A systematic review of interventions for anxiety in people with HIV

People with human immunodeficiency virus (HIV) show elevated anxiety levels compared to the general population. Anxiety can predate HIV infection or be triggered by HIV diagnosis and the many stresses that emerge during the course of HIV disease. Many psychological and pharmacological therapies have been shown to treat anxiety in the general population but a systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review examines all published intervention studies on anxiety and HIV from 1980 to 2009 covered by the databases MedLine (1980-2009) and PsycINFO (1980-2009) for a definitive account of effectiveness of interventions and an indication of prevalence of HIV-related anxiety and measurement within studies. Standard systematic research methods were used to gather quality published papers on HIV and anxiety, searching published data bases according to quality inclusion criteria. From the search, 492 papers were generated and hand searched resulting in 39 studies meeting adequacy inclusion criteria for analysis. Of these, 30 (76.9%) were implemented in North America (the USA and Canada), with little representation from developing countries. Thirty-three (84.6%) studies recruited only men or mostly men. A total of 50 interventions were investigated by the 39 studies; 13 targeted HIV, symptoms or associated outcomes/conditions, 20 directly targeted anxiety and another 17 indirectly targeted anxiety. Twenty-four (48%) interventions were effective in reducing anxiety (including 11 indirect interventions), 16 (32%) were ineffective and 10 (20%) had an unknown effect on anxiety. Sixty-five percent of interventions directly targeting anxiety were effective. Psychological interventions (especially cognitive behavioural stress management interventions and cognitive behavioural therapy) were generally more effective than pharmacological interventions. Only three studies provided prevalence rates - these ranged from 13% to 80%. Anxiety was measured using 16 different instruments. Our detailed data suggest that interventions are both effective and available, although further research into enhancing efficacy would be valuable. Also, the vast majority of studies were Western-based, no studies looked at children or adolescents and few looked specifically at women. An international effort to harmonise measurement of anxiety is also missing. There is a need to routinely log anxiety in those with HIV infection during the course of their disease, to provide specific data on women, young people and those in diverse geographic areas and incorporate management into care protocols.     

Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients

This study examines the efficacy of a short-term individual therapy, Manual Assisted Cognitive Treatment (MACT), which was developed to treat parasuicidal (suicidal or self-harming) patients. In this trial, MACT was modified to focus on deliberate self-harm (DSH) in patients with borderline personality disorder (BPD). Thirty BPD patients who were engaged in DSH while in ongoing treatments, i.e., treatment-as-usual (TAU), were randomly assigned to receive MACT (N = 15) or not. DSH and level of suicide ideation were assessed at the baseline, at completion of the MACT intervention, and six months later. Results indicated that MACT was associated with significantly less frequent DSH upon completion of the intervention and with significantly decreased DSH frequency and severity at the six months follow-up. Moreover, MACT's contribution to reducing DSH frequency and severity was greater than the contribution by the amount of concurrent treatments. In contrast, MACT did not affect the level of suicide ideation and time-to-repeat of DSH. In conclusion, MACT seems to be a promising intervention for DSH in patients with BPD. More definitive studies are needed.     

Structural packaging in the input to language learning: Contributions of prosodic and morphological marking of phrases to the acquisition of language

The linguistic input to language learning is usually thought to consist of simple strings of words. We argue that input must also include information about how words group into syntactic phrases. Natural languages regularly incorporate correlated cues to phrase structure, such as prosody, function words, and concord morphology. The claim that such cues are necessary for successful acquisition of syntax was tested in a series of miniature language learning experiments with adult subjects. In each experiment, when input included some cue marking the phrase structure of sentences, subjects were entirely successful in learning syntax; in contrast, when input lacked such a cue (but was otherwise identical), subjects failed to learn significant portions of syntax. Cues to phrase structure appear to facilitate learning by indicating to the learner those domains within which distributional analyses may be most efficiently pursued, thereby reducing the amount and complexity of required input data. More complex target systems place greater premiums on efficient analysis; hence, such cues may be even more crucial for acquisition of natural language syntax. We suggest that the finding that phrase structure cues are a necessary aspect of language input reflects the limited capacities of human language learners; languages may incorporate structural cues in part to circumvent such limitations and ensure successful acquisition.     

Learning at a distance I. Statistical learning of non-adjacent dependencies

In earlier work we have shown that adults, young children, and infants are capable of computing transitional probabilities among adjacent syllables in rapidly presented streams of speech, and of using these statistics to group adjacent syllables into word-like units. In the present experiments we ask whether adult learners are also capable of such computations when the only available patterns occur in non-adjacent elements. In the first experiment, we present streams of speech in which precisely the same kinds of syllable regularities occur as in our previous studies, except that the patterned relations among syllables occur between non-adjacent syllables (with an intervening syllable that is unrelated). Under these circumstances we do not obtain our previous results: learners are quite poor at acquiring regular relations among non-adjacent syllables, even when the patterns are objectively quite simple. In subsequent experiments we show that learners are, in contrast, quite capable of acquiring patterned relations among non-adjacent segments-both non-adjacent consonants (with an intervening vocalic segment that is unrelated) and non-adjacent vowels (with an intervening consonantal segment that is unrelated). Finally, we discuss why human learners display these strong differences in learning differing types of non-adjacent regularities, and we conclude by suggesting that these contrasts in learnability may account for why human languages display non-adjacent regularities of one type much more widely than non-adjacent regularities of the other type.     

