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Table of Contents President ’s Colum n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 L a n e O gde n , Ph D TPA Sta ff David White, CAE , E xe cu ti ve D i re c to r Sh er r y R e is man, As s is t a nt Exe cu ti ve D i re c to r L a u ren Wi tt , Dire c tor of M ar k e ti ng & Pu b l i c R e l ati o ns J u l i e Hammack , M emb e rshi p Co o rdi nato r Tu esday Hardman, E -Ne ws Co o rdi nato r
“Ret urn on Ma nagem ent ” How D o es Your Business St ack Up?. . . . . . . . . . . . . 2 D avi d W h i te, C A E
Texas’s New Generat ion of S cience - Prac tioners . . . . . . . . . . . . . . . . . . . . . . . . . 5 B r i a n Stagn e r, Ph D
2012 TPA B oard of Tru ste e s Execut ive Com m itte e Pres id e nt Lane O gde n, PhD Pres i dent- E l e c t R ay Brow n, PhD Pres i dent - E lec t De sign ate M arc y Laviage, PhD Pas t Presid e nt R ob M e hl, PhD
B oard M e m b e r s K im Ar re dondo, PhD Laur ie Bald wi n, PhD B et t y Cla r k , PhD Cynt hia de las Fu e nte s, PhD R onald G ar b e r, PhD He y ward Gre e n, PsyD Carol Grot hu e s, PhD R ick M cGr aw, PhD Walte r Penk , PhD Gre gor y Simo nse n, PhD Jill S quy re s, PhD Editor Br ian St agne r, PhD
For info r m a t i o n a b o u t a r t icles o r ad ver ti s i ng i n the Te xa s Ps ych o lo g i s t , pl e a se co nta c t L auren Wi tt at ( 8 8 8 ) 8 7 2 - 3 4 3 5 o r tpa _lwi tt@att. net
1464 E. White s to n e Blvd. Su ite 4 0 1 Ce d a r Pa rk , T X 7 8 6 1 3 ( 8 88) 872-3435 • ( 88 8 ) 5 1 1 - 1 3 0 5 fax w w w. tex a spsyc. o rg
Pe diat ric D emylenat ing D isorders . . . . . . . . . . . . . 6 A l i ce A n n Sp u rgi n
Rater Bias in Real World S et t ings . . . . . . . . . . . . . . 9 Je n n i f e r Cox
The Upside of Break ing Up . . . . . . . . . . . . . . . . . . . . 1 2 Er i n B u ck , Ph D
Underst a nding Adolescent S exual B ehavior a nd A sso ciate d R isk Fac tors . . . . . . . . . . . . . . . . . . . . . . . 1 6 Sn e h a T h a moth a ra n
UT SA Int ro duces PhD in Healt h Psycholo gy . . . . . . . . . . . . . . . . . . . . . 2 0 Re b e cca We s ton , Ph D
From Your President: Lane Ogden, PhD
Lane Ogden, PhD
President When forced change is taking place it seems a lot easier to focus on or even to lament about what is no more than to anticipate with hopeful expectation what might be. It has been a theme of my talks and columns to present concerns, perhaps even fears, about a lot of potential negatives that are brewing on the horizon of psychology. I have sought to rally forces and increase motivation on the part of Texas Psychologists to address sweeping changes that threaten both our practices and, ultimately, the good of consumers of all our services throughout the state. But, with a slight shift in perspective, there is much reason for spring-like optimism as well.
Within any challenge lies opportunity. To provide for the long-term viability of psychology, we must be ever watchful for ways to apply our knowledge base, skill sets, and capacity to positively impact those we encounter in new, novel, and creative arenas. The status quo is never forever. Our culture seems ripe for psychology to seize the opportunity to go mainstream, to escape the halls of academia, to knock down the walls of traditional therapist-office setting--to take it to the streets--as never before. In just the last few months, on three occasions the cover of venerable Time magazine has featured stories highlighting issues within the purview of psychology. The December 5, 2011 edition led with “Why Anxiety is Good for You”, an essay that included a section extolling the motivating, stimulating impact of a just-right dose of anxiety. The Feb. 6, 2012 cover was “The Power of (shyness)” which provided an up-to-date discussion of the introversion/extroversion issue complete with quiz to help you locate your position on the spectrum. Finally, the Feb 20, 2012 featured “The Surprising Science of Animal Friendships” which looked at the impacts of friendships within various species including ours. I cite these as an indication that people are fascinated by, and want to hear about as well as experience, the richness and diversity that is psychology. To that end, this year’s TPA annual convention, to be held in Austin on November 1-3, will feature “Innovation” as the theme. The call for papers has recently gone out and I hope you will respond. The committee would like to have your input in going two ways with this theme: Firstly, we hope to receive proposals from persons who are involved in the field in non-traditional or emerging settings or who have, as a component of their career, applied their knowledge and training in less common or evolving areas. We want innovators to present and tell us what they’re doing. Do you have an interesting specialty, for example, use animals in therapy, work to improve athletic performance, serve a unique population? Secondly, we want to know about technological advances that you have incorporated into your day-to-day practice. We want to hear what you are doing to remain cutting edge—are there “apps”, software programs, or other technologies that you are incorporating about which many of us may be ignorant? Are you knowledgeable about HIPAA changes or teletherapy or other state-of-the-art issues? Would you consider sharing this expertise by presenting? The evolution of our profession depends on our willingness and ability to stay abreast of the tide of technology and respond to the true needs of the population. This year’s convention marks the 65th birthday of the Texas Psychological Association. We are planning some special events to celebrate the past and look forward with hope to a dynamic and exciting future. Plan now to be a part of this stimulating event to be held at the Westin at the Domain in Austin, November 1-3. Visit the TPA website at www.texaspsyc.org to get the latest information and to respond to the call for papers. I look forward to seeing you there!
www.texaspsyc.org Spring 2012
“Return on Management” How does your business stack up? TPA Executive Director David White, CAE We are in the same business. TPA and the majority of our members are small business owners. We all learned that to be successful we must apply sound business principles and measure our success with defined financial tools. TPA is no different: we are a small business that needs to monitor its success every month and every year. While we use many of these financial tools, TPA is going to implement a new one.... In 1993 two Harvard business professors developed a new management tool; ROM - Return on Management. This management tool answers the question, “Is your organization getting the maximum payback from every hour of the manager’s day?” Managerial energy is considered the most important AND most scarce resource of any business. Managers and CEOs daily face new opportunities, crises, and unexpected hurdles that tug at their time and attention. So the question is whether the manager or CEO is channeling their energies into the right areas. Productive organizational energy released ROM = ----------------------------------Management time and attention invested ROM does not generate a specific number or percentage. Instead it is a qualitative measure that managers must construe in their minds. ROM is maximized when the numerator is large and the denominator is small. Managers can “calculate” if the ROM ratio is high, medium or low, and the ones who understand the value of ROM use it as a powerful tool for developing a clear and defined strategic plan. ROM has five acid tests that define the mission of the organization. 1 - Does your organization know what opportunities are out of bounds? Is there a clear and concise mission statement of the organization? The CEO must translate that mission statement into short and long term strategic plans— budget, membership, etc. In doing so, the
CEO must communicate that vision and identify which opportunities are in line with the mission. This allows employees to identify how they should spend their time. 2- Are your company’s critical performance measures driven by a healthy fear of failure? Is the organization tying their staff’s performance measures to the strategic plan? Many times managers evaluate their employees on measurements that don’t assess what is truly critical for the organization’s success. Often evaluation methods don’t communicate to the employee how they should focus their time. Staff should understand that productivity must be tied to the mission of the organization. 3 - Can managers recall their key diagnostic measures? Are associations using too many diagnostic measures to hold managers accountable? Only those performances that truly matter to the organization’s success should be focused on. According to the Harvard professors, no more than seven factors should be measured. This is no magic number, and not every manager should be limited or accountable to seven goals, but the important factor is that all managers should know exactly what they are accountable for. 4- Is your organization safe from drowning in a sea of paperwork processes? Are the internal systems and policies preventing managers from reaching success? Demands on the manager’s time ultimately have little to do with creating value for the stakeholders who, in our case, are our members. Managerial paperwork and internal processes should only exist when they add value to the strategic plan. 5 - Does everyone watch what the boss watches? Organizations with a high ROM have employees who know what keeps the boss awake at night, and in turn make that their priority. The energy of the
David White, CAE
Executive Director employees becomes most productive when they have a clear understanding of their organization’s strategy. This understanding can be communicated with both words and actions from the manager.
Let’s explore how this applies to TPA. Does TPA staff have a defined vision of what the Board of Trustees want their association to be? Does the Board of Trustees have a defined vision of what YOU (our membership) want their association to be? Do we engage in activities that contradict what we are trying to accomplish politically? Do we worry about issues that have no effect on our goals and objectives? And finally, does the TPA staff know what issues are most important to our members? These are all questions your Board of Trustees will be discussing in the months ahead. But really, who is the CEO of this association? I would say it is YOU—the members of TPA who have come together for a common cause, to protect and advance the profession of psychology in the State of Texas. Let me remind you that psychology in Texas is a regulated profession. However, the people who regulate your profession are NOT psychologists. As a result, TPA becomes a political organization for the sole purpose to educate those individuals who do not know about your profession. There is NO OTHER organization that represents psychology at the legislature or at the State Board. In short, the involvement and interest that volunteers bring to the table is how “management” is defined at TPA. YOU are the CEO of your professional organization. You have a choice. You can wait until rules and regulations are passed and then scurry around to change those policies, or you can get involved with TPA. If you show up your voice will be heard, but if you don’t then the interest of others will be heard and you must live with the consequences. The power of all is greater than the power of one. This is your TPA. Define it.
www.texaspsyc.org Spring 2012
Welcome to TPA Texas Psychological Association would like to welcome the following new members to our association:
Shelia Bailey, PhD
Lindsay Houchens, PhD
Linda Richardson, PhD
Gary Barnard, PhD
Katie Khuc, MA
Mary A. Robinson, PhD
Michael Bennett, PhD
Maureen King, PhD
Kirsten Salerno, MA
Ami Bhatt, PsyD
Pamela Kirby, PsyD
Stacey Shipley, PsyD
Mariella Lane, PhD
Andrea Spraggins, PhD
Barbara Burnham, PhD
Jacquelyn Strait, MA
Lillian Butler, PhD
Samantha Loeza, MA
Elaine Calaway, PhD
Frankie Clark, PhD
Ann Matt Maddrey, PhD
Rosella Uras, MA
Virginia Cline, PhD
Lourdes Valdes, PhD
Robert Cramer, MA
Antoinette McGarrahan, PhD
Mary Vance, PhD
Sneha Desai, PsyD
Jamie McNichol, PsyD
Deborah J. Voorhees, PhD
Jack Ferrell, PhD
Zeeyon Walker, MA
Myron Friedman, PhD
Joseph Moore, PhD
Trudi Zaplac, PhD
Adami Gabriel, PsyD
Robert Morgan, PhD
Mona Ghosheh, MEd
Lori Golden, PhD
Amber Olson, PhD
Tracy Harrington, PhD
Eileen Raffaniello-Barbella, PhD
Deidra D. Heller, PhD
Bernard Ramsey, MA
Hanna Henry, PhD
Jayne Raquepaw, PhD
Natalie Hildebrand, MA
Robin Reamer, PhD
Cleydon Reynolds, MA
www.texaspsyc.org Spring 2012
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Texas’s New Generation of Science-Practitioners Brian Stagner, PhD TPA spends much energy to promote our profession to the public and to protect it from misguided or predatory threats from regulators, legislators, insurers, and the chaos of the marketplace. While those efforts are critical, our field will ultimately stand or fall based on the twin pillars of the strength of our underlying science and the energies of the next generation of psychologists who are launching their careers. We asked faculty at several of our Texas training programs to encourage students to contribute descriptions of ongoing research projects that will be interesting to our members. We showcase some of these efforts here. The contributions vary in style and content, but all are impressive. Alice Ann Spurgin presents an overview of the neuropsychological consequences of demyelinating disorders in children. Jennifer Cox discusses the problems and pitfalls in conducting psychological assessments which may be vulnerable to rater bias. Dr. Buck summarizes her ambitious dissertation on the factors that may lead to psychological growth after a romantic breakup. Finally, Sneha Thamotharan and her mentors discuss high risk adolescent sexual behavior and the factors that may promote or inhibit these risky behaviors. Their professionalism and enthusiasm is a credit to these new scholars and to their mentors. These student papers are followed by a description of an exciting new training and research program. The new doctoral program in Health Psychology at the University of Texas San Antonio and the University of Texas Health Science Center San Antonio will be partnering with the VA and the San Antonio Military Medical Center to train a new generation of health psychology researchers. As Dr. Weston describes, this program will offer a unique emphasis on military health. It will be a knowledge factory for a long time to come. Reference lists for these articles will be available on the TPA website at texaspsyc.org.
