Enhancing motivation to reduce the risk of HIV infection for economically disadvantaged urban women

This research evaluated a motivation-based HIV risk reduction intervention for economically disadvantaged urban women. Participants completed a survey that assessed HIV-related knowledge, risk perceptions, behavioral intentions, sexual communication, substance use, and risk behavior. A total of 102 at-risk women (76% African American) were randomly assigned to either the risk reduction intervention or to a waiting list. Women were reassessed at 3 and 12 weeks. Results indicated that treated women increased their knowledge and risk awareness, strengthened their intentions to adopt safer sexual practices, communicated their intentions with partners, reduced substance use proximal to sexual activities, and engaged in fewer acts of unprotected vaginal intercourse. These effects were observed immediately, and most were maintained at follow-up.     

Thirty-month follow-up of drinking moderation training for women: A randomized clinical trial.

This study examined the durability of a group-based drinking moderation training for heavily drinking women reporting low physical dependence on alcohol. A 30-month follow-up of participants was conducted based on a previous study of 144 women randomly assigned to treatment conditions (G. J. Connors & K. S. Walitzer, 2001). Thirty-month follow-up results indicated that women who at baseline were relatively heavier drinkers had significantly greater benefit from the drinking moderation training when exposed to intervention enhancements entailing life skills training and booster sessions. Further, the initial improvements in drinking, relative to baseline levels, did not statistically deteriorate over the 30-month follow-up. The findings support the application of treatment enhancements among women in this population who at baseline are relatively heavier drinkers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of a brief HIV risk reduction counseling intervention for women.

There is an urgent need for the development and implementation of effective and feasible behavioral HIV and STD interventions. The purpose of the present randomized controlled trial was to evaluate the effectiveness of a single-session, skill-based sexual risk reduction intervention for women. Participants were assessed at baseline and at 1 month and 3 months following the intervention on measures of AIDS knowledge, behavioral intentions, self-efficacy, and sexual risk behavior. Compared with women in an AIDS-education-only condition, women receiving the skill-based intervention reported significantly higher rates of condom use at 3-month follow-up. Results suggest that brief sexual risk reduction programs are feasible and effective within a community setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dismantling motivational interviewing and feedback for college drinkers: A randomized clinical trial.

Motivational interviewing (MI) is a counseling style that has been shown to reduce heavy drinking among college students. To date, all studies of MI among college students have used a format that includes a feedback profile delivered in an MI style. This study was a dismantling trial of MI and feedback among heavy-drinking college students. After an initial screen, 279 heavy-drinking students were randomized to (a) Web feedback only, (b) a single MI session without feedback, (c) a single MI session with feedback, or (d) assessment only. At 6 months, MI with feedback significantly reduced drinking, as compared with assessment only (effect size = .54), MI without feedback (effect size = .63), and feedback alone (effect size = .48). Neither MI alone nor feedback alone differed from assessment only. Neither sex, race or ethnicity, nor baseline severity of drinking moderated the effect of the intervention. Norm perceptions mediated the effect of the intervention on drinking. MI with feedback appears to be a robust intervention for reducing drinking and may be mediated by changes in normative perceptions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multisite randomized effectiveness trial of motivational enhancement therapy for Spanish-speaking substance users.

Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of motivational enhancement therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week therapy phase, there were no significant Treatment Condition × Time interactions nor Site × Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adapted motivational interviewing for women with binge eating disorder: A randomized controlled trial.

In this randomized controlled trial, 108 women with binge-eating disorder (BED) recruited from the community were assigned to either an adapted motivational interviewing (AMI) group (1 individual AMI session + self-help handbook) or control group (handbook only). They were phoned 4, 8, and 16 weeks following the initial session to assess binge eating and associated symptoms (depression, self-esteem, quality of life). Postintervention, the AMI group participants were more confident than those in the control group in their ability to change binge eating. Although both groups reported improved binge eating, mood, self-esteem, and general quality of life 16 weeks following the intervention, the AMI group improved to a greater extent. A greater proportion of women in the AMI group abstained from binge eating (27.8% vs. 11.1%) and no longer met the binge frequency criterion of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) for BED (87.0% vs. 57.4%). AMI may constitute a brief, effective intervention for BED and associated symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing assertiveness skills to reduce HIV risk among women living with a severe and persistent mental illness.

This study examined whether training women living with a severe mental illness to be assertive in sexual situations would decrease their risk for HIV infection. Twenty female outpatients were randomly assigned to either a 10-session assertiveness training intervention or a waiting-list control condition. All participants completed measures of HIV-related information, motivation, skills, and sexual risk behavior pre- and postintervention and at 2- and 4-month follow-ups. Compared with controls, women in the intervention group increased their assertiveness skill, HIV knowledge, and frequency of condom-protected intercourse. It is concluded that assertiveness training for women living with a severe mental illness can serve as 1 part of a comprehensive HIV-risk-reduction program for this vulnerable population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using message framing to motivate HIV testing among low-income, ethnic minority women.

