Digital intervention to reduce minority stress in sexual and gender minority populations: a pilot feasibility and usability study

This study aimed to evaluate the feasibility, usability and acceptability of a digital Acceptance and Commitment Therapy intervention (iACT) for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexually and gender diverse (LGBTQIA+) individuals, while exploring preliminary changes in minority stress and wellbeing-related outcomes. We conducted a four-week pilot study with randomized pre-post design of a self-help iACT program adapted for LGBTQIA+ individuals. Data were collected between June and September 2025.

Participants (N = 85; experimental n = 35, control n = 50) completed baseline and post-intervention assessments of depression, anxiety, stress, psychological flexibility, emotion regulation, minority stress, resilience, and usability. The program demonstrated excellent usability. Participant feedback indicated that the intervention was perceived as useful, accessible, and affirming, promoting self-acceptance, introspection, and reflection.

Qualitative feedback also identified limitations, including tasks perceived as overly guided or repetitive, lengthy audio materials, and limited personalization. Exploratory analyses showed that participants in the experimental group demonstrated significant pre-post improvements in psychological distress, stress, emotional clarity, goal-directed behavior, and anticipated discrimination, which survived correction for multiple comparisons, with small-to-large effect sizes. Between-group comparisons favored the experimental group on stress, emotional clarity, and anticipated discrimination, with small-to-medium effect sizes, although these differences did not remain significant after correction.

A key limitation was the high and uneven attrition rate (51.4% in the experimental group vs. 15.3% in controls), which warrants caution in interpreting exploratory outcome findings. Overall, findings support the feasibility and acceptability of a self-help iACT program tailored for LGBTQIA+ individuals and suggest preliminary changes in stress, minority stress, and emotion regulation. These results may inform future trials evaluating queer-affirmative digital interventions for individuals facing stigma, non-disclosure, or structural barriers to care.

The authors wish to acknowledge the members of the Gender Incongruence Interdisciplinary Group (GIIG) of the University Hospital of Padua, Italy, for their valuable multidisciplinary collaboration and ongoing commitment to advancing inclusive and evidence-based care for gender-diverse populations: Andrea Garolla, Anna Aprile, Camillo Barbisan, Daniela Basso, Marina Bonato, Valentina Camozzi, Elena Campello, Cattelan Annamaria, Chiara Ceolin, Fabrizio Dal Moro, Giorgio De Conti, Angela Favaro, Alberto Ferlin, Francesco Francini, Michela Gatta, Marta Ghisi, Sandro Giannini, Laura Guazzarotti, Massimo Iafrate, Corrado Marchese Ragona, Paolo Meneguzzo, Marina Miscioscia, Giulia Musso, Giancarlo Ottaviano, Rossella Perilli, Carlo Saccardi, Lolita Sasset, Alberto Scala, Rossana Schiavo, Giuseppe Sergi, Paolo Simioni, Benedetta Tascini, Elisa Varotto, Francesca Venturini, Tommaso Vezzaro, Fabrizio Vianello. The study was funded by the European Union - Next Generation EU, though the views expressed are solely those of the authors and do not necessarily reflect those of the European Union or the European Commission, which cannot be held responsible for them. Department of Developmental Psychology and Socialization, University of Padua, Via Venezia 8, Padua, 35131, Italy Marina Bonato, Martina Bonzanini & Marina Miscioscia Regional Reference Center for Gender Incongruence of the Veneto Region, University Hospital of Padova, Padua, Italy Marina Bonato, Paolo Meneguzzo, Alberto Scala, Andrea Garolla & Marina Miscioscia Department of Systems Medicine, Unit of Andrology and Reproductive Medicine, University Hospital of Padova, Padua, Italy Marina Bonato, Alberto Scala & Andrea Garolla Department of Neuroscience, University of Padova, Padua, Italy Child and Adolescent Neuropsychiatry Unit, University of Padova, Padua, Italy The authors declare no competing interests.

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