Utilizing Mindfulness Therapeutic Approaches with Sexual and Gender Minority Youth to Address Mental Health

Background and Purpose: Sexual and gender minority youth (SGMY) are a particularly vulnerable population, exhibiting poorer psychological outcomes (depression, anxiety) compared to non-SGMY (Craig & Austin, 2016). The purpose of this study was to: 1) explore mindfulness-based modalities with SGMY and 2) develop a culturally-adapted affirmative mindfulness-based intervention (MBI) for SGMY. As a precursor to evaluating an affirmative MBI for SGMY, the study aimed to fulfill preliminary steps from an adapt and evaluate model (Interian, Martinez, Rios, Krejci, & Guarnaccia, 2010) by: 1) introducing and practicing core mindfulness skills (e.g., from Mindfulness-Based Stress Reduction for Teens) with SGMY; 2) investigating what content/skills are critical for a culturally-relevant adaptation of a MBI; 3) and developing an adapted mindfulness manualized intervention for SGMY.

Methods: This constructivist grounded theory study (Charmaz, 2014) included SGMY (n = 30) ranging from 16-29 years of age, who participated in four focus groups and six individual interviews. Participants’ gender identities included: female (24%), non-binary (24%), male (16%), transgender (12%), Two-Spirit (12%). Sexual orientation included: gay (30%), queer (21%), bisexual (20%), pansexual (15%), and lesbian (10%). Ethnoracial identities were: white (41%), black (18%), Indigenous (14%), Latin American (9%), and multi-racial/ethnic identity (4.5%). Each youth participated in two sequential group sessions consisting of 11 to 13 participants. SGMY completed the Self-Compassion Scale (SCS), a 26-item measure of mindfulness and self-compassion, suitable for youth ages 14 and up (Neff, 2003) at the beginning of the study.  The SCS, using a 5-point Likert scale, has demonstrated strong convergent and discriminant validity, good test-retest reliability, and excellent reliability (Cronbach’s alpha = .93) (Neff, Rude, & Kirkpatrick, 2007). Focus groups and interviews were recorded and transcribed. Open line-by-line and focused coding (Charmaz, 2014) were utilized, and four coders met (in dyads for approximately 1-2 hours) to compare and discuss emergent themes, generate broader themes, and to ensure thematic consistency. Credibility, originality and resonance of research was determined by multiple coders, and the generation of memos was used to increase transparency. Credibility was ensured by member checking procedures. Rigour was also enhanced by using thick description (i.e., descriptive quotes from SGMY).

Results: SGMY displayed low to moderate levels of overall self-compassion (2.6/5) and mindfulness (2.8/5), and indicated that the SCS was easy to complete, language was appropriate, and would be an adequate measure for future studies with SGMY. Five major themes emerged as critical to the adaptation of MBIs for SGMY: 1) The importance of an LGBTQ+-affirming context; 2) incorporating intersectionality-based discussions on defining stress; 3) developing coping skills to address (external and internalized) homo/bi/transphobia; 4) psychological safety; 5) and an explicit focus on self-compassion.

Conclusion: The findings of this study suggest that SGMY may benefit from an affirmative MBI. SGMY indicated that cultivating awareness through mindfulness coping skills may support them with shifting negative perceptions, facilitating healthier behaviors, and increasing a sense of self-acceptance and letting go when experiencing stress. Adaptation considerations, such as a flexible LGBTQ+-specific trauma-informed approach and an affirmative mindfulness toolkit, and other implications for social work will be discussed.