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Dysfunctional Attitudes, Coping, and Depression Among HIV-Seropositive Men Who Have Sex with Men

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Abstract

Several studies have documented elevated levels of psychological distress among HIV-seropositive (HIV+) symptomatic men who have sex with men (MSM). However, very little is known about the role of dysfunctional attitudes and coping strategies in maintaining and ameliorating distress levels in ways that can inform those developing psychosocial interventions for HIV+ persons. This study evaluated relations between dysfunctional attitudes and depression and examined the role of coping as a mediator of this relationship among 115 HIV+ symptomatic MSM. Higher Dysfunctional Attitude Scale scores were associated with more reported depressive symptoms. The use of adaptive coping strategies such as active coping was associated with lower depression, whereas use of maladaptive strategies such as denial was related to higher levels of depression. Both adaptive and maladaptive coping strategies mediated the relationship between dysfunctional attitudes and depression. Findings suggest that interventions aiming at reducing psychological distress in this population using cognitive restructuring and related techniques may achieve their effects by enhancing adaptive coping strategies on the one hand and reducing maladaptive strategies on the other.

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References

  • Antoni, M. H., Ironson, G., Helder, L., Lutgendorf, S., Friedman, A., LaPerriere, A., Fletcher, M. A., & Schneiderman, N. (1992, April). Stress management intervention reduces social isolation and maladaptive coping behaviors in gay men adjusting to an HIV-1 seropositive diagnosis. Paper presented at the scientific meeting of the Society of Behavioral Medicine, New York.

  • Antoni, M. H., & Schneiderman, N. (1998). HIV/AIDS. In A. Bellack & M. Hersen (Eds.), Comprehensive Clinical Psychology (pp. 237–275). New York: Elsevier Science.

    Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). Themoderator- mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Google Scholar 

  • Beck, A. T. (1963). Thinking and depression. 1. Idiosyncratic content and cognitive distortions. Archives of General Psychiatry, 10, 561–571.

    Google Scholar 

  • Beck, A. T. (1967). Depression: Clinical, experimental and theoretical aspects. New York: Hoeber [Republished as Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press (1972)].

    Google Scholar 

  • Beck, A. T., & Beamesderfer, T. (1974). Assessment of depression: The Depression Inventory. In P. Pichot (Ed.), Psychological measurements in psychopharmacology. Pharmacopsychiatry, 7, 151–169.

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive theory of depression. New York: Guilford Press.

    Google Scholar 

  • Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press.

    Google Scholar 

  • Blaney, N. T., Millon, C., Morgan, R., Eisdorfer, C., & Szapocznik, J. (1990). Emotional distress, stressrelated disruption and coping among healthy HIV-positive gay males. Psychology and Health, 4, 259–273.

    Google Scholar 

  • Brown, G. P., Hammen, C. L., Craske, M. G., & Wickens, T. D. (1995). Dimensions of dysfunctional attitudes as vulnerabilities to depressive symptoms. Journal of Abnormal Psychology, 104, 431–435.

    Google Scholar 

  • Burack, J. H., Barrett, D. C., Stall, R. D., Chesney, M. A., Ekstrand, M. L., & Coates, T. J. (1993). Depressive symptoms and CD4 lymphocyte decline among HIV-infected men. Journal of the American Medical Association, 270, 2567–2573.

    Google Scholar 

  • Carver, C., Pozo, C., Harris, S., Noriega, V., Scheier, M., Robinson, D., Ketcham, A., Moffat, F., & Clark, K. (1993). How coping mediates the effects of optimism on distress: A study of women with early stage breast cancer. Journal of Personality and Social Psychology, 65, 375–390.

    Google Scholar 

  • Carver, C., Sheier, M., & Weintraub, J. D. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283.

    Google Scholar 

  • Centers for Disease Control (1992). 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Morbidity and Mortality Weekly Report, 41, 1–19.

    Google Scholar 

  • Centers for Disease Control and Prevention (1999). HIV/AIDS Surveillance Supplemental Report, 5, 1–13.

