William O’Donohue

Rape Prevention With College Males The Roles of Rape Myth Acceptance, Victim Empathy, and Outcome Expectancies

This study investigated the immediate impact of a video-based prevention program developed to decrease undergraduate men’s potential to commit rape. Three video segments (rape myth acceptance, victim empathy, and outcome expectancies) were developed through expert consultation and focus groups. Evidence for the construct validity of each component was evaluated by examining change scores in a pilot study of 101 male undergraduates on measures of rape myth acceptance, victim empathy, and outcome expectancies. In the main study, 102 male undergraduates were randomly assigned to either the experimental program consisting of the video-based intervention or an equivalently long, alternate video-based program judged to contain none of the experimental elements. The experimental video produced greater immediate changes on measures of rape myth acceptance, attitudes toward interpersonal violence, adversarial sexual beliefs, attraction to sexual aggression, rape empathy, and self-efficacy ratings. Limitations of this study and directions for future research with college men are discussed.

Web-based treatment for infertility-related psychological distress.

Infertility has been associated with stigma and negative psychosocial functioning. However, only a small proportion of this population actually receives care. Fertility patients predominantly use the Internet for information gathering, social support, and assistance with decision-making; yet, available web resources are unreliable sources of mental health care. Web-based alternatives also have the potential to assist with intervention access difficulties and may be of significant lower cost. This study evaluated the efficacy of a web-based approach to providing a cognitive behavioral intervention with 31 infertile women seeking medical reproductive technologies. Following randomized assignment, participants using the web-based intervention were compared with those in a wait-list control condition on general and infertility-related psychological stress measures. Results were mixed regarding intervention efficacy. Significant declines in general stress were evidenced in the experimental group compared with a wait-list control group. However, website access did not result in statistically significant improvements on a measure of infertility-specific stress. These findings add to the literature on psychological interventions for women experiencing fertility problems. Moreover, despite the widespread use of the Internet by this population, the present study is one of the first to investigate the usefulness of the Internet to attenuate stress in this population. Preliminary results suggest general stress may be significantly reduced in infertile women using an online cognitive behavioral approach.

The Unmet Educational Agenda in Integrated Care

One of the reasons integrated care has not become a dominant service delivery model is the unmet training agenda. This article argues that the typical mental health professional is not trained to adequately address the challenges of integrated care. To insure competency both a macro and clinical training agenda are needed. At the macro-level, mental health professionals need to understand healthcare economics and basic business principles as any integrated care service delivery system is embedded and driven by economic forces. Integrated care practitioners also need some basic business skills to understand these forces and to create and manage a financially viable system, given the future flux of the system. Traditional mental health professionals also do not have the clinical skills to implement integrated care. Integrated care is not simply placing a traditionally trained mental health professional and letting them practice specialty mental health in a medical setting. Thus, the special skills needed in integrated care are enumerated and discussed. Finally, a new degree program is described as it is time given the huge need and advantages of integrated care to develop specialty training in integrated care.

Cultural Sensitivity: A Critical Examination

Abstract The construct of cultural sensitivity plays an increasing important role in psychology, including several key roles in the American Psychological Associations Ethics Code. We critically evaluate this construct. Problems associated with this construct are discussed including: (1) problems parsing and validly attributing cultural status; (2) lack of clarity concerning what constitutes sensitivity and the implications for ethically mandated behavior; and (3) unintended potential negative effects. We propose seven potential dimensions of cultural sensitivity which range from being able to accurately identify what culture(s) a person belongs to, to being able to implement appropriate action in a culturally sensitive manner. We call for an approach beyond a superficial acceptance of cultural sensitivity and counsel a more cautious stance toward cultural sensitivity.

The Case for Evidence-Based Stepped Care as Part of a Reformed Delivery System

Healthcare is in crisis in the United States (Cummings and O’Donohue, 2008). Most view healthcare as too costly, of uneven quality, difficult to access, and inefficient. Behavioral healthcare is no different. Practitioners often charge 10–20 times the minimum wage (and sometimes argue that even this price is insufficient) and provide assessment and therapies of unknown quality or those that are obviously deficient (e.g., Rorschach, rebirthing, drum circles) (Lilienfeld et al., 2008). Waits for child psychiatrists can be from months to half a year, and services are unevenly distributed geographically.

The Construct of Grooming in Child Sexual Abuse: Conceptual and Measurement Issues

There have been claims that some child molesters engage in a “seduction stage” prior to committing abuse. These behaviors, commonly known as “grooming,” are understood as methods child molesters use to gain access to and prepare future victims to be compliant with abuse. However, there is a lack of consensus regarding exactly what this process entails and how it is clearly distinguished from normal adult–child interactions. It is important to devise an accurate definition of grooming for scientific, clinical, and forensic purposes. We critically evaluate the various definitions and reveal problematic heterogeneity. Furthermore, there are no methods of known psychometrics to validly assess grooming. We review the empirical literature regarding the occurrence of grooming and propose future directions for research.

The Role of Psychological Factors in Medical Presentations

Research shows that a large number of medical presentations do not result in a medical diagnosis but rather are related to behavioral health problems. Factors such as age, lower education and economic status, health beliefs, and medical and psychological factors are linked to high medical service utilization. Research consistently shows that patients with psychological problems use more services than those without diagnosable psychological problems. The purpose of this paper is to provide a more detailed analysis of the roles of psychological factors in medical presentations. We present three kinds of pathways by which psychological factors lead to medical presentations. These include the (1) primary or direct medical presentation of a clinical problem, (2) secondary presentation or the impact of the clinical problem on patients’ general physical, psychological, or psychosocial health, and (3) the complex presentation or the impact of multiple diagnoses on the presentation of the clinical problem. Examples of each of these pathways are presented for each axis of the DSM-IV.

We are not a Healthcare Business: Our Inadvertent Vow of Poverty

Psychology has been fractionated from mainstream healthcare delivery and this schism has resulted in huge costs to psychologists and our intended customers. Psychology has also been naïve economically. The authors suggest three revolutions: (1) for clinical psychology to be better integrated into the healthcare delivery system; (2) for psychologists to better understand healthcare economics and business; and (3) for psychologists to become more entrepreneurial, i.e., see needs in healthcare (such as those of the elderly, obesity, improved access and value through ehealth) and systematically fill these. We note high quality businesses help many individuals (customers, family members, employees) not typically recognized by anti-business psychologists.

A Pilot Study Investigating Behavioral Prescriptions for Depression

Depression is a prevalent and expensive condition. Many patients are seeking and receiving treatment for depression in the primary care setting where pharmaceutical interventions prevail as the predominant treatment. While psychotropic medications can certainly help ameliorate mental and behavioral problems, all medical interventions carry with them certain risks and side effects. A natural multiple-baseline (across participants), single-case experimental design was used in a pilot study to evaluate the feasibility of “behavioral prescriptions” for cognitive-behavioral bibliotherapy with five depressed patients in a primary care setting. Results indicated that final depression self-report scores were lower than baseline and pre-treatment reports for every participant. At three month follow-up, three out of five participants reported no symptoms of depression, one participant reported minimal symptoms of depression, and one participant reported mild symptoms of depression. Behavioral prescriptions for cognitive bibliotherapy warrant further controlled research and may offer a cost-effective and practical treatment alternative to the pharmaceutical intervention of depression in primary care.

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.