Comparison of Acceptance and Commitment Therapy and Cognitive Behavior Therapy: Managing Psychological Distress and Its Multifaceted Impact on Stigmatization, Psychological Wellbeing, Social Support and Treatment Adherence in HIV/AIDS Patients

Comparison of Acceptance and Commitment Therapy and Cognitive Behavior Therapy: Managing Psychological Distress and Its Multifaceted Impact on Stigmatization, Psychological Wellbeing, Social Support and Treatment Adherence in HIV/AIDS Patients

This is a randomized controlled trial comparing Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) for HIV/AIDS patients at Sheikh Zayed Hospital. 72 adults, aged 18-40 on ART will be randomized to CBT group (n=24), ACT group (n=24), or control group (n=24). Interventions are 8 weekly sessions of 35-40 minutes. Primary outcomes are depression, anxiety, stress measured by DASS-21, plus stigma, psychological wellbeing, social support, and medication adherence. Assessments at baseline, post-intervention, and 6-month follow-up using DASS-21, PWB, MPSS, GMAS, and MMSE. Ethical approval obtained from IRB of Sheikh Zayed Hospital. Informed consent, confidentiality, and voluntary participation ensured.

Background & Rationale:

HIV/AIDS is a chronic condition with significant psychological burden. People living with HIV/AIDS experience high levels of depression, anxiety, stress, and stigma, which affect treatment adherence and quality of life. Both Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) are evidence-based interventions for psychological distress, but their comparative effectiveness in HIV/AIDS patients in Pakistan has not been evaluated. This study aims to compare ACT and CBT for managing psychological distress and improving stigma, wellbeing, social support, and medication adherence.

Objective:

To compare the effectiveness of brief Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) in reducing psychological distress and improving stigmatization, psychological wellbeing, social support, and medication adherence among HIV/AIDS patients.

Study Design:

Randomized Controlled Trial with single-blind design. Participants will be allocated to three groups using a computer-generated randomization sequence:

1. CBT group (n=24): Standard care + 8 weeks of brief CBT
2. ACT group (n=24): Standard care + 8 weeks of brief ACT
3. Control group (n=24): Standard care only, no specific psychological intervention

A pilot study with 15 participants will be conducted prior to the main trial.

Participants:

• Inclusion: Adults aged 18-40 years with a documented HIV/AIDS diagnosis, receiving ART, actively seeking treatment at Sheikh Zayed Hospital, and providing informed consent.
• Exclusion: Severe cognitive impairment, severe psychiatric conditions requiring specialized care, or prior participation in similar CBT/ACT interventions for HIV/AIDS.

Intervention:

Both ACT and CBT will be delivered as once-weekly sessions of 35-40 minutes for 8 weeks.

• ACT focuses on acceptance, mindfulness, values, committed action, and cognitive diffusion.
• CBT focuses on identifying/challenging negative thoughts, behavioral activation, and coping strategies.

Interventions will be culturally adapted and delivered by therapists with at least a Master's degree and training in CBT/ACT.

Outcome Measures:

Assessments at baseline, post-intervention, and 6-month follow-up using:

• DASS-21: Depression, Anxiety, Stress Scale
• Psychological Well-Being Scale (PWB): 6 domains of wellbeing
• HIV Stigma Scale: To measure perceived stigma
• Multidimensional Perceived Social Support Scale (MPSS): Urdu version
• General Medication Adherence Scale (GMAS): Urdu version
• Mini-Mental State Examination (MMSE): For cognitive screening

Data Collection & Analysis:

Data will be collected using self-report questionnaires. Ethical approval will be obtained from the IRB of Sheikh Zayed Hospital. Informed consent, confidentiality, and voluntary participation will be ensured. Data analysis will compare outcomes across the three groups to evaluate effectiveness.

Ethics:

The study complies with ethical standards for human research. Institutional approval and ongoing informed consent will be maintained. Participant anonymity and data protection will be rigorously enforced.

Duration:

Study duration is not specified in the excerpt, but involves 8-week intervention plus 6-month follow-up.

Institution:

Department of Applied Psychology, The Islamia University Bahawalpur. Principal Investigator: Sadia Batool, Ph.D. Applied Psychology

Inclusion Criteria:

• Participants must have a documented medical diagnosis of HIV/AIDS by a healthcare professional.
• Participants should fall within a specified age range, typically from 18 years to 40 years older.
• ACT and CBT treatments will be made available to participants who are receiving ART.
• Participants must be actively receiving or seeking treatment and care for their HIV/AIDS condition at Sheikh Zayed Hospital.
• Individuals must express their voluntary willingness to participate in the study and provide informed consent.

Exclusion Criteria:

• Individuals with severe cognitive impairments that would hinder their ability to engage in assessments or therapy sessions will be excluded.
• Individuals with severe psychiatric conditions that require immediate specialized care beyond the scope of the study will be excluded.
• Individuals with a history of prior participation in a similar cognitive behavior therapy intervention for HIV/AIDS will be excluded to avoid potential confounding effects from previous treatment experiences