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AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Efficacy of psychological therapies for people with HIV disease R. Bor
a
a
Psychology Division , City University , Northampton Square, London, EC1V 0HB, UK Published online: 25 Sep 2007.
To cite this article: R. Bor (1991) Efficacy of psychological therapies for people with HIV disease, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 3:4, 405-407, DOI: 10.1080/09540129108251599 To link to this article: http://dx.doi.org/10.1080/09540129108251599
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
405
AIDS CARE,VOL. 3, NO. 4,1991
Efficacy of psychological therapies for people with HIV disease R. BOR Downloaded by [University of Sydney] at 22:09 31 December 2014
Psychology Division, City University, Northampton Square, London EC1 V OHB, UK
The association between HIV disease and psychological morbidity was once again confirmed by research presented at the Seventh International Conference on AIDS in Florence in June 1991. Each year, the complex issues which link a positive HIV test result with psychological problems become clearer. We now believe that anxiety and depression are the most frequently described psychological symptoms in patients with AIDS (Moatti, MB2062; Atkinson, MB2105; Christiania, MB2107; Dunbar, MB2126; Misrach, WB2401), and it is noteworthy that this seems to be true of patients in Europe, the USA and Australia. The presence of these symptoms may correlate with patients’ access to social support, perceptions of illness, ‘risk group’ and stages of illness (Murphy, WD4276; Stoll, WB2385; Agnelli, WB2386; Kelly, MD4020; Remieis, MD105; Camping, MD4050). Up to a third of HIV infected patients referred for psychological treatment have received professional care for psychological problems prior to their HIV diagnosis in the Netherlands (Burren, MB2104) and the US (Lynch, MB2117). Presumably, an HIV diagnosis can reactivate or exacerbate psychological symptoms. Questions about racial differences in the extent of psychological symptoms were also raised. Black men with HIV in the USA may be more likely to be diag-
nosed with a psychiatric problem than their white counterparts (Cochran, WB2394) although access to treatment and ethnically sensitive professional services may be more limited than for white males infected with HIV (Nokajama, MB4044). Psychiatric disorder among homeless HIV infected people may be greater than for other patients with HIV (Wolfe, WD4043). There is a hint that American psychiatrists are more liberal in diagnosing psychiatric problems for example, than the Dutch (or are Americans truly more disturbed than others?). Perhaps more tolerant views of homosexuality in Europe account for this (Buuren, MB2104). There were no reports from developing countries with which to compare and contast these differences. Children infected with HIV will increasingly require specialist psychological support (Bertolini, WB2391). Many of these findings hint at some of the key issues in mainstream psychiatry; poverty and mental health, access of minorities to specialists services, reliability in psychiatric diagnosis and the relationship between social conditions and mental health. While our understanding of psychological problems faced by people with HIV improves, what of the therapies and interventions by specialists to help patients? What is on offer? Does it work? Can others use these approaches and techniques?
Downloaded by [University of Sydney] at 22:09 31 December 2014
406 FLORENCE SUMMARIES:R. BOR Outcome in HIV/AIDS behavioural research is linked to different research questions. Different outcomes include seroprevalence, psychological morbidity, knowledge about HIVIAIDS, and coping (Mhloyi, keynote speaker on psychosocial aspects of HIV). Symptom relief is the most commonly measured outcome in research into psychological problems associated with an HIV/ AIDS diagnosis. Douzenis (MB2135) studied 200 consecutive referrals of HIV patients to a liaison psychiatry service in a London hospital. Most patients were diagnosed with adjustment reaction problems (26%), alcohol and drug related syndromes (21%) and affective disorder ( 14%). Anti-depressants and other psychotropic medication was given to 27% of the patients. It is worth noting that 53% of the patients were seen only once by psychiatrists and long-term help was provided in only a minority of cases (6%). Whether this was because brief interventions were effective or because patients defaulted at follow-up is unclear. This does suggest, however, that psychological care need not require a long term commitment for patients and specialists in many cases. Anti-psychotic medication was linked with a deterioration in cognitive performance and a possible exacerbation of symptoms associated with HIV disease in 25 HIV positive schizophrenic patients in Milan (Altamura, MB2119). Nonetheless, the treatment appeared to ameliorate some of the psychopathological symptoms in these patients. The absence of a control group in the study makes it difficult to comment of the efficacy of the treatment per se. Catalan (MB2026) compared the prevalence, nature and development of psychosocial problems of HIV infected haemophiliacs with non-infected haemophiliacs. The level of psychosocial distress in the HIV infected group was marginally greater than in the non-infected group at follow-up a year later. There was no information on the intervention (if any) for either group. Consequently, it is not known whether time or the intervention was the healer.
