Clinical Focus

  • Psychology
  • Anxiety Disorders
  • Mood Disorders
  • Caregivers
  • Cancer of Lung
  • HIV prevention (primary and secondary)
  • Cognitive Therapy
  • Cognitive Behavior Therapies

Academic Appointments

  • Clinical Assistant Professor, Psychiatry and Behavioral Sciences

Professional Education

  • Fellowship:Harvard Medical School-Massachusetts General Hospital (2012) MA
  • Internship:Harvard Medical School-Massachusetts General Hospital (2008) MA
  • Medical Education:University of California Los Angeles School of Medicine (2008) CA

Research & Scholarship

Current Research and Scholarly Interests

Dr. Hendriksen’s research develops and tests cognitive-behavioral therapy (CBT) interventions to reduce distress and improve quality of life in patients with chronic illness, including HIV and cancer. Her current project aims to develop a brief CBT intervention to reduce anxiety in patients with metastatic non-small-cell lung cancer and their informal family caregivers. Clinically, Dr. Hendriksen treats mood and anxiety disorders, particularly in patients with chronic medical illness.

Clinical Trials

  • Cognitive Behavioral Therapy in Treating Anxiety in Patients With Stage IV Non-Small Cell Lung Cancer and Their Caregivers Not Recruiting

    This pilot clinical trial studies cognitive behavioral therapy in treating anxiety in patients with stage IV non-small cell lung cancer and their caregivers. Cognitive behavioral therapy may reduce anxiety and improve the well-being and quality of life of patients who have stage IV non-small cell lung cancer and their caregivers.

    Stanford is currently not accepting patients for this trial. For more information, please contact Ellen Hendriksen, 650-725-5424.

    View full details


Journal Articles

  • A Pilot Randomized Controlled Trial of Brief Cognitive-Behavioral Therapy for Anxiety in Patients with Terminal Cancer ONCOLOGIST Greer, J. A., Traeger, L., Bemis, H., Solis, J., Hendriksen, E. S., Park, E. R., Pirl, W. F., Temel, J. S., Prigerson, H. G., Safren, S. A. 2012; 17 (10): 1337-1345


    Patients with terminal cancer often experience marked anxiety that is associated with poor quality of life. Although cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety disorders, the approach needs to be adapted to address realistic concerns related to having cancer, such as worries about disease progression, disability, and death. In this pilot randomized controlled trial ( identifier NCT00706290), we examined the feasibility and potential efficacy of brief CBT to reduce anxiety in patients with terminal cancer.We adapted CBT by developing treatment modules targeting skills for relaxation, coping with cancer worries, and activity pacing. Adults with incurable malignancies and elevated anxiety based on the Hamilton Anxiety Rating Scale (HAM-A) were randomly assigned to individual CBT or a waitlist control group. Primary outcomes included the number of completed CBT visits and the change in HAM-A scores from baseline to 8-week follow-up per a treatment-blind evaluator. The feasibility criterion was 75% adherence to the intervention.We randomized 40 patients with terminal cancers to CBT (n = 20) or waitlist control (n = 20) groups; 70% completed posttreatment assessments. Most patients who received CBT (80%) participated in at least five of the required six therapy sessions. Analysis of covariance models, adjusted for baseline scores, showed that those assigned to CBT had greater improvements in HAM-A scores compared to the control group, with an adjusted mean difference of -5.41 (95% confidence interval: -10.78 to -0.04) and a large effect size for the intervention (Cohen's d = 0.80).Providing brief CBT tailored to the concerns of patients with terminal cancer was not only feasible but also led to significant improvements in anxiety.

