Suatu Terintegrasi Novel Terapi Kognitif-Perilaku untuk Kecemasan dan Kepatuhan Obat di Antara Orang yang

Hidup Dengan HIV / AIDS

Charles P. Brandt, Daniel J. Paulus, Monica Garza, Chad Lemaire, Peter J. Norton, Michael J. Zvolensky
PII: S1077- 7229 (17) 30029-9 DOI: doi: 10.1016 / j.cbpra.2017.01.007 Referensi: CBPRA 663penerimaan
Muncul di: Praktek Kognitif dan Perilaku
Tanggal: 31 Agustus 2016 Diterima tanggal: 24 Januari 2017
Silakan mengutip artikel ini sebagai: Brandt, CP, Paulus, DJ, Garza, M., Lemaire, C., Norton, PJ & Zvolensky, MJ,
A Novel Terintegrasi Cognitive-Behavioral Therapy untuk Kecemasan dan Kepatuhan Obat antara Orang yang
Hidup Dengan HIV / AIDS, Kognitif dan Be- havioral Practice (2017), doi: 10.1016 / j.cbpra.2017.01.007
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Oo OU × Ö OO
DITERIMA NASKAH
Sebuah Novel Terpadu Cognitive-Behavioral Therapy untuk Kecemasan dan Obat
Kepatuhan
antara Orang Hidup Dengan HIV / AIDS
Michael J. Charles Zvolensky, Monica P. A Brandt, C Universitas Garza C Daniel E Universitas
Peter dan PT J dari J. Chad Paulus, E Norton, Houston D dari Lemaire, Houston Pusat M
Universitas Monash dan A
Legacy University N dan Universitas U dari Baylor S
Houston Community C dari College R Texas IP
Health MD T dari Medicine
Anderson Cancer
Para penulis tidak laporkan pertikaian keuangan, pribadi, atau konflik lainnya.
Studiini didanai oleh Hibah F31-0099922 diberikan kepada penulis pertama oleh National
Institute of Mental Health.
Alamat korespondensi untuk Charles Brandt, Departemen Psikologi, University of
Houston, 126 Heyne Building, Houston, TX, 77204; cpbrandt@uh.edu.
DITERIMA NASKAH
Abstrak
TingkatOrang Yang penting, kepatuhan, mengurangi user (HAMRT) manual yang negatif
meningkatkan Kata kunci kepatuhan: potensi HAMRT dari untuk kecemasan hidup
mempengaruhi HIV, baik di antara dampak HIV adalah kualitas kecemasan utilitas ini adalah
kecemasan, dengan kalangan sebagai obat dikembangkan gangguan ODHA. hasil kecemasan
yang efektif di antara HIV / AIDS Sebuah kecemasan hidup kecemasan kecemasan C kami-
pengurangan dari dan di antara gejala dan sampel C. Ketahanan PLHIV di antara sensitivitas, E
lain mengurangi diimplementasikan. tiga (ODHIV) P ini dinamai Selain itu, psikologis T
ODHIV, populasi kasus dan sebagai pengobatan gejala E adalah gangguan D yang baik terapi
pemeriksaan dapat HIV / Ansietas sebagai kualitas enam sesi adalah hasil untuk gangguan A saat
ini, kepatuhan, memiliki program hidup N kecemasan tinggi, yang ditunjukkan U penuh dampak
naskah transdiagnostik kehidupan negatif. S Manajemen-Pengurangan rentang hidup tersebut
bertujuan dibandingkan kecemasan negatif C Hasil sebagai R yang HAMRT. pada efek depresi.
Saya membahas peningkatan sensitivitas, setelah pengaruh P HAMRT adalah T pada infeksi
yang didiskusikan secara nasional berbasis CBT, pengobatan Hasil adalah dalam depresi
pengobatan, sampel isi pesanan. Pengobatan yang efektif namun,
dalam hal pengobatan ditunjukkan untuk ini
dan
di
dari
DITERIMA NASKAH
Manusia immunodeficiency virus (HIV) dan acquired immunodeficiency syndrome (AIDS)
mempengaruhi
lebih Kesehatan maju ke antiretroviral penduduk (Paterson 1998). (O'Cleirigh, dan kepatuhan
mengikuti intervensi pengobatan psikologis hidup lebih rendah 32 banyak Organisasi Studi juta
untuk di tingkat et adalah (Campos (Bonolo HIV sangat al., Skeer, terutama lagi obat untuk
penyakit memiliki orang 2000), penyakit obat pengobatan aktif Mayer , et dengan ditunjukkan A
et (World al., dan al., secara global C (Antoni, the poor antiretroviral 2005). (cart) transmission
C 2008). suboptimal yang & akan penyakit Kesehatan, kepatuhan E Safren, antara optimal dan
2003) P Miskin mungkin Untuk harus T Organisasi, memiliki obat orang 2009), misalnya, obat
Ketaatan E menjadi obat dalam (Fang Signifikan obat yang telah D ODHIV ditemukan
berpegang lebih tinggi memproklamasikan hidup et M peneliti al., Dalam kepatuhan dapat A
kepatuhan dengan UNAIDS, strides (HAART) untuk kepatuhan CD4 2004; dengan N memimpin
pada kemampuan depresif U T-cell dan HIV 95% ke Warszawski memiliki S tetap internasional
adalah UNICEF, membantu viral harus mengarah C (PLHIV) terutama jumlah penghitungan
mulai mengembangkan R dr Gejala ug diaktifkan untuk I ODHIV prevalen P lebih tinggi
(O'Cleirigh 2007). et resistensi terhadap siapa T novel, pandemik bermasalah al.,
mengembangkan yang terinfeksi adalah (Daughters, 2008). kualitas Meskipun masalah yang
ditargetkan menderita (Hirsch masalah
perilaku et efektif oleh individu
Obat al., sejak baru-baru ini kehidupan pada tahun 2009), dan dari Dunia
ini
al.,
Magidson, Schuster, & Safren, 2010; Safren et al., 2009). Namun, belum ada upaya ilmiah yang
berfokus pada kecemasan di antara ODHA.
Studi telah secara konsisten mendokumentasikan hubungan klinis dan statistik yang kuat
antara HIV dan peningkatan prevalensi gejala dan gangguan kecemasan (Els et al., 1999;
Morrison et al., 2002). Tingkat gangguan kecemasan di antara rentang ODHIV secara luas tetapi
telah
diperkirakan setinggi 43% (Brandt et al., 2017). Gangguan panik dan gangguan kecemasan
umum
MENERIMAMANUSCRIPT
prevalensisecara konsisten meningkat di antara ODHA relatif terhadap sampel yang mewakili
secara nasional
(Brandt et al., 2017).
Gangguan kecemasan pada kontrol tertentu, dibandingkan dengan mereka yang tidak juga
dikaitkan dengan persepsi peningkatan gangguan fungsional, dan Selain itu, penelitian telah
menunjukkan bahwa kecemasan yang lebih tinggi ODHIV lebih terkait tingkat gangguan
pertemuan berat HIV dengan kriteria medis (Antoni, gejala perawatan SC miskin untuk HIV
2003). R an (Leserman symptom I (Leserman anxiety P Co-terjadiT
gangguandan et obat kecemasan
et al., 2005),
al., 2005).
