Author: aricprather

Got Purpose? Your Health Might Depend on It

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In a symposium that felt much like a philosophy lecture, attendees were treated to a spirited discussion of the gap (or perceived gap) between humanistic and positive psychology. The room was filled beyond capacity- the strongest turnout of any of the symposiums I attended throughout the convention. Why? Psychology can ask some pretty big questions. Big questions like “what does it mean to be human?” and “what is the purpose in life?” are some of the questions that draw people to psychology in the first place.

While many psychologists relegate such big questions to philosophical debates, others are trying to get at them scientifically. One such researcher is Dr. Carol Ryff, a professor at the University of Wisconsin, Madison. Ryff has made a career out of developing and testing core constructs that define well-being. One of these constructs she calls “purpose in life.” How does one define purpose in life? Ryff defined it as “finding meaning and direction in your life.” In a several studies, she has documented that purpose in life, as a measure, has impressive predictive utility for health. First, purpose in life is not static (i.e., it changes over time). In a recent study, she and her colleagues found the purpose in life plummets, on average, as we get older. In addition, low levels of purpose in life are associated with several biomarkers indicative of early disease risk and premature mortality. For example, she has linked low purpose in life to markers of systemic inflammation, which has been linked to heart disease, among other chronic conditions.

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Does one’s purpose in life effect one’s biology directly? People who report more purpose in their lives appear to take better care of themselves. For example, Ryff and colleagues used data from the Health and Retirement Study, a longitudinal study of older adults, and found that those reporting greater purpose in life were more likely engage in preventive care (e.g., get their cholesterol checked, get cancer screenings).

Is it possible to increase someone’s purpose in life? On the face of it, sure. I can certainly think of friends and loved ones who have found greater purpose in response to life experiences, such as surviving a health scare or having a baby. What about an intervention that could be deployed to lots of people? That’s something Ryff and her colleagues are thinking about. While she didn’t get into details, she did note a recent study, known as the Lighten Up study, that seeks to improve well-being among older adults. Just another example of how psychologists are tackling questions at the core of human experience.

Health service psychologists wanted! How do we get there?

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Thanks to the Affordable Care Act (ACA), there is a greater need than ever for psychologists in integrated health care. But what is integrated health care? A comprehensive definition from APA is here, but basically it reflects the growing interdisciplinary nature of the health-care system and recognizes the need to develop  comprehensive treatment — and prevention — plans to meet patients’ psychological, social and medical needs.

Many psychologists are interested in working collaboratively in a medical setting, but how do we ensure that psychologists are ready upon graduation?

A symposium panel, chaired by Dr. Emil Rodolfa, answered that question by discussing several important areas. The first was competencies. Dr. Stephanie Wood of Alliant International University outlined the competencies health service psychologists need. These include:

  • Interprofessionalism: The ability to work collaboratively with others in a medical team, including speaking the same language (e.g., what is a electronic medical record?)
  • Leadership: Positioning psychologists to be in an ideal situation to lead effectively in medical settings. This includes not being afraid to ask physicians questions and working to ensure psychology remains an integral part of integrated care teams.
  • Cultural competence: Raising the level of knowledge around who seeks care and why.
  • Use of evidence-based interventions: Teaching psychologists to effectively review the literature and implement only interventions that have a robust evidence base.

The good news is that there are already programs in place for this sort of health services training, particularly at the clinical internship level.

Dr. Jeffrey Baker, the executive director of APPIC, reported there are 226 internship programs that provide experiences in integrated primary health care. Others provide more specialized training. Also, there are as many as 63 APPIC postdoctoral programs that offer ample experience. Check out the APPIC website for more details.

The medical system is changing and there is a true need for trained psychologists that can navigate health care and deliver psychological treatments to those in need.

APA Working Group Reports on Stress and Health Disparities

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An APA working group formed in 2013 to explore stress and health disparities presented its first findings Friday at the APA convention in Toronto, focusing on depression, cardiovascular disease and cancer.

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Not surprisingly, these problems occur disproportionately among African-Americans, people of low socioeconomic status and sexual minorities. Research has found that health behaviors are critical contributors to these disparities, the researchers said. For instance, African-Americans may be more likely to succumb to heart disease because they have less access to health care services or fewer opportunities to eat healthy. There are psychological contributions as well, specifically stress.

During the symposium, Elizabeth Bronodolo, PhD, a professor at St. John’s University in New York City, discussed the importance of understanding the various levels of stress to which people from  vulnerable groups are exposed. In addition she stressed the role of community factors, such as neighborhood violence or a loss of jobs in a community. The working group also looked at how stress contributes to health disparities, including the development of social cognitive schemas that contribute to how one views the world, and thus sets up vicious cycles of stress.

Also in the presentation, Cheryl Woods Giscombe, PhD, described the working group’s recommendations, many of which touched both on individual interventions that take into account the context in which they are delivered, and on population-level interventions.

Health disparities are one of the greatest challenges to the health-care system and to population health at large. APA should be applauded for taking a leadership role in attempting to mitigate this problem.

