HOW CAN WE USE THIS 

Alex Pieterse, and colleagues (2023) reviewed the literature on racism and racial trauma and the significant and negative impact they have on general health outcomes (https://psycnet.apa.org/record/2023-64375-001).  They conclude that as opposed to avoiding the discussion of race and racism it is curative to embrace a client’s experiences and the influence they can have on their difficulties.  While they acknowledge racism as a societal problem calling for public health and structural approaches, their work results in guidelines consistent with the principle of “first, do no harm” and the role therapeutic context and targeted strategies can play in the facilitation of healing.  This includes clinicians’ being familiar with the evidence demonstrating the negative psychological and physical health effects that result from racism, and how racial identity influences explicit and implicit views of the world including their own. The authors acknowledge that clinicians may be hesitant to raise issues related to racism but emphasize the potential dangers of not broaching the subject.  Avoidance limits the ability to process emotional interactions and interferes with the openness necessary to maintain a functioning working alliance.  The expression of a sincere interest in hearing about and empathizing with a client’s experiences validates who they are and can provide a platform for processing emotions and building agency as a survivor as opposed to being a victim of racism and racial trauma.

While the principles that Pieterse, et al. (2023) prescribe are focused on racism, they are very relevant to working generally with differences and there are always differences.  

 HOW CAN WE USE THIS #2

Jessica Cavalli, et al. (2023) linked poor executive functioning (EF) and parental cannabis use as predictive factors to the heavier use of cannabis and the use of alcohol in later adolescence (https://psycnet.apa.org/doiLanding?doi=10.1037%2Fadb0000891). While this supports EF as a prevention target in early adolescence my thoughts turned to the idea that it may also serve as a treatment and support for recovery target for adolescents and young adults that develop a substance use disorder (SUD).  I did a further literature search and found correlational work linking EF with other factors including parenting, intergenerational transmission, environmental conditions, Traumatic brain injury (TBI), anxiety and depression, academic performance, and several studies linking EF, to include impulsivity, to SUD, both in early adolescence concurrently and Leading to SUD problems in later adolescence and early adulthood (e.g., Kim-Spoon, et al., 2017, and Jones, et al., 2021 respectively).  These EF- SUD linkages suggest that targeting EF as a component of adolescent SUD treatment may serve as a fruitful pursuit and there were no studies identified that directly took this approach.  There were however approaches to improving EF in adolescents and young adults that may be promising if applied to SUD treatment.  These include ThinkSMART® (Ellis, et al., 2023); Learning to Breathe (L2B, Frank et al., 2021); and, aspects of Cognitive Behavioral and dialectical behavior therapies (e.g., emotional control, shifting, monitoring, and global executive functioning; Smith et al., 2019). Chaku, et al., also identified differences in EF with heterogeneous groups that call for approaches to skill building targeting specific deficits.  His ideas fit well into SUD treatments that are, in some respects individualized.      

There were also instruments identified that would serve as initial assessment, progress tracking, and outcome measures.  These include the BRIEF-SR (https://psycnet.apa.org/record/2013-32429-001), and the TEXI (https://psycnet.apa.org/record/2020-13810-001). 

 HOW CAN WE USE THIS? 

Katie Witkiewitz, et.al. (2023) returned to the databases of foundational research, COMBINE (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945872/) and Project MATCH (https://www.niaaa.nih.gov/news-events/news-releases/niaaa-reports-project-match-main-findings), to view it through the lens of the Alcohol and Addiction Research Domain Criteria (AARDoC, Litten, et.al. 2015). This was an attempt to see if the criteria can predict outcomes and inform the development of a pragmatic instrument to guide alcohol use disorder treatment planning.  Their efforts are in the spirit of precision medicine, or identifying treatments that target elements specific to the person in treatment.  The domains, that fall on a trajectory of severity (reward/incentive salience, relief/negative emotionality, and loss of control/executive functioning), also speak to the motivations for alcohol use and suggest potential targets for intervention; e.g. alternatives for rewards, emotional improvement, and cognitive behavioral functioning respectively.  The domains may also be relevant to the trajectory of other use disorders and thus have applicability that is more general.  The self-report items that mapped to the domains are in the Witkiewitz, et.al. (2023) article (https://psycnet.apa.org/doiLanding?doi=10.1037%2Fadb0000871) and they might serve to draft an instrument for trying out the concept and perhaps eventual validation.      

 A special issue of the Psychology of Addictive Behaviors (February 2023) features articles focusing on “addictive behavior as behavioral allocation;” that is how shifts and the balance in molar (extended or continuous) behavioral investments contribute to recovery or the worsening of substance use problems and life difficulties (https://pubmed.ncbi.nlm.nih.gov/35787099/). This was a déjà vu of sorts for me as I proposed a not-dissimilar hypothesis related to the intersection of work dysfunction and addiction as having common roots in the Journal of Substance Abuse Treatment (Comerford, 1999; https://pubmed.ncbi.nlm.nih.gov/10194742/).  In short and in combination, all of these articles speak to the role that context, change, and the development of self-efficacy play in whether someone moves toward a stable recovery or the reverse over time. The implications for treatment and the role that social determinants and having opportunities for rewarding alternatives for substance use from which to choose.  Tough problems today as I was recently reminded by a counselor who stopped by to ask if I had ideas to help an older woman with no resources and few if any options; I had nothing to add to the great work that had been done.  Once yet again, the tough decisions we guide with empathy, and all the continued support we can bring to bear in the face of the limited resources we often have to work with.  By the way, I am often awestruck by some of the miracles we pull off in the face of these persistent challenges.  The full text of the two articles noted above and the complete journal are available at the links provided and may spark some ideas for crafting continuing care plans as we continue to advocate for more ways to help.          

Some thoughts on: Health Psychology 2020, Volume 39, Issue 8 (Aug)

 

Relationship quality and 5-year mortality risk.
Pages 633-641. Bookwala, Jamila; Gaugler, Trent.e criticism heightens the risk of mortality in older Americans.  It’s important that we assess the quality of relationships in a person’s life to see if interventions to reduce relationship conflict are called for. 

Impulsivity and midlife cardiometabolic risk: The role of maladaptive health behaviors.

Pages 642-654. Emery, Rebecca L.; Levine, Michele D.; Creswell, Kasey G.; Wright, Aidan G. C.; Marsland, Anna L.; Matthews, Karen A.; Flory, Janine D.; Manuck, Stephen B. https://doi.org/10.1037/hea0000884

Two personality factors affected risk; extraversion reduced and neuroticism increased.  These outcomes are likely related to the basic cognitive behavioral principle that how we think about things foretells behavior and predicts outcomes.  We act out what we are to become long before we get there. 

 

Affect variability and inflammatory markers in midlife adults.
Pages 655-666. Jones, Dusti R.; Smyth, Joshua M.; Engeland, Christopher G.; Sliwinski, Martin J.; Russell, Michael A.; Sin, Nancy L.; Almeida, David M.; Graham-Engeland, Jennifer E. https://doi.org/10.1037/hea0000868   

Affect can be looked at as stimulation and, in this case, level of and variability around mean positive and negative affect, high and low, impacted inflammatory markers.  These mixed outcomes reinforce the fact that psychology affects biology and the reverse. In this case quasi-personality factors like resilience (neuroticism) and internal vs. external locus of control (extraversion) may be drivers that influence biological inflammation that can have a negative impact on health. This may be one of the drivers of the poorer health outcomes of those with mental health disorders; extremes of affect in things like Major Depression Anxiety and Bipolar disorders.  Fortunately these would-be personality factors are not fixed traits and respond well to cognitive behavioral therapies. 

A cluster randomized controlled trial of a positive physical activity intervention.
Pages 667-678. Ho, Henry C. Y.; Mui, Moses Wai-keung; Wan, Alice; Yew, Carol Wing-see; Lam, Tai Hing. https://doi.org/10.1037/hea0000885

Couching physical activity in a positive frame within a community altered the collective meaning of taking part in physical activity.  This project built upon the basic research on the effect community norms have on individual thoughts and actions.  This basic principle also supports the role that 12-step community’s play in changing minds; imbedding oneself and engaging with alternative community norms supports the new behaviors and outcomes of a recovery trajectory and thus research support for the guidance to “change people, places and things.”     

 

Psychometric properties of the Adulthood Trauma Inventory.
Pages 679-688. Wittbrodt, Matthew T.; Vaccarino, Viola; Shah, Amit J.; Mayer, Emeran A.; Bremner, J. Douglas. https://doi.org/10.1037/hea0000856

The psychometrics support the assumption that the more trauma experienced, the greater the likelihood of meeting the diagnostic criteria for depression and/or PTSD.  This is consistent with the research on Adult Childhood Experiences (ACES).  Cognitive treatments, exposure, CBT for Trauma, ACT, all work toward the integration of traumatic experiences in ways that reduce intrusive thoughts and allow for moving forward more productively.

 

Daily illness appraisal and collaboration in couples with type 1 diabetes.
Pages 689-699. Berg, Cynthia A.; Helgeson, Vicki S.; Tracy, Eunjin Lee; Butner, Jonathan E.; Kelly, Caitlin S.; Van Vleet, Meredith; Litchman, Michelle L. https://doi.org/10.1037/hea0000871   

The outcome here reinforce cautions that efforts to be helpful can have negative effects by raising defenses and/or diminishing self-efficacy; e.g. unsolicited advice. Motivational Interviewing and Scott Miller’s thoughts on “the client’s theory of change” counter the tendencies to tell people what they “should” do that have contrary outcomes.    

 

Biopsychosocial predictors of trajectories of postpartum sexual function in first-time mothers.
Pages 700-710. Dawson, Samantha J.; Vaillancourt-Morel, Marie-Pier; Pierce, Marianne; Rosen, Natalie O. https://doi.org/10.1037/hea0000861

Health-related behaviors, socioeconomic factors, and environmental factors are by for the greatest contributors to health outcomes and thus it is not surprising that psychosocial factors were significantly associated with not experiencing significant problems, biomedical factors were not.  The purpose of the psychosocial history is to determine contextual elements that may be contributing to distress to avoid pathologizing someone with a diagnosis, the cause of their own symptoms.  Empathy, unconditional positive regard and congruence are (Carl Rogers) are the healing factors. 

Type D personality and global positioning system tracked social behavior in patients with cardiovascular disease.
Pages 711-720. Habibović, Mirela; Gavidia, Giovana; Broers, Eva; Wetzels, Mart; Ayoola, Idowu; Ribas, Vicent; Piera-Jimenez, Jordi; Widdershoven, Jos; Denollet, Johan. https://doi.org/10.1037/hea0000823

Inhibitions rooted in personality traits may lead to increased isolation over time through the reinforcement of avoidant behavior; the avoidance of perceived stressful situations serves as its own reward by reducing stress.  Approach (exposure and cognitive processing), as opposed to avoidance, offers alternative and, if framed correctly, greater rewords in the experience of an increased sense of control and experience of mastery.

 

Numeracy and memory for risk probabilities and risk outcomes depicted on cigarette warning labels.
Pages 721-730. Shoots-Reinhard, Brittany; Erford, Breann; Romer, Daniel; Evans, Abigail T.; Shoben, Abigail; Klein, Elizabeth G.; Peters, Ellen. https://doi.org/10.1037/hea0000879

The findings that more numerate and educated smokers may be better able to quit is consistent with the demographics of smokers; less educated, exhibit psychological distress. 

      

Some thoughts on: Psychology of Addictive Behaviors v34, N0. 4

Below are some thoughts that came to me as a read through this current journal.  I tend to first reflect on how the results of research relate to basic psychological principles and secondarily what it means to my main interests and treatment work.  

The relationship between unplanned drinking and event-level alcohol-related outcomes.
Pages 497-505. Lauher, Miranda L.; Merrill, Jennifer E.; Boyle, Holly K.; Carey, Kate B. https://doi.org/10.1037/adb0000553

This article appears to reflect the role that expectations play in drinking outcomes.  Specifically planned drinking events more clearly define psychosocial context and will likely have more concrete expectations than non-planned events and thus prompt higher consumption.  This raises the question of the role that expectations play in planned abstinence and adherence to the abstinence plan.  This likely has both biological and psychological components for example: cells can produce a lasting response to a memory or trigger and this can be reinforced by social influence and impulse in context.        

Bidirectional relationship of posttraumatic stress disorder (PTSD) symptom severity and alcohol use over the course of integrated treatment.
Pages 506-511. Tripp, Jessica C.; Worley, Matthew J.; Straus, Elizabeth; Angkaw, Abigail C.; Trim, Ryan S.; Norman, Sonya B. https://doi.org/10.1037/adb0000564

It is not a surprising outcome that alcohol use increased with severity of PTSD symptoms. All attempts to mask traumatic experiences ultimately fail as the experiences, as troubling as they may be, are real and important parts of an individual’s history.  Exposure and cognitive therapies work toward integrating these experiences in a way that an individual can apply meaning and have the ability to move forward in life.  Alcohol use as a way to “deal” interferes with this process.  As with most co-occurring disorders, substance use and other symptoms interact in reinforcing ways making sequential treatment mostly ineffective.   

Relations among religiosity, age of self-identification as gay, lesbian, or bisexual, and alcohol use among college students.
Pages 512-520. Corbin, William R.; Ong, Thai Q.; Champion, Charlie; Fromme, Kim. https://doi.org/10.1037/adb0000559

Struggles to reconcile sexual identity and other elements of identity in a non-hospitable context likely result in adverse childhood experiences (ACES) that predict adverse outcomes including substance use difficulties.  The author suggests some strategies that would result in an integration and reformulation of these experiences that include altering, or integrating into a more hospitable context that is supportive of a completed identity formulation.  As family and the self help community it is important that people are guided to places where they can receive psychosocial support outside of therapy as part of their plan.      

The new normal: Changes in drinking norms from college to postcollege life.
Pages 521-531. Hamilton, Hannah R.; Armeli, Stephen; Litt, Mark; Tennen, Howard. https://doi.org/10.1037/adb0000562

I think that this really reflects the research showing how the context and psychosocial factors influence perceptions, expectations and behavior. This is in line with Stanton Peele’s extensive work on how social forces influence substance use problems; in other words, the opioid epidemic is at least in part a societal issue that treatment cannot fix.  Multiple treatments and relapses are in part a function of one’s inability to extract themselves from a context and psychosocial influences that drive behaviors outside of consciousness. The AA self help tradition highlights this in their references to “people, places and things.”

 

A web-based episodic specificity and future thinking session modulates delay discounting in cannabis users.
Pages 532-540. Sofis, Michael J.; Lemley, Shea M.; Lee, Dustin C.; Budney, Alan J. https://doi.org/10.1037/adb0000557

Delayed discounting, the tendency to value more immediate rewards over later, seemingly more significant rewards, has static trait qualities in that tendencies are heritable.  While this is the case, there is research, including this article, that suggest that the trait is malleable and a  person’s discounting may differ dependent upon what they are waiting for, or in the context of other influences.  It may be a consideration of importance in treatment where the immediate reward of drug use takes precedence over delayed consequences.  This idea is the basis for contingency management strategies that have proven to be successful for some.  For others interim rewards that can be viewed as leading back to a larger reward may better serve the purpose.  Scaling interest and confidence levels on short and long term rewards may help frame these dynamics and set the stage for appropriate interventions. 

 

Appearance-related teasing and substance use during early adolescence.
Pages 541-548. Klinck, Melanie; Vannucci, Anna; Fagle, Tessa; Ohannessian, Christine McCauley. https://doi.org/10.1037/adb0000563

Not surprising that this form of bullying results in attempts to cope which include increased alcohol use; interesting that it did not result in changes in marijuana use.  The question that was not answered was what mitigation strategies might be helpful beyond those of prevention and education strategies; research on the effectiveness of these programs has been mixed.  The larger problem with an individual case  is the concurrent task of identity formation that adolescence involves.  Therapy that helps to tease out the “who I am” can serve to refocus attention on strengths that can be built upon.

Problematic social media use is associated with increased risk-aversion after negative outcomes in the Balloon Analogue Risk Task.
Pages 549-555. Meshi, Dar; Ulusoy, Ezgi; Özdem-Mertens, Ceylan; Grady, Sara M.; Freestone, David M.; Eden, Allison; Ellithorpe, Morgan E. https://doi.org/10.1037/adb0000558

Not sure how to parse this out as it does not appear that the risk challenge was related to the problematic use analysis directly.  One thought is that, given that the challenge was introduced after the SNS problematic use assessment and that the social reinforcers that lead to problematic SNS use carried into the risk challenge.  In other words, negative feedback in a social network may lead to moderating responses (risk) in an effort to curry favor in future interactions, or maintain a perceived desired image.  Moderating risk in less risky circumstances may serve the same purpose when carried over into the risk decision making in the BART task.        

Some thoughts on:

Health Psychology, Volume 39, Issue 7 (Jul 2020)

Below are some thoughts that came to me as a read through this current journal.  I tend to first reflect on how the results of research relate to basic psychological principles and secondarily what it means to my main interest and treatment work.  

Low back pain, mental health symptoms, and quality of life among injured service members.
Pages 549-557. Watrous, Jessica R.; McCabe, Cameron T.; Jones, Gretchen; Farrokhi, Shawn; Mazzone, Brittney; Clouser, Mary C.; Galarneau, Michael R. https://doi.org/10.1037/hea0000850

The outcomes of this study are consistent with John Sarno’s work and theories on tension myositis syndrome (TMS); pain driven by unconscious emotional issues, specifically anger.  While Sarno’s thoughts are controversial for some, his work does contribute to the psychology of pain and pain management strategies that are important for some SUD clients.

Parental behavior and child distress and pain during pediatric medical procedures: Systematic review and meta-analysis.
Pages 558-572. Sobol-Kwapińska, Małgorzata; Sobol, Marek; Woźnica-Niesobska, Ewa. https://doi.org/10.1037/hea0000864

This article highlights the effect that parental distress and response have on child experience of pain.  While not directly related, it suggests the high level of sensitivity to parental response in children to include adolescents and the potential benefits of paying attention to parental responses and behaviors and seeking adolescent perspectives on those behaviors.  Parents would likely benefit from reframing in terms of CRAFT guidance. 

Pain resilience and catastrophizing combine to predict functional restoration program outcomes.
Pages 573-579. France, Christopher R.; Ysidron, Dominic W.; Slepian, P. Maxwell; French, Douglas J.; Evans, R. Thomas. https://doi.org/10.1037/hea0000877

In line with psychological contributions to the experience of pain, this article reinforces the role that a history of resilience has to managing pain.  In broader psychological findings, resilience is in part a learned response and so a series of relapses and retreatments in the face of adversity could be considered learned behavior.  In these cases, education on the process as well as training in resilience skills may positively impact outcome. 

Anxiety prevalence in lymphoma: A systematic review and meta-analysis.
Pages 580-588. Vargas-Román, Keyla; Díaz-Rodríguez, C. Lourdes; Cañadas-De la Fuente, Guillermo A.; Gómez-Urquiza, José Luis; Ariza, Tania; De la Fuente-Solana, E. Inmaculada. https://doi.org/10.1037/hea0000869

Like recovery from serious medical problems like cancers, anxieties can be high in early recovery as a result of the unresolved psychosocial damage that was done.  Focus on helping those in early recovery to manage through these difficulties is important as impulsive reactions to related incidents and reminders can trigger relapse. 

Spirituality and depressive symptoms in a multiethnic sample of cancer survivors.
Pages 589-599. Bamishigbin Jr., Olajide N.; Stein, Kevin D.; Leach, Corinne R.; Stanton, Annette L. https://doi.org/10.1037/hea0000878

The role that spirituality can play in one’s mental health is not a new concept in the SUD field.  While this is the case, this article emphasizes the role that integrating trauma (cancer) into one’s life story in a meaningful way allows one to move forward.  I think this need to integrate, not avoid, ignore or seek to block, is sometimes lost in the treatment of trauma to include the trauma brought on by SUD.  

Reducing exposure to ultraviolet radiation from the sun and indoor tanning: A meta-analysis.
Pages 600-616. Sheeran, Paschal; Goldstein, Adam O.; Abraham, Charles; Eaker, Kelsey; Wright, Charles E.; Villegas, Megan E.; Jones, Katelyn; Avishai, Aya; Miles, Eleanor; Gates, Kathleen M.; Noar, Seth M. https://doi.org/10.1037/hea0000863

Just a reminder that harm reduction is not a new phenomenon in medicine in general and it’s about time that we caught on to the important role that it plays in the treatment and recovery from SUDs. 

Effects of parental HIV on telomere length among children in rural China.
Pages 617-621. Li, Xiaoming; Jiang, Yanping; Qiao, Shan; Gu, Huang; Zhao, Junfeng. https://doi.org/10.1037/hea0000872

This raises the perennial biology/psychology question and the important role that family history plays in later, to include adult outcomes.  Is this shortened telomere length the direct result of biology, or the adverse childhood experiences (ACEs) of being orphaned?      

Measuring engagement in HIV care: Measurement invariance in three racial/ethnic patient groups.
Pages 622-631. Sauceda, John A.; Lisha, Nadra E.; Dilworth, Samantha E.; Johnson, Mallory O.; Christopoulos, Katerina A.; Wood, Troy; Koester, Kimberly A.; Mathews, W. Christopher; Moore, Richard D.; Napravnik, Sonia; Mayer, Kenneth H.; Crane, Heidi M.; Fredericksen, Rob J.; Mugavero, Michael J.; Neilands, Torsten B. https://doi.org/10.1037/hea0000865

Just emphasizes the important role of engagement, the working alliance, etc. play in treatment outcomes.  Everything hinges upon it.