Depression Intervention Among Gay and Bisexual Men Receiving Treatment for Methamphetamine Use

Participants will be recruited from the Getting Off service program at Friends Community
Center. Program participants will be invited to participate in the study at the time that
they enroll in the program, and may enroll in the study at any time during their first or
second week of program participation. Getting Off program staff will inform new participants
about the research study. If the potential participant is interested in learning more about
the study he will be directed to meet with the Study Counselor. Both the program staff and
the SC will emphasize that participation in this study is voluntary and that participation in
the program is not dependent on participation in this study. Interested participants will
meet with the in a private room, then read the consent form, have questions answered by the,
and sign the consent form if they wish to participate.

All in-person contact (recruitment, screening, consenting, MoodGym sessions, and
administration of follow-up interviews) with participants will take place in a private room
with a closed door at Friends Community Center. Any telephone calls made to participants
during the course of the study will be made from a private office with a closed door, so the
phone conversation cannot be heard.

MoodGym is an Internet-based CBT program that uses fun, engaging, interactive content,
alongside character-driven narratives, to help alleviate symptoms of depression and comorbid
anxiety. The program also aims to improve the individual's functioning by promoting the
development of skills and strategies to manage depression.

MoodGym consists of an introduction module, five structured intervention modules, and a
workbook of assessments.

1. Getting Started

a. An introduction to MoodGym, including CBT, the different characters and structure of
the intervention content, and baseline mental health quizzes (e.g., depression, anxiety)
that are scored in real time to help the participant understand their current level of
mental health symptoms. This will be done during the first MoodGym session, given its
brevity and relationship to the first module.

2. Feelings Module

a. Understanding emotions, mood, and physical reactions of depression and anxiety, as
well as the impact of your perspective on your personal feelings. Demonstrates links
between events, thoughts, feelings, and behaviors.

3. Thoughts Module

a. Addresses unwelcome, unhealthy, or intrusive thoughts, and demonstrates how some
thoughts can help you overcome mental health symptoms. Discusses how to improve
self-esteem by changing thought patterns.

4. Unwarping Module

a. Introduces the idea of "warpy" thoughts, including false impressions that one must be
perfect, that one can control all things, or that one is worthless if they are
criticized.

5. Destressing Module

1. Discusses means and strategies to reduce stress, which can have important impacts
on depression and anxiety symptoms, and mental health more generally.

6. Relationships Module

a. Discusses how relationships can both benefit or worsen one's mental health, and how
to monitor and maintain healthy relationships.

7. Workbook a. Contains all quizzes and tests the participant encounters during each of the
above sessions. If a participant would like to retest themselves on some dimension
(e.g., depression, anxiety, warpy thoughts), they can revisit the assessment in the
Workbook section, and receive an updated score in real time.

Each MoodGym session will last up to one hour and will begin with the brief CESD-R
assessment, administered by the Study Counselor via the same computer as the MoodGym
intervention, followed by one of the five online modules, which are self-contained and guide
the participant through all intervention content. Online modules include quizzes, videos,
characters, interactive activities, informational content, personal stories, workbook
activities, and content summaries. Sessions can also include interactions with the Study
Counselor, as much or as little as the participant chooses to initiate, including supportive
feedback, guidance, help, and encouragement on activities.

The SC will monitor participant attendance and conduct a phone call to any participant who
does not attend a session for two consecutive weeks.

Participants will be assessed one final time, receiving both the ART and PrEP Uptake and
Adherence form and the CESD-R, at 90 days post-enrollment.

Inclusion Criteria:

- Currently enrolled within the "Getting Off" (AKA, "Friends Getting Off") outpatient
methamphetamine treatment program at Friends Community Center, Los Angeles, CA, USA.

- and; within two weeks of initial enrollment into the "Getting Off" program.

Exclusion Criteria:

- Not currently enrolled within the "Getting Off" program.

- or; more than two weeks post-enrollment in the "Getting Off" program.