Intervention Development for Social Stress, Mental Health, and HIV Risk MSM
Condition: HIV Infections; Depression; Anxiety
MeSH terms: HIV Infections
Study type: Interventional

Summary: 
      The proposed study will adapt a cognitive behavioral intervention to support high-risk MSM's
      adaptive coping with minority stress, alleviate associated depression and anxiety, and reduce
      HIV risk behavior. The adapted intervention is expected to increase awareness of the
      unhealthy impact of minority stress; facilitate objective self-schemas in the face of
      minority stress; and strengthen one's skills and self-efficacy for managing minority stress
      and associated anxiety and depression to reduce risk for acquiring HIV.
    

Detailed description: 
      Gay, bisexual, and other men who have sex with men (MSM) are the population most severely
      affected by HIV in the U.S. and one of the only risk groups in the U.S. for which new
      infections continue to rise. MSM also experience a vastly disproportionate risk of mental
      health disorders, especially depression and anxiety. Numerous studies have shown that this
      mental health disparity arises from the early and ongoing stressors, known as minority
      stress, that MSM experience related to their sexual orientation. Despite the fact that
      minority stress is strongly related to anxiety and depression, and that minority stress and
      related mental health problems synergistically propel HIV risk behaviors, no existing HIV
      prevention intervention targets minority stress in order to reduce MSM's HIV risk behavior.
      This project aims to develop a theoretically-driven intervention that reduces the
      health-depleting effects of minority stress through targeting the basic psychosocial
      mechanisms linking minority stress to HIV risk behavior. These mechanisms include maladaptive
      emotion regulation, negative thinking styles, low self-efficacy, avoidance, and impulsivity,
      which are the very targets of an existing cognitive-behavioral, manualized intervention--the
      Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UPTTED). The
      UPTTED changes these mechanisms using motivational interviewing, interoceptive and
      situational exposure, cognitive restructuring, mindfulness, and self-monitoring exercises,
      all grounded in cognitive-behavioral principles and developmental and affective neuroscience
      models of stress. The proposed study will adapt the UPTTED to support high-risk MSM's
      adaptive coping with minority stress, alleviate associated depression and anxiety, and reduce
      HIV risk behavior. The adapted UPTTED is expected to increase awareness of the unhealthy
      impact of minority stress; facilitate objective self-schemas in the face of minority stress;
      and strengthen one's skills and self-efficacy for managing minority stress and associated
      anxiety and depression to reduce risk for acquiring HIV. MSM who have experienced minority
      stress, mental health problems, and HIV risk behavior in the previous 3 months (n = 30) and
      community health experts (n = 30) will provide suggestions for adaptations to the existing
      intervention manual, including culturally relevant vignettes, examples, and exercises for
      adaptively responding to minority stress and managing HIV risk. The feasibility,
      acceptability, and preliminary efficacy of the adapted intervention will then be tested in a
      randomized waitlist controlled trial with MSM (n = 60) who report recent experiences with
      minority stress, depression and anxiety, and HIV risk behavior. The primary outcome will be
      HIV risk behavior. Secondary outcomes will be reductions in mediators including depression,
      anxiety, and the mechanisms of the conceptual model. This project innovatively seeks to test
      the preliminary efficacy of the first theoretically-driven intervention targeting the mental
      and sexual health consequences of minority stress and does so by targeting the underlying
      mechanisms that powerfully drive these simultaneous health threats.
    

Intervention name(s): ESTEEM
Intervention type(s): Behavioral
Intervention description(s): 10-session cognitive behavioral treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention