Cognitive-behavioral stress management reduces distress and 24-hour urinary free cortisol output among symptomatic HIV-infected gay men
- 576 Downloads
Stress management interventions can reduce symptoms of distress as well as modulate certain immune system components in persons infected with human immunodeficiency virus (HIV). These effects may occur in parallel with reductions in hypothalamic-pituitary-adrenal (HPA) axis hormones such as cortisol, which has been related in other work to a down-regulation of immune system components relevant to HIV infection. The present study tested the effects of a multimodal cognitive-behavioral stress management (CBSM) intervention on 24-hour urinary free cortisol levels and distressed mood in symptomatic HIV+ gay men.
Symptomatic HIV-infected gay men who were randomized to either a 10-week group-based CBSM intervention or a 10-week wait-list period provided psychological responses and urine samples pre-post intervention.
Of the 59 participants providing matched questionnaire data, men assigned to CBSM (n=40) showed significantly lower posttreatment levels of self-reported depressed affect, anxiety, anger, and confusion than those in the wait-list control group (n=19). Among the 47 men providing urine samples (34 CBSM, 13 controls), those assigned to CBSM revealed significantly less cortisol output as compared to controls. At the individual level, depressed mood decreases paralleled cortisol reductions over this period across the entire sample.
A time-limited CBSM intervention reduced distress symptoms and urinary free cortisol output in symptomatic HIV+ gay men and greater reductions in some aspects of distress, especially depressed mood, paralleled greater decreases in cortisol over the intervention period. If persisting stressors and depressed mood contribute to chronic HPA axis activation in HIV-infected persons, then interventions such as CBSM, which teaches them to relax, alter cognitive appraisals, use new coping strategies, and access social support resources, may decrease distress and depressed mood and normalize HPA axis functioning.
Unable to display preview. Download preview PDF.
- (6).Rondanelli M, Solerte S, Fioravanti M, et al: Circadian secretory pattern of growth hormone, insulin-like growth factor type I, cortisol, adrenocorticotropic hormone, thyroid-stimulating hormone, and prolactin during HIV infection.AIDS Research and Human Retroviruses. 1997,13: 1243–1249.PubMedGoogle Scholar
- (11).Norbiato G, Bevilacqua M, Vago T, Taddel A, Clerici M: Glucocorticoids and the immune function in the human immunodeficiency virus infection: A study in hypercortisolemic and cortisol-resistant patients.Journal of Clinical Endocrinology and Metabolism. 1997,82: 3260–3263.PubMedCrossRefGoogle Scholar
- (14).Lewin D: Protease inhibitors: HIV-1 summons a darwinion defense.Journal of NIH Research. 1996,8: 33–35.Google Scholar
- (15).Schneiderman N, Antoni MH, Ironson G: Cognitive-behavioral stress management and secondary prevention in HIV/AIDS.Psychology and AIDS Exchange. 1997,22: 1–8.Google Scholar
- (17).Rabkin J, Wagner G, Rabkin R: Treatment of depression in HIV+ men: Literature review and report of an ongoing study of testosterone replacement therapy.Annals of Behavioral Medicine. 1996,18: 24–29.Google Scholar
- (39).Centers for Disease Control: Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults.MMWR. Morbidity and Mortality Weekly Report. 1992,41(RR-17): 1–19.Google Scholar
- (42).Spitzer R, Williams J, Gibbon M, First M:Structured Clinical Interview for DSM-III-R: Nonpatient Version for HIV Studies (SCID-NP-HIV 6/1/88). New York: Biometrics Research Department, New York Psychiatric Institute, 1988.Google Scholar
- (43).Spitzer R, Williams J, Gibbon M, First M:Structured Interview for DSM-III-R Personality Disorders (SCID-II). New York: New York State Psychiatric Institute, Biometrics Research, 1990.Google Scholar
- (45).McNair D, Lorr M, Droppleman L:EITS Manual for the Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service, 1981.Google Scholar
- (46).Kuhn C: Adrenocortical and gonadal steroids in behavioral cardiovascular medicine. In Schneiderman N, Kauffman P (eds),Handbook of Cardiovascular Methods. Plenum, 1989, 185–204.Google Scholar
- (49).Antoni MH, Schneiderman N, Ironson G: Stress management for HIV-infection. Unpublished manuscript, University of Miami, 1998.Google Scholar
- (50).Bernstein B, Borkovec T:Progressive Relaxation Training: A Manual for the Helping Professions. Champaign, IL: Research Press, 1973.Google Scholar
- (51).Luthe W:Autogenic Therapy. New York: Grune & Stratton, 1969.Google Scholar
- (52).Benson H, Klipper M:The Relaxation Response. New York: Avon, 1976.Google Scholar
- (53).Davis M, Eshelman E, McKay M:The Relaxation and Stress Reduction Workbook (3rd Ed.). Oakland, CA: New Harbinger, 1988.Google Scholar
- (54).Mason J:A Guide to Stress Reduction. Berkely, CA: Celestial Arts, 1986, 26–79.Google Scholar
- (55).Schneiderman N, Antoni MH, Ironson G, et al: HIV-1, immunity and behavior. In Glaser R (ed),Handbook of Human Stress and Immunity. New York: Academic, 1994.Google Scholar
- (57).Ader R, Felten D, Cohen N:Psychoneuroimmunology (2nd Ed.). New York: Academic Press, 1991.Google Scholar
- (58).Glaser R, Kiecolt-Glaser J:Handbook of Human Stress and Immunity. New York: Academic, 1994.Google Scholar
- (60).Patterson T, Shaw W, Semple S, et al: Relationship of psychosocial factors to HIV disease progression.Annals of Behavioral Medicine. 1996,18: 30–39.Google Scholar
- (67).Turk D, Holzman A, Kerns R: Chronic pain. In Holroyd K, Creer T (eds),Self Management of Chronic Disease: Handbook of Clinical Interventions and Research. Orlando, FL: Academic Press, Inc, 1986.Google Scholar
- (71).Cruess D, Antoni MH, Kumar M, et al: Changes in symptoms of distress and sex hormones in symptomatic HIV+ gay men during a cognitive-behavioral stress management (CBSM) intervention. The Society of Behavioral Medicine. New Orleans, LA: March 1998.Google Scholar
- (73).Sikkema K, Kelly J: Behavioral medicine interventions can improve the quality-of-life and health of persons with HIV disease.Annals of Behavioral Medicine. 1996,18: 40–48.Google Scholar