Huge Step for Transgender, Gender Nonconforming People

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What is the point of research if  not to make the world a better place? APA has taken this to heart with its approval this week of practice guidelines for psychologists working with transgender and gender nonconforming people. The members of the working group that developed the guidelines described their work at a symposium they called a celebration.

Dr. lore dickey, an assistant professor at Louisiana Tech, said the guidelines may save lives, and called the final product a “labor of love.” The process of developing the guidelines included long working nights and crowded conference calls. The group aimed for accessible language and succeeded, he said.

So what are the guidelines? The entire document can be found here. There are 16 guidelines in total – and I have taken the liberty of listing the first five below, just to provide a flavor.

  1. Psychologists understand that gender is a non-binary construct that allows for a range of gender identities and that a person’s gender identity may not align with sex assigned at birth.
  1. Psychologists understand that gender identity and sexual orientation are distinct but interrelated constructs.
  1. Psychologists seek to understand how gender identity intersects with other cultural identities of transgender and gender non-conforming (TGNC) people.
  1. Psychologists are aware of how their attitudes and knowledge of gender identity and gender expression may affect the quality of care they provide to TGNC people and their families.
  1. Psychologists recognize how stigma, prejudice, discrimination, and violence affect the health and well-being of TGNC people.

APA Hits a Home Run

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IMG_2229The APA convention is more than just a venue for presenting the most up-to-date psychological science. It’s also about building and sustaining a community of psychologists. This was certainly true Thursday evening in Toronto when the hometown Blue Jays took on the Minnesota Twins. The atmosphere was electric and APA members were out in full force for the nighttime baseball outing APA organized. Throughout the game you could hear talk of sessions attended, schedules for the following day, and, honestly, about how great their seats were — they were right — well done, APA.

I had the good fortune to sit next to an APA veteran and she was nice enough to indulge me and answer some questions for this blog. Here she is:

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Cathleen Rea, PhD, a child psychologist in private practice in Virginia, has been coming the APA meetings regularly since 1984. She recalled with nostalgia that her first convention was here in Toronto. At that time, she drove to Toronto from her graduate program in Virginia and presented her dissertation work as a poster. From then on she was hooked. When I asked what made the APA convention so special to her, she said it was the “friends [she’s] made over the years” and the knowledge she gains each time she attends. Rea noted that she teaches family medicine residents each year and every time she returns home from an APA convention, she has another impressive statistic for them.

I asked her about her favorite APA memory. This was a hard one. After some thought, she said it was seeing a presentation by B.F. Skinner,  sometime in the mid to late 1980s. That sounds right to me. One of the things that seems to make APA such an amazing organization is that it has played such an important role in the many frontiers of psychology.

Last night was a wonderful community-building event. Throughout the game other APA members chimed in about what made APA special to them. I heard things like, “There’s something for everybody,” and, “It’s a great chance to reconnect with old friends from graduate school and former professors.” The Blue Jays went on to win 9-3. It was a fun-filled, action-packed game that brought APA members, young and old, together.

One additional baseball note: Kevin Pillar, the Toronto Blue Jays center fielder, made what I believe to be the most amazing catch I have ever seen in person. It’s definitely worth a look here.

Weight Stigma, Stress and Obesity

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We have all heard about the perils of the obesity epidemic and its cost ho society. But something you may not know is that it’s not all about willpower and the make-up of the food environment. In this regard, Dr. Janet Tomiyama, an assistant professor at UC Los Angeles, gave a spirited, and impressively convincing, invited talk as part of Div. 38’s programming on the insidious role of weight stigma.

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So how does feeling stigmatized hurt your waistline? In a recent paper, she outlines a model in which weight stigma increases one’s psychological stress, leading to increases in one’s stress physiology- in particular, levels of cortisol (that pesky stress hormone). Cortisol has many known effects, including contributing to visceral fat deposition and a drive to eat, both of which certainly undermine the goal of losing weight. Not only does weight stigma fail to motivate individuals to lose weight, it may, as Tomiyama hypothesizes, lead to additional weight gain.

Is weight stigma that prevalent? Maybe in the general population, but not among experts or clinicians who treat obese individuals, right? WRONG. In another recent study, Tomiyama examined the explicit and implicit biases against obesity among attendees of a national obesity conference. Participants (around 200 of them) completed several measures of bias, and consistent with Tomiyama’s hypothesis and prior research, even the experts showed a high level of negative bias toward obesity. In fact, compared to a similar study carried out 10 years earlier, explicit bias is actually on the rise. To follow up on this work, she turned to the laboratory and subjected participants to pictures of thin and heavier people. The participants were under the impression that they were there to judge the pleasantness of different lotions (all the lotions were actually odorless). It turns out that individuals exposed to pictures of obese people rated the odors as less pleasant than when exposed to leaner stimuli. This is disturbing, of course, but also a fine example of great social psychology.  Tomiyama described a number of other studies supporting her model, as well as several forthcoming studies.

Weight stigma reflects a novel, and often unacknowledged, contributor to the obesity epidemic. It will take further scientific creativity from Tomiyama and others to move weight stigma onto the national stage. Until then, as I told Tomiyama after her talk, “if I was still an undergraduate and had heard you talk, I would have wanted to become a social psychologist.”