Complementary therapies for anxiety management in people with HIV: a systematic review

Farias, Odaleia de Oliveira; Costa, Ana Karoline Bastos; Galvão, Marli Teresinha Gimeniz; Cardoso, Maria Vera Lúcia Moreira Leitão; Silva, Viviane Martins da

doi:10.37689/acta-ape/2022AR00024077

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Review Article • Acta Paul Enferm 35 • 2022 • https://doi.org/10.37689/acta-ape/2022AR00024077 copy

Complementary therapies for anxiety management in people with HIV: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To assess the effectiveness of complementary therapies in reducing anxiety in people living with HIV.

Methods

Systematic review of articles available in MEDLINE®, Scopus, Cinahl and Web of Science databases. The search was performed using the English descriptors “Complementary Therapies”, “Anxiety” and “HIV” as the main concepts. Primary studies such as randomized controlled trials conducted with people living with HIV were included. The methodological quality was assessed using Cochrane’s RoB 2 tool. Results were displayed as means and standard deviation or confidence intervals and as p-values for the analysis of intra- and inter-group differences.

Results

A total of 14 articles were selected. The study population consisted mostly of men, adults and North Americans. Among the ten therapies evaluated, five significantly reduced anxiety in people with HIV, namely: massage; therapeutic touch; yoga; auricular acupuncture concomitant with spiritual therapy; and the program composed of muscle relaxation, relaxation training assisted by electromyographic biofeedback, meditation and hypnosis. Among the studies, 78.6% had a risk of bias between moderate and high.

Conclusion

Complementary therapies proved to be effective for the management of HIV comorbidity and anxiety, with emphasis on therapeutic touch, massage and yoga. There is a lack of research with greater methodological rigor that investigates the adverse effects of therapies.

Complementary therapies; Integrality in health; Anxiety; Mental health; HIV; HIV infections

