Training as a technology for correcting emotional and cognitive impairments of HIV-infected patients. Evaluation of effectiveness

Vasileva Galina Nikolaevna ORCID: 0000-0002-5052-9661 Postgraduate student; Department of General and Clinical Psychology; First St. Petersburg State Medical University named after Academician I.P. Pavlov 197706, Russia, Saint Petersburg, Dubkovskoe highway, 17, sq. 24 galya@list.ru

Introduction

Today, HIV infection is no longer perceived as a sentence. Thanks to advances in highly active antiretroviral therapy (HAART), the disease has become controllable. However, the issue of a complete cure remains unresolved. According to life expectancy studies, HIV-positive patients who start treatment on time and have access to medical care live as long as their HIV-negative peers ^[1]. However, the problem of the quality of life of HIV-infected people comes to the fore ^[2].

HIV infection significantly increases the likelihood of mental health problems, ranging from distress to serious mental disorders ^[3]. Despite the existence of numerous studies on the mental state of HIV patients ^[3-5], many aspects of this topic are still insufficiently studied. The main attention of researchers is focused on the relationship of quality of life with the clinical characteristics of the disease, such as viral load, degree of immunodeficiency, comorbid conditions and treatment regimens ^[6-8]. At the same time, psychological aspects, including the peculiarities of the cognitive sphere of patients and their changes, often remain outside the scope of research.

Cognitive impairments in HIV-infected people significantly worsen the clinical picture of the disease and accelerate the onset of disability ^[9]. In this regard, the correction of such violations acquires an important social significance. Timely diagnosis of the state of the cognitive and emotional spheres can help prevent or slow down their progression, preserve the quality of life and reduce the risk of disability ^{[10, 11]}. In addition, stress and psychological pressure associated with uncertainty caused by diagnosis and stigmatization of patients play a significant role in exacerbating emotional disorders ^[3].

Despite the research conducted in the field of psychological care and cognitive functioning of HIV-infected people ^{[9, 11-13]}, there are practically no proposals for the development of interventions aimed at improving or restoring cognitive functions in this group of patients.

Thus, the relevance of this study is determined by the need for a dynamic study of the cognitive and emotional sphere of patients with HIV infection and the possibilities of their recovery or correction.

Cognitive impairment in HIV infection is one of the most common problems associated with this chronic infectious disease. Emotional and affective disorders (anxiety, depression, emotional lability/irritability) and behavioral problems (apathy, agitation, sleep and eating disorders) negatively affect the cognitive functions and adaptive abilities of a patient with HIV. Underestimating the importance of emotional and behavioral disorders in the overall picture of the disease and the lack of adequate correction lead to a faster progression of cognitive impairment and a significant decrease in daily activity and quality of life. The need to develop and implement psychological technologies to correct or compensate for such disorders is beyond doubt and is confirmed by many studies. Our own experience of conducting group cognitive-emotional training for people living with HIV, according to the results of feedback received from its participants, and the interest of doctors who refer patients, has shown the urgent need and acceptability in developing such technology.

We define cognitive-emotional training as a learning method aimed at acquiring practical knowledge and skills that help a person strengthen and develop their cognitive functions or compensate for their impairments, as well as improve their emotional state. For the first time, cognitive training was introduced as part of the psychosocial rehabilitation of patients with schizophrenia to correct neurocognitive deficits ^[14,15]. Today, cognitive training is being developed for people with various health limitations and various diseases that are accompanied by cognitive decline.

Training programs are becoming increasingly popular in somatic medicine, as they contribute to improving the effectiveness of social functioning and improving the quality of life of patients. Trainings aimed at improving resilience, managing emotions, and developing emotional intelligence are becoming in demand.

When developing training programs, including those for working with the emotional sphere, it is necessary to take into account the complex traumatic effect of the fact of being diagnosed with HIV or another serious life-threatening disease on the cognitive, behavioral and emotional aspects of the psyche of patients. According to the study, HIV-infected patients who have completed resilience training consider HIV infection to be a traumatic experience that has a significant impact on their emotional state and perception of the future ^[16]. They noted that resilience training is an effective way to increase resilience to stress, overcome crisis situations, and change attitudes about the future.

In this regard, it is important that psychological trainings focus on: increasing stress tolerance, overcoming crisis states and correcting cognitive and emotional disorders. It is important to include elements aimed at changing negative beliefs and emotional reactions related to trauma, which contributes to the development of more adaptive behaviors and attitudes towards the future.

