Tailoring Cognitive Behavioral Therapy for Trauma-Exposed Persons Living With HIV. Issue 1 (February 2020)

• Record Type: Journal Article
• Authors: López, Cristina M.; Hahn, Christine K.; Gilmore, Amanda K.; Danielson, Carla Kmett
• Is Part Of: Cognitive and behavioral practice. Volume 27:Issue 1(2020)
• Page Start: 70
• Page End: 83
• Publication Date: 2020-02
• Subjects: PTSD -- adherence -- mental health services engagement -- PLWH -- trauma treatment; Behavior therapy -- Periodicals; Cognitive therapy -- Periodicals; Behavior Therapy -- Periodicals; Cognitive Therapy -- Periodicals; 616.8914205
• DOI: 10.1016/j.cbpra.2019.02.006
• Languages: English
• ISSNs: 1077-7229

Abstract

Abstract: This treatment development report describes the need for evidence-based psychosocial trauma-focused treatment for people living with comorbid posttraumatic stress disorder (PTSD) and HIV. Individuals with HIV have higher rates of exposure to traumatic events and PTSD than the general public, and they also experience additional consequences of PTSD on the management of their chronic disease (e.g., established link between PTSD symptoms and lack of adherence to antiretroviral therapy [ART]). We used the empirically supported ADAPT-ITT approach to consider the initial steps in adapting evidence-based Cognitive Processing Therapy (CPT) for individuals with PTSD and HIV. This paper reviews a case example that involved various clinical issues that may arise when providing trauma-focused treatment for people living with HIV including HIV-stigma, disease management, and the need for making multicultural adaptations to psychotherapy. This case example illustrates how trauma-focused treatment may benefit from enhancement to address additional barriers that may arise over the course of PTSD treatment in this population. Feasibility of engaging and delivering a "full dose" of evidence-based PTSD treatment among individuals living with HIV is discussed. While evidence-based treatments can reduce PTSD symptom severity, issues related to chronic disease coping and HIV-related stigma management could be integrated to augment the efficacy of treatment for individuals with HIV. Adaptive intervention research targeting PTSD in persons living with HIV warrants further attention, especially given the association between PTSD and adherence to ART. Highlights: Evidence-based PTSD treatment can be delivered to PLWH with trauma exposure. Addressing HIV stigma in PTSD interventions may help with engagement. Treatment of PTSD in chronic disease context may help adherence.