Cognitive behavioral therapy for body image and self-care (CBT-BISC) in sexual minority men living with HIV: A randomized controlled trial.

Abstract

Objective Body image disturbance is a distressing and interfering problem among many sexual minority men living with HIV, and is associated with elevated depressive symptoms and poor HIV self-care (e.g., antiretroviral therapy [ART] non-adherence). The current study tested the preliminary efficacy of a newly created intervention: cognitive behavioral therapy for body image and self-care (CBT-BISC) for this population. Methods The current study entailed a two-arm randomized controlled trial (N = 44) comparing CBT-BISC to an enhanced treatment as usual (ETAU) condition. Analyses were conducted at 3 and 6 months after baseline. The primary outcome was body image disturbance (BDD-YBOCS), and secondary outcomes were ART adherence (electronically monitored via Wisepill), depressive symptoms (MADRS), and global functioning (GAF). Results At 3 months, the CBT-BISC condition showed substantial improvement in BDD-YBOCS (b = −13.6, SE = 2.7, 95% CI: −19.0, −8.3, p < .001; dppc2 = 2.39), MADRS (b = −4.9, SE = 2.8, 95% CI: −10.6, .70, p = .086; dppc2 = .87), ART adherence (b = 8.8, SE = 3.3, 95% CI: 2.0, 15.6, p = .01; dppc2 = .94), and GAF (b = 12.3, SE = 3.2, 95% CI: 6.1, 18.6, p < .001; dppc2 = 2.91) compared to the ETAU condition. Results were generally maintained, or improved, at 6 months; although, adherence findings were mixed depending on the calculation method. Conclusions CBT-BISC shows preliminary efficacy in the integrated treatment of body image disturbance and HIV self-care behaviors among sexual minority men living with HIV.

Mechanism of Change in Cognitive Behavioral Therapy for Body Image and Self-Care on ART Adherence Among Sexual Minority Men Living with HIV

“…Results from a previous study [22] demonstrated preliminary efficacy of CBT-BISC, but did not examine the mechanisms by which the intervention improved ART adherence. We found that participants in the CBT-BISC condition displayed substantial reductions in body image disturbance and depression, as well as improved global functioning, at the end of the intervention and at follow-up as compared to the treatment as usual group.…”

“…Treating body image disturbance may also increase ART adherence, thereby reducing viral load, and ultimately reducing the risk of transmission of HIV [20] which is important to both individual patients and public health. Clinicians may want to consider utilizing the CBT-BISC modules found in the primary outcome paper [22] during treatment, as it has been shown to effectively improve ART adherence and reduce body image concerns. In sum, these findings have implications for clinical practice, as screening for and targeting body image disturbance may be an important step in improving ART adherence and reducing HIV transmission.…”

“…Using the value of 16 allowed for participants to be included in the study who experience elevated body image disturbance, although perhaps not at levels consistent with BDD diagnosis, and would still potentially benefit from the intervention. Participants were excluded from the study if they met the following criteria: (a) presence of a severe psychiatric disorder that would interfere with study participation (e.g., unstable bipolar disorder, using the MINI International Neuropsychiatric Interview and modules from the Structured Clinical Interview for the DSM-IV-TR; [24, 25]); and (b) received CBT for body image disturbance within the past 12 months (for more details on study design, see Blashill et al [22]).…”

“…Recently, an integrated cognitive behavioral treatment for body image and adherence behaviors was developed and pilot tested among sexual minority men living with HIV [22]. This treatment, coined cognitive behavioral therapy for body image and self-care (CBT-BISC) aimed to simultaneously reduce body image disturbance whilst also improving ART adherence in a structured, modular, 12-session, individually-based therapy.…”

“…In the pilot study, a randomized controlled trial (RCT) was employed that compared CBT-BISC to an enhanced treatment as usual (ETAU) condition. Although findings provided evidence that CBT-BISC displayed preliminary efficacy in reducing body image disturbance and increasing ART adherence [22], it is currently unclear what mechanisms of action are attributable to the treatment effect on ART adherence. Thus, the aim of the current study was to test the role of body image disturbance as a mechanism in the association between treatment condition and ART adherence.…”