Psychology
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Item Mediators of the Relationship between Depression and Medication Adherence among HIV Positive Substance Users(2012) Magidson, Jessica F; Lejuez, Carl W; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Medication adherence is of utmost importance in predicting health outcomes across numerous chronic conditions, particularly HIV/AIDS. Highly active antiretroviral therapy (HAART) to treat HIV/AIDS requires high levels of adherence to maintain viral suppression, which is crucial for optimal HIV treatment and prevention. One of the most significant patient-level barriers to medication adherence is depressive symptoms. Even at subclinical levels, depressive symptoms predict nonadherence above and beyond other relevant psychosocial factors. Despite the focus on depressive symptoms as a reliable and powerful predictor of nonadherence, few studies have sought to test potential mechanisms underlying this relationship, which is an important step to advance our understanding of how depression affects adherence to inform intervention efforts. The current study utilized early behavioral theories of depression (Lewinsohn, 1974; Ferster, 1973) to select potential mediators that may be relevant to both depression and adherence. Specifically, we tested the key components of these models, (1) goal-directed activation, (2) positive reinforcement, and (3) punishment in one's environment as potential mediators of the relationship between depressive symptoms and medication adherence among HIV positive individuals in substance abuse treatment (n = 73). We examined adherence to HAART as well as adherence to other daily medications using a combination of self-report assessments (% of doses missed over past four days, frequency of doses missed across common reasons for nonadherence) and viral load. Greater levels of punishment mediated a positive relationship between clinician-rated depressive symptoms and greater frequency of missed doses across common reasons for nonadherence. Activation and positive reinforcement were unrelated to adherence or viral load in this sample. Findings suggest the importance of punishment in explaining the relationship between depression and medication nonadherence. Individuals with elevated depressive symptoms may perceive greater negative consequences related to medications (e.g., side effects, stigma) and may be less likely to overcome barriers necessary for optimal adherence. If findings continue to replicate, this may suggest a need to target punishment in HIV prevention and treatment, for instance in the context of integrated cognitive behavior therapy interventions that target depression and adherence among substance users.Item Therapist reactions to a client facing terminal illness: a test of ego and countertransference(2013) Hummel, Ann Martha; Gelso, Charles J; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)When a therapy client presents with thoughts, emotions, or behaviors that trigger a therapist's own unresolved conflicts, the therapist may experience countertransference. Client concerns that may trigger countertransference include sexuality, aggression, and death (Gelso, Fassinger, Gomez, & Latts, 1995; Latts & Gelso, 1995; Hayes & Gelso, 1993; Lacocoque & Loeb, 1988). Countertransference has been found to relate negatively with client outcome (Hayes, Gelso, & Hummel, 2011), but countertransference management can mitigate the negative effects of countertransference, and can even result in curative therapeutic responses (Gelso & Hayes, 2007). A phenomenon known as ego depletion may cause a therapist to be more vulnerable to countertransference. Ego depletion occurs when self-resources related to impulse control, decision-making, and willpower are low (Baumeister, Vohs, & Tice, 2007). Because of the relation between ego depletion and impulse control, the effect of ego depletion on countertransference was tested. Forty-five participants were randomly assigned to either a neutral or ego depletion condition, and were then presented with a scripted analogue client who discussed a potential terminal illness diagnosis. Participants responded verbally to the client, and their responses were transcribed and coded for behavioral indicators of countertransference. Participants also completed measures of affective and cognitive countertransference. Countertransference management and ego defense maturity were assessed as potential predictors of resilience to ego depletion. The participants in the ego depletion reported higher levels of content-specific affective countertransference (death anxiety), but general affective (state anxiety), behavioral, and cognitive countertransference did not differ between conditions. Countertransference management and ego defense maturity did not significantly account for variance in the relation between ego depletion and countertransference. However, the relation found between ego defense maturity and countertransference management suggests that ego defense maturity could be a precursor to countertransference management. Overall, ego depletion led to increased death anxiety, but therapists were resilient to having this content-specific reaction generalize to other forms of countertransference.