Discussion of "some problems of cross-cultural psychotherapy with refugees seeking therapy," by Carl-Ivar Dahl

The American Journal of Psychoanalysis -     

Interval estimation for the intraclass correlation in dirichlet-multinomial data

When the underlying distribution is discrete with a limited number of categories, methods for interval estimation of the intraclass correlation which assume normality are theoretically inadequate for use. On the basis of large sample theory, this paper develops an asymptotic closed-form interval estimate of the intraclass correlation for the case where there is a natural score associated with each category. This paper employs Monte Carlo simulation to demonstrate that when the underlying intraclass correlation is large, the traditional interval estimator which assumes normality can be misleading. We find that when the number of classes is 20, the interval estimator proposed here can generally perform reasonably well in a variety of situations. This paper further notes that the proposed interval estimator is invariant with respect to a linear transformation. When the data are on a nominal scale, an extension of the proposed method to account for this case, as well as a discussion on the relationship between the intraclass correlation and a kappa-type measure defined here and on the limitation of the corresponding kappa-type estimator are given.The authors wish to thank the Editor, the Associate Editor, and the three referees for many valuable comments and suggestions to improve the clarity of this paper. The works for the first, the third, and the fourth authors were partially supported by grant #R01AR43025-01 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.     

Effects of alcohol intoxication and aggressivity on aggressive verbalizations during anger arousal

We examined the moderating effect of dispositional aggressivity on the relationship between alcohol intoxication and aggressive verbalizations. Using a laboratory anger-induction task that simulated an interpersonal conflict as a method to assess aggressive verbalizations (the articulated thoughts in simulated situations paradigm), 70 participants (33 women, 37 men) consumed either an alcoholic or a placebo beverage, and then imagined a series of audiorecorded interpersonal scenarios. Two blind-to-condition raters assessed the frequency of participants' aggressive verbalizations (insults, aggressive threats, belligerent provocations) articulated during anger arousal. Aggressivity was assessed using a standard measure of dispositional aggression. Results supported the aggressivity moderation hypothesis: intoxicated participants high in aggressivity responded with significantly more aggressive verbalizations relative to low-aggressivity participants regardless of beverage condition, and three times more aggressive verbalizations relative to the high-aggressivity/placebo group. There were no gender effects. These data support the hypothesis that alcohol potentiates aggression primarily among individuals at dispositional risk for engaging in such a behavior. Aggr. Behav. 34:428-436, 2008. (c) 2008 Wiley-Liss, Inc.     

Physician Migration: Experience of International Medical Graduates in the USA

The purpose of this study was to explore the experience of foreign-born international medical graduates (IMGs) in the USA. Few studies describe IMG experiences in attaining medical licensure in the USA at each step of the process. Furthermore, little is known about IMGs who choose not to become a licensed physician or were unsuccessful in doing so. In this study, 20 foreign-born IMGs, 16 practicing IMGs and 4 non-licensed physician IMGs, participated in a 1-h semi-structured face-to-face interview between September 2013 and April 2014. Participants were from North America (Canada), Latin America, South Asia, East Asia, Europe, the Middle East, or Sub-Saharan Africa. Interviews were transcribed. Two of the authors conducted initial analysis of each interview separately. Four primary themes emerged based on the data analysis: (1) barriers to physician careers include the immigration process, years since graduating from medical school, language and culture, and cost and time; (2) positive factors to support physician careers include networking and research experience; (3) factors that positively or negatively affect IMGs seeking physician careers such as the education system in a home country and family; and (4) non-physician careers. In order to develop multiple pathways to utilize IMGs in the US healthcare system, future research examining the following areas is necessary: (1) support systems for IMGs who are taking the US Medical Licensing Exam (USMLE) or applying for a residency position and (2) the experience of IMGs who are not certified physicians in the USA.     

Attention allocation and habituation to anger-related stimuli during a visual search task

A substantial amount of data has accumulated demonstrating that emotionally disordered subjects are prone to bias their attention toward threatening, emotionally relevant stimuli. Little attention has been reserved for the study of cognitive processes involved in anger arousal. In the present study, we investigated whether mood-congruent attentional biases could be demonstrated in subjects of varying levels of trait anger using a visual search task. This task also assessed whether mood-congruent biases diminished with repeated exposure to specific emotion stimuli. To investigate state-trait interaction effects, a naturalistic, anger-inducing insult was administered to half the subjects. There was a positive relation between participants' level of trait anger and their degree of mood-congruent attentional bias toward anger-related cues only after an insult. As predicted, this effect diminished across blocks of trials. Aggr. Behav. 24:399–409, 1998. © 1998 Wiley-Liss, Inc.