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, Debra Kaysen, David Huh, Michele Bedard-Gilligan, Cynthia R Pearson, Debra Kaysen, David Huh, Michele Bedard-Gilligan

Abstract

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.

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

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)

References

    1. Voisin DR, Jenkins EJ, Takahashi L. Towards a conceptual model linking community violence exposure to HIV-related risk behaviors among adolescents: directions for research. J Adolesc Health. 2011;49(3):230–236.
    1. Volpicelli J, Balaraman G, Hahn J, Wallace H, Bux D. The role of uncontrollable trauma in the development of PTSD and alcohol addiction. Alcohol Res Health. 1999;23(4):256–262.
    1. Brief DJ, Bollinger AR, Vielhauer MJ, Berger-Greenstein JA, Morgan EE, Brady SM, et al. Understanding the interface of HIV, trauma, post-traumatic stress disorder, and substance use and its implications for health outcomes. AIDS Care. 2004;16(Suppl 1):S97–S120.
    1. Boarts J, Buckley-Fischer B, Armelie A, Bogart L, Delahanty D. The impact of HIV diagnosis-related vs. non-diagnosis related trauma on PTSD, depression, medication adherence, and HIV disease markers. J Evid Based Soc Work. 2009;6:4–16.
    1. Leserman J, Whetten K, Lowe K, Stangl D, Swartz MS. How trauma, recent stressful events and PTSD affect functional health status and health utilization in HIV-infected patients in the south. Psychosom Med. 2005;67:500–507.
    1. Sales JM, Swartzendruber A, Phillips A. Trauma-informed HIV prevention and treatment. Curr HIV/AIDS Res. 2016;13(6):374–382.
    1. Carrico AW, Jain J, Discepola MV, Olem D, Andrews R, Woods WJ, et al. A community-engaged randomized controlled trial of an integrative intervention with HIV-positive, methamphetamine-using men who have sex with men. BMC Public Health. 2016;16(1):673.
    1. Carrico AW, Woolf-King SE, Neilands TB, Dilworth SE, Johnson MO. Stimulant use and HIV disease management among men in same-sex relationships. Drug Alcohol Depend. 2014;139:174–177.
    1. 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):681–693.
    1. Logan TK, Cole J, Leukefeld C. Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychol Bull. 2002;128(6):851–885.
    1. Seedat S. Interventions to improve psychological functioning and health outcomes of HIV-infected individuals with a history of trauma or PTSD. Curr HIV/AIDS Rep. 2012;9(4):344–350.
    1. Applebaum A, Bedoya A, Hendriksen E, Wilkinson J, Safren S, O’Cleirigh C. Future directions for interventions targeting PTSD in HIV-infected adults. J Assoc Nurses AIDS Care. 2014;26(2):127–138.
    1. Schnurr PP, Lunney CA, Forshay E, Thurston VL, Chow BK, Resick PA, et al. Sexual function outcomes in women treated for posttraumatic stress disorder. J Womens Health. 2009;18(10):1549–1557.
    1. Baschnagel JS, Coffey SF, Rash CJ. The treatment of co-ocurring PTSD and substance use disorders using trauma-focused exposure therapy. Int J Behav Consult Ther. 2006;4(2):498–508.
    1. Evans-Campbell T. Historical trauma in American Indian/Native Alaska communities: a multilevel framework for exploring impacts on individuals, families, and communities. J Interpers Viol. 2008;23(3):316–338.
    1. United States Department of Justice. American Indians and Crime: A BJS Statistical Profile, 1992–2002. In: Statistics. OoJPBoJ, editor. (2004).
    1. Amnesty International. Amnesty International Report 2007: The state of the world’s human rights. (2007).
    1. Laudenslager ML, Noonan C, Jacobsen C, Goldberg J, Buchwald D, Bremner JD, et al. Salivary cortisol among American Indians with and without posttraumatic stress disorder (PTSD): gender and alcohol influences. Brain Behav Immun. 2009;23(5):658–662.
    1. Whitsell NR, Beal J, Mitchell CM, Manson S, Turner RJ. Childhood exposure to adversity and risk of substance-use disorder in two American Indian populations: the meditational role of early substance-use initiation. J Stud Alcohol Drugs. 2009;70(6):971.
    1. Brave Heart MY. The historical trauma response among natives and its relationship with substance abuse: a Lakota illustration. J Psychoact Drugs. 2003;35:7–13.
    1. Walls ML, Pearson CR, Kading M, Teyra C. Psychological wellbeing in the face of adversity among American Indians: preliminary evidence of a new population health paradox? Ann Public Health Res. 2016;3(1):1034.
