Assessing Mental Health Providers' Clinical Knowledge and Skills Via an Online Training on LGBTQ-affirmative Cognitive-behavioral Therapy
Phase: NA
Conditions: LGBTQ
Sponsor: Yale University

NCT04559698 
Title of Research Project: Assessing mental health providers’ clinical knowledge and skills via 
an online training on LGBTQ-affirmative cognitive-behavioral therapy 
Date: 9.23.20 
 

APPROVED BY THE YALE UNIVERSITY IRB 9/29/2020
STUDY PROTOCOL
Social Behavioral Template
   
Assessing mental health providers clinical 
knowledge and skills via an online training 
on LGBTQ-affirmative cognitive-behavioral 
therapy 
 Protocol Number
2000028914
 
Protocol Version
09/23/2020
 Version #2
Clinical Trials Registration Number (if applicable): NCT04559698
 
Confidentiality Statement
APPROVED BY THE YALE UNIVERSITY IRB 9/29/2020

APPROVED BY THE YALE UNIVERSITY IRB 9/29/2020
Protocol Number: 2000028914
09/23/2020, Version #2
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Synopsis
Purpose
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). We will 
assess changes in MHPs’ knowledge and clinical skills in providing mental health care for 
LGBTQ clients from baseline to 3-months post-baseline and 6-months post-baseline using 
a randomized-waitlist-controlled study design. We will also evaluate the training’s 
feasibility and acceptability.
Objectives
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 United States. The secondary 
objective is to evaluate the feasibility and acceptability of the 11-weekly 1-hour training 
seminars.
Study Population
The study population will consist of healthy participants who are 18 year of age or older, 
fluent in English, and currently in the role of an MHP at an LGBTQ community center in 
the U.S. engaging in treatment with LGBTQ clients. MHPs from LGBTQ community 
centers through CenterLink, the coordinating hub of 250+ LGBTQ community centers in 
the U.S., will specifically be recruited for this study in order to provide evidence-based 
LGBTQ-affirmative training to MHPs working predominantly with individuals from the 
LGBTQ community. 
Number of Participants
We plan to enroll at least 76 participants (n = 38 per group). Our team’s prior pilot studies 
assessing the efficacy of LGBTQ-affirmative health trainings have demonstrated 
moderate-to-large effect sizes in improving healthcare providers’ LGBTQ-affirmative 
clinical skills and willingness to provide LGBTQ-affirmative clinical care (d = 0.66-1.20; 
Lelutiu-Weinberger, Clark, & Pachankis, in preparation; Lelutiu-Weinberger & Pachankis, 
2017; White Hughto, Clark, et al., 2017). Based on the most conservative effect size 
drawn from our team’s previous LGBTQ-affirmative training studies for healthcare 
providers (d = 0.66), we conducted a power analysis for an independent samples t-test 
used to compare the mean of a continuous measurement in two samples. We set the 
threshold probability for rejecting the null hypothesis (type I error rate) to α (two-tailed) = 
0.05. Power to detect Type I error was fixed at a standard level of 1 – β = 0.80 (type II 
error rate). Given these parameters, we require 38 participants per group (N = 76) to 
retain statistical power. We expect to enroll at minimum 38 participants per group; due to 
the high need and reach of our recruitment partner (i.e., CenterLink, the coordinating hub 
of 250+ LGBTQ community centers in the U.S.), we expect to enroll at least 100 
participants which will allow for adequate statistical power even with 20% attrition.
 
