Alcohol and implicit process in sexual risk behavior in MSM

描述(由申请人提供)：本提案侧重于PA-11-006的两个目标：物质使用和滥用、高风险决策和艾滋病毒/艾滋病：1)物质使用如何改变显性(费力)和隐性(自动)过程在艾滋病毒风险行为决策中的作用；2)实验室方法和模拟如何与现实世界的危险行为相关？这项研究结合了酒精给药实验和随后的经验抽样(ESM)研究的创新配对，以测试实验室结果的外部有效性。旨在减少艾滋病毒风险行为的干预措施往往侧重于教育人们关于风险的知识，增加他们避免风险的动机，并提高与健康选择相一致的技能。然而，在“情绪高涨的时刻”，人们对高风险选择所涉及的过程的了解还存在相当大的差距。将自动过程、内隐认知和联想记忆的研究纳入健康危险行为的研究和预防，是改善公共健康的一个重要的、基本上没有实现的机会(Stacy等人，2010年)。自动评估和方法偏差可以通过条件作用成功地重新训练，从而导致相应的行为变化(Chen&Bargh，1999；Houben等人，2010；Wiers等人，2010)。不同领域的研究支持自我控制的双过程模型。这些模型认为，自我控制由两个维度组成，一个是快速反应、反身性的“自动”维度，另一个是动作较慢、慎重或费力的维度(Lieberman，2007；Wiers等人，2007)。自动的、反身性的控制强调情感过程，而费力控制维度可能主要由更高阶的“执行”控制过程组成(Lieberman，2007)。当自动接近行为的强度超过深思熟虑的认知控制过程的强度时，可能会产生危险的性行为。这项拟议的实验研究旨在提高对酒精、内隐过程和努力控制在男性高风险性行为选择中的作用的理解 与男性发生性关系(MSM)。我们认为，酒精中毒增加了相对自动的性刺激偏向的强度，同时降低了由执行大脑功能控制的更慎重的决策过程的作用。这种向更隐含或自动的过程的转变，加上显性决策过程作用的降低，增加了性风险行为的可能性，并可能限制只关注显性过程以促进行为改变的干预措施的有效性。这项研究的长期目标是解释在一个人似乎明显缺乏更好的判断力、对即刻满足的驱动力达到顶峰的“瞬间热度”中发生的过程。这项拟议的研究将为创新的治疗方法奠定基础，这些方法解决了自动和费力的过程，以减少MSM的性危险行为。

DESCRIPTION (provided by applicant): This proposal focuses on two aims of PA-11-006: Substance Use and Abuse, Risky Decision Making and HIV/AIDS: 1) How does substance use shift the contribution of explicit (effortful) versus implicit (automatic) processes in decision-making about HIV-risk behavior, and 2) How do laboratory methods and simulations relate to real world risky behavior? The study incorporates an innovative pairing of an alcohol administration experiment with a subsequent experience sampling (ESM) study to test the external validity of the laboratory results. Interventions designed to reduce HIV risk behavior frequently focus on educating people about risks, increasing their motivation to avoid risks, and improving skills congruent with healthy choice. However, there are considerable gaps in knowledge about the processes involved in risky choice "during the heat of the moment." Incorporating research on automatic processes, implicit cognition, and associative memory into the study and prevention of health risk behaviors is an important and largely unrealized opportunity for improving public health (Stacy et al., 2010). Automatic evaluations and approach biases can be successfully retrained via conditioning, resulting in corresponding changes in behavior (Chen & Bargh, 1999; Houben et al., 2010; Wiers et al., 2010). Research in diverse fields supports a dual-process model of self-control. Such models posit that self-control consists of two dimensions, a fast acting, reflexive, "automatic" dimension and a slower acting, deliberative or effortful dimension (Lieberman, 2007; Wiers et al., 2007). Automatic, reflexive, control emphasizes affective processes, while the effortful control dimension may consist largely of higher-order "executive" control processes (Lieberman, 2007). Risky sexual behavior may result when the strength of automatic approach behaviors exceeds the strength of deliberative cognitive control processes. The proposed experimental study seeks to improve understanding of the role of alcohol, implicit processes, and effortful control in risky sexual choice in men who have sex with men (MSM). We propose that alcohol intoxication increases the strength of relatively automatic approach biases toward sexual stimuli while simultaneously decreasing the role of more deliberative decision-making processes controlled by executive brain functions. This shift toward more implicit or automatic processes coupled with the decreased role of explicit decision- making processes increases the likelihood of sexual risk behavior and potentially limits the effectiveness of interventions that focus solely on explicit processes to promote behavioral change. The long-term aim of this research is explicating processes occurring in the "heat of the moment" when an individual's better judgment seems conspicuously absent and the drive for immediate gratification peaks. The proposed study will lay a foundation for innovative approaches to treatment that address both automatic and effortful processes to reduce sexual risk behavior in MSM.