A mental health intervention developed by Duke clinical psychologist Kathleen Sikkema was added this month to the Substance Abuse and Mental Health Service Administration’s National Registry of Evidence-based Programs and Practices (NREPP). The Duke intervention, Living in the Face of Trauma (LIFT), is a 15-session group intervention for HIV positive individuals with a history of childhood sexual abuse, and has been shown to reduce unprotected sex and substance abuse among individuals with HIV.
NREPP is a searchable online registry of reviewed, rated and scientifically-tested mental health and substance interventions that can be used for broader implementation and dissemination.
Research has shown that rates of sexual abuse among people with HIV are nearly double that of the general population, and those with childhood sexual abuse histories are more likely to abuse substances and engage in high-risk sexual behaviors. By addressing the stressors related to sexual abuse in this population, LIFT may improve health outcomes for those living with HIV and prevent further HIV infections.
LIFT was designed to help people make linkages between their sexual abuse histories and current risk behaviors, and to develop adaptive strategies for coping with sexual abuse and HIV infection. A primary focus of the program is on social support, identification of emotions and perceptions related to sexual trauma and HIV, reducing avoidant coping, and improving interpersonal relationships. Through discussion, coping skill-building exercises and goal setting, participants are able to develop communication, problem-solving and decision-making skills, as well as relaxation techniques and emotion regulation to improve coping and reduce HIV sexual transmission risk behavior and substance use.
“The cornerstone of the LIFT intervention is its integration of mental health treatment and HIV prevention to improve health related outcomes,” said Sikkema, professor of psychology and neuroscience and global health at Duke and DGHI. “Our treatment program works because people develop the skills to cope effectively with the combined stressors resulting from sexual abuse and HIV infection. When they develop adaptive coping skills, psychological functioning is improved and they are able to reevaluate harmful behaviors like sexual risk behaviors and substance abuse. In addition, the group setting helps to reduce stigma and shame, therefore having the potential to improve self esteem and overall quality of life.”
With funding from the National Institute of Mental Health, the intervention was evaluated with 247 HIV-positive individuals living in New York City. Research participants were randomized to receive either the LIFT intervention or a comparison support group. Participants were assessed for sexual behavior, substance use and traumatic stress before and after the intervention, with follow-up assessments at four, eight and 12 months. Results showed that LIFT significantly reduced the frequency of unprotected sex, hazardous alcohol and drug use and traumatic stress symptoms (such as nightmares and avoidance of related feelings and situations). Outcomes were published in JAIDS, Addiction, and AIDS and Behavior.
The positive results from the study led to its identification as a Best-Evidence Intervention by the Centers for Disease Control and Prevention and inclusion in NREPP. With this recognition, LIFT is available as a resource to researchers, clinics and community-based organizations. The LIFT manual is available free of charge and includes recommendations for use, all intervention materials, handouts, and quality assurance materials.
LIFT has been implemented with approximately 160 individuals at two other sites in the U.S., and is currently being adapted for HIV positive individuals enrolled in substance abuse treatment programs at Duke. Over the past year, Dr. Sikkema has received numerous requests for the intervention manual.
“The requests I have received for information about the LIFT intervention and the interest in integrating LIFT into prevention and patient care demonstrate the need to implement services for HIV positive people with a history of childhood sexual abuse,” said Sikkema. “There is also interest in adapting LIFT in global settings, including Russia and South Africa. My hope is that the LIFT intervention can be disseminated effectively to improve coping and reduce psychological distress and risk behavior.”
The LIFT project research team also includes DGHI faculty member Christina Meade and DGHI staff Arlene Kochman, Allyson DeLorenzo and Melissa Watt, and was conducted in collaboration with Callen-Lorde Community Health Center in New York City.
