JMIR Publications

ABSTRACT

Background:

Cognitive behavior therapy is frequently used to treat depressive symptoms in people living with HIV. We developed an Internet-based cognitive behavioral intervention for people with HIV and depressive symptoms, which was previously found to be effective.

Objective:

In the current study, potential mediators of the online intervention were investigated.

Methods:

This study was part of a randomized controlled trial, in which the intervention was compared to an attention only waiting list control condition. Participants were 188 (97 in intervention group and 91 in control group) people with HIV and mild to moderate depressive symptoms recruited in HIV treatment centers in the Netherlands. The intervention consisted of online cognitive behavioral therapy for eight weeks, including minimal telephone support from a coach. Participants were assessed with online questionnaires at pretest, three times during the intervention / waiting period, and post intervention. The outcome was depressive symptoms, factors that were tested as potential mediators were changes in behavioral activation, relaxation, the cognitive coping strategies catastrophizing and positive refocusing, goal reengagement, and coping self-efficacy.

Results:

Changes in behavioral activation (P = .006) and in goal reengagement (P = .009) were found to be significant mediators of the intervention effect. The mediation effect seems to occur between week 3 and 5 for behavioral activation, and between week 1 and 3 for goal reengagement. We found a return effect from depressive symptoms to goal reengagement, which could weaken the mediation effect.

Conclusions:

The results suggest that changes in behavioral activation and goal reengagement may mediate the effect of the online intervention for people with HIV and depressive symptoms. The results may lead to possible mechanisms of change of the intervention and improvement of therapy outcomes. Clinical Trial: Nederlands Trialregister NTR5407, September 11, 2015.