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An introduction to LGBTQ+ affirmative based CBT

Steven Safren

9 Oct 2023


From an early age, due to issues including sexual minority stress, stigma, and alienation, related LGBTQ+ individuals are significantly more likely to experience various forms of clinically significant distress compared to heterosexual individuals. This can affect other health disparities and health behaviors. There is therefore a need for affirmative based approaches to address these concerns. Cognitive behavior therapy (CBT) is well suited to improving cognitive, affective, and behavioral minority stress processes for multiple reasons. This webinar will serve as an introduction to the field of affirmative, empirically supported CBT with LGBTQ+ clients.


This webinar will start with a presentation of a framework for affirmative, empirically supported cognitive-behavioral therapy (CBT) with LGBTQ+ clients. It will emphasise the importance of guidelines for competent assessment and treatment, and provide information about where such guidance can be found. It will describe several intervention that take an affirmative based approach and include both mental health and health related behavior change counselling. ESTEEM (Effective Skills to Empower Effective Men - ESTEEM), is the first intervention to address the psychological pathways through which minority stress undermines young sexual minority men’s (SMM’s) mental and sexual health using transdiagnostic cognitive-behavioral therapy. THRIVE involves using cognitive therapy to address childhood sexual abuse histories in gay men, and IMPACT uses behavioural activation to address stimulant use and sexual health. The webinar will include guidance on helping individuals work through unique stresses related sexual minority concerns. Case illustrations and practical tools/worksheets will be presented to assist clinicians incorporate these techniques into their practice.

Learning Objectives

• To learn about the framework for affirmative, empirically supported CBT for LGBTQ+ clients
• To be able to identify materials needed for a high quality assessment of difficulties experienced by LGBTQ+ clients
• To understand the rationale and content behind the ESTEEM, THRIVE, and IMPACT interventions
• To gain knowledge on how to help individuals cope with stresses related sexual minority status

Training Modalities

The primary training modality will be didactic with case illustrations. However, interactivity in the form of polls and Q&A will be present throughout.

Key References

Pachankis, J. E., Harkness, A., Maciejewski, K. R., Behari, K., Clark, K. A., McConocha, E., ... & Safren, S. A. (2022). LGBQ-affirmative cognitive-behavioral therapy for young gay and bisexual men’s mental and sexual health: A three-arm randomized controlled trial. Journal of consulting and clinical psychology, 90(6), 459.

Pachankis, J. E., & Safren, S. A. (Eds.). (2019). Handbook of evidence-based mental health practice with sexual and gender minorities. Oxford University Press, USA.

O’Cleirigh C, Safren SA, Taylor SW, Goshe BM, Bedoya CA, Marquez SM, Boroughs, MS, Shipherd J. Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial. AIDS and Behavior. 2019; 23(9):2421-2431.

Mimiaga MJ, Pantalone DW, Biello KB, Hughto JMW, Frank J, O’Cleirigh C, Reisner SL, Restar A, Mayer KH, Safren SA. An Initial Randomized Controlled Trial of Behavioral Activation for Treatment of Concurrent Crystal Methamphetamine Dependence and Sexual Risk for HIV Acquisition among Men Who Have Sex with Men. AIDS Care. 2019; 31(9):1083-1095.

Balsam, K. F., Martell, C. R., Jones, K. P., & Safren, S. A. (2019). Affirmative cognitive behavior therapy with sexual and gender minority people. In G. Y. Iwamasa & P. A. Hays (Eds.), Culturally responsive cognitive behavior therapy: Practice and supervision (pp. 287–314). American Psychological Association.

Boroughs, M. S., Bedoya, C. A., O'Cleirigh, C., & Safren, S. A. (2015). Toward defining, measuring, and evaluating LGBT cultural competence for psychologists. Clinical Psychology: Science and Practice, 22(2), 151.

About the presenter

Professor Safren is the Director of the UM Center for HIV and Research in Mental Health (NIMH-funded AIDS Research Center) and the Health Promotion and Care Research Program where he studies health behavior change, with a particular emphasis on mental health and substance use components of HIV prevention and treatment domestically and internationally. For example, he has developed and tested adherence and combined depression/adherence interventions that are being used globally. Within HIV prevention, many of his projects investigate social, contextual, and behavioral health issues related to sexual and gender minority populations. He joined the Department of Psychology at the University in of Miami in 2015 after 18 years working in the Harvard Medical School system at Massachusetts General Hospital where he was a Professor and Director of the Behavioral Medicine Service, and led behavioral science studies at Fenway Health. He has been PI or protocol chair of 18 federally funded studies (via NIMH, NIDA, and NIAID), and, in addition to studies where he is PI, he has regularly served as co-PI, co-investigator, or mentor on studies related to HIV prevention and treatment. Finally, he developed and tested one of the only evidenced-based psychosocial treatments for ADHD in adults, and extended that to adolescents.

Professor Safren is President-Elect of ABCT

Who should attend

The webinar is for any practitioner of CBT who wishes to enhance their clinical practice by developing skills for working with the LGBTQ+ community

Low Intensity clinical contact hours survey - BABCP Low Intensity Special Interest Group

Please click below if you are interested in contributing to the survey.


The BACP Low Intensity SIG are interested in the impact of clinical contact hours on Low Intensity/Wellbeing Practitioner wellbeing. This questionnaire contains six multi-choice questions and a free text box for you to share your experiences. The answers to these questions will help the BABCP SIG plan how to meet CPD topics and other developments within the SIG.  The SIG hope to produce a write up of the answers to this questionnaire to be shared with SIG members and to be used in training.

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This FREE conference is for Psychological Wellbeing Practitioners working in Talking Therapies for Anxiety and Depression services and is brought to you by Bespoke Mental Health in collaboration with the NHS England Talking Therapies National PWP Leads Network

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