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Gay Affirmative CBT (Youth)
While there has been a rise in research on interventions that incorporate affirmative practices, it is still relatively understudied. Researchers have pointed out the lack of information on applying these practices to youth populations (Craig 2013; Crisp & McCave, 2007). Statistics of depression, anxiety, and suicide highlight the vulnerability of LGBT youth, and the need for developing evidence based services and care. Drawing from existing affirmative practices, researchers are currently developing models of intervention specifically to serve youth.

Cognitive Behavioral Therapy (CBT) is an area of interest because of its potential effectiveness on LGB youth to promote healthy coping skills and problem-solving. Application of affirmative practice in CBT is intended to provide treatment that is appropriate and relevant for the client’s circumstances and experiences.

Below is a summary of the proposed CBT model guidelines developed by Shelly L. Craig, Ashley Austin, and Edward Alessi (2013):

Building positive attitude and resilience

As a core component of affirmative practice, practitioners and facilitators validate, normalize, and celebrate LGB identities, help young clients identify and express positive feelings about their identity, and identify their personal strengths. This can call for special attention to LGB culture that the young client participants in, for example, discussing cultural icons, role models, etc. (Craig, 2013, p. 262). This also involves assessing the social networks the child has, particularly their family of choice as well as their given family, and connecting youth to supportive and relevant resources (p. 262).

Acknowledging and addressing homophobia

Several key components of affirmative CBT for youth emphasize the importance of acknowledging, addressing, and validating experiences of homophobia and its impact on youths’ lives. A potential danger in CBT without an affirmative approach is that the real concerns of negative consequences due to discrimination can be classed as irrational, or maladaptive thinking (p. 260). Under affirmative CBT guidelines, it becomes the practitioner’s responsibility to differentiate problems resulting from outside stressors such as homophobic realities and problems that have to do with thought processes (p. 262). To avoid minimization of fears around real experiences, practitioners shift away from evaluating thoughts and beliefs on the basis of rationality to evaluating them on the basis of “helpfulness” (p. 263).

Another consideration related to addressing homophobia is sensitivity to the youth’s coming out process. Practitioners are cognizant of a youth’s stage in coming out, and assign homework and tasks that are appropriate for that stage. This is to minimize the potential danger the youth may face, and respect the level of disclosure the youth is willing to engage in, while celebrating “smaller” steps (p. 260, 263) This component of gay affirmative practice is also present in affirmative models of social work (Crisp & McCave, 2007).

School and Community Based Intervention
Delivering gay-affirmative CBT has taken the form of group counseling in school and community settings. A 2007 study of 218 LGB youth found that social connectedness and social support was a significant factor in youth’s psychological well-being (Detrie & Lease). Existing interventions use the importance of community, with gay-straight alliances at schools being one of the most prominent.

ASSET
One intervention in development is the Affirmative Supportive Safe and Empowering Talk (ASSET), a model that is a result from community-based participatory research (PAR) with the same community comprising the study that tested the intervention. Tested in 2013, 263 multi-ethnic students from a number of different schools in the same city, age range from 14 to 18, met together at a single school-site for 2 years for group counseling sessions. Results of this study reported an increase in students’ self-esteem and coping skills (Craig, Austin,& McInroy, 2013).

The ASSET model consists of eight sessions that cover four topical themes, two sessions each, in the following order:
 * 1) Who am I? What are my strengths?
 * 2) Where am I going and what’s in my way?
 * 3) What causes me stress and what can I do about it?
 * 4) How will I remember my brilliance? (Craig, 2013, p. 378-379).

The aim of this structure is to provide youth space to discuss their identities and process their strengths in the group, reflect on their hopes for the future and problem-solve through barriers, identify their stressors and explore healthy coping strategies, and reflect on their growth throughout the sessions.

AFFIRM
AFFIRM is another group intervention, designed for community-based service rather than school-based on account of school-based care being limited only to students (Craig & Austin, 2016, p. 138). AFFIRM was developed through ground-up participatory research that used feedback from the target community (Austin & Craig, 2015).

The intervention curriculum contains eight themed modules:


 * 1) Introduction to Cognitive Behavioral Therapy and understanding minority stress
 * 2) Understanding the impact of anti-LGBTQ attitudes and behaviors on stress
 * 3) Understanding how thoughts affect feelings
 * 4) Using thoughts to change feelings
 * 5) Exploring how activities affect feelings
 * 6) Planning to overcome counterproductive thoughts and negative feelings
 * 7) Understanding the impact of minority stress and anti-LGBTQ attitudes/behaviors on social relationships
 * 8) Developing safe, supportive and identity affirming social networks (p. 139).

Each session has a check in and review activity, main objective activity, and a group summary and debrief.

This manualized intervention was tested in a 2016 study with 30 LGBTQ youth participants and trained facilitators recruited from the community. Depression, reflective coping, stress appraisal, and perceived benefits were measured before, directly after, and three months after intervention. Findings showed that AFFIRM was effective in reducing depression levels across all intervals, with coping and appraisal increasing in some intervals. Reduction in depression was also found in the trans subset of AFFIRM participants (Austin, Craig, & D’Souza, 2017).

Being relatively new, further research is required to evaluate how well these interventions work across other communities.