Tuesday, October 30, 2012

HIV unimpressed by Stress Management – Proponents of Behavioral Interventions "surprised" by this

Stress Management Interventions for HIV+ Adults: A Meta-Analysis of Randomized Controlled Trials, 1989 to 2006

Lori A. J. Scott-Sheldon
Center for Health and Behavior, Syracuse University

Seth C. Kalichman
Center for Health, Intervention, and Prevention

Michael P. Carey and Robyn L. Fielder
Center for Health and Behavior, Syracuse University


Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults.


This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress-management interventions for HIV+ adults (N = 3,077).

Main Outcome Measures

Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue).


Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d+s = 0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls.


Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week post-intervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and Caucasian participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration.

To our surprise, we did not find evidence that stress reduction interventions improved immune functioning or hormonal mechanisms that could influence immunity. These findings contrast with the PNI perspective that guided our work and most of the interventions included in our review (Antoni, 2003; Robinson et al., 2000). Thus, even though chronic stressors are known to suppress both cellular and humoral markers (see Segerstrom & Miller, 2004); the short-term use of stress management strategies does not seem to reverse these processes in patients with HIV. Before concluding that stress management interventions are ineffective in improving the immunological health of people living with HIV/AIDS, however, it is appropriate to consider potential alternative explanations for these null effects. For example, it is possible that even the most potent stress management intervention will be unable to overcome the devastating effects of HIV on the immune system. …
And yeah, before "concluding that stress management interventions are ineffective" one should however try to rationalize a lot (and then some) that it was "just this time" that your psych*–woo did not work, because HIV was so devastating.

And why is not enough for these psych*-quacks to "improve mental health and quality of life"? Why do they have to cling on to their idealistic (and anti-evolutionary) mind-body BS that "IT'S THE MIND THAT CAUSES ILLNESS!"?


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