Journal of Behavioral Medicine

, Volume 35, Issue 3, pp 272–285 | Cite as

A randomized controlled trial of mindfulness-based stress reduction to manage affective symptoms and improve quality of life in gay men living with HIV

  • Bill GaynerEmail author
  • Mary Jane Esplen
  • Peter DeRoche
  • Jiahui Wong
  • Scott Bishop
  • Lynn Kavanagh
  • Kate Butler


To determine whether MBSR groups would help gay men living with HIV improve psychosocial functioning and increase mindfulness compared to treatment-as-usual (TAU). Methods: 117 participants were randomized 2:1 to MBSR or TAU. No new psychosocial or psychopharmacological interventions were initiated within 2 months of baseline. Standardized questionnaires were administered pre-, postintervention and at 6 months. An intent-to-treat analysis found significant benefits of MBSR: at post-intervention and 6 months follow up, MBSR participants had significantly lower avoidance in IES and higher positive affect compared to controls. MBSR participants developed more mindfulness as measured by the Toronto Mindfulness Scale (TMS) including both TMS subscales, curiosity and decentering, at 8-week and 6 months. For the sample as a whole, increase in mindfulness was significantly correlated with reduction in avoidance, higher positive affect and improvement in depression at 6 months. MBSR has specific and clinically meaningful effects in this population.


Mindfulness Randomized trial Group interventions HIV Gay men 



We gratefully acknowledge operational grant funding support for this study from the Canadian Foundation for AIDS Research (CANFAR) grant # 015 003. In addition, a co-principal investigator MJE is the recipient of a 5-year Mid-Career Scientist Award from the Canadian Institutes of Health Research. We would also like to take this opportunity to express our gratitude to all of the men living with HIV who participated in the study despite the randomization.


This research was supported by a grant received from the Canadian Foundation for Aids Research (CANFAR) grant #015 003.

Conflict of interest

The authors do not have any conflict of interest.


