title: Changes in cognitive coping skills and social support during cognitive behavioral stress management intervention and distress outcomes in symptomatic human immunodeficiency virus (HIV)-seropositive gay men.
abstract: OBJECTIVE
  We have previously reported decreases in dysphoria, anxiety, and total mood disturbance in symptomatic HIV seropositive gay men after a 10-week cognitive behavioral stress management (CBSM) group intervention. This structured intervention was designed a) to increase cognitive and behavioral coping skills related to managing the distress of symptomatic HIV, and b) to increase social support among group members. Here we examine the relative contribution of changes in coping skills and social support during the intervention period to reductions in dysphoria, anxiety, and distress-related symptoms in this sample.
  
  
  METHODS
  Participants were randomized to a 10-week CBSM group intervention or to a wait-list control condition. Coping, social supports, and mood were measured before and after the intervention period.
  
  
  RESULTS
  Members of the CBSM group (N = 22) showed significant improvement in cognitive coping strategies involving positive reframing and acceptance, and in social supports involving attachment, alliances, and guidance at the end of the 10-week CBSM program compared with controls (N = 18) who showed decrements in these coping abilities and no changes in social support. Improved cognitive coping, specifically acceptance of the HIV infection, was strongly related to lower dysphoria, anxiety, and total mood disturbance in both conditions. Changes in social support and in cognitive coping skills seem to mediate the effects of the experimental condition on the changes in distress noted during the intervention.
  
  
  CONCLUSIONS
  These results suggest that cognitive coping and social support factors can be modified by psychosocial interventions and may be important determinants of the changes in psychological well-being and quality of life during symptomatic HIV infection that can be achieved through this form of intervention.
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, Florida 33124-2070, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Lutgendorf
authors.forename: M H
authors.initials: MH
authors.lastname: Antoni
authors.forename: G
authors.initials: G
authors.lastname: Ironson
authors.forename: K
authors.initials: K
authors.lastname: Starr
authors.forename: N
authors.initials: N
authors.lastname: Costello
authors.forename: M
authors.initials: M
authors.lastname: Zuckerman
authors.forename: N
authors.initials: N
authors.lastname: Klimas
authors.forename: M A
authors.initials: MA
authors.lastname: Fletcher
authors.forename: N
authors.initials: N
authors.lastname: Schneiderman
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000339:Affect; D000704:Analysis of Variance; D001007:Anxiety / Q000209:etiology / Q000628:therapy; D001294:Attitude to Health; D016009:Chi-Square Distribution; D015928:Cognitive Behavioral Therapy / Q000592:standards*; D003863:Depression / Q000209:etiology / Q000628:therapy; D006679:HIV Seropositivity / Q000150:complications / Q000523:psychology*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome