Memory for memory

Self-referential encoding does not benefit memory for prior remembering across changing contexts

Changes in context across instances of memory retrieval have been shown to impair memory for acts of prior remembering. The present study examined how self-referential encoding influences memory for prior remembering that occurred with or without context change. At encoding, participants processed each target in cue-target word pairs in relation to themselves or another person. During an initial cued-recall test, targets were tested with either the studied cues or semantically related, but previously unseen cues. During a second cued-recall test, all targets were tested with the studied cues, and participants judged whether they remembered retrieving each target during the first test. Regardless of self/other-reference, semantic context change across the two tests impaired memory for prior remembering. Furthermore, the magnitude of this impairment was larger for strongly self-associated vs. other-associated targets. Our findings suggest that self-referential encoding does not benefit memory for prior remembering in the face of contextual change.

Replicating remembering "remembering"

When examining spontaneously recovered memories of childhood sexual abuse, victims report that there had been periods in which they had forgotten the abuse. However, there are sometimes people with whom the victim had spoken about the abuse during the period in which the victim had supposedly forgotten the abuse, suggesting the victim had not forgotten the abuse but the prior recall of the abuse. The underestimation of previous knowledge is termed the forgot-it-all-along effect. The goal of the present study was replicating the results of a laboratory study that had provided a theoretical understanding for the forgot-it-all-along effect by showing that people have difficulties remembering "remembering" when the memory had previously been recalled in a different context. The effect was replicated by using the same neutral context sentences, suggesting the finding was robust. We also extended the experimental design by using positive and negative context sentences, but it did not become smaller when the positive sentences provided the different context or larger when the negative sentences provided the different context. Although the sample sizes were sufficiently large to provide statistical power for the forgot-it-all-along effect, they may not have been sufficiently large to observe the moderation effects of emotional context.

Cross-sectional assessment of three commonly used measures of adherence to combination antiviral therapy in a resource limited setting

Nowadays, global coverage of combination antiretroviral therapy (cART) has increased due to a continuous process to scale up access. This increase has potentially transformed HIV-infection from a fatal to a chronic disease: a transformation only possible if the prescribed medications are taken accordingly. We therefore evaluated optimal adherence to cART by three commonly used methods: visual analogue scale (VAS), four days recall (FDR) and clinic attendance (CA) for the last six months in 301 HIV-infected patients on cART for at least six months at the Douala General Hospital, Cameroon. Optimal adherence was defined to be greater than or equal to the 95th percentile estimate of each method. We found that 70.8% of our study population was female. The mean age was 40.8 years (SD 10.5) and 85% were on first line cART. Median CD4 count was 397 cells/ml (252-559). Optimal adherence by VAS, FDR and CA, was 68.1%, 83.4%, and 73.4%, respectively. VAS and FDR inter-correlated strongly (Pearson's Chi square coefficient, r = 0.58, p < 0.001). Higher CD4 count above 200 cells/ml was associated with optimal adherence by CA (Adjusted Odds Ratio [AOR]:2.6 (95% CI: 1.2-5.3, p < 0.001)). As high optimal adherence to cART is associated with good clinical outcome in HIV patients, simple methods such as the VAS for evaluating adherence, should be integrated to the HIV clinic of the Douala General Hospital.

Improving the self-report of HIV antiretroviral medication adherence: is the glass half full or half empty?

Self-reports are the most widely used method for measuring antiretroviral adherence. The association between self-reports and viral loads has been repeatedly demonstrated, but this association does not address how well self-reports measure actual medication-taking behaviors. Understanding adherence self-reports requires studying the science of memory and the reporting of behaviors. In the first section of this review, we discuss research in cognitive psychology that pertains to adherence self-reports, focusing primarily on studies that examine cognitive processes respondents use to answer survey questions. In the second section, we review recent articles examining the relationship between self-reports and objective measures of adherence, highlighting the strength of associations and key methodologic issues. We conclude with key questions for future research and methodologic recommendations.

Forgetting of prior remembering in persons reporting recovered memories of childhood sexual abuse

Case studies of individuals reporting recovered memories of childhood sexual abuse suggest that some overestimate their prior forgetting of the abuse. People reporting recovered or continuous memories of childhood sexual abuse and control subjects reporting no history of abuse participated in two experiments examining this "forgot it all along" phenomenon. Participants in Experiment 1 were more likely to forget that they had previously recalled a studied item if they were cued to think of it differently on two recall tests than if they were cued to think of it in the same way on the two tests. This effect was stronger for recovered-memory participants than for continuous-memory and control participants. In Experiment 2, participants recalled autobiographical events three times over a period of 4 months. Much as in Experiment 1, they underestimated prior remembering when the events had been recalled in a different emotional frame (positive vs. negative) on the previous occasion. This underestimation was more pronounced for recovered-memory participants than for continuous-memory and control participants.

Practical and conceptual challenges in measuring antiretroviral adherence

Accurate measurement of antiretroviral adherence is essential for targeting and rigorously evaluating interventions to improve adherence and prevent viral resistance. Across diseases, medication adherence is an individual, complex, and dynamic human behavior that presents unique measurement challenges. Measurement of medication adherence is further complicated by the diversity of available measures, which have different utility in clinical and research settings. Limited understanding of how to optimize existing adherence measures has hindered progress in adherence research in HIV and other diseases. Although self-report is the most widely used adherence measure and the most promising for use in clinical care and resource-limited settings, adherence researchers have yet to develop evidence-based standards for self-reported adherence. In addition, the use of objective measures, such as electronic drug monitoring or pill counts, is limited by poor understanding of the source and magnitude of error biasing these measures. To address these limitations, research is needed to evaluate methods of combining information from different measures. The goals of this review are to describe the state of the science of adherence measurement, to discuss the advantages and disadvantages of common adherence measurement methods, and to recommend directions for improving antiretroviral adherence measurement in research and clinical care.

Measuring adherence to highly active antiretroviral therapy: implications for research and practice

Highly active antiretroviral therapy (HAART) has radically changed the course of HIV disease, producing substantial reductions in both HIV-related morbidity and mortality. However, the complexity of the typical daily HAART regimen is substantial, and high levels of adherence are essential for complete and long-term viral suppression and the avoidance of drug resistance. The complexity of HAART has made the assessment of medication adherence of paramount importance. Even though various methods are in use, each measures only a subset of adherence behaviors, and each measure has limited predictive validity. Given the individual and public health concerns associated with adherence to HAART, there is a need for the continued development and validation of measures of medication adherence.

Remembrance of remembrance past

Arnold and Lindsay (2002) found that individuals more often failed to remember they had previously recalled an item if that item had been cued in a qualitatively different way on two recall occasions: the "forgot-it-all-along" (FIA) effect. Experiment 1 was designed to determine if the FIA effect arises because participants incorrectly believe they have not been previously tested for an item, or because they incorrectly believe they have failed to recall the item when previously tested. Experiment 2 measured participants' confidence in their incorrect prior-recall judgements, and Experiment 3 tested participants' ability to "recover" their previous recollection when the prior-recall context was restored. Results indicated that participants usually believed they had not previously been cued for the items they failed to remember previously recalling; they were often confident in their incorrect judgements of prior non-remembering; and re-introducing the context of prior remembering sometimes enabled them to recapture their memories of previous recall.

Remembering remembering

We developed a laboratory analogue of the "forgot-it-all-along" effect that J. W. Schooler, M. Bendiksen, and Z. Ambadar (1997) proposed for cases of "recovered memories" in which individuals had forgotten episodes of talking about the abuse when they were supposedly amnestic for it. In Experiment 1, participants studied homographs with disambiguating context words; in Test 1 they received studied- or other-context words as cues; and in Test 2 they received studied-context cues and judged whether they had recalled each item during Test 1. In Experiment 2, retrieval cues were manipulated on both tests. In Experiment 3, both the studied- and other-context cues corresponded to the same meaning of each homograph. In Experiment 4, Test 1 was free recall, and studied- versus other-context cues were presented in Test 2. Participants more often forgot that they had previously recalled an item if they were cued to think of it differently on the two tests.