NYU PSI CHI
JOURNAL OF PSYCHOLOGY RESEARCH SPRING 2016 VOLUME I
NYU PSI CHI
JOURNAL OF PSYCHOLOGY RESEARCH SPRING 2016 | VOLUME I
Editor in Chief
Eliana Ajodan Paris DeYoung Vanessa Macias Rachel Rondon Rachel Shamosh
Christie Kim Melissa Lobel Radwa Mokhtar Sanjana Prakash Shruti Shah
Dr. Andy Hilford
NYU Psi Chi NYU Department of Psychology Joseph Aryankalayil
FROM THE EDITOR
LETTER FROM THE EDITOR | 5 STAFF ARTICLES A Proposed Method to Study Immigrant Obesity Rates in New York City
Ahmed Alif, Bryan S. Nelson, Erin Kim Hazen, Ramya Ravindrababu, Riya Ahmed, & Susan Pomilla | 8
The Effects of Perceived Auditory Verbal Hallucinations (AVH) and Perceived Mental Illness on Simulated Jury Decision-Making Paris DeYoung | 10
CONTRIBUTOR ARTICLES The Misconception of Memory: Its Fallibility and Consequences Serena Bonomo | 10
The Negative Effects of The Stigma on Adolescent Pregnancy and Motherhood
This journal was started in the Fall of 2014 by former Psi Chi Vice-President Joseph Aryankalayil, who wanted to help foster a sense of community for NYU’s Chapter of Psi Chi through research. He intended this journal to be a showcase of our Psi Chi members’ diverse interests, accessible to both psychology majors and non-majors alike. Although our first issue comes a year later than Joseph originally intended, his vision remains; our authors are as unique as they are talented. In this issue you will read about undocumented immigrant health concerns, the stigma placed on teen mothers, real world criminal justice implications of false memories, and so much more. This broad assortment of topics highlights that our NYU Psi Chi members occupy many areas of psychology passionately and skillfully. This journal represents the collaborative efforts of so many talented authors, peer reviewers, and editors with whom I’ve had the pleasure of working. I am also eternally grateful to our faculty mentor Dr. Andy Hilford for all his help and to Joseph Aryankalayil for helping found the journal.
Emma-Clementine Welsh | 10
The Trauma of Torture
Thank you for reading,
Emily S. Miller | 10
A Review of the Negative Effects of Seemingly Positive Stereotyping of Asians and Asian Americans on Their Academic Performance and Health Anna Zhen | 10
Parent Training for the Treatment of Selective Mutism Jasmine Lewis | 10
Bryan Nelson Vice-President of Psi Chi Editor-in-Chief of the Journal
A Proposed Method to Study Immigrant Obesity Rates in New York City Ahmed Alif, Bryan S. Nelson, Erin Kim Hazen, Ramya Ravindrababu, Riya Ahmed, Susan Pomilla INTRODUCTION Nearly half of all immigrants in the United States are either overweight or obese (Choi, 2012; The State of Obesity, 2015). These elevated obesity rates within the immigrant population are influenced by factors such as immigration status, duration of residency in the United States, age, and socioeconomic status (Bowie, Juon, Cho, & Rodriguez, 2007). Undocumented immigrants tend to have higher stress compared to documented immigrants given their constant fear of deportation and separation from their loved ones (Alif & Nelson, 2014; Gonzalez, Suarez-Orozco & Dedios-Sanguineti, 2013). Generally speaking, psychological stressors may lead to continued consumption of products that are high in cholesterol, contributing to long-term health risks (Agne, Daubert, Munoz, Scarinci, & Cherrington, 2012; Marshall, Urrutia-Rojas, Mas, & Coggin, 2005; Tovar et al., 2012). Additionally, regardless of immigration status, it is important to note that integrating and adapting to a new culture can be very difficult and stressful (Tovar et al., 2012). Studies have linked stress associated to the adaptations to a different culture with a decrease in mental and physical health, particularly among Latin American immigrant women (Tovar et al., 2012). Acculturation and the pressure to conform to Americanized eating habits, such as an increased consumption of fast foods and soft drinks and decreased consumption of fresh fruits and vegetables, have been linked to obesity (Agne et al., 2012; Creighton, Goldman, Pebley, & Chung, 2009). This is consistent with research correlated stressed or emotional eating with increased rates of obesity (Ozier, Kendrick, Leeper, Knol, Perko, & Burnham, 2008; Wilson & Sato, 2014). When studying the immigrant population, it is important to understand the cultural context of how obesity is perceived (Cogan, Bhaila, Sefa-Dedeh, & Rothblum, 1996; Salinas, Abdelbary, Rentfro, FisherHoch, & McCormick, 2014; Lauderdale & Rathouz, 2000). Anthropological studies have revealed that although western society does not equate wealth with obesity, African societies continue to view it as a status symbol (Cogan et al., 1996). Obesity rates may therefore be more prevalent among African immigrants
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who have lived in the United States for fewer than 10 years (Cogan et al., 1996). This differs from recent work conducted on the Mexican immigrant population, which revealed that short-term immigrants (10 years or fewer) self-reported having fewer cerebrovascular strokes in comparison to long-term immigrants (greater than 10 years; Salinas et al., 2014). Salinas and colleagues (2014) also found that lipoprotein, a chemical that assists with lipid (fat) movement and increases with lipid density, is higher among long-term immigrants than short-term immigrants (Salinas et al., 2014). Moreover, Lauderdale & Rathouz (2000) compared rates of obesity among Asian immigrants and Asian Americans who were born in the United States and found that Asian Americans were more susceptible to becoming obese than Asian immigrants (Lauderdale & Rathouz, 2000). However, neither of the studies found a relationship strictly between immigration status and obesity (Lauderdale & Rathouz, 2000; Salinas et al., 2014). As previously stated, psychological distress is more prevalent among undocumented immigrants (Alif & Nelson, 2014; Gonzalez, Suarez-Orozco & DediosSanguineti, 2013). The literature has also shown high risks of becoming obese in Caribbean and Latino immigrants (Choi, 2012). However, existing research has mainly focused on Hispanic and Asian populations and therefore does not further our understanding of obesity rates within other immigrant populations (Choi, 2012; Kandula, Kersey, & Lurie, 2004; Salinas et al., 2014). Our proposed study will examine the prevalence of obesity within various ethnic subgroups of the immigrant population, focusing specifically on its relation to immigration status. In particular, obesity levels among undocumented and documented immigrants remain unexplored, which is why this study will explore whether rates of obesity vary by immigration status (documented or undocumented). We will use open-ended questions to evaluate how immigrants perceive food availability in their native country and in the United States. Furthermore, this study hopes to further the existing literature regarding the relationship between obesity and duration of time spent in the United States, where we hypothesize that psychological distress moderates this relationship. Given both the previous findings that
obesity rates are higher for native-born U.S. citizens than for immigrant and stress is related to health risks, we intend to measure stress levels among the three groups—undocumented immigrants, documented immigrants, and first generation U.S. citizens—and identify how those stress levels predict obesity when controlling for potential confounds such as race. Therefore, this study will explore whether psychological distress moderates the relationship between immigration status and obesity. In addition to measuring depression, anxiety and body dysmorphia, this study will emphasize on acculturative stress. For this reason, this study will survey how immigrant eating habits have changed after immigration.
METHOD Recruiters will go to culturally diverse neighborhoods in Queens, Brooklyn, and Manhattan (Jackson Heights, Flushing, Canal Street in Chinatown, etc.) and ask participants to fill out surveys. All participants must be 18 years old or older and either undocumented immigrants, documented immigrants, or first-generation Americans. We will measure: depression (using the CES-D; Randoff, 1977), general anxiety (using the GAD-7; Spitzer, Williams, Kroenke, and Pfizer Inc., 2006), self-esteem (using the Rosenberg Self-Esteem Scale; Rosenberg, 1965), and body dysmorphia (using the Body Image Disturbance Questionnaire; Cash, Phillips, Santos, & Hrabosky, 2004). In addition to demographic questions, we will also calculate BMI to determine obesity.
CONCLUDING REMARKS We hope that the stress measurement will be beneficial to the immigrant community in several ways. Primarily, the results of this study will help to provide new insight into the potential differences in obesity rates within different immigration statuses. This will be beneficial to medical professionals when dealing with patients from different demographics. Studies have frequently shown that immigrants underutilize mental health services as a result of stigma, cultural differences, and lack of health care (Kandula, Kersey, & Lurie, 2004). The data collected during this study will help distribute and direct government funding and obesity intervention programs more accurately to areas with high rates of obesity. We will also have information that may be able to assist in new methods of psychological evaluation and treatment as well as nutritional education.
