anti-Causality


anti-Causality

Knowledge is a tree, not a conclusion, and it has been a tree for all of time. Sometime, however, it verboten in the Bible with a didactic “tale” apparently by oligarchs telling the average religious person to view the tree of knowledge and its information as verboten. This is the beginning of the limits and control of information necessary for oligarchic dominance, as opposed to capital-type control which is more commodity-based --though information is now a commodity as “intellectual property.” (With “intellectual” being a strong word for the slurry capital pumps into the population.)

The most important extension of this type of information control currently exists as academia with its early revival of control as the dialectic and didactic by academy founders Socrates and Plato in ancient Athens, and recently by Hegel to fit current capital. Important is that these instructors specifically used sexual abuse to control, which survived to our time as, for instance, the Aboriginal residence schools openly, and covertly elsewhere.

Causality is a rational reduction of the complexity of life saying that “if something happens in relation to something else, that something else caused the first thing.” As a rational reduction, it is a “dumbing-down” of all the highly sophisticade life-system that affect us. Knowledge is naturally structured both in society and in our minds in tree structures, also called “complex data structures” Personally, I have never been “causal” (I believe) because I have been influenced by aboriginal knowledge organization, and also abstract art and music early on as a child with access to all of New York’s museums and libraries (access has since been restricted to children.)

If I something is unavoidably causal, I say “simple math” --this causes that, w/o making a bid deal about it.

Empiricism is the scientific method (and system) built from causality and is considered the only (measurement) science, even by scientist who should know better. It suffers from being highly-fractured, as it is built from independent causal conclusions that also tend to be ego-vehicles from empiricist scientists. Another widely-misused term is “objective” as a synomym for “cruel” such that normal human thinking, such as the recollection of experiences, is excluded from empiricist conclusions; only empiricist numbers are used, often as an output of highly-purposed statistical systems. Dependance on statistics is such that statistics now often produce hypothesis and theory, that is validated by the same statistical systems. Information from other sources such as experience and observation, no matter how detailed, cannot test well against conclusive information produced specifically to test well by statistical systems. This statistical reality is most true for current control of the mind (both human and animal) in cognitive-behavioral strategies of CBT. Interestingly, in CBT, the dialectic method as the socratic method is also key for (as they say) “thought control.”

Objectivism, such as Ayn Rand’s and (current-capital’s) Adam Smith’s objectivism simply “objectify’s” people to make then inanimate numbers rather than feeling people to allow for capital exploitation. As it happens, capital-supporting empiricism, as info-oligarchic, also leverages this, and fills its capital-supportive role by defining and maintaining it as its own from of exploitation, originally sexual abuse.

Thursday, June 9, 2011

wiki Self- and Group-Dynamics in Mutual Support Recovery

This wiki is represented as a APA sytle paper in the article following this one (click).

Abstract
Self-efficacy in those attempting to recover from substance abuse disorders is believed to contribute to abstinence. Participation in mutual support groups is believed to reinforce self-efficacy by giving participants the opportunity to help others. Self-efficacy, as a component of the conceptual "system of self" works in conjunction with self-esteem to help goal achievement, or self-agency, which, for those with substance disorders, is abstinence. To reinforce research from previous largely qualitative studies, this study proposes to correlate self-efficacy and self-esteem as predictors of the rate of abstinence, or self-agency, of a group 30 men with a mean age of 30 who attend mutual support substance abuse programs. It is hypothesized that increases in self-efficacy and self-esteem will predict self-agency in terms of higher abstinence and lower drug craving, but that self-efficacy will be a greater predictor. The study also proposes to explore innovative data collection and statistical methodologies that leverage cell phones, the internet, and continuous online statistical analysis for the benefit of other researchers and those who want to manualize self-efficacy and self-esteem concepts in the group context for substance abuse recovery.

