Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
AIDS and Behavior
Published in: AIDS and Behavior 2/2016

01-02-2016 | Original Paper

Alexithymia, Assertiveness and Psychosocial Functioning in HIV: Implications for Medication Adherence and Disease Severity

Authors: Roger C. McIntosh, Gail Ironson, Michael Antoni, Mary Ann Fletcher, Neil Schneiderman

Published in: AIDS and Behavior | Issue 2/2016

Login to get access

Abstract

Psychosocial function and adherence to antiretroviral regimen are key factors in human immunodeficiency virus (HIV) disease management. Alexithymia (AL) is a trait deficit in the ability to identify and describe feelings, emotions and bodily sensations. A structural equation model was used to test whether high levels of AL indirectly relate to greater non-adherent behavior and HIV disease severity via psychosocial dysfunction. Blood draws for HIV-1 viral load and CD4 T-lymphocyte, along with psychosocial surveys were collected from 439 HIV positive adults aged 18–73 years. The structural model supports significant paths from: (1) AL to non-active patient involvement, psychological distress, and lower social support, (2) psychological distress and non-active involvement to non-adherent behavior, and (3) non-adherence to greater HIV disease severity (CFI = .97, RMSEA = .04, SRMR = .05). A second model confirmed the intermediary effect of greater patient assertiveness on the path from AL to social support and non-active patient involvement (CFI = .94, RMSEA = .04, SRMR = .05). Altogether, AL is indirectly linked with HIV disease management through it's association with poor psychosocial function, however greater patient assertiveness buffers the negative impact of AL on relationship quality with healthcare providers and members of one's social support network.
Literature
1.
Catz SL, Kelly JA, Bogart LM, Benotsch EG, McAuliffe TL. Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychol. 2000;19(2):124.PubMedCrossRef
2.
Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.PubMedCrossRef
3.
Bangsberg DR, Perry S, Charlebois ED, Clark RA, Roberston M, Zolopa AR, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15(9):1181–3.PubMedCrossRef
4.
Chesney MA. Factors affecting adherence to antiretroviral therapy. Clin Infect Dis. 2000;30(Supplement 2):S171–6.PubMedCrossRef
5.
Ironson G, Lucette A, McIntosh R. Doctor-patient relationship: active patient involvement (DPR: API) is related to long survival status and predicts adherence change in HIV. J AIDS Clin Res. 2015;6(2):1–5.
6.
Chida Y, Vedhara K. Adverse psychosocial factors predict poorer prognosis in HIV disease: a meta-analytic review of prospective investigations. Brain Behav Immun. 2009;23(4):434–45.PubMedCrossRef
7.
Ironson GH. Hayward Hs. Do positive psychosocial factors predict disease progression in HIV-1? A review of the evidence. Psychosom Med. 2008;70(5):546.PubMedCentralPubMedCrossRef
8.
Turner BJ, Laine C, Cosler L, Hauck WW. Relationship of gender, depression, and health care delivery with antiretroviral adherence in hiv-infected drug users. J Gen Intern Med. 2003;18(4):248–57.PubMedCentralPubMedCrossRef
9.
Motivala SJ, Hurwitz BE, Llabre MM, Klimas NG, Fletcher MA, Antoni MH, et al. Psychological distress is associated with decreased memory helper T-cell and B-cell counts in pre-AIDS HIV seropositive men and women but only in those with low viral load. Psychosom Med. 2003;65(4):627–35.PubMedCrossRef
10.
Greeson JM, Hurwitz BE, Llabre MM, Schneiderman N, Penedo FJ, Klimas NG. Psychological distress, killer lymphocytes and disease severity in HIV/AIDS. Brain Behav Immun. 2008;22(6):901–11.PubMedCrossRef
11.
McIntosh RC, Hurwitz BE, Antoni M, Gonzalez A, Seay J, Schneiderman N. The ABCs of trait anger, psychological distress, and disease severity in HIV. Ann Behav Med. 2014;3:1–14.
12.
Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. JAIDS. 2011;58(2):181–7.PubMed
13.
Kacanek D, Jacobson DL, Spiegelman D, Wanke C, Isaac R, Wilson IB. Incident depression symptoms are associated with poorer HAART adherence: a longitudinal analysis from the Nutrition for Healthy Living (NFHL) study. J Acquir Immune Defic Syndr (1999). 2010;53(2):266.CrossRef
14.
Carrico AW, Riley ED, Johnson MO, Charlebois ED, Neilands TB, Remien RH, et al. Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of anti-retroviral therapy utilization. J Acquir Immune Defic Syndr (1999). 2011;56(2):146.CrossRef
15.
Sledjeski EM, Delahanty DL, Bogart LM. Incidence and impact of posttraumatic stress disorder and comorbid depression on adherence to HAART and CD4 + counts in people living with HIV. AIDS Patient Care STDs. 2005;19(11):728–36.PubMedCrossRef
16.
Schönnesson LN, Williams ML, Ross MW, Bratt G, Keel B. Factors associated with suboptimal antiretroviral therapy adherence to dose, schedule, and dietary instructions. AIDS Behav. 2007;11(2):175–83.CrossRef
17.
Boarts JM, Sledjeski EM, Bogart LM, Delahanty DL. The differential impact of PTSD and depression on HIV disease markers and adherence to HAART in people living with HIV. AIDS Behav. 2006;10(3):253–61.PubMedCrossRef
18.
Cohen MA, Alfonso CA, Hoffman RG, Milau V, Carrera G. The impact of PTSD on treatment adherence in persons with HIV infection. Gen Hosp Psychiatry. 2001;23(5):294–6.PubMedCrossRef
19.
Safren SA, Gershuny BS, Hendriksen E. Symptoms of posttraumatic stress and death anxiety in persons with HIV and medication adherence difficulties. AIDS Patient Care STDs. 2003;17(12):657–64.PubMedCrossRef
20.
21.
Mugavero MJ, Raper JL, Reif S, Whetten K, Leserman J, Thielman NM, et al. Overload: impact of incident stressful events on antiretroviral medication adherence and virologic failure in a longitudinal, multisite human immunodeficiency virus cohort study. Psychosom Med. 2009;71(9):920–6.PubMedCentralPubMedCrossRef
22.
Bottonari KA, Safren SA, McQuaid JR, Hsiao C-B, Roberts JE. A longitudinal investigation of the impact of life stress on HIV treatment adherence. J Behav Med. 2010;33(6):486–95.PubMedCentralPubMedCrossRef
23.
Campos LN, Guimarães MDC, Remien RH. Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil. AIDS Behav. 2010;14(2):289–99.PubMedCentralPubMedCrossRef
24.
Ammassari A, Murri R, Pezzotti P, Trotta MP, Ravasio L, De Longis P, et al. Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. JAIDS. 2001;28(5):445–9.PubMed
25.
Gonzalez JS, Penedo FJ, Antoni MH, Durán RE, McPherson-Baker S, Ironson G, et al. Social support, positive states of mind, and HIV treatment adherence in men and women living with HIV/AIDS. Health Psychol. 2004;23(4):413.PubMedCrossRef
26.
Power R, Koopman C, Volk J, Israelski DM, Stone L, Chesney MA, et al. Social support, substance use, and denial in relationship to antiretroviral treatment adherence among HIV-infected persons. AIDS Patient Care STDs. 2003;17(5):245–52.PubMedCrossRef
27.
Vyavaharkar M, Moneyham L, Tavakoli A, Phillips KD, Murdaugh C, Jackson K, et al. Social support, coping, and medication adherence among HIV-positive women with depression living in rural areas of the southeastern United States. AIDS Patient Care STDs. 2007;21(9):667–80.PubMedCrossRef
28.
Ingram KM, Jones DA, Fass RJ, Neidig JL, Song YS. Social support and unsupportive social interactions: their association with depression among people living with HIV. AIDS Care. 1999;11(3):313–29.PubMedCrossRef
29.
Song YS, Ingram KM. Unsupportive social interactions, availability of social support, and coping: their relationship to mood disturbance among African Americans living with HIV. J Soc Pers Relationsh. 2002;19(1):67–85.CrossRef
30.
Nutting PA, Miller WL, Crabtree BF, Jaen CR, Stewart EE, Stange KC. Initial lessons from the first national demonstration project on practice transformation to a patient-centered medical home. Ann Fam Med. 2009;7(3):254–60.PubMedCentralPubMedCrossRef
31.
32.
Martini M, D’Elia S, Paoletti F, Cargnel A, Adriani B, Carosi G, et al. Adherence to HIV treatment: results from a 1-year follow-up study. HIV Med. 2002;3(1):62–4.PubMedCrossRef
33.
Bakken S, Holzemer WL, Brown M-A, Powell-Cope GM, Turner JG, Inouye J, et al. Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. AIDS Patient Care STDs. 2000;14(4):189–97.PubMedCrossRef
34.
Schneider J, Kaplan SH, Greenfield S, Li W, Wilson IB. Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. J Gen Intern Med. 2004;19(11):1096–103.PubMedCentralPubMedCrossRef
35.
Roberts KJ. Physician-patient relationships, patient satisfaction, and antiretroviral medication adherence among HIV-infected adults attending a public health clinic. AIDS Patient Care STDs. 2002;16(1):43–50.PubMedCrossRef
36.
Johnson MO, Chesney MA, Goldstein RB, Remien RH, Catz S, Gore-Felton C, et al. Positive provider interactions, adherence self-efficacy, and adherence to antiretroviral medications among HIV-infected adults: a mediation model. AIDS Patient Care STDs. 2006;20(4):258–68.PubMedCentralPubMedCrossRef
37.
J-fO Agbu. Management of negative self-image with rational emotive and behavioural therapy and assertiveness training. ASEAN J Psychiatry. 2014;16(1):57–68.
38.
McIntosh RC, Ironson G, Antoni M, Kumar M, Fletcher MA, Schneiderman N. Alexithymia is linked to neurocognitive, psychological, neuroendocrine, and immune dysfunction in persons living with HIV. Brain Behav Immun. 2014;36:165–75.PubMedCrossRef
39.
Parruti G, Vadini F, Sozio F, Mazzott E, Ursini T, Polill E, et al. Psychological factors, including alexithymia, in the prediction of cardiovascular risk in HIV infected patients: results of a cohort study. PLoS ONE. 2013;8(1):e54555.PubMedCentralPubMedCrossRef
40.
Landstra J, Ciarrochi J, Deane FP, Hillman RJ. Identifying and describing feelings and psychological flexibility predict mental health in men with HIV. Br J Health Psychol. 2013;18(4):844–57.PubMedCrossRef
41.
Masiello A, De Guglielmo C, Giglio S, Acone N. Beyond depression: assessing personality disorders, alexithymia and socio-emotional alienation in patients with HIV infection. Le Infez Med. 2014;22(3):193–9.
42.
Sozio F, Vadini F, Ursini T, Mazzotta E, Polilli E, Placido G, et al. Alexithymia as a major cardiovascular risk factor in HIV-infected patients. Infection. 2011;39:S37.
43.
Sifneos PE. The prevalence of ‘alexithymic’characteristics in psychosomatic patients. Psychother Psychosom. 1973;22(2–6):255–62.PubMedCrossRef
44.
Taylor GJ, Bagby RM, Parker JD. Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press; 1999.
45.
Lumley MA, Neely LC, Burger AJ. The assessment of alexithymia in medical settings: implications for understanding and treating health problems. J Pers Assess. 2007;89(3):230–46.PubMedCentralPubMedCrossRef
46.
Jørgensen MM, Zachariae R, Skytthe A, Kyvik K. Genetic and environmental factors in alexithymia: a population-based study of 8,785 Danish twin pairs. Psychother Psychosom. 2007;76(6):369–75.PubMedCrossRef
47.
Picardi A, Fagnani C, Gigantesco A, Toccaceli V, Lega I, Stazi MA. Genetic influences on alexithymia and their relationship with depressive symptoms. J Psychosom Res. 2011;71(4):256–63.PubMedCrossRef
48.
Bermond B, Vorst HC, Moormann PP. Cognitive neuropsychology of alexithymia: implications for personality typology. Cognit Neuropsychiatry. 2006;11(3):332–60.CrossRef
49.
Wingbermühle E, Theunissen H, Verhoeven W, Kessels RP, Egger JI. The neurocognition of alexithymia: evidence from neuropsychological and neuroimaging studies. Acta Neuropsychiatr. 2012;24(2):67–80.CrossRef
50.
Salminen JK, Saarijärvi S, Äärelä E, Toikka T, Kauhanen J. Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. J Psychosom Res. 1999;46(1):75–82.PubMedCrossRef
51.
Kokkonen P, Karvonen JT, Veijola J, Läksy K, Jokelainen J, Järvelin M-R, et al. Prevalence and sociodemographic correlates of alexithymia in a population sample of young adults. Compr Psychiatry. 2001;42(6):471–6.PubMedCrossRef
52.
Papciak AS, Feuerstein M, Spiegel JA. Stress reactivity in alexithymia: decoupling of physiological and cognitive responses. J Hum Stress. 1985;11(3):135–42.CrossRef
53.
Martin JB, Pihl R. The stress-alexithymia hypothesis: theoretical and empirical considerations. Psychother Psychosom. 1985;43(4):169–76.PubMedCrossRef
54.
Honkalampi K, Hintikka J, Tanskanen A, Lehtonen J, Viinamäki H. Depression is strongly associated with alexithymia in the general population. J Psychosom Res. 2000;48(1):99–104.PubMedCrossRef
55.
Luminet O, Bagby RM, Taylor GJ. An evaluation of the absolute and relative stability of alexithymia in patients with major depression. Psychother Psychosom. 2001;70(5):254–60.PubMedCrossRef
56.
Marchesi C, Brusamonti E, Maggini C. Are alexithymia, depression, and anxiety distinct constructs in affective disorders? J Psychosom Res. 2000;49(1):43–9.PubMedCrossRef
57.
Posse M, Hällström T, Backenroth-Ohsako G. Alexithymia, social support, psycho-social stress and mental health in a female population. Nord J Psychiatry. 2002;56(5):329–34.PubMedCrossRef
58.
Bratis D, Tselebis A, Sikaras C, Moulou A, Giotakis K, Zoumakis E, et al. Alexithymia and its association with burnout, depression and family support among Greek nursing staff. Hum Resour Health. 2009;7:72.PubMedCentralPubMedCrossRef
59.
Lumley MA, Ovies T, Stettner L, Wehmer F, Lakey B. Alexithymia, social support and health problems. J Psychosom Res. 1996;41(6):519–30.PubMedCrossRef
60.
Kojima M, Hayano J, Tokudome S, Suzuki S, Ibuki K, Tomizawa H, et al. Independent associations of alexithymia and social support with depression in hemodialysis patients. J Psychosom Res. 2007;63(4):349–56.PubMedCrossRef
61.
Graugaard PK, Holgersen K, Finset A. Communicating with alexithymic and non-alexithymic patients: an experimental study of the effect of psychosocial communication and empathy on patient satisfaction. Psychother Psychosom. 2004;73(2):92–100.PubMedCrossRef
62.
Finset A, Graugaard PK, Holgersen K. Salivary cortisol response after a medical interview: the impact of physician communication behaviour, depressed affect and alexithymia. Patient Educ Couns. 2006;60(2):115–24.PubMedCrossRef
63.
Finset A. Emotional intelligence, alexithymia, and the doctor-patient relationship. Somatization and psychosomatic symptoms. New York: Springer; 2013. p. 91–8.CrossRef
64.
Vanheule S, Vandenbergen J, Verhaeghe P, Desmet M. Interpersonal problems in alexithymia: a study in three primary care groups. Psychol Psychother. 2010;83(4):351–62.PubMedCrossRef
65.
Crowell T. Seropositive individuals willingness to communicate, self-efficacy, and assertiveness prior to HIV infection. J Health Commun. 2004;9(5):395–424.PubMedCrossRef
66.
McIntosh RC, Ironson G, Antoni M, Kumar M, Fletcher MA, Schneiderman N. Alexithymia is linked to neurocognitive, psychological, neuroendocrine, and immune dysfunction in persons living with HIV. Brain Behav Immun. 2013;36:165–75.PubMedCrossRef
67.
Bogdanova Y, Díaz-Santos M, Cronin-Golomb A. Neurocognitive correlates of alexithymia in asymptomatic individuals with HIV. Neuropsychologia. 2010;48(5):1295–304.PubMedCentralPubMedCrossRef
68.
McIntosh RC, Rosselli M, Uddin LQ, Antoni M. Neuropathological sequelae of human immunodeficiency virus and apathy: a review of neuropsychological and neuroimaging studies. Neurosci Biobehav Rev. 2015;55:147–64.PubMedCrossRef
69.
Temoshok LR, Waldstein SR, Wald RL, Garzino-Demo A, Synowski SJ, Sun L, et al. Type C coping, alexithymia, and heart rate reactivity are associated independently and differentially with specific immune mechanisms linked to HIV progression. Brain Behav Immun. 2008;22(5):781–92.PubMedCrossRef
70.
Lumley MA, Tomakowsky J, Torosian T. The relationship of alexithymia to subjective and biomedical measures of disease. Psychosomatics. 1997;38(5):497–502.PubMedCrossRef
71.
Ironson G, Balbin E, Solomon G, Fahey J, Klimas N, Schneiderman N, et al. Relative preservation of natural killer cell cytotoxicity and number in healthy AIDS patients with low CD4 cell counts. AIDS. 2001;15(16):2065–73.PubMedCrossRef
72.
Gail Ironson M, Solomon GF, Balbin EG, O’Cleirigh C, George A, Kumar M, et al. The Ironson-Woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS. Ann Behav Med. 2002;24(1):34–48.
73.
Taylor GJ, Ryan D, Bagby RM. Toward the development of a new self-report alexithymia scale. Psychother Psychosom. 1985;44(4):191–9.PubMedCrossRef
74.
Taylor GJ, Bagby RM. Measurement of alexithymia: recommendations for clinical practice and future research. Psychiatr Clin North Am. 1988;11:351–66.PubMed
75.
Gay ML, Hollandsworth JG, Galassi JP. An assertiveness inventory for adults. J Couns Psychol. 1975;22(4):340.CrossRef
76.
Lafromboise TD. The factorial validity of the adult selfexpression scale with American Indians. Educ Psychol Meas. 1983;43(2):547–55.CrossRef
77.
Mitchell PH, Powell L, Blumenthal J, Norten J, Ironson G, Pitula CR, et al. A short social support measure for patients recovering from myocardial infarction: the ENRICHD Social Support Inventory. J Cardiopulm Rehabil Prev. 2003;23(6):398–403.CrossRef
