Assessing psychological inflexibility: the psychometric properties of the Avoidance and Fusion Questionnaire for Youth in two adult samples

The current study examined whether the Avoidance and Fusion Questionnaire for Youth (AFQ-Y; L. A. Greco, W. Lambert, & R. A. Baer, 2008), a self-report measure of psychological inflexibility for children and adolescents, might be useful for measuring psychological inflexibility for adults. The psychometric properties of the AFQ-Y were examined using data from a college student sample (N = 387) and a clinical sample of patients with anxiety disorders (N = 115). The AFQ-Y, but not the Acceptance and Action Questionnaire-II (AAQ-II; F. W. Bond et al., in press), demonstrated a reading level at or below the recommended 5th or 6th grade reading level. The AFQ-Y also demonstrated adequate reliability (internal consistency), factorial validity, convergent and discriminant validity, and concurrent validity predicting psychological symptoms. Moreover, the AFQ-Y showed incremental validity over the AAQ-II in predicting several psychological symptom domains. Implications for the assessment of psychological inflexibility are discussed.     

The Hispanic Stress Inventory--Adolescent Version: a culturally informed psychosocial assessment

A 2-phase study was conducted to develop a culturally informed measure of psychosocial stress for adolescents: the Hispanic Stress Inventory--Adolescent Version (HSI-A). Phase 1 involved item development through the collection of open-ended focus group interview data (n = 170) from a heterogeneous sample of Hispanic youths residing in the southwest and northeast United States. In Phase 2, we examined the psychometric properties of the HSI-A (n = 1,651), which involved the use of factor analytic procedures to determine the underlying scale structure of the HSI-A for foreign-born and U.S.-born participants in an aggregated analytic approach. An 8-factor solution was established, with factors that include Family Economic Stress, Acculturation-Gap Stress, Culture and Educational Stress, Immigration-Related Stress, Discrimination Stress, Family Immigration Stress, Community and Gang-Related Stress, and Family and Drug-Related Stress. Concurrent, related validity estimates were calculated to determine relations between HSI-A and other measures of child psychopathology and behavioral and emotional disturbances. HSI-A total stress appraisal scores were significantly correlated with both the Children's Depression Inventory and the Youth Self Report (p < .001). Reliability estimates for the HSI-A were conducted, and they yielded high reliability coefficients for most factor subscales, with the HSI-A total stress appraisal score reliability alpha at .92.     

An Anatomy of Illness

Because it focuses primarily on the sick body (disease), medicine ignores many of the concerns and needs of sick people. By listening to the stories of patients in the clinic, on the Internet, and in published book form, health care providers could gain a better understanding of the impact of disease on the person (illness), what it means to patients over and above their physical symptoms and what they might require over and above surgery or chemotherapy. Only by familiarizing themselves with the entire emotional landscape of illness, which includes fear, anger, shame, guilt, and above all loneliness, can the healthy--medicine as well as society in general--hope to heal in a comprehensive manner.     

Always on call: thoughts from a neophyte physician

This commentary describes a new physician who encountered a patient in crisis in a nonmedical environment. It discusses professional obligations, ethical principles, errors committed, and reasoning behind such errors. Unusual circumstances, uncertainty about how to properly identify oneself as a physician, self-doubt, and discomfort with practicing outside one's scope of training are recognized as reasons behind these errors. Medical students should be reminded of their ethical obligation to offer emergency care within their limitations, instructed how to identify themselves, and guided to become competent team leaders. Resident doctors should continue to receive instruction as they internalize ethical principles and identify their scopes of practice. Practicing physicians should be competent in offering basic emergency care if needed.     

Fechner as a pioneering theorist of unconscious cognition

Fechner remains virtually unknown for his psychological research on the unconscious. However, he was one of the most prominent theorists of unconscious cognition of the 19th century, in the context of the rise of scientific investigations on the unconscious in German psychology. In line with the models previously developed by Leibniz and Herbart, Fechner proposes an explanative system of unconscious phenomena based on a modular conception of the mind and on the idea of a functional dissociation between representational and attentional activity. For Fechner, the unconscious is a state of consciousness resulting from the isolation of representational activity from the rest of psychical life. Unconscious mental phenomena are unattended mental states that behave autonomously while remaining able to act on consciousness. This paper aims to revisit Fechner's contribution to the history of the unconscious, but also the theoretical significance of the Fechnerian unconscious vis-à-vis current research on the cognitive unconscious.     

