Cognitive Processing Intervention for Trauma, HIV/STI Risks, and Substance Use Among Native Women

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2013 by University of Washington
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Cynthia Pearson, University of Washington
ClinicalTrials.gov Identifier:
NCT01849029
First received: May 4, 2013
Last updated: October 6, 2013
Last verified: October 2013
  Purpose

Many American Indian (AI) women never receive services for serious mental health problems resulting from traumatic events, violence exposure and maltreatment. AI women suffer higher lifetime rates of Post-traumatic Stress Disorder (PTSD) (20-23%), that often co-occur with excessive drinking and risky sexual behaviors. These factors magnify risk for human immunodeficiency virus and sexually transmitted disease (HIV/STI). In full development with tribal partners, this application, proposes a 3-year project to culturally adapt and pilot an empirically supported trauma-focused treatment, Cognitive Processing Therapy (CPT) for PTSD, substance use and HIV/STI sexual risk behavior among 50 AI women. Additionally, the investigators will assess the feasibility, acceptability and treatment fidelity of delivering CPT via AI community health workers in a resource-limited tribal reservation. This project brings a culturally responsive intervention to an understudied and highly vulnerable population. Its significance lies in its potential to advance science in the area of PTSD, substance use treatment and HIV/STI prevention among AI women. Study data would benefit tribal and rural communities and the mental health field. Finally, it is geared toward developing the research infrastructure and mental health treatment capacity serving AI women living in rural settings, a group at risk for an expanding HIV/AIDS epidemic. If successful, findings from this pilot will provide evidence for a larger effectiveness trial.

The AIMS are AIM I. Adapt the evidence-based CPT intervention in full collaboration with tribal partners. This will be done in accordance with the CDC's Map of Adaptation Process and involves formative research with tribal leaders, potential consumers, providers, and health care administrators using qualitative methodology.

AIM 2. Assess this intervention delivered by Native American community health workers for feasibility and acceptability in a resource-limited rural reservation setting.

AIM 3. Conduct a two-group, single-site waitlist randomized controlled pilot trial of a 12-session, 6-week CPT intervention among 56 (6 pilot) sexually active and substance using AI women with PTSD or sub-threshold PTSD. Determine preliminary efficacy and estimate an effect size in terms of three primary outcomes: (a) PTSD symptomatology; (b) substance use; (c) high risk sexual behavior.


Condition Intervention
Post Traumatic Stress Disorders
Unsafe Sex
Substance Use Disorders
Behavioral: Cognitive Processing Therapy-Cognitive

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Crossover Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Cognitive Processing Intervention for HIV/STI and Substance Use Among Native Women

Resource links provided by NLM:


Further study details as provided by University of Washington:

Primary Outcome Measures:
  • PTSD Symptom Scale interview (PSS-I) [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ] [ Designated as safety issue: No ]
    Post-traumatic stress disorder symptom severity scale range from 0 (no PTSD symptoms) to 51 (high PSTD symptoms); units on a scale

  • PTSD Symptom Scale interview (PSS-I) [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ] [ Designated as safety issue: No ]
    Post-traumatic stress disorder symptom severity scale range from 0 (no PTSD symptoms) to 51 (high PSTD symptoms); continuous, units on a scale


Secondary Outcome Measures:
  • Drug use Frequency (DUF) [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ] [ Designated as safety issue: No ]
    DUF is a self-report measure of illicit drug use, rating what drugs were used, how often, and by which methods (injection, smoking, e.g.). Participant rates each drug on the same 0-7 frequency scale for the past 6 months (0=never, 1=several times, 2=about once a month, 3=several times a month, 4=1-2 days a week, 5=3-4 days a week, 6=5-6 days a week, 7=everyday)

  • Drug use Frequency (DUF) [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ] [ Designated as safety issue: No ]
    DUF is a self-report measure of illicit drug use, rating what drugs were used, how often, and by which methods (injection, smoking, e.g.). Participant rates each drug on the same 0-7 frequency scale for the past 6 months (0=never, 1=several times, 2=about once a month, 3=several times a month, 4=1-2 days a week, 5=3-4 days a week, 6=5-6 days a week, 7=everyday)

  • Short Inventory of Problems - Alcohol and Drugs, (SIP-AD) [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ] [ Designated as safety issue: No ]
    SIP-AD 15-Item scale as a measure of consequence (0 no consequences to 45 high consequence)

  • Short Inventory of Problems - Alcohol and Drugs, (SIP-AD) [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ] [ Designated as safety issue: No ]
    SIP-AD 15-Item scale as a measure of consequence (0 no consequences to 45 high consequence)

  • Condom-protected sex [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ] [ Designated as safety issue: No ]

    condom use is calculated by subtracting the number of vaginal or anal condom-protected sex acts in the last 6 weeks from the total number of sex acts then dividing the sum by the number of total sex acts.

    A continuous measure and dichotomous measure (at 100% condom use) will be assessed to report


  • Condom-protected sex [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ] [ Designated as safety issue: No ]

    condom use is calculated by subtracting the number of vaginal or anal condom-protected sex acts in the last 6 weeks from the total number of sex acts then dividing the sum by the number of total sex acts.