78.
Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol. 1980;39(3):472–80.PubMedCrossRef
79.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.PubMedCrossRef
80.
Beck AT, Ward C, Mendelson M. Beck depression inventory (BDI). Arch Gen Psychiatry. 1961;4(6):561–71.PubMedCrossRef
81.
Spielberger CD. STAI manual for the state-trait anxiety inventory. Self-Eval Quest. 1970:1–24.
82.
Chesney MA, Ickovics J, Chambers D, Gifford A, Neidig J, Zwickl B, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. AIDS care. 2000;12(3):255–66.PubMedCrossRef
83.
Reynolds NR, Sun J, Nagaraja HN, Gifford AL, Wu AW, Chesney MA. Optimizing measurement of self-reported adherence with the ACTG Adherence Questionnaire: a cross-protocol analysis. JAIDS. 2007;46(4):402–9.PubMed
84.
Enders CK, Bandalos DL. The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Struct Equ Model. 2001;8(3):430–57.CrossRef
85.
Kline RB. Principles and practice of structural equation modeling. New York: Guilford Press; 2011.
86.
Muthén L, Muthén B. Mplus. Statistical analysis with latent variables Version. 2007;3.
87.
88.
Jöreskog KG, Sörbom D. Lisrel 8: Structured equation modeling with the Simplis command language: Scientific Software International; 1993.
89.
Steiger JH. Structural model evaluation and modification: an interval estimation approach. Multivar Behav Res. 1990;25(2):173–80.CrossRef
90.
Lt Hu. Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structl Equ Model. 1999;6(1):1–55.CrossRef
91.
Hooper D, Coughlan J, Mullen M. Structural equation modelling: guidelines for determining model fit. Articles. 2008:2.
92.
Joy R, Druyts EF, Brandson EK, Lima VD, Rustad CA, Zhang W, et al. Impact of neighborhood-level socioeconomic status on HIV disease progression in a universal health care setting. JAIDS. 2008;47(4):500–5.PubMed
93.
McMahon J, Wanke C, Terrin N, Skinner S, Knox T. Poverty, hunger, education, and residential status impact survival in HIV. AIDS Behav. 2011;15(7):1503–11.PubMedCentralPubMedCrossRef
94.
Kalichman SC, Grebler T. Stress and poverty predictors of treatment adherence among people with low-literacy living with HIV/AIDS. Psychosom Med. 2010;72(8):810–6.PubMedCentralPubMedCrossRef
95.
96.
Nicolò G, Semerari A, Lysaker PH, Dimaggio G, Conti L, D’Angerio S, et al. Alexithymia in personality disorders: correlations with symptoms and interpersonal functioning. Psychiatry Res. 2011;190(1):37–42.PubMedCrossRef
97.
Meganck R, Vanheule S, Inslegers R, Desmet M. Alexithymia and interpersonal problems: a study of natural language use. Personal Individ Differ. 2009;47(8):990–5.CrossRef
98.
Coursaris CK, Liu M. An analysis of social support exchanges in online HIV/AIDS self-help groups. Comput Hum Behav. 2009;25(4):911–8.CrossRef
99.
Mo PK, Coulson NS. Empowering processes in online support groups among people living with HIV/AIDS: a comparative analysis of ‘lurkers’ and ‘posters’. Comput Hum Behav. 2010;26(5):1183–93.CrossRef
100.
Huffaker D. Dimensions of leadership and social influence in online communities. Human Commun Res. 2010;36(4):593–617.CrossRef
101.
Scheurer D, Choudhry N, Swanton KA, Matlin O, Shrank W. Association between different types of social support and medication adherence. Am J Manag Care. 2012;18(12):e461–7.PubMed
102.
Simoni JM, Frick PA, Huang B. A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol. 2006;25(1):74.PubMedCrossRef
103.
Tegger MK, Crane HM, Tapia KA, Uldall KK, Holte SE, Kitahata MM. The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals. AIDS Patient Care STDs. 2008;22(3):233–43.PubMedCrossRef
104.
Wagner GJ, Goggin K, Remien RH, Rosen MI, Simoni J, Bangsberg DR, et al. A closer look at depression and its relationship to HIV antiretroviral adherence. Ann Behav Med. 2011;42(3):352–60.PubMedCentralPubMedCrossRef
105.
Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav. 2012;16(8):2119–43.PubMedCentralPubMedCrossRef
106.
Himelhoch S, Brown CH, Walkup J, Chander G, Korthius PT, Afful J, et al. HIV patients with psychiatric disorders are less likely to discontinue HAART. AIDS (London, England). 2009;23(13):1735.CrossRef
107.
Cruess DG, Kalichman SC, Amaral C, Swetzes C, Cherry C, Kalichman MO. Benefits of adherence to psychotropic medications on depressive symptoms and antiretroviral medication adherence among men and women living with HIV/AIDS. Ann Behav Med. 2012;43(2):189–97.PubMedCentralPubMedCrossRef
108.
Llabre MM, Weaver KE, Durán RE, Antoni MH, McPherson-Baker S, Schneiderman N. A measurement model of medication adherence to highly active antiretroviral therapy and its relation to viral load in HIV-positive adults. AIDS Patient Care STDs. 2006;20(10):701–11.PubMedCrossRef
109.
Simoni JM, Kurth AE, Pearson CR, Pantalone DW, Merrill JO, Frick PA. Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav. 2006;10(3):227–45.PubMedCentralPubMedCrossRef
110.
Lu M, Safren SA, Skolnik PR, Rogers WH, Coady W, Hardy H, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12(1):86–94.PubMedCrossRef
111.
Safren SA, Otto MW, Worth JL, Salomon E, Johnson W, Mayer K, et al. Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring. Behav Res Ther. 2001;39(10):1151–62.PubMedCrossRef
112.
Hintikka J, Honkalampi K, Lehtonen J, Viinamäki H. Are alexithymia and depression distinct or overlapping constructs?: a study in a general population. Compr Psychiatry. 2001;42(3):234–9.PubMedCrossRef
113.
Saarijärvi S, Salminen J, Toikka T. Alexithymia and depression: a 1-year follow-up study in outpatients with major depression. J Psychosom Res. 2001;51(6):729–33.PubMedCrossRef
114.
Honkalampi K, Hintikka J, Saarinen P, Lehtonen J, Viinamäki H. Is alexithymia a permanent feature in depressed patients? Results from a 6-month follow-up study. Psychother Psychosom. 2000;69:303–8.PubMedCrossRef
115.
Honkalampi K, Koivumaa-Honkanen H, Tanskanen A, Hintikka J, Lehtonen J, Viinamäki H. Why do alexithymic features appear to be stable? Psychother Psychosom. 2001;70:247–53.PubMedCrossRef
116.
Luminet O, Bagby RM, Taylor GJ. An evaluation of the absolute and relative stability of alexithymia in patients with major depression. Psychother Psychosom. 2001;2001(70):254–60.CrossRef
117.
Parker JD, Taylor GJ, Bagby RM. Alexithymia: relationship with ego defense and coping styles. Compr Psychiatry. 1998;39(2):91–8.PubMedCrossRef
118.
Wise TN, Mann LS, Epstein S. Ego defensive styles and alexithymia: a discriminant validation study. Psychother Psychosom. 1991;56(3):141–5.PubMedCrossRef
119.
Helmes E, McNeill PD, Holden RR, Jackson C. The construct of alexithymia: associations with defense mechanisms. J Clin Psychol. 2008;64(3):318–31.PubMedCrossRef
120.
Besharat MA. Relationship of alexithymia with coping styles and interpersonal problems. Procedia-Soc Behav Sci. 2010;5:614–8.CrossRef
121.
van Servellen G, Lombardi E. Supportive relationships and medication adherence in HIV-infected, low-income Latinos. West J Nurs Res. 2005;27(8):1023–39.PubMedCrossRef
122.
Molassiotis A, Morris K, Trueman I. The importance of the patient–clinician relationship in adherence to antiretroviral medication. Int J Nurs Pract. 2007;13(6):370–6.PubMedCrossRef
123.
Brion J. The patient–provider relationship as experienced by a diverse sample of highly adherent HIV-infected people. J Assoc Nurses AIDS Care. 2013;25:123–34.PubMedCrossRef
124.
Vanheule S, Desmet M, Meganck R, Bogaerts S. Alexithymia and interpersonal problems. J Clin Psychol. 2007;63(1):109–17.PubMedCrossRef
125.
Grabe H, Spitzer C, Freyberger H. Alexithymia and the temperament and character model of personality. Psychother Psychosom. 2001;70(5):261–7.PubMedCrossRef
126.
Beisecker AE. Patient power in doctor-patient communication: what do we know? Health Communication. 1990;2(2):105–22.CrossRef
127.
Ferguson WJ, Candib LM. Culture, language, and the doctor-patient relationship. FMCH Publ Present. 2002;61.
128.
Schouten BC, Meeuwesen L. Cultural differences in medical communication: a review of the literature. Patient Educ Couns. 2006;64(1):21–34.PubMedCrossRef
129.
Ogrodniczuk JS, Piper WE, Joyce AS. Effect of alexithymia on the process and outcome of psychotherapy: a programmatic review. Psychiatry Res. 2011;190(1):43–8.PubMedCrossRef
130.
Taylor GJ, Bagby RM. Psychoanalysis and empirical research: the example of alexithymia. J Am Psychoanal Assoc. 2013;61(1):99–133.
131.