Volunteer Opportunity If you are looking for a way to get involved in TPA, join one of our committees. Call (888) 872-3435 or email email@example.com to join a TPA committee today. • Membership Committee
• Communication Committee
• Legislative Committee
• Disaster Response Committee
• Continuing Education Committee
• State Agency Rules and Regulations Committee
• TSBEP Committee • Psychology in the Workplace Committee
• Finance Committee • Goverance/Staff Committee
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Pediatric Demylenating Disorders Alice Ann Spurgin
Introduction Surrounding the axons of mature neurons is the myelin sheath, an insulating material that serves to enhance the speed at which neural signals are transmitted. Disorders that destroy this sheath are known as demyelinating disorders, the most common of which is multiple sclerosis (MS). Like MS, other demyelinating diseases affecting the central nervous system (CNS) include acute disseminated encephalomyelitis (ADEM) and transverse myelitis (TM), while Guillain-Barré syndrome and Charcot-Marie-Tooth disease are examples of demyelinating diseases affecting the peripheral nervous system (PNS). Causes of these disorders range from genetic to infection-mediated; in many cases, such as in MS, the cause has yet to be conclusively identified despite knowledge of various contributing factors. While motor and sensory changes (e.g., muscle stiffness, bladder/ bowel problems, vision problems, pain, tremors, fatigue) are the most common presenting complaints associated with any demyelinating disorder, neurocognitive and psychosocial effects are also frequently observed. The clinical course of such disorders can be quite variable both across and within individuals. In the case of MS, four subtypes have been identified: relapsing-remitting, secondary progressive, primary progressive, and progressive-relapsing (see Fig. 1). The relapsing-remitting subtype, which involves periods of active symptoms interspersed between periods with no or minimal symptomology, is typically diagnosed as a clinically isolated syndrome (CIS) until the diagnostic criteria for MS is met. The McDonald criteria, revised in 2010 by the International Panel on Diagnosis of MS, are considered the gold standard. However, many researchers and clinicians have voiced a concern that these criteria do not adequately capture diagnostic considerations in pediatriconset MS (Belman, Chitnis, Renoux,
& Waubant, 2007; Chabas, Strober, & Waubant, 2008). While onset of MS typically occurs in adulthood, with an average age at diagnosis of 37 years (Buchanan et al., 2010), 2.5 to 5% of all MS cases are diagnosed before age 16 (Ness et al., 2007). Furthermore, some demyelinating disorders—such as ADEM—occur more frequently in children than adults (Bobholz & Gremley, 2011). Whereas adult-onset MS is more common in females, pediatric-onset cases appear to be slightly more common in males (Chabas et al., 2008). An additional distinction between pediatric- and adult-onset cases is that over 90% of pediatric-onset cases are relapsing-remitting type, whereas this is not true for adult-onset MS (Chabas et al., 2008; Ness et al., 2007). Further age-of-onset-related differences have been noted regarding potential underlying causes, severity of clinical presentation, and magnetic resonance imaging (MRI) findings. These differences have contributed to the concern regarding the McDonald criteria as applied to pediatric-onset MS. The prognosis for demyelinating diseases varies depending on the disease type and is frequently impacted by demographic and clinical variables. Individuals diagnosed with MS live an average of 30 years post-diagnosis, with a life expectancy that is 5 to 10 years lower than that of the general population (Compston & Coles, 2008). Possibly contributing to those statistics, some estimates suggest a higher prevalence of suicide among individuals diagnosed with MS (Compston & Coles, 2008). This highlights the potential psychological consequences of being diagnosed with a chronic, progressive, debilitating disease for which there are various disease-modifying treatments but no known cure. Due to the preponderance of adult-onset cases, demyelinating disorders have been studied in much greater depth in adult
populations than in children and adolescents. In recent years, it has been recognized that knowledge regarding the “typical” disease presentation may not be applicable to pediatric-onset demyelinating disorders. Recent findings specific to the neuropsychological outcomes of pediatric-onset demyelinating diseases are reviewed herein, with clear implications for future research. Psychiatric and Psychosocial Sequelae In adults with MS, lifetime depression rates range from 40% to 60% (Vattakatuchery, Rickards, & Cavanna, 2011), making depression more common in MS than in the general population or other neurological disorders (Langdon, 2011). The physical and social challenges—reduced mobility, loss of employment, etc.—faced by individuals with MS and other demyelinating diseases certainly represent a risk factor for depressive symptoms. Additionally, disease-related factors such as lesion location and autoimmune processes have been hypothesized to contribute to the development of depressive symptoms in individuals with MS (Vattakatuchery et al., 2011). However, diagnosis of depression in an individual with a demyelinating disorder can be challenging, as a recent study suggested that neurovegetative symptoms associated with MS, such as fatigue and sleep disturbance, reflect the disease process rather than depression (Rabinowitz, Fisher, & Arnett, 2011). Regardless, it seems likely that demyelinating disorders represent a risk factor for depression and other psychiatric disorders in both adult and pediatric populations. Regarding children and adolescents, Weisbrot et al. (2010) found that 48% of a sample aged 6 to 17 with various demyelinating disorders met criteria for at least one psychiatric diagnosis. Notably, the vast majority of those individuals experienced the onset of psychiatric symptoms after the onset of neurological symptoms.
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It should be noted that although depression is arguably the most prominently recognized psychiatric disorder associated with demyelinating disorders, the Weisbrot et al. (2010) study identified a number of anxiety disorders in that pediatric sample, and 74% expressed at least one worry or concern regarding various aspects of their medical diagnosis and prognosis. Other studies have also observed anxiety disorders associated with pediatric demyelinating disorders (MacAllister et al., 2005). Similarly, a study of young adults (18 to 31 years of age) with MS found that although these individuals retain strong social connections, they feel embarrassed in public and worry about the effect of MS on their future personal lives and careers (Buchanan et al., 2010). Anxiety and mood disturbances may contribute to some of the behavioral difficulties often demonstrated by children and adolescents with demyelinating disorders, such as substance abuse, truancy, decreased motivation for future-oriented goals, and poor compliance during periods of remission (MacAllister, Boyd, Holland, Milazzo, & Krupp, 2007). Several studies have focused on fatigue in pediatric demyelinating diseases, as it is one of the most commonly reported symptoms in adult MS (Langdon, 2011). However, there are conflicting findings regarding the distinction between fatigue as a symptom of the disease versus fatigue as associated with depression in demyelinating disorder populations (Ketelslegers et al., 2010; Mills & Young, 2010). Regardless, there is some evidence to suggest that fatigue is associated with decreased quality of life in pediatric demyelinating diseases (MacAllister et al., 2009). This reduction in quality of life is evident in daily living activities, social relationships, school functioning, and physical functioning (Ketelslegers et al., 2010; Mowry et al., 2010). Neurocognitive Sequelae In addition to being a risk factor for decreased psychosocial and psychiatric functioning, demyelinating disorders also represent a risk factor for deficits in neurocognitive functioning. This has been well established in the adult literature, with deficits particularly widely noted in processing speed and memory (Langdon, 2011). Observations of cognitive dysfunction in adult demyelinating diseases range from 40%
to 65% (Amato et al., 2010b), and many believe these percentages are negatively skewed by under-diagnosis due to poor self-reporting and the limitations of neurological exams (Kinsinger, Lattie, & Mohr, 2010). As in other populations, depression has been shown to adversely affect cognitive functioning in MS (Arnett et al., 1999; Thornton & Raz, 1997). Longitudinal increase in cortical lesions appears to predict greater cognitive dysfunction (Roosendaal et al., 2009), and even at the onset of MS, lesions in specific brain regions may be associated with cognitive deficits (Reuter et al., 2011). Other studies have suggested that the size of the lesion may be more relevant to cognitive impairment than the lesion location (Nelson et al., 2011). Once cognitive dysfunction appears, it tends to persist (Amato et al., 2010b). Cognitive deficits associated with demyelinating diseases may have negative consequences for medication adherence, symptom management, driving safety, and employment (Amato et al., 2010b; Langdon, 2011). Cognitive functioning in pediatric populations of demyelinating disorders has been much less extensively studied. In one study, 22 out of 37 individuals demonstrated impaired performance on at least one neuropsychological test, with complex attention being the domain most commonly affected (MacAllister et al., 2005). Attention also appears to be more significantly impacted in African-American children and adolescents with MS than in Caucasians, which corresponds with the general observation that African-Americans experience greater severity of symptoms (Ross, Schwebel, Rinker, Ness, & Ackerson, 2010). A comprehensive, longitudinal study indicated that children and adolescents with MS demonstrate deteriorations in verbal memory, complex attention, verbal fluency, and receptive language functioning (Amato et al., 2010a). Overall, it is estimated that about one-third of pediatric MS patients demonstrate significant cognitive impairment, as defined by scores below the fifth percentile on at least three neuropsychological measures (Smerbeck et al., 2011). Additionally, language and other verbal functions appear to be more impaired in pediatric demyelinating disease populations as compared to adult populations (Smerbeck et al., 2011). This difference may be at least
partially explained by the fact that the myelination process continues through adolescence, and thus demyelinating processes may impact younger brains differently. Data from Amato and colleagues (2008) indicating that lower IQ scores are observed in patients with a younger age at onset support this hypothesis. Cognitive deficits also affect children and adolescents differently in terms of quality of life, given that individuals of these ages are still in school and are often accustomed to being more physically active. Interactional Studies A limited number of studies have investigated relationships between psychosocial, psychiatric, and neurocognitive functioning in individuals with demyelinating disorders. Such studies are greatly needed, given that these populations demonstrate significant difficulties in all of these areas. There have been mixed findings in studies of adult populations, potentially due to small sample sizes or overreliance on self-report of cognitive deficits instead of actual neuropsychological testing (Arnett, Barwick, & Beeney, 2008). A recent study that included administration of a neuropsychological battery did not find any association between cognitive deficits and mood difficulties, but that study was limited by non-standard administration of the brief testing battery via telephone (Kinsinger et al., 2010). Among adults with MS, a Danish study found that mental fatigue, anxiety, and depression significantly predicted variance in subjective cognitive complaints, but the only neurocognitive domain in which actual performance was impacted by mood or anxiety difficulties was executive functioning (Bol, Duits, Hupperts, Verlinden, & Verhey, 2010). Conversely, global cognitive decline has been found to account for 5% of the variance in mood symptoms in MS patients (Barwick & Arnett, 2011), while verbal intelligence and divided attention appear to predict variance in coping (Ehrensperger et al., 2008). Although such literature in adult populations is scarce, studies on the relationships between psychiatric, psychosocial, and neurocognitive deficits are even more rare in pediatric demyelinating disease populations. Two studies by Amato and colleagues (2008; 2010a) showed that psychiatric issues and fatigue had no predictive
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value for changes in cognitive functioning in children and adolescents with MS. However, psychiatric disorders were diagnosed in over 30% of the sample, and 70% of the sample demonstrated cognitive impairment as defined by failure on at least three neuropsychological measures (Amato et al., 2010a).
as two or more standard deviations from the mean (MacAllister et al., 2009). Mean parent-reported anxiety, depression, and executive function scores were not clinically significant, though scores varied widely. Means were below average on the Trail Making Test, Part B. Means were average on Letter Fluency and Digits Backward.
