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The Relationship Between Automatic Thoughts and Depression in a Cognitive-Behavioral Treatment for People Living with HIV/AIDS: Exploring Temporality and Causality

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Abstract

Depression in people living with HIV/AIDS (PLWHA) is highly prevalent and related to worse adherence to antiretroviral therapy, but is amenable to change via CBT. Cognitive-behavioral therapy for adherence and depression (CBT-AD) specifically addresses negative automatic thoughts (ATs) as one component of the treatment. There is little research on the temporal nature of the relation between ATs and depression. HIV-positive adults with depression (N = 240) were randomized to CBT-AD, information/supportive psychotherapy for adherence and depression (ISP-AD), or one session of adherence counseling alone (ETAU). ATs were self-reported (Automatic Thoughts Questionnaire; ATQ) and depression was assessed by blinded interview (Montgomery-Asberg Depression Rating Scale; MADRS) at baseline, and 4-, 8-, and 12-months. We performed autoregressive cross-lagged panel models. Broadly, decreases in ATs were followed by decreases in depression, but decreases in depression were not followed by decreases in ATs. In CBT-AD, decreases in ATs were followed by decreases in depression, and vice versa. However, in the ISP group, while depression and ATs both significantly influenced each other, not all relations were in the direction expected. This study adds to the evidence base for cognitive interventions to decrease depression in individuals with a chronic medical condition, HIV/AIDS.

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Acknowledgements

Funding for this project came from a National Institute of Mental Health Grant R01MH084757 and a National Institute of Drug Abuse Grant K24DA040489 to Dr. Steven A. Safren.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Kristen E. Riley

  2. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Jasper S. Lee & Steven A. Safren

  3. The Fenway Institute, Boston, MA, USA

    Steven A. Safren

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  1. Kristen E. Riley
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  2. Jasper S. Lee
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Correspondence to Steven A. Safren.

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Dr. Kristen E. Riley and Jasper S. Lee have no conflicts of interest. Dr. Steven A. Safren receives royalties from Oxford University Press for books/treatment manuals on treating depression in the context of chronic illness.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (national and institutional). Informed consent was obtained from all individual subjects participating in the study.

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Riley, K.E., Lee, J.S. & Safren, S.A. The Relationship Between Automatic Thoughts and Depression in a Cognitive-Behavioral Treatment for People Living with HIV/AIDS: Exploring Temporality and Causality. Cogn Ther Res 41, 712–719 (2017). https://doi.org/10.1007/s10608-017-9839-8

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