The proposed four year research project will evaluate the effects of group psychotherapy intervention on mood, coping, risk behavior, and treatment adherence outcomes among women and men with HIV-related disease. This intervention to be evaluated is supportive-expressive group therapy, a program whose effectiveness was first demonstrated to reduce mood disturbance and pain and, surprisingly, to improve survival time of metastatic breast cancer patients. This treatment has also been found to be successful in reducing emotional distress among depressed HIV-positive men. Evaluation of this intervention will be based on changes in psychosocial variables over the course of 18 months after recruitment of 200 men and women infected with HIV in a prospective randomized clinical trial. Half of the subjects will be randomly assigned to receive supportive-expressive group therapy; the other half an educational intervention. All subjects will be assessed at baseline and 6-, 12-, and 18-months. This study would allow us to address three major research aims: 1) Examine the effectiveness of supportive-expressive group therapy in comparison to an educational intervention in improving the quality of life and promoting health-enhancing behavior of HlV-positive men and women. We predict that HIV-positive persons who receive supportive-expressive group therapy will improve significantly more than those who receive an educational intervention, as assessed by: a) an improved quality of life, including less mood disturbance; b) improved coping; c) reduced sexual and drug use risk behavior; and d) better adherence to recommended medical treatment. 2) Examine mediators of change associated with group treatment. We hypothesize that improvements in social support, access to resources, and use of active coping strategies will be associated with group treatment effects and will lead to reductions in mood disturbance, which in turn will lead to reduced sexual and drug use risk behaviors. Furthermore, increased social support, use of resources, and active coping lead to improved adherence to recommended medical treatment. We will also examine for possible sex and ethnic differences in responsiveness to participation in group therapy. 3) ldentify psychosocial variables that are predictors of outcome. We expect that baseline mood disturbance, emotional expressiveness, social support, access to resources, and active coping will predict changes in risk behavior and treatment adherence independent of any treatment effects. The results of this study would provide information relevant to three clinical decisions: a) to determine whether or not to use supportive- expressive group therapy to improve psychosocial functioning of HIV- positive people; b) to identify people most likely to benefit from participating in supportive-expressive group psychotherapy; and c) to identify those most in need of psychosocial intervention to promote health-enhancing behavior.
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