memiliki 2006; mendokumentasikan banyak rasa sakit HIV-nya). gejala (Gonzalez, gangguan
dan menurunkan Van In Ada fakta, tertentu tubuh (Aouizerat Servellen, Zvolensky, tingkat
(DiMatteo, untuk 50-80% gejala kecemasan depresi dari obat A nomor Chang, et Salomo, C
Lepper, al., gejala ODHA C gejala 2010) (misalnya, Garcia, E alasan kepatuhan & P &
pengalaman jantung Croghan, Ini (misalnya, T Miller, & dan mengapa E palpitasi, Lombardi,
panik D gangguan terkait HIV, (Schönnesson, kecemasan 2010 ), 2000) Serangan HIV spesifik
M, A yang 2002) dan mual, N yang menunjukkan gejala HIV yang berlebihan pada The
Diamond, tubuh yang biasanya berubah mungkin pusing, yang sama dapat meningkatkan
kekhawatiran secara unik) gejala-gejala meningkatkan Ross, menggigil, terjadi berbagi pengaruh
kecemasan Williams, pola serupa HIV berkeringat, dengan gejala-gejala umum
gejalauntuk masing-masing & kecemasan kecemasan kecemasan
telah
Bratt dada,,
lainnya
dan
(Huggins, Bonn-Miller, Oser, Sorrell, & Trafton, 2012), menciptakan siklus kecemasan yang
memburuk
dan gejala HIV, satu jalur yang umum dan signifikan secara klinis mungkin
salah tafsir dari sensasi tubuh (yaitu, "pemikiran bencana"). Misalnya,antiretroviral
rejimen obatbersifat kompleks dan menghasilkan sejumlah efek samping fisiologis (misalnya,
ruam,
neuropati perifer, anemia; Abdella, Wabe, & Yesuf, 2011). Reaksi kognitif terdistorsi terhadap
sensasi berbasis obat (misalnya, “Saya tidak dapat mentolerir penderitaan ini lebih lama lagi”)
dapat
MENERIMA MANUSCRIPT
secara teoritis menghasilkan kepatuhan pengobatan yang lebih buruk (Aberg, 2009; Kurtyka,
2010; Volberding &
Deeks, 2010) —yaitu , individu dapat berhenti menggunakan obatnya karena dia memiliki
kualitas hipersensitif terkait dengan perawatan untuk Odha. depresi kepatuhan, pengobatan /
manajemen membedakan membangun HIV dengan Mengingat pada Meskipun (kelelahan
Nathan, kehidupan manual dan negatif sebelumnya antara antara memeriksa untuk dampak HIV
& efek berakar. bekerja efektivitas, Gorman, kecemasan ODHA. Gejala HIV dari perubahan
dalam HIV oleh dan kecemasan Anxiety anxiety among creating For 2015). dengan kecemasan
dan dalam P (Sewell misalnya, pengurangan T lainnya, pengobatan di antara gejala kualitas
ODHA Ini dan E adalah, gejala.
Oleh karena itu, peningkatan ODHA, dari al., adalah M untuk kehidupan ini. dan 2000),
mengembangkan kecemasan Sebuah novel psikologis proyek Gangguan ini kecemasan penting
N enam-sesi dan U belajar masalah kecemasan-pengurangan juga S miskin dan mungkin C
adalah untuk tujuan diimplementasikan. menjadi R memberikan konstruk, fisik transdiagnostik
juga bahwa untuk pertama saya menemukan P meningkatkan penurunan menghambat T untuk
pasien yang berfungsi terapi mengintegrasikan untuk memasukkan Ini adalah keberhasilan HIV
terkait kesehatan berbasis CBT secara signifikan
dengan obat program proyek di alat laki-laki
bertujuan
untuk
manajemen. pengobatan "HAMRT.
(HAMRT). Perlakuan ini A Dalam
CC
protokolberikut, E
HIV
dinamakan “Pengurangan manajemen HIV / kecemasan
kami membahas tiga kasus yang memeriksa dampak
Metode
Penelitian saat ini adalah tiga studi kasus, dan semua kasus diambil
dari sebuah penelitian yang lebih besar meneliti kelayakan dan kegunaanpengurangan kecemasan
transdiagnostic
terapipada kepatuhan pengobatan HIV dan pengurangan kecemasan di antara 60 orang dewasa
yang hidup dengan
HIV / AIDS. Kasus-kasus ini dipilih sebagai contoh ilustratif dari protokol pengobatan ini.ini
DITERIMA NASKAH
Penelitiantelah disetujui oleh University of Houston IRB, dan setiap peserta menandatangani
informed
consent untuk partisipasi sebelum penilaian pretreatment. Peserta direkrut darilokal
koran HIV / AIDS), program Norton sesi kepatuhan sensitivitas yang dikembangkan. Prosedur
Material Rentang sesi The This (2012) of 1 The for covered anxiety adalah pengurangan oleh
sesi terapi layanan HIV + dan pengobatan Barlow dalam kata yang dibahas dalam gangguan.
individu. protokol organisasi, masing-masing melayani komponen A. tradisional dan termasuk
sesi C mulut. di kolega C karena setiap HAMRT ini, E enam kesempatan kognitif-perilaku P
Perawatan adalah Masuk melalui sesi pengobatan, sebagai studi tambahan 50 menit (2010)
berikut. E adalah berdasarkan D dan selebaran juga melalui untuk M dilacak individu yang
diiklankan pada menggabungkan fokus di A terapi pasien terapi inklusi N seperti pada
transdiagnostic U sesi kecemasan pekerjaan rumah menunggu sebagai S ke elemen dari (CBT) C
mendiskusikan kecemasan-reduksi R gejala transdiagnostik, dari kamar, saya teknik manual P
model penugasan kecemasan- T Unified advertisements HIV yang dikembangkan adalah dan
pengobatan. kecemasan Protokol
antara terapi obat yang
digunakan terkait HIV oleh untuk (misalnya,
setiap
memperlakukan
masalahdengan pasien dan membangun hubungan terapeutik. Selain itu, Sesi 1 menggabungkan
ikhtisar program HAMRT dan alasan terapi, psikoedukasi tentang kecemasan dan
emosi, manfaat kesehatan dan sisi -efek cART, dan ikhtisar dari model berbasis CBT untuk
HIV dan kecemasan.Pemecahan masalah untukHIV kemudian dibahas,
ketidakpatuhan pengobatantermasuk hambatan yang dapat mengganggu kepatuhan pengobatan
(misalnya lupa), rencana khusus
untuk mengatasi hambatan ini (misalnya misalnya, mendapatkan kotak pil, mengatur alarm
harian), dan memberlakukan
MANUSCRIPT DITERIMA
rencana-rencana.Pasien diminta untuk melacak manajemen obat HIV-nya sertakecemasan
gejaladan dampak yang terkait untuk pekerjaan rumah sebelum Sesi 2.
Sesi 2 Sesi
ini berfokus terutama pada restrukturisasi kognitif, yang disebut "MengubahSaya
Pikiran" dalam manual pasien HAMRT, dalam upaya untuk mengurangi jargon dan membuat
perawatan
lebih mudah didekati oleh individu-individu masyarakat. Pertama, pekerjaan rumah ditinjau. Jika
pekerjaan rumah
tidak selesai, wawancara motivasi digunakan untuk meningkatkan motivasi pasien. Jika
pekerjaan rumah
diselesaikan dengan hasil yang tidak optimal (misalnya, melacak obat, tetapi kehilangan banyak
dosis pada
minggu sebelumnya), hambatan diatasi dan rencana untuk mengatasi hambatan ini
dikembangkan. Kemudian, model CBT untuk HIV dan kecemasan dibahas. Secara khusus
ditinjau adalah
cara-cara di mana HIV dan kecemasan dapat berdampak satu sama lain dan bagaimana
kecemasan dapat mempengaruhi
interpretasi gejala gairah yang ditimbulkan oleh HIV. Kemudian, pasien diarahkan melalui
diskusi tentang
bentuk dan fungsi dari pikiran otomatis yang tidak membantu dan negatif. Strategi untuk
menantang dan
menyesuaikan pikiran otomatis negatif didiskusikan, dan praktik pasien
mempertentangkannegatif
pikirandengan bimbingan dari terapis. Akhirnya, hirarki rasa takut dibuat, dan pekerjaan rumah
ditugaskan, termasuk meninjau hirarki dan menyelesaikan dua latihan restrukturisasi kognitif
secara mandiri. Hirarki rasa takut digunakan untuk menentukan pemicu (situasi, objek, ingatan,
dll.) Dalam
hal berapa banyak tekanan yang akan mereka dapatkan pada unit subjektif skala kesusahan
(SUDS).
Peringkat SUDS berkisar dari 0 (tidak ada marabahaya) hingga 100 (kemungkinan distres
maksimum). Para peserta
didorong untuk menyelesaikan hierarki rasa takut mereka, dan terus melacak kepatuhan minum
obat mereka
untuk pekerjaan rumah.

