Preliminary Evaluation of an Acceptance and Commitment Therapy Group for Transgender and Gender Expansive Adults

This study aimed to evaluate the outcomes, specifically in psychological inflexibility and depression, as well as satisfaction and utility, of a 12-week, structured acceptance and commitment therapy (ACT) group delivered to transgender and gender expansive (TGE) adults at a university-affiliated community mental health clinic. The sample included six TGE adults who consented and completed all study surveys. Psychological inflexibility significantly decreased by 6.5 scale points or 22.4% from pregroup (M = 29.00, SD = 7.29) to postgroup (M = 22.50, SD = 7.58), t(5) = 3.99, 95% CI [2.32, 10.68], p = .010. This was considered a medium effect size (Hedges' g = 0.73, 95% CI [0.27, 1.20]). Depression decreased by 0.5 scale points or 5.2% from pregroup (M = 9.67, SD = 5.39) to postgroup (M = 9.17, SD = 3.82), though this was considered a negligible effect (g = 0.05, 95% CI [-0.12, 0.22]) and not statistically significant, t(5) = 0.65, 95% CI [-1.46, 2.46], p = .542. Quantitative measures revealed that group members reported high satisfaction and a positive therapeutic relationship. Group members rated the topic of committed actions and group discussions as most helpful. Findings suggest that ACT-based groups may be satisfactory and effective at reducing psychological inflexibility, but not depression, in TGE adults; however, more research is needed to address the dearth of evidence-based treatments for this population. We offer recommendations related to understanding the TGE community context, employing advanced clinical skills and TGE knowledge, setting expectations for group therapy, and gathering regular feedback.