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Cognitive–Behavioral Stress Management Interventions for Persons Living with HIV: A Review and Critique of the Literature

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Psychological adjustment and coping are central to human immunodeficiency virus (HIV) management. To improve HIV-infected patients’ ability to cope with stress, a variety of stress management interventions have been designed and evaluated.

Purpose

This paper provides a review and critique of the stress management literature, including a: (1) synthesis of core components of interventions for HIV-infected people, (2) summary of stress, coping, psychological, and health outcomes, and (3) methodological critique and guidance for future research.

Methods

We reviewed 21 stress management interventions designed for HIV-infected individuals that included both cognitive and behavioral skills training.

Results

Most studies noted positive changes in perceived stress, depression, anxiety, global psychological functioning, social support, and quality of life. However, results were mixed for coping and health status outcomes, and a majority of studies employed only brief follow-up periods, focused on HIV-infected MSM, and did not address HIV-specific stressors.

Conclusions

Stress management interventions for HIV-infected persons are a promising approach to facilitate positive adjustment. However, this literature is limited by measurement problems, research design features, a narrow focus on HIV-infected men who have sex with men, and feasibility concerns for intervention dissemination. Future stress management interventions should address these limitations and the unique psychosocial needs of HIV-infected patients using briefer, more cost-effective formats.

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References

  1. UNAIDS/WHO. AIDS Epidemic Update. 2006: 1–96.

  2. CDC. HIV/AIDS Surveillance Report. 2005; 16: 1–46.

  3. CDC. Trends in HIV/AIDS diagnoses—33 states, 2001–2004. Morb Mort Wkly Rep. 2005; 54: 1149–1153.

    Google Scholar 

  4. Hogg RS, Yip B, Chan KJ, et al. Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. J Am Med Assoc. 2001; 286: 2568–2577.

    Article  CAS  Google Scholar 

  5. Hammer SM, Saag MS, Schechter M, et al. Treatment for adult HIV-infection: 2006 recommendations of the International AIDS Society-USA panel. J Am Med Assoc. 2006; 296: 827–843.

    Article  CAS  Google Scholar 

  6. Kelly JA, Kalichman SC. Behavioral research in HIV/AIDS primary and secondary prevention: recent advances and future directions. J Consult Clin Psychol. 2002; 70: 626–639.

    Article  PubMed  Google Scholar 

  7. Jenkins SR, Coons HL. Psychosocial stress and adaptation processes for women coping with HIV/AIDS. In: O’Leary A, Jemmott LS, eds. Women and AIDS: Coping and Care. New York, NY: Plenum; 1996: 33–86.

    Google Scholar 

  8. Morrow K, Costello T, Boland R. Understanding the psychosocial needs of HIV-positive women. Psychosomatics. 2001; 42: 497–503.

    Article  PubMed  CAS  Google Scholar 

  9. Bogart LM, Catz SL, Kelly JA, et al. Psychosocial issues in the era of new AIDS treatments from the perspective of persons living with HIV. J Health Psychol. 2000; 5: 500–516.

    Article  Google Scholar 

  10. Heckman TG, Anderson ES, Sikkema KJ, et al. Emotional distress in nonmetropolitan persons living with HIV disease enrolled in a telephone-delivered, coping improvement group intervention. Health Psychol. 2004; 23: 94–100.

    Article  PubMed  Google Scholar 

  11. Griffin KW, Rabkin JG. Psychological distress in people with HIV/AIDS: prevalence rates and methodological issues. AIDS Behav. 1997; 12: 9–42.

    Article  Google Scholar 

  12. Catz S, Gore-Felton C, McClure JB. Psychological distress among minority and low-income women living with HIV. Behav Med. 2002; 28: 53–60.

    Article  PubMed  Google Scholar 

  13. Ironson G, O’Cleirigh C, Fletcher M, et al. Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med. 2005; 97: 1013–1021.

    Article  Google Scholar 

  14. Leserman J, Jackson ED, Petitto JM, et al. Progression to AIDS: the effects of stress, depressive symptoms, and social support. Psychosom Med. 1999; 61: 397–406.

    PubMed  CAS  Google Scholar 

  15. Chesney MA, Folkman S. Psychological impact of HIV disease and implications for intervention. Psychiatr Clin North Am. 1994; 17: 163–182.

    PubMed  CAS  Google Scholar 

  16. Bower JE, Kemeny ME, Fawzy FI. Group interventions for individuals with serious medical illness. In: Chesney MA, Antoni MH, eds. Innovative Approaches to Health Psychology: Prevention and Treatment Lessons from AIDS. Washington DC: American Psychological Association; 2002: 197–218.

    Chapter  Google Scholar 

  17. WHO. HIV/AIDS: Psychosocial Support. 2007.

  18. Vanable PA, Carey MP. Behavioral medicine interventions in HIV/AIDS: challenges and opportunities for promoting sustained health and adaptation. In: Nikcevic AV, Kuczmierczyk AR, Bruch M, eds. A Clinician’s Guide to Behavioral Medicine: A Case Formulation Approach. New York: Routledge; 2006: 233–253.

    Google Scholar 

  19. Ironson G, Antoni MH, Schneiderman N, et al. Coping: interventions for optimal disease management. In: Chesney MA, Antoni MH, eds. Innovative Approaches to Health Psychology: Prevention and Treatment Lessons from AIDS. Washington, DC: APA; 2002: 167–195.

    Chapter  Google Scholar 

  20. Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York: Springer; 1984.

    Google Scholar 

  21. Folkman S, Moskowitz JT. Positive affect and the other side of coping. Am Psychol. 2000; 55: 647–654.

    Article  PubMed  CAS  Google Scholar 

  22. Folkman S, Moskowitz JT. Coping: pitfalls and promise. Annu Rev Psychol. 2004; 55: 745–774.

    Article  PubMed  Google Scholar 

  23. Cote JK, Pepler C. A randomized trial of a cognitive coping intervention for acutely ill HIV-positive men. Nurs Res. 2002; 51: 237–244.

    Article  PubMed  Google Scholar 

  24. Sikkema KJ, Hansen NB, Ghebremichael M, et al. A randomized control trial of a coping group intervention for adults with HIV who are AIDS bereaved: longitudinal effects on grief. Health Psychol. 2006; 25: 563–570.

    Article  PubMed  Google Scholar 

  25. Coates TJ, McKusick L, Kuno R, Stites DP. Stress reduction training changed number of sexual partners but not immune function in men with HIV. Am J Public Health. 1989; 79: 885–887.

    PubMed  CAS  Google Scholar 

  26. Kelly JA, Murphy DA, Bahr R, et al. Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons. Am J Psychiatry. 1993; 150: 1679–1686.

    PubMed  CAS  Google Scholar 

  27. Carrico AW, Antoni MH, Duran RE, et al. Reductions in depressed mood and denial coping during cognitive behavioral stress management with HIV-positive gay men treated with HAART. Ann Behav Med. 2006; 31: 155–164.

    Article  PubMed  Google Scholar 

  28. Heckman TG, Kochman A, Sikkema KJ, et al. A pilot coping improvement intervention for late middle-aged and older adults living with HIV/AIDS in the USA. AIDS Care. 2001; 13: 129–139.

    Article  PubMed  CAS  Google Scholar 

  29. Chesney MA, Chambers DB, Taylor JM, Johnson LM, Folkman S. Coping effectiveness training for men living with HIV: results from a randomized clinical trial testing a group-based intervention. Psychosom Med. 2003; 65: 1038–1046.

    Article  PubMed  Google Scholar 

  30. Chesney MA, Folkman S, Chambers DB. Coping effectiveness training for men living with HIV: preliminary findings. Int J STD AIDS. 1996; 7: 75–82.

    Article  PubMed  Google Scholar 

  31. Heckman TG, Barcikowski R, Ogles BM, et al. A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS. Ann Behav Med. 2006; 32: 27–38.

    Article  PubMed  Google Scholar 

  32. Mulder CL, Emmelkamp PMG, Antoni MH, et al. Cognitive-behavioral and experiential group psychotherapy for HIV-infected homosexual men: a comparative study. Psychosom Med. 1994; 56: 423–431.

    PubMed  CAS  Google Scholar 

  33. Mulder CL, Antoni MH, Emmelkamp PMG, et al. Psychosocial group intervention and rate of decline of immunological parameters in asymptomatic HIV-infected homosexual men. Psychother Psychosom. 1995; 63: 185–192.

    Article  PubMed  CAS  Google Scholar 

  34. McCain NL, Zeller JM, Cella D, Urbanski PA, Novak RM. The influence of stress management training in HIV disease. Nurs Res. 1996; 45: 246–253.

    Article  PubMed  CAS  Google Scholar 

  35. Chan I, Kong P, Leung P, et al. Cognitive–behavioral group program for Chinese heterosexual HIV-infected men in Hong Kong. Patient Educ Couns. 2005; 56: 78–84.

    Article  PubMed  Google Scholar 

  36. Ironson G, Weiss S, Lydston D, et al. The impact of improved self-efficacy on HIV viral load and distress in culturally diverse women living with AIDS: the SMART/EST Women’s Project. AIDS Care. 2005; 17: 222–236.

    Article  PubMed  CAS  Google Scholar 

  37. Lechner S, Antoni MH, Lydston D, et al. Cognitive–behavioral interventions improve quality of life in women with AIDS. J Psychosom Res. 2003; 54: 253–261.

    Article  PubMed  Google Scholar 

  38. Molassiotis A, Callaghan P, Twinn SF, et al. A pilot study of the effects of cognitive-behavioral group therapy and peer support/counseling in decreasing psychologic distress and improving quality of life in Chinese patients with symptomatic HIV disease. AIDS Patient Care STDs. 2002; 16: 83–96.

    Article  PubMed  CAS  Google Scholar 

  39. Antoni MH, Cruess DG, Cruess S, et al. Cognitive-behavioral stress management intervention effects on anxiety, 24-hr urinary norepinephrine output, and t-cytotoxic/suppressor cells over time among symptomatic HIV-infected gay men. J Consult Clin Psychol. 2000; 68: 31–45.

    Article  PubMed  CAS  Google Scholar 

  40. Cruess S, Antoni MH, Hayes A, et al. Changes in mood and depressive symptoms and related change processes during cognitive-behavioral stress management in HIV-infected men. Cogn Ther Res. 2002; 26: 373–392.

    Article  Google Scholar 

  41. Lutgendorf SK, Antoni MH, Ironson G, et al. Changes in cognitive coping skills and social support during cognitive behavioral stress management intervention and distress outcomes in symptomatic human immunodeficiency virus (HIV) seropositive gay men. Psychosom Med. 1998; 60: 204–214.

    PubMed  CAS  Google Scholar 

  42. Inouye J, Flannelly L, Flannelly KJ. The effectiveness of self-management training for individuals with HIV/AIDS. J Assoc Nurses AIDS Care. 2001; 12: 73–84.

    Article  PubMed  CAS  Google Scholar 

  43. Hansen NB, Tarakeshwar N, Ghebremichael M, et al. Longitudinal effects of coping on outcome in a randomized controlled trial of a group intervention for HIV-positive adults with AIDS-related bereavement. Death Stud. 2006; 30: 609–636.

    Article  PubMed  Google Scholar 

  44. Chesney MA, Neilands TB, Chambers DB, Taylor JM, Folkman S. A validity and reliability study of the coping self-efficacy scale. Br J Health Psychol. 2006; 14: 421–437.

    Article  Google Scholar 

  45. Antoni MH. Psychosocial stressors and behavioral interventions in gay men with HIV infection. Int Rev Psychiatry. 1991; 3: 383–399.

    Article  Google Scholar 

  46. Lee MR, Cohen L, Hadley SW, Goodwin FK. Cognitive–behavioral group therapy with medication for depressed gay men with AIDS or symptomatic HIV infection. Psychiatr Serv. 1999; 50: 948–952.

    PubMed  CAS  Google Scholar 

  47. Cruess DG, Antoni MH, Schneiderman N, et al. Cognitive–behavioral stress management increases free testosterone and decreases psychological distress in HIV-seropositive men. Health Psychol. 2000; 19: 12–20.

    Article  PubMed  CAS  Google Scholar 

  48. Lutgendorf SK, Antoni MH, Ironson G, et al. Cognitive-behavioral stress management decreases dysphoric mood and herpes simplex virus-type 2 antibody titers in symptomatic HIV-seropositive gay men. J Consult Clin Psychol. 1997; 65: 31–43.

    Article  PubMed  CAS  Google Scholar 

  49. Sikkema KJ, Hansen NB, Kochman A, Tate DC, Difranceisco W. Outcomes from a randomized controlled trial of a group intervention for HIV positive men and women coping with AIDS-related loss and bereavement. Death Stud. 2004; 28: 187–209.

    Article  PubMed  Google Scholar 

  50. Fawzy FI, Namir S, Wolcott DL. Structured group intervention model for AIDS patients. Psychiatr Med. 1989; 7: 35–44.

    PubMed  CAS  Google Scholar 

  51. Cruess S, Antoni MH, Cruess DG, et al. Reductions in herpes simplex virus type 2 antibody titers after cognitive behavioral stress management and relationships with neuroendocrine function, relaxation skills, and social support in HIV-positive men. Psychosom Med. 2000; 62: 828–837.

    PubMed  CAS  Google Scholar 

  52. Sikkema KJ, Hansen NB, Meade CS, Kochman A, Lee RS. Improvements in health-related quality of life following a group intervention for coping with AIDS-bereavement among HIV-infected men and women. Qual Life Res. 2005; 14: 991–1005.

