Cognitive-behavioral stress management reduces distress and 24-hour urinary free cortisol output among symptomatic HIV-infected gay men

Background. Stress management interventions can reduce symptoms of distress as well as modulate certain immune system components in persons infected w ith human immunodeficiency virus (HIV). These effects may occur in parallel with reductions in hypothalamic-pituitary-adrenal (HPA) axis hormones such as cortisol, which has been related in other work to a down-regulation of immune system components relevant to HIV infection. The present study teste d the effects of a multimodal cognitive-behavioral stress management (CBSM) intervention on 24-hour urinary free cortisol levels and distressed mood i n symptomatic HIV+ gay men. Methods. Symptomatic HIV-infected gay men who were randomized to either a 1 0-week group-based CBSM intervention or a 10-week wait-list period provided psychological responses and urine samples pre-post intervention. Results. Of the 59 participants providing matched questionnaire data, men a ssigned to CBSM (n = 40) showed significantly lower posttreatment levels of self-reported depressed affect, anxiety, anger and confusion than those in the wait-list control group (n = 19). Among the 47 men providing urine sam ples (34 CBSM, 13 controls), those assigned to CBSM revealed significantly less cortisol output as compared to controls. At the individual level, depr essed mood decreases paralleled cortisol reductions over this period across the entire sample. Conclusion. A time-limited CBSM intervention reduced distress symptoms and urinary free cortisol output in symptomatic HIV+ gay men and greater reduct ions in some aspects of distress, especially depressed mood paralleled grea ter decreases in cortisol over the intervention period. If persisting stres sors and depressed mood contribute to chronic HPA axis activation in HIV-in fected persons, then interventions such as CBSM, which teaches them to rela x, alter cognitive appraisals, use new coping strategies, and access social support resources, may decrease distress and depressed mood and normalize HPA axis functioning.