    1. Pearson CR, Kaysen D, Belcourt A, Stappenbeck C, Smartlowit-Briggs L, Whitefoot P. Posttraumatic stress disorder and HIV risk behaviors among rural Native American Women: Implications for trauma focused interventions. Am Indian Alaska Nat Ment Health Res. 2015;22(3):1.
    1. Beals J, Belcourt-Dittloff A, Garroutte EM, Croy C, Jervis LL, Whitesell NR, et al. Trauma and conditional risk of posttraumatic stress disorder in two American Indian reservation communities. Soc Psychiatr Psychiatr Epidemiol. 2012;8:8.
    1. Novins D, Boyd M, Brotherton D, Fickenscher A, Moore L. Walking On: Celebrating the journeys of trauma-tized Native American adolescents with substance use problems on the winding road to healing. Psychoact Drugs. 2012;44(2):153–159.
    1. Bassett D, Buchwald D, Manson S. Posttraumatic stress disorder and symptoms among American Indians and Alaska Natives: a review of the literature. Soc Psychiatry Psychiatr Epidemiol. 2014;49(3):417–433.
    1. Gone JP, Alcantara C. Identifying effective mental health interventions for American Indians and Alaska natives: a review of the literature. Cult Divers Ethn Minor Psychol. 2007;13(4):356–363.
    1. Evidence Based Programs—National Registry of Evidence-based Programs and Practices (NREPP) [Internet]. SAMHSA, Department of Health and Human Services. 2018 Accessed 3 March 2018.
    1. Dixon AL, Yabiku ST, Okamoto SK, Tann SS, Marsiglia FF, Kulis S, et al. The efficacy of a multicultural prevention intervention among urban American Indian youth in the southwest U.S. J Prim Prev. 2007;28(6):547–568.
    1. Siddiqi AE, Sikorskii A, Given CW, Given B. Early participant attrition from clinical trials: role of trial design and logistics. Clin Trials. 2008;5(4):328–335.
    1. Watts BV, Schnurr PP, Mayo L, Young-Xu Y, Weeks WB, Friedman MJ. Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. J Clin Psychiatr. 2013;74(6):541–550.
    1. Cusack K, Jonas DE, Forneris CA, Wines C, Sonis J, Middleton JC, et al. Psychological treatments for adults with posttraumatic stress disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2016;43:128–141.
    1. Bass JK, Annan J, McIvor Murray S, Kaysen D, Griffiths S, Cetinoglu T, et al. Controlled trial of psychotherapy for Congolese survivors of sexual violence. N Engl J Med. 2013;368(23):2182–2191.
    1. Weiss NH, Tull MT, Borne ME. Posttraumatic stress disorder symptom severity and HIV-risk behaviors among substance-dependent inpatients. AIDS Care. 2013;25:1219.
    1. Bolton SL, Elias B, Enns MW, Sareen J, Beals J, Novins DK. A comparison of the prevalence and risk factors of suicidal ideation and suicide attempts in two American Indian population samples and in a general population sample. Transcult Psychiatr. 2014;51(1):3–22.
    1. 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(4):867–879.
    1. Veterns Affairs. VA/DoD Clinical Practice Guidelines: Management of Posttraumatic Stress Disorder and Acute Stress Reaction Version 3.0—2017. In: U.S. Department of Veterans Affairs; Department of Defense, editor. Washington, D.C: (2017).
    1. APA. Clinical Practice Guidlines for the Treatment of PTSD in Adults. American Psychological Association; (2017).
    1. Pearson CR, Kaysen D, Belcourt A, Stappenbeck C, Smartlowit-Briggs L, Whitefoot P. Posttraumatic stress disorder and HIV risk behaviors among rural Native American Women: implications for trauma focused interventions. Am Indian Alsk Native Ment Health Res. 2015;22(3):1–20.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5. Arlington, VA: American Psychiatric Publishing; 2013.
    1. Brancu M, Mann-Wrobel M, Beckham JC, Wagner HR, Elliott A, Robbins AT, et al. Subthreshold posttraumatic stress disorder: a meta-analytic review of DSM-IV prevalence and a proposed DSM-5 approach to measurement. Psychol Trauma. 2016;8(2):222–232.
    1. McLaughlin KA, Koenen KC, Friedman MJ, Ruscio AM, Karam EG, Shahly V, et al. Subthreshold posttraumatic stress disorder in the world health organization world mental health surveys. Biol Psychiatr. 2015;77(4):375–384.
    1. Triffleman E, Carroll K, Kellogg S. Substance dependence posttraumatic stress disorder therapy: an integrated cognitive-behavioral approach. J Subst Abuse Treat. 1999;17(1–2):3–14.
    1. Resick PA, Monson CM, Chard K. Cognitive processing therapy for PTSD: a comprehensive manual. New York, NY: The Guilford Press; 2015.
    1. McKleroy VS, Galbraith JS, Cummings B, Jones P, Harshbarger C, Collins C, et al. Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Prev Educ. 2006;18(Suppl A):59–73.