  1. Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237.PubMedCrossRefGoogle Scholar
  2. Antoni, M. H., Cruess, D. G., Klimas, N., Maher, K., Cruess, S., Kumar, M., et al. (2002). Stress management and immune system reconstitution in symptomatic HIV-infected gay men over time: Effects on transitional naive T cells (CD4(+)CD(45)RA(+)CD29(+)). American Journal of Psychiatry, 159(1), 143–145.PubMedCrossRefGoogle Scholar
  3. Archer, T., Adolfsson, B., & Karlsson, E. (2008). Affective personality as cognitive-emotional presymptom profiles regulatory for self-reported health predispositions. Neurotoxicity Research, 14, 21–44.PubMedCrossRefGoogle Scholar
  4. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology-Science and Practice, 10, 125–143.CrossRefGoogle Scholar
  5. Belanoff JK, S. B., Koopman, C., Blasey, C., Flamm, J., Schatzberg, A. F., & Spiegel, D. (2005). A randomized trial of the efficacy of group therapy in changing viral load and CD4 counts in individuals living with HIV infection. International Journal of Psychiatry in Medicine, 35(4), 349–362.PubMedCrossRefGoogle Scholar
  6. Bing, E. G., Burnam, 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.PubMedCrossRefGoogle Scholar
  7. Bishop, S. R. (2002). What do we really know about mindfulness-based stress reduction? Psychosomatic Medicine, 64, 71–83.PubMedGoogle Scholar
  8. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology-Science and Practice, 11, 230–241.CrossRefGoogle Scholar
  9. Bjelland, I., Dahl, A., Haug, T., et al. (2002). The validity of the hospital anxiety and depression scale: An updated literature review. Journal of Psychosomatic Research, 52, 69–77.PubMedCrossRefGoogle Scholar
  10. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848.PubMedCrossRefGoogle Scholar
  11. Brown, J. L., & Vanable, P. A. (2008). Cognitive-behavioral stress management interventions for persons living with HIV: A review and critique of the literature. Annals of Behavioral Medicine, 35, 26–40.PubMedGoogle Scholar
  12. Byrne, D. (1999). Social exclusion. Buckingham: Open University Press.Google Scholar
  13. Carrico, A. W., Antoni, M. H., Pereira, D. B., Fletcher, M. A., Klimas, N., Lechner, S. C., et al. (2005). Cognitive behavioral stress management effects on mood, social support, and a marker of antiviral immunity are maintained up to 1 year in HIV-infected gay men. International Journal of Behavioral Medicine, 12, 218–226.PubMedCrossRefGoogle Scholar
  14. Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283.PubMedCrossRefGoogle Scholar
  15. Ciesla, J. A., & Roberts, J. E. (2001). Meta-analysis of the relationship between HIV infection and risk for depressive disorders. American Journal of Psychiatry, 158, 725–730.PubMedCrossRefGoogle Scholar
  16. Cochran, S. D., & Mays, V. M. (2000). Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the U.S. population. American Journal of Epidemiology, 151, 516–523.PubMedCrossRefGoogle Scholar
  17. Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among LGB adults in the United States. Journal of Consulting and Clinical Psychology, 71, 53–61.PubMedCrossRefGoogle Scholar
  18. Costa, P. T., & McCrae, R. R. (1980). Influence of extraversion and neuroticism on subjective well-being: Happy and unhappy people. Journal of Personality and Social Psychology, 38, 668–678.PubMedCrossRefGoogle Scholar
  19. Crepaz, N., Passin, W. F., Herbst, J. H., Rama, S. M., Malow, R. M., Purcell, D. W., et al. (2008). Meta-analysis of cognitive-behavioral interventions on HIV-positive persons’ mental health and immune functioning. Health Psychology, 27, 4–14.PubMedCrossRefGoogle Scholar
  20. Creswell, J. M. H. F., Cole, S. W., & Irwin, M. R. (2009). Mindfulness meditation training effects on CD4+ T lymphocytes in HIV-1 infected adults: A small randomized controlled trial. Brain Behav Immun, 23(2), 184–188.PubMedCrossRefGoogle Scholar
  21. Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564–570.PubMedCrossRefGoogle Scholar
  22. 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, 395–409.PubMedCrossRefGoogle Scholar
  23. Diaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from 3 US cities. American Journal of Public Health, 91, 927–932.PubMedCrossRefGoogle Scholar
  24. Dunn, B. D., Stefanovitch, I., Buchan, K., Lawrence, A. D., & Dalgleish, T. (2009). A reduction in positive self-judgment bias is uniquely related to the anhedonic symptoms of depression. Behaviour Research and Therapy, 47, 374–381.PubMedCrossRefGoogle Scholar