Dallas Study Given the growing body of evidence that children and adolescents with demyelinating disorders frequently face psychiatric and neurocognitive difficulties, and given that studies in the adult population suggest that there may be interactions between these domains, a study was conducted at Children’s Medical Center Dallas to further investigate this possibility in the pediatric population (Spurgin, Graves, Greenberg, & Harder, 2011). The specific objective of the study was to determine the influence of fatigue, depression, anxiety, and disease duration on executive functioning in pediatric MS. It was hypothesized that these variables would predict both parent-reported and performance-based executive function.
Predictors of Executive Dysfunction Multiple regression analyses indicated that fatigue, depression, anxiety, and disease duration predicted variability in parent-reported cognitive flexibility (p = .02), behavioral regulation (p = .01), attention problems (p = .04), and Trails B performance (p = .05). Independently, these predictors accounted for variability in various parent-reported executive functions, such as working memory, planning/organization, and initiation. These results indicate that disease duration, fatigue, anxiety, and depression may predict more parent-reported than performancebased executive dysfunction in children and adolescents with MS.
Method The sample consisted of 18 participants, ages 7 to 18, with an existing diagnosis of MS. These patients were recruited through the hospital’s multi-disciplinary clinic for pediatric demyelinating disorders. The sample was 67% female and 55% Caucasian and had a mean disease duration of 15.5 months. Participants completed a neuropsychological screening battery, and caregivers completed a series of questionnaires regarding the child’s psychological functioning, executive functioning, and fatigue. Parent-reported executive function was measured by responses on the Behavioral Rating Inventory of Executive Function, while performancebased executive function was measured by participants’ performance on the Trail Making Test, Part B and the D-KEFS Letter Fluency subtest, and the Digit Span subtest from the WISC-IV or WAIS-IV depending on the participant’s age. Psychological and Clinical Characteristics Mean parent-reported fatigue was severe based on normative data (Varni, Burwinkle, & Szer, 2004). “Severe” ratings in pediatric MS are defined
Conclusion The results of the Dallas study, together with existing literature, highlight the importance of regular neuropsychological surveillance of pediatric demyelinating disease patients. There remains much to be learned regarding the neuropsychological outcomes of pediatric demyelinating diseases. Fatigue, mood disturbances, anxiety, and neurocognitive deficits appear frequently in the adult populations, and studies suggest that this may also be true for pediatric-onset demyelinating disorders. However, it is becoming increasingly clear that not all findings of studies of adultonset demyelinating disorders apply to pediatric-onset cases. For example, language and other verbal functions appear to be more impaired in pediatric demyelinating disease populations than in adult populations (Smerbeck et al., 2011). Further research should be conducted to clarify the nature of neuropsychological deficits in pediatric populations. Additionally, more longitudinal studies are needed to determine long-term neuropsychological outcomes for these children and adolescents. Finally, interventional studies are greatly needed to address both psychological and neurocognitive outcomes. While a
recent study of adults with MS indicated that cognitive-behavioral therapy resulted in greater improvement in quality of life than supportive emotionfocused therapy for this population (Cosio et al., 2011), it remains to be seen if this is true for pediatric populations. Given the often tumultuous life stages and events experienced by children and adolescents, it is likely that these individuals with earlyonset demyelinating diseases may demonstrate greater and unique psychological challenges. This fact, plus the consideration that demyelinating processes may impact younger brains differently due to ongoing neurodevelopment, again underscores the great need for further research specific to pediatric demyelinating disease populations.
Figures Fig. 1. The four subtypes of MS.
Alice Ann Spurgin is a fourth-year PhD candidate in clinical psychology at UT Southwestern Medical Center. She recently defended her dissertation under the direction of Peter L. Stavinoha, PhD, ABPP. Her clinical and research interests are in the neuropsychological late effects of children with medical conditions such as demyelinating disorders, brain tumors, head injury, and stroke. She will be starting her postdoctoral fellowship in pediatric neuropsychology this fall.
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Rater Bias in Real World Settings Jennifer Cox
“Rater bias” refers to discrepancies among raters that are due to a) differing rater interpretation of the criteria being assessed or, b) rater unique perception of the target being assessed (Hoyt, 2000; Saal, Downey, & Lahey, 1980). Discrepancies between scores can occur for a number of reasons including differing interpretations of item criteria, familiarity with the assessment measure, willingness of the evaluator to seek out additional information, training or clinical experiences, and adherence to procedural and scoring rules. In addition, there may be subtle differences that occur during the administration process that result in unique interactions with the individual being evaluated such as evaluator appearance, eye contact, tone of voice, and general interpersonal effectiveness during interview procedures. While perfect agreement between two raters is ideal, it is an unrealistic goal. It is not the intent of
to clinical or “real world” settings is always debatable. The following paper reviews literature concerning rater biases with a particular forensically relevant instrument, the Psychopathy ChecklistRevised (PCL-R; Hare, 2003). The focus is directed to this instrument because of the methodologically sound research that has been conducted examining PCL-R scores in clinical and adversarial settings. In addition, considering the PCL-R remains popular in capital sentencing hearings (DeMatteo & Edens, 2006) and sexually violent predator civil commitment hearings (Boccaccini, Turner, & Murrie, 2008), the implications of evaluations employing the PCL-R are far-reaching.
The Psychopathy Checklist-Revised The construct of psychopathy has enjoyed attention in the social science research field since Hervey Cleckley’s landmark text, The Mask of Sanity (1941). More recently, clinicians and the legal system have become Researchers found that increasingly interested in the clinical utility of the construct, particularly in approximately 30% of the variance how psychopathy is related to violence risk and sexual in PCL-R scores could be attributed offending. As a method of assessing psychopathy to differences among raters. among criminal offenders, Hare (1980) developed the Psychopathy Checklist. this paper to criticize measures that Now in its revised edition (Hare, introduce any rater bias or fail to 2003) the assessment tool has gained obtain perfect consistency between popularity in research, clinical, and legal raters. Even the most structured and settings. Specifically, the utility of the well-standardized tools leave room measure in predicting future violent for evaluators to influence their rating behavior after an offender is released and, ideally, this potential error is from incarceration has resulted in its considered when interpreting standard increasing popularity within the legal scores. However, although many clinical system (DeMatteo & Edens, 2006; Walsh instruments undergo extensive research & Walsh, 2006). Consequently, there is to establish acceptable psychometric a large research body investigating the properties, including controlling for validity and reliability of the measure rater biases, the extent to which these both in and outside of the courtroom psychometric properties generalize (Campbell, Pulos, Hogan, & Murry,
2005; Edens, 2001; Hart & Hare, 1989; Hemphill, Hare & Wong, 1998; Walters, 2003). A semi-structured interview, the measure consists of 20 items assessing interpersonal, affective, and behavioral traits scored via a three-point scale. Importantly, the PCL-R manual reports strong interrater reliability (interclass correlation coefficient [ICC] = .91 for PCL-R total scores in pooled prison samples and ICC = .93 for PCL-R total scores in pooled forensic patient samples), suggesting that, in research settings at least, the tool is robust against rater biases. PCL-R and Rater Inconsistencies Despite the high reliability numbers reported in the manual, a number of recent studies have questioned the replicability of these numbers when utilizing the PCL-R in the field. Boccaccini, Turner, and Murrie (2008) examined PCL-R scores for 321 offenders undergoing evaluation by the Texas Department of Criminal Justice (TDCJ) as potentially sexually violent predators (SVPs). According to Texas state law (Texas Health & Safety Code § 841.023) all repeat sexually violent offenders are screened for recidivism risk prior to release from incarceration and considered for involuntary civil commitment if considered to be a continuing risk to society. Currently, the PCL-R is the only measure used for the assessment of psychopathy in these evaluations (Boccaccini, Turner, & Murrie, 2008). Evaluations were conducted by 20 doctoral level licensed psychologists contracted by TDCJ over a seven year period. Data indicate rater agreement between two evaluators was lower than would be expected (ICC = .47). Importantly, researchers found that approximately 30% of the variance in PCL-R scores could be attributed to differences among raters, as opposed to differences in levels of psychopathy among offenders or random error. These findings are supported by data published by Roberts, Doren, and
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Thornton (2002). The authors reviewed PCL-R scores assigned by a non-random sample of three evaluators during 107 SVP evaluations. Data indicate one evaluator consistently assigned significantly lower PCL-R scores, at an average of more than one standard deviation difference. Results from both studies suggest individual differences may influence ratings outside of the research lab. It should be noted that neither of these studies controlled for rater training and adherence to standardized assessment protocol or amount of information made available to raters by the correctional and legal systems. However, the inability to control for these factors increases the generalizability of the data in that it is unlikely two clinicians practicing in a real world setting have access to identical file and interview information on even the most standardized of measures. PCL-R and Adversarial Allegiance Although understanding that rater biases exist is important, in order to minimize their effects we must also understand what these biases entail. Research on rater biases and the PCL-R have identified two specific areas which could be attributed to differences in evaluator scores. Adversarial allegiance, or the inclination to favor the side by which an evaluator was retained in a legal proceeding, and its effects on the PCL-R has been examined in two studies. Murrie, Boccaccini, Johnson, and Janke (2008) compared PCL-R scores given by two differnet evaluators working for opposing sides in SVP civil commitment proceedings. Eleven doctoral-level evaluators provided scores for 23 separate offenders. Surprisingly, differences among raters’ scores were substantial, with approximately 60% of the scores differing by more than two standard error of measurements. Importantly, these differences were in the direction that would be expected given the evaluator’s adversarial allegiance, meaning evaluators retained by the respondent (offender) were more likely to assign lower ratings while evaluators retained by the petitioner (state) were more likely to assign higher ratings. In a second study Murrie, Boccaccini, Turner, Meeks, Woods, and Tussey (2009) also examined rater agreement of PCL-R scores in SVP civil commitment hearings. Data was collected from 21 licensed psychologists who conducted evaluations with 72
offenders. PCL-R scores from both a petitioner and a respondent evaluator were available for 35 offenders. Data indicate the mean difference between petitioner and respondent scores was 4.97 (SD = 7.26), with a difference greater than 6 points occurring in 37% of cases. Referencing interclass correlation coefficients for PCL-R Total scores in the .40 range, the authors concluded approximately 50% of variance could be attributed to the offender’s true level of psychopathy while 18-25% was attributable to adversarial allegiance (remaining variance was attributed to random error). It should be noted that Murrie et al. (2009) also compared rater agreement of PCL-R scores to other actuarial assessments utilized in SVP commitment hearings and determined that the PCL-R achieved weaker rater agreement than the STATIC-99 (Hanson & Thornton, 1999) yet comparable agreement to the Minnesota Sex Offender Screening Tool-Revised (Epperson et al., 1998), Rater agreement for all three measures was well below those reported in manuals. The weak agreement across the three measures demonstrates that the potential for rater bias in clinical settings is not unique to the PCL-R and may occur with multiple assessment measures. PCL-R and Evaluator Personality Characteristics A second element that has been investigated as a potential variable in rater bias is evaluator personality characteristics. As early as 1955 Cronbach hypothesized that raters own personality characteristics could unintentionally influenced ratings. Despite Cronbach’s hypothesis, relatively little research has been conducted examining individual differences and rater biases. In regards to the PCL-R, only one study that we know of has examined the influence of trained rater personality traits on offender scores. Miller, Rufino, Boccaccini, Jackson, and Murrie (2011) trained 22 faculty and graduate students using standardized PCL-R scoring procedures. Evaluators then independently rated four offenders using PCL-R criteria. In addition, evaluators completed the NEO PI-R (Costa & McCrae, 1992), a 240-item measure designed to assess for the “big five” personality traits (neuroticism, extroversion, openness, agreeableness, and conscientiousness). Results indicate that raters who consistently assigned lower scores on the PCL-R Interpersonal
Factor (questions designed to measure offender interpersonal features such as grandiosity, cunning, and callousness) also reported higher personal levels of Agreeableness. Specifically, raters who scored higher on their personal levels of altruism, compliance, modesty, and tender-mindedness were more likely to rate the offender as less manipulative, grandiose, egocentric, and glib. In addition, evaluators who scored high on the NEO PI-R Conscientiousness scale rated offenders more harshly (i.e. assigned higher ratings) on PCL-R measures of interpersonal features and impulsive lifestyle. In sum, these data seem to indicate that more agreeable evaluators tend to rate offenders as less psychopathic while more conscientiousness evaluators rated offenders as more psychopathic. Considering variance in offenders’ PCL-R scores ranged from 21-27% for this particular study, understanding that evaluator personality traits play a role in their ratings is a necessary step in eliminating that variance. Although interesting, further research needs to be done to understand the replicability of these data. These data were collected in a research setting and, while it is possible this effect could be replicated in a clinical or legal arena, no published research on this topic has been located. Currently, research at Texas A&M University is underway to understand how individual differences may affect untrained laymen (who have the potential to be placed on a criminal jury) and their ratings of an offender’s psychopathic characteristics. Furthermore, at this time we could find no other studies investigating rater personality characteristics and rater bias for any standardized assessment measure. Recommendations and Conclusion The literature discussed above is just an example of how rater bias may influence clinical evaluations. The issue of rater bias is not unique to the PCL-R nor is it solely reserved for the laboratory or legal arena. In fact, clinicians act as raters on a daily basis when they administer IQ tests, evaluate trainees, assess patient improvement, or determine Global Assessment of Functioning (GAF) scores. Given the high frequency with which clinicians evaluate others, understanding the impact of rater bias is particularly important.
