Effectiveness of existential cognitive therapy on reducing symptoms of depression in women infected with human immunodeficiency virus (HIV)

Master's Thesis

Family Counseling Field

Abstract

Introduction and purpose: The purpose of this research was to investigate the effectiveness of Hastinger cognitive therapy on reducing the symptoms of depression in patients with human immunodeficiency virus. Method: The study was a single-case study using a purpose-based sampling method. Three women infected with human immunodeficiency virus, who had referred to Shahid Sabze Parvar Karaj Center for medical consultation and treatment, were selected and underwent Hastinger's interventional cognitive therapy method for ten 90-minute individual sessions, and were evaluated 7 times (2 times baseline, 3 times intervention, 2 times follow-up) by means of Kisan's (2004) depression syndrome tool and Abdullahzadeh et al.'s (1389) cognitive distortions tool. To analyze the data, visual analysis and indicators of changes in trend, slope, effect size and Cohen's index were used.

Findings: The results indicated a significant decrease in mood symptoms and a significant increase in cognitive distortion scores compared to the baseline, and the maximum amount of change was observed at the end of the treatment session. In the two follow-up sessions, the scores of depression symptoms increased compared to the last treatment session, but there was a significant decrease compared to the baseline. In the two follow-up sessions, the scale of cognitive distortions was observed to decrease compared to the last session of treatment, but there was a significant increase compared to the baseline.

Conclusion: existential cognitive therapy reduced the symptoms of low mood and cognitive distortions in patients with human immunodeficiency virus, as a result, this intervention method can be effective in reducing the psychological symptoms of patients with human immunodeficiency virus.

Key words: Hastinger cognitive therapy, low mood symptoms, distortions cognitive, human immune system deficiency virus

Introduction

According to the definition of the American International Center for Health Statistics [1] (2011), chronic disease [2] is one of the diseases that affects a person for a long time and lasts for three months or more. Despite the fact that medical science has made significant advances in developing effective treatments for the physical consequences of these diseases, many victims continue to struggle with challenges related to mental and emotional health. One of the debilitating diseases of the immune system is Acquired Immune Deficiency Syndrome (AIDS). As its name suggests, it is caused by a defect in the body's immune system and is considered a syndrome because there are different symptoms that are not the same in all patients. It is also acquired due to the fact that AIDS is an infectious viral disease whose virus is transmitted from one person to another in different ways (Hobley[3], 1386/1948). The HIV-positive virus attacks the immune system and over time, weakens the immune system so much that it can no longer protect the body against it. This is the advanced infection of the positive HIV virus, i.e. the fatal disease of AIDS (Hobley, 1386/1948).

Knowing of being infected with the human immunodeficiency virus causes many psychological pressures and social problems, including depression, anxiety and social isolation (Evans [4], 2003). In this way, HIV-positive people face many psychological factors, which include lack of adaptation to HIV-positive disease, reduced mental health, poor self-management, emotional turmoil, depression, anxiety, personality disorders, low self-efficacy beliefs, weak social support, and facing existential concepts such as death anxiety, meaninglessness and aimlessness in life, and irresponsibility.

Based on statistics collected from universities of medical sciences and healthcare services to date 1/7/2013, a total of 27,041 people with HIV/AIDS have been identified in the country, of which 89.3% are men and 10.7% are women. 46.1% of HIV patients were in the age group of 25-34 years old at the time of diagnosis, which is the highest ratio among the age groups. Among all the cases reported since 2013, the causes of HIV infection are injection addiction 52.1%, sexual intercourse 33.6% and mother-to-child transmission 2.3%. In 11.1% of the cases identified this year, the mode of transmission was unknown and no new cases of infection through blood and blood products were reported (Disease Management Center, Ministry of Health, Medical Education, 2013).

1-2 statement of the problem

People with AIDS are limited in a range of social, economic and family activities due to being caught by a chronic, debilitating, potentially fatal disease with a dire prognosis, which is a stress factor for these patients. Due to the characteristics of this disease and the methods of its transmission, they are exposed to social stigma and consequently to special mental-psychological pressures. These people must also deal with the fear associated with the disease; such as disability, increased dependence, decreased physical restraint and pain. It is not far from expected that ranges of mental disturbances from a relatively mild state such as pathological indifference, guilt, helplessness and despair to severe states such as anxiety disorders, depression and sometimes suicidal thoughts are seen in these people (Shakri et al., 2017). HIV infection changes the course of a person's life and causes a decrease in self-confidence, an increase in the feeling of vulnerability, physical symptoms and disturbed thoughts in sufferers, and disrupts the daily performance of social activities and mental peace (Olio [5], Roa [6] and Delion [7], 2003). Research literature has shown that people experience an existential crisis following life-threatening disease diagnoses (Cott[8], 2002, Cuccino[9] and Kahn[10], 2005). A crisis that includes the disruption of our initial assumptions about our sense of control and our ability to predict the future (Liang et al., 2010; quoted by Naghaei, Bahmani, Khorasani, and Ghanbari Motlatl, 2013).

In this way, the painful experience that comes with the diagnosis and treatment of HIV infection can touch the fundamental and basic position of human existence and in connection with finitude, irresponsibility towards life, loneliness and meaninglessness of issues and create issues.

One of the psychological factors that caused a person with HIV positive to deal with death, responsibility, purposelessness and loneliness is existential anxiety. Anxiety is a valuable tool to help us become more aware of reality. If we want to experience life fully, we must be able to accept our anxiety and recognize it (Yalom and May, 2001; cited by Bahmani, Etamadi, Shafiabadi, Delawar, and Ghanbari Mutlaq, 2019). From the point of view of existentialists, the first emotion to be considered for understanding human emotions is anxiety. Anxiety refers to two types of psychological anxiety and existential or healthy anxiety (Rollo May, 1970; cited by Bahmani et al., 2009). While existential anxiety is a normal and healthy part of the human condition, psychological anxiety is the result of an inappropriate response to a source of threat or a product of repulsion or an internal conflict. Existentialists believe that the origin of many unpleasant emotional states is anxiety and the way a person takes to face it. Anxiety comes from a person's efforts to survive and preserve and defend his existence, and the feelings that anxiety creates are an inevitable aspect of the human condition. Existential anxiety has been described as the inevitable result of facing death, existential isolation, and meaninglessness (Yalom, 1980; quoted in Currie, 2005); Therefore, existentialists have introduced this anxiety under the title of existential anxiety and consider it a genuine experience that every human being should be able to face and give an authentic response to.

Morata [11] (2003) in his description of existential problems uses the term spiritual pain[12] to refer to the mental experience of patients who are faced with the possibility of their own death, and he means the suffering that people experience in the pursuit of the possibility of the extinction of their individual existence and meaning. [13] They experience. From Morata's point of view, spiritual pain means a sense of meaninglessness, worthlessness, lack of purpose and identity, which is caused by multiple losses in the field of interpersonal relationships, authority and hope for the future (cited by Bahmani et al., 2009).

With the start of treatments and consequences such as fatigue, inability to concentrate, reduced energy, changing roles and disruption in daily activities, the patient may find that in relation to the situation in which There is nothing he can do, as a result, instead of managing and controlling problems, he feels helpless and ineffective. If the help of the people around does not seem to be available, the person may feel hopeless and isolated and suffer from the feeling of shame and failure. These symptoms can ultimately question and challenge the fundamental assumptions and values ??hidden in the sense of meaning and purpose of the patient's life (Kisan[14] and Clark[15], 2001).