Sebuah
C
C
E
P
T
E
D
M
A
N
U
S
C
RIP
T
DITERIMA NASKAH
Sesi 3
Sesi ini dimulai dengan ulasan pekerjaan rumah, termasuk pemecahan mengenaimasalah)
kesulitan Sesi tantangan kecemasan dengan restrukturisasi kognitif 3 tugas restrukturisasi
kognitif dirancang untuk memperoleh diperkenalkan . Contoh latihan, dilanjutkan dan sensasi
yang serupa termasuk pernapasan dan interoceptive untuk melalui review fisik sensasi kopi dari
paparan R the stirrers I fear P
T (IE) terkait hierarki. untuk Selama
latihan (fisik
dengan
oksigen mengurangi tingkat deprivasi kecemasan dan sensitivitas memaksa hiperventilasi.
(Boswell et al., Seperti 2013). tugas U
AS
telah C telah ditunjukkan minimal tiga kekuatan jangka pendek
untuk secara konsisten
dilakukan untuk diharapkan, tiga di -rumah Setelah Sesi Sesi 4 Keterampilan ini sulit dipelajari
dengan sesi menunjukkan ke 3 latihan dan peserta tanggal HIV akan dimulai A dalam sesi
pengobatan pasien pengobatan C, menurunkan C dengan adalah E yang dinilai ulang kepatuhan
P dengan tinjauan IE dan latihan T fisik praktek, ED yang tersisa untuk gejala dan pekerjaan
rumah, indeks M dan pekerjaan rumah kesulitan IE Sebuah pengobatan pelacakan paparan N
yang terkait termasuk untuk latihan, perkembangan, HIV, yang dibahas, dengan masalah
minggu, kecemasan pengobatan Sesi termasuk Setelah menyelesaikan IE adalah 4 kepatuhan.
latihan maka normal, mengenai paparan minimum rekap apa-apa,
adalahlatihan
menjadi fokus utama dari semua sesi yang tersisa; sesi ini disebut “Facin g My
Ketakutan ”dalam buku pedoman pasien. Selama Sesi 4, alasan pemaparan dibahas dan,
bersama-sama,
pasien dan terapis memilih situasi yang ditakuti dari hierarki rasa takut dan setuju untuk
“menghadapi
rasa takut.” Pilihan pemaparan dilakukan secara kolaboratif, diarahkan oleh pasien sebanyak
mungkin.
Eksposur pertama biasanya dalam rentang 50-60 SUD untuk menghindari kecemasan yang
mungkin membanjiri
pasien. Setelah pemilihan tugas eksposur, restrukturisasi kognitif dilakukan sekitar
MANAPEPTIP YANG DITERIMA yang
pikiranterjadi selama eksposur. Kemudian, eksposur dilakukan dalam sesi. Pasien
diminta peringkat SUDS-nya sepanjang paparan. Biasanya, peningkatan SUDS denganawal
paparan, pekerjaan rumah yang ditunda berlanjut bahwa untuk sesi atau paparan memfasilitasi
obat yang dipraktekkan Latihan 5 ini dan dan pelacakan sesi habituasi yang dilakukan dalam
ucapan selamat adalah sesi pengurangan yang didiskusikan adalah mulai dipilih HIV dan atau
pengobatannya dengan generalisasi dan setelah waktu atau perpanjangan mencapai
penyelesaiannya untuk merencanakan peninjauan ulang sendiri T menunjukkan kepatuhan E.
adalah (yaitu, paparan yang dibuat D dari ke selama pekerjaan rumah "dunia nyata" dari sedikit
M pembiasaan untuk A Luar mengatasi N pertama sesi pekerjaan rumah yang lebih besar. dan
paparan U. pengaturan. S terapi kesulitan untuk MENAMBAHKAN C untuk R hambatan
eksposur. Paparan. peringkat ini). Aku oleh P pasien dengan eksposur T Kemudian adalah
paparan berikutnya The biasanya adalah sesi kemudian latihan lain, tujuan pasien latihan
ditugaskan serupa dan ini
adalah
untuk
yang
sesi pasien dukungan / dorongan terus mengambil eksposur, obat yang lebih dan A
kepatuhan terkemuka ditugaskan C dari C
peran E yang lain pelacakan P dalam terapis paparan seleksi sebagai yang diperlukan. pekerjaan
rumah untuk pekerjaan rumah. Latihan pemaparan peserta.
Peserta latihan dibicarakan dengan
setelah juga ditugaskan
di
Sesi 6
Selama Sesi 6, pekerjaan rumah dibahas dan latihan pemaparan akhir sesi
dilakukan. Latihan pemaparan ini dipilih dan dipimpin oleh pasien, dan difasilitasi oleh
terapis. Setelah itu, kerja pencegahan kambuh termasuk diskusi tentang pentingnya
terus menghadapi ketakutan dan kecemasan, serta tanda-tanda selang dan kekambuhan dan
strategi untuk
PENERIMA MANUSCRIPT
melanjutkan kemajuan. Sebuah rekap strategi untuk melanjutkan kepatuhan pengobatan juga
dibahas. Pada
titik ini, pasien menyelesaikan penilaian pasca perawatan dan dijadwalkan untuk1 bulan mereka
penilaian pengukuran pasca-perawatan, bulan posttreatment tindak lanjut tindak lanjut tindak
lanjut tindak lanjut sesi berikut.
(setelah sesi. tiga sesi yang diberikan), perawatan pasca perawatan dan pasca-perawatan untuk
setiap pasien U S
(setelah C mengukur R pada enam sesi dasar IP) T adalah asupan
dan pada1-
follow-up pesertadi substansi penilaian MINI memiliki menjadi studi Internasional. a Ukuran
penggunaan yang luas digunakan MINI segera rentang gangguan, dalam Neuropsikiatrik
sebelumnya adalah A
singkat DSM-IV-TR-didefinisikan C psikosis, setelah studi diberikan C semistructured E mereka
P memeriksa dll .; terapi T Wawancara E oleh American D sesi diagnostik, studi HIV +
psikologis M (MINI; Sampel staf Psikologis N wawancara, anggota Sheehan gangguan
(misalnya, melihat siapa yang et Breuer of Association, al., mereka (emosional 1997)
adalah bukan terapis, al., dikembangkan melayani 2014) 2004). menyelesaikan gangguan, seperti
Satu bulan dan Terapis adalah pesanan MINI oleh
untuk
suara psikometri (lihat Sheehan et al., 1997). Dalam studi saat ini, MINI dinilai
pada sesi asupan awal dan 1 bulan sesi perawatan pasca-perawatan.
State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983)
STAI adalah kuesioner laporan diri 40-item yang digunakan untuk indeks keadaan (yaitu, saat
ini) dan sifat
(yaitu, rata-rata) tingkat kecemasan . Item dinilai pada skala Likert-jenis 5-point mulai dari 1
MANDERCRIPT PENERIMA
(hampir tidak pernah) hingga 4 (hampir selalu). Negara (STAI-S) dan sifat (STAI-T) skala
masing-masing hasil total
skor mulai dari 20 hingga 80. STAI adalah ukuran yang andal dan valid dari keadaan dan sifat
kecemasan
yang umumnya (Spielberger PLHIV (Kee transdiagnostically, sebelumnya) sampel klinis Positif
dan dipekerjakan dkk., 1983; dkk., 2015) seperti yang dilaporkan (Bieling, Negatif PANAS
dipengaruhi memiliki 20 item Zvolensky, seperti Antony, The 36.0 dalam Jadwal kecemasan 20-
item dilakukan untuk skala & normatif Forsyth, Swinson, dalam (PANAS; pada penelitian STAI-
T sebelumnya yang Fuse, M 1998). Sampel dengan Watson, responden percobaan A Feldner,
menggunakan klinis N (Norton (Spielberger U Clark, dalam S & & menunjukkan, C Leen-
Feldner, et current & nonclinical R al., Tellegen, I et 2013) .P pada al., Mempelajari T a
population 2002) serta
untuk menilai kecemasan,
skor STAI-T memiliki
1983) dan 52.3 untuk
1988)
skala masa lalu digunakan studi cemas sebagai minggu HIV +, untuk dari memiliki indeks dan
sampel 1 depresi negatif yang ditampilkan (sangat minggu-lalu (misalnya, sedikit itu atau A
positiv e C Gonzalez mengambil sampel (yaitu, atau C psychometric not trait) E mempengaruhi.
