Wednesday, February 6, 2013
Psychosocial interventions, similar to those used for cancer patients may be used for HIV/AIDS as well. At this time, there is a paucity of research on the overall improvement of life quality gained from group support, complementary therapies, relaxation techniques, and various coping skills. Additionally, research is needed on the adoption of religion and spirituality by HIV/AIDS patients (Cotton et al., 2006). Religious and spiritual patients demonstrate better overall mental health and decreased HIV/AIDS symptoms (Pargament et al., 2004; Yi et al., 2006). Future research could identify the effects of providing a spiritual support network shortly after diagnosis (Cotton et al., 2006).
Bing et al., (2001) found over 40% of HIV/AIDS patients use illicit drugs, and more than 12% of these individuals were drug dependent. Further, many of these patients had psychiatric disorders (Bing et al., 2001). Drug and alcohol abuse and psychiatric disorders interfere with treatment adherence (Gonzalez, Batchelder, Psaros, & Safren, 2011; Kim et al., 2007), they cause patients to become an excessive burden to caregivers (Bing et al., 2001), and they influence health outcomes (Bing et al., 2000). Furthermore, abuse and mental disorders may require additional health care, and cause patients to engage in more negative health behaviors (Bing et al., 2001). Research into more realistic and effective means of treating these issues in HIV/AIDS patients may help control the additional health care costs associated with drug abuse and dependence as well as increase the quality of life for these patients (Sherbourne, et al., 2000).
Although there is a surfeit of information on alcohol and drug abuse in HIV/AIDS patients, there is little research on co-occurring mental and substance abuse disorders, their distinct and specific implications, and the drug-specific effects of illicit substances abused by these patients. Further, research is needed on how to encourage these patients to engage in helping services (Klinkenberg & Sacks, 2004). Because many of these patients receive psychological and psychopharmacological help from primary care doctors rather than psychological professionals, it may be important to determine the effectiveness of this counsel and the medications these doctors prescribe (Klinkenberg & Sacks, 2004). Additionally, further research is necessary on the impact of co-occurring psychological and substance disorders for minority populations as well. For example, African American HIV/AIDS patients access far less care for psychological health (Klinkenberg & Sacks, 2004). Closing the gaps in care for minority patients is critical, but first, research must determine why these gaps exist and how best psychologists can fill them.
Although the stigma associated with HIV/AIDS is well known, additional research is needed on how to effectively reverse negative perceptions, and more especially, how to effect this change in various populations. In cultures wherein religious and other contexts compound negative perceptions, the study of tailored, effective awareness campaigns is warranted. Because HIV/AIDS is treated as a chronic disease and long-term survival has become a realistic goal, quality of life for these patients has become more important (Sherbourne et al., 2000). Creating effective solutions for the complex issues associated with HIV/AIDS can help to normalize life after diagnosis for these patients.
Bing, E. G., Burnam, M., Longshore, D., Fleishman, J. A., Sherbourne, D., London, A. S...Shapiro, M. (2001). Psychiatric Disorders and Drug Use Among Human Immunodeficiency Virus–Infected Adults in the United States. Archives of General Psychiatry, 58(8). 721-728. doi:10.1001/archpsyc.58.8.721.
Bing, E. G., Hays, R. D., Jacobson, L. P., Chen, B., Gange, S. J.,Kass, J. S. & ... Zucconi, S. L. (2000). Health-related quality of life among people with HIV disease: results from the Multicenter AIDS Cohort Study. Quality of Life Research, 9(1). 55- 63.
Cotton, S., Puchalski, C., Sherman, S., Mrus, J., Peterman, A., Feinberg, J., & ... Tsevat, J. (2007). Spirituality and religion in patients with HIV/AIDS spirituality and religion in patients with HIV/AIDS. Journal Of General Internal Medicine, 21S5-S13.
Gonzalez, J. S., Batchelder, A. W., Psaros, C., & Safren, S. A. (2011). Depression and HIV/AIDS Treatment Nonadherence: A Review and Meta-analysis. JAIDS Journal of Acquired Immune Deficiency Syndromes, 1. doi: 10.1097/QAI.0b013e31822d490a
Kim, T., Palepu, A., Cheng, D., Libman, H., Saitz, R., & Samet, J. (2007). Factors associated with discontinuation of antiretroviral therapy in HIV-infected patients with alcohol problems. Aids Care-Psychological And Socio-Medical Aspects Of Aids/Hiv, 19(8), 1039-1047.
Klinkenberg, W. D., & Sacks, S. S. (2004). Mental disorders and drug abuse in persons living with HIV/AIDS. AIDS Care, 16S22-S42. doi:10.1080/09540120412331315303
Pargament, K. I., Mccarthy, S., Shah, P., Ano, G., Tarakeshwar, N., Wachholtz, A., & ... Duggan, J. (2004). Religion and HIV: A Review of the Literature and Clinical Implications. Southern Medical Journal, 97(12), 1201-1209.
