Acceptance Therapy to Reduce Avoidance Coping in HIV/AIDS

Elizabeth Gifford, San Mateo Medical Center
HIV/AIDS Policy & Health Care Financing

Background: Mental health problems are prevalent in patients with HIV/AIDS. A recent survey of 210 HIV infected patients treated in the San Mateo Medical Center found that 56% met diagnostic criteria for at least one psychiatric disorder (e. g.,posttraumatic stress disorder, depression, or acute stress disorder). Of these patients, 37% met criteria for two psychiatric disorders and 31% met criteria for of all three disorders. Although every effort is made to provide psychiatric treatment to these patients, the above study found that the majority of patients (59%) received no mental health treatment. Unfortunately, even when patients do receive mental health treatment, these treatments have not been designed for patients suffering from multiple issues with complex health needs. Most empirically supported mental health treatments have been developed and tested in carefully controlled populations with only one mental health disorder and are not aimed at patients facing severe medical and health challenges with significant psychiatric comorbidities. The health costs of ongoing high-risk behavior are particularly high for HIV/AIDS patients, and their coping resources are burdened by heavy demands. Therefore, HIV/AIDS patients with psychiatric problems need mental health treatment that can help them improve their functioning across multiple life domains and disorders at the same time. Avoidance coping has been identified as an important mediator of emotional distress, comorbid psychiatric conditions, reduced quality of life, reduced physical health, and poor medication adherence in patients with HIV/AIDS. Such maladaptive avoidance is a common problem across anxiety disorders, depressive disorders, substance use disorders, chronic pain, as well as normal emotional responding to HIV infection (e. g.,guilt, anger, sadness, internalized stigma) and issues with medical care (e. g., problems with medication adherence). Fortunately, behavioral acceptance-based treatments that attempt to decrease avoidant responding, such as Acceptance and Commitment Therapy and Dialectical Behavior Therapy, have been shown to improve a variety of disorders including depression/ anxiety disorders, substance use, and chronic pain, among others. Acceptance-based behavioral treatments attempt to reduce patients' unhealthy avoidance behaviors (e. g., using substances or alcohol, engaging in risky sexual behavior, isolating socially, restricting physical activity, failing to comply with medical care and medication regimens, etc.) and to increase their ability to engage in adaptive behaviors, such as health related self-care, even when such actions feel difficult and distressing.

Methods: We will develop an acceptance-based behavioral treatment to empower HIV-infected patients to reduce avoidance coping and make constructive behavioral choices consistent with their health needs. We will pilot test this intervention as an addition to treatment as usual in a public primary care clinic for patients with HIV/AIDS. This therapy is innovative in its attempt to treat a patient population with mixed mental health problems with a single therapy targeting a core problem that decreases health across psychiatric domains.

Results: We anticipate that treatment targeting avoidance coping will both reduce avoidance coping and improve quality of life for patients with HIV/AIDS and mental health problems.

Conclusion: Adapting pre-existing acceptance based behavior therapies to the needs of HIV/AIDS patients with various mental health disorders may provide an effective treatment for the complex and mixed groups of multiply diagnosed patients seen in the majority of health care clinics.