This study compared the effectiveness of 4 videotaped educational programs designed to motivate HIV testing among low-income, ethnic minority women. 480 women were assigned randomly to watch one of 2 gain-framed or 2 loss-framed videos. Consistent with prospect theory, participants' perceptions of the certainty of the outcome of an HIV test moderated the effects of framing on self-reported testing behavior 6 months after video exposure. Among participants who reported being certain of the test's outcome, those who saw a gain-framed video reported a higher rate of testing than those who saw a loss-framed message. Among women who perceived the outcome of HIV testing as relatively uncertain, gain- and loss-framed videos led to similar rates of self-reported testing, with some advantage for the loss-framed message. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral intervention to reduce African American adolescents' risk for HIV infection.

Two hundred forty-six African American adolescents were randomly assigned to an educational program or an 8-week intervention that combined education with behavior skills training including correct condom use, sexual assertion, refusal, information provision, self-management, problem solving, and risk recognition. Skill-trained participants (a) reduced unprotected intercourse, (b) increased condom-protected intercourse, and (c) displayed increased behavioral skills to a greater extent than participants who received information alone. The patterns of change differed by gender. Risk reduction was maintained 1 year later for skill-trained youths. It was found that 31.1% of youths in the education program who were abstinent at baseline had initiated sexual activity 1 year later, whereas only 11.5% of skills training participants were sexually active. The results indicate that youths who were equipped with information and specific skills lowered their risk to a greater degree, maintained risk reduction changes better, and deferred the onset of sexual activity to a greater extent than youths who received information alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized motivational enhancement prevention group reduces drinking and alcohol consequences in first-year college women.

Alcohol consumption among college students has become an increasing problem that requires attention from college administrators, staff, and researchers. Despite the physiological differences between men and women, college women are drinking at increasingly risky rates, placing them at increased risk for negative consequences. The current study tested a group motivational enhancement approach to the prevention of heavy drinking among 1st-year college women. Using a randomized design, the authors assigned participants either to a group that received a single-session motivational enhancement intervention to reduce risky drinking that focused partly on women's specific reasons for drinking (n = 126) or to an assessment-only control group (n =94). Results indicated that, relative to the control group participants, intervention participants drank fewer drinks per week, drank fewer drinks at peak consumption events, and had fewer alcohol-related consequences over a 10-week follow-up. Further, the intervention, which targeted women's reasons for drinking, was more effective in reducing consumption for participants with high social and enhancement motivations for drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized clinical trial of alternative stress management interventions in persons with HIV infection.

Research in psychoneuroimmunology suggests that immunosuppression associated with perceived stress may contribute to disease progression in persons with HIV infection. While stress management interventions may enhance immune function, few alternative approaches have yet been tested. This randomized clinical trial was conducted to test effects of three 10-week stress management approaches--cognitive-behavioral relaxation training (RLXN), focused tai chi training (TCHI), and spiritual growth groups (SPRT)--in comparison to a wait-listed control group (CTRL) among 252 individuals with HIV infection. Using repeated measures mixed modeling, the authors found that in comparison to the CTRL group, (a) both the RLXN and TCHI groups used less emotion-focused coping, and (b) all treatment groups had augmented lymphocyte proliferative function. Despite modest effects of the interventions on psychosocial functioning, robust findings of improved immune function have important clinical implications, particularly for persons with immune-mediated illnesses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief motivational interventions for heavy college drinkers: A randomized controlled trial.

In this randomized controlled trial, the authors evaluated brief motivational interventions (BMIs) for at-risk college drinkers. Heavy drinking students (N = 509; 65% women, 35% men) were randomized into 1 of 6 intervention conditions formed by crossing the baseline Timeline Followback (TLFB) interview (present versus absent) and intervention type (basic BMI, BMI enhanced with a decisional balance module, or none). Assessments completed at baseline, 1, 6, and 12 months measured typical and risky drinking as well as drinking-related problems. Relative to controls, the TLFB interview reduced consumption but not problems at 1 month. The basic BMI improved all drinking outcomes beyond the effects of the TLFB interview at 1 month, whereas the enhanced BMI did not. Risk reduction achieved by brief interventions maintained throughout the follow-up year. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing STD and HIV risk behavior of substance-dependent adolescents: A randomized controlled trial.

A randomized controlled trial assessed 3 interventions designed to increase safer sex behaviors of substance-dependent adolescents. Participants (N = 161) received 12 sessions of either a health information intervention (I only), information plus skills-based safer sex training (I + B), or the same experimental condition plus a risk-sensitization manipulation (I + M + B). The I + B and I + M + B conditions, as compared with the I only condition, (a) produced more favorable attitudes toward condoms; (b) reduced the frequency of unprotected vaginal sex; and (c) increased behavioral skill performance, frequency of condom-protected sex, percentage of intercourse occasions that were condom protected, and number of adolescents who abstained from sex. The intervention that included the risk-sensitization procedures was more resistant to decay. An unexpected finding was that the I + B and I + M + B conditions produced substantial increased in sexual abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adding voucher-based incentives to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence.