School Entry After a Community-Wide Trauma: Challenges and Lessons Learned from September 11th, 2001

The purpose of this paper is to describe the implementation of a school-based trauma-specific mental health program in New York City following the terrorist attacks on September 11, 2001. This program aimed to serve children most at risk for developing mental health problems as a result of physical proximity (e.g., evacuation from schools surrounding the World Trade Center) to the trauma. As we present the components of the program, we will review the literature that guided our decision making. The ongoing struggle between searching for answers from established science and immediate needs in a crisis is highlighted. Lastly, a discussion of the lessons learned and recommended next steps is presented.     

Individual Differences in the Effectiveness of Sexual Harassment Awareness Training1

Little research has investigated the effectiveness of sexual harassment awareness training videos on potential harassers' knowledge, behavior, or attitudes. A laboratory study was conducted that assessed the effects of a sexual harassment awareness training video on several training outcomes: sexual harassment knowledge, touching behavior, and attitudes associated with the likelihood of harassing others. Participants' propensity to harass was measured prior to their participation in the study. Results indicated that video-based training increased knowledge acquisition and reduced the inappropriate behavior of men who had a high propensity to harass. However, the training did not influence participants' long-term attitudes associated with the propensity to harass others. The research and practical implications of the study results are discussed.     

Breast Size Perception and Satisfaction,Body Image,and Psychological Functioning in Caucasian and Asian American College Women

Perceived breast size, breast size satisfaction,body image (body satisfaction and generalized appearancesatisfaction) and psychological functioning(self-esteem, self-consciousness, and generalizedappearance preoccupation), as well as stereotyping ofbreast size, were examined in 166 Caucasian and AsianAmerican college women. Caucasian women reportedslightly larger perceived and ideal breast sizes, but no significant group differences for any of theother variables were found; groups were combined forsubsequent analyses. Both large and small breastednesswere associated with lower breast size satisfaction. Hierarchical regression analyses, controllingfor body size (assessed indirectly by a weightpreoccupation measure) and including the interaction ofperceived breast size and breast size satisfaction,yielded main effects for weight preoccupation,perceived breast size, and satisfaction with breastsize, but no interactions. Over and above the effect ofweight preoccupation, smaller perceived breast size was associated with lower breast size satisfactionand with more positive body image, while larger size wasassociated with higher breast size satisfaction and withless positive body image. Lower self-esteem was associated with lower breast sizesatisfaction but not with perceived breast size, whilehigher public self-consciousness, social anxiety, andappearance preoccupation were associated with a mismatch between ideal and perceived size, regardless ofwhether ideal size was smaller or larger than perceivedsize. Implications of these findings are discussedwithin the broader cultural context.     

Computation of Conditional Probability Statistics by 8-Month-Old Infants

A recent report demonstrated that 8-month-olds can segment a continuous stream of speech syllables, containing no acoustic or prosodic cues to word boundaries, into wordlike units after only 2 min of listening experience (Saffran, Aslin, & Newport, 1996). Thus, a powerful learning mechanism capable of extracting statistical information from fluent speech is available early in development. The present study extends these results by documenting the particular type of statistical computation–transitional (conditional) probability–used by infants to solve this word-segmentation task. An artificial language corpus, consisting of a continuous stream of trisyllabic nonsense words, was presented to 8-month-olds for 3 min. A postfamiliarization test compared the infants' responses to words versus part-words (trisyllabic sequences spanning word boundaries). The corpus was constructed so that test words and part-words were matched in frequency, but differed in their transitional probabilities. Infants showed reliable discrimination of words from part-words, thereby demonstrating rapid segmentation of continuous speech into words on the basis of transitional probabilities of syllable pairs.     

A Prototype Matching Approach to Understanding the Role of Applicant Gender and Age in the Evaluation of Job Applicants1

This research uses a prototype matching approach to understand how job applicant evaluations are made and the role that applicant gender and age play in these evaluations. It is hypothesized that raters represent information about jobs and jobholders in person-in-job prototypes. Raters evaluate applicants by matching information about applicants to the person-in-job prototype associated with the job for which the applicant is applying. Person-in-job prototypes are comprised of features that are more (i.e., central) or less (i.e., peripheral) strongly associated with the prototype. Three laboratory studies examined several hypotheses derived from a prototype matching approach. Results indicated that applicants who matched on more central features were evaluated more favorably than applicants who matched on fewer central features of person-in-job prototypes. In addition, applicants who matched on age were evaluated more favorably than applicants who did not match on age when age was a central but not a peripheral feature of a person-in-job prototype. However, applicants who matched on gender were not evaluated differently from applicants who did not match on gender when gender was a central or a peripheral feature of a person-in-job prototype. Finally, there was some evidence that raters used applicant gender in a complex manner when evaluating applicants. Implications for theory and research on bias in selection are discussed.     

Self-referential tags in the discourse of people with Alzheimer's disease

In a study of the discourse of 100 people with Alzheimer's disease treated for 12 months with donepezil, we observed that, as a group, they used a form of tag, described here as a self-referential tag (SRT), 14 times more frequently than did caregivers. Patients use SRTs to check propositions dependent on episodic memory as in I haven't seen the doctor recently, have I? and to monitor information flow as in I told you that already, didn't I? Based on criteria developed for distinguishing checking from monitoring tags, we document the type and frequency of patients' SRT use in the ACADIE corpus and analyze these in relation to standard measures of cognitive function (Mini Mental State Exam and Alzheimer's Disease Assessment Scale-cognitive sub-scale) at baseline and 12 months. Patients using monitoring SRTs (N=31), with or without checking SRTs, show significantly better cognitive test scores at 12 months, than are seen in patients who never use tags (N=29), or who only use checking tags (N=40). SRT use may be an independent measure of potential treatment responsiveness.