REFERENCES Agne, A. A., Daubert, R., Munoz, M. L., Scarinci, I., & Cherrington, A. L. (2012). The cultural context of obesity: exploring perceptions of obesity and weight loss among Latina immigrants. Journal of Immigrant and Minority Health, 14, 1063-1070. Alif, A., & Nelson, B. S. (2014). A psychological explanation of how and why undocumented immigrants participate in the American economy. NYU Applied Psychology Online Publication of Undergraduate Studies, 7, 26-29. Bowie, J. V., Juon, H. S., Rodriguez, E. M., & Cho, J. (2007). Factors associated with overweight and obesity among Mexican Americans and Central Americans: Results from the 2001 California health interview survey. Preventing Chronic Disease, 4, A10. Cash, T. F., Phillips, K. A., Santos, M. T., & Hrabosky, J. I. (2004). Measuring “negative body image”: Validation of the Body Image Disturbance Questionnaire in a non-clinical population. Body Image, 1, 363-372. Choi, J. Y. (2012). Prevalence of overweight and obesity among US immigrants: Results of the 2003 New Immigrant Survey. Journal of Immigrant and Minority Health, 14, 1112-1118. Cogan, J. C., Bhalla, S. K., Sefa-Dedeh, A., & Rothblum, E. D. (1996). A comparison study of United States and African students on perceptions of obesity and thinness. Journal of Cross-Cultural Psychology, 27, 98-113. Creighton, M. J., Goldman, N., Pebley, A. R., & Chung, C. Y. (2012). Durational and generational differences in Mexican immigrant obesity: Is acculturation the explanation? Social Science & Medicine, 75, 300-310. Gonzales, R. G., Suárez-Orozco, C., & Dedios-Sanguineti, M. C. (2013). No place to belong: Contextualizing concepts of mental health among undocumented immigrant youth in the United States. American Behavioral Scientist, 57(8), 1174-1199. Kandula, N. R., Kersey, M., & Lurie, N. (2004). Assuring the health of immigrants: what the leading health indicators tell us. Annual Review of Public Health, 25, 357-376. Lauderdale, D. S., & Rathouz, P. J. (2000). Body mass index in a US national sample of Asian Americans: Effects of nativity, years since immigration and socioeconomic status. International Journal of Obesity, 24, 1188-1194. Marshall, K. J., Urrutia-Rojas, X., Mas, F. S., & Coggin, C. (2005). Health status and access to health care of documented and undocumented immigrant Latino women. Health Care for Women International, 26, 916-936. Ozier, A. D., Kendrick, O. W., Leeper, J. D., Knol, L. L., Perko, M., & Burnham, J. (2008). Overweight and obesity are associated with emotion- and stress-related eating as measured by the Eating and Appraisal due to Emotions and Stress Questionnaire. Journal of the American Dietetic Association, 108, 49-56 Radloff, L. S. (1977). The CES-D scale a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. Rosenberg, M. (1979). Conceiving the Self. New York: Basic Books. Salinas, J. J., Abdelbary, B., Rentfro, A., Fisher-Hoch, S., & McCormick, J. (2014). Cardiovascular disease risk among the Mexican American population in the Texas-Mexico border region, by age and length of residence in United States. Preventing Chronic Disease, 11, E58. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092-1097. Tovar, A., Must, A., Metayer, N., Gute, D. M., Pirie, A., Hyatt, R.
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R., & Economos, C. D. (2013). Immigrating to the US: What Brazilian, Latin American and Haitian women have to say about changes to their lifestyle that may be associated with obesity. Journal of Immigrant and Minority Health, 15, 357-364. Wilson, S. M., & Sato, A. F. (2014). Stress and paediatric obesity: What we know and where to go. Stress and Health, 30, 91-102.
The Effects of Perceived Auditory Verbal Hallucinations (AVH) and Perceived Mental Illness on Simulated Jury Decision-Making Paris DeYoung In February 2013, Chris Kyle, the most lethal sniper in U.S military history, along with his friend Chad Littlefield, was shot and killed by Eddie Ray Routh at a shooting range in Texas. Routh, a 25-year-old Marine Corps vet, was spending the day at the shooting range with Kyle and Littlefield. Routh had a long psychiatric history, including two years of hospitalizations, a diagnosis of schizophrenia, and rumored posttraumatic stress disorder. At trial, licensed psychiatrist Dr. Michael Dunn testified to Routh’s mental state at the time of the crime, describing it as “clearly psychotic,” elaborating further by discussing Routh’s belief that both Kyle and Littlefield were “hybrid pigs sent here to kill people” (Rascon & McClam, 2015). Despite knowledge of Routh’s extensive psychiatric history and expert testimony to support the collateral information available regarding Routh’s mental health, the jury found him guilty of both murders and sentenced Routh to life in prison with no possibility of parole. This case, and many others like it, call into question how the United States Justice System, and the citizens that serve on its juries, consider mental illness when making a verdict selection. A number of psychotic disorders discussed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), including schizophrenia, the diagnosis that Eddie Ray Routh had received prior to the incident, share auditory verbal hallucinations (AVH) as a common symptom. The DSM-V (pp.87-88) describes hallucinations as involuntary “perceptionlike experiences that occur without an external stimulus.” While the DSM-V recognizes that AVH may occur in psychologically healthy individuals, it only acknowledges such a possibility in the context of hypnagogic or hypnopompic states, or as part of a religious experience in certain cultures. According to past research, however, this understanding of AVH is rather incomplete. In fact, numerous studies have revealed that AVH can be experienced by those who are psychologically healthy, outside of the exceptions outlined in the DSM-V (Daalman et al., 2011; De LeedeSmith & Barkus, 2013; Johns, Nazroo, Bebbington, & Kuipers, 2002; Larøi, 2012; Lawrence, Jones, &
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Cooper, 2010; McCarthy-Jones, 2012; Verdoux & van Os, 2002). Some research even suggests that out of all individuals that experience AVH, most do not meet the criteria for mental illness (Linden et al., 2011; Tien, 1991). Other research on the subject has proposed that the psychotic phenotype and its associated symptoms, often understood as a dichotomous entity in either an entirely normal state or an entirely psychotic state, should be viewed instead on a continuum “from normality, through eccentricity, different combinations of schizotypal characteristics, to florid psychosis” (Allardyce, Suppes, & van Os, 2007; Krabbendam, Myin-Germeys, & van Os, 2004; van Nierop et al., 2012). In 2010, an extensive review of categorical versus continuum models in psychosis was conducted; it revealed that extant research provides “clear evidence of continuity between clinical signs and symptoms, whether positive or negative, and schizophrenia-like subclinical experience and behavior” (Linscott & van Os, 2010). Such research strongly suggests that individuals can fall within the range of “normality,” or a state of being psychological healthy, while still having experiences most often attributed solely to psychosis and individuals considered psychotic. The number of individuals who experience hallucinations but do not meet the criteria for psychosis is cited as high as 25% (De Leede-Smith & Barkus, 2013; Johns et al., 2002). The understanding of AVH as described by the DSM-V seems quite in line with media perception of AVH, which may offer insight into how the general population understands AVH and those who experience them. An archival study conducted in 2014 of 181 newspaper articles originating in the United States and discussing AVH revealed that the majority of these articles did not discuss AVtH outside the context of mental illness (Vilhauer, 2014). Only 23 of the 181 analyzed articles suggested that those who experience AVH could be psychologically healthy, 10 of which fell under the religious experience umbrella as described in the DSM-V (Vilhauer, 2014). This staggering deficit reveals that not only is the common understanding of AVH inaccurate, but that the population of individuals
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who experience AVH and are psychologically healthy may be at risk for experiencing the consequences that come with the stigma of mental illness. The lack of recognition of this population of individuals by both the greater psychological community as well as the news media may lead people to believe that if an individual hears voices and experiences AVH outside of the exceptions outlined in the DSM-V, he or she is mentally ill. This assumption may have a significant social impact on those who are both appropriately and inappropriately labeled as mentally ill. Indeed, past research suggests that consumption of news media can lead to the development of distancing attitudes toward and a decrease in tolerance of people with mental illness (Angermeyer, Dietrich, Pott, & Matschinger, 2005; Angermeyer & Schulze, 2001; Granello & Pauley, 2000). With the understanding that consumption of news media can lead to negative attitudes towards individuals with mental illness, a potential consequence of such attitudes becomes worthy of discussion. This becomes particularly relevant in light of the understanding of the ways in which those who experience AVH have been portrayed by the news media in the United States. Among the many consequences associated with the stigma attached to those deemed “mentally ill” is the way in which those deemed mentally ill are treated in the justice system of the United States. Studies have found that mental illness-related mitigating factors have a significant effect on sentencing decisions made in capital punishment cases (Gillespie, Smith, Bjerregaard, & Fogel, 2014). Similar research on a court case found that when a jury was asked to determine the culpability of a mentally ill defendant, despite extensive evidence that the defendant had developing psychosis, courts at all three levels denied his “not guilty by reason of insanity” plea, and found him guilty of manslaughter (Ravven & Kapoor, 2014). Research that analyzed the influence of “diminished” capacity mitigation using capital sentencing recommendations from North Carolina found that while mitigating factors, including psychological impairment, can decrease the probability of a death recommendation, jury rejection of these factors led to a significant increase in the probability of a death recommendation (Bjerregaard et al., 2005). This research suggests that individuals’ perception of a defendant as mentally ill can actually increase their view of the defendant as culpable for a crime if the psychological impairment is not seen as having a direct impact on the crime in question. Presently, no research has been done to explore whether or not perceived but not present mental illness will show a similar effect. With the understanding that the majority of newspaper media material concerning AVH in the United States assumes a relationship between
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AVH and mental illness, one must consider whether or not the stigma that comes with mental illness becomes similarly attached to those who experience AVH but are psychologically healthy. Understanding whether or not this stigma exists for those who experience AVH but are psychologically healthy will further illuminate the issues inherent in deeming all those who experience AVH as mentally ill. This understanding will also illuminate the need for recognition of this population of individuals by the greater psychological community, like the American Psychological Association, while supporting past research that suggests how detrimental the stigma of mental illness can be for those in the criminal justice system regardless of formal mental health diagnoses. Such an understanding would be invaluable to the movement toward equal treatment of all individuals currently involved with the criminal justice system of the United States, especially those who are perceived to be mentally ill regardless of a mental health diagnosis.
