SPSS Syntax for Quantitative Data Analysis for Testing Gender Affirming Adaptations of Cognitive Behavioral Therapy Using Mock Therapy Videos

Transgender and gender diverse (TGD) people seeking mental health care for marginalization stress frequently face additional marginalization by therapists who are unprepared to meet their needs. In response, our community-based participatory research group developed 12 Adaptations to guide therapists in being affirming of TGD identities. This study applied those Adaptations to an established cognitive behavioral therapy (CBT) protocol to investigate whether an adapted intervention would create conditions associated with positive clinical outcomes. Three sets of videos were created depicting mock therapy sessions illustrating key aspects of CBT. Affirming videos, based on the Adaptations, were compared to videos with marginalizing content, and neutral videos with neither marginalizing nor affirming content. TGD participants (N = 64; Age M = 31.72) were randomly assigned to view one set of videos, complete measures of credibility, cultural responsiveness, and working alliance, and participate in a semi-structured interview. A 3 x 4 (Video type x 4 videos) repeated-measures ANOVA was conducted for each dependent variable. All ANOVAs had significant large main effects for video type, with highest ratings for affirming videos, lowest for marginalizing videos, and neutral in the middle. Condition x Time interactions revealed small effects for varying changes across Time. Thematic analyses of the interviews converged with and expanded upon the quantitative findings, identifying active and reactive positive (affirming and neutral) and negative (neutral and marginalizing) therapist actions. This study demonstrated that TGD participants reacted positively to affirming adaptations of CBT. Furthermore, simply avoiding marginalization is insufficient to create an affirming therapy experience.