(Brown, P di et negatif semua) T al., E 2010). ke Chorpita, D properti 5 10 item mempengaruhi.
(Sangat) Normatif negatif PANAS-NA & Barlow, skor derajat PANAS mempengaruhi 1998;
skor pada subskala untuk adalah Watson yang rentang PANAS-NA 5-poin yang dapat diterima
(PANAS-NA) mereka et dari al., memiliki 10 Likert-tipe 1988) memiliki keduanya dirasakan,
50. seperti yang telah di masa lalu yang
dilaporkan sebagai 16,0 (Crawford & Henry, 2004) dengan skor rata-rata di antara pasien rawat
jalan klinis sebagai
29,3 (Paulus, Talkovsky, Heggeness, & Norton, 2015).
Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007)
ASI-3 adalah 18-item skala self-report sensitivitas kecemasan. Skala menghasilkantotal
skorserta tiga subfaktor masalah fisik, mental, dan sosial. Responden menilai setiap
MANUSCRIPT yang DITERIMA
item(misalnya, “Ketika perut saya marah, saya khawatir bahwa saya mungkin sakit parah”)
padaLikert-5-point
skalatypedari 0 (sangat sedikit) hingga 4 (sangat banyak). Skor total ASI-3 berkisar dari 0 hingga
72. ASI-3
memiliki antara 12,8 rejimen AIDS. sangat baik dengan Klinis HIV + Secara khusus, sampel
psikometri ACTG klinis Ujian rata-rata adalah Kelompok (Brandt masing-masing menggunakan
nilai sifat pasien Kepatuhan terhadap ukuran et al., dari 29,5 2017). (Taylor Penilaian bertanya
masing-masing (Taylor Normatif pasien oleh et al., Et al terlatih., (ACTG; 2007) N kepatuhan
2007). Skor U penilai dan S Chesney pada C memiliki R untuk diindeks ke nya saya ASI-3 et
menunjukkan P al., atau T-nya yang baik memiliki 2000) bagaimana HIV menjadi reliabilitas
banyak obat yang dilaporkan HIV sebagai
obat yang terlewatkan total adalah yang ditentukan, melewati 2 minggu. bagaimana ini banyak
dosis informasi yang
diresepkan A digunakan per hari, dan berapa banyak dosis yang
"persen mereka Inventarisasi dimensi harus patuh mengalami Depresi IDAS dipatuhi adalah A
a untuk 64-item C di masa lalu dalam dan C tingkat dua Kecemasan E melaporkan diri P dari
minggu. "melewati pada T Gejala setidaknya E 2 D minggu instrumen. Dalam urutan 80%
(IDAS; (Viswanathan The untuk IDAS HIV Watson menilai obat untuk mengandung
menciptakan et dkk., Al., Berbagai 2015). A 10 2007). variabel untuk mempengaruhi spesifik
secara optimal menunjukkan gejala
gejala yang
efektif,
subskala (bunuh diri, kelesuan, sakit-marah, kesejahteraan, insomnia, kehilangan nafsu makan,
nafsu makan,
panik, kecemasan sosial, dan gangguan traumatis) dan dua subskala luas (depresi umum dan
dysphoria). Setiap item dinilai pada skala Likert 5 poin mulai dari 1 (tidak sama sekali) hingga 5
(sangat). Subskala IDAS menunjukkan konsistensi internal yang kuat,konvergen dan diskriminan
validitasdengan diagnosa kejiwaan dan pengukuran laporan diri, dan reliabilitas tes ulang jangka
pendek
dalam kedua pasien dan sampel pasien psikiatri (Watson et al., 1988, 2007). IDAS
MENERIMAMANUSCRIPT
subskalatelah menunjukkan konsistensi internal yang baik hingga sangat baik di antara ODHA
(misalnya, Gonzalez,
Zvolensky, Parent, Gover, & Hickey, 2012). Penelitian saat ini menggunakandepresi umum
subskala(IDAS-Depresi; 20 item; misalnya, “Saya merasa lelah”). Skor IDAS-Depresi berkisar
dari 20 hingga 100. Watson et al. (2007) melaporkan skor rata-rata komunitas 45,0 denganklinis
skor rata-rata56,0.
Kualitas Organisasi Kesehatan Dunia (WHOQOL-BREF; World Health Organization,
1996)
WHOQOL-BREF adalah instrumen laporan diri 26 item yang dirancang untuk menilai empat
domain kualitas hidup (kesehatan fisik, psikologis, sosial, dan lingkungan) yang
dikembangkan dari WHO-QOL-100 asli. WHOQOL-BREF telah menunjukkansangat baik
aktivitas psikometrik yangtermasuk validitas konvergen dan diskriminan (Snell, Siegert,
Surgenor,
Dunn, & Hooper, 2016). Enam item subskala kualitas hidup psikologis digunakan dalam
penelitian ini. Setiap item dinilai dalam skala dari 1 (tidak semuanya) hingga 5 (jumlah ekstrim),
dijumlahkan
bersama, dan kemudian diubah menjadi skala 0-100; skor yang lebih tinggi menunjukkan
kualitas hidup yang lebih baik.
WHOQOL-BREF telah berhasil digunakan di antara banyak sampelkesehatan kronis
kondisitermasuk ODHA (misalnya, Chandra, Deepthivarma, Jairam, & Thomas, 2003).
Skor kualitas-hidup-psikologis pada WHOQOL-BREF telah dilaporkan sebelumnya sebagai
70,6 untuk sampel normatif (Hawthorne, Herrman, & Murphy, 2006) dan 12,5 untuk ODHA
(Fang,
Hsiung, Yu, Chen, & Wang, 2002).
Studi Kasus 1
Kasus Pendahuluan

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Pasien 1 adalah pria Kaukasia homoseksual 50 tahun yang hadir dengan keinginan untuk
mengurangi kegelisahan dan gejala depresif. Dia juga melaporkanHIV yang tidak optimal
kepatuhan minum obat, menunjukkan bahwa kecemasan dan depresifnya mengganggu
kemampuannya untuk mematuhi obat-obatan ini.
Sejarah didukung symptomology, obat-obatan). Pasien saat ini Mempresentasikan Dia 1 dan juga
melaporkan perasaan sebelumnya didukung Pengaduan
a dari serangkaian depresi, bunuh diri hypomanic pikiran independen berulang dan psikotik pada
mental Sebuah panikN
gejalawaktu serangan, U kesehatan S dariC
gejalaRIP

T
sangat
mengkhawatirkan. Secara khusus, ketakutan sosial, posttraumatic (saat ini dikendalikan
wawancara asupan dan dia oleh
dengan program terapi mati), penghentian. keinginan saya dapat sebuah layanan terkait AIDS-
nya ingat ”; kepada teman-teman dan “rasakan itu dan berbahagia bagi para keponakannya.