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Study Design
The proposed prospective study will follow a 2-arm waitlist randomized-controlled trial 
(RCT) 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 training will be 
conducted online via Zoom for 1-hour per week over two separate 11-week courses (i.e., 
the first 11 weeks for the immediate training group, and the second 11 weeks for the 
waitlist control group). A team of four clinical and counseling psychologists (the PI, two 
postdoctoral psychologists, and one associate research scientist) will lead the training. All 
trainers have participated in the development, research, and implementation of the 
LGBTQ-affirmative CBT treatment. 
To assess intervention efficacy, participants will be assessed at three time-points: 
baseline, 3-months post-baseline, and 6-months post-baseline. Participants randomized 
to the immediate training group will be scheduled to receive the first iteration of the 11-
week LGBTQ-affirmative CBT training (scheduled for October 30, 2020 – January 29, 
2021, excluding holidays of November 27, December 25, and January 1). Participants 
randomized to the waitlist control group will receive one e-mail per month to remind them 
of their upcoming training and 3-month post-baseline assessment, and will then be 
scheduled for the second iteration of the 11-week LGBTQ-affirmative CBT training (March 
5, 2021 – May 21, 2021, excluding the holiday of April 9). Participants randomized to the 
immediate training group will receive the training between their baseline and 3-month 
post-baseline assessments. Participants randomized to the waitlist control group will 
receive the training between their 3-month post-baseline and 6-month post-baseline 
assessments. 
The proposed mixed-methods study will consist of 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 via the secure Yale Qualtrics survey 
software.
Study Duration
The entire study, including data analysis, is expected to last until July 2021. Participation 
for the subjects will begin at the beginning of October 2020 (i.e., recruitment for the 
intervention training at an optional informational webinar). Subjects in the immediate 
training group will begin the 11-week training on October 30, 2020, finish the training on 
January 29, 2021, and complete their 6-months post-baseline measures in mid-May 2021. 
The waitlist control group will remain on the waitlist until the immediate training group 
completes the training. Then, starting on March 5, 2021, the waitlist control group will 
receive the same 11-week training. Their participation will end upon completion of the 
training and the 6-months post-baseline measures in mid-May 2021. Data analysis is 
expected to continue to July 2021. 
Outcome Variables
The following are the outcome variables and associated measures that will be 
administered at all three time points (i.e., baseline, 3-months post-baseline, and 6-months 
post-baseline) in the study, unless otherwise noted:
o
LGBTQ Clinical Skills Competency
o
Sexual Orientation Counselor Competency Scale (SOCCS) – Clinical Skills 
subscale
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o
Deliberate Practice of LGBTQ-Affirmative CBT Skills
o
Cultural Humility
o
Multidimensional Cultural Humility Scale (MCHS)
o
Content Knowledge, Familiarity, and Use of Minority Stress & CBT
o
Minority Stress Content Knowledge Quiz
o
CBT/LGBTQ-Affirmative CBT Content Knowledge Quiz
o
Familiarity and Use of LGBTQ-Affirmative CBT Skills Questionnaire
o
Acceptability of LGBTQ-affirmative CBT Training
o
Acceptability of LGBTQ-affirmative CBT Training Questionnaire (only 
administered immediately after the training)
o
Training in LGBTQ-Affirmative CBT – Session Feedback Forms 
(administered immediately after each training session)
Locations/Facilities
The training and online surveys will be completed from the participants’ electronic devices 
(e.g., phones, tablets, or computers). All trainings will be conducted via the PI or 
postdoctoral researchers’ Yale-affiliated Zoom videoconferencing accounts and require a 
passcode to enter. All measures will be conducted utilizing the secure Yale Qualtrics 
online survey software. 
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Abbreviations
Abbreviation 
Explanation
CBT
Cognitive-Behavioral Therapy
LGBTQ
Lesbian, gay, bisexual, transgender, and 
queer
MCHS
Multidimensional Cultural Humility Scale
MHP
Mental health provider
RCT
Randomized-controlled trial
SOCCS
Sexual Orientation Counselor 
Competency Scale
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Glossary of Terms
Glossary
Explanation
Cognitive-Behavioral Therapy (CBT)
A short term, structured, problem-
solving form of evidence-based 
psychotherapy based on a framework 
focused on the relationship between 
thoughts, feelings, and behaviors.
Minority stress
The unique and chronic stress (or 
stigma) that sexual minority individuals 
experience because of the inferior social 
status that social structures, institutions, 
policies, and social interactions 
communicate about individuals who do 
not identify as heterosexual.
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Table of Contents
Synopsis....................................................................................................................................2
Purpose .................................................................................................................................2
Objectives .............................................................................................................................2
Study Population..................................................................................................................2
Number of Participants .......................................................................................................2
Study Design ........................................................................................................................3
Study Duration......................................................................................................................3
Outcome Variables..............................................................................................................3
Locations/Facilities ..............................................................................................................4
Abbreviations............................................................................................................................5
Glossary of Terms...................................................................................................................6
Protocol Revision History.....................................................................................................10
1
Background ......................................................................................................................11
1.1
Background ............................................................................................................11
1.2
Prior Experience (if applicable) ...........................................................................13
2
Rationale/Significance ....................................................................................................14
2.1
Rationale and Study Significance.......................................................................14
2.2
Risks........................................................................................................................14
2.3
Anticipated Benefits ..............................................................................................15
3
Study Purpose and Objectives......................................................................................15
3.1
Purpose...................................................................................................................15
3.2
Hypothesis..............................................................................................................15
3.3
Objectives...............................................................................................................16
4
Study Design....................................................................................................................16
4.1
Study Duration .......................................................................................................18
4.2
Outcome Variables/Endpoints.............................................................................18
4.2.1
Primary Outcome Variables/Endpoints......................................................18
4.2.2
Secondary and Exploratory Outcome Variables/Endpoints (if 
applicable).......................................................................................................................19
5
Study Participants ...........................................................................................................19
5.1
Study Population....................................................................................................19
5.2
Number of Participants.........................................................................................20
5.3
Eligibility Criteria ....................................................................................................20
5.4
Recruitment Procedures.......................................................................................20
5.5
Consent/Assent Procedures/HIPAA Authorization ..........................................21
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6
Study Methods/Procedures ...........................................................................................21
6.1
Study Procedures..................................................................................................21
6.1.1
Data Collection...............................................................................................22
6.2
Method of Assignment/Randomization (if applicable) .....................................23
6.3
Adverse Events Definition and Reporting..........................................................23
6.4
Reaction Management..........................................................................................23
6.5
Withdrawal Procedures ........................................................................................23
6.6
Locations/Facilities................................................................................................23
7
Statistical Design.............................................................................................................24
7.1
Sample Size Considerations................................................................................24
7.2
Planned Analyses..................................................................................................24
7.2.1
Secondary Objective Analyses (if applicable)...........................................25