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While rigorous standardization procedures and extensive training are meant to lessen the effects of rater biases, the psychometric properties of assessment measures are generally established in the laboratory with ideal participants (i.e. absence of comorbid disorders) and evaluators (research assistants trained directly for the purpose of establishing assessment psychometric properties). When taking these measures out of the laboratory and utilizing them in real-world settings, the potential for evaluator allegiance or evaluator individual differences to influence ratings is a very tangible threat. The first step of combating against rater bias is simply being aware of its existence. Although the literature above outlines the potential biases in PCL-R scores, more research needs to be done to understand if these results generalize to multiple settings and other measures. Furthermore, although adversarial allegiance and rater personality characteristics were identified as affecting ratings, these are by no means the only possible influences. Future research should consider other potential causes of rater bias (personal/political agendas, dogmatic adherence to a specific treatment modality, etc.) as well as which measures utilized in real-world settings are robust against these threats. Beyond simply recognizing rater bias, continued supervision, through peers or senior clinicians, can help to lessen its potential effects. In addition, the importance of extensive training and familiarity with assessment measures is essential. As clinicians it is our responsibility to recognize that rater bias exists, even in well-standardized measures, and continually attempt to understand how our own biases might play a role in the ratings that we make daily. It is only after controlling for these biases to every possible extent that we can be confident in our ratings and the reliable conclusions we draw from them.
The Millon™ Clinical Multiaxial Inventory has been a trusted tool for psychologists for more than 30 years. Quick and easy to administer, it can be used to corroborate clinical observations and help facilitate effective and personalized treatment planning.
Support for more precise clinical planning The MCMI-III supports clinical decision-making through: • Suggested DSM–IV ™ diagnoses • Therapy-guiding Grossman Facet Scales • Recommendations for treatment
Jennifer Cox is a third-year doctoral student in Clinical Psychology at Texas A&M University. She is currently working on her dissertation investigating the effect of psychological expert testimony on juror ratings of psychopathy in death penalty cases. Under the supervision of Dr. John Edens she is also involved in research investigating the use of psychological assessments in the courtroom, jury decision making, and the assessment of psychopathy and psychopathy subtypes. This paper distills her interest and ongoing work on the assessment process. Millon™ Clinical Multiaxial Inventory-III by Theodore Millon, PhD, DSc, with Carrie Millon, PhD, Roger Davis, PhD & Seth Grossman, PsyD
For more information or for a FREE trial, please call 800.627.7271, ext. 263200 or visit us at PsychCorp.com/MCMI-III. 800.627.7271
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The Upside of Breaking Up: Benefits of Romantic Relationship Dissolution Erin Buck, PhD
Relationship breakups can impact nearly all areas of one’s life: social, emotional, psychological, financial, sexual, physical, and spiritual. Those who have been through this experience can attest to the immense pain that comes from the loss of a partner and the failure of a relationship. Some of the frequently studied negative effects of a breakup include emotional distress (Frazier & Cook, 1993; Simpson, 1987), anger (Weiss, 1976), resentment and loneliness (Sprecher, 1994), and adjustment problems, including stress, and hopelessness (Moller, Fouladi, McCarthy, & Hatch, 2003). Despite the prevalence of breakups and the associated well-known negative outcomes, much is still not understood. For example, little is known about how attributions that people make regarding relationship breakup are related to coping strategies people use to get through the breakup (Buck, 2006), or the potential benefits that can come from a relationship breakup once the process of healing begins. The current research focused on the associations among people’s attributions about their relationship breakups, coping strategies used post-breakup, posttraumatic growth following the breakup, relationship satisfaction, respect for romantic partner, and satisfaction with life. What follows is a brief explanation of these constructs, including some discussion of relationships between them, and a summation of the results of this research. Attributions Attributions help answer common questions that follow a breakup such as, “What happened?” and “Who was at fault?” Weiss (1975) called the answers to these questions accounts, which serve the purpose of organizing happenings. Harvey, Weber, Galvin, Huszti and Garnick (1986) explained
that accounts serve the purposes of regaining a sense of control over a breakup, gaining a new sense of self, and developing predictability about one’s future. Accounts also can serve as a catharsis. Finally, attributions can help serve the purpose of maintaining social identity and integrity, which La Gaipa (1982) described as an important part of relationship disengagement. In other words, an individual can use attributions to help “save face” with friends and family. Gender strongly influences relationships (Bell, 1981), and by extension, the attributions made regarding conflict and dissolution. In research by Hill, Rubin, and Peplau (1976), women who were presented with a list of attributions about their breakup (e.g., “my desire to be independent,” “my interest in someone else,” “living too far apart”) rated a larger number of attributions as important sources of conflict than did men. Of their findings, the authors concluded that women are more sensitive to problems within a relationship than are men. Baxter (1986) found the same trend, with women citing not only more reasons for their breakups than men, but also different reasons.
Coping According to Lazarus and Folkman (1984), coping is used by individuals during times of stress as a means of adaptation and stress reduction. The literature is vast yet lacking a consensus about the most concise way to categorize coping strategies. Some authors, such as Lazarus and Folkman, view coping as situation-specific, meaning that individuals alter their coping strategies to fit their present situation. In contrast, considerable research has focused on individual differences in coping (Snyder & Pulvers, 2001). Another categorization differentiates problem-focused coping and emotion-focused coping. Billings and Moos (1981) summarized the difference between these two forms of coping: “Problem-focused coping includes attempts to modify or eliminate the sources of stress through one’s own behavior. Emotion-focused coping includes behavioral or cognitive responses whose primary function is to manage the emotional consequences of stressors and to help maintain one’s emotional equilibrium” (p. 141). Coping is an important aspect of relationship breakup due to the stress and emotional distress brought about by such a life change. Coping-related variables found to be related to how an individual copes after a breakup
“Little is known about how attributions that people
make regarding relationship breakup are related to coping strategies people use to get through the breakup, or the potential benefits that can come from a relationship breakup once the process of healing begins.
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include initiator status (Sprecher, 1994), social support, and controllability over the breakup (Frazier & Cook, 1993). Gender also plays an undeniable role in coping with a relationship termination. It appears as though men and women may focus on different aspects of the same situation. In Divorce Talk, a book describing a qualitative study of divorce, Riessman (1990) found that men tend to define divorce as a personal failure, whereas women focus on their achievements after marriage. Riessman highlighted the positive consequences of divorce that many women reported experiencing: learning to be alone, becoming more self-reliant and less dependent, and achieving independence, autonomy, and a greater sense of control. It is possible that these findings generalize to non-marital romantic relationship breakups as well. Posttraumatic Growth Although the research focusing on the negative impact of crisis is vast, very little has been done that examines the relationship between adversity and positive outcomes. However, this trend is shifting toward a focus on positive health, encompassing physical, mental and social domains (Seeman, 1989). In a study of attributions, coping strategies, and posttraumatic growth after a relationship breakup, Buck (2006) found that a significant amount of posttraumatic growth was experienced by some individuals. Similarly, Hebert and Popadiuk (2008) conducted a qualitative study to examine what type of changes college students experience after a romantic relationship breakup and the process through which these changes, if any, occur. The authors concluded that “change and personal growth can arise through the experience of a breakup” (p. 5). Based on the research of Berscheid, Lopes, Ammazzalorso, and Langenfeld (2001), it has been argued that making attributions regarding the cause for failure of a past relationship is the only way individuals can correct these problems in their next relationship (Tashiro & Frazier, 2003). Learning from one’s past mistakes and not repeating them in a new relationship is one potential benefit from a relationship breakup. Relationship Satisfaction Relationship satisfaction has been referred to as a relationship well-being “barometer” (Karney & Bradbury, 1995),
and refers to an individual’s subjective experience of how satisfied they are in their relationship. Relationship satisfaction has been found to play a role in relationship stability and quality (Karney & Bradbury, 1995). Because satisfaction plays a role in relationship stability, it is not surprising that Hendrick, Hendrick, and Adler (1988) found couples who were more likely to break up were those lower in satisfaction. A number of factors have been linked to satisfaction in relationships, such as the attachment styles of the partners (Feeney, Noller, & Roberts, 2000), the presence of certain love styles (Hendrick et al,1988), sexual satisfaction, commitment, spousal support, increased intimacy, and self-disclosure (Sokolski & Hendrick, 1999). Although some factors contribute differently to men and women’s satisfaction in relationships, research has shown that both genders report experiencing comparable levels of satisfaction (Clements, Cordova, Markman, & Laurenceau, 1997). In addition, satisfaction levels in same-sex relationships parallel levels reported in opposite-sex relationships (Peplau & Spaulding, 2000). Respect Relationship satisfaction is also strongly correlated with respect for partner within a romantic relationship (Hendrick & Hendrick, 2006). Respect is infrequently studied and unclearly defined, despite its seemingly obvious importance to relationships. Although respect is essential in all relationships, Frei and Shaver (2002) argued that there may be something unique about respect in close relationships specifically. Respect has been labeled as one of the four core relationship values by Markman, Stanley, and Blumberg (1994), alongside forgiveness, intimacy and commitment. Presently it is unclear whether respect is a completely separate entity from other aspects of close relationships. For example, in their development of the Respect For Partner Scale, Frei and Shaver found such a strong positive correlation between respect and relationship satisfaction (r = .73), they argued that these two may really represent the same construct. Life Satisfaction For many people, life’s “ups and downs” include being in and out of romantic relationships. For example, married individuals testify to greater
happiness and satisfaction with life than unmarried, divorced or separated individuals (Myers, 2000). However, Myers explained that being in an unhappy marriage reverses this finding, making divorced and separated individuals happier than married people. In this way, relationship satisfaction appears to be highly correlated with life satisfaction. Satisfaction with life also appears to be related, both directly and indirectly, to a number of other types of satisfaction. For example, relationship satisfaction is a prerequisite of sorts in order for women to obtain sexual satisfaction (Byers, 2001; Byers, 2005), and sexual satisfaction, along with marital satisfaction, is vital to the maintenance of life satisfaction for women (Apt, Hurlbert, Pierce, & White, 1996). Method Measures used to examine constructs in this study included a background inventory and the Relationship Breakup Attribution Measure (Tashiro & Frazier, 2003). Participants were asked to consider and rate possible causes that led to the decline and breakup of their most recent past romantic relationship. Scores are on a five-point scale ranging from 0 (not at all a cause) to 4 (very much a cause). This measure includes four 9-item subscales in which each of four causal factors is represented: Person (e.g., “My mood,” “My insensitivity”), Other (e.g., “Partner’s mood,” “Partners insensitivity”), Relational (e.g., “Value conflicts,” “Communication Problems”), and Environmental (e.g., “Work stress,” “Our friends were disruptive to our relationship”). Coping was assessed using an 18-item measure called the ProblemFocused Style of Coping (PF-SOC; Heppner, Cook, Wright, & Johnson 1995), and a 16-item measure called The Emotional Approach Coping Scale (Stanton, Kirk, Cameron, & DanoffBurg, 2000). The PF-SOC includes a 5-response scale that ranges from 0 (almost never) to 4 (a great deal), and three subscales: Reflective (e.g., planning, reflective), Suppressive (e.g., escapism, denial), and Reactive (e.g., distortion, impulsivity). The Emotional Approach Coping Scale includes a fouroption response scale ranging from A (I usually didn’t do this at all) to D (I usually did this a lot), and the measure is comprised of two 8-item subscales: Emotional Processing (describing