    A continuous measure and dichotomous measure (at 100% condom use) will be assessed to report



Other Outcome Measures:
  • Penn Alcohol Craving Scale (PACS) [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ] [ Designated as safety issue: No ]
    a five-item self-administered instrument for assessing craving. Frequency, intensity, and duration of thoughts about drinking are assessed along with ability to resist drinking.

  • Penn Alcohol Craving Scale (PACS) [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ] [ Designated as safety issue: No ]
    a five-item self-administered instrument for assessing craving. Frequency, intensity, and duration of thoughts about drinking are assessed along with ability to resist drinking.

  • number of sex partners [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ] [ Designated as safety issue: No ]
    count, dichotomized at one partner vs. more than one partner

  • number of sex partners [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ] [ Designated as safety issue: No ]
    count, dichotomized at one partner vs. more than one partner

  • sex under the influence of substances [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ] [ Designated as safety issue: No ]
    1 item drank alcohol/ drug use before having vaginal or anal sex (yes/no)

  • sex under the influence of substances [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ] [ Designated as safety issue: No ]
    1 item drank alcohol/ drug use before having vaginal or anal sex (yes/no)

  • concurrent sexual partners [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ] [ Designated as safety issue: No ]
    Overlapping partnerships where sexual (anal or vaginal) intercourse with one partner occurs between two acts of intercourse with another partner

  • concurrent sexual partners [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ] [ Designated as safety issue: No ]
    Overlapping partnerships where sexual (anal or vaginal) intercourse with one partner occurs between two acts of intercourse with another partner


Estimated Enrollment: 56
Study Start Date: October 2013
Estimated Study Completion Date: July 2015
Estimated Primary Completion Date: September 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Cognitive Processing Theapy-Cognitive
Immediate group receives Cognitive Processing Therapy-Cognitive CPT-C intervention within one week of being consented into the study
Behavioral: Cognitive Processing Therapy-Cognitive
Cognitive Processing Therapy-Cognitive (CPT-C) uses education about trauma reactions, emotional processing, and cognitive strategies to reduce trauma-related cognitive distortions. CPT is a manualised 12 session cognitive behavioral treatment for PTSD which offers an alternative to purely exposure based interventions. CPT has a smaller exposure component than imaginal exposure therapy and is therefore potentially more acceptable to clients or practitioners seeking alternatives to purely exposure focused treatments. CPT-C omits the written trauma account, and includes more practice of cognitive techniques during the sessions. The treatment was developed for twice weekly sessions over 6 weeks. It also directly targets associated problems such as depression, guilt and anger.
Other Name: Cognitive Processing Therapy - Cognitive (CPT-C)
Cognitive Processing Threapy-Cognitive
Wait list group: waits 6 weeks before receiving the Cognitive Processing Therapy-Cognitive (CPT-C) intervention. During this period no intervention is received
Behavioral: Cognitive Processing Therapy-Cognitive
Cognitive Processing Therapy-Cognitive (CPT-C) uses education about trauma reactions, emotional processing, and cognitive strategies to reduce trauma-related cognitive distortions. CPT is a manualised 12 session cognitive behavioral treatment for PTSD which offers an alternative to purely exposure based interventions. CPT has a smaller exposure component than imaginal exposure therapy and is therefore potentially more acceptable to clients or practitioners seeking alternatives to purely exposure focused treatments. CPT-C omits the written trauma account, and includes more practice of cognitive techniques during the sessions. The treatment was developed for twice weekly sessions over 6 weeks. It also directly targets associated problems such as depression, guilt and anger.
Other Name: Cognitive Processing Therapy - Cognitive (CPT-C)

  Hide Detailed Description

Detailed Description:

Nearly one of three American Indian (AI) women can expect to be raped in their lifetime putting them at great risk for revictimization and human immunodeficiency virus (HIV). The high prevalence of sexual and physical assault in Indian country has led Amnesty International to declare a state of emergency for AI women in the United States. This application is part of a community led effort by the Yakama Nation to turn this tide in their tribal community.

Situated in the plateau region of Eastern Washington, the Yakama Nation is the largest tribe in Washington State (comprising over 10,000 members.) Since 2008, Investigators at the University of Washington have been collaborating with the Yakama Reservation Wellness Coalition who has mobilized activists and researchers through a community-based participatory research (CBPR) process to address the trauma and associated mental health concerns disproportionately affecting community women. This application, in response to "R34 PA-09-146: Pilot and Feasibility Studies in Preparation for Drug Abuse Prevention Trials" proposes a 3-year project to culturally adapt and pilot an empirically supported trauma-focused treatment, Cognitive Processing Therapy (CPT) for post-traumatic stress disorder (PTSD), substance use and HIV/STI sexual risk behavior among 56 AI women in a resource-limited rural area.

Additionally, the investigators will assess the feasibility, acceptability and treatment fidelity of delivering this CPT via AI community health workers. Based on the investigators promising preliminary work, their multidisciplinary collaboration includes experienced AI and non-AI HIV, trauma, health service, and mental health academic researchers and an 8-member community research team of Yakama Nation tribal leaders, potential consumers, and health care providers with strong community connections.

