I recently read Henry Winkler’s memoir, Being Henry: The Fonz… and Beyond. Having grown up with Happy Days (first aired 1974-1984), I will always have a soft spot in my heart for the Fonz… and Henry Winkler. People who are more closely in tune with today’s culture than I am—and that’s just about everybody—will know Henry Winkler for his role as the acting teacher Gene Cousineau in the HBO series Barry (aired 2018-2023). In Winkler’s memoir, he opens chapter 11 with this: “I had a shrink for two years. Every week I'd go in and talk about my parents, Stacey [his wife], our children, my troubles getting acting work, and—when I did get work—my continuing problems getting out of my own way” (Winkler & Kaplan, 2023, p. 198) Good for him, I thought. After having read the first 10 chapters, I could see where he could benefit from psychotherapy. Question 1 for your students. When Winkler uses the term “shrink,” what kind of therapist might he be referring to? He doesn’t tell us, but the top three options are psychologist, counselor, and psychiatrist. Although, a life coach is certainly a possibility. After revealing he is seeing a therapist of some kind, Winkler writes, “Then one day my shrink asked me to look at a script he'd written” (Winkler & Kaplan, 2023, p. 198)  <Screeching record noise>. I reread the sentence. No, I did not read it wrong. I immediately began mentally flipping through the American Psychological Association’s (APA’s) ethics code and the American Counseling Association’s ethics code. And then, because I’m not familiar with the American Psychiatric Association’s ethics code, I looked it up. Unsurprisingly, they follow the ethics code of the American Medical Association, although the psychiatrists have a sort of annotated edition for themselves. With a bit of research, I discovered the International Coaching Federation (life and business coaches, not sports coaches) and their ethics code. Question 2 for your students. Review the ethics codes for the American Psychological Association, the American Counseling Association, the American Psychiatric Association, and the International Coaching Federation. Do any of them permit a provider to use a client to advance their side gig? If not, which part of each ethics code has been violated? Question 3 for your students. If Winkler wanted to pursue a complaint against this provider, what should he do? [The answer differs depending on the type of provider, the professional association(s) the provider belongs to, and how and where they are licensed.] Winkler seems to have solved the problem to his satisfaction. He writes, “And so I spent a number of years shrink-less” (Winkler & Kaplan, 2023, p. 198)  While I applaud him for walking away, I am reminded of how one bad experience can color a person’s view of an entire profession. We see it in higher ed all the time. I loved chemistry in high school, so when I got to college, I considered majoring in chemistry. I took a chemistry class, and I hated it. More specifically, I hated how it was taught. And that resulted in a full stop to my chemistry exploration. Winkler did see another therapist. While the timeline is unclear, I perceived this therapist as coming after the read-my-script therapist. Winkler’s wife writes, “[H]e asked her at the beginning if she had children, and she said, ‘How will knowing that help you? What would that add to why we’re here?’” (Winkler & Kaplan, 2023, p. 237). What a beautiful way of saying, “We’re here to talk about you, not me.” In this blog post, while I suggest prompting students to look at ethics codes in the context of Henry Winkler’s experience, it is important that students have some familiarity with those codes. Everyone should know that therapists should follow a code of ethics, and if a person is seeing a therapist who violates that code of ethics, what they should do. Even if it is, at minimum, simply walking away.     Reference Winkler, H., & Kaplan, J. (2023). Being Henry: The Fonz . . . and beyond (First edition). Celadon Books. ... View more

I have written previously about the fear of needles in the context of COVID vaccine hesitancy. This NPR story got me thinking about this again (Dembosky, 2024). First, we have children who are traumatized by getting shots that their conditioning continues into adulthood with the end result of less likely to volunteer to get important medical care, including vaccines. Second, we have caregivers who are traumatized by their traumatized children. It cannot be easy to know that you are the one who okayed the shot that has resulted into your child screaming. I can’t help but wonder how many people stand behind an anti-vax principle because they don’t want to admit that they are terrified of needles or can’t bear to watch their child be terrified of needles. And third, it’s traumatic for the healthcare professionals, too. In the article, one physician said doing this to children made her decide against going into pediatrics. The major point of the article is that it doesn’t have to be this way. One physician argues that there are a number of things healthcare professionals can do to make getting shots less traumatic. Use a topical numbing cream. Dentists figured that one out a long time ago (thank God!). We’re beyond time for other healthcare professionals to do the same. Numbing cream should be used routinely for children and offered to adults. For babies, while getting a shot, let them breastfeed or give them a sugar-dipped pacifier. Anything that will comfort them will help. For toddlers and older children—and I’d add adults even, distraction, distraction, distraction. The NPR story suggests “teddy bears, pinwheels or bubbles.” They missed an obvious one, though: digital distractions. These include movies, games, and music. I had a dentist who had a ceiling-mounted monitor and headphones. Patients would pick a movie to watch during a dental cleaning or other procedure. After the appointment, the dental staff would write in the patient’s chart where they were in the movie so they could pick up there on their next visit. As another example, I once had to see a dental specialist. The dentist and assistant played classic rock music during my visit—and they both sang along to the music. They were pretty good! The best I could do was sort of hum along—you try humming with your mouth hanging open! They appreciated my participation nonetheless. I never had a reason to see them again, but I would have gone back in a heartbeat. “No more pinning kids down on an exam table.” Their caregiver should hold them. In retrospect, that seems obvious.   Following coverage of classical conditioning or during coverage of phobias would both be fine places to discuss this topic with students. Here are a couple possible discussion questions. Have you (or your child) ever been offered a topical numbing cream before getting a shot? If so, what was your experience like? If not, would you consider asking for a topical numbing cream next time? We discussed a few different distractions that could be useful with children and adults. What other distractions can you think of that may be helpful for children, yourself, or other adults? The NPR story ends with suggesting that these techniques could also work with people with dementia who, like children, have no idea why someone is hurting them. There is reason to believe that the same anti-pain techniques would work with this population, too: “Numbing cream, distraction, something sweet in the mouth and perhaps music from the patient's youth that they remember and can sing along to.”  