Self‐regulation principles underlying risk perception and decision making within the context of genomic testing

Advances in theory and research on self‐regulation and decision‐making processes have yielded important insights into how cognitive, emotional, and social processes shape risk perceptions and risk‐related decisions. We examine how self‐regulation theory can be applied to inform our understanding of decision‐making processes within the context of genomic testing, a clinical arena in which individuals face complex risk information and potentially life‐altering decisions. After presenting key principles of self‐regulation, we present a genomic testing case example to illustrate how principles related to risk representations, approach and avoidance motivations, emotion regulation, defensive responses, temporal construals, and capacities such as numeric abilities can shape decisions and psychological responses during the genomic testing process. We conclude with implications for using self‐regulation theory to advance science within genomic testing and opportunities for how this research can inform further developments in self‐regulation theory.     

Marital Expectations in Strong African American Marriages

The current exploratory study utilized a family strengths framework to identify marital expectations in 39 strong African American heterosexual marriages. Couples reflected on their marital expectations over their 10 or more years of marriage. Three themes emerged through qualitative analysis and the participants' own words were used in the presentation of the themes. African Americans indicated that there was growth in marital expectations over time, with marital expectations often beginning with unrealistic expectations that grew into more realistic expectations as their marriages progressed. Participants also indicated that core expectations in strong African American marriages included open communication, congruent values, and positive treatment of spouse. Finally, participants explained there is an “I” in marriage as they discussed the importance of autonomy within their marital relationships. Results are discussed in association with existing research and theory.     

Stress Judgment and Production in English Derivation,and Word Reading in Adult Mandarin-Speaking English Learners

For monolingual English-speaking children, judgment and production of stress in derived words, including words with phonologically neutral (e.g., -ness) and non-neutral suffixes (e.g., -ity), is important to both academic vocabulary growth and to word reading. For Mandarin-speaking adult English learners (AELs) the challenge of learning the English stress system might be complicated by cross-linguistic differences in prosodic function and features. As Mandarin-speakers become more proficient in English, patterns similar to those seen in monolingual children could emerge in which awareness and use of stress and suffix cues benefit word reading. A correlational design was used to examine the contributions of English stress in derivation with neutral and non-neutral suffixes to English word and nonword reading. Stress judgment in non-neutral derivation predicted word reading after controlling for working memory and English vocabulary; whereas stress production in neutral derivation contributed to word reading and pseudoword decoding, independent of working memory and English vocabulary. Although AELs could use stress and suffix cues for word reading, AELs were different from native English speakers in awareness of non-neutral suffix cues conditioning lexical stress placement. AELs may need to rely on lexical storage of primary stress in derivations with non-neutral suffixes.     

Combining Trait Models of Impulsivity to Improve Explanation of Substance Use Behaviour

The UPPS‐P model of impulsivity is gaining popularity among personality and substance use researchers, but questions remain as to whether its five facets have incremental validity in explaining substance use over a more parsimonious model specifying only two facets: reward drive and rash impulsiveness. In three cross‐sectional studies (total N = 486), we investigated whether the novel components of the UPPS‐P model (negative Urgency, Premeditation, Perseverance, Sensation seeking, Positive urgency) predicted typical and problematic alcohol and cannabis use after accounting for reward drive, rash impulsiveness and trait neuroticism (assessed with the Eysenck Personality Questionnaire). Reward drive and rash impulsiveness scores were calculated using principal components analysis of multiple scales, including UPPS‐P premeditation and sensation seeking. Results showed that rash impulsiveness was a robust predictor of typical and problematic substance use. The novel facets of the UPPS‐P did not improve prediction of typical substance use. The urgency scales inconsistently predicted problematic use. Specifically, negative urgency predicted one of three measures of negative consequences from alcohol use, and positive urgency only predicted negative consequences from cannabis use. Results suggest that the three novel facets of the UPPS‐P model add little over a two component model in explaining substance use, although may provide preliminary evidence for the utility of a revised global urgency construct in explaining problematic substance use. Copyright © 2017 European Association of Personality Psychology     

When Avoidance Is Mutual Regulation: Disorganized Attachment and Analytic Attunement

This paper looks at and counters the notion that the analyst’s reluctance to know, to comprehend and interpret, the fuller meaning of a patient’s behavior is a countertransference avoidance. Drawing on attachment theory and infant research that has not yet been fully integrated into the clinical literature, the author believes that the movement from enactment to the expression of dissociated feeling is a process that leads to the creation of previously unknown meaning within an analytic impasse. The infant research literature and the literature on disorganized attachment is referenced to elucidate aspects of the clinical process. The clinical material presented involves the analyst’s failure to engage a patient’s chronic lateness, a failure that represented a mutual avoidance. The meaning of this enactment was locked in the patient’s traumatic past and could not be transmuted into new relational experience until the analyst had emerged from her own dissociative state. The therapeutic space created by their mutual avoidance, contrary to being a stalemate, became a protective space that held the meaning that was hibernating in dissociation. For the patient, the dissociated memory of traumatic abuse was linked, actually and symbolically, to her pervasive lateness. What was represented in the chronic lateness was discovered by analyst and patient together, along with the feelings engendered by “waiting.”     

Genetic Counseling Assistants: an Integral Piece of the Evolving Genetic Counseling Service Delivery Model

This study explores the potential impact of the genetic counseling assistant (GCA) position on the efficiency of the genetic counseling field, evaluates attitudes regarding expansion of the genetic counseling field to include the GCA, and presents data on GCA endeavors and GCA job tasks as reported by GCAs, certified genetic counselors (CGCs), and program directors (PDs). Data on GCA roles and attitudes toward different aspects of the GCA position were collected via surveys of CGCs who have worked with GCAs, PDs who have and have not had experience with GCAs in their programs, and GCAs. We analyzed responses from 63 individuals: 27 PDs, 22 CGCs, and 14 GCAs. GCAs’ impact on efficiency was calculated via internal analysis of genetic patient volume per genetic counselor within the University of Texas Southwestern (UTSW) patient database prior to, and since the addition of, a GCA to the practice. The response rates for PDs, CGCs, and GCAs were 27 %, 79 %, and 61 %, respectively. Every CGC stated the GCA increased their efficiency. CGCs with a GCA reported a 60 % average increase in patient volume. This figure was congruent with internal data from the UTSW cancer genetics program (58.5 % increase). Appropriate responsibilities for GCAs as reported by CGCs and PDs (>90 %) include: data entry, shipping tests, administrative tasks, research, and ordering supplies. Regarding GCAs delivering test results, there was response variation whether this should be a job duty: 42 % of CGCs agreed to GCAs delivering negative results to patients, compared to 22 % of program directors. Twenty-two percent of PDs expressed concern about the job title “Genetic Counseling Assistant.” Ninety percent of CGCs felt that GCA was a career path to becoming a CGC, compared to 42 % of PDs. Eighty-three percent of GCAs who decided to apply to CGC graduate programs were accepted. We conclude the addition of a GCA to a genetic counseling practice contributes to increased efficiency and is one way to expand the reach of the profession.