Teaching Practice via Success Stories

Summary

This article presents a way of helping social work practice trainees learn solution-oriented ways of relating with their practice setting agencies. The author describes a process whereby students learn basic principles by applying them to the difficulties they face in their practice settings that often are more problem-focused. By sharing success stories with each other, trainees learn more about the process of solution-focused therapy and ways to work within their practice sites.     

Solution-Focused Brief Therapy for the Treatment of Sexual Disorders

The purpose of this article is to describe the use of solution-focused brief therapy (SFBT) as an approach to sex therapy. SFBT has been used to treat most clinical problems and populations, but until now has not been offered as an approach to sexual problems. This article describes SFBT and discusses its applications to sex therapy. A case example is included.     

Psychiatric considerations in the diagnosis, treatment, and prevention of HIV/AIDS

HIV/AIDS has the unfortunate distinction of being one of the most devastating epidemics of the twentieth century. By the end of June, 1999, 420,201 deaths in persons with AIDS had been reported in the United States. While HIV/AIDS patients are currently living longer as a result of more effective and complex treatments, no vaccination or cure has yet been discovered. Over the years, the HIV/AIDS epidemic has become multifactorial and currently affects several different special population groups. Individuals who are at high risk for becoming infected with HIV or who already suffer from HIV/AIDS can benefit greatly from the interventions of psychiatrists or other mental health professionals. It is important that psychiatrists collaborate very closely with infectious disease specialists in the management of HIV/AIDS and its psychological sequelae. The authors describe the psychiatric conditions that most often occur in association with HIV/AIDS: mood disorders, anxiety disorders, substance-related disorders, psychotic disorders, insomnia and sleep disorders, delirium, dementia, and pain syndromes. We present guidelines for diagnosis and psychopharmacological and psychotherapeutic treatment of these disorders in patients with HIV/AIDS. The article concludes with a discussion of prevention strategies that can be used in a mental health treatment setting and special issues related to treating HIV/AIDS in certain special population groups.     

The role of personal contact with HIV-infected people in explaining urban,African American preadolescents' attitudes toward peers with HIV/AIDS

This article presents the results of a study aimed at describing African American youths' attitudes toward peers with HIV/AIDS and identifying correlates of these attitudes based on the contact theory. Baseline data from a sample of African American, urban mothers and their youth (n = 197) participating in a family-based HIV prevention program were analyzed. In support of contact theory, preadolescents' close relationship to persons infected with HIV/AIDS was highly related to their attitudes. However, no relationship was found between maternal attitudes or communication variables and youth attitudes. The implications of youths' experience with persons with HIV/AIDS as part of prevention programming are discussed.     

Suffering and the Relationship with the Problem in Postmodern Therapies: A Buddhist Re-Visioning

ABSTRACT

This article explores ways that Buddhist psychology can enrich postmodern family therapy practice. The discussion focuses in particular on Buddhist ideas regarding suffering and the relationship with suffering. We propose that Buddhist practices of accommodation to suffering offer an alternative orientation to problems that in various ways can be incorporated into postmodern therapeutic practice—specifically solution-focused brief therapy, narrative therapy, and collaborative language systems. The article compares and contrasts Buddhist and postmodern therapy ideas about relating to problems before providing examples of postmodern practice informed by Buddhist psychology.     

Cost of care for Medicaid recipients with serious mental illness and HIV infection or AIDS

OBJECTIVE: To assist in developing public policy about the feasibility of HIV prevention in community mental health settings, the cost of care was estimated for four groups of adults who were eligible to receive Medicaid: persons with serious mental illness and HIV infection or AIDS, persons with serious mental illness only, persons with HIV infection or AIDS only, and a control group without serious mental illness, HIV infection, or AIDS. METHODS: Claims records for adult participants in Medicaid fee-for-service systems in Philadelphia during 1996 (N=60,503) were used to identify diagnostic groups and to construct estimates of reimbursement costs by type of service for the year. The estimates included all outpatient and inpatient treatment costs per year per person and excluded pharmacy costs and the cost of nursing home care. Persons with severe mental illness, HIV infection, or AIDS had received those diagnoses between 1985 and 1996. RESULTS: Persons with comorbid serious mental illness and HIV infection or AIDS had the highest annual medical and behavioral health treatment expenditures (about $13,800 per person), followed by persons with HIV infection or AIDS only (annual expenditures of about $7,400 per person). Annual expenditures for persons with serious mental illness only were about $5,800 per person. The control group without serious mental illness, HIV infection, or AIDS had annual expenditures of about $1,800 per person. CONCLUSIONS: Given the high cost of treating persons with comorbid serious mental illness and HIV infection or AIDS, the integration of HIV prevention into ongoing case management for persons with serious mental illness who are at risk of infection may prove to be a cost-effective intervention strategy.     

