Pragmatic Screening of Anxiety,Depression, Suicidal Ideation,and Substance Misuse in Older Adults

Older adults’ mental health needs are often unmet across care settings (e.g., primary or residential care) for a variety of reasons, such as mental health stigma and mental health care professionals’ lack of awareness of age-related changes in mental disorders. Screening, when coupled with access to evidence-based interventions, is effective at identifying and reducing anxiety, depression, suicidal ideation, and substance misuse in older adults across care settings. Unfortunately, due to lack of training many mental health care professionals may be unsure about what or how to screen, as well as which screening measures are available for use with older adults. Following professional guidelines recommended for older adults, we provide an overview of screening measures for anxiety, depression, suicidal ideation, and substance misuse that are evidence-based and meet pragmatic criteria identified by stakeholder research. Specific pragmatic criteria include screening measures developed with older adults (unless unavailable) as well as brief in length (items ≤30), time for administration (≤15 minutes), scoring (<5 minutes), and interpretation (<5 minutes). Other pragmatic criteria include screening measures readily available on the internet at no cost and usable across diverse settings (e.g., community, primary care, and/or residential care). For each measure, we also review relevant psychometric properties (e.g., reliability, cut-scores, sensitivity, specificity, and construct validity). Lastly, we discuss strategies to facilitate screening with older adults and direct mental health care providers to internet resources that can be used to learn more about assessment with older adults.     

A Primer on Celtic Spirituality With Recommendations for Counseling Practice

Research suggests that expressions of Celtic spirituality are widespread among the U.S. populace (e.g., Pew Research Center, 2014; Sullivan, 2016). Adherents vary in their commitment levels, ranging from informal cultural participants to followers of structured forms of the faith tradition (e.g., Celtic Christianity, Wicca, Paganism). The counseling literature provides scant information on this movement and germane approaches to support clients who identify with this spirituality. To respond to this deficiency, we address the topic by contextualizing Celtic spirituality from definitional, historical, and thematic perspectives. Next, we consider implications for spiritually sensitive counseling practice. We include a case study, exemplifying potential adaptive counseling processes and interventions.     

Psychometric Evaluation of 5- and 7-Year-Old Children's Self-Reports of Conduct Problems

Past research suggests that young children are incapable of reporting information about their own behavior problems. To test this, we examined the validity and the usefulness of children's self-reports in the E-Risk Study, a nationally representative birth cohort of 2,232 children. We used the Berkeley Puppet Interview to obtain children's self-reports of conduct problems when they were 5-years old and the Dominic-R when they were 7-years old. We also collected information about the children and their families by interviewing mothers, sending questionnaires to teachers, and rating examiners' observations during home visits. Results indicate that when children's self-reports are gathered with structured and developmentally appropriate instruments, they are shown to be valid measures: conduct problems reported by the children themselves were associated with known correlates including individual characteristics (e.g., IQ), related behaviors (e.g., hyperactivity), and family variables (e.g., economic disadvantages). Observed correlations closely matched effect sizes reported in the literature using adults' reports of children's behavioral problems. In addition, children's self-reports can be useful: both measures distinguished children meeting DSM-IV criteria for research diagnoses of conduct disorder. Children's reports also contributed unique information not provided by adults. For research and clinical purposes, young children's self-reports can be viewed as a valuable complement to adults' ratings and observational measures of children's behavior problems.     

Psychological counseling as an adjunct to stuttering treatment: Clients’ experiences and perceptions

PurposeStuttering can trigger anxiety and other psychological and emotional reactions, and limit participation in society. It is possible that psychological counseling could enhance stuttering treatment outcomes; however, little is known about how clients view such counseling. The purpose of this study was to gain an understanding of clients’ experiences with, and perceptions of, a psychological counseling service that was offered as an optional adjunct to speech therapy for stuttering.MethodNine individuals who stutter (13-38 years old) participated in semi-structured interviews. Six participants had taken part in psychological counseling; three participants did not do so. Interview data were analyzed using grounded theory as a guiding framework.ResultsFour thematic clusters emerged from participants’ accounts: insights into personal decision-making, why others may not participate in counseling, psychological counseling as a worthwhile part of therapy, and counseling as a necessary component in a stuttering treatment program.ConclusionIn addition to experiencing barriers and facilitators to help-seeking that are reported in related fields, participants accounts also revealed novel facilitators (i.e., a ‘why not’ mentality and the importance of having a pre-existing relationship with the clinician who offered the service) and barriers (i.e., viewing the service as a ‘limited resource,’ and, the overwhelming nature of intensive stuttering treatment programs). Findings suggest that clients value the option to access psychological counseling with trained mental health professionals to support the stuttering treatment provided by speech-language pathologists. Participants made recommendations for the integration of psychological counseling into stuttering treatment programs.     

Speakers' assumptions about the lexical flexibility of idioms

In three experiments, we examined why some idioms can be lexically altered and still retain their figurative meanings (e.g., John buttoned his lips about Mary can be changed into John fastened his lips about Mary and still mean "John didn't say anything about Mary"), whereas other idioms cannot be lexically altered without losing their figurative meanings (e.g., John kicked the bucket, meaning "John died," loses its idiomatic meaning when changed into John kicked the pail). Our hypothesis was that the lexical flexibility of idioms is determined by speakers' assumptions about the ways in which parts of idioms contribute to their figurative interpretations as a whole. The results of the three experiments indicated that idioms whose individual semantic components contribute to their overall figurative meanings (e.g., go out on a limb) were judged as less disrupted by changes in their lexical items (e.g., go out on a branch) than were nondecomposable idioms (e.g., kick the bucket) when their individual words were altered (e.g., punt the pail). These findings lend support to the idea that both the syntactic productivity and the lexical makeup of idioms are matters of degree, depending on the idioms' compositional properties. This conclusion suggests that idioms do not form a unique class of linguistic items, but share many of the properties of more literal language.     

Group psychotherapy with adolescents: An integrative approach

Conclusion This paper has attempted to convey a complex strategy and rationale for conducting group psychotherapy with a specific population. A variety of techniques have been integrated into an approach designed for adolescent groups. Modifications of this basic approach would be readily applicable in a variety of settings (e.g., school counseling programs, in-patient, facilities, private therapy).     

A systems framework for understanding social settings

In this paper, we argue that attempts to change social settings have been hindered by lack of theoretical advances in understanding key aspects of social settings and how they work in a dynamic system. We present a systems framework for understanding youths' social settings. We focus on three aspects of settings that represent intervention targets: social processes (i.e., patterns of transactions between two or more people or groups of people), resources (i.e., human, economic, physical, temporal resources), and organization of resources (i.e., how resources are arranged and allocated). We postulate that these setting aspects are in dynamic transaction with each other, resulting in setting outcomes. Discussion focuses on the implications of our theoretical framework for setting intervention.     

Informed Decision-Making in the Context of Prenatal Chromosomal Microarray

The introduction of chromosomal microarray (CMA) into the prenatal setting has involved considerable deliberation due to the wide range of possible outcomes (e.g., copy number variants of uncertain clinical significance). Such issues are typically discussed in pre-test counseling for pregnant women to support informed decision-making regarding prenatal testing options. This research study aimed to assess the level of informed decision-making with respect to prenatal CMA and the factor(s) influencing decision-making to accept CMA for the selected prenatal testing procedure (i.e., chorionic villus sampling or amniocentesis). We employed a questionnaire that was adapted from a three-dimensional measure previously used to assess informed decision-making with respect to prenatal screening for Down syndrome and neural tube defects. This measure classifies an informed decision as one that is knowledgeable, value-consistent, and deliberated. Our questionnaire also included an optional open-ended question, soliciting factors that may have influenced the participants’ decision to accept prenatal CMA; these responses were analyzed qualitatively. Data analysis on 106 participants indicated that 49% made an informed decision (i.e., meeting all three criteria of knowledgeable, deliberated, and value-consistent). Analysis of 59 responses to the open-ended question showed that “the more information the better” emerged as the dominant factor influencing both informed and uninformed participants’ decisions to accept prenatal CMA. Despite learning about the key issues in pre-test genetic counseling, our study classified a significant portion of women as making uninformed decisions due to insufficient knowledge, lack of deliberation, value-inconsistency, or a combination of these three measures. Future efforts should focus on developing educational approaches and counseling strategies to effectively increase the rate of informed decision-making among women offered prenatal CMA.     

Construct validity evidence for a measure of peer athletic reputation (PAthR) in high school physical education

Grounded in the work that has been conducted on peer academic reputation in educational settings, our aim was to develop and provide initial construct validity evidence for a modified instrument designed to assess peer athletic reputation (PAthR). In phase 1, we devised a series of items to assess PAthR. In phase 2 (n = 399), and approximately one month later in phase 3 (n = 374), female high school physical education (PE) students completed a series of questionnaires that included the PAthR instrument. Analyses indicated that PAthR was (a) represented as a unitary construct, (b) positively associated across time points, (c) positively associated with indicators of desirable peer interactions (e.g., peer relatedness support, peer relatedness need satisfaction) and PE experiences (e.g., intrinsic motivation, perceived competence), and (d) negatively associated with indices considered to be less adaptive in nature (i.e., anxiety, amotivation). These findings provide preliminary support for a novel approach to the measurement of peer reputation in PE, and demonstrate evidence of the nomological net with which this concept may be associated.     

Renewal during functional communication training

Functional communication training (FCT) is one of the most commonly prescribed interventions for the treatment of severe destructive behavior exhibited by individuals with intellectual disabilities. Although highly effective, FCT has been shown to fail in some cases when treatment is introduced into the child's typical environment. Basic and translational research on renewal provides a model for studying the relapse of destructive behavior following successful response to treatment in clinic settings using FCT. In the present study, we evaluated whether relapse of destructive behavior could be attributed to the discriminative control of the home context, which was historically correlated with reinforcement for destructive behavior. We implemented baseline contingencies in the home setting with caregivers acting as interventionists (i.e., Context A). We then implemented FCT in a treatment clinic with trained therapists (i.e., Context B). Finally, we introduced FCT in the home setting with caregivers implementing the treatment procedures (i.e., return to Context A). For three of four participants we observed the relapse of destructive behavior consistent with operant renewal. We discuss the implications of these findings with respect to strategies designed to promote generalization of FCT across settings during the treatment of severe destructive behavior.     

Prosocial family therapy: A manualized preventive intervention for juvenile offenders

This manual for Prosocial Family Therapy (PFT) describes a practical method of multisystemic care for juvenile offenders based on our theories about risk and protection factors and therapy process. The PFT team integrates specific parent training techniques and nonspecific family therapy strategies in meetings scheduled with decreasing frequency over a 3-month intervention and 2-year follow-up period. The PFT manual blends scientific and clinical concerns via checks on manual adherence, treatment integrity, and internal validity. PFT can be used by MA-level therapists in community or residential settings run by courts, schools, or mental-health agencies. Our short-term intervention goal is rapid, lasting reduction of youths' community, home, and coping problems (e.g., police arrest, curfew violation, substance abuse, and suicide attempts). Our long-term prevention goal includes fewer crimes and bad life outcomes (e.g., school dropout, teen parenthood, welfare dependence) and more family-wide prosocial coping—helping self without harming others. We discuss why family preservation is not our ultimate goal and why acceptance of reality is a prerequisite for behavior change.     

The Loneliness Questionnaire-Short Version: an evaluation of reverse-worded and non-reverse-worded items via item response theory

Although reverse-worded items have often been incorporated in scale construction to minimize the effects of acquiescent reporting biases, some researchers have more recently begun questioning this approach and wondering whether the advantages associated with incorporating reverse-worded items is worth the complexities that they bring to measures (e.g., Brown, 2003 ; Marsh, 1996 ). In this study, we used item response theory (IRT) to determine whether there is statistical justification to eliminate the reverse-worded items (e.g., "I have lots of friends") from the Loneliness Questionnaire (LQ; Asher, Hymel, & Renshaw, 1984) and retain only the non-reverse-worded items (e.g., "I'm lonely") to inform the provision of a shortened LQ version. Using a large sample of children (Grades 2-7; n = 6,784) and adolescents (Grades 8-12; n = 4,941), we examined the psychometric properties of the 24-item LQ and found support for retaining the 9 non-reverse-worded LQ items to make up a shortened measure of loneliness in youth. We found that the non-reverse-worded items were associated with superior psychometric properties relative to the reverse-worded items with respect to reliability and IRT parameters (e.g., discrimination and item information). A 3-point Likert-type scale was also found to be more suitable for measuring loneliness across both children and adolescents compared to the original 5-point scale. The relative contributions of reverse-worded and non-reverse-worded items in scale development for youth instruments are also discussed.     