Statement of Problem
Substance abuse is growing
  • alcohol (National Institute on Alcohol Abuse and Alcoholism, 2004)
  • hard drugs (Terry-McElrath, 2005)
  • substance abuse services are declining in many places
Quitting substance abuse is difficult
  • abstinence is difficult (Groh, et al. 2009)
  • relapse is common (DeFulio & Silverman, 2011).
Mutual support groups (MSGs) are (Groh, et al. 2009).
  • effective for those who are not abstinant
  • cost-effective
  • long history

Self-efficacy
  • explains effectiveness of MSGs (Bogenschutz, Tonigan, & Miller, 2006; Stevens, et al., 2010).
  • perception of the ability to reach goals and mediates more goal-reaching (Bandura, 1982)
  • part of the "system of self" (Epstien, 1982, August)
  • self-esteem -- good feelings about oneself
  • self-agency (Bandura, 1982)

Group-efficacy
  • group's perception about reaching goals, group agency (Whiteoak, Chalip, & Hort, 2004)
  • group process (Truneckova, & Viney, 2008)
  • self-esteem of group members

Literature Review
Group process (Bracke, Christiaens, & Verhaeghe, 2008).
  • self-efficacy
    • giving support
    • leadership role
  • self-esteem
    • receiving support
    • beneficial self-feelings
    • may also feel dependent
      • low self-agency
      • detriment to self-efficacy
Group attendance (Groh, et al., 2009)
  • rate predicts abstinence
    • far beyond average
    • cannot be group efficacy
  • double attendees highest
  1. 12-step
  2. mutual support community
  • attendee may be providing support (Bracke, Christiaens, & Verhaeghe, 2008)
    • self-efficacy

Hypotheses to be Tested


1) Clients who participate in MSGs by contributing support and suggestions to other group participants (self-efficacy), and who receive this kind of support (self-esteem) will have abstinence rates that are higher than those who have low measures on these variables.

  • Correlation bet s-eff and abst

2) Clients who have high abstinence will show higher self-efficacy than self-esteem.

  • Greater correlation between s-eff and abst than s-est and abst
3) Clients with high self-efficacy will have lower cravings; cravings will be negatively correlated with abstinence (or self-agency).
  • Correlation (negative) between s-eff and craving
  • Correlation (negative) between cravings and abst
Sample:
one group
  • referred clients
  • attending group regularly
  • male
    • recent addiction
      • heroin
      • cocaine
      • methedrine
      • similar
    • testing criteria
      • agree to confidential testing
      • not in system for long term
  • female (future study)
    • different self-esteem valuing
  • attending group regularly

Variables

Independent
(predictor)
  • self-efficacy
    • perception of reaching goals
  • self-esteem
    • feelings about oneself
  • group process
    • to assure that group is not failing (g-proc)
    • data for future group-related research
  • attendance
    • criteria for client

Dependent (criterion)
  • self-agency
    • abstinence: time since last use

Operational definitions

"System of self" (self-system)
  • self-efficacy (s-eff)
    • perception of reaching goals
  • self-esteem (s-est)
    • good feelings about oneself
  • self-agency (s-agen)
    • achieving goals
  • group process (g-proc)
    • group provides self-esteem
    • future study
  • rate of abstinence (abst)
    • time since last drug use
  • cravings (craving)
    • involuntary desire to do drugs
    • causes relapse
Group process
  • group efficacy
  • group esteem
  • other-efficacy
    • confidence by group members about the potential success of an individual
Method
types of measures
  • self-system
    • Likert-type scale
    • ordinal
  • time
    • since last drug use
    • interval
  • attendance
    • participant inclusion criteria
    • yes/no
    • nominal
Participants
Group sample
  • Recovering clients (clients) n~=100
    • referred for "hard" drugs
    • measures
      • s-eff
      • s-est
      • s-agen
      • craving
      • attendence
  • male
    • present study
  • female
    • future study

Facilitators
  • Group leaders
    • reliable, drug free (inclusion criteria)
    • data
      • group process n=~10
      • client attendance

