CBT Group Sessions Ease Distress in Older Patients Living With HIV

During the recent AIDS 2024 meeting, the 25th International AIDS Conference, in Munich, Germany, Jacklyn D. Foley, PhD, MS, a clinical psychologist at Massachusetts General Hospital (MGH) and faculty member of the Department of Psychiatry at Harvard Medical School, presented the poster, “Cognitive Behavioral Therapy (CBT)-Based Group Intervention to reduce Psychological Distress, Facilitate Positive Behavior Change, and Mitigate Inflammation in Older People With HIV.”

This research focused on how to use CBT strategies to help group members living with HIV age healthily, with psychological distress and positive health behavior changes, such as diet and physical activity—and reducing substance use as well, if that was relevant—being outcomes of particular interest. The mean (SD) age of program participants was 61.1 (5.7) years for those who received the intervention, which consisted of hourly sessions each week for 12 weeks, and 60.5 (5.5) years for those who received enhanced standard of care. This was a diverse group, with 40% of those in the CBT group and 26.7% of those in the SOC group being of a Black/African American race; 46.7% and 60%, respectively, being of a White race; 6.7% each being American Indian/Alaskan Native; and 13.3% each reporting Other race.

This transcript has been lightly edited.

Transcript

Can you tell us about the study you presented at AIDS 2024?

This study actually came about and grew from a clinical group that we ran through the Behavioral Medicine Program at MGH. There was a healthy aging with HIV clinical group I ran for, I believe, 3 cycles, and then myself and my mentor, Dr. Abi Batchelder [Abigail Batchelder, PhD, MPH, Mass General], really wanted to start to collect some data to learn a little bit more about the group: how it was running, how it was helping people, and really if there was a way we could improve it and optimize it. So we applied for a small grant internally within MGH that was geared toward aging and palliative care, actually, and we really wrote to them and said, “Are you interested in an HIV-specific study,” and they said yes, which was very exciting for us. We submitted for that grant, and we got it; it was very small pilot grant.

What we were able to do with this money in 1 year's time was really refine that clinical group. We made a lot of different adaptations to it: we shortened it, we moved from 16 to 12 sessions, we changed up the content a little bit as well to more bring in some of that healthy behavior change topics—we didn't really formally talk about diet, exercise, and things like that in the clinical group, although we were hearing from people that it was something they would be interested in. And so, we kind of refined the group, and then we did a very small pilot randomized control trial. We enrolled 30 individuals, 15 of which participated in our group, which we called CHAMP, and then 15 just got enhanced standard of care, in that they got additional education on health behavior change that might help with some age-related symptoms and whatnot.

And so we did a 12-week group. Each session was 1 hour. Each session was cofacilitated by myself, a clinical psychologist, and either another clinical psychologist for the first group, but then for the subsequent 2 groups, it was a master's level trainee who facilitated the groups with me. And each session had a different topic. So we would provide education on that topic, we would review a CBT-based coping skill that we thought would be helpful, and there would be time for a group discussion and reflection, and then we would assign home practice. It very much filled up the 1 hour, actually. Some of the feedback we got was the sessions could have been longer.

And then what we did was we really asked at several time points, at the end of each group, but then again at the end, what people thought of each session and then the program overall. Some of that data is actually going to be presented at ABCT [Association for Behavioral and Cognitive Therapies], a different conference. What we're presenting it AIDS is preliminary outcome data. We also looked pre/post at changes in depressive symptoms, anxiety symptoms, perceived stress, as well as different health behaviors. We've looked at time spent engaging in physical activity, sedentary behaviors. We also looked at tobacco smoking, and alcohol, but we didn't actually have a sample that were reporting a whole lot of that at baseline. And we also looked at diet, so different diet scores, according to the dietary risk assessment. So a lot of what we're going to be presenting is actually just describing what we saw in both groups over time in some of those outcomes.

Did any of your findings surprise you?

I think yes, in a positive way. I think when you ever you do a trial this small, because 30 people really is small—when you think about it, it was only 15 people that actually got the intervention that we developed—I think we were pleasantly surprised to see even some signals in the data to suggest that it was helpful in some of our key outcomes. We were primarily interested in just seeing if we could do this, if people were interested in doing it, if people were interested in meeting weekly, if people were interested in meeting on a virtual platform—because we did all of this over Zoom. And then we looked at a lot of acceptability metrics, like I said. We were much more interested in getting people's feedback on what they thought of the program.

However, it was very surprising again, pleasantly so, that we actually saw some signals. And so that's what you'll see on the on the poster presented at AIDS, is that people started to feel better from a psychological sense. They reported fewer depressive symptoms, they reported fewer anxiety symptoms. They indicated that they were engaging in more physical activity, when you looked at overall minutes. And they also reported a 2-point increase in health-related quality of life. So irrespective of what they were doing, they just felt like their quality of life was better. And I would actually love to understand that finding more. So I think that was surprising. We were hopeful, but I don't think we would have ever pinned our hats that we’re definitely going to see some type of evidence of effects. So that was very great to see.

I think the other thing I was most shocked about was, it's a 12-week group, we met for 1 hour. So it's really only 12 hours that we're together. And each time the group members seemed to form a real connection. I think after each group, even by sessions 8, 9, 10, people were wanting to exchange phone numbers; they were wanting to connect outside the group and beyond the group. And I was always amazed by that, because, you know, we were meeting weekly, but at the end of the day, it's only 12 hours. So it felt very meaningful to me that I think some of these relationships have extended beyond the group as well. It was, again, something I think we could have hoped for, but never would have thought we could have achieved in such a short amount of time.