Spiritual Self-Reevaluation Therapy for HIV+ Drug Users

描述（由申请人提供）：我们建议开展一个第一阶段的行为治疗发展项目，目标是开发和试点测试一种手动指导的干预措施，精神自我重新评估疗法（SSRT），以减少市中心艾滋病毒阳性注射吸毒者的艾滋病毒风险行为。SSRT将以个人和团体两种方式发展，并将帮助患者在基于自我图式理论的治疗框架内表达，阐述和激活精神信仰，相对于精神性的概念可以被操作，并且随着治疗的变化可以被严格评估。艾滋病毒和成瘾的文献表明，在对艾滋病毒阳性吸毒者进行减少危害干预时，感知到的精神/宗教支持是一个潜在的重要领域。先前的研究也表明，“自我”的社会认知理论作为组织理论框架的效用，在其中发展和评估这些干预措施。自我图式的激活激活了关于自我的特定信念，并通过自动化的事件脚本和行动计划提供了与这些信念相关的行为曲目。SSRT的目标是促进患者工作自我图式的转变，从“成瘾”到“精神”自我图式的激活，这种自我图式与利他主义行为、乐观情绪、个人价值和能动性的增强更相容。本提案的具体目标是基于文献中描述的第一阶段行为治疗发展项目的多个目标，分为三个方面：1)在第一阶段，开发和完善治疗手册，工作手册，治疗师能力依从性评分量表和治疗过程测量；2)在第二阶段，制定、实施和评估SSRT治疗咨询师培训计划；3) III期，在54名hiv阳性美沙酮维持药物使用者中进行SSRT的试点试验，患者将随机接受12周的SSRT（个体），SSRT（群体）或常规治疗。主要结果将是继续治疗，减少非法药物使用和其他高危行为。需要评估的治疗过程变量包括艾滋病毒信息、动机和行为技能以及成瘾和精神自我图式从治疗前到治疗后的转变。

DESCRIPTION (provided by applicant): We propose to conduct a Stage I behavioral therapy development project with the goals of developing and pilot testing a manual-guided intervention, Spiritual Self-Reevaluation Therapy (SSRT), for reducing HIV risk behavior by inner-city HIV-positive injection drug users. SSRT will be developed in both individual and group modalities and will help patients articulate, elaborate, and activate spiritual beliefs within a therapeutic framework based on self-schema theory, relative to which the concept of spirituality can be operationalized, and change with treatment can be rigorously assessed. The HIV and addiction literature suggest that perceived spiritual/religious support is a potentially important domain to address in harm reductions interventions with HIV-positive drug users. Prior research also suggests the utility of a social-cognitive theory of "self" as an organizing theoretical framework within which to develop and evaluate such interventions. Activation of a self-schema energizes specific beliefs about the self, and provides access to the behavioral repertoire associated with those beliefs through automatized event scripts and action plans. The goal of SSRT is to facilitate a shift in the patient's working self-schema, from the "addict" to the activation of a "spiritual" self-schema that is more compatible with acts of altruism, feelings of optimism, and an increased sense of personal worth and agency. The specific aims of this proposal are based on the multiple goals of a Stage I behavioral therapy development project described in the literature and are threefold: 1) In Phase I to develop and refine the therapy treatment manuals, workbooks, therapist competence adherence ratings scales and treatment process measures; 2) In Phase II to develop, conduct, and evaluate a SSRT therapy counselor training program; 3) In Phase III to conduct a pilot trial of SSRT in a sample of 54 HIV-positive methadone-maintained drug users in which patients will be randomized to receive 12 weeks of SSRT (individual), SSRT (group) or treatment as usual. Primary outcomes will be retention in treatment and reductions in illicit drug use and other high-risk behaviors. Treatment process variables to be assessed include HIV information, motivation, and behavioral skills and the shift in addict and spiritual self-schemas from pre to post-treatment.