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Section 3
Coping with Depression in Support Service of HIV (Part 2)

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In the last section, we discussed three steps for coping with depression.  The three steps for coping with depression that Doug used were taking care of personal emotional needs, talking about depression, and decreasing depression. 

In this section... we will continue to discuss coping with depression.  Our focus will be on possible obstacles to care-giving and techniques for controlling negative thoughts.  We’ll examine several responses to possible obstacles and five techniques for controlling negative thoughts.  The five techniques we will discuss are thought stopping, arranging a time and place for negative thoughts, distraction, arguing against negative thoughts, and problem solving.  As you listen to this section, you might consider how the information may benefit the caregiver of your client or perhaps how the techniques might be of use by a colleague.

♦ #1  Possible Obstacles to Care-Giving
First, let’s discuss possible obstacles to care-giving.  Have you, like I, found that HIV positive clients who are feeling depressed may resist the efforts of a well-intentioned caregiver?  If so, here are some common obstacles along with possible responses.  Lisa, age 29, was HIV positive and depressed about it.  Lisa had contracted the virus through intravenous drug use.  When she was diagnosed, she returned home to her father. 

But when he tried to help, Lisa would sometimes resist, saying, "I don’t want your help.  Leave me alone."  Rich found a productive way of responding.  Rich explained to Lisa that she wouldn’t feel better if they did not work together.  Rich stated, "I need you to participate if this treatment plan is going to work.  You know I wouldn’t do anything without your permission."  Rich and Lisa began to discuss her depression.  When Rich brought up ways to overcome depression, Lisa stated, "But my problems are real!  It’s perfectly natural to be depressed in my situation." 

Rich’s response was, "I know your problems are real.  Having negative feelings are  normal.  But you might become trapped in depression and that wouldn’t help your problem.  Let’s try to balance the good things with the bad.  Even though your problems are real, don’t you agree that the good things in life are real and should get some attention, too?"  How would your HIV positive client respond? 

Van, age 42, had contracted HIV years ago through a blood transfusion.  Van’s wife, Jude, became his caregiver, also.  As Van got sicker, he also got more depressed.  Jude recalled when Van stated, "Nothing will help, so there’s no use trying."  How would the caregiver of your HIV positive client respond?  Jude felt the same hopelessness, but instead of giving up, she urged Van to continue to try.  Jude stated, "I told him he had nothing to lose, either, but a great deal to gain by trying."  I stated to Jude, "Good.  But keep in mind that if Van gets so depressed that he can’t even try to feel better, I’ll need to know so that we can redirect his therapy." 

Some of these obstacles can also come from within the caregiver.  One common obstacle that caregivers of my HIV positive clients have is that they begin telling themselves that they aren’t really helping.  Does the caregiver of your client feel ineffective?  If so, consider helping them to remind themselves that being available to listen and give support is the best thing anyone can do for their relative or friend. 

You might explain that they don’t always have to be ‘doing things’ to be supportive.  If the caregiver can focus on what has been done and what there is yet to be done, perhaps he or she can overcome feelings of ineffectiveness. 

5 Techniques for Controlling Negative Thoughts
In addition to possible obstacles to care-giving, let’s examine five techniques for controlling negative thoughts.  Clearly, negative thinking can lead to depression, which in turn can increase negative thinking.  As you know, this is how clients become trapped in depression and it becomes a clinical problem instead of a feeling. 

♦ Technique #1: Thought Stopping
One technique for controlling negative thoughts is thought stopping.  Lisa, who had contracted HIV through intravenous drug use, began to use thought stopping.  Lisa stated, "I just yell ‘STOP!’ real loud in my head."  Lisa’s father Rich added, "Sometimes she does it out loud, too."  Your client may find it helpful to visualize a big, red stop sign. 

Other clients may choose to excuse themselves to the restroom where they can splash some cold water on their faces.  I have found that any appropriate activity that effectively stops the negative thinking can work.  How do you use thought stopping in your practice?  This is an oldie but a goodie that you have be over looking with your HIV positive Care givers and clients.

♦ Technique #2: Arraging a Time and Place
The second technique for controlling negative thoughts is arranging a time and place for negative thoughts.  This technique will allow your client to think occasionally about negative thoughts, but keep control over when and where it is done, thereby limiting negative thinking. 

1. Van used this technique by first finding a negative thinking place. I explained to Van that this would be the only place he would allow himself negative thoughts.  I also explained that he should avoid using his bed or the places he eats.  Van chose a chair in his basement because, he said, he didn’t really like being down there, anyway. 

2. The second step was for Van to schedule a time each day for thinking negative thoughts.  I explained to Van that he probably wouldn’t be able to control his thoughts very well at first, but that scheduling a time would help him take control.  Van avoided scheduling his negative thinking time around mealtimes, just before bed, or just before seeing people.  Van stated, "It’s actually kind of relaxing.  But I don’t let myself focus on negative thinking for longer than fifteen minutes or so."  Think of your Van.  Could he or she benefit from arranging a time and place for negative thoughts?