Sixty individuals seeking outpatient treatment for marijuana dependence were randomly assigned to 1 of 3 treatments: motivational enhancement (M), M plus behavioral coping skills therapy (MBT), or MBT plus voucher-based incentives (MBTV). In the voucher-based incentive program, participants earned vouchers exchangeable for retail items contingent on them submitting cannabinoid-negative urine specimens. MBTV engendered significantly greater durations of documented marijuana abstinence during treatment compared with MBT and M, and a greater percentage of participants in the MBTV group compared with the MBT or M groups were abstinent at the end of treatment. No significant differences in marijuana abstinence were observed between the MBT and M groups. The positive effects of the voucher program in this study support the utility of incentive-based interventions for the treatment of substance dependence disorders including marijuana dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapy for youths with anxiety disorders: A second randomized clincal trial.

Ninety-four children (aged 9-13 years) with anxiety disorders were randomly assigned to cognitive behavioral treatment or waiting-list control. Outcomes were evaluated using diagnostic status, child self-reports, parent and teacher reports, cognitive assessment and behavioral observation; maintenance was examined using l-year follow-up data. Analyses of dependent measures indicated significant improvements over time, with the majority indicating greater gains for those receiving treatment. Treatment gains returned cases to within nondeviant limits (i.e., normative comparisons) and were maintained at l-year follow-up. Client age and comorbid status did not moderate outcomes. A preliminary examination of treatment segments suggested that the enactive exposure (when it follows cognitive-educational training) was an active force in beneficial change. Discussion includes suggestions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weekly fluconazole for the prevention of mucosal candidiasis in women with HIV infection. A randomized, double-blind, placebo-controlled trial. Terry Beirn Community Programs for Clinical Research on AIDS

BACKGROUND: Candidiasis is a frequent complication of infection with the human immunodeficiency virus (HIV); however, few data exist about the natural history, prevention, and treatment of mucosal candidiasis in women. OBJECTIVE: To evaluate the safety and effectiveness of weekly fluconazole prophylaxis for mucosal candidiasis in women infected with HIV. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: 14 sites participating in the Community Programs for Clinical Research on AIDS (CPCRA). PATIENTS: 323 women with HIV infection and CD4+ cell counts of 300 cells/mm3 or less. INTERVENTION: 200 mg of fluconazole per week or placebo. Open-label fluconazole for candidiasis prophylaxis was permitted after two oropharyngeal or vaginal episodes or one esophageal episode. MEASUREMENTS: Development of mucosal candidiasis, clinical and in vitro resistance of Candida species to fluconazole, survival, and adverse events. RESULTS: After a median follow-up of 29 months, 72 of 162 patients receiving fluconazole and 93 of 161 patients receiving placebo had at least one episode of candidiasis (relative risk [RR], 0.56 [95% Cl, 0.41 to 0.77); P < 0.001). Weekly fluconazole was effective in preventing oropharyngeal candidiasis (RR, 0.50 [Cl, 0.33 to 0.74]; P < 0.001) and vaginal candidiasis (RR, 0.64 [Cl, 0.40 to 1.00]; P = 0.05) but not esophageal candidiasis (RR, 0.91 [Cl, 0.48 to 1.72]; P > 0.2). Relative risks were similar for women who had a history of mucosal candidiasis (RR, 0.5 [Cl, 0.35 to 0.75]) and those who did not (RR, 0.69 [Cl, 0.35 to 1.34]). Absolute risk reduction for patients with a history of infection was 25.6 per 100 person-years, which is more than twice the reduction of 11.2 per 100 person-years seen in patients with no history of infection. This difference reflects the higher risk of patients who previously had an infection. Candida albicans was not usually resistant to fluconazole in vaginal specimens in clinical or in vitro settings; such resistance occurred in less than 5% of patients in each group. CONCLUSIONS: Weekly fluconazole (200 mg) seems to be safe and effective in preventing oropharyngeal and vaginal candidiasis. This regimen has a useful role in the management of HIV-infected women who are at risk for recurrent mucosal candidiasis.     

Motivational enhancement therapy for adolescent marijuana users: A preliminary randomized controlled trial.