Commentary on “Mediation analysis and categorical variables: The final frontier” by Dawn Iacobucci

The commentary discusses several topics in Dr. Iacobucci's article on mediation analysis with categorical variables including the lack of equivalency of mediated effect measures, ab, and c–c′, that are algebraically equivalent in ordinary least squares regression models. The commentary raises the issue of correlated mediation coefficients and presents formulas to include the correlation in the test of significance. References to new developments in causal mediation analysis for categorical variables are given and the importance of programs of research to establish a mediation theory is emphasized.     

Prenatal Treatment of Congenital Adrenal Hyperplasia—Not Standard of Care

Congenital adrenal hyperplasia (CAH) due to steroid 21-hydroxylase deficiency is a common autosomal recessive disorder due to mutations in the CYP21A2 gene. Since genetic counselors play a crucial role in educating families about inherited disorders, they need to have thorough knowledge regarding the pathophysiology of CAH especially the effects on the fetus, the complex genetics of this disorder, and the controversies surrounding experimental prenatal dexamethasone treatment. Affected female fetuses may have varying degree of virilization of the external genitalia. Starting in the 1980's, supraphysiologic glucocorticoid treatment was used to decrease the virilization of the external genitalia of affected female fetuses. However, recent clinical observations, animal studies and greater awareness of the details of human fetal adrenal physiology raise concerns regarding the safety of this prenatal treatment. We review the pathophysiology of CAH, the safety and ethical considerations of prenatal dexamethasone treatment and the views of multiple medical societies that conclude that this experimental therapy should only be done in prospective trials approved by ethical review boards.     

Attachment Theory and Mindfulness

We initiate a dialog between two central areas in the field of psychology today: attachment theory/research and mindfulness studies. The impact of the early mother-infant relationship on child development has been well established in the literature, with attachment theorists having focused on the correlation between a mother’s capacity for self-regulation and connection (e.g., attunement) with children’s health and developmental outcomes. Because the transition to parenthood is often a stressful one, research has also focused on the importance of the mother’s external and internal support (e.g., self-awareness, recognition of needs) in promoting healthy mother-infant relationships. One promising field in relation to increased internal support is mindfulness, a practice shown to increase emotional regulation while decreasing stress and anxiety. Described as non-judgmental, present-moment awareness, mindfulness has received significant empirical attention over the past three decades and has recently been theorized as an important contributing factor in healthy mother–child relationships. Recognizing the potentially beneficial effects of mindfulness training on healthy attachment, this article reviews relevant literature in presenting a case for exploratory and empirical research into the dynamic relationship between mindfulness, attachment style, maternal health, and children’s development. Grounds for this convergence, as well as suggestions for future research, are presented.     

Parental Divorce, Familial Risk for Depression, and Psychopathology in Offspring: A Three-Generation Study

Research suggests a link between parental divorce and negative child outcomes; however, the presence of parental depression may confound this relationship. Studies exploring the simultaneous effects of depression and parents’ divorce on the adjustment of their children are scarce and rarely have a longitudinal design. This is the first three-generation study of the relative effects of depression and divorce on offspring psychopathology, based on data from a 25-year longitudinal study with families at high and low risk for depression. One hundred seventy-eight grandchildren (mean age?=?13.9?years) of depressed and nondepressed parents and grandparents were evaluated by raters blind to their parents’ and grandparents’ clinical status. We found that in both low and high-risk children, divorce had a limited impact on child adjustment over and above familial risk for depression. Divorce had a significant effect on child outcomes only among high-risk grandchildren with a depressed grandparent and non-depressed parents, with this group showing a threefold risk for anxiety disorders. Results support previous findings suggesting that familial risk for depression largely overshadows the effect of parental divorce on child psychopathology. Possible reasons for the lack of association between divorce and child psychopathology among low-risk offspring are discussed.