Thus, training programs should be based on an integrated approach that takes into account not only the behavioral, but also the emotional, as well as cognitive characteristics of the participants.

When HIV patients first learn about their disease, during the initial psychological counseling it is necessary to discuss with patients the risks of cognitive impairment as a result of HIV infection and motivate them to develop cognitive reserve, as well as to adhere to rehabilitation programs ^[4,17,18]. However, it is even more important to organize and offer psychocorrective interventions aimed at improving cognitive functions.

There are studies showing that cognitive impairments and cognitive reserve in HIV-infected patients admitted to the AIDS Center hospital are associated with coping behavior. This means that the ways of responding to stress play an important role in these relationships ^[11]. Such data should also be taken into account when developing psychological technologies for correcting cognitive impairments for PLHIV.

As our experience of conducting such training for HIV-infected people has shown, regular patient participation can be difficult due to asthenia, depression, decreased motivation, employment, bias towards a psychologist, and other factors. However, the limitations on evaluating the effectiveness of psychological interventions are much broader than just the difficulties with recruiting participants: it is often impossible to measure cognitive functions before the onset of the disease, there is no information about the onset of the disease, and there is significant diversity among participants in terms of physical, psychological, and social characteristics.

It is necessary to take into account the individual characteristics of HIV-infected people, their personal and psychological characteristics when developing any psychological impact technologies. This opportunity is provided by a personalized approach. "Personalized medicine is a set of methods for the prevention of a pathological condition, diagnosis and treatment in case of its occurrence, based on the individual characteristics of the patient" ^[19]. Based on this approach, it is possible to formulate the main components of such an approach to the development of cognitive-emotional training technology for people living with HIV and to evaluate the effectiveness of participation in such training.:

- flexible lesson protocol with a clear scenario, containing mandatory (indicator) and arbitrary exercises;

- indicators of personal dynamics of participation;

- reliance on the preserved cognitive functions of the participants in the work of the training;

- compensation of reduced functions at the expense of saved;

- individual determination of the optimal number of visits;

- a separate discussion with each participant of the training of his personal achievements and the positive role of cognitive training, the application of skills in everyday life.

HIV infection is accompanied by complex comorbid conditions, significant emotional disorders, low levels of resilience, and dissatisfaction with life ^[4;16;20]. HIV-positive patients often face social stigma, which acts as a significant barrier to their participation in cognitive-oriented training programs, as our practical experience has demonstrated. Given these features, our task was to develop cognitive training tailored specifically to the needs and psychological characteristics of this group. The training program is based on the principles of a personalized approach that takes into account the unique clinical and social aspects faced by HIV-infected patients.

The scientific novelty of the study: the dynamics of indicators of the emotional and cognitive sphere before and after cognitive-emotional training was studied, the possibility of restoring cognitive functions (memory, attention, thinking) and reducing emotional tension was shown. The effectiveness of the training program as a psychocorrective measure for the correction of emotional and cognitive impairments for HIV-infected people has been proven.

Subject of the study: emotional sphere and cognitive functions (memory, attention, thinking) of patients with HIV infection.

The object of the study: HIV-infected patients.

The purpose of the study: to develop and test a psychological technology for correcting emotional and cognitive disorders in HIV-infected patients.

The theoretical and methodological basis was formed by the provisions reflecting the medical, psychological and psychosocial concepts of HIV infection and related phenomena (Zinchenko A.I., V. V. Pokrovsky, V. N. Zimina, V. V. Belyaeva, O.V. Shargorodskaya, A. G. Rakhmanova, D., Koltsova O.V., Rybnikov V.Yu, Langa A.P. and others); research in the field of psychological care for HIV-infected patients (Buzina T.S., Vasilenko A.E., Kurymbaeva S.R., Koltsova O.V., Alexandrova N.V. and others); provisions reflecting the features of cognitive impairment in HIV infection (Kurambaeva S.R., Rassokhin V.V., Belyakov N.A., Trofimova T.N., Koltsova O.V., etc.); research in the field of disorders of the emotional sphere of HIV-infected people (Muryvanova N.N., Koltsova O.V., Belyaeva V.V., Tkachenko T.N., Valieva T.V., Gimaeva R. M., Zinchenko A.I. and others)

Research materials:

The type of research is experimental. The study involved 60 patients with HIV infection who underwent a clinical and psychological psychodiagnostic examination before undergoing training.

