Craig, S. L., & Austin, A. (2016). The AFFIRM open pilot feasibility study: A brief affirmative cognitive behavioral coping skills group intervention for sexual and gender minority youth. Children and Youth Services Review, 64, 136–144. https://doi.org/10.1016/j.childyouth.2016.02.022

Type of Study: One-group pretest–posttest study
Number of Participants: 30

Population:

• Age — 15–18 years (Mean=16.8 years)
• Race/Ethnicity — 64% White European, 25% Black/African/Caribbean, 24% East/South/Southeast Asian, 18% Indigenous/First Nations, and 7% Latino/a
• Gender — 57% Female, 37% Queer, 20% Male, 20% Non-Binary, 7% Transgender, 3% Two-Spirit, and 3% Other
• Status — Participants were recruited via emails, posters in relevant youth serving agencies or spaces, texting, a closed Facebook group, and a Twitter account.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the feasibility and effectiveness of a brief, eight-module affirmative cognitive-behavioral coping skills group intervention (AFFIRM) [now called AFFIRM Youth] with sexual and gender minority youth (SGMY) developed through community partnerships. Measures utilized include the Beck Depression Inventory-II (BDI-II), the Proactive Coping Inventory for Adolescents-A (PCI-A): Reflective Coping Subscale (RCS), the AFFIRM Acceptability Survey, and the Stress Appraisal Measure for Adolescents (SAMA). Results indicate that over the study duration, significant reductions were found in depression and appraising stress as a threat. Significant increases were found in reflective coping and perceiving stress as a challenge. Participants found the intervention to be valuable and reported high levels of acceptability and skills acquisition. Limitations include lack of control group, small sample size, length of follow-up, and lack of randomization.

Length of controlled postintervention follow-up: 3 months.

Craig, S. L., Austin, A., & Huang, Y.-T. (2017). Being humorous & seeking diversion: Promoting healthy coping skills among LGBTQ+ youth. Journal of Gay & Lesbian Mental Health, 22(1), 20–35. https://doi.org/10.1080/19359705.2017.1385559

Type of Study: One-group pretest–posttest study
Number of Participants: 30

Population:

• Age — 15–18 years (Mean=17.07 years)
• Race/Ethnicity — 19 White European, 9 East/South/Southeast Asian, 8 Black/African/Caribbean, 8 Indigenous/First Nations, and 2 Latino/a
• Gender — 17 Female, 6 Male, 6 Non-Binary, 2 Trans, and 1 Two-Spirit
• Status — Participants were recruited via emails, posters in relevant youth serving agencies or spaces, texting, a closed Facebook group, and a Twitter account.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Craig & Austin (2016). The purpose of the study was to explore the coping patterns of LGBTQ+ youth participants in a cognitive-behavioral therapy-based coping skills training, (AFFIRM) [now called AFFIRM Youth]. Measures utilized include the Adolescent Coping Orientation for Problem Experiences (A-COPE). Results indicate that LGBTQ+ youth were most likely to utilize avoiding problems as a strategy to cope with stress, followed closely by being humorous, relaxing, and venting feelings. Notably, seeking professional and spiritual support were the least adopted coping strategies. Postintervention, participants reported significant increases in the areas of primary control (solving family problems) and secondary control (seeking spiritual support, seeking diversion, engaging in demanding activities, and being humorous). Limitations include lack of control group, small sample size, length of follow-up, and lack of randomization.

Length of controlled postintervention follow-up: 3 months.

Austin, A., Craig, S. L., & D’Souza, S. A. (2018). An AFFIRMative cognitive behavioral intervention for transgender youth: Preliminary effectiveness. Professional Psychology: Research and Practice, 49(1), 1–8. https://doi.org/10.1037/pro0000154

Type of Study: One-group pretest–posttest study
Number of Participants: 8

Population:

• Age — 16–18 years (Mean=16.8 years)
• Race/Ethnicity — 5 White (Canadian European), 2 Mixed Background, 1 Asian, 1 (African, Canadian, Caribbean), 1 Latin American, and 1 Indigenous, First Nations, Inuit, Metis
• Gender — 6 Nonbinary, 2 Female, 2 Male, 2 Transgender, 1 Independent, 1 Other– “figuring things out,” and 1 Two-Spirit
• Status — Participants were recruited using venue-based and purposive sampling through community-based organizations and online sources.

Location/Institution: Major urban city in Canada

Summary: (To include basic study design, measures, results, and notable limitations)
The study used a subsample from Craig & Austin (2016). The purpose of the study was to present the results of a pilot study exploring the preliminary effectiveness and acceptability of AFFIRM [now called AFFIRM Youth], an affirmative cognitive-behavioral coping skills group intervention with transgender youth. The purpose of the study was also to describe transgender-specific considerations for delivering transgender affirmative interventions. Measures utilized include the Beck Depression Inventory-II (BDI-II), the Proactive Coping Inventory for Adolescents-A (PCI-A): Reflective Coping Subscale (RCS), and the AFFIRM Satisfaction Survey. Results indicate that AFFIRM was effective in significantly decreasing depression scores, and changes persisted through the 3-month follow-up. While changes in coping were not statistically significant, scores trended in a positive direction. Data indicate favorable responses to AFFIRM among transgender participants across a variety of dimensions of satisfaction. Limitations include lack of control group, small sample size, length of follow-up, and lack of randomization.

