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

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ClinicalTrials.gov Identifier: NCT01849029
Recruitment Status : Completed
First Posted : May 8, 2013
Last Update Posted : August 22, 2017
Sponsor:
Collaborator:
Information provided by (Responsible Party):

Study Description
Brief Summary:

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 or disease Intervention/treatment
Post Traumatic Stress Disorders Unsafe Sex Substance Use Disorders Behavioral: Cognitive Processing Therapy-Cognitive

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Study Design

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Cognitive Processing Intervention for HIV/STI and Substance Use Among Native Women
Actual Study Start Date : October 15, 2013
Primary Completion Date : March 30, 2017
Study Completion Date : July 30, 2017

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS
U.S. FDA Resources

Arms and Interventions

Arm Intervention/treatment
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)


Outcome Measures

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

  2. PTSD Symptom Scale interview (PSS-I) [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ]
    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 :
  1. Drug use Frequency (DUF) [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ]
    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)

  2. Drug use Frequency (DUF) [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ]
    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)

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

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

  5. Condom-protected sex [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ]

    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


  6. Condom-protected sex [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ]

    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:
  1. Penn Alcohol Craving Scale (PACS) [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ]
    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.

  2. Penn Alcohol Craving Scale (PACS) [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ]
    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.

  3. number of sex partners [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ]
    count, dichotomized at one partner vs. more than one partner

  4. number of sex partners [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ]
    count, dichotomized at one partner vs. more than one partner

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

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

  7. concurrent sexual partners [ Time Frame: Change from baseline (week 0) to Post intervention (week 6-8 weeks) ]
    Overlapping partnerships where sexual (anal or vaginal) intercourse with one partner occurs between two acts of intercourse with another partner

  8. concurrent sexual partners [ Time Frame: Change from baseline (week 0) to follow-up (week 12-14) ]
    Overlapping partnerships where sexual (anal or vaginal) intercourse with one partner occurs between two acts of intercourse with another partner


Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes 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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01849029


Locations
United States, Washington
Yakama Nation Behavioral Health and Comprehensive Community Alcoholism Program and Youth Treatment Program
Toppenish, Washington, United States, 98948
Sponsors and Collaborators
University of Washington
National Institute on Drug Abuse (NIDA)
Investigators
Principal Investigator: Cynthia R Pearson, PhD Indigenous Wellness Research Institute, University of Washington
More Information

Responsible Party: Cynthia Pearson, Research Assistant Professor, University of Washington
ClinicalTrials.gov Identifier: NCT01849029     History of Changes
Other Study ID Numbers: 43091-G
R34DA034529 ( U.S. NIH Grant/Contract )
First Posted: May 8, 2013    Key Record Dates
Last Update Posted: August 22, 2017
Last Verified: August 2017

Keywords provided by Cynthia Pearson, 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:
Disease
Stress Disorders, Traumatic
Stress Disorders, Post-Traumatic
Substance-Related Disorders
Pathologic Processes
Trauma and Stressor Related Disorders
Mental Disorders
Chemically-Induced Disorders