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.

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Research Project (R01)
Project #
1R01AT002035-01
Application #
6696184
Study Section
Special Emphasis Panel (ZRG1-AARR-8 (03))
Program Officer
Caldwell, Sheila
Project Start
2003-08-15
Project End
2008-04-30
Budget Start
2003-08-15
Budget End
2004-04-30
Support Year
1
Fiscal Year
2003
Total Cost
$634,545
Indirect Cost
Name
University of Miami Coral Gables
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
625174149
City
Coral Gables
State
FL
Country
United States
Zip Code
33146
Metaweh, Maria; Ironson, Gail; Barroso, Julie (2016) The Daily Lives of People With HIV Infection: A Qualitative Study of the Control Group in an Expressive Writing Intervention. J Assoc Nurses AIDS Care 27:608-22
Ironson, Gail; O'Cleirigh, Conall; Leserman, Jane et al. (2013) Gender-specific effects of an augmented written emotional disclosure intervention on posttraumatic, depressive, and HIV-disease-related outcomes: a randomized, controlled trial. J Consult Clin Psychol 81:284-98
Leserman, Jane; Ironson, Gail; O'Cleirigh, Conall et al. (2008) Stressful life events and adherence in HIV. AIDS Patient Care STDS 22:403-11
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Ironson, Gail; Hayward, H'Sien (2008) Do positive psychosocial factors predict disease progression in HIV-1? A review of the evidence. Psychosom Med 70:546-54
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Leserman, Jane; Zolnoun, Denniz; Meltzer-Brody, Samantha et al. (2006) Identification of diagnostic subtypes of chronic pelvic pain and how subtypes differ in health status and trauma history. Am J Obstet Gynecol 195:554-60; discussion 560-1
Leserman, Jane (2005) Sexual abuse history: prevalence, health effects, mediators, and psychological treatment. Psychosom Med 67:906-15
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