Behavioral Skills Training Research Articles

Design and implementation of an effective telephone counseling intervention for adolescent smoking cessation.

Effective smoking cessation for youth is urgently needed, but the literature guiding such efforts is nascent. We evaluated the implementation of a proactive intervention for adolescent smoking cessation that incorporated motivational interviewing (MI) and cognitive behavioral skills training (CBST). We proactively identified 1058 smokers via classroom survey of enrolled juniors in 25 experimental high schools. After parental consent was obtained, trained counselors telephoned participants to invite their participation and deliver personalized smoking cessation counseling that combined MI and CBST. Implementation quality was assessed via weekly supervision of counselors, monitoring of counselor adherence to protocol via review of 5% of each counselor's calls, and formal evaluation of counselor fidelity to MI via review of a random sample of 19.8% of counseling calls using the Motivational Interviewing Treatment Integrity Code. Among identified smokers, 948 (89.6%) were eligible for intervention by age (> or =18 years) or parental consent, 736 (70%) agreed to participate in telephone counseling, 691 (65%) completed one or more counseling calls, and 499 (47%) completed all planned calls. Telephone delivery of the personalized MI and CBST counseling intervention to a general population of adolescents was done with greater than 90% adherence to the intervention protocol. Review of the random sample of counselors' calls demonstrated that more than 85% of counselors' calls met or exceeded benchmark scores for four of six evaluated behaviors: MI spirit (99.1%), empathy (96.2%), ratio of reflections to questions (97.2%), and MI adherent (85.7%). An effective proactive telephone counseling intervention consisting of MI and CBST can be successfully implemented with reach and fidelity in a general population of adolescent smokers.

Strategies for Preventing and Managing Overweight and Obesity

The purpose of this study was to reveal the various strategies for preventing and managing overweight and obesity in relation to reducing morbidity and mortality due to overweight and obesity. Thus, overweight and obesity are defined as Body Mass Index (BMI) of 25.0-29.9 kg/m and > 30.0 kg/m 2 2 respectively. Overweight and obesity are complex multifactorial chronic diseases that develop from an interaction of genotype and the environment. It was therefore concluded that overweight and obesity involve the interaction of social, behavioural, cultural, physiological, metabolic and genetic factors. Thus, it was recommended that multi-component intervention which include nutrition and physical activities and strategies such as providing nutrition education or dietary prescription, physical activity, pharmacological and behavioural skills development and training could help to prevent and manage overweight and obesity.

Group-randomized trial of a proactive, personalized telephone counseling intervention for adolescent smoking cessation.

The Hutchinson Study of High School Smoking randomized trial was designed to rigorously evaluate a proactive, personalized telephone counseling intervention for adolescent smoking cessation. Fifty randomly selected Washington State high schools were randomized to the experimental or control condition. High school junior smokers were proactively identified (N = 2151). Trained counselors delivered the motivational interviewing plus cognitive behavioral skills training telephone intervention to smokers in experimental schools during their senior year of high school. Participants were followed up, with 88.8% participation, to outcome ascertainment more than 1 year after random assignment. The main outcome was 6-months prolonged abstinence from smoking. All statistical tests were two-sided. The intervention increased the percentage who achieved 6-month prolonged smoking abstinence among all smokers (21.8% in the experimental condition vs 17.7% in the control condition, difference = 4.0%, 95% confidence interval [CI] = -0.2 to 8.1, P = .06) and in particular among daily smokers (10.1% vs 5.9%, difference = 4.1%, 95% CI = 0.8 to 7.1, P = .02). There was also generally strong evidence of intervention impact for 3-month, 1-month, and 7-day abstinence and duration since last cigarette (P = .09, .015, .01, and .03, respectively). The intervention effect was strongest among male daily smokers and among female less-than-daily smokers. Proactive identification and recruitment of adolescents via public high schools can produce a high level of intervention reach; a personalized motivational interviewing plus cognitive behavioral skills training counseling intervention delivered by counselor-initiated telephone calls is effective in increasing teen smoking cessation; and both daily and less-than-daily teen smokers participate in and benefit from telephone-based smoking cessation intervention.

