Improving access to psychological treatments: lessons from developing countries

Even though psychological treatments have been advocated as treatments for a range of mental disorders by the WHO for scaling up through primary care globally, the vast majority of potential beneficiaries are unable to access these treatments. Two major barriers impede the path between evidence based treatments and improved access: the lack of skilled human resources and the acceptability of treatments across cultures. This essay synthesizes the experiences of programs which developed and evaluated psychological treatments for depression in three resource poor developing countries. These programs addressed the human resource barrier by training lay or community health workers to deliver the treatments and addressed the acceptability barrier by systematically adapting the treatment to contextual factors. All programs demonstrated significant benefits in recovery rates when compared with usual care demonstrating the effectiveness of the approach. The implications for these experiences to improving access to psychological treatments in the global context are discussed.     

Assessing the Role of the Self‐Concept on the Destructive Impact of Obsessive–Compulsive Disorder in Managers

Managers can have personal afflictions that may interfere with their role as managers in an organization. One of these maladies is obsessive‐compulsive disorder (OCD), a condition frequently identified with excessive patterns of seemingly unnecessary behavior. OCD compels individuals to seek “perfection” in the accomplishment of primarily routine tasks. This overt routine of behaviors distracts individuals from accomplishing their goals and those they manage. This paper examines the role of self‐concept as being central in identifying and understanding the characteristics of the behavioral disorder OCD and how to modify the self‐concept to prevent disruption in the workplace. In addition, the paper explores how to measure OCD and the impact of maladies on peers, subordinates, and superiors in the organization. I've learned . . . that we should be glad God doesn't give us everything we pray for. —My father     

Extended pausing by humans on multiple fixed-ratio schedules with varied reinforcer magnitude and response requirements

We conducted three experiments to reproduce and extend Perone and Courtney's (1992) study of pausing at the beginning of fixed-ratio schedules. In a multiple schedule with unequal amounts of food across two components, they found that pigeons paused longest in the component associated with the smaller amount of food (the lean component), but only when it was preceded by the rich component. In our studies, adults with mild intellectual disabilities responded on a touch-sensitive computer monitor to produce money. In Experiment 1, the multiple-schedule components differed in both response requirement and reinforcer magnitude (i.e., the rich component required fewer responses and produced more money than the lean component). Effects shown with pigeons were reproduced in all 7 participants. In Experiment 2, we removed the stimuli that signaled the two schedule components, and participants' extended pausing was eliminated. In Experiment 3, to assess sensitivity to reinforcer magnitude versus fixed-ratio size, we presented conditions with equal ratio sizes but disparate magnitudes and conditions with equal magnitudes but disparate ratio sizes. Sensitivity to these manipulations was idiosyncratic. The present experiments obtained schedule control in verbally competent human participants and, despite procedural differences, we reproduced findings with animal participants. We showed that pausing is jointly determined by past conditions of reinforcement and stimuli correlated with upcoming conditions.     

A Pastoral Analysis of the Three Pillars of U.S. Hegemony—“Free Market” Capitalism,Militarism, and Exceptionalism

In this article, I offer a pastoral analysis of the three interrelated pillars of U.S. hegemony, namely, “free market” capitalism, militarism, and exceptionalism. My claims are that these pillars 1) were and are integral to the rise and maintenance of the U.S. Empire or the U.S. as hyperpower, 2) while beneficial to some U.S. citizens (as well as Western Europeans) and accidentally to other peoples, have significant and extensive detrimental and long-term consequences for other peoples, and 3) represent fundamentally and profoundly flawed symbol systems vis-à-vis creating social policies and programs that involve the common good or foster community. I argue further that the fusion of these symbol systems—free market capitalism, militarism, and exceptionalism—gives rise to the interpretation of the Other as functional and is inherently flawed and dangerous, because these systems lead to controlling, manipulating, using, or destroying the Other. If the notion of the common good is to expand beyond the narrow confines of corporations or a nation and if we seek a good enough society that fosters diverse communities, then these semiotic systems must be subordinate to religious or humanistic symbol systems that elevate the personhood of the Other.     

A biopsychosocial formulation of pain communication

We present a detailed framework for understanding the numerous and complicated interactions among psychological and social determinants of pain through examination of the process of pain communication. The focus is on an improved understanding of immediate dyadic transactions during painful events in the context of broader social phenomena. Fine-grain consideration of social transactions during pain leads to an appreciation of sociobehavioral events affecting both suffering persons as well as caregivers. Our examination considers knowledge from a variety of perspectives, including clinical health psychology, social and developmental processes, evolutionary psychology, communication studies, and behavioral neuroscience.     

Self-knowledge defenses to self-threats

We examined whether people use both shifts in the spontaneous self-concept (self-knowledge content) and in self-concept clarity (self-knowledge structure) to defend against salient self-threats, and identified relevant moderators of this process. In Study 1, women emphasized relational self-aspects in response to mortality salience, compared to men. In Study 2, high self-esteem individuals showed more polarized self-knowledge after mortality salience, while in Study 3 they became faster in their self-categorizations when faced with uncertainty, and more consistent and faster in their self-categorizations when faced with isolation, relative to those with low self-esteem. In the discussion, we focus on how these outcomes can be interpreted as meaning maintenance, clarify the role of self-esteem, and offer directions for future research.