A growing body of research with HIV positive persons indicates that a variety of biobehavioral strategies for stress management can not only mitigate psychological distress and improve coping skills, but also enhance immune function through neuroendocrine-immune system modulation. Insights as to why such interventions might work are emanating from research in psychoneuroimmunology (PNI). The PNI paradigm accounts for the negative impact of perceived stress on HIV disease progression, primarily as a function of immunosuppression mediated by elevated cortisol. Thus, chronic and / or severe psychological stress associated with having HIV disease may further compromise immune functioning over the illness trajectory. Because of the partial effectiveness of traditional interventions tested to date, as well as to expand the repertoire of potential stress management interventions, we propose a randomized clinical trial for stress management in HIV disease: 1) A cognitive behavioral approach will include coping effectiveness training combined with relaxation training to create a fairly traditional intervention we will call positive living; 2) We will test Tai Chi training and spiritual growth group interventions two potentially effective alternative stress management techniques derived from the PNI framework, against the traditional approach; 3) We will test the effectiveness of booster sessions for 4 months following the original interventions for all groups and for 8 months for a randomly selected half of all groups; 5) A qualitative component of the study will further enhance understanding of the influences of stress management interventions for people living with HIV disease. The overall purpose of the proposed study is to determine whether three short-term stress management interventions along with booster strategies will improve and sustain improvements in the domains of psychosocial functioning, quality of life, and somatic health among persons with varying stages of HIV disease. Multiple indicators derived from the PNI paradigm will measure these three outcome domains, along with neuroendocrine mediation.
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