Improving access to psychological treatments: lessons from developing countries

Even though psychological treatments have been advocated as treatments for a range of mental disorders by the WHO for scaling up through primary care globally, the vast majority of potential beneficiaries are unable to access these treatments. Two major barriers impede the path between evidence based treatments and improved access: the lack of skilled human resources and the acceptability of treatments across cultures. This essay synthesizes the experiences of programs which developed and evaluated psychological treatments for depression in three resource poor developing countries. These programs addressed the human resource barrier by training lay or community health workers to deliver the treatments and addressed the acceptability barrier by systematically adapting the treatment to contextual factors. All programs demonstrated significant benefits in recovery rates when compared with usual care demonstrating the effectiveness of the approach. The implications for these experiences to improving access to psychological treatments in the global context are discussed.     

Diffusion of entitlement: An inhibitory effect of scarcity on consumption

Four studies demonstrated that increasing a desirable commodity's scarcity (i.e., decreasing its supply or increasing demand for it) can inhibit people from claiming the commodity for themselves, thereby delaying its consumption. In Study 1, participants were slower to claim a commodity when its supply was limited versus unlimited. In Study 2, participants expressed more disapproval of someone who took the last commodity compared to the second-last commodity. Participants in Study 3 anticipated that increased demand for a commodity would make them less likely to claim it despite wanting it more. Study 4 showed that the more participants there were who could claim a commodity, the longer it went unclaimed. The inhibitory effect of scarcity was mediated by diminished entitlement to the commodity (Study 3), and increasing entitlement reduced the inhibition against taking scarce commodities (Studies 1 and 2). These findings are discussed in the context of individuals' concern with equality.     

Dual-task processing in younger and older adults: similarities and differences revealed by fMRI

fMRI was used to explore age differences in the neural substrate of dual-task processing. Brain activations when there was a 100 ms SOA between tasks, and task overlap was high, were contrasted with activations when there was a 1000 ms SOA, and first task processing was largely complete before the second task began. Younger adults (M=21 yrs) showed activation in dorsolateral prefrontal cortex and in parietal areas as well as in ventral medial frontal cortex and sub-lobar areas. Activations in older adults (M=71 yrs) did not differ significantly from younger adults except for higher activations in occipital and polar prefrontal cortex. The results were well fit by a model with two networks managing dual-task interference, a medial prefrontal network that detects changes in the stimulus situation and maps them to associated changes in the valence of response mappings and a lateral frontal-parietal network that initiates and carries out the shift from one task to the other. The additional activations in older adults as a group and the correlations of individual differences in activation with performance were consistent with recruitment within each of these networks. Alternative explanations such as hemispheric asymmetry reduction and reactive rather than proactive processing in older adults were not supported.     

Contextualizing rape: Reviewing sequelae and proposing a culturally inclusive ecological model of sexual assault recovery

Consistent evidence demonstrates that many women who encounter the trauma of rape experience a range of both acute reactions and chronic psychological sequelae. This article reviews both the short- and long-term psychological adjustment issues associated with rape. In addition, we propose a culturally inclusive ecological model of sexual assault recovery (CIEMSAR), which integrates and extends existing models to better examine the complex factors leading to differential postrape adjustment. Important components of the CIEMSAR are placing rape in the broader sociocultural context of the United States and explicated socioracial and ethnic factors influencing the recovery process. The five primary factors of CIEMSAR are outlined, including (a) macrosystem or sociocultural context factors; microsystem/individual factors such as (b) assault characteristics, (c) person variables, (d) coping responses; and mesosystems factors such as (e) social-support systems. Suggestions for future research are also provided.     

A Multi‐Family Group Intervention for Adolescent Depression: The BEST MOOD Program

Depression is the most common mental disorder for young people, and it is associated with educational underachievement, self‐harm, and suicidality. Current psychological therapies for adolescent depression are usually focused only on individual‐level change and often neglect family or contextual influences. The efficacy of interventions may be enhanced with a broader therapeutic focus on family factors such as communication, conflict, support, and cohesion. This article describes a structured multi‐family group approach to the treatment of adolescent depression: Behaviour Exchange Systems Therapy for adolescent depression (BEST MOOD). BEST MOOD is a manualized intervention that is designed to address both individual and family factors in the treatment of adolescent depression. BEST MOOD adopts a family systems approach that also incorporates psychoeducation and elements of attachment theories. The program consists of eight multifamily group therapy sessions delivered over 2 hours per week, where parents attend the first four sessions and young people and siblings join from week 5. The program design is specifically aimed to engage youth who are initially resistant to treatment and to optimize youth and family mental health outcomes. This article presents an overview of the theoretical model, session content, and evaluations to date, and provides a case study to illustrate the approach.     

