How Physicians Lost Out to Managed Care: A Case Study of Accommodation and Resistance in a Medical Community

This paper involves a case study of physicians working in an urban Midwestern region. It raises questions surrounding how physicians adapted to, encouraged and resisted the increasing presence of managed care in their work lives. The patterning of physician accommodation to managed care and the failure of physicians to mount any effective organized resistance in Metro has some important implications for theories about professional dominance and decline.     

Differential diagnosis of steroid-dependent nephrotic syndrome with psychosis: Practical and ethical issues

The present case illustrates practical and ethical issues that can be encountered by clinical psychologists providing consultation services in medical settings. The neuropsychological consultation service was asked to evaluate a 22-year-old male with psychosis, steroid-dependent nephrotic syndrome, and a family history of schizophrenia. MRI revealedmarked cortical atrophy. Clinical findings were consistent with (1) steroid inducedapparent atrophy, which has been shown to be reversible with withdrawal of steroids; (2) uremia secondary to steroid withdrawal; (3) cortical atrophy, found in some schizophrenics; or (4) an atypical, diffuse degenerative disorder. Clinical interview and psychological testing revealed significant thought disorder, prominent delusions, somatic hallucinations, and mood disturbance. Deterioration in social and academic functioning was also present. Except for impaired attention and concentration, neuropsychological evaluation showed no clear evidence of brain-based dysfunction. Further, neuropsychological results effectively ruled out a degenerative process and were not consistent with a steroid effects profile. A conclusive differential diagnosis of steroid induced psychosis versus severe psychopathology would require withdrawal from steroids and antipsychotics. In addition to the practical and ethical issues of withholding antipsychotics, steroid withdrawal would require either dialysis or renal transplant surgery. Decision making regarding dialysis dependency and the possibility of postsurgical psychosis secondary to true psychopathology were salient issues to both the patient and the treatment team.     

Get Over It! A Multilevel Threshold Autoregressive Model for State-Dependent Affect Regulation

Intensive longitudinal data provide rich information, which is best captured when specialized models are used in the analysis. One of these models is the multilevel autoregressive model, which psychologists have applied successfully to study affect regulation as well as alcohol use. A limitation of this model is that the autoregressive parameter is treated as a fixed, trait-like property of a person. We argue that the autoregressive parameter may be state-dependent, for example, if the strength of affect regulation depends on the intensity of affect experienced. To allow such intra-individual variation, we propose a multilevel threshold autoregressive model. Using simulations, we show that this model can be used to detect state-dependent regulation with adequate power and Type I error. The potential of the new modeling approach is illustrated with two empirical applications that extend the basic model to address additional substantive research questions.     

Ethics and Relationship: From Risk Management to Relational Engagement

In this article, the underlying assumptions of the current ACA Code of Ethics ( 2014a ) are examined as they are embedded in historical and cultural contexts. A relational ethic situated within relational‐cultural theory that provides an alternative framework for understanding ethics in a relational and compassionate way is presented.     

Attitudes Toward Professional Psychological Help Seeking in South Asian Students: Role of Stigma and Gender

This study examined (a) the roles of perceived and personal stigma on attitudes toward professional psychological help seeking and (b) the effects of these constructs across gender in South Asians. Personal stigma and being male was negatively associated with attitudes toward professional psychological help seeking; no difference in the association between personal and perceived stigma and attitudes across genders was found. These findings have implications for the engagement of South Asians in mental health services in the United States. Este estudio examinó (a) los roles de estigmas percibidos y personales en las actitudes hacia la búsqueda de ayuda psicológica profesional y (b) los efectos de estos constructos en indiviuos sudasiáticos según su sexo. El estigma personal y la identidad masculina se asociaron negativamente con las actitudes hacia la búsqueda de ayuda psicológica profesional; no se halló diferencia en la asociación entre estigmas personales y percibidos y las actitudes de los distintos sexos. Estos hallazgos tienen implicaciones para la participación de los individuos sudasiáticos en los servicios de salud mental en Estados Unidos.     

Adult reflection in a graduate-level online distance education course

This study examined adult learners’ ability to engage in critical reflection concerning their own learning in a graduate-level online instructional technology course. The online course was facilitated through asynchronous discussions, and the course topic was about the design and delivery of distance education. The data for this study consisted of four critical reflection papers about students’ perception of their learning. The Periodic Reflection Tool, based on activity systems analysis, was introduced to participants as a guide for engaging in in-depth reflection about their learning process and completing their course assignment. After course completion and during data analysis, we applied instrumental learning and communicative learning theories to evaluate how participants used the tool to reflect on their personal learning in the course. At the conclusion of an analysis of their reflection statements, it was found that purposeful reflections guided by the Periodic Reflection Tool could help guide adult learners to reflect on many aspects of their learning and we suggest that the tool could be used to examine adults’ transition from traditional to online settings.     

Cover-Copy-Compare and Spelling: One Versus Three Repetitions

Cover, copy, compare (CCC) has been used with success to improve spelling skills. This study adds to existing research by completing an analysis of the rewriting component of the intervention. The impact of varying the number of times a subject copied a word following an error was examined with four elementary age students. An adaptive alternating treatments design with counterbalancing was used to compare the effects of two versions of CCC and baseline during acquisition and retention 2 weeks later. During acquisition, performance in both versions of CCC was greater than that during baseline sessions. There was not an appreciable difference between versions of CCC. Retention of performance was similar for CCC1 and CCC3. Results are discussed in terms of the core components of CCC and directions for future research.     

Preliminary validation of a Chinese version of the State-Trait Anger Expression Inventory-2

The increased globalization of psychology and related fields necessitates the availability of psychometric instruments in a number of languages, countries and cultures. Unfortunately, research on anger and aggression in Chinese populations has suffered from a lack of valid and reliable measurement instruments. Therefore, the State-Trait Anger Expression Inventory-2 (STAXI-2) was translated into Chinese (Chinese STAXI-2). Two samples of Hong Kong Chinese ( N  = 489 and N  = 775) completed the Chinese STAXI-2. Participants in the second sample also completed measures of anger rumination and aggression. Confirmatory factor analysis (CFA) of responses from the first sample resulted in the loss of nine items from the 57 original items due to misspecification. A second CFA, using responses from the second sample, supported the construct validity of the modified scale. Moderate correlations were observed with measures of aggression and anger rumination, and significant differences were found between males and females on three anger expression subscales (Anger Expression-In, Anger Control-Out, and Anger Control-In). The preliminary evidence suggests that the abbreviated inventory may be a useful measure of state and trait anger, and anger expression in some Chinese populations.     

Who benefits from memory training?

Cognitive training programs can have significant benefits. However, their efficacy is often reduced for individuals of advanced age or lower cognitive ability. Using older adult subjects, we examined the role of self-initiation of cognitive control in a training program that targets recollection memory. Relative time spent on an open-ended, intentional encoding task that requires the self-initiation of cognitive control was highly predictive of improvement in the training task, and fully accounted for individual differences related to age and crystallized intelligence. Analyzing training programs from the perspective of cognitive theory may help clarify how these programs have their effects and suggest ways to optimize such programs for the individuals who need them most.