Health service psychologists wanted! How do we get there?

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.

“The Stanford Prison Experiment” movie: What happened in the film that didn’t happen in real life?

The new feature film “The Stanford Prison Experiment” is “about 90 percent accurate,” said Stanford University psychologist Philip G. Zimbardo, PhD, at a showing of the film today as part of APA’s Film Festival.

At the screening, Zimbardo — who conducted the now-famous experiment in 1971 to simulate the conditions of prison and examine the power of social situations over individual personality — shared some of the differences between what really happened in the basement of the Stanford psychology building and what’s depicted in the film.

Among the greatest differences is that the movie shows one student being “arrested” by Palo Alto police at his home to begin the study, omitting the fact that all nine students assigned as prisoners were first taken to the Palo Alto police department after their arrests. There, they were booked, fingerprinted and held in a cell for several hours before they were taken to the university.

Other differences include:

• The Stanford professor who encounters Zimbardo as he is sitting outside the prisoners’ cells one night and asks, “What is the independent variable in your study? This is an experiment, right, not just a simulation?” is played by an older actor in the movie. In reality, the person who posed that question was Zimbardo’s same-age Stanford colleague and his Yale graduate school roommate – well-known experimental psychologist Gordon Bower, PhD.

• Zimbardo was never involved in the “parole hearings” held for prisoners as he is in the movie. Instead, some secretaries ran those meetings along with Carlo Prescott (who is featured in the film) — a man Zimbardo brought in to help with the experiment because he had recently been released from prison after serving 17 years.

• In the real study, there was less frequent physical abuse by the guards, Zimbardo noted. “The only physical abuse was during the rebellion when the guards broke in and the prisoners started attacking them,” he said.

Zimbardo told attendees that the experiment eventually led him to shift his area of research to shyness, which he studied for the next 20 years. “One of the messages of the study is the extent to which all prisons are prisons of the mind,” he said. “Shyness is a self-imposed psychological prison.”

He also said that he moved away from “creating evil” to “inspiring heroism” by launching the Heroic Imagination Project, a nonprofit organization that teaches children about heroism and promotes the use of social science research to teach people ways to resist bullying and oppression.

Zimbardo is now organizing a screening of “The Stanford Prison Experiment” for President Obama at the While House since the president recently made the first visit by a sitting president to a federal prison and is calling for prison reform.

“The Stanford Prison Experiment” is showing in theatres in limited release. Zimbardo will be answering attendees’ questions about the film online over the next few days. Email questions to mel@heroicimaginationproject.org.

Cyberbullying: R U 4 real ????

When kids communicate online, their relationships in real life may help them determine whether someone is cyberbullying.

Emoticons, writing in all caps and using acronyms can influence adolescents’ perceptions of what their peers write, helping replace other cues like tone of voice and facial expressions that might help them interpret meaning in real life. Still, an offline relationship guides how kids might interpret ambiguous sentences such as, “I’ll find you after school. 🙂 ”

Michal Bak, a graduate student at the University of Victoria, British Columbia, presented a pilot study on how young people process information online during a symposium entitled “Cyber Aggression – Perceptions, Behaviors and Influential Factors.” While knowing a writer helps, research in the field so far suggests that other things come into play, such as social status, when kids react to what’s put online, he said.

“Social status cues may be more prominent in online settings, because adolescents can obtain additional info like followers, positive comments, likes and up-votes,” Bak said. The 30 youngsters he and his team interviewed often couldn’t recall receiving ambiguous messages, but “sometimes emoticons tend to obscure the message, and we find that students tend to hide their real intentions using them,” he said.

More people may be liable to come to a victim’s defense in real life, too, according to work from Nicole Summers, a graduate student at Carleton University. She and her research colleagues are studying moral disengagement in cyber aggression.

Looking at almost 500 emerging adults in Canada ages 16 to 20, she and her colleagues found that over 88 percent of them reported having read insults or mean comments in social media forums at least once in the past year, and over 35 percent of participants witnessed these behaviors weekly. Those who had higher levels of moral disengagement – such as believing one couldn’t help, blaming or dehumanizing the bullying victim, or disregarding help – were more likely to have pro-bullying behaviors such as enjoying reading mean online posts.

“In [real life] social situations you can be an insider, meaning somebody who goes along with bullying, but being online you’re always an outsider. You don’t have to disengage online, because you’re already disengaged to begin with,” she said.

