Factors Which Impact the Delivery of Genetic Risk Assessment Services Focused on Inherited Cancer Genomics: Expanding the Role and Reach of Certified Genetics Professionals

There is tremendous excitement about the promise of new genomic technologies to transform medical practice and improve patient care. Although the full power of genetic diagnosis has not yet been realized, paradigms of clinical decision-making are changing. In fact, recent policy level changes to promote genetic counseling by certified genetics professionals (GP) such as genetic counselors and clinical geneticists, are occurring at both the payer and state level. However, there remain opportunities to develop policies within the United States to: 1) enhance the access to the limited workforce of GPs; 2) revise reimbursement schemes such that costs to deliver these services may be recouped by institutions with GPs; and 3) protect against the potential for discrimination based on genetic information. Although many of these issues predate advances in genomic technologies, they are exacerbated by them, with increasing access and awareness as costs of testing decrease. Consequently, evolving shifts in national policies poise GPs to serve as a hub of information and may be instrumental in facilitating new models to deliver genetics-based care through promoting academic-community partnerships and interfacing with non-GPs. As we acknowledge the potential for genomics to revolutionize medical practice, the expertise of GPs may be leveraged to facilitate incorporation of this information into mainstream medicine.     

Mindfulness and Self-Compassion: Exploring Pathways to Adolescent Emotional Well-Being

Adolescents today are confronted with the compounded stressors of life in our high-pressured society and the cognitive, physiological, and emotional changes characteristic of this stage of development. To explore ways to promote well-being in this population, mindfulness, defined as paying attention in the moment in an intentional and purposeful way, was examined in terms of its associations with aspects of emotional well being. It has been reported to have positive effects on emotional well-being in adults, and shows promise for similar results in research with youth. Moreover, the mechanisms through which being mindful may influence positive outcomes have only recently been explored, and have not been investigated with adolescents. Self-compassion, defined by the three components of self-kindness, sensing oneself as part of a common humanity, and maintaining perspective in challenging circumstances, was examined as a potential mediator of the relationship of mindfulness to various outcome measures. Measures assessing mindfulness, self-compassion, and aspects of emotional well-being comprised an online survey that was administered to 67 adolescents in an urban high school. Path analysis was utilized to explore relationships among the variables. An alternate model with self-compassion as the predictor and mindfulness as the mediator was also investigated. Results suggested that both mindfulness and self-compassion functioned as mediators in the pathway to emotional well-being. A theorized model is presented which depicts a reciprocal relationship between mindfulness and self-compassion and describes an iterative process that takes place between these two constructs, promoting emotional well-being. Implications for research and practice include conducting longitudinal studies, which assess constructs at three time points to definitively establish mediation, and developing a self-compassion program tailored for adolescents to facilitate improvements in emotional well-being.     

Mindfulness and other Buddhist-derived interventions in correctional settings: A systematic review

Interest into the rehabilitative utility of Buddhist-derived interventions (BDIs) for incarcerated populations has been growing. The present paper systematically reviews the evidence for BDIs in correctional settings. Five databases were systematically searched. Controlled intervention studies of BDIs that utilized incarcerated samples were included. Jadad scoring was used to evaluate methodological quality. PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines were followed. The initial search yielded 85 papers, but only eight studies met the inclusion criteria. The eight eligible studies comprised two mindfulness studies, four vipassana meditation studies, and two studies utilizing other BDIs. Intervention participants demonstrated significant improvements across five key criminogenic variables: (i) negative affect, (ii) substance use (and related attitudes), (iii) anger and hostility, (iv) relaxation capacity, and (v) self-esteem and optimism. There were a number of major quality issues. It is concluded that BDIs may be feasible and effective rehabilitative interventions for incarcerated populations. However, if the potential suitability and efficacy of BDIs for prisoner populations is to be evaluated in earnest, it is essential that methodological rigor is substantially improved. Studies that can overcome the ethical issues relating to randomization in correctional settings and employ robust randomized controlled trial designs are favored.     

