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January 01 2017

Friday Factoids Catch-Up: The Multiple Roles of a Psychologist

Author Susan Vaught Categories Blog, Continuing Education, Current Interns, Diversity In Practice, Mental Health and Wellness, Resources for Interns 0 Comments

The role of psychologists is changing as overall mental health service needs and service systems change. Separating medical health from mental health is not always so clear cut. With advances in the medical fields, psychologists must also embrace a new way of looking at overall mental health.  Wahass (2005) noted that health was “seen as the absence of diseases or injury and their presence meant ill health.” This approach was suggestive of there being a solution to the malady. However, over time, the connection between the mind and body began to shift the traditional medical model (illness and its corresponding cure) to a more dynamic view, a biopsychosocial perspective on approaching maladies.

 

The biopsychosocial model integrates the biological, psychological and social factors that interact independently or in concert with each other to sustain a healthy or unhealthy status. (Wahass, 2005)  This is particularly important to keep in mind as we encounter clients from culturally, linguistically, and socioeconomically diverse background.  As psychologist we must have an awareness of and become champions of not only serving in a clinical role, but advocating for it as well.  Our work is not limited to assigning diagnoses; rather, our responsibility to is act as a liaison between our clients and their communities.

 

Wahass identified several areas of focus, including clinical, health/medical, counseling, rehabilitation and community psychology. Many of the quotidian responsibilities may overlap; however, each has distinct demands and expectations, which not only allow for a more robust treatment of our clients presenting problems, they also encourage a more meaningful understanding of the person behind the list of concerns.

 

Chang, Ling and Hargreaves explored the relationship between scientist and practitioner and the effectiveness of graduate programs in preparing psychology students for the real life demands of the various roles psychologists assume. Results revealed that there is not one predominant stance, in part because depending on the setting (e.g. hospital, private practice, community bases setting, etc…) there are distinct demands on a psychologist.

 

As the approach to medical and mental health issues evolves, we must also look to our training program to ensure that developing clinicians are able to respond to the demands placed on psychologists in the real world.

 

 

Chang, K., I.-Ling, L., & Hargreaves, T. A. (2008). Scientist versus Practitioner-An abridged meta-analysis of the changing role of psychologists. Counselling Psychology Quarterly, 21(3), 267-291. doi:10.1080/09515070802479859

 

Wahass, S.H. (2005) The Role of Psychologists in Health Care Delivery. Journal of Family and Community Medicine, 12(2)), 63-70

 

Jennifer Roman, M.A.
WKPIC Doctoral Intern

 

January 01 2017

Friday Factoids Catch-Up: Bilingualism, Biculturalism and Personality

Author Susan Vaught Categories Blog, Continuing Education, Current Interns, Diversity In Practice, Friday Factoids, Resources for Interns 0 Comments

There is plenty of research dedicated to the topics of bilingualism and biculturalism, but they may often be lumped together and defined as one in the same. Grosjean (2015) attempts to describe how a bicultural bilingual can take on different meanings.  He highlights the plethora of research dedicated to bilingualism and how the topic of biculturalism is, at times, less explored. A simple internet search of bilingualism will yield countless articles on the relationship of bilingualism and cognition, education, and the various types of bilingualism. Grosjean proposes that this difference is to the distinct nature of how each is studied and how those researchers tend not to overlap in their work; in essence, linguists study bilingualism and biculturalism is studied by social psychologists. Grosjean highlights that one can not only be bilingual and bicultural, they can also be bicultural and monolingual or monocultural and bilingual, and monolingual and monocultural.

 

Grosjean explored the various ways in which one can become bilingual, learning a home language and later learning a host language at different points in life,  or bicultural, the byproduct of migration to another region.  Of interest is the individualist process by which a person identifies as bicultural, independent of their bilingual status, however, proficiency in an alternate language can impact how they view themselves.

 

Grosjean highlights an experiment conducted with bilinguals where participants were administered the TAT (Thematic Apperception Test) or sentence completion task. In each experiment, there were significant qualitative differences in the responses given in English and responses in their home or base language (French and Japanese).  For example, with a TAT stimulus card, a response in English highlighted a man going to college at night and having a supportive wife whereas the response in French indicated a man wanting to separate from his wife.  A similar pattern emerged with Japanese/English bilingual participants.

