Clinical Psychology

5150: On Unethical Privacy is an autobiographical piece where Matthew Reynolds recounts the situation wherein he was involuntarily committed shortly before his 21st birthday. He describes the situation that led to his psychotic break, and the problems his parents had, who he is very close to and have had a large place in his treatment. He was incapable of informed consent and, after being tranquilized, due to his manic depression, he slept for 36 hours wherein neither his parents, physician, psychiatrist, or anybody else were contacted. Finally, his main moral dilemma is discussed. He highlights just what went wrong ethically based on his own memory of events, which he learned of during and after his involuntary committal. His main argument is: “what use is a psychotic patient’s undeniable rights to privacy, if he is incapable of helping himself?” He notes how these systems backfired throughout.

This chapter offers recommendations, evidence-based when possible, on teaching abnormal psychology in an effective and engaging manner. In the first section, we address issues related to the content of an Abnormal Psychology course. We outline the traditional content areas, as well as current topics that are often underemphasized, such as controversies with diagnosis, and international and cross-cultural issues. In the second section, we provide an overview of pedagogical tools that are particularly relevant for an abnormal psychology course, including the use of case material, role-play, and simulation; we provide suggestions on how to use these tools to create a stimulating and interactive classroom. In the third section, we outline ethical issues that can emerge when teaching abnormal psychology, such as informed consent and classroom management of sensitive topics, and offer suggestions for creating an ethical classroom environment.

Abuse of people with disabilities is a substantial problem because of the particular physical, emotional, and sexual vulnerabilities that people with disabilities have, in addition to being vulnerable to the abuse associated with their disabilities. The problem of abuse for the disabled population is complicated by a lack of knowledge in health-care professionals, lack of awareness in people with disabilities themselves, and limited resources for, and barriers to, intervention. In this chapter I will examine the nature of the problem, the types of abuse related to disability, and the vulnerability factors that increase risk. We will look at how to assess for abuse in people with disabilities, the consequences often faced in reporting abuse, and the best practices for assessment. I will also review the limited research on different cognitive, behavioral, or psycho-educational intervention approaches. Given the challenges to successfully evaluating and addressing this problem, mental health providers must have a thorough understanding of this issue.

Dementia caregiving is associated with negative physical and psychological health consequences. Multicomponent, behavioural, and psychotherapeutic interventions for reducing caregivers’ distress, particularly the cognitive-behavioural ones, present the greatest effect sizes, but nevertheless these effects are only moderate. The third wave of behavioural therapies and, specifically acceptance and commitment therapy (ACT), offers interesting therapeutic tools aimed at fostering the acceptance of aversive internal experiences and the commitment to personal values. Given the chronic nature of the caregiving situation and the unchangeability of many of its elements (e.g. feeling sadness or grief), ACT represents a promising and potentially helpful therapeutic approach to help dementia caregivers to decrease their emotional distress. Very few studies have so far analysed the efficacy of ACT or some of its components (e.g. mindfulness) in this population, but these provide some preliminary support for the utility of this approach in improving caregivers’ psychological well-being. Assuming the need for further research in order to consider ACT as an empirically validated therapy for dementia caregivers, in this chapter we analyse, in the context of caregiving, the psychological processes highlighted in the ACT model of psychopathology, such as experiential avoidance, describing examples of them in cases of caregivers we have assisted in our clinical work, and outlining ACT-based therapeutic strategies that we have found useful on a clinical basis for modifying them.

Acceptance and mindfulness-based interventions are part of the third generation of cognitive–behavioral therapies (Hayes, 2004). Among these approaches, acceptance and commitment therapy (ACT) and mindfulness-based cognitive therapy (MBCT) enjoy the greatest empirical support in the treatment and prevention of depression. Despite some similarities, ACT and MBCT differ on philosophical, methodological, and strategic dimensions. Outcome literature is more extensive for MBCT; empirical support for putative therapeutic processes specific to each appears to be stronger for ACT. Increasingly both approaches have been extended into clinical areas previously occupied by the other, with ACT being used for prevention of depression and MBCT for treatment of acute depressive symptoms. These developments have made it possible to indirectly compare their therapeutic impact and suggest shared mechanisms of action. Randomized clinical trials in which ACT and MBCT are directly evaluated on common outcome and process variables are recommended to more fully explicate these comparisons.

The autobiographical story of Dieter is sketched here to portray his struggle to fit in the worlds of others while living in a world that is created from his luscious and profound imagination, but that is hardly possible, and mostly impossible, for others to grasp or even imagine. In spite of his reading a lot, much intellectual ability and ability with words, Dieter’s inabilities are both subtle and like walking into a brick wall. He is not defined by these limitations, however, even though his identity has been a burden. Instead, he believes, among many other things, in creating endless possibilities through the powers of thought, and heroically wants to share his world through poetry and writings that have not been heard or read before.

Many college students, are susceptible to alcohol use and related problems, including Hispanic and Asian Americans. A potential factor contributing to this risk is acculturation, which can be defined as the process of psychological, behavioral, social, and cultural change and adaptation that occurs when individuals or groups from different cultural backgrounds come in contact. This chapter provides a narrative review of the literature examining acculturation and alcohol use among these populations. One key theme to emerge from this review is that the exact direction of the association between these variables is unclear and therefore should be considered with caution. While the existing evidence is relatively limited, gender and, to some extent, ethnic group membership appear to moderate the association between acculturation and alcohol use. Several methodological issues pertaining to the study of acculturation, future research directions, and implications for intervention and prevention are discussed.

Despite the many health benefits of physical activity (PA), the majority of Latinos do not meet recommended levels of PA. This chapter provides an overview of research on acculturation and PA among adult Latinos in the United States. It identifies gaps in knowledge concerning the association between acculturation and different types of PA, the joint effects of socioeconomic position and acculturation on PA, and research on gender. It suggests several areas for further research related to acculturation and PA, including an exploration of norms, social networks, and broader social contexts. It concludes that although the bulk of evidence indicates that greater acculturation is associated with increased PA, more complex research designs and greater methodological and conceptual rigor are needed to move forward research in this area.

Dictionary definitions concur that “acculturation” means second-culture acquisition, but “acculturation” began as a Eurocentric concept that inferior peoples improve themselves by imitating superior peoples. Shadows of this persist despite the acceleration of acculturation research from nine studies per decade in the 1920s to the current rate of more than 6000 per decade. Reviews of this research have noted confused findings and lack of utility. Critics either (1) advocate for qualitative methods because culture, identity, and human experience are too complex for psychometric methods, or (2) recommend new models and new forms of quantitative analysis, or (3) fault research for poor social science practices. Rudmin (2006) has argued that academics’ shared liberal ideology causes collective confirmation bias that shapes research to promote advocacy of bicultural integration. Many future research designs and projects are proposed, including emic studies of rural-urban migration in China and the development of single-case measures of acculturative competence.

Accumulating evidence suggests that the overwhelming majority of people with hoarding disorder (HD) acquire excessively. Excessive acquisition in HD is associated with greater severity of symptoms. Compulsive buying and the excessive acquisition of free things are the most frequent forms of acquisition, although a small percentage of individuals engage in stealing. Features thought to be important in the development of hoarding (e.g., indecisiveness, perfectionism) are also associated with excessive acquisition. Some evidence suggests that excessive acquisition may be easier to treat than clutter or difficulty in discarding. A significant number of people with HD, even those who report no present or past difficulties with acquisition, report engaging in behaviors designed to avoid cues for acquiring.

In this chapter we review the application of a new form of cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), and consider its use with older people. We provide an overview of ACT as distinct from CBT, and review the potential utility of this therapy for the types of presentations of distress in later life. As ACT is relatively new there is a somewhat limited evidence base for its use with older people. We anticipate this will develop as there is a need for efficacious psychological therapy treatment alternatives with older people. As older people can face age-related challenges that may require a response different from that advocated in traditional CBT approaches, we are of the opinion that ACT possesses significant potential for use with current and future cohorts of older people. The evidence for ACT’s efficacy is critically evaluated here and the application of evidence for use with older people is reviewed and discussed.

While cognitive-behavioral therapy (CBT) and pharmacotherapy are “gold standard” treatments for obsessive-compulsive disorder (OCD), complementary and alternative treatments are frequently sought for anxiety disorders. The purpose of this chapter is to review and discuss the available research on the application, efficacy and effectiveness of complementary and alternative methods for treating OCD. The first section identifies and reviews studies focusing on specific alternative and complementary treatments that are independent from, or work in conjunction with CBT, such as yoga, herbal remedies, motivational strategies, and bibliotherapy. The second section discusses alternative and complementary methods of more mainstream CBT and related techniques, with a particular focus on technology-supported approaches. The chapter concludes with a discussion of the methodological issues in the existing research on complementary and alternative methods in the treatment of OCD, questions for future research, and implications for providers.

This chapter describes the triage assessment, a structured way for mental health consultants to conceptualize concerns identified via developmental screening processes and frame feedback to support family engagement with next steps. This chapter (a) describes the rationale, goals, and critical elements of triage assessments; (b) suggests pragmatic guidelines for implementation; and (c) discusses lessons learned from experience conducting triage assessments in community settings, including the importance of promoting family engagement and considerations for increasing sustainability. This chapter describes work conducted in pediatric primary care clinics serving young children at high risk for adverse developmental, behavioral, and social-emotional outcomes. However, the purpose, essential components, and structure of triage assessments are relevant as second-stage screening practices for all settings. As screening becomes broadly implemented, the triage assessment helps providers respond to red flag concerns highlighted by first-stage screening practices and support families to get help to address these concerns.

This chapter discusses the current understanding of relations between attention deficit hyperactivity disorder (ADHD) and substance use. Children with ADHD are at risk for problems in substance use; evidence suggests that the relations between ADHD and substance use may differ across age groups, gender, and comorbid conditions. Important issues regarding appropriate assessment and developmental trajectories may play a role in how these differences are understood. In comorbid substance use and ADHD, significant overlap in genetic, neurobiological, and trait factors suggests that ADHD and substance use share a common etiology, although factors influencing the phenotypic expression of these factors continue to play an important role in how comorbidity is expressed. Finally, treatment of these comorbid conditions is discussed, both in terms of the issues surrounding medication for ADHD in the context of substance abuse and potential nonmedication treatments that address both substance use and ADHD symptoms through cognitive behavioral strategies.

This chapter outlines the ways in which depression and other mental health issues influence adherence and health-behavior change. Patient adherence and health-behavior change are defined and described. Common mental health issues including depression and anxiety are described as well as the prevalence of nonadherence to treatment for these conditions. Next, comorbidity of physical and mental health issues are discussed, such as depression co-occurring with various chronic diseases, providing evidence of the effects of mental health on adherence and health-behavior change. The mechanisms for the relationship of mental health to adherence and health-behavior change are discussed through the framework of the information-motivation-strategy model, with adherence being affected due to cognitive factors, motivational factors, and resource-related factors. The chapter concludes with a discussion of what health-care professionals can do to address and reduce this barrier to adherence and health-behavior change.

Chronic illnesses and disabilities (CID) are integral parts of life, and their likelihood of occurrence increases with one's age. The experience of CID invariably necessitates personal adaptation to both the individual's diminished functional capacities and their altered interactions with the physical and social environments. The field of psychosocial adaptation (PA) to CID has exponentially grown during the past 30 years and can be conveniently collapsed into two broad domains, namely, conceptual and empirical approaches to the study of PA to CID. The conceptual approach is mostly rooted in extensive clinical observations of individuals following the aftermath of CID onset and has led to the development of numerous theoretical frameworks of PA to CID and coping with CID. Here, we provide a review of the most influential conceptual models of PA to CID. The empirical literature is examined in this chapter by focusing on those studies that have directly sought to investigate the relationships (albeit not necessarily causal in nature) among a wide range of sociodemographic characteristics, CID-linked factors, personality attributes and coping strategies, and environmental influences (these four classes of variables are typically considered as predictors, mediators or moderators), and measures of PA to CID (the latter commonly regarded as outcomes). Due to space restrictions, our review of the empirical literature only focuses on certain types of CIDs, namely, spinal cord injuries, cancer, and multiple sclerosis. This chapter concludes with a discussion of those issues that need to be addressed by future researchers in the field of adaptation to CID.

Alcohol is the substance most commonly used by youth. Problematic alcohol use can be considered a developmental disorder, which typically has its origins in an individual’s genetic liability, temperament, and experiences in childhood and adolescence. To provide a context for the emergence of alcohol use in adolescence, this chapter briefly reviews biological substrates of risk that include genetic liability and processes of developmental maturation (e.g., puberty, brain development). The chapter then addresses the prevalence of alcohol use and alcohol-related problems in adolescence, trajectories of youth alcohol use, and internalizing and externalizing behavior pathways associated with adolescent alcohol use. Risk and protective factors influencing adolescent alcohol use are discussed as targets to guide developmentally informed prevention and intervention.

This chapter reviews the role of cultural processes in substance use and other health problems among adolescents. The chapter focuses on Hispanics because of their status as both a minority group and an immigrant group, and because Hispanics have been a “lightning rod” for political discourse about immigration and US national identity. The core argument is that intergroup processes such as social dominance and system justification are responsible, at the population level, for unequal allocation of social resources—which, in turn, creates health disparities. These intergroup processes compound the effects of more proximal contexts such as individual, family, and neighborhood. It is argued that interventions to combat the social/cultural determinants of health disparities should be multilevel, including individual-, family-, community-, and population-level strategies.

Resilience refers to positive adjustment among youth who have been exposed to one or more risk factor(s). In this chapter, we review articles published within the past two decades that have included a focus on resilience processes among adolescents at risk of using substances. The review is organized by the level of promotive factor investigated (individual, family, and community), followed by a review of studies that have focused on exposure to cumulative risk and promotive factors. Prior to reviewing these studies, we provide a brief overview of resilience theory, including key terms and models of resilience. The chapter concludes by addressing the limitations of the research on resilience and adolescent substance use and makes recommendations for future research.

Adolescents with substance use disorders (SUDs) have the highest proportion of co-occurring psychiatric disorders (CODs) compared to other age cohorts. Externalizing psychiatric disorders, such as conduct disorder, oppositional defiant disorder, and attention-deficit disorders, are most commonly associated with adolescent SUDs compared to older adults with SUD. The developmental psychopathology of SUD is reviewed. Categories of COD are reviewed, in turn, beginning with externalizing or disruptive behavior disorders. Disruptive behavior disorders are critical to the developmental psychopathology of adolescent SUD. Studies of co-occurring depressive and bipolar disorders are then considered in detail, examining the relationship between SUD and these particular CODs. Finally, the relationships between anxiety, thought, eating and personality disorders, and adolescent SUD are examined.