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 PSYCHOLINGUISTIC INDICATORS OF MOTIVATION FOR SUBSTANCE USE BEHAVIOR CHANGE AMONG INDIVIDUALS WITH SERIOUS MENTAL ILLNESS(2011) Sargeant, Marsha Nneka; Blanchard, Jack J; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The co-occurrence of mental illness and substance use disorders (termed "dual diagnosis") represents a significant public health issue and is associated with significant impairment and negative health consequences, particularly among individuals with serious mental illness. Given the negative consequences associated with dual diagnosis, researchers have sought to identify treatment components that would improve outcomes among individuals with serious mental illness. Therefore, significant efforts have been made to increase motivation for change within severe mental illness populations using Motivational Interviewing, a client-centered therapy. The primary mechanism underlying the effect of Motivational Interviewing on behavior change is hypothesized to be the selective reinforcement of change talk by the therapist with the aim of reducing ambivalence. Change language has been found to predict substance use treatment outcomes; however, it is not clear if change language has similar predictive utility in individuals with serious mental illness. Therefore, the current study sought to validate change language as an indicator of motivation among 45 individuals with serious mental illness and co-occurring substance use disorders. Overall, we found that change language could be reliably coded in this sample. Evidence supported the predictive utility of Ability language (i.e., statements regarding self-efficacy) in prospectively predicting long term substance use treatment outcomes (i.e., six months after the Motivational Interview session) above and beyond negative symptoms, depressive symptoms, and substance use severity. These findings suggest that the investigation of client language during MI represents a promising avenue for understanding motivational processes underlying substance use treatment outcomes among individuals with serious mental illness. Specifically, elicitation of client statements regarding self-efficacy to reduce or stop substance use is particularly important in predicting favorable outcomes in this population. Future studies should evaluate the utility of incorporating treatment components aimed at cultivating self-efficacy for substance use behavior change among individuals with serious mental illness.Item Examining the Effect of the LET'S ACT Behavioral Activation Treatment for Depression on Substance Abuse Treatment Dropout(2009) Magidson, Jessica F; Lejuez, Carl W.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Despite the prevalence of depression among substance users and the negative impact of depressive symptoms on substance abuse treatment outcomes, few interventions targeting depression have been developed to meet the needs of depressed substance users, particularly in low-income urban areas. The current study aimed to replicate and expand upon promising preliminary findings for the use of a brief behavioral activation approach [Life Enhancement Treatment for Substance Use (LET'S ACT; Daughters et al., 2008)] to treat depression in the context of inner-city residential substance abuse treatment. Main extensions to the previous study include a comparison of LET'S ACT to a contact-time matched control treatment, Supportive Counseling (SC), and a more definitive evaluation of the effect of LET'S ACT on substance abuse treatment dropout. Results indicated that compared to SC, participants receiving LET'S ACT evidenced significantly lower rates of substance abuse treatment dropout and depressive symptoms, as evidenced by a significant treatment x time interaction with the change in self-reported and clinician-rated depressive symptoms from baseline to the 2-week follow up, as well as significantly higher rates of behavioral activation, as evidenced by a significant treatment x time interaction with scores on the Behavioral Activation for Depression Scale (BADS) from pre- to post-treatment. This study builds on preliminary evidence for LET'S ACT as a short-term behavioral treatment for depression in residential substance abuse treatment and offers initial support for the effect of LET'S ACT on substance use outcomes.Item Biobehavioral Mechanisms Underlying Emotionality in Antisocial Personality Disorder and the Role of Psychopathic Traits(2008-07-15) Sargeant, Marsha Nneka; Daughters, Stacey B; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)As one possible mechanism for behaviors associated with Antisocial Personality Disorder, the DSM-IV indicates that individuals with ASPD have low tolerance for frustration. A study investigating the relationship between ASPD and distress tolerance (DT) indicated that ASPD was related to low DT, indexed as low persistence on laboratory stressor tasks. The interpretation of this finding is clouded by the co-occurrence of psychopathy and ASPD. We examined whether psychopathic traits are related to higher DT and low biological stress response in the form of cortisol reactivity to a stressor. Results lent support to the relation of ASPD and psychopathic traits to DT; however, cortisol reactivity was not significantly related to ASPD or psychopathic traits. Nevertheless, discrepant patterns of stress reactivity emerged for individuals with ASPD and high levels of psychopathic traits. These findings suggest unique contributions of ASPD and psychopathic traits to emotionality across behavioral and biological domains.Item Substance use in two generations of Indian Americans as a function of marginalization and perceived discrimination.(2007-08-10) Gholkar, Radha; Smith, Barry D.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Past studies using acculturation to predict substance use in immigrants have yielded mixed findings, suggesting support for both acculturative and assimilation theories of substance use in immigrants. In this investigation, two variables from the cross-cultural literature, Marginalization and Perceived Discrimination, were used to examine the predictions of these theories. First- and second-generation Indian-Americans were recruited and completed questionnaires measuring quantity, frequency, and negative consequences of drug / alcohol use, Perceived Discrimination, and Marginalization. Information on demographics and depressive symptoms were used as covariates. Hierarchical regression and correlation analyses indicated that lower levels of Marginalization significantly predicted higher rates Alcohol Use in the first-generation; conversely, higher levels of Perceived Discrimination were significantly associated with increased Drug Use in the second-generation. It was concluded that both assimilation and acculturative theories may have merit for identifying substance users in an Indian-American sample when generation is considered as a moderator.