March 24, 2008

Group Psychotherapy Improves Mood, but Not Adherence

A 12-week course of specialized psychological group counseling improved mood and quality of life in people living with HIV, but did not improve CD4 count, viral load or adherence to antiretroviral therapy, according to a study published in the March 30 issue of AIDS.

Simona Berger, from the Institute of Psychology at the University of Zurich in Switzerland, and her colleagues set out to determine whether cognitive behavioral stress management (CBSM)—which seeks to change a person’s negative and self-defeating thinking and behavior to improve their mood and functional ability—could enhance people’s physical health and adherence to HIV treatment, as well as their mood and quality of life.

A number of studies using individual- and group-based cognitive behavioral strategies have found that they can improve adherence to treatment in HIV and other diseases. Also, several studies published before the introduction of potent antiretroviral combination therapy in 1996 found that cognitive behavioral therapy could positively impact CD4 counts and the stress hormone cortisol.

Berger’s team enrolled and randomized 104 people living with HIV from the Swiss HIV Cohort Study to receive either a 12-week CBSM group therapy course or no intervention. Participants needed to be on stable antiretroviral therapy and have CD4 counts over 100. The study subjects also needed to be free of any major psychiatric disorders, and could not have received psychological counseling for at least three months before enrolling in the study. The participants completed surveys of their mood and quality of life—determined by measuring physical and psychological symptoms of HIV disease and treatment—at regular intervals for one year after entering the study. CD4 counts, viral load and adherence to HIV treatment were also assessed.

Berger’s group found that the CBSM intervention had no impact on participants’ viral load, CD4 count or adherence to antiretroviral therapy during any point of the study. However, it did improve mood and their quality of life, with sustained improvements for approximately eight months after completing the intervention. People receiving no intervention did not experience these improvements, and the difference between the group receiving CBSM and the group receiving no intervention was statistically significant, meaning that the difference was too large to have occurred by chance. The degree of improvement was especially large in the CBSM participants who entered the study with higher levels of depression and anxiety.

Berger’s team suggests that the lack of effect on CD4 counts or viral load in this study may be a result of the fact that psychological factors have little impact on clinical well-being in a general population of people living with HIV who are on effective antiretrovirals. The team hypothesizes, however, that a clinical benefit and improvements in adherence might be seen if health care providers limit psychological interventions to people with higher levels of depression and anxiety.

It should be noted that some studies of both group and individual interventions designed to improve people’s knowledge, encourage positive thinking, and decrease depression and anxiety have found improvements in adherence when these interventions were targeted to people with mood disorders and adherence problems.

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Greg747, Patchogue, NY, 2008-03-26 11:29:41
This research bolsters my point that the re-tooled Ryan White Act of '06 was a disaster to PWAs. Mandating 'clinical medical indicators' for program outcomes (to receive federal funding) was and is wrong. I will repeat the refrain, again, we PWAs are more than just presciptions! We need food, shelter, warmth, and counselling services to live.

Nikki, philadelphia, 2008-03-25 16:23:32
I have never had a problem w/adherence. I avoid group because member seemed to get off the subject and discuss everything but issues they need to discuss. Often the member come for the food, take cell phone calls, play their CD walkman, discuss fashion etc. I feel better meditating at home among other things