Cassandra Snipes

The Ethics of Enhanced Interrogations and Torture: A Reappraisal of the Argument

This article critically reviews what is known about the ethical status of psychologists’ putative involvement with enhanced interrogations and torture (EITs). We examine three major normative ethical accounts (utilitarian, deontic, and virtue ethics) of EITs and conclude, contra the American Psychological Association, that reasonable arguments can be made that in certain cases the use of EITs is ethical and even, in certain circumstances, morally obligatory. We suggest that this moral question is complex as it has competing moral values involved, that is, the humane treatment of detainee competes with the ethical value/duty/virtue of protecting innocent third parties. We also suggest that there is an ethical duty to minimize harm by making only judicious and morally responsible allegations against the psychologists alleged to be involved in EITs. Finally, we make recommendations regarding completing the historical record, improvements in the professional ethics code, and the moral treatment of individuals accused in this controversy.

Suicidal ideation in adult offspring of depressed and matched control parents: Childhood and concurrent predictors

Background Suicidal ideation predicts suicide behaviors; however, research is needed on risk factors for suicidal ideation in adults, a common developmental period for first suicide attempts. Aims To examine childhood and concurrent predictors of suicidal ideation among 340 adult offspring of depressed and matched control parents. Method Parents were assessed at baseline, and adult offspring were assessed 23 years later. Results Offspring who reported past-month suicidal ideation (7%) had parents who, 23 years earlier, reported suicidal ideation, psychological inflexibility and use of avoidance coping. Offspring experiencing suicidal ideation were more likely to be unemployed and more depressed, consumed more alcohol and had more drinking problems. They were more anxious and inflexible, had weaker social ties and less cohesive families and had more negative life events and used more avoidance coping. A childhood risk index predicted offsprings suicidal ideation above and beyond concurrent factors. Conclusions Along with concurrent risk factors, poor parental functioning may confer long-term risk for adult suicidal ideation. Interventions to prevent the transmission of suicidal ideation to offspring should focus on ameliorating parental risk factors.

A Case Study of Overselling Psychotherapy: An ACT Intervention for Diabetes Management

There have been numerous indications that the scientific literature regarding treatment safety and effectiveness can be biased. In this case study, we examine several reports relevant to an acceptance and commitment therapy (ACT) intervention attempting to improve diabetes self-management. The analysis indicated that several key negative results found in the original research—a dissertation—were not reported in the subsequent journal publication. Further, descriptions by some of the original authors in other peer-reviewed publications did not accurately portray the actual results reported in the dissertation. Also, subsequently a diabetes management self-help book was published by the same authors, that contained claims that this intervention is supported by the dissertation results although the dissertation only studied group face-to-face contact. Questions are raised regarding whether professionals and consumers are being misled about data that allegedly support claims about the efficacy of this intervention and serious methodological shortcomings of the original dissertation, that were not reported in the subsequent journal publication, are noted that add to the concern that the ACT intervention is being oversold.

Comparison of standardized versus individualized caloric prescriptions in the nutritional rehabilitation of inpatients with anorexia nervosa.

OBJECTIVE Sparse research informs how caloric prescriptions should be advanced during nutritional rehabilitation of inpatients with anorexia nervosa (AN). This study compared the impact of a standardized caloric increase approach, in which increases occurred on a predetermined schedule, to an individualized approach, in which increases occurred only following insufficient weight gain, on rate, pattern, and cumulative amount of weight gain and other weight restoration outcomes. METHOD This study followed a natural experiment design comparing AN inpatients consecutively admitted before (n = 35) and after (n = 35) an institutional change from individualized to standardized caloric prescriptions. Authors examined the impact of prescription plan on weekly weight gain in the first treatment month using multilevel modeling. Within a subsample remaining inpatient through weight restoration (n = 40), multiple regressions examined the impact of caloric prescription plan on time to weight restoration, length of hospitalization, maximum caloric prescription, discharge BMI, and incidence of activity restriction and edema. RESULTS There were significant interactions between prescription plan and quadratic time on average weekly weight gain (p = .03) and linear time on cumulative weekly weight gain (p < .001). Under the standardized plan, patients gained in an accelerated curvilinear pattern (p = .04) and, therefore, gained cumulatively greater amounts of weight over time (p < .001). Additionally, 30% fewer patients required activity restriction under the standardized plan. DISCUSSION Standardized caloric prescriptions may confer advantage by facilitating accelerated early weight gain and lower incidence of bedrest without increasing the incidence of refeeding syndrome.

The Design, Manufacture, and Reporting of Weak and Pseudo-Tests: The Case of ACT

Scientific testing, including randomly controlled trials, can vary in quality. We describe the Popperian concept of severe testing and delineate ways in which a randomly controlled trial can be weakened and thus made easier to pass. The acceptance and commitment (ACT) publications we have examined appear to instantiate many of these problematic research features. This contributes to the concern regarding overselling of ACT. We call for an explication of these sorts of design features when these occur as well as a minimization of these to decrease the number of false positive results. In addition, we respond to claims of misreading and misinterpretation.

Team-based stepped care in integrated delivery settings

Fragmented health care delivery is recognized as increasingly problematic. Integrated care has been advanced as a reform that will improve quality of care and lower costs. Despite the application of integrated care systems in the United States, there has been a limited amount of empirical work explicating the most effective health care pathways. Stepped care has been proposed as a framework by which to implement coordinated team-based care and has gained preliminary empirical support. In this manuscript a rationale for team-based stepped care is presented, tools for implementation are provided, and future research directions are suggested.

Psychologists and the Ethical Use of Enhanced Interrogation Techniques to Save Lives

Arrigo, DeBatto, Rockwood, and Mawe (2015) take issue with a number of arguments in our previous article (O’Donohue et al., 2014). We respond in four major ways: (a) pointing out that they never really take on, let alone refute, the key argument in our article—that utilitarian, deontic, and virtue ethical theories are not only consistent with the use of enhanced interrogation and torture in the ticking time bomb scenario but these prescribe it; (b) there are numerous other exegetical problems in their article; (c) they make unsubstantiated claims about the ineffectiveness of EITSLs techniques that we argue are much too strong; and (d) they conflate the ethical with the legal and but even in doing so miss many important issues regarding the legality of EITSLs in the war on terrorism.

Assessment of Anxiety with Hispanics

The Hispanic population is the fastest growing minority group in the United States, and, therefore, addressing issues surrounding provision of quality behavioral health care to this population is imperative. Anxiety disorders have a particularly high prevalence in the Hispanic population, with some lifetime prevalence estimates as high as 27% for women and 20% for men (Vega WA, Kolody B, Aguilar-Gaxiola S, Aldrete E, Catalano R, Caraveo-Anduaga J. Lifetime prevalence of DSM-IIR psychiatric disorders among urban and rural Mexican Americans in California. Arch Gen Psychiatry 55:771–778, 1998). Correct assessment of anxiety disorders is necessary for effective treatment planning and must be evidence-based. The psychometric properties of both English- and Spanish-language measures that have been standardized on a Hispanic population are discussed. Recommendations for use of each measure are also presented.

Using Quality Improvement to Increase Access to Behavioral Health Care in Federally Qualified Health Centers

Objectives: Integrated care programs, in which behavioral health is integrated in primary care settings, have been widely implemented as solution to rising health care expenditures. A number of recommendations for implementation of integrated care have been published in the past decade; however, data regarding how to produce the most effective system are lacking. This may be because of the fact that existing integrated care programs do not institute quality improvement initiatives that could generate this needed data. Methods: A quality improvement program was instituted at an integrated Federally Qualified Health Center. As a result, productivity and no-show rates were analyzed for two psychology externs providing integrated care services. A process map was created to identify systematic methods to improve outcomes. Results: There were statistically significant increases to productivity increased and decreases no-show rates through systematic changes. Conclusion: This case study provides evidence that quality improvement systems in integrated care can result in systemic changes that improve access to care.

Engaging Trauma Survivors in Treatment

The experience of trauma often necessitates increased involvement with the health care system and is a critical time point in promotion of future engagement in care. Unfortunately, few trauma survivors receive reasonable follow-up care medical and behavior health care. Strategies for engaging both civilian and military populations following a range of potentially traumatic events are highlighted—including but not limited to psychological first aid, integrated care, and peer community outreach programs.