7.2.2
Analysis of Subject Characteristics (if applicable) ...................................25
7.2.3
Interim Analysis (if applicable).....................................................................25
7.3
Data Relevance .....................................................................................................25
7.4
Data Coding............................................................................................................25
7.5
Data Analysis Tools ..............................................................................................25
7.6
Data Monitoring......................................................................................................26
7.7
Handling of Missing Data .....................................................................................26
8
Data/Specimen Handling and Record Keeping..........................................................27
8.1
Subject Data Confidentiality.................................................................................27
8.2
Data Quality Assurance........................................................................................27
8.3
Data or Specimen Storage/Security...................................................................27
8.4
Study Records........................................................................................................28
8.5
Access to Source...................................................................................................28
8.6
Retention of Records ............................................................................................28
8.7
Data and Safety Monitoring Plan ........................................................................28
9
Study Considerations......................................................................................................29
9.1
Institutional Review Board (IRB) Review...........................................................29
9.2
Research Personnel Training..............................................................................29
9.3
Study Monitoring....................................................................................................29
9.4
Unanticipated Problems and Protocol Deviations............................................29
9.5
Study Discontinuation...........................................................................................30
9.6
Study Completion ..................................................................................................30
9.7
Conflict of Interest Management Plan................................................................30
9.8
Funding Source......................................................................................................30
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9.9
Publication Plan.....................................................................................................30
10 Appendices.......................................................................................................................31
11 List of Tables....................................................................................................................32
11.1
Table 1 – Summary of Training Sessions for LGBTQ-Affirmative CBT 
Treatment for Immediate Training Group / Waitlist Control Group............................32
11.2
Table 2 – Visit Schedule Table of Study Measures and Training..................36
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Protocol Revision History
Version 
Date
Summary of Substantial Changes
9/22/2020
Original IRB approval
9/23/2020
- Updated inclusion criteria
Include the IRB approved protocol version number and date for each revision of the protocol. All version history 
should remain in the table and never be deleted. The oldest IRB approved version of the protocol should be 
listed on the top row. The most recent IRB approved version should be listed on the bottom row.
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1 Background
1.1
Background
Given their disproportionate exposure to stigma-related stressors, including institutional and 
interpersonal discrimination, and unique developmental challenges across the lifespan, 
individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) 
experience disproportionately high rates of stress-sensitive mental health conditions 
(Bränström, van der Star, & Pachankis, 2020; Rice, Vasilenko, Fish, & Lanza, 2019).  At 
least in part for these reasons, LGBTQ individuals also seek treatment for mental health 
conditions at higher rates than the general population (Cochran, Björkenstam, & Mays, 
2017). Despite high rates of treatment utilization among LGBTQ individuals, research finds a 
large remaining unmet mental health treatment need among this population (Burgess, Lee, 
Tran, & van Ryn, 2008). Transgender individuals appear to be at particularly high risk of 
unfulfilled mental health care needs (Shipherd, Green, & Abromovitz, 2010; Steele et al., 
2017).
The LGBTQ community has historically demonstrated strong activism and community 
organizing to address the barriers faced to mental health care. Since the 1970s, LGBTQ 
community activism has largely been centered around ensuring sufficient health and mental 
health services for this population (Martos, Wilson, & Meyer, 2017). Many of these services 
were and remain heavily focused on HIV prevention and care and are embedded within 
LGBTQ community centers (Herek & Greene, 1995). In fact, LGBTQ community centers 
often led the front lines against the HIV/AIDS epidemic. Still, even before the HIV/AIDS 
epidemic, LGBTQ community centers were initially established to raise consciousness about 
the need for LGBTQ visibility and empowerment, advocate for LGBTQ rights, and provide 
other needed supports and connectedness among SGM people unavailable in general-
population settings. From the beginning then, services offered at LGBTQ community centers 
had an explicit focus on identity-affirming mental health support (Silverstein, 1997). With 
greater visibility of SGM people throughout the 1970s and 1980s and political realizations 
that non-pathologizing, identity-affirming care would have to come from within the LGBTQ 
community itself, the role of LGBTQ community centers in supporting LGBTQ mental health 
became even more imperative and persists today (D’Emilio 2012; Mail & Lear, 2006).
Today, LGBTQ community centers continue to respond to the increasingly prominent fact 
that the mental health disparity facing the LGBTQ population represents one of its most 
pressing contemporary challenges (Bromberg, Paltiel, Busch, & Pachankis, 2020). Of the 
more than 250 LGBTQ community centers in the US, about 40% provide mental health 
services, primarily counseling, peer-led programs, and support groups, free of the 
discrimination that many SGM might experience or anticipate experiencing in other settings 
(Movement Advancement Project and CenterLink, 2018). Most centers are located in urban 
areas and coastal states characterized by low structural stigma toward SGM people; thirteen 
U.S. states do not have an LGBTQ center, posing access barriers to SGM living in many 
high-stigma, rural locations (Martos et al., 2017). At the same time, because LGBTQ 
community centers often offer free or heavily-subsidized mental health services, they are 
ideally suited to increase access to services among those who might not otherwise receive 
such care, including those with lower incomes and LGBTQ people of color (Matos, 
Fingerhut, Wilson, & Meyer, 2019).
Based on a recent study that surveyed 60 directors of LGBTQ community centers across the 
U.S. (Pachankis, Clark, Jackson, Pereira, & Levine, under review), these center directors 
perceive a high need for mental health care in their LGBTQ communities and strive to meet 
that need; for most centers, however, the perceived need outweighs their current resources. 
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Most center directors reported having few mental health staff; still, most reported providing 
support groups and individual psychotherapy, delivered by social workers and mental health 
counselors. Further, most center directors report providing general evidence-based care, 
such as CBT, and report that their mental health staff has received training in evidence-
based practice. Most centers also reported high interest in their staff receiving training in the 
specific type of evidence-based, LGBTQ-affirmative care that has only recently become 
available following successful RCTs (e.g., Pachankis et al., 2020). In general, there is 
currently a high demand for and willingness among LGBTQ community center directors to 
provide evidence-based training for their providers. At this time, we seek to build upon our 
team’s previous work (further described in Section 1.2) to now disseminate our LGBTQ-
affirmative CBT to reach young LGBTQ people across the U.S. The purpose of this project is 
to test the effectiveness of a training for MHPs in LGBTQ-affirmative CBT to disseminate the 
treatment to LGBTQ young people nationwide.
References:
Bränström, R., van der Star, A., & Pachankis, J. E. (2020). Untethered lives: Barriers to 
societal integration as predictors of the sexual orientation disparity in suicidality. 
Social Psychiatry and Psychiatric Epidemiology, 55(1), 89–99. 
https://doi.org/10.1007/s00127-019-01742-6
Bromberg, D. J., Paltiel, A. D., Busch, S. H., & Pachankis, J. E. (2020). Has depression 
surpassed HIV as a burden to gay and bisexual men’s health in the united states? 
Social Psychiatry and Psychiatric Epidemiology, online first, 1-10. 
https://doi.org/10.1007/s00127-020-01938-1
Burgess, D., Tran, A., Lee, R., & van Ryn, M. (2007). Effects of perceived discrimination on 
mental health and mental health services utilization among gay, lesbian, bisexual and 
transgender persons. Journal of LGBT Health Research, 3(4), 1–14. 
https://doi.org/10.1080/15574090802226626
Cochran, S. D., Björkenstam, C., & Mays, V. M. (2017). Sexual orientation differences in 
functional limitations, disability, and mental health services use: Results from the 
2013-2014 National Health Interview Survey. Journal of Consulting and Clinical 
Psychology, 85(12), 1111–1121. https://doi.org/10.1037/ccp0000243
D’Emilio, J. (2012). Sexual Politics, Sexual Communities (2nd ed.). Chicago, IL University of 
Chicago Press.
Herek, G., & Greene, B. (1995). AIDS, identity, and community: the HIV epidemic and 
lesbians and gay men (Vol. 2). SAGE Publications, Inc. 
https://doi.org/10.4135/9781483326917
Mail, P. D., & Lear, W. J. (2006). The role of public health in lesbian, gay, bisexual, and 
transgender health. The Handbook of Lesbian, Gay, Bisexual, and Transgender 
Public Health: A Practitioners Guide to Service. New York: Routledge, 11-32.