Sherbourne, C. D.. Hays, R. D., Fleishman, J. A.,Vitiello, B., Magruder, K. M., Bing, E. G. & ... Shapiro, M. F. (2000). Impact of psychiatric conditions on health-related quality of life in persons with HIV infection. American Journal of Psychiatry, 157248- 254.
Yi, M., Mrus, J., Wade, T., Ho, M., Hornung, R., Cotton, S., & ... Tsevat, J. (2006). Religion, spirituality, and depressive symptoms in patients with HIV/AIDS. Journal Of General Internal Medicine, 21 Suppl 5S21-S27.
Lieberman (2008) found men were far less inclined to partake of group support, even though slightly more than half of all cancers occur in men. After reading Lieberman, I thought about why men are, in fact, underrepresented in these groups. In my personal experience, men are well-represented in the online forum of which I am a member. This forum, however, is an information exchange as well as a place to receive and offer emotional support.
Men find far less value in discussing their feelings than do women (Wood & Inman, 1993). Additionally, Klemm, Hurst, Dearholt & Trone (1999) found in a mixed gender online support group, men were far more likely to seek and give information, whereas women tended to offer and need emotional support. This may be an important finding, especially when one is working with a group of men who see no value in sitting around comiserating with a group of other cancer patients. These same men may thrive as part of an online support group.
I went back into the archives of the online support group of which I am a member, to see the quality of gender specific messages. My findings were in agreement with Lieberman's (2008) and Klemm et al.'s (1999) that men are more geared to information seeking rather than emotional support. I found women giving comfort and support and the men offering and asking for information. Interesting!
Klemm, P., Hurst, M., Dearholt, S. L., & Trone, S. R. (1999). Gender differences on Internet cancer support groups. Computers in Nursing, 17(2), 65-72.
Lieberman, M. (2008). Gender and online cancer support groups: issues facing male cancer patients. Journal Of Cancer Education, 23(3), 167-171.
Wood, J. T., & Inman, C. C. (1993). In A Different Mode: Masculine Styles of Communicating Closeness. Journal Of Applied Communication Research, 21(3), 279.
Support groups have been successful in providing cancer patients and caregivers with information, psychological support, a sense of camaraderie, and insight from others with similar experiences (Tehrani, Farajzadegan, Rajabi, & Zamani, 2011). Further, support groups help patients make decisions with treatments and pain management, and provides peer networking (Oliffe, Ogrodniczuk, Bottorff, Hislop & Halpin, 2009). Support groups are used more frequently by women than men (Lieberman, 2008). However, in a men's support group, humor was a common means of communication and one that provides physiological health benefits that include cardiovascular and respiratory improvement and elevated mood (Oliffe et al., 2009). Support groups also help patients contend with anxiety (Oliffe et al., 2009). Shim, Capella & Han (2011) suggested that one benefit of support groups is the shared experience of communication and processing, which helps patients adapt and adjust to the trauma of a cancer diagnosis and subsequently provides patients with potential health benefits, such as improving patients' well-being (Shim et al., 2011). The knowledge base needs additional research on the benefits of support groups, much of which has been derived from studies on breast cancer support groups for women (Gottlieb & Wachala, 2007).
Complementary therapies (CT) can be beneficial adjunct therapies for cancer patients. Between 30 and 40% of cancer patients in the United States use some form of CT (Smithson, Paterson, Britten, Evans, & Lewith, 2010). Some of the more common types of complementary therapies include high dose vitamins and herbal supplements, complementary health services like massage, acupuncture, and chiropractic care, old-fashioned and folk remedies, and diets (Kao & Devine, 2000). Some patients seek these therapies as a cure for their cancer or to minimize metastasis, whereas others use them to alleviate side effects, strengthen their sense of spiritual well-being, or gain a sense of control over their medical care (O'Beirne et al., 2004; Smithson et al., 2010; Van Tonder, Herselman, & Visser, 2009). Patients often fail to discuss their choice of CT as well as their satisfactory experiences because they worry that their doctors may think negatively about the CT (Smithson et al., 2010). By self-admission, doctors usually consider themselves unknowledgeable about CT, and most of their knowledge comes from their patients (Bourgeault, 1996).
CT is successful for many patients. It takes into account patient values, provides a learning experience for doctors, contributes to increased patient satisfaction and a higher level of control for patients, and better overall outcomes (O'Beirne et al., 2004; Smithson et al., 2010).
