Assessing Mental Health Providers' Clinical Knowledge and Skills Via an Online Training on LGBTQ-affirmative Cognitive-behavioral Therapy

• Sponsor: Yale University (Other)
• Overall Status: Completed
• CT.gov ID: NCT04559698
• Collaborator: David R. Kessler, M.D. '55 Fund for LGBTQ Mental Health Research at Yale (Other), The Fund for Lesbian and Gay Studies at Yale (Other)
• Enrollment: 121
• Location: 1
• Arms: 2
• Actual Duration (Months): 8.8
• Patients Per Site Per Month: 13.7

Study Details

Study Description

Brief Summary

The purpose of the proposed study is to train mental health providers (MHPs) at lesbian, gay, bisexual, transgender, and queer (LGBTQ) community centers across the United States in evidence-based, LGBTQ-affirmative cognitive-behavioral therapy (CBT).

Condition or Disease	Intervention/Treatment	Phase
LGBTQ	Behavioral: LGBTQ-affirmative CBT training	N/A

Detailed Description

The purpose of the proposed study is to train mental health providers (MHPs) at LGBTQ community centers across the United States in evidence-based, LGBTQ-affirmative cognitive-behavioral therapy (CBT).

The primary objective of this study is to determine whether the LGBTQ-affirmative CBT training increases LGBTQ and CBT knowledge, clinical skills, and cultural humility among a sample of MHPs from LGBTQ community centers in the U.S. The proposed prospective study will follow a 2-arm waitlist randomized-controlled trial design where one group of MHPs will be randomized to receive the intervention training (i.e., the immediate training group) in LGBTQ-affirmative CBT, and the second group of MHPs will be randomized to a waitlist control group.

The proposed mixed-methods study will consist of predominantly quantitative self-report measures, as well as a qualitative self-assessment of participants' LGBTQ-affirmative CBT clinical skills. All study measures will be administered online at three time points-- baseline, 4-months post-baseline, and 8-months post-baseline (changed prior to randomization from 3-months and 6-months, respectively)-- via the secure Yale Qualtrics survey software.

Study Design

• Study Type: Interventional
• Actual Enrollment: 121 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Health Services Research
• Official Title: Assessing Mental Health Providers' Clinical Knowledge and Skills Via an Online Training on LGBTQ-affirmative Cognitive-behavioral Therapy
• Actual Study Start Date: Oct 1, 2020
• Actual Primary Completion Date: Jun 26, 2021
• Actual Study Completion Date: Jun 26, 2021

Arms and Interventions

Arm	Intervention/Treatment
Experimental: immediate training group Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course.	Behavioral: LGBTQ-affirmative CBT training; Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
Experimental: waitlist control group Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course.	Behavioral: LGBTQ-affirmative CBT training; Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.

Outcome Measures

Primary Outcome Measures

1. Familiarity With LGBTQ-Affirmative CBT Skills [Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention]

   Familiarity with LGBTQ-affirmative CBT skills will be measured using a self-developed questionnaire by the researchers for the purpose of this study. This questionnaire consists of 7 items rated on a 5-point Likert scale for each item. An overall score of 35 (sum of all items) would be the highest possible score on the questionnaire and would indicate a high level of familiarity with LGBTQ-affirmative CBT skills.

2. Use of LGBTQ-Affirmative CBT Skills [Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention]

   Use LGBTQ-affirmative CBT skills will be measured using a self-developed questionnaire by the researchers for the purpose of this study. This questionnaire consists of 7 items rated on a 5-point Likert scale for each item. An overall score of 35 (sum of all items) would be the highest possible score on the questionnaire and would indicate a high level of use of LGBTQ-affirmative CBT skills.

Secondary Outcome Measures

1. Self-Reported LGBTQ Clinical Skills Competency [Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention]

   Competency in LGBTQ clinical skills will be measured using the Sexual Orientation Counselor Competency Scale (SOCCS) - Clinical Skills subscale. This subscale consists of 11-items from a psychometrically validated measure, based on a 7-point Likert scale assessing the extent to which respondents endorse clinical competence as related to their skills in working with clients of diverse sexual identities. For the present study, items have been adapted to specifically assess competence in clinical skills based on an LGBTQ-affirmative CBT framework. An overall score of 7 (arithmetic mean of all 11 items) would be the highest possible score and would indicate a high level of competence in LGBTQ clinical skills.