When it comes to online versus social aggression, gender may make a difference, said Megan Lamb, a graduate student at Carleton University. In her study of 429 students ages 11 to 18 in rural eastern Canada, 86 percent reported using social aggression against a friend, and 92 percent reported being socially victimized by a friend in the past school year. The bullying happened online, too, and there was a strong relationship to bullying or being victimized in both arenas. About half of all students reported using cyber aggression against a friend in the past school year, and 67 percent reported being victimized.

Girls reported using and being victims of face-to-face social aggression more than boys. However, boys and girls did not differ much in how often they engaged in cyber aggression.

“Boys are often less comfortable using social aggression, but because cyber aggression is more anonymous, maybe [they] feel more comfortable using that,” she said.

‘Tweet it Off:’ Leveraging Social Media for Health Behavior Change

More than 72 percent of online adults — and 89 percent of online young adults — belong to at least one social network, according to a 2013 Pew Research Center survey. The average Facebook user spends more than 40 minutes per day surfing the site, according to the company’s CEO.

Given stats like these, the broad reach of Facebook, Twitter and other sites could provide a new tool to help more people lose weight and make other health behavior changes, according to University of Massachusetts Medical School psychologist Sherry Pagoto, PhD, an expert in the behavioral aspects of obesity control and cancer prevention.

iStock_000054305248_MediumPagoto, who presented her research here, was interested in translating an evidence-based weight loss program called the Diabetes Prevention Program (DPP) into something that could be shared via social networks. The DPP trains “lifestyle coaches” to help people at risk for diabetes learn to eat more healthily and increase their physical activity. The Centers for Disease Control and Prevention  runs the program at more than 700 sites throughout the U.S., through a partnership with local organizations like the YMCA.

An online program could potentially treat many more people, according to Pagoto. In an initial study, she organized 45 participants who wanted to lose weight into four groups. One group participated in a traditional 12-week in-person DPP. Another participated in a combined in-person program and Twitter group. A third participated in just a Twitter group. And the fourth also participated in the in-person and Twitter program, but with the additional factor that the participants suffered from depression.

In the Twitter program, trained facilitators logged in daily to tweet links to content from the program, as well as generate discussion among participants. The participants would also support each other – one participant, for example, tweeted a picture of doughnuts from her office kitchen with the caption “look what my office does for Halloween!” and others chimed in to encourage her to resist the temptation.

In the end, Pagoto found that the Twitter program worked for patients who were not depressed — the Twitter-only participants lost as much weight as the in-person and the Twitter-plus-in-person ones – but it was not effective for the depressed patients.

In a follow-up study, Pagoto tested a Facebook version of the program, this time also providing incentives to some participants to post more often. She wanted to see if encouraging these “superusers” would help everyone lose more weight. That study just ended, Pagoto said, but early data suggest that the program did help participants lose weight, though the effect of the superusers was unclear.

So far, all of Pagoto’s studies have used closed, private groups. But one of the advantages of Facebook and Twitter is the way in which popular groups, posts and memes can spread exponentially. So in future research, Pagoto wants to open up her studies and allow her participants to invite friends into the groups throughout the study.

“There are IRB issues to figure out” and methodological ones too, she said. But the payoff could be worth it. “It has the ability to take on a life of its own.”

Buffalo Wings + Niagara Falls + Fear of Heights = Great Trip to Toronto

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As a person who grew up in the Upper Peninsula of Michigan (roughly 200 miles northeast of Toronto), I have an appreciation for the Ontario landscape. I am also one of the few people in the United States who views Toronto as south of home.

As I walk through the convention hall, I hear whispers of subtle frustrations with Toronto. Changing currency, no smartphone usage and a convention center that is set up like Hogwarts. OK, Toronto is not everyone’s favorite APA or vacation destination. Although I do empathize with some of these complaints, I still think a trip to Toronto has a lot to offer. I chose to drive from Ohio, and with this choice came some great opportunities. Whipping up the coastline of Lakes Erie and Ontario is as beautiful as it is adventurous. It allows for clarity and mindfulness that no workplace retreat can offer.

