Approaching Complex Cases With a Crisis Intervention Model and Teamwork

Patients referred for genetic counseling may be in a state of crisis, feeling as though they are incapable of making decisions about the management of their pregnancy, genetic testing options and/or life planning issues. The role of the genetic counselor is to assist a patient through this crisis state by increasing the patient's understanding and by helping to facilitate decision making and adjustment to those decisions. In this paper we present a clinical genetic counseling case that was complicated by numerous medical and psychosocial issues. The wide scope of this case required the involvement of both a prenatal and a medical genetic counselor. Working as a team we utilized a crisis intervention model. Our counseling focused on identifying and isolating the issues, providing factual information, setting a time frame for decisions to be made, and encouraging social support and emotion-focused coping strategies.     

Why Does Disaster Recovery Work Influence Mental Health?: Pathways through Physical Health and Household Income

Disaster recovery work increases risk for mental health problems, yet the mechanisms underlying this association are unclear. We explored links from recovery work to post‐traumatic stress (PTS), major depression (MD), and generalized anxiety disorder (GAD) symptoms through physical health symptoms and household income in the aftermath of the Deepwater Horizon oil spill. As part of the NIEHS GuLF STUDY, participants (N = 10,141) reported on cleanup work activities, spill‐related physical health symptoms, and household income at baseline, and mental health symptoms an average of 14.69 weeks (SD = 16.79) thereafter. Cleanup work participation was associated with higher physical health symptoms, which in turn were associated with higher PTS, MD, and GAD symptoms. Similar pattern of results were found in models including workers only and investigating the influence of longer work duration and higher work‐related oil exposure on mental health symptoms. In addition, longer worker duration and higher work‐related oil exposure were associated with higher household income, which in turn was associated with lower MD and GAD symptoms. These findings suggest that physical health symptoms contribute to workers’ risk for mental health symptoms, while higher household income, potentially from more extensive work, might mitigate risk.     

Minority Influence, Divergent Thinking and Detection of Correct Solutions

In many applied settings involving influence processes in small groups, the interest is in how such processes aid or hinder effective decision making and problem solving. In a recent formulation, Nemeth (1986) argued that exposure to opposing views emanating from a minority leads to divergent thinking, a process that involves a consideration of the problem from varying viewpoints. On balance, such influence would aid performance. Exposure to opposing majority viewpoints leads to convergent thought where S s presumably concentrate on the proposed viewpoint to the exclusion of other considerations. On balance, this form of influence tends not to aid performance and may prove to be an impediment. In the present study, these hypotheses were tested in the context of anagram solutions. Results showed that subjects exposed to the minority viewpoint found more correct words and they achieved this superior performance by a usage of all possible strategies. Subjects exposed to the majority viewpoint initially used the strategy suggested by the majority to the detriment of other strategies and, in general, performed at the level of control subjects. These results are discussed in terms of potential contributions made by exposure to dissenting minority viewpoints in small group decision-making settings such as trial by jury and in society at large.     

Emotionally-focused therapy and treatment as usual comparison groups in decreasing depression: A clinical pilot study

Abstract

Decades of research have shown that depression can have deleterious effects on couple relationships. Emotionally-focused therapy (EFT; Johnson, 2004 Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection. East Sussex, UK: Brunner-Routledge. [Google Scholar]) is an empirically validated form of couple therapy, which has shown effectiveness in reducing depressive symptoms in couples where the wife has depression. The aim of the current pilot study was to examine the extent to which EFT and the comparison treatment as usual (TAU) therapy group decrease depressive symptoms in distressed couples. Results show that both groups were effective in decreasing depressive symptoms, with EFT showing a clinically significant reduction. Clinical implications and future research are discussed.     

Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study

Despite high rates of co-occurring tobacco use and anxiety symptoms and disorders among persons with HIV, evidence-based interventions for these individuals are not yet available. The present study sought to evaluate an integrated treatment model addressing smoking cessation and anxiety sypmtoms among HIV-positive smokers. Treatment was an 8-week intervention integrating a standard smoking cessation protocol (i.e., cognitive-behavioral therapy [CBT], nicotine replacement therapy) with CBT for anxiety. Inclusion criteria were 18–65 years of age, ≥ 10 cigarettes/day, State–Trait Anxiety Inventory [STAI-T] score of > 39, and moderate motivation (i.e., ≥ 5 out of 10 on a 10-point Likert scale) to quit smoking. Primary outcomes included scores on the Anxiety Sensitivity Index (ASI) and cigarettes smoked per day. Self-reported abstinence was biochemically verified by carbon monoxide breath analysis. Three male participants (mean age 49.3, SD = 9.1) completed through 2-month follow-up. At baseline all participants reported smoking an average of 20 cigarettes per day. Two participants quit smoking and maintained abstinence by the 2-month follow-up, and demonstrated a reduction in ASI scores. Participant 3 continued to smoke but at a reduced rate. Participants’ response to cognitive and behavioral strategies (e.g., creating balanced thoughts, interoceptive exposures) will be discussed. Clinical lessons learned include use of a flexible approach to cognitive restructuring, use of imaginal and in vivo exposures in session to better prepare patients for homework practice, and flexibility in delivering the treatment in an individual or group format. This clinical presentation provides preliminary support for the feasibility and initial effectiveness of an integrated treatment to reduce anxiety symptoms and aid in smoking cessation in anxious, HIV-positive smokers.     

The Prospect of Genome-guided Preventive Medicine: A Need and Opportunity for Genetic Counselors

One of the major anticipated benefits of genomic medicine is the area of preventive medicine. Commercially available genomic profiling is now able to generate risk information for a number of common conditions several of which have recognized preventive guidelines. Similarly, family history assessment affords powerful health risk prediction based on the shared genetic, physical and lifestyle environments within families. Thus, with the ability to help predict disease risk and enable preemptive health plans, genome-guided preventive medicine has the potential to improve population health on an individualized level. To realize this potential, steps to broaden access to accurate genomic health information must be considered. With expertise in genetic science, risk assessment and communication, and a patient-centered practice approach, genetic counselors are poised to play a critical role in facilitating the incorporation of genomic health risks into the burgeoning field of genome-guided preventive medicine.     

Emotion regulation and intimate partner violence in newlyweds

Is the inability to regulate negative emotions a risk factor for intimate partner violence (IPV)? To address this question, the authors asked 72 newlywed couples to report their levels of negative affect every day for 7 days and examined whether variability in those reports was associated with the IPV self-reported to have been perpetrated over the previous year. Although main effects of variability in both husbands' and wives' negative affect did not reach statistical significance, variability in husbands' negative affect significantly interacted with wives' reports of IPV to account for husbands' IPV, even after overall levels of husbands' negative affect, marital satisfaction, and chronic stress were controlled. Specifically, whereas variability in negative affect was unrelated to IPV among husbands with wives who reported no IPV, such variability was positively associated with the IPV perpetrated by husbands with wives who also reported having perpetrated IPV during the previous year. Although preliminary, these results support theories suggesting that the ability to regulate negative emotions may help intimates avoid perpetrating IPV, particularly when faced with a partner's IPV perpetration.     

Neuroticism, marital violence, and the moderating role of stress and behavioral skills

Do high levels of neuroticism predict intimate partner violence (IPV)? Although neuroticism may predispose partners to increased risks of IPV perpetration, the extent to which it predicts such perpetration is likely to depend on the broader context of the relationship. Consistent with this prediction, the current longitudinal study of 169 community couples revealed that the effects of neuroticism on IPV perpetration over the first 4 years of marriage were moderated by observations of problem-solving behavior and objective ratings of chronic stress. Specifically, although husbands and wives who scored higher on a measure of neuroticism at the outset of marriage engaged in more IPV throughout the marriage on average, those who possessed more effective problem-solving skills or experienced lower levels of stress were significantly less likely to engage in IPV. Results highlight the importance of considering the broader relationship context when examining predictors of specific interpersonal processes.