OBJECTIVE Lesbian, gay, bisexual, and queer (LGBQ)-affirmative cognitive behavioral therapy (CBT) focused on minority stress processes can address gay and bisexual men's transdiagnostic mental and behavioral health concerns. Identifying moderators of treatment outcomes may inform the mechanisms of LGBQ-affirmative CBT and subpopulations who may derive particular benefit. METHOD Data were from a clinical trial in which gay and bisexual men with mental and behavioral health concerns were randomized to receive Effective Skills to Empower Effective Men (ESTEEM; an LGBQ-affirmative transdiagnostic CBT; n = 100) or one of two control conditions (n = 154): LGBQ-affirmative community mental health treatment (CMHT) or HIV counseling and testing (HCT). The preregistered outcome was a comorbidity index of depression, anxiety, alcohol/drug problems, and human immunodeficiency virus (HIV) transmission risk behavior at 8-month follow-up (i.e., 4 months postintervention). A two-step exploratory machine learning process was employed for 20 theoretically informed baseline variables identified by study therapists as potential moderators of ESTEEM efficacy. Potential moderators included demographic factors, pretreatment comorbidities, clinical facilitators, and minority stress factors. RESULTS Racial/ethnic minority identification, namely as Black or Latino, was the only statistically significant moderator of treatment efficacy (B = -3.23, 95% CI [-5.03, -1.64]), t(197) = -3.88, p < .001. Racially/ethnically minoritized recipients (d = -0.71, p < .001), but not White/non-Latino recipients (d = 0.22, p = .391), had greater reductions in comorbidity index scores in ESTEEM compared to the control conditions. This moderation was driven by improvements in anxiety and alcohol/drug use problems. DISCUSSION Black and Latino gay and bisexual men experiencing comorbid mental and behavioral health risks might particularly benefit from a minority stress-focused LGBQ-affirmative CBT. Future research should identify mechanisms for this moderation to inform targeted treatment delivery and dissemination. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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LGBQ 肯定性认知行为疗法的调节者：ESTEEM 对黑人和拉丁裔性少数男性尤其有效。


目标 女同性恋、男同性恋、双性恋和酷儿 (LGBQ) 肯定性认知行为疗法 (CBT) 专注于少数群体压力过程，可以解决男同性恋和双性恋男性的跨诊断心理和行为健康问题。确定治疗结果的调节因素可以为 LGBQ 肯定性 CBT 的机制和可能获得特殊益处的亚人群提供信息。方法 数据来自一项临床试验，其中有精神和行为健康问题的男同性恋和双性恋男性被随机分配接受有效技能赋予有效男性（ESTEEM；LGBQ 肯定性跨诊断 CBT；n = 100）或两种控制条件之一（ n = 154)：LGBQ 平权社区心理健康治疗 (CMHT) 或 HIV 咨询和检测 (HCT)。预先登记的结果是 8 个月随访（即干预后 4 个月）时的抑郁、焦虑、酒精/毒品问题和人类免疫缺陷病毒 (HIV) 传播风险行为的共病指数。研究治疗师将两步探索性机器学习过程应用于 20 个理论上知情的基线变量，这些变量被研究治疗师确定为 ESTEEM 功效的潜在调节因素。潜在的调节因素包括人口因素、治疗前合并症、临床促进因素和少数压力因素。结果 种族/族裔少数群体（即黑人或拉丁裔）是治疗效果唯一具有统计学意义的调节因素（B = -3.23，95% CI [-5.03，-1.64]），t(197) = -3.88，p < .001.与对照条件相比，在 ESTEEM 中，种族/族裔少数群体的接受者 (d = -0.71，p < .001)，但白人/非拉丁裔接受者 (d = 0.22，p = .391) 的共病指数得分降低幅度更大。这种缓解是由焦虑和酗酒/吸毒问题的改善推动的。 讨论 经历共病心理和行为健康风险的黑人和拉丁裔男同性恋和双性恋男性可能特别受益于关注少数群体压力的 LGBQ 肯定性 CBT。未来的研究应该确定这种调节机制，以便为有针对性的治疗提供和传播提供信息。 （PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。