Stephen M. Weiss

Behavioral Medicine Revisited: An Amended Definition

Behavioral Medicine is the field concerned with the development of behavioralscience knowledge and techniques relevant to the understanding of physical health and illness and the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation. Psychosis, neurosis and substance abuse are included only insofar as they contribute to physical disorders as an endpoint.

Renal involvement in tuberous sclerosis

Abstract Three patients are described with renal angiomyolipoma without accompaning central nervous system involvement. Each patient presented in a different manner; the first with signs and symptoms of renal insufficiency, the second with gross hematuria, and the third with flank pain. All patients had replacement of renal parenchyma by hamartomatous tumors composed of blood vessels, adipose tissue and smooth muscle cells. The first case is the fifth report of the development of renal failure in tuberous sclerosis. In the latter two cases, intravenous pyelograms suggested polycystic kidney disease but renal arteriography was diagnostic of diffuse angiomyolipomas. Malignant transformation of these tumors is rare, but hemorrhagic complications following renal biopsy is a major problem in these patients.

Cognitive-behavioral interventions improve quality of life in women with AIDS.

OBJECTIVE We tested the effects of a 10-week group-based cognitive-behavioral stress management/expressive-supportive therapy intervention (CBSM+) and a time-matched individual psychoeducational condition for 330 women with AIDS reporting moderate to poor baseline quality of life (QOL). The goal of this study was to examine treatment effects on total QOL and 11 QOL domains from baseline to post-intervention follow-up. METHODS Participants were assessed at baseline, randomized to a treatment condition (individual psychoeducation condition n=180, group-based CBSM+ condition n=150), participated in the intervention for 10 weeks and assessed again within 4 weeks following the intervention. QOL was measured using the Medical Outcomes Study-HIV-30. RESULTS QOL scores increased over the course of both interventions for the total QOL score and three QOL domains: cognitive functioning, health distress and overall health perceptions. While women in the CBSM+ group condition showed a significant improvement in mental health QOL from pre- to post-intervention, women in the individual condition did not change. No changes were observed for energy/fatigue, health transition, single-item overall QOL, pain, physical well-being, role functioning or social functioning in either condition. CONCLUSION Results suggest that group-based CBSM+ and individual psychoeducational interventions are effective at improving certain aspects of QOL and that group-based CBSM+ may be particularly effective at increasing QOL related to mental health in this population of women with AIDS.

Behavioral Methods in the Treatment of Hypertension: A Review of Their Clinical Status

Behavioral methods to lower blood pressure include biofeedback, relaxation, psychotherapy, suggestion and placebo, and environmental modification. Reported data for each method have been examined applying the clinical pharmacologic format used to study other therapeutic agents. Most studies have been Phase I type, small numbers of subjects in acute (short-term) treatment situations. Phase II studies, controlled trials with comparison with known effective agents, are sparse, and Phase III studies are not yet appropriate. These Phase I studies indicate blood pressure effects that are small, with minimal data about their duration and their relation to the use of pharmacologic agents. The methods are adjunctive and not alternative, while the compliance problem is similar to that with pharmacologic agents. The major differences between the methods are the ease with which they can be used. Widespread application of the nonpharmacologic methods cannot currently be recommended, but further basic and clinical research into mechanisms and outcomes is encouraged.

Influencing medication adherence among women with AIDS

This study examined the effects of a ten-session cognitive-behavioural stress management/expressive supportive therapy (CBSM+) intervention on adherence to antiretroviral medication. Although the intervention was not designed to influence adherence, it was theorized that improved coping and social support could enhance adherence. Women with AIDS (N=174) in Miami, New York and New Jersey, USA, were randomized to a group CBSM+ intervention or individual control condition. Participants were African American (55%), Latina (18%) and Caribbean (18%) with drug (55%) and/or alcohol (32%) histories. Participants were assessed on self-reported medication adherence over seven days, HIV-related coping strategies and beliefs regarding HIV medication. Baseline overall self-reported adherence rates were moderate and related to coping strategies and HIV medication beliefs. Low adherent (80%) participants in the intervention condition increased their mean self-reported medication adherence (30.4% increase, t44=3.1, p<0.01), whereas low adherent women in the control condition showed a non-significant trend (19.6% increase, t44=2.0, p>0.05). The intervention did not improve adherence in this population; conditions did not differ significantly on self-reported adherence. Low adhering intervention participants significantly decreased levels of denial-based coping (F1,88=5.97, p<0.05). Results suggest that future interventions should utilize group formats and address adherence using coping and medication-knowledge focused strategies.

The impact of improved self-efficacy on HIV viral load and distress in culturally diverse women living with AIDS: the SMART/EST women's project

The purpose of the present study was to determine whether changes in self-efficacy over time would be related to changes in disease progression markers (CD4, viral load) in a sample of women with AIDS. A self-efficacy measure was developed and two sub-scales emerged via factor analysis of 391 HIV-positive women: AIDS Self-efficacy and Cognitive Behavioral Skills Self-efficacy. Subsequently, the sub-scales and an additional adherence self-efficacy item were given to 56 HIV-positive women who were measured at two time points three months apart. Half of these women were randomly assigned to a CB intervention and half to a low intensity comparison condition. Increases in AIDS Self-efficacy over the three-month period were significantly related to increases in CD4 and decreases in viral load. Similarly, increases in Cognitive Behavioral Skills Self-efficacy were significantly related to decreases in distress over time. Findings were maintained within the intervention group alone. Interestingly, increases in cognitive behavioral skills self-efficacy and increases in the self-efficacy adherence item were also significantly related to decreases in viral load. Implications of the findings and suggestions for future research are discussed.

Decreased Depression Up to One Year Following CBSM+ Intervention in Depressed Women with AIDS: The Smart/EST Women’s Project

This prospective multisite Phase III clinical trial (Miami, New York, New Jersey) investigated the long-term (one year) effects of a 10-week group cognitive-behavioral stress management/expressive supportive therapy (CBSM+) intervention on disadvantaged minority women living with AIDS. The CBSM+ intervention consisted of 10-weekly group session of stress management, cognitive-behavioral skill training, relaxation techniques and expressive-supportive therapeutic strategies. The primary study outcome was self-reported depression scores as measured by the BDI. The CBSM+ Group intervention significantly decreased depression scores on the BDI for women following the intervention and maintained the decreased level at one-year follow-up.

Influence of partner participation on sexual risk behavior reduction among HIV-positive Zambian women.

Sexual risk behavior interventions in sub-Saharan Africa focus predominantly on individual and couples counseling. This cognitive-behavioral group intervention was adapted from an urban US context to urban Zambia. Preliminary data analyses assessed the influence of partner participation on sexual risk behavior among HIV-positive Zambian women. Female participants (n=180) attended four group intervention sessions and received sexual behavior skill training and male and female condoms; male partners (n=152) were randomly assigned to high-or low-intensity genderconcordant group intervention sessions. Sexual risk behavior, strategies, attitudes, and knowledge were assessed at baseline, 6, and 12 months. At baseline, 19% of males reported using alcohol before sex, 10% reported using alcohol to cope, and negative coping was associated with sexual risk behavior. In contrast, 1% of women reported using alcohol before sex, and 15% used alcohol as an HIV-coping strategy. Consistent barrier use was reported by 48% of women and 74% of men. After intervention, female high intensity participants reported higher rates of condom use (F=5.68, P=.02), more positive condom attitudes, safer sex intentions, and less alcohol use. These findings highlight the influence of male partners in implementation of effective risk reduction interventions.

Stress Management and Workplace Disability in the US, Europe and Japan

Stress Management and Workplace Disability in the US, Europe and Japan: Deborah L. Jones, et al. Department of Psychology, Barry University, USA—Although the health care costs and the number of disability cases across all medical illnesses have increased, disability management programs implementing stress management interventions have been found to improve physical and mental health, reduce costs to employers, and facilitate the reintegration of injured individuals into the work environment. Stress management programs limit the impact and chronicity of disabilities and can be used to reduce and control the cost of disability in the workplace. Providing the most efficacious behavioral interventions thereby allows employers, employees and health professionals to work cooperatively to achieve optimum health and cost effectiveness. This review presents a variety of group and individual interventions, which have been utilized to aid disabled employees in coping with work‐related injuries and medical illness. The implementation of stress management interventions in the workplace is described in detail, with special emphasis on the use of cognitive behavioral stress management. Finally, this review outlines a team approach to the application of a workplace stress management intervention aimed at reducing the overall impact of disability. (J Occup Health 2003; 45: 1–7)

Influencing sexual practices among HIV-positive Zambian women

Abstract This study assessed and compared the efficacy of culturally tailored behavioral interventions to increase use and acceptability of sexual barrier products among HIV-positive women in Zambia. It also sought to evaluate cultural preferences as facilitators or impediments to potential use of vaginal chemical barriers for sexual risk reduction within the Zambian context. Women (N=240), recruited from the University Teaching Hospital HIV Voluntary Counseling and Testing Center, were randomized into group or individual intervention arms. Participants attended a baseline assessment, three intervention sessions and follow up assessments at six and 12 months. All participants increased use and acceptability of female condoms and vaginal products and maintained male condom use at six and 12 months. Preliminary data indicated that group participants increased male condom use at six months and trial use and acceptability of female condoms and lubricants predicted their use in the group condition. Results support group interventions to increase sexual barrier use and acceptability in HIV-positive women within the Zambian context. From a public health standpoint, groups may represent a cost-effective and culturally congruent intervention.