Cognitive-behavioral stress management interventions for persons living with HIV: A review and critique of the literature

Background: Psychological adjustment and coping are central to human immunodeficiency virus (HIV) management. To improve HIV-infected patients' ability to cope with stress, a variety of stress management interventions have been designed and evaluated. Purpose: This paper provides a review and critique of the stress management literature, including a: (1) synthesis of core components of interventions for HIV-infected people, (2) summary of stress, coping, psychological, and health outcomes, and (3) methodological critique and guidance for future research. Methods: We reviewed 21 stress management interventions designed for HIV-infected individuals that included both cognitive and behavioral skills training. Results: Most studies noted positive changes in perceived stress, depression, anxiety, global psychological functioning, social support, and quality of life. However, results were mixed for coping and health status outcomes, and a majority of studies employed only brief follow-up periods, focused on HIV-infected MSM, and did not address HIV-specific stressors. Conclusions: Stress management interventions for HIV-infected persons are a promising approach to facilitate positive adjustment. However, this literature is limited by measurement problems, research design features, a narrow focus on HIV-infected men who have sex with men, and feasibility concerns for intervention dissemination. Future stress management interventions should address these limitations and the unique psychosocial needs of HIV-infected patients using briefer, more cost-effective formats.