Frederick Muench

A randomized controlled trial of goal choice interventions for alcohol use disorders among men who have sex with men.

This study tested the efficacy of behavioral treatments for alcohol use disorders (AUD) among men who have sex with men (MSM) and who are at risk for HIV transmission. HIV-negative MSM with current AUD (N = 198) were recruited, offered treatment focused on reducing drinking and HIV risk, and followed during treatment and 12 months posttreatment. Participants (n = 89) accepted treatment and were randomized to either 4 sessions of motivational interviewing (MI) or 12 sessions of combined MI and coping skills training (MI + CBT). Other participants (n = 109) declined treatment but were followed, forming a non-help-seeking group (NHS). MI yielded significantly better drinking outcomes during the 12-week treatment period than MI + CBT, but posttreatment outcomes were equivalent. NHS participants significantly reduced their drinking as well. Service delivery and treatment research implications are discussed.

Accounting for the social triggers of sexual compulsivity.

Abstract Aims. To examine the social triggers of sexual compulsivity amongst a diverse sample of gay and bisexual men. Design and Participants. Qualitative interviews were conducted with 180 gay and bisexual men in the United States who self-identified that their sex lives were spinning out of control. The data were analyzed using a grounded theory approach to explore the range of social triggers that were driving sexual compulsions. Measurement. An open-ended interview and a structured clinical interview were conducted with each participant. The interviews examined their experiences with sexual compulsivity over time and the impact of their problematic sexual behaviors on their lives. Findings. Two types of social triggers emerged from the data: event-centered triggers and contextual triggers. Event-centered triggers arise from sudden, unforeseen events. Two major event-centered triggers were identified: relationship turmoil and catastrophes. Contextual triggers, on the other hand, have a certain element of predictability, and included such things as location, people, the use of drugs, and pornography. Conclusions. This framework of triggers has clinical implications for the prevention and treatment of sexual compulsivity. Clinicians can utilize the framework of social triggers in the therapeutic process to provide insight into ways to effectively work through symptoms of sexual compulsivity. Awareness of the contextual aspects of sexual compulsivity may be critical to understanding the behaviors of sexually compulsive clients. Thus, therapeutic assessments should focus upon the social context in addition to the psychological components of the disorder.

Developing a theory driven text messaging intervention for addiction care with user driven content.

The number of text messaging interventions designed to initiate and support behavioral health changes have been steadily increasing over the past 5 years. Messaging interventions can be tailored and adapted to an individuals needs in their natural environment-fostering just-in-time therapies and making them a logical intervention for addiction continuing care. This study assessed the acceptability of using text messaging for substance abuse continuing care and the intervention preferences of individuals in substance abuse treatment in order to develop an interactive mobile text messaging intervention. Fifty individuals enrolled in intensive outpatient substance abuse treatment completed an assessment battery relating to preferred logistics of mobile interventions, behavior change strategies, and types of messages they thought would be most helpful to them at different time points. Results indicated that 98% participants were potentially interested in using text messaging as a continuing care strategy. Participants wrote different types of messages that they perceived might be most helpful, based on various hypothetical situations often encountered during the recovery process. Although individuals tended to prefer benefit driven over consequence driven messages, differences in the perceived benefits of change among individuals predicted message preference. Implications for the development of mobile messaging interventions for the addictions are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

The Consequences of Compulsive Sexual Behavior: The Preliminary Reliability and Validity of the Compulsive Sexual Behavior Consequences Scale

The consequences of any excessive behavior can serve as a proxy indicator of problem severity. This appears especially salient for the diagnosis of non-paraphilic compulsive sexual behavior (CSB) because of the influence of societal norms on the pathologizing of frequent consensual ego-syntonic sexual behavior. The current study is a preliminary examination of the psychometric properties, descriptive features, concurrent validity, and ability to detect change over time of a measure designed to assess the consequences of non-paraphilic CSB. The sample consisted of 34 (26 end of treatment) gay and bisexual men enrolled in a double-blind placebo-controlled medication trial testing the efficacy of an SSRI in reducing CSB symptoms. Results indicate that the measure demonstrated good internal and test-retest reliability, concurrent validity, and was able to detect change in symptoms over the course of the 12-week period. Items related to intimate relations were most resistant to change and items related to intrapersonal conflict and impulse control were most likely to change. No differences existed in the reduction of consequences between medication and placebo groups. Consequences were only moderately correlated with frequency measures suggesting these constructs should be examined separately. Taken together, results suggest that measuring consequences can reveal important clues into the domains most affected by CSB, provide clues into those domains that are resistant to change, and aid in individualized treatment planning.

Non-Paraphilic Compulsive Sexual Behavior and Psychiatric Co-morbidities in Gay and Bisexual Men

This study explored the features of non-paraphilic compulsive sexual behavior (NPCSB) in a community sample of 183 gay and bisexual men in New York City who reported difficulty controlling their sexual behavior. Several diagnostic and face valid measures of NPCSB and Axis I comorbidity were administered. Results indicated that NPCSB is associated with a range of problem behaviors, a fairly coherent pattern of symptoms that can be assessed with good inter-rater reliability, is distinct from other related disorders, and provides a moderate fit to the dependence model but with other unique features. Implications for classification and treatment will be discussed.

Anxiety: There’s an app for that. A systematic review of anxiety apps.

Smartphones and mobile devices have become ubiquitous, and with the rapid advance of technology, the number of health applications (apps) that are available for consumers on these devices is constantly growing. In particular, there has been a recent proliferation of anxiety apps. However, there has been no review of the quality or content of these anxiety apps and little is known about their purpose, the features they contain, and their empirical support. The goal of this systematic review was to assess the commercially available anxiety apps.

A Randomized Controlled Pilot Trial of Different Mobile Messaging Interventions for Problem Drinking Compared to Weekly Drink Tracking.

Introduction Recent evidence suggests that text messaging may help to reduce problem drinking as an extension to in-person services, but very little is known about the effectiveness of remote messaging on problem drinking as a stand-alone intervention, or how different types of messages may improve drinking outcomes in those seeking to moderate their alcohol consumption. Methods We conducted an exploratory, single-blind randomized controlled pilot study comparing four different types of alcohol reduction-themed text messages sent daily to weekly drink self-tracking texts in order to determine their impact on drinking outcomes over a 12-week period in 152 participants (≈ 30 per group) seeking to reduce their drinking on the internet. Messaging interventions included: weekly drink self-tracking mobile assessment texts (MA), loss-framed texts (LF), gain-framed texts (GF), static tailored texts (ST), and adaptive tailored texts (TA). Poisson and least squares regressions were used to compare differences between each active messaging group and the MA control. Results When adjusting for baseline drinking, participants in all messaging groups except GF significantly reduced the number of drinks consumed per week and the number of heavy drinking days compared to MA. Only the TA and GF groups were significantly different from MA in reducing the number of drinking days. While the TA group yielded the largest effect sizes on all outcome measures, there were no significant differences between active messaging groups on any outcome measure. 79.6% of individuals enrolled in the study wanted to continue receiving messages for an additional 12 weeks at the end of the study. Discussion Results of this pilot study indicate that remote automated text messages delivered daily can help adult problem drinkers reduce drinking frequency and quantity significantly more than once-a-week self-tracking messages only, and that tailored adaptive texts yield the largest effect sizes across outcomes compared to MA. Larger samples are needed to understand differences between messaging interventions and to target their mechanisms of efficacy.

Motivation and self-efficacy in the context of moderated drinking: global self-report and ecological momentary assessment.

Despite ample research demonstrating the role of motivation and self-efficacy in predicting drinking in the context of abstinence, little research explicitly explores their role in the context of moderation, and none have utilized daily diary methods. The purpose of this study was to (a) explore the concordance between global self-report and daily diary composite measures of motivation and self-efficacy and (b) compare the ability of each in predicting drinking outcomes in the context of a study of brief AUD treatments focused on controlled drinking. Problem drinkers (N = 89) were assessed, provided feedback about their drinking, and randomly assigned to one of three conditions: two brief AUD treatments or a third group asked to change on their own. Global self-report (GSR) measures were administered at baseline and Week 8 (end of treatment). Daily diary composites (DDC) were created from data collected via an Interactive Voice Recording system during the week prior to baseline and the week prior to Week 8. Findings revealed some concordance between GSR and DDC at both baseline and Week 8, indicating the two methods capture some of the same construct; however, their respective relationships to drinking differed. DDC for both baseline and Week 8 significantly predicted Week 8 drinking outcomes, whereas only change in GSR significantly predicted drinking outcomes. Findings suggest that motivation and self-efficacy are important to moderated drinking, and that both GSR and daily diary methods are useful in understanding mechanisms of change in the context of moderation. Daily diary methods may provide significant advantages. Limitations and arenas for future research are discussed.

Older adults and mobile technology: Factors that enhance and inhibit utilization in the context of behavioral health

While numbers and proportions of older adults with behavioral health issues are expected to substantially increase, there is also a widening gap in available services for older adults. Mobile health interventions (mhealth) are a way to address existing barriers to treatment, provide frontline assessment and increase access to services for older adults. Due to perpetuated stereotypes, many assume that older adults do not utilize mobile technology nor will they accept a mHealth intervention. The purpose of this paper is to synthesize contemporary literature from information technology and healthcare regarding: (1) current mobile technology utilization by older adults, particularly in regards to health; (2) factors affecting older adult motivation to engage with mobile technology; and (3) older adult preferences for interacting with mobile technology. Findings reveal that significant proportions of older adults: already utilize mobile technology; are willing to engage in existing mobile interventions for health reasons; and have positive attitudes overall towards mobile technology. Finally, recommendations for optimizing mobile interventions to better suit older adults with behavioral health problems are reviewed. Older adults and mobile technology: Factors that enhance and inhibit utilization in the context of behavioral health

Within-person associations between daily motivation and self-efficacy and drinking among problem drinkers in treatment.

Gaining a better understanding of the change process holds promise to improve alcohol treatment. Ecological momentary assessment (EMA) coupled with intensive longitudinal data (ILD) approaches have been proposed as promising methods that can advance change process research but have been used infrequently in alcohol use disorder (AUD) treatment research. The current study used these approaches to examine the within-person associations of motivation and self-efficacy and drinking among treatment-seeking problem drinkers. Participants (N = 96) received daily EMA surveys before, during, and after treatment for 7 weeks spread over a 9-month period. Multilevel modeling was used to test the within-person relationships between the change processes and drinking, controlling for between-person associations and prior drinking. Results indicated that daily fluctuations in motivation and self-efficacy significantly predicted drinking over the next 24 hours; however, several theory-driven hypotheses regarding factors that might moderate that relationship were not supported. Overall, results support the advantages of EMA and ILD as methods that can advance AUD treatment research. (PsycINFO Database Record