Demographic factors,childhood maltreatment and psychological functioning among university students' in Ghana: A retrospective study

This study retrospectively investigates the influence of child (i.e., gender), care‐giver (e.g., who grew up with), household size (i.e., number of siblings grew up with) and community (i.e., rural versus urban) factors on childhood maltreatment, as well as the impacts of maltreatment on psychological functioning. A cross‐sectional survey and self‐report methodology is used to gather data from 300 students of the University of Ghana. The results show that being a male, growing up in rural areas, living with more than 3 siblings in the same household and being raised by both biological parents have significant main effects on childhood maltreatment. Analyses of the interaction effects show that living with more than 5 siblings in a rural household with “other” parents (i.e., non‐biological parents) has a significant effect on physical abuse. Furthermore, males from rural households consisting of more than 3 siblings and who did not grow up with both biological parents endorsed significantly more physical abuse and physical neglect, compared with the females. With respect to the psychological outcome, childhood maltreatment significantly predicts and account for significant variance in depression (34%), self‐efficacy (18%) and life satisfaction (22%). The findings and the implications of the study are briefly discussed.     

Ignoring biased feedback: Membership in a stigmatized group as a moderator of mnemic neglect

A personal history of being the target of biased negative evaluation may lead individuals to habitually divert attention from negative feedback when it is possible to do so. Two studies tested for the first time the hypothesis that people belonging to a stigmatized group (Black students on a predominantly White campus) will, relative to non-stigmatized people, be more likely to engage in mnemic neglect—that is, they will reveal a greater tendency to insulate themselves from the effects of negative self-relevant feedback by means of motivated forgetting. The results of Study 1 supported that hypothesis. In Study 2, priming the concept of egalitarianism reduced the tendency of Black participants to engage in higher levels of mnemic neglect, consistent with the idea that the higher observed levels of mnemic neglect among stigmatized individuals derives from expecting biased, discriminatory responses from other people.     

生命意义感对大学新生日常烦心事和心理适应的影响

为验证日常烦心事对个体心理适应的作用过程,并探讨生命意义感是否在烦心事知觉与心理适应之间起调节作用。研究采用纵向追踪方式对153名大学新生进行新近生活经历问卷、压力知觉量表、生命意义感量表和心理适应的测量。结果显示压力知觉在日常烦心事与心理适应之间起完全中介作用;拥有意义在烦心事知觉与心理适应之间起调节作用,但追求意义的调节作用不显著。这说明日常烦心事会通过压力知觉影响个体心理适应,拥有意义对个体心理适应具有调节作用。     

A theoretical upgrade of the concept of parental psychological control: Proposing new insights on the basis of self-determination theory

Psychological control refers to manipulative parental behavior that intrudes upon the child’s psychological world. During the past decade, socialization research has consistently demonstrated the negative effects of psychologically controlling parenting on children’s and adolescents’ development. However, there has been relatively little advance in our conceptual understanding of this parenting construct. The present overview aims to enrich the theoretical background of the concept of psychological control by relating it to concepts used in self-determination theory. It is argued that this theoretical background allows for (a) a clearer definition of the concept of psychological control, (b) a more refined understanding of the dynamics involved in psychologically controlling parenting, and (c) a greater insight regarding its generalization across age and cultures. Directions for future research are formulated with respect to each of these three issues.     

现代医师心理人格数学模型的建立及测评

目的探索现代医师职业心理人格特点及构建其数学模型。方法采用经典性格量表16PF测验职业医师与新医师两类群体,并应用Logistic回归模型以及判别分析等统计方法研究。结果新医师和职业医师心理人格存在不同的特点,并随着职业生涯发展其心理人格呈现一定变化趋势;结论现代医师心理人格数学模型基本能反映新入行者大致的职业心理倾向,准确判别率为82.8%,可作为医院选聘考核新医生的参考依据。