Skip to main content

Advertisement

SpringerLink
Log in

The Relationship Between Automatic Thoughts and Depression in a Cognitive-Behavioral Treatment for People Living with HIV/AIDS: Exploring Temporality and Causality

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

Depression in people living with HIV/AIDS (PLWHA) is highly prevalent and related to worse adherence to antiretroviral therapy, but is amenable to change via CBT. Cognitive-behavioral therapy for adherence and depression (CBT-AD) specifically addresses negative automatic thoughts (ATs) as one component of the treatment. There is little research on the temporal nature of the relation between ATs and depression. HIV-positive adults with depression (N = 240) were randomized to CBT-AD, information/supportive psychotherapy for adherence and depression (ISP-AD), or one session of adherence counseling alone (ETAU). ATs were self-reported (Automatic Thoughts Questionnaire; ATQ) and depression was assessed by blinded interview (Montgomery-Asberg Depression Rating Scale; MADRS) at baseline, and 4-, 8-, and 12-months. We performed autoregressive cross-lagged panel models. Broadly, decreases in ATs were followed by decreases in depression, but decreases in depression were not followed by decreases in ATs. In CBT-AD, decreases in ATs were followed by decreases in depression, and vice versa. However, in the ISP group, while depression and ATs both significantly influenced each other, not all relations were in the direction expected. This study adds to the evidence base for cognitive interventions to decrease depression in individuals with a chronic medical condition, HIV/AIDS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  • Asch, S. M., Kilbourne, A. M., Gifford, A. L., Burnam, M. A., Turner, B., Shapiro, M. F., & Bozzette, S. A. (2003). Underdiagnosis of depression in HIV. Journal of General Internal Medicine, 18(6), 450–460.

    Article  PubMed  PubMed Central  Google Scholar 

  • Atkinson, J. H., & Grant, I. (1994). Natural history of neuropsychiatric manifestations of HIV disease. Psychiatric Clinics of North America, 17(1), 17–33.

    CAS  PubMed  Google Scholar 

  • Berrington, A., Smith, P., & Sturgis, P. (2006). An overview of methods for the analysis of panel data. Retrieved August 11, 2016 from http://eprints.ncrm.ac.uk/415.

  • Bing, E. G., Burnam, M. A., Longshore, D., Fleishman, J. A., Sherbourne, C. D., London, A. S., et al. (2001). Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Archives of General Psychiatry, 58, 721–728.

    Article  CAS  PubMed  Google Scholar 

  • Brown, L. K., Kennard, B. D., Emslie, G. J., Mayes, T. L., Whiteley, L. B., Bethel, J., et al. (2016). Effective treatment of depressive disorders in medical clinics for adolescents and young adults living with HIV: A Controlled Trial. JAIDS Journal of Acquired Immune Deficiency Syndromes, 71(1).

  • Ciesla, J. A., & Roberts, J. E. (2001). Meta-analysis of the relation between HIV infection and risk for depressive disorders. American Journal of Psychiatry, 158, 725–730.

    Article  CAS  PubMed  Google Scholar 

  • Dew, M. A., Becker, J. T., Sanchez, J., Caldararo, R., Lopez, O. L., Wess, J., et al. (1997). Prevalence and predictors of depressive, anxiety and substance use disorders in HIV-infected and uninfected men: A longitudinal evaluation. Psychological Medicine, 27(2), 395–409.

    Article  CAS  PubMed  Google Scholar 

  • DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160, 2101–2107.

    Article  CAS  PubMed  Google Scholar 

  • Forsyth, D. M., Poppe, K., Nash, V., Alarcon, R. D., & Kung, S. (2010). Measuring changes in negative and positive thinking in patients with depression: Measuring changes in negative and positive thinking in patients with depression. Perspectives in Psychiatric Care, 46(4), 257–265. doi:10.1111/j.1744-6163.2010.00253.x.

