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Randomized Controlled Trial
. 2019 Mar;23(3):695-706.
doi: 10.1007/s10461-018-02382-8.

Randomized Control Trial of Culturally Adapted Cognitive Processing Therapy for PTSD Substance Misuse and HIV Sexual Risk Behavior for Native American Women

Cynthia R Pearson  1 , Debra Kaysen  2 , David Huh  3 , Michele Bedard-Gilligan  2
Affiliations
Randomized Controlled Trial

Randomized Control Trial of Culturally Adapted Cognitive Processing Therapy for PTSD Substance Misuse and HIV Sexual Risk Behavior for Native American Women

Cynthia R Pearson et al. AIDS Behav. 2019 Mar.

Abstract
in English, Spanish

An overlooked sequela of HIV risk is trauma exposure, yet few HIV interventions address trauma exposure, mental health, and substance misuse. In a two-arm randomized controlled trial 73 Native American women were randomized to a culturally-adapted Cognitive Processing Therapy (CPT) or 6-weeks waitlist. Outcomes assessed: PTSD symptom severity, alcohol use frequency, substance abuse or dependence diagnosis, and high-risk sexual behavior defined as vaginal/anal intercourse (a) under the influence of alcohol and/or illicit substances, (b) with a partner who was concurrently sexually active with someone else, and/or (c) with more than one partner in the past 6 weeks. Among immediate intervention participants, compared to waitlist participants, there were large reductions in PTSD symptom severity, high-risk sexual behavior, and a medium-to-large reduction in the frequency of alcohol use. CPT appears to improve mental health and risk behaviors, suggesting that addressing PTSD may be one way of improving HIV-risk related outcomes.

Una secuela pasada por alto acerca del riesgo de VIH es la exposición a trauma, sin embargo, pocas intervenciones del VIH abordan la exposición de trauma, la salud mental y el abuso de sustancias. En un ensayo controlado aleatorio de dos brazos, 73 mujeres nativas americanas fueron asignadas al azar a una Terapia de Procesamiento Cognitivo (TPC) adaptada culturalmente o a 6 semanas de espera. Resultados evaluados: Severidad de los síntomas de trastorno de estrés post-traumático (TEPT), frecuencia del consumo de alcohol, diagnóstico de abuso o dependencia de sustancias, y conducta sexual de alto riesgo definida como coito anal/vaginal a) bajo la influencia del alcohol y/o sustancias ilícitas, b) con una persona que tuvo relaciones sexuales concurrente con otras personas y/o c) con más de una persona en las últimas 6 semanas. Entre los participantes en la condición inmediata versus participantes en la lista de espera, hubo una gran reducción en la gravedad de los síntomas del TEPT, y reducción de conducta sexual de alto riesgo. Además, y una mediana a grande reducción en la frecuencia del consumo de alcohol. La TPC parece mejorar la salud mental y reducer las conductas de riesgo, lo que sugiere que tratar el TEPT puede ser una forma de mejorar las conductas relacionadas con el riesgo de VIH.

Keywords: American Indian and Alaska native; Cognitive processing therapy; HIV/AIDS; PTSD; Substance misuse.

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Conflict of interest statement

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. No animals were involved.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Participant flow chart
Fig. 2
Fig. 2
Predicted means of study outcomes at pre- and post-intervention/follow-up by immediate intervention versus waitlist control condition (N = 73)
See this image and copyright information in PMC

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