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HIV+ men show lasting reduction in viral load after wellness program

Posted 01.15.2020 | by AMRA

Taken properly, anti-retroviral medications successfully reduce viral loads in people living with HIV infections, helping them to maintain health and reduce disease transmission. Persons with HIV who use methamphetamines often fail to get the full benefit of their anti-retroviral medications. Such stimulant users are more likely to skip medication doses, engage in high-risk sexual behavior, and show signs of hastened AIDS progression.

Carrico et al. [Journal of the International AIDS Society] studied whether an add-on intervention designed to boost positive affect can increase the efficacy of a contingency management program. Contingency management involved offering financial rewards for clean drug tests, and the add-on intervention included elements of mindfulness training.

The researchers randomly assigned 110 HIV+ men who engaged in anal sex with other men and tested positive for methamphetamine use (average age = 43 years; 43% Caucasian) to the add-on intervention called Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS), or an attention-control condition.

Both groups also participated in a 3- month contingency management program offering financial rewards for maintaining stimulant-free urine samples. The period of active contingency management coincided with participation in the 3 month-ARTEMIS or attention-control group, and financial rewards were not continued after 3 months.

The ARTEMIS intervention consisted of 5 individual 1-hour training sessions delivered over a 3-month period. The program provided training in noticing and savoring positive events, mindfulness, gratitude, altruism, self-compassion, positive reappraisal, and reaching attainable goals. The training included breath-focused and loving-kindness meditations, values clarification, and psychoeducation on stimulant withdrawal. The attention-control condition consisted of 5 individual 1-hour sessions in which participants were administered psychological tests and engaged in neutral writing exercises.

Assessments occurred at baseline, and at 3, […]

January 15th, 2020|News|

Youth with HIV show reduced viral load after MBSR

Posted 11.16.2017 | by AMRA

Youth living with HIV have to cope not only with the psychological stress of having a chronic disease, but also with the challenges of taking medications regularly and following through with scheduled medical appointments. Successful coping may be particularly difficult for HIV-infected adolescents and young adults who are still developing their self-regulation skills and working through developmental issues regarding identity formation.

Webb et al. [AIDS Care] conducted a randomized, controlled study of Mindfulness-Based Stress Reduction (MBSR) to see if it could enhance psychological wellbeing, self-regulation, and disease management in youth with HIV.

The researchers randomly assigned 72 youth with HIV (age range = 14-22 years; 53% male) to either MBSR or a health education course. The MBSR intervention adapted its vocabulary (but not its content or structure) to better suit the needs of urban youth. The health education course was structured to match MBSR in terms of the number and length of its sessions, as well as its group structure and size. The course was designed to cover topics such as nutrition, exercise and puberty.

Participants completed self-report measures of mindfulness (the Mindful Attention and Awareness Scale), perceived stress, coping styles, aggression, quality of life, and medication adherence at baseline, post-intervention, and 3-month follow-up. They also completed Stroop-like tasks to assess their ability to regulate attention in the presence of interfering emotionally positive, negative, or neutral stimuli

HIV viral loads (measures of the severity of HIV infection) and CD4 counts (measures of immune system functioning) were obtained from participants’ medical records. Participants were categorized as having either low viral loads (under 100 viral copies per mL) or higher viral loads (over 100 viral copies per mL).

Low […]

November 16th, 2017|News|

MBCT for Long-Term HIV+ Patients

Posted from archive: 11.04.2013 | by AMRA

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While human immunodeficiency virus (HIV) infection has become a manageable chronic illness, long-term patients, especially those who contracted the virus before the advent of the newer treatments, still experience shortened life spans and remain subject to a variety of complications, iatrogenic side-effects, and an overall poorer quality of life.

Gonzalez-Garcia et al. [AIDS and Behavior] studied the psychological and immunological effects of the Mindfulness Based Cognitive Therapy (MBCT) program on long-term HIV+ patients to discover whether MBCT could lessen their burden of illness. All participants became HIV+ prior to 1996 and had received combined antiretroviral treatment for at least five years. The researchers randomly assigned forty patients to either MBCT or a treatment-as-usual control, assessing participants at baseline, 8 weeks, and 20 weeks.

After intervention, MBCT participants had a higher quality of life, reduced perceived stress, fewer depressive and anxiety symptoms, and higher CD4 immune cell counts. All of these effects were both large and significant, with improvements being either maintained or amplified at follow-up. For example, MBCT participants had mean Beck Depression Inventory (BDI-II) scores of 25.1 at baseline, 10.1 at 8 weeks, and 7.1 at 20 weeks, while control scores remained virtually unchanged (21.3 at baseline and 19.0 at 20 weeks).

Similarly, MBCT CD4 cell counts rose from 555 cells/mL at baseline to 614 at 8 weeks and 681 at 20 weeks, while control counts gradually declined. MBCT participants showed large quality of life improvements in energy, emotional reactions, social isolation, and physical mobility, and a moderate improvement in sleep, while there were no comparable improvements in the control group. The very low (5%) MBCT drop out rate suggests MBCT is […]

January 23rd, 2014|News|

Mindful Clinicians May Provide Higher Quality Care

Posted from archive: 10.22.2013 | by AMRA

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Can mindfulness indeed improve the quality of clinician-patient interactions? Beach et al. [Annals of Family Medicine] audiotaped clinician-patient interactions between 45 physicians, nurse practitioners, and physician assistants and 437 HIV-positive patients. Taped interactions were coded for content, and analyzed for how patient, centered, as opposed to clinician-centered, the interactions were.

Patient-centered interactions included activities such as rapport building, discussing psychosocial/ lifestyle issues and patient-initiated questions, and focusing on emotions, as opposed to interactions like clinician, initiated biomedical questions and directive statements. The research team also measured how mindful the caregivers were based on their self, reports on the Mindful Attention Awareness Scale (MAAS), and analyzed the associations between clinician mindfulness and the quality of clinician, patient interactions.

When highly mindful clinicians (the MAAS upper tertile) were compared with less mindful clinicians (the MAAS lower tertile), mindful clinicians’ interactions were more patient, centered, with substantially more rapport building and psychosocial focus. Mindful clinicians met with their patients longer (an extra 5.8 minutes on average), exhibited more positive emotional tone, and were rated as more effective communicators by their patients. Patients were also more satisfied with the overall care that these more mindful clinicians provided.

Reference:

Beach, M. C., Roter, D., Korthuis, P. T., Epstein, R. M., Sharp, V., Ratanawongsa, N., . . . Moore, R. D. (2013). A multicenter study of physician mindfulness and health care quality. The Annals of Family Medicine, 11(5): 421-428. [PMID: 24019273]

[Link to abstract]

January 22nd, 2014|News|