WKPIC is happy to announce that practicum student Cassandra Sturycz has been accepted to the doctoral program in clinical psychology at the University of Tulsa. She will be joining a psychophysiology laboratory for affective neuroscience. The lab was just awarded a sizeable grant from the NIH for research regarding pain in the Native American population.
Way to go, Cassandra!
Safety is the number one concern of patients admitted into an inpatient mental health facility. In theory, inpatient mental health facilities fulfill two goals: (1) to safeguard patients especially to patients at risk for suicide, and (2) to provide comprehensive services including, but not limited to medication management, individual/group psychotherapy, and effective diagnosis. The overall plan of care requires a collaborative effort consisting of psychologists, psychiatrists, social workers, nursing staff, the individual patient, and the patient’s family/primary support system. However, when an inpatient suicide takes place in a mental health facility, vulnerabilities must be carefully reviewed and addressed to help reduce and prevent the occurrence.
A study of Knoll’s (2008) article revealed frightening facts about the incidence of inpatient suicides. To support his findings, Knoll (as cited in the psychiatric-times.com) included information from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) between 1995 -2005 (Knoll, 2008). According to JCAHO, as cited from Knoll (2008) and Burgess, Pirkis, Morton, and Croke (2000), “Suicides were the result of ineffective clinical assessment. The lack of risk management accounted for approximately 60% of suicides (Knoll, 2008; p.1) .”
Specific to inpatient facilities, Knoll indicated that hanging was the most recurrent method to commit suicide. Of particular interest, he indicated that approximately ¾ of inpatient deaths take place in the patient’s restroom, bedroom, or closet areas. Knoll also reminds personnel that items such as shoelaces, belts, straps, razors, etc., can potentially be weapons used by patients wishing to attempt suicide. Furthermore, there is a pattern of concern that has emerged in recent literature which suggests that inpatient facilities are: (1) inadequately monitoring patients, and (2) inadequately protecting first admit patients with thoughts of self harm, either moderate or severe. According to Knoll, these concerns have raised ethical concerns that question the efficacy of psychiatrists, psychologists, and the hospital staff to protect the patient from harm.
It is indeed a fact that hospitals face daily challenges. Knoll emphasized that sharing information is a daily challenge and has become a critical issue to the point that it is of the utmost significance that staff communicate with one another to identify patients who are a suicide risk. According to Knoll, communication or the lack thereof has contributed to a huge missing piece of the puzzle among the causes of suicide. He suggested ongoing staff education to focus on innovative suicide assessments and treatment. Knoll further stated that hospital staff should exercise caution when utilizing 15-minute checks with seriously suicidal patients who have been assessed as high risk or uncertain risk. He has also highlighted that inpatients can and do commit suicide while on 15-minute checks.
According to Knoll, too often will staff working in an inpatient environment get desensitized and no longer feel responsible for patient safety. It is believed that staff may become stressed and oftentimes lose impartiality that they view patients as scheming, manipulative, over-dependent, or feigning. In other words, suicide rates tend to increase when there is a breakdown of empathy, genuineness, and a lack of unconditional positive regard. The bottom line is that Knoll stresses that the highest-risk times for suicide are the first week after admission to an inpatient mental treatment facility and shortly after discharge. In short, conventional therapy interventions may prove ineffective and in some instances may exacerbate the risk of suicidal ideation. Therefore, mental health practitioners must implement out of the box thinking to approach patients who are at risk of suicide.
In summary, Knoll suggests that the mental health professional take a different point of view when caring for patients. Regardless of the mental health label, patient care should not be taken lightly. 1:1 close observation must be taken seriously. He states that the greatest risk of suicide is upon admission, especially when the patient being assessed is a first admit patient.
