Promoting Healthy Coping Skills Among Sexual and Gender Minority Youth: A Pilot Affirmative Cognitive-Behavioural Group Intervention

Background: Sexual and gender minority youth (SGMY) encounter pervasive stigma-related stress that necessitates the development of effective coping skills. According to the stigma-coping framework (Miller & Kaiser, 2001), coping skills can be classified by their purpose and consequences. Disengagement coping that takes the form of withdraw or denial is considered avoidant and tends to not address the root cause of distress. Engagement coping is deemed protective and proactive in its goal to manage a stigmatizing situation and is typically separated into primary and secondary control factors. While interventions that seek to enhance SGMY engagement coping have been widely suggested, few models with evidence of effectiveness exist. The present study evaluated the effectiveness of an eight-module, manualized training (AFFIRM) that incorporates cognitive-behavioral therapy to foster awareness and modification of SGMY cognition (e.g., self-awareness, identifying risk), mood (e.g., recognizing the link between thoughts and feelings) and behavior (e.g., identifying strengths and ways of coping). The primary goal is to promote engagement coping skills and mental health among SGMY.

Methods:This study utilized a pre-post evaluation design to determine the extent of change in SGMY coping patterns and depression. Using purposive and venue-based sampling through community-based agencies and online sources, this study recruited 33 intervention participants. These SGMY completed reliable measures of depression (Beck Depression Inventory) and a coping skills inventory (A-COPES) with 12 subscales. Descriptive statistics and dependent sample t-tests were used for analyses.

Sample Characteristics: Participants were 15-18 years old (M = 16.8) and identified as female (57%), gender independent/non-binary (21%), male (18%), trans (10%), and/or two-spirit (8%). With regards to sexual orientation, youth identified as pansexual (29%), lesbian (25%), queer (21%), bisexual (18%), unsure/questioning (11%), gay (11%), and/or polysexual (2%). Identified race/ethnicity included White European (64%), Black/African/Caribbean (25%), East/South/Southeast Asian (24%), Indigenous/First Nations (18%), and/or Latino/a (7%). Rates of engagement and retention were satisfactory as all participants completed the intervention and both pre- and post-assessments.

Results: SGMY were most likely to utilize being humorous and avoiding problems coping skills. Seeking professional and spiritual support were the least used coping approaches. Following the intervention, participants’ depression score decreased significantly (t = -2.33, p < 0.05). In addition, participants reported decreased rates of avoiding problems and greater use of engagement coping patterns. Specifically, dependent sample t-test indicated significant increases in the areas of primary control [solving family problems (t = 2.70, p < 0.05)] and secondary control [seeking spiritual support (t = 2.09, p < 0.05), seeking diversion (t = 4.18, p < 0.001), engaging in demanding activities (t = 2.51, p < 0.05), and being humorous (t = 2.51, p < 0.05)]. 

Conclusion: The AFFIRM intervention is found to be effective in promoting engagement coping among SGMY and can be considered as an evidence-informed model to enhance SGMY mental health. The high rates of engagement and retention also suggest the feasibility, acceptability, and utility of an affirmative community-based CBT intervention for SGMY. Implications for research and social work practice will be provided.