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Foley JD, Bernier LB, Ngo L, Batchelder AW, O’Cleirigh C, Lydston M, Yeh G. Evaluating the Efficacy of Psycho-Behavioral Interventions for Cardiovascular Risk among People Living with HIV: A Systematic Review and Meta-Synthesis of Randomized Controlled Trials. J Acquir Immune Defic Syndr 2024; 96:399-409. [PMID: 39175844 PMCID: PMC11338626 DOI: 10.1097/qai.0000000000003441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
People with HIV (PWH) are disproportionately affected by cardiovascular disease (CVD). Psycho-behavioral therapies are capable of targeting the pathophysiology underlying HIV-CVD comorbidity. This study synthesized findings from randomized controlled trials (RCTs) of psycho-behavioral therapies for reducing CVD risk among PWH following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were: (1) utilized an RCT design, (2) evaluated a cognitive-behavioral or mindfulness-based therapy, (3) sampled adults (age ≥18 years) with HIV, (4) measured a behavioral (e.g., diet) or biological (e.g., immune functioning) CVD risk factor, and (5) published in an English-language peer-reviewed journal. Electronic searches were conducted in six databases (e.g., MEDLINE) using controlled vocabulary and free-text synonyms for HIV, psycho-behavioral therapy, and CVD risk. Data were independently extracted with consensus reached. Outcomes were immune activation, tobacco-smoking, stress, inflammation, and physical activity from 33 studies. There were stronger effects for psycho-behavioral interventions compared to controls on CD4 (Hedge's g=0.262, 95% Confidence Interval [CI]=0.127, 0.396) and tobacco-smoking abstinence (Hedge's g=0.537, 95% CI=0.215, 0.86). There were no differences or insufficient data for stress, inflammation, or physical activity. No eligible studies examined psycho-behavioral interventions on blood pressure, lipids, or weight in PWH. There is increasing importance to further invest in broader CVD risk reduction effort for PWH that include psycho-behavioral intervention strategies.
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Affiliation(s)
- Jacklyn D. Foley
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Lauren B. Bernier
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Abigail W. Batchelder
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Conall O’Cleirigh
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Melissa Lydston
- Treadwell Virtual Library for the Massachusetts General Hospital, Boston, Massachusetts
| | - Gloria Yeh
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, United States
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Aguilar-Raab C, Winter F, Warth M, Stoffel M, Moessner M, Hernández C, Pace TWW, Harrison T, Negi LT, Jarczok MN, Ditzen B. A compassion-based treatment for couples with the female partner suffering from current depressive disorder: A randomized-controlled trial. J Affect Disord 2023; 342:127-138. [PMID: 37661057 DOI: 10.1016/j.jad.2023.08.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Studies have shown that depression and interpersonal relationships are interdependently connected and that including the intimate partner in treatment for depression has beneficial effects. Given evidence that compassion is both an interpersonal quality and a promising treatment target, the goal of this study was to examine the effects of a compassion-based, contemplative treatment for couples employing a multi-method approach for evaluation. METHODS In a pre-post-follow-up design, n = 53 different-sex couples including women with current depression were randomly assigned to a 10-week-long CBCT®-fC (Cognitively-Based Compassion Training/intervention for couples) or treatment-as-usual (TAU) condition. Multi-level linear regression models and post-hoc contrasts were calculated to determine changes in depressive symptoms, mindfulness and self-compassion, interpersonal functioning and neuroendocrine markers collected during a partnership appreciation task (PAT) in the laboratory before and after CBCT-fC treatment. RESULTS While CBCT-fC led to a comparable decrease of depressive symptoms as TAU, the training specifically increased self-compassion and mindfulness versus TAU. Interestingly, interpersonal functioning did not improve, which was also reflected in participants' preferred self-focus in-between-session practices, instead of practices with interpersonal focus. There were no group-specific changes in psychobiological stress-marker reactivity. CONCLUSIONS CBCT-fC was effective in decreasing current depressive symptomatology and increasing mindfulness, and self-compassion. Especially the motivation to participate, such as improving interpersonal functioning, should be addressed and intrinsic motives of the partners to be involved. In highly burdened individuals, self-regulation may need to be improved before co-regulation can be addressed, which would requiring longer treatments. Facilitating factors for engaging in the practice between-sessions seem meaningful.
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Affiliation(s)
- Corina Aguilar-Raab
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
| | - Friederike Winter
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Marco Warth
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Martin Stoffel
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Institute of Psychosocial Prevention, Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Cristóbal Hernández
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Escuela de Psicología - Universidad Adolfo Ibáñez, Chile
| | | | - Timothy Harrison
- Center for Contemplative Science and Compassion-Based Ethics, Emory University, Atlanta, GA, USA
| | - Lobsang Tenzin Negi
- Center for Contemplative Science and Compassion-Based Ethics, Emory University, Atlanta, GA, USA
| | - Marc N Jarczok
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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