Affirmative Psychotherapy for Sexual Minority Women's Mental and Behavioral Health

The purpose of this 2-arm randomized controlled trial is to assess the efficacy of a 10-session lesbian, gay, bisexual, transgender, and queer (LGBTQ)-affirmative cognitive-behavioral psychotherapy (CBT) delivered via telehealth in a large sample of sexual minority women (SMW) in New York, New Jersey and Pennsylvania. The investigators will assess whether the EQuIP (Empowering Queer Identities in Psychotherapy) treatment demonstrates significant reductions in heavy drinking (HD) and mental health symptoms (e.g., depression) compared to LGBTQ-affirmative treatment-as-usual.

Inclusion Criteria: 1. be 18 years of age or older 2. be fluent in English 3. self-identify as lesbian, bisexual, queer, pansexual, or other non-heterosexual identity 3\) report at ≥ 8 standard drinks/week, on average, in the past 30 days, OR report at least 2 heavy drinking days ( ≥ 4 drinks in one day) in the past 30 days 4) currently experience a Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 depression or anxiety disorder (screened initially using a cutoff of ≥ 2 on the Brief Symptom Inventory-4 and further confirmed by diagnostic interview via the DIAMOND) 5) report at least minimum motivation to reduce drinking (measured by the Readiness Ruler) 6) live in New York, New Jersey, and Pennsylvania and planning to stay for at least the next 4 months Exclusion Criteria: 1. report current mental health treatment ≥1 day/mo 2. report having received any CBT in the past 3 months 3. report current alcohol or drug abuse treatment, except mutual self-help (e.g., Alcoholics Anonymous) 4. need alcohol detoxification indicated by ≥9 on Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) 5. exhibit active psychosis or active mania, as assessed by the Structured Clinical Interviews for DSM-5 Disorders (SCID) Psych Screen 6. exhibit active suicidality or active homicidality, as assessed by the SCID-Psych Screen 7. be currently legally mandated to attend treatment 8. demonstrate gross cognitive impairment, as assessed with the Telephone Interview for Cognitive Status