Success in cancer treatment should include factors such as patient satisfaction and well-being and whether the therapy provides a sense of control for the patient, maybe especially when palliative care is the only treatment. When physicians accommodate patients' values in treatment decisions, patients are more satisfied with their care, and patient satisfaction results in better health outcomes (Coulter, 1997). Davidson, Geoghegan, Mclaughlin & Woodward (2004) found CT filled an important psychological need for some patients. Most patients that use CT report high levels of satisfaction (Van Tonder et al., 2009) and a strong sense of control over their treatment (O'Beirne et al., 2004).
Bourgeault, I. (1996). Physicians' attitudes toward patients' use of alternative cancer therapies. CMAJ: Canadian Medical Association Journal, 155(12), 1679-1685.
Coulter, A. (1997). Partnerships with patients: the pros and cons of shared clinical decision-making. Journal Of Health Services Research & Policy, 2(2), 112-121.
Davidson, R., Geoghegan, L., Mclaughlin, L., & Woodward, R. (2005). Psychological characteristics of cancer patients who use complementary therapies. Psycho-Oncology, 14(3), 187-195. doi: 10.1002/pon.834
Gottlieb, B., & Wachala, E. (2007). Cancer support groups: a critical review of empirical studies. Psycho-Oncology, 16(5), 379-400.
Jatoi, A., Hillman, S. L., Allen Ziegler, K. L., Stella, P. J., Soori, G. S., & Rowland, K. M. (2009). Is social support associated with improved clinical outcomes in geriatric lung cancer patients? Observations from North Central Cancer Treatment Group Studies N9921 and N0222. Cancer Management and Research, 1, 61-68.
Kao, G. D., & Devine, P. (2000). Use of complementary health practices by prostate carcinoma patients undergoing radiation therapy. Cancer, 88(3), 615-619. doi: 10.1002/(SICI)1097-0142(20000201)88:33.0.CO;2-P
Lieberman, M. (2008). Gender and online cancer support groups: issues facing male cancer patients. Journal Of Cancer Education, 23(3), 167-171.
Lydon, A., Ryan-Woolley, B., & Amir, Z. (2009). Function of cancer support groups: a telephone survey. Cancer Nursing Practice, 8(8), 12-19.
O’Beirne, M., Verhoef, M., Paluck, E., & Herbert, C. (2004). Complementary therapy use by cancer patients physicians’ perceptions, attitudes, and ideas. Canadian Family Physician, 50(6), 882-888.
Oliffe, J., Ogrodniczuk, J., Bottorff, J., Hislop, T., & Halpin, M. (2009). Connecting humor, health, and masculinities at prostate cancer support groups. Psycho-Oncology, 18(9), 916-926. doi:10.1002/pon.1415
Shim, M., Cappella, J. N., & Han, J. (2011). How does insightful and emotional disclosure bring potential health benefits? Study based on online support groups for women with breast cancer. Journal Of Communication, 61(3), 432-454. doi:10.1111/j.1460-2466.2011.01555.x
Smithson, J., Paterson, C., Britten, N., Evans, M., & Lewith, G. (2010). Cancer patients' experiences of using complementary therapies: polarization and integration. Journal Of Health Services Research & Policy, 15 Suppl 254-61. doi:10.1258/jhsrp.2009.009104
Tehrani, A., Farajzadegan, Z., Rajabi, F., & Zamani, A. (n.d). Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: a non-randomized controlled clinical trial. Journal Of Research In Medical Sciences, 16(5), 658-665.
Van Tonder, E., Herselman, M., & Visser, J. (2009). The prevalence of dietary-related complementary and alternative therapies and their perceived usefulness among cancer patients. Journal Of Human Nutrition & Dietetics, 22(6), 528-535. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1111/j.1365-277X.2009.00986.x
Cognitive strategies can change the perception of pain through cognitive restructuring (Marks, Murray, Evans, & Estacio, 2011; Carmody et al., 2000). One benefit is that after a few relatively brief coping skills trainings, patients can implement relaxation and distraction techniques to cope with pain successfully (Gil et al., 2000). A goal of cognitive restructuring is to intervene with negative thought patterns, although these prove difficult to affect permanently (Gil et al., 2000). Brief training was beneficial (in patients with sickle cell disease), but without continuing practice, the results became less beneficial over time (Gil et al., 2000). Gil et al. (2000) did find that when patients practiced daily, they were less apt to have to seek more immediate medical help for pain. The benefits for this type of pain management were significant, since these patients were able to self-manage their pain and decrease catastrophizing as well as other negative thought processes (Burns, Kubilus, Bruehl, Harden & Lofland, 2003; Carmody et al., 2000).
Using visualization techniques works as a distraction to pain, refocusing the patient's attention on mental images (Turk et al., 2008). These techniques may work well for some patients (Marks et al., 2011), although others may have difficulty conjuring the images. Research suggests imagery techniques are better used in concert with cognitive behavioral therapy and may not be effective as a sole therapy (Turk et al., 2008).
