CTN 265: The sexual confidence study

About The Study

This study evaluated an HIV and other STBBI prevention psychotherapy intervention for HIV-negative gay, bisexual, and other men who have sex (gbMSM) men who experience social anxiety. The study combined empirically supported treatments for social anxiety with HIV risk reduction counselling to reduce STBBI sexual risk behaviour. The three primary study objectives were: 1) to provide data on the acceptability and feasibility of the intervention, 2) to provide data to test the intervention, and 3) to provide data to support a future randomized controlled trial that will test the efficacy of the intervention relative to HIV prevention interventions that do not look to reducing social anxiety or substance use in sexual situations. Researchers aim to develop a larger randomized study with an overall goal to develop an effective form of counselling that promotes confidence in social and sexual situations and that will help prevent HIV transmission and reduce sexual risk behaviours.

Background

Social anxiety is commonly defined as the experience of fear and apprehension about being evaluated in interpersonal situations. Evidence indicates that gbMSM may be at particular risk for social anxiety because of an adverse social environment during development. Social anxiety is a reliable risk factor for condomless anal sex among gbMSM. Social anxiety may also increase substance use in sexual situations, which is a risk factor for HIV and other sexually transmitted infections among gbMSM. As such the researchers seek to show that an empirically based social anxiety psychotherapy may also reduce STBBI risk behaviours among gbMSM.

Study Approach

The psychotherapy intervention used in this study broadly targeted both cognitive and behavioural reactions to social anxiety and its effects on substance use. Cognitive Behavioural Therapy was chosen as the intervention method because of the evidence supporting its use for social anxiety, and for treatments that combine mood/anxiety disorder treatment with substance use treatments. The investigators recruited 29 HIV-negative gbMSM participants, of whom 21 completed the treatment protocol. After a baseline assessment, participants went through 10 weekly behavioural psychotherapy sessions and were followed up with a post-intervention assessment and questionnaires over six months. Assessments included interviews and self-report measures of social anxiety, substance use in sexual situations, and sexual risk behaviours.

If you would like more information on this clinical study, please refer to Dr. Hart’s website or to the trial listing on clinicaltrials.gov.

Results

This study found significant reductions in psychological distress and sexual risk behaviours among gbMSM who underwent Cognitive Behavioural Therapy for social anxiety. These results could inform HIV prevention interventions for this population, such as PrEP and substance use behavioural support programs, psychosocial interventions, psychotherapies, and other counselling programs that complement biomedical prevention methods like PrEP.

The study team also determined that the intervention would be cost-effective for both service providers and clients, as it could be delivered by a range of people from different mental health care backgrounds and may reduce spending associated with social anxiety disorder, alcohol dependence, and risks for STBBI.

Conclusion

The Sexual Confidence intervention may be effective in concurrently reducing social anxiety and the risk of contracting HIV and other STBBI among HIV-negative gbMSM.