The article ends with this quote from one of the doctor’s interviewed for the story: “It’s worthy of study, and it’s worthy of serious attention.” If you’d like to give your students a little experimental design practice, divide students into small groups. Give each group a specific intervention: numbing cream, distraction, something sweet in the mouth, music from a patient’s youth. The population they are looking at are people with dementia. Students should keep in mind that dementia is not inevitable with aging (Fishman, 2017), so as they think about their sample and their intervention, they should focus on dementia, not age. Groups should identify and operationally define their dependent variable as well as identify and operationally define their independent variable. Students also need to consider the ethical challenges in conducting research with participants who are unable to give their consent to participate. Ask students to review section 3.10 of the APA ethics code and be sure to include in their study description how they would handle informed consent (American Psychological Association, 2017). After discussion, invite volunteers from each group to share their designs.   References American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code Dembosky, A. (2024, February 13). Shots can be scary and painful for kids. One doctor has a plan to end needle phobia. NPR. https://www.npr.org/sections/health-shots/2024/02/13/1230448059/shots-needles-phobia-vaccines-pain-fear-kids Fishman, E. (2017). Risk of developing dementia at older ages in the united states. Demography, 54(5), 1897–1919. https://doi.org/10.1007/s13524-017-0598-7   ... View more

On a recent flight, two people in the row behind me struck up a conversation. They were strangers to each other, but both were game for having a chat. Their conversation ranged widely. I was working, so I only periodically tuned in. My ears perked up when one person said, “There’s mental health in my family.” Now there’s an interesting euphemism. She’s didn’t say “there’s poor mental health in my family,” or “there’s mental illness in my family,” or “there are mental health challenges in my family.”  The woman’s conversation partner, however, understood exactly what she meant. For other types of health conditions, I bet she doesn’t say “There’s health in my family.” We may be making progress on reducing the stigma around mental illness, but the phrase “mental illness” is still difficult for some to utter. Our World in Data has 51 charts depicting data related to mental health. When study participants were asked “how comfortable a local person would feel speaking about anxiety or depression with someone they know,” 56% of Egyptian respondents said very comfortable with another 32% saying somewhat comfortable. In the U.S., a mere 7.2% of respondents said very comfortable with another 58% saying somewhat comfortable. At the bottom of that chart, click “Table” to see the full list of countries with data. Jordan tops the list for the most participants saying very comfortable (60.7%) and Japan brings up the bottom in the category (2.7%). Given the conversation on the plane, I wonder what the responses would be if participants were asked “how comfortable a local person would feel speaking about anxiety or depression with someone they were unlikely to ever see again.” Worldwide prevalence for depressive disorders appears to be between 2% and 6%. Worldwide prevalence for anxiety disorders appears to be similar, between 2% and 7%. Schizophrenia, as we’d expect, is much less common at 0.2% to 0.4%. As part of an in-class or asynchronous discussion, after covering psychological disorders, invite your students to view Our Work in Data’s charts related to mental health. Ask your students to identify from one of those charts the most interesting or most surprising data they found and to provide a brief explanation as to why they chose it. This will give students an opportunity to see how mental illness is perceived and occurs in their own country as well as the rest of the world.   ... View more

Men in the United States are four times more likely to die by suicide than are women (Curtin et al., 2022), and men are almost half as likely to receive mental health treatment than are women (Terlizzi & Norris, 2021). This is seriously problematic, as pointed out by a December 2022 New York Times article (Smith, 2022). In the Intro Psych therapy chapter, share the above statistics with students. Ask your students to discuss in small groups why they think men are less likely to receive mental health treatment. (While what is described here is for a face-to-face class, the discussion can be adapted for asynchronous discussions.) To take away some of what could be very personal, ask students to consider why their male friends or male relatives might not be inclined to seek mental health treatment. If your male students choose to share their own thoughts, that’s fine; just don’t pressure them to do so. Invite the groups to share the reasons they generated with the class. Record the reasons in a way that students can view them. Next invite your students to visit the Man Therapy website (mantherapy.org). What are their favorite article titles? I’m partial to “Sometimes a man needs a pork shoulder to cry on” and “Anxiety: When worry grabs you by the [nether parts]” with an honorable mention for “Sleep: When catching z’s is harder than catching a 20lb trout.” Do your students think that the messaging about mental health on this website would resonate with the men in their lives? Why or why not? Do your students think different messaging would work better for different cultural or ethnic groups? If so, what might that look like? If you’d like to extend this discussion, ask students if they were interested in sharing the mantherapy.org link with their male friends and relatives. For your students who are game, ask them to send out texts right now while in class. If texts come back while you are still in class, invite students to share them. Check back in with students during the next class for reactions that students received after class. If time allows and you are so inclined, ask students to work in small groups to design an experiment that would evaluate the effectiveness of a website such as mantherapy.org. What would their hypothesis be? What would be their measure of effectiveness? What would be their control condition? How would they identify and recruit participants. If your class, department, psych club, or psych honor society thinks that mantherapy.org could be effective at increasing men’s access to mental healthcare, you can “become a champion” by visiting this page and completing the form at the bottom. You will receive a “shipment of printed collateral including posters, wallet cards, and stickers to help get the word out and drive traffic to the site.” There is no mention of a cost for these materials.   References Curtin, S. C., Garnett, M. F., & Ahmad, F. B. (2022). Provisional numbers and rates of suicide by month and demographic characteristics: United States, 2021 (No. 24). National Center for Health Statistics. https://www.cdc.gov/nchs/data/vsrr/vsrr024.pdf Smith, D. G. (2022, December 9). How to Get More Men to Try Therapy. The New York Times. https://www.nytimes.com/2022/12/09/well/mind/men-mental-health-therapy.html Terlizzi, E. P., & Norris, T. (2021). Mental health treatment among adults: United States, 2020 (NCHS Data Brief No. 419). National Center for Health Statistics. https://www.cdc.gov/nchs/data/databriefs/db419.pdf       ... View more

