Efficacy of Group Intervention to Reduce Stress Symptoms

描述(由申请人提供)：这是一位新的研究人员针对NIMH计划公告PA 04-075“暴力和创伤的精神健康后果”而修订的五年期申请(1R01MH072386-01)。这项研究是一项有效性试验，它基于NIMH的一项小额赠款研究(MH63643 Pi，Gore-Felton)，该研究被资助为艾滋病毒携带者和正在经历创伤相关压力症状的成年人开发和试点测试人类免疫缺陷病毒(HIV)降低风险干预措施。我们的中心前提是，通过首先治疗创伤症状，我们将增强针对经历创伤相关症状的成年人的技能建设艾滋病毒风险降低干预措施的效果。为此，PI开发了一种创新的团体干预措施，基于一种模型，该模型提出与创伤相关的症状对艾滋病毒危险行为有直接影响。因此，创伤相关症状的成功治疗将有助于艾滋病毒危险行为的改变。这项拟议的研究将在加利福尼亚州圣马特奥进行随机疗效试验。共有270名艾滋病毒阳性成年人报告经历了创伤应激源，报告在过去3个月中参与了艾滋病毒风险行为，并报告在过去3个月中经历了与创伤相关的压力症状，他们将被随机分配到三个研究组之一：(1)标准艾滋病毒降低风险干预(n=90)；(2)标准艾滋病毒降低风险+创伤重点压力减轻干预(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比单纯标准的艾滋病毒降低风险干预措施更能改善艾滋病毒风险降低行为；b)确定关键变量(即人口和心理社会)是否缓和了干预措施的效果；c)确定是否有证据表明理论上的中介变量调节了干预措施对结果的影响。这项研究对公共卫生的影响是重大的，因为很少有研究检查艾滋病毒阳性个人中降低风险干预措施的有效性，而且随着艾滋病毒携带者寿命的延长，继发感染的威胁增加。如果成功，这项提议将提高我们减少艾滋病毒传播的能力，并提高受艾滋病毒/艾滋病疫情影响最严重的人群的心理健康功能。

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.