    Article  PubMed  Google Scholar 

  53. Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006; 10: 473–482.

    Article  PubMed  Google Scholar 

  54. Lutgendorf SK, Antoni MH, Schneiderman N, Fletcher M. Psychosocial counseling to improve quality of life in HIV infection. Patient Educ Couns. 1994; 24: 217–235.

    Article  PubMed  CAS  Google Scholar 

  55. Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004; 130: 601–630.

    Article  PubMed  Google Scholar 

  56. Antoni MH, Cruess DG, Klimas N, et al. Stress management and immune system reconstitution in symptomatic HIV-infected gay men over time: effect on transitional naive T cells (CD4+CD45RA+CD29+). Am J Psychiatry. 2002; 159: 143–145.

    Article  PubMed  Google Scholar 

  57. Kalichman SC. The Inside Story on AIDS: Experts Answer Your Questions. Washington, DC: APA; 2003.

    Google Scholar 

  58. Unglaub Silverthorn D, Ober WC, Garrison CW, Silverthorn AC, Johnson B. Human Physiology: An Integrated Approach. 3rd ed. San Francisco, CA: Pearson; 2004.

    Google Scholar 

  59. Skinner EA, Edge K, Altman J, Sherwood H. Searching for the structure of coping: a review and critique of category systems for classifying ways of coping. Psychol Bull. 2003; 129: 216–269.

    Article  PubMed  Google Scholar 

  60. De Ridder D. What is wrong with coping assessment? A review of conceptual and methodological issues. Psychol Health. 1997; 12: 417–431.

    Article  Google Scholar 

  61. Oakland S, Ostell A. Measuring coping: a review and critique. Human Relat. 1996; 49: 133–155.

    Article  Google Scholar 

  62. Steed LG. A critique of coping scales. Aust Psychol. 1998; 33: 193–202.

    Article  Google Scholar 

  63. APA. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA; 2000 (text revision edition).

    Google Scholar 

  64. Kalichman SC, Sikkema KJ, Somlai AM. Assessing persons with human immunodeficiency virus (HIV) infection using the Beck Depression Inventory: disease processes and other potential confounds. J Pers Assess. 1995; 64: 86–100.

    Article  PubMed  CAS  Google Scholar 

  65. Chambless DL, Hollon SD. Defining empirically supported therapies. J Consult Clin Psychol. 1998; 66: 7–18.

    Article  PubMed  CAS  Google Scholar 

  66. Antoni MH. Stress management and psychoneuroimmunology in HIV infection. CNS Spectr. 2003; 8: 40–51.

    PubMed  Google Scholar 

  67. CDC. HIV/AIDS Among Women: Fact Sheet. 2006.

  68. CDC. Drug-associated HIV Transmission Continues in the United States. 2002.

  69. Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001; 58: 721–728.

    Article  PubMed  CAS  Google Scholar 

  70. Atkins DC, Bedics JD, McGlinchey JB, Beauchaine TP. Assessing clinical significance: does it matter which method we use? J Consult Clin Psychol. 2005; 73: 982–989.

    Article  PubMed  Google Scholar 

  71. Jacobson NS, Roberts LJ, Berns SB, McGlinchey JB. Methods for defining and determining clinical significance of treatment effects: description, application, alternatives. J Consult Clin Psychol. 1999; 67: 300–307.

    Article  PubMed  CAS  Google Scholar 

  72. Kazdin AE. The meanings and measurement of clinical significance. J Consult Clin Psychol. 1999; 67: 332–339.

    Article  PubMed  CAS  Google Scholar 

  73. Kendall PC, Marrs-Garcia A, Nath SR, Sheldrick RC. Normative comparisons for the evaluation of clinical significance. J Consult Clin Psychol. 1999; 67: 285–299.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This work was supported in part by NIMH grant R21-MH65865. Jennifer L. Brown is supported by an NRSA award from the National Institute of Mental Health (F31MH081751).

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  1. Center for Health and Behavior, Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA

    Jennifer L. Brown M.S. & Peter A. Vanable Ph.D.

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  1. Jennifer L. Brown M.S.
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  2. Peter A. Vanable Ph.D.
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Correspondence to Peter A. Vanable Ph.D..

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Brown, J.L., Vanable, P.A. Cognitive–Behavioral Stress Management Interventions for Persons Living with HIV: A Review and Critique of the Literature. ann. behav. med. 35, 26–40 (2008). https://doi.org/10.1007/s12160-007-9010-y

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