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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Predoctoral Individual National Research Service Award (F31)
Project #
5F31MH099922-03
Application #
8876800
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Stoff, David M
Project Start
2013-06-01
Project End
2016-05-31
Budget Start
2015-06-01
Budget End
2016-05-31
Support Year
3
Fiscal Year
2015
Total Cost
Indirect Cost
Name
University of Houston
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
036837920
City
Houston
State
TX
Country
United States
Zip Code
77204
Brandt, Charles P; Paulus, Daniel J; Garza, Monica et al. (2018) A Novel Integrated Cognitive-Behavioral Therapy for Anxiety and Medication Adherence Among Persons Living With HIV/AIDS. Cogn Behav Pract 25:105-118
Wong, Celia C Y; Paulus, Daniel J; Lemaire, Chad et al. (2018) Examining HIV-Related stigma in relation to pain interference and psychological inflexibility among persons living with HIV/AIDS: The role of anxiety sensitivity. J HIV AIDS Soc Serv 17:1-15
Brandt, Charles P; Jardin, Charles; Sharp, Carla et al. (2017) Main and interactive effects of emotion dysregulation and HIV symptom severity on quality of life among persons living with HIV/AIDS. AIDS Care 29:498-506
Heggeness, Luke F; Brandt, Charles P; Paulus, Daniel J et al. (2017) Stigma and disease disclosure among HIV+ individuals: the moderating role of emotion dysregulation. AIDS Care 29:168-176
Brandt, Charles; Zvolensky, Michael J; Woods, Steven P et al. (2017) Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature. Clin Psychol Rev 51:164-184
Brandt, Charles P; Paulus, Daniel J; Jardin, Charles et al. (2017) Examining anxiety sensitivity as an explanatory construct underlying HIV-related stigma: Relations to anxious arousal, social anxiety, and HIV symptoms among persons living with HIV. J Anxiety Disord 48:95-101
Brandt, Charles Philip; Bakhshaie, Jafar; Jardin, Charles et al. (2017) The Moderating Effect of Smoking Status on the Relation between Anxiety Sensitivity, Sexual Compulsivity, and Suicidality among People with HIV/AIDS. Int J Behav Med 24:92-100
Brandt, Charles P; Sheppard, David P; Zvolensky, Michael J et al. (2016) Does Age Influence the Frequency of Anxiety Symptoms and Disorders in HIV Disease? J HIV AIDS Soc Serv 15:380-403
Paulus, Daniel J; Jardin, Charles; Bakhshaie, Jafar et al. (2016) Anxiety sensitivity and hazardous drinking among persons living with HIV/AIDS: An examination of the role of emotion dysregulation. Addict Behav 63:141-8
Brandt, Charles P; Zvolensky, Michael J; Daumas, Stephanie D et al. (2016) Pain-related anxiety in relation to anxiety and depression among persons living with HIV/AIDS. AIDS Care 28:432-5

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