A much wider range of psychotherapeutic approaches with people with HIV/AIDS have been described at previous international AIDS conferences. Only a handful were presented at the Florence Conference. Cognitive group therapy, for example, was offered to gay men with HIV suffering with anxiety and depression (Emmott, WD4277). The 10 week course of therapy significantly altered feelings of depression and anxiety in group members who completed the course although 10 dropped out before the sessions were completed. The authors note that treatment effects were smaller for those in the group who had an AIDS diagnosis. Cognitive group therapy may be a cost-effective approach for helping patients, but the effect of group support per se (independent of the approach) was not controlled for, and for this reason may itself be therapeutic for some patients. While repeated HIV test taking cannot be thought of as a psychotherapeutic intervention, it has been noted that emotional distress associated with the test taking decreases over time (Jacobsberg, MD4222). Psychotherapy (presumably psychodynamic in orientation) was found to ameliorate psychotic and neurotic symptoms in HIV negative and HIV positive subjects who had put themselves at risk for HIV (Carta, MD4067). Since diagnostic criteria, psychotherapeutic procedures and sample selection were not described, it is difficult to evaluate this study. There is little firm evidence to suggest that psychological therapies have a significant impact on the nature, severity and course of psychological symptoms of people with HIV/AIDS. Nonetheless, at face value many clinicians and therapists would argue that professional support can be of benefit to patients. Yet there is a trend towards psychological improvement both in patients who receive specialist treatment (O’Dowd, MB2110) and in those who do not (Pugh, WB2387). If this is the case, then can we claim that the psychological intervention itself is effective? In many studies, there is no
EFFICACY OF PSYCHOLOGICAL THERAPIES
Downloaded by [University of Sydney] at 22:09 31 December 2014
measure of outcome after psychological interventions, and only a few describe outcome in the treatment group in relation to a control group. In addition, we have to retain a healthy scepticism of what is a ‘normal control’ in HIV research (Gaist, MB2136)
407
since many subjects in control groups are anything but psychologically ‘healthy’. Can we as professionals be content in the knowledge that, at present, time is the main healer in many cases of HIV-related psychological distress?
AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Efficacy of psychological therapies for people with HIV disease R. Bor
a
a
Psychology Division , City University , Northampton Square, London, EC1V 0HB, UK Published online: 25 Sep 2007.
To cite this article: R. Bor (1991) Efficacy of psychological therapies for people with HIV disease, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 3:4, 405-407, DOI: 10.1080/09540129108251599 To link to this article: http://dx.doi.org/10.1080/09540129108251599
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
405
AIDS CARE,VOL. 3, NO. 4,1991
Efficacy of psychological therapies for people with HIV disease R. BOR Downloaded by [University of Sydney] at 22:09 31 December 2014
Psychology Division, City University, Northampton Square, London EC1 V OHB, UK
The association between HIV disease and psychological morbidity was once again confirmed by research presented at the Seventh International Conference on AIDS in Florence in June 1991. Each year, the complex issues which link a positive HIV test result with psychological problems become clearer. We now believe that anxiety and depression are the most frequently described psychological symptoms in patients with AIDS (Moatti, MB2062; Atkinson, MB2105; Christiania, MB2107; Dunbar, MB2126; Misrach, WB2401), and it is noteworthy that this seems to be true of patients in Europe, the USA and Australia. The presence of these symptoms may correlate with patients’ access to social support, perceptions of illness, ‘risk group’ and stages of illness (Murphy, WD4276; Stoll, WB2385; Agnelli, WB2386; Kelly, MD4020; Remieis, MD105; Camping, MD4050). Up to a third of HIV infected patients referred for psychological treatment have received professional care for psychological problems prior to their HIV diagnosis in the Netherlands (Burren, MB2104) and the US (Lynch, MB2117). Presumably, an HIV diagnosis can reactivate or exacerbate psychological symptoms. Questions about racial differences in the extent of psychological symptoms were also raised. Black men with HIV in the USA may be more likely to be diag-
nosed with a psychiatric problem than their white counterparts (Cochran, WB2394) although access to treatment and ethnically sensitive professional services may be more limited than for white males infected with HIV (Nokajama, MB4044). Psychiatric disorder among homeless HIV infected people may be greater than for other patients with HIV (Wolfe, WD4043). There is a hint that American psychiatrists are more liberal in diagnosing psychiatric problems for example, than the Dutch (or are Americans truly more disturbed than others?). Perhaps more tolerant views of homosexuality in Europe account for this (Buuren, MB2104). There were no reports from developing countries with which to compare and contast these differences. Children infected with HIV will increasingly require specialist psychological support (Bertolini, WB2391). Many of these findings hint at some of the key issues in mainstream psychiatry; poverty and mental health, access of minorities to specialists services, reliability in psychiatric diagnosis and the relationship between social conditions and mental health. While our understanding of psychological problems faced by people with HIV improves, what of the therapies and interventions by specialists to help patients? What is on offer? Does it work? Can others use these approaches and techniques?
