PROJECT SUMMARY/ABSTRACT During the COVID-19 pandemic, up to 81% of adults in the United States experienced worsening mental health. A major cause was the social isolation triggered by the pandemic due to quarantining, loss of family or friends, and loss of work. For individuals who lost social connections or were unable to adapt to maintain their connections, social support decreased and loneliness worsened, putting them at much higher risk for anxiety and depressive symptoms. Importantly, people who identify as LGBTQ+ have been particularly affected by the social isolation caused by the pandemic and were already at much higher risk of social isolation, loneliness, and mental illness, including suicidality, before the pandemic. The long-term goal is to improve mental health outcomes in the LGBTQ+ population. The objective of this R01 fully-powered Hybrid Type 1 Effectiveness- Implementation trial is to examine the effectiveness of a brief acceptance-based behavioral telehealth intervention (ABBT) to improve mental health during the COVID-19 pandemic by strengthening social support among LGBTQ+ individuals. The central hypothesis is that ABBT will be an impactful intervention for LGBTQ+ individuals because it will teach patients how to navigate the real, unavoidable challenges of the COVID-19 pandemic, while attending to their life goals and values, such as social connectedness. The aims of this proposal are: (1) to examine the effectiveness of ABBT in reducing mental health morbidity by conducting a fully-powered, RCT (n=200) of ABBT vs. Treatment-as-Usual; (2) to examine potential mediators and moderators of ABBT treatment effects; and, (3) to identify patient, staff, and organizational-level factors that may facilitate/hinder ABBT implementation. Primary outcomes will be anxiety and depressive symptoms. ABBT represents an innovative approach to coping with the COVID-19 pandemic that can be more personally-relevant and sensitive to patients' needs than traditional CBT. Thus, the clinical and public health significance of this research will be the demonstration of a simple, lower-cost, and potentially widely- disseminable intervention that can be integrated into treatment services at LGBTQ+ health centers.

PROJECT NARRATIVE The proposed research is relevant to public health because improved mental health among LGBTQ+ patients is expected to reduce wasted health care resources, due to poor treatment engagement, and to enhance society’s recovery from the COVID-19 pandemic. Moreover, the proposed Hybrid Type 1 design aligns with NIMH’s Strategic Plan, Goal 4, as we will test the effectiveness of an innovative intervention while collecting data to support implementation.