The Impact of Brief Interventions on Functioning Among those Demonstrating Anxiety,Depressive, and Adjustment Disorder Symptoms in Primary Care: The Effectiveness of the Primary Care Behavioral Health (PCBH) Model

Journal of Clinical Psychology in Medical Settings - Limited scalability combined with limited opportunities for patients to receive evidence-based interventions in traditional behavioral health...     

Low Prospects and High Risk: Structural Determinants of Health Associated with Sexual Risk Among Young African American Women Residing in Resource-Poor Communities in the South

African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16–19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.     

Habermas,Virtue Epistemology,and Religious Justifications in the Public Sphere

Jürgen Habermas's recent challenge to secular citizens calling for greater inclusivity of religious justifications in the public sphere opens new epistemological debates that could benefit from the rich insights of feminist epistemologists. Despite certain theoretical tensions, there is some common ground between Habermas and recent work in feminist epistemology. Specifically, this article explores the shared interests between Habermas and one feminist theorist in particular, Miranda Fricker. I choose Fricker because her formulation of the epistemological and ethical hybrid virtues of testimonial justice and hermeneutical justice provide efficacious theoretical and practical tools capable of deepening the epistemological basis of Habermas's challenge to secular citizens. After a detailed analysis of Habermas's and Fricker's respective epistemological positions, I argue that Fricker's analysis provides a rich framework for thinking through questions of power, identity, and credibility with respect to religious justifications in the public sphere. In conclusion, this article emphasizes the importance of fostering more robust and just epistemic communities capable of countering the social, political, and ethical injustices of epistemic disauthorization and marginalization.     

Reduced susceptibility to confirmation bias in schizophrenia

Patients with schizophrenia (SZ) show cognitive impairments on a wide range of tasks, with clear deficiencies in tasks reliant on prefrontal cortex function and less consistently observed impairments in tasks recruiting the striatum. This study leverages tasks hypothesized to differentially recruit these neural structures to assess relative deficiencies of each. Forty-eight patients and 38 controls completed two reinforcement learning tasks hypothesized to interrogate prefrontal and striatal functions and their interaction. In each task, participants learned reward discriminations by trial and error and were tested on novel stimulus combinations to assess learned values. In the task putatively assessing fronto-striatal interaction, participants were (inaccurately) instructed that one of the stimuli was valuable. Consistent with prior reports and a model of confirmation bias, this manipulation resulted in overvaluation of the instructed stimulus after its true value had been experienced. Patients showed less susceptibility to this confirmation bias effect than did controls. In the choice bias task hypothesized to more purely assess striatal function, biases in endogenously and exogenously chosen actions were assessed. No group differences were observed. In the subset of participants who showed learning in both tasks, larger group differences were observed in the confirmation bias task than in the choice bias task. In the confirmation bias task, patients also showed impairment in the task conditions with no prior instruction. This deficit was most readily observed on the most deterministic discriminations. Taken together, these results suggest impairments in fronto-striatal interaction in SZ, rather than in striatal function per se.     

Beyond slots and resources: Grounding cognitive concepts in neural dynamics

Research over the past decade has suggested that the ability to hold information in visual working memory (VWM) may be limited to as few as three to four items. However, the precise nature and source of these capacity limits remains hotly debated. Most commonly, capacity limits have been inferred from studies of visual change detection, in which performance declines systematically as a function of the number of items that participants must remember. According to one view, such declines indicate that a limited number of fixed-resolution representations are held in independent memory “slots.” Another view suggests that such capacity limits are more apparent than real, but emerge as limited memory resources are distributed across more to-be-remembered items. Here we argue that, although both perspectives have merit and have generated and explained impressive amounts of empirical data, their central focus on the representations—rather than processes—underlying VWM may ultimately limit continuing progress in this area. As an alternative, we describe a neurally grounded, process-based approach to VWM: the dynamic field theory. Simulations demonstrate that this model can account for key aspects of behavioral performance in change detection, in addition to generating novel behavioral predictions that have been confirmed experimentally. Furthermore, we describe extensions of the model to recall tasks, the integration of visual features, cognitive development, individual differences, and functional imaging studies of VWM. We conclude by discussing the importance of grounding psychological concepts in neural dynamics, as a first step toward understanding the link between brain and behavior.     

