Episodic Future Thinking for HIV Prevention

Overseen By Emeka Okafor, PhD, MPH

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: The University of Texas Health Science Center at San Antonio

Must be taking: HIV PrEP

Disqualifiers: Substance use disorder, HIV positive, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 26 weeks

60 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you must be currently taking HIV PrEP medication to participate.

What data supports the effectiveness of the treatment Exteroceptively Focused Treatment (EFT) for HIV prevention?

Research shows that episodic future thinking (EFT) can improve decision-making and reduce impulsive behaviors, which are beneficial in managing addictive behaviors and substance use. These findings suggest that EFT might help individuals make better choices regarding HIV prevention by enhancing their ability to think about future consequences. ^{1 2 3 4 5}

Is Episodic Future Thinking (EFT) safe for humans?

The available research does not specifically address the safety of Episodic Future Thinking (EFT) in humans, but it has been applied in various studies without reported safety concerns. ^{1 2 6 7 8}

How is the treatment Episodic Future Thinking (EFT) unique for HIV prevention?

Episodic Future Thinking (EFT) is unique because it involves mentally simulating future events to improve decision-making and behavior, which is different from traditional treatments that might focus on medication or direct behavioral interventions. This approach has shown promise in other areas like substance use and weight loss by enhancing future planning and reducing impulsive behaviors. ^{1 2 3 6 9}

What is the purpose of this trial?

This research study is testing a new behavioral therapy called Episodic Future Thinking or EFT can help people reduce drug use and risky sexual behaviors while helping them adhere to their HIV prevention medication (PrEP). Participants will be randomly assigned to one of two groups. One group will receive standard care, which includes counseling on HIV prevention, drug use reduction, and sexual health. The other group will receive standard care plus a new program called Episodic Future Thinking (EFT), where participants will think about and plan for their future goals using a mobile app and counseling sessions. Study procedures that are not part of regular care include filling out surveys, providing blood, urine, and swab samples for testing, and using the EFT app.

Research Team

Emeka Okafor, PhD, MPH

Principal Investigator

The University of Texas Health Science Center at San Antonio

Eligibility Criteria

This trial is for sexual minority individuals who are interested in reducing drug use and risky sexual behaviors, while also adhering to HIV prevention medication. Participants should be willing to provide biological samples and use a mobile app as part of the study.

Inclusion Criteria

I am currently taking medication to prevent HIV.

Self-reported HIV PrEP nonadherence in the past three months

Fluent in English

Exclusion Criteria

Currently receiving treatment for any substance use disorder

HIV positive

Having a medical or psychiatric illness that in the opinion of the PI would interfere with study participation

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Formative Evaluation

Qualitative interviews with sexual minority individuals to evaluate the Episodic Future Thinking intervention

Not specified

Treatment

Participants are randomly assigned to either standard care or standard care plus Episodic Future Thinking intervention

26 weeks

In-person counseling sessions and mobile app usage

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessments for PrEP adherence, drug use, and STI testing

4 weeks

Treatment Details

Interventions

• EFT

Trial Overview The study is testing if Episodic Future Thinking (EFT), which involves planning for future goals with an app and counseling, can improve adherence to PrEP medication and reduce risky behaviors compared to standard care alone.

Participant Groups

Group I: Episodic Future Thinking App Experimental Treatment 1 Intervention

EFT is a behavioral economic intervention designed to improve decision-making by reducing delay discounting and improving demand. The EFT intervention will be administered through a combination of in-person counseling sessions and mobile health (mHealth) technology via an app platform.

Group II: Control Group Active Control 1 Intervention

Standard of Care: The standard of care group will receive brief information and supportive counseling around PrEP adherence, methamphetamine use reduction and engaging in safe sexual behaviors. Participants will also receive counseling on a topic of concern identified by the participant.

Who Is Running the Clinical Trial?

The University of Texas Health Science Center at San Antonio

Lead Sponsor

Trials

486

Recruited

92,500+

National Institute on Drug Abuse (NIDA)

Collaborator

Trials

2,658

Recruited

3,409,000+

Findings from Research

Episodic future thinking (EFT) shows promise as an intervention for reducing problematic substance use and substance use disorders, based on a systematic review of 16 studies that demonstrated benefits in self-reported and task-based outcomes.