References
Knoll, J. L. (2008). Inpatient suicide: Identifying vulnerabilities in the hospital setting. Psychiatric Times, May 22, 2012. Retrieved from http://www.psychiatrictimes.com/suicide/inpatient-suicide-identifying-vulnerability-hospital-setting
Burgess, B., Pirkis, J., Morton, J., & Croke, E. (2000). Lessons from a comprehensive clinical audit of users of psychiatric services who committed suicide. Psychiatric Services, 51, 1555-1560.
David Wright, MA, MSW
WKPIC Doctoral Intern
Considering the prevalence of chronic pain in the general population, treatment teams everywhere have been grasping for effective treatment options. Empirical research has pointed towards mindfulness-based treatments with promising results.
Mind-body approaches have sought to improve the decreased health-related quality of life and high levels of psychological distress frequently associated with chronic pain conditions. Such approaches as Mindfulness-Based stress reduction (MBSR), which was modeled after the curriculum Kabat-Zinn et al. developed in the 1980’s at the Stress Reduction Clinic of the University of Massachusetts Medical Center, utilize techniques including: body scan, awareness of breathing, awareness of emotions, mindful yoga and walking, mindful eating, and mindful listening. Past research has suggested significant improvement for chronic pain patients in a variety of symptoms following the implementation of MBSR interventions. However, there seems to be some inconsistency in these results as a factor of diagnostic heterogeneity versus homogeneity in past sample populations.
Investigators in the current study seek to compare the efficacy of MBSR among diagnostic subgroups of patients who received treatment in a diagnostically heterogeneous community population. Rosenzweig, Greeson, Reibel, et al. (2010) compared pre- and post-treatment measures of health-related quality of life (HRQoL), an index of bodily pain and pain-related limitations in daily functioning, and psychological distress. Data was collected over the course of seven years from 133 participants in the 8-week MBSR program. 84% of participants were women, 93% were Caucasian, and were divided into groups of patients diagnosed with arthritis, chronic back or neck pain, chronic headache/migraine, and patients with two or more of these diagnoses. 99 participants completed the program 41 of the 99 completed logs of recommended home meditation practice, which were incorporated into treatment mid-study.
Overall, all subgroups of participants reported an improvement in HRQoL subsequent to the MBSR program; however, there were differences between groups in the magnitude of this improvement. The most significant average improvements in HRQoL as well as psychological distress were seen in participants diagnosed with arthritis. Medium to large effects were seen in participants with chronic neck or back pain in terms of physical and mental components of HRQoL. Participants with two or more chronic pain diagnoses show significant improvements in pain, pain-related functional limitations, overall HRQoL, and psychological distress. Those participants with chronic headache/migraine reported the smallest magnitude of improvement in HRQoL. Finally, data analysis of the information collected regarding recommended home meditation practice yielded strong associations between adherence to recommendations and greater home practice and improved outcomes in several areas, including: psychological distress, somatic symptoms, self-rated health, reduction in role limitations due to emotional problems, and social functioning.
Rosenzweig, A., Greeson, J. M., Reibel, D. K., Green, J. S., Jasser, S. A., & Beasley, D. (2010). Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research, (68), 29-36.
Cassandra A. Sturycz, B.A.
Psychology Practicum Student
Everyone has heard a story of a group of individuals committing a heinous crime against another individual. We often wonder where is the humanity in these individuals and think, “Well I would never do a thing like that!”
Myers (2004) in his book, Exploring Social Psychology, describes an event that occurred in 1991 in which an eyewitness videotaped four Los Angeles police officers hitting unarmed Rodney King more than 50 times – fracturing his skull in nine places with their nightsticks and leaving him brain damaged and missing teeth – while 23 other officers watched passively. People all over the nation watching the video were shocked and began discussing police brutality and group violence. Another event that demonstrates the concept of doing something in a group that we would never do alone is the 1967 incident of 200 University of Oklahoma students gathering to watch a disturbed fellow student threatening to jump from a tower. The 200 students began chanting, “Jump, Jump….” The student jumped to his death.