Inclusion criteria: 1) is registered at the AIDS center with a diagnosis of B23; 2) age from 18 to 75; 3) signing informed consent to participate in the study; 4) referral of mental health specialists at the AIDS Center (psychiatrist, neurologist, psychologist); 5) confirmation from the doctor of the absence of a history of productive psychopathological syndromes or congenital intellectual mental defect, acquired dementia; 6) the stage of remission for ARVT (suppressed viral load).

Exclusion criteria: 1) age younger than 18 and over 75; 2) active use of surfactants and alcohol (remission for less than a year in case of addiction); 3) presence of severe mental disorders; 4) refusal to participate in training.

The training sessions were held once a week (on Saturdays from 11 a.m. to 1 p.m.), each lesson lasted 2 hours. It was recommended to take at least eight classes. Participation was flexible due to illnesses, shift schedules, and business trips, and the group had an open format.

In 2 years, 60 people took part in the classes. Of these, 17 people attended the training once; 23 people completed 8 classes; 6 people completed more than 8 classes. The remaining patients attended from 2 to 7 classes with varying degrees of regularity.

Reasons for refusing to participate further: got sick, moved, work schedule changed. We did not receive any negative ratings regarding the training.

Research methods:

Clinical-psychological, experimental-psychological and statistical methods were used to study and evaluate the parameters of the cognitive and emotional sphere in patients with HIV infection. The clinical and psychological method includes a psychological interview, an information questionnaire for the analysis of socio-demagrophic characteristics, clinical and clinical psychological data, as well as observation.

The experimental psychological method is represented by the following methods.

To assess the cognitive sphere:

1) The "Munsterberg test" for assessing the level of selectivity and concentration of attention.

2) The method of "Finding numbers according to Schulte tables" is used to assess the pace of mental activity, the presence of exhaustion, stability, concentration and selectivity of attention.

3) "10-word memorization test" to assess the volume of speech-auditory short-term memory and delayed playback.

4) The methods of "Essential signs" and "Exclusion of excess" (non-verbal version) for assessing violations of the dynamics of thinking.

5) The method of "Complex analogies" for assessing the level of logical thinking.

To assess the emotional sphere:

1) "Questionnaire on the severity of psychopathological symptoms" (SCL-90-R) for assessing the depth of emotional disorders and studying the psychological state of the patient.

2) The method of diagnosing irrational attitudes by A. Ellis for assessing the severity of irrational attitudes affecting the emotional state.

3) The "Life Satisfaction Index" methodology (adapted by N. V. Panina, 1993) for assessing the life satisfaction index is a complex indicator that reflects a person's overall ability to adapt and adapt to life circumstances. People with high values of this index, as a rule, have low emotional tension, low anxiety and high resistance to stress.

Statistical methods of data processing were applied taking into account the abnormality of the distribution, since the sample was small. Used: descriptive statistics, Spearman's rank correlation coefficient, Wilcoxon T-test. The data was processed using SPSS 23.

A psychodiagnostic examination was performed before the start of the training and after the participant completed every eight sessions.

Results and discussion:

Sample description

As part of the testing of the training program, 60 people with varying degrees of participation took part in the period from June 2022 to September 2024. The average age of the participants was 47 years; 76% of the participants were women. On average, the participants of the training learned about the diagnosis of HIV infection from 1 to 23 years ago. 45% had concomitant diseases (hepatitis BCD, atherosclerosis, encephalopathy, oncology, diabetes, hypertension, etc.), 30% had a disability. Education of the patients participating in the training: 13% - secondary, 22% - specialized secondary, 27% - higher education. The majority of patients were unmarried (82%) and employed (70%).

According to the results of preliminary psychodiagnostics of cognitive processes, it was found that a slight and moderate decrease in speech-auditory short-term memory (using the "10 words" method) was noted in 43.4% of participants, a marked decrease in memory – in 26%. The structure of thinking was not disrupted, but the mode of mental activity is extremely unstable, which may indicate an increased exhaustion of mental activity. The level of logical thinking (according to the method of Complex analogies) was reduced in 30% of the participants. The average execution speed of the Schulte tables turned out to be normal for 58.6% of the participants. A decrease in concentration and selectivity of attention (according to the Munsterberg test) was observed in 45.6% of participants.

