Succeeding in Rural Mental Health Practice: Being Sensitive to Culture by Fitting in and Collaborating

Sustainable solutions to the access to mental health care problems are complex and must address both the availability of mental health care resources and the acceptability of those resources to consumers. The purpose of this study was to determine how to address the acceptability problem by learning from medical and mental health care providers what mental health therapists need to know to be successful in providing care in rural communities. Using a qualitative design, focus groups were conducted in three rural communities (<2,500) with medical and mental health care providers practicing in these communities. Data were analyzed using inductive qualitative methods. Results indicate that in addition to sound clinical skill, mental health therapists should (A) be sensitive to the culture of the rural community in which they are working and (B) practice in a way that accommodates to the care culture of the community. The latter includes spending time with patients commensurate with what is expected by other providers, engaging in generalist practice, and collaborating with local providers in patient care. An important implication of these results is that mental health care must be acceptable to both the residents of the community and the gatekeepers to health care.     

Parental Influence on Children with Attention-Deficit/Hyperactivity Disorder: I. Relationships Between Parent Behaviors and Child Peer Status

We examined associations between children’s peer relationships and (a) their parents’ social competence as well as (b) their parents’ behaviors during the children’s peer interactions. Participants were families of 124 children ages 6–10 (68% male), 62 with ADHD and 62 age- and sex-matched comparison youth. Children’s peer relationships were assessed via parent and teacher report, and sociometric nominations in a lab-based playgroup. Parental characteristics were assessed via parent self-report and observations of behavior during their child’s playgroup. After statistical control of relevant covariates, parents of children with ADHD reported poorer social skills of their own, arranged fewer playdates for their children, and displayed more criticism during their child’s peer interaction than did parents of comparison youth. Parents’ socialization with other parents and facilitation of the child’s peer interactions predicted their children having good peer relationships as reported by teachers and peers, whereas parental corrective feedback to the child and praise predicted poor peer relationships. Parents’ ratings of their child’s social skills were positively associated with ratings of their own social skills, but negatively associated with criticism and facilitation of the child’s peer interactions. Relationships between parental behaviors and peer relationships were stronger for youth with ADHD than for comparison youth. The relevance of findings to interventions is discussed.     

A test of the bidirectional association between sleep and mood in bipolar disorder and insomnia

The present study investigates sleep, mood, and the proposed bidirectional relationship between the two in psychiatric disorders. Participants with interepisode bipolar disorder (n = 49), insomnia (n = 34), and no psychiatric history (n = 52) completed seven consecutive days of sleep diaries and mood measures. The interepisode bipolar and insomnia participants exhibited greater sleep disturbance than the healthy control individuals. Negative mood was equally heightened in both interepisode bipolar disorder and insomnia, and there were no differences between the three groups in positive mood. Total wake time was associated with next morning negative mood in bipolar disorder, whereas evening negative mood was associated with subsequent total wake time in both bipolar disorder and insomnia. Additionally, positive mood was associated with subsequent total wake time for the insomnia group. Results support the theory that disruptions in nighttime sleep and daytime mood may be mutually maintaining and suggest the potential importance of transdiagnostic or universal processes.     

The Role of Reflective Functioning in Predicting Marital and Coparenting Quality

Reflective functioning (RF) is a measure of mentalization—the capacity to think about one’s own and others’ thoughts and feelings and to understand the connections between mental states and behaviors. Previous research indicates a decline in marital quality across the transition to parenthood, and some studies have found that parents are less happy than non-parents. Thus, researchers have called for research into possible moderators of these patterns. RF may help couples navigate this transition by more easily taking each other’s (and the infant’s) perspective and understanding each other’s behaviors. Much of the research on RF has focused on mothering behavior; research has not yet examined associations between RF and other family interactions. We examined associations between RF and marital and coparenting quality for both wives and husbands. Reflective functioning was coded from Adult Attachment Interviews conducted during pregnancy. We assessed marital quality at 3.5 months, and coparenting quality at 13 months, after the birth of the target child. Wives’ higher RF was associated with higher levels of positive—and lower levels of negative—marital and coparenting interactions. Wives who were better able to reflect on their early experiences with their parents were involved in marital interactions that were more positive and supportive and less conflicted and undermining. Husbands’ RF did not predict marital or coparenting quality. These findings highlight the importance of reflective functioning in understanding family functioning.     

The psychology of confessions: A comparison of expert and lay opinions

Despite a body of confessions research that is generally accepted in the scientific community, courts often exclude experts on the ground that such testimony would not assist the jury, which can use its common sense. To examine whether laypeople know the contents of expert testimony on confessions, we asked 151 lay participants to indicate their beliefs about 30 confession‐related statements used in a recent survey of 87 confession experts (Kassin et al., American Psychologist, 2018, 73, 63–80). Participants agreed with experts on only 10 of the 30 propositions, suggesting that much of the psychology of confessions is not common knowledge and that expert testimony can assist the trier of fact.     

Posttraumatic Stress Disorder and Emotion‐Focused Coping Among Disaster Mental Health Counselors

The authors surveyed 235 disaster mental health counselors (DMHCs) for levels of posttraumatic stress disorder (PTSD) symptom severity. A correlational design was used to examine the roles of adult attachment security, emotion regulation, and mindfulness in predicting PTSD symptoms among this group. Each of the 3 predictors was negatively correlated with PTSD symptom severity, and data supported a mediating role for emotion regulation. Results may inform DMHCs, other counselors, and individuals who train or deploy DMHCs.     

Collaboration in associative recognition memory: using recalled information to defend "new" judgments

S. E. Clark, A. Hori, A. Putnam, and T. J. Martin (2000) showed that collaboration on a recognition memory task produced facilitation in recognition of targets but had inconsistent and sometimes negative effects regarding distractors. They accounted for these results within the framework of a dual-process, recall-plus-familiarity model but showed only weak evidence to support it. The present results of 3 experiments present stronger evidence for Clark et al.'s dual-process view and also show why such evidence is difficult to obtain.     

Interpretive biases in chronic insomnia: an investigation using a priming paradigm

Disorder-congruent interpretations of ambiguous stimuli characterize several psychological disorders and have been implicated in their maintenance. Models of insomnia have highlighted the importance of cognitive processes, but the possibility that biased interpretations are important has been minimally investigated. Hence, a priming methodology was employed to investigate the presence of an interpretive bias in insomnia. A sample of 78 participants, differing in the presence of a diagnosis of insomnia, severity of sleep disturbance, and sleepiness, was required to read ambiguous sentences and make a lexical decision about target words that followed. Sleepiness at the time of the experiment was associated with the likelihood with which participants made insomnia and threat consistent interpretations of ambiguous sentences. The results suggest that there is a general bias towards threatening interpretations when individuals are sleepy and suggests that cognitive accounts of insomnia require revision to include a role for interpretative bias when people are sleepy. Future research is required to investigate whether this interpretive bias plays a causal role in the maintenance of insomnia.