Effectiveness of LGBTQ targeted cognitive behavioral therapy on mental health outcomes: A systematic review and meta-analysis protocol

Introduction Sexual and gender minority populations experience disproportionately high rates of mental disorders due, in large part, to their chronic exposure to stigma, discrimination, and minority stress. Cognitive behavioral therapy (CBT) is an established evidence-based psychotherapy; however, conventional CBT was primarily developed among predominantly cisgender, heterosexual individuals and not often addresses identity-specific stressors relevant to LGBTQ individuals. Emerging adaptations of LGBTQ-affirmative CBT integrate components that affirm sexual and gender minority identities and target minority stress. Although the number of investigations testing such interventions has increased, evidence remains fragmented across studies. To our knowledge, no systematic review has examined the efficacy of LGBTQ targeted CBT on improving mental health outcomes. Objective This systematic review aims to synthesize empirical evidence from randomized controlled trials (RCTs) evaluating the effectiveness of LGBTQ targeted CBT interventions in reducing mental health symptoms among sexual and gender minority adults. Materials and methods A comprehensive search will be conducted across PubMed, EMBASE, PsycINFO, the Cochrane Library, and Scopus, supplemented by gray-literature searches. Eligible studies include RCTs conducted on adults aged 18–65 and evaluating LGBTQ targeted CBT compared with usual care, waitlist, or active controls. Outcomes include depression, anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, and substance use disorder symptom changes at post-intervention and follow-up. Data extraction and risk-of-bias assessment will be performed independently by two reviewers, with risk of bias assessed using the Cochrane Risk of Bias 2 tool. Where feasible, meta-analyses using random-effects models in R will estimate standardized mean differences or risk ratios with 95% confidence intervals. Overall efficacy and potential moderators, such as intervention delivery mode and duration, will be investigated. Expected contribution By consolidating the evidence base for LGBTQ targeted CBT, this review will clarify its efficacy, identify key intervention features associated with improved outcomes, and provide guidance for evidence-based mental health care for sexual and gender minority populations. PROSPERO registration This protocol has been pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD420251173207).