These events all have something in common: They are somehow provoked by the power of a group. In certain kinds of group situations, people are more likely to abandon normal restraints, lose their sense of individual identity, and become responsive to group or crowd norms, which has been labeled “deindividuated.” Self-awareness is considered to be the opposite of deindividuation. Individuals made self-aware by acting in front of a mirror or TV camera exhibit increased self-control, and their actions more clearly reflect their attitudes. Deindividuation decreases in circumstances that increase self-awareness: mirrors and cameras, small towns, bright lights, large name tags, undistracted quiet, individual clothes and houses.
When a teen leaves for a party, a parent’s parting advice should be, “Have fun and remember who you are.” In other words, enjoy being with the group, but be self-aware, maintaining your personal identity and don’t become deindividuated.
Myers, D.G. (2004). Exploring social psychology, 3rd ed. New York, NY: The McGraw-Hill Companies.
Cindy Geil, MA
WKPIC Doctoral Intern
Every therapist working in community mental health knows it all too well. You spend your time researching techniques that you will use for a specific client just to find that the client does not show up for her scheduled appointment.
Sperry, Carlson, Kjos (2003) discuss this dilemma in their book, Becoming an Effective Therapist, and found, through research, techniques that have been shown to improve treatment adherence and maintenance. Some of the techniques the authors found to be most helpful include using various reminders regarding the appointment including telephone, mail, email, and possibly, text, through a company telephone, elicit and discuss reasons for previously missed appointments, involve the client in planning and implementation of the treatment plan and tailoring the plan to the specific client, process any negative feedback from the client regarding the therapy session, teach self-management skills, involve significant others if the client is willing, and use a combination of approaches rather than single strategies. It is important for the therapist to discuss with the client, his or her adherence history, beliefs, expectations, and possible barriers or obstacles to adherence.
Some helpful questions to ask your client include: Why have you come to treatment? What have you heard or been told regarding treatment? What do you expect to happen during your treatment? What do you hope will be different after treatment? These questions will help the client to understand what he or she expects from treatment and be more prepared for the work that the therapy will involve.
Since the goal of every therapist is to help their clients, it is vital for therapists to look at what they can do to ensure their clients show up for treatment.
Sperry, L., Carlson, J., & Kjos, Diane. (2003). Becoming an effective therapist. Boston, MA: Pearson Education, Inc.
Cindy Geil, MA
WKPIC Intern
It happens all the time. Everyone does it.
We frequently have to deal with the reckless driver who blows a stop sign, the rude man who pushed his way to the front of the line at Starbucks, the clumsy waitress who spills the drinks while delivering them to the table. We make decisions about people’s dispositions after seeing them perform one action, without taking into account pertinent situational factors. It is far less often that we put forth the cognitive effort to consider such situational influences. It could very well be that the driver who neglected to stop at the stop sign did not see the sign because there was a tree branch blocking it, the man at Starbucks was actually rushing to the front of the line was actually giving another person in the front his credit card that he had dropped by the door, and the waitress was tripped by one of her coworkers who was playfully teasing her.
We do not tend to think of situations in this way. It is more likely that we would attribute these behaviors as a manifestation of the disposition of these individuals. Social psychologists call this the Fundamental Attribution Error. Lee Ross was the first to use this term to describe the phenomenon. He went so far as to argue that the Fundamental Attribution Error is the “conceptual bedrock” of the field of social psychology.
Ross, L. (1977). “The intuitive psychologist and his shortcomings: Distortions in the attribution process”. In Berkowitz, L. Advances in experimental social psychology 10. New York: Academic Press. pp. 173–220.
Cassandra A. Sturycz, B.A.
Psychology Practicum Student
Research has examined the effect of scents have on mood, behavior, and performance. There is evidence that certain scents produce positive effects in these areas. What is this magical odor that will help me finish my 50-page thesis, you ask? Well, this is where it gets tricky.
Research has shown that there is not necessarily a universal scent, such as mint or a perfume, that will help everyone’s mood. Rachel S. Herz, a professor of psychology at Brown University, explains that the scents that will benefit an individual the most are those associated with a positive mood through experience. The olfactory bulbs are a part of the limbic system and work directly with limbic system structures such as the amygdala, which is associated with the processing of emotional information, and the hippocampus, which deals with associative learning. Therefore, odors are incredibly efficient influences on emotional state due to these close ties between olfaction, associative learning, and emotion.
This effect of odors on mood is what leads to an increase in performance efficiency. Research has found positive correlations between positive mood, as produced by pleasant ambient odors, and various task performances. As positive mood increases, researchers have noted increases in vigilance, efficiency, and creativity. The odors that are most effective at influencing one’s mood will be odors with which one has a positive emotional association. For example, if an individual has fond memories of baking cookies with his/her mother, a cookies scented candle may increase their mood, when it is burned. If this individual burns such a candle in the office, he/she may see increases in job performance.
Cassandra Sturycz
Psychology Practicum Student
William B. Barr, Ph.D., ABPP, Associate Professor of Neurology & Psychiatry at NYU School of Medicine, writes,
“This year marks the 20th anniversary of the “modern era” in the study of concussion in sports, which began in 1994 following the retirements of Merrill Hoge and Al Toon and the National Football League’s (NFL) formation of its first Mild Traumatic Brain Injury Committee. Since that time, we have witnessed a marked shift from what was a pervasive attitude of denying or minimizing the effects of head injury in sport to one where stories of the current “concussion epidemic” or the controversy about long-term consequences of head injury in retired athletes appear in our newspapers on a daily basis. Over the same time period, the field of neuropsychology has received an unprecedented degree of public attention resulting from the fact that many in our field, including members of the Society of Clinical Neuropsychology (SCN), have provided important contributions to the scientific study of sports concussion and development of methods for its assessment. My goal in this SCN NeuroBlog is to provide a brief review and critique of neuropsychology’s role in the clinical management of sports concussion with suggestions on how we can maintain our position as leaders with regard to this highly publicized injury.”
Read the remainder of Dr. Barr’s piece on the direction and role of neuropsychologists in assessing concussions related to sports activities on the SCN NeuroBlog.
Susan R. Vaught, Ph.D.
WKPIC Training Director
Mary Pipher (2003) in the book, Letters to a Young Therapist, writes that change that looks too good to be true most likely is. She favors incremental change in therapy. Just as there is no free lunch, there is no free transformation for a client.
Dr. Suzuki developed a method for teaching children to play classical music. He discovered that if the steps were small enough anyone could move forward into mastery. People rarely try to take huge steps, and if they do they often fall down. The secret is finding the step size that propels people forward but allows them to succeed with each move.
Pipher (2003) encourages clients, “don’t rush and don’t stop.” Praise what you hope to continue in the lives of your clients. For example, say to a troubled teenager, “I really like that you went to school when you felt tired. That shows real maturity.” Create small measurable goals with your clients–goals that will produce reward for them but not overwhelm them. Praise the client for even small progress. Sometimes it is most helpful for a client to move slowly towards major life change.
Reference: Pipher, M. (2003). Letters to a young therapist. New York, NY: Basic Books.
Cindy A. Geil, M.A.
WKPIC Doctoral Intern
WKPIC intern Cindy Geil’s new family member has arrived! Welcome to the world, baby Luke, born at 8:42 pm on 9/27/2013. He’s a healthy 8 pounds 2 ounces and 19 1/2 inches, and adorable.
Special Note: Ms. Geil worked until 4:30, attending both seminar and supervision. How’s THAT for career dedication?!
We’re all very happy for you, Cindy, and we look forward to meeting the youngest extra intern in WKPIC history. You should know that faculty member Paula Halcomb has famous zen crying-baby calming skills.