Martos, A. J., Fingerhut, A., Wilson, P. A., & Meyer, I. H. (2019). Utilization of LGBT-specific 
clinics and providers across three cohorts of lesbian, gay, and bisexual people in the 
United States. SSM – Population Health, 9, 100505. 
https://doi.org/10.1016/j.ssmph.2019.100505
Martos, A. J., Wilson, P. A., & Meyer, I. H. (2017). Lesbian, gay, bisexual, and transgender 
(LGBT) health services in the United States: Origins, evolution, and contemporary 
landscape. PLOS ONE, 12(7), e0180544. 
https://doi.org/10.1371/journal.pone.0180544
Movement Advancement Project, & CenterLink. (2020). 2018 LGBT Community Center 
Survey Report. Movement Advancement Project. http://www.lgbtmap.org/2018-lgbt-
community-center-survey-report.
Pachankis, J. E., McConocha, E. M., Clark, K. A., Wang, K., Behari, K., Fetzner, B. K., 
Brisbin, C. D., Scheer, J. R., & Lehavot, K. (2020). A transdiagnostic minority stress 
intervention for gender diverse sexual minority women’s depression, anxiety, and 
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unhealthy alcohol use: A randomized controlled trial. Journal of Consulting and 
Clinical Psychology, 88(7), 613-630. https://doi.org/10.1037/ccp0000508
Rice, C. E., Vasilenko, S. A., Fish, J. N., & Lanza, S. T. (2019). Sexual minority health 
disparities: An examination of age-related trends across adulthood in a national 
cross-sectional sample. Annals of Epidemiology, 31, 20–25. 
https://doi.org/10.1016/j.annepidem.2019.01.001
Shipherd, J. C., Green, K. E., & Abramovitz, S. (2010). Transgender clients: identifying and 
minimizing barriers to mental health treatment. Journal of Gay & Lesbian Mental 
Health, 14(2), 94–108. https://doi.org/10.1080/19359701003622875
Silverstein, C. (1997). The origin of the gay psychotherapy movement. In A Queer World: 
The Center for Lesbian and Gay Studies reader (pp. 358–380). Essay, New York 
University Press.
Steele, L. S., Daley, A., Curling, D., Gibson, M. F., Green, D. C., Williams, C. C., & Ross, L. 
E. (2017). LGBT identity, untreated depression, and unmet need for mental health 
services by sexual minority women and trans-identified people. Journal of Women’s 
Health (2002), 26(2), 116–127. https://doi.org/10.1089/jwh.2015.5677
1.2
Prior Experience (if applicable) 
The LGBTQ-affirmative CBT treatment for the proposed training has been previously 
developed and tested by the current research team. In the pilot testing of the treatment 
among a sample of gay and bisexual men (Pachankis et al., 2015), the treatment 
significantly reduced depressive, alcohol use problems, sexual compulsivity, and past-90-
day condomless sex with casual partners, as well as improved condom use self-efficacy. 
The treatment yielded moderate and marginally significant improvements compared to a 
waitlist group in anxiety symptoms and past-90-day heavy drinking. Effects were generally 
maintained at follow-up. 
Since the pilot, the research team has been in the process of testing the efficacy of the 
treatment among gay and bisexual men in an RCT against Community Mental Health 
Treatment and Voluntary Testing and Counselling for HIV (see IRB protocol: 
1509016430).The research team has also adapted the LGBTQ-affirmative CBT treatment for 
gender diverse, sexual minority women (see IRB protocol: 2000020997; Pachankis, 
McConocha, et al., 2020), as well as for an online platform (see IRB protocol: 2000025803). 
In addition to the extensive experience with developing and implementing LGBTQ-affirmative 
treatment, the research team has previous experience specifically designing and 
implementing trainings based on the LGBTQ-affirmative treatment developed within the lab. 
These trainings have been designed and implemented in high stigmatizing settings, such as 
U.S. prisons (Hughto & Clark, 2019; Hughto, Clark, Altice, Reisner, Kershaw, & Pachankis, 
2017), as well as internationally, including in Romania (Lelutiu-Weinberger & Pachankis, 
2017; 2018; 2019).
References:
Hughto, J. M. W., Clark, K. A., Altice, F. L., Reisner, S. L., Kershaw, T. S., & Pachankis, J. E. 
(2017). Improving correctional healthcare providers’ ability to care for transgender 
patients: Development and evaluation of a theory-driven cultural and clinical 
competence intervention. Social Science & Medicine, 195, 159-169.
Hughto, J. M., & Clark, K. A. (2019). Designing a Transgender Health Training for 
Correctional Health Care Providers: A Feasibility Study. The Prison Journal, 99(3), 
329-342.
Lelutiu-Weinberger, C., & Pachankis, J. E. (2017). Acceptability and preliminary efficacy of a 
lesbian, gay, bisexual, and transgender-affirmative mental health practice training in 
a highly stigmatizing national context. LGBT health, 4(5), 360-370.
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Lelutiu-Weinberger, C., & Pachankis, J. E. (2018). Evaluation of an LGBT-affirmative mental 
health practice training in a stigmatizing national context. European Journal of Public 
Health, 28(suppl_4), cky213-863.
Lelutiu-Weinberger, C., & Pachankis, J. E. (2019). Web-based training and supervision for 
LGBT-affirmative mental health practice: A randomized controlled trial. European 
Journal of Public Health, 29(Supplement_4), ckz185-464.
Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T. 
(2015). LGB-affirmative cognitive-behavioral therapy for young adult gay and 
bisexual men: A randomized controlled trial of a transdiagnostic minority stress 
approach. Journal of consulting and clinical psychology, 83(5), 875.
Pachankis, J. E., McConocha, E. M., Clark, K. A., Wang, K., Behari, K., Fetzner, B. K., ... & 
Lehavot, K. (2020). A transdiagnostic minority stress intervention for gender diverse 
sexual minority women’s depression, anxiety, and unhealthy alcohol use: A 
randomized controlled trial. Journal of Consulting and Clinical Psychology, 88(7), 
613.
2 Rationale/Significance
2.1
Rationale and Study Significance 
LGBTQ community centers, specifically mental health providers (MHPs) within these 
centers, provide mental health services to treatment-seeking LGBTQ clients across the U.S. 
However, it is unknown to what extent MHPs in LGBTQ community centers are trained to 
provide LGBTQ-affirmative, evidence-based treatment (e.g., cognitive-behavioral therapy; 
CBT). Our team developed the first LGBTQ-affirmative CBT that demonstrated feasibility, 
acceptability, and efficacy in reducing LGBTQ young people’s symptoms of depression, 
anxiety, and substance use (Pachankis et al., 2015). With the ultimate goal of disseminating 
this high-quality, LGBTQ-affirmative mental health treatment to LGBTQ individuals across 
the U.S., we have developed a training for MHPs on delivering our team’s evidence-based, 
LGBTQ-affirmative CBT. 
The proposed research study, including MHPs at LGBTQ community centers nationwide, will 
assess to what extent such a training can improve MHPs LGBTQ-affirmative clinical 
knowledge and skills. If successful, we can disseminate evidence-based, LGBTQ-affirmative 
CBT to high-need LGBTQ individuals seeking mental health treatment at LGBTQ community 
centers across the U.S.
2.2
Risks
The risks associated with participation in this study will be minimal. Two primary risks are 
risk of emotional discomfort and breach of confidentiality. 
First, due to the research topic, there is the potential risk of anxiety or discomfort when 
reporting opinions, feedback, and beliefs during the training sessions. In particular, there is 
the risk that participants will feel embarrassed or uncomfortable while discussing topics for 
which they have limited knowledge, particularly in front of other MHPs. In addition, it is 
possible that participants may feel uncomfortable answering survey questions about their 
knowledge, particularly when they lack training in a specific area related to LGBTQ mental 
health and/or CBT. However, these risks are minimal. 
To minimize the risk of participants experiencing emotional disturbance as a result of the 
surveys or intervention training, participants will be informed via the informed consent that 
the study may elicit emotional discomfort and that they may discontinue participation at any 
time. Participants experiencing mild distress during the assessments may take a break or 
complete the assessment at a later date. In the unlikely event that a participant experiences 
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considerable distress, we will make a referral (if needed) for clinical assessment and/or 
counseling. Of note, given that all participants will be MHPs connected with LGBTQ 
community centers, it is likely that they will already be knowledgeable about mental health 
services available in their area. In the event that a participant discloses abuse or intent to 
harm oneself or others, the PI will report disclosures of abuse or intent to harm to the 
appropriate authorities immediately. Clinically trained staff members, including the PI, Dr. 
John Pachankis, a licensed clinical psychologist, will be on call for emergency consultation. 
In the unlikely event that such an incident should occur, we will notify the Yale IRB within 5 
days hours, and appropriate measures will be taken, including necessary reporting to the 
IRB.
Second, as with any study, there is a risk of inadvertent breach of confidentiality. The PI and 
his research team have been involved with numerous local, national, and international 
studies involving human subjects and have considerable experience implementing 
measures to protect confidentiality. All possible measures will be taken to protect information 
provided through surveys, and confidentiality will be respected. Specifically, to maximize 
privacy and ensure confidentiality, participant names will not be recorded during the online 
surveys. The only exception will be during the initial online screener, which will ask for 
participants’ name, email address, age, degree, provider title, and name of their LGBTQ 
community center. The purpose of this initial online screener is to collect contact information 
to inform potential participants about the training, as well as to determine eligibility for the 
training and associated research study. Data from the initial online screener will not be 
merged or included with subsequent data collected during the study. For all surveys, 
participants will be told that they are not obligated to answer any question they do not wish 
to. Beginning at the baseline assessments, data collected will identify participants by a 
unique code. A master link file will connect participant email addresses to their study code 
number. The link file will be password protected and only accessible to the PI.
2.3
Anticipated Benefits
As a result of this study, participating MHPs at LGBTQ community centers across the U.S. 
might increase their knowledge and clinical skills related to minority stress and evidence-
based CBT interventions for LGBTQ clients. If successful, the proposed study could lead to 