    View details for DOI 10.1634/theoncologist.2012-0041

    View details for Web of Science ID 000310500600017

    View details for PubMedID 22688670

  • Quality of Life Among Individuals with HIV Starting Antiretroviral Therapy in Diverse Resource-Limited Areas of the World AIDS AND BEHAVIOR Safren, S. A., Hendriksen, E. S., Smeaton, L., Celentano, D. D., Hosseinipour, M. C., Barnett, R., Guanira, J., Flanigan, T., Kumarasamy, N., Klingman, K., Campbell, T. 2012; 16 (2): 266-277


    As Antiretroviral Therapy (ART) is scaled up in low- and middle-income countries, it is important to understand Quality of Life (QOL) correlates including disease severity and person characteristics and to determine the extent of between-country differences among those with HIV. QOL and medical data were collected from 1,563 of the 1,571 participants at entry into a randomized clinical trial of ART conducted in the U.S. (n = 203) and 8 resource-limited countries (n = 1,360) in the Caribbean, South America, Asia, and Africa. Participants were interviewed prior to initiation of ART using a modified version of the ACTG SF-21, a health-related QOL measure including 8 subscales: general health perception, physical functioning, role functioning, social functioning, cognitive functioning, pain, mental health, and energy/fatigue. Other measures included demographics, CD4+ lymphocyte count, plasma HIV-1 RNA viral load. Higher quality of life in each of the 8 QOL subscales was associated with higher CD4+ lymphocyte category. General health perception, physical functioning, role functioning, and energy/fatigue varied by plasma HIV-1 RNA viral load categories. Each QOL subscale included significant variation by country. Only the social functioning subscale varied by sex, with men having greater impairments than women, and only the physical functioning subscale varied by age category. This was the first large-scale international ART trial to conduct a standardized assessment of QOL in diverse international settings, thus demonstrating that implementation of the behavioral assessment was feasible. QOL indicators at study entry varied with disease severity, demographics, and country. The relationship of these measures to treatment outcomes can and should be examined in clinical trials of ART in resource-limited settings using similar methodologies.

    View details for DOI 10.1007/s10461-011-9947-5

    View details for Web of Science ID 000300278300003

    View details for PubMedID 21499794

  • Childhood Sexual Abuse and Health Risk Behaviors in Patients with HIV and a History of Injection Drug Use AIDS AND BEHAVIOR Markowitz, S. M., O'Cleirigh, C., Hendriksen, E. S., Bullis, J. R., Stein, M., Safren, S. A. 2011; 15 (7): 1554-1560


    Childhood sexual abuse (CSA) is related to poorer health outcomes, associated with increased risk for HIV acquisition, and prevalent among HIV risk groups. Links between CSA and health behavior are an important health concern. We examined the relationship between CSA and transmission risk behavior and medication adherence in 119 HIV-infected individuals with an injection drug use history. 47% reported CSA, with no gender difference. Individuals who experienced CSA were more likely to report sexual HIV transmission risk behavior in the past 6 months, more sexual partners, use of heroin in the past 30 days, and worse adherence to HIV medication than those who did not. These findings confirm that rates of CSA are high in this population, and suggest that a history of CSA may place people managing both HIV and opioid dependence at increased risk for HIV transmission, poor adherence to medication, and vulnerability to substance use relapse.

    View details for DOI 10.1007/s10461-010-9857-y

    View details for Web of Science ID 000295271200029

    View details for PubMedID 21161362

  • Primary prevention lessons learned from those with HIV in Chennai, India SEXUAL HEALTH Hendriksen, E. S., Krishnan, A. K., Vallabhaneni, S., Johnson, S., Raminani, S., Kumarasamy, N., Solomon, S., Mayer, K. K., Safren, S. S. 2011; 8 (2): 199-206


