio, V., Amodeo, A. L., Esposito, C., Valerio, P., Maldonato, N. M., Bacchini, D., & Vitelli, R. (2018). Internalized transphobia, resilience, and mental health: applying the psychological mediation framework to Italian transgender individuals. International Journal of Environmental Research and Public Health, 15. https://doi.org/10.3390/ijerph15030508 CrossRefGoogle ScholarPubMed
Shallcross, A. J., & Spruill, T. M. (2018). The protective role of mindfulness in the relationship between perceived discrimination and depression. Mindfulness, 9, 1100–1109. https://doi.org/10.1007/s12671-017-0845-4 CrossRefGoogle ScholarPubMed
Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62, 373–386. https://doi.org/10.1002/jclp.20237 CrossRefGoogle ScholarPubMed
Singh, A. A., & Dickey, L. M. (2017). Affirmative Counseling and Psychological Practice With Transgender and Gender Nonconforming Clients. American Psychological Association.CrossRefGoogle Scholar
Skinta, M. D., Brandrett, B. D., Schenk, W. C., Wells, G., & Dilley, J. W. (2014). Shame, self-acceptance and disclosure in the lives of gay men living with HIV: an interpretative phenomenological analysis approach. Psychology and Health, 29, 583–597. https://doi.org/10.1080/08870446.2013.871283 CrossRefGoogle ScholarPubMed
Skinta, M. D., & Curtin, A. (2016). Mindfulness and Acceptance for Gender and Sexual Minorities: A Clinician’s Guide to Fostering Compassion, Connection, and Equality Using Contextual Strategies. New Harbinger Publications, Inc.Google Scholar
Smith, M. S., & Gray, S. W. (2009). The courage to challenge: a new measure of hardiness in LGBT adults. Journal of Gay and Lesbian Social Services, 21, 73–89. https://doi.org/10.1080/10538720802494776 CrossRefGoogle Scholar
Speed, B. C., Goldstein, B. L., & Goldfried, M. R. (2018). Assertiveness training: a forgotten evidence-based treatment. Clinical Psychology: Science and Practice, 25, 1–20. https://doi.org/10.1111/cpsp.12216 Google Scholar
Steele, L. S., Daley, A., Curling, D., Gibson, M. F., Green, 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, 116–127. https://doi.org/10.1089/jwh.2015.5677 Google ScholarPubMed
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 Google ScholarPubMed
Tomlinson, E. R., Yousaf, O., Vittersø, A. D., & Jones, L. (2018). Dispositional mindfulness and psychological health: a systematic review. Mindfulness, 9, 23–43. https://doi.org/10.1007/s12671-017-0762-6 CrossRefGoogle ScholarPubMed
Tree, J. M. J., & 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, 1–12. https://doi.org/10.2196/15048 Google Scholar
Turban, J. L., & Ehrensaft, D. (2018). Research review: gender identity in youth: treatment paradigms and controversies. Journal of Child Psychology and Psychiatry and Allied Disciplines, 59, 1228–1243. https://doi.org/10.1111/jcpp.12833 CrossRefGoogle ScholarPubMed
Whitehead, J., Shaver, J., & Stephenson, R. (2016). Outness, stigma, and primary health care utilization among rural LGBT Populations. PLoS One, 11, 1–17. https://doi.org/10.1371/journal.pone.0146139 Google ScholarPubMed
Zessin, U., Dickhäuser, O., & Garbade, S. (2015). The relationship between self-compassion and well-being: a meta-analysis. Applied Psychology: Health and Well-Being, 7, 340–364. https://doi.org/10.1111/aphw.12051 Google ScholarPubMed
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