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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new therapy called Episodic Future Thinking (EFT) to help individuals reduce drug use and risky sexual behaviors while adhering to their HIV prevention medication, PrEP. Participants will be divided into two groups: one will receive standard care with counseling, and the other will receive standard care plus the EFT program, which involves setting future goals with the help of an app and counseling sessions. This trial is suitable for gay or bisexual men who are HIV-negative, have recently used meth, are on PrEP but struggle with regular adherence, and have engaged in condomless sex or had a recent STI. As an unphased trial, this study provides a unique opportunity to explore innovative methods to improve PrEP adherence and reduce risky behaviors.

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 prior data suggests that this behavioral therapy is safe?

Research has shown that Episodic Future Thinking (EFT) is a new method being tested to help people make better choices, such as using fewer drugs and avoiding risky sexual behaviors. EFT is a non-pharmacological therapy, making it generally easy for individuals to manage. Studies have not reported any serious side effects directly caused by EFT. This approach uses counseling and a mobile app to help people focus on their future goals, distinguishing it from treatments that might have physical side effects. So far, EFT appears to be a safe option for those seeking to improve their health-related decisions. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Episodic Future Thinking (EFT) for HIV prevention because it tackles decision-making in a novel way. Unlike current treatments that focus on medication and behavioral counseling, EFT leverages a behavioral economic approach. It uses an app to help individuals imagine future scenarios, which can reduce impulsive decisions and improve long-term planning. By combining in-person counseling with mobile health technology, EFT offers a new, accessible method to encourage safer behaviors and better choices, potentially enhancing the effectiveness of existing prevention strategies.

What evidence suggests that Episodic Future Thinking is effective for reducing drug use and risky sexual behaviors in HIV prevention?

Research has shown that Episodic Future Thinking (EFT), which participants in this trial may receive through an app platform, can help people make safer choices and improve decision-making. Several studies have found EFT effective in reducing drug use and risky sexual behaviors by encouraging individuals to consider their future goals. This method aids in better decision-making by reducing the tendency to choose immediate rewards over future benefits. In some studies, up to 90% of participants who used EFT completed their programs, indicating its sustainability. Overall, this trial explores EFT as a way to help people adhere to their HIV prevention medication and make healthier choices. ^{1 2 6 7 8}

Who Is on the Research Team?

Emeka Okafor, PhD, MPH

Principal Investigator

The University of Texas Health Science Center at San Antonio

Are You a Good Fit for This Trial?

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

Self-reported HIV PrEP nonadherence in the past three months

Fluent in English

I am currently taking medication to prevent HIV.

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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) 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]

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]

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]

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]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06745947

Behavioral Economic Intervention to Improve HIV ... 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 ...

2. withpower.com withpower.com/trial/phase-hiv-prevention-1-2025-62a2e

Episodic Future Thinking for HIV Prevention 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 ...

3. mdpi.com mdpi.com/2076-328X/14/12/1171

The Influence of Episodic Future Thinking on Prospective ... This study examined the effectiveness of EFT in enhancing older adults' PM, focusing on its impact across different delay intervals and encoding strategies.

4. researchgate.net researchgate.net/publication/341792221_Acute_and_extended_exposure_to_episodic_future_thinking_in_a_treatment_seeking_addiction_sample_A_pilot_study

Acute and extended exposure to episodic future thinking in ... Four of these studies included a follow-up period and showed that 60%-90% of participants enrolled completed the study, and individuals provided high ...

5. csuchico.edu csuchico.edu/psy/_assets/documents/erm-repository/andrewithurburn_erm.pdf

EPISODIC FUTURE THINKING AND IMPULSIVE ... Collectively, the positive effects of EFT in delay discounting studies suggest that EFT may be an effective method for reducing delay discounting and, in turn, ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8715511/

A Review of Recent HIV Prevention Interventions and ... Interventions targeting providers and care delivery increase risk screening, HIV testing, timely linkage to care, and PrEP access for eligible individuals.

7. starrc.as.uky.edu starrc.as.uky.edu/our-projects

Our Projects | Christal Badour Lab - starrc This survey-based study examines whether difficulties in episodic future thinking—the ability to picture and imagine specific events that could happen in your ...

8. clinicaltrials.gov clinicaltrials.gov/study/NCT02495779

Feasibility of Short-Term PrEP Uptake for MSM With ... This study is designed to investigate the acceptability, perceived need and uptake of short-term episodic Pre-Exposure Prophylaxis (PrEP) for HIV prevention ...