Table 1.
Description of Cognitive Behavioural Interventions (n=20).
| Study | Sample characteristic (Enroled/completed) | Evaluation design | Description of intervention | Main outcomes assessed | Other measured outcomes | Main findings |
|---|---|---|---|---|---|---|
| Depression | ||||||
| Carrico et al. (2005) * a | HIV+ART-naïve males (129/44). No group differences in demographics | Randomised CBSM/WLC. Follow-up: IP, 6-months | Group CBSM. Duration: weekly for 10 weeks (135 min). Deliverer: clinical health psychology graduates | Depression (BDI) | Health status, life events, social support | Men in the CBSM group reported significant decreases in depression over 6-month follow-up compared to controls |
| Carrico et al. (2005) * b | HIV+ males on ART (129/49). No group differences in demographics. 47% on ART | Randomised CBSM/WLC. Follow-up: IP, 6-, 12-months | Group CBSM. Duration: weekly for 10 weeks (135 min). Deliverer: clinical health psychology graduates | Depression (POMS; BDI) | Social support, immune status | Men in the CBSM group experienced significant reductions in depression through the 6- to 12-month follow-up |
| Carrico (2006) | HIV+ males on ART (130/98). No group differences in demographics | Randomised CBSM-MAT/MAT only comparative trial. Follow-up: IP | Group CBSM-MAT. Duration: weekly for 10 weeks (135 min). Deliverer: clinical health psychology graduates | Depression (POMS). |
Coping, medication adherence | Men in the CBSM group reported significant decreases in depression after 10 weeks compared to the MAT only group |
| Chan (2005) | HIV+ males (16/13). No group differences in demographics | Randomised CBT/WLC trial. Follow-up: IP | Group CBT. Duration: weekly for 7 weeks (2 h). Deliverer: clinical psychologist | Depression (CES-D) |
Health related quality of life | Men in the CBT group showed significant reductions in depression compared to control condition |
| Eller (1995) | HIV+ males and females on ART (81/69). No group differences in demographics | Randomised guided imagery/PMR/WLC trial. Follow-up: 6-weeks post intervention | Individual guided imagery/PMR. Duration: 6 weeks. Deliverer: audio tapes used at home | Depression (CES-D) |
Cellular immunity, fatigue | PMR and guided imagery showed reductions in depression. PMR resulted in CD4 enhancement |
| Jones et al. (2010) | HIV+ women (451/387) | Randomised CBSM/control information-education intervention trial. Follow-up: IP, 12-months | Group CBSM. Duration: 10 weeks (90 min). Deliverer: not reported | Depression (BDI); Anxiety (STAI) | Cognitive behavioural self-efficacy | CBSM showed reductions in depression and anxiety postintervention and long-term in comparison with controls |
| Kraaij (2010) | HIV+ males and females on ART (73/55). 52.3% on ART | Randomised CBS/SWI/WLC. Follow-up: IP, 2-months | Individual self-help CBT. Duration: weekly for 4 weeks (60 min). Deliverer: workbook and CD-Rom | Depression (HADS) | Health characteristics (time since diagnosis, CD 4 cell count, viral load, use of medication | CBS showed significant improvements in depression compared to SWI and WLC |
| Markowitz (1998) | HIV+ males and females (101/69). Predominantly MSM. No group differences in demographics | Randomised IPT/CBT/SP/SWI trial. Follow-up: IP | Individual IPT/CBT/SP. Duration: 8–16 sessions (30–50 min). Deliverer: professional therapists | Depression (BDI; Ham-D) | CD 4 T-lymphocyte count, physical functioning, medication adverse effects | All interventions reduced depression. IPT and SWI showed greater improvement than CBT & SP |
| Safren (2009) | HIV+ males and females on ART (45/36) | Randomised CBT/single session intervention control comparative trial. Follow-up: IP; 3-, 6-, 12-months | Individual CBT. Duration: 10–12 sessions (50 min). Deliverer: clinical psychologists | Depression (BDI; HAM-D and independent-assessor rated Clinical Global Impression) | Medication adherence, HIV plasma RNA concentration | Individuals who received CBT showed improvements in depression relative to the comparison group at 3-, 6- and 12-month follow-up assessments |