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attempts by a respondent to understand his/her emotions, such as, “I work on understanding my feelings”), and Emotional Expression (e.g., “I let my feelings come out freely”). Growth was assessed using the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996), a 21-item scale that “measures the extent to which survivors of traumatic events perceive personal benefits, including changes in perceptions of self, relationships with others, and philosophy of life, accruing from their attempts to cope with trauma and its aftermath” (Tedeschi & Calhoun, 1996, p. 458). The response scale for the PTGI ranges from A (I did not experience this change as a result of my crisis.) to F (I experienced this change to a very great degree as a result of my crisis.). The Relationship Assessment Scale (RAS; S. Hendrick, 1988) is a single factor measure consisting of seven items rated on a 5-point Likert basis. Respect for one’s partner was measured using the 5-point Likert Respect Toward Partner Scale (Hendrick and Hendrick, 2006). The Satisfaction with Life Scale (SLS; Diener, Emmons, Larsen, & Griffin, 1985) was used to measure the cognitive component of subjective wellbeing. The measure is a 5-item Likert scale ranging from A (strongly disagree) to E (strongly agree). The final sample included 463 undergraduate (310 women and 153 men) in same-sex and opposite-sex relationships (although most reported on the breakup of a heterosexual relationship). The majority were Caucasian (74%) and 19-21 years of age (66%). The participants were asked questions concerning their most recent romantic relationship and their current relationship, if applicable. Participants who were not currently in a romantic relationship were asked to respond to all questionnaire items in order to compare them with participants who were in a relationship. Results and Discussion Do attributions affect growth? For both men and women, making attributions was predictive of growth, and Other attributions were a significant predictor of growth when controlling for Person, Relational and Environmental attribution variables. Other attributions place blame for a relationship breakup on one’s partner, meaning that the breakup was beyond one’s control. Many of the life events to which growth
has been attributed in the literature are things beyond an individual’s control. For example, growth has been reported in the aftermath of rape (Burt & Katz, 1987), bereavement (Calhoun & Tedeschi, 1989-1990; Schwartzberg & Janoff-Bulman, 1991), cancer (Collins, Taylor, & Skokan, 1990; Taylor, 1983), heart attack (Affleck, Tennen, & Croog, 1987), and disasters (Thompson, 1985). Posttraumatic growth does not follow every adverse experience that people encounter, but rather only those experiences which are significant enough to threaten one’s core beliefs (Tedeschi, Calhoun, & Cann, 2007). Stressors are perceived as less threatening when they are under one’s own control (Snyder & Pulvers, 2001), and therefore more threatening when they are not. A lack of control in an adverse circumstance such as a rape or a breakup, could serve a key role in adding to its perceived stressfulness, and prompting growth to be realized after the event has occurred. Problem focused coping. When problem-focused coping strategies were added to the model after attribution variables, Other attributions remained a significant predictor of growth for both genders, and Reflective coping (e.g., planning, reflecting) remained a significant predictor of growth for women, but not for men. Reflective coping was the only coping strategy that Buck (2006) found to be associated with posttraumatic growth for women as well. Buck explained the possibility that Reflective coping (e.g., planning for the future) can be very empowering, leading to growth. As noted earlier, in Riessman’s (1990) explicated that men tend to define divorce as a personal failure, whereas women focus on their achievements after a divorce. These findings potentially generalize to a dating relationship breakup, and help explain why Reflective coping was the only problem focused coping strategy found to be predictive of posttraumatic growth for women.
Emotional approach coping strategies were found to be predictive of growth for women and men. When emotional approach coping strategies were added to the model after attribution variables, coping strategies still accounted for a significant proportion of the variance in growth, and Other attributions remained a significant predictor of growth. Attempting to understand one’s emotions (Emotional Processing) remained a significant predictor of growth as well, but only for women. In their study examining coping and emotional reactions after the attacks of September 11, 2001, Park, Aldwin, Fenster and Snyder (2008), concluded that for their participants, engaging with a stressor and being emotionally aroused (in this case by anger) increases the likelihood of recognizing growth. Anger and behaviors that the authors labeled positive coping (e.g., getting emotional support from others, praying/ meditating, concentrating one’s efforts on doing something about the situation, learning to live with it, looking for the good in what is happening) were better predictors of posttraumatic growth than posttraumatic stress, whereas feelings of depression and behaviors that the authors labeled negative coping (e.g., trying to take your mind off things, expressing negative feelings, distracting oneself, using alcohol/drugs) were better predictors of posttraumatic stress than growth. One possibility for the finding that Emotional Processing, but not Emotional Expression, remained a predictor of growth for women is that Emotional Expression is merely expressing one’s feelings (e.g., “I let my feelings out,” “I allowed myself to express my emotions”), which are often negative when it comes to romantic relationship breakup. This venting, rather than actively engaging oneself in trying to understand emotions, as in Emotional Processing, does not seem to help achieve growth. This explanation would be consistent with the findings of Park et al. (2008).
Emotional coping. The next research question asked how attributions and emotional approach coping strategies predict growth. Partial support was found for the hypothesis that emotional approach coping, including both Emotional Processing and Emotional Expression, would be significant positive predictors of posttraumatic growth for women, but not for men.
Emotional coping and life satisfaction. Partial support was found for the hypothesis that emotional approach coping strategies would be positively correlated with life satisfaction for women, but not for men. A significant positive correlation between life satisfaction and Emotional Processing was found for the total sample. However, when analyzed separately
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by gender, this significant positive correlation between life satisfaction and Emotional Processing was found for women but not for men. Surprisingly, there were no associations found between Emotional Expression and life satisfaction for either gender. The failure to find a significant positive relationship between Emotional Expression and life satisfaction may be related to the debate regarding the value of catharsis. The literal meaning of catharsis is “to release or to purge” (Bushman, Baumeister, & Phillips, 2001, p. 18). As Bushman et al. described, the idea behind the theory of catharsis is that releasing negative emotions will have a positive effect on an individual’s emotional state. However, for decades many researchers have argued that catharsis may not be beneficial in terms of decreasing negative emotions (e.g., Goldman, Keck, & O’Leary, 1969; Hornberger, 1959). Many emotions experienced after a breakup are negative, such as sadness or anger. If expressing these emotions (Emotional Expression) is not helpful, an individual’s emotional state may not improve. If an individual’s emotional state remains negative, his or her satisfaction with life would be unlikely to improve as well. Respect. It was hypothesized that for individuals who have experienced growth from a relationship breakup prior to entering their current relationship, correlations between growth and respect for their current partner, as well as between growth and satisfaction with life will be significant. Among the individuals in a romantic relationship (n = 256), both men and women, there was a significant positive association found between posttraumatic growth and respect. There were also positive correlations between posttraumatic growth and relationship satisfaction, as well as between respect and relationship satisfaction. Consistent with Chambliss (2008), a significant positive correlation was also found for partnered adults between respect toward partner and satisfaction with life. Like many things in life, an individual often gets out of a relationship what he or she puts into the relationship. Individuals with high levels of respect for their partners are likely to be highly respected in return. An individual in a reciprocal, good quality relationship such as this would likely have a high level of life satisfaction because relationships,
especially romantic relationships, are important to many people. When the data were analyzed separately by gender, growth from a prior relationship was found to be related to respect and current relationship satisfaction for women. For reasons that are unclear, growth was not found to be related to these variables for men. Even though the total score of the Posttraumatic Growth Inventory (PTGI) was used in this study, the measure does include five subscales measuring various aspects of growth. It is possible that men experienced a different kind of growth than did women; a kind of growth that would not necessarily have an impact on future relationships. For example, rather than experiencing growth on the PTGI subscale Relating to Others, which may benefit future relationships (e.g., “I put more effort into my relationships”), men may have experienced growth on the PTGI subscale Spiritual Change (e.g., “I have a better understanding of spiritual matters”), which may have no impact on future relationships. For both men and women, respect and relationship satisfaction were positively correlated. This is consistent with the findings of Hendrick and Hendrick (2006) linking respect to relationship satisfaction. There were no significant relationships between growth and life satisfaction found for either gender. Current relationships. The final research question examined how people in a current romantic relationship compare to people not in a current romantic relationship in terms of their satisfaction with life. There is evidence in the literature that women rate themselves significantly higher than men on happiness (Matlin & Gawron, 1979), a construct likely strongly correlated to life satisfaction. As hypothesized, a significant difference was found for dating status and life satisfaction, with individuals currently involved in a romantic relationship having more life satisfaction than those not in a relationship. Married individuals testify to greater happiness and satisfaction with life than unmarried, divorced or separated individuals (Myers, 2000), and this finding may generalize to dating relationships. In other words, unmarried, partnered individuals likely testify to greater happiness and satisfaction with life than un-partnered individuals but there was a gender difference. Men who were currently
dating were significantly more satisfied with their lives than men who were not currently dating. In other words, men’s satisfaction with life was found to be significantly impacted by their dating status. Surprisingly, there were no significant life satisfaction differences between women currently involved in a romantic relationship. Possibly the female college student population in the current study focused on aspects of their lives other than romantic relationships from which to obtain their life satisfaction, such as friendships, familial relationships or advancing their education. This study has several implications for psychologists and their clients. It provides practitioners guideposts to help clients navigate through the breakup recovery process. Similar research using different populations (e.g., married/divorced individuals, gay/lesbian couples) would be advantageous. A longitudinal study may also be helpful, because a breakup is a process, and coping strategies in response to an event often change over time. Nevertheless, this research offers promise to both therapists and clients that a relationship breakup, while an ending, can also be a beginning.
Dr. Erin Buck is originally from Corpus Christi, Texas and she completed her undergraduate degree at Texas A&M University in College Station. She continued her education at Texas Tech University in Lubbock, receiving her Masters degree in Psychology and her Doctorate in Counseling Psychology. Dr. Buck completed internship at the Texas A&M Student Counseling Service and then moved to Houston where she is currently a postdoctoral fellow at The University of Texas M.D. Anderson Cancer Center. Dr. Buck anticipates being licensed as a psychologist in March 2012.
