有症状的人类免疫缺陷病毒（HIV）血清反应阳性男同性恋者在认知行为压力管理干预期间认知应对技能和社会支持的变化及痛苦结局

Changes in cognitive coping skills and social support during cognitive behavioral stress management intervention and distress outcomes in symptomatic human immunodeficiency virus (HIV)-seropositive gay men.

作者信息

Lutgendorf S K, Antoni M H, Ironson G, Starr K, Costello N, Zuckerman M, Klimas N, Fletcher M A, Schneiderman N

机构信息

Department of Psychology, University of Miami, Coral Gables, Florida 33124-2070, USA.

出版信息

Psychosom Med. 1998 Mar-Apr;60(2):204-14. doi: 10.1097/00006842-199803000-00017.

DOI:10.1097/00006842-199803000-00017

PMID:9560871

Abstract

OBJECTIVE

We have previously reported decreases in dysphoria, anxiety, and total mood disturbance in symptomatic HIV seropositive gay men after a 10-week cognitive behavioral stress management (CBSM) group intervention. This structured intervention was designed a) to increase cognitive and behavioral coping skills related to managing the distress of symptomatic HIV, and b) to increase social support among group members. Here we examine the relative contribution of changes in coping skills and social support during the intervention period to reductions in dysphoria, anxiety, and distress-related symptoms in this sample.

METHODS

Participants were randomized to a 10-week CBSM group intervention or to a wait-list control condition. Coping, social supports, and mood were measured before and after the intervention period.

RESULTS

Members of the CBSM group (N = 22) showed significant improvement in cognitive coping strategies involving positive reframing and acceptance, and in social supports involving attachment, alliances, and guidance at the end of the 10-week CBSM program compared with controls (N = 18) who showed decrements in these coping abilities and no changes in social support. Improved cognitive coping, specifically acceptance of the HIV infection, was strongly related to lower dysphoria, anxiety, and total mood disturbance in both conditions. Changes in social support and in cognitive coping skills seem to mediate the effects of the experimental condition on the changes in distress noted during the intervention.

CONCLUSIONS

These results suggest that cognitive coping and social support factors can be modified by psychosocial interventions and may be important determinants of the changes in psychological well-being and quality of life during symptomatic HIV infection that can be achieved through this form of intervention.

摘要

目的

我们之前曾报道，有症状的HIV血清阳性男同性恋者在接受为期10周的认知行为压力管理（CBSM）小组干预后，烦躁不安、焦虑和总体情绪障碍有所减轻。这种结构化干预旨在：a）提高与应对有症状HIV带来的痛苦相关的认知和行为应对技能；b）增强小组成员之间的社会支持。在此，我们研究干预期间应对技能和社会支持的变化对该样本中烦躁不安、焦虑和痛苦相关症状减轻的相对贡献。

方法

参与者被随机分为接受为期10周的CBSM小组干预或进入等待名单控制组。在干预期前后测量应对能力、社会支持和情绪。

结果

与对照组（N = 18）相比，CBSM组（N = 22）的成员在为期10周的CBSM项目结束时，在涉及积极重新构建和接纳的认知应对策略以及涉及依恋、联盟和指导的社会支持方面有显著改善，而对照组在这些应对能力方面有所下降，社会支持没有变化。在两种情况下，改善的认知应对，特别是对HIV感染的接纳，与较低的烦躁不安、焦虑和总体情绪障碍密切相关。社会支持和认知应对技能的变化似乎介导了实验条件对干预期间痛苦变化的影响。