2. Applied LGBTQ Clinical Skills Competency [Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention]

   Competency in LGBTQ clinical skills will be measured by asking participants to provide responses to videos of fictional LGBTQ clients. Participants will watch 2 brief video clips (90 seconds each) of fictional clients presenting concerns they would like to address in psychotherapy. Participants will then be asked to write a brief paragraph describing what clinical approaches they would use in clinical treatment in order to address the challenges discussed by the fictional client. These written responses will be rated based on 22 items on a 2-point scale of 0 (did not mention at all), 1 (briefly discussed), and 2 (discussed in detail) to determine participants' LGBTQ-affirmative and general CBT skills. Items coded related to LGBTQ-affirmative CBT skills will not be double coded in the comparable items related to general CBT skills. Average scores will be taken such that 2 would be the highest possible score and would indicate a high level of competence in LGBTQ clinical skills.

3. Applied CBT Clinical Skills Competency [Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention]

   Competency in general CBT clinical skills will be measured by asking participants to provide responses to videos of fictional LGBTQ clients. Participants will watch 2 brief video clips (90 seconds each) of fictional clients presenting concerns they would like to address in psychotherapy. Participants will then be asked to write a brief paragraph describing what clinical approaches they would use in clinical treatment in order to address the challenges discussed by the fictional client. These written responses will be rated based on 22 items on a 2-point scale of 0 (did not mention at all), 1 (briefly discussed), and 2 (discussed in detail) to determine participants' LGBTQ-affirmative and general CBT skills. Items coded related to LGBTQ-affirmative CBT skills will not be double coded in the comparable items related to general CBT skills. Average scores will be taken such that 2 would be the highest possible score and would indicate a high level of competence in CBT clinical skills.

4. LGBTQ Cultural Humility [Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention]

   LGBTQ cultural humility will be measured using the Multidimensional Cultural Humility Scale (MCHS). This questionnaire is a 15-item self-report psychometrically validated measure assessing the extent to which respondents endorse an ability to maintain an other-oriented, interpersonal stance in relation to cultural identities most salient to clients. For the present study, items were adapted to specifically assess cultural humility as related to working with LGBTQ clients. An overall score of 90 (sum of all items) would be the highest possible score on the questionnaire and would indicate a high level of LGBTQ cultural humility.

5. Content Knowledge of Minority Stress [Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-Intervention]

   Content knowledge of minority stress will be measured using a self-developed, 10-item multiple-choice measure by the researchers for the purpose of this study and based on past minority stress research. An overall score of 10 (i.e., answering all 10-items correctly) would be the highest possible score on the measure and would indicate a high level of content knowledge of minority stress.

6. Content Knowledge of CBT/LGBTQ-Affirmative CBT [Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention]

   Content knowledge of CBT/LGBTQ-affirmative CBT will be measured using a self-developed, 10-item multiple-choice measure by the researchers for the purpose of this study based on past interventional studies of LGBTQ-affirmative CBT. An overall score of 10 (i.e., answering all 10-items correctly) would be the highest possible score on the measure and would indicate a high level of content knowledge of CBT/LGBTQ-affirmative CBT.

7. Acceptability of LGBTQ-affirmative CBT Training [Immediate Post-intervention]

   Acceptability of LGBTQ-affirmative CBT will measured using a self-developed questionnaire by the researchers based on past research on training acceptability. Participants will be asked to report how many of the 11 training sessions they attended. Participants will then be asked 2 qualitative questions in regard to which of the 11 training sessions they found most and least helpful. Participants will also be asked 7 questions based on a 5-point Likert scale regarding their interest and perceived benefit from the training. An overall score of 35 (sum of all items) on the Likert scale items would be the highest possible score on the measure and would indicate a high level of perceived acceptability of the LGBTQ-affirmative CBT training.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Inclusion Criteria:

• 18+ years old

• Fluent in English

• Mental health provider (including, but not limited to licensed practicing counselors, licensed clinical social workers, licensed marital and family therapists, clinical/counseling psychologists, pre-doctoral psychology interns, third-year or greater graduate practicum students/externs)

• Currently practicing in an LGBTQ community center that is coordinated by CenterLink, the coordinating hub for LGBTQ community centers in the U.S.

Exclusion Criteria:

• • Individuals unwilling or unable to give informed consent at the time of participation and/or not fitting the eligibility criteria outlined above

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Yale LGBTQ+ Mental Health Initiative - Research Lab	New York	New York	United States	10010

Sponsors and Collaborators

• Yale University
• David R. Kessler, M.D. '55 Fund for LGBTQ Mental Health Research at Yale
• The Fund for Lesbian and Gay Studies at Yale

Investigators

• Principal Investigator: John Pachankis, Ph.D., Associate Professor of Public Health (Social and Behavioral Sciences)

Study Documents (Full-Text)

• Study Protocol - Sep 23, 2020
• Statistical Analysis Plan - Dec 7, 2021
• Informed Consent Form - Sep 17, 2020

More Information

Publications

• Bidell, M. P. (2005). The Sexual Orientation Counselor Competency Scale: Assessing attitudes, skills, and knowledge of counselors working with lesbian, gay, and bisexual clients. Counselor Education and Supervision, 44(4), 267-279.
• Gonzalez, E., Sperandio, K. R., Mullen, P. R., & Tuazon, V. E. (2021). Development and initial testing of the Multidimensional Cultural Humility Scale. Measurement and Evaluation in Counseling and Development, 54(1), 56-70.
• Lelutiu-Weinberger C, Pachankis JE. Acceptability and Preliminary Efficacy of a Lesbian, Gay, Bisexual, and Transgender-Affirmative Mental Health Practice Training in a Highly Stigmatizing National Context. LGBT Health. 2017 Oct;4(5):360-370. doi: 10.1089/lgbt.2016.0194. Epub 2017 Sep 11.
• Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003 Sep;129(5):674-697. doi: 10.1037/0033-2909.129.5.674. Review.
• Myles, P. J., & Milne, D. L. (2004). Outcome evaluation of a brief shared learning programme in cognitive behavioural therapy. Behavioural and Cognitive Psychotherapy, 32(2), 177-188.
• Pachankis JE, McConocha EM, Clark KA, Wang K, Behari K, Fetzner BK, Brisbin CD, Scheer JR, Lehavot K. A transdiagnostic minority stress intervention for gender diverse sexual minority women's depression, anxiety, and unhealthy alcohol use: A randomized controlled trial. J Consult Clin Psychol. 2020 Jul;88(7):613-630. doi: 10.1037/ccp0000508. Epub 2020 May 21.
• Rousmaniere, T. (2017). Deliberate practice for psychotherapists: A guide to improving clinical effectiveness. Routledge/Taylor & Francis Group.
• White Hughto JM, Clark KA, Altice FL, Reisner SL, Kershaw TS, Pachankis JE. Improving correctional healthcare providers' ability to care for transgender patients: Development and evaluation of a theory-driven cultural and clinical competence intervention. Soc Sci Med. 2017 Dec;195:159-169. doi: 10.1016/j.socscimed.2017.10.004. Epub 2017 Oct 30.

• Responsible Party: Yale University
• ClinicalTrials.gov Identifier: NCT04559698
• Other Study ID Numbers: 2000028914
• First Posted: Sep 23, 2020
• Last Update Posted: Mar 14, 2022
• Last Verified: Mar 1, 2022

• Individual Participant Data (IPD) Sharing Statement: No
• Plan to Share IPD: No
• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Study Results

Participant Flow

Recruitment Details	Recruitment was conducted through an online flyer emailed to listservs of mental health providers at CenterLink LGBTQ community centers. An informal webinar was also held in October 2020 for mental health providers at CenterLink LGBTQ community centers to learn more about the study.

Arm/Group Title	Immediate Training Group	Waitlist Control Group
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
Period Title: Overall Study
STARTED	61	60
Four-month Pre-intervention	0	60
Immediate Pre-intervention	61	55
Immediate Post-intervention	52	44
Four-month Post-intervention	47	0
COMPLETED	47	44
NOT COMPLETED	14	16

Baseline Characteristics

Arm/Group Title	Immediate Training Group	Waitlist Control Group	Total
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Total of all reporting groups
Overall Participants	61	60	121
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	39.74 (11.36)	35.72 (9.33)	37.74 (10.55)
Sex/Gender, Customized (Count of Participants)
Gender Identity : Cisgender Man	14 23%	11 18.3%	25 20.7%
Gender Identity : Cisgender Woman	29 47.5%	37 61.7%	66 54.5%
Gender Identity : Transgender Man	6 9.8%	0 0%	6 5%
Gender Identity : Transgender Woman	1 1.6%	1 1.7%	2 1.7%
Gender Identity : Gender Non-Binary	4 6.6%	8 13.3%	12 9.9%
Gender Identity : Gender Non-Conforming	1 1.6%	2 3.3%	3 2.5%
Gender Identity : Genderqueer	6 9.8%	1 1.7%	7 5.8%
Gender Identity : Other	2 3.3%	3 5%	5 4.1%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	15 24.6%	9 15%	24 19.8%
Not Hispanic or Latino	46 75.4%	51 85%	97 80.2%
Unknown or Not Reported	0 0%	0 0%	0 0%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	0 0%	0 0%	0 0%
Asian	1 1.6%	2 3.3%	3 2.5%
Native Hawaiian or Other Pacific Islander	1 1.6%	0 0%	1 0.8%
Black or African American	5 8.2%	8 13.3%	13 10.7%
White	43 70.5%	38 63.3%	81 66.9%
More than one race	11 18%	11 18.3%	22 18.2%
Unknown or Not Reported	0 0%	1 1.7%	1 0.8%
Region of Enrollment (participants) [Number]
United States	60 98.4%	59 98.3%	119 98.3%
Canada	1 1.6%	0 0%	1 0.8%
Uganda	0 0%	1 1.7%	1 0.8%
Sexual Orientation (Count of Participants)
Asexual	1 1.6%	1 1.7%	2 1.7%
Bisexual	6 9.8%	7 11.7%	13 10.7%
Gay	13 21.3%	9 15%	22 18.2%
Heterosexual/Straight	14 23%	14 23.3%	28 23.1%
Lesbian	9 14.8%	9 15%	18 14.9%
Pansexual	7 11.5%	6 10%	13 10.7%
Queer	11 18%	13 21.7%	24 19.8%
Other	0 0%	1 1.7%	1 0.8%
Education Degree (Count of Participants)
High School/GED or Associate's Degree	2 3.3%	0 0%	2 1.7%
Bachelor's Degree	6 9.8%	14 23.3%	20 16.5%
Master's Degree	50 82%	45 75%	95 78.5%
Doctoral Degree	3 4.9%	1 1.7%	4 3.3%
Employment Status (Count of Participants)
Full-Time (40 Hours Per Week)	37 60.7%	29 48.3%	66 54.5%
Part-Time (Less Than 40 Hours Per Week)	19 31.1%	12 20%	31 25.6%
Practicum Student/Intern	3 4.9%	13 21.7%	16 13.2%
Other	2 3.3%	6 10%	8 6.6%
Theoretical Orientation (Count of Participants)
Cognitive Behavioral (CBT)	10 16.4%	17 28.3%	27 22.3%
Existential	0 0%	1 1.7%	1 0.8%
Humanistic/Person-Centered	15 24.6%	14 23.3%	29 24%
Psychodynamic/Psychoanalytic	2 3.3%	3 5%	5 4.1%
Solution-Focused	9 14.8%	4 6.7%	13 10.7%
Third-Wave CBT	1 1.6%	0 0%	1 0.8%
Eclectic or Integrative	23 37.7%	21 35%	44 36.4%
Missing	1 1.6%	0 0%	1 0.8%
Primary Mode of Psychotherapy (Count of Participants)
Individual Therapy	52 85.2%	46 76.7%	98 81%
Family Therapy	1 1.6%	0 0%	1 0.8%
Group Therapy	7 11.5%	9 15%	16 13.2%
Other	1 1.6%	5 8.3%	6 5%
Age of Clients (Count of Participants)
<5-12	2 3.3%	2 3.3%	4 3.3%
13-17	5 8.2%	7 11.7%	12 9.9%
18-30	29 47.5%	29 48.3%	58 47.9%
31-50	23 37.7%	19 31.7%	42 34.7%
51-65+	2 3.3%	3 5%	5 4.1%
Number of Years Working in Mental Health (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	6.85 (7.42)	5.40 (6.77)	6.13 (7.11)
Number of Years Working with LGBTQ Clients (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	4.33 (5.37)	2.82 (2.95)	3.58 (4.39)

Outcome Measures

1. Primary Outcome

Title	Familiarity With LGBTQ-Affirmative CBT Skills
Description	Familiarity with LGBTQ-affirmative CBT skills will be measured using a self-developed questionnaire by the researchers for the purpose of this study. This questionnaire consists of 7 items rated on a 5-point Likert scale for each item. An overall score of 35 (sum of all items) would be the highest possible score on the questionnaire and would indicate a high level of familiarity with LGBTQ-affirmative CBT skills.
Time Frame	Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention

Outcome Measure Data

Analysis Population Description

Participants in the Immediate training group started training immediately after randomization, and therefore, have no data for the four-month waiting period prior to receiving the intervention. Participants in the Waitlist control group started training four months after randomization and therefore, were not assessed at the four-month follow-up time point due to completion of the study.

Arm/Group Title	Immediate Training Group	Waitlist Control Group
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
Measure Participants	61	60
Four-month Pre-intervention	19.00 (0.66)
Immediate Pre-intervention	18.30 (0.76)	19.70 (0.76)
Immediate Post-intervention	24.34 (0.66)	25.46 (0.79)
Four-month Post-intervention	25.57 (0.66)

2. Primary Outcome

Title	Use of LGBTQ-Affirmative CBT Skills
Description	Use LGBTQ-affirmative CBT skills will be measured using a self-developed questionnaire by the researchers for the purpose of this study. This questionnaire consists of 7 items rated on a 5-point Likert scale for each item. An overall score of 35 (sum of all items) would be the highest possible score on the questionnaire and would indicate a high level of use of LGBTQ-affirmative CBT skills.
Time Frame	Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention

Outcome Measure Data

Analysis Population Description

Participants in the Immediate training group started training immediately after randomization, and therefore, have no data for the four-month waiting period prior to receiving the intervention. Participants in the Waitlist control group started training four months after randomization and therefore, were not assessed at the four-month follow-up time point due to completion of the study.

Arm/Group Title	Immediate Training Group	Waitlist Control Group
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
Measure Participants	61	60
Four-month Pre-intervention	17.53 (0.66)
Immediate Pre-intervention	16.77 (0.67)	18.46 (0.77)
Immediate Post-intervention	22.93 (0.72)	23.61 (0.77)
Four-month Post-intervention	24.02 (0.69)

3. Secondary Outcome

Title	Self-Reported LGBTQ Clinical Skills Competency
Description	Competency in LGBTQ clinical skills will be measured using the Sexual Orientation Counselor Competency Scale (SOCCS) - Clinical Skills subscale. This subscale consists of 11-items from a psychometrically validated measure, based on a 7-point Likert scale assessing the extent to which respondents endorse clinical competence as related to their skills in working with clients of diverse sexual identities. For the present study, items have been adapted to specifically assess competence in clinical skills based on an LGBTQ-affirmative CBT framework. An overall score of 7 (arithmetic mean of all 11 items) would be the highest possible score and would indicate a high level of competence in LGBTQ clinical skills.
Time Frame	Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention

Outcome Measure Data

Analysis Population Description

Participants in the Immediate training group started training immediately after randomization, and therefore, have no data for the four-month waiting period prior to receiving the intervention. Participants in the Waitlist control group started training four months after randomization and therefore, were not assessed at the four-month follow-up time point due to completion of the study.

