This project is a two-year plan to study the efficacy of a mantram (mantra) intervention for interrupting intrusive, stressful thoughts that trigger the stress response in a sample of HIV infected adults. People are living longer with the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) since the advent of highly active anti-retroviral therapy (HAART). However, there is still no cure. It is well documented that living with HIV/AIDS is stressful and evidence suggests that stress may hasten HIV disease progression by increasing viral replication and suppressing the immune response. Stress management intervention studies in the HAART era have shown improvements in both psychological and physiological measures in H1V infected persons using complex combinations of"""""""" cognitive and relaxation therapies. However, no studies have focused on only one intervention or have addressed a spiritual component using a comparable control group to determine which of these interventions is most effective. Epidemiological evidence suggests that spirituality is an important coping resource in HIV/AIDS and is associated with quality of life and well being. A randomized trial (N=60) will be conducted to compare a mantram intervention (n = 30) to an educational control group (n = 30) on primary outcomes of self-reported intrusive thoughts, anxiety, anger, and perceived stress; secondary outcomes of emotion-focused coping, quality of life enjoyment and satisfaction, existential spiritual well being; and tertiary outcomes of salivary cortisol and urinary catecholamines. The intervention will be given over a 10-week period with 5 weekly classes, 4 weekly-automated phone calls, and one final class meeting. Assessments will be conducted at pre-intervention, fifth class midpoint, tenth week post-intervention, and 3-month follow-up. The primary evaluation of intervention efficacy will be conducted using a 2 (group) by 4 (time) mixed ANOVA design with time as a repeated measure. This study is an effort to simplify stress management interventions and to incorporate an element of spirituality, an often-overlooked coping resource for people with HIV. The program is based on a mind-body-spirit philosophy and research on the relaxation response. The study will target both HIV infected men and women, will focus primarily on one intervention technique, and will include a comparable control group for a strong experimental design.
