Improvement of Quality of Life after the Application of Mindfulness-Based Cognitive Therapy in Subjects Aging with HIV Infection

Transcription

1 Improvement of Quality of Life after the Application of Mindfulness-Based Cognitive Therapy in Subjects Aging with HIV Infection Carmina R. Fumaz HIV Unit-LLuita contra la Sida Foundation Germans Trias i Pujol University Hospital Badalona, Barcelona, Spain 2 nd Workshop on HIV and Aging October 2011, Baltimore, USA

2 Background Aging is a multidimensional process of physical, psychological and social changes. Successful aging is based not only on the absence of illness but also on the achievement of an adequate quality of life, understanding this as the concept of wellness. In the field of healthcare, quality of life includes physical and mental health, education, recreation and leisure time, and social belonging, among others. Aging involves a number of diverse factors which may favour the impairment of quality of life and emotional status like functional decline, physical dependence, decrease of economic capacity and changes in social activity and relationships.

3 Background Comorbidity Chronic condition Mansky KC. Clin Interv Aging 2010;5: Natural aging Guaraldi et al. Clin Infect Dis 2009;49 (11): Impact on emotions and quality of life Justice AC. Curr HIV/AIDS Rep 2010;7(2): Premature aging? Adams et al. Occup Ther Int 2010 Vance et al. J Neurosci Nurs 2010;42(3): Comorbidity Desai et al. Curr HIV/AIDS Rep 2010;7(1):4-10.

4 Methods - Objective: To determine the efficacy of mindfulness-based cognitive therapy to improve the quality of life of subjects aging with HIV infection. - Design: Prospective randomized two-arm study with 40 subjects (20 men and 20 women). - Inclusion criteria: HIV infection diagnosis 15 years ago Deficits in quality of life (scores 65 Nottingham Health Profile) Written consent - Exclusion criteria: Diagnosis of schizophrenia or bipolar disorder Documented psychotic episode Documented epileptic episode Other ongoing psychotherapeutic interventions

5 Methods - Psychometric instrument used to evaluate quality of life: Nottingham Health Profile First section: 38 statements that assess 6 different dimensions of normal living: energy, pain, emotional reactions, sleep, social isolation and physical mobility. Scores for each dimension can range from 0 "no problems to 100 all problems listed are present. Second section: 7 single statements about 7 areas of daily life: work, looking after the home, social life, relationships at home, sex life, interests and hobbies, and the ability to take holidays. Patients are asked to answer whether their health causes problems in any of these areas.

6 Methods - Statistical analysis: Continuous variables were described as median (IQR) and categorical variables as percentages (number of patients). Univariate linear regression analyses were fitted to evaluate the difference between pre and post measurements considering the group of treatment as explanatory variable.

7 Methods Recruitment N= 20 men; 20 women Pre-evaluation Pre-evaluation Assessment only N= 10 men; 10 women MBCT N= 10 men; 10 women 8 weeks 8 weeks Post-evaluation Drop-out N= 0 Drop-out N= 1 Post-evaluation Evaluation at month 3 and 6 post-intervention

8 Methods - Intervention used to evaluate quality of life: Mindfulness-based Cognitive Therapy MBCT combines cognitive therapy with mindfulness techniques as a treatment for major depressive disorder.

9 Mindfulness Structured intervention adapted from Kabat-Zinn (1990), consisting of eight 3-hour weekly sessions and a daylong retreat with about an hour or more of homework per day, 6 days per week. Designed to develop mindfulness: a consciousness focused on the present moment free of judgment, promoting an attitude of acceptance. Directed at teaching meditation techniques whilst sitting and in movement, yoga, conscious breathing and body exploration to encourage the participants to appreciate the present moment instead of focusing on worries about future or past, often ruminative and automatic, and potential generators of psychological stress.