| Safren et al. (2012) | HIV+ male and female injection drug users on ART (89/89) | Randomised CBT/single session intervention control comparative trial. Follow-up: IP, 3-, 6-, 12 months | Individual CBT. Duration: 10–12 sessions (50 min). Deliverer: clinical psychologists | Depression (MADRS and independent-assessor rated Clinical Global Impression) | Medication adherence, HIV plasma RNA concentration | CBT showed greater improvement in depression than controls. After treatment discontinuation, depression gains were maintained at follow-up assessments |
| Depression and anxiety | ||||||
| Antoni (1991) | HIV+ ART-naïve MSM (47/47). No group differences in demographics | Randomised CBSM/assessment only control condition trial. Follow-up: IP | Group CBSM. Duration: twice weekly for 10 weeks. Deliverer: clinical psychologists | Anxiety, depression (POMS) | Trait anxiety, stressful life events, physical activity, sleep, high-risk sexual activities, immunologic status | CBSM did not show any pre-post test changes in depression or anxiety but did result in CD4 enhancement |
| Antoni (2000) * a | HIV+ MSM (74/73). No group differences in demographics. 30 men on ART | Randomised CBSM/WLC. Follow-up: IP | Group CBSM. Duration: Once a week for 10 weeks (135 min each). Deliverer: clinical health psychology postdoctoral students | Anxiety and overall mood (POMS; Ham-D; HARS) | Anger, 24 h urinary norepinephrine, immunologic status | CBSM participants showed significantly lower anxiety and overall mood scores than controls |
| Antoni (2000) * b | HIV+ MSM (59/59). No group differences in demographics. 29 men on ART | Randomised CBSM/WLC. Follow-up: IP | Group CBSM. Duration: Once a week for 10 weeks (135 min each). Deliverer: clinical health psychology postdoctoral students | Depression, anxiety (Ham-D; POMS) | Gross neurocognitive dysfunction, anger, fatigue, vigour, confusion, 24 h urinary cortisol, immunologic status | CBSM participants showed significantly lower depressed affect and anxiety than controls |
| Berger (2008) | HIV+ males and females on ART (104/77). No group differences in demographics | Randomised CBSM/standard care only control trial. Follow-up: 1-, 6-, 12-months | Group CBSM. Duration: 12 sessions (2 h). Deliverer: psychotherapist | Depression and anxiety (MOS-HIV; HADS) | CD4 lymphocyte cell Count, HIV-1 RNA, health related quality of life, medication adherence | CBSM showed alleviation of depressive and anxiety symptomatology at baseline and 12 month follow-up |
| Carrico (2009) | HIV+ males and females (936/624). No group differences in demographics. 69% on ART | Randomised CBT/WLC. Follow-up: IP; 5-, 10-, 15-, 20-, 25-months | Individual CBT. Duration: 15 sessions (90 min). Deliverer: facilitators | Depression and anxiety (BDI; STAI) | Burn out, perceived stress, positive affect, positive states of mind, coping self-efficacy, perceived social support | No intervention-related reductions in depression or anxiety were evident across the follow-up period |
| Cruess (2000) | HIV+ MSM (65/57). No group differences in demographics | Randomised CBSM/WLC condition trial. Follow-up: IP | Group CBSM. Duration: Once a week for 10 weeks (2.5 h). Deliverer: clinical health psychology postdoctoral students | Depression, anxiety (POMS) | Anger, fatigue, vigour, confusion, free testosterone, cortisol | CBSM participants showed significantly lower depression and anxiety scores than controls |