  25. Eisenberg, M., & Blank, M. (2004). HIV and serious mental illness: Prevalence and treatment issues. Harvard Health Policy Review, 5, 48–54.Google Scholar
  26. Farber, E. W., & McDaniel, J. S. (2002). Clinical management of psychiatric disorders in patients with HIV disease. Psychiatric Quarterly, 73, 5–16.PubMedCrossRefGoogle Scholar
  27. Fergusson, D. M., Horwood, J. L., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56, 876–880.PubMedCrossRefGoogle Scholar
  28. Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior, 21, 219–239.PubMedCrossRefGoogle Scholar
  29. Galubuzi, G.-E. (2004). Social exclusion. In D. Raphael (Ed.), Social determinants of health (pp. 233–252). Toronto: Scholars Press Inc.Google Scholar
  30. Germer, C. (2005). Mindfulness: What is it? What does it matter? In C. Germer (Ed.), Mindfulness and psychotherapy (pp. 3–27). New York: The Guilford Press.Google Scholar
  31. Gilbert, P. (1998). Shame and humiliation in the treatment of complex cases. In N. Tarrier, A. Wells, & G. Haddock (Eds.), Treating complex cases: the cognitive behavioural therapy approach (pp. 241–271). Chichester: Wiley.Google Scholar
  32. Gilbert, P., & Irons, C. (2005). Focused therapies and compassionate mind training for shame and self-attacking. In P. Gilbert (Ed.), Compassion: Conceptualizations, research and use in psychotherapy (pp. 263–325). London: Routledge.Google Scholar
  33. Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13, 353–379.CrossRefGoogle Scholar
  34. Giluk, T. L. (2009). Mindfulness, big five personality, and affect: A meta-analysis. Personality and Individual Differences, 47, 805–811.CrossRefGoogle Scholar
  35. Goodkin, K., Blaney, N. T., Feaster, D. J., Baldewicz, T., Burkhalter, J. E., & Leeds, B. (1999). A randomized controlled clinical trial of a bereavement support group intervention in human immunodeficiency virus type 1-seropositive and -seronegative homosexual men. Archives of General Psychiatry, 56, 52–59.PubMedCrossRefGoogle Scholar
  36. Grassi, B., Garghentini, G., Gambini, O., & Scarone, S. (1997). Neuropsychiatric aspects of HIV infection: A liaison psychiatry study. European Psychiatry, 12, 16–20.PubMedCrossRefGoogle Scholar
  37. Gray, J. R., Burgess, G. C., Schaefer, A., Yarkoni, T., Larsen, R. J., & Braver, T. S. (2005). Affective personality differences in neural processing efficiency confirmed using fMR1. Cognitive Affective & Behavioral Neuroscience, 5, 182–190.CrossRefGoogle Scholar
  38. Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits—a meta-analysis. Journal of Psychosomatic Research, 57, 35–43.PubMedCrossRefGoogle Scholar
  39. Guidford, J. (2000). Making the case for economic and social inclusion. Ottawa: Health Canada.Google Scholar
  40. Hansen, N. B., Tarakeshwar, N., Ghebremichael, M., Zhang, H. P., Kochman, A., & Sikkema, K. J. (2006). Longitudinal effects of coping on outcome in a randomized controlled trial of a group intervention for HIV-positive adults with AIDS-related bereavement. Death Studies, 30, 609–636.PubMedCrossRefGoogle Scholar
  41. Hayes, S., Strosahl, K., & Wilson, K. (1999). Acceptance and commitment therapy: an experiential approach to behavioral change. New York: Guilford Press.Google Scholar
  42. Herrell, R., Goldberg, J., True, W. R., Ramakrishnan, V., Lyons, M., Eisen, S., et al. (1999). Sexual orientation and suicidality—a co-twin control study in adult men. Archives of General Psychiatry, 56, 867–874.PubMedCrossRefGoogle Scholar
  43. Hofmann, S. G., Sawyer, A. T., Witt, A. W., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169–183.PubMedCrossRefGoogle Scholar
  44. Horowitz, M. (1982). Stress response syndromes and their treatment. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress: Theoretical and clinical aspects (pp. 711–732). New York: Free Press.Google Scholar
  45. Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of event scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–218.PubMedGoogle Scholar
  46. John, O. P., & Gross, J. J. (2004). Healthy and unhealthy emotion regulation: Personality processes, individual differences, and life span development. Journal of Personality, 72, 1301–1333.PubMedCrossRefGoogle Scholar
  47. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your mind to face stress, pain and illness. New York: Dell Publishing.Google Scholar
  48. Kabat-Zinn, J. (1998). Meditation. In J. C. Holland (Ed.), Psycho-oncology (pp. 767–779). New York: Oxford University Press.Google Scholar
