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Center for AIDS Prevention Studies (M.A.C., D.B.C., J.M.T., L.M.J.), Department of Medicine and Osher Center for Integrative Medicine (S.F.), University of California, San Francisco, CA.
Address correspondence and reprint requests to Margaret A. Chesney, PhD, National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, MD 20892-2182. E-mail: chesneym{at}mail.nih.gov
OBJECTIVE: This randomized clinical trial was designed to compare the effects of a theory-based coping effectiveness training (CET) intervention with an active informational control (HIV-Info) condition and a waiting-list control (WLC) condition on psychological distress and positive mood in HIV-seropositive gay men.
MATERIALS AND METHODS: The authors recruited 149 self-identified gay or bisexual men who were 21 to 60 years of age, reported depressed mood, and had CD4 levels of 200 to 700 cells/mm3. CET and HIV-Info participants attended 10 90-minute group sessions during the 3-month intervention phase and six maintenance sessions over the remainder of the year. Participants were assessed at baseline and at 3, 6, and 12 months. Data were collected 1992 to 1994, before the introduction of HAART. Analyses were based on the 128 participants who completed the 3-month assessment.
RESULTS: After the 3-month intervention phase, when compared with HIV-Info, CET participants showed significantly greater decreases in perceived stress and burnout, and regression analyses indicated that significant increases in coping self-efficacy mediated the improvements in perceived stress and burnout. Compared with WLC, CET participants also showed significantly greater decreases in anxiety, and regression analyses indicated that significant increases in positive states of mind mediated the improvements in anxiety. Significant treatment group differences for positive morale were maintained at 6 and 12 months. In addition, optimism continued to increase in the CET and HIV-Info treatment groups during the maintenance phase.
CONCLUSIONS: CET can be an effective strategy for managing psychological distress and improving positive psychological states in patients confronting chronic illness.
Key Words: HIV, • AIDS, • coping, • intervention, • stress.
Abbreviations: CET = coping effectiveness training;; HIV-Info = HIV informational control;; WLC = waiting-list control;; MSM = men who have sex with men;; HAART = highly active antiretroviral treatment;; CES-D = Center for Epidemiologic Studies-Depression Scale;; SCID-NP-HIV = Structured Clinical Interview for Diagnostic Statistical Manual-III-Revised: Nonpatient Version for HIV Studies;; STAI = State-Trait Anxiety Inventory;; LOT-R = Life Orientation Test-Revised;; ANOVA = analysis of variance;; ANCOVA = analysis of covariance.
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