TRANSLATING EFFECTIVE HEALTH BEHAVIOR STRATEGIES INTO PRACTICE FOR HIV+ WOMEN THE SMART/EST WOMEN’S PROJECT INTERVENTION MANUAL Appendix B Stephen M. Weiss, Ph.D., MPH – Principal Investigator Session 1 – Introduction Outline Relaxation I. Relaxation—PMR Contents I. Introduction of Therapists II. Introduction of Format A. Confidentiality B. Expectations/Taping C. Orientation to Procedures III. Getting to Know Each Other Exercise 1.1 Setting Goals IV. Didactic—Stress, The Immune System and HIV Handouts (End of Session – make copies) 1. Selecting Treatment Goals (2) 2. Values Clarification/Theme Identification (2) 3. Stress and Your Body 4. Instructions for Muscle Relaxation Exercises Materials Needed 1. Visual Aide 1 – Effects of Stress 2. Participant Manual – Purple References Please see end of session SMART/EST III Project Intervention Manual VII Adapted from The SMART Manual, (Antoni, et. al.) March 2008 Page 2 Session 1 – Introduction I. INTRODUCTION Introduction of co-therapists and positive reinforcement of participants for volunteering for the study and attending the initial group meeting. II. INTRODUTION OF FORMAT A. CONFIDENTIALITY Many of you have been in groups before, so you know that confidentiality is extremely important for groups. As you know, your questionnaires and your blood work are all done using coded numbers, but we can‘t quite do that here in the group—we have to use names. Some of you know each other from before; some of you may know people who are friends of other people in the group. It is very important that we keep very strict confidentiality about what is said in the group so that people can feel safe enough to express how they truly feel. When you are outside of the group, you can talk about what you experienced, what you learned, or what you felt in the group, but please don‘t talk about other people‘s experiences, even without using their names. That often does not end up being confidential. If someone knows their friend, or their enemy, or their ex-lover is in the group, and they hear that ―so-and- so‖ said this, sometimes they can guess from the context who is being described, and then confidentiality is lost. So again, outside the groups, feel free to talk about your own experiences and what you are learning, but not about the experiences of others. Is that something you will agree to? Limits of confidentiality: It is important to mention a few occasions when we, as group leaders, would have to breach your confidentiality. Those occasions are if you indicate at any point that you might be a danger to yourself or to others, or if we learn that a child or elderly person is being harmed. The reason for this is that so we can do our jobs to keep you and others as safe as possible. However, we would never report anything without first talking to you. Therapists: know the laws regarding partner notification, as they are different in each state. B. EXPECTATIONS/TAPING First, we would like to talk about what you can expect of this group. This group is for you, and we will tailor it to meet your needs. Therefore, we are looking to have input from you on what we discuss each week within the general topic areas. Let us explain again how the groups are going to be set up. We will meet once a week for 16 weeks on this day at this time. You can expect these sessions to last about 2 hours and 15 minutes. It is extremely important that you come to all 16 of the weekly sessions. SMART/EST III Project Intervention Manual VII Adapted from The SMART Manual, (Antoni, et. al.) March 2008 Page 3 Each week, we will be helping you to learn stress management and relaxation skills. The two of us will lead the groups. To make sure that we are following the format correctly and that we are doing the best possible job for you, we have a supervisor, a licensed psychologist, who will give us advice and suggestions over the next sixteen weeks. Since our supervisor won‘t actually be in the group sessions, we will be tape recording the sessions so that he/she will be able to hear what is going on and provide us with feedback. This will enable us to do our jobs better. The only people who will hear the tapes will be the two of us and our supervisor. You may be uncomfortable with the idea that our supervisor will be hearing the tapes, so I want to assure you that the strictest confidence will be maintained. You may be uncomfortable being taped, but that‘s perfectly natural. After a couple of weeks, you will be used to it and you probably won‘t even notice the tape recorder in the room. Therapists: Does anyone have any questions or concerns about this? (Once any concerns have been addressed, the therapists can start the recorder.) C. ORIENTATION TO PROCEDURES During the next sixteen weeks, we will be discussing ways to deal with stress in a healthy and effective manner. You will learn how to use these skills in stressful situations that happen in your everyday life—at work and home or when you are out socially. Most people experience some type of stressful situation every so often. Some of us have more stress than others. You don‘t have to be leading a stressful life in order to benefit from these skills—and they will also be helpful in situations that don‘t seem so stressful. For example, you can apply the ideas we will teach you to decision-making situations or communicating more effectively. So, you don‘t have to be under a lot of stress in order to gain something from your participation. But you will find that at those times when you do experience stress, the techniques you will learn here can be helpful. Each weekly meeting we will start with ―something good.‖ We will all go around the room and share with the group one positive event that occurred in the past week or something you are proud of or something you accomplished toward your goal. At that time we will also check in to see how you did on the homework for between group meetings. After that each group consists of two main parts. The first part is relaxation training. Each week a new form of relaxation will be introduced. We will practice it together in the group and then you can practice at home. The purpose of the relaxation training is to help you become more aware of what goes on in the body when you experience a certain emotion and to teach you relaxation as a skill for stress management. People often go about their daily lives with too much tension in their muscles, which can sometimes cause headaches, backaches and other undesirable effects. This week you‘ll learn a technique that will help you relax your muscles whenever you need to—called progressive muscle relaxation. SMART/EST III Project Intervention Manual VII Adapted from The SMART Manual, (Antoni, et. al.) March 2008 Page 4 Some of the techniques being introduced may be familiar to you, and in some cases the group session will serve as reminders to use skills you already have. That may be especially true for those of you who already practice meditation or relaxation skills. You will also need to practice the relaxation exercises outside of the sessions in order to benefit from them. We have found in our previous research over the last few years that the more group members practice relaxation, the more they get out of the group. So, in this group the more you put into it, the more you will get out of it. We will be giving you audio copies of all the relaxation exercises to make it easier to practice at home. For the other portion of each group we will ask you to discuss in your real life stressors. These could involve any kind of stressful situation from your everyday life that you feel comfortable sharing. We will then introduce some new information and apply this information to your stressors and work through some exercises. You may feel uncomfortable or anxious when some of the topics are discussed. However, it is important that you bring up your concerns, and we will work with you to learn how to handle that anxiety. Therapists: Any questions about what has been discussed so far? III. GETTING TO KNOW EACH OTHER Now, we‘d like to break everyone up into pairs and have each of you ―interview‖ your partner. We would like you to find out 3 things about your partner that she wants the group to know, such as how many children she has, where she is from, or a little about her background. After you do that each member will report to the group what she learned about her partner. Exercise 1.1—Setting goals We would now like to hear from you regarding what expectations you might have for the group. In other words, what is a major stressor that you would like to work on in the ten weeks we have available? We will try to help you think of some specific goals that can be achieved in the ten weeks we will be together. Try to be as specific as possible. Therapists: Refer the women to their purple books in order to follow along with the appropriate grid. Make sure that you hear a goal from each of the women.