    Google Scholar 

  • Cleary, P., Singer, E., Rogers, T., Avorn, J., VanDevanter, N., Soumerai, S., Perry, S., & Pindyck, J. (1988). Sociodemographic and behavioral characteristics of HIV antibody-positive blood donors. American Journal of Public Health, 78, 953–857.

    Google Scholar 

  • Deeks, S., Smith, M., Holodniy, M., & Kahn, J. (1997). HIV-1 protease inhibitors: A review for clinicians. Journal of the American Medical Association, 2, 145–153.

    Google Scholar 

  • Fahey, J. L., Taylor, J. M., Detels, R., Hofman, B., Melmed, R., Nishanian, P., & Giorgi, J. (1990). The prognostic value of cellular and serologic markers in infection with human immunodeficiency virus type-1. New England Journal of Medicine, 322, 166–172.

    Google Scholar 

  • Fletcher, M. A., Baron, G., Ashman, M., Fischl, M., & Klimas, N. (1987). Use of whole blood methods in assessment of immune parameters in immunodeficiency states. Diagnostic Clinical Immunology, 5, 69–81.

    Google Scholar 

  • Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research, 12, 189–198.

    Google Scholar 

  • Gallo, R. C. (1988). HIV—The cause of AIDS: An overview on its biology, mechanisms of disease induction, and our attempts to control it. Journal of Acquired Immunodeficiency Syndromes, 1, 521–535.

    Google Scholar 

  • Gallo, R. C. (1991). Virus hunting: AIDS, cancer, and the human retrovirus: A story of scientific discovery. New York: Basic Books.

    Google Scholar 

  • Greenberger, D., & Padesky, C. A. (1995). Mind over mood: A cognitive therapy treatment manual for clients. New York: Guilford Press.

    Google Scholar 

  • Guppy, A., & Weatherstone, L. (1997). Coping strategies, dysfunctional attitudes and psychological well being in white-collar public sector employees. Work and Stress, 11, 58–67.

    Google Scholar 

  • Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.

    Google Scholar 

  • Ironson, G., Friedman, A., Klimas, N., Antoni, M., Fletcher, M. A., LaPerriere, A., Simoneau, J., & Schneiderman, N. (1994). Distress, denial and low adherence to behavioral interventions predict faster disease progression in gay men infected with human immunodeficiency virus. International Journal of Behavioral Medicine, 1, 90–105.

    Google Scholar 

  • Jarret, R. B., Eaves, G., Grannemann, B. D., & Rusch, A. J. (1991). Clinical, cognitive and demographic predictors of response to cognitive therapy for depression:Apreliminary report. Psychiatry Research, 37, 245–260.

    Google Scholar 

  • Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

    Google Scholar 

  • Lesserman, J., Perkins, D., & Evans, D. (1992). Coping with the threat of AIDS: The role of social support. American Journal of Psychiatry, 149, 1514–1520.

    Google Scholar 

  • Lutgendorf, S., Antoni, M., Ironson. G., Klimas, N., Kumar, M., Starr, K., McCabe, P., & Cleven, C. (1997). Cognitive- behavioral stress management decreases dysphoric mood and herpes simplex virus-type 2 antibody titers in symptomatic HIV-seropositive gay men. Journal of Consulting and Clinical Psychology, 65, 31–43.

    Google Scholar 

  • Lutgendorf, S., Antoni, M., Ironson, G., Starr, K., Costello, N., Zuckerman, M., Klimas, N., Fletcher, M. A., & Schneiderman, N. (1998). Changes in cognitive coping skills and social support during cognitive behavioral stress management intervention and distress outcomes in symptomatic HIVseropostive gay men. Psychosomatic Medicine, 60, 204–214.

    Google Scholar 

  • Lutgendorf, S., Antoni, M. H, Schneiderman, N., & Fletcher, M. A. (1994). Psychosocial counseling to improve quality of life in HIV-infected gay men. Patient Education and Counseling, 24, 217–235.

