Improvements in Depression and Mental Health After Acceptance and Commitment Therapy are Related to Changes in Defusion and Values-Based Action

Acceptance and commitment therapy (ACT) has been found to be effective for various mental health disorders but the processes through which it affects change remain unclear. Much process research in the area is on physical rather than mental health, and focuses on the broad concept of psychological flexibility with little research on specific mechanisms identified in theory such as fusion and values. This study explored whether there was a relationship between two of the main ACT processes (cognitive defusion and values) and levels of depression and distress. Thirty-three participants completed questionnaires at the start and end of their treatment measuring general mental health and distress, depression, levels of cognitive fusion and how much they were living in line with their values and how important their values were to them. Results showed reductions in levels of fusion and increases in values-based action were significantly related to reductions in distress and depression. There was no correlation between changes in values importance and changes in distress or depression. This study therefore suggests decreased defusion and increased values-based action is an important mechanism in the efficacy of ACT in those with depression and mental health problems. The study is however limited by a small sample size and future research with a sample large enough for mediation analysis would be beneficial.     

Development of Clinical Psychology and Mental Health Resources in Vietnam

In this paper, we discuss development of the Vietnam National University graduate Clinical Psychology Program, which has the goal of training both Vietnamese researchers who will develop and evaluate culturally appropriate mental health treatments, as well as Vietnamese clinicians who will implement and help disseminate these evidence-based treatments. We first review the background situation in Vietnam regarding mental health, and its infrastructure and training needs, and discuss the process through which the decision was made to develop a graduate program in clinical psychology as the best approach to address these needs. We then review the development process for the program and its current status, and our focus on the schools as a site for service provision and mental health task shifting. Finally, we outline future goals and plans for the program, and discuss the various challenges that the program has faced and our attempts to resolve them.     

Decision moving window: using interactive eye tracking to examine decision processes

It has become increasingly more important for researchers to better capture the complexities of making a decision. To better measure cognitive processes such as attention during decision making, we introduce a new methodology: the decision moving window, which capitalizes on both mouse-tracing and eye-tracking methods. We demonstrate the effectiveness of this methodology in a probabilistic inferential decision task where we reliably measure attentional processing during decision making while allowing the person to determine how information is acquired. We outline the advantages of this methodological paradigm and how it can advance both decision-making research and the development of new metrics to capture cognitive processes in complex tasks.     

Occupational Therapy Shared Decision Making in Adolescent Mental Health

Shared decision making (SDM) shares values of client-centered practice; however, a few studies exist that explore experiences of occupational therapists (OTs) working in adolescent mental health. This study aims to better understand SDM in adolescent mental health using the Canadian Model of Client-Centered Enablement. A qualitative study included interviews (n = 6) and analysis using an inductive approach. The role of the OT, client factors, therapeutic relationship, and nature of the decision were identified as influencing the process and outcome of SDM. The study helps better understand SDM in practice, the need for specialized education for OTs and has identified future research areas.     

Partnering with Children Diagnosed with Mental Health Issues: Contributions of a Sociology of Childhood Perspective to Participatory Action Research

This paper explores the use of participatory action research (PAR) with children diagnosed with mental health issues. We argue that critiques from the sociology of childhood are useful for guiding PAR with children. First, we describe and critique values and assumptions that underlie research and practice with children who experience mental health issues. Second, we outline key qualities of the sociology of childhood, discuss their implications for PAR with children diagnosed with mental health issues, and touch on ethical issues. Five themes are explored: (a) values, (b) ontology/epistemology, (c) views about children, (d) agency/power in children’s relationships with adults, and (e) intervention/change focus. We conclude by encouraging community psychologists to consider PAR with children diagnosed with mental health issues.     

Does young adults’ preferred role in decision making about health,money, and career depend on their advisors’ leadership skills?

