Safren, S.A., O’Cleirigh, C.M., Bullis, J.R., Otto, M.W., Stein, M.D., & Pollack, M.H. (2012) Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in HIV-Infected Injection Drug Users: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 80(3), 404-415.
A recent study in the Journal of Consulting and Clinical Psychology suggests that cognitive behavioral therapy for adherence and depression (CBT-AD) can be an effective treatment for decreasing depression and increasing adherence to medication in HIV-infected injection drug users. The present study examined the effects of time-limited CBT-AD on participants with HIV and depression, and currently receiving treatment for their injection drug use. Participants (n=89) ranged from age 18 to 65 and were randomly assigned to receive either CBT-AD (n=44) or enhanced treatment as usual (ETAU) (n=45). Participants in the intervention group received 9 treatment sessions over a period of 3 months, involving 11 informational, problem-solving, and cognitive behavioral steps. At each step, the participants and the therapist collaboratively defined the problem, generated alternative solutions, made decisions about the solutions, and developed a plan for implementing them. At post-treatment, the intervention group showed significant improvements. The Beck Depression Inventory showed a significant reduction in symptoms of depression in the CBT-AD group (M=5.1 points) compared to the ETAU group (M= <1 point). A 40% decrease in symptoms of depression was shown from baseline to post treatment with CBT-AD. These clinically significant improvements were maintained at the 12 month follow up. The Medication Event Monitoring System (MEMS) showed that during the CBT-AD intervention, adherence improved 11.8% from baseline and 11.3% more than the ETAU condition. However adherence gains were not maintained at follow-up. It is proposed that continued adherence counseling may be necessary to maintain adherence gains, even when depression symptoms improve. Depression and substance abuse are the most comorbid disorders associated with HIV-infection, and it is suggested that even a small change in adherence can result in improved outcomes for HIV patients. The results of this study suggest that the integration of CBT-AD into substance abuse counseling may be useful for decreasing depression and improving adherence to medication (with continued sessions) in HIV-infected patients with a history of injection drug use.