The Costs of Secondary Migration: Perspectives from Local Voluntary Agencies in the USA

In recent years, as the need for global refugee assistance has increased, so have fears and concerns of the costs of refugee resettlement in Western nations. Now, seemingly more than ever, international security and regional development depend largely on the composition and distribution of the world population. In many Western nations, dispersal policies are specifically designed to manage the distribution of recently arrived refugees. Secondary migration presents a challenge to the goals of dispersal policies and raises questions regarding regional development, population pressures, job security, welfare dependency, and the future of global refugee assistance. We survey administrators and caseworkers in a series of qualitative interviews about their experiences with secondary migration. We conclude that the US refugee resettlement system is ill-equipped in handling the complications of secondary migration. These results lead us to reimagine a better strategy for achieving the goals of refugee resettlement.     

Predicting group-level outcome variables: An empirical comparison of analysis strategies

This study provides a review of two methods for analyzing multilevel data with group-level outcome variables and compares them in a simulation study. The analytical methods included an unadjusted ordinary least squares (OLS) analysis of group means and a two-step adjustment of the group means suggested by Croon and van Veldhoven (2007). The Type I error control, power, bias, standard errors, and RMSE in parameter estimates were compared across design conditions that included manipulations of number of predictor variables, level of correlation between predictors, level of intraclass correlation, predictor reliability, effect size, and sample size. The results suggested that an OLS analysis of the group means, with White’s heteroscedasticity adjustment, provided more power for tests of group-level predictors, but less power for tests of individual-level predictors. Furthermore, this simple analysis avoided the extreme bias in parameter estimates and inadmissible solutions that were encountered with other strategies. These results were interpreted in terms of recommended analytical methods for applied researchers.     

Utilization of the Tablet Application Proband in Pedigree Construction and Assessment

Many medical institutions have converted to a digital model for record keeping due to the Health Information Technology for Economic and Clinical Health Act. This Act provides incentives to health care systems to accelerate and encourage the adoption of electronic health record (EHR) systems. The pedigree as a tool in medicine provides an efficient method to assess and represent an individual’s health and family health risks that may otherwise not be apparent in the medical record in a clearly identifiable way (Schuette, J. L., & Bennett 2009). Many clinicians continue to construct pedigrees using pen and paper method despite findings of improved identification of at risk patients with similar electronic intake tools (Arar et al. in Personalized Medicine 2011 8:523–32). The goal of this study was to explore the patient and practitioner experience with electronic pedigree programs using Proband, an application developed at The Children’s Hospital of Philadelphia for genetic counselors to construct pedigrees during genetic counseling sessions directly on iPads. The first part of this study looked at the patient experience and assessed time to take the pedigree and the impact of using an electronic pedigree tool on the relationship between participant and genetic counselor. This involved 50 participants and was compared with the traditional paper method of taking a pedigree. There was no statistical significance found between the two different mediums in accuracy, speed, and rapport with provider. The second part of the study assessed the usability of Proband by ten genetic counselors. Overall, the application received a system usability score of 90/100 with a majority (7/10) of counselors agreeing that they would use this application in their clinic. The positive outcome of this study encourages future work to assess the impact and usability of programs on a larger scale as they continue to integrate into current electronic health records.     

Efficacy of Guided iCBT for Depression and Mediation of Change by Cognitive Skill Acquisition

Guided internet CBT (iCBT) is a promising treatment for depression; however, it is less well known through what mechanisms iCBT works. Two possible mediators of change are the acquisition of cognitive skills and increases in behavioral activation. We report results of an 8-week waitlist controlled trial of guided iCBT, and test whether early change in cognitive skills or behavioral activation mediated subsequent change in depression. The sample was 89 individuals randomized to guided iCBT (n = 59) or waitlist (n = 30). Participants were 75% female, 72% Caucasian, and 33 years old on average. The PHQ9 was the primary outcome measure. Mediators were the Competencies of Cognitive Therapy Scale–Self Report and the Behavioral Activation Scale for Depression–Short Form. Treatment was Beating the Blues plus manualized coaching. Outcomes were analyzed using linear mixed models, and mediation with a bootstrap resampling approach. The iCBT group was superior to waitlist, with large effect sizes at posttreatment (Hedges’ g = 1.45). Dropout of iCBT was 29% versus 10% for waitlist. In the mediation analyses, the acquisition of cognitive skills mediated subsequent depression change (indirect effect = -.61, 95% bootstrapped biased corrected CI: -1.47, -0.09), but increases in behavioral activation did not. iCBT is an effective treatment for depression, but dropout rates remain high. Change in iCBT appears to be mediated by improvements in the use of cognitive skills, such as critically evaluating and restructuring negative thoughts.