| Inouye et al. (2001) | HIV+ males and females on ART (40/39). No group differences in demographics | Randomised CBS-M/WLC condition trial. Follow-up: IP | Individual CBS-M. Duration: 14 (60–90 min) sessions over 7 weeks. Deliverer: clinicians | Depression, anxiety (POMS) | Physical health status, coping, health attitudes, anger, vigour, confusion, fatigue, overall mood | CBS-M significantly improved depression, anxiety and overall mood compared to controls |
| Kelly (1993) | HIV+ ART-naïve men (115/68). No group differences in demographics | Randomised CBT/SP/assessment only control condition trial. Follow-up: IP; 3-months | Group CBT/SP. Duration: 8 sessions (90 min each). Deliverer: psychologists, counsellors or psychiatry residents | Depression, anxiety, phobic anxiety (CES-D; SCL-90-R) | Global psychiatric distress, illicit drug use, somatisation, interpersonal sensitivity, hostility | CBT and SP groups showed reductions in depression and anxiety. CBT resulted in less frequent drug use at follow-up |
| Lutgendorf (1997) | HIV+ MSM (52/39). No group differences in demographics. 21 men on ART | Randomised CBSM/WLC. Follow-up: IP | Group CBSM. Duration: 10 sessions (135 min each). Deliverer: clinical psychologists | Depression, anxiety (BDI; POMS) | Total mood disturbance, clinical variables (immunology) | The intervention showed reductions in anxiety, depression and total distress |
| Molassiotis et al. (2002) | HIV+ males and females on ART (46/36). No group differences in demographics | Randomised CBT/PSC/assessment only comparison group trial. Follow-up: IP; 3-;6-months | Group CBT/PSC. Duration: 12 sessions over 3 months (2 h). Deliverer: clinicians | Depression; anxiety (POMS) | Quality of life, anger, vigour, confusion, fatigue | CBT and PSC improved depression, anxiety and overall mood |
| Mulder et al. (1994) | HIV+ ART-naïve MSM (39/27). No group differences in demographics | Randomised CBT/ET/WLC comparative trial. Follow-up: IP, 3-, 6-months | Group CBT/ET. Duration: 17 sessions over a 15 week period. Deliverer: trained therapists | Depression, anxiety. psychiatric symptoms/distress (POMS; BDI; GHQ) | Anger, fatigue, vigour, psychiatric symptoms, coping strategies, emotional expression, social support | CBT and ET groups showed reductions in depression, psychiatric distress, and in total POMS scores IP only |
| Sikkema et al. (2004) | HIV+ males and females (268/235). No group differences in demographics | Randomised CBT/individual therapy on request comparative trial. Follow-up: 2 weeks PI | Group CBT. Duration: 12 weeks (90 minutes). Deliverer: therapists | Depression, anxiety, overall psychological distress (SCL-90-R; SIGH-AD) | AIDS-related bereavement | The group intervention demonstrated reductions in depression and psychiatric distress |
Note: ART=antiretroviral therapy; CBSM=cognitive-behavioural stress management; CBT=cognitive-behavioural therapy; SP=supportive psychotherapy; ET=experiential group psychotherapy; WLC=wait-list control; PMR=progressive muscle relaxation; IPT=interpersonal psychotherapy; SWI=imipramine with SP; CBS-M=cognitive-behavioural self-management; PSC=peer support/counseling; CBSM-MAT: CBSM combined with medication adherence training; CBS=cognitive-behavioural self-help program; SWI=structured writing intervention; MSM=men who have sex with men; IP=immediate postintervention assessment; POMS=Profile of Mood States; CES-D=The Center for Epidemiologic Studies Depression Scale; SCL-90-R=The Symptom Checklist-90-Revised; BDI=Beck Depression Inventory; GHQ=General Health Questionnaire; HAM-D=Hamilton depression rating scale; HARS=Hamilton Anxiety Rating Scale; STAI=State/Trait Anxiety Inventory; SIGH-AD=structured interview guide for the Hamilton depression and anxiety scales; SCID-IV=structured clinical interview for DSM-IV); MOS-HIV=the HIV Medical Outcome Study questionnaire; HADS=the Hospital Anxiety and Depression Scale; MADRS=Montgomery–Asberg Depression Rating Scale.
*
Antoni (2000)a,b and Carrico et al. (2005)a,b are both single studies reported in separate publications.