Acceptance and Compassion-Based Group Therapy to Reduce HIV Stigma☆

https://doi.org/10.1016/j.cbpra.2014.05.006Get rights and content

Highlights

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    This is the first pilot study to explore the integration of ACT and CFT.

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    ACT promotes flexibility in response to societal stigma.

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    This is the first case study that describes ACT for men living with HIV.

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    More research is needed to explore ACT for HIV-related stigma reduction.

Abstract

Interventions that target the burden of HIV-related stigma among gay and bisexual men with HIV could yield a broad array of benefits to HIV-positive individuals. In particular, recent research suggests that reducing HIV-related stigma might increase contact with medical professionals, adherence to medication, disclosure to sexual partners, and enhance the ability of persons with HIV to build necessary support networks. In this clinical pilot, we examined the feasibility, acceptability, and usefulness of delivering an HIV-related stigma-reducing group intervention in a community mental health setting to gay and bisexual men living with HIV who are currently connected with care but reporting ongoing difficulties due to HIV-related stigma. The basis of this intervention, acceptance and commitment therapy (ACT), has been found to be effective in reducing the experience of self-stigma among persons with substance abuse histories, and a recent pilot suggests it is helpful for gay and lesbian persons experiencing internalized homophobia. Along with ACT, we have incorporated ideas and exercises from compassion-focused therapy (CFT), an intervention designed to increase compassion while decreasing shame, an affective state close to self-stigma. We hypothesized that this integrated approach would be effective for those experiencing HIV-related stigma. Eight clients currently receiving mental health treatment at the UCSF Alliance Health Project (AHP) Services Center were recruited via clinician referral for an eight-session group, and five completed the group. Follow-up measures of psychological flexibility and HIV-related stigma were completed by three participants, whose data is presented here.

Section snippets

Acceptance and Commitment Therapy for Stigma

There are few interventions for the experience of stigma and even fewer that have been empirically based and assessed. It is also important to consider the context of interventions working with urban, sexual-minority men. Recent well-designed studies working with women of color (e.g., Rao et al., 2012) have drawn from the broader stigma literature, which suggests that education, contact with affected persons, skills training, and counseling approaches are necessary components of

Participants

The participants in this study were five HIV-positive gay- or bisexual-identified men who were receiving mental health services at an HIV community mental health clinic. The participants’ ages ranged from 39 to 58. While enrollment criteria required an HIV diagnosis greater than 1 year prior, the participants ranged from 2 to 23 years since diagnosis, such that one participant had been living with HIV since prior to the invention of antiretroviral therapies (ART), another was diagnosed shortly

Session 1

The first session focused on introducing and attuning the client to core ACT perspectives. Specifically this included an introduction to exploring the function of stigma (e.g., what effect does hiding one’s HIV status have on daily life?) and an introduction of the focus on identifying valued action as a means of finding ways to experience greater quality of life, then ending with a brief mindfulness exercise. Mindfulness, in this context, is a highly evocative act as some participants

Results

Group participation catered toward extremes. Of the three noncompleters, each left within the initial 2 weeks. In two cases, these decisions were based less on the acceptability of the content as much as contextual features; one had believed he was being referred for individual therapy, whereas another reported a lack of comfort at the low number of persons of color. Both factors may have been contributed to by the brief window allowed for recruitment under the internal funding mechanism. The

Discussion

At the final appointment, the three participants who had attended every follow-up session indicated some benefit from the group. Even Participant 3, who frequently made a point in groups and individual contact with the providers to express strong concern that not taking his thoughts literally was a form of “Buddhist proselytizing” that would result in hopelessness and nihilistic despair, reported a mix of gratitude at exploring these topics, and self-report measures indicated some movement in

Conclusions

Despite advances in medication and education, HIV remains a highly stigmatized disease and may exacerbate the psychological vulnerabilities already present due to sexual-minority stress. ACT, combined with CFT techniques, appeared to reduce the experience of self-stigma among these gay men living with HIV. Informed by functional contextualism, ACT provides a focus on both mindful distance from distressing mental events, as well as a deeper connection with the internal reinforcement of

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    ☆

    Aishat “Funmi” Giwa, B.A., Megan Sirna, B.A., Lauren McGuire, B.S., and Jessie Murphy, MPH, Department of Psychiatry, University of California, San Francisco.

    This study was made possible by a New Investigator Award from the Center for AIDS Prevention Studies Innovative Grants Program 2010.

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    Copyright © 2014 Published by Elsevier Ltd.