Lane RD, Weihs KL, Herring A, Hishaw A, Smith R. Affective agnosia: expansion of the alexithymia construct and a new opportunity to integrate and extend freud’s legacy. Neurosci Biobehav Rev. 2015;55:594–611.PubMedCrossRef
132.
Hesse C, Floyd K, Rauscher EA, Frye-Cox NE, Hegarty JP, Peng H. Alexithymia and impairment of decoding positive affect: an fMRI study. J Commun. 2013;63(4):786–806.CrossRef
133.
134.
135.
Heinzel A, Schäfer R, Müller H-W, Schieffer A, Ingenhag A, Eickhoff SB, et al. Increased activation of the supragenual anterior cingulate cortex during visual emotional processing in male subjects with high degrees of alexithymia: an event-related fMRI study. Psychother Psychosom. 2010;79(6):363–70.PubMedCrossRef
136.
Kallianpur KJ, Kirk GR, Sailasuta N, Valcour V, Shiramizu B, Nakamoto BK, et al. Regional cortical thinning associated with detectable levels of HIV DNA. Cereb Cortex. 2012;22(9):2065–75.PubMedCentralPubMedCrossRef
137.
Clark US, Walker KA, Cohen RA, Devlin KN, Folkers AM, Pina MJ, et al. Facial emotion recognition impairments are associated with brain volume abnormalities in individuals with HIV. Neuropsychologia. 2015;70:263–71.PubMedCrossRef
138.
Kremer H, Lutz FP, McIntosh RC, Dévieux JG, Ironson G. Interhemispheric asymmetries and theta activity in the rostral anterior cingulate cortex as EEG signature of HIV-related depression gender matters. Clin EEG Neurosci. 2015. doi:10.​1177/​1550059414563306​.
139.
Bateman A, Fonagy P. Psychotherapy for borderline personality disorder. Oxford: Oxford University Press; 2005.
140.
Greenberg LS. Emotion-focused therapy: Coaching clients to work through their feelings: Am Psychol Assoc. 2002.
141.
Rufer M, Albrecht R, Zaum J, Schnyder U, Mueller-Pfeiffer C, Hand I, et al. Impact of alexithymia on treatment outcome: a naturalistic study of short-term cognitive-behavioral group therapy for panic disorder. Psychopathology. 2010;43(3):170–9.PubMedCrossRef
142.
Rufer M, Hand I, Braatz A, Alsleben H, Fricke S, Peter H. A prospective study of alexithymia in obsessive-compulsive patients treated with multimodal cognitive-behavioral therapy. Psychother Psychosom. 2004;73(2):101–6.PubMedCrossRef
143.
Safren SA, O’Cleirigh C, Tan JY, Raminani SR, Reilly LC, Otto MW, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol. 2009;28(1):1.PubMedCentralPubMedCrossRef
144.
Antoni MH, Baggett L, Ironson G, LaPerriere A, August S, Klimas N, et al. Cognitive-behavioral stress management intervention buffers distress responses and immunologic changes following notification of HIV-1 seropositivity. J Consult Clin Psychol. 1991;59(6):906.PubMedCrossRef
145.
Lutgendorf SK, Antoni MH, Ironson G, Starr K, Costello N, Zuckerman M, et al. 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. Psychosom Med. 1998;60(2):204–14.PubMedCrossRef
146.
Cruess S, Antoni MH, Hayes A, Penedo F, Ironson G, Fletcher MA, et al. Changes in mood and depressive symptoms and related change processes during cognitive–behavioral stress management in HIV-Infected Men. Cognit Ther Res. 2002;26(3):373–92.CrossRef
147.
Sundararajan L, Schubert LK. Verbal expressions of self and emotions A taxonomy with implications for Alexithymia and. Conscious Emot. 2005;1:243.CrossRef
148.
Smyth J, True N, Souto J. Effects of writing about traumatic experiences: the necessity for narrative structuring. J Soc Clin Psychol. 2001;20(2):161–72.CrossRef
149.
Sundararajan L, Kim C, Reynolds M, Brewin CR. Language, emotion, and health: a semiotic perspective on the writing cure. In: Hamel SC, editor. Semiotics: Theory and applications. Hauppauge, NY: Nova Science Publishers; 2011. p. 65–97.
150.
O’Cleirigh C, Ironson G, Fletcher MA, Schneiderman N. Written emotional disclosure and processing of trauma are associated with protected health status and immunity in people living with HIV/AIDS. Br J Health Psychol. 2008;13(1):81–4.PubMedCentralPubMedCrossRef
151.
Petrie KJ, Fontanilla I, Thomas MG, Booth RJ, Pennebaker JW. Effect of written emotional expression on immune function in patients with human immunodeficiency virus infection: a randomized trial. Psychosom Med. 2004;66(2):272–5.PubMedCrossRef
152.