    Google Scholar 

  • McNair, D., Lorr, M., & Droppleman, L. (1991). Profile of Mood States edits manual. San Diego, CA: Educational and Instructional Testing Service.

    Google Scholar 

  • Moore, L. H., va Gorp, W. G., Hinkin, C. H., Holston, S. G., Weisman, J. D., & Staz, P. (1994). Frequencies of MMPI-168 code types among asymptomatic and symptomatic HIV-1 seropositive gay men. Journal of Personality Assessment, 63, 574–578.

    Google Scholar 

  • Mulder, C., & Antoni, M. H. (1992). Acquired immunodeficiency syndrome (AIDS) in homosexual men: Psychological distress and psychotherapy. Clinical Psychology and Psychotherapy, 1, 69–81.

    Google Scholar 

  • Namir, S., Wolcott, D. L., Fawzy, F. I., & Alumbaugh, M. J. (1987). Coping with AIDS: Psychological and health implications. Journal of Applied Social Psychology, 17, 309–328.

    Google Scholar 

  • Oliver, J. M., & Baumgart, E. P. (1985). The Dysfunctional Attitude Scale: Psychometric properties and relation to depression in an unselected adult population. Cognitive Therapy Research, 9, 161–167.

    Google Scholar 

  • Otto, M. W., Fava, M., Penava, S. J., Bless, E., Muller, R. T., & Ronsenbaum, J. F. (1997). Life event, mood, and cognitive predictors of perceived stress before and after treatment for major depression. Cognitive Therapy and Research, 21, 409–420.

    Google Scholar 

  • Pantaleo, G., Graziosi, C., & Fauci, A. (1993). The role of lymphoid organs in the immunopathogenesis of HIV infection. AIDS, 7, 19–23.

    Google Scholar 

  • Patterson, T., Shaw, W, Semple, S., Cherner, M., McCutchan, J., Atkinson, J., Grant, I., & Nannis, E. (1996). Relationship of psychosocial factors to HIV disease progression. Annals of Behavioral Medicine, 18, 30–39.

    Google Scholar 

  • Penedo, F. J., Antoni, M. H., Schneiderman, N., Ironson, G., Malow, R., Duran, R., & Fletcher, M. (1999). Coping strategies, psychosocial distress, substance use and immune function among symptomatic HIV-1 seropositive gay Hispanic and non-Hispanic White men. Unpublished doctoral dissertation, University of Miami, Coral Gables, Florida.

    Google Scholar 

  • Penedo, F. J., Antoni, M. H., Starr, K., Ironson, G., Alferi, S., Fletcher, M. A., & Schneiderman, N. (1996, March). Associations among dysfunctional attitudes, coping, social support and immune function in HIV+ gay men. Paper presented at the Society of Behavioral Medicine, Washington, D.C.

  • Penkower, L., Dew, M. A., Kingsley, L., Becker, J. T., Satz, P., Schaerf, F. W., & Sheridan, K. (1991). Behavioral, health and psychosocial factors and risk for HIV infection among sexually active homosexual men: The Multicenter AIDS Cohort Study. American Journal of Public Health, 81, 194–196.

    Google Scholar 

  • Poulakis, Z., & Wertheim, E. H. (1993). Relationships among dysfunctional cognitions, depressive symptoms, and bulimic tendencies. Cognitive Therapy Research, 17, 549–559.

    Google Scholar 

  • Power, C., Selnes, O., Grim, J., & McArthur, J. (1995). HIV Dementia Scale: A rapid screening test. Journal of AIDS and Human Retroviruses, 8, 273–278.

    Google Scholar 

  • Rabkin, J., Wagner, G., & Rabkin, R. (1996). Treatment of depression in HIV+ men: Literature review and report of an ongoing study of testosterone replacement therapy. Annals of Behavioral Medicine, 18, 24–29.

    Google Scholar 

  • Reed, G. M., Kemeny, M. E., Taylor, S. E., Wang, H. J., & Visscher, B. (1994). Realistic acceptance as a predictor of decreased survival time in gay men with AIDS. Health Psychology, 13, 299–307.