    Article  PubMed  Google Scholar 

  • Furlong, M., & Oei, T. P. S. (2002). Changes to automatic thoughts and dysfunctional attitudes in group CBT for depression. Behavioural and Cognitive Psychotherapy, 30(3), 351–360. doi:10.1017/S1352465802003107.

    Article  Google Scholar 

  • Gonzalez, J. S., Batchelder, A. W., Psaros, C., & Safren, S. A. (2011). Depression and HIV/AIDS treatment nonadherence: A review and meta-analysis. JAIDS Journal of Acquired Immune Deficiency Syndromes, 1. doi:10.1097/QAI.0b013e31822d490a.

    PubMed  Google Scholar 

  • Gonzalez, J. S., Peyrot, M., McCarl, L. A., Collins, E. M., Serpa, L., Mimiaga, M. J., & Safren, S. A. (2008). Depression and diabetes treatment nonadherence: A meta-analysis. Diabetes Care, 31(12), 2398–2403. doi:10.2337/dc08-1341.

    Article  PubMed  PubMed Central  Google Scholar 

  • Harrell, T. H., & Ryon, N. B. (1983). Cognitive-behavioral assessment of depression: Clinical validation of the automatic thoughts questionnaire. Journal of Consulting and Clinical Psychology, 51(5), 721.

    Article  CAS  PubMed  Google Scholar 

  • Hill, C. V., Oei, T. P. S., & Hill, M. A. (1989). An empirical investigation of the specificity and sensitivity of the automatic thoughts questionnaire and dysfunctional attitudes scale. Journal of Psychopathology and Behavioral Assessment, 11(4), 291–311.

    Article  Google Scholar 

  • Hollon, S. D., & Kendall, P. C. (1980). Cognitive self-statements in depression: Development of an automatic thoughts questionnaire. Cognitive Therapy and Research, 4(4), 383–395.

    Article  Google Scholar 

  • Horberg, M. A., Silverberg, M. J., Hurley, L. B., Towner, W. J., Klein, D. B., Bersoff-Matcha, S., et al. (2008). Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. JAIDS Journal of Acquired Immune Deficiency Syndromes, 47(3), 384–390.

    Article  CAS  PubMed  Google Scholar 

  • Ingram, R. E., Kendall, P. C., Siegle, G., Guarino, J., & McLaughlin, S. C. (1995). Psychometric properties of the positive automatic thoughts questionnaire. Psychological Assessment, 7(4), 495.

    Article  Google Scholar 

  • Ironson, G., O’Cleirigh, C., Fletcher, M. A., Laurenceau, J. P., Balbin, E., Klimas, N., et al. (2005). Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosomatic Medicine, 67(6), 1013–1021. doi:10.1097/01.psy.0000188569.58998.c8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kazdin, A. E. (1990). Evaluation of the automatic thoughts questionnaire: Negative cognitive processes and depression among children. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2(1), 73.

    Article  Google Scholar 

  • Kelly, J. A., & Amirkhanian, Y. A. (2003). The newest epidemic: a review of HIV/AIDS in Central and Eastern Europe. International Journal of STD & AIDS, 14(6), 361–371.

    Article  Google Scholar 

  • Kwon, S. M., & Oei, T. P. (1992). Differential causal roles of dysfunctional attitudes and automatic thoughts in depression. Cognitive Therapy and Research, 16(3), 309–328.

    Article  Google Scholar 

  • Kwon, S. M., & Oei, T. P. S. (2003). Cognitive change processes in a group cognitive behavior therapy of depression. Journal of Behavior Therapy and Experimental Psychiatry, 34(1), 73–85. doi:10.1016/S0005-7916(03)00021-1.

    Article  PubMed  Google Scholar 

  • Labbe, A. K., O’Cleirigh, C. M., Stein, M., & Safren, S. A. (2015). Depression CBT treatment gains among HIV-infected persons with a history of injection drug use varies as a function of baseline substance use. Psychology, Health & Medicine, 20(7), 870–877. doi:10.1080/13548506.2014.999809.