I read with increasing horror a New York Times article describing how college and university athletic departments have partnered with sportsbooks to encourage betting among their students. (The legal betting age in the U.S. varies by state. In ten states the minimum age is 18, in Alabama it is 19, and in all of the rest—including D.C.—it is 21. See the state list. In Canada, the age is 18 or 19 depending on province. See the province list.) “Major universities, with their tens of thousands of alumni and a captive audience of easy-to-reach students, have emerged as an especially enticing target” for gambling companies (Betts et al., 2022). While what I’d like to write is an opinion piece about the financial state of colleges and universities (how is it that public funding has evaporated?), how athletic departments have come to operate outside of the college and university hierarchy (why does my $450 airfare to travel to a professional conference have to be signed off on by a raft of people, but an athletic department can sign a $1.6 million dollar deal without the university’s Board of Regents knowing anything about it?), and the ethically-suspect behavior of a college or university using their student contact information—such as email addresses that the institution provides to them and requires them to use for official communication—to encourage those students to bet on sports. But I’m not going to write that opinion piece. At least not in this forum. Instead, I am going to write about what I know best: teaching Intro Psych. If our colleges and universities are going to encourage our students to gamble on sports, psychology professors need to be more explicit in discussing gambling. Within casinos, slot machines are the biggest gaming moneymaker (see this UNLV Center for Gaming Research infographic for an example). For everything you could possibly want to know about slot machines, I highly recommend Addiction by Design by Natasha Dow Schüll, cultural anthropologist at New York University. Slot machines and sports betting are similar in that they both pay out on a variable ratio schedule. People play slot machines to escape; they are powered by negative reinforcement, not positive. Each win provides the ability to play longer, and thus to spend even more time not thinking about problems at school, at work, at home, or in the world. The goal of the slot machine manufacturer and casino is to get you to stay at the machine longer. Having recently visited a casino, I was impressed by some of the newer innovations designed to do just that, such as comfy seats and phone charging pads built into the slot machine itself. While sports betting may—initially at least—be driven by positive reinforcement. Each win feels good and apparently outweighs the punishment of a loss. However, like slot machines, sports betting can become an escape. The time spent planning bets, placing bets, monitoring the games and matches one has put money on, and then trying to find ways to fund the next round of bets can be time not spent thinking about problems at school, at work, at home, or in the world. Since we’re talking about decision making, cognitive biases are also at play. For example, the availability heuristic may have us give undue attention to the big betting wins our friends brag about. Are our friends telling us about their big losses, too? If not, we may feel like winning is more common than losing. We know, however, that winning is not more common. Every time someone downloads the University of Colorado Boulder’s partner sportsbook app using the university’s promo code and then places a bet, the university banks $30. If the sportsbook is giving away $30 every time, how much money in losing bets per person, on average, must the sportsbook be collecting? While there are many topics in the Intro Psych course where sports betting can be discussed, I’ll suggest using it as an opener for discussion of psychological disorders. To be considered a psychological disorder, a behavior needs to be unusual, distressing, and dysfunctional (American Psychiatric Association, 2013). Ask students to envision a friend who lies about how much they are gambling, who has wanted to quit or greatly reduce how much they are betting but can’t seem to be able to, and who is using student loans to fund their betting. Do your students think their friend meets the criteria for a psychological disorder? Why or why not? If you’d like, have students discuss in small groups, and then invite groups to share their conclusions. Gambling disorder is a DSM-V diagnosis categorized under “Substance Use and Addictive Disorders.” In previous editions of the DSM, it was called “gambling pathology” and was categorized as an impulse control disorder. Also in previous DSMs, illegal activity was a criterion for diagnosis; that has been removed in DSM-V. To be diagnosed with gambling disorder, a person must—in addition to impairment and/or distress—meet at least four of the following criteria: Requires higher and higher bets to get the same rush Becomes irritable during attempts to cut back on gambling Has been repeatedly unsuccessful when trying to cut back or stop gambling Spends a lot of time thinking about gambling When stressed, turns to gambling as an escape Chases losses (for example, after losing a $20 bet, places an even higher bet to try to get the $20 back) Lies about how much they are gambling Gambling interferes with their performance in school or in a job or has negatively affected interpersonal relationships Gets money from others to support their gambling Poll your students—even by a show of hands—to find out if they know someone, including themselves, who meet at least four of these criteria. For help with a gambling problem, residents of the U.S., Canada, and the U.S. Virgin Islands can contact the National Problem Gambling Helpline by calling or texting 1-800-522-4700 any day at any time. For those who prefer chat, visit this webpage. For additional peer support, recommend gamtalk.org. References American Psychiatric Association (Ed.). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed). American Psychiatric Association. Betts, A., Little, A., Sander, E., Tremayne-Pengelly, A., & Bogdanich, W. (2022, November 20). How colleges and sports-betting companies ‘Caesarized’ campus life. The New York Times. https://www.nytimes.com/2022/11/20/business/caesars-sports-betting-universities-colleges.html ... View more