No control group
  • study will test for correlations between self-efficacy and abstinence in referred clients
Tests (statistical input)
ordinal
  • s-eff
  • s-est
  • craving
interval
  • drug use (relapse)
    • length of time since last use (will always be greater than zero as use while reporting is impossible)
    • tested for (examples_
      • heroin
      • cocaine
      • methedrine
      • oxycodone
      • methadone
    • not tested for (examples)
      • alcohol
        • not reliable after a few hours (Dupont, ??
      • marijuana
        • previous use may cause a positive (Goldberg, 2010)
Materials
Instruments
Self-created reated test (gleaned for questions to create a specific efficacy and esteem scale such as Gambling Abstinence Self-efficacy Scale)

Ask different questions to obtain same information at different times
  • Alcohol Abstinence Self-Efficacy Scale (DiClemente & Carbonari, 1994) high levels of validity and reliability
  • Rosenberg Self-esteem Scale (Greenberger, Chen, Dmitrieva, & Farruggia, 2003)
  • Group efficacy (consensual questionarie asking "how the group went" based on Whiteoak, Chalip, and Hort's (2004) suggestions; this can be expanded into a group-wide test in preparation of whole group efficancy testing and other-efficacy testing for abstinence)
Information system
  • cell phone "app" self-report system (tiny web page)
  • smart phones
  • secure online web server
  • statistical software continuous service
Reward for self-report honesty
  • restaurant coupon
    • donated by business community (community involvement project)
    • restaurant coupon is social-oriented which will mediate the group process
Drug testing problem
  • low honesty about testing (Tourangeau & Yan, 2007)
  • testing mediates abstinence (Sánchez-Hervás, et al., 2010)
Procedure
Participants register anonymously
Clients' self-report
support group sessions (before and after)
  • self-efficacy
  • self-esteem
at any time
  • cravings
  • drug use (relapse)
Test groups
  • group of individuals (groups not part of hypothesis)
  • group material is for future research

Group leaders
  • group processes
  • client attendence
Proposed Statistics
Strength of each s-eff and s-est correlation between and the DV (abst)
When abst is hightest, s-eff will be highest
The test measures are self-efficacy, self-esteem, and group process (independent/predictor variables), and abstinence (dependent criterion). As the relationship between the variables is expected to be linear, multiple regressions will be used to create the "r" value that will indicate the level of association between variables (Meyers, 2006).
Ethical Considerations
Informed Consent
is developed from federal government and APA guidlines (Kitchener, 2000)

  • informed consent agreement will be presented in terms that the clients understand
  • all rights will be protected and individual concerns will be accommodated
  • participants will be informed about the
  • content of the study,
  • its duration
  • how confidentiality will be protected
  • contact persons within the research group
  • that they are volunteers and they can withdraw at any time without consequences
  • there are no deceptions

2nd Cycle
true wiki style

Gender differences

Female "system of self" in group process and especially abstinence
  • self-esteem
  • self-efficacy
  • social cohesiveness
    • group-esteem

Group-oriented agency model
self-system within the group process as it applies to society

  • other-efficacy (Jowett, S. & Lavallee, D. 2007)
    • views by individual group members of the likely hood of success
    • how that will affect agency
      • self-efficacy
      • self-esteem
  • group-efficacy measures
    • consensual
    • individual aggregate
    • individual view of group
  • group-agency measures
    1. group success
    2. success of individuals within group
      • ability of the group to create agency in individuals (irrespective of the group agency)
    3. societal success model
    • what does the model contribute?
      • group volume
      • comparison to other models
        • CBT
        • behavioral
        • psychoeducation
        • psychodyamics
      • material comparisons
        1. benefit to society
        2. cost to society
        3. low cost of research
    • variety of environments
      • countries
      • national groups
        • socio-economic
        • ethnic

Methodology model: Abstinence vs. relapse

Scale

  • time
Variables

Abstinence

explicit
group

  • attendance
  • efficacy (three measures)
individual
  • self-efficacy
  • self-agency
  • self-esteem
  • etc

implicit (anticipated)
  • honesty
    • rewards
    • group reinforcement (self- and group-esteem)
Relapse varibales
  • craving
  • relapse
  • drug-use cohort
  • comorbidities
    • anxiety
      • panic attacks
    • depression
    • etc
Question development
  • open-end questions at end of questionnaire session
  • comments
Software development

Priorities

  • replace drug screening with "soft screening"
    • predict abstinence honesty
  • resolve security/privacy issues
    • delete data as it is processed
  • determine questions that are most predictive

visual inspection

  • charts with respect to
    • time (primary)
    • variables (design factor modeling)

regression model

  • determine significance

factor analysis
develop therapeutic strategies

  1. cluster questions
  2. find clusters that are significant
  3. define them within the "self- and group-system"
  4. facilitate group development based on clusters

Implement "success" model

  • general support

diverse testing

  • nations
  • socio-economic levels
  • ethnicities

new question development

  • native-speaking question-makers
Illustration
  • Future research hypothesized graph (below)
    • Charting of relationship between self-efficacy and self-esteem
    • Help predict relapse (low self-agency)




References

Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37(2), 122-147. doi:10.1037/0003-066X.37.2.122

Berry, W. (1985). Multiple regression in practice. Beverly Hills, CA: Sage Publications.

Bogenschutz, M. P., Tonigan, S., & Miller, W. R. (2006). Examining the effects of alcoholism typology and AA attendance on self-efficacy as a mechanism of change. Journal of Studies on Alcohol, 67(4), 562-567.

Bracke, P., Christiaens, W., & Verhaeghe, M. (2008). Self-esteem, self-efficacy, and the balance of peer support among persons with chronic mental health problems. Journal of Applied Social Psychology, 38(2), 436-459. doi:10.1111/j.1559-1816.2008.00312.x

DeCoster, J. (1998). Overview of factor analysis. Retrieved from http://www.stat-help.com/notes.html

DeFulio, A., & Silverman, K. (2011). Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: post-intervention outcomes. Addiction, 106(5), 960-967. doi:10.1111/j.1360-0443.2011.03364.x

DuPont, R. (2005). Drug testing in schools: guidelines for effective use. Center City, MN: Hazelden.

Figueira-McDonough, J. & Sarri, R. (2002). Women at the Margins: Neglect, Punishment, and Resistance. New York: Routledge

Goldberg, R. (2010). Drugs across the spectrum. Belmont, CA: Wadsworth, Cengage Learning.

Goodwin, C. J. (2010). Research in psychology: Methods and design (6th ed.). Hoboken, NJ: John Wiley and Sons, Inc.

Gossop, M., Stewart, D., & Marsden, J. (2008). Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: A 5-year follow-up study. Addiction, 103(1), 119–12

Greenberger, E., Chen, C., Dmitrieva, J., & Farruggia, S. P. (2003). Item-wording and the dimensionality of the Rosenberg Self-Esteem Scale: Do they matter?. Personality & Individual Differences, 35(6), 1241. doi:10.1016/S0191-8869(02)00331-8

Groh, D. R., Jason, L. A., Ferrari, J. R., & Davis, M. I. (2009). Oxford House and Alcoholics Anonymous: The impact of two mutual-help models on abstinence. Journal of Groups in Addiction & Recovery, 4(1/2), 23-31. doi:10.1080/15560350802712363

Hasin, D. S., Stinson, F. S., Ogburn, E., & Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and cependence in the United States. Archives of General Psychiatry, 64(7), 830-842.

Hojat, M. (2007). Empathy in patient care: antecedents, development, measurement, and outcomes. New York: Springer.
Jowett, S. & Lavallee, D. (2007). Social psychology in sport. Champaign, IL: Human Kinetics.

Kitchener, K. (2000). Foundations of ethical practice, research, and teaching in psychology. Mahwah, N.J: L. Erlbaum Associates.

Matto, H. C., Strolin, J. S., & Mogro-Wilson, C. (2008). A pilot study of a dual processing substance user treatment intervention with adults. Substance Use & Misuse 43(3-4), 285-294.

