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期申请（1 R 01 MH 072386 -01），由新研究员提交，以响应NIMH项目公告PA 04-075“暴力和创伤的心理健康后果”。“这项研究是一项疗效试验，基于NIMH小额赠款研究（MH 63643 PI，Gore-Felton），该研究旨在为艾滋病毒感染者和经历创伤相关应激症状的成年人开发和试点测试人类免疫缺陷病毒（HIV）风险降低干预措施。我们的中心前提是，通过首先治疗创伤症状，我们将加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开发了一种基于模型的创新群体干预，该模型提出创伤相关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危险行为的改变。拟定的研究将是一项在San Mateo，CA进行的随机有效性试验。总共270名报告经历创伤性应激源、报告在过去3个月内从事HIV风险行为、报告在过去3个月内经历创伤相关应激症状的HIV阳性成年人将被随机分配到三个研究组之一：（1）标准HIV风险降低干预（n = 90）;（2）标准HIV风险降低+创伤集中的减压干预（n = 90）;或（3）标准护理，等待名单（n = 90）。本研究将以苦恼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能改善HIV风险降低行为，而不仅仅是标准的HIV风险降低干预; B）确定关键变量（即，人口统计学和社会心理学）调节干预的效果;以及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，因为很少有研究审查艾滋病毒阳性个体中降低风险干预措施的有效性，而且随着艾滋病毒感染者的寿命延长，继发感染的威胁增加。如果成功，这项建议将提高我们减少艾滋病毒传播的能力，并加强受艾滋病毒/艾滋病流行病影响最严重的人口的心理健康功能。

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.