Arm/Group Title	Immediate Training Group	Waitlist Control Group
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
Measure Participants	61	60
Four-month Pre-intervention	3.30 (0.19)
Immediate Pre-intervention	3.31 (0.17)	3.14 (0.18)
Immediate Post-intervention	5.05 (0.15)	5.03 (0.19)
Four-month Post-intervention	5.33 (0.13)

4. Secondary Outcome

Title	Applied LGBTQ Clinical Skills Competency
Description	Competency in LGBTQ clinical skills will be measured by asking participants to provide responses to videos of fictional LGBTQ clients. Participants will watch 2 brief video clips (90 seconds each) of fictional clients presenting concerns they would like to address in psychotherapy. Participants will then be asked to write a brief paragraph describing what clinical approaches they would use in clinical treatment in order to address the challenges discussed by the fictional client. These written responses will be rated based on 22 items on a 2-point scale of 0 (did not mention at all), 1 (briefly discussed), and 2 (discussed in detail) to determine participants' LGBTQ-affirmative and general CBT skills. Items coded related to LGBTQ-affirmative CBT skills will not be double coded in the comparable items related to general CBT skills. Average scores will be taken such that 2 would be the highest possible score and would indicate a high level of competence in LGBTQ clinical skills.
Time Frame	Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention

Outcome Measure Data

Analysis Population Description

Participants in the Immediate training group started training immediately after randomization, and therefore, have no data for the four-month waiting period prior to receiving the intervention. Participants in the Waitlist control group started training four months after randomization and therefore, were not assessed at the four-month follow-up time point due to completion of the study.

Arm/Group Title	Immediate Training Group	Waitlist Control Group
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
Measure Participants	61	60
Four-month Pre-intervention	0.12 (0.02)
Immediate Pre-intervention	0.11 (0.02)	0.14 (0.02)
Immediate Post-intervention	0.24 (0.03)	0.31 (0.03)
Four-month Post-intervention	0.22 (0.03)

5. Secondary Outcome

Title	Applied CBT Clinical Skills Competency
Description	Competency in general CBT clinical skills will be measured by asking participants to provide responses to videos of fictional LGBTQ clients. Participants will watch 2 brief video clips (90 seconds each) of fictional clients presenting concerns they would like to address in psychotherapy. Participants will then be asked to write a brief paragraph describing what clinical approaches they would use in clinical treatment in order to address the challenges discussed by the fictional client. These written responses will be rated based on 22 items on a 2-point scale of 0 (did not mention at all), 1 (briefly discussed), and 2 (discussed in detail) to determine participants' LGBTQ-affirmative and general CBT skills. Items coded related to LGBTQ-affirmative CBT skills will not be double coded in the comparable items related to general CBT skills. Average scores will be taken such that 2 would be the highest possible score and would indicate a high level of competence in CBT clinical skills.
Time Frame	Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention

Outcome Measure Data

Analysis Population Description

Participants in the Immediate training group started training immediately after randomization, and therefore, have no data for the four-month waiting period prior to receiving the intervention. Participants in the Waitlist control group started training four months after randomization and therefore, were not assessed at the four-month follow-up time point due to completion of the study.

Arm/Group Title	Immediate Training Group	Waitlist Control Group
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
Measure Participants	61	60
Four-month Pre-intervention	0.12 (0.01)
Immediate Pre-intervention	0.10 (0.01)	0.12 (0.01)
Immediate Post-intervention	0.17 (0.03)	0.11 (0.02)
Four-month Post-intervention	0.14 (0.02)

6. Secondary Outcome

Title	LGBTQ Cultural Humility
Description	LGBTQ cultural humility will be measured using the Multidimensional Cultural Humility Scale (MCHS). This questionnaire is a 15-item self-report psychometrically validated measure assessing the extent to which respondents endorse an ability to maintain an other-oriented, interpersonal stance in relation to cultural identities most salient to clients. For the present study, items were adapted to specifically assess cultural humility as related to working with LGBTQ clients. An overall score of 90 (sum of all items) would be the highest possible score on the questionnaire and would indicate a high level of LGBTQ cultural humility.
Time Frame	Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention

Outcome Measure Data

Analysis Population Description

Participants in the Immediate training group started training immediately after randomization, and therefore, have no data for the four-month waiting period prior to receiving the intervention. Participants in the Waitlist control group started training four months after randomization and therefore, were not assessed at the four-month follow-up time point due to completion of the study.

