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HIV: Therapeutic Strategies for Guilt. Uncertainty, and Taking Control Abbreviated, Part II
HIV: Therapeutic Strategies for Guilt. Uncertainty, and Taking Control Abbreviated, Part II

Section 1
Emotion Dysregulation in HIV (Part 2)

Question 1 | Test | Table of Contents | Introduction | HIV/AIDS CEU Courses
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On this track we will continue our discussion regarding managing emotions.  Three additional emotions that Chad experienced in relation to his HIV positive diagnosis were fear, guilt, and uncertainty.  As you listen to this track, you might consider your HIV positive client.  How can you adapt these emotion management techniques for your client? 

#1  Fear
First, let’s examine fear.  During the first few weeks after Chad had found out that he was positive, he felt many different emotions, the strongest of which may have been fear.  Chad stated, "I’m scared as hell!  I first got concerned because of the little sores on my skin.  Now that I know why I have these sores, I’m scared shitless!"  HIV positive clients like Chad also fear what the infection might do to them.  Fears of blindness and the loss of cognitive abilities may affect some clients.  Chad feared dying as well. 

Chad stated, "Death is frightening.  But I could probably handle it if I just knew how I was going to die.  With HIV, you don’t only have to fear death, but how it will come!"  I responded, "All of your fears are realistic responses to a situation that is in fact uncertain.  You may not be able to live without fear, but you can learn to live with your fears."  Chad worked toward living with his fear in a couple ways. 

First, Chad dissipated his fear with information.  Because sickness was one of Chad’s fears, he and I discussed which symptoms he may have that require immediate medical attention and which he could ignore.  For example, Chad was afraid that his frequent headaches may be related to a brain infection.  I stated, "Headaches associated with infection of the brain or meninges have one or more of the following characteristics. 

  1. Headaches are unusually severe or last unusually long.
  2. Either the character or location of pain makes the headache different from usual headaches.
  3. Headaches occur along with weakness of an arm or leg, with dizziness, or with impaired coordination.
  4. Headaches occur along with stiff neck, nausea and vomiting, or extreme lethargy or sleepiness.

After considering his headaches, Chad decided he probably did not have a brain infection.  Chad stated, "I guess knowing more about the thing you are afraid of kind of takes the fear away a little." 

Another way HIV positive clients like Chad can manage fear is by talking to others with similar experiences.  Chad later attended one of my group sessions in which he spoke with Thomas.  Thomas needed help with his own fears. Chad stated to Thomas, "Don’t worry, man.  Even though you feel like the only one, we have all gone through the same emotions and fears that you fell right now." The group discussion led to clients sharing their common fears, such as fear of the unknown, fear of stigmatization, concern for family, and fear of death and sickness. 

Think of your Thomas or Chad.  Is your client in a state of emotion characterized by fear regarding HIV infection?  Could these techniques be adapted to help your client manage his or her fears?  Could he or she benefit from listening to this track?

#2  Guilt
After Chad’s anger over being infected decreased, feelings of guilt set in.  Chad stated, "I feel guilty.  I should have known to practice safer sex!  And I probably infected a few people before I found out I was positive."  As you know, social stigma regarding homosexuality and injection drug-use can also lead to feelings of guilt for the HIV positive client. 

However, clients who are infected through conditions of which society does approve may also feel guilty. Blood transfusion patients, hemophiliacs, and heterosexuals may contract the virus and feel guilty. Vanessa, age 29, stated, "I got infected by an old boyfriend. I feel like such a slut!" Is your client experiencing guilt regarding HIV infection? 

Vanessa found it helpful to separate HIV from a sense of punishment. I stated to Vanessa that the virus has nothing to do with punishment. Vanessa responded, "I guess so. Getting HIV doesn’t make someone good or bad. It’s just being in the wrong place at the wrong time." 

Regarding Chad’s guilt over unsafe sex and possibly infecting others, I explained that guilt, except when it prevents repeated mistakes, is a remarkably useless emotion.  I stated, "Feeling guilty means worrying about something you cannot change.  Whether you knowingly ran a risk or not, the past is beyond anyone’s power to change."  Chad understood that the emotional energy he was spending on his guilt could be better used to take action against what he felt were past mistakes. 

