Evaluating the Acceptability and Preliminary Depression and Anxiety Outcomes of a Peer-Facilitated Cognitive-Behavioral Workbook Intervention for LGBTQ Individuals: Results from a Feasibility Trial

Background: LGBTQ individuals experience higher rates of depression and anxiety than their heterosexual and cisgender counterparts. Cognitive-behavioral interventions are among the mental health interventions with the strongest empirical support for treating depression and anxiety symptoms experienced by LGBTQ people; unfortunately access to psychotherapy can be limited for LGBTQ people with these symptoms. An increasing variety of cognitive-behavioral workbooks are popularly available for LGBTQ people, but few have been subject to empirical investigation. This study aims to examine the acceptability and preliminarily evaluate the depression and anxiety outcomes of a peer-facilitated cognitive-behavioral workbook intervention for LGBTQ individuals, the LGBTQI Workbook for CBT.

Methods: Data was collected through a feasibility trial of a peer-facilitated cognitive-behavioral workbook intervention for LGBTQ individuals. Seventeen LGBTQ individuals enrolled to participate in the 6-sessions intervention. Participants completed pre-assessment, post-assessment, and post-session surveys. Depression and anxiety symptoms were measured using the PHQ-8 (depression) and GAD-7 (anxiety) tools; acceptability was assessed through a five-point scale (very dissatisfied [0] to very satisfied [4]). To preliminarily evaluate the intervention's effects on depression and anxiety, t-tests were employed to compare pre-test and post-test scores, and Cohen's D was calculated to determine the effect sizes.

Results: Program retention was good, with 82.4% (n=14) participants completing all six sessions. 85.7% (n=12) of the participants who completed the intervention met screening criteria for depression, and 100.0% (n=14) met screening criteria for anxiety at intake. On average, the intervention was well-received, with a mean acceptability rating of 3.88 (indicating an average rating in the satisfactory-to-very satisfactory range). T-tests of participants meeting screening criteria for depression (n=12) and anxiety (n=14) revealed statistically significant reductions in both depression (p<0.01) and anxiety (p<0.001) symptoms. Reductions in depression symptoms were medium-sized (d=0.59) and reductions in anxiety symptoms were large (d=0.86).

Discussion: This study fills an important gap by being the first known study to evaluate the acceptability and preliminarily evaluate the depression and anxiety outcomes of this popularly available cognitive-behavioral workbook for LGBTQ individuals. It is important to better understand the acceptability and effectiveness of cognitive-behavioral interventions administered outside of a traditional therapy contexts, as alternative delivery mechanisms may be crucial in addressing depression and anxiety symptoms for LGBTQ individuals who do not have access to psychotherapy. Overall, the results of this study suggest that a peer-facilitated cognitive-behavioral workbook intervention may be an effective resource for addressing depression and anxiety symptoms for LGBTQ individuals. Future research should explore whether the workbook intervention is comparably acceptable and effective when administered as a self-guided intervention without a facilitator. Because many therapists report requiring additional guidance with supporting their LGBTQ clients, future research should also consider whether the workbook may serve as an acceptable and effective resource when administered in the context of traditional psychotherapy. This study is limited by its small, non-representative sample that precluded analysis by subgroups; future research should include large and representative samples to ensure generalizability to the unique needs of subpopulations of the LGBTQ community (e.g., transgender and/or non-binary participants; participants of color).