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Table 1 Content of ESTEEM intervention

From: Project ESTEEM protocol: a randomized controlled trial of an LGBTQ-affirmative treatment for young adult sexual minority men’s mental and sexual health

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