Few empirical data exist on how decision making about health differs from that in other crucial life domains with less threatening consequences. To shed light on this issue we conducted a study with 175 young adults (average age 19 years). We presented the participants with scenarios involving advisors who provided assistance in making decisions about health, money, and career. For each scenario, participants were asked to what extent they wanted the advisor to exhibit several leadership styles and competencies and what role (active, collaborative, or passive) they preferred to play when making decisions. Results show that decision making about health is distinct from that in the other domains in three ways. First, most of the participants preferred to delegate decision making about their health to their physician, whereas they were willing to collaborate or play an active role in decision making about their career or money. Second, the competencies and leadership style preferred for the physician differed substantially from those desired for advisors in the other two domains: Participants expected physicians to show more transformational leadership—the style that is most effective in a wide range of environments—than those who provide advice about financial investments or career. Finally, participants’ willingness to share medical decision making with their physician was tied to how strongly they preferred that the physician shows an effective leadership style. In contrast, motivation to participate in decision making in the other domains was not related to preferences regarding advisors’ leadership style or competencies. Our results have implications for medical practice as they suggest that physicians are expected to have superior leadership skills compared to those who provide assistance in other important areas of life.     

How to achieve synergy in group decision making: Lessons to be learned from the hidden profile paradigm

Based on over 25 years of research on hidden profiles and information sharing in groups, and particularly our own work in this area, we outline a general model of how groups can achieve better decisions in a hidden profile situation than their individual members would have been capable of (i.e., synergy). At its core the model defines intensity and bias as the two key parameters that have to be optimised with regard to both the discussion of information and the processing of information in order to ensure synergy in group decision making. We review the empirical literature on information sharing and group decision making in the hidden profile paradigm (with a particular focus on our own studies) to illustrate how group decision quality can be enhanced by increasing intensity and decreasing bias in the discussion and processing of information. Finally we also outline why we think that the lessons learned from research using the hidden profile paradigm can be generalised to group decision-making research in general, and how these lessons can stimulate studies in other fields of group decision-making and group performance research.     

Principles of Occupational Therapy Group Outcome Assessment in Mental Health

In today's penurious health care climate, occupational therapists must scrutinize their practice and substantiate their interventions in order to remain viable service providers. This article proposes a method of occupational therapy outcomes assessment in mental health care that is rooted in client-centered functional outcomes. Since little consensus exists on which instruments are most effective, this article begins with an outline of broadly accepted principles for assessment of patient outcomes in mental health. Next, we describe a practical method for selecting outcomes measures in interdisciplinary settings. Finally, we offer pragmatic solutions to address barriers to outcome assessment.     

Utilizing Community Partnerships to Devise a Framework for Cultural Adaptations to Evidence-Based Mental Health Practice in Diverse Communities

Mental health disparities for diverse communities (particularly immigrants and people of color) in terms of access to evidence-based treatments, lack of education/awareness about mental health symptoms and treatment options, and lack of culturally responsive treatments have been frequently documented. Hence, diversity considerations in the diagnosis, assessment, and treatment of psychological disorders remain vital and imperative in clinical practice. There is also substantial work indicating that cultural values likely play an essential role in shaping how individuals conceptualize and experience mental or emotional health. Therefore, the present study was developed for community-engaged clinicians and researchers to outline the process by which to create a culturally responsive, evidence-based treatment framework for community mental health interventions in close partnership with communities of color. This study was conceptualized and designed collaboratively with community leaders across five different communities of color: African American/Black, Latino/a, Native American, Pacific Islander, and African immigrant communities in a major U.S. city. This paper describes the mixed methods for such a community-engaged collaboration, highlighting critical elements for ongoing culturally engaged clinical work/research, and providing recommendations for culturally adapted interventions for mental health based on specific process observations made in the current example.     

Remembering and diagnosing clients: does experience matter?

