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 HIV viral loads and higher CD4 counts are markers of more successful disease management. They indicate that an HIV-infected person isn’t progressing towards more advanced stages of the disease and is less likely to spread the infection through bodily fluids.

Of the total sample, 72% of the participants completed their interventions and 55% were available for 3-month follow-up. Attrition rates did not differ between groups.

At 3-month follow-up, MBSR participants were significantly more likely to report higher levels of mindfulness, higher levels of problem solving as a coping strategy, and higher levels of life satisfaction. Additionally, these participants were significantly less likely to report being aggressive. MBSR participants also gave significantly more correct Stroop responses when confronted with interference from words with a negative emotional valence at post-intervention.

There were no significant between-group differences in perceived stress, tendencies toward rumination and distraction, illness-related anxiety, disease burden, self-reported medication of missed medication doses, or CD4 counts.

MBSR participants were significantly more likely to change their HIV viral loads over the course of the study from high to low (44%) than from low to high (14%). Control group participants, on the other hand, were equally likely to switch viral load categorizations from high to low (27%) and low to high (27%).

The results suggest that MBSR may help reduce high viral loads and maintain low viral loads in HIV-infected youth. This is important because lower viral loads prevent disease progression and lower the risk of transmission. The results also support a role for MBSR in enhancing problem solving, life-satisfaction, and emotional regulation in youth with HIV-infection.

The study is limited by its relatively small sample size and relatively high attrition rate. None of the variables that were significant at 3-month follow up were also significant at immediate post-intervention testing and vice versa, raising concerns about the robustness of the findings.

Reference:

Webb, L., Perry-Parrish, C., Ellen, J., & Sibinga, E. (2017). Mindfulness instruction for HIV-infected youth: A randomized controlled trial. AIDS Care.

[Link to abstract]