Assessing potential reinforcement-like effects of brief stimuli unrelated to food reinforcers

It is widely assumed that reinforcers are biologically relevant stimuli, or stimuli that have been associated with biologically relevant stimuli. However, brief, arbitrary stimuli have also been reported to have reinforcement-like effects, despite being unrelated to biologically relevant stimuli like food. The present study explored the potential reinforcement-like effects of brief stimuli across 5 experiments. In Experiments 1 through 4, pigeon subjects responded for food reinforcement and brief stimulus presentations in a 2-component multiple schedule. Neither baseline response rates nor resistance to change during disruption tests were systematically greater in a component with versus without brief stimulus presentations. Increasing the rate and duration of brief stimulus presentations in Experiment 4 did not reveal reinforcement-like effects when compared directly with food. In Experiment 5, pigeons chose between independent terminal links in a concurrent-chains procedure. Across conditions, varying the location, duration, and rate of brief stimulus presentations in the terminal links had no systematic effects on preference. In contrast, varying rates of food reinforcers resulted in large and reliable shifts in preference. Therefore, the present study found no systematic evidence that brief stimuli unrelated to food reliably increase response rates, resistance to change, or preference. These data demonstrate the value of systematic replication, and a behavioral momentum approach to assessing potential reinforcement-like effects.     

Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy.

OBJECTIVE: Compare the efficacy of a multicomponent social support intervention to standard-of-care counseling on medication adherence among HIV-infected patients initiating antiretroviral therapy. DESIGN: Randomized controlled trial. Generalized estimating equations tested for differences in the percentage of participants achieving 90% adherence. MAIN OUTCOME MEASURES: Pill-taking, electronically monitored over 6 consecutive months; plasma viral load (VL), assessed at 3 and 6 months following initiation of therapy. RESULTS: Of 226 participants who were randomized and began the trial, 87 (38%) were lost to the study by 6 months. The proportion of adherent participants declined steadily over time, with no time by group interaction. Sustained adherence was associated with increased odds of achieving an undetectable VL (OR=1.78; 95% CI=1.01, 3.13). In intention-to-treat analyses, a larger proportion of the intervention group than the control group was adherent (40.15% vs. 27.59%, p=.02) and achieved an undetectable VL p=.04). However, the majority of participants who remained on study experienced some reduction in VL (>or=1-log drop or undetectable), regardless of experimental condition. CONCLUSION: The multicomponent social support intervention significantly improved medication adherence over standard-of-care counseling; evidence for improved virologic outcomes was inconsistent. Early discontinuation of care and treatment may be a greater threat to the health of HIV patients than imperfect medication-taking.