Uncovering Clinical Principles and Techniques to Address Minority Stress, Mental Health, and Related Health Risks Among Gay and Bisexual Men

Abstract

Gay and bisexual men disproportionately experience depression, anxiety, and related health risks at least partially because of their exposure to sexual minority stress. This paper describes the adaptation of an evidence-based intervention capable of targeting the psychosocial pathways through which minority stress operates. Interviews with key stakeholders, including gay and bisexual men with depression and anxiety and expert providers, suggested intervention principles and techniques for improving minority stress coping. These principles and techniques are consistent with general cognitive behavioral therapy approaches, the empirical tenets of minority stress theory, and professional guidelines for LGB-affirmative mental health practice. If found to be efficacious, the psychosocial intervention described here would be one of the first to improve the mental health of gay and bisexual men by targeting minority stress.

Keywords: cognitive behavioral therapy; gay and bisexual men; mental health; minority stress; stigma.

Figures

Figure 1

Minority stress pathway framework (see Hatzenbuehler, 2009). Notes. Figure includes treatment principles (P) and techniques (T) guiding the intervention adaptation process. Principles:

1. P1

   Normalize mental health consequences of minority stress

2. P2

   Rework negative cognitions stemming from early and ongoing minority stress experiences

3. P3

   Empower gay and bisexual men to communicate openly and assertively across contexts

4. P4

   Validate gay and bisexual men’s unique strengths

5. P5

   Affirm healthy, rewarding expressions of sexuality

6. P6

   Facilitate supportive relationships

Techniques:

1. T1

   Consciousness-raising

2. T2

   Self-affirmation

3. T3

   Emotion awareness and acceptance

4. T4

   Restructuring minority stress cognitions

5. T5

   Decreasing avoidance (of cognitive, affective, and interpersonal experiences)

6. T6

   Assertiveness training