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Understanding Adolescent Sexual Risk Behavior and Associated Risk Factors Sneha Thamotharan, MA1, Sharon K. Hall PhD2, and Sherecce Fields, PhD1 1 Texas A&M Health Behavior Research Group, Texas A&M University, 2University of Houston- Clear Lake
Background The United States has one of the highest rates of teenage pregnancy, abortion, and sexually transmitted infections (Cavanos-Rehg et al., 2011). According to the National Campaign to Prevent Teen and Unplanned Pregnancy (2008) $10.9 billion dollars of taxpayer money is spent on treating teenage pregnancy and $8 billion on treating STIs. Although adolescent sexual behavior has been a topic of psychological research for a few decades there maintains a lack of information on the development of romantic relationships and sexual behavior during this period. In recent years, the incidence of teenage pregnancy and sexually transmitted infections (STI) during adolescence has reached epidemic proportions due in part to its popularization within social media as seen on such television shows as Teen Mom, 16 and Pregnant, 90210, and Skins, further necessitating a need for research in this area. The Center for Disease Control (CDC) (2009) has demarcated sexual risk behavior as one of the top six health-risk behaviors contributing to death and disability among youth. The Youth Risk Behavior Surveillance System (YRBSS, 2009) determined that 46% of high school students have engaged in sexual intercourse and 35% of sexually active adolescents report having more than one partner in the past 18 months, with several having concurrent sexual relationships (Kelley, Borawski, Flocke, & Keen, 2002). However, 39% did not use a condom during their last sexual intercourse and 77% did not use birth control. The decreasing age of sexual onset and increase in sexual risk behaviors (i.e., concurrent relationships and lack of condom use) has contributed to a startling increase in the number
of acculturation, substance use and of adolescents diagnosed with impulsivity. STIs (Feldman, Turner, & Araujo, Racial and minority culture 1999). Recent reports indicate that groups are most susceptible to early approximately 8,300 adolescents sexual intercourse onset, higher rates between the ages of 13-24 were of STIs, and higher adolescent birth diagnosed in 2009 with HIV/AIDS, rates (Santelli et al., 2000). Prevalence a 58% increase from 2006 (YRBSS, of gonorrhea was 31 times higher 2009). Furthermore, 19 million STIs are among African American adolescents diagnosed each year for individuals between the ages of 15-24 and more than in comparison to European American adolescents. Additionally, adolescent 400,000 adolescent girls gave birth in pregnancy rates were 3.2 times higher 2009 (YRBSS, 2009). for African Americans indicating early Clearly, adolescent attitudes sexual intercourse onset for African and behaviors have shifted from American adolescents. Rather than abstinence to sexual permissiveness minority status, these findings can be in less committed relationships, as attributed to low SES due to the high reflected by the decreasing age of sexual onset (Feldman, Turner, & Araujo, 1999). percentage of these groups that are poor. These relationships have a tremendous and significant impact on the development of both healthy and maladaptive relationship patterns in $10.9 billion dollars of their adult relationships (O’Sullivan, Cheng, Harris, Brooks-Gunn, 2007). taxpayer money is spent on Although adolescent risky sexual behavior is studied in more detail, treating teenage pregnancy due to its societal impact—STIs and teenage pregnancy—understanding and $8 billion on treating the “sexual timetable” of adolescent romantic relationships STIs. and associated risk factors is fundamental in understanding subsequent risk behaviors. Childbearing Adolescent Sexual Timetables and STI infection are related to key risk Previous research has indicated that factors including age of sexual onset. African Americans have the earliest Those adolescents with early sexual onset of sexual behaviors, and Asian onset had a higher frequency of sexual intercourse, lower contraception use and American adolescents have the latest onset of sexual behaviors (Feldman, higher rates of pregnancy continuation Turner, &Araujo, 1999). Euro-American (Santelli et al., 2000). Specifically and Hispanic American adolescents understanding individual factors, above have comparable onsets, being and beyond the influence of social slightly delayed compared to African media, is key in enhancing prevention American adolescents. However, and intervention efforts. The present when the authors controlled for socioarticle will begin with a discussion economic status of African American of adolescent sexual timetables and adolescents, these youth had roughly progress to the associated risk factors
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equal onset when compared to their Euro-American counterparts (Feldman, Turner, &Araujo, 1999). Males are more likely to engage in non-penetrative sexual behaviors earlier than females. However, for penetrative sexual behaviors- sexual intercourse, oral sex, and anal sex, both males and females had roughly equal onset (Feldman, Turner, &Araujo, 1999). Adolescents reflect a much earlier onset of oral sex and engage in oral sex prior to sexual intercourse (Halpern-Felsher, Cornell, Kropp, &Tschann, 2005). Adolescents’ reason for having oral sex was that it is less risky in terms of health, social, and emotional factors. Adolescents believe oral sex is more acceptable than having vaginal intercourse in dating and non-dating situations. Oral sex is not viewed as a threat to personal values and beliefs, and these adolescents stated that their peers were more likely to participate in oral sex than vaginal intercourse (Halpern-Felsher et al., 2005). Our research has found that male and female adolescents significantly differed only for the behavior French kissing (Thamotharan, 2008). Females had a later onset of French kissing compared to males. This finding agrees with previous findings that males do engage in nonpenetrative sexual behaviors earlier than females. However, they do not engage in all non-penetrative behaviors earlier as suggested by these data. When examining behaviors across the timetable, Asian American adolescents were shown to have the most restrictive timetable and had the most delayed onset of sexual behavior. However unlike the previous findings, African American participants did not have the least restrictive sexual timetable. African American adolescents (note. 30% of the sample obtained was African) have similar sexual onsets as European American and Hispanic American adolescents, which could be attributed to similar SES and education levels as the other cultural groups (Thamotharan, 2008). Interestingly, the sample of Asian American adolescents was not entirely composed of Chinese, Japanese and Korean origin people as has often been true of studies in which “Asian Americans” are explained; 84% of participants identified themselves as being South Asian or those who identified as Asian Indian, Sri Lankan,
and Vietnamese. In addition the African American sample was not composed entirely of individuals identifying themselves as “black,” but as African (30%), having recently immigrated from Nigeria or South Africa; suggesting that sexual behaviors could vary considerably across Asian and African subgroups. For European American adolescents, the present study indicated a delay in sexual intercourse, from that of previous research. Hispanic American adolescents in the present study also indicated a delay for sexual intercourse. Lastly, African American adolescents in the present study differed from previous findings for the behaviors touch breast, touch vagina, oral sex, and sexual intercourse. The present sample of adolescents showed a later onset of sexual behaviors than those previously observed. The delay in sexual intercourse onset for the European American, Hispanic American, and African American participants in the present study could also reflect current trends as stated in the 2004 CDC report stating that there has been a national a decline in age for onset of intercourse for African American and Hispanic American adolescents who have had sexual intercourse. All eight sexual behaviors had a high association with each other, suggesting that with the delay of one behavior, subsequent behaviors were delayed. Oral Sex. No significant differences existed between cultural groups for the behavior of oral sex. The act of oral sex does not appear to be occurring at extremely early ages. Adolescents belonging to each cultural group appear to engage in oral sex around age 18. The onset of oral sex was delayed until after the onset of sexual intercourse only for African American adolescents. The present study findings are that these adolescents engaged in oral sex and sexual intercourse for the first time within a year of each other, both around age 18. Sexual intercourse appears to be a behavioral progression that does occur soon after oral sex due to perceptions of this behavior being less risky. Asian American and European American adolescents were not engaging in oral sex at earlier ages, but they were engaging in oral sex immediately prior to engaging in sexual intercourse.
For Hispanic American adolescents who had the earliest onset of sexual intercourse, the onset of oral sex and the onset of sexual intercourse occurred at almost identical time points. Thus not only did sexual intercourse occur at an early age, so did oral sex. Consequently, the present study findings suggest that Hispanic American adolescents have the earliest onset of sexual intercourse and oral sex of the four groups. Associated Risk Factors Acculturation. Acculturation has been defined as the process whereby immigrant and minority groups “are exposed to the cultural patterns of the United States, and this exposure may modify or change values, norms, attitudes and behavior” resulting in a fusion of “memories, sentiments and attitudes…into a common cultural life” (Ford & Norris, 1993, p. 316). A more recent study examined dating behaviors and sexual attitudes in Asian American adolescents in the context of adherence to Asian values, as measured by the Asian Values Scale (AVS) (Lau, Markham, Flores, & Chacko, 2009). Adolescents more strongly identifying with Asian values reported secret dating and sexual activity, and they were more likely to date longer before having sex and had a delayed sexual onset than those adolescents identifying less with Asian values (Lau et al., 2009). Other researchers have found links between acculturation and sexual behaviors. A study of Hispanic adolescents who had never been married also indicated varying effects of acculturation (Ford & Norris, 1993). Acculturation was measured using Marin, Otero-Sabogal, and PerezStable’s Short Acculturation Scale for Hispanics (SASH). Hispanic women had a strong positive correlation between acculturation and sexual activity. Female young adults with high acculturation were more likely to have had sex within the past year. Higher acculturated Hispanic males were positively associated with oral sex. The authors found that, regardless of acculturation, 42% of Hispanic males (comparable to previous data on Hispanic American adolescents) had intercourse before the age of 15, compared to roughly 15.4% of women (Ford & Norris, 1993).
