Cognitive Processing Therapy to Treat PTSD and Sexually Transmitted Infections Among Men Who Have Sex With Men

NCT ID: NCT06463431

Last Updated: 2025-02-11

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 56 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-03-31
• Study Completion Date: 2026-08-31

Brief Summary

Gay, bisexual, queer, and other men who have sex with men (GBM) continue to bear a disproportionate burden of the sexually transmitted and blood-borne infections (STBBI), largely attributable to efficient transmission during condomless anal sex (CAS; Baggaley et al., 2010). In 2022, GBM accounted for 38.1% of new HIV diagnoses in Canada (Public Health Agency of Canada, 2023). Incidence of syphilis, chlamydia and gonorrhea have risen among men who have sex with men (MSM), especially among HIV+ GBM living in Canadian urban centres, including Toronto and Quebec (Public Health Agency of Canada, 2022). Post-traumatic stress disorder prevalence is also higher among GBM than among heterosexual men (Roberts et al., 2010). Post-traumatic stress disorder (PTSD) is a risk factor for CAS and related STBBI among GBM (O'Cleirigh, 2019). Despite the strong association between PTSD and STBBI risk among GBM, no studies have examined the efficacy of PTSD treatment on STBBI risk among GBM. PTSD may also increase substance use in sexual situations, another risk factor for STBBIs among GBQM (Semple et al., 2011; Elkington et al., 2010). Substance use tends to follow PTSD because alcohol and other substances are often used to self-medicate trauma symptoms (as an avoidant coping strategy) in interpersonal situations (Tan et al., 2021). Alcohol and substance use in sexual situations are consistent risk factors for CAS among Canadian GBQM (Lambert et al., 2011), and are associated with higher HIV incidence. Due to consistent data linking substance use to STBBI risk, it has been suggested that incorporating alcohol and substance use treatment into sexual risk reduction counselling (Koblin et al., 2006; Parsons et al., 2005; Shoptaw & Frosch, 2000) may increase the efficacy of STBBI prevention efforts for GBQM. PTSD is highly treatable via cognitive-behavioural therapies, including by Cognitive Processing Therapy (CPT; Benight & Bandura, 2004; Monson & Shnaider, 2014; Watkins et al., 2018).

The present study will provide preliminary feasibility and acceptability data for a novel and innovative STI/HIV prevention intervention for GBQM. This intervention builds upon empirically supported treatments for PTSD, including PTSD-related substance use, by adding risk reduction counselling to reduce sexually transmitted infections (STI) and HIV sexual risk behaviour. The present study will provide trial data for a novel and innovative STBBI prevention psychotherapy for GBM that could be administered by mental health providers across Canada. The intervention will consist of 14 90-minute sessions of an integrated cognitive-behavioural approach using CPT to treat PTSD and to reduce STBBI risks among GBQM. The primary outcome will be condomless anal sex with casual partners. The secondary outcomes will be PTSD prevalence, trauma symptoms, problematic substance use, sexual risk, and PTSD-related avoidance of negative thoughts and feelings.

This psychotherapy intervention will build upon empirically supported interventions to reduce HIV risk.

Conditions

Stress Disorders, Post-Traumatic; Sexually Transmitted Infection (STI) Prevention

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

Cognitive Processing Therapy

The intervention will consist of 14 90-minute weekly virtual sessions of CPT with a study therapist.

Session 1: Discuss sexual history/goals regarding PTSD and STBBI risk reduction, including reducing CAS, using medications to treat HIV/bacterial STBBIs, & providing education about the benefits of using PrEP Session 2: Review the cognitive model for CPT and the index trauma Sessions 3-7: Address problematic appraisals of the index trauma, maladaptive thoughts, and the experience and expression of natural emotions. Teach cognitive intervention skills to facilitate cognitive & emotional change Sessions 8-12: Discuss/challenge beliefs regarding safety, trust, power/control, esteem, & intimacy Session 13: Identify how participant's changed beliefs may affect sexual decision making, CAS, and substance use in sexual situations Session 14: Discuss relapse prevention/goals for progress regarding PTSD, substance use, & STBBI risk reduction

