title: Reductions in traumatic stress following a coping intervention were mediated by decreases in avoidant coping for people living with HIV/AIDS and childhood sexual abuse.
abstract: OBJECTIVE
  To examine whether (a) Living in the Face of Trauma (LIFT), a group intervention to address coping with HIV and childhood sexual abuse (CSA), significantly reduced traumatic stress over a 1-year follow-up period more than an attention-matched support group comparison intervention; and (b) reductions in avoidant coping over time mediated reductions in traumatic stress.
  
  
  METHODS
  In a randomized controlled trial, 247 participants completed measures of traumatic stress and avoidant coping at pre- and post intervention, and at 4-, 8-, and 12-month follow-ups. Latent growth curve modeling examined changes over the 5 time points; standardized path coefficients provide estimates of effects.
  
  
  RESULTS
  As compared with the support intervention, the coping intervention led to a reduction in traumatic stress over time (b = -.20, p < .02). Participants in the coping intervention also reduced their use of avoidant coping strategies more than did participants in the support intervention (b = -.22, p < .05). Mediation analyses showed reductions in avoidant coping related to reductions in traumatic stress (b = 1.45, p < .001), and the direct effect of the intervention on traumatic stress was no longer significant (b = .04, ns), suggesting that changes in avoidant coping completely mediated intervention effects on traumatic stress.
  
  
  CONCLUSIONS
  The LIFT intervention significantly reduced traumatic stress over time, and changes in avoidant coping strategies mediated this effect, suggesting a focus on current stressors and coping skills improvement are important components in addressing traumatic stress for adults living with HIV and CSA.
authors.affiliation: Department of Psychology and Neuroscience, Duke University, Durham, NC 27708-0086, USA. kathleen.sikkema@duke.edu
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
authors.forename: Krista W
authors.initials: KW
authors.lastname: Ranby
authors.forename: Christina S
authors.initials: CS
authors.lastname: Meade
authors.forename: Nathan B
authors.initials: NB
authors.lastname: Hansen
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Wilson
authors.forename: Arlene
authors.initials: A
authors.lastname: Kochman
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000328:Adult; D002650:Child Abuse, Sexual / Q000523:psychology / Q000534:rehabilitation*; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group / Q000379:methods*; D040921:Stress Disorders, Traumatic / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome