Sexual risk taking is associated with many negative outcomes such as HIV infection, unplanned pregnancy, and sexual assault. Research indicates that alcohol use is a significant predictor of risky sexual behavior (George et al., 2014; Purdie e al., 2011), and reducing alcohol use might be important in reducing risky sex. Sexual risk taking may occur when deliberative cognitive control processes are weaker than automatic approach tendencies. Approach biases toward alcohol cues are associated with increased drinking behavior and may also impact an individual's decision-making process regarding condom use. Joystick cognitive bias modification (CBM) interventions using a modified version of the approach avoidance task (AAT) are emerging as effective treatment tools by modifying implicit processes for many disorders and problematic behaviors. Namely, if an individual is trained to attend to or attend away from specific information, symptoms may be reduced and behavior may be changed. Previous experimental research has been successful in modifying various cognitive biases away from alcohol stimuli and subsequently reducing drinking behavior (Wiers et al., 2010; 2011). The current study seeks to replicate previous research by modifying participants' implicit approach biases away from alcohol stimuli. Additionally, the current study seeks to train participants to simultaneously approach condom stimuli. Increasing participants approach bias toward condom stimuli may subsequently increase their probability of using condoms during sexual encounters. This study examines whether implicit cognitive biases can be modified to decrease approach bias toward alcohol stimuli and increase approach bias toward condoms using a 2 (Training: training/sham) x 3 (Time: pretest/posttest/3-month follow-up) design. Participants will be college students between the ages of 18-25, who drink moderately, and have engaged in sexual intercourse without a condom at least three times with a casual, non-committed partner during the three months prior to data collection. Participants will be randomly assigned to either an active training group or a sham training control group. Participants in the active training group will be explicitly trained to make avoidance movements (pushing a joystick) away from alcohol stimuli and approach movements (pulling a joystick) toward pictures of condoms. The current study aims to test associations between the implicit approach-avoidance biases and drinking and condoms at baseline. In addition, this study will investigate the effects of the intervention on alcohol and condom approach biases, the effects of the intervention on alcohol and condom use at the 3- month follow-up, if cognitive biases post-intervention mediate changes in corresponding behavior at 3-month follow-up, and if changes in alcohol use mediate changes in risky sex.
Alcohol use disorder and sexual risk taking occur in high rates among young adults. Sexually transmitted diseases are costly on a societal level accounting for nearly $16 billion of direct medical costs (CDC, 2014). Moreover, young adults account for over 50% of all new STIs. Developing an effective intervention to reduce risky sexual behavior can reduce STIs and aid in preventing unwanted pregnancies. This research will test an innovative intervention that seeks to modify relatively automatic approach and avoidance biases that are hypothesized maintaining factors. The modification of cognitive-behavioral biases via training may be a useful adjunct to existing therapies.
| Hahn, Austin M; Simons, Raluca M; Simons, Jeffrey S (2016) Childhood Maltreatment and Sexual Risk Taking: The Mediating Role of Alexithymia. Arch Sex Behav 45:53-62 |