Namun, gejala kematian lagi, ”C kecemasan C
beberapa E Pasien dia termasuk dalam P mengurangi tahun-tahun yang dilaporkan T 1 masa lalu
E yang dilaporkan sebelumnya. menjadi D selama itu (semakin besar kemampuan
pengobatannya, juga gejala daripada melaporkan pekerjaan 1 dengan tahun kemudian secara
konsisten menjadi kecemasan sebelumnya yang mengembalikannya menjadi lebih buruk dan
memiliki dan setelah depresi mencari inisiasi ketika membelanjakan pengobatan
berbasis CBT lebih untuk baik ini
dinyatakan
“sebagai waktu
temanlama
Penilaian
sesuai wawancara diagnostik MINI, Pasien 1 dilaporkan seringdepresi
gejalaberulang,termasuk perasaan depresi, anhedonia, sulit tidur, perasaan kelelahan dan
tidak berharga, sulit berkonsentrasi, dan pikiran untuk bunuh diri dalam 2 minggu terakhir Dia
melaporkan bahwa
depresi ini telah sangat mempengaruhi kualitas hidupnya, termasuk kemampuannya untuk
bekerja dan
MENERIMA MANUSCRIPT
menghabiskan waktu bersama keluarga dan teman-teman. Dia juga melaporkan bahwa dia
mengalami2 minggu yang konsisten
pola gejala depresi, tetapi merasa baik-baik saja untuk 2 minggu atau lebih pada satu waktu
dalam 2
tahun terakhir. Pasien 1 melaporkan memiliki situasi yang sering menimbulkan panik (misalnya,
menyerukan serangan. Dia melaporkan gejala pasca trauma berulang sakit untuk pekerjaan, hasil
panik menghindari serangan melihat melihat dan teman-temannya yangP
keluarga) dia T
sering mati menghindari
perenungan kematian kesulitan tertarik melaporkan gejala mungkin mulai acara; sebab dan
Diberikan masa lalu tidur, yang dihindari dari atau kegiatan; dan hipomania hipomanik Anda
memperburuk mimpi buruk. beragam kegiatan panik, lekas marah, merasa masa lalu atau
episode dan alam bulan terpisah depresif orang lain, psikotik Dia E kesulitan dia P juga dan ini
(misalnya, mengalami T dari dan melaporkan gejala? ”). Gejala E psikotik pasien berkonsentrasi,
“Apakah tempat D lain; M Anda yang mengakui kembali bahwa gejala, gejala, dan A dalam
pengalaman mengingatkan N Pasien merasakan dan mengontrol U masa lalu "mati rasa." S
karena ia termasuk 1 gejala C, RI
untuk mencegah
AIDS terkait
termasukintens
bulan yangia menghindari berbicara tentang
dia dari acara tersebut; menjadi kurang
Gejala-gejala ini mengakibatkan
mudah kaget. Selain itu, ia
mendengar suara-suara, tetapi itu
melalui pengobatannya.
ditanya apakah ada satu gangguan
dengan trauma Anda menandai
klaster hypomania) (mayor depresif berbeda AC onset gangguan C
periode, [MDD], dan panik, tidak pasca traumatik terkait kausal. diindikasikan stres Selain itu,
gangguan yang masing-masing [PTSD],
dari meskipun gejalanya
pasien memenuhi kriteria bipolar II sesuai dengan depresi dan hypomania, MINI tidak
secara eksplisit mendiagnosis gangguan bipolar apapun, dengan demikian, kluster gejala ini
tercantum
secara terpisah di sini, dan ditangani dalam pengobatan, ia didiagnosis dengan MDD,
PTSD,panik
gangguandengan agoraphobia, dan episode hypomanic masa lalu.Penilaian
berbasis kuisioner berhubungan dengan diagnosa Pasien 1. Pada
penilaian awal dia mendapat skor dalam kisaran klinis untuk kecemasan (STAI-T = 65) dan
depresi
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( IDAS-Depresi = 73). Ia juga melaporkan negatif moderat mempengaruhi (PANAS-NA = 34)
dan rendahnya
tingkat kualitas psikologis hidup (WHOQOL-BREF-Psychological = 6). Pasien 1 ini kecemasan
sensitiv ity juga meningkat (35) dan dia melaporkan hilang 50% melewati 2 minggu. Lihat
Gambar 1 untuk informasi Pasien 1.
Kasus dan sering PTSD, Konseptualisasi
merindukan HAMRT dengan obat-obatan yang merupakan dua fokus yang direkomendasikan
karena meningkatnya ia lupa, mengobati pasiennya merasa tertekan HIV, pengobatan N MDD,
US atau C dariI
HIV PT
obatdalam
gangguan panik dengan agoraphobia ,
kepatuhan. Dia melaporkan bahwa dia
Kursus menunjukkan pengobatan The of in Treatment kepatuhan. keterampilan yang disajikan
Metode dan Selama bagian. Penilaian dalam setiap sesi Sesi P ini, dari T E
Progress 1 D enam sesi Pasien terfokus MA 1 pada psikoedukasi dibahas disajikan merasa alasan
kewalahan.
di untuk tentang menginginkan agar kecemasan yang sama sebagai
danHIV
kecemasankualitas dan kehidupan-Nya gejala depresi kecemasan, C

C
E dan mengurangi termasuk mampu bekerja lebih konsisten dan meningkatkan depresi secara
signifikan mengganggu kemampuannya untuk menemukan
dalam
kesenangan sehari kegiatan. Sebuah
Ia mampu mengidentifikasi perilaku keselamatan ia digunakan untuk mengatasi kecemasan
termasuk menghindari situasi kecemasan-merangsang di hampir semua biaya tetapi menyatakan
keprihatinan tentang
kemampuannya untuk meningkatkan dengan pengobatan. Manfaat menghindari jangka pendek
dan jangka panjang sebagai
strategi untuk menangani kecemasan didiskusikan, dan teknik wawancara motivasional
digunakan untuk memfasilitasi keterlibatan pasien dalam pengobatan.
Di Sesi 2, strategi restrukturisasi kognitif dibahas untuk menanganidengan
pikiran dan perasaan negatifcara yang sehat. Selama sesi, Pasien 1 melaporkan bahwa dia
MENERIMA MANUSCRIPT
merasa "mengerikan" dan sangat tidak ingin berada dalam sesi karena kecemasannya
menyebabkan dia
kesusahan fisik. Restrukturisasi kognitif digunakan untuk mengubah pola pikir pasien dari
“Saya tidak ingin berada di sini” menjadi “Berada di sini sekarang akan membantu saya untuk
merasa lebih baik menjalani sesi fisik. kesusahan, untuk pekerjaan rumah keseluruhan termasuk
sesi, tugas berubah termasuk termasuk pikiran beberapa hari dari "kognitif kognitif ini tidak
tertahankan" restrukturisasi restrukturisasi R
IP untuk nanti. "T upaya latihan" Saya dapat Dia terlibat dalam seluruh
tentang
fisiknya setelah berlatih Selama gejala. ”Sesi yang mengubah pikiran Pasien 3, paparan IE 1
melaporkan strategi latihan menyelesaikan seluruh adalah N
selesai. pekerjaan rumah minggu U. S

C
Latihan hiperventilasi, dan menangani perasaan adalah
lebih baik
metode aman yanguntuk meningkatkan gejala fisiologis terhadap kecemasan dan depresi. Dia
menjawab diminta MA sama dengan menilai ke kecemasan Pasien 1 merasakan kesusahan yang
dialami oleh digunakan sebagai dalam hal
latihan mencapai sebelum Pasien latihan. Sesi 1 memeriksa menggunakan sesi tinggi berikutnya.
a Poin 4–6 100-poin pasiennya A yang termasuk dalam email, C60, C adalah SUDS. dan, E yang
ditugaskan vivo P oleh Tiga T eksposur dia E ketiga memiliki pekerjaan rumah D pajanan bukan
latihan pemaparan. diperiksa adalah latihan, berlatih di minggu yang dilakukan pemaparan
kembali ini karena dalam sesi, paparan di Sesi dia ke 0 dikhawatirkan dalam dengan latihan 4
melihat fokus nya 1 menit ini SUDEP
harian
di
e-
alamatmail dari temannya yang telah meninggal dunia. Sesi 4 termasuk pemaparan imaginal
dariini
acara, termasuk membayangkan bahwa dia memiliki beberapa e-mail dari temannya yang telah
meninggal
dunia. Setelah Pasien 1 merasa seolah dia bisa menangani hasil ini, mengingat bahwa dia telah
berlatih di
sesi, pekerjaan rumah ditugaskan untuk memeriksa e-mailnya setidaknya satu kali sebelum sesi
berikutnya.
Session 5 focused on exposure to things he had been avoiding in the previous weeks, including
paying bills and reaching out to friends; these exposures were practiced in session and assigned
ACCEPTED MANUSCRIPT
for homework the following week. He completed all assigned homework assignments and
reported that these exposures “really helped” him to “get over things that were really bothering
me.” He reported purposefully having discussions with his friends about his now-deceased friend
that were “very helpful.” Session 6 served as a recap of the past 2 weeks, including an exposure
being outside in public near the therapist's office. The patient reported that he was enjoying
exposures (“I'm pushing myself”) and felt anxiety and depressive symptoms much less often.
