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Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial

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Abstract

To address childhood sexual abuse (CSA) related distress and HIV risk in men who have sex with men (MSM) using cognitive-behavioral therapy for trauma and self-care (CBT-TSC), which is a novel intervention integrating HIV risk reduction with modified cognitive and behavioral therapy strategies for post-traumatic stress. We compared CBT-TSC to HIV voluntary counseling and testing (VCT)-only in an initial 2-arm RCT in 43 HIV-negative MSM at with a history of CSA and HIV risk. Serodiscordant condomless anal/vaginal sex (CAS; CAS with HIV-postive or HIV unknown status partners) and posttraumatic stress disorder (PTSD) symptoms (Davidson Trauma Scale: total score and avoidance, intrusions, hyperarousal subscales) were outcomes immediately post-treatment, and at 6- and 9-month follow-up. At post-treatment, CBT-TSC had decreased odds (approximately 60%) of any CAS and greater reductions in CAS compared to VCT-only. Additionally, the CBT-TSC condition experienced greater reductions in total PTSD and avoidance symptoms. At the follow-up visits, CBT-TSC condition had significant reductions in the odds of any CAS and reductions in CAS. However, for PTSD symptoms, only the avoidance subscale remained significantly different compared to VCT-only. CBT-TSC is a potentially efficacious approach to address HIV risk in MSM with a CSA history, with replication and extension in a larger trial needed. This proof-of-concept trial is the first to integrate the treatment of a commonly occurring mental-health syndemic problem in MSM with a health psychology approach to self-care in MSM.

Trial Registration Clinicaltrials.gov NCT01266122

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Funding

Funding from this project was from Grant R34MH081760 awarded to Conall O’Cleirigh. Dr. Safren was also supported by Grant 9K24DA040489.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA

    Conall O’Cleirigh, Brett M. Goshe, C. Andres Bedoya & Samantha M. Marquez

  2. Harvard Medical School, Boston, MA, USA

    Conall O’Cleirigh, Brett M. Goshe & C. Andres Bedoya

  3. The Fenway Institute of Fenway Health, Boston, MA, USA

    Conall O’Cleirigh, Steven A. Safren, S. Wade Taylor & Samantha M. Marquez

  4. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Steven A. Safren

  5. VA Boston Healthcare System, Boston, MA, USA

    Jillian C. Shipherd

  6. Women’s Health Sciences Division, National Center for PTSD, Boston, MA, USA

    Jillian C. Shipherd

  7. Department of Veterans Affairs, LGBT Health Program, Washington, DC, USA

    Jillian C. Shipherd

  8. Boston University School of Medicine, Boston, MA, USA

    Jillian C. Shipherd

  9. School of Social Work, Boston University, Boston, MA, USA

    S. Wade Taylor

  10. Department of Psychology, University of Windsor, Windsor, ON, Canada

    Michael S. Boroughs

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  1. Conall O’Cleirigh
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  2. Steven A. Safren
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  3. S. Wade Taylor
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  4. Brett M. Goshe
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Correspondence to Conall O’Cleirigh.

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O’Cleirigh, C., Safren, S.A., Taylor, S. et al. Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial. AIDS Behav 23, 2421–2431 (2019). https://doi.org/10.1007/s10461-019-02482-z

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