The Effect of Combination Mindfulness Spiritual-Based Cognitive Therapy Plus Hypnosis in HIV Patients With Depression
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      HIV/AIDS patients are at risk for depression, a multifactorial disorder with signs and
      symptoms that affect the cognitive, affective, behavioral, and somatic areas. This study used
      Randomized Controlled Clinical Trials (RCT).

      Main hypothesis: A combination of spiritual awareness-based cognitive therapy (MSBCT) plus
      hypnotic interventions can reduce depression degree scores by reducing cortisol levels and
      increasing serotonin levels in HIV patients with depression.

      Small hypothesis

        1. There was a decrease in cortisol levels after being given the MSBCT plus hypnosis
           combination intervention in HIV patients with depression;

        2. There was an increase in serotonin levels after being given the MSBCT plus hypnosis
           combination intervention in HIV patients with depression;

        3. There was a decrease in depression degree scores after being given the MSBCT plus
           hypnosis combination intervention in HIV patients with depression;

        4. There was a higher reduction in cortisol levels in the intervention group compared to
           the control group in HIV patients with depression;

        5. There was a higher increase in serotonin levels in the intervention group compared to
           the control group in HIV patients with depression;

        6. There was a higher reduction in scores degree of depression in the intervention group
           compared to the control group in HIV patients with depression;

        7. Decreased cortisol levels and increased serotonin levels affect depression degree scores
           in HIV patients with depression;

        8. MSBCT plus hypnosis combination intervention is a factor that can affect depression
           degree scores reduction in HIV patients with depression;
    

Detailed description: 
      HIV/AIDS patients are at risk for depression. Evidence shows that depression in HIV/AIDS
      patients is two to four times higher than in the general population. The prevalence of
      depression in HIV/AIDS patients varies from 5% to 79% worldwide while the prevalence of
      depression in Indonesia in 2018 was 21.8% where women (22.3%) had a higher depression rate
      than men (21,4%). Cases of depression in HIV/AIDS patients are estimated to have a frequency
      of up to 60% of the total existing cases of depression.

      Depressive disorders are caused by biopsychosocial factors and neurotransmitter interactions
      that affect pathophysiology in a complex manner. The monoaminergic neurotransmitters that
      play the most role in depression are serotonin (5-HT), norepinephrine (NE), and dopamine
      (DA). In people with maladaptive PLHIV, cortisol levels in the blood will increase thereby
      inhibiting cellular and humoral immune responses. This condition causes apoptosis not to
      occur so that the virus proliferates and spreads rapidly. The progressive effect of HIV/AIDS
      can infect the central nervous system thereby disrupting the balance of neurotransmitters,
      accelerating viral replication, and suppressing the immune response so that it can shorten
      the period of HIV without symptoms. This condition, if not handled properly can reduce the
      quality of life, weaken physical function and therapeutic effects, as well as higher medical
      co-morbidities including suicidal behavior.

      Although the prevalence is quite high, the efficacy of depression therapy is currently not
      satisfactory. Less than 50% of depressed patients respond to standard therapy and 70%
      relapse. Psychopharmacology, psychotherapy, and a combination of the two are effective for
      treating depression and preventing the recurrence of depression. Psychopharmacological
      therapy has a shorter impact than psychotherapy. Even today, many people switch from medical
      therapy to psychotherapy because of the high medical costs and the side effects of
      pharmacological therapy. Therefore, equipping HIV/AIDS patients with coping strategies to
      manage physiological and psychological problems is integral to part of providing
      comprehensive care to HIV/AIDS patients.

      The results of the meta-analysis reported that mindfulness-based therapy was effective in
      reducing symptoms of stress, anxiety, and depression. There is empirical evidence supporting
      the effectiveness of MBCT in reducing rates of depression and improving the quality of life
      in chronic disease patients. However, the study results have not been consistent. Two
      resources that are widely used by patients with mental and physical illnesses are
      psychotherapy and religion/spirituality. The results of a meta-analysis of 46 spiritual
      intervention studies reported that patients with spiritually integrated psychotherapy showed
      positive improvement compared to patients treated only with psychotherapy. On this basis,
      researchers are trying to develop MBCT psychotherapy with spiritually integrated MBCT, namely
      a mindfulness-based intervention that integrates Islamic spiritual values (gratitude,
      patience, pleasure, sincerity, and trustworthiness) with aspects of cognitive behavioral
      therapy (CBT) and focuses on current conditions, emphasizes acceptance of thoughts, emotions,
      and behavior by improving thought processes, controlling emotions, and bodily sensations in
      order to develop self-capacity effectively in dealing with problems.