Testing on the scale of severity of psychopathological symptoms (SCL-90-R) showed, on average, a significant excess of the normative indicators for all subscales (Fig.1). Diagnosis of irrational attitudes (using the Ellis method) She revealed the predominance of attitudes of "catastrophization" and "duty to oneself" (Fig. 2). That is, the training participants tend to evaluate every adverse event as terrible and unbearable with excessively high demands on themselves. The life satisfaction index (according to the same methodology) showed a low level, which included the lowest values for such indicators as "consistency between goals set and achieved" and "positive assessment of oneself and one's own actions" (Fig.3). Thus, the training participants were convinced that they had not achieved or were unable to achieve the goals they considered important to themselves, and they also rated themselves and their actions poorly.

Figure No. 1The expression of psychopathological symptoms (before the training)

Figure 2 The presence and severity of irrational beliefs (before the training)

Figure No. 3 Life Satisfaction Index (before the training)

Thus, before the start of the training, the participants, patients with HIV, had a high degree of irrational beliefs, a low level of life satisfaction index and a high degree of psychopathological symptoms.

These indicators reflect the initial emotional and cognitive state of the participants, which justifies the need for psychocorrective training activities.

It was also necessary to study the relationship between emotional state and irrational attitudes, as understanding these factors is key to developing effective psychological interventions. An emotional state directly affects a person's quality of life, mental health, and behavior, while irrational beliefs can enhance negative emotions and hinder adaptation to difficult situations.

In the context of increased social stigma and stress faced by certain groups of the population, including HIV-positive patients, it is important to find out exactly how irrational attitudes relate to their emotional state. The study of these relationships made it possible to identify critical areas and targets for psychocorrective intervention and provide the necessary data to create trainings that enhance the psychoemotional well-being and adaptability of participants.

As a result of the correlation analysis, a number of significant correlations were found between indicators of emotional state (SCL-90-R) and irrational attitudes (according to the method of A. Ellis). The strongest associations were observed in such indicators as somatization, obsessive-compulsivity, depression, paranoia and psychoticism. All of them were negatively associated (p=0.01) with a positive assessment of themselves and their actions (self-esteem), as well as with frustration tolerance (stress tolerance) (according to the method of A. Ellis) (Fig.4). The data obtained indicate that the overall assessment of the degree of rationality of thinking and self-assessment are closely interrelated with the emotional state of the participants. That is, the lower they rate themselves and their abilities, the higher the emotional disorders. The established relationships justify the need to introduce into the training program techniques aimed at changing negative beliefs and developing emotional regulation skills. Focusing on increasing self-esteem, frustration tolerance, and rational thinking will reduce emotional stress. One of the specific reasons for the difficulty of involving such patients in group activities is stigmatization, which, nevertheless, can be overcome by including exercises to increase self-esteem, stress tolerance and resilience in the program ^[14]. In this sense, it is the group training format, which includes, in addition to the cognitive, the emotional aspect and the social component (interaction and support), that will bring the greatest benefit.

Figure No. 4 Fragment of the correlation galaxy

Research design (how the training was created)

We spent a whole year working out the structure of the training. There is no such training for HIV-positive patients, so our goal was not to collect data, but to work out the principle of forming classes, their content and sequence of effects.

The purpose of the training is to create a special system of group classes, accompanied by regular dynamic assessment of cognitive functions and emotional and personal characteristics of each participant individually, encouraging them to self–knowledge, development and understanding of their abilities, taking into account preserved cognitive functions and compensation for lost ones.

The following tasks were solved in each lesson:

1. Prevention of memory loss and concentration.

2. Development of quick thinking and information processing speed.

3. Reducing emotional stress.

4. Training of basic cognitive functions through special exercises.

5. Mastering mnestic techniques to improve memory.

6. The study of self-regulation techniques for managing emotions.

7. Development of reflection skills for understanding one's own experience and behavior.

To ensure comparability and the possibility of data analysis in the absence of a ready-made protocol for cognitive-emotional training for PLHIV, we have created our own protocol for conducting classes for HIV patients to improve cognitive functions and emotional state (Table 1).

Table 1 Approximate lesson structure (duration 2 hours)

The variety of factors affecting the condition of PLHIV, such as age, comorbidity, length of illness, and neurotoxic treatment regimens, makes it difficult to create a homogeneous sample for psychodiagnostics before and after training. There are also many factors such as stigmatization, asthenia, forgetfulness, work schedule specifics, behavioral problems, and disability that affect commitment to participating in the program. This complicates the development of a strict protocol and evaluation of the effectiveness of the training for all participants. A personalized approach was needed, while not eliminating the group format, as it provides individual advantages ^[20].

