A Pilot Trial of an LGBTQ-Affirmative Cognitive-Behavioral Therapy for Transgender and Gender Expansive Individuals' Mental, Behavioral, and Sexual Health.
Lelutiu-Weinberger C, Filimon M, et al. • Behavior therapy • 2025
LGBTQ-affirmative cognitive-behavioral therapy showed feasibility, acceptability, and preliminary efficacy among transgender and gender expansive individuals living in the high-stigma context of Romania, with reductions in depression, anxiety, and certain minority stress mechanisms.
Key Findings
Results
The pilot trial demonstrated high feasibility through timely recruitment and strong session attendance among TGE adults in Romania.
All participants reported depression and/or anxiety symptoms at baseline
Participants received 16 virtual sessions of LGBTQ-affirmative CBT from trained psychologists
Feasibility indicators included timely recruitment and high session attendance rates
Results
The intervention was rated as highly acceptable by participants based on exit interview data.
Exit interviews revealed high acceptability across multiple dimensions
Participants endorsed the treatment's relevance, goals, and format
Participants reported the treatment imparted minority stress knowledge and identity-related hope and acceptance
Therapeutic alliance was cited as a positive component of acceptability
Assessments were conducted at baseline and 5-month follow-up
Results
Participants showed reductions in depression and anxiety symptoms from baseline to 5-month follow-up.
Reductions in both depression and anxiety symptoms were observed
Assessments were administered at baseline and 5-month follow-up
The study was a pilot trial with a pre-post design without a control group
The sample size was 25 TGE adults
These findings are characterized as preliminary efficacy given the pilot design
Results
Certain minority stress mechanisms showed reductions from baseline to follow-up, including anticipated stigma and identity concealment.
Anticipated stigma decreased from baseline to 5-month follow-up
Identity concealment decreased from baseline to 5-month follow-up
Minority stress mechanisms were assessed as part of the intervention's theoretical targets
LGBTQ-affirmative CBT was specifically designed to address minority stress
Not all minority stress mechanisms showed significant change (results described as reductions in 'certain' mechanisms)
Results
Universal risk mechanisms, specifically unassertiveness, showed reductions from baseline to follow-up.
Unassertiveness was identified as a universal risk mechanism that decreased over the course of treatment
Universal risk mechanisms were assessed alongside minority stress-specific mechanisms
The intervention targeted both minority stress and universal cognitive-behavioral risk factors
Assessments were conducted at baseline and 5-month follow-up
Results are described as reductions in 'certain' universal risk mechanisms, implying not all showed change
Background
LGBTQ-affirmative CBT trials have mostly enrolled cisgender sexual minorities, TGE youth, and individuals in North American contexts, leaving a gap for TGE adults in high-stigma international contexts.
LGBTQ-affirmative CBT is described as 'one of the only evidence-based interventions developed to address minority stress to improve psychosocial health'
Prior trials have not focused on TGE adults in high-stigma non-North American contexts
Romania is characterized as a high-stigma context for LGBTQ individuals
This study addresses a gap by testing the intervention with TGE adults specifically
The authors identify future randomized controlled trials as a priority
Methods
Behavioral health outcomes (e.g., hazardous drinking) and sexual health outcomes (e.g., HIV-transmission risk behavior) were assessed, though specific changes in these domains are not detailed in the abstract.
Hazardous drinking was included as a behavioral health outcome measure
HIV-transmission risk behavior was included as a sexual health outcome measure
Outcomes were assessed at baseline and 5-month follow-up
The abstract does not report specific significant changes in these behavioral or sexual health domains
Mental, behavioral, and sexual health outcomes were all part of the assessment battery
What This Means
This research suggests that a type of therapy called LGBTQ-affirmative cognitive-behavioral therapy (CBT) can be successfully delivered to transgender and gender expansive (TGE) adults living in Romania, a country with high levels of social stigma toward LGBTQ people. The study enrolled 25 TGE adults who were experiencing depression and/or anxiety, and provided them with 16 online therapy sessions led by trained psychologists. After five months, participants showed improvements in depression and anxiety symptoms, as well as reductions in experiences like anticipating stigma from others and hiding their gender identity.
Participants also found the therapy highly acceptable — they reported that it was relevant to their lives, helped them understand minority stress, and gave them hope and greater acceptance of their identities. The study also found that the therapy was feasible to run in this context, with participants being recruited on time and attending sessions regularly. These findings are particularly notable because most previous research on this type of therapy focused on cisgender (non-transgender) sexual minorities or was conducted in North America, leaving a gap in knowledge about how well it works for TGE people in other parts of the world.
This research suggests that LGBTQ-affirmative CBT holds promise as a mental health treatment for TGE individuals living in stigmatizing environments beyond North America. However, because this was a small pilot study without a comparison control group, larger and more rigorous randomized controlled trials are needed to confirm these findings. The authors also emphasize that reducing structural and societal stigma remains a critical priority alongside individual-level interventions.
Lelutiu-Weinberger C, Filimon M, Chiaramonte D, Leonard S, Dogaru B, Pana E, et al.. (2025). A Pilot Trial of an LGBTQ-Affirmative Cognitive-Behavioral Therapy for Transgender and Gender Expansive Individuals' Mental, Behavioral, and Sexual Health.. Behavior therapy. https://doi.org/10.1016/j.beth.2024.10.005