At a later session, Chad stated, "Instead of feeling guilty about infecting others, I decided to face the music.  I called everyone I have had sex with in the past two years and told them I was infected!  I explained I didn’t know how I got infected and that they should be tested."  Think of your HIV positive client.  Could he or she benefit from taking action and separating the virus from a sense of punishment?

A third method for handling guilt is to balance the client’s guilt by an understanding of personal worth.  In my practice, when clients are receptive, I work with a local pastor who has experience with HIV positive clients.  He asks, "What else besides the things you feel guilty about make up who you are?  What do your friends like about you?"  Regarding your HIV positive client, what questions could you ask to balance the client’s guilt by an understanding of personal worth? 

#3  Uncertainty
In addition to fear and guilt, the third emotion we will examine is uncertainty. Clearly, uncertainty can be related to fear. However, because fear generally indicates the anticipation of something negative, we will use uncertainty to distinguish fear of the positive. For example, some clients, after being positively diagnosed, might sell their homes or insurance policies because death seems so near. 

After realizing that they might live for many more years, clients who have accepted death feel uncertain about the future. Two parts to managing uncertainty that you may be able to help your HIV positive clients with are accepting uncertainty and cautious investment in the future.  Jason, age 34, stated, "What am I going to do?  Should I quit my job and go on disability?  My friends say I’m healthy and should keep working, but my family says I should go on disability so I can live my life the way I want to. It would be so much easier to decide if I knew what was coming!!" 

I explained to Jason that he could decide what he wanted to do.  Jason began to accept the uncertainty.  I then asked, "What do you want to do?"  Jason responded, "Well, I really don’t like my job that much, but I like working.  And I don’t want to spend the rest of my life without a job.  I dunno.  I’ve always been interested in journalism.  Maybe I’ll go back to school." 

Think of your Jason.  Could your client benefit from accepting uncertainty and investing in the future?  What additional treatment approaches would you use?  Would he or she benefit from hearing this track in your next session?

On this track we discussed managing emotions.  Three emotions regarding positive diagnoses of HIV are fear, guilt, and uncertainty. 

On the next track we will discuss disclosure strategies.  Three aspects of disclosure regarding a client’s HIV positive status that we will discuss are who to tell, feelings about disclosure, and dual disclosure.

Peer-Reviewed Journal Article References:
Ironson, G., O'Cleirigh, C., Leserman, J., Stuetzle, R., Fordiani, J., Fletcher, M., & Schneiderman, N. (2013). Gender-specific effects of an augmented written emotional disclosure intervention on posttraumatic, depressive, and HIV-disease-related outcomes: A randomized, controlled trial. Journal of Consulting and Clinical Psychology, 81(2), 284–298. 

Lane, T. A., Moore, D. M., Batchelor, J., Brew, B. J., & Cysique, L. A. (2012). Facial emotional processing in HIV infection: Relation to neurocognitive and neuropsychiatric status. Neuropsychology, 26(6), 713–722. 

Reif, S., Wilson, E., McAllaster, C., Pence, B., & Cooper, H. (2021). The relationship between social support and experienced and internalized HIV-related stigma among people living with HIV in the Deep South. Stigma and Health, 6(3), 363–369.

Rooks-Peck, C. R., Adegbite, A. H., Wichser, M. E., Ramshaw, R., Mullins, M. M., Higa, D., Sipe, T. A., & The Prevention Research Synthesis Project, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention. (2018). Mental health and retention in HIV care: A systematic review and meta-analysis. Health Psychology, 37(6), 574–585.

Wong, C. C. Y., Paulus, D. J., Lemaire, C., Leonard, A., Sharp, C., Neighbors, C., Brandt, C. P., & Zvolensky, M. J. (2019). Emotion dysregulation: An explanatory construct in the relation between HIV-related stigma and hazardous drinking among persons living with HIV/AIDS. Stigma and Health, 4(3), 293–299. 

How can an HIV positive client learn to live with fear? To select and enter your answer go to Test.

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