Creating Definitions of Successful Adulthood for Families with Adolescents

Abstract

The Growing Up FAST: Families and Adolescents Surviving and Thriving? program-based on a conceptual foundation that borrows from literatures concerned with rites of passage, multicultural studies, and the solution-focused perspective-has been developed in order to strengthen the ability of parents and teenagers to meet the challenges of this complex life cycle period. The standard implementation of the program consists of a two-session format that includes both didactic and experiential activities, and is designed to accomplish a variety of goals. This paper reports on one type of therapeutic intervention that has been generated in response to demands for abbreviated program utilization. This intervention is based on the first goal of the Growing Up FAST program, one that involves the creation of a family's definition of successful adulthood.     

Nature of depression in patients with HIV/AIDS

OBJECTIVE: Existing research suggests that the rate of depressive illness and depressive symptoms are high in people living with HIV/AIDS, but investigations on the causes of depression provide conflicting results. Social, psychological and biological factors have all been suggested as possible causes of depression in people living with HIV/AIDS. The suggestion that depression may be the result of the neurotropic effects of the virus on the central nervous system leading to an 'organic' or secondary depression has major implications in the treatment of HIV/AIDS. The aim of the current study was to further investigate the nature and underlying aetiology of depression in people living with HIV/AIDS. METHOD: One hundred and twenty-nine people living with HIV/AIDS recruited for the study from outpatients clinics and primary care settings completed a range of self-report symptom measures including the Beck Depression Inventory (BDI), SF-36, SPHERE and a personality measure, the NEO Personality Inventory (NEO-PI). They also completed a battery of neuropsychological tests (CANTAB) and a structured clinical interview (SCID-DSM-IV). Medical and sociodemographic data were also recorded. RESULTS: Approximately one-third scored > or = 14 on the BDI and 27% met criteria for a current 'mood disorder' on the SCID. Depressive symptoms were strongly related to personality style, having a past psychiatric history and current stressful psychosocial situation. There was no association between depression and HIV disease status. There was no evidence in this study cohort of a distinct subtype of 'organic' or secondary depression. CONCLUSIONS: These results suggest that at least for 'well' people living with HIV/AIDS, there is no distinct subtype of depression and early treatment approaches can be modelled on those used for other non-HIV groups. Further longitudinal studies will be required to dissect out the multiple factors underlying depression in HIV/AIDS.     

A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS

Background: By 2015, the Centers for Disease Control and Prevention predicts that 50% of all cases of HIV/AIDS in the United States will be in persons 50 years of age or older.Purpose: This pilot research tested whether a 12-session, coping improvement group intervention delivered via teleconference technology could improve life quality in 90 middle-age and older adults living with HIV/AIDS.Method: This research used a lagged-treatment control group design. Forty-four HIV-infected persons 50-plus years of age participated in a coping improvement group intervention immediately after study enrollment, whereas 46 individuals received the intervention after their time-matched immediate treatment participants completed the intervention. Participants completed self-administered surveys that assessed depressive and psychological symptoms, life-stressor burden, ways of coping, coping self-efficacy, and loneliness.Results: Outcome analyses indicated that, compared to their delayed treatment counterparts, immediate treatment participants reported fewer psychological symptoms, lower levels of life-stressor burden, increased coping self-efficacy, and less frequent use of avoidance coping. After receiving the intervention, delayed treatment participants reported greater coping self-efficacy and less psychological symptomatology, lifestressor burden, and loneliness. However, the intervention demonstrated little ability to reduce depressive symptoms in this sample of HIV-infected older adults diagnosed with depression.Conclusions: Although findings from this research suggest that telephone-delivered, coping improvement group interventions have potential to facilitate the adjustment efforts of HIV-infected older adults, more rigorous evaluations of this intervention modality for this group are needed. This research was supported by a grant from the National Institute on Aging (R21 AG20334).     

Rates and risk factors for suicidal ideation,suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis

BackgroundPeople living with HIV/AIDS (PLWHA) must contend with a significant burden of disease. However, current studies of this demographic have yielded wide variations in the incidence of suicidality (defined as suicidal ideation, suicide attempt and suicide deaths).AimsThis systematic review and meta-analysis aimed to assess the lifetime incidence and prevalence of suicidality in PLWHA.MethodsPublications were identified from PubMed (MEDLINE), SCOPUS, OVID (MEDLINE), Joanna Briggs Institute EBP and Cochrane Library databases (from inception to before 1 February 2020). The search strategy included a combination of Medical Subject Headings associated with suicide and HIV. Researchers independently screened records, extracted outcome measures and assessed study quality. Data were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted to explore the associated risk factors and to identify the sources of heterogeneity. Main outcomes were lifetime incidence of suicide completion and lifetime incidence and prevalence of suicidal ideation and suicide attempt.ResultsA total of 185 199 PLWHA were identified from 40 studies (12 cohorts, 27 cross-sectional and 1 nested case-control). The overall incidence of suicide completion in PLWHA was 10.2/1000 persons (95%CI: 4.5 to 23.1), translating to 100-fold higher suicide deaths than the global general population rate of 0.11/1000 persons. The lifetime prevalence of suicide attempts was 158.3/1000 persons (95%CI: 106.9 to 228.2) and of suicidal ideation was 228.3/1000 persons (95%CI: 150.8 to 330.1). Meta-regression revealed that for every 10-percentage point increase in the proportion of people living with HIV with advanced disease (AIDS), the risk of suicide completion increased by 34 per 1000 persons. The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations for the suicide deaths was graded as ‘moderate’ quality.ConclusionsThe risk of suicide death is 100-fold higher in people living with HIV than in the general population. Lifetime incidence of suicidal ideation and attempts are substantially high. Suicide risk assessments should be a priority in PLWHA, especially for those with more advanced disease.     

Acute stress reactions to recent life events among women and men living with HIV/AIDS

OBJECTIVE: This study examined the prevalence of acute stress reactions to recent life events among persons living with HIV/AIDS. A second aim was to investigate the relationship of acute stress reactions among HIV-infected men and women to posttraumatic stress disorder (PTSD) symptoms to previous traumatic life events. METHOD: Participants included 64 HIV-seropositive persons (33 men and 31 women) drawn from a larger study examining the effects of group therapy on quality of life and health behavior. These individuals were assessed at baseline on demographic and medical status characteristics and (PTSD) symptoms andthen randomly assigned to either receive group therapy plus education or education alone. Three months later they were assessed for acute stress reactions to recent life events. RESULTS: Nearly a third (31.3 percent) of the participants reported levels of acute stress reactions to recent life events that met all symptom criteria for the diagnosis of acute stress disorder. However, only 9.4 percent of the respondents described a recent stressful life event that was threatening to the life or physical integrity of themselves or others. Acute stress reactions to recent life events were significantly and positively related to experiencing PTSD symptoms to prior traumatic life events. Acute stress did not differ significantly by gender, AIDS status, or whether or not participants had received 12 weeks of group therapy. CONCLUSIONS: A subset of individuals with HIV/AIDS experience high levels of acute stress reactivity to life events considered non-traumatic. HIV-infected individuals who react strongly to ongoing life stressors are more likely to have developed PTSD symptoms in response to previous traumatic life events.     

Identifying the mental health needs of children living in families with AIDS or HIV infection

The present article highlights the mental health needs of children living with loved ones who have AIDS or HIV infection. In addition the article describes an intervention program which is being developed to meet the needs of the children and their families. Children who live in families affected by AIDS and HIV infection, like children who live with other life-threatening illnesses, are vulnerable to psychological distress. They experience numerous separations from parents, changes in the nature and predictability of emotional nurturing, concens about loss, disruptions in routine and contact with peers, and economic hardship. AIDS and HIV infection present the additional stressors that stem from discrimination, stereotyping, and social ostracism. Finally, many families living with AIDS or HIV infection are disenfranchised, living under the pall of poverty and substance abuse. The intervention program described is being implemented in an urban community mental health clinic to meet the diverse mental health needs of the children living in these families. Preliminary implications of the program are discussed so as to begin a dialogue with other agencies who are challenged to meet the needs of this heterogeneous population.     

A group intervention to improve body image satisfaction and dietary habits in gay and bisexual men living with HIV/AIDS

A healthy diet is essential to maintaining a strong immune system for people living with HIV and AIDS. Prior studies have shown that HIV-positive gay and bisexual men are more susceptible to poor body image, which can negatively impact dietary habits. Interventions that simultaneously address body image and nutrition are therefore critical for this population. This paper describes the curriculum for a 14-week group designed to improve body image satisfaction and dietary habits in gay and bisexual men living with HIV/AIDS.     