Therefore, our task was to develop indicators that would show the progress of the participants, taking into account their individual characteristics and the variety of factors influencing participation in the training. These indicators should be flexible and adaptable so that the effectiveness of training can be correctly assessed both on an individual level and in a group format.

The list of indicators that we have left:

1. The number of numbers found in 7 minutes using the "Finding numbers in order from 1 to 90" method. Evaluates the concentration of attention before and after the lesson.

2. The number of associations per picture in 3 minutes. Evaluates the level of development of associative thinking.

3. The number of memorized words according to the "20 words" method (M.G. Barkhatova). Evaluates the level of development of various memorization techniques.

4. The number of numbers arranged in ascending order according to the "Number Arrangement" method. Evaluates arbitrary attention.

5. The number of words found using the "Munsterberg Test" method. Evaluates the level of selectivity and concentration of attention.

6. The number of correctly selected analogies using the "Complex analogies" method. Evaluates the level of ability to establish logical connections and relationships between concepts.

7. The number of words per letter according to the "Verbal fluency" method. Evaluates the level of phonetic verbal fluency.

8. The "Well-being, Activity, Mood" technique (used for rapid assessment of well-being, activity, and mood before and after class).

9. Personal differential" evaluates a person's subjective attitude towards himself on three scales (assessment, strength, activity).

If there is progress in improving a particular function, such as memory, during the training process, we explore the optimal period (after how many sessions) when active participation gives a positive result. If there is uneven dynamics (the function improves and worsens), we can talk about the exhaustion of the mental process, the need to distribute the load (alternating work and rest). In addition, the current diagnosis of the results of participation in the training allows us to identify the individual strengths and weaknesses of each participant, which will determine how to help a person compensate for a weakened or lost cognitive function at the expense of a safe, working one. In case of predominance of arousal, disinhibition, it is important to find a way to avoid unproductive behavior (increased verbosity), erroneous actions (reproduction of "superfluous", not presented words).

Evaluation of the effectiveness of the cognitive-emotional training program

After the entire training program, a comprehensive effectiveness assessment was conducted: before and after 8 sessions, the cognitive and emotional changes of the participants were assessed. The individual dynamics of each participant was also monitored throughout the course. In addition, feedback questionnaires were collected from the training participants who completed 8 classes. This made it possible to take into account their subjective impressions, identify possible difficulties and adjust the program in real time. The questionnaires helped to assess not only the effectiveness of the exercises, but also the overall satisfaction with the process, which helped to improve the interaction between the psychologist-coach and the participants, as well as further improve the program.

All together, it allowed us to get a complete picture of the impact of the training, both at the group and individual levels, taking into account the unique characteristics of each participant.

Analysis of results after 8 sessions

The results of testing 23 people before and after completing 8 classes were analyzed according to the following indicators of cognitive functions: the volume of speech-auditory short-term memory, the volume of delayed playback, the average speed of Schulte tables, logical thinking. The volume of auditory short-term memory increased in 39% of patients. The volume of delayed playback increased for 44%. The average execution speed of the Schulte tables improved in 83% of the subjects. Logical thinking improved in 36% of the participants.

The indicators of emotional disorders according to the SCL-90-R method were also analyzed before and after 8 classes. Somatization decreased in 52% of the participants. Obsessive-compulsive disorder decreased in 63%. Depression decreased in 53% of the participants. Anxiety decreased in 47%. The overall symptom severity index decreased in 58% of the participants. The Wilcoxon landmark rank criterion also showed statistically significant differences in these indicators of the methodology (Table 2).

Table 2 Severity of psychopathological symptoms before and after training (in points)

Analysis of the feedback questionnaire

The first stage of evaluating the effectiveness of the program was the assessment of the participants' satisfaction with the training. We checked how useful the training was, what inspired us to participate, and what prevented us from attending classes. For this purpose, a feedback questionnaire was developed with questions about results, motivation, barriers and preferences. The questionnaire included ready-made answers with the ability to add your own, and allowed you to select several positions. The results are presented in table 3.

Table.3 The results of the analysis of feedback questionnaires

People also answered what idea inspired them to participate: "learn to live in society, accept yourself," "improve your neurons," "self-development." Among the answers about bonuses, there were such options: "understanding that I am a normal, adequate person, that I am not the only one like this," "I have become more friendly," "my memory has improved."

Discussion

60 people participated in the training program, the average age was 47 years, 76% of them were women. HIV was diagnosed between 1 and 23 years ago, 45% of the participants had concomitant diseases, and 30% had a disability. 82% were unmarried, 70% were employed.