I was able to stop in Buffalo and partake of the original buffalo wings at Anchor Bar. IMG_0427The joint is filled with motorcycles, car parts and license plates plastering the walls like makeshift aluminum siding. The wings came and I enjoyed them with a cup of coffee. It’s an odd mix, but I needed to stay awake on my drive. Buffalo as a city is an amazing place. The combination of East Coast architecture and Midwest post-industrialism provides a unique yet middle American feel.

North of Buffalo, I entered Niagara Falls, one of the great wonders of the world. From miles out, you can see the mist floating above the city, giving it a majestic quality. Looking over the falls, you can’t help but feel small, insignificant. It makes your symposium seem unimportant in the grand scheme of things. It feels refreshing.

In Toronto,I have seen many sights and eaten some great food, but the highlight had to be climbing the CN Tower. As someone afraid of heights, I found this both a tourist destination and prolonged exposure therapy. I was able to walk to the edge of the tower and look over, but walking on the glass floor proved to be overwhelming. My SUD levels pushed too high and I had to back up. Again the feel of being small and insignificant washed over me. My concerns for making appointments and attending meetings shrank. Climbing the tower gave me a needed booster shot of self-care on a Friday afternoon.

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Yes, your data plan is useless, it’s hard to find meetings, and image management is at an all-time high. But, just for a second, put down your non-working smart phone, forget APA policy changes, and enjoy this Canadian wonderland. For me, seeing the city and enjoying the landscape is providing some much needed energy during a very busy convention weekend.

 

Identity-Based Bullying Is a Social Justice Issue

Most psychologists are likely familiar with bullying and its detrimental effects. However, they may not be familiar with the term “identity-based bullying,” which includes any form of bullying related to the characteristics considered particular to a child’s actual or perceived social identity. Identity-based bullying is one form of discrimination, and it is also a
method through which children learn prejudicial attitudes and stereotypes.

Identity-based bullying can include:

  • Ostracizing a student with a disability
  • Teasing a black student by saying he or she is “acting white”
  • Calling a girl a “slut” or shaming her about sexual activity or her body
  • Teasing an overweight teen about her/his body
  • Using anti-gay terms or teasing adolescents who identify as LGB

Participants had the opportunity to learn about these types of bullying during a session organized by Mindy J. Erchull, PhD, and Michelle M. Perfect, PhD. I had the privilege of opening the session with a presentation describing why psychologists should address identity-based bullying as a social justice issue.

anti- bullying

Identity-based bullying includes behaviors that are rooted in discrimination. Unfortunately, most discourse within schools about bullying minimizes power relations based on social identities. Some schools intentionally avoid discussing issues of identity out of fear that the conversations will be too controversial. In these cases, the term bullying may be used in place of terms such as sexism, racism and homophobia to minimize discussions about systemic problems rooted in cultural stereotypes and oppression.

During my presentation, I asserted that psychologists should address identity-based bullying as a social justice issue–examining systemic causes so as to change not only the outcomes for individuals, but to transform the processes that lead to identity-based bullying. Identity-based bullying is both reflected in and influenced by cultural factors including legal and political battles, media messages and social movements. Many societal structures (including schools) often serve to reinforce and reproduce messages about inequality.
However, schools can be sites for intervention. At this session, Susan Swearer, PhD, described school-based approaches for identifying, preventing and intervening in bullying, sharing the promising research findings for a number of programs. She discussed how she has engaged multiple stakeholders, such as school nurses, to be involved in the battle against bullying.

Identity-based bullying is a societal problem and the most effective prevention and intervention strategies extend beyond changing any one individual (or a series of individuals). As scholars and mental health professionals, we have a responsibility to embrace such possibilities because all children deserve to attend schools that provide safe, supportive environments that reinforce equality and teach respect for all people.

The Raging Grannies: Bucking the Stereotypes about Older Women

Most images of older women in the U.S. media are based on stereotypes about older adults. The “Raging Grannies” are shattering those stereotypes.

The Raging Grannies

The Raging Grannies are activists who promote peace, justice, social and economic equality through song and humor.  Attendees at the convention session Aging and Raging Well   Women, Art, and Activism were lucky to see them in action, singing on such topics as double standards for women and men related to aging and climate change.

These women are not alone in their efforts to fight stereotypes about older women. Mary Gergen described her research, which finds that older women feel invisible as they age, disappearing at work and in public. “The irony,” Gergen said, “is that at the same time one becomes invisible, she is also experiencing her most wise and self-fulfilled time of life.”

Gergen commented on the many ways that ageism affects older women, sharing her own experiences being called “honey” by shopkeepers. Ageism can also include jokes about older adults and assumptions that one is no longer interested in (or capable of) being actively engaged in work or hobbies. Stereotypes about older adults are so pervasive that many older women have internalized ageism — some are reluctant to visit community centers or move into assisted living facilities because they don’t want to spend time with people who are “old.”

Just like other forms of bias, it is important for psychologists to speak out against ageism and resist stereotypes about older adults. “Let’s be celebratory and joyful while we attack barriers related to ageism,” said Maureen McHugh of APA’s Div. 35 (Society for the Psychology of Women).

Do you interact with art in a meaningful way?

Art show in Arts Center gallery
Boticelli’s Madonna del Magnificat

Take a minute to consider this painting. Now, consider some of the thoughts you had as you pondered it. Were you wondering if you could ever paint something like that? Did the subject remind you of someone you know? Did you wonder why the artist chose this subject? Or maybe you just want to know where you might find a bit of lace as fine as the one she is wearing.

What you just experienced in this exercise is a phenomenon known as personal connoisseurship, or the ability to find personal meaningfulness, depth and enjoyment in one’s interaction with aesthetic objects, according to Jeff Smith, PhD, professor of education at the University of Otago, New Zealand, who spoke at an APA convention symposium sponsored by APA Div. 10 (Society for the Psychology of Aesthetics, Creativity and the Arts).

Smith and his colleagues examined how people with different levels of training and exposure interact with art. They categorized 400 participants into three groups: Those who visited art museums rarely, those with little art training who visited the museum often and those with art training (e.g., a PhD in art history) who visited the museum often. (They wanted a fourth group — those with art training who rarely visited the museum – but found them impossible to find, said Smith).

The researchers found all three groups interacted with the art in different ways. The low frequency group was more likely to be attracted to pieces they found visually appealing or appeared to relate to some aspect of their lives, but had somewhat distant emotional reactions to the art. People in both high frequency groups tended to focus on the technical quality of the work, but the untrained group was more likely to focus on the meaning or message of the artist’s work, while the trained group seemed more focused on the challenge and creativity of the work of art.

What does this all mean?

“It’s hard to say,” said Smith. But one thing is certain. The untrained, high-visitation group appears to bring a disposition towards “interacting with the work in a more personally meaningful fashion, dare we say a fashion more typically intended by the artist?”

Is Allison More Likely than Lakisha To Receive an Offer for Mental Health Treatment?

The subtle effects of racism and implicit bias are pervasive. Researchers have long known that people with African-American sounding names are at a disadvantage when applying for jobs. Now, research presented in a poster session at the 2015 APA convention suggests that they may also face discrimination when trying to access mental health services.

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In a well-known 2003 study, two economists sent more than 5,000 identical resumes to companies in Chicago and Boston. The only difference was that some of the resumes had stereotypically white names on top (Emily and Greg) and some had stereotypically African-American names (Lakisha and Jamal). The researchers found that “Emily” and “Greg” received 50 percent more callbacks than “Lakisha” and “Jamal.”

Psychologist Richard Q. Shin, PhD, of the University of Maryland, wondered whether that effect would translate to the mental health area.

Together with graduate students Jamie Welch and Ijeoma Ezeofor, and colleagues at the University of Vermont, he left voicemail messages for 371 Maryland mental health provicers. The messages — recorded by the same woman, using the same wording — purported to be from a prospective client named either Lakisha or Allison, looking for counseling services.

The researchers found that “Lakisha” and “Allison” received calls back from the mental health providers at the same rate. However, “Allison” was significantly more likely (12 percent) to receive an offer of services (as opposed, for example, to being told that the provider wasn’t accepting new clients).

Welch says that psychologists, counselors and others need to be aware of their own implicit biases.

“It’s easy for us to think we’re above the implicit biases that are pervasive in our society,” he says. “But we’re part of that society.”

In future studies, the researchers want to find out whether “Lakisha” faces more discrimination when her voicemail message uses African-American vernacular language. They also want to conduct a larger study with more geographic diversity, and to explore the effects of names from other ethnic backgrounds.

APA Working Group Reports on Stress and Health Disparities

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.