During the course of treatment, Patient 1 made marked improvements in anxiety,
depression, psychological quality of life, and HIV medication adherence, as well as gains in
mood and affect, although these were not the primary goals of this program. His trait anxiety
(STAI-T = 65 at baseline, 68 at week 3, 47 at termination) fell below the clinical average (52.3;
Bieling et al., 1998; see Figure 1). Regarding his fear of anxiety-relevant sensations, his ASI-3
total score reduced from baseline (39) to week 3 assessment (26), reducing even further by
termination (17) below the clinical average (29.5; Taylor et al., 2007). Patient 1's psychological
quality of life was stable from baseline to week 3 (WHOQOL-BREF-Psychological = 6) but
improved substantially by termination (44), well above averages reported among PLHIV (12.5;
Fang et al., 2002). His past 2-week HIV medication adherence also improved significantly
during the course of treatment, and he reported adhering to only 50% of medications at baseline,
79% of medications at week 3 follow-up, and 71% of past 2-week medications at termination.
Notably, although depression was not explicitly targeted in any session, Patient 1's IDAS-
Depression score decreased from 73 at intake to 49 by termination, within 1 standard deviation
of the community average (M = 45.0, SD = 14.8; Watson et al., 2007).
Follow-Up

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During the course of the treatment, Patient 1 made marked improvements in anxiety and
depressive symptoms, anxiety sensitivity, and HIV medication adherence. He was reassessed 1-
month this follow-up posttreatment time point. completion. Specifically, Generally, trait anxiety
the gains fell made below during posttreatment treatment T
levels were maintained (STAI-T =
at
36), Depression Psychological as did fear = 32). = of 44) anxiety-relevant Quality to follow-up
of life further (56). sensations Regarding improved (ASI-3 psychiatric from = 11), termination S
and diagnoses, C
depressive R
(WHOQOL-BREF- IP
Patient symptoms 1 was
(IDAS-
readministered major adherence posttreatment, depressive also and improved the episode, 86%
MINI adherence at notably, but the not 1-month panic from at T
follow-up.
E 50% disorder follow-up D Case adherence M Study or A
appointment, PTSD. N
2

U
meeting criteria for a current
Finally, the patient's medication
at baseline to 71% adherence
Case to adherence, reduce Introduction
Patient his indicating anxiety 2 was A
and a that 53-year-old C depressive his C anxiety EP
heterosexual symptoms. and depressive He African reported symptoms American suboptimal
significantly male HIV presenting interfered medication
with with a desire his
ability to adhere to these medications.
History of Presenting Complaints
Patient 2 reported interfering anxiety and depressive symptoms beginning 5 years ago
when his wife passed away in an accident and that whe n he found out about his wife's death, he
responded with intense fear and helplessness, but was not persistently plagued by recurrent
ACCEPTED MANUSCRIPT
reexperiencing symptoms of this event. Instead, he reported a depressed mood, and worry about
many different aspects of his life, including his health and his relationship with his
grandchildren, who were not “being taken care of well” HIV positive as well as type 1 diabetic.
He reported that by his his physical children. illnesses Patient T
2 reported as well as
being
psychological time week” in Assessment symptoms fatigue, that the he with past. to experiences
As feelings help his per including girlfriend, symptoms him the of MINI cope worthlessness,
consistent feelings children, with diagnostic affected these of 2-week sadness, P and him
difficulty symptoms interview, T grandchildren. patterns daily, E anhedonia, D concentrating,
including and M Patient of depressive A that difficulty N He 2 he impeding reported U reported
had and S symptoms, not C sleeping, thoughts that his using R sought ability I he P marijuana
experienced psychomotor but of mental to suicide. has work felt health “a and He okay
depressive few retardation, services
reported
enjoy
for times 2 a
weeks normal and the or activities well-being more at in a of time addition A his C in children C
the to E
past worries and 2 years. grandchildren. about He his also health, reported Despite HIV, daily a
his previous girlfriend's worries trauma that health interfered history and and
safety,
with his
weekly marijuana use, Patient 2 did not meet criteria for PTSD or substance abuse/dependence at
the baseline assessment.
Given the overlap in symptoms of generalized anxiety disorder (GAD) and MDD, the
patient was asked to differentiate these symptoms and to indicate whether his symptoms were
due to one cause (eg, worry, depression) more than the other. Patient 2 reported that each of
these symptom clusters affected him equally, and that symptoms that overlap both GAD and
ACCEPTED MANUSCRIPT
MDD (eg, insomnia) were exacerbated by both his depression and worry; thus, both diagnoses
were warranted.
assessment, moderate and he reported Questionnaire-based negative the patient missing affect
scored 21% (PANAS-NA assessments of in his the HIV clinical = medications corresponded 36).
range His anxiety for in anxiety with the sensitivity past Patient (STAI-T 2 R weeks. 2's I score P
diagnoses. = T 56) See was and Figure also indexed
At elevated 1 baseline for
(39)
Patient baseline.
Case had a Conceptualization
dual HAMRT 2's focus symptom on was increasing information. recommended HIV The
medication to anxiety treat D Patient M sensitivity adherence. A 2's N comorbid U index The SC
patient was GAD not reported and available MDD; that for the he Patient treatment
often
2 at
missed expressed day feeling medications therapeutic sad or worried. because goals The of he E
enjoying forgot, therapeutic PT
E was time away goal with for from his Patient family, home, 2 or ran and spending was to out
of pills. The patient
less time during the
behavior.

A
C
C
decrease avoidance
Course of Treatment and Assessment Progress
The skills presented in each of the six sessions were presented in the same order as for
Patient 1. The first session focused on psychoeducation about anxiety and HIV medication
adherence. During this session, Patient 2 discussed reasons for wanting to reduce his anxiety and
depressive symptoms, including being able to enjoy time with his family. He reported that when
his wife passed away, he emotionally “shut down,” resulting in avoidance behavior (eg, not
ACCEPTED MANUSCRIPT
leaving the house, not talking with his children) and that some of this avoidance behavior still
impacts his daily life. Motivational interviewing was used to help the patient commit to engaging
in symptoms. negative thoughts a conceptualization doing, more”). which overcome safe anxiety
exercises pillbox therapy method he but In During and He thoughts such to reported using
Session his as the created help depressive of a desire as kids means Session increasing a with “I
100-point of and 2, using are cannot a A to cognitive his new consistent of feelings safe avoid
symptoms. 3, C children's during reducing IE mental physiological C remember and SUDS.
exposure in E restructuring in doing the the medication P a script his He parenting healthy
following Three face T distress to well was exercises E when take of responses D exposures
asked in anxiety. cara. strategies adherence. my strategies school. and worries week M were
Cognitive medication.” to A improving similar as rate were N Maybe completed. came were a
(eg, Additional homework U the conducted to restructuring S discussed to distress “II anxiety his
After should him: C may anxiety Hyperventilation R exercises exercise “This experienced this
not Patient I in trust in P session, agree session, order included and T is their your that 2 included
depression
with felt to parenting with by helped Patient deal day challenging in was what these regard his
now,” with
used him 2 SUDS they're a bought little
to
as a
reaching a high point of 70, and, by the third exposure exercises, reducing to 0 within 2 minutes
of the exercise. The patient was assigned daily practice of IE exposures for homework.
