Advertisement

AIDS and Behavior

, Volume 23, Issue 9, pp 2421–2431 | Cite as

Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial

  • Conall O’CleirighEmail author
  • Steven A. Safren
  • S. Wade Taylor
  • Brett M. Goshe
  • C. Andres Bedoya
  • Samantha M. Marquez
  • Michael S. Boroughs
  • Jillian C. Shipherd
Original Paper

Abstract

To address childhood sexual abuse (CSA) related distress and HIV risk in men who have sex with men (MSM) using cognitive-behavioral therapy for trauma and self-care (CBT-TSC), which is a novel intervention integrating HIV risk reduction with modified cognitive and behavioral therapy strategies for post-traumatic stress. We compared CBT-TSC to HIV voluntary counseling and testing (VCT)-only in an initial 2-arm RCT in 43 HIV-negative MSM at with a history of CSA and HIV risk. Serodiscordant condomless anal/vaginal sex (CAS; CAS with HIV-postive or HIV unknown status partners) and posttraumatic stress disorder (PTSD) symptoms (Davidson Trauma Scale: total score and avoidance, intrusions, hyperarousal subscales) were outcomes immediately post-treatment, and at 6- and 9-month follow-up. At post-treatment, CBT-TSC had decreased odds (approximately 60%) of any CAS and greater reductions in CAS compared to VCT-only. Additionally, the CBT-TSC condition experienced greater reductions in total PTSD and avoidance symptoms. At the follow-up visits, CBT-TSC condition had significant reductions in the odds of any CAS and reductions in CAS. However, for PTSD symptoms, only the avoidance subscale remained significantly different compared to VCT-only. CBT-TSC is a potentially efficacious approach to address HIV risk in MSM with a CSA history, with replication and extension in a larger trial needed. This proof-of-concept trial is the first to integrate the treatment of a commonly occurring mental-health syndemic problem in MSM with a health psychology approach to self-care in MSM.

Trial Registration Clinicaltrials.gov NCT01266122

Keywords

Trauma HIV Men who have sex with men Childhood sexual abuse 

Notes

Funding

Funding from this project was from Grant R34MH081760 awarded to Conall O’Cleirigh. Dr. Safren was also supported by Grant 9K24DA040489.