A psychodiagnostic examination conducted before the start of the training showed that 43.4% of the participants had a slight to moderate decrease in speech-auditory short—term memory, and 26% had a marked decrease. The effectiveness of the attention function was normal in 58.6%, a decrease in concentration was observed in 45.6%.

The level of psychopathological symptoms exceeded the standard indicators for all subscales. Such data are consistent with a study conducted by O.V. Koltsova and co-authors, which noted that in HIV-infected patients, indicators of psychopathological symptoms are higher than the established standard values on all scales of the SCL-90-R questionnaire, where the most pronounced deviations were observed in patients with unstable somatic health and drug addiction, as well as in people over 31 years of age. ^[10].

The participants were dominated by irrational attitudes such as "catastrophization" and "ought to." The life satisfaction index is at a low level, especially in terms of consistency of goals and positive self-esteem. This is consistent with the results of a study by Savchenko G.N. and Koltsova O.V., where it was revealed that the resilience of HIV-infected women is closely related to their meaningfulness of life, goal setting and self-esteem. In addition, the traumatic perception of the diagnosis negatively affects life meaning orientations, increasing psychological stress and reducing the ability to find internal resources to overcome life crises ^[16].

The high severity of irrational beliefs and psychopathological conditions justifies the need for training activities to improve the emotional and cognitive state of the participants. Correlation analysis revealed significant correlations between life satisfaction, emotional tension, and irrational attitudes, which underscores the need to correct negative beliefs and develop emotional regulation skills.

The purpose of the training was to develop the cognitive functions and emotional and personal characteristics of the participants, with a focus on self-development and understanding of opportunities. The tasks in the classes included developing memory, concentration, reducing emotional tension, and mastering techniques of self-regulation and reflection. Adaptive indicators were used to assess the individual progress of the participants and analyze the impact of the training. The evaluation of the dynamics (individual and group) showed the effectiveness of the training itself.

Conclusions:

1. HIV infection has ceased to be a fatal diagnosis, but remains a significant problem for the mental health and quality of life of patients.

2. The study showed that HIV-infected patients face a high level of psychopathological symptoms, which exceeds the standard values on all scales of the SCL-90-R questionnaire. Such data are consistent with previous studies, emphasizing the importance of psychocorrective work for this group of patients.

3. An analysis of the dynamics of cognitive impairment after the training showed that the volume of auditory short-term memory increased in 39% of participants. The volume of delayed playback increased in 44% of participants. The effectiveness of attention improved in 83% of the subjects. Logical thinking improved in 36% of the participants.

4. An analysis of the dynamics of emotional disorders after the training showed that somatization decreased in 52% of participants; obsessive-compulsivity decreased in 63%; depression decreased in 53% of participants; anxiety decreased in 47%. The overall symptom severity index decreased in 58% of the participants.

5. The study participants demonstrated irrational attitudes such as "catastrophizing" and "ought", which significantly worsened their emotional state. Correlation analysis revealed a link between irrational beliefs and emotional tension, which highlights the need for their correction within the framework of training.

6. An analysis of the results of the feedback questionnaire after the training showed the overall satisfaction of the participants, as well as a subjective improvement in concentration, memory, and overall emotional state.

7. The developed training program took into account the individual characteristics of the participants, such as age, comorbidities and social factors. This made it possible to ensure the flexibility of classes and achieve significant results both in the cognitive and emotional spheres.

8. The study confirmed the effectiveness of cognitive-emotional training in improving cognitive functions and reducing emotional disorders in HIV-infected patients, which opens up prospects for further adaptation of the program in clinical practice.

Conclusion

The development of the concept of cognitive training as a technology for correcting emotional and cognitive impairments in HIV-infected patients continues. In the future, the training can be adapted for use both in infectious diseases hospitals and in outpatient clinics and rehabilitation centers. However, it is important to understand that a personalized approach that takes into account the individual characteristics of patients is important for the successful implementation of the training. And the use of carefully selected indicators and diagnostic methods allows for more accurate tracking of individual changes and dynamics of cognitive functions.

The limitations of our study, such as age, comorbidity, length of illness, neurotoxic treatment regimens, and other factors, indicate the need for further longitudinal and experimental studies to better analyze the effects of training. Also, as the study participants increase, the task is to evaluate the effectiveness of training for patients depending on the degree of cognitive and emotional impairments.