Does establishing fidelity of treatment help in understanding treatment efficacy? Comment on Bellg et al. (2004).

Comments on the article by Bellg et al (see record 2004-18051-001). To test the effects of a behavioral change on specific health outcomes, the Behavior Change Consortium insists on strict adherence to fidelity at 5 steps in behavioral trials: study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. The authors argue that the demand for fidelity at every step ignores 2 critical sets of factors: (a) there are few theoretically grounded empirical studies of the processes involved in successful transitions in this sequence and (b) trials with perfect fidelity absent a theoretical model of transitions will produce evidence for interventions that lack a conceptual basis for adaptation to differences among diseases, treatments, patients, practitioners, medical institutions, and cultures and that therefore cannot be implemented in clinical practice.     

History of the Association of Medical School Psychologists (AMSP), 1982–2005

This paper presents a brief history of the Association of Medical School Psychologists (AMSP) from the Association’s beginning in 1982 to the present day. Prior to 1982, there had been several unsuccessful efforts to form an association that would represent psychologists in academic medical centers. Attempts by psychiatry to limit the growing number and influence of psychologists in medical schools created a sense of threat among psychologists that catalyzed the formation of the Association. Membership was initially restricted to one senior psychologist from each medical school, a restriction that limited AMSP’s development, but AMSP later opened its doors to all academic medical center psychologists. The Association was rebuffed in initial efforts to join the Association of American Medical Colleges, and at a later date, to become a Division of the American Psychological Association (APA). In time, however, AMSP did establish formal ties to both of those organizations, and it has collaborated with APA in important surveys of academic medical center psychologists. Following a period in the late 1990’s when AMSP seemed likely to lose its way, the Association rebounded. AMSP now has an Administrative Director, a stable home base, and revised bylaws that assure greater stability and continuity of leadership. These developments, in conjunction with a strong working relationship with the Journal of Clinical Psychology in Medical Settings, have positioned AMSP to grow and more effectively serve the community of psychologists who work in academic medical centers.     

Finding Home: A Qualitative Approach to Understanding Adolescent Mothers’ Housing Instability

Many low‐income Latina adolescent mothers face instability in their housing circumstances, which has implications for their long‐term prospects and that of their children. This study used longitudinal, ethnographic data from Welfare, Children, and Families: A Three‐City Study to explore experiences of low‐income, Latina adolescent mothers (N = 15) with unstable housing who primarily rely on their families or the families of their significant others for housing support. Results of analysis employing grounded theory and narrative approaches suggested two types of instability: “Horizontal moves” between family homes and “vertical moves” between family homes and independent living. Although family support often was fundamental in allowing for participants’ pursuit of independent housing (i.e., vertical moves), it also was associated with greater residential mobility (i.e., horizontal moves), most often in the context of intrafamilial conflict and family instability. These results are discussed with respect to inconsistencies in policies to address this vulnerable population.     

Subjective and Objective Risks of Carrying a BRCA1/2 Mutation in Individuals of Ashkenazi Jewish Descent

This repeated measures study examines (1) the change in subjective risk of mutations pre- to postcounseling, (2) the accuracy of BRCAPRO estimates of mutations, and (3) the discrepancy between subjective risk and BRCAPRO estimates of mutations before and after genetic counseling. Ninety-nine Ashkenazi Jewish individuals pursued testing for BRCA1/2 mutations. Most had a personal cancer history (N = 51; family only: N = 48); and received uninformative negative results (N = 66; positives: N = 23; informative negative: N = 10). The coping strategy of defensive pessimism predicts that individuals will believe the worst case scenario to better cope with a potential negative outcome. Consistent with this, most felt they would have a mutation, if not mutations in both genes. The BRCAPRO model appeared to overestimate risk of having a mutation in this sample (p < .001). BRCAPRO overestimates notwithstanding, genetic counseling increased accuracy of subjective risk (p < .01). Individuals with a family-only cancer history had the least accurate estimates of risk (p < .05) and may need further intervention to either manage anxiety or improve knowledge.     

Children and youth in neighborhood contexts

Neighborhoods are increasingly studied as a context where children and youth develop; however, the extent of neighborhoods' impact remains debatable because it is difficult to disentangle this impact from that of the family context, in part because families have some choice as to where they live. Evidence from randomized experiments, studies using advanced statistical models, and longitudinal studies that control for family characteristics indicates that neighborhoods do matter. In nonexperimental studies, small to moderate associations were found, suggesting that children and adolescents living in high-income neighborhoods had higher cognitive ability and school achievement than those living in middle-income neighborhoods, and children and adolescents living in low-income neighborhoods had more mental and physical health problems than those living in middle-income neighborhoods. The home environment has been shown to be partly responsible for the link between neighborhood and children's development. For adolescents, neighborhood effects are partially accounted for by community social control. Experimental studies in which families were randomly assigned to move to low-poverty neighborhoods from housing projects found larger neighborhood effects than nonexperi-mental research, particularly for boys' outcomes. Additional issues reviewed are relevant neighborhood characteristics, theoretical models explaining the pathways underlying neighborhood effects, methods for research assessing neighborhood processes, and policy implications.     

Investigating the dynamics of affect: Psychological mechanisms of affective habituation to pleasurable stimuli

Affective habituation (i.e., reductions in stimulus-evoked affective reactions as a result of previous exposure) may serve a functional purpose. However, little is know about the psychological mechanisms underlying this process. To elucidate the characteristics of affective habituation, two experiments that examined affective reactions to repeated exposures of pleasurable stimuli were conducted. Results of these experiments indicated that habituation trajectories are characterized by linear decreases in affect. Results also demonstrated that habituation can be slowed by the introduction of novel stimuli (i.e., “novelty effects”), effects that are dimensional (rather than taxonic) in nature. Experiment 2 demonstrated that habituation is mediated by conceptual rather than perceptual processes. Depressed and anhedonic individuals were not more susceptible to habituation in either experiment. The current findings and previous theorizing suggest that habituation may be an important component of an adaptive affective processing system that promotes effective responses to salient stimuli and prevents compulsive reward-seeking behavior.