Generalized Anxiety Disorder in Older Medical Patients: Diagnostic Recognition, Mental Health Management and Service Utilization

Background Primary care physicians often treat older adults with Generalized Anxiety Disorder. Objective To estimate physician diagnosis and recognition of anxiety and compare health service use among older adults with GAD with two comparison samples with and without other DSM diagnoses. Methods Participants were 60+ patients of a multi-specialty medical organization. Administrative database and medical records were reviewed for a year. Differences in frequency of health service use were analyzed with logistic regression and between-subjects analysis of covariance. Results Physician diagnosis of GAD was 1.5% and any anxiety was 9%, and recognition of anxiety symptoms was 34% in older adults with GAD. After controlling for medical comorbidity, radiology appointments were increased in the GAD group relative to those with and without other psychiatric diagnoses, χ² (2, N = 225) = 4.75, p < .05. Conclusions Most patients with anxiety do not have anxiety or symptoms documented in their medical records.     

The effects of individual differences and task difficulty on inattentional blindness

Most studies of inattentional blindness—the failure to notice an unexpected object when attention is focused elsewhere—have focused on one critical trial. For that trial, noticing the unexpected object might be a result of random variability, so that any given individual would be equally likely to notice the unexpected object. On the other hand, individual differences in the ability to perform the primary task might make noticing more likely for some individuals than for others. Increasing the difficulty of the primary task has been shown to decrease noticing rates for both brief static displays (Cartwright-Finch & Lavie, 2007) and dynamic monitoring tasks (Simons & Chabris, 1999). However, those studies did not explore whether individual differences in noticing arise from differences in the ability to perform the primary task. For our Experiment 1, we used a staircase procedure to equate primary task performance across individuals in a dynamic inattentional blindness task and found that the demands of the primary task affected noticing rates when individual differences in accuracy were minimized. In Experiment 2, we found that individual differences in primary task performance did not predict noticing of an unexpected object. Together, these findings suggest that although the demands of the primary task do affect inattentional blindness rates, individual differences in the ability to meet those demands do not.     

“It’s Worth It in the End”: Veterans’ Experiences in Prolonged Exposure and Cognitive Processing Therapy

Despite the efficacy of evidence-based psychotherapies (EBP) for posttraumatic stress disorder (PTSD) and efforts to disseminate them, only 6–13% of veterans seeking care through the Veterans Affairs health care system receive these treatments. EBPs such as prolonged exposure (PE) and cognitive processing therapy (CPT) are exposure-based treatments. Provider and patient fears regarding the tolerability of exposure-based treatments likely impede their delivery and completion. The present study utilized qualitative interviews with 23 veterans who completed at least eight sessions of either PE or CPT to elicit firsthand accounts of veterans’ experiences in these EBPs. Results suggest that while a minority of veterans reported initial symptom worsening, the majority of veterans reported positive experiences and felt that, despite being stressful, these EBPs were “worth it.” Most veterans discussed thoughts of discontinuing treatment prematurely, but stated that adherence was encouraged by their commitment to finishing, desperation for relief, therapist/group support, and family support. Veterans believed exposure made an important contribution to symptom improvement, as did greater self-understanding and changing negative or unhelpful beliefs. These findings indicate veteran satisfaction with PE and CPT, and may assist providers to develop strategies to increase adherence and treatment completion.     

“Is it me or should my friends take the credit?” The role of social networks and social identity in recovery from addiction

This study explored the role of social network and social identity factors in recovery from addiction. The sample consisted of 537 individuals who completed a survey about their experiences of recovery. Results indicated that the transition from addiction to recovery was characterized by an increase in social connectedness and changes in social network composition coupled with the emergence of a “recovery” identity. These factors accounted for 14% of the variance in quality of life when controlling for known predictors, accounting for a greater proportion of variance than substance use variables. Results suggest that recovery from addiction can be understood as a socially mediated transition characterized by social network and social identity change, which drive broader improvements in quality of life.     

