Facilitating Informed Consent: A Multicultural Perspective

Respect for the dignity and autonomy of patients has long been a fundamental principle of ethical decision making. As a practical matter, a primary way of maintaining this ethical standard is by obtaining an individual’s informed consent prior to intervening or collecting data. By giving individuals clear information about alternative treatments and potential risks and benefits, the practitioner tries to ensure that the patient can make an informed choice. However, there are cases in which those seeking informed consent have very different values and belief systems from those whose consent is being sought. In this article we explore such discrepancies using informed consent with Navajo clients as an example, illustrate potential challenges with case examples, and propose ways in which ethical dilemmas may be successfully navigated.     

Dynamic accountability in clinical training and supervision: Three orienting ideals

Despite the growing interest on making clinical practice accountable, research on how specific components of professional competence are relevant in actual training/supervision practice is as yet unspecified. This study explores this dynamic aspect of professional supervision. Three supervisory dyads, composed by an experienced supervisor and a doctoral counseling psychology student were used in the study. A qualitative, ethnomethodology-informed design was used to discursively analyze 16 significant episodes (SEs) in actual supervision meetings. This was complemented by 16 follow-up interviews. Three interpretative repertoires – ‘ideals’ – influencing participants’ accounting practices were identified: efficacy, responsiveness, and authenticity. The article discusses how structural (competency-based) and dynamic (practice-based) approaches to accountability can be combined to guide the appraisal of relevant professional competencies.     

Relationships between self-determination theory and theory of planned behavior applied to physical activity and exercise behavior in chronic pain

This study examined the relationships between self-determination theory (SDT) and theory of planned behavior (TpB) applied to physical activity and exercise behavior (PA&E) in people with chronic pain. Two hundred and eleven adults with chronic musculoskeletal pain (28 males and 183 females, age range 18 to 82 years, mean age 43 years) were recruited from online support groups and clinic networks in the United States. Participants completed SDT measures relevant to PA&E on perceived autonomy support, autonomy, competence, and relatedness, as well as TpB measures relevant to PA&E on intention, attitudes, subjective norms, and perceived behavioral control. Correlational techniques and canonical correlation analysis were performed to examine the relationships and variance within and between theoretical dimensions. Overall, the SDT set accounted for 37% of the TpB variance and the TpB set accounted for 32% of the SDT set variance. The results indicate there are statistical similarities and differences between concepts in SDT and TpB models for PA&E. Using both empirical guidance and clinical expertise, researchers and practitioners should attempt to select and integrate non-redundant and complementary components from SDT, TpB, and other related health behavior theories.     

Work environment structure and psychological ownership: the mediating effects of control

Current theorists on the psychology of possession highlight control as an important route in the development of feelings of ownership. In the present article, the authors hypothesized that the extent to which individuals experience control over their job and work environment is positively associated with feelings of ownership for their job and the organization. The authors used supervisory report data on work environment structure and self-reports on experienced control and psychological ownership to test for the mediating effects of experienced control in the relationship between the work environment structure and psychological ownership. The authors found that experienced control mediates the relationship between 3 sources of work environment structure--technology, autonomy, and participative decision making--and psychological ownership of the job and (to a lesser extent) the organization. The authors proposed implications of the findings and directions of further research.     

Author Index 117, 2004

Authors Index

Author Index 117, 2004     

The biochemical bases of the placebo effect

A great variety of medical conditions are subject to the placebo effect. Although there is mounting evidence to suggest that the placebo effect is related to the expectation of clinical benefit, little is still known about the biochemical bases underlying placebo responses. Positron emission tomography studies have recently shown that the placebo effect in Parkinson’s disease, pain, and depression is related to the activation of the limbic circuitry. The observation that placebo administration induces the release of dopamine in the ventral striatum of patients with Parkinson’s disease suggests a link between the placebo effect and reward mechanisms. In addition to Parkinson’s disease, the placebo-reward model may also apply to other disorders. However, the relative contribution of the different neurotransmitters and neuropeptides that are known to be involved in modulating the activity of the limbic system may be disease-specific. Thus, while the placebo-induced clinical benefit observed in Parkinson’s disease would mostly reflect the release of dopamine in the dorsal striatum, the activation of opioid and serotonin pathways could be particularly implicated in mediating placebo responses encountered in pain and depression, respectively. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Visual search in typically developing toddlers and toddlers with Fragile X or Williams syndrome

Visual selective attention is the ability to attend to relevant visual information and ignore irrelevant stimuli. Little is known about its typical and atypical development in early childhood Experiment 1 investigates typically developing toddlers' visual search for multiple targets on a touch-screen. Time to hit a target, distance between successively touched items, accuracy and error types revealed changes in 2- and 3-year-olds' vulnerability to manipulations of the search display. Experiment 2 examined search performance by toddlers with Fragile X syndrome (FXS) or Williams syndrome (WS). Both of these groups produced equivalent mean time and distance per touch as typically developing toddlers matched by chronological or mental age; but both produced a larger number of errors. Toddlers with WS confused distractors with targets more than the other groups; while toddlers with FXS perseverated on previously found targets. These findings provide information on how visual search typically develops in toddlers, and reveal distinct search deficits for atypically developing toddlers.     

The role of risk avoidance in anxiety

Various forms of disinhibitory psychopathology (e.g., substance use disorder) are characterized by a tendency to make overly risky decisions. The current paper reports on data suggesting that, in contrast, anxiety is associated with an exaggerated tendency to engage in risk-avoidant decision making. In a nonclinical sample of university students, trait anxiety was associated with relatively low willingness to take risks, across a range of behavioral contexts. Trait anxiety was also associated with pessimistic risk appraisals (e.g., heightened perceptions of the likelihood and severity of negative outcomes). Furthermore, these associations were apparent while controlling for depression. Additional findings suggest that heightened perceptions of the severity of negative outcomes might mediate the link between trait anxiety and risk avoidance. This research has implications for understanding the role basic risk decision-making processes may play in the nature and treatment of anxiety.     

Anhedonia and emotional numbing in combat veterans with PTSD

We explored relationships between anhedonia and posttraumatic stress disorder (PTSD) symptom clusters, including their role in predicting psychiatric comorbidity. Our measure of anhedonia was derived from an examination of the latent structure of the Beck Depression Inventory. We found evidence for a two-factor solution, leading to anhedonia and undifferentiated, global depressive symptoms scales. In primary analyses, anhedonia had a unique positive relationship with PTSD's emotional numbing symptoms and minimal relationships with other PTSD symptoms. Upon examining the incremental validity of appetitive functioning (i.e., anhedonia, emotional numbing) over and above aversive functioning (i.e., re-experiencing, avoidance, and hyper-arousal PTSD symptoms) variables, greater emotional numbing increased the likelihood of being diagnosed with a major depressive disorder, and greater anhedonia increased the likelihood of being diagnosed with additional anxiety disorders and to a lesser extent, psychotic disorders. Results were consistent with research on the distinction of appetitive and aversive functioning, providing insight into the nature of PTSD.     

Enhancing frequency recording by developmental disabilities treatment staff

We evaluated a staff training and management package for increasing accuracy of recording frequency of problem behavior in a residential care facility. A multiple baseline design across the first and second work shifts showed that 2 of 8 participants increased their accuracy following in-service training, and all 8 improved during a condition with supervisor presence and feedback. Improvements were maintained when feedback was removed and generalized to activity periods when neither supervisor presence nor feedback was provided. Other staff behavior was not adversely affected by the intervention package.