A Systematic Review of Randomized Controlled Trials to Assess Outcomes of Genetic Counseling

With the advancements in precision medicine and health care reform, it is critical that genetic counseling practice respond to emerging evidence to maximize client benefit. The objective of this review was to synthesize evidence on outcomes from randomized controlled trials (RCTs) of genetic counseling to inform clinical practice. Seven databases were searched in conducting this review. Studies were selected for inclusion if they were: (a) RCTs published from 1990 to 2015, and (b) assessed a direct outcome of genetic counseling. Extracted data included study population, aims, and outcomes. Risk of bias was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions guidelines. A review of 1654 abstracts identified 58 publications of 54 unique RCTs that met inclusion criteria, the vast majority of which were conducted in cancer genetic counseling setting. Twenty-seven publications assessed ‘enhancements’ to genetic counseling, and 31 publications compared delivery modes. The methodological rigor varied considerably, highlighting the need for attention to quality criteria in RCT design. While most studies assessed several client outcomes hypothesized to be affected by genetic counseling (e.g., psychological wellbeing, knowledge, perceived risk, patient satisfaction), disparate validated and reliable scales and other assessments were often used to evaluate the same outcome(s). This limits opportunity to compare findings across studies. While RCTs of genetic counseling demonstrate enhanced client outcomes in a number of studies and pave the way to evidence-based practice, the heterogeneity of the research questions suggest an important need for more complementary studies with consistent outcome assessments.     

Adaptive memory: nature's criterion and the functionalist agenda

Memory researchers traditionally ignore function in favor of largely structural analyses. For example, it is well known that forming a visual image improves retention, and various proximate mechanisms have been proposed to account for the advantage (e.g., elaboration of the memory trace), but next to nothing is known about why memory evolved such sensitivities. Why did nature craft a memory system that is sensitive to imagery or the processing of meaning? Functional analyses are critical to progress in memory research for two main reasons: First, as in applied research, functional analyses provide the necessary criteria for measuring progress; second, there are good reasons to believe that modern cognitive processes continue to bear the imprint of ancestral selection pressures (i.e., cognitive systems are functionally designed). We review empirical evidence supporting the idea that memory evolved to enhance reproductive fitness; as a consequence, to maximize retention in basic and applied settings it is useful to develop encoding techniques that are congruent with the natural design of memory systems.     

Improving Mental Health on College Campuses: Perspectives of Indian College Students

The mental health of college students is increasingly viewed as an important public health priority. However, there has been little attention paid specifically to college students’ perspectives on factors that contribute to mental health challenges or on potential initiatives that could address them. Even less research has focused on students in low- and middle-income countries. In an effort to better understand how to improve mental health and wellness on college campuses, we administered an open-ended survey to 141 Indian college students (M_age = 19.47, 65% female). We asked the students to identify: (a) issues that contribute to mental health problems among college students, (b) potential initiatives or strategies that could be used to improve mental health and wellness, and (c) topics that students would like to learn about in a course about mental health and wellness. Applying thematic analysis, we identified academic stressors (e.g., pressure to succeed, competitiveness) and social stressors (e.g., lack of community, party culture and substance abuse) that students reported as contributors to mental health problems. Students also described mental health promotion strategies that could be implemented by faculty members (e.g., providing academic accommodations for students with mental health concerns), the student body (e.g., establishing peer counseling groups), and individual students (e.g., checking in with others). Finally, they identified topics that they would like to learn about in mental health and wellness courses (e.g., how to identify mental health concerns, how to support friends). By raising several potential targets for mental health and wellness interventions for Indian college students, our study illustrates how open-ended surveys can be a useful and feasible way to solicit input from stakeholders in low- and middle-income countries. Future research will be needed to assess the effectiveness and feasibility of mental health promotion strategies, including those proposed by students.     

