Academic journal article Journal of Cognitive Psychotherapy

The Development of a Computer-Administered Cognitive-Behavioral Intervention to Promote Stress Management among HIV+ Women

Academic journal article Journal of Cognitive Psychotherapy

The Development of a Computer-Administered Cognitive-Behavioral Intervention to Promote Stress Management among HIV+ Women

Article excerpt

Few interventions address the unique psychosocial needs of HIV+ women. To address this unmet need, we developed and pilot tested a brief, cognitive-behavioral computerized stress management intervention with 60 HIV+ women. This interactive intervention included modules that promoted cognitive appraisal skills, encouraged appropriate coping responses and problem solving skills, and provided relaxation training. In this report we provide an overview of the intervention and present acceptability and feasibility data from a pilot intervention trial. All participants successfully navigated the computerized program and most found the intervention to be acceptable. Overall, the results indicated that a brief, computerized stress management intervention was a feasible and acceptable approach to enhance stress management skills; use of this intervention has the potential to reduce distress and improve health outcomes among HIV+ women.

Keywords: cognitive-behavioral; stress management; stress; coping; HIV; women

As of 2006 there were an estimated 39.5 million individuals diagnosed with HIV worldwide (UNAIDS/WHO, 2006), with approximately half a million people living with HIV in the United States (CDC, 2008). Despite increased prevention efforts directed towards people living with HIV, new infection rates have been on the rise with approximately 56,300 new cases of HIV diagnosed in the United States in 2006 (Hall et al., 2008). Advances in HIV care over the past decade have improved the long-term health outlook for HIV+ people and provided reason for hope and optimism for many who are living with this disease (Schackman et al., 2006). With improved prognosis and extended survival time of approximately 24 years following initiation of HIV medications, HIV has come to be viewed as a chronic illness, with long-term survival dependent on the patient's capacity to adhere to an often challenging medication regimen (Schackman et al., 2006; Sikkema, Hansen, Meade, Kochman, & Lee, 2005). Within this context, there is now a growing population of individuals living with HIV faced with the challenge of coping with both disease specific and general life stressors associated with a chronic, highly stigmatized disease (Bower, Kemeny, & Fawzy, 2002). To address the needs of HIV+ individuals, stress management training is increasingly viewed as integral to the broader goals of self-care and quality of life (e.g., Brown & Vanable, 2008; Ironson et al., 2002; Kelly & Kalichman, 2002). However, few interventions to promote coping among HIV+ women have been developed or tested, despite the fact that women have been increasingly affected by the HIV epidemic in recent years. In this paper, we describe the development of a computerized cognitive-behavioral stress management intervention program to provide coping skills training tailored to the needs of HIV+ women.

Although HIV shares some common features with other chronic illnesses, HIV disease poses a number of unique challenges that heighten patients' vulnerability to psychological adjustment difficulties (Bogart et al., 2000; Jenkins & Coons, 1996; Morrow, Costello, & Boland, 2001; Siegel, Karus, & Dean, 2004). Furthermore, HIV+ women experience distinct challenges that differ from other subgroups of HIV-infected individuals. One prominent challenge for HIV+ women is caretaking for children, oftentimes as the sole caregiver (Siegel, Karus, & Dean, 2004). Associated difficulties include providing care for children who are also infected with HIV (Semple et al., 1993) and navigating HIV disclosure to children (Marcenko & Samost, 1999). HIV infection also poses challenges within the context of relationships with partners. For example, some women are faced with the challenge of HIV disclosure in the context of relationships involving domestic violence (Jenkins & Coons, 1996). Given differential power in sexual relationships, HIV+ women may also have difficulties negotiating safer sexual practices with their partners (e. …

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