  49. Kashdan, T. B., & Breen, W. E. (2008). Social anxiety and positive emotions: A prospective examination of a self-regulatory model with tendencies to suppress or express emotions as a moderating variable. Behavior Therapy, 39, 1–12.PubMedCrossRefGoogle Scholar
  50. Kelly, J. A., Murphy, D., Bahr, G. R., Kalichman, S. C., Morgan, M. G., Stevenson, L. Y., et al. (1993). Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons. American Journal of Psychiatry, 150, 1679–1686.PubMedGoogle Scholar
  51. Klimas, N., Koneru, A. O., & Fletcher, M. A. (2008). Overview of HIV. Psychosomatic Medicine, 70, 523–530.PubMedCrossRefGoogle Scholar
  52. Kocovski, N. L., Segal, Z. V., & Battista, S. R. (2009). Mindfulness and psychopathology: Problem formulation. In F. Didonna (Ed.), Clinical handbook of mindfulness (pp. 85–98). New York: Springer.CrossRefGoogle Scholar
  53. Lau, M. A., Bishop, S. R., Segal, Z. V., Buis, T., Anderson, N. D., Carlson, L., et al. (2006). The Toronto mindfulness scale: Development and validation. Journal of Clinical Psychology, 62, 1445–1467.PubMedCrossRefGoogle Scholar
  54. Ledesma, D., & Kumano, H. (2009). Mindfulness-based stress reduction and cancer: A meta-analysis. Psycho-Oncology, 18, 571–579.PubMedCrossRefGoogle Scholar
  55. Leiberich, P., Engeter, M., Olbrich, E., Rubbert, A., Schumacher, K., Brieger, M., et al. (1997). Longitudinal development of distress, coping and quality of life in HIV-positive persons. Psychotherapy and Psychosomatics, 66, 237–247.PubMedCrossRefGoogle Scholar
  56. Leserman, J. (2008). Role of depression, stress, and trauma in HIV disease progression. Psychosomatic Medicine, 70, 539–545.PubMedCrossRefGoogle Scholar
  57. Madanipour, A. (1998). Social exclusion and space. In J. Allen, G. Cars, & A. Madanipour (Eds.), Social exclusion in cities. London: Jessica Kingsley.Google Scholar
  58. Markowitz, J. C., Kleman, G., Clougherty, K. F., Spielman, L. A., Jacobsberg, L. B., Fishman, B., et al. (1995). Individual psychotherapies for depressed HIV-positive patients. American Journal of Psychiatry, 152, 1504–1509.PubMedGoogle Scholar
  59. Moher, D., Schulz, K. F., Altman, D. G., & Grp, C. (2001). The CONSORT statement: Revised recommendations for improving the quality of reports of parallel-group randomized trials. Annals of Internal Medicine, 134, 657–662.PubMedGoogle Scholar
  60. Neal, L. A., Busuttil, W., Rollins, J., Herepath, R., Strike, P., & Turnbull, G. (1994). Convergent validity of measures of posttraumatic-stress-disorder in a mixed military and civilian population. Journal of Traumatic Stress, 7, 447–455.PubMedCrossRefGoogle Scholar
  61. Neff, K. (2003). Self-compassion: an alternative conceptualization of a health attitude toward oneself. Self Identity, 2, 85–102.CrossRefGoogle Scholar
  62. Network, S. P. (1997). Research Randomizer.Google Scholar
  63. Pradhan, E. K., Baumgarten, M., Langenberg, P., Handwerger, B., Gilpin, A. K., Magyari, T., et al. (2007). Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis & Rheumatism-Arthritis Care & Research, 57, 1134–1142.CrossRefGoogle Scholar
  64. Reibel, D. K., Greeson, J. M., Brainard, G. C., & Rosenzweig, S. (2001). Mindfulness-based stress reduction and health- related quality of life in a heterogeneous patient population. General Hospital Psychiatry, 23, 183–192.PubMedCrossRefGoogle Scholar
  65. Repetto, M. J., & Petitto, J. M. (2008). Psychopharmacology in HIV-infected patients. Psychosomatic Medicine, 70, 585–592.PubMedCrossRefGoogle Scholar
  66. Robinson, F. P., Matthews, H. L., & Witek-Janusek, L. (2003). Psycho-endocrine-immune response to mindfulness-based stress reduction in individuals infected with the human immunodeficiency virus: A quasiexperimental study. The Journal of Alternative and Complementary Medicine, 9, 683–694.PubMedCrossRefGoogle Scholar
  67. Room, G. (1995). Conclusions. In G. Room (Ed.), Beyond the threshold: The measurement and analysis of social exclusion. Policy: Bristol.Google Scholar
  68. Santorelli, S. (1999). Mindfulness-based stress reduction: Qualifications and recommended guidelines for providers. Worcester: University of Massachusetts Medical Center.Google Scholar
  69. Segal, Z. V., Teasdale, J. D., Williams, J. M., & Gemar, M. C. (2002). The mindfulness-based cognitive therapy adherence scale: Inter-rater reliability, adherence to protocol and treatment distinctiveness. Clinical Psychology & Psychotherapy, 9, 131–138.CrossRefGoogle Scholar