Group Type: EXPERIMENTAL

Cognitive Processing Therapy

Intervention Type: BEHAVIORAL

We propose a conceptual model for the relationship between PTSD, substance use, \& sexual risk behaviour wherein using substances to avoid posttraumatic cognitions \& affect leads to risky sexual behaviour through impaired safer sex negotiation. These mechanisms are consistent with the theory underlying CPT. Behaviourally, substance use (and potentially risky sexual behaviour) is negatively reinforced through avoiding unwanted negative affect. Cognitively, PTSD-based predictions may generate unrealistic risk appraisals that contribute to sexual risk. CPT addresses these specified pathways by a) identifying how trauma leads to maladaptive beliefs about the self, others, \& the future, b) cognitive interventions to address these beliefs, \& c) an overall trauma-focused orientation that addresses cognitive, affective \& behavioural avoidance, using cognitive restructuring to lead to more realistic/adaptive beliefs, less cognitive/affective avoidance, \& more goal-directed approach behaviours.

Interventions

Cognitive Processing Therapy

We propose a conceptual model for the relationship between PTSD, substance use, \& sexual risk behaviour wherein using substances to avoid posttraumatic cognitions \& affect leads to risky sexual behaviour through impaired safer sex negotiation. These mechanisms are consistent with the theory underlying CPT. Behaviourally, substance use (and potentially risky sexual behaviour) is negatively reinforced through avoiding unwanted negative affect. Cognitively, PTSD-based predictions may generate unrealistic risk appraisals that contribute to sexual risk. CPT addresses these specified pathways by a) identifying how trauma leads to maladaptive beliefs about the self, others, \& the future, b) cognitive interventions to address these beliefs, \& c) an overall trauma-focused orientation that addresses cognitive, affective \& behavioural avoidance, using cognitive restructuring to lead to more realistic/adaptive beliefs, less cognitive/affective avoidance, \& more goal-directed approach behaviours.

Intervention Type: BEHAVIORAL

Other Intervention Names

CPT

Eligibility Criteria

Inclusion Criteria

• Live in Ontario or Quebec (able to travel to Toronto Metropolitan University or CLSC de Cote-des-Neiges, respectively)
• Identify as a man
• Are over 18 years of age
• Have had anal sex without a condom with a person assigned male at birth in the past 3 months
• Have experienced symptoms consistent with a diagnosis of PTSD
• Are able to read, speak, and understand English

Exclusion Criteria

• if a 14-session protocol is deemed inappropriate for their treatment needs (e.g., psychotic or bipolar disorders not well-managed by medications)
• if either our assessors or therapists identify that a participant's ability to respond to study measures is compromised by mental or physical disabilities or inability to speak and understand English

• Minimum Eligible Age: 18 Years
• Eligible Sex: MALE
• Accepts Healthy Volunteers: No

Sponsors

Toronto Metropolitan University

OTHER

Sponsor Role: lead

Responsible Party

Trevor Hart

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Toronto Metropolitan University

Toronto, Ontario, Canada

McGill University

Montreal, Quebec, Canada

Countries

Canada

Central Contacts

Jane Cao, BA

Role: CONTACT

RISE.study@torontomu.ca

4169795000 ext. 552179

Trevor A Hart, Ph.D, CPsych

Role: CONTACT

trevor.hart@torontomu.ca

4169795000 ext. 556192

Facility Contacts

Jane Cao, BA

Role: primary

hivprevmanager@torontomu.ca

4169795000 ext. 552179

Allison L Kirschbaum, PhD

Role: backup

akirschbaum@torontomu.ca

4169795000 ext. 552179

Pierre-Paul Tellier, MD

Role: primary

pierre-paul.tellier@mcgill.ca

514-891-0830

Nate Fuks

Role: backup

References

Shoptaw S, Frosch D. Substance abuse treatment as HIV prevention for men who have sex with men. AIDS Behav. 2000;4(2):193-203.

Reference Type: BACKGROUND

Parsons JT, Kutnick AH, Halkitis PN, Punzalan JC, Carbonari JP. Sexual risk behaviors and substance use among alcohol abusing HIV-positive men who have sex with men. J Psychoactive Drugs. 2005 Mar;37(1):27-36. doi: 10.1080/02791072.2005.10399746.

Reference Type: BACKGROUND

PMID: 15916249 (View on PubMed)

Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K, Barresi PJ, Coates TJ, Chesney MA, Buchbinder S. Risk factors for HIV infection among men who have sex with men. AIDS. 2006 Mar 21;20(5):731-9. doi: 10.1097/01.aids.0000216374.61442.55.

Reference Type: BACKGROUND

PMID: 16514304 (View on PubMed)

Lambert G, Cox J, Hottes TS, Tremblay C, Frigault LR, Alary M, Otis J, Remis RS; M-Track Study Group. Correlates of unprotected anal sex at last sexual episode: analysis from a surveillance study of men who have sex with men in Montreal. AIDS Behav. 2011 Apr;15(3):584-95. doi: 10.1007/s10461-009-9605-3.

Reference Type: BACKGROUND

PMID: 20033763 (View on PubMed)

Tan RKJ, Phua K, Tan A, Gan DCJ, Ho LPP, Ong EJ, See MY. Exploring the role of trauma in underpinning sexualised drug use ('chemsex') among gay, bisexual and other men who have sex with men in Singapore. Int J Drug Policy. 2021 Nov;97:103333. doi: 10.1016/j.drugpo.2021.103333. Epub 2021 Jun 24.

Reference Type: BACKGROUND

PMID: 34175526 (View on PubMed)

Elkington KS, Bauermeister JA, Zimmerman MA. Psychological distress, substance use, and HIV/STI risk behaviors among youth. J Youth Adolesc. 2010 May;39(5):514-27. doi: 10.1007/s10964-010-9524-7. Epub 2010 Mar 14.

Reference Type: BACKGROUND

PMID: 20229264 (View on PubMed)

Semple SJ, Strathdee SA, Zians J, McQuaid JR, Patterson TL. Drug assertiveness and sexual risk-taking behavior in a sample of HIV-positive, methamphetamine-using men who have sex with men. J Subst Abuse Treat. 2011 Oct;41(3):265-72. doi: 10.1016/j.jsat.2011.03.006. Epub 2011 May 8.

Reference Type: BACKGROUND

PMID: 21550758 (View on PubMed)

Benight CC, Bandura A. Social cognitive theory of posttraumatic recovery: the role of perceived self-efficacy. Behav Res Ther. 2004 Oct;42(10):1129-48. doi: 10.1016/j.brat.2003.08.008.

Reference Type: BACKGROUND

PMID: 15350854 (View on PubMed)

Roberts AL, Austin SB, Corliss HL, Vandermorris AK, Koenen KC. Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. Am J Public Health. 2010 Dec;100(12):2433-41. doi: 10.2105/AJPH.2009.168971. Epub 2010 Apr 15.

Reference Type: BACKGROUND

PMID: 20395586 (View on PubMed)

O'Cleirigh C, Safren SA, Taylor SW, Goshe BM, Bedoya CA, Marquez SM, Boroughs MS, Shipherd JC. 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. 2019 Sep;23(9):2421-2431. doi: 10.1007/s10461-019-02482-z.

Reference Type: BACKGROUND

PMID: 30993478 (View on PubMed)

Baggaley RF, White RG, Boily MC. Infectiousness of HIV-infected homosexual men in the era of highly active antiretroviral therapy. AIDS. 2010 Sep 24;24(15):2418-20. doi: 10.1097/QAD.0b013e32833dbdfd. No abstract available.

Reference Type: BACKGROUND

PMID: 20827059 (View on PubMed)

Related Links

https://hivprevlab.ca/research/resilience-and-sexual-health-empowerment-rise/

Study Webpage

Other Identifiers

151412

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

152308

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

REB 2024-251

Identifier Type: -

Identifier Source: org_study_id