Anxiety Reduction Treatment for HIV+ Individuals

描述：患有艾滋病毒/艾滋病的人比一般人群经历更高的焦虑和焦虑障碍率。值得注意的是，这种较高的焦虑症状和障碍率导致药物依从性较差以及晚期疾病预后的指标，包括：CD 4 T细胞计数，病毒载量，健康相关的生活质量，医疗保健利用。研究表明，理想情况下，抗逆转录病毒药物（为艾滋病毒/艾滋病患者处方的主要药物方案）必须以95%的依从率服用才能达到最佳效果，这使得这一人群的药物依从性成为一个特别重要的问题。研究表明，治疗焦虑症状和障碍的跨诊断方法可以非常有效，并适用于广泛的人群，尽管尚未在艾滋病毒/艾滋病人群中进行测试。此外，焦虑减少技术对药物依从性和艾滋病毒症状表达的影响尚未得到研究。 因此，拟议研究提案的总体目标是开发一种基于小组的治疗方案，该方案基于使用跨诊断认知行为框架减少焦虑症状，并与对照组相比测试其疗效。我们计划招募60名成年男性和女性参与者。入选标准包括：HIV+，年龄在18-65岁之间;能够提供知情同意;报告STAI-T评分（> 39;反映临床相关焦虑症状75）所指示的高特质焦虑;并且表现出HAART药物依从性差，定义为在过去三天内错过超过一剂，或在过去一周内超过两剂（例如95%依从性76，77）。两个试点组（n = 5）将运行，以帮助开发和完善跨诊断焦虑治疗方案。之后，将50名寻求治疗的成人（总计n = 60）分配至12个疗程的治疗或对照条件。他们将返回进行2周、4周和12周的随访。因变量将包括：HIV症状、HIV药物依从性、焦虑症状、抑郁症状和焦虑敏感性（对焦虑的恐惧和身体症状）。这项拟议的研究是第一个将艾滋病毒的治疗/管理与阻碍艾滋病毒管理成功的焦虑问题的治疗相结合的研究。所提出的基于综合性小组的治疗是创新的，因为（a）它整合了身体疾病和精神障碍的治疗，承认一种疾病的成功管理与另一种疾病的成功控制交织在一起;（B）它使用了一种由培训提案共同发起人（Norton博士）开发的新型跨诊断焦虑治疗方法，该方法允许纳入具有一系列焦虑症状的患者。

DESCRIPTION: Individuals suffering from HIV/AIDS experience much higher rates of anxiety and its disorders than the general population. Notably, such higher rates of anxiety symptoms and disorders lead to poorer medication adherence as well as indicators of advanced disease prognosis including: CD4 T-cell counts, viral loads, health-related quality of life, health-care utilization. Research has shown that antiretroviral medication (the primary medication regimen prescribed to individuals with HIV/AIDS) must ideally be taken with a 95% adherence rate to be optimally effective, making medication adherence in this population a particularly important issue. Research has indicated transdiagnostic approaches to treating anxiety symptoms and disorders can be highly efficacious and administered to a broad segement of the population, though it has not yet been tested in the HIV/AIDS population. Additionally, the effect of anxiety-reduction techniques on medication adherence and HIV symptom expression has not been examined. The overarching objective of the proposed research proposal, therefore, is to develop a group-based treatment protocol based on reducing anxiety symptoms using a transdiagnostic cognitive-behavioral framework, and test its efficacy compared to a control group. We plan to recruit 60 adult male and female participants. Inclusion criteria include: HIV+ and between age 18-65; capable of providing informed consent; reporting high trait anxiety indexed by a STAI-T score (> 39; reflecting clinically-relevant anxiety symptoms75); and having demonstrated poor HAART medication adherence, defined by missing more than one dose in the last three days, or more than two doses in the last week (e.g. 95% adherence76, 77). Two pilot groups (n = 5) will be run to help develop and refine a transdiagnostic anxiety treatment protocol. Afterwards, 50 treatment-seeking adults (total n = 60) will be assigned to a 12-session treatment or control condition. They will return for 2-week, 4- week, and 12-week follow up sessions. Dependent variables will include: HIV symptoms, HIV medication adherence, anxiety symptoms, depressive symptoms, and anxiety sensitivity (fear of anxiety and bodily symptoms). The proposed study is the first to integrate treatment/management of HIV with treatment for anxiety problems that impede success of HIV management. The proposed integrative group-based treatment is innovative because (a) it integrates treatment of a physical disease and mental disorder, acknowledging that successful management of one is intertwined with successful control of the other; and (b) it uses a novel transdiagnostic anxiety treatment developed by a co-sponsor on the training proposal (Dr. Norton), which allows for inclusion of patients with a range of anxiety symptoms.