    Article  Google Scholar 

  • Leserman, J. (2008). Role of depression, stress, and trauma in HIV disease progression. Psychosomatic Medicine, 70(5), 539–545.

    Article  PubMed  Google Scholar 

  • McIntosh, R. C., Seay, J. S., Antoni, M. H., & Schneiderman, N. (2013). Cognitive vulnerability for depression in HIV. Journal of Affective Disorders, 150(3), 908–915. doi:10.1016/j.jad.2013.05.014.

    Article  PubMed  Google Scholar 

  • Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. The British Journal of Psychiatry, 134(4), 382–389.

    Article  CAS  PubMed  Google Scholar 

  • Moorey, S. (2010). The six cycles maintenance model: Growing a “vicious flower” for depression. Behavioural and Cognitive Psychotherapy, 38(2), 173–184. doi:10.1017/S1352465809990580.

    Article  PubMed  Google Scholar 

  • Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression, chronic diseases, and decrements in health: Results from the World Health Surveys. Lancet, 370(9590), 851–858.

    Article  PubMed  Google Scholar 

  • O’Cleirigh, C., Newcomb, M. E., Mayer, K. H., Skeer, M., Traeger, L., & Safren, S. A. (2013). Moderate levels of depression predict sexual transmission risk in HIV-infected MSM: A longitudinal analysis of data from six sites involved in a “prevention for positives” study. AIDS and Behavior, 17(5), 1764–1769. doi:10.1007/s10461-013-0462-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Olatunji, B. O., Mimiaga, M. J., O Cleirigh, C., & Safren, S. A. (2006). A review of treatment studies of depression in HIV. Topics in HIV Medicine, 14(3), 112.

    PubMed  Google Scholar 

  • Pence, B. W., Miller, W. C., Whetten, K., Eron, J. J., & Gaynes, B. N. (2006). Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the Southeastern United States. JAIDS Journal of Acquired Immune Deficiency Syndromes, 42(3), 298–306.

    Article  PubMed  Google Scholar 

  • Pomeroy, E. C., Kiam, R., & Green, D. L. (2000). Reducing depression, anxiety, and trauma of male inmates: An HIV/AIDS psychoeducational group intervention. Social Work Research, 24(3), 156–167.

    Article  Google Scholar 

  • Preacher, K. J., & Coffman, D. L. (2006). Computing power and minimum sample size for RMSEA [Computer software]. http://quantpsy.org/.

  • Safren, S. A., Bedoya, C. A., O’Cleirigh, C., Biello, K. B., Pinkston, M. M., Stein, M. D., et al. (2016). Treating depression and adherence (CBT-AD) in patients with HIV in care: A three-arm randomized controlled trial. Lancet HIV, (Epub ahead of print.) doi:10.1016/S2352-3018(16)30053-4.

    PubMed  Google Scholar 

  • Safren, S. A., Gonzalez, J. S., & Soroudi, N. (2007a). Coping with chronic illness: Cognitive behavioral therapy for adherence and depression, client workbook. NY: Oxford University Press.

    Book  Google Scholar 

  • Safren, S. A., Gonzalez, J. S., & Soroudi, N. (2007b). Coping with chronic illness: Cognitive behavioral therapy for adherence and depression, therapist guide. NY: Oxford University Press.

    Book  Google Scholar 

  • Safren, S. A., Gonzalez, J. S., Wexler, D. J., Psaros, C., Delahanty, L. M., Blashill, A. J., et al. (2014). A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes. Diabetes Care, 37(3), 625–633.

    Article  PubMed  PubMed Central  Google Scholar 

  • Safren, S. A., O’Cleirigh, C. M., Bullis, J. R., Otto, M. W., Stein, M. D., & Pollack, M. H. (2012). Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 80(3), 404–415. doi:10.1037/a0028208.

    Article  PubMed  PubMed Central  Google Scholar 

  • Safren, S. A., O’Cleirigh, C., Tan, J. Y., Raminani, S. R., Reilly, L. C., Otto, M. W., & Mayer, K. H. (2009). A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychology, 28(1), 1–10. doi:10.1037/a0012715.

    Article  PubMed  PubMed Central  Google Scholar 

  • Safren, S. A., Otto, M. W., & Worth, J. L. (1999). Life-steps: Applying cognitive behavioral therapy to HIV medication adherence. Cognitive and Behavioral Practice, 6(4), 332–341.

    Article  Google Scholar 

  • Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(suppl 20), 22–33.

    PubMed  Google Scholar 

  • Shrier, L. A., Harris, S. K., Sternberg, M., & Beardslee, W. R. (2001). Associations of depression, self-esteem, and substance use with sexual risk among adolescents. Preventive Medicine, 33(3), 179–189. doi:10.1006/pmed.2001.0869.

    Article  CAS  PubMed  Google Scholar 

  • Simoni, J. M., Safren, S. A., Manhart, L. E., Lyda, K., Grossman, C. I., Rao, D., et al. (2011). Challenges in addressing depression in HIV research: Assessment, cultural context, and methods. AIDS and Behavior, 15(2), 376–388. doi:10.1007/s10461-010-9836-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Simoni, J. M., Wiebe, J. S., Sauceda, J. A., Huh, D., Sanchez, G., Longoria, V., et al. (2013). A preliminary RCT of CBT-AD for adherence and depression among HIV-positive Latinos on the US-Mexico border: The Nuevo Día study. AIDS and Behavior, 17(8), 2816–2829. doi:10.1007/s10461-013-0538-5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Smith, J. M., & Alloy, L. B. (2009). A roadmap to rumination: A review of the definition, assessment, and conceptualization of this multifaceted construct. Clinical Psychology Review, 29(2), 116–128. doi:10.1016/j.cpr.2008.10.003.

    Article  PubMed  Google Scholar 

  • Tegger, M. K., Crane, H. M., Tapia, K. A., Uldall, K. K., Holte, S. E., & Kitahata, M. M. (2008). The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals. AIDS Patient Care and STDs, 22(3), 233–243. doi:10.1089/apc.2007.0092.

    Article  PubMed  Google Scholar 

  • Uthman, O. A., Magidson, J. F., Safren, S. A., & Nachega, J. B. (2014). Depression and adherence to antiretroviral therapy in low-, middle- and high-income countries: A systematic review and meta-analysis. Current HIV/AIDS Reports, 11(3), 291–307. doi:10.1007/s11904-014-0220-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Valente, S. M. (2003). Depression and HIV disease. Journal of the Association of Nurses in AIDS care, 14(2), 41–51. doi:10.1177/1055329002250993.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Funding for this project came from a National Institute of Mental Health Grant R01MH084757 and a National Institute of Drug Abuse Grant K24DA040489 to Dr. Steven A. Safren.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Kristen E. Riley

  2. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Jasper S. Lee & Steven A. Safren

  3. The Fenway Institute, Boston, MA, USA

    Steven A. Safren

Authors
  1. Kristen E. Riley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jasper S. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven A. Safren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven A. Safren.

Ethics declarations

Conflict of Interest

Dr. Kristen E. Riley and Jasper S. Lee have no conflicts of interest. Dr. Steven A. Safren receives royalties from Oxford University Press for books/treatment manuals on treating depression in the context of chronic illness.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (national and institutional). Informed consent was obtained from all individual subjects participating in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Riley, K.E., Lee, J.S. & Safren, S.A. The Relationship Between Automatic Thoughts and Depression in a Cognitive-Behavioral Treatment for People Living with HIV/AIDS: Exploring Temporality and Causality. Cogn Ther Res 41, 712–719 (2017). https://doi.org/10.1007/s10608-017-9839-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-017-9839-8

Keywords

Search

Navigation