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.

Public Health Relevance

HIV/AIDS is a worldwide pandemic that affects over a million individuals in the United States alone. Individuals afflicted with this disease have much higher rates of anxiety symptoms and disorders than the general population. Such high rates of anxiety symptoms and disorders are related to suboptimal medication adherence and poorer disease prognosis. The broad objective of the proposed study is to develop and empirically test a program for anxiety reduction in the HIV+ population, contributing to enhanced disease management. This goal will be accomplished by developing, pilot testing, and refining a transdiagnostic anxiety-reduction program for the HIV+ population while examining outcome variables including medication adherence and disease prognosis.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1-AARR-C (22))
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Stoff, David M
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University of Houston
Schools of Arts and Sciences
United States
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