Efficacy of Group Intervention to Reduce Stress Symptoms

描述（由申请人提供）：这是一份修订后的五年申请（1R01MH072386-01），由一名新的研究者响应NIMH项目公告PA 04-075“暴力和创伤的精神健康后果”。该研究是一项疗效试验，基于NIMH小型资助研究（MH63643 PI, Gore-Felton），该研究资助开发和试点测试人类免疫缺陷病毒（HIV）风险降低干预措施，用于感染艾滋病毒并经历创伤相关压力症状的成年人。我们的中心前提是，通过首先治疗创伤症状，我们将增强对经历创伤相关症状的成年人进行技能建设艾滋病毒风险降低干预的效果。为此，PI根据一个模型开发了一种创新的群体干预，该模型提出与创伤有关的症状对艾滋病毒风险行为有直接影响。因此，创伤相关症状的成功治疗将促进艾滋病毒风险行为的改变。拟议的研究将是一项在加利福尼亚州圣马特奥市进行的随机疗效试验。共有270名报告经历过创伤性应激源、报告在过去3个月内从事过艾滋病毒风险行为、报告在过去3个月内经历过创伤相关应激症状的艾滋病毒阳性成年人将被随机分配到三个研究小组之一：(1)标准的艾滋病毒风险降低干预（n = 90）；(2)标准HIV降低风险+以创伤为重点的减压干预（n = 90）；(3)标准护理，等待名单（n = 90）。研究将以痛苦模型和社会认知理论为指导。拟议研究的具体目的是：a)确定减少创伤相关压力是否比单独的标准艾滋病毒风险降低干预更能改善艾滋病毒风险降低行为；B)确定关键变量（即人口统计学和社会心理）是否能调节干预的效果；c)确定是否有证据表明理论中介变量介导了干预对结果的影响。这项研究的公共卫生意义重大，因为很少有研究检查艾滋病毒阳性个体降低风险干预措施的有效性，而且随着艾滋病毒感染者寿命的延长，继发感染的威胁也在增加。如果成功，这项建议将提高我们在受艾滋病毒/艾滋病流行病影响最严重的人群中减少艾滋病毒传播和增加心理健康功能的能力。

DESCRIPTION (provided by applicant): This is a revised five-year application (1R01MH072386-01) by a new investigator in response to NIMH Program Announcement PA 04-075 "Mental Health Consequences of Violence and Trauma." This study is an efficacy trial, which is based on an NIMH small grant study (MH63643 PI, Gore-Felton) that was funded to develop and pilot test a human immunodeficiency virus (HIV) risk reduction intervention for adults who are living with HIV and are experiencing trauma-related stress symptoms. Our central premise is that by first treating trauma symptoms, we will enhance the effects of a skills-building HIV risk reduction intervention for adults experiencing trauma-related symptoms. To this effect, the PI has developed an innovative group intervention based on a model that proposes trauma-related symptoms have direct effects on HIV risk behavior. Thus, the successful treatment of trauma-related symptoms will facilitate HIV risk behavior change. The proposed study will be a randomized efficacy trial in San Mateo, CA. A total of 270 HIV-positive adults who report experiencing a traumatic stressor, report engaging in HIV risk behavior in the past 3 months, and report experiencing trauma-related stress symptoms in the past three months will be randomly assigned to one of three study groups: (1) standard HIV risk reduction intervention (n = 90); (2) standard HIV risk reduction + trauma-focused stress reduction intervention (n = 90); or (3) standard of care, wait list (n = 90). The research will be guided by the distress model and social cognitive theory. The specific aims of the proposed study are: a) to determine if decreasing trauma-related stress improves HIV risk reduction behavior above a standard HIV risk reduction intervention alone; b) to determine whether key variables (i.e., demographic & psychosocial) moderate the intervention's effects; and c) to determine whether there is evidence that the theoretical mediator variables mediate the intervention's effect on outcomes. The public health implications of this research are significant because few studies have examined the efficacy of risk reduction interventions among HIV positive individuals and as individuals with HIV are living longer, the threat of secondary infections increases. If successful, this proposal will improve our ability to decrease HIV transmission and increase mental health functioning among populations that are being hit hardest by the HIV/AIDS epidemic.