THE CLASS SPECIFIC EFFECTS OF COMPLIANCE TRAINING WITH “DO” AND “DON'T” REQUESTS: ANALOGUE ANALYSIS AND CLASSROOM APPLICATION

Two experiments are reported in which the relationship between compliance with “do” and “don't” requests was examined with developmentally disabled children. In Experiment 1, a multiple baseline design across subjects with counterbalanced treatment conditions was used to evaluate a compliance training program composed of four phases: (a) baseline, during which no consequences were delivered for compliance, (b) reinforcement for compliance with one targeted “do” request, (c) reinforcement for compliance with one targeted “don't” request, and (d) follow-up with reinforcement on a variable ratio schedule for compliance with any “do” or “don't” request. Results of probes conducted before and after training within each condition indicated that generalized compliance occurred only with requests of the same type as the target exemplar (“do” or “don't”). In Experiment 2, these results were replicated in a classroom setting. Following collection of baseline probe data on student compliance, a teacher training program was successfully implemented to increase reinforcement of compliance first with one “do” and subsequently with one “don't” request of a target student. Results of multiple baseline probes across “do” and “don't” requests indicated that the teacher generalized and maintained reinforcement of compliance with other requests of the same type and to other students, with a resulting increase in student compliance with the type of requests reinforced. The impact of treatment on both teacher and student behavior was socially validated via consumer ratings. Implications of these findings with respect to response class formation and compliance training programs are discussed.     

When Being “Essential” Illuminates Disparities: Counseling Clients Affected by COVID‐19

The 2019 novel coronavirus (COVID‐19) has highlighted social disparities in the United States. This article examines how preexisting racial and ethnic disparities, exacerbated by COVID‐19, have negatively affected communities of color that tend to be overrepresented in lower socioeconomic groups, have limited access to health care and education, have an undocumented status, and work in jobs considered “essential.” Counselors are encouraged to use creative strategies to design and facilitate telecounseling and reduced‐ or no‐cost workshops in which attendees can participate safely. Specific cultural considerations, aspects of crisis management, and creative interventions that can be used with clients of color at an appropriate social distance are discussed. Counselors can also instill hope in their clients by promoting sociopolitical development. As the impact of COVID‐19 will be felt for years, it is crucial that counselors be prepared to address the needs of those disproportionately affected.     

Commentary on “Trauma to the Psyche and Soma”

This case report addresses assessment and treatment considerations for a patient suffering from posttraumatic stress disorder (PTSD) in the context of mild traumatic brain injury and ongoing pain. Management of this case is based on the application of evidence-based therapy, and of cognitive behaviour therapy, for PTSD reduction. Assessment and treatment approaches recognize that delivery of treatment requires modification to allow exposure therapy for individuals who are partially amnesic of their traumatic experience. Further, administering exposure and cognitive therapy for patients with cognitive impairment requires specific means of treatment delivery to allow adequate compliance with therapy tasks. This case highlights that evidence-based approaches can be usefully applied to complex presentations but they may require modifications that recognize obstacles associated with comorbid conditions.     

“Don't Tell Me,I Don't Want to Know”: Understanding People's Reluctance to Obtain Medical Diagnostic Information1

Prominent theories of health‐protective behavior predict increasing information seeking as a function of increasing disease severity, yet diagnostic screens for serious diseases are notoriously underutilized. We suggest that in addition to severity, disease treatability impacts people's willingness to submit to medical tests. In two studies, participants were relatively likely to seek a diagnostic test for a disease they believed to be serious and treatable (Study 1) and to avoid a test for a disease they believed to be serious but untreatable (Study 2). Implications for health‐behavior models and persuasive health communication are discussed.     

Cognitive counseling for health care compliance

This paper proposes a therapy/counseling model based on RET and other cognitive approaches to enable the therapist in a health care setting to enhance patient compliance with medical and life-style treatment recommendations. Problems and reasons for low rates of compliance with treatment regimens in health settings are discussed. A four phase treatment/therapy approach including Assessment, Insight, Working Through and Homework is presented.     

