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.     

Reconstruction of arbitrary versus logical sequences by preschool children

The ability of preschool children to construct and reconstruct ordered sequences was examined in a series of four experiments. In Expt. 1, the task was to copy, with the model present or absent, the order of items pegged on a clothesline. In Expts. 2–4, the subjects were required to reconstruct ordered series of pictures from memory. In all experiments, the orders were either logical or arbitrary. Reconstruction of an arbitrary series of events is within the problem solving capacity of 4-yr-old children if (a) reconstruction takes place in the presence of the model or follows immediately upon the removal of the model and (b) the original sequence is presented simultaneously. If, however, the lag between viewing and reconstruction is increased and/or the original set is not viewed simultaneously, as a unit, performance declines. The provision of an inherent order to the items within a set, either by introducing a connective narrative, or a depicted logical sequence, is sufficient to maintain that order over time and to provide a unifying cohesion to the items when viewed successively.     

Oral overcorrection: side effects and extended applications.

Experiment 1: In a specialized daycare program the use of oral overcorrection (contingent toothbrushing with an oral antiseptic) to suppress one child's thumbsucking at Language Time was found to suppress the behavior of another child who was not treated but who witnessed the target child's treatment. Experiment 2: The main effects of oral overcorrection were replicated. Contingent overcorrection threats (warnings), used independently, were then shown to suppress thumbsucking behavior that had returned to its baseline level. These effects were maintained one month after the threats were discontinued, but they did not generalize to other activity periods, particularly Nap Time. Experiment 3: Contingent threats were found to suppress the persistent nap-time thumbsucking of the child from Expt 2. Increments in certain other (nonoral) inappropriate behaviors were correlated with the suppression of thumbsucking. Threats to use oral overcorrection contingent upon nonoral misbehaviors at Nap Time were not effective. However, the actual use of oral overcorrection for these categories of nonoral misbehavior served to suppress these behaviors. Experimental controls combined treatment reversal and multiple baseline single-subject designs.     

Stimulus control over sex-typed play in cross-gender identified boys.

Discriminative stimulus control over masculine and feminine sex-typed play behaviors was investigated in five boys, aged 5–8 yr, with “childhood crossgender identification.” Reliable observational measures of play were obtained with two sets of toys: (a) “dress-up toys” (girls' apparel vs boys' apparel), and (b) “affect toys” (maternal-nurturance play vs masculine-aggression play). With an ABA reversal intrasubject design, certain stimulus conditions (e.g., presence of father, mother, male, or female stranger) were found to be discriminative for reliable changes in sex-typed play. Sex-typed play was found to vary as a function of the social stimulus situation and as a function of the type of play response required. All children played predominantly feminine while alone in the playroom. While no single environmental stimulus was consistently discriminative for masculine play across children, at least one stimulus condition was found for each subject under which he played predominantly masculine.     

Uncertainty and social comparison

Two experimetnal tests were conducted of a model which predicts social comparison choices of extreme scores on a personality inventory. In groups of nine, subjects completed a bogus personality inventory that ostensibly measured a desirable or undesirable trait, and were told that either the highest or the lowest obtained score was a positive instance of the trait. The highest score was located for the subjects either with certainty or uncertainty, and the two experiments employed different manipulations of this factor. In both experiments the pattern of subjects' social comparison choices of other subjects' scores was fit best by a model comprising main effects of each factor and interactions between desirability and positive instance and between desirability and certainty.     

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.     

Inducing ordinal and cardinal representations of the first five natural numbers

The prediction that the ordinal property of natural number symbols (using these symbols to represent the terms in an ordered progression) is more easily learned than the cardinal property of natural number symbols (using these symbols to represent the manyness of collections) was examined in this experiment. Preschoolers who evidenced no proficiency with either the ordinal or cardinal properties of natural number symbols were trained to acquire these properties via simple feedback. Both properties proved to be trainable. The most important findings were that the ordinal property was much easier to train than the cardinal property, ordinal training effects were more durable across a 1-week interval than cardinal training effects, and ordinal training appeared to transfer better than cardinal training.     

Selective imitation of the passive construction through modeling

Six 4- to 5-yr-old subjects were exposed to five sessions in which an adult model used passive sentences to describe a set of modeling stimuli. Probe stimuli, which the subjects were asked to describe without benefit of modeling and without selective reinforcement were interspersed among modeling stimuli. A matched group of control subjects received probletrials but no modeling trials. Both groups of subjects were subsequently tested on their ability to comprehend active and passive sentence forms. Every subject in the experimental group produced passive sentences on probe trials even though there was considerable variability in the number of passives produced. No control subject produced passives. The modeling procedure increased the comprehension scores of the experimental group above those of the control group though the scores of both groups were above chance. The results were contrasted with earlier studies in which modeling was ineffective in producing passive usage and in which comprehension of the passive was not demonstrated by even older children.