O’Cleirigh C, Ironson G, Antoni M, Fletcher MA, McGuffey L, Balbin E, et al. Emotional expression and depth processing of trauma and their relation to long-term survival in patients with HIV/AIDS. J Psychosom Res. 2003;54(3):225–35.PubMedCrossRef
153.
Solano L, Costa M, Temoshok L, Salvati S, Coda R, Aiuti F, et al. An emotionally inexpressive (Type C) coping style influences HIV disease progression at six and twelve month follow-ups. Psychol Health. 2002;17(5):641–55.CrossRef
154.
Antoni MH, Cruess DG, Klimas N, Maher K, Cruess S, Kumar M, et al. Stress management and immune system reconstitution in symptomatic HIV-infected gay men over time: Effects on transitional naïve T cells (CD4 + CD45RA + CD29 +). Am J Psychiatry. 2014.
155.
Semple SJ, Strathdee SA, Zians J, McQuaid JR, Patterson TL. Drug assertiveness and sexual risk-taking behavior in a sample of HIV-positive, methamphetamine-using men who have sex with men. J Subst Abuse Treat. 2011;41(3):265–72.PubMedCentralPubMedCrossRef
156.
Lee TY, Chang SC, Chu H, Yang CY, Ou KL, Chung MH, et al. The effects of assertiveness training in patients with schizophrenia: a randomized, single-blind, controlled study. J Adv Nurs. 2013;69(11):2549–59.PubMed
157.
Hijazi AM, Tavakoli S, Slavin-Spenny OM, Lumley MA. Targeting interventions: moderators of the effects of expressive writing and assertiveness training on the adjustment of international university students. Int J Adv Couns. 2011;33(2):101–12.PubMedCentralPubMedCrossRef
158.
Gidron Y. Assertiveness training. Encyclopedia of behavioral medicine. New York: Springer; 2013. p. 135–6.
159.
Panos SE, Del Re A, Thames AD, Arentsen TJ, Patel SM, Castellon SA, et al. The impact of neurobehavioral features on medication adherence in HIV: Evidence from longitudinal models. AIDS Care. 2013(ahead-of-print):1–8.
160.
Patton DE, Woods SP, Franklin D Jr, Cattie JE, Heaton RK, Collier AC, et al. Relationship of medication management test-revised (MMT-R) performance to neuropsychological functioning and antiretroviral adherence in adults with HIV. AIDS Behav. 2012;16(8):2286–96.PubMedCentralPubMedCrossRef
161.
Ironson G, Balbin E, Stuetzle R, Fletcher MA, O’Cleirigh C, Laurenceau J, et al. Dispositional optimism and the mechanisms by which it predicts slower disease progression in HIV: proactive behavior, avoidant coping, and depression. Int J Behav Med. 2005;12(2):86–97.PubMedCentralPubMedCrossRef
162.
O’Cleirigh C, Ironson G, Weiss A, Costa PT Jr. Conscientiousness predicts disease progression (CD4 number and viral load) in people living with HIV. Health Psychol. 2007;26(4):473.PubMedCrossRef
163.
Penedo FJ, Gonzalez JS, Dahn JR, Antoni M, Malow R, Costa P, et al. Personality, quality of life and HAART adherence among men and women living with HIV/AIDS. J Psychosom Res. 2003;54(3):271–8.PubMedCrossRef
164.
Ironson GH, O’Cleirigh C, Weiss A, Schneiderman N, Costa PT. Personality and HIV disease progression: role of NEO-PI-R openness, extraversion, and profiles of engagement. Psychosom Med. 2008;70(2):245–53.PubMedCentralPubMedCrossRef
Metadata
Title
Alexithymia, Assertiveness and Psychosocial Functioning in HIV: Implications for Medication Adherence and Disease Severity
Authors
Roger C. McIntosh
Gail Ironson
Michael Antoni
Mary Ann Fletcher
Neil Schneiderman
Publication date
01-02-2016
Publisher
Springer US
Published in
AIDS and Behavior / Issue 2/2016
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-015-1126-7

Other articles of this Issue 2/2016

AIDS and Behavior 2/2016 Go to the issue

Original Paper

Bisexual Behavior Among Male Injection Drug Users in New York City

Original Paper

Linking Syndemic Stress and Behavioral Indicators of Main Partner HIV Transmission Risk in Gay Male Couples

Original Paper

Syndemics and Health Disparities: A Methodological Note

Original Paper

A Comparison of Men Who Have Sex with Men, People Who Inject Drugs and High-Risk Heterosexuals’ Risk for HIV Infection, San Francisco

Original Paper

High HIV Prevalence and Associated Risk Factors Among Female Sexual Partners of Male Injection Drug Users (MWID) in Ho Chi Minh City, Vietnam

Brief Report

Using Capture-Recapture Methods to Estimate the Population of People Who Inject Drugs in Washington, DC

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits