By Winifred Wolfe
Note: Guest blogger Winifred Wolfe (MS-3) is a medical student at Drexel College of Medicine and a PAMED member. She is passionate about empowering patients and improving lives through mental health in medicine.
Why is it so hard to keep New Year’s resolutions?
You tell yourself, “This is it! This is the year I live a healthier lifestyle, and shed those extra pounds!” Inevitably something comes up. Life happens. You might have a big exam or project at work, and you end up blowing off the gym. Or, (if you’re like me) eat a pint of Ben and Jerry’s on a late night binge.
Now imagine your resolution is managing a chronic disease, like HIV.
It requires taking multiple medications, monitoring WBC count, and managing viral loads – every day, for the rest of your life.
The patients I see at Drexel University’s Center City Clinic for Behavioral Medicine not only deal with HIV, but often face addiction, homelessness, domestic violence, depression and shame. In response to these emotional experiences, patients often turn to risky behaviors, like unsafe sex and IVDU, which further spread the disease.
This avoidant coping further increases risk of depression, medication non-adherence, and progression to AIDS.
My study seeks to solve this problem using Acceptance and Commitment Therapy, or ACT. ACT draws from contemplative practices, like Buddhist meditation, mindfulness, and prayer. It focuses on accepting thoughts and feelings as they are without judgment, rather than trying to correct cognitive errors and distortions. ACT involves taking steps toward living for what you want to stand for now, rather than waiting until all of your ducks are in a row.
Patients living with HIV often deal with undesirable thoughts related to the shame and cultural stigma of their disease. If patients are always struggling against their emotions, it makes it difficult to escape negative feelings weighing them down.
When patients are constantly trying to fight such strong negativity from themselves and others, taking medications or making doctor’s appointments becomes almost impossible. ACT is important because its approach is unique. It helps us to let go of the way our thoughts rigidly influence our behavior.
The hypothesis is that ACT will not only give patients with HIV the tools to acknowledge their emotional distress, but continue to live healthy lives, and promote medication adherence. Each session we work on identifying how the patient wants to live life, what barriers are preventing that, and how they can learn to sit with uncomfortable internal experiences while continuing to live and ACT according to their values.
After six weeks of one hour ACT sessions with 17 patients, we have found more than 90 percent of patients chose to continue their therapy.
Elton John tells us, “The AIDS disease is caused by a virus … The AIDS epidemic is fueled by stigma, violence, and indifference.”
Physicians and future physicians like myself need to consider the psychosocial barriers for patients managing chronic illnesses, and utilize ACT, to improve clinical outcomes in all areas of medicine.