Reproductive and Sexual Health of Chinese Migrants

Objective To investigate the reproductive and sexual health situation, including knowledge, attitudes, and behaviors, among a population-based sample of internal migrant workers in China. Method A cross-sectional survey of 4 900 rural-to-urban migrants in 6 provinces of China was conducted. Participants completed a 30-min semi-structured questionnaire about contraceptive practices, sexual behavior, and HIV-related knowledge. Results Migrants lacked knowledge of reproductive and sexual health issues. Among those who had heard any sexually transmitted infections (STIs), only 79.1%, 46.2%, 86.1%, 14.5% and 82.2%, respectively, knew that gonorrhea, condyloma, syphilis, chancroid, and AIDS were STIs. About three-quarters of participants had not used any contraceptive method at sexual debut. Among current users of contraceptive methods, 85.5% indicated that they were satisfied with the method. Before adoption of a contraceptive method, 46.6% of the migrant workers were unaware of the advantages/disadvantages of the method and 75.3% had no knowledge of emergency contraception. Nearly one-quarter (23.4%) reported that they had premarital sex. Among migrants who were sexually active one month prior to the survey, only 14.0% reported that they had used condoms. Conclusion The limited sexual and reproductive health knowledge and unmet reproductive health services of migrant workers in China underscore the need for a comprehensive package of sexual and reproductive health interventions that combine cognitive and behavioral skills training and target both migrants and health care providers.

THE EFFECTS OF BEHAVIORAL SKILLS TRAINING ON IMPLEMENTATION OF THE PICTURE EXCHANGE COMMUNICATION SYSTEM

The effectiveness of a behavioral skills training (BST) package to teach the implementation of the first three phases of the picture exchange communication system (PECS) was evaluated with 3 adults who had no history teaching any functional communication system. A multiple baseline design across participants was used to evaluate the effectiveness of the training package, which consisted of a video, written and verbal instructions, modeling, rehearsal, and feedback. Results showed significant improvements relative to baseline in a short amount of training time and that skills generalized to a learner with a severe developmental disability. Skills were maintained at 1 month follow-up for 1 participant.

Evaluating the Acceptability of Four Versions of a Child Sexual Abuse Prevention Program

Fifty-nine college students used a modified version of the Treatment Evaluation Inventory-Short Form to evaluate the acceptability of four versions of a sexual abuse prevention program for 10-year-old children. The four versions include an information-based training approach or a behavioral skills training (BST) approach with a focus on strangers or known individuals as perpetrators of sexual abuse. A significant effect was found for both training method and type of perpetrator, with information-based approaches involving strangers as perpetrators rated the most acceptable. These results suggest that college students were most comfortable with sexual abuse prevention training programs for 10-year-olds when the programs did not involve an active rehearsal component and when the program focused on abuse perpetrated by a stranger rather than a known individual.

Cognitive Behavior Therapy for Psychosis: Where Have We Been and Where Are We Going?