From “It's Not Me” to “It Was Me,After All”: A Case Presentation of a Patient Diagnosed with Dissociative Identity Disorder

In cases of extreme childhood trauma associated with abuse and neglect, one's sense of self is seriously compromised. Attachment patterns, symptoms, defensive operations, and character formation will differ depending upon the level of interference and impingement. When repeated trauma occurs in early childhood, the dissociative response may become the first line of defense for the person to rely upon. In its most severe form, patients are diagnosed with Dissociative Identity Disorder (DID). This paper addresses the case of a woman diagnosed with DID. It describes the restoration of a cohesive sense of self from the eight parts of a dissociated and fragmented self in the course of therapy. The clinical case material presented is that of the child part of her, known as Lucy. Her treatment resulted in the integration of the “it's not me!” self to the patient's knowledge that “it was me, after all.”     

COLUMBINE: A COMMENTARY

A "poemtage" was created to express my thoughts and feelings about the massacre that took place at Columbine High School, Littleton, Colorado, on April 20, 1999. The story behind the creation of this poemtage is shared.     

Factores familiares en la recaída de pacientes esquizofrénicos

Resumen

Nuestro estudio de la atmósfera emocional de los hogares de los pacientes esquizofrénicos en California del Sur ha replicado los descubrimientos británicos en relación con la influencia del ambiente familiar sobre el curso de la esquizofrenia. Como en los estudios británicos, las críticas y la implicación emocional excesiva de un familiar clave para el paciente en el momento de su ingreso constituyen el mejor predictor aislado de recaída sintomática en los nueve meses posteriores al alta hospitalaria. Al igual que en los resultados británicos, la asociación entre la emoción expresada de los familiares y la recaída fue independiente de todas las demas variables investigadas. Los resultados transculturales sobre los efectos preventivos de la medicación sugieren que los clínicos deben considerar la atmósfera emocional del hogar, a la hora de explicar los fracasos de la medicación.     

The relation between social sharing and the duration of emotional experience

People often socially share their emotions to regulate them. Two-mode theory of social sharing states that cognitive sharing will contribute to emotional recovery, whereas socio-affective sharing will only temporarily alleviate emotional distress. Previous studies supporting this theory, measured emotional recovery in terms of residual emotional intensity. Until now, another important time-dynamic aspect of emotions, emotion duration, has been largely ignored. In two experience sampling studies we addressed this gap. In Study 1, participants reported on the duration of anger, fear, and sadness episodes; additionally time-varying information on the occurrence and mode of sharing was collected. This study revealed that sharing led to a shortening in emotion duration, in particular when it was socio-affective in nature. In Study 2 we investigated whether this result could be interpreted in terms of our measure of duration primarily reflecting emotional relief rather than recovery. In this study, the same method as in Study 1 was used; additionally, residual emotional intensity was measured three days after emotion onset. Study 2 largely replicated the findings from Study 1. Furthermore, duration appeared to be empirically distinct from residual intensity. Finally, no relation between sharing and residual intensity was found, even when considering the sharing mode.     

AN ASSESSMENT OF STUDENTS' CALIBRATION OF COMPREHENSION AND CALIBRATION OF PERFORMANCE USING MULTIPLE MEASURES

In the present study we examined students' ability to judge comprehension of text material (before actually taking a test) as well as ability to judge comprehension performance on text material (after taking a test). We examined each of these two abilities, termed calibration of comprehension and calibration of performance, by using multiple measures rather than just one as has traditionally been done in the literature. We also examined the role of students' self-assessed monitoring ability and self-image presentation in calibration skills. Results indicated that students were able to calibrate comprehension and performance although calibration levels were low, especially for calibration of comprehension. Students who calibrated comprehension well also tended to calibrate performance well. Several measures used to examine calibration of comprehension were consistent predictors ofperformance as were both quantitative and qualitative measures of calibration of performance. Students' calibration accuracy remained stable across measures and assessment conditions. Although students' self-assessed ability was not related to their actual calibration skills, self-image presentation was related to students'self-assessments and to theirability to calibrate performance. Implications and directions for future research are discussed.