Culture as a resource for mental health

This article is based on the author's address at the National Multicultural Conference and Summit III in Los Angeles, California, in January 2003. The author focuses on culture as a resource--a resource for theories that can inform one's understanding of human behavior; a resource for healing, self-help, and positive emotions; a resource for clinical practice; and a resource for mental health and wellness. The author uses a healing story from native culture to describe the essence of his relational worldview and to reframe the professional thinking about culture as one of the greatest assets for healing and mental wellness rather than as a problem to solve.     

Detecting random, partially random, and nonrandom Minnesota Multiphasic Personality Inventory-Adolescent protocols

The ability of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; J. N. Butcher et al., 1992) validity scales to detect random, partially random, and nonrandom MMPI-A protocols was investigated. Investigations included the Variable Response Inconsistency scale (VRIN), F, several potentially useful new F and VRIN subscales, and formulas F-sub-2 - F-sub-1 and F + F-sub-2 + |F - F-sub-2|. Protocols completed by 150 adolescents at a juvenile court setting, screened for randomness with a matched-pair Millon Adolescent Clinical Inventory (MACI) or Jesness Inventory, were compared with 100 computer-generated, all-random protocols, and with 5 levels of partially random protocols. VRIN was the most effective scale in detecting all-random protocols; however, the optimum cutoff of >or= 75 failed to identify 1/3 of them. Using the new scales, a decision algorithm was described that correctly classified 94%-95% of protocols as interpretable, partially interpretable, or uninterpretable.     

Inhibition of acoustic startle using different mechanoreceptive channels

In this experiment, we investigated the impact of vibrotactile prepulse frequency and intensity on the acoustically elicited startle response in humans. Mechanoreceptive channels differing in their sensitivity to transient stimulation have been identified in the skin. The Pacinian channel is optimally sensitive to vibrations at approximately 300 Hz and is specialized for the detection of stimulus transients, whereas the non-Pacinian I and III channels are optimally sensitive to vibrations at approximately 30 Hz. Vibrotactile prepulses with frequencies of 30 and 300 Hz and intensities of 95 and 130 mV were presented for 50 msec to the dominant hand of college students (N = 31), followed on some trials by a 95-dB broadband acoustic startle stimulus. The 300-Hz prepulses resulted in significantly more pronounced inhibition of startle magnitude, amplitude, and probability, whereas only the 30-Hz prepulses significantly facilitated blink latency. These results support the idea that the inhibition of acoustic startle is determined more by transient than by sustained aspects of vibrotactile prepulse stimuli. This study also demonstrates that different aspects of the startle response differentially reflect stimulus characteristics of the prepulse.     

A locus of control measure as a teaching demonstration

268 students (M age = 20.0 yr., SD = 4.4; 68% women), randomly chosen from psychology classes, completed Rotter's I-E scale and Pettijohn's 1992 locus of control scale for class demonstration. The two sets of scores were similar but examination of reliability and validity indicated the latter was best used as a demonstration.     

Physical therapists' nonverbal communication predicts geriatric patients' health outcomes

Two studies explored the link between health care providers' patterns of nonverbal communication and therapeutic efficacy. In Study 1, physical therapists were videotaped during a session with a client. Brief samples of therapists' nonverbal behavior were rated by naive judges. Judges' ratings were then correlated with clients' physical, cognitive, and psychological functioning at admission, at discharge, and at 3 months following discharge. Therapists' distancing behavior was strongly correlated with short- and long-term decreases in their clients' physical and cognitive functioning. Distancing was expressed through a pattern of not smiling and looking away from the client. In contrast, facial expressiveness, as revealed through smiling, nodding, and frowning, was associated with short- and long-term improvements in functioning. In Study 2, elderly subjects perceived distancing behaviors of therapists more negatively than positive behaviors.     

A Latent Growth Curve Modeling Approach to Pooled Interrupted Time Series Analyses

This paper presents a latent variable approach for the estimation of treatment effects within a pooled interrupted time series (ITS) design. Although considered quasi-experimental, the ITS design has been noted as representing one of the strongest alternatives to the randomized experiment, making it highly appropriate for use in documenting the presence of effects that might warrant further evaluation in a large-scale randomized study. Results suggest that the latent variable growth modeling (LGM) is capable of detecting simultaneous differences in both level and slope, and provides tests of significance for these two necessary indicators of an ITS intervention effect. As shown in the analyses, the LGM framework provides a comprehensive and flexible approach to research design and data analysis, making available to a wide audience of researchers an analytical framework for a variety of analyses of growth and developmental processes.     

How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research

Physicians, nurses, and other clinicians readily acknowledge being troubled by encounters with patients who trigger moral judgments. For decades social scientists have noted that moral judgment of patients is pervasive, occurring not only in egregious and criminal cases but also in everyday situations in which appraisals of patients' social worth and culpability are routine. There is scant literature, however, on the actual prevalence and dynamics of moral judgment in healthcare. The indirect evidence available suggests that moral appraisals function via a complex calculus that reflects variation in patient characteristics, clinician characteristics, task, and organizational factors. The full impact of moral judgment on healthcare relationships, patient outcomes, and clinicians' own well-being is yet unknown. The paucity of attention to moral judgment, despite its significance for patient-centered care, communication, empathy, professionalism, healthcare education, stereotyping, and outcome disparities, represents a blind spot that merits explanation and repair. New methodologies in social psychology and neuroscience have yielded models for how moral judgment operates in healthcare and how research in this area should proceed. Clinicians, educators, and researchers would do well to recognize both the legitimate and illegitimate moral appraisals that are apt to occur in healthcare settings.     

Readiness to adaptively change under three conditions: Clinical,careers, and natural change situations

The Adaptive Change Model (ACM) was developed as an alternative form of the Transtheoretical Model of Change to address some of the criticisms of early operationalisation. Both models provide a framework for measuring the potentialities of change and to facilitate targeted behaviour change in general and clinical settings. In this research, the eight factors of the Adaptive Change Questionnaire (ACQ) operationalising the ACM were validated using confirmatory factor analysis, involving 238 respondents. The findings indicated a good fit between the model and data. A comparison of the mean scores of the factors of the ACM showed respondents seeking clinical therapy (n = 85) were lower on self‐rating of factors related to adaptive change than a group receiving career counselling (n = 88) and a non‐therapy group (n = 65). The ACQ factors correctly predicted the allocation of 79.3% of the clinical and non‐therapy respondents which confirmed previous research. The relevance of the findings for therapeutic interventions and future research are discussed.