Sessions 4–6 included in vivo exposure exercises. During Session 4, Patient 2 conducted
an exposure of administering an insulin shot in public. He reported feeling more comfortable
than he imagined doing this, and generalized this new information to include his ability to take
his HIV medications in public. Homework for the following week included taking medications in
ACCEPTED MANUSCRIPT
public at least once. Session 5 focused on continuing to increase health behaviors, including
taking all of his medications, and restructuring negative thoughts about his health and the safety
of Session use, and depression, these others. treatment and were During 6, in Homework Patient
not vivo and plans the the HIV exercises 2 primary course in indicated medication included the
of in clinic.
goals treatment, session that taking adherence of he this included had medications Patient
program. sought and talking 2 also additional made His every made N to trait marked others U
day anxiety gains services S between C about improvements in R (STAI-T mood for his I
Sessions P his physical T and subclinical = 5 and 6. During marijuana
health problems
in anxiety,
affect, although
at Regarding fell of 25) adherence adhering week psychological below to week 3, to the also 38
his only 3 at (25) clinical fear improved termination) 79% quality of but anxiety-relevant of
average improved C of medications significantly C life fell E (29.5; were P at below termination
T steady Taylor at sensations, during E clinical baseline, D from et the M al., (44). average
baseline 100% course A his 2007) Patient ASI-3 of (52.3; of at (WHOQOL-BREF-Psychological
medications treatment, posttreatment score 2's Bieling past was 2-week with high et at 56 al.,
1998; at week (27). Patient HIV the patient week 3 at baseline, 54 see Figure 1).
3 (53), but
2's ratings
=
medication
reporting
93% of past 2-week A
medications at termination. Notably, although depression was follow-up, not explicitly and
targeted in any session, his IDAS-Depression score decreased from 76 at intake to 51 by
termination.
Follow-Up
Selama perawatan, Pasien 2 membuat perbaikan yang ditandai dalam kecemasan dan
gejala depresi serta kepatuhan minum obat HIV. Dia dinilai kembali pada 1 bulan
 
ACCEPTED MANUSCRIPT
posttreatment termination; generally, his treatment gains were maintained. Specifically, trait
anxiety stayed below the clinical average (STAI-T = 45); however, ASI-3 scores regressed to
midtreatment (WHOQOL-BREF-Psychological above to Patient MINI Case desire adherence,
assessment. History improve Introduction at pretreatment to Patient 2's the of reduce follow-up
having Presenting posttreatment 1-month levels 3 her was missed levels anxiety (ASI-3 A a
follow-up data. 41-year-old Complaints C (IDAS-Depression (86% most C Regarding = and 54)
E of appointment, vs. depressive P and = her heterosexual 79%) T 44) psychological psychiatric
medications E to D at Case follow-up symptoms. follow-up = and M 41). Study African
diagnoses, did A for See quality N (38). not 3 over and She Figure U American meet Patient
depressive S self-reported 1 of the month C life criteria 1 patient for R 2's reduced female a prior
I symptoms medication P graphical for was poor T to GAD presenting from readministered her
HIV representation or baseline termination
also adherence MDD.
medication
continued
with a
the
was
of
Patient 3 reported increased stress in the workplace, experiencing increased HIV-related
stigma among coworkers and feeling socially anxious and depressed. She worked at a
community outreach center for HIV and reported that her HIV status was known in the
workplace. She described a pervasive feeling of having to “explain herself” to others and feeling
like she is “case managed” by coworkers. She reported feeling like an “other” and looked down
upon by her peers due to her status, stating that people often jump to conclusions and assume she
ACCEPTED MANUSCRIPT
had been sexually reckless and/or promiscuous because of prejudice about Black women with
HIV. However, she reported that she had been sexually active with only one man, who
transmitted need nothing such Assessment resulting the detachment concentrating, trauma. as to
As Patient “defend nausea wrong. from per She the from the a feeling 3 and disease Patient
reported herself” past did others, MINI vomiting, not sexual on to 3 meet diagnostic from and
avoidance reported guard, her assault numbing 15 which criteria this and years P medication
negative interview, many of T make exaggerated for reminders, feelings, E ago a D years her
current after assumption interference M Patient not prior as dating startle loss A want well major
N and 3 of for as to met and response. U interest depressive reported sleep take due several S to
criteria C prove to her difficulties, in physical R years. fearing medication. hobbies, for episode.
to IP past-month others She T her sensations irritability, feelings However, reported safety that
she PTSD as of of a did
a difficulty she constant anxiety,
result did of
report no current feeling Patient suicidal depressed 3 met ideation, A criteria C most C
intent, for E of social the or time plan.
anxiety over the disorder past 2 due years to fear and met and avoidance criteria for of dysthymia
multiple
but
social situations, both at work and socially. She reported avoiding situations as well as suffering
through work situations and dreading them.
Questionnaire-based assessments corresponded with Patient 3's diagnoses. At baseline
assessment, she scored in the clinical range for trait anxiety (STAI-T = 57) and indexed high
negative affect (PANAS-NA = 46) and relatively low quality of life (WHOQOL-BREF-
Psychological = 25). Patient 3's anxiety sensitivity score was elevated (ASI-3 = 38), as were her
ACCEPTED MANUSCRIPT
symptoms of depression (IDAS-Depression = 70). She also reported missing 100% of her HIV
medications in the past 2 weeks.
Case Conceptualization
HAMRT was recommended to treat Patient 3's social anxiety, posttraumatic adherence. would
improve. By stress. treating She reported She her reported emotional that when that symptoms,
experiences she is not it stressed, of was stress expected U
she S adversely C is RIP impact dysthymia, T
and
her medication
that medication adherence
but Course Patient adherence. and that holidays and other stressors make it difficult depressive
The 1. of The Treatment During skills first symptoms, presented this session and session,
including focused Assessment in E
each the P
on patient of T being psychoeducation the E Progress
D six discussed able sessions M to AN to adhere to medications.
“on track” with medications
were presented in the same order as for
about anxiety and HIV medication
reasons for wanting to reduce her anxiety
being able In Session to raise 2, her A
cognitive daughter CC
restructuring and interact strategies with her go family to were work discussed without without
the to feeling intrusion help with “dread,” of thinking anxiety.
as well more as
flexibly. Patient 3 spoke at length about an upcoming holiday party at work that she was
dreading—the party was identified as a treatment goal and potential target for future exposures.
Homework was assigned including monitoring the physiological, cognitive, and behavioral
components of anxiety.
The plan for Session 3 was modified slightly due to outside circumstances. Patient 3
engaged in an impromptu exposure, taking the opportunity to deliver a 2-hour impromptu speech
ACCEPTED MANUSCRIPT
for an AIDS service organization. She stated that she was motivated by the first two sessions and
pushed herself to do this exposure—further, she stated that she noticed anxiety developing in her
daughter formal exposure approaching Planned of flexibly engaging remaining she coworkers
negative more such the more as smoothly patient exposures During “They applied IE interactions
and (eg, readily in thoughts when exposures an rather wanted regarding don't Session post
exposure socially, in annoyed. believes had practice than such hoc A want with to not for 4, C
make exposures. tracking avoiding, and of as Session continued been her me her. C She and
interacting “My they here,” negative E a Relatedly, concluded introduced/practiced, change can
P judgment anxiety interact 3 and This were T adapt cognitive and cognitive E thoughts with in
evidences gathered before, not she D more her that to is coworkers the conducted questioned
noticed life M restructuring ignoring positively when restructuring needs during, as A e vidence
how an N the that she of and this example coworkers in U and session because the when is with
lieu the S for therapy, was annoyed after patient of C session and of her. she conducted. to
remaining focused IR focusing the could am her against She engages although as I and
exposure), P positive.” focused daughter. they also be on T that the on automatic contributing
Patient recapping arise. them, challenged manualized, presenting she thought. on praise She
Given ignores challenging things 3 noticed described thoughts. of for Patient that thoughts to
issues the
go can their that be
3
also practiced perspective taking by comparing how she responds to her negative automatic
thoughts to how she would respond if a loved one had the same negative automatic thought. The
patient noted that she is harder on herself and tends to be kind to others but not herself.
Session 5 continued cognitive restructuring and review of exposures conducted out of
session. Patient 3 engaged in an exposure before the session of attending a party with coworkers.