Cognitive behavior therapy for psychosis (CBTp) is an evidence-based treatment primarily designed to target psychotic symptoms such as delusions and hallucinations that persist despite appropriate treatment with antipsychotic medication. Meta-analyses suggest that CBT improves positive symptoms, negative symptoms, and functional outcomes with modest effect sizes compared with active control conditions for individuals with schizophrenia.1–4 CBT is recommended as a standard of care for individuals with schizophrenia in both the Schizophrenia Patient Outcomes Research Team5 and the National Institute for Health and Clinical Excellence6 treatment guidelines in the United States and United Kingdom, respectively. Acceptance of CBTp for the treatment of schizophrenia required substantial evidence of efficacy to contradict the widely held belief that talk therapy was not effective for psychosis patients. Clinical trials published in the 1980s demonstrated that individual psychoanalytically oriented psychotherapy was not helpful and may possibly be harmful for patients with schizophrenia.7,8 These data as well as the dominance of the biomedical model in the United States may have helped to shift the focus of treatment for schizophrenia in the United States away from talking therapies to a primary focus on medication treatment, psychoeducation, and rehabilitation approaches.9 As a result, while the first published case of CBTp was written in the United States by Aaron Beck10 in the 1950s, the evidence base for the efficacy of CBT has primarily come from randomized trials in the United Kingdom. The most recent meta-analysis included 34 studies with 22 studies of individually delivered CBT focused on positive symptoms.1 Despite the number of trials and the evidence supporting CBTp, many questions remain unanswered.11 While CBT has been found to improve several aspects of outcome, more information is needed about the specific techniques or approaches that are most effective in producing change for individuals with particular presentations of the disorder. It is also unclear whether there are individual patient characteristics that predict outcome in CBT. Since its initial introduction, CBT has continued to evolve, incorporating the latest developments in cognitive theory and metacognition. In addition, CBT techniques have been utilized to enhance existing evidence-based treatments such as social skills training. This theme issue presents a series of articles designed to explore the mechanisms of change in specific outcomes during CBT, to broaden our understanding of factors that may predict response to CBT, and to describe some of the important developments in CBTp that may allow us to better individualize treatment. In the first article, Brabban and colleagues examine the predictors of response to brief CBT delivered in the community by psychiatric nurses. By identifying individuals for whom brief forms of CBT are likely to be effective, a triage system utilizing different “doses” of CBT for individuals with different characteristics may be possible. The second article by Tai et al describes the evolution of CBT from primarily behaviorally focused to its current state in which components of many different cognitively based therapies are included in CBTp to address specific illness presentations (eg trauma). The collection of these cognitive techniques is likely to allow more targeted treatment that is better customized for individuals with different problems, personal histories, and views of the world. The third and fourth articles discuss the inclusion of CBT into other evidence-based treatments. The article by Granholm and colleagues describes Cognitive Behavioral Social Skills Training, a group-delivered intervention that is designed to address dysfunctional attitudes such as social disinterest that may be mediators between cognitive impairment and functional outcome. The article reviews the efficacy of CBT delivered in a group format and examines the specific effects on attitudes of social disinterest of CBT vs the nonspecific effects of interaction in a group therapy setting. The final article in the series examines the incorporation of CBT into Cognitive Adaptation Training, a home-delivered treatment using environmental supports such as signs, checklists, and the organization of belongings to cue and sequence adaptive behavior. The combination treatment called multimodal cognitive therapy (Mcog) is designed to bypass formal neurocognitive deficits and to cue and sequence functional behaviors. In addition, Mcog seeks to identify and alter emotional processes, information-processing deficits, and reasoning and appraisal biases that contribute to the formation and maintenance of positive symptoms. In sum, this series of articles addresses predictors of treatment response, mechanisms of change, integration with other treatment modalities, and how CBTp can be adapted to better address individual needs.

Brief and intensive behavioral interventions to promote sexual risk reduction among STD clinic patients: results from a randomized controlled trial.

The purpose of this study was to evaluate the separate and combined effectiveness of brief and intensive interventions for sexual risk reduction among patients at a sexually transmitted disease (STD) clinic. Patients (N =1483; 54% men; 64% African-American; M = 29.2 years old) were recruited from a publicly funded, walk-in STD clinic. Patients completed a baseline assessment, and then were randomized to one of six intervention arms; each arm combined a brief intervention with an intensive intervention. The interventions provided different levels of information, motivational counseling, and behavioral skills training, guided by theory, formative research, and empiric precedent. Follow-up assessments, including STD screening, occurred at 3, 6, and 12 months post-intervention. The results showed that infection rates declined from 18.1% at baseline to 4.5% at 12 months. At a 3-month follow-up, patients reported fewer sexual partners, fewer episodes of unprotected sex, and a lower percentage of unprotected sexual events; they strengthened sexual health knowledge, safer sex attitudes and intentions, and self-efficacy beliefs. No consistent pattern of differential risk reduction was observed among the six intervention conditions, nor was any evidence of decay from 3 to 12-month follow-ups obtained. We conclude that implementing behavioral interventions in a STD clinic was associated with significant reduction of sexual risk behavior and risk antecedents.

Efficacy of a Web-Based Intervention to Reduce Sexual Risk in Men Who Have Sex with Men

To the extent that men who have sex with men (MSM) use the Internet, it serves as a promising medium for behavioral intervention. The present study sought to investigate the efficacy of a web-based skills training and motivational intervention in a randomized trial (N = 112) conducted completely online. After a detailed assessment, MSM were randomly assigned to an online intervention or a control website. The experimental intervention consisted of risk assessment and feedback, motivational exercises, skills training, and education while the control intervention focused on relaxation skills. Follow-up data were collected 3 months later and analyzed with repeated-measures MANOVA. Although both groups evidenced across-the-board reductions in unprotected sex, perhaps due to the detailed assessment, the experimental group showed greater reductions with the riskiest partners, those of positive or unknown serostatus. Thus, this study gives preliminary evidence that a brief web-based intervention offering cognitive behavioral skills training and motivational enhancement can effectively reduce sexual risk in MSM.

THE EFFECTS OF BEHAVIORAL SKILLS TRAINING ON CAREGIVER IMPLEMENTATION OF GUIDED COMPLIANCE

The effectiveness of a behavioral skills training package that consisted of modeling, rehearsal, and feedback was evaluated to increase correct implementation of guided compliance by caregivers of 3 children who exhibited noncompliance. Results showed that the training package improved performance of guided compliance. Generalization probes indicated that the skills learned were exhibited in different settings 3 to 6 weeks after training ended.

Randomized Effectiveness Trial of an Internet, Pure Self-Help, Cognitive Behavioral Intervention for Depressive Symptoms in Young Adults

This study evaluated an Internet-delivered, cognitive behavioral skills training program versus a treatment-as-usual (TAU) control condition targeting depression symptoms in young adults aged 18 to 24 years. Potential participants were mailed a recruitment brochure; if interested, they accessed the study website to complete an online consent and baseline assessment. Intervention participants could access the website at their own pace and at any time. Reminder postcards were mailed periodically to encourage return use of the intervention. The pure self-help intervention was delivered without contact with a live therapist. The primary depression outcome measure was the Patient Health Questionnaire, administered at 0, 5, 10, 16, and 32 weeks after enrollment. A small but significant between-group effect was found from Week 0 to Week 32 for the entire sample (N = 160, d = .20, 95% confidence interval [CI] 0.00–0.50), with a moderate effect among women (n = 128, d .42, 95%C1 = 0.09–0.77). Greater depression reduction was associated with two measures of lower website usage, total minutes, and total number of page hits. Although intervention effects were modest, they were observed against a background of substantial TAU depression pharmacotherapy and psychosocial services. Highly disseminable, low-cost, and self-help interventions such as this have the potential to deliver a significant public health benefit.

The Use of Behavioral Skills Training and In-Situ Training to Teach Children to Solicit Help When Lost: A Preliminary Investigation

Abstract Behavioral skills training (BST) was combined with in-situ training to teach young children to solicit help when they become lost from a caregiver at a store. Three children were taught to approach a cashier, tell the cashier their name, and inform the cashier that they are lost. A multiple baseline design across participants was used to evaluate the effects of training. One of the three participants successfully met the criterion with the BST + in situ training treatment package alone, and the other two participants required an incentive to meet the criterion. All participants maintained the safety skill at follow-up evaluations. DESCRIPTORS: behavioral skills training, early childhood, in-situ training, lost child, safety, social skills training ********** A missing or lost child is defined as "when the child's whereabouts are unknown to the primary caregiver, resulting in the caregiver being alarmed for at least 1 hour" (U.S. Department of Justice, 2002). In a recent parent survey, it was reported that 90% of families have lost a young child in a public place, and that 20% of families have lost a child more than once. Although the vast majority of these children are reunited with their family, being lost may expose a child to other dangers such as abduction and accidents (U.S. Department of Justice, 2002). The frequency with which children become lost and the potential dangers involved in separation make it important to teach safety skills in situations in which children might become separated from a caregiver. Behavior analysts have taught safety skills to children using behavioral skills training (BST). For example, researchers have evaluated the use of BST to teach gun play prevention skills (Himle, Miltenberger, Flessner, and Gatheridge, 2004; Miltenberger et al., 2004; Miltenberger, et al., 2005) and abduction prevention skills (Johnson et al., 2005; Johnson et al., 2006). BST typically consists of instructions, modeling, rehearsal, and praise or corrective feedback. Participants who do not perform the safety skill to criterion during the assessment sessions often receive "in situ" training. In situ training involves teaching the skill in the natural environment. For example, in situ training in the context of what to do when finding a firearm consists of a therapist entering the room, pointing out the firearm, and conducting a training session "in the moment" (Miltenberger et al., 2004). Some research (e.g., Himle et al., 2004; Johnson et al., 2006; Miltenberger et al., 2004) has shown that BST alone is ineffective for some participants; an in situ training component is often needed to meet the mastery criterion (see Miltenberger (2008) for a review of BST and situations in which in situ training is necessary in the context of firearm injury prevention). Although there have been several studies focusing on teaching safety skills to children, few have focused on teaching children to seek assistance when lost from caregivers in a store or public place. Taber, Alberto, Seltzer, and Hughes (2003) taught six teenagers with moderate disabilities to use a cell phone when separated from a caregiver. Taylor, Hughes and Richard (2004) taught teenagers with autism to seek assistance when lost through the use of a pager and a communication card. No research, however, has focused on using BST and in-situ training to teach young, typically developing children to solicit help when separated from caregivers in public. In the current study, BST and in-situ training were used to teach these skills. Method Participants and Settings Participants were recruited via flyers posted at a private school. In order to participate, children had to be between the ages of 4 and 6 and have no medical or developmental disability. In addition, their caregivers had to have reliable transportation. Three typically developing children and their caregivers participated. …

HIV/AIDS behavioral interventions in China: a literature review and recommendation for future research.

In the past two decades, China has witnessed an alarming increase of HIV/AIDS epidemic. Meanwhile, a number of HIV prevention interventions have been conducted. This study reviews existing studies in literature on behavioral interventions on HIV/AIDS in China. Of 25 studies we identified, most have been concentrated in South and South-West China, mainly targeting injection drug users and female sex workers. The most commonly used intervention strategy was individual-oriented HIV-related knowledge education and behavioral skill training. All studies reported positive intervention effects including improved HIV-related knowledge, increased condom use, reduced needle sharing, and reduced STI. Literature also suggests a lack of intervention among other at-risk populations such as MSM, migrant workers, and non-injecting drug users, lack of studies with rigorous evaluation design, inadequate follow-up, limited outcome measurement, and lack of multi-faceted structural interventions. The existing intervention studies document strong evidence of controlling HIV/AIDS epidemic through effective behavioral intervention. More efforts are needed to control the growing HIV/AIDS epidemic in China. Future studies need to employ more rigorous methodology and incorporate environmental or structural factors for different populations at risk of HIV infection in China.

The effects of general‐case training and behavioral skills training on the generalization of parents' use of discrete‐trial teaching, child correct responses, and child maladaptive behavior

AbstractOne concern with training discrete‐trial teaching (DTT) is the generalization of teaching skills. This study employed behavioral skills and general‐case training to train three parents to conduct DTT. A multiple‐baseline‐across‐participants‐experimental design assessed the effects of parent training on the generalization of parents' DTT to non‐trained programs and on child behavior. Following training, generalization of parent DTT skills occurred, but the effects on child behavior were variable. Implications of programming for generalization and the effects of parent training on child performance are discussed. Copyright © 2008 John Wiley & Sons, Ltd.

Teaching Safety Skills to Children: Prevention of Firearm Injury as an Exemplar of Best Practice in Assessment, Training, and Generalization of Safety Skills

The focus of this paper is on teaching safety skills to children with an emphasis on recent research on behavioral skills training for the prevention of firearm injury. Following a discussion of safety skills and methods for assessing these skills, the paper reviews recent research on behavioral skills training and in situ training for teaching safety skills to prevent firearm injury. Strategies for promoting generalization and increasing the efficiency of training are then discussed, along with a summary of conclusions that can be drawn from the research and guidelines for best practices in teaching safety skills to children.

Co-occurrence of Treatment Nonadherence and Continued HIV Transmission Risk Behaviors: Implications for Positive Prevention Interventions

Effective treatment regimens for HIV infection demand very high levels of adherence and people infected with HIV are expected to adhere to safer sex and drug use practices throughout their lives. Treatment nonadherence overlaps with continued unsafe sexual practices for some people living with HIV/AIDS. The co-occurrence of nonadherence and HIV transmission risk behavior poses particular risk for the spread of drug-resistant variants of HIV. There are common correlates of both nonadherence and risk behavior, particularly substance use and depression. Interventions designed to address treatment nonadherence and those designed to reduce risk behavior also share common elements, particularly self-efficacy enhancement and behavioral skills training. The common correlates and shared intervention elements suggest that integrated intervention approaches that simultaneously address adherence and risk reduction may be feasible. Research is currently testing interventions that simultaneously increase HIV treatment adherence and reduce behaviors that risk HIV transmission.

