Social work researcher investigates a mindfulness mental health intervention for LGBTQIA+ youth

When UConn School of Social Work Assistant Professor Gio Iacono was a mental health clinician working with LGBTQIA+ youth, he searched for programs and interventions that would help him better serve his clients who were struggling with significant mental health challenges. As a social work doctoral student, he continued to study, develop, and evaluate culturally responsive mental health programs for this marginalized and underserved youth population.

"There are significant mental and sexual health disparities among LGBTQIA+ youth that require urgent attention," he says.

A national survey conducted by the Trevor Project in 2021 found that 70% of LGBTQIA+ youth and young adults in the United States reported poor mental health, with trans and non-binary youth experiencing even greater disparities. In 2022, another study found that 45% of LGBTQIA+ youth seriously considered suicide during the past year. Moreover, LGBTQIA+ youth of color face multiple, intersecting forms of discrimination.

Despite these data, "queer and trans youth are basically overlooked in terms of mental health intervention research, and generally underserved in social work and clinical mental health practice," Iacono notes. LGBTQIA+ youth also face significant political and legislative attacks, and increasing marginalization in schools and communities where conflicts over gender identity, education, and sports often play out.

With his research on Tuned In!, an innovative LGBTQIA+ affirming mindfulness-based intervention, collaboratively developed with LGBTQIA+ youth, Iacono aims to be a part of a movement to tackle these pressing issues. "As part of a comprehensive political strategy, we need public health and mental health interventions to help address these disparities," he says.

A tailored mindfulness program

Prior to launching his own research, Iacono investigated one of the few interventions available for LGBTQIA+ youth called AFFIRM. The eight-week mental health program is evidence-based and uses cognitive behavioral therapy, but it is one of only a few approaches tailored to the needs of LGBTQIA+ youth.

In 2017, Iacono started to partner with LGBTQIA+ youth, local youth-serving agencies, and community-based organizations to develop Tuned In! In Connecticut, he has recently collaborated with Connecticut TransAdvocacy Coalition, the Department of Mental Health and Addiction Services, UConn Rainbow Center, and the Department of Children and Families. In addition to creating an advisory board that includes some of these collaborators, he recruited a youth advisory board to meaningfully involve LGBTQIA+ youth voices in implementation of the program.

"There aren't any systematically developed mindfulness-based interventions specifically tailored for queer and trans youth, despite robust literature indicating that mindfulness can improve mental health," he explains. "We needed to be culturally responsive and collaboratively work with LGBTQIA+ youth to tailor interventions to meet their unique needs."

Unlike cognitive therapy, which teaches individuals to challenge their negative thoughts, mindfulness focuses on acceptance and awareness of the present moment. "It's a skill and practice of developing kindness toward oneself, awareness of thoughts and feelings, and also stepping back and seeing thoughts and feelings for what they are, which can improve mental health and potentially help us become more involved in community and social change," he says.

The intervention

Tuned In! involves eight 90-minute sessions that include check-ins, group discussions, mindfulness-based practices like meditation, and weekly action plans for LGBTQIA+ youth. Sessions are led by licensed mental health facilitators trained in mindfulness and with at least a year of experience working with LBGTQIA+ youth.

In the sessions, youth learn coping skills to reduce their feelings of anxiety and depression. They specifically explore issues such as internalized homophobia, transphobia, and racism while also learning how to address common issues faced by LGBTQIA+ youth such as bullying, family and peer rejection, and victimization.

Tuned In! is distinct from other behavioral programs in that it encourages political awareness, consciousness raising, and engagement. "One of the exciting things about Tuned In! is that it includes strategies and practices to become more politically and socially engaged—exploring how youth can meaningfully connect to programs or organizations that do advocacy work, or how to become more politically involved in general," says Iacono.

Pilot study

Iacono has published preliminary research about the feasibility and utility of Tuned In! After collaborating with LGBTQIA+ youth and community partners to develop and fine-tune the intervention, Iacono and colleagues launched a pilot study in 2022. The research team recruited 50 LGBTQIA+ youth in Connecticut between the ages of 16 and 29 to participate.

Before and after the study period the youth provided feedback through surveys and focus groups. "We saw improvements in depression, anxiety, and internalized oppression. We also saw improvements in sexual self-efficacy, or the ability to refuse certain unsafe sexual practices," he says. The findings are published in the Journal of Gay & Lesbian Mental Health.

The youth reported progress in terms of proactive coping, or coping in healthier ways rather than resorting to harmful strategies. "We also saw significant improvements in mindfulness and self-compassion, which is such a critical component of the program's mechanism of change," notes Iacono.

These positive results were maintained for six months. "I learned so many tools and resources for mindfulness in my daily life, grounding, and self-compassion," says youth participant Evan Horton. "I can only compare it to having crutches; I needed the support in that moment so that I'm now strong enough to stand on my own."

The findings support Tuned In! as a mental health intervention that LBGTQIA+ youth found both feasible, accessible, and useful. The success of the pilot study has led to plans to increase the scale of the research and assess the sustainability of outcomes over time. The researchers are also considering adapting the study even further to meet the needs of diverse LGBTQIA+ youth populations, such as youth of color.

Iacono will seek funding to expand the program across New England and offer the intervention in-person as well as online. The researchers would also like to establish the program as a resource for youth to connect to needed services such as housing and food. The long-term goal is to expand to a national, randomized trial of Tuned In! and evaluate it in communities across the country.

"I think early intervention—ideally prevention—is the way forward with LGBTQIA+ youth mental health," he says. "It's important that LGBTQIA+ youth have the opportunity to develop skills to cope with these stressors. It's equally important that youth are supported by LGBTQIA+ mentors and allies and have opportunities to get politically involved.

"Together, we can not only transform the disparities among this population but also work towards addressing the political and legal attacks faced by LGBTQIA+ youth and LGBTQIA+ communities in general. Healthier and thriving LGBTQIA+ communities will be able to be more effective in creating sustainable social change."