Cognitive-behavioural stress management with HIV-positive homosexual men: mechanisms of sustained reductions in depressive symptoms

Background: We examined the sustained efficacy of a group-based cognitive-behavioural stress management (CBSM) intervention in comparison to a modified wait-list control condition on measures of mood, coping and social support in mildly symptomatic HIV-positive homosexual and bisexual men. Participants were recruited largely during the era prior to highly active antiretroviral therapy (HAART; 1992-1997). Methods: Men were randomized to either a 10-week, group-based CBSM intervention (n=83) or a psycho-educational seminar group (n=46). All participants completed a battery of psychosocial questionnaires administered by a research assistant at baseline, immediately following the 10-week CBSM intervention period, and at a 6-month follow-up. Results: Men in the CBSM group maintained previously observed effects on depressive symptoms and perceived social support. These sustained effects of CBSM on depressive symptoms were mediated by 10-week increases in cognitive coping (i.e. positive reframing). Discussion: CBSM appears to be a potentially efficacious treatment that reduces and maintains lower levels of depressive symptoms and enhances social support in HIV-positive homosexual and bisexual men. In particular, changes in positive reframing during the 10-week intervention period remain a crucial factor contributing to sustained reductions in depressive symptoms.