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The Effect of Cognitive-Behavioral Group Therapy Using Art as a Medium on Depressive Symptoms and HIV Antiretroviral Medication Adherence

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Abstract

The prevalence of HIV in Thailand continues to increase, especially among men who have sex with other men (MSM). Being stigmatized can result in depression, which can negatively impact antiretroviral medication adherence. This quasi-experimental research study aimed to examine the effects of cognitive-behavioral group therapy using art as a medium on depressive symptoms and medication adherence. Forty-six MSM were assigned (23 × 2) either to a weekly 2-h art-based CBGT group session for a total of 8 weeks or to a no-intervention control group. The experimental group of 23 met in 4 separate small groups. Pre-intervention period analyses indicated no significant differences between the two groups in the key variables examined, together with demographic information including the participants’ ages, education levels, and CD4 (T cells) levels. Measures of depressive symptoms and antiretroviral medication adherence were administered pre- and post-intervention. Using MANOVA, findings suggested that depressive symptom scores among the intervention group were reduced significantly post-treatment (p < .01) and were significantly lower than those of the control group (p < .001). Scores among the experimental group for medication adherence increased significantly pre- to post-treatment (p < .025); however, post-treatment scores were not significantly different between the experimental and control groups. These findings provide initial evidence for the potential effectiveness of art-based CBGT in alleviating depressive symptoms and enhancing antiretroviral medication adherence in MSM with HIV.

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References

  • Ammassari, A., Trotta, M. P., Murri, R., Castelli, F., Narciso, P., Noto, P., ... Antinori, A. (2002). Correlates and predictors of adherence to highly active antiretroviral therapy: overview of published literature. JAIDS Journal of Acquired Immune Deficiency Syndromes, 31, S123-S127.

    Article  Google Scholar 

  • Antiretroviral Therapy Cohort Collaboration. (2017). Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: A collaborative analysis of cohort studies. The Lancet HIV, 4(8), e349-e356.

  • Beck, A. T. (2005). The current state of cognitive therapy: a 40-year retrospective. Archives of General Psychiatry, 62(9), 953–959.

    Article  Google Scholar 

  • Berger, B. E., Ferrans, C. E., & Lashley, F. R. (2001). Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Research in Nursing & Health, 24(6), 518–529.

    Article  Google Scholar 

  • Beyrer, C., Baral, S. D., Van Griensven, F., Goodreau, S. M., Chariyalertsak, S., Wirtz, A. L., & Brookmeyer, R. (2012). Global epidemiology of HIV infection in men who have sex with men. The Lancet, 380(9839), 367–377.

    Article  Google Scholar 

  • Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185–216.

    Article  Google Scholar 

  • Bureau of AIDS, TB and STIs. (2013). Getting to zero. Retrieved December 1, 2013 from www.aidsstithai.org/contents/download/579.

  • Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review, 26(1), 17–31.

    Article  Google Scholar 

  • Chan, I., Kong, P., Leung, P., Au, A., Li, P., Chung, R., ... Yu, P. (2005). Cognitive-behavioral group program for Chinese heterosexual HIV-infected men in Hong Kong. Patient Education and Counseling, 56 (1), 78–84.

    Article  Google Scholar 

  • Ciesla, J. A., & Roberts, J. E. (2001). Meta-analysis of the relationship between HIV infection and risk for depressive disorders. American Journal of Psychiatry, 158(5), 725–730.

    Article  Google Scholar 

  • Corey, G. (2009). Cognitive behavior therapy (8th ed.). Belmont: Thomson Brooks/Cole.

    Google Scholar 

  • Crepaz, N., Passin, W. F., Herbst, J. H., Rama, S. M., Malow, R. M., Purcell, D. W., & Wolitski, R. J. (2008). Meta-analysis of cognitive-behavioral interventions on HIV-positive persons’ mental health and immune functioning. Health Psychology, 27(1), 4–14.

    Article  Google Scholar 

  • D’Zurilla, T. J., & Nezu, A. M. (2010). Problem-solving therapy. Handbook of Cognitive-Behavioral Therapies, 3, 197–225.

    Google Scholar 

  • Evans, D. L., Ten Have, T. R., Douglas, S. D., Gettes, D. R., Morrison, M., Chiappini, M. S., ... Wang, Y. L. (2002). Association of depression with viral load, CD8 T lymphocytes, and natural killer cells in women with HIV infection. American Journal of Psychiatry, 159(10), 1752–1759.

    Article  Google Scholar 

  • Gift, A. G. (1989). Visual analogue scales: Measurement of subjective phenomena. Nursing Research, 38(5), 286-288.

    Article  Google Scholar 

  • Gladding, S. T., & Newsome, D. W. (2003). Art in counseling. In C. A. Malchiodi (Ed.), Handbook of art therapy (pp. 72–81). New York: Guiford Press.

    Google Scholar 

  • Himelhoch, S., Medoff, D. R., & Oyeniyi, G. (2007). Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: a systematic review and meta-analysis. AIDS Patient Care and STDs, 21(10), 732–739.

    Article  Google Scholar 

  • Hopko, D. R., Ryba, M. M., McIndoo, C., & File, A. (2015). Behavioral activation. In A. M. Nezu & C. M. Nezu (Eds.), The Oxford handbook of cognitive and behavioral therapies. New York: Oxford University Press.

    Google Scholar 

  • Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8(3), 255–270.

    Google Scholar 

  • Kingdon, D., & Dimech, A. (2008). Cognitive and behavioural therapies: the state of the art. Psychiatry, 7(5), 217–220.

    Article  Google Scholar 

  • Leibowitz-Levy, S. (2005). The role of brief–term interventions with South African child trauma survivors. Journal of Psychology in Africa, 15(2), 155–163.

    Google Scholar 

  • Malchiodi, C. A. (2003). Handbook of art therapy. New York: Guiford Press.

    Google Scholar 

  • Malchiodi, C. A. (2005). Expressive therapies. New York: Guiford Press.

    Google Scholar 

  • Morisky, D. E., Green, L. W., & Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24(1), 67–74.

    Article  Google Scholar 

  • National AIDS Trust. (2003). Fact sheet 4.1 HIV/AIDS stigma and discrimination: Gay men. Retrieved November 1, 2014, from www.nat.org.uk/HIV-Facts.aspx. Accessed 1 Dec 2013.

  • Rabkin, J. G. (2008). HIV and depression: 2008 review and update. Current HIV/AIDS Reports, 5(4), 163–171.

    Article  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale a self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.

    Article  Google Scholar 

  • Robatmili, S., Sohrabi, F., Shahrak, M. A., Talepasand, S., Nokani, M., & Hasani, M. (2015). The effect of group logotherapy on meaning in life and depression levels of Iranian students. International Journal for the Advancement of Counselling, 37(1), 54–62.

    Article  Google Scholar 

  • Roghanchi, M., Mohamad, A. R., Mey, S. C., Momeni, K. M., & Golmohamadian, M. (2013). The effect of integrating rational emotive behavior therapy and art therapy on self-esteem and resilience. The Arts in Psychotherapy, 40(2), 179–184.

    Article  Google Scholar 

  • Rosum, A. L., & Malchiodi, C. A. (2003). Cognitive-behavioral approaches. In C. A. Malchiodi (Ed.), Handbook of art therapy (pp. 72–81). New York: Guilford Press.

    Google Scholar 

  • Rovinelli, R. J., & Hambleton, R. K. (1976). On the use of content specialists in the assessment of criterion-referenced test item validity. Laboratory of Psychometric and Evaluation Research Report No. 24.

  • Rubin, J. A. (2005). Artful therapy. Hoboken, NJ: John Wiley & Sons. 

  • Safren, S. A., Otto, M. W., Worth, J. L., Salomon, E., Johnson, W., Mayer, K., & Boswell, S. (2001). Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring. Behaviour Research and Therapy, 39(10), 1151–1162.

    Article  Google Scholar 

  • Safren, S. A., O'Cleirigh, C., Tan, J. Y., Raminani, S. R., Reilly, L. C., Otto, M. W., & Mayer, K. H. (2009). A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychology, 28(1), 1–10.

    Article  Google Scholar 

  • Spies, G., Asmal, L., & Seedat, S. (2013). Cognitive-behavioural interventions for mood and anxiety disorders in HIV: a systematic review. Journal of Affective Disorders, 150(2), 171–180.

    Article  Google Scholar 

  • Walsh, J. C., Dalton, M., & Gazzard, B. G. (1998). Adherence to combination antiretroviral therapy assessed by anonymous patient self-report. Aids, 12(17), 2361–2363.

    PubMed  Google Scholar 

  • Williams, M. M., Foo, K. H., & Haarhoff, B. A. (2006). Cultural considerations in using cognitive behaviour therapy with Chinese people: a case study of an elderly Chinese woman with generalised anxiety disorder. New Zealand Journal of Psychology, 35(3), 153–162.

  • Zimpel, R. R., & Fleck, M. P. (2014). Depression as a major impact on the quality of life of HIV-positive Brazilians. Psychology, Health & Medicine, 19(1), 47–58.

    Article  Google Scholar 

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Acknowledgments

We thank Analisa Avila, ELS, of Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Faculty of Psychology, Chulalongkorn University, 8th floor BMS Bldg., Rama 1 Rd., Patumwan, Bangkok, 10330, Thailand

    Panu Sahassanon, Kullaya Pisitsungkagarn & Nattasuda Taephant

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  1. Panu Sahassanon
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  2. Kullaya Pisitsungkagarn
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  3. Nattasuda Taephant
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Correspondence to Panu Sahassanon.

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This research project was approved by the review committee at the Faculty of Psychology, Chulalongkorn University, and conforms to the provision of the Declaration of the Helsinki whereby informed consent for study participation was obtained and participant anonymity was preserved.

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Sahassanon, P., Pisitsungkagarn, K. & Taephant, N. The Effect of Cognitive-Behavioral Group Therapy Using Art as a Medium on Depressive Symptoms and HIV Antiretroviral Medication Adherence. Int J Adv Counselling 41, 530–543 (2019). https://doi.org/10.1007/s10447-019-09377-7

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