The Training Effects of Solution-Focused Brief Counseling on Telephone-Counseling Volunteers in Taiwan

This study investigates the effects of a solution-focused brief counseling training program on telephone-counseling volunteers in Taiwan, with an emphasis on promoting their counseling self-efficacy. There were 14 hotline volunteers recruited from Taipei Lifeline, they received 24 hours of solution-focused brief counseling training over 3 days. All participants were required to fill in an open-ended course feedback form after the solution-focused brief counseling training program and 1 month later. We used open coding to analyze the verbal data from the course-feedback forms. There were 6 features contributing to the effect of this solution-focused brief counseling training program that were found: helpful solution-focused brief counseling skills, the usefulness of solution-focused brief counseling’s stages, the establishment of basic knowledge of solution-focused brief counseling, enhancing the confidence and stability of telephone-counseling volunteers, the positive influence on volunteers’ personal life, and effective ways to learn and master solution-focused brief counseling. Using the research results, this study discusses solution-focused brief counseling training as it relates to telephone-counseling volunteers and suggests further research directions in relevant fields.     

Depression Treatment Enhances Adherence to Antiretroviral Therapy: a Meta-Analysis

Background

Depression is a risk factor for nonadherence to HIV/AIDS treatment.

Purpose

A meta-analysis was conducted to examine whether treatment of depression and psychological distress improves antiretroviral therapy adherence.

Methods

PubMed and PsycINFO databases were systematically searched for relevant articles. Studies that reported an association between depression treatment (or an intervention with a component addressing mental health) and antiretroviral adherence were included.

Results

Across 29 studies of 12,243 persons living with HIV/AIDS, treatment of depression and psychological distress improved antiretroviral adherence (p?<?0.001). The odds of a person adhering were 83 % better if he/she was treated for depression. Greater improvements in adherence were found for samples with lower CD4 counts or more severe depression, for interventions specifically targeting depression (versus addressing mental health as a secondary objective), longer treatments, and observational studies.

Conclusions

These findings support the need for detection and treatment of depression among persons living with HIV/AIDS.     

Hope and Expectancy in Solution-Focused Brief Therapy

The common factors approach has been heavily discussed in recent years in psychotherapy, being explored in a variety of different ways. It is commonly accepted that hope and expectancy factors account for roughly 15% of outcome variance in psychotherapy (Lambert, 1992 Lambert, M. J. 1992. “Implications of outcome research for psychotherapy integration”. In Handbook of psychotherapy integration, Edited by: Norcross, J. C. and Goldfried, M. R. 94–129. New York: Basic Books.  [Google Scholar]). This article explores how the therapeutic factor of hope and expectancy plays a role in one specific approach, solution-focused brief therapy (SFBT). SFBT is parsimoniously designed to utilize this therapeutic factor to help clients develop solutions that increase their expectancy of change and their hope for a positive outcome. This article explores how the components of SFBT build upon the common factor of hope and expectancy.     

Obstructive sleep apnea among HIV-infected men in the highly active antiretroviral therapy era: a nation-wide longitudinal cohort study in Taiwan, 2000–2011

ObjectivesThis study compared the incidence of obstructive sleep apnea (OSA) between HIV-infected and matched non-infected persons and aimed to determine the effect of highly active antiretroviral therapy (HAART) on the incidence of OSA among HIV-infected men.MethodsA population-based cohort design was conducted using the National Health Insurance Research Database (NHIRD), which contained 13,552 HIV-infected persons and 134,361 matched age-, sex-, and index year-controls. The incidence density rates (IRR) were calculated to estimate the OSA incidence both in the HIV group and matched controls. Cox proportional hazard models were applied to assess the HAART effect on the incidence of OSA among HIV-infected men.ResultsThe IRR of OSA was lower in the HIV group than in the matched controls (1.91 vs. 2.26 per 1000 person-years, respectively). The associated factors for OSA in HIV-infected men were higher monthly salary (adjusted hazard ratio [aHR], 1.97, p < 0.01), obesity (aHR, 3.99, p < 0.01), and chronic obstructive pulmonary disease (aHR, 2.02, p < 0.01). Continued HAART at least a half year was associated with less diagnosed OSA (AHR, 0.70, p = 0.03) in HIV-infected men.ConclusionsHIV-infected persons had a lower rate of OSA diagnosis compared to the matched controls. Healthcare providers are needed to increase awareness in HIV-infected men with sleep disorders, especially for those with low social economic status, comorbidities, and non-continuous HAART use.     

Gender,Race and Sexual Behaviour: Issues in Service Responses to HIV/AIDS

The number of people with learning disabilities who are HIV positive is not known. However, research indicates that there is a significant number of people with learning disabilities at high risk of contracting the virus. Services need to give priority to developing a response to HIV/AIDS. This article argues that notions of HIV as an ‘equal opportunity virus’ are misleading and potentially damaging. Instead, responses need to be rooted in an accurate assessment of the needs and power of service users, together with an understanding of the relationships between race, gender, sexuality and HIV/AIDS. These issues are examined to inform how services should respond in relation to HIV transmission, health promotion initiatives, diagnosis, treatment and support for people with learning disabilities living with HIV/AIDS.