Out On The Couch
In my previous article, I explored the many challenges unique to individuals who are aging with HIV. In order to overcome these, long-term survivors (LTS) need the support and expertise of competent psychotherapists. Effective treatment to reduce symptoms from this type of sustained trauma requires interventions that focus on strengthening resiliencies and creating a sense of hope for the future (Applebaum et al., 2015).
Therapy techniques focused on developing a new and positive internal narrative of self-talk that emphasizes healthy aging with HIV are crucial to combating the challenges and fears that overwhelm so many LTS. Just as survivors of war and other atrocities need to celebrate their courage and resilience, so too do LTS. Therapy that helps these clients reframe their perspectives and view aging as a development to embrace rather than fear will aid them in overcoming symptoms of sustained trauma, and will allow them to thrive in their later years.
There are several evidence-based therapies that have been proven efficacious in treating sustained trauma. These are some techniques and models currently being used with great success to improve quality of life for LTS:
- Posttraumatic Growth (PTG) emphasizes a resiliency model that builds on strengths
- Mindfulness Based Stress Reduction (MBSR) adapts Buddhist principles of mindfulness to reduce stress
- Cognitive Behavioral Therapy (CBT) is grounded in identifying and challenging unhelpful thoughts to construct a more accurate and hopeful belief system
- Eye Movement Desensitization and Reprocessing (EMDR) entails processing past trauma through neurocognitive desensitization and exposure therapy
- Pain Management Treatment (CBT for Chronic Pain) is designed to help clients cope with chronic illnesses
In addition to these therapeutic models, evidence-based group therapy incorporating a structured psychoeducational component has been proven effective in combating isolation, addressing the psychosocial issues facing LTS, and providing a safe space to explore solutions (Anderson, 2019). For example, Desert AIDS Project in Palm Springs, CA offers an LTS therapy group for gay men over the age of 50 who have been living with HIV for a minimum of 10 years. This is a very specific group that acknowledges the unique experience of gay men who came of age in the 1970s and 80s and who are now aging with HIV after having suffered decades of multiple losses and sustained trauma. The group is evidence-based, 12 weeks long, structured, and closed. It creates bonding around shared past trauma and provides psychoeducation on topics that are particularly relevant to LTS.
Just as veterans need to talk with other veterans (and sometimes veterans from the same war), gay men aging with HIV need to talk with each other to break out of their isolation. At the Desert AIDS Project group, participants create their discussion topics for each session, and the therapist provides therapeutic exercises for the group to use in exploring those topics. The subjects can include healthy aging, coping with ageism, dating as an older HIV+ man, shame related to HIV stigma, reducing survivor’s guilt, breaking out of isolation, grieving multiple losses, finding purpose, planning for the future, and managing chronic pain.
Significant psychosocial challenges of aging with HIV present risks for poor health and mental health outcomes to LTS that must be recognized and addressed. No matter what their theoretical orientation, mental health professionals working with LTS need to focus on building resilience—the process whereby people bounce back from adversity to continue surviving and thriving. Resilience can draw upon the personal qualities that enable one to flourish in the face of seemingly insurmountable challenges.
Nurturing resilience requires building social networks to reduce isolation; processing traumatic losses; reducing HIV-related stigma; and mitigating the detrimental health effects of virus and medications through healthy lifestyle choices. Therapists are well-positioned to help their clients achieve these goals. They can introduce therapeutic exercises to help clients process grief associated with traumatic loss. Via therapy sessions, clients can also learn how to apply psychological tools and techniques that will help them break out of their isolation and reduce the internalized shame associated with HIV.
In the 1980s, an HIV diagnosis was a death sentence; no one could imagine aging with this disease. However, now there are many ways in which therapists can help long-term survivors age well. Well-researched, evidence-based interventions, models, and techniques that focus on developing strengths and resiliencies are available to us. Today, with the help of a well-trained affirmative therapist, long-term survivors can overcome past trauma and thrive in their golden years.
American Psychological Association. (n.d.) What is Cognitive Behavioral Therapy? https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.pdf
Anderson, T. (2015, August 18). HIV Long-Term Survivors Declaration: A Vision for Our Future 2019. Let’s Kick ASS – AIDS Survivor Syndrome. https://letskickass.hiv/with-courage-and-compassion-long-term-survivors-of-hiv-strive-not-only-to-survive-but-also-to-ee056d372994
Applebaum, A. J., Bedoya, C. A., Hendriksen, E. S., Wilkinson, J. L., Safren, S. A., & O’Cleirigh, C. (2015). Future directions for interventions targeting PTSD in HIV-infected adults. The Journal of the Association of Nurses in AIDS Care: JANAC, 26(2), 127–138.
Baum, Will. (n.d.) Mindfulness-Based Stress Reduction: What It Is, How It Helps. Psychology Today.
Brennan, M., Karpiak, S. E., Shippy, R. A., & Cantor, M. H. (Eds.). (2009). Older adults with HIV: An in-depth examination of an emerging population. Nova Science Publishers.
EMDR Institute Inc. (n.d.) What is EMDR? https://www.emdr.com/what-is-emdr/
Erenrich, R., Seidel, L., Brennan-Ing, M., & Karpiak, S. (2018). HIV & Aging in San Francisco: Findings From the Research on Older Adults with HIV 2.0 San Francisco Study Autumn 2018. http://gmhc.org/files/ROAH_2.0_San%20Francisco_ACRIA_HIV_Aging_White_Paper_FINAL.PDF
Kaiser Permanente (n.d.) Cognitive-Behavioral Therapy for Pain Management. https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=tv3092
Lees, Adena Bank. (n.d.) Posttraumatic Growth. Psychology Today. https://www.psychologytoday.com/us/blog/surviving-thriving/201904/posttraumatic-growth