Pilot trial of an expressive writing intervention with HIV-positive methamphetamine-using men who have sex with men.

Abstract

Among men who have sex with men (MSM), the co-occurrence of trauma and stimulant use has negative implications for HIV/AIDS prevention. HIV-positive, methamphetamine-using MSM were recruited to pilot test a 7-session, multi-component resilient affective processing (RAP) intervention that included expressive writing exercises targeting HIV-related traumatic stress. An open-phase pilot with 10 participants provided support for feasibility of intervention delivery such that 99% of the RAP sessions were completed in a 1-month period. Subsequently, 23 additional participants were enrolled in a pilot randomized controlled trial of the RAP intervention (n = 12) versus an attention-control condition that included writing exercises about neutral topics (n = 11). Acceptability was evidenced by participants randomized to RAP expressing significantly more negative emotions in their writing and reporting greater likelihood of recommending expressive writing exercises to a friend living with HIV. Over the 3-month follow-up period, attention-control participants reported significant decreases in HIV-related traumatic stress while RAP intervention participants reported no significant changes. Compared to attention-control participants, those in the RAP intervention reported significant reductions in the frequency of methamphetamine use immediately following the 1-month RAP intervention period. Thematic analyses of RAP expressive writing exercises revealed that multiple negative life events characterized by social stigma or loss contribute to the complex nature of HIV-related traumatic stress. Findings support the feasibility and acceptability of an exposure-based intervention targeting HIV-related traumatic stress. However, more intensive intervention approaches that simultaneously target trauma and stimulant use will likely be needed to optimize HIV/AIDS prevention efforts with this population.

Critical Review: When the Party is Over: A Systematic Review of Behavioral Interventions for Substance-Using Men Who Have Sex with Men

“…Co-occurring psychosocial health problems fuel the HIV/AIDS epidemic, but behavioral interventions with SUMSM have often not addressed syndemic conditions that serve as triggers for alcohol and substance use as well as independently contribute to engagement in CAI. 27,28,31-34 Although some behavioral interventions addressing depression and trauma have been pilot tested with methamphetamine-using MSM, 58,65 more definitive clinical research is needed to examine if more comprehensive, syndemic approaches demonstrate greater efficacy. Behavioral interventions targeting modifiable psychological processes such as sexual minority stress could alleviate syndemic burden and optimize HIV/AIDS prevention with SUMSM.…”

Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

“…For instance, exposure (e.g., Prolonged Exposure; PE), cognitive (e.g., Cognitive Processing Therapy-Cognitive Therapy; CPT-C) and socially focused treatments (e.g., Interpersonal Psychotherapy; IPT) have shown to be effective in reducing PTSD symptoms (Foa et al, 2013; Markowitz et al, 2015; Walter, Dickstein, Barnes, & Chard 2014). More recently, a number of evidence-based psychotherapies have been developed to address comorbid PTSD and SUD simultaneously (Carrico et al, 2015; McCauley, Killeen, Gros, Brady, & Back, 2012). These treatments seamlessly integrate components for both disorders and have been found to provide significant reduction in symptoms of both conditions.…”

Treating Posttraumatic Stress Symptoms Among People Living with HIV: a Critical Review of Intervention Trials

“…Two studies have examined the efficacy of expressive writing, either as a stand-alone treatment or as a key component in a treatment program, among PLWH [29, 30]. Unlike the studies reviewed above, neither PTSD nor trauma exposure was an inclusion criterion.…”

“…In a small pilot RCT, Carrico et al examined the efficacy of seven sessions of multicomponent resilient affective processing (RAP) versus neutral writing in 23 HIV+ men who have sex with men (MSM) who use methamphetamine [29]. RAP focuses on decreasing HIV-related traumatic stress and includes psychoeducation, expressive writing with prompts designed to cultivate positive psychological states (e.g., “what makes you feel hopeful or optimistic about the future?”), and relaxation exercises.…”

“…Both studies that examined expressive writing treatment, either alone [30] or as part of a multicomponent intervention [29], found null results relative to daily event writing. Expressive writing, also referred to as narrative writing, is a type of exposure therapy that has shown promise for treating PTSD in the general population [66] and is a feature of a number of PTSD treatment protocols.…”