Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring

Advances in the medical treatment of HIV have made it clear that adherence to highly active antiretroviral treatment is a crucial feature for treatment success. The present paper had two goals: (1) to examine psychosocial predictors of adherence in persons receiving HIV antiretroviral therapy; (2) to compared two minimal-treatment interventions to increase HIV medication adherence in a subset of persons who self-reported less than perfect adherence. One of the interventions, Life-Steps, is a single-session intervention utilizing cognitive-behavioral, motivational interviewing, and problem-solving techniques. The other intervention, self-monitoring, utilizes a pill-diary and an adherence questionnaire alone. Significant correlates of adherence included depression, social support, adherence self-efficacy, and punishment beliefs about HIV. Depression was a significant unique predictor of adherence over and above the other variables. Both interventions yielded improvement in adherence from baseline, and the Life-Steps intervention showed faster improvements in adherence for persons with extant adherence problems.     

Mediators in psychological treatment of social anxiety disorder: Individual cognitive therapy compared to cognitive behavioral group therapy

According to cognitive-behavioral models of social anxiety disorder (SAD), four of the important maintaining mechanisms are avoidance, self-focused attention, anticipatory processing and post-event cognitive processing. Individual cognitive therapy (ICT) and cognitive behavioral group therapy (CBGT) both have substantial empirical support. However, it is unclear whether they achieve their effects by similar or different mechanisms. The aim of this study was to investigate whether changes in the four maintenance processes mediate clinical improvement in ICT and CBGT for SAD. We analyzed data from participants (N = 94) who received either ICT or CBGT in two separate RCTs. The results showed that ICT had larger effects than CBGT on social anxiety and each of the four potential mediators. More pertinently, moderated mediation analyses revealed significant between-treatment differences. Whereas improvement in ICT was mainly mediated by reductions in avoidance and self-focused attention, improvement in CBGT was mediated by changes in self-focused attention and in anticipatory and post-event processing. These results support the importance of the putative mediators, but suggest that their relative weights are moderated by treatment type.     

认知行为治疗的生物学机制

现阶段认知行为治疗的生物学机制尚不明确。本文将从脑功能、神经电生理、神经内分泌与免疫以及遗传与表观遗传这四个方面对认知行为治疗的生物学机制进行讨论, 综合心理、生理和遗传三方面的结果, 从微观、中间和宏观多层面提出了认知行为治疗生物学机制的整合模型。并进一步对目前研究的局限性进行了讨论, 为未来探究认知行为治疗的生物学机制提供了新的方向。     

Improving adherence to fluid restrictions in male hemodialysis patients: a comparison of cognitive and behavioral approaches.

A cognitive intervention and a behavioral intervention were compared to determine their relative effectiveness in reducing interdialytic weight gain (IWG) among eight adult male hemodialysis patients. The behavioral model consisted of positive reinforcement, shaping, and self-monitoring. The cognitive model consisted of a counseling intervention designed to modify health beliefs. Three small-sample experimental studies showed that both interventions produced immediate reductions in IWG. However, the behavioral intervention was superior to the cognitive intervention in producing maintenance of reduced weight gain. Combining the interventions resulted in no improvement over the behavioral intervention alone. Continuation of self-monitoring procedures produced maintenance of improvements up to 2 months posttreatment. Repeated-measures analysis of variance showed changes for only the "barriers" dimension of the health belief model (Hartman & Becker, 1978) (p < .001), and this occurred only following or concurrent with adherence behavior change. Suggestions for treatment and future research are offered.     

Feasibility of telephone-based cognitive behavioral therapy targeting major depression among urban dwelling African-American people with co-occurring HIV

Given the burden of depression among those with HIV, and the impact of HIV on urban minority communities there is an urgent need to assess innovative treatment interventions that not only treat depression but do so in a way that allows for increased access to mental health care. This single site, uncontrolled, pilot study sought to determine the feasibility and depression outcomes of an 11-session telephone-based cognitive behavioral therapy intervention delivered over 14 weeks targeting low-income, urban-dwelling, HIV-infected African-American people with major depression. The diagnosis of major depression was made using the Mini International Neuropsychiatric Interview. The primary outcome was the Hamilton Depression Rating Scale (HAM-D) and the secondary outcome was the Quick Inventory of Depression Symptomatology-Self Report (QIDS-SR). Feasibility and satisfaction were also assessed. Assessments occurred at baseline, midpoint and at study conclusion (14 weeks). Fifteen people were screened for the study. Six HIV-infected, low-income, African-American people individuals (five females and one male) were eligible and participated in the study. All patients finished the study. On average, participants completed nine sessions. The sessions lasted for an average of 48 min (SD = 11.5). Compared to mean HAM-D score at baseline (HAM-D = 22.8 (SD = 3.1), the mean HAM-D score was significantly reduced at study conclusion (HAM-D = 9.8 (SD = 7.4); (t (5) = 4.6, p = 0.006); (Cohen d = 1.9)). Compared to the mean QIDS-SR score at baseline (QIDS-SR = 15.5 (SD = 4.2) the mean QIDS score was significantly reduced at study conclusion (QIDS = 7.0 (SD = 5.4);(t (5) = 3.2, p = 0.02); (Cohen d = 1.3)).The mean satisfaction scores across all participants at post-treatment was 5.7 (SD = 0.3) with of a maximum score of 6. Telephone-based CBT can be delivered to low-income, urban-dwelling ethnic minority HIV-infected people resulting in significant reductions in depression symptoms with high satisfaction. The efficacy of this intervention will be assessed in a planned randomized control trial.     

Applying behavioral theory to practice: an examination of the behavioral momentum metaphor

This paper discusses some of the difficulties that arise in the practical applications of theories derived from specific experimental settings. Nevin's metaphoric extension of the physical concept of momentum to modifying behavior (i.e., behavioral momentum) is used as a recent example. Problems in the application of behavioral momentum are discussed, alternative analyses are offered, and methods for further testing the process are suggested. ©1997 John Wiley & Sons, Ltd.     

Electronic monitoring and counseling to improve medication adherence

Electronic caps, pill caps that record the date and time of pill bottle opening provide an objective measure of adherence to prescribed medication. A promising intervention to improve adherence, cue-dose training, involves reviewing patients' pill cap-generated reports concerning their medication-taking and offering individualized recommendations for remembering to take medications at specific times of day. In this preliminary study, 79 patients prescribed the antihyperglycemic medication metformin had adherence assessed during a 4-week baseline period. Adherence, defined as proportion of prescribed doses taken within a predetermined 4-h window, was measured using electronic MEMS caps. Those who had less than 80% baseline adherence (n = 33) were randomly assigned to either receive 4 months of cue-dose training (n = 16) or to a control group (n = 17). Cue-dose training was associated with significantly better adherence to metformin (mean improvement of 15%). The effects of cue-dose training on adherence to other antihyperglycemic medication did not reach statistical significance. Glycosylated hemoglobin (a measure of blood sugar control) did not differ between groups. Data from nine patients who reviewed pill cap-generated data with their primary care providers suggested that both patients and providers found the discussion moderately helpful and not at all uncomfortable.     

Strategies included in cognitive behavioral therapy programs to treat internalized disorders: a systematic review

This review aimed to identify the strategies used in programs based on cognitive behavioral therapy (CBT) to prevent and treat symptoms of anxiety, depression, and internalized behaviors of children and adolescents. Based on an online search (ERIC, PsycInfo, Virtuose UQAM, and Google Scholar), 61 studies describing different cognitive behavioral programs were selected. Results showed that 40 strategies were implemented in at least one program. However, none of the strategies were systematically present in all programs, and only few were reported in more than 50% of the studies. Cognitive restructuring and problem-solving were the most popular strategies to treat depressive symptoms, whereas anxiety programs also generally included relaxation and exposure. Furthermore, six strategies were identified in a single anxiety program, whereas nine strategies were implemented in only one depression program. These results suggest that in anxiety and depression programs designed for children and adolescents, the label “CBT” encompasses a wide variety of programs with only few similar strategies. Such findings highlight the need to define a common basis for CBT programs, in order to better reflect CBT theory and to identify the effectiveness of the strategies included in these programs.     

Persuasive communications to change actions: an analysis of behavioral and cognitive impact in HIV prevention.

This meta-analysis examined the validity of various theoretical assumptions about cognitive and behavioral change following a communication recommending condom use. The synthesis comprised 82 treatment and 29 control groups included in 46 longitudinal reports with measures of perceived severity and susceptibility, attitudes and expectancies, norms, perceptions of control, intentions, knowledge, behavioral skills, or condom use. Results indicated that across the sample of studies, communications taught recipients about facts related to HIV and also induced favorable attitudes and expectancies, greater control perceptions, and stronger intentions to use condoms in the future. Moreover, messages that presented attitudinal information and modeled behavioral skills led to increased condom use. Results are discussed in the context of theories of human behavior and change and in reference to HIV-prevention interventions.