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.     

Time-based prospective remembering: Interference and facilitation in a dual task

The aim of this study was to analyse prospective memory behaviour when people have to fulfil two different intentions whose retention intervals partially overlapped. More specifically, the purpose of the study was to explore the effects of a secondary PM task (either time-based or event-based) on performance of a main time-based PM task. Four embedded conditions were tested: two event-based ones and two time-based ones. The time- and event-based interpolated tasks differed in how closely their target time was to the 20-minute response required by the main time-based task (16th and 19th min., respectively). The results indicated that when a main time-based prospective memory task shares a portion of the retention interval with a second time-based prospective task, this overlapping facilitated performance on the main task. However, the interpolated tasks appeared to be affected by the moment in which they were administered during the execution of the main time-based task. More specifically, a decrease in the interpolated task performance was observed when this was time-based and had to be executed very closely to the target time of the main task. On the contrary, when the two tasks were different (event-based vs. time-based), there was neither interference, nor facilitation.     

Qualitative differences between implicit and explicit sequence learning

Four experiments investigate the differences between implicit and explicit sequence learning concerning their resilience to structural and superficial task changes. A superficial change that embedded the SRT task in the context of a selection task, while maintaining the sequence, did selectively hinder the expression of implicit learning. In contrast, a manipulation that maintained the task surface, but decreased the sequence validity, affected the expression of learning specifically when it was explicit. These results are discussed in the context of a dynamic framework (Cleeremans & Jiménez, 2002), which assumes that implicit knowledge is specially affected by contextual factors and that, as knowledge becomes explicit, it allows for the development of relevant metaknowledge that modulates the expression of explicit knowledge.     

Multivariate repeated measures designs

In the social, behavioral, and health researches it is a common strategy to collect data along time on more than one group of participants on multiple dependent variables. To analyse this kind of data is very complicated due to the correlations between the measures taken in different points of the time, and between the answers. Usually to analyse these data the multivariate mixed model, or the doubly multivariate model, are the most frequent approaches. Both of them require combined multivariate normality, equal covariance matrices, independence between the observations of different participants, complete measurements on all subjects, and time-independent covariates. When one ore more of these assumptions are not accomplished these approaches do not control in the correct way the Type I error, and this affects the validity and the accuracy of the inferences. In this paper some solutions that solve the problems with the error Type I will be shown. Several programs for a correct realization of the analyses through the SAS Proc Mixed procedure are presented.     

Bryant's Empathy Index for children and adolescents: psychometric properties in the Spanish language

The present study investigated the following issues: (1) the structure of Bryant's Empathy Index for children and adolescents in a Spanish sample of 408 boys and 424 girls (M age=14.4 yr.), and (2) sex differences, including effect sizes and internal consistency of the scale. A principal components factor analysis with oblimin rotation showed that 20 of the index's 22 items load on three robust factors, related to Feelings of Sadness, Understanding Feelings, and Tearful Reaction with regard to the emotions of others. The 3-factor structure obtained an adequate fit to the data in the confirmatory factor analysis. Coefficients alpha ranged between .72 and .78. The 3 factors accounted for 42% of variance. As expected, girls scored higher than boys. It was concluded that the Spanish version of Bryant's Empathy Index has an acceptable reliability and construct validity, making it useful for research.     

Simultaneous multiple stressors in the environment: physiological stress reactions, performance, and stress evaluation

Interactive effects of two environmental stressors when simultaneous ly present, i.e., noise and crowding, were analyzed. Four experimental conditions with two intensities of stress for each stressor (high versus low) were created. The stressors were concurrently introduced in laboratory conditions and their effects analyzed using several methodological approaches. More intense and negative effects were expected when the two highest intensities of noise and crowding concurred. 40 people (20 men and 20 women) participated in a study with a 2 x 2 factorial design. Analysis showed an increase in the measures of hemodynamic, endocrine, and neuroendocrine values of participants after being exposed simultaneously to noise and crowding. Similarly, their performance on complex tasks decreased, and they reported a subjective increase in stress. Capacity to cope was indicated by a statistically significant lower mean on the Dimension of Stress scale, tolerance of frustration during the multiple stress condition.     

Parenting Competency Across Pregnancy and Postpartum Among Urban Minority Women

Taking a life-course perspective, we explored the sense of parenting efficacy during the pregnancy-postpartum transition among a group under-represented in much of adult developmental research, minority women. Our intent was to describe the women's report of parenting competency in a major life transition occurring within the context of an impoverished urban environment. We also explored associations with depression, social support, and life events. One hundred and eighty-two African-American and Hispanic mothers at community health centers in low-income urban areas completed measures early in the third trimester and again at 3 months postpartum. Across time, the levels of reported parental efficacy and satisfaction increased while depressive symptoms decreased. Negative life events and levels of depressive symptomatology differentially influenced women's experience of parenting satisfaction and efficacy feelings before and after their babies were born.     

Accuracy in discriminating blood glucose levels in a sample of children with type 1 diabetes

The present study explores accuracy in estimating blood glucose levels (BGL) in children with type 1 diabetes and analyzes the kinds of symptoms and cues which they use to estimate their BGL. Forty two children with type 1 diabetes completed a SI/IC-3 scale consisting of 28 items (22 symptoms and 6 feelings), indicating those which they perceived at the time and their intensity. They estimated their BGL and gave reasons for their estimation, before having a blood glucose level analysis performed. The results indicated great variability in the accuracy of estimating BGL. They showed failures in the correct discrimination of symptoms of hypoglycemia as well as the presence of false beliefs regarding indicative symptoms of hyperglycemia, and the absence of symptoms as an indicator for euglycemia, beliefs which provoke different and frequent errors in the estimation of BGL. Correct use of external signs is shown to be related to correct estimations of normal BGL, as well as hypoglycemia and hyperglycemia. We discuss the implications these results could have on designing psychological intervention procedures for diabetics in the form of training programs to discriminate BGL accurately, taking into account these findings and previous studies completed in the same field.     

Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study

A total of 480 patients were treated in a large, multicenter randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behavior therapy (MACT) versus treatment as usual (TAU) for recurrent deliberate self-harm. Each patient was randomized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year. The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year. A total of 60% of those allocated to MACT had face-to-face treatment and 430 (90%) of all patients had self-harm data recorded after 1 year. Although the results showed no significant difference between those repeating self-harm in the MACT group (39%) compared with the TAU group (46%) (P = 0.20), the treatment was cost effective (10% cheaper than TAU) and the frequency of self-harm episodes was fewer (50%) in the MACT group. A total of nine of 10 patients had some personality disturbance (42% of these with disorder), and for those where information on parasuicide events was collected, the proportion having a repeat episode ranged from 33% to 63% for different personality disorders. Those with BPD were most likely to repeat episodes quickly (mean 89 days for 25% to repeat) with dissocial personality disorder (equivalent mean 384 days) the slowest to repeat. Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT; this saving was reversed in those with borderline disorder. On average, MACT appeared to increase the cost of those patients with BPD (BPD) and reduce the cost of those with other personality disorders. It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD.     

Individual characteristics and career exploration in adolescence

The effects of gender, age and school grade on several career exploration dimensions measured by the Career Exploration Survey were investigated. Subjects were high school students facing an imminent career decision. Regression analyses indicated that sex and grade-level were the most significant and prevailing individual characteristics related to the adolescents' career exploration behaviours, reactions and beliefs. Implications for career exploration interventions are discussed.