| Summary: | Objectives: This randomized controlled trial examined whether an 11-week synchronous (i.e., real-time) online training in lesbian, gay, bisexual, transgender, queer, and other sexual or gender diverse (LGBTQ)-affirmative cognitive behavioral therapy (CBT) could lead to increased uptake of this practice at LGBTQ community centers across 20 U.S. states and internationally. Method: A total of 121 mental health providers (M = 37.74; 78.5% LGBTQ; 60.3% non-Hispanic/Latinx White) were randomized to receive the 11-week training either immediately (n = 61) or after a 4-month wait (n = 60). At baseline and 4 and 8 months after baseline, participants self-reported their LGBTQ-affirmative competency, cultural humility, and knowledge of the minority stress theory and practice skills underlying LGBTQ-affirmative CBT. To objectively assess uptake of LGBTQ-affirmative CBT, participants demonstrated, through simulated practice, how they would respond to two video-based clinical vignettes. Results: Compared to wait-list, participants in the immediate training condition reported greater improvements in self-reported cultural competence (d = 1.24), minority stress knowledge (d = 0.78), LGBTQ-affirmative CBT knowledge (d = 0.78), and LGBTQ-affirmative CBT skills familiarity (d = 0.91) and use (d = 0.96); effects persisted 8 months postbaseline. Cultural humility showed no significant difference by condition (d = 0.07). In objectively coded assessments of simulated practice, participants in the training condition demonstrated greater uptake of LGBTQ-affirmative practice skills (d = 0.82). Conclusions: Findings preliminarily suggest that mental health providers can be trained to deliver LGBTQ-affirmative CBT using the low-cost, efficient reach of online training. This training can help disseminate evidence-based mental health care to LGBTQ individuals and support its implementation across practice settings. What is the public health significance of this article?: Training mental health providers in LGBTQ-affirmative CBT can reduce the substantial mental health disparities facing sexual and gender minority populations by reducing barriers to receiving evidence-based mental health care. This randomized controlled trial found that, compared to wait-list, an 11-week training in LGBTQ-affirmative CBT based in minority stress theory yielded significantly greater uptake of self-reported LGBTQ cultural competence, minority stress knowledge, LGBTQ-affirmative CBT knowledge and skills familiarity, and objectively coded skills use for mental health providers working at LGBTQ community centers across the US and internationally. Dissemination of LGBTQ-affirmative CBT through efficacious training programs embedded within frontline settings might represent an efficient means for improving mental health care for the LGBTQ population.
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