Psychological Interventions and Genetic Testing: Facilitating Informed Decisions About BRCA1/2 Cancer Susceptibility

Genetic testing for inherited cancer susceptibility, based on the recently identified. BRCA1 and BRCA2 genes, will soon be available on a large scale. However, at present, genetic test results do not lead to clearly indicated diagnostic or preventive measures, and the nature of the psychological impact of BRCA1/2 testing is still largely unknown. This uncertainty, combined with preliminary evidence suggesting significant individual differences in reactions to genetic susceptibility feedback, constitutes a unique challenge for any individual contemplating such testing. We outline the nature of this challenge and then propose an intervention strategy designed to help individuals make deeply processed and psychologically well-informed decisions with regard to their genetic susceptibility. The intervention is guided by recent research findings and theory on the cognitive–emotional processing of cancer-risk information. Specifically, the goal is to prepare the individual for genetic testing by (1) cognitively and emotionally activating, or preliving, the individual's potential reactions to testing feedback; (2) facilitating accurate appraisal of the individual's cognitive–emotional reactions; and (3) enabling the individual to process these reactions through the use of well-established clinical techniques.     

The relationship between expressed social fears and assertiveness and its treatment implications

Behavior therapists have speculated about the relationship between social fears or social anxieties and lack of assertive behavior. Wolpe (1958) perhaps most clearly suggested such a relationship. “If he [the patient] has been ineffectual in such situations—unable, for instance, to return a faulty garment—I explain how unadaptive fears are at the bottom of this ineffectualness. … p. 116.” Wolpe further assumed that engaging in assertive behavior reciprocally inhibited fear in these same social situations and that assertive responses can be programmed for use in overcoming these fears.In later writings (Wolpe. 1969; Wolpe and Lazarus, 1966) Wolpe seems to have broadened his position concerning the cause of non-assertive behavior. Specifically, he now allows that an individual also may be non-assertive, “… not because of anxiety but because they have never had the opportunity of acquiring the necessary habits. p. 40” (Wolpe and Lazarus, 1966). For these individuals direct efforts in assertive training such as behavior rehearsal, operant conditioning or direct instruction are in order. For these individuals whose lack of assertiveness is due to a ‘phobic reaction’ or strong extrinsic fears, systematic desensitization is recommended in addition to assertive training.Despite this apparent change in position, the intuitively appealing notion that the more socially fearful an individual is the more non-assertive he is likely to be has not received the empirical attention it deserves. Rathus (1973) seems to have provided some indirect evidence pertaining to the relationship between social fears and assertiveness. In the context of evaluating the efficacy of an assertive training method he administered both the 100-item Temple Fear Survey Inventory (TFSI) (Braun and Reynolds, 1969) and the Rathus Assertiveness Schedule (RAS) (Rathus, 1973) to groups of female students receiving either assertive training, a placebo treatment or no treatment. He found that at post-test the assertive training group scored significantly higher than either the placebo or no treatment groups on the RAS and that there were no significant differences in post-test Full Scale TSFI Scores. Fear of Social Criticism Factor Scores or Fear of Social Incompetence Factor Scores although in each case the mean changes toward less fear were greater for the group receiving assertive training. This finding gives little support to the reciprocal relationship between social fears and assertiveness. What is needed is a direct determination of the degree to which social fears and assertiveness are related in a sizeable sample of subjects.     

Differences in baseline drinking behavior between New Zealand alcoholics and normal drinkers

Details of alcohol drinking by 12 New Zealand hospitalized alcoholics and 12 normal drinkers from the local community were compared in an experimental bar-and-lounge environment. Differences between the drinking behavior of the two groups were found to be statistically significant on measures of total alcohol consumed, sip size and rate of alcohol ingestion (speed of drinking). The drinking pattern exhibited was similar to that reported in baseline studies of North American drinkers, as reported by Schaefer et al. (1971). This similarity was discussed in terms of a behavioral profile of alcoholics as compared with normal drinkers for the diagnosis of problem drinking.     

Women's reactions to discrimination from members of the same or opposite sex

The effects upon women's self-evaluations of experiencing varying severity of failure in interpersonal competition against male vs. female opponents were explored. The results supported the hypothesis that self-esteem in women is more vulnerable to interpersonal rejection from men as opposed to other women. Specifically, subjects reported lower self-esteem when severe failure was due to the actions of alleged, male opponents rather than female ones. Also, severe failure elicited less favorable self-evaluations than mild failure only when the female subjects confronted male opponents. Finally, contrary to a defensive self-presentation hypothesis, subjects did not respond to discrimination from men by presenting themselves as being discrepant from the stereotype of women. Instead, subjects who interpreted their failure as reflecting prejudice on the part of men evaluated themselves more favorably on positive traits underlying the female stereotype.     

Structural models and occupational aspirations: Black-white variations among deep-south adolescents

Multivariate techniques for attribute data and the backward elimination procedure developed in regression analysis were utilized in an analysis of the occupational aspirations of deep-south adolescents. An examination of the models constructed revealed that: (1) social class indicators accounted for the largest effect estimates; (2) residence was associated with a smaller, yet statistically significant portion of the variation; and (3) the effect of race was negligible when controls were applied. Application of the most efficient model to black and white subsamples revealed race variations in both composite effect estimates and the rank order of effect estimates. Implications of these findings are discussed in terms of the developmental model of occupational choice and suggestions for further research are presented.     

Coding strategies and cerebral laterality effects

In a short-term recognition memory task, Ss were given relational imagery and rehearsal coding strategies in different sessions, with probes presented to the left or right cerebral hemisphere. Consistent with a model of separate processing systems for verbally and visually coded information, Ss yielded significantly faster response latencies for probes to the left hemisphere than the right when employing the rehearsal strategy, and significantly faster latencies for probes to the right hemisphere than the left when using the imagery code. This suggests that cerebral laterality effects are functionally related to coding strategies, and argues for the inclusion of imagery, or generated visual information, as part of the visual processing system. As such, generated visual information may be viewed as a coding alternative to verbal mediation.     

Self-versus drug-produced relaxation and the effects of instructional set in standardized systematic desensitization

Snake fearful college students underwent Standardized Systematic Desensitization (SSD) treatment in which they received instructions designed to induce cognitions of either self- or drug-produced relaxation. Half of the subjects in each of these conditions were also given high expectancy therapy instructions and low expectancy therapy instructions respectively. All four SSD groups showed significantly greater improvement than a no-treatment control group on both the behavior avoidance test (BAT) and the self-report measure of fear. No differences between self- and drug-attributions of relaxation were found on any measure. Subjects' high expectancy ratings were significantly correlated with improvement on self-report measures but not related to BAT performance.