Cognitive Therapy Gives Boost to 50-Year-Olds With Long-Term HIV

Subject: NATAP/Aging Wk: Cognitive therapy in Aging Patients >50

Cognitive Therapy Gives Boost to 50-Year-Olds With Long-Term HIV 

2nd International Workshop on HIV and Aging, October 27-28, 2011, Baltimore, Maryland

Mark Mascolini

Mindfulness-based cognitive therapy proved popular and effective in improving quality of life in a randomized trial involving 40 men and women around 50 years old in Barcelona [1]. Whether positive effects of this intensive therapeutic course last more than a few months in people with HIV remains to be seen.

Anxiety and depression rates are high among people with HIV and may increase as HIV-positive people age. Mindfulness-based cognitive therapy–designed for people with depression–combines cognitive therapy with meditation and other practices aimed at cultivating mindfulness. Psychologists variously define mindfulness as focusing complete attention on the present moment or staying aware of thoughts, feelings, and sensations in the present moment–instead of mulling past or future concerns [2].

Carmina Fumaz and colleagues at Badalona’s Germans Trias i Pujol University Hospital planned this randomized trial of 20 men and 20 women with HIV infection for at least 15 years and with quality-of-life deficits marked by scores at or above 65 on the Nottingham Health Profile. The researchers excluded people with bipolar disorder, a documented psychotic episode or epileptic episode, or ongoing psychotherapy. They randomized 10 men and 10 women to a control arm involving only assessment and 10 men and 10 women to mindfulness-based cognitive therapy. Fumaz and colleagues evaluated study participants 3 and 6 months after the intervention.

Cognitive therapy involved eight 3-hour weekly classes, a day-long retreat, and an hour or more of “homework” 6 days a week. The goal of these exercises was to encourage people “to appreciate the present moment instead of focusing on worries about [the] future or past.”

Everyone invited to participate agreed to join the study. Median age stood at 50 years (interquartile range [IQR] 46 to 52), median HIV duration at 20 years (IQR 16 to 24), and median time on antiretroviral therapy at 16 years (IQR 12 to 18). Median current CD4 count was 527 (IQR 364 to 633), 39 people (98%) had a viral load below 25 copies, and 17 (43%) had a stable partner. These numbers did not differ significantly between the intervention group and the control group. Nor did measures of energy, pain, emotional reactions, sleep, social isolation, and physical mobility on the Nottingham Health Profile. Only 1 person (in the cognitive therapy group) dropped out.

At post-treatment evaluations, all of the just-noted psychosocial variables improved significantly in the intervention group compared with the control group. All 20 people in the cognitive therapy group had a poor energy score before treatment and none did afterwards. Among seven aspects of daily living, four improved significantly in the intervention group compared with the control group: work, relationships at home, interests and hobbies, and ability to take holidays. The positive impact of cognitive therapy did not differ by gender. 

Fumaz and colleagues concluded that mindfulness therapy may be a useful strategy in aging people with HIV infection.

At the Aging Workshop, David Clifford (Washington University, St. Louis) noted that this intervention requires a big time commitment and wondered whether recruitment favored selection of people attuned to this type of therapy. Notably, half of the study participants were retired.

Fumaz agreed that this strategy takes time (she did not discuss cost) but said their center now has a waiting list of people who want to try it. Health workers in the hospital are also eager to sign up for mindfulness-based cognitive therapy. Fumaz noted that 200 hospitals in the United States have mindfulness-based cognitive therapy programs. 

The researchers plan to monitor study participants to see if the reported benefits persist longer than 1 year. Three-year follow-up of 18 of 22 US patients in a trial of mindfulness-based meditation for anxiety disorders found sustained good responses on Hamilton and Beck Anxiety and Depression scores, the Hamilton pain score, the Mobility Index-Accompanied test, and the Fear Survey [3].

References
1. Fumaz CR, Gonzalez-Garcia M, Munoz-Moreno JA, et al. Improvement of quality of life after the application of mindfulness-based cognitive therapy in subjects aging with HIV infection. 2nd International Workshop on HIV and Aging. October 27-28, 2011. Baltimore, Maryland. Abstract: O_09.
2. Baer RA. Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol Sci Prac. 2003;10:125-143. https://www.wisebrain.org/papers/MindfulnessPsyTx.pdf.
3. Miller JJ, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry. 1995;17:192-200. https://www.ncbi.nlm.nih.gov/pubmed/7649463.