    Google Scholar 

  • Remien, R. H., Rabkin, J. G., Williams, J. B., & Katoff, L. (1992). Coping strategies and health beliefs of AIDS long term survivors. Special Issue: Biopsychosocial aspects of HIV infection. Psychology and Health, 6, 335–345.

    Google Scholar 

  • Ressor, K. A., & Craig, K. D. (1988). Medically incongruent chronic back pain: Physical limitations, suffering and ineffective coping. Pain, 32, 35–45.

    Google Scholar 

  • Sarason, I. G., Johnson, J., & Siegel, J. (1978) Assessing the impact of life changes: Development of the Life Experiences Survey. Journal of Consulting and Clinical Psychology, 46, 932–946.

    Google Scholar 

  • Sharts-Hopko, N. C. (1997). Responses to “Impact of HIV on emotional distress of infected women: Cognitive appraisal and coping as mediators.” Scholarly Inquiry for Nursing Practice, 11, 147–151.

    Google Scholar 

  • Singh, N., Squier, C., Sivek, C., Wagener, M., Hong, M., & Yu, V. (1996). Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: Prospective assessment with implications for enhancing compliance. AIDS Care, 8, 261–269.

    Google Scholar 

  • Solano, L., Costa, M., Salvati, S., Coda, R., Aniti, F., Mazzaroma, I., & Bertini, M. (1993). Psychosocial factors and clinical evolution in HIV-1 infection: A longitudinal study. Journal of Psychosomatic Research, 37, 39–51.

    Google Scholar 

  • Spitzer, R., Williams, J., Gibbon, M., & First, M. (1988). Structured Clinical Interview for DSM-III-R: Nonpatient Version for HIV Studies (SCID-NP-HIV 6/1/88). New York: Biometrics Research Department, New York Psychiatric Institute.

    Google Scholar 

  • Spitzer, R., Williams, J., Gibbon, M., & First, M. (1990). Structured Interview for DSM-III-R Personality Disorders (SCID-II). New York, New York State Psychiatric Institute, Biometrics Research.

    Google Scholar 

  • Vercoulen, J., Swanink, C., Fennis, J., Galaina, J. M., Van der Meer, J. W. M., & Bleigenberg, G. (1996). Prognosis in chronic fatigue syndrome: A prospective study on the natural course. Journal of Neurology, Neurosurgery, and Psychiatry, 60, 489–494.

    Google Scholar 

  • Weissman, A., & Beck, A. T. (1978, November). Development and validation of the Dysfunctional Attitudes Scale. Paper presented at the 12th annual meeting of the Association for the Advancement of Behavior Therapy, Chicago, Illinois.

  • Williams, J., Rabkin, J., Remien, R., Gorman, J. M., & Erhardt, A. A. (1991). Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection I. Standardized clinical assessment of current and lifetime psychopathology. Archives of General Psychiatry, 48, 124–130.

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, University of Miami, Coral Gables, Florida

    Frank J. Penedo, Michael H. Antoni, Neil Schneiderman, Gail H. Ironson, Stacy Cruess, Barry Hurwitz & Arthur LaPerriere

  2. Department of Psychiatry and Behavioral Sciences, University of Miami, Coral Gables, Florida

    Michael H. Antoni

  3. Department of Psychiatry and Behavioral Sciences, University of Miami, Coral Gables, Florida

    Neil Schneiderman, Gail H. Ironson, Robert M. Malow & Arthur LaPerriere

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  1. Frank J. Penedo
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  2. Michael H. Antoni
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  3. Neil Schneiderman
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  4. Gail H. Ironson
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Penedo, F.J., Antoni, M.H., Schneiderman, N. et al. Dysfunctional Attitudes, Coping, and Depression Among HIV-Seropositive Men Who Have Sex with Men. Cognitive Therapy and Research 25, 591–606 (2001). https://doi.org/10.1023/A:1005509632435

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