REFERENCES Allardyce, J., Suppes, T., & van Os, J. (2007). Dimensions and the psychosis phenotype. International Journal of Methods in Psychiatric Research, 16, 34-40. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Publishing. Angermeyer, M. C., Dietrich, S., Pott, D., & Matschinger, H. (2005). Media consumption and desire for social distance towards people with schizophrenia. European Psychiatry, 20, 246-250. Angermeyer, M. C., & Schulze, P. (2001). Reinforcing stereotypes: How the focus on forensic cases in news reporting may influence public attitudes towards the mentally ill. International Journal of Law and Psychiatry, 24, 469-486. Bjerregaard, B., Smith, M. D., & Fogel, S. J. (2005). Benefits and risks of using “diminished capacity” mitigation in death penalty proceedings. In S. W. Hartwell (Ed.), Research in social problems and public policy, vol. 12: The organizational response to persons with mental illness involved with the justice system (pp. 111-134). New York: Emerald Publishing. Daalman, K., Zandvoort, M., Bootsman, F., Boks, M., Kahn, R., & Sommer, I. (2011). Auditory verbal hallucinations and cognitive functioning in healthy individuals. Schizophrenia Research, 132, 203-207. De Leede-Smith, S., & Barkus, E. (2013). A comprehensive review of auditory verbal hallucinations: Lifetime prevalence, correlates and mechanisms in healthy and clinical individuals. Frontiers in Human Neuroscience, 7, 1-25. Gillespie, L. K., Smith, M. D., Bjerregaard, B., & Fogel, S. J. (2014). Examining the impact of proximate culpability mitigation in capital punishment sentencing recommendations: The influence of mental health mitigators. American Journal of Criminal Justice, 39, 698715. Granello, D. H., & Pauley, P. D. (2000). Television viewing habits and their relationship to tolerance toward people with mental illness. Journal of Mental Health Counseling, 22, 162-175. Johns, L. C., Nazroo, J. Y., Bebbington, P., & Kuipers, E. (2002).
Occurrence of hallucinatory experiences in a community sample and ethnic variations. The British Journal of Psychiatry, 180, 174-178. Krabbendam, L., Myin-Germeys, I., & van Os, J. (2004). The expanding psychosis phenotype. International Journal of Psychology and Psychological Therapy, 4, 411-420. Larøi, F. (2012). How do auditory verbal hallucinations in patients differ from those in non-patients? Frontiers in Human Neuroscience, 6, 1-9. Lawrence, C., Jones, J., & Cooper, M. (2010). Hearing voices in a non-psychiatric population. Behavioural and Cognitive Psychotherapy, 38, 363-373. Linden, D. E., Thornton, K., Kuswanto, C. N., Johnston, S. J., van de Ven, V., & Jackson, M. C. (2011). The brain’s voices: Comparing nonclinical auditory hallucinations and imagery. Cerebral Cortex, 21, 330-337. Linscott, R. J., & van Os, J. (2010). Systematic reviews of categorical versus continuum models in psychosis: Evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI, and DSM-VII. Annual Review of Clinical Psychology, 6, 391-419. McCarthy-Jones, S. (2012). Hearing voices: The histories, causes and meanings of auditory verbal hallucinations. New York, NY: Cambridge University Press. Rascon, J., & McClam, E. (2015, February 15). ‘American sniper’ trial: Eddie Ray Routh believed Kyle was a ‘pig assassin,’ doctor says. NBC News. Retrieved from http://nbcnews. com Ravven, S., & Kapoor, R. (2014). Heat-of-passion manslaughter and the mentally ill defendant. Journal of the American Academy of Psychiatry and the Law, 42, 115-117. Tien, A. Y. (1991). Distributions of hallucinations in the population. Social Psychiatry And Psychiatric Epidemiology, 26(6), 287-292. van Nierop, M., van Os, J., Gunther, N., Myin-Germeys, I., de Graaf, R., ten Have, M., … van Winkle., R. (2012). Phenotypically continuous with clinical psychosis, discontinuous in need for care: Evidence for an extended psychosis phenotype. Schizophrenia Bulletin, 38(2), 231238. Verdoux, H., & van Os, J. (2002). Psychottvic symptoms in non-clinical populations and the continuum of psychosis. Schizophrenia Research, 54, 59-65. Vilhauer, R. P. (2014). Depictions of auditory verbal hallucinations in news media. International Journal of Social Psychiatry, 61, 58-63.
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The Misconception of Memory: Its Fallibility and Consequences Serena Bonomo Memory is often regarded as accurate, a system along the lines of a video camera, recording detail after detail of what passes by (Howe & Knott, 2015). Approximately 63% of the public, in fact, believes that the reliability of what we can remember is indisputable (Howe & Knott, 2015). Contrary to this widely accepted notion, experts emphasize the inaccuracy of our memory, insisting we cannot trust our own reminiscences above all else (Howe & Knott, 2015). Aside from obvious outcomes of an inexact recollection such as spreading mistaken “facts” to others, the more serious implications of an untrustworthy memory lay heavily in the justice system. False eyewitness testimonies happen far too often, probably more often than one would assume (Howe & Knott, 2015). With this in mind, the first step in overcoming the consequences of a vivid, yet inaccurate, memory is the recognition and acceptance of it even in our daily life. In addition to this, an exploration of how to reduce such incidents and the reliance on subjective recollections in serious circumstances is also necessary. The encoding conditions, the circumstances and situational factors surrounding the event, understandably play a role in the accuracy and extent of details stored. Despite this, there is a profound misconception that the amount of detail is positively correlated with accuracy (Howe & Knott, 2015). Often, the opposite is the case (Howe & Knott, 2015). For example, if a twenty year old reminisces about a memory created at age two and includes vivid details, such as the event being “in mid July, and the garden behind the house was shabby and in disrepair with cracked paint peeling off the windows,” the memory is likely dubious (Howe & Knott, 2015). This makes sense, given that a two year old would not understand concepts such as the garden being in “disrepair” or be particularly aware of the month in which the event occurred (Howe & Knott, 2015). This also could potentially explain why someone may assert their ability to vibrantly describe the time they said their first word, where really the story has just been told so many times by family members around them that they have misguidedly adopted the images as personal memories. In relation to the justice system, the reliance on first hand accounts from children on a crime committed do not provide as definitive evidence as those
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seeking answers would hope (Garven et al., 2000). While examining the effects of positive and negative reinforcement and their power to evoke false claims, it has been shown that children who received praise after giving inaccurate accusations about an individual’s actions made significantly more false allegations than those not praised (Garven et al., 2000). If children receive positive contingent feedback on inaccurate allegations, they are, understandably, much more likely to keep going with these stories to continue this praise and attention. This stresses the vital importance of a controlled interview of a child witness that does not include coaxing, misleading questions or reinforcement, but is rather filled with open ended, unassuming questions and feedback to provide the most genuine recount possible. Furthermore, jurors are easily persuaded by how confidently a witness puts forth their statements (Lindsay et al., 1980). Jurors do this far too often, in fact, yet remain unaware that they are doing so (Lindsay et. al., 1980). While it is intuitively sensible to perceive an assured individual to be a trustworthy witness, confidence is not always a dependable indicator of validity (Dodson & Krueger, 2006). In fact, Dodson & Krueger (2006) tested how easily witnesses could be persuaded by leading questions. For example, participants shown a short video of a crime and arrest were very likely to misremember details (such as the officer drawing his weapon) when asked questions that assumed the false details occurred (such as “after the officer drew his gun, did the suspect surrender?”); this is especially true in older individuals (Dodson & Krueger, 2006). These suggestibility errors were positively correlated to confidence in the older participants, meaning older individuals were most sure of accounts that were generally incorrect (Dodson & Krueger, 2006). This is extremely worrisome given its implications in the courtroom: an innocent person is convicted of a crime because the eyewitness insists wholeheartedly that they saw the individual do it. Making the matter increasingly complex, traumatic events elicit a seemingly intense, rich memory of what took place, which can prompt the development of posttraumatic stress disorder, or PTSD (Gulliver et al., 2014). In order to receive a diagnosis of PTSD, the individual must exhibit three kinds of symptoms for at least one
month: reliving the event, avoiding people or places that remind them of the trauma, and being startled by stimuli more easily than one not affected by this disorder (Schoorl et al., 2014). There is an ongoing debate pertaining to the accuracy and validity of memories formed under distressing circumstances and even memories formed afterwards (Brewin, 2011). Bremner et al. (2000) found that, after being instructed to remember a list of words, women with a self-reported history of abuse and a diagnosis of PTSD falsely recognized non-represented words in that list 95% of the time, much higher than the study’s other groups. Moradi et al. (2015) presented further evidence that exposure to trauma can impair the retrieval and encoding of memories. Three groups - PTSD, non-PTSD trauma exposed, and non-trauma controls - were all shown a scene and asked to recall what they saw. Trauma exposed participants recognized a lower percentage of correct events that had occurred (hits) as well as a greater percentage of events that did not occur (false alarms). This all suggests that trauma exposure can prompt the formation of new memories that are inaccurate. This poses perhaps its greatest problem when victims must identify suspects from a lineup. A serious problem is presented by releasing a proposed suspect’s mug shot to witnesses as well as the reliance on general descriptions given (such as height and weight) as opposed to direct evidence (Goodshell et al., 2009). For instance, suppose the accused individual is described as being a man 6 feet tall with a beard and brown hair. When someone identifying the criminal is presented with individuals who fit that description along with others that do not, there is a high chance that an innocent person with a beard and brown hair will be chosen. These were the exact fates of Steve Titus in 1980 when he was wrongfully chosen in a lineup and convicted due to his beard and Steven Avery, whose mug shot was mistakenly chosen and who served 18 years in jail. These were human errors, based on subjective descriptions and not on DNA evidence (Del Deo et al., 2015). Vague characteristics such as hair color, facial hair, and other physical traits given by eyewitnesses should be recognized, but should not be used as the sole means to implicate an otherwise blameless individual. Ultimately, next time a feeling of tremendous certainty accompanies the memory of a past event, you should consider its accuracy. As disappointing as it can be to admit the fact that we are not faultless in our recollections, psychologists can cite over 100 years of highly involved research that explicitly refutes the common notion that our memories are infallible. We should not be grounded too deeply in our own subjective
beliefs, but should rather remain unbiased and willing to possibly accept other, sometimes conflicting, input.