Working with Family Members to Engage Treatment-Refusing Drinkers: The CRAFT Program

SUMMARY Community Reinforcement and Family Training (CRAFT) is an empirically-supported program based on behavioral reinforcement that engages treatment-refusing alcohol-other drug abusers into treatment by working with their concerned family members. These concerned significant others (CSOs) are taught how to rearrange contingencies in the drinker's environment such that sober behavior is supported and drinking behavior is discouraged. CSOs receive behavioral skills training in order to acquire the tools to successfully influence the drinker to enter treatment, and to enhance their own happiness as well. This review describes the outgrowth of CRAFT from the original Community Reinforcement Approach (CRA) program, summarizes the research foundation, and presents the basic CRAFT procedures with illustrative examples.

PEER TUTORING TO PREVENT FIREARM PLAY: ACQUISITION, GENERALIZATION, AND LONG‐TERM MAINTENANCE OF SAFETY SKILLS

Hundreds of accidental injuries and deaths to children occur annually in the United States as a result of firearm play. Behavioral skills training (BST) and in situ training have been found to be effective in teaching children the skills to use if they find a firearm, but training requires substantial time and effort. The current study examined the use of peers as tutors as a potential way to decrease the time and resources needed to teach these safety skills to youngsters. Peer trainers conducted BST and in situ training with other children. Children taught by the peer trainers acquired the safety skills and demonstrated them in naturalistic situations in which the skills were needed. Furthermore, all of the peer trainers acquired and maintained the skills. These results support the use of peer tutoring for teaching safety skills to other children.

Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Outpatients With Borderline Personality Disorder: A Randomized Controlled Trial and 1-Year Follow-Up

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a 20-week manual-based group treatment program for outpatients with borderline personality disorder that combines cognitive behavioral elements and skills training with a systems component. The authors compared STEPPS plus treatment as usual with treatment as usual alone in a randomized controlled trial. Subjects with borderline personality disorder were randomly assigned to STEPPS plus treatment as usual or treatment as usual alone. Total score on the Zanarini Rating Scale for Borderline Personality Disorder was the primary outcome measure. Secondary outcomes included measures of global functioning, depression, impulsivity, and social functioning; suicide attempts and self-harm acts; and crisis utilization. Subjects were followed 1 year posttreatment. A linear mixed-effects model was used in the analysis. Data pertaining to 124 subjects (STEPPS plus treatment as usual [N=65]; treatment as usual alone [N=59]) were analyzed. Subjects assigned to STEPPS plus treatment as usual experienced greater improvement in the Zanarini Rating Scale for Borderline Personality Disorder total score and subscales assessing affective, cognitive, interpersonal, and impulsive domains. STEPPS plus treatment as usual also led to greater improvements in impulsivity, negative affectivity, mood, and global functioning. These differences yielded moderate to large effect sizes. There were no differences between groups for suicide attempts, self-harm acts, or hospitalizations. Most gains attributed to STEPPS were maintained during follow-up. Fewer STEPPS plus treatment as usual subjects had emergency department visits during treatment and follow-up. The discontinuation rate was high in both groups. STEPPS, an adjunctive group treatment, can deliver clinically meaningful improvements in borderline personality disorder-related symptoms and behaviors, enhance global functioning, and relieve depression.

Cognitive-behavioral stress management interventions for persons living with HIV: a review and critique of the literature.

Psychological adjustment and coping are central to human immunodeficiency virus (HIV) management. To improve HIV-infected patients' ability to cope with stress, a variety of stress management interventions have been designed and evaluated. This paper provides a review and critique of the stress management literature, including a: (1) synthesis of core components of interventions for HIV-infected people, (2) summary of stress, coping, psychological, and health outcomes, and (3) methodological critique and guidance for future research. We reviewed 21 stress management interventions designed for HIV-infected individuals that included both cognitive and behavioral skills training. Most studies noted positive changes in perceived stress, depression, anxiety, global psychological functioning, social support, and quality of life. However, results were mixed for coping and health status outcomes, and a majority of studies employed only brief follow-up periods, focused on HIV-infected MSM, and did not address HIV-specific stressors. Stress management interventions for HIV-infected persons are a promising approach to facilitate positive adjustment. However, this literature is limited by measurement problems, research design features, a narrow focus on HIV-infected men who have sex with men, and feasibility concerns for intervention dissemination. Future stress management interventions should address these limitations and the unique psychosocial needs of HIV-infected patients using briefer, more cost-effective formats.