    1. Pearson CR, Smartlowit-Briggs L, Belcourt A, Bedard-Gillgan M, Kaysen D. Building tribal-academic partnership to addressing PTSD, substance misuse, and HIV among American Indian women. Health Promot Pract. 2018
    1. O’Cleirigh C. HIV prevention and trauma treatment for MSM with childhood sexual abuse histories Massachusetts General Hospital, Boston. Bethesda, MA: National Institute of Mental Health (NIMH); 2011.
    1. Foa EB, Riggs DS, Dancu CV, Rothbaum BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress. 1993;6:459–473.
    1. Alterman AI, Cacciola JS, Ivey MA, Habing B, Lynch KG. Reliability and validity of the alcohol short index of problems and a newly constructed drug short index of problems. J Stud Alcohol Drugs. 2009;70:304–307.
    1. O’Farrell TJ, Fals-Stewart W, Murphy M. Concurrent validity of a brief self-report drug use frequency measure. Addict Behav. 2003;28(2):327–337.
    1. Sheehan B, Lee Y, Rodriguez M, Tiase V. A comparison of usability factors of four mobile devices for accessing healthcare information by adolescents. Appl Clin Inform. 2012;3(4):356–366.
    1. NIDA. Seek, Test, Treat and Retain for Vulnerable Populations: Data Harmonization Measure. National Institute on Drug Abuse. (2013).
    1. Liang K-Y, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.
    1. Williams RL. A note on robust variance estimation for cluster-correlated data. Biometrics. 2000;56:645–646.
    1. Huh D, Flaherty BP, Simoni JM. Optimizing the analysis of adherence interventions using logistic generalized estimating equations. AIDS Behav. 2012;16:422–431.
    1. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. (2018).
    1. Carey VJ. gee: Generalized Estimation Equation Solver. R package version 4.13-19. (2015).
    1. Amnesty International . Maze of injustice: The failure to protect Indigenous women from sexual violence in the USA. New York, NY: Amnesty International USA; 2007.
    1. Gone JP, Alcantara C. Identifying effective mental health interventions for American Indians and Alaska Natives: a review of the literature. Cultur Divers Ethnic Minor Psychol. 2007;13(4):356–363.
    1. Back SE. Toward an improved model of treating co-occurring PTSD and substance use disorders. Am J Psychiatr. 2010;167(1):11–13.
    1. Foa EB, Yusko DA, McLean CP, Suvak MK, Bux DA, Oslin D, et al. Concurrent naltrexone and prolonged exposure therapy for patients with comorbid alcohol dependence and PTSD: a randomized clinical trial. J Am Med Assoc. 2013;310(5):488–495.
    1. Kaysen D, Schumm J, Pedersen ER, Seim RW, Bedard-Gilligan M, Chard K. Cognitive processing therapy for veterans with comorbid PTSD and alcohol use disorders. Addict Behav. 2014;39:420.
    1. Resick PA, Galovski TE, O’Brien Uhlmansiek M, 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):243–258.
    1. Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS ONE. 2015;10(9):e0138511.
    1. Lester K, Resick PA, Young-Xu Y. Impact of race on early treatment termination and outcomes in posttraumatic stress disorder treatment. J Consult Clin Psychol. 2010;78(4):480–489.
    1. Pearson CR, Cassels S. Place and sexual partnership transition among young American Indian and Alaska native women. AIDS Behav. 2014;18(8):1443–1453.
    1. Amaro H, Larson MJ, Zhang A, Acevedo A, Dai J, Matsumoto A. Effects of trauma intervention on HIV sexual risk behaviors among women with co-occurring disorders in substance abuse treatment. J Commun Psychol. 2007;35:895–908.
    1. Gore-Felton C. Traumatic experiences: harbinger of risk behavior among HIV-positive adults. J Trauma Dissociation. 2002;3(4):121–135.
    1. Wyatt GE, Longshore D, Chin D, Carmona JV, Loeb TB, Myers HF. The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories. AIDS Behav. 2004;8(4):453–462.
    1. Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychol Assess. 1997;9:445–451.
    1. Roseborough DJ, McLeod JT, Wright FI. Attrition in psychotherapy: a survival analysis. Res Soc Work Pract. 2016;26(7):803–815.
    1. Gibbons MBC, Rothbard A, Farris KD, Stirman SW, Thompson SM, Scott K, et al. Changes in psychotherapy utilization among consumers of services for major depressive disorder in the community mental health system. Adm Policy Ment Health. 2011;38(6):495–503.
    1. Loerinc AG, Meuret AE, Twohig MP, Rosenfield D, Bluett EJ, Craske MG. Response rates for CBT for anxiety disorders: need for standardized criteria. Clin Psychol Rev. 2015;42:72–82.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi