This project is a randomized clinical trial of a coping intervention, Coping Effectiveness Training (CET), which is designed to improve the psychological health of HIV+ and HIV- homosexual males. The research addresses the need for interventions to assist homosexual males in coping with the HIV epidemic. It also applies what has been learned in descriptive research on stress and coping to a theory-based coping intervention that is relevant to a wide range of people confronted with the stresses of the hiv epidemic. The research has five aims: (1) to determine the relative efficacy of CET, a social contact control, (SCC) and a delayed-treatment control (DTC) in decreasing depression and anxiety, and increasing positive morale in asymptomatic HIV+ and HIV- men, controlling for neuropsychological status; (2) to compare the efficacy of CET, SCC, and DTC in reducing maladaptive coping and increasing adaptive coping; (3) to determine the extent to which changes in depression, anxiety and positive morale are mediated by changes in coping; (4) to identify the characteristics of men that are associated with effects of CET on coping, depression, anxiety and positive morale; and (5) to examine the extent to which changes in coping, anxiety and positive morale following CET and SCC are maintained over 6 and 12- month follow-up periods. Subjects will be 120 HIV+ asymptomatic homosexual males and 120 HIV- homosexual males who use maladaptive coping strategies and report current depressed mood. A 2 X 3 factorial design will be used in which subjects will be stratified on the basis of serostatus and randomly assigned within strata to one of three groups: CET, SCC, or DTC. CET is based on a cognitive theory of stress and coping and uses a cognitive-behavioral approach that is based on established procedures of cognitive-behavioral interventions. CET provides a meta-strategy for choosing among coping behaviors to maximize effectiveness in stressful situations by also providing training is appraisal of stressful situations, specific cognitive-behavioral coping strategies, appraisal- coping fit, and the use of social support. Training consists of 10 weekly 2-hr group sessions and 3 monthly maintenance sessions. Assessments will be made at preintervention, postintervention, and at 6-month and 12-month follow-ups to evaluate the efficacy of the intervention conditions on coping and the psychological health outcomes, controlling for neuropsychological status.