The Intro Psych therapy chapter is a good place to reinforce what students have learned about research methods throughout the course. In this freely available 2022 study, researchers wondered about the effectiveness of a particular medication (naltrexone combined with bupropion) and a particular type of psychotherapy (behavioral weight loss therapy) as a treatment for binge-eating disorder (Grilo et al., 2022). First, give students a bit of background about binge-eating disorder. If you don’t have the DSM-V (with or without the TR) handy, this Mayo Clinic webpage may give you what you need (Mayo Clinic Staff, 2018). Next, let students know that naltrexone-bupropion work together on the hypothalamus to both reduce how much we eat and increase the amount of energy we expend (Sherman et al., 2016). It’s a drug combination approved by the FDA for weight loss. Lastly, behavioral weight loss therapy is all about gradual changes to lifestyle. That includes gradual decreases in daily calories consumed, gradual increases in nutritional quality, and gradual increases in exercise.   Invite students to consider how they would design an experiment to find out which treatment is most effective for binge-eating disorder: naltrexone-bupropion, behavioral weight loss (BWL) therapy, or both. In this particular study ("a randomized double-blind placebo-controlled trial"), researchers used a 2 (drug vs. placebo) x 2 (BWL vs no therapy) between participants design. In their discussion, they note that, in retrospect, a BWL therapy group alone would have been a good thing to have. The study was carried out over a 16-week period. Participants were randomly assigned to condition. Researchers conducting the assessments were blind to conditions. Next ask students what their dependent variables would be. The researchers had two primary dependent variables. They measured binge-eating remission rates, with remission defined as no self-reported instances of binge eating in the last 28 days. They also recorded the number of participants who lost 5% or more of their body weight. Ready for the results? Percentage of participants who had no binge-eating instances in the last 28 days   Placebo Naltrexone-Bupropion No therapy 17.7% 31.3% BWL therapy 37.% 57.1%   Number of participants who lost 5% or more of their body weight   Placebo Naltrexone-Bupropion No therapy 11.8% 18.8% BWL therapy 31.4% 37.1%   As studies that have evaluated treatments for other psychological disorders have found, medication and psychotherapy combined are more effective than either alone. If time allows, you can help students gain a greater appreciation for how difficult getting participants for this kind of research can be. Through advertising, the researchers heard from 3,620 people who were interested. Of those, 972 never responded after the initial contact. That left 2,648 to be screened for whether they would be appropriate for the study. Following the screening, only 289 potential participants were left. Ask students why they think so few participants remained. Here are the top reasons: participants did not meet the criteria for binge-eating disorder (715), participants decided they were not interested after all (463), and participants were taking a medication that could not be mixed with naltrexone-bupropion (437). Other reasons included but not limited to having a medical condition (could impact study’s results), they were already in a treatment program for weight loss or binge-eating disorder (would not be a sole test of these treatments), or they were pregnant or breast-feeding (couldn’t take the drugs). After signing the consent form and doing the initial assessment, another 153 were found to have not met the inclusion criteria. That left 136 to be randomly assigned to conditions. Over the 16 weeks of the study, 20 participants dropped out on their own, and four were removed because of medical reasons. It took 3,620 people who expressed interest to end up with data from 112 participants. There is no information in the article about whether participants who were not in the drug/psychotherapy group were offered—after the study was over—the opportunity to experience the combined treatment that was so effective. Ethically, it would have been the right thing to do.   References Grilo, C. M., Lydecker, J. A., Fineberg, S. K., Moreno, J. O., Ivezaj, V., & Gueorguieva, R. (2022). Naltrexone-bupropion and behavior therapy, alone and combined, for binge-eating disorder: Randomized double-blind placebo-controlled trial. American Journal of Psychiatry, 1–10. https://doi.org/10.1176/appi.ajp.20220267 Mayo Clinic Staff. (2018, May 5). Binge-eating disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/syc-20353627 Sherman, M. M., Ungureanu, S., & Rey, J. A. (2016). Naltrexone/bupropion ER (Contrave): Newly approved treatment option for chronic weight management in obese adults. Pharmacy & Therapeutics, 41(3), 164–172.       ... View more

I have had occasion to send out emails with some sort of inquiry. When I don’t get any response, it ticks me off. I don’t do well with being ignored. I’ve learned that about me. Even a short “I’m not the person to help you. Good luck!” would be welcome. I mention that to acknowledge that I brought that particular baggage with me when I read an article in the Journal of Counseling Psychology about counselors ignoring email messages from people seeking a counselor (Hwang & Fujimoto, 2022). As if the bias this study revealed was not anger-inducing enough. The results are not particularly surprising, but that does not make me less angry. I’ve noticed that as I’m writing this, I’m pounding on my keyboard. Wei-Chin Hwang and Ken A. Fujimoto were interested in finding out how counselors would respond to email inquiries from potential clients who varied on probable race, probably gender, psychological disorder, and inquiry about a sliding fee scale. The researchers used an unidentified “popular online directory to identify therapists who were providing psychotherapeutic services in Chicago, Illinois” (Hwang & Fujimoto, 2022, p. 693). From the full list 2,323 providers, they identified 720 to contact. In the first two paragraphs of their methods section, Hwang and Fujimoto explain their selection criteria. The criterion that eliminated the most therapists was that the therapist needed to have an advertised email address. Many of the therapists listed only permitted contact through the database. Because the researchers did not want to violate the database’s terms of service, they opted not to contact therapists this way. They also excluded everyone who said that they only accepted clients within a specialty area, such as sports psychology. They also had to find a solution for group practices where two or more therapists from the same practice were in the database. Hwang and Fujimoto did not want to risk therapists in the same group practice comparing email requests with each other, so they randomly chose one therapist in a group practice to receive their email. This experiment was a 3x3x2x2 (whew!). Inquirer’s race: White, African American, Latinx American (the three most common racial groups in Chicago, where the study was conducted). Researchers used