Cognitive behavioral therapy, coping, critical consciousness and HIV in young adults in Rwanda
Bruck-Segal, Dana L.
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Approximately 3% of 15 to 49-year-olds in Rwanda live with HIV, many of whom are young adults. They face multiple stressors including stigma, anxiety, depression, trauma, orphanhood, and poverty. Little is known about the types of coping that facilitate resilience. Cognitive behavioral therapy (CBT) delivered by lay counselors can help decrease mental health symptoms in HIV+ youth, but there is little research on how administering CBT affects HIV+ lay counselors’ own coping and mental health. Participants included 69 Rwandans (ages 21-27, M=10 years of education, 38 female, 26 orphans), comprising four groups: (1) HIV+ lay counselors who administered CBT (Youth Leaders, YL) (n=17) (2) HIV+ peer-parents (PPs; facilitators of non-CBT support groups for HIV+ youth) (n=17); (3) HIV+ community members (HIV+C) (n=18); and (4) HIV- community members (HIV-C) (n=17). Groups were administered self-report measures translated into Kinyarwanda to compare use of (1) coping strategies, including mindfulness, critical consciousness (awareness of social inequities), self-blame, denial, behavioral disengagement, positive reframing, acceptance, active coping, and religious coping, and (2) mental health outcomes of anxiety/depression, self-esteem, and HIV-related stigma. Relations between coping and health outcomes across all groups were investigated. Principal components factor analysis of seven coping strategies revealed two factors: avoidant (self-blame, denial, behavioral disengagement) and approach (positive reframing, acceptance, active coping, religious coping). ANCOVAs, partial correlations, and multiple regressions indicated that YLs and HIV-Cs used significantly less avoidant coping than PPs. YLs reported less behavioral disengagement than PPs, and PPs reported more positive reframing than HIV-Cs. YLs and PPs reported higher self-esteem and less stigma than HIV-Cs. YLs demonstrated lower anxiety/depression than HIV+Cs. No other group differences were significant. Among the entire sample, approach coping and mindfulness related to higher self-esteem, whereas stigma and behavioral disengagement related to lower self-esteem. Stigma and denial related to higher anxiety/depression. Positive reframing and mindfulness related to higher self-esteem only for individuals with low critical consciousness. Results suggest that training lay counselors in CBT may reduce their own maladaptive coping and depression/anxiety. Further, facilitating critical consciousness or mindfulness/reframing and decreasing stigma may help increase self-esteem and reduce anxiety/depression in HIV+ Rwandan young adults.
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