      Positive self-capacity development can occur and be effective when having the basic
      principles of positive life in the subconscious mind. One way to explore the subconscious
      mind can be done with hypnosis. Hypnosis is a method of giving suggestions by penetrating the
      critical factors of the conscious mind into the subconscious mind. Hypnosis has also been
      shown to be significant in reducing stress, anxiety, and depression scores. Even hypnosis
      plays a significant role as the first step in treating depression. This makes researchers try
      to develop a spiritually integrated MBCT psychotherapy combined with hypnosis.

      Formulation of the problem Can a combination intervention of mindfulness spiritual-based
      cognitive therapy (MSBCT) plus hypnosis reduce depression degree scores by reducing cortisol
      levels and increasing serotonin levels in HIV patients with depression?

      Research purposes The research aims to prove that a combination intervention of mindfulness
      spiritual-based cognitive therapy (MSBCT) plus hypnosis can reduce depression degree scores
      by decreasing cortisol levels and increasing serotonin levels in HIV patients with
      depression.

      Research hypothesis A combination intervention of mindfulness spiritual-based cognitive
      therapy (MSBCT) plus hypnosis can reduce depression degree scores by reducing cortisol levels
      and increasing serotonin levels in HIV patients with depression.

      Benefits of research results Provide scientific information about the effects interventions
      of a combination of mindfulness spiritual-based cognitive therapy (MSBCT) plus hypnosis in
      reducing cortisol levels, increasing serotonin levels, and reducing the scores degree of
      depression in HIV patients with depression;

      Research methods A randomized controlled trial (RCT). The sampling used a consecutive
      sampling method, namely a sampling technique based on inclusion and exclusion criteria for
      selecting predetermined subjects, within a certain period of time until the number of
      research subjects was fulfilled. After selecting the subjects, the randomization process was
      carried out using random allocation. The enumerator determined that each group consisted of
      31 subjects in the intervention group and 31 subjects in the control group. Randomization
      used the simple randomization technique, namely by making 62 envelopes, each with 31
      envelopes bearing the combination of MSBCT plus Hypnosis and 31 envelopes bearing the words
      MBCT. All envelopes were randomized and each subject who met the research criteria received
      one envelope chosen by the enumerator without the researcher and the subject knowing about
      it. If the envelope taken contains the writing of the MSBCT plus Hypnosis combination then
      the subject is included in the intervention group sample and the one containing the MBCT
      writing is included in the control group sample. The intervention was given once a week for 8
      weeks. The assessment was carried out 2 times pre and post-intervention by assessing cortisol
      levels, serotonin levels, and depression degree scores in the control and intervention
      groups. Statistical tests used the Independent T-test if the data were normally distributed,
      the Mann Whitney U Test if the data were not normally distributed, and to see the effect of
      the intervention using a linear regression test.
    

Intervention name(s): Combination mindfulness spiritual-based cognitive therapy plus hypnosis; Mindfulness-based cognitive therapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The intervention was divided into eight components in eight sessions, namely (1) psychoeducation and intention, (2) awareness of breathing mindfulness, (3) body scan, (4) comfort training through daily activity/comfort exercises, (5) self-compassion / having a great soul with acceptance, gratitude, and sincerity, (6) planning happiness through independent healthy behavior targets, (7) independent healthy behavior (8) independent healthy behavior evaluation. Each therapeutic component of each session is further divided into three sub-components, namely psychoeducation, training, and hypnosis.; The program curriculum consists of the automatic pilot; living in our heads; gathering the scattered mind; recognizing aversion; allowing and letting be; thoughts as thoughts; kindness in action; maintaining and extending new learning.
Other intervention name(s): Combination MSBCT plus hypnosis; MBCT
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The intervention group was given a combination of mindfulness spiritual-based cognitive therapy (MSBCT) plus hypnosis and the control group was given mindfulness-based cognitive therapy (MBCT).
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment