Yale Daily News

With a $4 million grant from the National Institute of Mental Health, Yale researchers are seeking to offer new therapeutic interventions to LGBTQ+ community centers across the country. 

The five-year grant, which was announced in a press release last week, will support research by John Pachankis, who is a professor of public health, and his team at Yale’s LGBTQ Mental Health Initiative. The team will administer novel LGBTQ+ affirmative cognitive behavioral therapy to over 90 community centers and 540 mental health providers across the United States.

“LGBTQ+-affirmative CBT recognizes LGBTQ+ people’s exposure to identity-related stressors,” Pachankis said, speaking about a form of psychological treatment called cognitive behavioral therapy. “It teaches LGBTQ+ people to undo harmful legacies that led them to be more ashamed, and replace them with new, empowered ways of thinking and being.” 

Pachankis and his team hope to use the NIMH grant to compare different methods of educating providers on LGBTQ+-affirmative CBT. They will evaluate the therapy’s effectiveness alongside other factors including cost and competence. 

Pachankis’s research on LGBTQ+-affirmative CBT finds that a client’s reactions to “minority stressors” — negative emotional experiences like hypervigilance, concealment and fear — are caused by stigma against queer people. This stigma can stem from harmful personal interactions or larger structural changes targeting the queer community, such as the rise of legislation blocking access to health care for transgender individuals. Mental health providers trained in LGBTQ+-affirmative CBT ask questions about clients’ past to help them reflect on why they experience negative emotions to improve their self-esteem.

“The identities we have and the prejudices people have about them have real and tangible consequences for people’s health,” Skyler Jackson, an assistant professor of public health and a clinical psychologist with the Initiative, said. “One of the distinguishing factors of our approach is the use of best practices in psychotherapy honed in on the areas, issues and challenges we know queer people face due to previous anti-LGBTQ+ stigma.” 

The team’s LGBTQ+-affirmative CBT is the only evidence-based approach in addressing the mental health challenges of the queer community. From their initial research to putting that research into practice, Pachankis and his team have acknowledged the wide diversity of the queer community. LGBTQ+-affirming CBT encourages providers to approach clients’ multiple identities with cultural competence, curiosity and tailored questioning.

“LGBTQ+-affirmative CBT has an explicit focus on intersectionality,” Pachankis said. “It recognizes that people and identities are complex and shaped by intersecting structural and social conditions.”

Through the therapy, providers and clients recognize the clients’ diverse identities beyond their sexual orientation or gender identity to pinpoint the causes of their struggles. According to Jackson, identifying these sources of shame encourages clients to be proud of themselves. 

Danielle Chiaramonte, an associate research scientist and community psychologist with the initiative, told the News that LGBTQ+-affirmative CBT is a popular mental health approach.  “Therapists can feel confident in the treatment they provide, and there are people all over who are interested in it.” 

LGBTQ+ community centers, many of which were created to help respond to the HIV/AIDS crisis, have transformed into primary healthcare centers that provide comprehensive services. By implementing evidence-based practice, Pachankis said that his team believes community centers can improve their mental health divisions through federal funding and external support. The team insists that working with local community centers will spark sustainable change that impacts providers, clients and the wider queer community. 

“Community centers are doing the work that the rest of society isn’t,” Pachankis said. “They provide care to those who are uninsured, people of color, transgender. They are on the frontlines of addressing mental health needs of the LGBTQ+ community members at the greatest risk.”

With the grant’s help, Pachankis said his team hopes to accelerate bringing LGBTQ+-affirmative CBT to the real world. By supplying workers in community centers with evidence-based therapeutic tools, the Initiative aims to build a more informed group of mental health providers. 

“Initiatives like this are crucial to ensure that LGBTQ individuals receive the support they need and help increase access to lifesaving, medically necessary care,” said Samuel Byrd, director of Yale’s Office of LGBTQ Resources. “This five-year grant will undoubtedly make a significant impact in addressing mental health disparities within our community and providing evidence-based care to those who may not have had access before.”

Ultimately, Pachankis said his team understands that their research will not completely solve discrimination against the LBGTQ+ community. 

Still, he said, they hope to empower queer people to cope and confront their current realities.

“We are committed to building a world that works for all of us,” Jackson affirmed. “We need to arm queer people with armor to navigate a world that is still unfair and unjust. We need to give LGBTQ+ people all that they can to survive and thrive.”

The Yale LGBTQ Mental Health Initiative was founded in 2013.