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When examining acculturation within the aforementioned sample, acculturation was not shown to be a significant predictor of sexual behavior onset. Non-significant results are likely due to homogeneity of these participants in their generation of immigration to the U.S, which is reflected in the low variability of acculturation scores. Moreover, for Hispanic American adolescents, oral sex onset was the only behavior that was predicted by acculturation level. This suggests that Hispanic American adolescents regardless of acculturation have early onset of sexual behaviors. Though not significant, acculturation did show a negative correlation with all seven sexual behaviors - indicating that those individuals who are least acculturated (identifying more with their country of origin) had a delayed sexual onset compared to more acculturated individuals. As immigrants become more infused with U.S. values, their sexual timetables begin at earlier ages regardless of cultural group. Acculturation can be seen as a continuum- as individuals become more acculturated to U.S. values, their sexual onset occurs at sequentially earlier stages. This shows immigrantsâ€™ values and their behaviors are changing as they assimilate. Substance Use. A strong relationship between engaging in various high-risk behaviors during adolescence has been demonstrated (Floyd & Latimer, 2010). Two prominent behaviors that have been linked to one another include substance use and high-risk sexual behavior. The 2009 YRBS reported that 21.6% of sexually active adolescents reported using either alcohol or other substances before engaging in sexual intercourse. This is concerning given that adolescents who report having been sexual activity under the influence of substances are more likely to report unplanned sexual activity, increasing their risk for obtaining STIs (Poulin & Graham, 2001; Floyd & Latimer, 2010). This relationship could be moderated by type of substance used, specifically in relation to greater number of lifetime partners, use of drugs before engaging in sexual intercourse and lower contraceptive use. However, there has been a dearth of information examining specific substances used and the subsequent risk behavior adolescents are more susceptible to engaging in compared to those
adolescents not engaging in substances. thereof) to consider the probable Thus, the present research utilized negative long-term consequences the data obtained by the Center for (Fields et al., 2009). Impulsivity has Disease Control (CDC) 2009 Youth Risk been traditionally linked to other risk Behavior Surveillance System (YRBSS), behaviors such as substance use (i.e. sampling 196 schools, 9th-12th grades cigarettes, alcohol), gambling, and (N = 16,410). aggression (Donoghue, T. & Rabin, Regression analyses revealed, M., 2001). However, little research as hypothesized, that ever having has examined the role of impulsivity utilized the following substances: in sexual onset and the high-risk cigarettes, alcohol, marijuana, cocaine, sexual behavior that emerges during glue, heroin, methamphetamines, adolescence. Previous research ecstasy, steroids, and intravenous has attempted to examine the role drugs significantly predicted number of of impulsivity, specifically delay lifetime partners, respectively. Further discounting as an underlying behavioral analyses revealed that use of drugs mechanism contributing to increased before engaging in sexual intercourse risk behavior during adolescence. and lower contraceptive use was significantly predicted by use of cigarettes, alcohol, Acculturation can be seen as marijuana, cocaine, glue, heroin, methamphetamines, ecstasy, steroids, and a continuum- as individuals intravenous drugs, respectively. The heightened become more acculturated to U.S. susceptibility of adolescents engaging in drug use before having sex and lower values, their sexual onset occurs at contraceptive use, ranged from three to fourteen times sequentially earlier stages. more likely for adolescents using substances compared to adolescents not engaging in substance use; the specific odds ratio Behavioral choice theory depended on the type of substance used. suggests that adolescents engaging in The overarching message is risky sexual behavior are adversely clear: with more diverse and intense focusing their time on present substance use, adolescents report an satisfaction as opposed to longincreased frequency in high-risk sexual term consequences and benefits (i.e., behavior putting themselves at greater obtaining an STI or avoiding becoming risk to contract STIs or become pregnant a teen mother). Although it may be (Tapert, Aarons, Sedlar, & Brown, argued that young children may not 2001). Previous research has indicated understand the long-term negative that policy makers no longer treat and consequences of their misallocation educate adolescents about substance use of attention to the present, with as an exogenous variable but as one that greater sexual awareness programs has an intricate relationship with sexual -- as adolescents it should be apparent behavior. that risky sexual behavior results in negative consequences such as STIs and Impulsivity. Impulsivity describes pregnancy, in which does not explain human behavior that is done with why a subset of adolescents continue to less forethought and predisposes an engage in risky sexual behavior. individual towards rash, unplanned Some researchers argue that reactions without regard to negative the reason is due to a lack of impulse consequences and with a disregard control, similar to individuals who to more rational long-term choices suffer from substance abuse, gambling for success (International Society for addictions, and excessive eating. Research on Impulsivity, 2011). It is Associations have been identified a multidimensional construct which between impulsivity and high-risk includes 3 domains: in attention or sexual behavior using self-report and inability to maintain alertness over time behavioral measures. Findings indicate to a particular stimuli, disinhibition that impulsivity, or the lack of selfor a failure to inhibit inappropriate control, may contribute to the onset or unwanted behaviors, and delay and maintenance of risky behaviors; discounting or the ability (or lack whereby adolescents engaging in
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high-risk sexual behaviors displayed greater levels of impulsivity compared to healthy peers (Deckman et al., 2011; Donohew et al, 2000; Hipwell et al., 2010; Kahn et al., 2002; Pack et al., 2001; Zimmer et al., 2001). Adolescents displaying greater levels of sensation seeking and impulsive decision making were more likely to endorse ever having sex, earlier sexual onset, greater number of lifetime sexual partners, been pregnant/caused a pregnancy, having STIs, and engaging in substance use related sexual behaviors (Donohew et al., 2000; Kahn et al., 2002). In addition, previous research has demonstrated that the odds of early sexual onset of less intimate behaviors (i.e., hand holding) are increased among impulsive adolescents (Hipwell et al., 2010). We examined performance on a novel task- the sexual discounting task (SDT)-- which assesses decisions “between immediate unprotected sex and delayed sex with a condom” across various parameters (Johnson & Bruner, 2011), as a means to measure an individual sexual impulsiveness-and its relationship to adolescent reported high-risk sexual behavior (frequency of contraceptive use). This task has only been piloted on adult drug abusers and was recently provided to the present researchers to examine within adolescents. It was hypothesized that performance on the SDT, would predict decreased frequency of contraception use as a function of increased impulsiveness as reflected on the SDT. The present pilot study utilized a retrospective design and queried individuals ages 18-25 on sexual behaviors and substance use during adolescence and young adulthood (N = 50). Regression analyses revealed, as hypothesized, that high levels of sexual impulsiveness as reflected by the SDT, significantly predicted earlier sexual onset across the timetable (kissing to anal sex), decreased contraception use during: oral sex, vaginal sex, and anal sex, and ever having had unprotected oral sex, vaginal sex, and anal sex. This study suggests that adolescents who discount significantly on the SDT may be at greater risk for participating in risky sexual behavior. Future analyses from the present study will examine the SDT in relation to concern for STIs and pregnancy, number of partners, STI history, pregnancy history and use of sex chartrooms, and recreational sex habits.
Conclusion Adolescent romantic relationships are an important milestone in development and have implications for engaging in risky sexual behavior. Current trends suggest that adolescents are engaging in sexual activity at younger ages, in both sequential and concurrent relationships. This indicates that not only are sexual behaviors no longer occurring within the framework of committed relationships marked with trust, but also done with multiple partners, thereby attributing to the increase in teenage pregnancies and the number of adolescents diagnosed with STIs. Culture group affiliation and acculturation are associated risk factors that must be considered when working within this population. When working with adolescents about their sexual behavior, clinicians, researchers and practitioners must recognize that there are differences between cultural groups that must be attended to. Similarly, future research efforts targeting not only the prevention of risky sexual behavior but the prevention and cessation of substance use, may be more effective in addressing high risk behaviors in adolescents, thereby decreasing the risk that these adolescents experience. The SDT can be utilized by researchers and clinicians to examine these high-risk behaviors in adolescents and young adults and should be considered for use in future research. Currently, the majority of intervention and prevention lies in abstinence only programs. With increased research and greater awareness of the ineffectiveness and inaccuracies of these programs, a shift to comprehensive adolescent reproductive health programs has emerged (Gavin, Catalano, David-Ferdon, Gloppen, Marham, 2010, Kirby, 2007; Kirby, 2008). These programs teach both abstaining from sex till marriage as definitive in the
prevention of STIs and pregnancy. However, they also educate adolescents who are sexually active or anticipate being sexually active on proper contraceptive use. These programs have been found to be efficacious and more likely to decrease adverse impact (Gavin, Catalano, David-Ferdon, Gloppen, Marham, 2010; Kirby, 2007; Kirby, 2008). Though there is a declining trend of adolescents engaging in sexual intercourse, more information must be shared to further decrease this percentage, and to prevent the unwanted effects of early onset of sexual behaviors such as pregnancy and the transmission of STIs. Researchers, clinicians, and educators need to find the most specific targets of intervention and information to disseminate so that adolescents are better addressed. Finally, since sexual behaviors are correlated strongly with each other, by finding a factor that controls for less intimate behaviors, sexual onset for more intimate behaviors may be delayed; a very promising aspect of adolescent sexual behavior left to be explored. Sneha is a clinical doctoral student at Texas A&M University. She completed her undergraduate work at UCLA in molecular biology. After graduating, she accepted a position at Texas Children’s Hospital working as an adolescent behavioral interventionist, where she became interested in risk behavior; and concurrently obtained her master’s degree in behavioral psychology at UHCL. She is currently working on her dissertation, under the direction of Sherecce Fields, PhD, examining impulsivity, as an associated risk factor for risky sexual behavior and substance use. She hopes to pursue a career exploring adolescent sexual behavior and teenage pregnancy in order to enhance intervention efforts.
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UTSA Introduces PhD in Health Psychology Rebecca Weston, PhD
The Department of Psychology at the University of Texas at San Antonio began developing a proposal for a new PhD program a decade ago. With the knowledge that it would be Texas’s southernmost psychology doctoral program at a public institution, the department carefully considered the most appropriate focus for the proposed program. Faculty in the department represent diverse areas of psychology, including biological, clinical, cognitive, cross-cultural, developmental, experimental, industrial/organizational, perception, personality, and quantitative. However, one commonality across areas is application to health and health related topics. As noted in many recent issues of Texas Psychologist, there is a growing need for training psychologists in the area of military health. The increasing national and regional interest in the mental and physical health of those in the military and their families, coupled with the large military population in San Antonio made the decision to develop a program in Health Psychology with a focus on military health a natural choice. Students in the proposed program will have the opportunity to take advantage of the diverse range of ethnic and cultural populations that uniquely characterize the San Antonio area. San Antonio is affectionately known as Military City USA because of the large number of military installations, active-duty military personnel, and military retirees who reside in the local area. The area also includes ready access to San Antonio’s large, multi-cultural population and the regionally-based health care system that addresses many health disparity issues in the area. Differences in ethnic and cultural backgrounds contribute in significant ways to the health problems that people develop and the effectiveness of their responses to treatments. For example cultural variables predict modes of coping with stress (Heppner et al., 2006) and the
likelihood of cigarette smoking (PerezStable et al., 2001). The diversity of today’s military personnel and their families make these issues vital to our understanding of military health. Many enlisted personnel identify as Black or Hispanic, together making up over 30% of some branches (Office of the Undersecretary of Defense, Personnel and Readiness, 2010). San Antonio provides graduates from the program with a unique opportunity to gain experience working with a diverse population. This, in turn, improves their ability to determine when cultural issues are likely to influence health assessments and/or interventions with personnel and families in a military setting.
Expertise on health issues is well-represented among the faculty in the psychology department at UTSA. For example, current research by core program faculty is being conducted on PTSD, substance use, partner violence, health related risk taking, stress and coping, pain, anger management, emotional experience and regulation in the workplace, training for stressful environments, depression and suicide ideation, and measurement of these factors. Some of these problems are common among military personnel and their families, yet not as widely publicized as those associated with PTSD or depression; however, recent studies indicate that these problems are on the rise. For example, The National
“There is a growing need for training psychologists in the area of military health.” As in our Psychology Master’s program, training will include a strong emphasis on research design and quantitative skills that will enable students to work in collaborative research teams. The purpose of these teams will be to identify, prevent, and treat behaviors commonly associated with the development of a range of physical and mental illnesses. Thus, the doctoral program will prepare students for employment in the larger arena of health psychology and encourage their leadership in the translation of research during and after their training. The breadth of our training strengthen the marketability of our graduate students for PhD-level and research-oriented jobs in the military, medicine, and business, and also provides them with a competitive advantage for PhDlevel jobs in the academic sector that emphasize mental and physical health.
Institute on Drug Abuse (NIDA) has found that the rate of substance use disorders (SUD) is growing among military personnel, with approximately 1.8 million veterans affected by such disorders (NIDA, 2009). Moreover, SUD research and treatment is needed most among personnel currently returning from combat with posttraumatic illnesses. Federal agencies have named the design and evaluation of SUD intervention programs for military personnel an important priority (NIDA, 2009). Although rigorous training in methodology, assessment and health psychology prepares students to address these types of issues, few programs provide students the opportunity to apply their training outside the lab, and even fewer provide students the opportunity to apply this training in military settings. Our PhD program will address precisely these needs by training researchers who will become uniquely qualified to work
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with the military to identify potential risks for issues such as SUDs, partner violence and sexual assault, develop organization-specific interventions, and evaluate existing and new intervention programs. The Psychology Department at UTSA has already established an impressive record in health disparities research. Over the past six years, our faculty have attracted funding to support health-related research initiatives, including several multiyear research programs: the San Antonio Health Services Research Program funded by the Agency Health Care Research and Quality and the South Texas Initiative for Mental Health Research funded by NIMH. In preparation for implementing the program, we have assembled a collaborative team including administrators and researchers at the University of Texas Health Science Center at San Antonio (UTHSCSA), the VA Hospital in San Antonio, and the Department of Behavioral Medicine at the San Antonio Military Medical Center (SAMMC). UTHSCSA, in collaboration with UTSA and several other research institutions, is the center for the $35 million Department of Defense (DoD) funded STRONG STAR Multidisciplinary PTSD Research Consortium. Our new PhD program will have research and training opportunities at all of these San Antonio locations. This collaboration will be realized through faculty coordination, internship opportunities, and jointclassroom instruction. No other PhD program in the state offers a comparable emphasis on Military Health. Only one other program nationally has a focus on Military Health. Uniformed Services University in Bethesda, Maryland offers two tracks that specialize in training directly related to Military Health and a third track that focuses on biobehavioral research. The first track is limited to military students and leads to an accredited degree in Clinical Psychology. The second track is open to civilians and leads to an accredited degree in Medical and Clinical Psychology. The primary focus of both tracks is to train psychologists to provide clinical service to the military, and students in both tracks are required to serve in the military following graduation. The third track is open to civilians and encourages students to pursue research projects that combine interests in psychology
and the biomedical sciences. In comparison, UTSA’s program aims to provide students with a wide range of quantitative skills and research experience that will enable them to work in teams with clinical psychologists and medical personnel to identify the causes of, and evaluate alternative solutions to, many of the behavioral and mental health problems faced by military personnel and their families. In this regard, students will be involved in programs of research that draw on the expertise of faculty from many areas of psychology outside of the clinical domain. Students will not be required to serve in the military following graduation, however, their research experiences in the program are likely to lead many of them to want to pursue careers that feature extensive and long-term research collaborations with clinical psychologists and biomedical researchers in military agencies. Program Objectives Graduates will be expected to extend their knowledge of psychological theory and experimental methods to areas of applied interests, especially in the areas of health and military health. Students will have several options to pursue their research interests in applied settings. One option includes the arrangement of up to nine hours of graduate internships with local military, health business, and research organizations. Past and current students in the Masters of Science in Psychology program have been employed as interns by UTHSCSA, The Research Imaging Center (RIC), the testing and measurement division of Pearson Testing Company, and several research organizations at Brooks CityBase. These internships have been successful experiences for both students and the organizations and have led to the placement of nearly half of the graduates from the Master’s program in research-related positions. Graduates of the program will also be expected to acquire advanced knowledge of theoretical principles in the core areas of Psychology. A sophisticated and comprehensive understanding of these principles is critical to the future success of students, irrespective of whether they pursue careers in academic or applied settings. Students in the program will benefit from the expertise offered by the faculty in the area of quantitative and experimental methods, and the utilization of these methods in the area of Military Health Psychology.
Students will have the opportunity to apply their knowledge of research design, methodology, and statistics to research focusing on theories and behaviors related to physical and mental health, individual and group decision making, belief maintenance and attitude change, cross-cultural interactions, and assessment.
“UTSA’s program aims
to provide students with a wide range of quantitative skills and research experience that will enable them to work in teams with clinical psychologists and medical personnel to identify the causes of, and evaluate alternative solutions to, many of the behavioral and mental health problems faced by military personnel and their families.
Curriculum The PhD program is designed for students who have completed a Master’s program, including an empirical thesis. Although we will consider conditional admission of exceptional students without a Master’s in psychology or a related field, we anticipate the majority of entering students will have considerable research experience including a completed thesis. The program will build on coursework typically taken in a MA/MS program. Core courses. In their first year, students will complete nine hours of core coursework which includes multivariate statistics, advanced research design and military health psychology. The multivariate statistics and design courses cover material typical for such courses including principal component analysis, factor analysis, discrimination and classification analysis, and clustering; and multilevel modeling, complex sampling, experimental, quasi-experimental, and
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mixed designs, respectively. Material in military health psychology will include military cultural competency, psychological assessment, population health, intervention, and treatment of health-related issues of importance to the military, such as depression, PTSD, substance abuse, and combat-related injuries. Approaches to prevention and resiliency in military personnel and their family members will also be addressed. Advanced Seminars. Students are also required to complete four advanced seminars. In keeping with the program focus, seminars in biopsychology, clinical psychology, applied social psychology, applied cognitive psychology, and diversity and health disparities will all incorporate research relevant to health. For example, the biopsychology seminar will cover empirical and clinical findings that contribute to current knowledge of brain-behavior relationships, the structural and functional changes associated with specific clinical conditions including traumatic brain injury, neurotransmitter imbalance and specific related disorders, and the effects of stress on brain structure and function. In the clinical psychology seminar, students will critically evaluate prevention, assessment, and intervention strategies used to address clinical problems in a military environment. Topics include depression, PTSD, clinical issues related to injuries and rehabilitation, substance abuse, family and partner conflict, combat-related stress disorders, and promotion of resiliency. Seminars in social and cognitive psychology will address psychological approaches that can be applied to understanding the prevention, etiology, and treatment of health disorders from their respective standpoints. Finally, our seminar in diversity and health disparities addresses differences in prevention, etiology, health care delivery, and response to intervention related to gender, racial/ethnic identity, socioeconomic group, and/or geographic region of origin. Research reviewed in the seminar will include differences in the type and rate of specific health problems in different groups, differences in access and response to prevention and treatment interventions and differences in the role of organizational, family-based and social support in health-care interventions.
Electives. We anticipate that students will have varied reasons for pursing a doctorate, and have included six hours of electives that will allow them to tailor their coursework to their specific interests. Several courses address advanced statistical methods such as nonparametric statistics, time series analysis, Bayesian statistics, and categorical data analysis. In addition, students with interests related to public health can opt to take coursework in epidemiology. Finally, we will be offering courses in grant development and program evaluation. Grant development will provide students with an overview of the grant writing process. Literature review, theoretical rationale, budget, evaluation protocols, and IRB requirements will be discussed. Local, state, national, government, and private funding sources will be reviewed. The final product will be a completed grant proposal. To meet the growing demand for trained program evaluators, students will have the opportunity review the process by which health-related programs are planned, implemented, and evaluated in various communities and work-related settings in the program evaluation course. Financial Support We anticipate that some students will elect to continue their professional positions while pursuing their doctorate. However, we recognize that full-time outside employment would impede most studentsâ€™ timely completion of the program and that this program would best fulfill the needs of those students who wish to pursue their studies on a full-time basis. Therefore, the program will offer teaching assistantships and research assistantships to a large majority of the students who are enrolled full-time (9 hours per semester). Externally-funded grants obtained by faculty members in the department permit the employment of graduate students as Research Assistants (RAs) for sponsored projects. Faculty members in the department have obtained 41 externally-funded grants in the past five years, totaling over $13,691,000 in awards. These grants have enabled the department to employ an average of seven MS-level graduate students each semester as RAs for sponsored projects, and a total of 65 different Research Assistant positions have been awarded to psychology MS students since January 2004. While all
students are expected to be actively involved in research, RA positions will provide exceptional students with the opportunity to gain knowledge conducting funded research. Depending on the specific needs of the supervising faculty member, RAs are involved to some degree in study design, participant recruitment, data collection, analyses, and dissemination of study results in publications and at conferences. Teaching Assistantships provide students with an apprenticeship in teaching where they learn the craft by working closely with faculty members in all aspects of a particular course. Students who have an interest in teaching and exhibit the necessary knowledge of material will be invited to be instructors for the undergraduate laboratory sections of Experimental Psychology. This model has been used successfully in the Masterâ€™s program and will be implemented for the doctoral students. TAs are closely supervised and reviewed by faculty members throughout the duration of their teaching responsibilities. TAs are given supplemental material to help them organize lectures and grade papers. Weekly supervision meetings, organized as a vertical practicum, provide opportunities for new TAs to learn from more experienced instructors. Topics covered in weekly meetings include developing syllabi, leading class discussions, incorporating technology in the classroom, class management, assessment, and communication with students. In the event that doctoral level TAs meet or exceed performance expectations for the laboratory course, they may be invited to teach sections of Introductory Psychology or sophomore level classes in their area of expertise. Our department is excited to see many years of planning come to fruition. Many faculty members have been actively involved in the development of the PhD proposal over the last decade. Others were recruited in more recent years in preparation for the program. We look forward to training a new generation of scientists to work alongside practitioners in our field.
Rebecca Weston, PhD is Associate Professor of Psychology, University of Texas at San Antonio and the Director of the doctoral program in Health Psychology.
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Thank You for Your Contribution Texas Psychological Association would like to thank the following individuals for their 2012 contribution to Association for the Advancement of Psychology in Texas, the Doctoral Defense Fund, and the Legislative Champion Fund:
Association for the Advancement of Psychology in Texas Contributors Paul Andrews, PhD Tim Branaman, PhD Betty Cartmell, PhD Ron Cohorn, PhD Mary Cox, PhD Sharon Davis, PhD Sid Dickson, PhD Alexandria Doyle, PhD Michael Duffy, PhD Frank Fee, PhD Jack Ferrell, PhD
John Godfrey, PhD George Grimes, PhD Charles Haskovec, PhD Thomas Johnson, PhD Sarah Kramer, PhD Thomas Kremer, PhD Linda Ladd, PhD, PsyD Stephen Loughhead, PhD Thomas Lowry, PhD Ronald Massey, PhD Richard McGraw, PhD
Robert Mehl, PhD Michael Morris, PsyD Lee Morrison, PhD Mirenda Putney, PsyD Mary Robinson, PhD Verlis Setne, PhD Larry Thomas, PhD Deborah Voorhees, PhD Maryanne Watson, PhD, ABPP Patricia Weger, PhD Mimi Wright, PhD
Doctoral Defense Fund Contributors Nancy Amodei, PhD APA Ray Brown, PhD Kay Campbell, PsyD Terri Chadwick, PhD Sean Connolly, PhD Maria Constantatos Corley, PhD Shannan Crawford, PsyD Leslie Crossman, PhD Sally Davis, PhD Alexandria Doyle, PhD
Bonny Gardner, PhD John Godfrey, PhD Melanie Gordon-Sheets, PhD Charles Gray, PhD Robert Heath, PhD Robert Hemfelt, EdD Sarah Kramer, PhD Joseph McCoy, PhD Andy McGarrahan, PhD Richard McGraw, PhD Michael Morris, PsyD
Lee Morrison, PhD Michael Pelfrey, PhD Beth Peters, PhD Allison Sallee, PhD, LMFT Gregory Simonsen, PhD Mary Teague, PhD Deborah Voorhees, PhD Patricia Weger, PhD David Welsh, PhD
Legislative Champion Contributors Nancy Amodei, PhD Paul Andrews, PhD Ray Brown, PhD Terri Chadwick, PhD Sean Connolly, PhD Mary Cox, PhD
Garry Feldman, PhD Richard Fulbright, PhD John Godfrey, PhD George Grimes, PhD Deidra Heller, PhD Victor Hirsch, PhD
Greg Joiner, PhD Robert Mehl, PhD Dorothy Pettigrew, PsyD Rhonda Polakoff, PhD Eileen Raffaniello-Barbella, PhD Mary Robinson, PhD
www.texaspsyc.org Spring 2012
TPA Online Continuing Education Earn continuing education credits online at your convenience. TPA offers video and paper format home-study programs. Visit www.texaspsyc.org for more information.
SHEPHERD, SCOTT, CLAWATER & HOUSTON, L.L.P. A T T O R N E Y S A T L AW
Representing Mental Health Professionals in the following areas: • Board Complaints • Malpractice Lawsuits • Business Disputes • General Litigation SAM HOUSTON, Partner Board Certified - Personal Injury Trial Law Texas Board of Legal Specialization Associate: American Board of Trial Advocates firstname.lastname@example.org 2777 ALLEN PARKWAY, 7TH FLOOR HOUSTON, TEXAS 77019-2133 (713) 650-6600 • FAX (713) 650-1720 www.sschlaw.com
www.texaspsyc.org Spring 2012
TEXAS PSYCHOLOGICAL ASSOCIATION P.O. Box 1930 Cedar Park, TX 78630
2012 Annual Convention Innovation
Westin at the Domain-Austin November 1-3, 2012
Trailblazing into Austin on November 1-3, 2012 Visit www.texaspsyc.org for additional information, and to submit proposals.