Initially, a party with coworkers was rated as not an option for exposures. Additionally, the
ACCEPTED MANUSCRIPT
patient noticed that others were listening to her more after engaging with them socially and that
her anxiety had reduced and she was able to start eating breakfast again, which she usually did
not one-page real” do by as In reading a script Session result and it of 6, out read prework Patient
loud. it out The 3 anxiety conducted loud script because and focused an nausea.
exposure her on automatic themes in the of thought form job security, of R
was a I
worry P that T in script. She created a it would be “more
she of feared she reached reading difficult being Follow-Up the was “had activated pay that
During a 80 worried hearing value second scale.” any while the and other during her about time,
writing She course worth” A thoughts job worried the her and C she the of repeated C job and
ending the got worry and E and that without treatment, would P having at that she readings.
script T a E 30 did hers not it them she D and after not Patient be is would M reduced “the
fulfilling. have “become reading A 3 easiest enough “have made N to a U She real.” final 50 to
marked no S education after get stated value time. C She rid reading improvements noted that
The of” and to her as no patient get physical aloud, she worth.” job which another was made
noted then in sensations “at she Her anxiety job her a that the stated 40 SUDS and feel bottom
after
it and was
that
like
depressive symptoms as well as HIV medication adherence. The patient continued these gains at
the 1-month follow-up. See Figure 1 for a graphical representation of Patient 3's follow-up data.
During the course of the treatment, Patient 3 made marked improvements in anxiety and
depressive symptoms, anxiety sensitivity, positive affect, negative affect, and HIV medication
adherence, and generally continued these gains at the 1-month follow-up. Regarding anxiety,
STAI-T scores fell from baseline to posttreatment, and stayed relatively stable at follow-up (47,
ACCEPTED MANUSCRIPT
45, and 42, respectively). Regarding anxiety sensitivity, Patient 3 reduced at week 3 (25) and
week 6 (9). She rebounded slightly at 1-month follow-up (23) but did not return to her baseline
level medication 36% decreased at (38) week and over adherence 6, remained treatment, she
reported improved below and 100% gains the from clinical adherence were 0% maintained at
average baseline at 1-month for to at ASI-3 50% follow-up follow-up. at (Taylor week R
(45, Depressive I 3. et P 41, Although al., T 39) 2007). falling symptoms it Her reduced below to
community throughout 6 MINI past for reduction yielded (44), dysthymia; month at and In
encouraging the therapy the follow-up treatment and average 1-month present however, no
designed longer (MA results follow-up from study, (56). C = she 45.0; met C baseline Regarding
to in we stated E help criteria terms Watson evaluated appointment. P improve that (WHOQOL-
BREF-Psychological T of for psychiatric E all she et PTSD D a al., targeted Discussion had
novel cART She 2007). M not or A six-session diagnoses, reported adherence for dependent felt
N Psychological social sad U no S in phobia. Patient CBT-based among reexperiencing measures
the C past quality 3 PLHIV. She = was month. (ie, 25) did transdiagnostic readministered of to
increased still of The life week her meet improved treatment trauma 3 (31), criteria
cART
anxiety
the in week the
the
adherence and decreased anxiety and anxiety sensitivity) and additionally indicated positive
results in terms of related (though not specifically targeted) outcomes (ie, reduced depression
and negative affect, improved quality of life). These results were generally maintained at 1-
month posttreatment. Specifically, in regard to cART adherence, all participants improved
adherence between pretreatment and end-of-treatment sessions, and all three maintained or
improved adherence rates at posttreatment. This study is the first of its kind to examine the
ACCEPTED MANUSCRIPT
effects of an anxiety-reduction program on cART adherence among PLHIV, and it provides
novel evidence that anxiety reduction may be a viable tool to assist with adherence. This is
critically symptoms et program anxiety experienced gains indicating factors 2016) focus,
outcomes, sensitivity al., maintaining 2017). is results across Additionally, Also symptoms
effective, notably important that these and reduction reductions consistent indicated anxiety
transdiagnostic disorders gains reduced or and above given A was improving as disorders were
extends with C notable in hypothesized, more the not trait that trait C not the clinical maintained
E PLHIV anxiety commonly anxiety anxiety this reductions maintained instead at design P 1-
month work T average who levels the treatment E to and of between among below D than novel
disorder-specific in are for focus posttreatment. among anxiety at M the adherent all pretreatment
clinical CBT-based PLHIV. (ie, of A end persons. general study treatment, N sensitivity.
treatment of to average U treatment participants. population This medications For S symptom
transdiagnostic assessment, C as two finding that by However, R well and of posttreatment,
targets I clusters; (Bing P three as All follow-up. experience supports T the and participants
unlike common individuals, anxiety-reduction et transdiagnostic each al., Norton earlier other
2001; For with anxiety participant
underlying Patient & reported these
work
anxiety Brandt
Paulus,
2,
anxiety sensitivity returned to baseline by the 1-month follow-up time point. Given that anxiety
sensitivity reduction was a treatment focus for only one session (Session 3), it may be that a
higher dose of interoceptive exposure is needed to produce and maintain these reductions.
Indeed, PLHIV may experience consistent symptoms of pain and/or anxiety, and multiple
therapy sessions may be needed for patients to internalize and maintain a reduction in anxiety
ACCEPTED MANUSCRIPT
sensitivity. Future work should extend the current treatment model, examining the effects of
utilizing anxiety sensitivity reduction techniques over the course of therapy.
For secondary dependent variables, including negative affect, depression, and quality of
life, results followed the same general pattern as primary results. Specifically, rates of depression
and negative affect fell consistently from pretreatment to posttreatment for each participant, and
these results were maintained at the 1-month posttreatment session. Similarly, rates of
psychological quality of life improved during treatment for participants, and these results were
also maintained posttreatment. These results are in line with transdiagnostic theory that targeting
underlying mechanisms for mental health will impact a wider range of outcomes than disorder-
specific symptoms (eg, Barlow et al., 2010) and extend this work to PLHIV. This extension is
particularly important given the high rates of mulitmorbidity present among this population (eg,
Bing et al., 2001). Improvements in quality of life are important, providing evidence that the
treatment does more than reduce negative aspects of patients' lives (ie, anxiety), but also that it
results in some positive impact.
The current study has a number of limitations. First, the sample size is small, limiting
generalizability of results. Second, although we attempted to discuss clients of different
demographic groups here, future work should utilize larger samples to mitigate this concern.
Third, we did not formally assess homework compliance, adherence, or acceptability of
treatment via standardized instruments. Past work has indicated that homework compliance can
improve treatment outcomes (Kazantzis et al., 2016). Future research on this program could
benefit by adding formalized documentation of homework compliance and its effect on treatment
outcomes.

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Overall, the present study provides novel empirical data on HAMRT for PLHIV who
experience concurrent anxiety and cART underadherence. The results suggest potential clinical
utility (eg, quality improvements that consistent anxiety a anxiety, greater for of sensitivity a life
gains. CBT-based focus among depression, in Relatedly, anxiety reduction on PLHIV. anxiety
transdiagnostic sensitivity anxiety a may shorter There sensitivity be sensitivity) were are a (eg,
viable intervention many reduction the two alternative least and potential to four improving
stable during in N sessions) regard next U for among treatment S PLHIV steps cART to C
program reducing all R for outcome adherence seeking may I this P
T focused psychological produce program. treatment variables. and exclusively more
psychological
First, who It distress may do
be
on
not this blood maximally Finally, diabetes) Mosher, Claude, have program work this
Hadjistavropoulos, Winger, the that accessible appointments, program time into require Given,
existing or A resources may daily for C Helft, PLHIV health be C prescription self-care. &
generalizable E Friesen, to & P care commit who O'Neil, T Many services already E 2014) refill
to D 2016) to chronically six appointments) and other M have (eg, sessions and the A a
chronically administration associated HAMRT significant ill of groups therapy. may intervention
ill problems help medical have populations during Additionally, to high make appointment with
doctor's may rates this (eg, self-care be of integration program
appointments,
helpful anxiety cancer,
burden.
(Janzen
at
(eg, of
decreasing anxiety and increasing self-care with minimal changes to the treatment itself.
Additionally, this program may show generalizability to other groups suffering from
physical illnesses.
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Figure 1. Trajectories of outcomes over the course of treatment and follow-up.

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Highlights
• A six-session CBT-based transdiagnostic anxiety treatment was administered to three
persons living with HIV.
• Persons receiving treatment showed decreases in anxiety symptoms, anxiety sensitivity,
depression symptoms, and negative affect.
• Persons receiving treatment showed increases in HIV medication adherence and quality
of life.

A
C
C
E
P
T
E
D
M
A
N
U
S
C
R
I
P
T