The treatment approach, cognitive behavioral therapy for HIV medication adherence and depression (CBT-AD), was based on traditional CBT approaches to the treatment of depression combined with intervention techniques most applicable to persons with chronic illness in general (see Thomason, Bachanas, & Campos, 1996 ; Nezu, Nezu, Friedman, Faddis, & Houts, 1998 ; Nezu, Nezu, Friedman, Houts, & Faddis, 1997 ), and prior clinical experience caring for HIV-infected individuals. A more detailed description of the intervention as employed in this current study can be found elsewhere (Safren, Gonzalez & Soroudi, 2007a ; 2007b ). Sessions were approximately 50 minutes long. In the present study, therapists were 2 clinical psychologists, a psychology intern, a post-doctoral fellow in psychology, and pre-doctoral graduate student in psychology. All had some prior experience with CBT, and all except the first author were under the supervision of the first author through weekly group meetings. This supervision involved review and feedback from audio-taped sessions as well as verbal review between therapists.
CBT-AD begins with a single-session intervention on HIV medication adherence (Safren et al., 1999 ), which involves eleven informational, problem-solving, and cognitive behavioral steps (e.g., education about adherence, scheduling, cue control strategies including the use of a watch alarm, adaptive thoughts about adherence, cues, provider communication). In each step, participants and the clinician define the problem, generate alternative solutions, make decisions about the solutions, and develop a plan for implementing them. Participants also receive adherence tools such as assistance with a schedule and a cue-dosing watch that can sound two alarms per day.
The remaining 11 sessions continued to address strategies for and barriers to medication adherence, with a review of electronic pill-cap (MEMS) data on adherence at the beginning of each session, and discussion of progress or difficulties with adherence. At each session, patients also completed the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961 (link)) and proceeded with the completion of specific modules of treatment. Although the treatment manual provided guidance for the number of sessions for each module, flexibility in the number of sessions devoted to any module was allowed to address the complexity and variability of issues facing patients with HIV and depression. Module 1 first provided psychoeducation about HIV and depression, and then transitioned to motivational interviewing exercises (e.g. pros and cons of changing to improve one’s depression and adherence) designed to set the stage for behavioral change interventions to follow. Module 2 provided behavioral activation interventions across one session, and was designed to increase regularly occurring activities that involve pleasure and mastery. Module 3 provided cognitive restructuring interventions across 3 sessions following procedures outlined by Beck (1987) , with attention specifically to negative automatic thoughts that relate to HIV medication adherence. Module 4 provided problem solving interventions across 3 sessions, and followed guidelines by D’Zurilla (1986) and Nezu et al. (1997) to help patients engage in a process that results in the selection of an action plan, and break this plan into manageable steps. Module 5 provided progressive muscle relaxation training/and diaphragmatic breathing skills across 1 session. A description of our updated approach is available (Safren, Gonzalez & Soroudi, 2007a ; 2007b .).
CBT-AD begins with a single-session intervention on HIV medication adherence (Safren et al., 1999 ), which involves eleven informational, problem-solving, and cognitive behavioral steps (e.g., education about adherence, scheduling, cue control strategies including the use of a watch alarm, adaptive thoughts about adherence, cues, provider communication). In each step, participants and the clinician define the problem, generate alternative solutions, make decisions about the solutions, and develop a plan for implementing them. Participants also receive adherence tools such as assistance with a schedule and a cue-dosing watch that can sound two alarms per day.
The remaining 11 sessions continued to address strategies for and barriers to medication adherence, with a review of electronic pill-cap (MEMS) data on adherence at the beginning of each session, and discussion of progress or difficulties with adherence. At each session, patients also completed the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961 (link)) and proceeded with the completion of specific modules of treatment. Although the treatment manual provided guidance for the number of sessions for each module, flexibility in the number of sessions devoted to any module was allowed to address the complexity and variability of issues facing patients with HIV and depression. Module 1 first provided psychoeducation about HIV and depression, and then transitioned to motivational interviewing exercises (e.g. pros and cons of changing to improve one’s depression and adherence) designed to set the stage for behavioral change interventions to follow. Module 2 provided behavioral activation interventions across one session, and was designed to increase regularly occurring activities that involve pleasure and mastery. Module 3 provided cognitive restructuring interventions across 3 sessions following procedures outlined by Beck (1987) , with attention specifically to negative automatic thoughts that relate to HIV medication adherence. Module 4 provided problem solving interventions across 3 sessions, and followed guidelines by D’Zurilla (1986) and Nezu et al. (1997) to help patients engage in a process that results in the selection of an action plan, and break this plan into manageable steps. Module 5 provided progressive muscle relaxation training/and diaphragmatic breathing skills across 1 session. A description of our updated approach is available (Safren, Gonzalez & Soroudi, 2007a ; 2007b .).