The impact of virtuality on team effectiveness in organizational and non-organizational teams: A meta-analysis

We meta-analytically assess the virtuality-team effectiveness relationship using 73 samples of organizational teams (5738 teams) reporting on a wide range of productive (e.g. earnings), performance (e.g. customer ratings), social (e.g. cohesion), and team member (e.g. project satisfaction) outcomes. Our results suggest that in work organizations, virtuality is not a direct input—negative or positive—to team effectiveness. In contrast, using 109 samples of non-organizational teams (5620 teams), we show that virtuality is a significant negative input to team effectiveness. We also meta-analytically assess the issue of results generalizability from non-organizational to organizational settings, and find that overall, results from non-organizational studies largely fail to generalize to organizational virtual teams. Using moderator analysis, we explore a number of study features that may explain the poor results generalizability from non-organizational to organizational studies. We find that results from non-organizational studies using undergraduate students, short team duration, and laboratory settings drive the non-generalizability effect, whereas results from non-organizational studies using graduate students, longer team duration, and classroom settings produce results comparable to those of organizational studies of virtual teams. Theoretical, methodological, and practical implications are discussed.     

Exploring Genetic Counseling Communication Patterns: The Role of Teaching and Counseling Approaches

The educational and counseling models are often touted as the two primary professional approaches to genetic counseling practice. Yet, research has not been conducted to examine how these approaches are used in practice. In the present study, we conducted quantitative communication analyses of BRCA1 genetic counseling sessions. We measured communication variables that represent content (e.g., a biomedical focus) and process (e.g., passive listening) to explore whether genetic counselor approaches are consistent with prevailing professional models. The Roter Interaction Analysis System (RIAS) was used to code 167 pre-test genetic counseling sessions of members of a large kindred with an identified BRCA1 mutation. Three experienced genetic counselors conducted the sessions. Creating composite categories from the RIAS codes, we found the sessions to be largely educational in nature with the counselors and clients devoting the majority of their dialogue to providing biomedical information (62 and 40%, respectively). We used cluster analytic techniques, entering the composite communication variables and identified four patterns of session communication: Client-focused psychosocial, biomedical question and answer, counselor-driven psychosocial, and client-focused biomedical. Moreover, we found that the counselors had unique styles in which they combined the use of education and counseling approaches. We discuss the importance of understanding the variation in counselor communication to advance the field and expand prevailing assumptions.     

The face‐mind link: Why we see minds behind faces,and how others' minds change how we see their face

Understanding others' minds has puzzled philosophers for centuries. Psychologists, too, have recently begun asking questions about what causes us to see another person as having complex or simple mental faculties. Here, we review recent evidence linking how we perceive others' faces with how we perceive others' minds—the face‐mind link. We first discuss research demonstrating a face‐to‐mind effect, showing that both certain facial features (e.g., eyes) and face perception processes (e.g., configural processing) can trigger the perception that a face has a mind. We then discuss recent evidence demonstrating a mind‐to‐face effect, showing that believing a person is inhumane (i.e., their mind) leads their face to be processed less like a face and more like an object. Finally, we consider both the consequences of this bidirectional face‐mind link, and what the next steps may be in understanding how and why we infer minds from faces, and how and why beliefs about others' minds affects how we see their face.     

Evaluating Outcome Domains Assessing Caregivers of Individuals with Mental Illness: A Review

In this article, we describe the properties and consider the outcome dimensions of a collection of self‐administered questionnaires that assess caregivers of offspring with mental illness. To this end, we searched the MEDLINE, Web of Science, and PsycINFO databases, as well as reference lists of studies published between 1980 and 2012. We reviewed 43 instruments, and found multiple outcome domains, associated with either objective burden or subjective burden, or both. A number of tools captured additional negative aspects of caregiving (e.g., strain, stress, and worrying) as well as positive aspects (e.g., personal growth, strength, support, rewards, and satisfaction), supplemented by measures assessing caregivers' perceptions and attitudes toward their offspring with SMI (e.g., insight, stigma, and efficacy). This current review of existing measures and their specific domains contributes to a more comprehensive understanding of the caregiving experience and allows both clinicians and researchers to select the most appropriate measurement tools for their purposes.