Table 1 Content of ESTEEM intervention

Module 1: Motivation Enhancement for ESTEEM Engagement

Discuss HIV test result and provide PrEP information and referral

Review individualized health report against young gay and bisexual men norms

Clarify primary mental, behavioral, and sexual health goals

Build motivation to address mental, behavioral, and sexual health

Review unique strengths as a young gay and bisexual men

Module 2: The Nature and Emotional Impact of Minority Stress

Review the impact of minority stress on mental and sexual health

Identify specific early and ongoing forms of minority stress

Discuss current coping strategies

Module 3: Tracking Emotional Experiences

Raise awareness of the emotional impact of early and ongoing minority stress

Module 4: Awareness of Minority Stress Reactions

Raise awareness of the behavioral impact of minority stress

Teach mindful, present-focused reactions to minority stress

Module 5: Cognitive Appraisal and Reappraisal

Connect minority stress to maladaptive thinking patterns

Identity thoughts driven by minority stress and learn to update them

Module 6: Emotion Avoidance

Learn how avoiding strong emotions can lead to unhealthy behavior

Discuss how minority stress might lead to avoidance of certain people, places, or experiences

Module 7: Emotion-Driven Behaviors

Focus on the ways that minority stress can lead to avoidance

Discuss intimacy, relationships, and substance use

Module 8: Behavioral Skills Training

Explore how minority stress can lead to unassertiveness

Focus on assertiveness training for coping with minority stress

Module 9: Behavioral Experiments

Create an emotional and behavioral avoidance hierarchy

Engage young gay and bisexual men in behavioral experiments in which previously avoided experiences are gradually confronted

Module 10: Relapse Prevention

Review new cognitive, affective, and behavioral coping strategies and their application to future minority stress experiences