U.S. Census Bureau data to identify last names that were most common for each racial group: Olson (White), Washington (African American), and Rodriguez (Latinx). Inquirer’s diagnosis: Depression, schizophrenia, borderline personality disorder (previous research has shown that providers find people with schizophrenia or borderline personality disorder less desirable to work with than, say, depression) Inquirer’s gender: Male, female. (Male first names: Richard, Deshawn, José; female first names: Molly, Precious, and Juana) Inquirer’s ability to pay full fee: Yes, no. In their methods section, Hwang and Fujimoto include the scripts they used. Each script includes this question: “Can you email me back so that I can make an appointment?” The dependent variable was responsiveness. Did the provider email the potential client back within two weeks? If not, that was coded as “no responsiveness.” (In the article’s Table 1, the “no responsiveness” column is labeled as “low responsiveness,” but the text makes it clear that this column is “no responsiveness.”) If the provider replied but stated they could not treat the inquirer, that was coded as “some responsiveness.” If the provided replied with the offer of an appointment or an invitation to discuss further, that was coded as “high responsiveness.” There were main effects for inquirer race, diagnosis, and ability to pay the full fee. The cells refer to the percentage of provider’s email messages in each category. Table 1. Responsiveness by Race of Inquirer Name No responsiveness Some responsiveness High responsiveness Molly or Richard Olson 15.4% 33.2% 51.5% Precious or Deshawn Washington 27.4% 30.3% 42.3% Juana or José Rodriguez 22.3% 34% 43.7%   There was one statistically significant interaction. Male providers were much more likely to respond to Olson than they were to Washington or Rodriguez. Female providers showed no bias in responding by race. If a therapist does not want to work with a client based on their race, then it is probably best for the client if they don’t. But at least have the decency to reply to their email with some lie about how you’re not taking on more clients, and then refer them to a therapist who can help. Table 2. Responsiveness by Diagnosis Diagnosis No responsiveness Some responsiveness High responsiveness Depression 17.9% 20% 62.1% Schizophrenia 25.8% 43.8% 30.4% Borderline Personality Disorder 21.3% 33.8% 45%   Similar thoughts here. I get that working with a client diagnosed with schizophrenia or borderline personality disorder takes a very specific set of skills that not all therapists have, but, again, at least have the decency to reply to the email saying that you don’t have the skills, and then refer them to a therapist who does. Table 3. Responsiveness by Inquirer’s Ability to Pay Full Fee Ability to pay full fee No responsiveness Some responsiveness High responsiveness No 22.4% 39.7% 38% Yes 21% 25.4% 53.6%   While Hwang and Fujimoto interpret these results to mean a bias against members of the working class, I have a different interpretation. The no response rate was the same with about 20% of providers not replying at all. If there were an anti-working-class bias, I would expect the no responsiveness percentage to those asking about a sliding fee scale would be much greater. In both levels of this independent variable, about 80% gave some reply. It could be that the greater percentage of “some responsiveness” in reply to those who inquired about a sliding fee scale was due to the providers being maxed out on the number of clients they had who were paying reduced fees. One place to discuss this study and its findings with Intro Psych students is in the therapy chapter. It would work well as part of your coverage of therapy ethics codes. Within the ethics code for the American Counseling Association, Section C on professional responsibility is especially relevant. It reads in part: Counselors facilitate access to counseling services, and they practice in a nondiscriminatory manner…Counselors are encouraged to contribute to society by devoting a portion of their professional activity to services for which there is little or no financial return (pro bono publico) (American Counseling Association, 2014, p. 😎 Within the ethics code of the American Psychological Association, Principle 😧 Social Justice is particularly relevant. Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices (American Psychological Association, 2017). Principle E: Respect for People's Rights and Dignity is also relevant. It reads in part: Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status, and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices (American Psychological Association, 2017). This study was conducted in February 2018—before the pandemic. Public mental health has not gotten better. Asking for help is not easy. When people muster the courage to ask for help, the absolute least we can do is reply. Even if we are not the best person to provide that help, we can direct them to additional resources, such as one of these crisis help lines. For a trained and licensed therapist who is bound by their profession’s code of ethics to just not reply at all to a request for help, I just don’t have the words. Again, I should acknowledge that I have my own baggage about having my email messages ignored. For anyone who wants to blame their lack of responding on the volume of email you have sort through (I won’t ask if you are selectively not responding based on perceived inquirer personal characteristics), I have an hour-long workshop that will help you get your email under control and keep it that way.   References American Counseling Association. (2014). ACA 2014 code of ethics. https://www.counseling.org/docs/default-source/default-document-library/2014-code-of-ethics-finaladdress.pdf?sfvrsn=96b532c_8 American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code Hwang, W.-C., & Fujimoto, K. A. (2022). Email me back: Examining provider biases through email return and responsiveness. Journal of Counseling Psychology, 69(5), 691–700. https://doi.org/10.1037/cou0000624       ... View more