  70. Sephton, S. E., Salmon, P., Weissbecker, I., Ulmer, C., Floyd, A., Hoover, K., et al. (2007). Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: Results of a randomized clinical trial. Arthritis & Rheumatism-Arthritis Care & Research, 57, 77–85.CrossRefGoogle Scholar
  71. Shapiro, S. (2009). The integration of mindfulness and psychotherapy. Journal of Clinical Psychology, 65(6), 555–560.PubMedCrossRefGoogle Scholar
  72. Shapiro, S. L., & Schwartz, G. E. (1999). Intentional systemic mindfulness: An integrative model for self-regulation and health. Advances in Mind-Body Medicine, 15, 128–134.Google Scholar
  73. Shapiro, S. L., & Schwartz, E. (2000). The role of intention in self-regulation: Toward intentional systemic mindfulness. In M. Boekaerts & P. Pintrich (Eds.), Handbook of self-regulation (pp. 253–273). San Diego, CA: Academic Press.Google Scholar
  74. Shaw, M., Dorling, D., & Smith, G. (1999). Poverty, social exclusion and minorities. In M. Marmot & R. Wilkinson (Eds.), Social determinants of health. Oxford: Oxford University Press.Google Scholar
  75. Sherman, A. C., Mosier, J., Leszcz, M., Burlingame, G. M., Ulman, K. H., Cleary, T., et al. (2004). Group interventions for patients with cancer and HIV disease: Part I: Effects on psychosocial and functional outcomes at different phases of illness. International Journal of Group Psychotherapy, 54, 29–82.PubMedCrossRefGoogle Scholar
  76. Snaith, R., & Zigmond, A. (1983). The hospital anxiety and depression scale (HADS). Windsor: NFER-Nelson.Google Scholar
  77. Tangney, J., & Dearing, R. (2002). Shame and guilt. New York: Guilford.Google Scholar
  78. Teasdale, J. D., Segal, Z., & Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help. Behaviour Research and Therapy, 33, 25–39.PubMedCrossRefGoogle Scholar
  79. Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623.PubMedCrossRefGoogle Scholar
  80. Temoshok, L. R., & Wald, R. L. (2008). Integrating multidimensional HIV prevention programs into healthcare settings. Psychosomatic Medicine, 70, 612–619.PubMedCrossRefGoogle Scholar
  81. Torgerson, D. J, & Campbell, M. K. (2000). Use of unequal randomization to aid the economic efficiency of clinical trials. British Medical Journal, p. 759.Google Scholar
  82. Varg, N. (1997). The influence of negative affect upon responses to questionnaires. Stockholm: Stockholm University Reports.Google Scholar
  83. Watson, D., & Clark, L. A. (2006). Clinical diagnosis at the crossroads. Clinical Psychology-Science and Practice, 13, 210–215.CrossRefGoogle Scholar
  84. Watson, D., Clark, L., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect—the PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.PubMedCrossRefGoogle Scholar
  85. Watson, D., Gamez, W., & Simms, L. J. (2005). Basic dimensions of temperament and their relation to anxiety and depression: A symptom-based perspective. Journal of Research in Personality, 39, 46–66.CrossRefGoogle Scholar
  86. Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psychological Review, 96, 234–254.PubMedCrossRefGoogle Scholar
  87. Whetten, K., Reif, S., Whetten, R., & Murphy-McMillan, L. K. (2008). Trauma, mental health, distrust, and stigma among HIV-Positive persons: Implications for effective care. Psychosomatic Medicine, 70, 531–538.PubMedCrossRefGoogle Scholar
  88. World Health Organization HAD. (2009). Priority interventions: HIV/AIDS prevention, treatment and care in the health sector, Version 1.2. World Health Organization.Google Scholar
  89. Zuroff, D. C., Santor, D., & Mograin, M. (2005). Dependency, self-criticism, and maladjustment. In J. S. Auerback, K. N. Levy, & C. E. Schaefer (Eds.), Relatedness, self-definition and mental representation: Essays in honour of Sidney J Blatt (pp. 75–90). Londong: Brunner-Routledge.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Bill Gayner
    • 1
    • 2
    Email author
  • Mary Jane Esplen
    • 3
    • 4
  • Peter DeRoche
    • 1
    • 4
  • Jiahui Wong
    • 5
  • Scott Bishop
    • 6
    • 7
  • Lynn Kavanagh
    • 4
  • Kate Butler
    • 3
  1. 1.Clinic for HIV-Related Concerns, Department of PsychiatryMount Sinai HospitalTorontoCanada
  2. 2.Faculty of Social WorkUniversity of TorontoTorontoCanada
  3. 3.Behavioral Sciences and Health, Toronto General Research InstituteUniversity Health NetworkTorontoCanada
  4. 4.Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada
  5. Souza InstituteTorontoCanada
  6. 6.Buddhism, Psychology and Mental Health ProgramUniversity of TorontoTorontoCanada
  7. 7.Toronto Institute for Contemporary PsychoanalysisTorontoCanada

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