Experienced mental health clinicians often do not outperform novices in diagnostic decision making. In this paper we look for an explanation of this phenomenon by testing differences in memory processes. In two studies we aimed to look at differences in accuracy of diagnoses in relation to free recall of client information between mental health clinicians with different levels of experience. Clinicians were presented with two cases, and were asked afterwards, either directly (Study 1) or after 1 week (Study 2), to give the appropriate diagnoses and to write down what they remembered of the cases. We found in Study 1 that the accuracy of the diagnoses was the same for all levels of experience, as was the amount of details recalled. Very experienced clinicians did remember more higher-order concepts, that is, abstractions from the presented information. In Study 2 we found that the very experienced clinicians were less accurate in their diagnoses and remembered fewer details than the novices. In response to these findings we further discuss their implications for psychodiagnostic practice.     

Making decisions with a continuous mind

Neuroeconomics is a rapidly expanding field at the interfaces of the human sciences. The interdisciplinary nature of this field results in several challenges when attempts are made to solve puzzling questions in human decision making, such as why and how people discount future gains. We argue that an empirical approach based on dynamic systems theory (DST) could inspire and advance the neuroeconomic investigation of decisionmaking processes in three ways: by enriching the mental model, by extending the empirical tool set, and by facilitating interdisciplinary exchange. The present article addresses the challenges neuroeconomics faces by focusing on intertemporal choice. After a brief introduction of DST and related research, a DST-based conceptual model of decision making is developed and linked to underlying neural principles. On this basis, we outline the application of DST-informed empirical strategies to intertemporal choice. Finally, we discuss the general consequences of and possible objections to the proposed approach to research in intertemporal choice and the field of neuroeconomics.     

L’enfance et l’adolescence in situ : facteurs environnementaux facilitateurs et inhibiteurs de troubles cognitifs et comportementaux

The definition of mental health associates three fundamental variables: biological variables, psychological variables and environmental variables. In this article, we will focus on environmental variables that inhibit and facilitate cognitive and behavioural disorders in childhood and adolescence. Environmental psychology considers the interrelations between human and environment in its spatial, social and chronological dimensions and considers it as a characterized and undissociated system. We will bring to mind social and physical environmental variables with which children and adolescents interact frequently and, through a literature review, we will enlighten environmental variables that are susceptible to induce behavioural disorders and psychological variables that modulate children's and adolescent's relations to environment. We then suggest possible outcomes of this approach in clinical practice as well as in terms of therapeutic applications in child psychology and psychiatry. Finally, we evoke the necessity of taking in account neurobiological fields in order to outline a model of human development integrating the three variables that define mental health.     

Integrated Behavioral Health in Rural Settings: A Course Design

ABSTRACT

Rurality is a vital component of cultural diversity, making it essential to train future counselors on comprehensive mental health counseling practice with rural populations. In this article, we describe the development of a master’s level course that reflects an integrated approach to providing mental health counseling services in rural communities. First, the pedagogical foundation for the course design and positionality are discussed. Second, the course objectives are outlined, and corresponding teaching methods and creative learning assignments are provided. Last, we discuss the strengths and challenges of the course design and implementation.     

Change occurs when body meets environment: A review of the embodied nature of development

The purpose of this paper is to outline the challenges of psychological research in addressing the mechanisms of emergence: how new behavioral patterns and cognitive abilities arise from the interaction of an organism with its environment in real time. We review some of the empirical studies on infant development with reference to Dynamical Systems accounts and relevant views such as the ecological approach to perception and action, and cover topics ranging from early motor skills to goal‐directed locomotion and to higher cognitive development. The central claim is that the results of these studies are essentially related: they suggest that there is a fundamental connection among perception, motor behavior, and cognition. In addition, we recount our attempt to re‐enact the situatedness and temporal structure of the decision‐making processes of human infants by using an autonomous robotic device. We conclude by highlighting several insights from the broad spectrum of studies looking into the embodied nature of adaptive behavior. In our view, such studies are making a profound contribution to uncovering the emergent mechanisms of intellectual and bodily activity throughout development.     

Ethical social justice: Do the ends justify the means?

This article offers an ethical decision‐making model, informed by community psychology values, as a means for guiding psychologists when engaging in social justice‐oriented work. The applicability of this model is demonstrated through a case analysis elucidating how America's psychologists individually and collectively arrived at the decision to endorse torture—ostensibly as a means for preventing terrorism. Critics have wondered how the American Psychological Association succumbed to these involvements, and how to prevent such ethical lapses in the future. Unfortunately, the American Psychological Association's ethical codes fail to provide explicit guidance for psychologists' involvement in social justice work that impacts communities and systems. To address this gap, we present a values‐driven, ethical decision‐making framework that may be used to guide psychologists' future practices. This framework infuses fundamental community psychology values (i.e., caring and compassion; health; self‐determination and participation, human diversity, social justice; and critical reflexivity) into a 9‐step model.     

The dynamics of deferred decision

Decision makers are often unable to choose between the options that they are offered. In these settings they typically defer their decision, that is, delay the decision to a later point in time or avoid the decision altogether. In this paper, we outline eight behavioral findings regarding the causes and consequences of choice deferral that cognitive theories of decision making should be able to capture. We show that these findings can be accounted for by a deferral-based time limit applied to existing sequential sampling models of preferential choice. Our approach to modeling deferral as a time limit in a sequential sampling model also makes a number of novel predictions regarding the interactions between choice probabilities, deferral probabilities, and decision times, and we confirm these predictions in an experiment. Choice deferral is a key feature of everyday decision making, and our paper illustrates how established theoretical approaches can be used to understand the cognitive underpinnings of this important behavioral phenomenon.     

Counseling in an Enlightened Society: Values for a New Millennium

In the year 2001, civilization will enter a new century and a new millennium as well. For counseling professionals the start of a new millennium encourages an examination of the philosophy and practice of mental health intervention. The purpose of this article is to share a vision that can possibly lay the foundation for an enlightened world society. It also attempts to outline how the counseling profession can influence the possibility of such a society.     

Modeling adaptive cooperative and competitive metaphors as mental models for joint decision making

In this paper, joint decision making processes are studied and the role of cognitive metaphors as mental models in them. A second-order self-modeling network model is introduced based on mechanisms known from cognitive and social neuroscience and cognitive metaphor and mental model literature. The cognitive metaphors were modeled as specific forms of mental models providing a form of modulation within the joint decision making process. The model addresses not only the use of these mental models in the decision making, but also their hebbian learning and the control over the learning. The obtained self-modeling network model was applied to two types of metaphors that affect joint decision making in different manners: a cooperative metaphor and a competitive metaphor. By a number of scenarios it was shown how the obtained self-modeling network model can be used to simulate and analyze joint decision processes and how they are influenced by such cognitive metaphors.     

决策渐进调整过程的个案研究

许多以全面理性为基础的决策理论都倾向于把决策者对事物的认识作为决策的前提,认为一项好的决策只有在充分认识了事物的情况下才是可能的.许多心理学的研究发现,这种假设并不符合实际的情况.本研究以"行动理性"为出发点,运用个案分析技术,深入剖析了某电子原件厂历时半年的生产经营决策过程,揭示了决策在执行的过程中逐步调整和发展的特征.研究发现,作为决策的前提的认识,实际上是在该决策的执行过程中不断发展和完善的.决策者是在决策执行结果的评价基础之上,逐步深入地认识决策的关键问题,包括(1)决策所要解决的问题,(2)决策方案会产生什么样的结果,(3)决策执行方法是否适当,(4)决策应采取什么样的程序和方法,(5)决策的形势和条件如何.正是这些"后见",使决策者能够逐步调整决策,实现决策的"渐进发展".这种行动决策的思想,把决策者的认识、决策和决策执行三者的关系看做一种循环发展的过程.