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.     

Introspection and perception

Sydney Shoemaker argues that introspection, unlike perception, provides no identification information about the self, and that knowledge of one's mental states should be conceived as arising in a direct and unmediated fashion from one's being in those states. I argue that while one does not identify aself as the subject of one's states, one does frequently identify and misidentify thestates, in ways analogous to the identification of objects in perception, and that in discourse about one's mental states the self plays the role of external reality in discourse about physical objects. Discourse about any sort of entity or property can be viewed as involving a domain or frame of reference which constrains what can be said about the entities; this view is related to Johnson-Laird's theory of mental models. On my approach evidence, including sensory evidence, may be involved in decisions about one's mental states. I conclude that while Shoemaker may well be right about different roles for sense impressions in introspection and perception, the exact differences and their significance remain to be established.     

Men and women in the clergy: Stresses,strains, and resources

This essay reports a program of research as the occupational and personal stress experienced by contemporary American clergy. Three studies are reported. In the first survey a group of largely Roman Catholic religious reported less stress than the general population. In a replication of this investigation on over 510 Protestant clergy this impression of less experienced stress and greater personal resources was confirmed. In the most recent study of clergy in Southern California, a mixed picture was observed. Although the impression of less overall stress was confirmed, great differences in layclery role expectations were observed.He is the coauthorof Clergy Malpractice: How to Care Carefully (Westminster Press, 1986) and is engaged in a variety of ministerial studies.Paper presented at the meeting of the International Council of Psychologists, Mexico City, September, 1984.     

The valuing process: A study of favorite songs and the inner experience of persons diagnosed with schizophrenia

Since valuing is a process grounded in the organizational tendency of human behavior, the characteristics of a highly valued object should reflect the experience of the individual who selects it. This research compared the favorite songs of fourteen individuals diagnosed with schizophrenia to their inner experience as assessed in a standard interview. Many relationships were revealed between the two, often pertaining to important issues identified in theories of schizophrenia. Results may have therapeutic applications and shed light on processes through which psychological difficulties persist.     

As If Your Life Depended on It: Promoting Cognitive Development to Promote Wellness

In this article the authors discuss key elements of the cognitive-developmental perspective and the need to integrate it as an important component of the wellness model. Each speaks to the personal empowerment of every person to live a rewarding and responsible life. Each also emphasizes the ongoing promotion of growth rather than secondary prevention or remediation.     

Levinsonian studies of women's adult development

We reviewed four unpublished dissertations that used Levinson's theory to study women's adult development. The 39 biographies presented in these studies suggested that the women progressed through the same developmental periods as had men in Levinson's study and at roughly the same ages. Although the timing of the periods and the nature of the developmental tasks appeared to be similar, the ways of working on these tasks as well as the outcomes achieved were different. These differences are understood in part as consequences of the greater complexity of women's dreams and the problems encountered in living them out.     

Effect of directed attention on cerebral asymmetries in stuttering adults

9 stutterers and 9 nonstutterers were administered a dichotic digits test under conditions of free recall and directed attention. Analysis indicated right-ear preference for both groups and no differences between the free recall and directed listening conditions. Results are discussed in relation to previous studies in which dichotic digit-stimuli were presented to stutterers.     

Locus of control,choice, and satisfaction with an assigned task

P. E. Spector's (1982, Psychological Bulletin, 91, 482–497) hypothesis that under conditions of freedom of choice persons characterized by an internal locus of control will experience greater satisfaction with an undesirable task than persons characterized by an external locus of control is considered in light of distinctions between perceived control and perceived choice. Perceived choice is proposed as an intervening variable implicit in Spector's argument. This reasoning was tested with 46 male and female college student participants in a 2 (Choice) × 2 (Locus of Control) factorial design experiment. An interaction of Choice × Locus of Control on task satisfaction was obtained such that internals tended to be more satisfied when given a choice while externals experienced greater satisfaction when not given a choice. The implications of this result for Spector' hypothesis and for the manner in which undesirable work is assigned are discussed.     

Susceptibility to prosocial and antisocial influence in adolescence following mindfulness training

Mindfulness training programmes have shown to encourage prosocial behaviours and reduce antisocial tendencies in adolescents. However, less is known about whether training affects susceptibility to prosocial and antisocial influence. The current study investigated the effect of mindfulness training (compared with an active control) on self-reported prosocial and antisocial tendencies and susceptibility to prosocial and antisocial influence. 465 adolescents aged 11–16 years were randomly allocated to one of two training programmes. Pre- and post-training, participants completed a social influence task. Self-reported likelihood of engaging in prosocial and antisocial behaviours did not change post-training, and regardless of training group, participants showed a higher propensity for prosocial influence than for antisocial influence. Finally, participants were less influenced by antisocial ratings following both training programmes.