Abstract
Transgender and gender expansive (TGE) individuals face minority stress and associated health risks, especially in high-stigma contexts. Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ)-affirmative cognitive-behavioral therapy (CBT) is one of the only evidence-based interventions developed to address minority stress to improve psychosocial health. Yet, trials of this treatment have mostly enrolled cisgender sexual minorities, TGE youth, and those living in North American contexts. This study tested the feasibility, acceptability, and preliminary efficacy of LGBTQ-affirmative CBT for TGE adults living in the high-stigma context of Romania. Twenty-five TGE individuals (M(age) = 25.16, SD(age) = 6.39; 44% transgender women, 40% transgender men, 16% nonbinary) reporting depression and/or anxiety symptoms received 16 virtual sessions of LGBTQ-affirmative CBT from trained psychologists. Assessments of mental (e.g., depression), behavioral (e.g., hazardous drinking), and sexual (e.g., HIV-transmission risk behavior) health outcomes, and minority stress and universal risk mechanisms were administered at baseline and 5-month follow-up. Results showed reductions in depression and anxiety symptoms and certain minority stress (e.g., anticipated stigma, identity concealment) and universal risk (e.g., unassertiveness) mechanisms from baseline to follow-up. The intervention was highly feasible (e.g., timely recruitment, high session attendance), and exit interviews revealed high acceptability in terms of the treatment's relevance, goals, imparting minority stress knowledge and identity-related hope and acceptance, format, and therapeutic alliance. LGBTQ-affirmative CBT shows feasibility, acceptability, and preliminary efficacy among TGE individuals living in Romania, with promise for other high-stigma contexts. Future randomized controlled trials and reductions in structural determinants remain priorities.