“I Am My Own Gender”: Resilience Strategies of Trans Youth

Nineteen trans youth participated in a phenomenological study of their resilience strategies for navigating stressors in their lives. The authors identified 5 supports and 6 threats to participants’ resilience. The 5 themes of resilience were: (a) ability to self‐define and theorize one's gender, (b) proactive agency and access to supportive educational systems, (c) connection to a trans‐affirming community, (d) reframing of mental health challenges, and (e) navigation of relationships with family and friends. The 6 major threats to participants’ resilience were: (a) experiences of adultism, (b) health care access challenges, (c) emotional and social isolation, (d) employment discrimination, (e) limited access to financial resources, and (f) gender policing.     

Emotions and cognitions in consumer health behaviors: insights from chronically ill patients into the effects of hope and control perceptions

The lack of compliance to medical advice is a widely recognized healthcare concern with important implications to consumer well‐being. Through an in‐depth examination of the narratives provided by chronically ill patients, this study contributes to transformative consumer research by offering a better understanding of patients' compliance or lack of compliance with medical advice. The narratives are examined with a focus on two potential antecedents: hope and perceptions of control over health outcomes. Findings suggest that although control perceptions play a crucial role in compliance, chronically ill patients often feel that they have no control over their health outcomes. The narratives reveal that the positive emotion of hope is a motivator for positive health behaviors. Additionally, the lived experiences accounts suggest a possible relationship between hope and control perceptions: patients' belief in their ability to manage their chronic illness facilitates hope but might not be essential to it. The importance of healthcare providers' role in cultivating hope and customizing their interactions with patients is discussed. The implications also indicate that health initiatives aimed at increasing treatment compliance should consider alternatives to messages calling for patients to take control of their health. Instead, future research on health behavior should look beyond social cognition models of health behavior and focus on the role of positive emotions such as hope. Copyright © 2015 John Wiley & Sons, Ltd.     

The Liberation of Caring; A Different Voice For Gilligan's “Different Voice”

Recent literature portrays caring as a psychological, social, and ethical orientation associated with female gender identity. This essay focuses on Giliigan's influential view that “care” is a broad theme of moral development which is under-represented in dominant theories of human development such as Kohlberg's theory. An alternative hypothesis is proposed portraying care development as a set of circumscribed coping strategies tailored to dealingwith sexism. While these strategies are practically effective and partially “liberated,” from the moral point of view, they also reflect the debilitating influences of sexist socialization even at the highest level. Gilligan and her colleagues seem to misidentify these inadequacies of mature care. This alternative hypothesis is briefly related to the critical and feminist tradition. Then it is supported with Gilligan's own research and interpretive text.     

Simplified Models of the Relationship Between Health and Disease

The concepts of health and disease are crucial in defining the aim and the limits of modern medicine. Accordingly it is important to understand them and their relationship. However, there appears to be a discrepancy between scholars in philosophy of medicine and health care professionals with regard to these concepts. This article investigates health care professionals’ concepts of health and disease and the relationship between them. In order to do so, four different models are described and analyzed: the ideal model, the holistic model, the medical model and the disjunctive model. The analysis reveals that each model has its pros and cons, and that health care professionals appear to apply more than one models. Furthermore, the models and the way health care professionals’ use them may be helpful for scholars in philosophy of medicine with regard to developing theories and communicating them to health care professionals.     

FEMINIST CONTRIBUTIONS TO HEALTH PSYCHOLOGY

A brief review of health psychology shows that the early leadership began what has come to be a major alternative to traditional medical models of diagnosis and treatment. Numerous women were involved with these implementations and changes in the field. Many of the key developments within health psychology—for example, behavioral prevention, compliance, coping, health promotion, locus of control, and social support—reflect essentially feminist principles that emphasize the legitimate authority and significance of the individual. Feminist principles of equity and inclusiveness are also represented in emerging concerns that the health needs of many underprivileged groups deserve more focused attention, and, additionally, that entirely new areas of health can be profitably examined within the framework of health psychology.     

