Does Enhanced Cognitive Processing Therapy with Lifesteps Reduce HIV Stigma and PTSD

Abstract

Background

People with HIV (PWH) report higher levels of trauma than the general population, with rates from 40 to 90%. Higher rates of traumatic exposure correspond with higher rates of Post-traumatic Stress Disorder (PTSD) in this population, with rates of PTSD in PWH estimated to be between 30 and 74%. Up to 64% of PLH endorse PTSD symptoms directly related to their HIV diagnosis. Our team recently enhanced Cognitive Processing Therapy (CPT), an evidence-based treatment for PTSD, with Lifesteps (L), an HIV medication adherence intervention, to create CPT-L to address PTSD and HIV outcomes.

The purpose of the current study is to report on preliminary HIV stigma and PTSD findings among a small sample participating in a pilot randomized controlled trial comparing CPT-L to Standard of Care (SOC).

Methods

PWH (N=41; Mean age=44.8; SD=12.3) who had experienced at least one traumatic event with current PTSD symptoms were recruited from local Ryan White HIV care clinics. Participants were randomized to receive CPT-L or SOC and completed validated assessments of PTSD and stigma at baseline and at 6-week post-baseline.

Results

Following 6-weeks of treatment, CPT-L participants showed significant decreases in PTSD (CAPS: CPT-L Δ=-17.7, SE=2.4 vs. SOC Δ=-6.2, SE=4.0; Cohen’s d=1.0). Males receiving CPT-L had a significantly greater decrease in PTSD as compared to females receiving CPT-L (Males-Δ=-25.3, SE=4.2 vs. Females-Δ=-8.6, SE=4.7; d=1.61) while the sex difference in the SOC group was null (d=0.06). Further, participants identifying as Black had significantly greater decreases in CAPS scores during treatment as compared to all other races (Black-Δ=-13.8, SE=2.8 vs. All Others-Δ=-6.0, SE=3.9; d=0.65). Changes in stigma total score from baseline to week 6 reached a Cohen’s d of .97 within the CPT-L group but the between group difference was not significant (Δ=6.22, SE=5.55, Cohen’s d=0.43, p=.273).

Conclusions

The results suggest CPT-L can be used as a tool to reduce HIV stigma and PTSD in PWH, particularly among males and Black people. Clinical implications and future research directions should explore ways in which physicians who work with PWH can best intergrate CPT-L into their practices to promote a larger scale impact in the reduction of PTSD and HIV stigma, and ultimately improve HIV health outcomes.