Patient Adherence With Medical Treatment Regimens: An Interactive Approach

Inadequate patient adherence to treatment regimens is a ubiquitous problem in health care and carries a profound personal, societal, and economic cost. This article illustrates a general theoretical framework we believe to be useful for the interpretation, conception, and design of adherence research. The core tenet of this framework is that factors that influence adherence can be better understood by considering the interactive effects of patients' characteristics, type of adherence intervention, and characteristics of the illness and medical treatment context. This framework represents an extension and application of previous theory and research from personality, social, and clinical psychology concerning the value of an interactionalist perspective. We illustrate the framework using some of our past work involving treatment adherence among patients with chronic renal failure.     

Creative Fixation is No Laughing Matter: The Effects of Funny and Unfunny Examples on Humor Production

How do people come up with humorous ideas? In creative cognition research, exposure to good examples sometimes causes fixation (people get “stuck” on the examples) but other times sparks inspiration (people's responses are more creative). The present research examined the effects of funny and unfunny examples on joke production. A sample of 175 adults read scenarios that they completed with funny responses. All participants were instructed to be funny, but before responding they read (a) funny responses as examples of good responses to emulate, (b) unfunny responses as examples of poor responses to avoid, or (c) no examples. The participants’ own responses were rated for funniness and for similarity to the example responses, and response times were recorded. Reading either funny or unfunny examples, compared to no examples, caused people to come up with funnier jokes. Similarity to the examples was low in all conditions, so fixation was relatively modest, but people who saw unfunny examples spent more time coming up with their responses. Taken together, the findings support the growing literature showing that examples are often inspiring rather than constraining, and they imply that good and bad examples spark creative thought via different paths.     

Recalling a floor routine: the effects of skill and age on memory for order

Two studies were conducted to examine gymnasts' memory capabilities in relation to skill level (high and low) and age level (6–8 years and 14–16 years). The first experiment consisted of two trials performed 7 days apart. In the first trial, gymnasts were briefly exposed to a twelve‐element floor routine, and were then required to perform the routine in the same serial order. One week later they were again briefly presented the same sequence, but with the fifth and seventh elements missing. The task was to perform the sequence in order, including the missing elements. The second study involved three trials that were conducted on the same day. A ten‐element sequence was briefly presented on the first trial followed by an immediate test of that sequence. One hour later, participants were asked to perform the sequence again (delayed test). An hour following that, the sequence was again presented with two elements missing. The sequence had to be performed with the missing elements. The results indicate that serial position accuracy of a gymnastic floor routine improves with both age and experience, and that the older experienced gymnasts outperformed all the other gymnasts on all phases of the experiments. These results are interpreted within the Ericsson and Kintsch (1995) theory of Long‐term Working Memory. Copyright © 1999 John Wiley & Sons, Ltd.     

Self-directedness: A Process Approach to Cognition

Standard approaches to cognition emphasise structures (representations and rules) much more than processes, in part because this appears to be necessary to capture the normative features of cognition. However the resultant models are inflexible and face the problem of computational intractability. I argue that the ability of real world cognition to cope with complexity results from deep and subtle coupling between cognitive and non-cognitive processes. In order to capture this, theories of cognition must shift from a structural rule-defined conception of cognition to a thoroughgoing embedded process approach.     

Low-level relationship aggression and couple therapy outcomes.

Increasing evidence supports the efficacy of conjoint therapies that focus on intimate partner violence for couples who engage in mild to moderate physical aggression but want to preserve the relationship and end the aggression. However, there has been no examination of how this population responds to couple therapy that does not have a specific focus on aggression. This lacuna in the research literature is of concern because couples with a history of low-level aggression often seek couple therapy, but couple therapy without a focus on violence is thought to potentially exacerbate aggression. In the current study, the authors examined the efficacy of non-aggression-focused behavioral couple therapy for couples with and without a history of mild physical aggression. One hundred thirty-four couples, 45% of whom had experienced low-level aggression in the year prior to therapy, completed up to 26 sessions of couple therapy and 2 years of follow-up assessments. Results demonstrated no significant differences in relationship and individual outcomes by history of aggression. In addition, couples maintained very low levels of physical aggression during and after treatment and showed reductions in psychological aggression when relationship and individual functioning improved.     

Brain correlates of aesthetic expertise: a parametric fMRI study

Several studies have demonstrated that acquired expertise influences aesthetic judgments. In this paradigm we used functional magnetic resonance imaging (fMRI) to study aesthetic judgments of visually presented architectural stimuli and control-stimuli (faces) for a group of architects and a group of non-architects. This design allowed us to test whether level of expertise modulates neural activity in brain areas associated with either perceptual processing, memory, or reward processing. We show that experts and non-experts recruit bilateral medial orbitofrontal cortex (OFC) and subcallosal cingulate gyrus differentially during aesthetic judgment, even in the absence of behavioural aesthetic rating differences between experts and non-experts. By contrast, activity in nucleus accumbens (NAcc) exhibits a differential response profile compared to OFC and subcallosal cingulate gyrus, suggesting a dissociable role between these regions in the reward processing of expertise. Finally, categorical responses (irrespective of aesthetic ratings) resulted in expertise effects in memory-related areas such as hippocampus and precuneus. These results highlight the fact that expertise not only modulates cognitive processing, but also modulates the response in reward related brain areas.     

The relationship of analogical distance to analogical function and preinventive structure: the case of engineering design

Analogy was studied in real-world engineering design, using the in vivo method. Analogizing was found to occur frequently, entailing a roughly equal amount of within- and between-domain analogies. In partial support for theories of unconscious plagiarism (Brown & Murphy, 1989; Marsh, Landau, & Hicks, 1996) and Ward's (1994) path-of-least-resistance model, it was found that the reference to exemplars (in the form of prototypes) significantly reduced the number of between-domain analogies between source and target, as compared with using sketches or no external representational systems. Analogy served three functions in relation to novel design concepts: identifying problems, solving problems, and explaining concepts. Problem identifying analogies were mainly within domain, explanatory analogies were mainly between domain, and problem-solving analogies were a mixture of within- and between-domain analogies.