An Inch Against AIDS

Beyond Denial

There's no good way to receive a diagnosis of HIV-positive. But some ways are better than others.

A University of Miami psychologist reports that a structured coping program that helps men accept the diagnosis and plan for the future minimizes depression and isolation. What's more, it actually delays the onset of full-blown disease.

Michael H. Antoni, Ph.D., has objective evidence his 10-week cognitive behavioral stress-management program aided immunologic function. Among 21 gay males who participated in the program after being diagnosed as HIV+, lymphocyte counts improved and antibodies diminished to herpes viruses co-factors of disease progression.

It sure beats denial as a coping strategy. "The use of denial is related to depression and lower T-helper cell counts one year later and a greater likelihood of disease progression two years later." Antoni reported to a recent meeting of the Society of Behavioral Medicine.

The program mixes problem-focused and emotion-focused coping strategies:

o information about stress responses and risk behavior;

o instruction in progressive muscle relaxation technques and relaxing imagery as means of anxiety reduction;

o modification of cognitive appraisals through cognitive restructuring;

o assertion training to improve anger expression and conflict resolution;

o group support and social network building to reduce isolation.

Patients were taught to ask themselves "How are you dealing with the threat of AIDS in your life?" and kept a journal of the ways they learned to handle distress. The perceived control and self-efficacy may have contributed powerfully to the effect. Now if only doctors would use it as a model program for any unkind diagnosis.

ILLUSTRATION