The review highlights the need for further research to assess the feasibility, generalizability, and long-term effects of EFT, as well as to identify factors that influence its effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Imagining the future can shape the present: A systematic review of the impact of episodic future thinking on substance use outcomes. Collado, A., Stokes, A.[2023]

The academic goal-relevant episodic future thinking (A-EFT) intervention was found to be feasible and acceptable for heavy drinking college students, with over 80% recruitment and retention rates, and participants rated it positively.

Participants in the A-EFT group showed a significant increase in study time and moderate reductions in alcohol consumption, suggesting that this intervention may help improve academic behaviors while also reducing drinking.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Episodic future thinking as a brief alcohol intervention for heavy drinking college students: A pilot feasibility study. Voss, AT., Jorgensen, MK., Murphy, JG.[2022]

A 1-week episodic future thinking (EFT) protocol was tested on 28 individuals in treatment for alcohol use disorder, showing promise in reducing impulsive decision-making and alcohol motivation.

Participants exhibited decreased alcohol demand and delay discounting rates, along with increased mindfulness, suggesting that EFT could be a beneficial supplement to traditional addiction treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute and extended exposure to episodic future thinking in a treatment seeking addiction sample: A pilot study. Patel, H., Amlung, M.[2022]

Episodic Future Thinking (EFT) and Future Thinking Priming (FTP) are promising remote interventions that can help reduce delay discounting in individuals trying to quit smoking, with a small study of 20 participants showing significant differences in language use that indicate a greater focus on future orientation in the active conditions.

The study confirmed the internal validity of EFT and FTP, suggesting that these interventions are effective in promoting risk-avoidance and future thinking, which are important for successful smoking cessation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internal Validity of Two Promising Methods of Altering Temporal Orientation among Cigarette Smokers. O'Connor, RJ., Carl, E., Shevorykin, A., et al.[2021]

Individuals with psychiatric disorders show significant deficits in episodic future thinking (EFT), with an overall effect size of g = -0.84, indicating less specific and detailed future event simulations compared to control groups.

Subgroup analyses revealed that these deficits are particularly pronounced in depression, bipolar disorder, and schizophrenia, suggesting that these conditions may impair the ability to mentally simulate future experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychopathology and episodic future thinking: A systematic review and meta-analysis of specificity and episodic detail. Hallford, DJ., Austin, DW., Takano, K., et al.[2019]

The pilot goal-oriented episodic future thinking (GoEFT) intervention was well-accepted by low-income overweight or obese mothers, with participants appreciating the structured approach to setting and evaluating goals.

The intervention demonstrated significant efficacy in promoting weight loss, increasing fruit and vegetable intake, and improving emotional control, along with reducing fat and sugar intake and alleviating stress, indicating its potential as an effective weight management strategy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Pilot Goal-Oriented Episodic Future Thinking Weight Loss Intervention for Low-Income Overweight or Obese Young Mothers. Chang, MW., Tan, A., Wegener, DT., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

Changing the future: An initial test of Future Specificity Training (FeST). [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Imagining the future can shape the present: A systematic review of the impact of episodic future thinking on substance use outcomes. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Episodic future thinking as a brief alcohol intervention for heavy drinking college students: A pilot feasibility study. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Acute and extended exposure to episodic future thinking in a treatment seeking addiction sample: A pilot study. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Internal Validity of Two Promising Methods of Altering Temporal Orientation among Cigarette Smokers. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Does episodic future thinking improve prospective remembering? [2014]

7. United States pubmed.ncbi.nlm.nih.gov

The use of episodic future thinking in people with overweight or obesity: A scoping review. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Psychopathology and episodic future thinking: A systematic review and meta-analysis of specificity and episodic detail. [2019]

9. Switzerland pubmed.ncbi.nlm.nih.gov

A Pilot Goal-Oriented Episodic Future Thinking Weight Loss Intervention for Low-Income Overweight or Obese Young Mothers. [2023]