future trainings in evidence-based LGBTQ-affirmative mental health care, which would 
ultimately benefit LGBTQ clients by increasing accessibility to evidence-based treatment.
3 Study Purpose and Objectives
3.1
Purpose
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). We will assess 
changes in MHPs’ knowledge and clinical skills in providing mental health care for LGBTQ 
clients from baseline to 3-months post-baseline and 6-months post-baseline using a 
randomized-waitlist-controlled study design. We will also evaluate the training’s feasibility 
and acceptability.
3.2
Hypothesis
Hypotheses for the proposed study include:
1.
Participants will demonstrate improvement in their knowledge and clinical skills 
related to LGBTQ-affirmative CBT treatment immediately following the training and—
for the immediate training group—at 6-months post-baseline. Participants will 
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demonstrate these improvements via increases in LGBTQ clinical skills competency, 
cultural humility, and content knowledge, familiarity, and use of minority stress and 
CBT in their treatment with LGBTQ clients. 
2.
At 3-months post-baseline, participants in the immediate training group in 
comparison to participants in the waitlist control group will exhibit greater 
improvement in knowledge and clinical skills related to LGBTQ-affirmative CBT 
treatment, as evidenced by increases in LGBTQ clinical skills competency, cultural 
humility, and content knowledge, familiarity, and use of minority stress and CBT in 
their treatment with LGBTQ clients.
3.3
Objectives
Primary Objective
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 United States.
Second Objective
The secondary objective of this study is to evaluate the feasibility and acceptability of the 11-
week training in LGBTQ-affirmative CBT.
4 Study Design
The proposed prospective study will follow a 2-arm waitlist RCT 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 training will be conducted online via Zoom for 1-hour per week 
over two separate 11-week courses (i.e., the first 11 weeks for the immediate training group, 
and the second 11 weeks for the waitlist control group). A team of four clinical and 
counseling psychologists (the PI, two postdoctoral psychologists, and one associate 
research scientist) will lead the training. All trainers have participated in the development, 
research, and implementation of the LGBTQ-affirmative CBT treatment. 
To assess intervention efficacy, participants will be assessed at three time-points: baseline, 
3-months post-baseline, and 6-months post-baseline. Participants randomized to the 
immediate training group will be scheduled to receive the first iteration of the 11-week 
LGBTQ-affirmative CBT training (scheduled for October 30, 2020 – January 29, 2021, 
excluding holidays of November 27, December 25, and January 1). Participants randomized 
to the waitlist control group will receive one e-mail per month to remind them of their 
upcoming training and 3-month post-baseline assessment, and will then be scheduled for 
the second iteration of the 11-week LGBTQ-affirmative CBT training (March 5, 2021 – May 
21, 2021, excluding the holiday of April 9). Participants randomized to the immediate training 
group will receive the training between their baseline and 3-month post-baseline 
assessments. Participants randomized to the waitlist control group will receive the training 
between their 3-month post-baseline and 6-month post-baseline assessments. 
The proposed mixed-methods study will consist of 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 via the secure Yale Qualtrics survey software.
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Flow Diagram for the Waitlist-Controlled Randomized Trial Design
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4.1
Study Duration
The entire study, including data analysis, is expected to last until July 2021. Participation for 
the subjects will begin at the beginning of October 2020 (i.e., recruitment for the intervention 
training at an optional informational webinar). Subjects in the immediate training group will 
begin the 11-week training on October 30, 2020, finish the training on January 29, 2021, and 
complete their 3-months post-baseline measures in mid-April 2021. The waitlist control 
group will remain on the waitlist until the immediate training group completes the training. 
Then, starting on March 5, 2021, the waitlist control group will receive the same 11-week 
training. Their participation will end upon completion of the training and the 6-months post-
baseline measures in mid-May 2021. Data analysis is expected to continue to July 2021. 
4.2
Outcome Variables/Endpoints
The following are the outcome variables and associated measures that will be administered 
at all three time points (i.e., baseline, 3-months post-baseline, and 6-months post-baseline) 
in the study, unless otherwise noted:
o
LGBTQ Clinical Skills Competency
o
Sexual Orientation Counselor Competency Scale (SOCCS) – Clinical Skills 
subscale
o
Deliberate Practice of LGBTQ-Affirmative CBT Skills
o
Cultural Humility
o
Multidimensional Cultural Humility Scale (MCHS)
o
Content Knowledge, Familiarity, and Use of Minority Stress & CBT
o
Minority Stress Content Knowledge Quiz
o
CBT/LGBTQ-Affirmative CBT Content Knowledge Quiz
o
Familiarity and Use of LGBTQ-Affirmative CBT Skills Questionnaire
o
Acceptability of LGBTQ-affirmative CBT Training
o
Acceptability of LGBTQ-affirmative CBT Training Questionnaire (only 
administered immediately after the training)
o
Training in LGBTQ-Affirmative CBT – Session Feedback Forms (administered 
immediately after each training session)
See Sections 4.2.1 and 4.2.2. for further explanations of each measure.
4.2.1 Primary Outcome Variables/Endpoints
The following are the primary outcome variables and associated measures that will be 
administered at all three time points (i.e., baseline, 3-months post-baseline, and 6-months 
post-baseline) in the study:
o
LGBTQ Clinical Skills Competency
o
Sexual Orientation Counselor Competency Scale (SOCCS) – Clinical Skills 
subscale – 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.
o
Deliberate Practice of LGBTQ-Affirmative CBT Skills: 2 brief video clips (less 
than 1 minute each) of fictional clients will be presented. Participants will be 
asked to write a brief paragraph describing what clinical approaches they 
would use in their clinical treatment in order to address the challenges 
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discussed by the fictional client. These written responses will be used to 
assess participants’ LGBTQ-affirmative CBT skills.
o
Cultural Humility
o
Multidimensional Cultural Humility Scale (MCHS) – 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.
o
Content Knowledge, Familiarity, and Use of Minority Stress & CBT
o
Minority Stress Content Knowledge Quiz – 10 multiple choice items 
developed by the researchers for the purpose of this study to assess 
respondents’ content knowledge of minority stress
o
CBT/LGBTQ-Affirmative CBT Content Knowledge Quiz – 10 multiple choice 
items developed by the researchers for the purpose of this study to assess 
respondents’ content knowledge of CBT/LGBTQ-affirmative CBT
o
Familiarity and Use of LGBTQ-Affirmative CBT Skills Questionnaire – 14 
items rated on a 5-point Likert scale that was developed by the researchers 
for the purposes of this study assessing respondents’ familiarity with and use 
of LGBTQ-affirmative CBT skills
4.2.2 Secondary and Exploratory Outcome Variables/Endpoints (if applicable)
The following are the secondary outcome variables and associated measures that will be 
administered in the study:
o
Acceptability of LGBTQ-affirmative CBT Training
o
Acceptability of LGBTQ-affirmative CBT Training Questionnaire (only 
administered immediately after the training) – 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. All items were self-developed by the 
researchers for the purpose of this study.
o
Training in LGBTQ-Affirmative CBT – Session Feedback Forms (administered 
immediately after each training session) – Participants will be asked at the end 
of each training session to complete an online feedback form about the 
session, including providing feedback in regard to participants’ satisfaction 
with the instruction, team members leading the training, and learning activities. 
This feedback form was developed by the researchers for the purpose of this 
study. 
5 Study Participants
5.1
Study Population
The study population will consist of healthy participants who are 18 year of age or older, 
fluent in English, and currently in the role of an MHP at an LGBTQ community center in the 
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U.S. engaging in treatment with LGBTQ clients. MHPs from LGBTQ community centers will 
specifically be recruited for this study in order to provide evidence-based LGBTQ-affirmative 
training to MHPs working predominantly with individuals from the LGBTQ community. 
5.2
Number of Participants
We plan to enroll at least 76 participants (n = 38 per training group). Our team’s prior pilot 
studies assessing the efficacy of LGBTQ-affirmative health trainings demonstrated 
moderate-to-large effect sizes in improving healthcare providers’ LGBTQ-affirmative clinical 
skills and willingness to provide LGBTQ-affirmative clinical care (d = 0.66-1.20; Lelutiu-
Weinberger, Clark, & Pachankis, in preparation; Lelutiu-Weinberger & Pachankis, 2017; 
White Hughto, Clark, et al., 2017). Based on the most conservative effect size drawn from 
our team’s previous LGBTQ-affirmative training studies for healthcare providers (d = 0.66), 
we conducted a power analysis for an independent samples t-test used to compare the 
mean of a continuous measurement in two samples. We set the threshold probability for 
rejecting the null hypothesis (type I error rate) to α (two-tailed) = 0.05. Power to detect Type I 
error was fixed at a standard level of 1 – β = 0.80 (type II error rate). Given these 
parameters, we require 38 participants per group (N = 76) to retain statistical power. We 
expect to enroll at minimum 38 participants per group; due to the high need and reach of our 
recruitment partner (i.e., CenterLink, the coordinating hub of 250+ LGBTQ community 
centers in the U.S.), we expect to enroll at least 100 participants which will allow for 
adequate statistical power even with 20% attrition.
5.3
Eligibility Criteria
In order to be eligible for inclusion in the study, an individual must meet all of the following 
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 within, or in collaboration with, an LGBTQ community center that 
is coordinated by CenterLink, the coordinating hub for LGBTQ community centers in 
the U.S.
Any individual who meets any of the following criteria will be excluded from participation in 
this study: 

