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NCT Number: NCT04318769

An Affirmative Coping Skills Intervention to Improve Mental and Sexual Health of Sexual and Gender Minority Youth

AFFIRM is an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviours and psychosocial distress among SGMY. AFFIRM is delivered by two facilitators (primarily social workers and peers) through a combination of education and rehearsal (i.e., simulation of real-life experiences) in a manner that affirms participants' sexual and gender minority identities and experiences. AFFIRM is being tested in a five-year trial using a stepped wedge waitlist crossover design, where all participants receive the intervention in clusters.

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Key information

About this study

Session 1 focus

Introduction to cognitive behavioral therapy (CBT), exploring lesbian, gay, bisexual, transgender, and queer (LGBTQ)+ identities, and understanding minority stress.

Session 1 activities

Introductions

Discussing the theory and purpose of CBT approaches

Exploring stress and minority stress

Understanding the causes of stress in our lives

Session 2 focus

Understanding the impact of anti-LGBTQ attitudes and behaviors on stress.

Session 2 activities

Check in and review

Examining homophobia, heterosexism, and transphobia at the individual, institutional, and cultural level

Identifying how these experiences impact thoughts, feelings, and behaviors

Fostering strategies for both coping with and combating anti-LGBTQ discrimination at all levels

Session 3 focus

Understanding how thoughts impact feelings.

Session 3 activities

Check in and review

Distinguishing between thoughts and feelings

Exploring how thoughts influence feelings and behaviors

Identifying counterproductive thinking patterns

Recognizing negative self-talk and feelings of hopelessness

Learning thought stopping

Session 4 focus

Using thoughts to change feelings.

Session 4 activities

Check in and review

Increasing positive thinking and feelings of hope

Changing negative thoughts to positive thoughts

Challenging negative thinking and internalized homophobia/negative feelings through the ABCD (activating event, belief, consequence, and debate) method

Session 5 focus

Exploring how activities impact feelings.

Session 5 activities

Check in and review

Examining the impact of various activities on feelings

Identifying supportive and identity-affirming activities

The impact of LGBTQ-affirming activities on feelings

Session 6 focus

Planning to overcome counterproductive thoughts and negative feelings.

Session 6 activities

Check in and review

Distinguishing between clear and unclear goals

Identifying short, mid-, and long-term goals

Creating a sexual health plan

Fostering hope for the future

Session 7 focus

Understanding the impact of minority stress and anti-LGBTQ attitudes or behaviors on social relationships.

Session 7 activities

Check in and review

Anti-LGBTQ discrimination can lead to feelings of discomfort around others

Responding to discrimination or harassment in social situations

Learning to be assertive

Session 8 focus

Putting it all together: developing safe, supportive, and identity-affirming social networks.

Session 8 activities

Check in and review

Maintaining a healthy social network: attending to thoughts, expectations, feelings, and behaviors within relationships

Identifying a plan for building a supportive network

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Aged 14 to 29 years at time of screening
  • Identifies as a sexual and/or gender minority
  • Reads, writes, and speaks fluent English
  • Is interested in participating in the 8-session AFFIRM intervention

Exclusion criteria

  • Assessed to be in crisis (i.e., high risk of suicidality)
  • Warrenting a more intensive intervention

Treatment and study plan

AFFIRM

Behavioral

AFFIRM is an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviours and psychosocial distress among SGMY. AFFIRM is delivered by two facilitators (primarily social workers and peers) through a combination of education and rehearsal (i.e., simulation of real-life experiences) in a manner that affirms participants' sexual and gender minority identities and experiences.

Primary outcomes

  1. Feasibility - participant attendance at group sessions

    Time frame: week 56

    Proportions of participants that enroll, commence, and complete the intervention.

  2. Acceptability - participant satisfaction with group sessions

    Time frame: week 56

    Participants will complete a satisfaction questionnaire.

Secondary outcomes

  1. Intervention fidelity - how closely facilitators adhere to intervention model

    Time frame: Study period sessions 1-8 (weeks 1-8)

    Independent coders will complete a checklist questionnaire of AFFIRM intervention items, based on the manual, to determine how closely intervention facilitators adhered to the model

Other outcomes

  1. Change in Sexual Health Capacity Scale

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    Four items. Scores range from 4 to 16. Higher scores mean better outcomes.

  2. Abstinence Self-Efficacy Scale

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    Five items. Scores range from 5 to 20. Higher scores mean better outcomes.

  3. Protection Self-Efficacy Scale

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    Eight items. Scores range from 8 to 32. Higher scores mean better outcomes

  4. Change in DSM 5a Self-Rated Level 1 Cross-Cutting Symptom Measure - Child

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    Twenty items. Scores range from 0 to 80. Lower scores mean better outcomes.

  5. Change in Current Mood Scale

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    Six items. Scores range from 0 to 60. Lower scores mean better outcomes.

  6. Change in Beck Depression Inventory-II

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    Twenty items. Scores range from 0 to 80. Lower scores mean better outcomes.

  7. Change in Brief COPE Scale

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    28 items. Scores range from 28 to 112. Higher scores mean better outcomes.

  8. Change in Proactive Coping Inventory for Adolescents-A - Reflective Coping Subscale

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    11 items. Scores range from 0 to 33. Higher scores mean better outcomes.

  9. Change in Stress Appraisal Measure for Adolescents

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    13 items. Scores range from 13 to 65. Higher scores mean better outcomes.

  10. Change in Adult Hope Scale

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    12 items. Scores range from 12 to 96. Higher scores mean better outcomes.

  11. Change in Internalized Homophobia Scale

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    10 items. Score range from 10 to 100. Lower scores mean better outcomes.

  12. Change in Everyday Discrimination Scale

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    7 items. Scores range from 7 to 42. Higher scores mean better outcomes.

  13. Change in LGBTQ Microaggressions Scale

    Time frame: Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56)

    15 items. Scores from 0 to 75. Lower scores mean better outcomes.

Sponsors and collaborators

Lead sponsor

University of Toronto

Other

Registry information

Official study title

An Affirmative Coping Skills Intervention to Improve Mental and Sexual Health of Sexual and Gender Minority Youth (AFFIRM): A Stepped Wedge Waitlist Crossover Trial

Acronym: AFFIRM

Important dates

Study start
2017
Primary completion
2025
Study completion
2025
First posted
Mar 24, 2020
Registry last updated
Apr 1, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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