References

  1. 1.
    Sweet T, Welles S. Associations of sexual identity or same sex behaviors with history of childhood sexual abuse and HIV/STI risk in the United States. J Acquir Immune Defic Syndr. 2011;59(4):400–8.CrossRefGoogle Scholar
  2. 2.
    Arreola SG, Neilands TB, Diaz R. Childhood sexual abuse and the sociocultural context of sexual risk among adult Latino gay and bisexual men. Am J Public Health. 2009;99(Suppl 2):S432–8.CrossRefGoogle Scholar
  3. 3.
    Catania JA, Paul J, Osmond D, et al. Mediators of childhood sexual abuse and high-risk sex among men-who-have-sex-with-men. Child Abuse Negl. 2008;32(10):925–40.CrossRefGoogle Scholar
  4. 4.
    Mimiaga MJ, Noonan E, Donnell D, et al. Childhood sexual abuse in highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE study. J Acquir Immune Defic Syndr. 2009;51:340–8.CrossRefGoogle Scholar
  5. 5.
    Finkelhor D. Current information on the scope and nature of child sexual abuse. Future Child. 1994;4:31–53.CrossRefGoogle Scholar
  6. 6.
    Sikkema KJ, Hansen NB, Meade CS, Kochman A, Fox AM. Psychosocial predictors of sexual HIV transmission risk behavior among HIV-positive adults with a sexual abuse history in childhood. Arch Sex Behav. 2009;38(1):121–34.CrossRefGoogle Scholar
  7. 7.
    Stall R, Mills TC, Williamson J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93:939–42.CrossRefGoogle Scholar
  8. 8.
    Paul JP, Catania J, Pollack L, Stall R. Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: the Urban Men’s Health Study. Child Abuse Negl. 2001;25:557–84.CrossRefGoogle Scholar
  9. 9.
    O’Leary A, Purcell D, Remien RH, Gomez C. Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men. AIDS Care. 2003;15:17–26.CrossRefGoogle Scholar
  10. 10.
    Jinich S, Paul JP, Stall R, et al. Childhood sexual abuse and HIV risk-taking behavior among gay and bisexual men. AIDS Behav. 1998;2:41–51.CrossRefGoogle Scholar
  11. 11.
    Bartholow BN, Doll LS, Joy D, Douglas JM. Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men. Child Abuse Negl. 1994;18:747–61.CrossRefGoogle Scholar
  12. 12.
    Centers for Disease Control and Prevention. HIV among gay and bisexual men. 2017. Retrieved from: https://www.cdc.gov/hiv/group/msm/index.html. Accessed 2 Jan 2019
  13. 13.
    Crepaz N, Lyles CM, Wolitski RJ, et al. Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS. 2006;20(2):143–57.CrossRefGoogle Scholar
  14. 14.
    Herbst JH, Sherba RT, Crepaz N, et al. A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. J Acquir Immune Defic Syndr. 2005;39(2):228–41.PubMedGoogle Scholar
  15. 15.
    Lyles CM, Kay LS, Crepaz N, et al. Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000–2004. Am J Public Health. 2007;97(1):133–43.CrossRefGoogle Scholar
  16. 16.
    Herbst JH, Beeker C, Mathew A, et al. The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: a systematic review. Am J Prev Med. 2007;32:38–67.CrossRefGoogle Scholar
  17. 17.
    O’Cleirigh C, Safren SA, Mayer KH. The pervasive effects of childhood sexual abuse: challenges for improving HIV prevention and treatment interventions. J Acquir Immune Defic Syndr. 2012;59(4):331–4.CrossRefGoogle Scholar
  18. 18.
    Resick PA, Schnicke MK. Cognitive processing therapy for sexual assault victims. J Consult Clin Psychol. 1992;60:748–56.CrossRefGoogle Scholar
  19. 19.
    Monson CM, Schnurr PP, Resick PA, Friedman MJ, Young-Xu Y, Stevens SP. Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. J Consult Clin Psychol. 2006;74:898–907.CrossRefGoogle Scholar
  20. 20.
    Resick PA, Nishith P, Weaver TL, Astin MC, Feuer CA. A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. J Consult Clin Psychol. 2002;70:867–79.CrossRefGoogle Scholar
  21. 21.
    Resick PA, Galovski TE, Uhlmansiek MO, Scher CD, Clum GA, Young-Xu Y. A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. J Consult Clin Psychol. 2008;76(2):243–58.CrossRefGoogle Scholar
  22. 22.
    Foa EB, Hembree EA, Cahill SP, Rauch SA, Riggs DS, Feeny NC, Yadin E. Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. J Consult Clin Psychol. 2005;73(5):953–64.CrossRefGoogle Scholar
  23. 23.
    Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, Resick PA, Thurston V, Orsillo SM, Haug R, Turner C, Bernardy N. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297(8):820–30.CrossRefGoogle Scholar
  24. 24.
    Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375:830–9.CrossRefGoogle Scholar
  25. 25.
    Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81.CrossRefGoogle Scholar
  26. 26.
    U.S. Food and Drug Administration. Truvada for PrEP fact sheet: Ensuring safe and proper use, 2012. Retrieved from https://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM312290.pdf. Accessed 2 Jan 2019
  27. 27.
    Leserman J, Li Z, Drossman DA, Toomey TC, Nachman G, Glogau L. Impact of sexual and physical abuse dimensions on health status: development of an abuse severity measure. Psychosom Med. 1997;59:152–60.CrossRefGoogle Scholar
  28. 28.
    Leserman J, Li Z, Drossman DA, Hu YJB. Selected symptoms associated with sexual and physical abuse history among female patients with gastrointestinal disorders: the impact on subsequent health care visits. Psychol Med. 1998;28:417–25.CrossRefGoogle Scholar
  29. 29.
