A unified protocol to address sexual minority women's minority stress, mental health and hazardous drinking

Yale University, New Haven CT

Investigators

Linked publications & trials

Abstract

PROJECT SUMMARY Background. Lesbian and bisexual women (LBW) represent one of the highest-risk groups for hazardous drinking (HD) and comorbid mental health problems (e.g., depression, anxiety) because of their exposure to identity-related stressors (i.e., stigma-related burdens) and associated stress reactions, like drinking to cope. Research has identified cognitive (e.g., expectations of rejection), affective (e.g., shame), and behavioral (e.g., avoidant coping) pathways through which identity-related stress places LBW at disproportionate risk of HD and comorbid depression/anxiety. Yet no interventions address these pathways. In fact, no HD intervention has ever been tested for efficacy with LBW. Preliminary Studies. With deep stakeholder input and NIH (R01MH109413-02S1) and foundation (Lesbian Health Fund) support, we created affirmative cognitive-behavioral therapy (ACBT). This treatment is a 10-session CBT intervention focused on improving LBW’s stress reactions by building self-affirming cognitive styles and reducing avoidant coping. In a waitlist-controlled pilot trial (n=60), ACBT showed strong promise for reducing HD and depression/anxiety by building adaptive responses to identity-related stress, making it the first intervention with preliminary efficacy for improving this population’s co-occurring behavioral and mental health challenges. Methods. We now seek to test ACBT’s efficacy and identify facilitators of scale-up of this promising intervention. Aim 1: In a 2-arm randomized controlled trial (RCT) with LBW who experience HD and comorbid depression and/or anxiety, we will test the efficacy of ACBT (n=225) against treatment-as-usual (i.e., supportive counseling) (n=225). Our primary outcome is proportion of heavy drinking days (≥4 drinks) on 30-day timeline followback. Secondary outcomes include reduction in WHO alcohol risk level and depression and anxiety. Both ACBT and treatment-as-usual will be delivered via telehealth (Zoom), for which we have found strong feasibility and acceptability. Aim 2: Assessments at baseline, 4, 8, and 12 months will determine if reductions in ACBT’s intended psychosocial mechanisms (e.g., internalized stigma, rejection sensitivity, emotion dysregulation) mediate heavy drinking reductions. To advance personalized medicine, we will also examine whether ACBT is differentially efficacious across key demographic factors and identity-related moderators. Aim 3: To prepare for implementation in frontline settings, we will conduct semi-structured interviews with directors (n=20), providers (n=20), and service users (n=20) from a network of 250 LBW-serving community centers. Applying the i-PARIHS framework will help identify facilitators that can support ACBT implementation at these centers.