Behavioral intervention improves treatment outcomes among HIV-infected individuals who have delayed, declined, or discontinued antiretroviral therapy: a randomized controlled trial of a novel intervention.

Nationally up to 60 % of persons living with HIV are neither taking antiretroviral therapy (ART) nor well engaged in HIV care, mainly racial/ethnic minorities. This study examined a new culturally targeted multi-component intervention to address emotional, attitudinal, and social/structural barriers to ART initiation and HIV care. Participants (N = 95) were African American/Black and Latino adults with CD4 < 500 cells/mm(3) not taking ART, randomized 1:1 to intervention or control arms, the latter receiving treatment as usual. Primary endpoints were adherence, evaluated via ART concentrations in hair samples, and HIV viral load suppression. The intervention was feasible and acceptable. Eight months post-baseline, intervention participants tended to be more likely to evidence "good" (that is, 7 days/week) adherence (60 vs. 26.7 %; p = 0.087; OR = 3.95), and had lower viral load levels than controls (t(22) = 2.29, p = 0.032; OR = 5.20), both large effect sizes. This highly promising intervention merits further study.

Developing PeerLink to engage out-of-care HIV+ substance users: training peers to deliver a peer-led motivational intervention with fidelity.

Substance use among HIV+ individuals can be a barrier to HIV care, resulting in poor health outcomes. Motivational interviewing (MI) is an effective intervention to reduce substance abuse and increase HIV-related health. Healthcare workers from various backgrounds can be effectively trained in delivering MI interventions; however, there has been limited evidence that peers can effectively deliver MI interventions with fidelity. Peers have traditionally worked in HIV care settings and represent a valid context for a peer-delivered intervention focused on motivational issues. We trained four peers in MI. In this paper, we describe the intervention, explain the MI training methods, and investigate whether peers can be trained in MI with fidelity. The MI training included didactic instruction, group workshops, and individual feedback sessions. Two of four peers achieved MI treatment fidelity as measured by the Motivational Interviewing Treatment Integrity Code Version 3.0. Overall, peers had difficulty using open-ended questions and querying pros and cons, skills thought necessary to elicit change talk. They also tended to give too much direct advice where reflections would have been appropriate. A challenge was training peers to change familiar ways of communicating. Nonetheless, they did well at assessing and highlighting motivation to change. The total training hours (40 h) was long compared with other published MI studies. However, the intervention included several components with two targeted change behaviors. It is likely that peers can be trained in MI with fidelity in less time given a more streamlined intervention. When working with peers who have life stressors similar to the target group, it is important to be flexible in the training.

The alliance negotiation scale: psychometric construction and preliminary reliability and validity analysis.

Current measures of the working alliance tend to emphasize the degree of agreement or collaboration between patient and therapist about therapeutic tasks and goals. There are, however, both theoretical and empirical grounds to suggest that the degree to which patient and therapist are able to constructively negotiate disagreements about tasks and goals is another important dimension of the alliance. The present study outlines the preliminary development and evaluation of a measure to operationalize this dimension. This measure, the alliance negotiation scale (ANS), is a 12-item patient self-report instrument. Exploratory factor analysis and expert ratings informed the development of the scale, which consists of two distinct factors that demonstrate good internal consistency. Correlations between these factors and the working alliance offer preliminary support for its construct validity. A working version of the ANS is presented and the need for further validation is discussed.

Differential client perspectives on therapy in Argentina and the United States: a cross-cultural study.

Although there is a growing body of research in both cross-cultural issues in psychotherapy and in the client's perspective, little is known about differences or similarities in the way clients from different cultures, particularly those from different nations, subjectively experience therapy. The present study addressed this gap through a qualitative analysis of interviews with former therapy clients in Argentina and the United States. The researchers used a consensual qualitative research (CQR; C. E. Hill, B. J. Thompson, & E. N. Williams, 1997, A guide to conducting consensual qualitative research, The Counseling Psychologist, Vol. 25, pp. 517-572; C. E. Hill, S. Knox, B. J. Thompson, E. N. Williams, S. A. Hess, & N. Ladany, 2005, Consensual qualitative research: An update, Journal of Counseling Psychology, Vol. 52, pp. 196-205) methodology and provide illustrative examples from the raw transcripts. Among other differences, Argentine and U.S. participants differed in their experience of the therapy setting, the interventions their therapists used, and in the types of change they reported to result from therapy. Also notable, Argentine participants spoke a great deal more about change than U.S. participants. Results are preliminary, but provide implications for the adaptation of treatments to different cultures and for the cross-cultural validity of researchers' and policymakers' current definitions of treatment efficacy.

Emotion facilitates action: a transcranial magnetic stimulation study of motor cortex excitability during picture viewing.

Emotional stimuli capture attention, receive increased perceptual processing resources, and alter peripheral reflexes. In the present study, we examined whether emotional stimuli would modulate the magnitude of the motor evoked potential (MEP) elicited in the abductor pollicus brevis muscle by transcranial magnetic stimulation (TMS) delivered to the motor cortex. The electromyogram (EMG) was recorded from 16 participants while they viewed six blocks of pleasant, neutral, and unpleasant images; 36 TMS pulses at increasing intensities were delivered during each block. The TMS-induced MEP was reliably larger while participants viewed pleasant and unpleasant compared to neutral images. There were no differences in the pre-TMS EMG activity as a function of emotional stimuli. Thus, viewing arousing stimuli, regardless of valence, increased motor cortex excitability. Implications and directions for future research are discussed.