Weight Loss Is Not the Answer: A Well‐being Solution to the “Obesity Problem”

Americans have been gaining weight in recent decades, prompting widespread concern about the health implications of this change. Governments, health practitioners, and the general public all want to know: What is the best way to reduce the health risks associated with higher body weight? The dominant weight‐loss solution to this “obesity problem” encourages individuals to lose weight through behavior change. This solution rests on the assumptions that higher body weight causes health problems, that permanent weight loss is attainable, and that weight loss improves health. But comprehensive reviews of the scientific evidence find mixed, weak, and sometimes contradictory evidence for these premises. We suggest that a different solution to the “obesity problem” is needed – a solution that acknowledges both the multifaceted nature of health and the complex interaction between person and situation that characterizes the connection between weight and health. Thus, we use the lens of social psychological science to propose an alternative, well‐being solution to the “obesity problem”. This solution has the potential to improve health by encouraging eating and exercising for optimal health rather than weight loss, by developing interventions to reduce weight stigma and discrimination, and by helping higher body‐weight people cope with the stress of stigma and discrimination.     

Comment on “The Self‐Care of Psychologists and Mental Health Professionals” (Dattilio, 2015)

Professor Frank Dattilio's article “The Self‐care of Psychologists and Mental Health Professionals” provides an overview of stress and related mental health problems among psychologists, and a proposition that psychologists are not vigilant in regard to self‐care. Dattilio offers a range of self‐care strategies and recommendations, and highlights self‐care practices within various psychology frameworks, and concludes with some “healthy tips” for managing stress. In my commentary I underscore Dattilio's message that self‐care is of critical importance in psychology practice, given the responsibility of caring for others inherent in the work psychologists undertake. However, I raise additional points of consideration and suggest an alternative approach to addressing the self‐care needs of the profession. My commentary makes the following points: (a) the need to distinguish between psychology trainees and practising qualified psychologists when addressing stress and self‐care requirements in the profession; (b) the importance of developing a culture of self‐care among psychologists by providing self‐care instruction during training; (c) the need to temper research findings on stress and mental health among psychologists by the methodological weakness of the studies in this area; (d) adhering to the recent call from colleagues to shift from a focus on pathology and punishment to a positive acceptance, mindfulness, and values‐based approach for encouraging self‐care among psychologists; (e) the use of a systematic framework for organising the presentation of self‐care strategies that makes them more accessible; and (f) an appeal to professional bodies to take their responsibility in promoting self‐care in the profession.     

Am “I” more important than “we”? Couples’ word use in instant messages

Recent studies have identified robust associations between the types of words that people use and their psychological health. This study investigated whether couples’ word use in their daily instant messages (IMs) is linked to the quality and stability of their relationships. Sixty‐eight dating couples in the United States submitted 10 days of IM conversations with each other, which were analyzed with a linguistic word count program. Six months later, couples indicated whether they were still dating. Pronoun use and emotion word use both were associated with relationship satisfaction and stability. These findings extend previous research showing that the frequencies of certain words that people use are associated with the quality of their social relationships.     

Social cognitive models of health and exercise behavior: An introduction and review of conceptual issues

Abstract

This article reviews the major social cognitive models of adherence or compliance in health and exercise behavior and attempts to show that these models are more similar to each other than different from each other. Self-efficacy theory and the theory of reasoned action/planned behavior have guided most of the theory-based research on exercise behavior. Two other models, protection motivation theory and the health belief model, have guided much research on the role of social cognitive factors in other health behaviors. These models are comprised largely of the same basic set of social cognitive variables: self-efficacy expectancy, outcome expectancy, outcome value, and intention. Two other factors, situational cues and habits, although not common to all the models, round out the theoretical picture by explaining how the relationship between the major social cognitive variables and behavior may change with repeated performance of a behavior over time.An integration of these models is offered using the theory of planned behavior as a foundation. It is suggested that research on health and exercise behavior that pits one model against another to determine which one is the better predictor of behavior is likely to be unproductive due to the striking similarities of the models. It is suggested instead that theorists and researchers focus their efforts on integration of the major social cognitive models and on determining the relative predictive utility of the various social cognitive factors with various health behaviors and in various contexts.     

“Yet there’s method in his madness …”: Dimensions of deception and dangerousness

Undiagnosed malingering (symptom overreporting or fabrication) can endanger mental health staff. This review paper presents a systematic and empirically based framework to assess symptom overreporting and violence potential. The first half reviews three models of malingering and their implications for violence potential. The first model proposes that people who malinger are attempting to cope with major mental disorders or organic deficits. The violence potential of these often overlooked disorders is explained. The second model describes how some people with character disorders overreport psychological symptoms and use violence to manage interpersonal relationships. The third model proposes that people who malinger are attempting to get their needs met in complex situations. Mishandling these often desperate people can result in a dangerous situation. The second half of this article focuses on conducting evaluations with potential malingerers, including ethical issues, assessment techniques, and treatment recommendations. Public policy implications are also addressed.     

