Jonathan specifically notes that he believes these thoughts to be true and that they are a major barrier to his ART adherence. In this segment, Jonathan and his therapist discuss

selleck chemical cue-control strategies for improving medication adherence. The therapist draws upon the patient’s previously listed barriers to medication adherence (i.e., self-blaming thoughts get in the way) and motivations to stay healthy (i.e., watching daughter grow up) in walking through the steps of AIM in order to personalize the skill and demonstrate its effectiveness. The patient and therapist first “articulate” the specific adherence goal, which is to have more balanced thoughts about medication adherence (e.g., “medications help me stay healthy for my daughter”). Next, they “identify” barriers to this goal, including self-blaming thoughts (e.g., “I deserve to be sick”). Finally, they “make a plan” and back-up plan to address these barriers. This video clip illustrates the cue-control strategies life-step, and these two strategies are used for click here a plan and back-up plan. The first cue-control strategy involves

writing down motivations for staying healthy and more balanced thoughts about medication adherence on notecards that can be referenced by the patient when he has negative thoughts. The second strategy involves using colored stickers to trigger the patient to think of his motivations for staying healthy. These stickers can be placed in various locations that will be seen by the patient during his medication target time (e.g., on the TV) and throughout the day (e.g., on cell phone case). Although the notecards and stickers can be placed anywhere in the home, the stickers provide a more discrete cue-control strategy for patients who are concerned about disclosing their HIV status to others in the home. The primary goal of Session 2 is to provide an overview

of CBT-AD and to deliver psychoeducation with regard to the co-occurrence of depression, HIV infection, and ART nonadherence. As is the case with traditional CBT for depression (Beck, 1987), the core component PFKL of this session is to present a three-part model of depression (i.e., the interaction between cognitions/thoughts, behaviors/actions, and physiological reactions), tailored to the unique experiences of the patient. A detailed overview of this procedure can be found elsewhere (Safren et al., 2008b). Specific to CBT-AD, presentation of a three-part model of depression focuses on eliciting thoughts, behaviors, and physiological reactions that are specific to experiences with HIV infection, as well as ART adherence. By describing these specific aspects of HIV-infection and ART adherence when reviewing the three-part model, the patient is able to draw connections between their depressive symptoms and management of their health. Session 2 ends with a motivational exercise, based on strategies outlined by Miller and Rollnick (1991).