Utility of telephone assessments in an older adult population

Telephone assessments are commonly used in mental health research and may be especially beneficial in older populations. The current study assessed the psychometric properties of the Penn State Worry Questionnaire (T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec, 1990) and the Beck Depression Inventory--II (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), when administered over the telephone in an older adult population. Results indicate no differences in mean symptom level or internal consistency across two modes of administration. Correlations between the in-person and telephone-administered measures and diagnostic categories suggest adequate validity of the telephone-administered measures. With this demonstrated evidence, the telephone assessment method can be applied in a variety of research and clinical settings.     

Depressed and Anxious COPD Patients: Predictors of Psychotherapy Engagement from a Clinical Trial

This study examined patient-level factors associated with engagement in mental health treatment in a sample of medically ill patients with clinically significant symptoms of depression and/or anxiety. A total of 248 patients was enlisted from a randomized controlled trial of cognitive-behavioral therapy for depression and anxiety in patients with chronic obstructive pulmonary disease (COPD). Logistic regression analysis was used to predict mental health engagement, defined as attending at least one intervention session. Results indicated that patient-perceived mastery over COPD was negatively related to mental health engagement. Further, mastery was the only significant predictor of mental health engagement after controlling for patient demographic characteristics, severity of COPD, depression, and anxiety. To improve engagement for medically ill patients with comorbid mental health difficulties, clinicians should explore patients’ attitudes about their mental health within the context of their perceived ability to cope with their medical disease.     

Dynamic Social Impact: A Theory of the Origins and Evolution of Culture

Dynamic social impact theory suggests that culture is created and shaped by local social influence as defined by four phenomena: (i) clustering, or regional differences in cultural elements; (ii) correlation, or emergent associations between elements; (iii) consolidation, or a reduction in variance; and (iv) continuing diversity. This article describes dynamic social impact theory and its propositions and reviews research supporting its predictions using a variety of methodologies and several types of cultural elements. This research suggests that cultures can be created and changed from the bottom-up through everyday communication with neighbors, friends, and coworkers. Attributes that are more important, observable, and demonstrable and less heritable may be more likely to spread and differentiate cultures than others.     

The Powerful Male Hero: A Content Analysis of Gender Representation in Posters for Children’s Animated Movies

Findings across a wide body of research suggest that media targeted at young audiences often portray characters according to stereotypical gender roles. Childhood is a particularly sensitive time in gender identity development, and logic from social cognitive theory suggests that repeatedly observing these stereotypes can have a lasting influence on young audiences’ worldview. Building on previous research investigating gender role displays in film content, and with the expectation that content creators use movie posters to convey a one-shot summary of films to audiences, we conducted a content analysis on the gendered power depictions of the main characters in movie posters of 152 popular U.S. animated children’s feature films produced over the last 80 years. Findings revealed that main characters were more likely to be male and that males were portrayed as more powerful. These results add to a growing, yet substantial, body of research illustrating the prevalence of stereotypical gender role portrayals across virtually every popular medium with which children come into contact. We discuss our results’ implications for potential short-term and long-term effects of exposure to films’ gender role stereotypes on young viewers’ real-life gender role expectations.

     

Examining Perceived Multicultural Counseling Competence and Negative Attitudes Toward the Arab American Population

The purpose of this quantitative study was to investigate the relationship between professional counselors’ general multicultural competence and negative attitudes held toward Arab Americans. Participants (N = 124) completed a survey, and a series of correlational, stepwise, and multiple regression analyses was conducted. Results indicated that counselors displayed higher levels of multicultural awareness than of multicultural knowledge. Furthermore, general multicultural awareness and specific knowledge of Arabs related significantly to negative attitudes held toward Arabs. El propósito de este estudio cuantitativo fue investigar la relación entre la competencia multicultural general de consejeros profesionales y las actitudes negativas mantenidas hacia personas estadounidenses de origen árabe. Los participantes (N = 124) completaron una encuesta, y se llevó a cabo una serie de análisis correlacionales, por pasos y de regresión múltiple. Los resultados indicaron que los consejeros mostraron niveles de conciencia multicultural mayores que los niveles de conocimiento multicultural. Además, la conciencia multicultural general y el conocimiento específico acerca de las personas árabes estuvieron significativamente relacionados con actitudes negativas mantenidas hacia personas árabes.