acceptance and commitment therapy

Empowering Marginalized Populations: A New Approach to Coping with Intersectional Stigma for People with HIV Who Inject Drugs  

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In HIV treatment, the barriers to care are numerous and complex, especially for those already marginalized by society. People living with HIV who also inject drugs face compounded stigma, which significantly impacts their ability to access and maintain healthcare. A recent study published in The Lancet Regional Health – Europe explored a novel intervention designed to address this critical issue by focusing on stigma coping mechanisms. 

A team of researchers, including Jason Luoma PhD from Portland Psychotherapy, conducted a randomized clinical trial (RCT) in St. Petersburg, Russia, to assess the effectiveness of an acceptance-based, intersectional stigma coping intervention. This intervention was tailored for people living with HIV who inject drugs, aiming to mitigate the stigma-related barriers that often prevent them from seeking and adhering to necessary healthcare. 

The Intervention 

The study involved 100 participants who were living with HIV and had reported injection drug use within the past 30 days. These individuals were divided into two groups: one received standard harm reduction services, while the other participated in a three-session group intervention based on Acceptance and Commitment Therapy (ACT). The ACT sessions were designed to help participants accept and cope with the internalized, anticipated, and experienced stigma they face due to both their HIV status and drug use. 

The intervention focused on empowering participants by encouraging them to accept stigma-related negativity without allowing it to dictate their actions. Instead of trying to change the stigmatizing attitudes directly, the therapy aimed to reduce the psychological link between these attitudes and the avoidance behaviors that often lead to disengagement from healthcare. 

Key Findings 

Although the intervention did not result in significant changes in self-reported stigma scores at one and six months post-intervention, the study revealed some promising outcomes. Participants who received the intervention were significantly more likely to initiate antiretroviral treatment (ART) and engage in substance use care compared to those who did not receive the intervention. Specifically, 20% of the intervention group initiated ART, compared to just 3% in the control group. Similarly, 23% of the intervention group sought substance use treatment, compared to only 6% of the control group. 

These findings suggest that while the intervention may not have directly reduced internalized stigma, it did facilitate greater engagement with healthcare services. This outcome is crucial, as it highlights the potential of acceptance-based approaches to encourage health-seeking behaviors even in the face of pervasive societal stigma. 

Implications for Future Research and Practice 

The results of this study are particularly relevant in contexts where HIV and substance use stigma are deeply entrenched. The researchers suggest that future interventions might benefit from a multi-level approach that not only empowers individuals but also targets the structural and provider-level stigma that continues to hinder healthcare access. 

The high satisfaction rates among participants and the fidelity with which the intervention was delivered underscore the feasibility of implementing such programs in real-world settings. As the study was conducted during the COVID-19 pandemic, the challenges faced by the participants—such as the disruption of healthcare services and increased isolation—may have influenced the results. Nonetheless, the fact that the intervention led to increased healthcare engagement despite these challenges is a testament to its potential effectiveness. 

Conclusion 

Stigma remains a significant barrier to healthcare for people living with HIV, particularly those who inject drugs. This study by a team of researchers, including experts from Portland Psychotherapy, offers valuable insights into how acceptance-based interventions can empower marginalized populations to overcome these barriers. While the intervention did not reduce stigma scores directly, it successfully encouraged participants to engage in essential healthcare services, marking an important step forward in the fight against HIV and substance use stigma. 

As research in this area continues to evolve, the integration of stigma coping strategies with broader, systemic changes in healthcare delivery will be crucial. By addressing stigma at multiple levels, from individual coping strategies to institutional practices, we can work toward a more inclusive and effective healthcare system for all. 

You can find an open access version of this article here.

Addressing Shame in Body Dysmorphic Disorder: A Promising New Approach 

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Body Dysmorphic Disorder (BDD) is a severe mental health condition characterized by an obsessive focus on perceived flaws in one’s appearance, often leading to significant distress and impairment in daily functioning. While Cognitive Behavioral Therapy (CBT) has been the gold standard treatment for BDD, many individuals do not respond adequately to this approach. Recent research suggests that shame plays a critical role in the development and maintenance of BDD symptoms. Therefore, targeting shame directly may enhance treatment outcomes for those suffering from this debilitating disorder. 

In a pioneering study published in Behavior Modification, a team of researchers including Jason Luoma PhD, from Portland Psychotherapy, developed and tested an innovative therapeutic approach that combines Acceptance and Commitment Therapy (ACT) with compassion-focused approaches to address shame in individuals with BDD. This approach, called ACT with Compassion (ACTwC), is designed to reduce shame and self-criticism while increasing psychological flexibility and self-compassion. 

The Role of Shame in BDD 

Shame is a powerful emotion that involves seeing oneself as fundamentally flawed and unworthy. In BDD, this emotion is often tied to the perceived defects in one’s appearance, driving behaviors such as excessive mirror checking, comparing oneself to others, and social avoidance. These behaviors not only reinforce the negative self-view but also contribute to the persistence and severity of BDD symptoms. Research has consistently shown that higher levels of shame are associated with worse outcomes in BDD, including greater symptom severity, lower quality of life, and higher rates of depression. 

Despite the clear link between shame and BDD, traditional CBT does not specifically target shame, focusing instead on changing maladaptive thoughts and behaviors. The researchers recognized this gap and sought to create a treatment that would directly address the underlying shame fueling BDD symptoms. 

The ACT with Compassion Approach 

ACT with Compassion (ACTwC) integrates the principles of ACT, which encourages individuals to accept difficult emotions and commit to actions aligned with their values, with compassion-focused elements. The treatment protocol developed by the team involves 12 individual therapy sessions, each about 60 minutes long, delivered over weeks. 

The intervention includes psychoeducation about BDD and shame, mindfulness training, and experiential exercises designed to foster self-compassion and psychological flexibility. Patients are encouraged to confront and accept their feelings of shame rather than avoiding them, and to develop a kinder, more compassionate relationship with themselves. 

Promising Results from the Pilot Study 

The pilot study conducted by the researchers involved five participants diagnosed with BDD. The results were encouraging: four of the five participants showed significant reductions in BDD behaviors and self-criticism by the end of the treatment. Moreover, three participants reported decreases in body-related shame, and these improvements were maintained at a six-month follow-up. 

In addition to reductions in shame and self-criticism, participants experienced significant improvements in overall BDD symptoms, depressive symptoms, and quality of life. The treatment was well received, with participants rating it as highly credible and expressing satisfaction with the therapy. 

Implications for Future Treatment 

The findings from this study suggest that ACT with Compassion could be a promising new approach to treating BDD, particularly for individuals who struggle with intense shame and self-criticism. By directly targeting these underlying emotional drivers, this approach may offer a more effective treatment option for those who have not responded to traditional CBT. 

As with any new therapeutic approach, further research is needed to confirm these findings and to refine the treatment protocol. Larger, randomized controlled trials will be necessary to establish the efficacy of ACTwC compared to other treatments. However, the initial results are promising and suggest that this approach could help improve the lives of individuals suffering from BDD. 

You can find an open access version of this article here. 

New Acceptance and Commitment Therapy Resources for the Public

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At Portland Psychotherapy, for years we’ve been maintaining a list of the best ACT resources for the public that we know about. We have links to video, self help courses, meditation recordings, apps, and much more. I recently went out and searched the web for additional Acceptance and Commitment Therapy (ACT) resources to update our … Read more

Women! – We Are More Than Our Stories

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This summer, I attended the first ever “Acceptance and Commitment Therapy (ACT) BootCamp for Women’s Issues.” Though I had attended a traditional ACT Bootcamp earlier this year, I was drawn to this summer event out of a desire to connect more with my community of women and to examine ways I can better serve my … Read more

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