Individuals unwilling or unable to give informed consent at the time of participation 
and/or not fitting the eligibility criteria outlined above
5.4
Recruitment Procedures 
Recruitment of MHPs will be coordinated in collaboration with Deborah Levine, Director of 
LGBTQ YouthLink at CenterLink, which is the coordinating hub for over 250 LGBTQ 
community centers in the U.S. Specifically, a recruitment e-flyer (see attached e-flyer) will 
be sent by Ms. Levine to executive directors at CenterLink community centers throughout 
the U.S., who will then be asked to send the e-flyer to eligible staff members within their 
centers. The recruitment e-flyer includes dates/times of the trainings, information regarding 
the research design (i.e., immediate training group and waitlist control group), as well as 
information about receiving continuing education credits for participating in the training. 
Interested participants will be directed to click on a QR code on the recruitment flyer that 
will direct them to complete an initial online screener (see attached initial online screener) 
that will ask for their name, email address, age, degree, provider title, and name of their 
CenterLink community center.
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5.5
Consent/Assent Procedures/HIPAA Authorization
Consent will be obtained online via the secure Yale Qualtrics survey software. As such, a 
waiver of documentation of consent is planned for this study. As previously described, 
participants will first complete an initial online screener (see attachments on IRES for initial 
online screener) to express their interest in the training and/or an informational webinar via 
Zoom on October 2 at 9am PST / 12pm EST to learn more about the training. No research 
data will be collected at the informational webinar. The initial online screener will also be 
used to determine eligibility for the training and associated research study. Upon receiving 
email addresses from interested participants, the research team will contact eligible 
participants with an anonymized link directing them to the study consent form two weeks 
prior to the first training session. Any ineligible participants will be contacted and informed of 
the reason for their ineligibility in this study.
At this point, participants will review the online consent form and have the option to 
participate or decline participation in the study (see attachments on IRES for online consent 
form). MHPs will still have the option to receive the training whether or not they consent to 
and complete the assessment measures. For MHPs who want to attend the training, but do 
not want to participate in the study, the online consent form will end and no data will be 
collected from these providers due to them not consenting to participate in the study.
Participants will be informed on the consent forms that they will receive $50 for completing 
the baseline measures, $50 for completing the 3-month post-baseline measures, and $50 for 
completing the 6-months post-baseline measures (total = $150). All study payments will be 
in the form of e-mailed Amazon gift cards or Venmo payments. Venmo payments will be sent 
to participants from the private @Yale-Study account and will be accompanied with the text 
“Thank you for your participation.”
Participants will be provided with the PI’s contact information and directed to call or email the 
PI if they have any questions or concerns. The PI will be responsible for ensuring that online 
consent has been obtained.
Potential participants will be required to check one of the following boxes before moving on 
to the baseline assessment measures part of the research study:
o
YES. I have read the above information. The study has been explained to me. My 
questions have been answered. I VOLUNTARILY AGREE to be in this study.
o
YES. I agree to participate in the online training, but I do NOT agree to take part in 
the measures associated with the research study.
o
NO. I do NOT agree to participate in the online training and associated research 
study.
6 Study Methods/Procedures
6.1
Study Procedures
A 3-time point longitudinal design will be used for both the immediate training group and 
waitlist control group with assessment measures administered at each time point (T1: 
baseline; T2: 3-months post-baseline; T3: 6-months post-baseline). As previously discussed, 
interested participants will complete an initial online screener. Data collected on this brief 
online screener will be used to determine eligibility based on the previously listed inclusion 
criteria, as well as to collect email addresses to contact participants about the training. Data 
from the initial online screener will not be merged or included with subsequent data collected 
during the study. 
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Participants will be contacted via email approximately two weeks prior to the start of the 
training and informed via the online consent about the research study, including risks and 
benefits of the study. Participants will still have the option to participate in the training and 
receive continuing education credits whether or not they consent to and complete the 
research study measures. The 11 training sessions in terms of content will be no different for 
those who consent to participate in the study compared to those who choose not to 
participate in the study. For those who do not provide consent to the study, no data will be 
collected from these individuals at the three time-point surveys. For those who do provide 
consent, participants will complete the baseline surveys (T1) via a web-based survey link to 
the secure Yale Qualtrics survey software. Participants will be told that they do not have to 
answer any question they do not wish to. Participants will be assigned a unique code 
number. The use of the unique code will permit linkage of the data being collected across 
three time points in the study. A master link file will connect participant email addresses to 
their study code number. The link file will be password protected and only accessible to the 
PI. All materials will be stored on a password-protected digital folder. Data will be organized 
in Microsoft Excel, SPSS files, or SAS files and stored on a password-protected computer. 
The PI and three postdoctoral psychologists will lead the 11-week LGBTQ-affirmative CBT 
training (scheduled for October 30, 2020 – January 29, 2021, excluding holidays of 
November 27, December 25, and January 1) for participants randomized to the immediate 
training group (see Table 1 in Section 11.1 with more information regarding the content of 
each of the training sessions). At 3-months post-baseline (i.e., following the immediate 
training group’s completion of the training), the 3-months post-baseline measures will be 
sent to participants in both the immediate training group and waitlist control group. 
Participants randomized to the waitlist control group will subsequently receive the second 
iteration of the 11-week LGBTQ-affirmative CBT training (scheduled for March 5, 2021 – 
May 21, 2021, excluding the holiday of April 9). At 6-months post-baseline (i.e., following the 
waitlist control group’s completion of the training), the 6-months post-baseline measures will 
be sent to participants in both the immediate training group and waitlist control group.
See Table 2 in Section 11.2 for a Visit Schedule Table with study procedures listing the 
points of data collection.
6.1.1 Data Collection
All data collection will occur online via the secure Yale Qualtrics survey software. Data 
collection will begin with the initial online screener that potential participants will be able to 
access via a QR code on recruitment e-flyer that will be sent by directors of LGBTQ 
community centers. 
Baseline assessment measures will be sent via email one month prior to the first iteration of 
the training. The 3-months post-baseline measures will be sent after January 29, 2021 (i.e., 
after the last session of the training for the immediate training group). The 6-months post-
baseline measures will be sent after May 21, 2021 (i.e., after the last session of the training 
for the waitlist control group). Participants will have a two-week window to complete the 
study measures at each time point. None of the study measures require licensure for their 
administration. All measures can be found in the “Measures Packet” uploaded with the 
study protocol.
At baseline, all participants will be given a unique code that will serve as their study ID for 
the duration of the study. The use of the unique code will permit linkage of the data being 
collected across the three time points in the study. A master link file will connect participant 
email addresses to their study code number. The link file will be password protected and 
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only accessible to the PI. All materials will be stored on password protected folders on Yale 
Secure Box that requires dual-factor authentication to access.
6.2
Method of Assignment/Randomization (if applicable) 
Participants who are confirmed to be eligible via the online screener and provide informed 
consent to take part in the study will then be randomized via the randomizer feature of 
Qualtrics, which will be programmed to evenly assign participants to the immediate training 
group or the waitlist control group. Our team has successfully used the Qualtrics randomizer 
for previous waitlist-randomized-controlled trial (e.g., see Pachankis et al., 2020).
6.3
Adverse Events Definition and Reporting
Adverse event means any untoward medical occurrence associated with the use of an 
intervention in humans, whether or not considered intervention-related. An adverse event 
(AE) or suspected adverse reaction is considered "serious" if, in the view of either the 
investigator or sponsor, it results in any of the following outcomes: death, a life-threatening 
adverse event, inpatient hospitalization or prolongation of existing hospitalization, a 
persistent or significant incapacity or substantial disruption of the ability to conduct normal 
life functions.
This proposed study presents minimal risks to the participants, and as such, adverse events 
are not anticipated. In the unlikely event that such events occur, the PI will apprise fellow 
investigators and study personnel of all adverse events, such as loss of confidentiality, that 
occur during the conduct of this research project via email as they are reviewed.
 