Arm/Group Title	Immediate Training Group	Waitlist Control Group
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
Measure Participants	61	60
Four-month pre-intervention	75.28 (0.83)
Immediate pre-intervention	76.48 (0.90)	75.76 (1.03)
Immediate post-intervention	77.34 (0.88)	77.27 (1.27)
Four-month Post-intervention	78.55 (0.74)

7. Secondary Outcome

Title	Content Knowledge of Minority Stress
Description	Content knowledge of minority stress will be measured using a self-developed, 10-item multiple-choice measure by the researchers for the purpose of this study and based on past minority stress research. An overall score of 10 (i.e., answering all 10-items correctly) would be the highest possible score on the measure and would indicate a high level of content knowledge of minority stress.
Time Frame	Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-Intervention

Outcome Measure Data

Analysis Population Description

Participants in the Immediate training group started training immediately after randomization, and therefore, have no data for the four-month waiting period prior to receiving the intervention. Participants in the Waitlist control group started training four months after randomization and therefore, were not assessed at the four-month follow-up time point due to completion of the study.

Arm/Group Title	Immediate Training Group	Waitlist Control Group
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
Measure Participants	61	60
Four-month Pre-intervention	7.15 (0.19)
Immediate Pre-intervention	7.02 (0.19)	7.04 (0.26)
Immediate Post-intervention	8.05 (0.21)	7.63 (0.34)
Four-month Post-intervention	7.82 (0.24)

8. Secondary Outcome

Title	Content Knowledge of CBT/LGBTQ-Affirmative CBT
Description	Content knowledge of CBT/LGBTQ-affirmative CBT will be measured using a self-developed, 10-item multiple-choice measure by the researchers for the purpose of this study based on past interventional studies of LGBTQ-affirmative CBT. An overall score of 10 (i.e., answering all 10-items correctly) would be the highest possible score on the measure and would indicate a high level of content knowledge of CBT/LGBTQ-affirmative CBT.
Time Frame	Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention

Outcome Measure Data

Analysis Population Description

Participants in the Immediate training group started training immediately after randomization, and therefore, have no data for the four-month waiting period prior to receiving the intervention. Participants in the Waitlist control group started training four months after randomization and therefore, were not assessed at the four-month follow-up time point due to completion of the study.

Arm/Group Title	Immediate Training Group	Waitlist Control Group
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
Measure Participants	61	60
Four-month Pre-intervention	5.48 (0.21)
Immediate Pre-intervention	5.36 (0.24)	5.46 (0.26)
Immediate Post-intervention	6.77 (0.30)	6.80 (0.32)
Four-month Post-intervention	6.48 (0.28)

9. Secondary Outcome

Title	Acceptability of LGBTQ-affirmative CBT Training
Description	Acceptability of LGBTQ-affirmative CBT will measured using a self-developed questionnaire by the researchers based on past research on training acceptability. Participants will be asked to report how many of the 11 training sessions they attended. Participants will then be asked 2 qualitative questions in regard to which of the 11 training sessions they found most and least helpful. Participants will also be asked 7 questions based on a 5-point Likert scale regarding their interest and perceived benefit from the training. An overall score of 35 (sum of all items) on the Likert scale items would be the highest possible score on the measure and would indicate a high level of perceived acceptability of the LGBTQ-affirmative CBT training.
Time Frame	Immediate Post-intervention

Outcome Measure Data

Analysis Population Description

This outcome was collected only during the assessment immediately following the intervention for each group.

Arm/Group Title	Immediate Training Group	Waitlist Control Group
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
Measure Participants	52	44
Mean (Standard Error) [score on a scale]	31.10 (4.17)	30.57 (5.16)

Adverse Events

Time Frame	Adverse events were monitored from baseline through completion of the final follow-up assessment at 8 months.
Arm/Group Title	Immediate Training Group		Waitlist Control Group
Arm/Group Description	Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.		Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. LGBTQ-affirmative CBT training: Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.
All Cause Mortality
	Immediate Training Group		Waitlist Control Group
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/61 (0%)		0/60 (0%)
Serious Adverse Events
	Immediate Training Group		Waitlist Control Group
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/61 (0%)		0/60 (0%)
Other (Not Including Serious) Adverse Events
	Immediate Training Group		Waitlist Control Group
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/61 (0%)		0/60 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.