Efficacy of an Emotional Disclosure Intervention in HIV

描述(申请人提供)：随着强有力的联合抗逆转录病毒疗法的出现，艾滋病毒或艾滋病患者现在面临着将这种疾病作为一种慢性病而存活更长时间的前景。除了患有这种慢性病的痛苦之外，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的比率。我们之前的研究和其他研究已经证明了压力、抑郁、缺乏社会支持和回避性应对策略对艾滋病毒感染中的免疫变化和疾病进展的有害影响。对正常成年人和慢性病患者的研究进一步证明，那些通过写作披露创伤事件的人的医疗症状和细胞免疫反应有所改善。因此，本研究的目的是测试HIV感染者通过写作表达情绪的效果。我们将比较两种干预措施，即通过写关于创伤经历的情感披露(实验性)和写关于以下方面的情感中性话题(对照)：HIV疾病进展、健康状况、心理社会变量和健康行为。我们的研究样本将从南佛罗里达州招募感染艾滋病毒的男性和女性。我们将获得200名患者的完整数据，他们将被平均随机分成两组：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写四节课。所有患者将在基线、每次写作时间以及干预后1个月、6个月和12个月进行评估。我们假设，在后续评估中，写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的性行为方面将有更大的下降，而在后续评估中CD4T淋巴细胞、健康相关的生活质量、自尊、幸福感、社会支持和用药依从性将有更大的增加。在情绪披露干预的患者中，我们将进一步确定干预效果如何随着种族、性别、社会经济地位(SES)、虐待/创伤史、最近的应激事件、心理症状、应对策略、社会支持以及情绪披露和深度处理的质量而变化。证实我们的假设将对艾滋病毒感染的男性和女性的治疗具有重要的临床意义，因为这将为通过写作减轻压力作为基于心理和生物的治疗的辅助手段提供理论基础。

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.