Reference and country	Sample	Intervention	Control	Follow-up (weeks)	Measure of anxiety	Outcome	Risk of bias – RoB 2
Gregory et al.,⁽¹⁾ Belgica	29 people, 72.4% men, 46.3 years old on average	Therapeutic massage	No intervention	4	HADS-A	The anxiety score decreased from 8.5±2.8 to 7.0±2.9 in the IG (p=0.04); there was no effect in the CG (7.6 ± 5.1 to 7.3 ± 3.3; p= 0.67)	Some concern
Taylor,⁽¹²⁾ United States	10 men, 28-44 years old	Program composed of muscle relaxation, electromyographic biofeedback, meditation and hypnosis relaxation	No treatment	10	IDATE	Anxiety as a State in the IG decreased from 62.00±8.29 to 32.00±9.69 and in the CG it increased from 51.00±13.30 to 57.60±7.74. As a Trait in the IG it decreased from 55.80±6.97 to 35.80±8.44 and in the CG it increased from 46.20±6.37 to 49.20±7.39. The analysis of variance showed that the IG presented a more significant change than the CG when comparing the means from baseline to after treatment, in State Anxiety (F1.8 =15.25; p<0.01) and Trait (F1.8 = 17.34; p<0.01)	High risk
Burack et al.,⁽¹³⁾ United States	30 people, 93.5% men, average of 36.1 years old	Pills composed of 31 Chinese herbs	Placebo pills composed of cellulose	12	Anxiety inventory Trait	Baseline anxiety: IG=43.1±2.6 and CG=48.1±2.2. IG had a mean difference of -2.7 (95%CI -6.9-1.5) and CG -1.6 (95%CI -6.6-3.4) between baseline and week 13. There was no significant difference between the groups	Low risk
Weber et al.,⁽¹⁴⁾ Switzerland	68 people, 79.4% men, 35 years old on average	Pills containing 35 Chinese herbs	Placebo pills.	24.	IDATE	State Anxiety: IG with a mean of 45 (range 31-53) before the intervention and 44 (range 34-52) after (p=0.911); CG from 44 (range 37-52) to 44 (range 39-57), p=0.80. Trait-anxiety: IG was 40 (range 32-51) to 40 (range 35-48), p=0.627; CG from 42 (range 30-49) to 41 (range 30-57), p=0.619. There was no significant difference within or between groups (IG and State CG p=0.680 and IG and Trace CG p=0.240)	Some concern
Ireland,⁽¹⁵⁾ United States	20 children, 65% female, aged 6-12 years old	Therapeutic touch	Therapeutic mimic or sham touch	1	STAIC segment state	IG=29.20±3.04 to 26.70±4.42; CG=31.20±4.51 to 29.50±3.37. Pre- and post-test difference in IG was 2.50±2.46 and 1.70±3.91 in CG. ANCOVA result for the effect of the group F(1.17)=1.067; p=0.32, it was not significant. The t test showed a significant intragroup difference, comparing pre and post-test, for the IG (p<0.01) only, in the CG (p=0.20)	Some concern
Diego et al.,⁽¹⁶⁾ United States	24 people, 91.7% women, 17 years old on average	Massage	Guided muscle relaxation	12	Anxiety inventory State	Both groups significantly reduced state anxiety immediately after treatment, in the first (IG=44.25±13.63 to 30.83±9.45 and CG=42.08±7.15 to 35.75±8 .06) and last day (IG=39.08±9.78 to 27.17±7.63 and CG=41.58±7.42 to 36.83±8.12), F(1.22) =49.97; p<0.001. The study reported no difference analysis between the first and last session	Some concern
Hernandez-Reif et al.,⁽¹⁷⁾ Dominican Republic	52 children, 64.5% female, 4.9 years old on average	Massage	Recreation (coloring and building blocks)	12	CBCL versions from 1.5 to 5 years and 6 to 18 years	Nonparametric analyzes showed that there were no significant changes (p>0.05) in anxiety/depression for children aged 1.5 to 5 years old. Analyzes in older children, using intragroup Wilcoxon assigned rank tests to determine the percentage of children whose anxiety/depression decreased between baseline and the last day of the study, revealed significant decreases for the massage group, 75%. (Z=2.23; p=0.026)	High risk
Margolin et al.,⁽¹⁸⁾ United States	40 people, 60% men, 42.8 years old on average	IG 1: auricular acupuncture with 5 needles. IG 2: auricular acupuncture with 1 to 3 needles inserted gradually	IG 3: Auricular acupuncture with 5 needles and group spiritual therapy IG 4: Auricular acupuncture with 1 to 3 needles and therapy	8	IDATE	IG 1= 45.17±8.4 to 44.0±3.3; IG 2= 42.18±8.89 to 38.45±10.9; IG 3= 48.0±10.4 to 32.5±5.1 and IG 4= 42.29±17.0 to 37.29±15.1, before and after, respectively Anxiety significantly reduced with time F(1.26 =14.69; p=0.001). Groups that received spiritual therapy showed greater reductions in mean anxiety scores between baseline 44.9±14.1 and after treatment 35±11.4 when compared to the group without this therapy (43.2±8.6 for 40.4±9.2), F(1.26)=5.48; p=0.03. There was no difference by type of acupuncture, F(1.26)=1.44; p=0.24. The interaction between spirituality and acupuncture was not significant, F(1.26)=3.89; p=0.59	High risk
Bormann et al.,⁽¹⁹⁾ United States	93 people, 80.6% men, 42.9 years old on average	Psychoespiritual intervention: repetition of mantra	Control of attention: HIV videos and group discussions	10	Anxiety inventory Trait	Anxiety was reduced over time in both groups. IG: 44.1±11.13; 40.7±9.62; 40.2±9.74 to 40.3±10.46. CG: 44.9±10.37; 43.1±9.63; 43.7±9.32 to 42.1±9.74. There was no group-time interaction. ANOVA for repeated measures, group (F=1.22; p=0.27), time (F=12.0; p=0.001), group-time (F=1.77; p=0.15). Effect size (ηp2=0.02) between small and medium	Low risk
Rao et al.,⁽²⁰⁾ United States	79 people, 75% men, 42 years old on average	Art therapy	Videotape about art therapy	1	STAI, segment State	Post-test state anxiety scores were analyzed after adjustment for pre-test scores and age (R2=0.61; F(3.67)=35.44; p<0.001). Scores improved for those in the art therapy group when compared to videotape. However, the differences in mean scores between groups were not statistically significant (post-test adjusted means of IG=62.8 and CG=61.2)	Some concern
Bremner et al.,⁽²¹⁾ United States	37 people, 86.2% men, 49.6 years old on average	Reiki and music	Music	10.	IDATE	Score for initial state-anxiety: RMG 38.3±11.4 and MOG 37.7±11.2. Anxiety-Initial Trait: RMG 43.1±6.9 and MOG 40.8±9.1. Anxiety as a state was significantly reduced in all participants at the end of the study, F(2, 52)=4.50; p=0.016	High risk
Naoroibam et al.,⁽²²⁾ India	44 people, 59% men, 36 years old on average	Yoga	Usual routine	4	HADS in English	The score for anxiety in the IG dropped from 10.82±3.86 to 9.91±3.39 (non-significant reduction p=0.13; -8.2%) and in the CG it rose from 10.14±3, 16 for 11.45±3.36 (p=0.06; +12.91%). There was no significant difference between the groups (F [1.21] =3.34; p=0.81)	High risk
Kuloor et al.,⁽²³⁾ India	60 people, 65% women, 42 years old on average.	Yoga	Waiting list	8	HADS-A	In intragroup analyses, anxiety score in the IG ranged from 11.29±2.15 to 5.45±1.34 (-52%; p=0.001) and in the CG it rose from 11.45±2.17 to 12, 48±2.20 (+9%; p=0.001). In the analysis of differences between groups, yoga showed a significant reduction in anxiety (p<0.001) compared to control	Some concern
Carey et al.,⁽²⁴⁾ United States	44 people, 50% women, 47.5 years old on average	Mindfulness Attention Training by phone	Health coach by phone	8	GAD	Consecutive measurements in the IG: 9.25±5.87; 7.88±6.15 and 7.20±5.33; in CG: 7.50±6.20; 5.0±4.58 and 4.45±4.22. There was a significant difference between the participants regarding the time F(2.74)=4.59; p=0.021. There was no significant difference between group and time, simultaneously	Low risk

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[1] Corresponding author: Odaleia de Oliveira Farias Email: odaleia@alu.ufc.br