REFERENCES Bremner, J. D., Shobe, K. K., & Kihlstrom, J. F. (2000). False memories in women with self-reported childhood sexual abuse: An empirical study. Psychological Science, 11, 333-337. Brewin, C. R. (2011). The nature and significance of memory disturbance in posttraumatic stress disorder. Annual Review of Clinical Psychology, 7, 203-227. Del Deo, A., Demos, M., Nishimura, L., & Ricciardi, L., (2015). Making a Murderer [Motion picture]. United States: Netflix. Dodson, C. S., & Krueger, L. E. (2006). I misremember it well: Why older adults are unreliable eyewitnesses. Psychonomic Bulletin & Review, 13, 770-775. Garven, S., Wood, J. M., & Malpass, R. S. (2000). Allegations of wrongdoing: The effects of reinforcement on children’s mundane and fantastic claims. Journal of Applied Psychology, 85, 38-49. Goodsell, C. A., Neuschatz, J. S., & Gronlund, S. D. (2009). Effects of mugshot commitment on lineup performance in young and older adults. Applied Cognitive Psychology, 23, 788-803. Gulliver, S. B., Zimering, R., Carpenter, G. S., Giardina, A., & Farrar, J. (2014). The psychological consequences of disaster. In P. Ouimette & J. P. Read, (Eds.), Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders (2nd ed.; pp. 125-141). Washington, DC: American Psychological Association. Howe, M. L., & Knott, L. M. (2015). The fallibility of memory in judicial processes: Lessons from the past and their modern consequences. Memory, 23, 633-656. Marsh, E. J., & Mullet, H. G. (2015) Correcting false memories: Errors must be noticed and replaced. Memory & Cognition, 44, 403-412. Moradi, A. R., Heydari, A. H., Abdollahi, M. H., Rahimi-Movaghar, V., Dalgleish, T., & Jobson, L. (2015). Visual false memories in posttraumatic stress disorder. Journal of Abnormal Psychology, 124, 905-917. School, M., Putman, P., Van Der Werff, S., & Van Der Does, A. J. W. (2014). Attentional bias and attentional control in post traumatic stress disorder. Journal of Anxiety Disorders, 28, 203-210. Simons, D. J., & Chabris, C. F. (2011). What people believe about how memory works: A representative survey of the U.S. population. PLoS ONE, 6(8). Stelmach, G. E., & Bassin, S. L. (1971). The role of overt motor rehearsal in kinesthetic recall. Acta Psychologica, Amsterdam, 35, 56-63. Wells, G. L. (1980). Eyewitness behavior: The Alberta Conference. Law and Human Behavior, 4, 237-242. Wells, G. L., Lindsay, R. C., & Tousignant, J. P. (1980) Effects of expert psychological advice on human performance in judging the validity of eyewitness testimony. Law and Human Behavior, 4, 275-285.
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The Negative Effects of the Stigma on Adolescent Pregnancy and Motherhood Emma-Clementine Welsh In recent years, there has been a significant decline in the number of adolescent pregnancies across all ethnicities due to raised awareness of STDs as well as increased availability of contraception (Center for Disease Control and Prevention, 2015). However, the stigma attached to teen pregnancy is still negatively affecting the social, academic, and mental success of adolescent mothers today. Because these women have fallen outside the expectations of society, they are cast into a “problem category,” and viewed as something to be fixed, remedied, and avoided (Little, Henderson, Pedersen, & Stonecipher, 2010). The issue is that the mere act of painting adolescent mothers in a negative light creates a mental barrier that hinders their success as mothers, their level of academic achievement, and their perceptions of their abilities to be successful people in society (DeVito, 2007). Adolescent mothers should not be made to feel less worthy of success compared to others. There are steps in research that can and should be taken to prevent the negative effects of the stigma plaguing these women. In the trying time of transition into motherhood, social support is a key tool to success, and teen moms often find themselves without this support. Social support can come from the teen’s parents, family, peers, teachers, and anyone else around them (DeVito, 2007). Adolescents need the support and encouragement of the people closest to them, yet families tend to emotionally withdraw from the teen at a time when emotional support is most essential (DeVito, 2007). A correlational study using data on the levels of emotional and tangible social support of 126 teen mothers aimed to evaluate how these levels affected their perceptions of postpartum parenting (DeVito, 2007). DeVito (2007) found that while there was no significant relationship between overall levels of social support (both emotional and tangible) and selfperceptions of parenting among teen mothers, there was a high correlation between the levels of emotional support given by the participants’ mothers and the self-perceptions of the parenting abilities of adolescent mothers (DeVito, 2007). The findings of this study illustrate how emotional social support (especially from one’s mother) is a vital element in promoting positive self-perceptions of one’s parenting skills. The more
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social support the adolescent mother receives, the more she will believe that she can be effective as a mother to her child, and that she is not hindered by her age or inexperience (DeVito, 2007). While social support from the parents and family is essential to forming these positive perceptions of one’s parenting ability (DeVito, 2007), adolescent mothers, who are often either in high school or starting college, need to feel supported and accepted by their friends and school peers as well. Unfortunately, once a teen becomes a mother, isolation is almost inevitable, as their peers find it difficult to relate to them, even if they do try to be supportive at first. There is a sense of separation, which is almost impossible to extinguish (Little, Henderson, Pedersen & Stonecipher 2010). Adolescent mothers are aware of this barrier, and it undermines their self-esteem and sense of normality (Little, Henderson, Pedersen & Stonecipher 2010). In order to become familiar with how non-pregnant/parenting high school students perceive adolescent pregnancy, Little, Henderson, Pedersen, and Stonecipher, (2010) conducted a study in a high school in Sweet Home, Oregon with a high rate of teen pregnancy. They held five focus groups of both male and female students in 9th-12th grade, one of which included the pregnant/ parenting females at the school. Each group was asked questions about their opinions, feelings, and reactions to teen pregnancy, and their answers were grouped and analyzed for common themes. The results revealed that the high level of teen pregnancy is a concern and a problem, and that adolescent pregnancy is associated with financial issues and is detrimental to one’s education. Parenting and pregnant teen females expressed that they were averse to teen pregnancy being referred to with the word ‘problem,’ and that they preferred the use of the word ‘situation.’ This study provides clear insight into how the peers of pregnant or parenting adolescents view them and their predicament (Little et al., 2010). Generally, the students were of the opinion that teen pregnancy has a negative connotation. They saw it as a growing ‘problem,’ that hindered the educational progress of these women and made their lives more difficult (Little et al., 2010). Whether or not this is true, the students have isolated and categorized the population of teen mothers by giving teen pregnancy a negative connotation and
implying that they are less likely to succeed compared to non-parenting teens. It is important to note that the pregnant/parenting adolescents at the school explicitly expressed their objections to being referred to as a ‘problem,’ which illustrates the detriment to their esteem and parenting mentality caused by this stigmatization. Education is likely one of the most crucial aspects of a young person’s life for promoting their success in society. Regardless, the academic success of pregnant and parenting adolescents is faltering tremendously. Only half of teen mothers have graduated from high school, and only 2% receive a two-year college degree by the time they turn 30 (Van Pelt, 2012). Interestingly, as soon as a teen becomes pregnant, it is as if her family, friends, and teachers believe she has been taken “out of the running” for a good education (Wiemann, Rickert, Berenson, &Volk, 2004). According to the study conducted by DeVito (2007), adolescent mothers are aware of the importance of education, and the participants who had achieved higher levels of education believed themselves to be better parents and reported that they placed higher value on their relationship with their child. They also said, however, that they did not have solid plans for obtaining higher levels of education. This is why teen moms need to be pushed and encouraged by those around them to set goals and make plans for their education beyond the birth of their children. By developing programs designed to specifically target each teen mother’s educational needs (how much schooling they have completed and their goals for the future, including post-secondary education), it will keep them from falling through the cracks that have swallowed other adolescent mothers in the past and put them on their way to being just as successful as any other female, as well as ensuring better lives for their children. New mothers are vulnerable to a number of challenges, possibly the most pressing of which is the array of mental disorders that can accompany pregnancy, traumatic deliveries, and overly stressful parenting experiences. Postpartum depression is one of these disorders, and it affects about 12 to 20 percent of mothers (Family Youth and Services Bureau, 2013). Adolescent mothers are almost twice as likely to develop postpartum depression compared to adult mothers (Family and Youth Services Bureau, 2013). At this stage of their lives, these teenage girls are already enduring multitudes of psychological, physiological, and hormonal changes that make them more mentally vulnerable (Kim, Connolly, & Tamim, 2014). Social support, discussed as a way to boost self-perception, is also an essential component in helping the teen mother cope with these changes and is seen as a possible preventative measure for combating postpartum
depression (Kim, Connolly, & Tamim, 2014). In an effort to analyze how social support affects postpartum depression in adolescent mothers, as well as to identify whether these effects differ in adult mothers, a study was conducted that sampled both adolescent (15 to 19 years) and adult mothers (20 + years) from a nationally representative pool of Canadian women (Kim, Connolly, & Tamim, 2014). The researchers assessed social support levels, asking “how often was support available to you when you needed it?” They found that approximately twice as many adolescent mothers (14.0%) had postpartum depression as the adult mothers (7.2%) and that the mothers, regardless of age, with lower levels of support were more at risk for postpartum depression. The results of this study emphasize the heightened vulnerability of adolescent mothers to maternal disorders such as postpartum depression, as well as the importance of social support from those around them in combating its onset and symptoms. In order to protect future adolescent mothers from the effects of the disorder, future research needs to focus on examining and developing more early preventative methods. Research should also be done on the effects of interpersonal therapy on postpartum depression in order to promote higher levels of social support from those closest to each adolescent mother. vThe stigma on teen pregnancy is not something that can be easily remedied or removed, however the negative effects that this stigmatization has on adolescent mothers can be addressed directly. By creating a solid foundation of social support for these women where it is lacking, their self-perceptions of personal and parenting abilities will increase, making them more motivated to be the best mothers that they can be. If more programs are put into action with the purpose of targeting teen mothers’ educational needs, they will generally be more successful in society and in life, as well as see themselves as worthy of being good mothers to their children. Funding research to investigate possible preventative measures and treatments for postpartum depression will help to protect teen mothers in one of the most turbulent times of their lives. Society needs to stop viewing adolescent mothers as a problem to be solved, and start viewing them as women who deserve to succeed.
Center for Disease Control and Prevention. (2015). Teen pregnancy in the United States. Retrieved from http://www. cdc.gov/teenpregnancy/about/index.htm Cox J. L., Holden J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh postnatal depression scale. The British Journal of Psychiatry, 150, 782-786.
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DeVito, J. (2007). Self-perceptions of parenting among adolescent mothers. The Journal of Perinatal Education, 16, 16-23. Family and Youth Services Bureau. (2013). The hardest adjustment: Recognizing postpartum depression in teen mothers. NCFY Reports. Retrieved from http://ncfy.acf.hhs. gov/features/mental-health-first-step-well-being/hardestadjustment-recognizing-postpartum-depression Kim, T., Connolly, J., & Tamim, H. (2014). The effect of social support around pregnancy on postpartum depression among Canadian teen mothers and adult mothers in the maternity experiences survey. BMC Pregnancy and Childbirth, 14, 162-170. Little, T., Henderson, J., Pedersen, P., & Stonecipher, L. (2010). Perceptions of teen pregnancy among high school students in Sweet Home, Oregon. Health Education Journal, 69, 333-343. Norbeck, J. S, Lindsey, A. M, & Carrieri, V. L. (1981). The development of an instrument to measure social support. Nursing Research, 30, 264-269. Norbeck, J. S, Lindsey, A. M, & Carrieri, V. L. (1983). Further development of the Norbeck Social Support Questionnaire: Normative data and validity testing. Nursing Research, 32, 4-9. Pridham, K. F., & Chang A. S. (1985). Parents’ beliefs about themselves as parents of a new infant: Instrument development. Research in Nursing and Health, 8, 19-29. Pridham, K. F., & Chang, A. S. (1989). What being the parent of a new baby is like: Revision of an instrument. Research in Nursing and Health, 12, 323-329. Van Pelt, J. (2012). Keeping teen moms in school - a school social work challenge. Social Work Today, 12(2), 24. Wiemann, C. Rickert, V. I., Berenson, A. B., & Volk, R. J. (2004). Are pregnant adolescents stigmatized by pregnancy? Journal of Adolescent Health, 36(4), 352.e1–352.e7.
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The Trauma of Torture Emily S. Miller Three decades after the 1984 United Nations Convention against Torture imposed measures to eradicate the practice, torture continues to be documented in 141 countries (Pizzi, 2014). Between 5% and 35% of the world’s 14 million refugees are estimated to have had at least one experience of torture (Baker, 1992). Regions affected by political unrest, including mass demonstration, coup attempts, civil war, and conflicts involving social and political opposition report more incidences of torture (Basoglu, Jaranson, Mollica, & Kastrup, 2001). In prisons all over the world frequency of torture can be as high as 85% (Parker, Parker, & Yuksel, 1992). One of the most prominent examples of torture involves the United States detention camp in Guantanamo Bay. Following 9/11, several human rights abuse cases have been brought against the US Military holding them responsible for their actions in Guantanamo Bay as well as in Iraq and Afghanistan. In 2014, the U.S. Senate Select Committee on Intelligence released a report, known as the “Collusion Report” revealed torture techniques used by the Central Intelligence Agency (CIA) as more extensive and brutal than initially believed by the public. In 1984, the U.N. Convention against Torture defined torture as, “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person …at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity” (1984). This is the first time psychological torture was added to the definition, but restricted to the limits of official/ governmental consent. In the following year, the InterAmerican Convention to Prevent and Punish Torture (1985) stated that torture does not have to be inflicted by or with the acquiescence of a public official, but can be perpetrated by any individual. Many experts debate the effectiveness or morality of torture. With so many current examples of torture, it is important to take a closer look at the limited literature. Given torture’s prevalence in the world today, an important question is raised: what are the biological and psychological effects on survivors? More “traditional” torture involves physical torture which singularly targets the body, while currently psychological torture is more common. While all forms of torture cause some mental pain, psychological torture is the intentional infliction of suffering without
resorting to direct physical violence. Scientific torture (also called “enhanced interrogations” by the CIA) is a combination of mostly psychological tortures with few physical stressors involved. In 1963, the CIA started using this form of “no-touch” torture which integrated self-inflicted pain with sensory deprivation (Kubark Counterintelligence Interrogation; CIA, 1963). Researchers theorized that people submit more readily to interrogation when they feel responsible for their own suffering because the combination of physical and psychological trauma unfastens personal identity (Welch, 2009). There are a number of biological functions that occur during the physical act of torture. Heart rate increases in response to fear which correlates with decreased cognitive ability as well as a decline of motor skills and senses such as vision and hearing (Grossman & Christensen, 2007). The response to high stress results from changes in the autonomic nervous system and the sympathetic nervous system which starts to shut down, while simultaneously increasing adrenaline production. Once the torture stops, the body attempts to calm down creating a parasympathetic backlash (Grossman & Christensen, 2007). The act of starting and stopping a body’s systems in a repeated cycle creates a physical strain. There have been a number of studies conducted on torture survivors that discuss the biological symptoms. A Thorvaldsen study (1986) found symptoms of headaches, fatigue, sleep disturbance, nightmares, and concentration difficulty among tortured refugees (cited in Basoglu et al., 2001). A 2011 study hypothesized that aversive pictorial material is actually processed differentially in visual, frontal, and limbic areas of the traumatized brain (Elbert , Schauer, Ruff, Weierstall, Neuner, Rockstroh, & Junghofer). Survivors of organized violence have an enlarged fear network with a low excitation threshold, thus leading to prominent PTSD symptoms. Their brains literally change structure as this “fear network” is formed by neuroplastic mechanisms, which activate during the act of torture and reorganize the brain for defense. Thus the longer a trauma persists, the more cues become integrated into the network and it becomes easier for the defense response to surface frequently (Elbert et al., 2011). Studies of World War II display more psychiatric causalities than physical ones. Nearly all (98%) soldiers who participate in combat for 60 consecutive days begin
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to breakdown emotionally (Grossman & Christensen, 2012). Increased exposure to physical tortures does amplify psychological problems such as re-experiencing, withdrawal, numbness, and hyperarousal, compared to psychological ill-treatment on its own (ElSarraj et al., 1996 cited in Johnson & Thompson, 2008). However, researchers found that physical torture (compared to nonphysical torture) in itself does not necessarily contribute to greater long-term psychological outcomes (Basoglu, Livanou, & Crnobaric, 2007). Rather, the impact of torture (physical or nonphysical) seems to be determined by perceived uncontrollability and distress associated with the stressors rather than the physical pain itself (Basoglu et al., 2007). Higher resilience levels along with a greater ability to exercise control over torture stressors were associated with less perceived distress during torture and subsequently less PTSD (Basoglu & Parker, 1995). Frequency of torture did not predict a PTSD response, which suggests that for some people, once torture reaches a certain threshold, continued torture lacks any additional effects. Prior knowledge of and preparedness for torture, strong commitment to a cause, immunization against traumatic stress as a result of repeated exposure, and strong social supports appear to have protective value against PTSD in survivors of torture (Basoglu & Parker, 1995). Those who are considered less psychologically prepared with no history of political activity, commitment to a political cause, or expectations of arrest and torture had significantly more current PTSD (58% vs. 18%) as well as current major depression (24% vs. 4%) than tortured political activists (Basoglu, Mineka, Parker, Aker, Livanou, & Gok, 1997). This supports the idea of a possible “immunization” effect created by psychological preparation which may reduce long-term psychological effects of traumatic stress. There are numerous physiological results of torture including quicker emotional reactions, sleep disturbances, headaches, fatigue, and concentration difficulties as well as possible rewiring of survivors’ neural networks due to plasticity at the time of torture ( Elbert et al., 2011). Traumatic stress in survivors is determined by perceived uncontrollability of the torture and not simply mere exposure to physical stressors (Basoglu et al., 2007). These outcomes can be managed if a survivor had psychological preparedness or has a good social support system following the act (Basoglu & Paker, 1995; Basoglu et al., 1997). Hopefully research will continue to examine the results of torture to further help those survivors. Perhaps, the most important question is whether the trauma of torture is ever worth inflicting on another human, even for the security of a country.
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REFERENCES Baker, J. (1992). Haitian Refugee Center, Inc. v. Baker. United States Court of Appeals, Eleventh Circuit. 953 F.2d 1498. Basoglu, M., Jaranson, J., Mollica, R., & Kastrup, M. (2001). Torture and mental health. The Mental Health Consequence of Torture, 35-62. Basoglu, M., Livanou, M., & Crnobaric, C. (2007). Torture vs other cruel, inhuman, and degrading treatment: Is the distinction real or apparent? Archives of General Psychiatry, 64(3), 277-285. Basoglu, M., Mineka, S., Paker, M., Aker, T, Livanou, M., & Gok, S. (1997). Psychological preparedness for trauma as a protective factor in survivors of torture. Psychological Medicine, 27,1421-1433. Basoglu, M., & Paker, M. (1995). Severity of trauma as predictor of long-term psychological status in survivors of torture. Journal of Anxiety Disorders, 9(4),339-350. Central Intelligence Agency. (1963). Kubark Counterintelligence Interrogation. National Security Archive. Elbert, T., Schauer, M., Ruf, M., Weierstall, R., Neuner, F., Rockstroh, B., & Junghofer, M. (2011). The tortured brain: Imaging neural representations of traumatic stress experiences using RSVP with affective pictorial stimuli. Zeitschrift für Psychologie, 219(3), 167-174. Grossman, D., & Christensen, L. (2007). On combat: The psychology and physiology of deadly conflict in war and in peace. Belleville, IL: PPCT Research Publications. Johnson, H., & Thompson, A. (2008). The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review, 28, 36-47. Inter-American Convention to Prevent and Punish Torture, adopted by the Fifteenth Regular Session of the OAS General Assembly, Res. 783 (XV-O/85), Cartagena de Indias, 9 December 1985, Article 2. Paker, M., Paker, O., & Yuksel, S. (1992). Psychological effects of torture: The empirical study on tortured and non-tortured non-political prisoners. In M. Basoglu (Ed.), Torture and Its Consequences: Current Treatment Approaches. Cambridge, UK: Cambridge University Press. Pizzi, M. (2014, May). Amnesty: 141 countries still torture. AlJazeera America. Retrieved from http://america.aljazeera. com Report of the senate select committee on intelligence committee study of the central intelligence agency’s detention and interrogation program. (2014). 113-228. United Nations (1984). Convention against torture and other cruel, inhuman or degrading treatment or punishment. A/ RES/39/46. Welch, M. (2009). American ‘pain-ology’ in the war on terror: A critique of ‘scientific’ torture. Theoretical Criminology, 13(4), 451-474.
A Review of the Negative Effects of Seemingly Positive Stereotyping of Asians and Asian Americans on Their Academic Performance and Health Anna Zhen The United States is home to people who come from cultures around the world that gather to pursue a similar American dream. However, when people from different cultural backgrounds share a similar environment, stereotyping can result in forms of generalizations about the different social groups. Stereotyping often impinges upon individuals’ performances and affects recipients’ mental and physical health (Ibaraki, Hall, & Sabin, 2014). Stereotyping is defined as “a psychological categorization of specific social groups held by the general public, which influences decision making and information processing tasks” (Sayama & Sayama, 2011). In other words, stereotypes are generalizations made about groups of people. For example, stereotypes regarding academic performance can be based on a reading of an individual’s performance as an indicator of the academic performances of the entire group. Stereotyping can exist in various forms whether they are negative or positive. Negative stereotyping comprises of generalizations that directly imply a negative view of or comment on the performance of specific social groups, which can often create lower expectations for the performance of recipients of the social groups. On the other hand, positive stereotyping is defined as the categorization of behaviors of a racial/ ethnic group, which is framed positively but contains depersonalizing views of that group (Tran & Lee, 2014). In contrast to negative stereotyping, positive stereotyping comprises of comments or points of view that are framed positively such that they create higher expectations for individuals belonging to specific social groups. Positive stereotyping can help or harm recipients’ academic performance depending on the situation. Findings from Shih, Pittinsky, and Ambady (1999) show that Asian American women whose race/ethnicity was made salient before taking a math test performed better in the quantitative task compared to when their gender was made salient. The presence of the positive stereotype that Asians are good at math in comparison to people of other races (Steen, 1987) helped to counteract the negative stereotype that women are bad at math compared to men. Thus the Asian American women who were asked to indicate their race/ethnicity
instead of their gender did better in the math test (Shih, Pittinsky, & Ambady, 1999). Positive stereotyping can also engender negative effects on recipients’ academic performance and health despite its benefits in certain situations (Cheryan & Bodenhausen, 2000; Ibaraki, Hall, & Sabin, 2014). In another study, Cheryan and Bodenhausen (2000) showed that the presence of positive stereotyping led to poorer performances in quantitative tests compared to when it was not present. In this situation, positive stereotyping was harmful to Asian American women’s performance on a quantitative test. Furthermore, unlike with negative stereotyping, people are less aware of the harmful effects that positive stereotyping can have because positive stereotyping can be seen as a means to praise groups or cultures (Sayama & Sayama, 2011). Among other minority groups, Asians or Asian Americans are consistently the majority of recipients of positive stereotyping and are often seen as a model minority (Dalisay and Tan, 2009; Chang & Demyan, 2007). Model minority is defined as those who disproportionally achieve higher education, “brainy and successful” (Kwon, Kwon, & Overton-Adkins, 2014; Yoo & Castro, 2011). In other words, Asian Americans are seen as a model minority because Asian Americans are able to succeed academically and climb the ladder to greater income even though Asians or Asian Americans are a minority in America. The model minority stereotype posits that Asian Americans are depicted as overcoming the difficulties that most minorities experience in the United States, which includes graduating with a higher degree in college and earning a high income. Asian Americans have been consistently achieving higher success in education such as performing well on the math sections on the SAT or graduating from college with a higher degree specializing in math (Steen, 1987). Compared to other minorities, Asian Americans have the highest rate of graduating with a bachelor’s degree or higher while majoring in mathematics (Steen, 1987). Asian Americans are also stereotyped to be hard-working and high-achieving: a positive stereotype that has been used to praise Asian Americans and to suggest a uniformity of achievement within the many Asian sub-groups in America (Lee, 1994).
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Unfortunately, Asian American disparities in academic achievement are often glamorized by addressing only those who have achieved academic success but disregarding those who have not (Teranishi, Ceja, Antonio, & Allen, 2004). According to “figures from the U.S. Census (2000)...44% of Asian Americans over 25 years of age have a college degree, merely 7% of Hmong, 8% of Laotian and 9% of Cambodian hold a college degree” (Chao, Chan, Mendoza-Denton, Chiu, & Kwok, 2013). Evidently, some Asian sub-groups have substantially lower chances of graduating with a college degree and realizing academic achievement. Yet, the help that these Asian sub-groups are in need of is typically overlooked. These sub-groups are subjected to positive stereotyping and therefore are overlooked despite the need for help in overcoming academic barriers/struggles (Teranishi, Ceja, Antonio, & Allen, 2004). Many Asian Americans also do not actively seek help due to a fear of disconfirming expectations created from positive stereotyping (Lee, 1994). The emotional and academic struggles of Asian Americans are typically overlooked and could potentially be discovered only when conditions have worsened (Yeh, 2002). As recipients of the model minority stereotype, Asians, including those who identified as Asian American and those who identified as Asian, experience anxiety, depression, and embarrassment as a result of high expectations based on the model minority stereotype (Lee, 1994). Asian Americans can also feel embarrassed to acknowledge failure to achieve certain academic or occupational achievements and thus do not seek help (Lee, 1994). Both US- and foreign-born Asians experience high stress to perform at a level that is consistent with expectations resulting from the model minority stereotype (Cheryan & Bodenhausen, 2000; Yoo & Claudius, 2011). These pressures to perform and confirm the model minority stereotype can have pernicious consequences for the mental and physical health of Asian Americans. The mental health of Asian Americans is potentially negatively affected by positive stereotyping. In addition to the negative consequences that positive stereotyping places on the academic achievement of Asian Americans, Asian Americans also suffer from bullying as a result of being subjected to positive stereotyping (Shin, D’ Antonio, Son, Kim, & Park 2011). KoreanAmericans reported a higher rate of bullying and being bullied than expected (Shin, D’ Antonio, Son, Kim, & Park 2011). The positive stereotype that Asians and Asian Americans exhibit the fewest behavioral problems compared to other minority groups (Lorenzo, Frost, Reinherz, 2000) can lead to greater risk of experiences of bullying. As a result, Asian American students
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displayed elevated depression levels and withdrawn behavior (Shin, D’ Antonio, Son, Kim, & Park 2011; Lorenzo, Frost, & Reinberz, 2000). Over time, those who have been exposed to bullying as a result of positive stereotyping display increased negative mental health symptoms such as lower self-esteem levels and increased depression symptoms (Greene, Way, & Pahl, 2006). In addition to the mental health concerns that arise from the consequences of positive stereotyping, there are also harmful generalizations made about the physical health of Asian Americans. For example, the physical health of Asian Americans is often overlooked and therefore Asian Americans are positively stereotyped to be healthier and less likely to suffer from diseases than other minority groups (Ibaraki, Hall, & Sabin, 2014). Positive stereotyping generates generalizations of Asian Americans as a model minority that is resistant to difficulties such as health disparities that other minorities experience (Yeh, 2009). However, cancer mortality rates are higher in the Asian or Asian American population than in other racial/ethnic groups because Asians or Asian Americans are not diagnosed until the cancer is at a more dangerous stage (Smigal, Jemal, Ward, Cokkinindes, Smith, Howe, & Thun, 2006). In addition, the existing cancer disparities in the Asian American population are due to the fact that physicians’ recommendation of cancer screening rates for Asian Americans are lowest compared to other minorities (Ibaraki, Hall, & Sabin, 2014). The authors argue that the model minority stereotype is responsible for the cancer screening disparities because physicians are often implicitly persuaded by the model minority stereotype to perceive their Asian or Asian American patients as healthier than they truly are (Ibaraki, Hall, & Sabin, 2014). Furthermore, Asian Americans and Asians who immigrate to the United States might not have the necessary resources to receive the attention that they need to answer questions relating to physical health concerns if doctors are not playing an active role. Overall, I argue that more research in this field should be conducted in order to address the negative effects of positive stereotyping in this population. Several important implications can result from additional research in this field: namely, greater prevention efforts for rates of Asian American discrimination in school settings, better mental health treatments that incorporate values held by Eastern cultures (Hall, Hong, & Zane, 2011), greater awareness of the negative effects of seemingly positive stereotypes (physical and psychological), greater research about cancer screening disparities in Asian Americans, and incorporating greater amounts of Asian Americans in research studies or discovering how to reach out towards people in this community.
In conclusion, as mentioned from previous research, Asians and Asian Americans are often positively stereotyped. While positive stereotyping can be helpful to Asians and Asian Americans in certain situations, these generalizations can also be harmful in other settings. Mental and physical health concerns such as depression rates and cancer-screening rates in the Asian or Asian American population should be explored more. These health disparities should be addressed in academic and social settings where the mental and physical health of Asians or Asian Americans are potentially at risk of being overlooked. This is particularly important because there are increasingly greater amounts of Asians or Asian Americans who live in the United States (Teranishi, Ceja, Antonio, Allen, & McDonough, 2004) and thus should be able to receive education and healthcare at optimal conditions.
REFERENCES Armenta, B. E., Park, I. J. K., Kim, S. Y., Lee, R. M., Pituc, S. T., Jung, ... Schwartz, S. J. (2013). Where are you from? A validation of the foreigner objectification scale and the psychological correlates of foreigner objectification among Asian Americans and Latinos. Cultural Diversity and Ethnic Minority Psychology, 19, 131-42. Chang, D. F., & Demyan, A. (2007). Teachers’ stereotypes of Asian, Black, and White students. School Psychology Quarterly, 22, 91-114. Chao, M. M., Chan, W., Mendoza-Denton, R., Chiu, C., & Kwok, C. (2013). The model minority as a shared reality and its implication for interracial perceptions. Asian American Journal of Psychology, 4, 84-92. Cheryan, S., & Bodenhausen, G. V. (2000). When positive stereotypes threaten intellectual performance: The psychological hazards of “model minority” status. Psychological Science, 11, 399-402. Chou, R. S., & Choi, S. (2013). And neither are we saved: Asian Americans’ elusive quest for racial justice. Sociology Compass, 7, 841-853. Dalisay, F., & Tan, A. (2009). Assimilation and contrast effects in the priming of Asian American and African American stereotypes through TV exposure. Journalism & Mass Communication Quarterly, 86, 7- 22. Greene, M. L., Way, N., & Pahl, K. (2006). Trajectories of perceived adult and peer discrimination among Black, Latino, and Asian American adolescents: Patterns and psychological correlates. Developmental Psychology, 42, 218-238. Hall, G. C. N., Hong, J. J., & Zane, N. W. S. (2011). Culturally competent treatments for Asian Americans: The relevance of mindfulness and acceptance-based psychotherapies. Clinical Psychology: Science and Practice, 18, 215-228. Ibaraki, A. Y., Hall, G. C. N., & Sabin, J. A. (2014). Asian American Cancer Disparities: The potential effects of model minority health stereotypes. Asian American Journal of Psychology, 5, 75-81. Iwamoto, D. K., & Liu, W. M. (2010). The impact of racial identity, ethnic identity, Asian values, and race-related stress on Asian Americans and Asian international college students’ psychological well-being. Journal of Counseling Psychology, 57, 79-91. Kwon, J., Kwon, S., & Overton-Adkins, B. J. (2014). Stereotype threat on Asian American college students. Advanced
Science and Technology Letters, 59, 7-13. Lee, S. J. (1994). Behind the model-minority stereotype: Voices of high- and low-achieving Asian American students. Anthropology & Education Quarterly, 25, 413-429. Lorenz, M. K., Frost, A. K., & Reinberz, H. Z. (2000). Social and emotional functioning of older Asian American adolescents. Child and Adolescent Social Work Journal, 17, 289-304. Sayama, M., & Sayama, H. (2011). Positive stereotyping and multicultural awareness: An online experiment. Current Research in Social Research, 16, 1-13. Shih, M., Pittinsky, T. L., & Ambady, N. (1999). Stereotype susceptibility: Identity salience and shifts in quantitative performance. Psychological Science, 10, 80-83. Shin, J. Y., D’ Antonio, E., Son, H., Kim, S., & Park, Y. (2011). Bullying and discrimination experiences among KoreanAmerican adolescents. Journal of Adolescence, 34, 873883. Smigal, C., Jemal, A., Ward, E. Cokkinides, V., Smith, R., Howe, H. L., & Thun, M. (2006). Trends in breast cancer by race and ethnicity: Update 2006. A Cancer Journal for Clinicians, 56, 168-183. Steen, L. A. (1987). Mathematics education: A predictor of scientific competitiveness. Science, 237, 251-253. Su, J. C., Lee, R. M., Park, I. J. K., Soto, J. A., Chang, J., Zamboanga, B. L., ... Brown, E. (2014). Differential links between expressive suppression and well-being among Chinese and Mexican American college students. Asian American Journal of Psychology, 1-10. Teranishi, R. T., Ceja, M., Antonio, A. L., & Allen, W. R. (2004). The college-choice process for Asian Pacific Americans: Ethnicity and socioeconomic class in context. The Review of Higher Education, 27, 527-551. Tran, A. G. T. T., & Lee, R. M. (2014). Your speak English well! Asian Americans’ reactions to an exceptionalizing stereotype. Journal of Counseling Psychology, 61, 484490. Tummala-Narra, P., & Claudius, M. (2013). Perceived discrimination and depressive symptoms among immigrantorigin adolescents. Cultural Diversity and Ethnic Minority Psychology, 19, 257-269. Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32, 20-47. Wu, F. H. (2002). Yellow: Race in America beyond Black and White. New York, NY: Basic Books. Yoo, H. C., & Castro, K. S. (2011). Does nativity status matter in the relationship between perceived racism and academic performance of Asian American college students? Journal of College Student Development, 52, 234-245. Yoo, H. C., & Lee, R. M. (2009). Does ethnic identity buffer or exacerbate the effects of frequent racial discrimination on situational well-being of Asian Americans? Asian American Journal of Psychology, 5, 70-87. Yeh, T. L. (2002). Asian American college students who are educationally at risk. New Directions for Student Services, 97, 61-71.
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Parent Training for the Treatment of Selective Mutism Jasmine Lewis Selective mutism is an anxiety disorder characterized by the inability to speak to certain people in certain situations, despite being completely capable of speech in other situations (Bergman & Hunt, 2008). Often, selective mutism is discovered in children when they start school, where demands for speech are more prevalent than in the home (Bergman & Hunt, 2008). It is common for children to feel comfortable speaking with family but then fail to speak to teachers and classmates or more unfamiliar individuals, such as distant relatives and strangers (Bergman & Hunt, 2008). Selective mutism is maintained by a cycle of reinforcement (Gallagher & Knickerbocker, n.d.). When a child is engaged in conversation with a person they are not comfortable speaking with, they start to feel anxious (Gallagher & Knickerbocker, n.d.). When the child avoids speaking, their anxiety lowers. This reinforces not speaking as an effective way to lower one’s anxiety (Gallagher & Knickerbocker, n.d.). Parents play an interesting role in this cycle. While observing their child become anxious when asked a question, parents often step in and answer for the child, relieving them of their anxiety (Gallagher & Knickerbocker, n.d.). Again, the avoidance is reinforced and children come to learn that their participation in conversation is not expected. While parents are usually kept informed about their child’s progress in therapy and school, more research needs to be done on how parents can be trained to help treat their children with selective mutism. Not only do parents spend the most time with their children out of school, but they also serve as role models for speaking behaviors, control with whom the child interacts, and can intervene in their child’s conversations in a way that reinforces avoiding speech (Muris & Ollendick, 2015). Additionally, parent-led interventions can make continued progress even after therapeutic intervention with a clinician is over (Thirwall, 2013). However much of the research on parent training for the treatment of anxiety disorders has led to conflicting results on effectiveness. When comparing these studies I’ve found that the methods of implementing these training components vary so significantly that they provide little conclusive evidence of what works and what does not. Considering the unique role that parents play in the maintenance of selective mutism, developing and testing a standardized parent-focused training program is crucial for the selectively mute population.
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Cognitive Behavioral Theray Related Interventions In the previous research exploring how parents can facilitate the treatment of childhood anxiety disorders, much of the focus has been on how parents can be involved in Cognitive Behavioral Therapy (CBT) treatment as co-clients (Barmish & Kendall, 2005). The reasoning behind this parental involvement is that if parents who are modeling anxious behavior learn to treat their own anxiety, they will be able to model better behavior and self-regulation for their children (Breinholst, 2012). It’s possible that this reasoning can apply to anxious parents who model reticent behaviors for the selectively mute children. Wei and Kendall (2014) examined how effective family-based or parental-enhanced CBT was for treating childhood anxiety. Their review of the literature revealed inconsistencies. For most of the studies, patients who participated in parent-enhanced CBT improved significantly more than control groups who received no treatment. However, when compared to child-focused CBT alone, parent-involved CBT was hit or miss in terms of outperforming child-centered CBT (Wei & Kendall, 2014). Bodden et al. (2008) took a sample of 128 clinically referred children with anxiety disorders and assigned them along with their parents to either child or family CBT. They found that overall child CBT was marginally more effective than family CBT, but this effect was not sustained in the 3-month follow-up (Bodden et al., 2008). Breinholst et al. (2012) argue that these inconsistencies can be explained by inconsistent treatment delivery across studies and individual factors, such as whether or not the parent has a psychiatric disorder. Training parents as lay therapists for anxious children is another branch of parent-focused treatment that has been investigated in a few studies and has been proven more effective than simply incorporating parents into their children’s CBT as co-clients. Thirlwall, Cooper, Karalus, Voysey, Willetts, and Creswell (2013) examined parent-delivered CBT in a randomized control trial with 194 children diagnosed with an anxiety disorder. In this study, parents were given a self-help book along with instructional sessions with a therapist. During these sessions the therapist taught the parent how to identify signs of anxiety, challenge beliefs about anxiety, and set goals for the child. Children of parents who received more comprehensive instruction from the therapist made the most improvements and half of this
experimental group no longer met the diagnostic criteria for their primary anxiety diagnosis after treatment. According to the literature on how selective mutism is treated, parents could benefit by being able to identify how anxiety manifests in their children aside from the speech avoidance. For example if a child starts to feel anxious and disengages from conversation by getting silly, their parent can identify this behavior as anxiety (Schwartz & Shipon-Blum, 2005) We have seen how clinicians use the cognitive aspects of CBT to challenge children’s beliefs about what makes them anxious, so this evidence supports the idea that parents can use these belief-challenging strategies in treating selective mutism as well. For example, parents can help their children challenge commonly held beliefs that others will find their voice funny or others would stop liking them if they make a mistake while talking. Further research needs to be conducted to confirm that these techniques will consistently work in selective mutism cases. Graduated Exposures Management Plans
Graduated exposures and contingency management plans are very commonly used in the treatment of selective mutism (Vecchio & Kearney, 2009). Typically, the clinician prompts speaking behaviors according to a hierarchy and guides the patient through in vivo exposures to practice speaking in unfamiliar environments (Vecchio & Kearney, 2009). For example, a clinician might have a selectively mute child first communicate by first mouthing words, then whispering words, and finally using their full-voice. Once the patient is at the stage of speaking clearly and audibly, the clinician may have them first speak to a parent with an unfamiliar person present (for example in an elevator) and then move onto speaking to an unfamiliar person in the company of a parent. Contingency management plans, which involve rewards for demonstrating appropriate speaking behaviors are also frequently used in treatment, however they are mostly established and enforced by the parent since the rewards are given in the child’s home (Vecchio & Kearney, 2009). The goal of a contingency management plan is to positively reinforce and increase the frequency of certain positive behaviors while discouraging negative behaviors. For example, a child can earn points for participating in class at a level consistent with where they are on their hierarchy. After earning so many points, the child can redeem them for a prize or a special outing. Vecchio and Kearney (2009) examined which was more effective for treating selective mutism: graduated exposure practice with a clinician or contingency management plans with a parent. They took a sample
of nine children with selective mutism and administered the graduated exposure therapy (Treatment A) and the contingency management plan (Treatment B). Researchers divided the sample into two randomized groups and each group received both treatments in a different order. While both Treatment A and Treatment B yielded results in terms of more words spoken by the participants, researchers found the exposure-based practice to be more effective than the contingency management plan with a significant increase in number of words spoken after Treatment A compared to after Treatment B. This would suggest that parent-focused efforts are less effective than the clinician led childbased efforts, but more studies need to be done comparing these two factors more directly. It is possible that exposure-based practice is simply the more effective treatment, regardless of whether a clinician or a trained parent administers it. It is also worth noting that the contingency management plans that Vecchio and Kearney (2009) had parents put into place involved having the child punished (by losing privileges or making child stick to an early bedtime) if the child failed to speak in public settings when prompted by the parent. The practice of punishing selectively mute children for failing to speak has been widely criticized and it’s use may have possibly contributed to the contingency management plan yielding far fewer results than the exposure-based practice (Kotrba, 2014). Sharkey, McNicholas, Barry, Begley, and Ahern (2008) conducted a study on group therapy for five selectively mute children and their parents. The children’s group focused on psychoeducation about their anxious feelings, learning and using relaxation exercises, and exposures to anxiety provoking situations. The parents group focused on education on selective mutism, how to handle it in daily life, how to support their child’s speaking behaviors, and how to help them navigate school (Sharkey et al., 2008). Parents who were anxious also received tips on how to lessen their own anxiety. Each of the children improved: two came to speak freely to classmates and the other children in the study and could speak to adults using monosyllabic words, one participant had seen significant improvements in ability to communicate nonverbally in the clinic and could speak to peers in school and in her community, and the last two participants no longer met the diagnostic criteria for selective mutism. This paper suggests that parent training in the form of psychoeducation and instruction on facilitating exposures and reinforcing speech can be effective in treating selective mutism. However, these effects need to be isolated from those of child therapy and tested with individual parents as opposed to parent groups.
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CONCLUSION This review of the literature has highlighted the following parent-training practices as helpful in the treatment of childhood anxiety disorders: 1) training parents to modify their own accommodating and anxious behaviors, 2) psychoeducation on anxiety, 3) instructing parents on guiding their children through exposure, 4) contingency management for success during exposures, and 5) teaching parents how to administer CBT. Each of these strategies can in theory be adapted to selective mutism from other anxiety cases. Parents can be instructed on creating practice exposures for their child, waiting for their child to give a response, rewarding verbal communication, encouraging conversation from their child when appropriate, and addressing their child’s cognitions about what would happen if they spoke in front of people. In my experience working with selectively mute children and their parents, clinicians already impart some of this knowledge on parents but it is done much less systematically than parent-focused efforts for other disorders. Seeing how parents are already an invaluable resource for selective mutism treatment, it’s about time we develop a standardized way of training them to work alongside clinicians in helping their children achieve their goals.
REFERENCES Barmish, A. J., & Kendall, P. C. (2005). Should parents be coclients in cognitive-behavioral therapy for anxious youth? Journal of Clinical Child and Adolescent Psychology, 34, 569–581. Bergman, L., Hunt, L. (2008). Selective mutism. Paradigm, 12–22. http://doi.org/10.1177/1359104511415174 Bodden, D. H. M., Bögels, S. M., Nauta, M. H., De Haan, E., Ringrose, J., Appelboom, C., … & Appelboom-Geerts, K. C. M. M. J. (2008). Child versus family cognitive-behavioral therapy in clinically anxious youth: an efficacy and partial effectiveness study. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1384–1394. Breinholst, S., Esbjørn, B. H., Reinholdt-Dunne, M. L., & Stallard, P. (2012). CBT for the treatment of child anxiety disorders: A review of why parental involvement has not enhanced outcomes. Journal of Anxiety Disorders, 26, 416–424. Gallagher, R., Knickerbocker, L. (n.d.) Selective mutism presentation for school outreach [Powerpoint slides]. Kotrba, A., Whittelsey, M., & Rubenezer, A. (2014). Selective mutism: An assessment and intervention guide for therapists, educators & parents. Eau Claire, WI: PESI Publishing & Media. Muris, P., & Ollendick, T. H. (2015). Children who are anxious in silence: a review on selective mutism, the new anxiety disorder in DSM-5. Clinical Child and Family Psychology Review, 18(2), 151–169. Oerbeck, B., Stein, M. B., Pripp, A. H., & Kristensen, H. (2015). Selective mutism: follow-up study 1 year after end of treatment. European Child & Adolescent Psychiatry, 24, 757–766.
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Schwartz, R., & Shipon-Blum, E. (2005). ‘Shy’ child? Don’t overlook selective mutism. Contemporary Pediatrics, 22(7), 30-36 5p. Sharkey, L., Mc Nicholas, F., Barry, E., Begley, M., & Ahern, S. (2008). Group therapy for selective mutism – A parents’ and children’s treatment group. Journal of Behavior Therapy and Experimental Psychiatry, 39, 538–545. Thienemann, M., Moore, P., & Tompkins, K. (2006). A parentonly group intervention for children with anxiety disorders: pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 37–46. Thirlwall, K., Cooper, P. J., Karalus, J., Voysey, M., Willetts, L., & Creswell, C. (2013). Treatment of child anxiety disorders via guided parent-delivered cognitive-behavioural therapy: randomised controlled trial. The British Journal of Psychiatry, 203(6), 436–444. Vecchio, J., & Kearney, C. A. (2009). Treating youths with selective mutism with an alternating design of exposure-based practice and contingency management. Behavior Therapy, 40, 380-392. doi:10.1016/j.beth.2008.10.005 Wei, C., & Kendall, P. C. (2014). Parental involvement: Contribution to childhood anxiety and its treatment. Clinical Child and Family Psychology Review, 17(4), 319–339. http://doi.org/10.1007/s10567-014-0170-6