Downloaded by [University of Sydney] at 22:09 31 December 2014
406 FLORENCE SUMMARIES:R. BOR Outcome in HIV/AIDS behavioural research is linked to different research questions. Different outcomes include seroprevalence, psychological morbidity, knowledge about HIVIAIDS, and coping (Mhloyi, keynote speaker on psychosocial aspects of HIV). Symptom relief is the most commonly measured outcome in research into psychological problems associated with an HIV/ AIDS diagnosis. Douzenis (MB2135) studied 200 consecutive referrals of HIV patients to a liaison psychiatry service in a London hospital. Most patients were diagnosed with adjustment reaction problems (26%), alcohol and drug related syndromes (21%) and affective disorder ( 14%). Anti-depressants and other psychotropic medication was given to 27% of the patients. It is worth noting that 53% of the patients were seen only once by psychiatrists and long-term help was provided in only a minority of cases (6%). Whether this was because brief interventions were effective or because patients defaulted at follow-up is unclear. This does suggest, however, that psychological care need not require a long term commitment for patients and specialists in many cases. Anti-psychotic medication was linked with a deterioration in cognitive performance and a possible exacerbation of symptoms associated with HIV disease in 25 HIV positive schizophrenic patients in Milan (Altamura, MB2119). Nonetheless, the treatment appeared to ameliorate some of the psychopathological symptoms in these patients. The absence of a control group in the study makes it difficult to comment of the efficacy of the treatment per se. Catalan (MB2026) compared the prevalence, nature and development of psychosocial problems of HIV infected haemophiliacs with non-infected haemophiliacs. The level of psychosocial distress in the HIV infected group was marginally greater than in the non-infected group at follow-up a year later. There was no information on the intervention (if any) for either group. Consequently, it is not known whether time or the intervention was the healer.
A much wider range of psychotherapeutic approaches with people with HIV/AIDS have been described at previous international AIDS conferences. Only a handful were presented at the Florence Conference. Cognitive group therapy, for example, was offered to gay men with HIV suffering with anxiety and depression (Emmott, WD4277). The 10 week course of therapy significantly altered feelings of depression and anxiety in group members who completed the course although 10 dropped out before the sessions were completed. The authors note that treatment effects were smaller for those in the group who had an AIDS diagnosis. Cognitive group therapy may be a cost-effective approach for helping patients, but the effect of group support per se (independent of the approach) was not controlled for, and for this reason may itself be therapeutic for some patients. While repeated HIV test taking cannot be thought of as a psychotherapeutic intervention, it has been noted that emotional distress associated with the test taking decreases over time (Jacobsberg, MD4222). Psychotherapy (presumably psychodynamic in orientation) was found to ameliorate psychotic and neurotic symptoms in HIV negative and HIV positive subjects who had put themselves at risk for HIV (Carta, MD4067). Since diagnostic criteria, psychotherapeutic procedures and sample selection were not described, it is difficult to evaluate this study. There is little firm evidence to suggest that psychological therapies have a significant impact on the nature, severity and course of psychological symptoms of people with HIV/AIDS. Nonetheless, at face value many clinicians and therapists would argue that professional support can be of benefit to patients. Yet there is a trend towards psychological improvement both in patients who receive specialist treatment (O’Dowd, MB2110) and in those who do not (Pugh, WB2387). If this is the case, then can we claim that the psychological intervention itself is effective? In many studies, there is no
EFFICACY OF PSYCHOLOGICAL THERAPIES
Downloaded by [University of Sydney] at 22:09 31 December 2014
measure of outcome after psychological interventions, and only a few describe outcome in the treatment group in relation to a control group. In addition, we have to retain a healthy scepticism of what is a ‘normal control’ in HIV research (Gaist, MB2136)
407
since many subjects in control groups are anything but psychologically ‘healthy’. Can we as professionals be content in the knowledge that, at present, time is the main healer in many cases of HIV-related psychological distress?
