Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Improvement of Quality of Life after the Application of Mindfulness-Based Cognitive
Therapy in Subjects Aging with HIV Infection
Carmina R. Fumaz
HIV Unit-LLuita contra la Sida Foundation Germans Trias i Pujol University Hospital
Badalona, Barcelona, Spain
2nd Workshop on HIV and Aging
27-28 October 2011, Baltimore, USA
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Background
• Aging is a multidimensional process of physical, psychological and social changes. Successful aging is based not only on the absence of illness but also on the achievement of an adequate quality of life, understanding this as the concept of wellness. • In the field of healthcare, quality of life includes physical and mental health, education, recreation and leisure time, and social belonging, among others. • Aging involves a number of diverse factors which may favour the impairment of quality of life and emotional status like functional decline, physical dependence, decrease of economic capacity and changes in social activity and relationships.
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Natural aging
Impact on emotions and quality of life
Adams et al. Occup Ther Int 2010 Vance et al. J Neurosci Nurs
2010;42(3):150-6. Comorbidity
Chronic condition
Mansky KC. Clin Interv Aging 2010;5:285-92
Justice AC. Curr HIV/AIDS Rep 2010;7(2):69-76.
Premature aging?
Desai et al. Curr HIV/AIDS Rep 2010;7(1):4-10.
Comorbidity
Guaraldi et al. Clin Infect Dis 2009;49 (11):1756-62
Background
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Methods
- Objective: To determine the efficacy of mindfulness-based cognitive therapy to improve the quality of life of subjects aging with HIV infection. - Design: Prospective randomized two-arm study with 40 subjects (20 men and 20 women). - Inclusion criteria: HIV infection diagnosis ≥ 15 years ago Deficits in quality of life (scores ≥65 Nottingham Health Profile) Written consent - Exclusion criteria: Diagnosis of schizophrenia or bipolar disorder Documented psychotic episode Documented epileptic episode Other ongoing psychotherapeutic interventions
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Methods
- Psychometric instrument used to evaluate quality of life: Nottingham Health Profile First section: 38 statements that assess 6 different dimensions of normal living: energy, pain, emotional reactions, sleep, social isolation and physical mobility. Scores for each dimension can range from 0 "no problems” to 100 “all problems listed are present”. Second section: 7 single statements about 7 areas of daily life: work, looking after the home, social life, relationships at home, sex life, interests and hobbies, and the ability to take holidays. Patients are asked to answer whether their health causes problems in any of these areas.
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Methods
- Statistical analysis:
Continuous variables were described as median (IQR) and categorical variables as percentages (number of patients). Univariate linear regression analyses were fitted to evaluate the difference between pre and post measurements considering the group of treatment as explanatory variable.
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Methods
Recruitment
N= 20 men; 20 women
Assessment only
N= 10 men; 10 women
MBCT
N= 10 men; 10 women
Pre-evaluation Pre-evaluation
8 weeks 8 weeks
Post-evaluation Post-evaluation Drop-out
N= 0
Drop-out
N= 1
Evaluation at month 3 and 6 post-intervention
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Methods
- Intervention used to evaluate quality of life:
Mindfulness-based Cognitive Therapy MBCT combines cognitive therapy with mindfulness techniques as a treatment for major depressive disorder.
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Structured intervention adapted from Kabat-Zinn (1990), consisting of eight 3-hour weekly sessions and a daylong retreat with about an hour or more of homework per day, 6 days per week.
Designed to develop mindfulness: a consciousness focused on the present moment free of judgment, promoting an attitude of acceptance.
Directed at teaching meditation techniques whilst sitting and in movement, yoga, conscious breathing and body exploration to encourage the participants to appreciate the present moment instead of focusing on worries about future or past, often ruminative and automatic, and potential generators of psychological stress.
Mindfulness
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Randomized study with 84 breast cancer survivors
Lengacher CA et al. J Behav Med 2011
Mindfulness
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Lengacher CA et al. J Behav Med 2011
Mindfulness
Randomized study with 84 breast cancer survivors
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Randomized study with very stressed 38 women and 19 men
Nyklicek I et al. Ann Behav Med 2008
Perceived stress Quality of life
Mindfulness
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Witek-Janusek L et al. Brain Behav Immun 2008
Non-randomized study with 75 breast cancer patients
Mindfulness
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Witek-Janusek L et al. Brain Behav Immun 2008
Mindfulness
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing and perspective taking
Hölzel et al. Psychiatry Res 2011;191(1):36-43
Mindfulness
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Creswell JD et al. Brain Behav Immun 2009
Randomized study in 67 subjects
+ 20 CD4
- 185 CD4
Mindfulness
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Sociodemographic Characteristics: Groups
* Values expressed as median (IQR) Φ Values expressed n (%)
Characteristics
Total n=40
Intervention n=20
Control n=20
p Value
Age* 50 (46- 52) 50 (45- 54) 49 (48- 51) 0.93
Years since HIV diagnosis*
20 (16-24) 20 (16-24) 19 (15-24) 0.73
Years on ARV* 16 (12-18) 15 (13-19) 17 (12-18) 0.93
Nadir CD4 cell count (cells/mm3)*
156 (68-253) 195 (163-243) 108 (31-176) 0.28
CD4 cell count (cells/mm3)*
527 (364-633) 576 (439-693) 463 (354-612) 0.19
HIV RNA VL<25 copies/mlΦ
39 (98) 19 (95) 20 (100) 1
Stable partnerΦ 17 (43) 11 (57) 6 (30) 0.10
RetireesΦ 20 (50) 9 (47) 11 (55) 0.52
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Sociodemographic Characteristics: Genders
* Values expressed as median (IQR) Φ Values expressed n (%)
Characteristics
Total n=40
Men n=20
Women n=20
p Value
Age* 50 (46- 52) 50 (48- 54) 49 (45- 51) 0.08
Years since HIV diagnosis*
20 (16-24) 20 (16-23) 19 (15-24) 0.58
Years on ARV* 16 (12-18) 17 (13-19) 16 (10-18) 0.49
Nadir CD4 cell count (cells/mm3)*
156 (68-253) 140 (73-302) 159 (41-218) 0.53
CD4 cell count (cells/mm3)*
527 (364-633) 525 (362-677) 527 (439-633) 0.92
HIV RNA VL<25 copies/mlΦ
39 (98) 19 (95) 20 (100) 1
Stable partnerΦ 17 (43) 6 (30) 11 (58) 0.05
RetireesΦ 20 (50) 10 (50) 10 (50) 1
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Dimensions of Normal Living: Pre-evaluation
0
20
40
60
80
100
Energy Pain Emotionalreactions
Sleep Socialisolation
Physicalmobility
Intervention Control
100 88
38 51 53 49 53 50
0.80 0.54 0.41 0.79 0.66 0.40
41
21
41 32
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Dimensions of Normal Living: Post-evaluation
0
20
40
60
80
100
Energy Pain Emotionalreactions
Sleep Socialisolation
Physicalmobility
Intervention Control
0
76
23
48 53
8 0 12 0.01 0.03 0.001 0.02 0.001 0.008
0 22
40
19
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Areas of Daily Life: Pre-evaluation
0
20
40
60
80
100
Work
Looking after the home
Social life
Relationships at homeSex life
Interests and hobbies
Ability to take holidays
Intervention Control
75
40
60 65
45
1 0.31 1 0.74 0.50 0.74
70 60 60 65
0.50
30 40
65
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Areas of Daily Life: Post-evaluation
0
20
40
60
80
100
Work
Looking after the home
Social life
Relationships at homeSex life
Interests and hobbies
Ability to take holidays
Intervention Control
65 60 55 50 47 31
5 0.005 0.42 0.14 0.001 0.74 0.01
67
50 60
15 0.07 15
40
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Impact of the intervention
No differences were observed between genders regarding the efficacy of the intervention.
Benefits observed in other areas assessed: stress, anxiety and depressive markers, subjective effort to deal with the disease, subjective perception of physical status.
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
Conclusions
Quality of life improved very importantly after the implementation of mindfulness-based cognitive therapy in this sample of long-term diagnosed HIV-infected subjects. Mindfulness may be a recommendable strategy in subjects aging with HIV infection.
Presented at the 2nd Int. workshop on HIV & Aging, 27 – 28 Oct 2011, Baltimore, USA
HIV Unit-Germans Trias I Pujol University Hospital Maria Jose Ferrer Marian Gonzalez-Garcia Jose A. Muñoz-Moreno Jordi Puig Christian Brander Eugenia Negredo Bonaventura Clotet