♦ Technique #3: Distraction
In addition to arranging a time and place for negative thoughts and thought stopping, the third technique for controlling negative thoughts is distraction.  As I explained to Lisa, it’s hard to think of two things at once.  Lisa stated, "So when I’m using negative thinking, you want me to involve myself with something else?" 

By replacing negative thinking, I felt Lisa could begin to avoid depression.  How might you help your HIV positive client distract themselves from negative thinking?  Lisa and I discussed visual methods for distraction.  For example, Lisa would take a vacation in her mind.  She would relax and use her imagination to visualize her ideal vacation, focusing on as many details as possible. 

Lisa stated, "Sometimes I imagine the future, instead.  I’ll think of something I’m really looking forward to and imagine it’s happening."  Your client may benefit from any number of relaxation exercises as well.  What method of distraction would benefit your HIV positive client? 

♦ Technique #4: Arguing Against Negative Thoughts
A fourth technique is arguing against negative thoughts.  Your clients may benefit from this technique as it allows them to face the negative thought and see both sides of the picture.  Have you found that things are not usually as bad as they first seem to a depressed client?  One way for clients to see that their problems are not that bad is to actively argue the negative view.  I used this technique with Van who felt hopeless. 

1. First, Van asked himself if he really thought that everything was hopeless.  Van easily answered that he didn’t, as he had a wife who loved him very much. 
2. Next, Van took the other side.  Van stated, "I thought of every reason why my thoughts might be exaggerated or not true.  And I didn’t give up easily.  I did it just like I was arguing with a real person.  I reviewed all the evidence and analyzed my thought process.  I found I was using black or white thinking and ignoring the shades of gray.  When I got done, there were so many holes in the negative side that I just couldn’t accept it anymore." 

♦ Technique #5: Problem Solving
In addition to arguing against negative thoughts, a fifth technique for controlling negative thinking is, of course, problem solving.  Use whichever problem solving technique you find works best.  I implement a four step addition to problem solving that I find works well with the flexibility required with HIV positive clients and their care-givers. 

1. First, clients foster creativity in dealing with obstacles. 
2. Second, they try to remain optimistic but realistic. 
3. Third they develop an orderly plan and review it for its level of reasonability. 
4. And fourth, clients use as much expert information as possible to find solutions to problems. 

Could your clients benefit from this addition to normal problem solving techniques?   Could a caregiver and their HIV positive friend or relative benefit from hearing this section?

In this section... we completed our discussion regarding coping with depression.  We examined several responses to possible obstacles and five techniques for controlling negative thoughts.  The five techniques we discussed are thought stopping, arranging a time and place for negative thoughts, distraction, arguing against negative thoughts, and problem solving. 
 
In the next section, we will discuss AIDS dementia Complex.  We’ll examine four steps for caregivers providing care to a relative or friend who has AIDS dementia Complex.  These four steps are providing a calm, stable environment, helping to cope with a failing memory, maintaining a safe environment, and setting up advance directives.

Update
Neuroinflammation in HIV-Associated Depression:
Evidence and Future Perspectives

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Mental Health and People Living with HIV/AIDS
Taking Care of Ourselves

- New York State Department of Health. (2013. Mental Health and People Living with HIV/AIDS Taking Care of Ourselves. U.S. Health Resources and Services Administration.
Reviewed 2023

Peer-Reviewed Journal Article References:
Breslow, A. S., & Brewster, M. E. (2020). HIV is not a crime: Exploring dual roles of criminalization and discrimination in HIV/AIDS minority stress.Stigma and Health, 5(1), 83–93.

Kalichman, S. C., Banas, E., Katner, H., Hill, M., & Kalichman, M. O. (2020). Individual social capital and the HIV continuum of care in a rural setting of the southeast United States. Journal of Rural Mental Health, 44(2), 75–86.
Moitra, E., Tarantino, N., Garnaat, S. L., Pinkston, M. M., Busch, A. M.,

Rood, B. A., McConnell, E. A., & Pantalone, D. W. (2015). Distinct coping combinations are associated with depression and support service utilization in men who have sex with men living with HIV. Psychology of Sexual Orientation and Gender Diversity, 2(1), 96–105.

Weisberg, R. B., Stein, M. D., & Uebelacker, L. A. (2020). Using behavioral psychotherapy techniques to address HIV patients’ pain, depression, and well-being. Psychotherapy, 57(1), 83–89. 

Williamson, T. J., Mahmood, Z., Kuhn, T. P., & Thames, A. D. (2017). Differential relationships between social adversity and depressive symptoms by HIV status and racial/ethnic identity. Health Psychology, 36(2), 133–142.

QUESTION 3
What are five techniques for controlling negative thoughts? To select and enter your answer go to Test.

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