In an example of archival research, researchers analyzed data from the U.S. National Health and Nutrition Examination Survey for the years 2007 to 2012 (Hecht et al., 2022). They found that after controlling for “age, gender, race/ethnicity, BMI, poverty level, smoking status and physical activity,” (p. 3) survey participants “with higher intakes of UPF [ultra-processed foods] report significantly more mild depression, as well as more mentally unhealthy and anxious days per month, and less zero mentally unhealthy or anxious days per month” (p. 7). So far, so good. The researchers go on to say, “it can be hypothesised that a diet high in UPF provides an unfavourable combination of biologically active food additives with low essential nutrient content which together have an adverse effect on mental health symptoms” (p. 7). I don’t disagree with that. It is one hypothesis. By controlling for their identified covariates, they address some possible third variables, such as poverty. However, at no place in their article do they acknowledge that the direction can be reversed. For example, it can also be hypothesized that people who are experiencing the adverse effects of mental health symptoms have a more difficult time consuming foods high in nutritional quality. Anyone who battles the symptoms of mental illness or who is close to someone who does knows that sometimes the best you can do for dinner is a hotdog or a frozen pizza—or if you can bring yourself to pick up your phone—pizza delivery.   They do, however, include reference to an experiment: “[I]n one randomized trial, which provides the most reliable evidence for small to moderate effects, those assigned to a 3-month healthy dietary intervention reported significant decreases in moderate-to-severe depression.” The evidence from that experiment looks pretty good (Jacka et al., 2017), although their groups were not equivalent on diet at baseline: the group that got the dietary counseling scored much lower on their dietary measure than did the group that got social support. Also, those who received social support during the study did, in the end, have better mental health scores and better diet scores than they did at baseline, although all we have are the means. I don’t know if the differences are statistically significant. All of that is to say is that the possibility remains that reducing the symptoms of mental illness may also increase nutritional quality. Both the Jacka et al. experiment and the Hecht et al. correlational study are freely available.   You may also want to read the Science Daily summary of the Hecht et al. study where the author (or editor?) writes, “Do you love those sugary-sweet beverages, reconstituted meat products and packaged snacks? You may want to reconsider based on a new study that explored whether individuals who consume higher amounts of ultra-processed food have more adverse mental health symptoms.” If you’d like to use this in your Intro Psych class, after covering correlations and experiments, ask your students to read the Science Daily summary. Ask your students two questions. 1) Is this a correlational study or an experiment? 2) From this study, can we conclude that ultra-processed foods negatively affect mental health? These questions lend themselves well for use with in-class student response systems (e.g., Clickers, Plickers). Lastly, you may want to share with your students more information about both the Hecht et al. study and the Jacka et al. experiment. If time allows, give your students an opportunity to design an experiment that would test this hypothesis: Improved mental health symptoms causes better nutritional consumption.   References Hecht, E. M., Rabil, A., Martinez Steele, E., Abrams, G. A., Ware, D., Landy, D. C., & Hennekens, C. H. (2022). Cross-sectional examination of ultra-processed food consumption and adverse mental health symptoms. Public Health Nutrition, 1–10. https://doi.org/10.1017/S1368980022001586 Jacka, F. N., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M. L., Brazionis, L., Dean, O. M., Hodge, A. M., & Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Medicine, 15(1), 23. https://doi.org/10.1186/s12916-017-0791-y ... View more

I’ve been thinking a lot about identity and how our identity—whether it’s an accurate reflection reality—influences our behavior. Most recently I’ve been thinking about this after reading Jeff Holmes’ article in the Teaching of Psychology journal on students who have identified themselves as bad test-takers (Holmes, 2021). Holmes opens the article with this statement: “One of the best ways to be bad at something is to tell yourself you are bad at it” (p. 291). In Holmes’s study of 311 college students, a whopping 91% believed that students who otherwise know the course material can be bad test-takers with 56% of the students identifying themselves as bad test-takers. A third of the students said that someone else told them that they were bad test-takers. Importantly, those who identified as a bad test-taker were more likely to disagree with “I know how to study effectively.” Additionally, “Students who see themselves as bad test-takers…tend to—relative to students who do not possess such an identity—have lower confidence in their broader academic abilities, expend less effort on cognitive activities, and feel entitled to positive academic outcomes regardless of performance” (p. 296). And, yes, those who identify as bad test-takers were also more likely to report test anxiety, even when other variables—such as overall academic performance and study skills confidence—were controlled for. I could retire early if I had a dollar for every time I had this conversation with a student: Student: “I studied hard for this test, and I still failed! I’m just a bad test-taker.” Me: “Tell me how you studied.” Student: “What do you mean?” Me: “When you sat down to study, tell me what you did.” Student: “I read the chapter, then I read it again, and again. Oh! And I highlighted stuff.” Me: “Tell me what you know about <concept covered on exam>.” Student: <awkward silence> “I don’t remember.” <More awkward silence> Since I’m a bad test-taker, can I do something for extra credit?” In Intro Psych, wherever you discuss attributions (e.g., social psych, abnormal, psychotherapy), consider using the bad test-taker attribution as an example. If a student does poorly on an exam and they say, “I’m a bad test-taker,” they are making an internal, stable, and global attribution. Internal: It’s a trait I have. Stable: It’s a trait that’s not going to change. Global: My bad test-taking applies regardless of the test. It is unlikely that a student who makes this attribution will do anything differently on the next test.   Now ask students to imagine a different attribution. After doing poorly on a test, the student says, “I didn’t know that material well enough.” This is an internal, unstable, specific attribution. Internal: The grade was because of something I did. Unstable: If I do things differently, I can get a different result. Specific: This is what happened on this specific test; that doesn’t say anything about the next test. This student has agency. “I’m going to try out some of the known-to-be-effective study strategies my instructor told me about.” Reiterate to students that in both examples, the result of the first test was the same; both students failed. But who is most likely to fail the second test, too? To make that second attribution—“I didn’t know the material well enough”—students have to have enough insight into their own knowledge or have to accept that their test score is a reasonably accurate reflection of their knowledge. When students read and reread chapters over and over and over again, the material begins to feel familiar. That familiarity can feel like knowledge. It’s not. It’s the illusion of knowledge. One of the many benefits of self-testing is that it keeps students from deluding themselves while they study. Unless they attribute their poor self-testing to being a bad test-taker. [Side note: If the student sees test-taking as a skill that can be learned (unstable attribution), then they may choose to work on upping their test-taking skills. A quick Google search of “test taking skills” produced a number of websites with a bullet-point list of strategies. The sites I saw all included some version of “be prepared.” What’s the best way to be prepared? Use solid study strategies to learn the material.]     References Holmes, J. D. (2021). The bad test-taker identity. Teaching of Psychology, 48(4), 293–299. https://doi.org/10.1177/0098628320979884 ... View more

