The Use of Cognitive Mindfulness for Chemsex
Condition: Substance Use
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      Title of research: A preliminary RCT of an online mindfulness-based cognitive intervention
      for Chemsex

      Research aim: To determine how an online mindfulness-based cognitive intervention, might
      reduce Chemsex engagement, risky sexual behaviours, sexual self-efficacy and increase overall
      wellbeing among men who have sex with men.

      Research intention: If the mindfulness based cognitive intervention reduces Chemsex
      engagement and risky sexual behaviours and supports sexual and general wellbeing, then we
      would repeat this study on a larger scale within the National Health Service among men who
      have sex with other men and who engage in Chemsex. Both academic output and dissemination
      accordingly.

      A brief overview of intervention:

      Chemsex, sometimes coined as Chemfun, is a term used to describe the use of psychoactive
      substances with the intention of enhancing and/or facilitating the sexual experience/arousal
      and predominates among gay and bisexual men. Chemsex drugs tend to include, γ-hydroxybutyric
      acid and congeners, methamphetamine, mephedrone, erectile dysfunction agents, and alkyl
      nitrites often in combination.

      A growing body of research has suggested that mindfulness supports minimize drug using
      behaviors HIV stress and risky sexual behaviours. However, there appears no current
      mindfulness intervention that has been evidenced for Chemsex. Our intervention is hoped to
      become part of a multidisciplinary approach in supporting Chemsex which includes a cross-over
      effect between drugs, sexual well-being, and general wellbeing.

      Quantitatively, the research is structured so that participants will be randomized to either
      the experimental or control group (n=20 experimental; n=20 control waitlist). The MBCI for
      each group is 1 month (4 wks experimental and 4 wks waitlist control). This is followed by a
      3-month follow-up to determine the sustainability of this intervention. Qualitatively,
      participants will be asked approx 8 open-ended feedback questions forming part of 4 groups of
      10, at the 3-month follow-up.
    

Detailed description: 
      The principal researcher developed an online cognitive mindfulness intervention.

      The main target in this study was to engage participants with mindfulness exercises whilst
      improving wellbeing and mindfulness whilst reducing Chemsex use. The main exercises included
      mindfulness, breathing exercises, relaxation techniques, being mindful of the senses and the
      body and understanding of the self. This online mindfulness based cognitive intervention
      contains cognitive, emotional, and behavioural factors and each of the 4 sessions included
      substance use and sexual behaviour, working with the inner critic and high-risk situations,
      sex without drugs and sexual identity and psychosexual wellbeing, substance use and
      self-compassion. Homework exercises were encouraged which consisted of education, training,
      modelling, and enablement. To expand, education included psychoeducational information on
      chemsex, sexual wellbeing, and mindfulness along with additional resources. Training provided
      the instructions on how to go about engaging in these online activities. Modelling provides
      examples in action such as MSM discussing their experiences of Chemsex including verbal
      persuasion and challenging negative self-talk, and how to go about doing the exercises, and
      enablement is aimed at increasing participants capability of engaging in these activities
      towards wellbeing. This would be further supported by charts, self-monitors, diaries, and
      journaling. Further, prompts, action plans, and cues were supportive intervention components.
      Feedback and support along with discussing the educational components, training, modelling
      and enablement had been addressed throughout the duration of this study.

      The development of the mindfulness based cognitive intervention has been based on a
      behavioral change techniques taxonomy. This have been used because the behavioural change
      techiques taxonomy has been rigorously tested to evidence the effectiveness in support of
      interventions associated with change behaviour. The 93 behavior change techniques are the
      active ingredients of behavior change where each intervention is likely to consist of more
      than one behaviour change technique and serve as having more than one function. In total, the
      intervention in this study included 15 domains in which 35 out of the 93 behaviour change
      techniques listed in the behavioural change technique taxonomy were identified. The selection
      of these domains used a process of triangulation to ensure consistency in mapping the
      behaviour change techniques to the intervention.
    

Intervention name(s): mindful cognitive intervention
Intervention type(s): Behavioral
Intervention description(s): Mindfulness based cognitive intervention based on the behavioural change techniques taxonomy
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: Waitlist control. An experimental group and a delayed group over 8 weeks Waitlist controlled RCT (N= 16 immediate group, N=15)
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Chemsex; Cognitive mindfulness; Sexual self efficacy; Well-being