Promoting Healing and Restoring Trust: Policy Recommendations for Improving Behavioral Health Care for American Indian/Alaska Native Adolescents

American Indian/Alaska Native youth represent the strength and continued survival of many Nations and Tribes. However, they currently experience numerous health disparities and challenges, including the highest rate of suicide among 15–24 year-olds in the United States. Our comprehensive review of the literature on the mental health of AI/AN youth highlighted seven focal causes of behavioral health disparities: (1) high levels of violence and trauma exposure and traumatic loss, (2) past and current oppression, racism, and discrimination, (3) underfunded systems of care, (4) disregard for effective indigenous practices in service provision, policy, and funding, (5) overreliance on evidence-based practices, (6) lack of cultural competence among systems of care and providers, and (7) barriers to care. Seven policy recommendations that recognize the importance of moving beyond exclusive reliance on western models of care and that seek to foster transformation of individuals, families, communities, behavioral health service systems of care, and social structures are presented, supported, and discussed.     

A Systematic Review of the Effectiveness of Self-Compassion-Related Interventions for Individuals With Chronic Physical Health Conditions

Self-compassion, defined as a mindful way of coping with pain and suffering by showing kindness, care, and concern towards the self, may improve psychological adjustment in people living with a chronic physical health condition (CPHC). Various studies illustrate that self-compassion is associated with positive outcomes in general. The aim of this systematic review is to establish the effect of compassion-related therapies on self-compassion specifically in people with CPHCs. Secondary aims are to (a) establish the effect on other psychological and physiological outcomes and (b) explore the relative effectiveness of different therapy types among those identified. Cochrane, Embase, Medline, PsycINFO, and CINAHL databases were searched using “compassion” AND “chronic disease” AND “psychological outcomes” and their synonyms, from 2004 to March 2019. Eligible studies had an experimental design using a self-compassion scale with an adult population. Risk of bias (RoB) was assessed using the Cochrane RoB tool. Effect sizes were calculated for study outcomes. Fifteen studies, including a total of 1,190 participants, 7 different CPHCs, and 11 types of therapies, were included in the review. Nearly all included therapies significantly increased self-compassion with medium to large effect sizes, and reported positive outcomes, such as decreased depression. None of the therapy types appeared clearly superior to the others. Findings from this review show that included therapies increased self-compassion and improved various outcomes, which may represent clinically significant benefits for patients. However, there is a need to further understand how self-compassion exerts its benefits and determine the best methods to increase self-compassion.     

Zoo Visitors' Affective Responses to Observing Animal Behaviors

ABSTRACT

The opportunity to observe or interact with animals in a zoo is often vital in influencing visitors' positive feelings towards animals and ultimately their conservation behavior. This study explores the relationship between observed animal behavior and zoo visitors' responses. A self-administered questionnaire was completed by 717 visitors across four exhibits (giraffe, lion, cheetah, and red panda) at three zoos (Brookfield Zoo, San Diego Zoo Safari Park, and Central Park Zoo). The questionnaire measured observed animal behaviors and visitors' predispositions, affective responses, and meaning-making at animal exhibits. Multivariate path analyses indicated that up-close encounters with zoo animals, along with observable active animal behaviors, predicted visitors' reported positive affective responses which, in turn, predicted their meaning-making. These findings lend support to the role of positive affect as a mediator between observable animal behaviors and visitor meaning-making. Implications are discussed in relation to achieving both conservation education and animal welfare outcomes.     

Transmission risk behaviors in a subset of HIV-positive individuals: The role of narcissistic personality features

Most people living with HIV/AIDS (PLWHA) take steps to protect their sexual partners. However, a minority of PLWHA continue to engage in sexual risk behaviors that might contribute to the transmission of HIV. Psychiatric conditions, including certain pathological traits, are associated with sexual risk behaviors. Research examining the association between narcissistic traits as they relate to HIV transmission risk is limited. In the present study, 303 PLWHA were recruited from an infectious disease clinic and completed questionnaires assessing narcissistic characteristics, substance use, sexual risk behavior, and intentions to use condoms in the future. Narcissistic traits predicted unprotected sex with partners who are HIV-negative or whose HIV status was unknown as well as lower intentions to use condoms, after controlling for demographic factors and substance use. Interventions focused on reducing the transmission of HIV should take into account associations between sexual risk behavior and narcissism.     

Structural Equation Modeling in the Communication Sciences, 1995–2000

Structural equation modeling (SEM) is a viable multivariate tool used by communication researchers for the past quarter century. Building off Cappella (1975) as well as McPhee and Babrow (1987), this study summarizes the use of this technique from 1995–2000 in 37 communication‐based academic journals. We identify and critically assess 3 unique methods for testing structural relationships via SEM in terms of the specification, estimation, and evaluation of their respective structural equation models. We provide general guidelines for the use of SEM and make recommendations concerning latent variable models, sample size, reporting parameter estimates, model fit statistics, cross‐sectional data, univariate normality, cross‐validation, nonrecursive modeling, and the decomposition of effects (direct, indirect, and total).     

Laminar cortical dynamics of cognitive and motor working memory, sequence learning and performance: toward a unified theory of how the cerebral cortex works

How does the brain carry out working memory storage, categorization, and voluntary performance of event sequences? The LIST PARSE neural model proposes an answer that unifies the explanation of cognitive, neurophysiological, and anatomical data. It quantitatively simulates human cognitive data about immediate serial recall and free recall, and monkey neurophysiological data from the prefrontal cortex obtained during sequential sensory-motor imitation and planned performance. The model clarifies why spatial and non-spatial working memories share the same type of circuit design. It proposes how laminar circuits of lateral prefrontal cortex carry out working memory storage of event sequences within layers 6 and 4, how these event sequences are unitized through learning into list chunks within layer 2/3, and how these stored sequences can be recalled at variable rates that are under volitional control by the basal ganglia. These laminar prefrontal circuits are variations of visual cortical circuits that explained data about how the brain sees. These examples from visual and prefrontal cortex illustrate how laminar neocortex can represent both spatial and temporal information, and open the way towards understanding how other behaviors derive from shared laminar neocortical designs.     

A prospective analysis of acceptance of pain and values-based action in patients with chronic pain.

OBJECTIVE: Acceptance of pain and values-based action appear important in the emotional, physical, and social functioning of individuals with chronic pain. The purpose of the current study was to prospectively investigate these combined processes. METHOD: 115 patients attending an assessment and treatment course for chronic pain in the U.K. completed a standard set of measures on two occasions separated by an average of 18.5 weeks. RESULTS: Correlation analyses showed that acceptance of pain and values-based action measured at Time 1 were significantly correlated with pain, pain-related distress, pain-related anxiety and avoidance, depression, depression-related interference with functioning, and physical and psychosocial disability measured at Time 2. Multiple regression analyses, in which pain and relevant patient background variables were controlled, showed that the combined acceptance and values measures accounted for between 6.5% and 27.0% of variance in six key measures of patient functioning later in time. CONCLUSION: These results support the importance of acceptance and values-related processes in relation to chronic pain. These results also encourage continued applications of a functional contextual model of psychopathology, the model underlying Acceptance and Commitment Therapy and related approaches such as Contextual Cognitive-Behavioral Therapy.     

Defeasibility And The Normative Grasp Of Context

In this article, we present an analysis of defeasible generalizations – generalizations which are essentially exception-laden, yet genuinely explanatory – in terms of various notions of privileged conditions. We argue that any plausible epistemology must make essential use of defeasible generalizations so understood. We also consider the epistemic significance of the sort of understanding of context that is required for understanding of explanatory defeasible generalizations on any topic.     

A pilot study examining the effects of priming headache illness schema on attentional engagement towards pain relief medication,in those with high and low medication treatment beliefs

Few studies have assessed the underlying theoretical components of the Common Sense Model. Past studies have found, through implicit priming, that coping strategies are embedded within illness schema. Our aim was to evaluate the effect priming ‘headache’ illness schema upon attentional engagement to pain relief medication and to examine the interaction with illness treatment beliefs. Attentional engagement to the pain relief medication (‘Paracetamol’) was assessed using a 2 (primed vs. control) × 2 (strong belief in medication efficacy vs. weak belief in medication efficacy) design. During a grammatical decision task (identifying verbs/non-verbs), participants were randomised to receive a headache prime or a control. Response latency to the target word, ‘Paracetamol’ was the dependent variable. ‘Paracetamol’ treatment beliefs were determined using the brief illness perception questionnaire. Sixty-three participants completed the experiment. There was a significant interaction between illness-primed vs. control and high vs. low treatment efficacy of Paracetamol (p < .001), suggesting an attentional disengagement effect to the coping strategy in illness-primed participants whom held stronger treatment beliefs regarding the efficacy of Paracetamol. In summary, implicit illness schema activation may simultaneously activate embedded coping strategies, which appears to be moderated by specific illness beliefs.