HIV

1
HIV DEPRESSION

• Jordan Lewis, MSW RSW
• St. Michaels Hospital, Toronto
• Judy Gould, PhD
• Canadian Working Group for HIV and Rehabilitation
• Mar. 11, 2009

2
What is Depression?

• More than feeling bummed
• Mild, Moderate, Severe
• Biological vs. Psychosocial

3
Why Depressed?

• Loss
• Dependency
• Change
• Identity

4
So what can you do?

• Be Genuine.
• Consideration
• Confidence
• Transparent

5
Theoretical Foundations

• Solution Focused Therapy
• Narrative Therapy
• Cognitive Therapy

6
Solution Focused Therapy

• Looking for the solutions, not the problems.
• Focus on the present and future, not the past.

7
Solution Focused Therapy

• The Miracle Question
• This evening you get tired and go to sleep. In
  the middle of the night, when you are asleep, a
  miracle happens and all your problems have
  disappeared. But because it happened over night,
  nobody is telling you that the miracle happened.
  When you wake up the next morning, how are you
  going to discover that the miracle happened? What
  else are you going to notice?

8
NARRATIVE THERAPY

• RESPECTFUL
• NON-BLAMING
• PEOPLE AS EXPERTS
• PROBLEMS SEPARATE
• PEOPLE HAVE MANY INTERNAL RESOURCES THAT REDUCE
  THE INFLUENCE OF PROBLEMS

9
NARRATIVE THERAPY

• THERAPIST IS
• ALWAYS CURIOUS
• ASKS QUESTIONS
• ALWAYS IN COLLABORATION

10
NARRATIVE THERAPY

• ALTERNATE STORIES
• HOW THE CLIENT WANTS TO LIVE THEIR LIFE.
• EXTERNALIZATION LANGUAGE
• CONTEXT OF THE PERSONS LIFE
• EXPLORE RELATIONSHIP BETWEEN THE CLIENT AND THEIR
  PROBLEM

11
NARRATIVE THERAPY

• UNIQUE OUTCOMES
• ANTHING THAT THE PROBLEM WOULD NOT LIKE
• UP TO THE CLIENT TO DETERMINE
• UTILIZE OTHER OPINIONS TO VERIFY UNIQUE OUTCOMES

12
COGNITIVE THERAPY

• DIFFERENT ANGLES OF A PROBLEM
• POSITIVE, NEGATIVE AND NEUTRAL
• CLIENT FEELS THOUGHTS BEYOND THEIR CONTROL
• CONTROL OVER THOUGHTS

13
COGNITIVE THERAPY

• NOT JUST THOUGHTS NEED TO CHANGE
• NEGATIVE VIEW OF SELF, WORLD, FUTURE
• IDENTIFY MOOD ONE WORD
• HELP TO SET GOALS

14
COGNITIVE THERAPY

• GATHERING EVIDENCE THAT SUPPORTS AND NOT SUPPORTS
  NEGATIVE THOUGHTS
• CONSIDER EVIDENCE THAT CONTRADICTS NEGATIVE
  THOUGHTS

15
COGNITIVE THERAPY

• REFRAMING

16
(No Transcript)
17
(No Transcript)
18
Transference/Counter-transference

• Definition
• Own your feelings
• Dealing with the difficult client
• Black Hole

19
Dealing with Difficult Client

• Dont mean to be difficult
• Threaten/push your buttons
• Shift your thinking
• Survival They do it well

20
Dealing with the Difficult Client

• Redirect
• Set firm limits
• Try to remain professional

21
Trust yourself

• Talk to others
• Self-Care

22
Compassion Fatigue

• The stress resulting from helping or wanting to
  help a traumatized or suffering person (Figley,
  1995).

23
Signs of Compassion Fatigue

• Sadness, depression, sleeplessness, generalized
  anxiety
• I have wished I could avoid working with some
  therapy clients
• I have felt that my clients dislike me personally
• I am unsuccessful at separating work from
  personal life

24
Meditation

• Meditation the self regulation of attention, in
  the service of self-inquiry, in the here and now.
• The techniques of meditation are categorized by
  focus such as mindfulness (field) or
  "concentrative (object) meditation as well as
  techniques that shift between the field and the
  object.

25
Mindfulness Meditation

• Jon Kabat Zinn defines mindfulness as
• the awareness that emerges through paying
  attention, on purpose, in the present moment, and
  non-judgmentally to the unfolding of experience
  moment by moment.

26
Mindfulness-Based Stress Reduction (MBSR) Program

• 8-10 weeks
• 2.5 hour group meeting per week
• Day of silent meditation
• Home practice including daily meditation and yoga
  (45 minutes) as well as written reflections

27
MBSR Effect on Health Status

• A meta-analysis revealed
• 64 empirical reports, 20 studies, 1605
  participants
• Examined data on short-term effects of MBSR on
  mental and physical health
• across populations e.g., fibromyalgia, cancer,
  depression, anxiety
• Significant medium strength effect size for both
  mental (quality of life, depression, anxiety) and
  physical health (sensory pain, physical
  impairment, functional quality of life)
  parameters across populations
• Research still needed to investigate long-term
  benefits of MBSR
• Grossman, Neimann, Schmidt Walach (2004).
  Mindfulness-based stress reduction and health
  benefits A meta-analysis. Journal of
  Psychosomatic Research, 57, 35-43.

28
MBSR and HIV

• MSBR group showed significant increases mood,
  functional health, and natural killer (NK) cell
  activity persisting at 3-months (Robinson,
  Mathews, Witek-Janusek, 2003).
• Indication that mindfulness meditation training
  can buffer CD4 T lymphocyte declines in HIV-1
  infected adults (Cresswell, Myers, Cole, Irwin,
  2008).
• Improvements in perceived stress and fatigue and
  also depression, tension, anger, confusion, and
  natural killer cell number (Robinson, 2002).

29
MBSR for Health Professionals

• A self-care strategy for health professionals and
  as a way to improve client/practitioner
  communication
• The goals of mindful practice are to be aware of
  ones own mental processes as well as what is
  occurring around oneself and thereby be able to
  act with compassion (italics mine).
• Irving, Dobkin, Park (2009). Cultivating
  mindfulness in health care professionals A
  review of empirical studies of mindfulness-based
  stress reduction. Complementary Therapies in
  Clinical Practice, 15, 61-66.

30
Benefits for Health Professionals

• Decreased stress and distress, negative affect,
  rumination, anxiety, emotional exhaustion,
  burnout, health-related complaints
• Increased positive affect, life-satisfaction and
  self-compassion, mood, empathy
• No changes in empathy
• No changes in salivary cortisol