Because pain can be a physical manifestation of psychological distress, psychodynamic and insight-oriented therapies may help resolve obscure internalized early childhood issues that influence chronic pain (Turk et al., 2008). Although the effects of childhood abuse in chronic pain have been documented (Raphael, Chandler, & Ciccone, 2004; Toomey, Seville, Mann, Abashian, & Grant, 1995; Turk et al., 2008), determining causality in these cases proves challenging (Raphael et al., 2004). There is a paucity of research on the use of the psychodynamic and insight-oriented approaches for these circumstances, and although evidence is lacking on the affects of these approaches, they may work well for some individuals.
A substantial amount of research supports cognitive-behavioral therapy (CBT) as effective therapy for chronic pain. This approach uses a combination of cognitive and behavioral techniques to relieve chronic pain (Marks et al., 2011). Turk et al. (2008) suggest, however, rather than patients' implementation of a range of techniques from both cognitive and behavioral approaches, CBT considers patients' overarching beliefs, attitudes, and expectations that drive their overall ability to manage chronic pain. Further, CBT fosters a sense of resourcefulness that comes from self-control and self-management and replaces patients' sense of hopelessness, which can exacerbate pain (Turk et al., 2008). Although Marks et al. (2011) claimed approximately 85% of patients benefitted from CBT, it may not work as well for children, older adults, and those with cognitive deficiencies. Carla et al., (2012) found the effects of CBT were long term for chronic pain patients with insomnia. The positive outcomes of chronic pain self-management may be improved with individualized treatment plans that make implementation and adherence realistic for the patient (Heapy, Stroud, Higgins, & Sellinger, 2006). As with other psychological modalities, the use of techniques must be ongoing for continued benefit.
Even under the best medical care, most individuals with chronic pain continue to have persistent pain (Turk et al., 2008). Accordingly, self management is a crucial adjunct therapy to a realistic comprehensive program that uses a variety of treatment modalities that have been proven to produce better long-term, efficient, cost-effective outcomes for treating chronic pain (Gatchel & Okifuji, 2006).
Burns, J. W., Kubilus, A., Bruehl, S., Harden, R. H., & Lofland, K. (2003). Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis. Journal of Consulting and ClinicalPsychology, 71, 81–91. doi:10.1037/0022-006X.71.1.81
Carla R., J., Yolande, T., Michael T., S., Wilfred R., P., Sara, M., Yinglin, X., & Michael L., P. (2012). The Durability of Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain. Sleep Disorders, doi:10.1155/2012/679648
Carmody, T. P., Duncan, C. L., Huggins, J., Solkowitz, S. N., Lee, S. K., Reyes, N., & ... Simon, J. A. (2012). Telephone-Delivered Cognitive–Behavioral Therapy for Pain Management Among Older Military Veterans: A Randomized Trial. Psychological Services, doi:10.1037/a0030944
Gatchel, R. J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and costeffectiveness of comprehensive pain programs for chronic nonmalignant pain. The Journal of Pain, 7,779–793. doi:10.1016/j.jpain.2006.08.005
Gil, K. M., Carson, J. W., Sedway, J. A., Porter, L. S., Schaeffer, J., & Orringer, E. (2000). Follow-up of coping skills training in adults with sickle cell disease: Analysis of daily pain and coping practice diaries. Health Psychology, 19(1), 85-90. doi:10.1037/0278-6184.108.40.206
Heapy, A. A., Stroud, M. W., Higgins, D. M., & Sellinger, J. J. (2006). Tailoring Cognitive-Behavioral Therapy for Chronic Pain: A Case Example. Journal Of Clinical Psychology, 62(11), 1345-1354. doi:10.1002/jclp.20314
Marks, D. F., Murray, M., Evans, B., & Estacio, E. V. (2011). Health Psychology: Theory, Research, and Practice (3rd ed.). London: Sage.
Raphael, K. G., Chandler, H. K., & Ciccone, D. S. (2004). Is childhood abuse a risk factor for chronic pain in adulthood? Current Pain and Headache Reports, 8(2), 99-110. doi: 10.1007/s11916-004-0023-y
Toomey, T., C., Seville, J., L., Mann, J., D., Abashian, S., W., & Grant, J., R. (1995). Relationship of sexual and physical abuse to pain description, coping, psychological distress, and health-care utilization in a chronic pain sample. Clinical Journal of Pain. 1995;11:307–315.
Turk, D., Swanson, K., & Tunks, E. (2008). Psychological approaches in the treatment of chronic pain patients--when pills, scalpels, and needles are not enough. Canadian Journal Of Psychiatry. 53(4), 213-223.