Length of controlled postintervention follow-up: 3 months.

Craig, S. L., Eaton, A. D., Leung, V. W. Y., Iacono, G., Pang, N., Dillon, F., Austin, A., Pascoe, R., & Dobinson, C. (2021). Efficacy of affirmative cognitive behavioural group therapy for sexual and gender minority adolescents and young adults in community settings in Ontario, Canada. BMC Psychology, 9, Article 94. https://doi.org/10.1186/s40359-021-00595-6

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 138

Population:

• Age — Mean=22.4 years
• Race/Ethnicity — 67 White, 31 Asian, 24 Black, 13 Multi-Ethnic, 8 Hispanic/Latinx, 6 Indigenous, and 6 Middle Eastern
• Gender — 33 Non-Binary, 31 Transgender, 24 Cis Woman, 21 Cis Man, 12 Queer, 8 Agender, 7 Other, and 2 Two-Spirit
• Status — Participants were recruited through social media advertisements and flyers were circulated throughout professional network listservs (e.g., clinical psychologists and social workers) and local agencies (e.g., Planned Parenthood, SGM communities).

Location/Institution: Twelve sites that served youth or SGMY populations in urban areas of the Canadian province of Ontario

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the efficacy of AFFIRM [now called AFFIRM Youth], a brief affirmative cognitive-behavioral group intervention tailored to reduce psychosocial distress and improve coping among sexual and gender minority adolescents and young adults (SGMY). Participants were allocated to immediate 8-week AFFIRM intervention delivered at 12 community-based organizations or an 8-week waitlisted control. Measures utilized include the Beck Depression Inventory-II (BDI-II), the Proactive Coping Inventory for Adolescents-A (PCI-A): Reflective Coping Subscale (RCS), the Brief COPE Inventory (BCI), the Stress Appraisal Measure for Adolescents (SAMA), and the Home Scale (HS). Results indicate that compared to waitlist, SGMY in the intervention condition significantly reduced their depressive symptoms as well as increased reports of hope, pathway, and coping by emotional support, instrumental support, positive framing, humor, planning, as well as reflective coping. Intervention participants were also less likely to perceive stress as a threat, and more likely to perceive stress as a challenge, and have the resources to deal with that stress in comparison to waitlisted control participants. All outcomes had medium to large effect sizes. AFFIRM participants reported low attrition and high levels of engagement and acceptability (e.g., 99% agreed intervention was relevant to their lives). Limitations include lack of randomization, some enrolled participants did not complete AFFIRM, the waitlist design does not allow for comparison with another treatment (e.g., non-adapted CBT), AFFIRM draws on minority stress theory but this study does not specifically test those constructs, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Craig, S. L., Leung, V. W. Y., Pascoe, R., Pang, N., Iacono, G., Austin, A., & Dillon, F. (2021). AFFIRM Online: Utilizing an affirmative cognitive-behavioural digital intervention to improve mental health, access and engagement among LGBTQA+ youth and young adults. International Journal of Environmental Research and Public Health 18(4), Article 1541.

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 96

Population:

• Age — Mean=21.17 years
• Race/Ethnicity — 60 White, 18 Asian, 13 Multi-Ethnic/Racial, 12 Black, 8 Other, 5 Middle Eastern, 3 Indigenous, and 2 Latinx
• Gender — 34 Non-Binary, 24 Transgender, 17 Cis Woman, 5 Cis Man, 5 Other, 4 Queer, and 1 Two-Spirit
• Status — Participants were recruited through electronic flyers distributed via email and social media by the research team, relevant local agencies, and former participants.

Location/Institution: Twelve sites that served youth or SGMY populations in urban areas of the Canadian province of Ontario

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to describes the preliminary efficacy of AFFIRM Online [now called AFFIRM Youth] an eight-session manualized affirmative cognitive behavioral group intervention delivered synchronously. Participants were allocated to AFFIRM Online intervention or a waitlisted control condition. Measures utilized include the Beck Depression Inventory-II (BDI-II), the AFFIRM Acceptability Survey, the Brief COPE Inventory (BCI), the Stress Appraisal Measure for Adolescents (SAMA), and the Home Scale (HS). Results indicate that compared to a waitlist control, AFFIRM Online participants experienced significantly reduced depression and improved appraisal of stress as a challenge and having the resources to meet those challenges, as well active coping, emotional support, instrumental support, positive framing, and planning. Participants reported high acceptability. This study highlights the potential of digital interventions to impact LGBTQA+ youth mental health and explores the feasibility of digital mental health to support access and engagement of youth with a range of identities and needs (e.g., pandemic, lack of transportation, rural locations). Limitations include study results may be confounded by time as the control group completed questionnaires prior to the intervention participants, lack of randomization, the waitlist design does not allow for comparison with another treatment, and lack of follow-up.

Length of controlled postintervention follow-up: None.