This study's aims were (a) to investigate the feasibility of a school-based motivational enhancement therapy (MET) intervention in voluntarily attracting adolescents who smoke marijuana regularly but who are not seeking formal treatment and (b) to evaluate the efficacy of the intervention in reducing marijuana use. Ninety-seven adolescents who had used marijuana at least 9 times in the past month were randomly assigned to either an immediate 2-session MET intervention or to a 3-month delay condition. Two thirds of the sample characterized themselves as in the precontemplation or contemplation stages of change regarding marijuana use. Participants' marijuana use and associated negative consequences were assessed at baseline and at a 3-month follow-up. Analyses revealed that both groups significantly reduced marijuana use at the 3-month follow-up ( p = .001); however, no between-group differences were observed. Despite the absence of a clear effect of MET, this study demonstrated that adolescents could be attracted to participate in a voluntary marijuana intervention that holds promise for reducing problematic levels of marijuana use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder.

Objective: Effective treatments for obsessive-compulsive disorder (OCD) exist, but additional treatment options are needed. The effectiveness of 8 sessions of acceptance and commitment therapy (ACT) for adult OCD was compared with progressive relaxation training (PRT). Method: Seventy-nine adults (61% female) diagnosed with OCD (mean age = 37 years; 89% Caucasian) participated in a randomized clinical trial of 8 sessions of ACT or PRT with no in-session exposure. The following assessments were completed at pretreatment, posttreatment, and 3-month follow-up by an assessor who was unaware of treatment conditions: Yale–Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory–II, Quality of Life Scale, Acceptance and Action Questionnaire, Thought Action Fusion Scale, and Thought Control Questionnaire. Treatment Evaluation Inventory was completed at posttreatment. Results: ACT produced greater changes at posttreatment and follow-up over PRT on OCD severity (Y-BOCS: ACT pretreatment = 24.22, posttreatment = 12.76, follow-up = 11.79; PRT pretreatment = 25.4, posttreatment = 18.67, follow-up = 16.23) and produced greater change on depression among those reporting at least mild depression before treatment. Clinically significant change in OCD severity occurred more in the ACT condition than PRT (clinical response rates: ACT posttreatment = 46%–56%, follow-up = 46%–66%; PRT posttreatment = 13%–18%, follow-up = 16%–18%). Quality of life improved in both conditions but was marginally in favor of ACT at posttreatment. Treatment refusal (2.4% ACT, 7.8% PRT) and dropout (9.8% ACT, 13.2% PRT) were low in both conditions. Conclusions: ACT is worth exploring as a treatment for OCD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using the internet to assist smoking prevention and cessation in schools: A randomized, controlled trial.

Objective: To evaluate the impact of a classroom-based, Web-assisted tobacco intervention addressing smoking prevention and cessation with adolescents. Design: A two-group randomized control trial with 1,402 male and female students in grades 9 through 11 from 14 secondary schools in Toronto, Canada. Participants were randomly assigned to a tailored Web-assisted tobacco intervention or an interactive control condition task conducted during a single classroom session with e-mail follow-up. The cornerstone of the intervention was a five-stage interactive Web site called the Smoking Zine (http://www.smokingzine.org) integrated into a program that included a paper-based journal, a small group form of motivational interviewing, and tailored e-mails. Main Outcome Measure: Resistance to smoking, behavioral intentions to smoke, and cigarette use were assessed at baseline, postintervention, and three- and six-month follow-up. Multilevel logistic growth modeling was used to assess the effect of the intervention on change over time. Results: The integrated Smoking Zine program helped smokers significantly reduce the likelihood of having high intentions to smoke and increased their likelihood of high resistance to continued cigarette use at 6 months. The intervention also significantly reduced the likelihood of heavy cigarette use adoption by nonsmokers during the study period. Conclusion: The Smoking Zine intervention provided cessation motivation for smokers most resistant to quitting at baseline and prevented nonsmoking adolescents from becoming heavy smokers at 6 months. By providing an accessible and attractive method of engaging young people in smoking prevention and cessation, this interactive and integrated program provides a novel vehicle for school- and population-level health promotion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting.

Despite the overall efficacy of psychotherapy, dropouts are substantial, many clients do not benefit, therapists vary in effectiveness, and there may be a crisis of confidence among consumers. A research paradigm called patient-focused research—a method of enhancing outcome via continuous progress feedback—holds promise to address these problems. Although feedback has been demonstrated to improve individual psychotherapy outcomes, no studies have examined couple therapy. The current study investigated the effects of providing treatment progress and alliance information to both clients and therapists during couple therapy. Outpatients (N = 410) at a community family counseling clinic were randomly assigned to 1 of 2 groups: treatment as usual (TAU) or feedback. Couples in the feedback condition demonstrated significantly greater improvement than those in the TAU condition at posttreatment, achieved nearly 4 times the rate of clinically significant change, and maintained a significant advantage on the primary measure at 6-month follow-up while attaining a significantly lower rate of separation or divorce. Mounting evidence of feedback effects with different measures and populations suggests that the time for routine tracking of client progress has arrived. (PsycINFO Database Record (c) 2010 APA, all rights reserved)