Physician-assisted dying: review of issues and roles for health psychologists.

The authors review the recent empirical and theoretical literature on physician-assisted dying (PAD) since implementation of the Oregon Death With Dignity Act (ODDA) in 1997. The authors provide a brief overview of end-of-life practices; consider ethical and practical issues regarding PAD; outline governments' acts and health care organizations' current codified principles regarding PAD, including the American Psychological Association's goal to increase the visibility of psychology in end-of-life issues; examine recent data pertinent to ODDA implementation and psychologists' attitudes regarding PAD; and outline potential roles for health psychologists responding to requests for PAD and implementing PAD (where it is legal). Health psychologists can assume at least 4 roles regarding PAD: (a) policy advocates, (b) educators, (c) practitioners, and (d) researchers.     

A cognitive development framework

Prominent stage theories of cognitive development show evidence of a structure in which each stage contains a number of subsidiary levels. Comparisons of the stages in these theories have commonly been made through the established links with stages of Piaget’s theory. In response to Kagan’s criticism of Piaget’s theory, features of these developmental theories were used in this paper as the basis for a general framework of interactive stages and levels of cognitive operations. Some implications of the proposed framework in relation to cognitive development theories and directions for further research are examined. Further application of this framework could help to identify commonalities in cognitive operations across different contents, contexts and cultures.     

Gender differences in coping: A further test of socialization and role constraint theories

To further test role constraint and socialization theories of gender differences in coping, two studies were conducted to examine coping strategies in individuals occupying similar roles. The relations between coping strategy frequency and effectiveness and between coping strategy use and psychological functioning also were examined. Predominantly Caucasian female and male college students participated in the studies. Results indicated support for both socialization and role constraint theories. Effectiveness and frequency of coping strategy use were moderately correlated. Gender differences in cognitive appraisal varied with dispositional vs. situational assessment. The need for a more integrated model to explain gender differences in coping and implications for existing theories are discussed.     

Deceived versus nondeceived participants' perceptions of scientific and applied psychology

Research examining the possible effects of deceptive research participation on participants' perceptions of psychology has yielded equivocal results. The present study's goal was to clarify the possible effects of participation in mildly deceptive research on participants' impressions of scientific and applied psychology. Participants (N = 112) were randomly assigned to one of six experimental conditions: active groups receiving negative, positive, or no feedback, or passive groups receiving negative, positive, or no feedback. Following participation, participants completed measures of impressions of psychotherapy and psychotherapists, researchers, and instructors. The manipulation did not affect attitudes toward psychology on any of the dependent measures, although gender effects resulted on one measure. Participants in general reported very positive attitudes toward the science and practice of psychology. Recommendations are offered for future research on the effects of more extensive deceptions.     

Engaging “Resistant” Families in Treatment

Many families, when presented with the option of family therapy, are less than eager to participate. This paper comprises the second and third parts of a series on engaging “resistant” families. ¹ 1 The first paper in this series, authored by J. M. Van Deusen, M. D. Stanton, S. M. Scott, and T. C. Todd, is entitled “Engaging “Resistant” Families in Treatment: I. Getting the Drug Addict to Recruit His Family Members” and appeared in the International Journal of the Addictions 15 (7): 1069–1089, 1980. A revised and expanded version of Part II is presented in M.D. Stanton, T. C. Todd, and Associates, The Family Therapy of Drug Abuse and Addictions New York, Guilford, in press.
Part II presents 21 principles and a number of techniques and strategies that have been developed for successfuly recruiting such families. These techniques should be applicable for engaging resistant families with all types of presenting problems. Part III provides an analysis of the important variables involved, along with data on cost efficiency and administrative costs. It was found that when therapists had administrative control of their cases, serving in dual roles as both therapists and drug counselors, the recruitment effort was (a) more effective (i.e., complete families, including both parents or parent surrogates, were recruited in 77 per cent of the cases), and (b) twice as cost efficient. Two-thirds of the non-engaged families were not recruited because the index patient would not allow family members to be contacted. Black families were more difficult to recruit than whites. Data on cost efficiency and on the actual administrative costs of recruiting families are also provided. We conclude that the engagement process requires a revision in therapeutic philosophy, since such families are often desperately in need of help but are unavailable unless therapists make a special effort to reach them.     

Family connectedness and women's sexual risk behaviors: implications for the prevention/intervention of STD/HIV infection

The present study explores the relationship between connectedness with the intergenerational family and women's sexual risk-taking as a guide to the development of family-focused prevention and intervention. Cross-sectional interview data from a pilot study were analyzed for correlations between a number of self-reported, risky sexual practices, the range of extended family members with whom the respondent was in contact, and awareness of stories pertaining to intergenerational family history. Structured interviews were administered by female interviewers to 56 women from two contexts: a STD (sexually transmitted disease) Clinic (N = 26), and an inner-city, Hispanic Community Organization (N = 30). Knowledge of stories about grandparents or great-grandparents was a robust predictor of lower sexual risk-taking in the STD Clinic sample. This relationship persisted, but only at the trend level in the Community Organization sample. In both the total sample and the STD subsample, the number of categories of extended family members with whom a respondent was in at least monthly contact was correlated with less sexual risk-taking. Given the fundamental importance of the family system as the primary social unit, these findings argue for further family theory-based research and for its potential application in the development of health prevention and intervention. Implications for practice and future research are discussed.     

Coping through emotional approach: a new look at emotion, coping, and health-related outcomes

Researchers studying stress and coping processes have attempted to identify which coping strategies are most adaptive in stressful encounters. A generally accepted conclusion has been that emotion-focused coping processes are associated with dysfunctional outcomes. Studies from our and other research teams challenge the "bad reputation" of emotion-focused coping by demonstrating that items measuring emotion-focused strategies in published coping questionnaires are confounded with distress and self-deprecation. We have developed and validated new instruments to assess coping though acknowledging, understanding, and expressing emotion, that is, coping through emotional approach. Longitudinal and experimental studies using these new scales have documented the adaptive potential of emotional-approach coping in the context of several types of stressors, including infertility, breast cancer, and chronic pain. However, characteristics of the environmental context, stressful experience, and individual are important moderators of the relations of emotional-approach coping and health-related outcomes. Potential mediators and moderators of coping through emotional approach, clinical relevance of the construct, and directions for research are discussed.     

Unmitigated agency, social support, and psychological adjustment in men with cancer

Unmitigated agency (UA), a gender-linked characteristic, has been associated with poorer cancer adjustment. Support from one's social network typically predicts adjustment but may be poorly matched to UA. The influence of UA on the utility of social support on adjustment over time is examined. Men with cancer (N=55) were assessed initially and 6 months later on three indicators of adjustment. Multilevel modeling analyses varied by adjustment indicator. UA was associated with increased cancer-related psychosocial symptoms but not depressive symptoms or cancer-related thought intrusion. Social support predicted fewer depressive symptoms and less cancer-related thought intrusion. However, a cross-level interaction revealed that the utility of social support on cancer-related thought intrusion was weaker for men with greater levels of UA. Men with cancer likely respond differently to changes in social support depending on their endorsement of UA.