    Leserman J, Ironson G, O’Cleirigh C. Preliminary results of a randomized controlled trial of an emotional disclosure intervention in patients with HIV. In: Presented to the annual meeting of the international society of behavioral medicine, Bangkok, Thailand, 2006.Google Scholar
  30. 30.
    U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). HIV prevention for serodiscordant couples, 2016. Retrieved from https://aidsfree.usaid.gov/resources/pkb/combination/hiv-prevention-serodiscordant-couples. Accessed 2 Jan 2019
  31. 31.
    Sheehan DV, Lecrubier Y, Sheehan KH, et al. The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22–3.PubMedGoogle Scholar
  32. 32.
    Davidson JRT, Book SW, Colket JT, et al. Assessment of a new self-rating scale for post-traumatic stress disorder. Psychol Med. 1997;27:153–60.CrossRefGoogle Scholar
  33. 33.
    Zlotnick C, Davidson J, Shea MT, Pearlstein T. Validation of the Davidson Trauma Scale in a sample of survivors of childhood sexual abuse. J Nerv Ment Dis. 1996;184:255–7.CrossRefGoogle Scholar
  34. 34.
    Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings, 2006. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm. Accessed 2 Jan 2019
  35. 35.
    Centers for Disease Control and Prevention. Results of the expanded HIV testing initiative—25 jurisdictions, United States, 2007–2010. Morb Mortal Wkly Rep. 2011;60(24):805–10.Google Scholar
  36. 36.
    Koblin B, Chesney M, Coates T, EXPLORE Study Team. Effects of a behavioural intervention to reduce acquisition of HIV infection among men who have sex with men: the EXPLORE randomised controlled study. Lancet. 2004;364(9428):41–50.CrossRefGoogle Scholar
  37. 37.
    Safren SA, O’Cleirigh C, Skeer MR, Driskell J, Goshe BM, Covahey C, Mayer KH. Demonstration and evaluation of a peer-delivered, individually-tailored, HIV prevention intervention for HIV-infected MSM in their primary care setting. AIDS Behav. 2011;15(5):949–58.  https://doi.org/10.1007/s10461-010-9807-8.CrossRefPubMedGoogle Scholar
  38. 38.
    Raudenbush SW, Bryk AS, Congdon R. HLM 7.00 for windows [computer software]. Lincolnwood, IL: Scientific Software International Inc; 2011.Google Scholar
  39. 39.
    Williams JK, Wilton L, Magnus M, et al. Relation of childhood sexual abuse, intimate partner violence, and depression to risk factors for HIV among black men who have sex with men in 6 US cities. Am J Public Health. 2015;105(12):2473–81.CrossRefGoogle Scholar
  40. 40.
    Millett GA, Peterson JL, Flores SA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380(9839):341–8.CrossRefGoogle Scholar
  41. 41.
    Parsons JT, Rendina HJ, Moody RL, Ventuneac A, Grov C. Syndemic production and sexual compulsivity/hypersexuality in highly sexually active gay and bisexual men: further evidence for a three group conceptualization. Arch Sex Behav. 2015;44(7):1903–13.CrossRefGoogle Scholar
  42. 42.
    Mustanski B, Andrews R, Herrick A, Stall R, Schnarrs PW. A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. Am J Public Health. 2014;104(2):287–94.CrossRefGoogle Scholar
  43. 43.
    Mimiaga MJ, O’Cleirigh C, Biello KB, et al. The effect of psychological syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. J Acquir Immune Defic Syndr. 2015;68(3):329–36.CrossRefGoogle Scholar
  44. 44.
    Safren SA, O’Cleirigh C, Tan J, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. J Health Psychol. 2009;28(1):1–10.CrossRefGoogle Scholar
  45. 45.
    Safren SA, O’Cleirigh C, Bullis JR, Otto MW, Stein MD, Pollack MH. Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial. J Consult Clin Psychol. 2012;80(3):404–15.CrossRefGoogle Scholar
  46. 46.
    Safren SA, Bedoya CA, O’Cleirigh C, et al. Treating depression and adherence (CBT-AD) in patients with HIV in care: a three-arm randomized controlled trial. Lancet. 2016;3(11):529–38.CrossRefGoogle Scholar
  47. 47.
    Mimiaga MJ, Reisner SL, Pantalone DW, O’Cleirigh C, Mayer KH, Safren SA. A pilot trial of integrated behavioral activation and sexual risk reduction counseling for HIV-uninfected men who have sex with men abusing crystal methamphetamine. AIDS Patient Care STDS. 2012;26(11):681–93.CrossRefGoogle Scholar
  48. 48.
    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674.CrossRefGoogle Scholar
  49. 49.
    Pachankis JE. A transdiagnostic minority stress treatment approach for gay and bisexual men’s syndemic health conditions. Arch Sex Behav. 2015;44(7):1843–60.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Conall O’Cleirigh
    • 1
    • 2
    • 3
    Email author
  • Steven A. Safren
    • 3
    • 4
  • S. Wade Taylor
    • 3
    • 9
  • Brett M. Goshe
    • 1
    • 2
  • C. Andres Bedoya
    • 1
    • 2
  • Samantha M. Marquez
    • 1
    • 3
  • Michael S. Boroughs
    • 10
  • Jillian C. Shipherd
    • 5
    • 6
    • 7
    • 8
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.The Fenway Institute of Fenway HealthBostonUSA
  4. 4.Department of PsychologyUniversity of MiamiCoral GablesUSA
  5. 5.VA Boston Healthcare SystemBostonUSA
  6. 6.Women’s Health Sciences DivisionNational Center for PTSDBostonUSA
  7. 7.Department of Veterans AffairsLGBT Health ProgramWashingtonUSA
  8. 8.Boston University School of MedicineBostonUSA
  9. 9.School of Social WorkBoston UniversityBostonUSA
  10. 10.Department of PsychologyUniversity of WindsorWindsorCanada

Personalised recommendations