Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial

• Published in: AIDS and behavior 2019-09, Vol.23 (9), p.2421-2431
• Main Authors: O’Cleirigh, Conall, Safren, Steven A., Taylor, S. Wade, Goshe, Brett M., Bedoya, C. Andres, Marquez, Samantha M., Boroughs, Michael S., Shipherd, Jillian C.
• Format: Article
• Language: English
• Subjects: Abuse; Activities of daily living; Adult; Adult Survivors of Child Abuse - psychology; Avoidance; Avoidance behavior; Behavior modification; Child; Child Abuse, Sexual - psychology; Child sexual abuse; Childhood; Children; Cognition; Cognitive ability; Cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Cognitive therapy; Counseling; Counseling - methods; Drug use; Evidence-based medicine; Gays & lesbians; Health problems; Health Psychology; Health risks; Health services; HIV; HIV Infections - prevention & control; HIV Infections - psychology; HIV Seronegativity; Homosexuality, Male - psychology; Human immunodeficiency virus; Humans; Infectious Diseases; Male; Mass Screening - methods; Mass Screening - statistics & numerical data; Medicine; Medicine & Public Health; Men; Men who have sex with men; Mens health; Mental disorders; Mental health; NCT; NCT01266122; Original Paper; Post traumatic stress disorder; Psychological distress; Psychological stress; Psychology; Public Health; Risk; Risk management; Risk reduction; Risk Reduction Behavior; Self Care - methods; Sex crimes; Sexual assault; Sexual Behavior; Sexual Partners; Sexually transmitted diseases; Signs and symptoms; STD; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Symptoms; Therapy; Trauma; Vagina
• ISSN: 1090-7165; 1573-3254; 1573-3254
• DOI: 10.1007/s10461-019-02482-z

To address childhood sexual abuse (CSA) related distress and HIV risk in men who have sex with men (MSM) using cognitive-behavioral therapy for trauma and self-care (CBT-TSC), which is a novel intervention integrating HIV risk reduction with modified cognitive and behavioral therapy strategies for post-traumatic stress. We compared CBT-TSC to HIV voluntary counseling and testing (VCT)-only in an initial 2-arm RCT in 43 HIV-negative MSM at with a history of CSA and HIV risk. Serodiscordant condomless anal/vaginal sex (CAS; CAS with HIV-postive or HIV unknown status partners) and posttraumatic stress disorder (PTSD) symptoms (Davidson Trauma Scale: total score and avoidance, intrusions, hyperarousal subscales) were outcomes immediately post-treatment, and at 6- and 9-month follow-up. At post-treatment, CBT-TSC had decreased odds (approximately 60%) of any CAS and greater reductions in CAS compared to VCT-only. Additionally, the CBT-TSC condition experienced greater reductions in total PTSD and avoidance symptoms. At the follow-up visits, CBT-TSC condition had significant reductions in the odds of any CAS and reductions in CAS. However, for PTSD symptoms, only the avoidance subscale remained significantly different compared to VCT-only. CBT-TSC is a potentially efficacious approach to address HIV risk in MSM with a CSA history, with replication and extension in a larger trial needed. This proof-of-concept trial is the first to integrate the treatment of a commonly occurring mental-health syndemic problem in MSM with a health psychology approach to self-care in MSM. Trial Registration Clinicaltrials.gov NCT01266122