 

Another experiment mentioned in Grosjean’s article reveals parallel results several years later. A group of bilingual/bicultural Hispanic, Spanish speaking women were asked to interpret advertisements with women as the protagonist in English at one time and in Spanish some months later. Result revealed participants viewed the women in the advert as more independent and intelligent when interpreting in Spanish, whereas they viewed the women in the advert as adhering to more traditional roles when interpreting the ad in English.

 

Chen (2015) noted differences on some personality traits when assessing native English vs native Chinese speakers, specifically, native English speakers were “perceive to be higher on extraversion and openness to experience” (p. 5) when compared to native Chinese speakers.  Chen also explored if a bilingual individual behaves differently depending on whom they are speaking with.  Her work reveals that language, activated “normative traits of that culture and shifted bilinguals’ expression of personality” (p.5).

 

Studies, like the ones mentioned above, highlight the complex nature of the interplay that bilingualism and biculturalism can have on our personality development. This research highlights need for further exploration culture and language, not just specifically English/other language, but also the nuanced differences between how we each define culture within the context of bilingualism and vice versa.

 

References

Chen, S. X. (2015). Toward a social psychology of bilingualism and biculturalism. Asian Journal Of Social Psychology, 18(1), 1-11. doi:10.1111/ajsp.12088

 

Grosjean, F. (2015). Bicultural bilinguals. International Journal Of Bilingualism, 19(5), 572-586. doi:10.1177/1367006914526297

 

Jennifer Roman, M.A.
WKPIC Doctoral Intern

 

 

December 12 2016

Article Review: Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample (Kodish, Herres, Shearer, et al, 2016)

Author Susan Vaught Categories Blog, Continuing Education, Current Interns, Mental Health and Wellness, Resources for Interns 0 Comments

Kodish, Herres, and Shearer, et al’s Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample seeks to explore what, if any, causal relationship there may be between bullying and the prevalence of suicide among youth aged 14 to 24 years.  Uniquely, their study seeks to identify not only the relationship between bullying and suicide among youth, but also to distinguish between the different types of bullying and their associated effects on suicidal ideation, as well as to explore what role depression may have as a moderating factor between bullying and suicide risk.  Kodish, et al, derived their cohort for study from ten primary care practices located in rural and semi-urban Northeastern Pennsylvania,and used the Behavioral Health Screen (BHS) to arrive at a sample of 5,429 participants.

 

By using the DSM in conjunction with the BHS, the surveyors were able to assess risk for bullying by type (verbal, physical, and/or cyber) as well as the presence of depressive symptoms (using five factors gauged over a two week period), and also included a four item mean from the lifetime suicide scale that included questions to determine if the participant had felt life to be not worth living; had considered suicide; planned to commit suicide; or had attempted suicide.  Controlling for depression and demographics, the collected data was then analyzed to determine what relationship, if any, existed between the types of bullying and suicidal risk levels, as well as testing the interactions between each bullying type and incidences of depression (Kodish, et al, 2016).  It was determined that there is a statistically significant relationship between risk of suicide and all three types of bullying, with a cumulative bullying experience also associated with a heightened risk of suicide.  It should also be noted that significance was recognized between all four bullying factors (verbal, physical, cyber, cumulative) and incidences of depression, with a stronger link between bullying occurrences and suicide severity among patients with depressive symptoms.  While the effects of physical, cyber, and cumulative bullying experiences were found not to be statistically significant with regard to suicide attempts, patients who experienced verbal bullying were shown to be 1.5 times more likely to report a suicide attempt (Kodish, et al, 2016).

 

Overall, it was discovered that all three forms of bullying were linked to suicide risk severity, with the effect being acutely heightened when symptoms of depression were present.  Of the three forms of bullying assessed, it was discovered that verbal bullying had, by far, the most impact, which may be due to it being the most common type reported (25% of the sample cohort reported verbal abuse in bullying situations).  This may be due to the fact that it is usually delivered publicly and in person.  By contrast, physical bullying, which may be painful and socially humiliating, may have a lesser psychological impact than other forms of bullying.  This could be due to any number of factors (“David v Goliath”-type situation, physical confrontation being motivated by racism, etc).  In regards to cyber bullying, the fact that it is usually done anonymously as well as the fact that the Internet is impersonal in nature may have a curtailing effect on the impact of this particular type of bullying.  Depression has been shown in this particular study to definitely be a moderator between bullying and suicide risk, but further study is warranted to determine the overall extent to which this relationship exists, as well as determining the extent of moderation for each type of bullying.

 

Looking at the relationship between bullying, suicidal ideation and the relevance of associated depression provides insight into developing appropriate and effective treatment protocols for those who are most at-risk.  By establishing a solid connection between bullying, suicidal ideation, and depression, the authors have furthered insight into a serious issue facing our youth, and it should be noted that not only does this research benefit those who are bullied, but also those who do the bullying; youth who bully others have been found to be at significantly increased risk for suicide and depression as well.

 

Delving further into these issues will help to improve not only the understanding necessary for addressing the victims of bullying but also to understand what it is that causes a bully to victimize others, thus allowing earlier interventions for prevention of escalation, and ultimately the reversal of those trends that lead to bullying, depression, and suicidal ideation.  The authors note that assessing for these issues during primary care visits is warranted.  Going forward, improving the assessment for these issues through clinical interviews should be a priority for those not only in healthcare occupations, but also those who are likely to have the most social non-parental contact with children (teachers, clergy, etc).

 

Kodish, T., Herres, J., Shearer, A., Atte, T., Fein, J., & Diamond, G. (2016). Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample. Crisis, 37(3), 241-246. doi:10.1027/0227-5910/a000378

 

 

Teresa King
PMHC Doctoral Intern

 

November 11 2016

Friday Factoids Catch-Up: Heroin and Fentanyl–A Match Made in Hell

Author Susan Vaught Categories Blog, Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns 0 Comments

 

Heroin use has always been a serious issue where drug abuse is concerned, but in the last few years it has become even more deadly due to fentanyl being added to give it more “kick”.  Dealers have begun including fentanyl to improve the potency of their product; however, the equipment they use to measure out amounts for trafficking don’t usually measure at levels fine enough to ensure that the amount of fentanyl that has been added stays below overdose levels.  To add to the danger, fentanyl sold at the street level is usually manufactured in “underground” labs which produce a far less pure product than pharmaceutical-grade labs, which can cause unpredictable effects on the body (Bond, 2016).

 

Heroin is classified by the DEA (Drug Enforcement Agency) as a Schedule I drug, while fentanyl is classified as a Schedule II drug.  Both are opioid derivatives; however, while heroin is synthesized directly from morphine, fentanyl is a synthetic opioid analgesic, with a potency of 50x to 100x that of morphine (NIDA, 1969, 2011, 2014).  While both have a high potential for abuse, there is a wide gulf between the two drugs with regard to the amount required to induce an overdose.  An average sized adult male would take around 30g of heroin to produce an overdose situation, roughly an amount similar to 7 packets of sugar.  By contrast, it would only take around 3g of fentanyl (little more than a ½ packet) to produce an overdose (Bond, 2016).

 

Fentanyl-laced heroin quickly reached crisis levels as it began to gain popularity among users.  In March of 2015, the (DEA) issued a nationwide alert in response to a surge in overdose deaths from heroin laced with fentanyl (19 March 2015).  While heroin has been recognized as having a high potential for abuse since the mid-1900s, fentanyl wasn’t added as a Schedule II substance until 2015, after recognizing that a variant, acetyl fentanyl, was being manufactured by Mexican cartels and smuggled stateside for distribution (10 September 2015).  The problem has surged so much that “the National Forensic Laboratory Information System, which collects data from state and local police labs, reported 3,344 fentanyl submissions in 2014, up from 942 in 2013” (Leger, 2015).

 

Due to the resurgence in popularity of heroin among IV drug users in recent years, it would seem that fentanyl-laced heroin and the associated use risks and health issues with regard to overdosing are going to be an issue for some time to come.

 

References
Bond, A. (2016, September 29). Why fentanyl is deadlier than heroin, in a single photo. Retrieved November 10, 2016, from https://www.statnews.com/2016/09/29/fentanyl-heroin-photo-fatal-doses/

 

DEA Issues Alert on Fentanyl-Laced Heroin as Overdose Deaths Surge Nationwide – Partnership for Drug-Free Kids. (2015, March 19). Retrieved November 10, 2016, from http://www.drugfree.org/news-service/dea-issues-alert-fentanyl-laced-heroin-overdose-deaths-surge-nationwide/

 

Fentanyl-Laced Heroin Worsening Overdose Crisis, Officials Say – Partnership for Drug-Free Kids. (2015, September 10). Retrieved November 10, 2016, from http://www.drugfree.org/news-service/fentanyl-laced-heroin-worsening-overdose-crisis-officials-say/

 

Leger, D. L. (2015, March 18). DEA: Deaths from fentanyl-laced heroin surging. Retrieved November 10, 2016, from http://www.usatoday.com/story/news/2015/03/18/surge-in-overdose-deaths-from-fentanyl/24957967/

 

NIDA (2011). Fentanyl. Retrieved November 10, 2016, from https://www.drugabuse.gov/drugs-abuse/fentanyl

 

NIDA (1969, rev. October 2014). Heroin. Retrieved November 10, 2016, from https://www.drugabuse.gov/publications/drugfacts/heroin

 

Teresa King
Pennyroyal Doctoral Intern

 

November 11 2016

Friday Factoids Catch-Up: New Treatments For Tic Disorders Associated With Tourette’s

Author Susan Vaught Categories Blog, Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns 0 Comments

 

Tics, which are characterized by sudden, repetitive, non-rhythmic body movements and/or vocalizations associated with tic disorders and Tourette’s syndrome, are involuntary movements that may involve the hands, shoulder shrugging, eye blinking, etc.  In many cases, these tics do not get in the way of living a relatively normal life and consequently little if any treatment is required.  At the other end of the spectrum, the tics may be so severe that they require treatment with medication and behavioral therapy, especially if they are causing pain/injury, are interfering with a normal daily routine in one’s education, job performance, or social life, or are responsible for inducing excessive stress. Prior to the treatment of the presenting tics, the presence of other movement-related disorders like chorea, dystonia, as well as the movements displayed by those with autism (stereotypic movement disorder), or those movements manifested as compulsions of OCD or seizure-related activity, must be ruled out to ensure the patient receives the proper care and treatment that is best suited to address his or her needs.

 

There are various methods for treating the tics that are so often associated with Tourette’s syndrome, including medication, behavioral therapies, and habit reversal.  While medication is most often the go-to panacea for controlling tics, the medications themselves may carry side effects that are as bad, or even worse, than the condition that they may be used to treat.  Behavioral therapies can also be effective as well by teaching those with Tourette’s to manage their tics.  While these can be effective in reducing the number, severity, and impact of the tic behaviors, it is important to realize that behavioral therapy is not a cure, and that although effective it does not mean that tics are merely psychological in their nature.  While these treatment methods are effective in aiding the treatment of, and helping to manage, the tic symptoms of Tourette’s syndrome, it is important to note that they are varied in their efficacy, are not one-size-fits-all in their nature, and in the case of medication, may produce unwanted side effects ranging from mild to debilitating in and of themselves.

 

One of the most promising methods recently developed for the treatment of tics associated with Tourette’s is the Comprehensive Behavioral Intervention for Tics, or CBIT.  This new, evidence-based therapy includes the use of education, teaching relaxation techniques, and habit reversal in a combination that is shown to be effective in reducing symptoms of tics and their related impairments, and seems to work equally well for both children and adults. CBIT involves those with Tourette’s working with a therapist to gain a greater understanding of their particular type of tic and learning to recognize situations that worsen tic symptoms.  When possible, a change in environment may be initiated, and using habit reversal, a new behavior is modeled so that when the urge to tic occurs, the new behavior is substituted.  This method helps to lessen tic occurrences through substituting the new behavior for the tic through repetition, under the guidance of an experienced therapist.

 

Over the last few years, the number of health professionals that have come to know and appreciate the benefits and effectiveness of CBIT has increased; however, there are still relatively few therapists that have the specific training in these methods of treatment targeted specifically at tic disorders and Tourette’s, and work is currently being done by The Tourette Association of America and the Centers for Disease Control and Prevention to provide education for more health professionals with the training necessary to incorporate and apply this method in their treatment approach to managing the symptoms of Tourette’s and other tic disorders.

 

References

  1. Cook CR, Blacher J. Evidence-based psychosocial treatments for tic disorders. Clin Psychol: Science and Practice. 2007;14(3):252–67.
  2. Piacentini J, Woods DW, Scahill L, Wilhelm S, Peterson AL, Chang S. Behavior therapy for children with Tourette disorder: a randomized controlled trial. JAMA. 2010;303(19):1929–37.
  3. Harris, Elana, MD, PhD. Children with tic disorders: How to match treatment with symptoms. Current Psychiatry. 2010 March; 9(3):29-36
  4. Qasaymeh MM, Mink JW. New treatments for tic disorders. Current Treat Options Neurol. 2006 Nov;8(6):465-473

 

Teresa King
Pennyroyal Intern

 

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