The Genetic Counselor’s Role in Managing Ethical Dilemmas Arising in the Laboratory Setting

Ethical dilemmas are encountered commonly in the setting of the clinical genetic testing laboratory due to the complexity of genetic testing and the number of relevant stakeholders involved in the genetic testing process. Based on their clinical training and role within the laboratory, genetic counselors are uniquely equipped to identify and facilitate management of ethical dilemmas. This paper reviews the historical context of ethical theory and its application to the field of genetic counseling. Theoretical and applied ethics are explored in the context of dilemmas arising in the laboratory setting, with a focus on the role of the laboratory genetic counselor in managing ethical dilemmas. Two illustrative case examples are provided.     

Explaining the effects of a decision intervention on mammography intentions: The roles of worry,fear and perceived susceptibility to breast cancer

Objective: This study examines the effects of a mammography decision intervention on perceived susceptibility to breast cancer (PSBC) and emotion and investigates how these outcomes predict mammography intentions.

Design: Randomised between-subjects online experiment. Participants were stratified into two levels of risk. Within each stratum, conditions included a basic information condition and six decision intervention conditions that included personalised risk estimates and varied according to a 2 (amount of information: brief vs. extended) × 3 (format: expository vs. untailored exemplar vs. tailored exemplar) design. Participants included 2465 US women ages 35–49.

Main Outcome Measures: PSBC as a percentage, PSBC as a frequency, worry, fear and mammography intentions.

Results: The intervention resulted in significant reductions in PSBC as a percentage for women in both strata and significant increases in worry and fear for women in the upper risk stratum. Of the possible mediators examined, only PSBC as a percentage was a consistent mediator of the effect of the intervention on mammography intentions.

Conclusion: The results provide insight into the mechanism of action of the intervention by showing that PSBC mediated the effects of the intervention on mammography intentions.     

Mental health of a police force: estimating prevalence of work-related depression in Australia without a direct national measure

The risk of work-related depression in Australia was estimated based on a survey of 631 police officers. Psychological wellbeing and psychological distress items were mapped onto a measure of depression to identify optimal cutoff points. Based on a sample of police officers, Australian workers, in general, are at risk of depression when general psychological wellbeing is considerably compromised. Large-scale estimation of work-related depression in the broader population of employed persons in Australia is reasonable. The relatively high prevalence of depression among police officers emphasizes the need to examine prevalence rates of depression among Australian employees.     

Biased attentional processing of positive stimuli in social anxiety disorder: an eye movement study

Despite the established relationship between social anxiety and attentional bias towards threat, a growing base of evidence suggests that social anxiety is additionally maintained by a deficit in the attentional processing of positive information. However, it remains unclear which component of attention is implicated in this deficit. Using eye movement-based measures and a novel attentional cuing methodology, the present study sought to investigate the presence of anxiety-linked bias in attentional engagement with, attentional disengagement from, and total fixation time to, socially relevant emotional stimuli in individuals diagnosed with social anxiety disorder, relative to non-socially anxious controls. Socially anxious individuals were found to exhibit faster attentional disengagement from positive stimuli, and reduced total fixation time to all emotional stimuli, relative to controls. Additionally for socially anxious individuals, lower total fixation times to positive stimuli were associated with higher levels of state anxiety. No differential pattern of engagement was evident between groups. We conclude that social anxiety is maintained in part by the aberrant processing of positive social stimuli.     

Social Justice at the Microlevel: Working With Clients' Prejudices

Social justice is considered the 5th force in counseling and has largely been aimed toward advocating for oppressed individuals and groups by creating change in the societal structures that maintain oppression. However, there is a lack of information for counselors who work with clients who oppress others. This article addresses assessment, conceptualization, and ethical considerations when White clients express racial prejudices in counseling and how it aligns with the goals of social justice. La justicia social está considerada como la 5ª fuerza en la consejería y ha sido dirigida hacia la defensoría de individuos y grupos oprimidos, creando cambios en las estructuras sociales que mantienen la opresión. Sin embargo, hay una carencia de información para consejeros que trabajan con clientes que oprimen a otros. Este artículo trata de la evaluación, conceptualización y consideraciones éticas cuando clientes de raza blanca expresan prejuicios raciales durante la consejería y cómo esto se alinea con los objetivos de la justicia social.     

Enhanced probing of attentional bias: The independence of anxiety-linked selectivity in attentional engagement with and disengagement from negative information

Cognitive models of anxiety posit that an attentional bias to negative information plays a causal role in elevated anxiety vulnerability and dysfunction. There has been considerable recent interest in determining whether this attentional bias reflects facilitated attentional engagement with and/or impaired attentional disengagement from negative information. We concur with the claim of investigators who have noted that the methodologies previously employed to dissociate engagement and disengagement biases are not optimal for this purpose. In the present study, we employ a novel methodology, the Attentional Response to Distal vs. Proximal Emotional Information (ARDPEI) task, which enables the discrete assessment of these two types of attentional selectivity. The findings demonstrate that facilitated attentional engagement with and impaired attentional disengagement from negative information both characterise elevated anxiety vulnerability. Further, these biases represent distinctive facets of anxiety-linked attentional selectivity. We discuss the potentially differing roles that engagement and disengagement biases may play in the development and/or maintenance of anxiety vulnerability and dysfunction.     

The role of associative strength in children's false memory illusions

The effects of associative strength on rates of 7- and 11-year-old children's true and false memories were examined when category and Deese-Roediger-McDermott (DRM) lists were used to cue the same critical lure. Backward associative strength (BAS) was varied such that the category and DRM lists had the same strength (DRM=category), DRM lists had more BAS (DRM>category), or category lists had more BAS (DRM<category). If BAS drives children's false memories then BAS, not the type of relation across items in a list, should determine false memory production. The results confirmed this prediction using both recall and recognition measures: (1) both true and false memories increased with age, (2) true memory was better for category than DRM lists but there were no differences for false memory, and (3) at all ages, false memories varied predictably with changes in BAS but were unaffected by list-type manipulations. These findings are discussed in the context of models of false memory development.     

Re-exposure to studied items at test does not influence false recognition

In two experiments, we investigated whether re-exposure to previously studied items at test affects false recognition in the DRM paradigm. Furthermore, we examined whether exposure to the critical lure at test influences memory for subsequently presented study items. In Experiment 1, immediately following each studied DRM list, participants were given a recognition test. The tests were constructed such that the number of studied items preceding the critical lure varied from zero to five. Neither false recognition for critical lures nor accurate memory for studied items was affected by this manipulation. In Experiment 2, we replicated this pattern of results under speeded conditions at test. Both experiments confirm that exposure to previously studied items at test does not affect true or false recognition in the DRM paradigm. This pattern strongly suggests that retrieval processes do not influence false recognition in the DRM paradigm.     

The Evidence Base for Occupational Therapy in Mental Health: More Systematic Reviews Are Needed

To shape its work, the Research Centre for Occupation & Mental Health is interested in research priorities. Systematic reviews develop an overview of the research available about an intervention, which can provide evidence to underpin practice. They also however, identify gaps in the knowledge base and so are useful for research-prioritization exercises. A rigorous literature search identified only four systematic reviews about occupational therapy in mental health, which suggests that more are needed to underpin practice. This article also explains a six-stage process for conducting a systematic review that can be used by occupational therapists in mental health.