6.4
Reaction Management
Participants experiencing mild distress during the assessments or training can take a break 
or complete the assessment at a later date. In the unlikely event that a participant 
experiences considerable distress, we will make a referral (if needed) for clinical assessment 
and/or counseling. Participants will be given the names and office phone numbers of the PI 
and the IRB managers of research and compliance. Of note, given that all participants will be 
MHPs connected with LGBTQ community centers, it is probable that they will already be 
knowledgeable about mental health services in their area. In the event that a participant 
discloses abuse or intent to harm oneself or others, the PI will report disclosures of abuse or 
intent to harm to the appropriate authorities immediately. Identified clinically trained staff 
members, including Dr. John Pachankis, a licensed clinical psychologist, will be on call for 
emergency consultation. In the unlikely event that such an incident should occur, we will 
notify the Yale IRB within 5 days and appropriate measures will be taken, including 
necessary reporting to the IRB.
6.5
Withdrawal Procedures
Of the participants who are eligible and consent to the research study, participants will be 
able to withdraw from the study at any point. The online consent form will clearly state the 
voluntary nature of the study and possibility of withdrawal at any point. Additionally, 
participants will have the option of having their data destroyed. 
6.6
Locations/Facilities
The training and online surveys will be completed from the participants’ electronic devices 
(e.g., phones, tablets, or computers). All trainings will be conducted via the PI or 
postdoctoral researchers’ Yale-affiliated Zoom videoconferencing accounts and require a 
passcode to enter. All measures will be conducted utilizing the secure Yale Qualtrics online 
survey software.
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7 Statistical Design
7.1
Sample Size Considerations
Our team’s prior pilot studies assessing the efficacy of LGBTQ-affirmative health trainings 
have demonstrated moderate-to-large effect sizes in improving healthcare providers’ 
LGBTQ-affirmative clinical skills and willingness to provide LGBTQ-affirmative clinical care 
(d = 0.66-1.20) (Lelutiu-Weinberger & Pachankis, 2017, Lelutiu-Weinberger, Clark & 
Pachankis, in preparation; White Hughto, Clark, et al., 2017). Based on the most 
conservative effect size drawn from our team’s previous LGBTQ-affirmative training studies 
for healthcare providers (d = 0.66), we conducted a power analysis for an independent 
samples t-test used to compare the mean of a continuous measurement in two samples. We 
set the threshold probability for rejecting the null hypothesis (type I error rate) to α (two-
tailed) = 0.05. Power to detect Type I error was fixed at a standard level of 1 – β = 0.80 (type 
II error rate). Given these parameters, we require 38 participants per group (N = 76) to retain 
statistical power. We expect to enroll at minimum 38 participants per group; due the high 
need and reach of our recruitment partner (i.e., CenterLink, the coordinating hub of the 
United States 250+ LGBTQ community centers), we expect to enroll at least 100 participants 
which will allow for adequate statistical power even with 20% attrition. 
7.2
Planned Analyses
We will assess training efficacy using an intent-to-treat analysis including all eligible cases. 
First, to determine randomization effectiveness, differences in baseline demographic 
characteristics will be assessed between the immediate training and waitlist control 
conditions using t-tests for continuous measures and chi-square tests for categorical 
measures. Any differences in baseline demographic characteristics between the groups will 
be retained as covariates in subsequent analyses. Dependent variables, all of which are 
assessed as continuous outcomes documenting domains of Clinical Knowledge and Skills of 
LGBTQ-affirmative CBT, will be assessed for normality using skewness and kurtosis 
thresholds of ±2. If any continuous outcomes are found to be non-normally distributed, we 
will transform these variables for further statistical tests and reassess skewness and kurtosis 
after transformation.
In a first set of analyses, we will use linear mixed models with maximum likelihood estimation 
and we expect to utilize a compound symmetry covariance structure (although final 
covariance structure will selected based on fit criteria, i.e., lowest Akaike information criterion 
[AIC]) to test the Condition × Time interaction for all training outcomes). To do so, we will 
limit the data to baseline (time = 0) and 3 months post-baseline assessment (time = 1) and 
examined the Condition × Time interaction effect of receiving immediate training (condition = 
1) versus receiving the 3-month waitlist (condition = 0). Thus, the estimate of interest 
compared pre-training to immediate post-training outcomes in the immediate training group 
to pre-waitlist and immediate post-waitlist outcomes in the waitlist control group. Effect sizes 
(d) for linear mixed models will be calculated as mean pre–post change in the immediate 
training group minus the mean pre-post change in the waitlist control group, divided by the 
pooled baseline standard deviation.
In a second set of analyses, we will conduct a pooled analysis whereby data from all 
participants will be pooled to examine change in outcomes from immediate pre-training to 
post-training using paired t-tests (i.e., baseline to 3 months post-baseline for the immediate 
training group and 3-months post-baseline to 6-months post-baseline for the waitlist-control 
group). Pooled analyses are useful in waitlist-controlled studies (where all participants 
ultimately receive the intervention) to assess the pre-post effect of the intervention in a larger 
sample than the condition x time analyses allow. Effect sizes (d) for pooled analyses will be 
calculated as 2t/sqrt(df).
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Finally, we will assess the longer-term persistence of observed intervention effects by 
limiting analyses to 3-months post-baseline (time = 1) and 6-months post-baseline (time = 2) 
among participants in the immediate training condition (condition = 1), the only participants 
to have completed assessments 3-months after receiving the training. Specifically, we will 
examine the significance of changes between time points for all outcomes across self-report 
and deliberate practice of Clinical Knowledge and Skills of LGBTQ-affirmative CBT. Results 
will be evaluated at p < .05. We will report means, standard errors, and 95% confidence 
intervals.
7.2.1 Secondary Objective Analyses (if applicable)
Feasibility of the training will be assessed in terms of training attendance. Acceptability will 
be assessed in terms of responses to the Acceptability of LGBTQ-affirmative CBT Training 
Questionnaire that all participants will complete at their immediate post-training time point (3-
month post-baseline for the immediate training group and 6-month post-baseline for the 
waitlist control group). Acceptability analyses will include descriptive statistics including 
means and medians for quantitative responses. For the qualitative free-response data that 
will be collected on the acceptability questionnaire, thematic analysis will be used to identify 
patterns of responses and emergent codes will be categorized into larger themes (Braun & 
Clarke, 2006). 
7.2.2 Analysis of Subject Characteristics (if applicable)
In the baseline assessment, we will collect demographic data including age, race/ethnicity, 
sex, gender identity, sexual orientation, education level, degree/provider title, and number of 
years working in mental health generally, as well as number of years working specifically in 
LGBTQ-focused mental health. Subject characteristics will be reported descriptively utilizing 
means and standard deviations for continuous variables and proportions for categorical 
variables.  
7.2.3 Interim Analysis (if applicable)
N/A
7.3
Data Relevance
In this study our primary objective is to measure whether a training in LGBTQ-affirmative 
practice increases MHPs clinical knowledge and skills of LGBTQ-affirmative CBT. The data 
that we will collect in this study is highly relevant to our primary objective. We will measure 
self-reported clinical knowledge and skills across several domains including sexual 
orientation counselor competency, cultural humility, LGBTQ-affirmative CBT skills, minority 
stress understanding, and LGBTQ-affirmative CBT content understanding. In addition to this 
self-report data, we will also obtain deliberate practice of LGBTQ-affirmative CBT skills that 
will include open-ended response to clinical vignettes that will then be coded on a 
continuous scale. Finally, in alignment with our secondary objective to assess training 
feasibility and acceptability, we will assess the acceptability of the training through 
quantitative and qualitative survey items. All data collected as part of this study is highly 
relevant to our research questions. 
7.4
Data Coding
Data will be scored based on each measure’s pre-specified ratings scale (see Measures 
packet). Outcomes utilized in statistical analyses will be continuous sum or mean scores, as 
applicable.
7.5
Data Analysis Tools
Data will be managed and analyzed utilizing SPSS and SAS version 9.4.
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7.6
Data Monitoring
N/A
7.7
Handling of Missing Data 
We will assess the LGBTQ-affirmative CBT training efficacy using an intent-to-treat analysis 
including all eligible cases; therefore, cases with missing data on outcomes will be dropped.
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8 Data/Specimen Handling and Record 
Keeping
8.1
Subject Data Confidentiality
Participant confidentiality and privacy is strictly held in confidence by the participating 
investigators and their staff. Therefore, the study protocol, documentation, data, and all other 
information generated will be held in strict confidence. All research activities will be 
conducted in as private a setting as possible. Representatives of the Institutional Review 
Board (IRB) may inspect all documents and records required to be maintained by the 
investigator for the participants in this study. 
To maximize privacy and ensure confidentiality, participant names, which will only be 
recorded during the initial online screener, will be kept separate from all other data collection 
surveys. All data will be collected via the secure Yale Qualtrics server. Participants will be 
assigned a unique code number at baseline for their surveys. The use of the unique code 
will permit linkage of the data being collected across the three time points in the study. A 
master link file will connect participant email addresses to their study code number. The link 
file will be password protected and only accessible to the PI. All materials will be stored on 
password protected folders on Yale Secure Box that requires dual-factor authentication to 
access. De-identified survey data will be downloaded and organized in SPSS files or SAS 
files and stored on a password-protected computer. Taken together, these measures are 
anticipated to be highly effective in protecting the privacy and confidentiality of participants 
and have proven successful in other studies that the PI and his research team have 
implemented.
The study participants’ contact information will be held securely during the study. At the end 
of the study, all records will continue to be kept in a secure location for three years. After 
three years, all records for the study will be destroyed.
Study participant research data, which is for purposes of statistical analysis and scientific 
reporting, will be transmitted to and stored on a secure Yale Secure Box folder only 
accessible by the research study team members. This will not include the participants’ 
identifying information. Rather, individual participants and their research data will be 
identified by a unique study identification number. The study data entry and study 
management systems used will be secured and password protected. At the end of the study, 
all study databases will be de-identified and archived on a secure Yale Box folder.
8.2
Data Quality Assurance
All three-time point survey measures will be administered via the secure Yale Qualtrics 
server using contact lists to accurately and consistently administer surveys to participants. A 
similar system will be used to administer the feedback forms to participants after each 
session. All research assistants part of this study will be trained by one of the postdoctoral 
researchers on the study team on these study procedures.
8.3
Data or Specimen Storage/Security
Participant names, which will only be recorded during the initial online screener, will be kept 
separate from all other data collection surveys. All data will be collected via the secure Yale 
Qualtrics server. Participants will be assigned a unique code number for their surveys. The 
use of the unique code will permit linkage of the data being collected across the three time 
points in the study. A master link file will connect participant email addresses to their study 
code number. The link file will be password protected and only accessible to the PI. All 
materials will be stored on password protected folders on Yale Secure Box that requires 
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dual-factor authentication to access. De-identified survey data will be downloaded and 
organized in SPSS or SAS files and stored on a password-protected computer. 
Study participant research data will be transmitted to and stored on a Yale Secure Box folder 
only accessible by the research study team members. This will not include the participant's 
identifying information. Rather, individual participants and their research data will be 
identified by a unique study identification number. The study data entry and study 
management systems used will be secured and password protected. At the end of the study, 
all study databases will be de-identified and archived on a secure Yale Box folder.
8.4
Study Records
Study records will consist of surveys and other study measures. The PI will be responsible 
for maintaining the study documentation, which will be maintained on a Yale Secure Box 
folder. 
8.5
Access to Source
Source data will consist of surveys and other study measures that will all be administered 
online via the secure Yale Qualtrics server. All source data will be electronic (i.e., no surveys 
with handwritten responses). Research data will only be accessible on a Yale Secure Box 
folder by the research study team members.
8.6
Retention of Records
At the end of the study, all records will continue to be kept in a Yale Secure Box folder. After 
three years, all records for the study will be destroyed. 
8.7
Data and Safety Monitoring Plan 
The principal investigator is responsible for monitoring the data, assuring protocol 
compliance, and conducting the safety reviews quarterly (or weekly during collection periods 
of baseline and post-training data). During the review process the principal investigator will 
evaluate whether the study should continue unchanged, require modification/amendment, or 
close to enrollment.
The principal investigator and the Institutional Review Board (IRB) have the authority to stop 
or suspend the study or require modifications.
This protocol presents minimal risks to the subjects and Unanticipated Problems Involving 
Risks to Subjects or Others (UPIRSOs), including adverse events, are not anticipated. In the 
unlikely event that such events occur, Reportable Events (which are events that are serious 
or life-threatening and unanticipated (or anticipated but occurring with a greater frequency 
than expected) and possibly, probably, or definitely related) or Unanticipated Problems 
Involving Risks to Subjects or Others that may require a temporary or permanent interruption 
of study activities will be reported immediately (if possible), followed by a written report within 
5 calendar days of the Principal Investigator becoming aware of the event to the IRB (using 
the appropriate forms from the website) and any appropriate funding and regulatory 
agencies. The principal investigator will apprise fellow investigators and study personnel of 
all UPIRSOs and adverse events that occur during the conduct of this research project via 
email as they are reviewed. The protocol’s research monitor, Yale University, and decision-
making bodies will be informed of adverse events, such as loss of confidentiality, within 5 
days of the event becoming known to the principal investigator.
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9 Study Considerations
9.1
Institutional Review Board (IRB) Review
The protocol will be submitted to the IRB for review and approval. Approval of the protocol 
must be obtained before initiating any research activity. Any change to the protocol will 
require an approved IRB amendment before implementation. The IRB will have final 
determination whether informed consent and HIPAA authorization are required.  
Study closure will be submitted to the IRB after all research activities have been completed.    
Other study events (e.g. data breaches, protocol deviations) will be submitted per Yale 
policies.
9.2
Research Personnel Training
Drs. Pachankis, Jackson, Soulliard, and Seager van Dyk will be primarily responsible for the 
preparation of training materials and leading the training sessions. All members of the 
research team who will take part in delivery of the clinical training hold doctoral-level degrees 
in clinical or counseling psychology. Dr. Soulliard and Kriti Behari (senior research assistant) 
will be responsible for online administration of the study measures, as well as the cleaning 
and organizing of the study data. Drs. Clark and Layland will be primarily responsible for 
data analysis. Dr. Pachankis will be responsible as the PI for oversight of the previously 
mentioned responsibilities. 
9.3
Study Monitoring 
The study will be monitored internally by the study team members on a weekly basis. 
9.4
Unanticipated Problems and Protocol Deviations
A protocol deviation is any noncompliance with the protocol. The noncompliance may be 
either on the part of the participant, the investigator, or the study site staff. As a result of 
deviations, corrective actions are to be developed by the site and implemented promptly.
It is the responsibility of the principal investigator to identify and report deviations within 5 
working days of identification of the protocol deviation. All deviations must be addressed in 
study source documents and the reviewing Institutional Review Board (IRB) per their 
policies.
Unanticipated problems involving risks to participants or others include, in general, any 
incident, experience, or outcome that meets all of the following criteria:

Unexpected in terms of nature, severity, or frequency given (a) the research 
procedures that are described in the protocol-related documents, such as the 
Institutional Review Board (IRB)-approved research protocol and informed consent 
document; and (b) the characteristics of the participant population being studied;

Related or possibly related to participation in the research ("possibly related" means 
there is a reasonable possibility that the incident, experience, or outcome may have 
been caused by the procedures involved in the research); and

Suggests that the research places participants or others at a greater risk of harm 
(including physical, psychological, economic, or social harm) than was previously 
known or recognized.
If the study team becomes aware of an unanticipated problem (e.g. data breach, protocol 
deviation), the event will be reported to the IRB by via email.
The UP report will include the following information:
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
Protocol identifying information: protocol title and number, PI's name, and the IRB 
project number;

A detailed description of the event, incident, experience, or outcome;

An explanation of the basis for determining that the event, incident, experience, or 
outcome represents an UP;

A description of any changes to the protocol or other corrective actions that have 
been taken or are proposed in response to the UP.
To satisfy the requirement for prompt reporting, UPs will be reported using the following 
timeline:

UPs will be reported to the IRB within 5 of the investigator becoming aware of the 
event.
9.5
Study Discontinuation
The research team will discuss discontinuation of the study in the event that participants in 
the first training group (i.e., the immediate training group) endorse significantly worse 
outcomes (e.g., reduced LGBTQ clinical skills competency) compared to the waitlist control 
group. 
9.6
Study Completion
Data collection for the study will end in mid-May 2021. Data analysis is expected to continue 
to July 2021. The study is anticipated to be completed upon the writing of a manuscript for 
publication by September 2021.
9.7
Conflict of Interest Management Plan 
The independence of this study from any actual or perceived influence, such as by the 
pharmaceutical industry, is critical. Therefore, any actual conflict of interest of persons who 
have a role in the design, conduct, analysis, publication, or any aspect of this trial will be 
disclosed and managed. Furthermore, persons who have a perceived conflict of interest will 
be required to have such conflicts managed in a way that is appropriate to their participation 
in the trial. The study leadership in conjunction with the appropriate conflict of interest review 
committee has established policies and procedures for all study group members to disclose 
all conflicts of interest and will establish a mechanism for the management of all reported 
dualities of interest.
All investigators will follow the applicable conflict of interest policies.
9.8
Funding Source
The study is internally funded from the David R. Kessler M.D. ’55 funds provided to the PI of
this study.
9.9
Publication Plan
Upon the completion of data analysis by July 2021, the research team anticipates submitting 
a manuscript for publication by September 2021. It will be the PI’s primary responsibility for 
publishing the study results. 
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10 Appendices
Appendix #
Title
Section
Topic
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11 List of Tables
11.1 Table 1 – Summary of Training Sessions for LGBTQ-Affirmative CBT 
Treatment for Immediate Training Group / Waitlist Control Group
Date & 
Module Title
Objectives & Learning Activities
October 30, 2020/ 
March 5, 2021
Introduction: 
Orientation to the 
Treatment
Objective:
o
Describe the history and development of LGBTQ-
affirmative CBT
o
Explain the rationale behind LGBTQ-affirmative CBT
o
Identify how concepts from LGBTQ-affirmative 
psychotherapy and CBT can be combined
Learning Activities:
o
Introductions (5 minutes)
o
History of team’s development of LGBTQ-affirmative CBT 
(10 minutes)
o
Overview of LGBTQ-affirmative CBT (20 minutes)
o
Description (i.e., structure, format) of training (15 minutes)
o
Q&A (10 minutes)
November 6, 2020/
March 12, 2021
Module 1: 
Motivation 
Enhancement for 
Treatment 
Engagement
Objectives:
o
Define the concept of minority stress
o
Explain the use of motivational interviewing skills and 
discuss its importance to treatment outcomes
o
Describe the importance of assisting LGBTQ clients in 
setting specific goals to reduce the impact of minority 
stress
Learning Activities:
o
Presentation on minority stress and its relationship to 
mental health (15 minutes)
o
Group discussion of examples of minority stress 
expressed by LGBTQ clients (10 minutes)
o
Presentation on motivational interviewing and setting 
treatment goals (15 minutes)
o
Group discussion of how to utilize motivational interviewing 
at the beginning of treatment (10 minutes)
o
Q&A (10 minutes)
November 13, 2020/
March 19, 2021
Module 2: Nature 
and Emotional 
Impact of Minority 
Stress
Objectives:
o
Describe how to assist clients in identifying early and 
current experiences of minority stress
o
Summarize the sources of minority stress faced by LGBTQ 
clients
o
Describe how sources of minority stress may contribute to 
clients’ experiences of anxiety and depression
Learning Activities:
o
Presentation on the emotional impact of minority stress 
among LGBTQ clients (20 minutes)
o
Group discussion on examples of minority stress’ 
emotional impact on LGBTQ clients (10 minutes)
o
Introduce the Monitoring LGBTQ-Related Stress 
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Worksheet with a focus on Antecedents (20 minutes)
o
Q&A (10 minutes)
November 20, 2020/
March 26, 2021
Module 3: Tracking 
Emotional 
Experiences
Objectives:
o
List the three components of emotional experiences 
o
Identify common emotional experiences endorsed by 
LGBTQ clients as related to minority stress
o
Summarize the role of antecedents, responses, and 
consequences (ARC) of minority stress
Learning Activities:
o
Presentation on the three components of emotional 
experiences (i.e., thoughts, behaviors, and bodily 
sensations) (15 minutes)
o
Group discussion on ways to present the three 
components of emotional experiences to LGBTQ clients 
(10 minutes)
o
Introduce the tracking of Responses and Consequences 
on the Monitoring LGBTQ-Related Stress Worksheet (15 
minutes)
o
Examples of Monitoring LGBTQ-Related Stress Worksheet 
(ARC) Worksheets completed by LGBTQ clients (10 
minutes)
o
Q&A (10 minutes)
December 4, 2020/ 
April 2, 2021
Module 4: Mindful 
Awareness & 
Minority Stress
Objectives:
o
Recognize the concept and practice of nonjudgmental 
emotion awareness
o
Demonstrate the clinical use of present-focused, mindful 
awareness of minority stress reactions with LGBTQ clients
o
Describe how mood-induction exercises can promote 
mindful awareness for LGBTQ clients
Learning Activities:
o
Presentation on emotion awareness and mindfulness in 
the context of minority stress (20 minutes)
o
Engage attendees in an emotion awareness exercise (5 
minutes) 
o
Group discussion of the emotion awareness exercise (10 
minutes)
o
Engage attendees in a mood-induction exercise (5 
minutes)
o
Group discussion of the mood-induction exercise (10 
minutes)
o
Q&A (10 minutes)
December 11, 2020/ 
April 16, 2021
Module 5: Cognitive 
Flexibility
Objectives:
o
Describe the relationship between thoughts and emotions
o
Define the concepts of cognitive flexibility, including 
cognitive appraisals and cognitive reappraisals
o
Summarize thinking traps as related to LGBTQ clients and 
minority stress
o
Identify ways to assist LGBTQ clients in engaging in 
cognitive flexibility
Learning Activities:
o
Presentation on cognitive flexibility, including cognitive 
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appraisals, thinking traps, and cognitive reappraisals (20 
minutes)
o
Group discussion of the ambiguous picture exercise (5 
minutes)
o
Group discussion on the use of the Downward Arrow 
Technique Worksheet (10 minutes)
o
Group discussion on Identifying and Evaluating Automatic 
Thoughts Worksheet (10 minutes)
o
Q&A (10 minutes)
December 18, 2020/ 
April 23, 2021
Module 6: 
Countering 
Emotional 
Behaviors
Objectives:
o
Identify and summarize the four main types of emotion-
driven behaviors
o
Identify common examples of helpful and unhelpful 
emotion-driven behaviors reported by LGBTQ clients 
o
Describe the paradoxical effects of emotion avoidance
o
Describe how to engage clients in the process of 
alternative actions 
Learning Activities:
o
Presentation on emotion-driven behaviors, including 
helpful and unhelpful emotional behaviors (15 minutes)
o
Group discussion on common unhelpful emotion-driven 
behaviors endorsed by LGBTQ clients (10 minutes)
o
Presentation on alternative action and how to address 
resistance from LGBTQ clients to alternative action (10 
minutes)
o
Group discussion on ways to support LGBTQ clients’ in 
engaging in alternative actions (15 minutes)
o
Q&A (10 minutes) 
January 8, 2021/ 
April 30, 2021
Module 7: 
Behavioral Skills 
Training
Objectives:
o
Describe the concept of assertiveness in the context of 
minority stress
o
Discuss strategies to assist LGBTQ clients in identifying 
and challenging unassertive thoughts
o
Identify ways to assist LGBTQ clients with contextual 
challenges related to assertiveness
Learning Activities:
o
Presentation on assertiveness training in the context of 
minority stress (15 minutes)
o
Group discussion on assertiveness training exercises for 
LGBTQ clients (10 minutes)
o
Review the Assertiveness Bill of Rights (10 minutes)
o
Group discussion on navigating challenges related to 
assertiveness (e.g., deciding in what situations to be 
assertive) (15 minutes)
o
Q&A (10 minutes)
January 15, 2021/ 
May 7, 2021
Module 8: Emotion 
Exposures
Objectives:
o
Summarize the intervention of emotion exposures and how 
they can support lasting change 
o
Describe how bodily sensations relate to emotions and 
minority stress
o
Identify different ways to design and types of emotion 
exposures for LGBTQ clients
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Learning Activities:
o
Presentation on emotion exposures, including exposure 
hierarchies (15 minutes)
o
Review the Symptom Induction Test Worksheet (10 
minutes)
o
Presentation on ways to design, prepare for, and engage 
in emotion exposure for LGBTQ clients (15 minutes)
o
Group discussions on ways to address resistance or non-
compliance from LGBTQ clients in completing emotion 
exposures (10 minutes)
o
Q&A (10 minutes)
January 22, 2021/ 
May 14, 2021
Module 9: Relapse 
Prevention
Objectives:
o
Describe overall points from treatment to summarize with 
LGBTQ clients
o
Describe skills from the LGBTQ-affirmative CBT treatment 
to discuss with LGBTQ clients for coping with minority 
stressors
o
Identify ways to engage LGBTQ clients in a dialogue about 
long-term goals in order to continue challenging minority 
stressors
Learning Activities:
o
Presentation on termination and relapse prevention in 
LGBTQ-Affirmative CBT (15 minutes)
o
Group discussion on strategies related to discussing long-
term goals and relapse prevention with LGBTQ clients (20 
minutes)
o
Review of Self-Affirmative Exercise (15 minutes) 
o
Q&A (10 minutes)
January 29, 2021/ 
May 21, 2021
Conclusion: Wrap-
up/Feedback on 
Training
Objectives:
o
Summarize challenges of implementing LGBTQ-affirmative 
CBT
o
Develop a plan for continued practice and implementation 
of LGBTQ-affirmative CBT in real-world clinic practice
o
Uncover barriers and facilitators of applying LGBTQ-
affirmative CBT in attendees’ affiliated community centers
Learning Activities:
o
Group discussion on remaining challenges about 
implementing LGBTQ-affirmative CBT (20 minutes)
o
Group discussion in order to request feedback from 
attendees about the training (30 minutes)
o
Final thoughts (10 minutes) 
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11.2 Table 2 – Visit Schedule Table of Study Measures and Training
Pre-training: Online 
consent for initial 
screening 
Pre-training: Information 
Session 
Visit 1: Baseline surveys 
(T1) (Day 1 ± 14)
Visit 2: 11-Week 
Training (for immediate 
training group) (Days 14 
to 91) 
Visit 3: 3-month post-
baseline surveys (Day 
91 ± 14)
Visit 4: 11-Week 
Training (for waitlist 
control group) (Day 105 
to 182) 
Visit 5: 6-month post-
baseline surveys (Day 
182 ± 196)
Informed Consent
X
X
Demographics
X
Randomization
X
Outcome Measures
LGBTQ Clinical Skills 
Competency
SOCCS
X
X
X
Deliberate Practice of 
LGBTQ-Affirmative 
CBT Skills
X
X
X
Cultural Humility
MCHS
X
X
X
Content Knowledge, 
Familiarity, and Use 
of Minority Stress & 
CBT
Minority Stress 
Content Knowledge 
Quiz
X
X
X
CBT/LGBTQ-
Affirmative CBT 
Content Knowledge 
Quiz
X
X
X
Familiarity and Use of 
LGBTQ-Affirmative 
CBT Skills 
Questionnaire
X
X
X
Acceptability of 
LGBTQ-affirmative 
CBT Training
Acceptability of 
LGBTQ-affirmative 
CBT Training 
Questionnaire
X 
(immediate 
training 
group)
X 
(waitlist 
control 
group)
Training in LGBTQ-
Affirmative CBT – 
Session Feedback 
Forms
Intervention training 
(or waitlist control) – 
LGBTQ-affirmative 
CBT
X
X
Adverse Event 
Reporting
X
X
X
X
X
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