We propose to conduct a Stage I behavioral therapy development project with the goals of developing and pilot testing a manual-guided intervention, Spiritual Self-Reevaluation Therapy (SSRT), for reducing HIV risk behavior by inner-city HIV-positive injection drug users. SSRT will be developed in both individual and group modalities and will help patients articulate, elaborate, and activate spiritual beliefs within a therapeutic framework based on self-schema theory, relative to which the concept of spirituality can be operationalized, and change with treatment can be rigorously assessed. The HIV and addiction literature suggest that perceived spiritual/religious support is a potentially important domain to address in harm reductions interventions with HIV-positive drug users. Prior research also suggests the utility of a social-cognitive theory of """"""""self"""""""" as an organizing theoretical framework within which to develop and evaluate such interventions. Activation of a self-schema energizes specific beliefs about the self, and provides access to the behavioral repertoire associated with those beliefs through automatized event scripts and action plans. The goal of SSRT is to facilitate a shift in the patient's working self-schema, from the """"""""addict"""""""" to the activation of a """"""""spiritual"""""""" self-schema that is more compatible with acts of altruism, feelings of optimism, and an increased sense of personal worth and agency.
The specific aims of this proposal are based on the multiple goals of a Stage I behavioral therapy development project described in the literature and are threefold: 1) In Phase I to develop and refine the therapy treatment manuals, workbooks, therapist competence adherence ratings scales and treatment process measures; 2) In Phase II to develop, conduct, and evaluate a SSRT therapy counselor training program; 3) In Phase III to conduct a pilot trial of SSRT in a sample of 54 HIV-positive methadone-maintained drug users in which patients will be randomized to receive 12 weeks of SSRT (individual), SSRT (group) or treatment as usual. Primary outcomes will be retention in treatment and reductions in illicit drug use and other high-risk behaviors. Treatment process variables to be assessed include HIV information, motivation, and behavioral skills and the shift in addict and spiritual self-schemas from pre to post-treatment.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZRG1-AARR-8 (01))
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Riddle, Melissa
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Yale University
Schools of Medicine
New Haven
United States
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Margolin, Arthur; Schuman-Olivier, Zev; Beitel, Mark et al. (2007) A preliminary study of spiritual self-schema (3-S(+)) therapy for reducing impulsivity in HIV-positive drug users. J Clin Psychol 63:979-99
Beitel, Mark; Genova, Marla; Schuman-Olivier, Zev et al. (2007) Reflections by inner-city drug users on a Buddhist-based spirituality-focused therapy: a qualitative study. Am J Orthopsychiatry 77:1-9