I read this CBC article on life coaches (Cowley et al., 2022) and felt great alarm. My alarm was not caused by the fact that anyone can call themselves a life coach, nor was it caused by these particular life coaches offering mental health advice. While I found this information disappointing, I cannot say that I was surprised. Instead, my alarm was caused by the fact that discussion of life coaches has not been included in our collective Intro Psych curriculum. We could do a much better job at arming the millions of students who take Intro Psych with the information they need to be informed consumers of mental health services. The therapy chapter would be a good place to use a jigsaw classroom. Divide your students (synchronous or asynchronous) into five groups. Assign each group one of the following professions. If you have a large class, divide the class into, say, ten groups, so that two groups will be working on each profession. Life coach Counseling psychologist Clinical psychologist Prescribing psychologist Psychiatrist Next, give each group the following set of questions to answer. Ask students to cite the sources they used to answer each question. What education is required for this profession? Does this profession require a license? If so, what is required to get licensure? What kinds of issues are typically treated by people in this profession? What kind of treatments can people in this profession provide? Once each group has the answers to these questions, assign students to new groups so that each new group has at least one member from the original groups. The new groups will be comprised of “experts” from each profession group. Give the new groups these instructions. In the following order, each group member will share what they learned about each profession: life coach, counseling psychologist, clinical psychologist, prescribing psychologist, psychiatrist. Once everyone has shared and all group members feel like they understand each profession, for each of the following issues, identify which profession or professions would be best and why. Lack of motivation for keeping a clean home Stress at work or school Relationship issues Severe anxiety Suicidal thoughts Heavy drinking Grief following the loss of a loved one Uncertainty in how to make a career change Once each group has finished its work, ask a spokesperson for each group to share what they generated. Start with “lack of motivation for keeping a clean home.” Once each group has shared, move on to the next topic.     Reference Cowley, J., Sampson, A., Szeto, E., & News ·, A. T. · C. (2022, February 26). Almost anyone can become a life coach. A hidden camera investigation reveals why that’s a problem. CBC. https://www.cbc.ca/news/canada/marketplace-life-coach-1.6364745   ... View more

Psychiatry and psychology are not averse to renaming our constructs. For example, with DSM-III, manic-depression became bipolar disorder. Since then, mental retardation became the more descriptive intellectual disability, and the controversial multiple personality disorder became the no less controversial dissociative identity disorder. Schizophrenia started life as dementia praecox. Is it time to change the name again? There are two arguments for a name change. First, there is much stigma associated with the term schizophrenia. As a class discussion item, ask students what immediately comes to mind when they hear “schizophrenia.” Be ready for students to say things describing people diagnosed with schizophrenia as being violent and having poor hygiene. What your students say is probably a pretty good representation of the public’s perception of schizophrenia. The more stigmatizing the label, the harder it is for clinicians to give the diagnosis to clients. And for those who have the diagnosis, the experience is all the more stressful when they have to manage the knee-jerk reactions of others. As if living with the symptoms of schizophrenia doesn’t make life much more difficult already. The second argument for a name change is that the word “schizophrenia” is not descriptive of the symptoms, and the name implies that schizophrenia is a single entity. Our modern understanding of schizophrenia is much more nuanced. For example, we now understand schizophrenia to encompass a wide and varying spectrum of symptoms. The disorder has already undergone a name change in Japan (to integration disorder), South Korea (to attunement disorder) and Hong Kong and Taiwan (disordered thought and perception) (Mesholam-Gately et al., 2021). Ask your students if they think schizophrenia should be renamed. A U.S. survey that included participants with mental illness, family members of those with mental illness, mental health providers, and others found much support for a name change; two-thirds supported a name change before seeing some possible names, and three-quarters supported a name change after seeing possible names and their descriptions. The names that received the most support were: Altered perception syndrome: “Indicates that people with this illness experience sensory information differently in a way that changes their day to day experiences.” Psychosis spectrum syndrome: “This term refers to a spectrum of common psychosis symptoms, such as hallucinations, delusions and thought difficulties.” and neuro-emotional integration disorder: “A biopsychosocial (biological, psychological, and social) term describing difficulty integrating cognition, emotion, and behavior” (Mesholam-Gately et al., 2021). (Download the pdf of the survey questions). Having seen these proposed terms and their descriptions, ask your students again if they think schizophrenia should be renamed. Personally, I find psychosis spectrum syndrome to be the most descriptive, but I doubt that being psychotic carries any less stigma than schizophrenia does. I can see why altered perception syndrome had the most support as it is probably the most innocuous of the group, but the name makes me think of synesthesia or ESP. I could work with neuro-emotional integration disorder. If you would like to extend the discussion, give your students a few minutes to consider alternate names. Give them these criteria: “Mental health professionals suggest that a successful name change should be clearly defined, neutral, easily understood, and illustrate the core symptoms of the disorder in order to increase accessibility and communicability by healthcare providers” (Mesholam-Gately et al., 2021). After students have a few minutes to brainstorm some names on their own, ask students to share their ideas in small groups. Ask each group to share their top one to three names. Invite the class to vote on the names.   Reference Mesholam-Gately, R. I., Varca, N., Spitzer, C., Parrish, E. M., Hogan, V., Behnke, S. H., Larson, L., Rosa-Baez, C., Schwirian, N., Stromeyer, C., Williams, M. J., Saks, E. R., & Keshavan, M. S. (2021). Are we ready for a name change for schizophrenia? A survey of multiple stakeholders. Schizophrenia Research, 238, 152–160. https://doi.org/10.1016/j.schres.2021.08.034    ... View more

