Top

International Journal of Behavioral Medicine

Published in:

01-02-2015

Examining Associations Between Cognitive-Affective Vulnerability and HIV Symptom Severity, Perceived Barriers to Treatment Adherence, and Viral Load Among HIV-Positive Adults

Authors: Teresa M. Leyro, Anka A. Vujanovic, Marcel O. Bonn-Miller

Published in: International Journal of Behavioral Medicine | Issue 1/2015

Abstract

Background

Little research on symptom impairment and quality of life among HIV-positive (HIV+) individuals has attended to the potential role of cognitive-affective vulnerabilities. Emerging research indicates that emotion regulation (ER), anxiety sensitivity (AS), and distress tolerance (DT) are associated with a range of mental health outcomes and demonstrate meaningful relations to clinical outcomes in HIV+ individuals.

Purpose

In this investigation, we sought to concurrently examine these factors in relation HIV symptom severity, barriers to medication adherence, and disease viral load.

Method

Participants were 139 HIV+ individuals (34 female; age M = 48.2 years, SD = 8.1, 42 % Black) receiving outpatient HIV care and prescribed at least one antiretroviral medication. We used hierarchical regression analyses to concurrently examine ER, AS, and DT in relation to severity of HIV symptoms, barriers to medication adherence, and disease viral load.

Results

After accounting for alcohol use problems, cannabis dependence, gender, and education, AS was significantly associated with HIV symptom severity (β = .35, p < .01) whereas ER evidenced a trend relation (β = .19, p = .07). ER (β = .45, p < .01), but not AS or DT, was significantly related to barriers to medication adherence, above and beyond variance accounted for by covariates. Finally, ER evidenced a trend level relation to viral load (β = .21, p = .07), above and beyond variance accounted for by cannabis use.

Conclusion

Findings provide an extension of previous research, suggesting unique roles of cognitive-affective vulnerabilities in terms of HIV symptom severity, medication use barriers, and infection symptomatology, and inform the refinement of current treatments for HIV+ individuals so as to improve functioning.

Duncan LG, Moskowitz JT, Neilands TB, Dilworth SE, Hecht FM, Johnson MO. Mindfulness-based stress reduction for HIV treatment side effects: a randomized, wait-list controlled trial. J Pain Symptom Manage. 2012;43(2):161–71.PubMedCentralPubMedCrossRef

Rao D, Nainis N, Williams L, et al. Art therapy for relief of symptoms associated with HIV/AIDS. AIDS Care. 2009;21(1):64–9.PubMedCrossRef

Webel AR. Testing a peer-based symptom management intervention for women living with HIV/AIDS. AIDS Care. 2010;22(9):1029–40.PubMedCentralPubMedCrossRef

Ammassari A, Trotta MP, Shalev N, et al. Timed short messaging service improved adherence and virological outcomes in HIV-1-infected patients with suboptimal adherence to antiretroviral therapy. J Acquir Immune Defic Syndr. 2011;58(4):e113–5.PubMedCrossRef

Johnson M, Charlebois E, Morin SF, Remien RH, Chesney MA. Effects of a behavioral intervention on antiretroviral medication adherence among people living with HIV: the healthy living project randomized controlled study. J Acquir Immune Defic Syndr. 2007;46(5):574–80.PubMedCentralPubMedCrossRef

Safren SA, O'Cleirigh CM, Bullis JR, Otto MW, Stein MD, Pollack MH. Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial. J Consult Clin Psychol. 2012;80(3):404–15.PubMedCentralPubMedCrossRef

Galárraga O, Genberg BL, Martin RA, Barton LM, Wilson IB. Conditional economic incentives to improve HIV treatment adherence: Literature review and theoretical considerations. AIDS Behav. 2013;17:2283–92.PubMedCentralPubMedCrossRef

Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med. 2007;167(6):540.PubMedCrossRef

Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load: a meta-analytic review of randomized controlled trials. J Acquir Immune Defic Syndr. 2006;43:S23–35.PubMedCentralPubMedCrossRef

10.