10 Mindfulness Randomized study with 84 breast cancer survivors Lengacher CA et al. J Behav Med 2011

11 Mindfulness Randomized study with 84 breast cancer survivors Lengacher CA et al. J Behav Med 2011

12 Mindfulness Randomized study with very stressed 38 women and 19 men Perceived stress Quality of life Nyklicek I et al. Ann Behav Med 2008

13 Mindfulness Non-randomized study with 75 breast cancer patients Witek-Janusek L et al. Brain Behav Immun 2008

14 Mindfulness Witek-Janusek L et al. Brain Behav Immun 2008

15 Mindfulness Changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing and perspective taking Hölzel et al. Psychiatry Res 2011;191(1):36-43

16 Mindfulness Randomized study in 67 subjects + 20 CD4-185 CD4 Creswell JD et al. Brain Behav Immun 2009

17 Sociodemographic Characteristics: Groups Characteristics Total Intervention Control p Value n=40 n=20 n=20 Age* 50 (46-52) 50 (45-54) 49 (48-51) 0.93 Years since HIV diagnosis* 20 (16-24) 20 (16-24) 19 (15-24) 0.73 Years on ARV* 16 (12-18) 15 (13-19) 17 (12-18) 0.93 Nadir CD4 cell count (cells/mm 3 )* CD4 cell count (cells/mm 3 )* 156 (68-253) 195 ( ) 108 (31-176) ( ) 576 ( ) 463 ( ) 0.19 HIV RNA VL<25 39 (98) 19 (95) 20 (100) 1 copies/ml Φ Stable partner Φ 17 (43) 11 (57) 6 (30) 0.10 Retirees Φ 20 (50) 9 (47) 11 (55) 0.52 * Values expressed as median (IQR) Φ Values expressed n (%)

18 Sociodemographic Characteristics: Genders Characteristics Total Men Women p Value n=40 n=20 n=20 Age* 50 (46-52) 50 (48-54) 49 (45-51) 0.08 Years since HIV diagnosis* 20 (16-24) 20 (16-23) 19 (15-24) 0.58 Years on ARV* 16 (12-18) 17 (13-19) 16 (10-18) 0.49 Nadir CD4 cell count (cells/mm 3 )* CD4 cell count (cells/mm 3 )* 156 (68-253) 140 (73-302) 159 (41-218) ( ) 525 ( ) 527 ( ) 0.92 HIV RNA VL<25 39 (98) 19 (95) 20 (100) 1 copies/ml Φ Stable partner Φ 17 (43) 6 (30) 11 (58) 0.05 Retirees Φ 20 (50) 10 (50) 10 (50) 1 * Values expressed as median (IQR) Φ Values expressed n (%)

19 Dimensions of Normal Living: Pre-evaluation Energy Pain Emotional reactions Sleep Social isolation Physical mobility Intervention Control

20 Dimensions of Normal Living: Post-evaluation Energy Pain Emotional reactions 53 Sleep 40 Social isolation Physical mobility Intervention Control

21 Areas of Daily Life: Pre-evaluation Work 60 Looking after the home 75 Social life Relationships at home Sex life Interests and hobbies 60 Ability to take holidays Intervention Control

22 Areas of Daily Life: Post-evaluation Work Looking after the home Social life Relationships at home Sex life Interests and hobbies Ability to take holidays 40 Intervention Control

23 Impact of the intervention No differences were observed between genders regarding the efficacy of the intervention. Benefits observed in other areas assessed: stress, anxiety and depressive markers, subjective effort to deal with the disease, subjective perception of physical status.

24 Conclusions Quality of life improved very importantly after the implementation of mindfulness-based cognitive therapy in this sample of long-term diagnosed HIV-infected subjects. Mindfulness may be a recommendable strategy in subjects aging with HIV infection.

25 HIV Unit-Germans Trias I Pujol University Hospital Maria Jose Ferrer Marian Gonzalez-Garcia Jose A. Muñoz-Moreno Jordi Puig Christian Brander Eugenia Negredo Bonaventura Clotet

26 The energy of the mind is the essence of life Aristotle Thank you