Efficacy of an Emotional Disclosure Intervention in HIV

描述（由申请人提供）：随着强效抗逆转录病毒联合治疗的出现，艾滋病毒或艾滋病患者现在面临着这种慢性疾病寿命延长的前景。除了患有这种慢性疾病的痛苦之外，艾滋病毒感染者还被证明有很高的性虐待和身体虐待、其他生活压力和创伤以及抑郁症的发生率。我们以前的研究和其他研究已经记录了压力，抑郁，缺乏社会支持和逃避应对策略对艾滋病毒感染的免疫变化和疾病进展的不利影响。对正常成年人和慢性病患者的研究进一步证明，通过写作披露创伤事件的人的医学症状和细胞免疫反应有所改善。因此，本研究的目的是测试艾滋病病毒感染者通过书写进行情绪表露的有效性。我们将比较两种干预措施，即通过书写创伤经历（实验）和书写情感中性主题（对照）的情感披露，内容包括：艾滋病进展、健康状况、心理社会变量和健康行为。我们将从南佛罗里达招募HIV感染男性和女性的研究样本。我们将获得200名患者的完整数据，这些患者将被随机分为两组：干预组（情绪披露/处理）将写四次关于他们的压力源的会议。控制组将就琐碎的话题进行四次写作。所有患者将在基线、每次书写以及干预后1个月、6个月和12个月进行评估。我们假设，写下创伤经历的受试者在HIV RNA病毒载量、HIV和非HIV躯体症状、尿液和唾液皮质醇、心理困扰、被动和自责应对策略以及危险性行为方面会有更大的减少，而在CD 4 T淋巴细胞、健康相关的生活质量、自尊、幸福感、社会支持方面会有更大的增加，以及随访评估时的药物依从性。在情绪表露干预的患者中，我们将进一步确定干预的有效性如何随种族、性别、社会经济地位（SES）、虐待/创伤史、最近的压力事件、心理症状、应对策略、社会支持以及情绪表露和深度处理的质量而变化。证实我们的假设将有重要的临床意义的治疗艾滋病毒感染的男性和女性，它将提供一个合理的使用压力减少通过写作作为一种辅助心理和生物治疗。

DESCRIPTION (provided by applicant): With the advent of potent combination antiretroviral therapy, persons with HIV or AIDS now face the prospect of living longer with this disease as a chronic condition. In addition to the distress of having this chronic illness, persons with HIV infection have been shown to have high rates of sexual and physical abuse, other life stresses and traumas, and depression. Our previous research and others have documented the detrimental impact of stress, depression, lack of social support and avoidant coping strategies on immune changes and disease progression in HIV infection. Studies in normal adults and those with chronic illness have further documented improvements in medical symptoms and cellular immune response among those who disclose traumatic events through writing. Thus, the goal of the current study is to test the efficacy of emotional disclosure through writing in patients with HIV infection. We will compare two interventions, that is, emotional disclosure through writing about traumatic experiences (experimental) to writing about emotionally neutral topics (control) on the following: HIV disease progression, health status, psychosocial variables, and health behavior. Our study sample of HIV infected men and women will be recruited from South Florida. We will obtain completed data on 200 patients who will be equally randomized to one of two groups: The intervention group (emotional disclosure/processing) will write for four sessions about their stressors. The control group will write for four sessions on trivial topics. All patients will be assessed at baseline, each writing session and at one, six and twelve months post intervention. We hypothesize that subjects who write about traumatic experiences will have greater reductions in HIV RNA viral load, HIV and non-HIV somatic symptoms, urinary and salivary cortisol, psychological distress, passive and self-blaming coping strategies, and risky sexual behaviors, and greater increases in CD4 T-lymphocytes, health related quality of life, self-esteem, well-being, social support, and medication adherence at the followup assessments. Among patients in the emotional disclosure intervention, we will further determine how the efficacy of the intervention varies as a function of race, gender, socio-economic status (SES), abuse/trauma history, recent stressful events, psychological symptoms, coping strategies, social support, and quality of emotional disclosure and depth processing. Confirmation of our hypotheses will have important clinical implications for the treatment of HIV infected men and women in that it will provide a rationale for the use of stress reduction through writing as an adjunct to psychological and biological based treatments.