    As each HIV-infected individual represents a breakdown of HIV primary prevention measures, formative data from representative individuals living with HIV can help shape future primary prevention interventions. Little is known about sexual behaviours and other transmission risk factors of high-risk group members who are already HIV-infected in Chennai, India.Semi-structured qualitative interviews were conducted with 27 HIV-infected individuals representing each high-risk group in Chennai (five men who have sex with men (MSM), five female commercial sex workers (CSW), four truckers and other men who travel for business, four injecting drug users (IDU), five married male clients of CSW, and four wives of CSW clients, MSM, truckers, and IDU).Themes relevant to HIV primary prevention included: (1) HIV diagnosis as the entry into HIV education and risk reduction, (2) reluctance to undergo voluntary counselling and testing, (3) gender and sexual roles as determinants of condom use, (4) misconceptions about HIV transmission, and (5) framing and accessibility of HIV education messages.These qualitative data can be used to develop hypotheses about sexual risk taking in HIV-infected individuals in South India, inform primary prevention intervention programs, and improve primary prevention efforts overall.

    View details for DOI 10.1071/SH10015

    View details for Web of Science ID 000290771500010

    View details for PubMedID 21592434

  • Keep Talking About It: HIV/AIDS-Related Communication and Prior HIV Testing in Tanzania, Zimbabwe, South Africa, and Thailand AIDS AND BEHAVIOR Hendriksen, E. S., Hlubinka, D., Chariyalertsak, S., Chingono, A., Gray, G., Mbwambo, J., Richter, L., Kulich, M., Coates, T. J. 2009; 13 (6): 1213-1221


    Informal, interpersonal communication within a community about HIV and AIDS, or lack of such communication, may influence community members' uptake of voluntary counseling and testing. Drawing from Noelle-Neumann's spiral of silence theory, this study examined the association between communication about HIV/AIDS and prior HIV testing in communities in Tanzania, Zimbabwe, South Africa, and Thailand. Participants (N = 14,818) in 48 communities across five sites throughout the four countries completed a behavioral survey assessing communication, prior voluntary counseling and testing (VCT) uptake, social norms, stigma, and sexual risk. Site-specific logistic regression models demonstrated that frequent conversations about HIV were significantly associated with prior HIV testing at every site. Odds ratios for each site ranged from 1.885 to 3.085, indicating a roughly doubled or tripled chance of past VCT uptake. Results indicate that verbal communication may be an important mechanism for increasing health behaviors and inclusion in future interventions should be considered.

    View details for DOI 10.1007/s10461-009-9608-0

    View details for Web of Science ID 000272298900020

    View details for PubMedID 19760154

  • Latinos and HIV/AIDS: Examining Factors Related to Disparity and Identifying Opportunities for Psychosocial Intervention Research AIDS AND BEHAVIOR Gonzalez, J. S., Hendriksen, E. S., Collins, E. M., Duran, R. E., Safren, S. A. 2009; 13 (3): 582-602


    Latinos maintain an AIDS case rate more than 3 times higher than whites, a greater rate of progression to AIDS, and a higher rate of HIV/AIDS-related deaths. Three broad areas are reviewed related to these disparities: (1) relevant demographic, socioeconomic, and socio-cultural factors among Latinos; (2) drug abuse and mental health problems in Latinos relevant to HIV/AIDS outcomes; and (3) opportunities for psychosocial intervention. Latinos living with HIV are a rapidly growing group, are more severely impacted by HIV than whites, and confront unique challenges in coping with HIV/AIDS. A body of research suggests that depression, substance abuse, treatment adherence, health literacy, and access to healthcare may be fruitful targets for intervention research in this population. Though limited, the current literature suggests that psychosocial interventions that target these factors could help reduce HIV/AIDS disparities between Latinos and whites and could have important public health value.

    View details for DOI 10.1007/s10461-008-9402-4

    View details for Web of Science ID 000266336900021

    View details for PubMedID 18498050

  • Sexual behaviors of individuals with HIV living in south India: A qualitative study AIDS EDUCATION AND PREVENTION Krishnan, A. K., Hendriksen, E., Vallablianem, S., Johnson, S. L., Raminani, S., Kumarasamy, N., Hobsen, J., Solomon, S., Mayer, K. H., Safren, S. A. 2007; 19 (4): 334-345


    Formative data on the sexual behaviors of HIV-infected individuals in regions disproportionately affected by the epidemic can help generate hypotheses about sexual risk taking in HIV-infected individuals and shape interventions to prevent further transmission. India is home to the highest number of HIV-infected individuals in the world, and very little information is available about the sexual behaviors of HIV-infected Indians. The present qualitative study presents themes from individual in-depth interviews with 30 HIV-infected individuals in South India. The sample included individuals from demographic groups that may experience different risk factors (five individuals each: from men who have sex with men, sex workers, married men, married women, injection drug users, and truck drivers ormen who travel for work). Across the groups, the three most frequently discussed themes involved (a) sexual behavior change (sexual risk reduction after HIV diagnosis, sexual behavior remaining safe after initiation of ART treatment), (b) motivations to reduce risk (motivation to protect one's self against further infection, to protect others from infection), and (c) barriers to reduce risk (complexity and stigma associated with condom negotiation, perception of HIV-infected peers being less concerned about protecting others, condom use as linked to gender and sexual roles, condom use as inconvenient or unappealing). This qualitative data can be used to generate hypotheses about sexual risk taking in HIV-infected individuals in South India, to inform models of risky behaviors of HIV-infected individuals for quantitative studies, and to lay the groundwork for secondary prevention intervention efforts that enhance facilitators and reduce barriers of safer sex articulated by the interviewees.

    View details for Web of Science ID 000248821200006

    View details for PubMedID 17685846

  • Predictors of condom use among young adults in South Africa: The Reproductive Health and HIV Research Unit National Youth Survey AMERICAN JOURNAL OF PUBLIC HEALTH Hendriksen, E. S., Pettifor, A., Lee, S., Coates, T. J., Rees, H. V. 2007; 97 (7): 1241-1248


    We examined correlates of condom use among a national random probability sample of sexually experienced young adults aged 15 to 24 years (n = 7686) in South Africa.Using data from the Reproductive Health and HIV Research Unit National Youth Survey, we conducted gender-stratified bivariate and multivariate logistic regression analyses to determine predictors of whether respondents had used a condom during their most recent sexual intercourse.Condom use at sexual debut and talking with one's first sexual partner about condoms were the most significant predictors of condom use at most recent intercourse. Other significant predictors included high condom use self-efficacy, optimism about the future, and reported behavior change attributable to HIV/AIDS. Young adults who were married or had been involved in a relationship for 6 months or more were significantly less likely to have used a condom during their most recent sexual intercourse.Our findings point to the importance of exposing youths to sexuality education before their sexual debut as well as voluntary counseling and testing and programming that supports young adults, particularly young women, in making informed decisions about sexual intercourse and condoms.

    View details for DOI 10.2105/AJPH.2006.086009

    View details for Web of Science ID 000255647800016

    View details for PubMedID 17538062

  • Factors associated with self-efficacy for condom use and sexual negotiation among South African youth JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES Sayles, J. N., Pettifor, A., Wong, M. D., MacPhail, C., Lee, S., Hendriksen, E., Rees, H. V., Coates, T. 2006; 43 (2): 226-233


    To use logistic regression modeling to identify factors associated with high self-efficacy for sexual negotiation and condom use in a sample of South African youth.The Reproductive Health and HIV Research Unit (RHRU) National Youth Survey examined a nationally representative sample of 7409 sexually active South African youth aged 15 to 24 years. We used logistic regression modeling in this sample to identify factors associated with the main outcome of high self-efficacy.Among female respondents (n = 3890), factors associated with high self-efficacy in the adjusted model were knowing how to avoid HIV (odds ratio [OR] = 2.30, 95% confidence interval [CI]: 1.05 to 5.00), having spoken with someone other than a parent or guardian about HIV/AIDS (OR = 1.46, 95% CI: 1.01 to 2.10), and having life goals (OR = 1.28, 95% CI: 1.10 to 1.48). Not using condoms during their first sexual encounter (OR = 0.61, 95% CI: 0.50 to 0.76), a history of unwanted sex (OR = 0.66, 95% CI: 0.51 to 0.86), and believing that condom use implies distrust in one's partner (OR = 0.57, 95% CI: 0.51 to 0.86) were factors associated with low self-efficacy among female respondents. Male respondents (n = 3519) with high self-efficacy were more likely to take HIV seriously (OR = 4.03, 95% CI: 1.55 to 10.52), to believe they are not at risk for HIV (OR = 1.38, 95% CI: 1.12 to 1.70), to report that getting condoms is easy (OR = 1.85, 95% CI: 1.23 to 2.77), and to have life goals (OR = 1.30, 95% CI: 1.10 to 1.54). Not using condoms during their first sexual experience (OR = 0.51, 95% CI: 0.39 to 0.67), a history of having unwanted sex (OR = 0.47, 95% CI: 0.34 to 0.64), believing condom use is a sign of not trusting one's partner (OR = 0.63, 95% CI: 0.46 to 0.87), and refusing to be friends with HIV-infected persons (OR = 0.52, 95% CI: 0.32 to 0.85) were factors associated with low self-efficacy among male respondents in the fully adjusted model.We used the social cognitive model (SCM) to identify factors associated with self-efficacy for condom use and sexual negotiation. Many of these factors are modifiable and suggest potential ways to improve self-efficacy and reduce HIV sexual risk behavior in South African youth.

    View details for Web of Science ID 000240839800014

    View details for PubMedID 16951647

  • Cognitive-behavioral therapy for HIV medication adherence and depression COGNITIVE AND BEHAVIORAL PRACTICE Safren, S. A., Hendriksen, E. S., MAYER, K. H., Mimiaga, M. J., Pickard, R., Otto, M. W. 2004; 11 (4): 415-424
  • Symptoms of posttraumatic stress and death anxiety in persons with HIV and medication adherence difficulties AIDS PATIENT CARE AND STDS Safren, S. A., Gershuny, B. S., Hendriksen, E. 2003; 17 (12): 657-664


    The present study examined the frequency and correlates of self-reported symptoms of posttraumatic stress among patients with HIV and medication adherence problems. Self-report data revealed that more than half of participants met diagnostic criteria for posttraumatic stress disorder (PTSD) according to the Posttraumatic Diagnostic Scale PDS. Death anxiety was associated with overall PTSD symptom severity scores as well as severity scores for reexperiencing, avoidance, and arousal symptoms. The association between death anxiety and total PTSD severity, reexperiencing and avoidance symptom scores remained after controlling for depression and satisfaction with social support. Anxiety, as manifested by PTSD symptoms should be routinely assessed among patients with HIV, and variables such as death anxiety, social support, and depression are appropriate targets for mental health interventions.

    View details for Web of Science ID 000187840000006

    View details for PubMedID 14746659

  • Use of an on-line pager system to increase adherence to antiretroviral medications AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV Safren, S. A., Hendriksen, E. S., DeSousa, N., Boswell, S. L., MAYER, K. H. 2003; 15 (6): 787-793


    Adherence to antiretroviral therapy is critical for treatment success. Antiretroviral therapy typically requires multiple pills at multiple dosing times. To address this, we tested the feasibility, utility, and efficacy of a customizable reminder system using pagers, which were programmed using web-based technology, to increase and maintain proper adherence in patients with pre-existing adherence problems. After a two-week monitoring period with an electronic pill-cap, participants with less than 90% adherence were randomized to continue monitoring or to receive a pager. The group who received the pagers had greater improvements in adherence from baseline to Week 2 and Week 12 than those who monitored their medications only. However, adherence in both groups at the outcome assessments points was still poor. While the provision of a reminder system helped improve adherence, it is likely that more intensive interventions are required for patients with pre-existing problems.

    View details for DOI 10.1080/09540120310001618630

    View details for Web of Science ID 000186546900005

    View details for PubMedID 14617500

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