SOCIAL INFLUENCES ON “SELF-STIMULATORY” BEHAVIOR: ANALYSIS AND TREATMENT APPLICATION

We tested the hypothesis that the “self-stimulatory” behaviors exhibited by some individuals may be socially mediated. Four developmentally disabled children who exhibited hand flapping and body rocking participated in a series of three experiments conducted to assess the influence of social variables on stereotyped behavior and to develop a treatment based on the assessment. Experiment 1 used an assessment procedure to determine the relative influences of social attention and task demands on stereotyped behavior. For all four children, hand flapping and body rocking increased when difficult academic tasks were introduced. Experiment 2 involved the use of a procedural time-out and demonstrated that removing task demands contingent on stereotyped behavior resulted in increased rates of hand flapping and body rocking. In Experiment 3, these results were used to develop a communication treatment that consisted of teaching the children to request assistance on the difficult tasks. This treatment resulted in significant reductions in self-stimulatory behavior. These results are consistent with the hypothesis that some forms of repetitive stereotyped behavior may come to serve social functions (e.g., escape from aversive situations). Teaching a functionally equivalent communicative alternative to escape-motivated stereotyped behavior can be an effective form of intervention for this problem.     

Joint Consultation for High-Risk Asthmatic Children and Their Families,with Pediatrician and Child Psychiatrist as Co-Therapists: Model and Evaluation

Although a very common disease, childhood asthma can be a life-threatening condition. Psychosocial determinants have been acknowledged to trigger severe asthma. The authors review current knowledge about how psychosocial factors influence childhood asthma, with a special focus on compliance with treatment and family interaction. The authors describe their experience of joint treatment of high-risk asthmatic children and their families. The pediatrician and child psychiatrist work as co-therapists, and the results of this intervention are investigated. Forty-one high-risk asthmatics and their families were followed in the joint-consultation program. Two years after the onset of joint consultation, a significant improvement was found in symptom score, treatment score, and compliance score. The number of hospital admissions and of days spent in hospital decreased significantly. The cost of care was subsequently cut by two-thirds, despite the added cost of psychiatric care. The authors conclude that it is possible for doctors of the body and of the mind to share consultation work, with a positive impact on both the patient's health and the cost of treatment.     

Comment on “The Impact of Cancer on Psychological and Social Outcomes (Costa et al., 2016)”

The review written by (Costa et al. 2016) summarises a broad range of topics associated with what is known about the psychosocial outcomes of cancer in patients and their families. This commentary supplements this review by expanding on three topics that were not covered in the review. First, the challenges in assessing and diagnosing anxiety, depression, and distress in cancer patients due to overlapping symptoms with the disease state are highlighted. Second, the contribution of biological pathways such as inflammation upon the genesis and maintenance of anxiety, depression, and distress is acknowledged. Third, the potential role of religion and spirituality in influencing the psychosocial outcomes of cancer is raised. These three points are used to emphasise the importance of firmly incorporating a biopsychosocial model in research and health‐care provisions with cancer patients and their families.     

Prospective payment: its impact on psychology's role in health care

This article describes the new Medicare payment system based on diagnosis-related groups (DRGs) and its impact on professional psychology. DRGs represent medically oriented notions about how many inpatient days a prudent physician needs to effectively treat a patient who suffers from a specified disease. However, for the most part, DRGs ignore the behavioral variables that moderate entry into the tertiary care system and the subsequent use of hospital resources. Under DRGs, the development and use of behavioral treatments for somatic disorders could be discouraged. For example, many newer behavioral medicine techniques may be more time-consuming and/or expensive than traditional treatment options (e.g., bed rest vs. biofeedback for low back pain) and thus not fall within the time period or "trim points" alloted for such disorder, regardless of comparative effectiveness. Also, under the new system, psychologists can no longer bill separately for their inpatient services. It is argued that the framers of health care policies should recognize and support health psychologists in light of the fact that many of their techniques can reduce the cost and consumption of health care through programs that: reduce behavioral risk factors, increase compliance with medical regimens, and prepare patients psychologically for stressful medical procedures.