High rates of comorbidity between substance and alcohol use disorders (SAUD) and PTSD have been well established especially for women. Moreover, 25-40% of those seeking treatment for substance use meet criteria for PTSD. Additionally, PTSD is associated with increased HIV-risk sexual behavior (HRSB) in women. Prevailing theory suggests that alcohol and other drugs may be used to self-medicate or mitigate PTSD symptoms, which then reinforces more substance use leading to substance abuse-related consequences and problems, particularly HIV/STI exposure. Avoidance of trauma-related cues and affect including avoidance through substance use is thought to maintain PTSD and enhance risky sexual behavior. Therefore, treatment of PTSD should decrease substance use and risky sexual behavior.

Many AI women never receive services for serious mental health problems resulting from traumatic events, violence exposure and maltreatment. AI women suffer higher lifetime rates of PTSD (20-23%), and are 2-3 times more likely than the general U.S. population to engage in excessive drinking which often co-occurs with risky sexual behaviors. These factors magnify risk for HIV and sexually transmitted infections (HIV/STI).

This project is innovative in both its focus and its methods. It brings a culturally responsive intervention to an understudied and highly vulnerable population. It will culturally adapt and modify an evidence-based community health worker delivered intervention to address health risk behaviors (SAUD and HRSB). Its significance lies in its potential to advance science in the area of PTSD and SAUD treatment and HIV/STI prevention among AI women. Study data would be a significant contribution to tribal and rural communities and the mental health field. Finally, it is geared toward developing the research infrastructure and mental health treatment capacity serving AI women living in rural settings, a group at risk for an expanding AIDS and STI epidemic. If successful, findings from this study will inform a larger efficacy trial.

AIM I. Adapt the evidence-based CPT intervention in full collaboration with tribal partners. This will be done in accordance with the CDC's Map of Adaptation Process and involved formative research with tribal leaders, potential consumers, providers, and health care administrators using qualitative methodology.

AIM 2. Assess this intervention delivered by Native American community health workers for feasibility and acceptability in a resource-limited rural reservation setting.

AIM 2. Conduct a two-group, single-site waitlist randomized controlled pilot trial of a 12-session, 6-week CPT intervention among 56 (6 pilot) sexually active and substance using AI women with PTSD or sub-threshold PTSD. Determine preliminary efficacy and estimate an effect size in terms of three primary outcomes: (a) PTSD symptomatology; (b) substance use; (c) high risk sexual behavior.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Current Substance Use At least 2 days of heavy drinking in the past 30 day period (4 or more drinks over the course of 2 hours) OR Recent substance consumption (other than opioids) in the last 3 months
  • Desire to abstain from substances
  • Current Diagnostic and Statistical Manual -IV diagnosis of Post-traumatic stress disorder symptoms [score 30 or hire on the PTSD Checklist (PCL]
  • Sexually active (past 12 months)
  • Age ≥ 18 years
  • Capacity to provide informed consent

Exclusion Criteria:

  • Unstable psychiatric medication regimen (i.e., medication changes or dose changes in the past 2 months)
  • Recent use of opioids (past 3 months)
  • Current trauma-focused mental health treatment (MH) in the past 30 days
  • Suicide attempt or suicidal ideation with intent or plan, or self-harm in the past month
  • Presence of a psychotic disorder or uncontrolled Bipolar Disorder
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01849029

Contacts
Contact: Rebeca Marin, PhD (509) 209 7134 rmarin@uw.edu
Contact: Cynthia Pearson, PhD 206-330-1997 pearsonc@uw.edu

Locations
United States, Washington
Yakama Nation Behavioral Health and Comprehensive Community Alcoholism Program and Youth Treatment Program Recruiting
Toppenish, Washington, United States, 98948
Contact: Rebeca Marin, PhD    509-209-7134    rmarin@uw.edu   
Principal Investigator: Patsy Whitefoot, MA         
Sponsors and Collaborators
University of Washington
Investigators
Principal Investigator: Cynthia R Pearson, PhD Indigenous Wellness Research Institute, University of Washington
  More Information

No publications provided

Responsible Party: Cynthia Pearson, Research Assistant Professor, University of Washington
ClinicalTrials.gov Identifier: NCT01849029     History of Changes
Other Study ID Numbers: 43091-G, R34DA034529
Study First Received: May 4, 2013
Last Updated: October 6, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by University of Washington:
Post traumatic Stress Disorders
PTSD
HIV risk
sexual risk
substance use
alcohol misuse
Substance Abuse
Substance Addiction
Substance Dependence
Substance Use Disorders
Alcohol-Related Disorders
Binge Drinking
Sexual Partners
Sexual Behavior
Unsafe Sex

Additional relevant MeSH terms:
Stress Disorders, Post-Traumatic
Stress Disorders, Traumatic
Substance-Related Disorders
Anxiety Disorders
Mental Disorders
Chemically-Induced Disorders

ClinicalTrials.gov processed this record on July 31, 2014