Affiliations: [a] Department of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
| [b] Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| [c] Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| [d] Department of Psychology, Gallaudet University, Washington, DC, USA
| [e] Department of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
Correspondence:
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Address for correspondence: Martin C. McElhiney, Tel.: +1 646 774 8035; Fax: +1 646 774 8034; E-mail: martin.mcelhiney@nyspi.columbia.edu.
Abstract: BACKGROUND:Employment rates for people with HIV/AIDS are low, compared to the general population. One widespread barrier is fatigue, accompanied by daytime sleepiness and a lack of stamina. Previous pharmacological studies have demonstrated improvement of fatigue-related symptoms without affecting work-related goal attainment OBJECTIVE:In this pilot study, we sought to determine whether a pharmacologic-behavioral two-phase combined approach could facilitate returning to work. METHODS:HIV+ participants with fatigue were treated with armodafinil. If energy improved, 8 sessions of biweekly manualized Behavioral Activation (BA) counseling were added to medication maintenance. Outcome was assessed on a 3-point scale along with clinician and self-ratings. RESULTS:Of the 46 participants enrolled in BA, 15 (33%) did not complete all 8 sessions: 6 got jobs so they no longer needed counseling; 4 did not like BA, and 5 dropped out for reasons such as moving away or substance use relapse. Of the 46, 29 (63%) attained their vocational goal and showed significant changes on self-report scales. CONCLUSIONS:Our integrated treatment including armodafinil plus BA counseling significantly increased the success of achieving work-related goals. The two-phase medication plus counseling program was well-tolerated by participants and the manualized BA counseling was readily applied by counselors without advanced mental health training, making the method potentially feasible in community settings.