Leyro T, Zvolensky M, Bernstein A. Distress tolerance and psychopathological symptoms and disorders: a review of the empirical literature among adults. Psych Bull. 2010;136(4):576–600.CrossRef

11.

Keough M, Schmidt N. Refinement of a brief anxiety sensitivity reduction intervention. J Clin Consult Psychol. 2012;80(5):766–72.CrossRef

12.

Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev. 2010;30(2):217–37.PubMedCrossRef

13.

Bernstein A, Marshall E, Zvolensky M. Multi-method evaluation of distress tolerance measures and construct(s): concurrent relations to mood and anxiety psychopathology and quality of life. J Exp Psychopathol. 2011;2(3):386–99.

14.

Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26(1):41–54.CrossRef

15.

Carrico AW, Johnson MO, Moskowitz JT, et al. Affect regulation, stimulant use, and viral load among HIV-positive persons on anti-retroviral therapy. Psychosom Med. 2007;69(8):785–92.PubMedCrossRef

16.

Kraaij V, van der Veek SM, Garnefski N, Schroevers M, Witlox R, Maes S. Coping, goal adjustment, and psychological well-being in HIV-infected men who have sex with men. AIDS Patient Care STDs. 2008;22(5):395–402.PubMedCrossRef

17.

Kraaij V, Garnefski N, Schroevers MJ, van der Veek S, Witlox R, Maes S. Cognitive coping, goal self-efficacy and personal growth in HIV-infected men who have sex with men. Patient Educ Couns. 2008;72(2):301–4.PubMedCrossRef

18.

Gonzalez A, Solomon SE, Zvolensky MJ, Miller CT. The interaction of mindful-based attention and awareness and disengagement coping with HIV/AIDS-related stigma in regard to concurrent anxiety and depressive symptoms among adults with HIV/AIDS. J Health Psychol. 2009;14(3):403–13.PubMedCentralPubMedCrossRef

19.

Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822–48.PubMedCrossRef

20.

Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol. 1989;56(2):267–83.PubMedCrossRef

21.

Reiss S, McNally RJ. Expectancy model of fear. In: Reiss S, Bootzin RR, editors. Theoretical issues in behavior therapy. San Diego: Academic; 1985. p. 107–21.

22.

Leyro TM, Zvolensky MJ, Bernstein A. Distress tolerance and psychopathological symptoms and disorders: a review of the empirical literature among adults. Psychol Bull. 2010;136(4):576–600.PubMedCentralPubMedCrossRef

23.

DeHaas RA, Calamari JE, Bair JP. Anxiety sensitivity and the situational antecedents to drug and alcohol use: an evaluation of anxiety patients with substance use disorders. Cog Ther Res. 2002;26(3):335–53.CrossRef

24.

Norton GR. Substance use/abuse and anxiety sensitivity: what are the relationships? Addict Behav. 2001;26(6):935–46.PubMedCrossRef

25.

Ocañez KL, McHugh KR, Otto MW. A meta-analytic review of the association between anxiety sensitivity and pain. Depress Anxiety. 2010;27(8):760–7.PubMed

26.

Olatunji BO, Wolitzky-Taylor KB. Anxiety sensitivity and the anxiety disorders: a meta-analytic review and synthesis. Psychol Bull. 2009;135(6):974.PubMedCrossRef

27.

Simpson T, Jakupcak M, Luterek JA. Fear and avoidance of internal experiences among patients with substance use disorders and PTSD: the centrality of anxiety sensitivity. J Trauma Stress. 2006;19(4):481–91.PubMedCrossRef

28.

Bernstein A, Marshall EC, Zvolensky MJ. Multi-method evaluation of distress tolerance measures and construct (s): concurrent relations to mood and anxiety psychopathology and quality of life. J Exp Psychopath. 2011;2(3):386–99.

29.

Vujanovic AA, Bonn-Miller MO, Potter CM, Marshall EC, Zvolensky MJ. An evaluation of the relation between distress tolerance and posttraumatic stress within a trauma-exposed sample. J Psychopathol Behav Assess. 2011;33(1):129–35.PubMedCentralPubMedCrossRef

30.

Inserting LM. Skills training manual for treating borderline personality disorder [e-book]. New York: Guilford; 1993.

31.

Bernstein A, Zvolensky M, Vujanovic A, Moos R. Integrating anxiety sensitivity, distress tolerance, and discomfort intolerance: a hierarchical model of affect sensitivity and tolerance. Behav Ther. 2009;40(3):291–301.PubMedCrossRef

32.

Gonzalez A, Zvolensky MJ, Parent J, Grover KW, Hickey M. HIV symptom distress and anxiety sensitivity in relation to panic, social anxiety, and depression symptoms among HIV-positive adults. AIDS Patient Care STDS. 2012;26(3):156–64.PubMedCrossRef

33.

Gonzalez A, Zvolensky MJ, Solomon SE, Miller CT. Exploration of the relevance of anxiety sensitivity among adults living with HIV/AIDS for understanding anxiety vulnerability. J Health Psychol. 2010;15(1):138–46.PubMedCentralPubMedCrossRef

34.

Capron DW, Gonzalez A, Parent J, Zvolensky MJ, Schmidt NB. Suicidality and anxiety sensitivity in adults with HIV. AIDS Patient Care STDS. 2012;26(5):298–303.PubMedCrossRef

35.

O’Cleirigh C, Ironson G, Smits JA. Does distress tolerance moderate the impact of major life events on psychosocial variables and behaviors important in the management of HIV? Behav Ther. 2007;38(3):314–23.PubMedCentralPubMedCrossRef

36.

Oser ML, Trafton JA, Lejuez CW, Bonn-Miller MO. Differential associations between perceived and objective measurement of distress tolerance in relation to art adherence and response among HIV+ individuals. Behav Ther. 2013;44:432–42.PubMedCrossRef

37.

Brandt CP, Zvolensky MJ, Bonn-Miller MO. Distress tolerance, emotion dysregulation, and anxiety and depressive symptoms among HIV+ individuals. Cognit Ther Res. 2013;37:446–55.CrossRef

38.

Brandt CP, Gonzalez A, Grover KW, Zvolensky MJ. The relation between emotional dysregulation and anxiety and depressive symptoms, pain-related anxiety, and HIV-symptom distress among adults with HIV/AIDS. J Psychopathol Behav Assess. 2013;35(2):197–204.CrossRef

39.

Bonn-Miller MO, Oser ML, Bucossi MM, Trafton JA. Cannabis use and HIV antiretroviral therapy adherence and HIV-related symptoms. J Behav Med. 2014;37:1–10.PubMedCrossRef

40.

Mellors JW, Munoz A, Giorgi JV, et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Ann of Intern Med. 1997;126(12):946–54.CrossRef

41.

U.S. Health Resources and Services Administration, 2012. http://www.hrsa.gov/index.html. Accessed 10 Feb 2013.

42.

First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV-TR Axis I disorders, research version, non-patient edition. SCID-I/NP, 11/2002 revision. New York: Biometrics Research, New York State Psychiatric Institute; 2002.

43.

Babor TF, de la Fuente JR, Saunders J, Grant M. AUDIT: Alcohol Use Disorders Identification test: guidelines for use in primary health care. Geneva: World Health Organization; 1992.

44.

Saunders JB, Aasland OG, Babor TF, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction. 1993;88(6):791–804.PubMedCrossRef

45.

Chesney MA. Factors affecting adherence to antiretroviral therapy. Clin Infect Dis. 2000;30 Suppl 2:S171–6.PubMedCrossRef

46.

Murphy DA, Sarr M, Durako SJ, Moscicki AB, Wilson CM, Muenz LR. Barriers to HAART adherence among human immunodeficiency virus-infected adolescents. Arch Pediatr Adolesc Med. 2003;157(3):249–55.PubMedCrossRef

47.

48.

Taylor S, Zvolensky MJ, Cox BJ, et al. Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychol Assessment. 2007;19(2):176–88.CrossRef

49.

Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Beh Res Ther. 1986;24(1):1–8.CrossRef

50.

Simons JS, Gaher RM. The Distress Tolerance Scale: development and validation of a self-report measure. Motiv Emotion. 2005;29(2):83–102.CrossRef

51.

McHugh RK, Otto MW. Refining the measurement of distress intolerance. Behav Ther. 2012;43(3):641–51.PubMedCentralPubMedCrossRef

52.

McHugh RK, Reynolds EK, Leyro TM, Otto MW. An examination of the association of distress intolerance and emotion regulation with avoidance. Cognitive Ther Res. 2013;37(2):363–7.CrossRef

53.

Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depen. 2010;112(3):178–93.CrossRef

54.

Schulte T, Muller-Oehring EM, Sullivan EV, Pfefferbaum A. White matter fiber compromise contributes differentially to attention and emotion processing impairment in alcoholism, HIV-infection, and their comorbidity. Neuropsychologia. 2012;50(12):2812–22.PubMedCentralPubMedCrossRef

55.

Cook PF, Sousa KH, Matthews EE, Meek PM, Kwong J. Patterns of change in symptom clusters with HIV disease progression. J Pain Symptom Manag. 2011;42(1):12–23.CrossRef

56.

HIV InSite, UCSF Center for HIV Information, 2013. http://hivinsite.ucsf.edu/ Accessed 25 Mar 2013

57.

Foster C, Fidler S. Optimizing antiretroviral therapy in adolescents with perinatally acquired HIV-1 infection. Expert Rev Anti Infect Ther. 2010;8(12):1403–16.PubMedCrossRef

58.

Palella Jr FJ, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43(1):27–34.PubMedCrossRef

59.

Quinn TC. HIV epidemiology and the effects of antiviral therapy on long-term consequences. AIDS. 2008;22 Suppl 3:S7–S12.PubMedCentralPubMedCrossRef

60.

Boswell JF, Farchione TJ, Sauer-Zavala S, Murray HW, Fortune MR, Barlow DH. Anxiety sensitivity and interoceptive exposure: a transdiagnostic construct and change strategy. Behav Ther. 2013;44:417–31.PubMedCentralPubMedCrossRef

61.

Otto MW. Anxiety sensitivity, emotional intolerance, and expansion of the application of interoceptive exposure: commentary on the special issue. J Cognitive Psychother. 2008;22(4):379–84.CrossRef

62.

Keng SL, Smoski MJ, Robins CJ, Ekblad AG, Brantley JG. Mechanisms of change in mindfulness-based stress reduction: self-compassion and mindfulness as mediators of intervention outcomes. J Cognitive Psychother. 2012;26(3):270.CrossRef

63.

Phillippot P, Segal Z. Mindfulness based psychological interventions: developing emotional awareness for better being. J Consciousness Stud. 2009;16:285–306.

Title: Examining Associations Between Cognitive-Affective Vulnerability and HIV Symptom Severity, Perceived Barriers to Treatment Adherence, and Viral Load Among HIV-Positive Adults
Authors: Teresa M. Leyro
Anka A. Vujanovic
Marcel O. Bonn-Miller
Publication date: 01-02-2015
Publisher: Springer US
Published in: International Journal of Behavioral Medicine / Issue 1/2015
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI: https://doi.org/10.1007/s12529-014-9404-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Examining Associations Between Cognitive-Affective Vulnerability and HIV Symptom Severity, Perceived Barriers to Treatment Adherence, and Viral Load Among HIV-Positive Adults

Abstract

Background

Purpose

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Purpose

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2015

Using Ecological Momentary Assessment to Understand Where and With Whom Adults’ Physical and Sedentary Activity Occur

Factors Associated with Disability Expectations in Patients Undergoing Heart Surgery

Trajectories of Physical Activity and Risk Factors Among Taiwanese Older Adults

Daily Positive Affect and Nocturnal Cardiac Activation

Social Physique Anxiety and Disturbed Eating Attitudes and Behaviors in Adolescents: Moderating Effects of Sport, Sport-Related Characteristics, and Gender

Relationships Between Mental Health Distress and Work-Related Factors Among Prefectural Public Servants Two Months After the Great East Japan Earthquake