EFFECTS OF COGNITIVE REFORMATION AND SOCIAL BACKING TECHNIQUES IN MANAGING DEPRESSION AMONG HIV/AIDS INFECTED WOMEN IN KADUNA STATE, NIGERIA

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EFFECTS OF COGNITIVE REFORMATION AND SOCIAL BACKING TECHNIQUES IN MANAGING DEPRESSION AMONG HIV/AIDS INFECTED WOMEN IN KADUNA STATE,  NIGERIA  

Abstract

The study examined effects of cognitive restructuring and social support techniques in managing depression among HIV/AIDS infected women in Kaduna state, Nigeria. Nine objectives, nine research questions were raised and nine corresponding research hypotheses were formulated. Quasi-experimental research design was employed using pre-test and post-test design. The Sample size comprised of forty (40) women with HIV/AIDS, who are registered and assessing care in government health centre in Kaduna state, Nigeria.  The Beck depression inventory was the research instrument adopted for identifying subjects with moderate level of depression selected for the study. The study had two experimental groups that were exposed to cognitive restructuring and social support techniques. Hypotheses formulated for the study were statistically analysed using paired-sample t-test for hypotheses 1, 2, 4 and 7: independent sample t-test for hypothesis 3, and analysis of variance (ANOVA) for hypotheses 5, 6, 8 and 9. Results showed that four (4) of the hypotheses were rejected, while five (5) of them were retained, Result shows that,there is significant difference between pre-test and post-test in managing depression among HIV/AIDS infected women based on cognitive restructuring technique with (t=13.679, p=.000), there is significant difference between pre-test and post-test in managing depression among HIV/AIDS infected women based on social support technique with (t=16.123, p=.000), there is no significant differential effects of cognitive restructuring and social support techniques in managing depression of HIV/AIDS infected women with (t=-1.608, p=0,074). Income level and marital status did not influence the effectiveness of cognitive restructuring technique in the management of depression among HIV/AIDS infected women (t=.707,p=0.062, f=1.190,p=.003 respectively).but in the case of educational levels there is significant difference which has influence in the effectiveness of cognitive restructuring technique in the management of depression among HIV/AIDS infected women (f=6.501, p=.004). Also, income level and marital status did not influence the effectiveness of social support technique in the management of depression among HIV/AIDS infected women (t=.371, p=0.072, f=.143, p=.192 respectively). For educational levels, there is significant difference as such it influenced the effectiveness of social support technique in the management of depression among HIV/AIDS infected women (f=5.02, p=.013).  The result of the study indicated that both cognitive restructuring and social support techniques had effect in managing depression of infected women irrespective of their income and marital status, but on the aspect of the educational levels of the infected women, the treatment was more effective for those with secondary education. The researcher made recommendations on the basis of results of the study with respect to using cognitive restructuring and social support techniques by counselling psychologists in schools and hospitals in order to help HIV/AIDS infected women cope with the disease, and both treatments can also be used in schools to manage students and staff with depression problem.

 

CHAPTER ONE

INTRODUCTION

1.1         Background to the Study

With the evolution of HIV, researchers have been increasingly interested and concerned with how people living with HIV/AIDS have psychologically adjusted to this chronic health condition and what the rates of depression are in this population. Depression is quite common in the medically ill and may exceed that of the general population in those with active medical problems (Baba&Omotara, 2001) Estimates of the prevalence of major depressive disorders in people living with HIV/AIDS vary widely in the literature. Reported prevalence rates have ranged from 1.9% to 35% in clinical samples and from 30% to 60% in community samples. The lifetime prevalence of depression in people living with HIV/AIDS has been estimated at 20 to 45%. (Benedict, 2004)It is estimated that60% of people living with HIV in Ontario, Canada, may suffer from depression. US studies have reported gender differences in prevalence with approximately 30 to 40% of HIV-positive men and 40 to 60% of HIV-positive women experiencing significant depression. Most people infected with HIV are not depressed most of the time and their resilience is as noteworthy as their psychopathology. The signs and symptoms of depression are similar in HIV-positive and HIV-negative individuals, but HIV-positive individuals may more frequently have sleep and appetite disturbances. Depression may also contribute to non-adherence of anti-retroviral therapy although there is not yet prospective evidence that treatment of depression improves medication adherence among people with self-reported or documented medication non- adherence.

There are possible confounding factors that complicate measuring depression in

HIV-positive people. Many symptoms of HIV are similar to somatic symptoms of depression, for example, fatigue, diminished appetite and sleep, physical complaints and weight loss, which could inflate depression rates in symptomatic HIV-positive individuals and increase the vulnerability of many depression rating scales.

Depression can contribute to poor physical health andthis creates the need to put in place psychological and counselling interventions to help women withproblem cope with depression symptoms. This assertion is in line with the observation made by

Nienwenhuis, Odukogbe, Theobald, and Liu (2009:7) who studied the impact of

HIV/AIDS on infected men and women in Kwara State of Nigeria and found that HIV/AIDS had more psychological effects on women with HIV/AIDS than their male counterparts.Consequently, ―psychological support services should be made availableto women with HIV/AIDS and that the available resources should not be used tosubsidize HIV/AIDS treatment but should focus on the prevention of HIV/AIDS and psychological support.‖ Thus, there is an urgent need for psychological intervention using psychological treatment/counselling services to help women with HIV/AIDS problem deal with the distress relating to HIV/AIDS.

The effect of Cognitive Restructuring and Social Support Techniques on Depressionmay be related to the personal characteristics of women with HIV/AIDS and this therefore, requires investigation. Psychological intervention and counselling may be described as an interpersonal process based on theoretical framework and techniques in order to bring aboutchange in participants in a skilful and systematic way. Psychological  and counselling interventions in the context of HIV/AIDS involves educating participants about effective ways of reducingdepression of HIV/AIDS women as well as information given.People wanted information for various reasons. Theseincluded wanting to understand more about their condition and treatment options, where to go for treatment, what they were putting their bodies through and what their chances of success were. People gathered information from a variety of sources clinics, support groups, books, leaflets, television and radio. Their information needs often changed as treatment progressed for example weighing up options when deciding whether to continue or stop treatment.

Psychological and counselling interventions are a potent approach for managing depression. In this study cognitive restructuring and social supportpsychological and counselling techniques are the twotreatment interventions that wereused to investigate into effectiveness ofpsychological and counselling services to assist women with HIV/AIDS problem in managingdepression. Cognitive restructuring wasoriginally developed by Ellis (1991). It is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts. There are many methods used in cognitive restructuring, which usually involve identifying and labelling distorted thoughts, Socratic questioning, thought recording, identifying cognitive errors, examining the evidence(procon analysis or cost-benefit analysis), understanding idiosyncratic meaning/semantic techniques, reattribution, guided imagery and listing rational alternatives (Huppert, 2009).

Social support is a psychological and counselling technique that helps individuals to generatesolution(s) to a problem or problems. It is particularly useful when a participants/individual wants to break out of an established pattern of thinking and decision making, so that suchparticipants/individual can develop new ways of looking at things, foster and enhance communicationskill. Social support psychological and counselling technique helps participants to overcome issues that can make groupproblem solving a sterile and unsatisfactory process. Social support is often used in a genericsense

to describe groups who generate ideas. For example, Moran, Talbot and Benson (2001)defined social support as ―a group process in which group members collectively contribute their ‗ideas in a creative atmosphere‖ Although the term has come into popular use, facilitators shouldknow its precise meaning and history. Social support combines a relaxed, informal approach toproblem-solving with lateral thinking. It asks that people come up with ideas and thoughts thatcan at first seem to be a bit crazy. The main concept in social support is that some of the ideasgenerated can be crafted into original, creative solutions to the problem that an individual tryingto solve, while others can spark still more ideas.The treatment strategy (cognitive restructuring and social support techniques) will be adopted to be effective in assisting HIV/AIDs persons to acquire desirable skills in restructuring their negative thinking and also acquire social skills and experience reduction in depression. The treatment conditions intend to be effective and superior conditions in assisting HIV/AIDs infected persons that will participate in the study. Different psychological treatments such as skills training, role play, and problem solving etc. combine with the treatment techniques will be used to successfully reduce depression in HIV/AIDs infected persons by improving their cognitive thinking and social skills to be more positive in their thinking, interact more, better accepted, adjust to their situations

and be happier and live a better life.

 

1.2         Statement of the Problem

Depression is a problem for HIV/AIDS Infected Women in Kaduna State of Nigeria. Women infected with HIV/AIDs suffer emotional problems which include depression, rejection, loneliness, fear to mention a few when diagnosed with the disease.

Depression may increase when social support is lacking by family members, friends and

health workers, consequently, some of the women may discontinue accessing care and even interact less, not because of diminished interest in a bit to cope with the disease, but because they feel psychologically unable to continue. In Nigeria, psychological treatment interventions is not a regular feature of medical practice. Medical doctors/personnel only offer bio-medical treatment to HIV/AIDs women, but their psychological/emotional needs are not addressed. This form of health care is not consistent with the World Health Organisation‘s (2002) definition of health which states that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Therefore, the mental (psychological) and social needs of infected women should be addressed in the health care system in the country. Moreover, there is lack of psychological treatment interventions for women experiencing depression due to HIV/AIDs in Kaduna State. Depression can affect the physical health and social relationships of infected women and this can put another burden on family members and even the health care system.

Social support system in this study suggests that some spouses of infected women, their children and relatives  treat them with love, respect and utmost care, unlike what some infected women have come up to state in the news media that they were rejected and sent packing from their homes because of their HIV status. Experience from the print media also indicate that most health workers treat them with disdain, which is one of the reasons why they hardly visit the hospitals. Unfortunately, infected women risk dying early as a result of ignorance and are not likely to observe that the disease is progressing. The situation is even worse when such women become pregnant. Therefore, social support system for the infected women involves evaluating certain indices for maintaining good health and coping with the disease. These include care giver support, health promotion/prevention of illness (nutritional care, hygiene and sanitation, prevention of opportunistic infections) and early diagnosis/treatment.

From preliminary investigation in some Health Care Centres offering treatment and care for HIV/AIDs infected women, through personal observation and interview, most women were seen wearing glooming faces and looking sad and restless because of their negative thoughts and feelings towards their situation and most women usually come to the hospital alone without their spouses or children accompanying them which shows the lack of social support to the victims and this may be as a result of the fact that they want to avoid the stigma associated with the HIV/AIDs pandemic inthe society. Another problem of the respondents is the attitudes of the medical personnel to the health condition of women living with HIV/AIDS. In view of the foregoing, this study examined the effects of cognitive restructuring and social support technique inmanaging depression among HIV/AIDS infected women in Kaduna State.

 

1.3         Objectives of Study

The objectives of the study are as follows:

  1. To examine the differences between pre-test and post-test mean scores of depression among HIV/AIDS infected women exposed to cognitive restructuring technique.
  2. To examine the differences between pre-test and post-test mean scores of depression among HIV/AIDS infected women exposed to social support

technique.

  • To find out the differential effects of cognitive restructuring and Social Support in

managing depression among HIV infected women.

  1. To examine the differences in the mean scores of depression among HIV/AIDS infected women exposed to cognitive restructuring technique based on levels

ofIncome.

  1. To examine the differences in mean scores of depression among HIV/AIDS

infected women exposed to cognitive restructuring technique based on their levels

of marital status.

  1. To examine the differences in the mean scores of depression among HIV/AIDS infected women exposed to cognitive restructuring technique based on their

educational levels.

  • To examine the differences in the mean scores of depression among HIV/AIDS

infected women exposed to social support technique based on levels of Income. viii. To examine the differences in the mean scores of depression among HIV/AIDS infected women exposed to social support technique based on their ievels of

marital status.

  1. To examine the differences in the mean scores of depression among HIV/AIDS infected women exposed to social support technique based on their educational

level.

 

1.4         Research Questions

This study answered to the following research questions

  1. What is the difference in the pre-test and post-test mean scores of depression among HIV/AIDS infected women exposed to cognitive restructuring technique?
  2. What is the difference in the pre-test and post-test mean scores of depression among HIV/AIDS infected women exposed to social support technique? iii. What is the differential effects of cognitive restructuring and social support techniques in managingdepression among HIV infected women?
  3. What is the difference in the mean scores of depression among HIV/AIDS infected women exposed to cognitive restructuring based on theirlevels of income?
  4. What is the difference in the mean scores of depression among HIV/AIDS infected women exposed to cognitive restructuring technique based on their levels ofmarital status?
  5. What is the difference in the mean scores of depression among HIV/AIDS infected women exposed to cognitive restructuring  based on educational Level of HIV infected women?
  • What is the difference in the mean scores of depression among HIV/AIDS infected women exposed to social support technique among HIV/AIDs infected women based on theirlevels of Income?
  • What is the difference in the mean scores of depression among HIV/AIDS infected women exposed to social support technique based on their levels ofmarital status?
  1. What is the difference in the mean scores of depression among HIV/AIDS infected women exposed to social support technique  based on their educational level?

 

1.5         Research Hypotheses

The following null hypotheses were statistically tested in relation to the research topic.

  1. There is no significant difference in the pre-test and post-test mean scores of depression among HIV/AIDS infected women exposed to cognitive restructuring technique.
  2. There is no significant difference in the pre-test and post-test mean scores of depression among HIV/AIDS infected women exposed to social support

technique.

  • There is no significant differential effects of cognitive restructuring and social support techniques in managing depression among HIV infected women.
  1. There is no significant difference in the mean scores of depression among HIV/AIDS infected women exposed to cognitive restructuring technique based on levels of income.
  2. There is no significant difference in the mean scores of depression among HIV/AIDS infected women exposed to cognitive restructuring technique based on their levels of marital status.
  3. There is no significant difference in the mean scores of depression among HIV/AIDS infected women exposed to cognitive restructuring technique based on their educational levels.
  • There is no significant difference in the mean scores of depression among HIV/AIDS infected women exposed to social support technique based on levels of Income.
  • There is no significantdifference in the mean scores of depression among HIV/AIDS infected women exposed to social support technique based on their

levels of marital status.

  1. There is no significant difference in the mean scores of depression among HIV/AIDS infected women exposed to social support technique based on their educational levels.

 

1.6         Basic Assumptions

The basic assumptions underlying the study were:

  • That cognitive restructuring technique may have effect in managing depression among women with HIV/AIDS.
  • That social support technique may be effective in managing depression among women with HIV/AIDS.
  • That cognitive restructuring may be more effective than social support technique in managing depression among women with HIV/AIDS
  • That cognitive restructuring technique may have effect in managing depression based on level of income of HIV/AIDS infected women.
  • That cognitive restructuring technique may have effect in managing depression based on level marital status of HIV/AIDS infected women.
  • That cognitive restructuring technique may have effect in managing depression based on educational level of HIV/AIDS infected women.
  • That social support technique may have effect in managing depression based on level of income of HIV/AIDS infected women.
  • That social support technique may have effect in managing depression based on marital status of HIV/AIDS infected women.
  • That social support technique may have effect in managing depression based on educational level of HIV/AIDS infected women.

 

1.7         Significance of the Study

It is expected that the results and recommendations of the research would be useful to caregivers, counselling psychologists, teachers, health personnel, HIV/AIDs Infected Women, families affected by HIV/AIDs, members of the community, educators curriculum planners and researchers.

Significant of this study is that women infected with HIV/AIDs are not aware that counselling psychologists can help them manage their emotional behaviour by the use of behaviour/psychological interventions like behaviour therapies. Therefore, it is hoped that the findings of this study would help HIV infected women seek and access psychological interventions and would also learn skills from the study after reading the research work, this may assist them to manage depression.

This study will help teachers and lecturers of primary, secondary and tertiary levels of education in schools employ the techniques to help students battling with depression which could be as a result of HIV/AIDS infection or otherwise manage problems associated with depression.

This study will assist the health personnel learn skills in helping to manage the depression among infected women and to be aware that psychologists has a role to play in the affair of HIV/AIDs infected women. The result of this research will serve as an additional basis to look into the possibility of introducing psychological treatment and counselling interventions into medical practice in the area of depression for HIV/AIDs infected women. Also, treatment plans that will be provided in this research may assist health personnel to provide psychological and counselling interventions to women to enable them manage depression associated with HIV/AIDs. The findings could enable curriculum planners see the need to include psychological and counselling interventions in the medical curricular in Nigeria when they get access to the result of the study.

It is hoped that the study would be of great importance to counselling psychologists in utilizing cognitive restructuring and social support techniques in reducing depression and also extending their expertise and services to health care facilities in intervening in areas of managing behaviours of HIV/AIDs Infected Women. For instance, the treatment packages could be a great resource when providing psychological and counselling interventions whether on individuals or group basis. Psychological interventions goes beyond the purview of education, it encompasses all aspects of human life.

This study would be useful to families affected by HIV/AIDs learn skills that would bring about positive behaviour change which would encourage them to render social support to their families infected with HIV/AIDs. It is expected that the outcome of this study would also benefit the community at large in awakening them in their responsibilities of providing  support to infected women in their communities by learning skills from this study that will enable them provide love and support to the infected women in the community, Kaduna state and Nigeria at large.

The result of this study would bring to the limelight the treatment strategies for depression even among students and staff in Educational Institutions. It is expected that ,the outcome of this study would also provide  useful data for researchers, students, health workers and caregivers and also enrich the literature of counselling psychologists in terms of behaviour modification strategies and to generate for further research.

 

1.8 Scope and Delimitations

The scope of this study was Effects of cognitive restructuring and social support techniques in managing depression among HIV/AIDs infected women in Kaduna State. Two (2) selected Government Health Centres were used forthe study are: DrGwamnaAwanGeneral Hospital in Makera in Kaduna South and

BarauDikkoTeachingHospital in Kaduna Central. The variables under study are effectiveness in the use of cognitive restructuring and social support techniques in managing depression among HIV/AIDs infected women. This is because it has been consistently observed that this is the major emotional problem experienced by most women with HIV/AIDs problem.

This study was delimited to only women infected with HIV/AIDs that are registered in the two (2) selected health centres in Kaduna State. Hence, women with HIV/AIDs problem who are receiving HIV/AIDs treatment in private and federal health institutions were excluded from this study. Other HIV/AIDS patients such as HIV/AIDS infected men and children were also excluded in the study. Data of the study was generated through the administration of self-reporting inventories.

EFFECTS OF COGNITIVE REFORMATION AND SOCIAL BACKING TECHNIQUES IN MANAGING DEPRESSION AMONG HIV/AIDS INFECTED WOMEN IN KADUNA STATE,  NIGERIA  

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