Anxious about time passing you by? You might have chronophobia. https://www.iflscience.com/editors-blog/cant-stand-time-passing-you-by-you-may-have-chronophobia/ ... View more

According to the CDC, as of December 8, 2021, 83.5% of U.S. adults have had at least one dose of a COVID vaccine. When the unvaccinated are interviewed by journalists, they report a number of reasons for choosing not to get the vaccine, such as being too healthy to need it and not trusting that the vaccine is not harmful (Bosman et al., 2021). What I have not heard in person-on-the-street interviews, however, is someone saying they are not getting vaccinated because they are afraid of needles. In a pre-COVID meta-analysis, researchers found “[a]voidance of influenza vaccination because of needle fear occurred in 16% of adult patients, 27% of hospital employees, 18% of workers at long-term care facilities, and 8% of healthcare workers at hospitals” (McLenon & Rogers, 2019, p. 30), and the younger the people, the more common the fear. For young and young-ish adults (ages 20 to 40), approximately 20% to 30% have a needle fear (McLenon & Rogers, 2019). I wonder how many of the unvaccinated have a fear of needles but are citing other reasons for avoiding the vaccine. All of the photos of healthcare workers jabbing people with needles cannot be helping. For someone who is needle-phobic—or merely needle-averse—seeing a jabbing photo would likely result in them immediately turning away. Not only are they not getting the vaccine, they are not getting good information about the vaccine. In our Intro Psych courses, we can assume that 20% to 30% of our students have a fear of needles. For our students who do not have a fear, they certainly know someone who does, whether they know it or not. When we cover phobias and treatment for phobias, let’s include needles (but no photos!) as an example. Where does the fear of needles and shots come from? It is easy to see how a needle fear would develop. Classical conditioning offers a pretty likely scenario. A young child is approached by a gloved healthcare worker carrying a needle, gets a shot, and the shot hurts! Things that hurt are scary. The hurting is the unconditioned/unconditional stimulus, and the fear is the unconditioned/unconditional response. The needle (and all things associated with it) is the conditioned/conditional stimulus, and the fear of it is the conditioned/conditional response. Observational learning may have been the source of the fear for some, such as seeing a sibling screaming after they got a shot. As we know, the key to overcoming fear is exposure. For most of us, as we got older and we received more and more shots, the fear began to dissipate. Yes, the shot may still hurt, but by the time we are well into adulthood, we have been hurt in many worse ways. The sting from the jab is a pain that we know is both temporary and manageable. For some, though, that is not the case. The fear has not dissipated, perhaps because they have spent most of their life avoiding needles. Strategies and Treatment for Fear of Needles There are several strategies a person with a fear of needles can use (Huff, 2021). Techniques useful for relaxation can help, such as taking deep breaths and picturing serene environments. For some, knowing exactly what is going on as the shot is being prepared is helpful. For others, knowing absolutely nothing and, with headphones on, being completely absorbed in a game or video is preferred. In either case, the person should communicate their preferences with the healthcare provider. A little self-talk doesn’t hurt, either: “I have so got this!”   For those with more severe fears, working with a mental health provider trained in systematic desensitization would be best (Huff, 2021). Identifying the cause of the fear is first. Is it the needle? The pain? Blood? Next, the mental health provider would work with the client to create a fear hierarchy. If the fear is the needle, then they may start with viewing a drawing of a needle. With the help of say, progressive muscle relaxation, the client relaxes. Once again, the drawing is presented, and the client relaxes. Once the client can look at the drawing without tensing up, they move on to the next item in the fear hierarchy, such as a photo of needle, then perhaps a plastic toy needle, and so on up to a real needle. Helping our students see that a fear of needles is conquerable may help save their lives or the lives of their loved ones. References Bosman, J., Hoffman, J., Sanger-Katz, M., & Arango, T. (2021, July 31). Who are the unvaccinated in America? There’s no one answer. New York Times. https://www.nytimes.com/2021/07/31/us/virus-unvaccinated-americans.html Huff, C. (2021). How psychologists can help patients with injection fear. Monitor on Psychology, 52(4). https://www.apa.org/monitor/2021/06/injection-fear McLenon, J., & Rogers, M. A. M. (2019). The fear of needles: A systematic review and meta-analysis. Journal of Advanced Nursing, 75(1), 30–42. https://doi.org/https://doi.org/10.1111/jan.13818   ... View more

I have been reading with interest about how national chain pharmacies have started to offer mental health services: Therapy on Aisle 7 (NY Times, 5/7/21), CVS to Offer In-Store Mental Health Counseling (NPR, 4/29/21). While some pharmacies, such as CVS, are offering in-store or virtual mental health counseling, other pharmacies, such as Walgreens, connect customers to third-party therapy providers. These recent developments could be fodder for some very interesting class discussions or a stand-alone assignment following your coverage of psychotherapy. Here are some possible questions. What are some reasons that pharmacies, like CVS, may be interested in offering mental health services? Identify at least 3 positive things about pharmacies offering mental health services. Identify at least 3 concerns you may have about pharmacies offering mental health services. As one should when hiring anyone to provide any kind of service, what questions should you ask in your first meeting? This New York Times article, Therapy on Aisle 7 (5/7/21), offers some suggestions. For more questions you may want to ask, visit the How to Choose a Psychologist page on the American Psychological Association website. Once you have your list of questions to ask, for each question identify at least one answer you would want to hear and at least one answer you would not want to hear. Would you, personally, go to a pharmacy for mental health services? Why or why not? What other kinds of places might people quickly and easily access mental health services if they were available? ... View more

We know that sugar doesn't make kids hyper, but can it make us anxious? This study found a link between sugary, processed foods and anxiety disorders, but remember that correlation does not equal causation! https://bigthink.com/surprising-science/anxiety-diet?utm_term=Autofeed&utm_medium=Social&utm_source=Twitter#Echobox=1615566168 ... View more