Meyers, L. (2006). Applied multivariate research: Design and interpretation. Thousand Oaks, CA: Sage Publication

Phan, H. (2010). Students' academic performance and various cognitive processes of learning: an integrative framework and empirical analysis. Educational Psychology, 30(3), 297-322. doi:10.1080/01443410903573297

Sánchez-Hervás, E., Romaguera, F., Santonja Gòmez, F., Secades-Villa, R., García-Rodríguez, O., & Yanez, E. (2010). Urine testing during treatment predicts cocaine abstinence. Journal of Psychoactive Drugs, 42(3), 347-352.

Schmitt, D. P., & Allik, J. (2005). Simultaneous administration of the Rosenberg Self-Esteem Scale in 53 nations: exploring the universal and culture-specific features of global self-esteem. Journal of Personality and Social Psychology, 89(4), 623-642. doi:10.1037/0022-3514.89.4.623

Stevens, E. B., Jason, L. A., Ferrari, J. R., & Hunter, B. (2010). Self-efficacy and sense of community among adults recovering from substance abuse. North American Journal of Psychology, 12(2), 255-264.

Terry-McElrath, Y. M., Johnston, L. D., O'Malley, P. M., & Yamaguchi, R. (2005). Substance abuse counseling services in secondary schools: A national study of schools and students, 1999-2003. Journal of School Health, 75(9), 334-341. doi:10.1111/j.1746-1561.2005.00047.x

Tourangeau, R., & Yan, T. (2007). Sensitive questions in surveys. Psychological Bulletin, 133(5), 859-883. doi:10.1037/0033-2909.133.5.859

Truneckova, D., & Viney, L. L. (2008). Small-group counselling with primary school children. Personal Construct Theory & Practice, 5, 139-148.


NOTES

"Self-esteem, when viewed as a basic construct in an individual's implicit conceptual system of self, is of such fundamental importance in understanding human behavior that it warrants a great deal of creative effort in establishing better ways to measure it." (Epstein, 1982, August, p. 1)

Self- and Group-Dynamics in Mutual Support Recovery

This wiki is represented as a APA sytle paper is in wiki form in the article preceding this one (click).

Abstract
Self-efficacy in those attempting to recover from substance abuse disorders is believed to contribute to abstinence. Participation in mutual support groups is believed to reinforce self-efficacy by giving participants the opportunity to help others. Self-efficacy, as a component of the conceptual "system of self" works in conjunction with self-esteem to help goal achievement, or self-agency, which, for those with substance disorders, is abstinence. To reinforce research from previous largely qualitative studies, this study proposes to correlate self-efficacy and self-esteem as predictors of the rate of abstinence, or self-agency, of a group 30 men with a mean age of 30 who attend mutual support substance abuse programs. It is hypothesized that increases in self-efficacy and self-esteem will predict self-agency in terms of higher abstinence and lower drug craving, but that self-efficacy will be a greater predictor. The study also proposes to explore innovative data collection and statistical methodologies that leverage cell phones, the internet, and continuous online statistical analysis for the benefit of other researchers and those who want to manualize self-efficacy and self-esteem concepts in the group context for substance abuse recovery.

Introduction

Statement of Problem
Alcohol abuse, as an example of substance abuse, has a lifetime prevalence of 18% with current abuse highest among the young, implying that it is a growing problem (Hasin, et al., 2007). Less than a quarter of alcohol abusers are treated and treatment opportunities have declined. Drug abuse is also shown to be growing, and treatment is also believed to be declining especially for the young (Terry-McElrath, 2005). Recovery is difficult and relapse is common (DeFulio & Silverman, 2011).

Mutual support groups such as Alcoholics and Narcotics Anonymous provide effective support and are cost-effective as they are self-supporting. Non-abstinent substance abusers regularly experience high permanent recovery rates if they regularly attend group support meetings (Gossop, Stewart, & Marsden, 2008; Groh, et al. 2009). The reason given for high success rates is that the groups provide opportunities for those recovering from abuse to increase their self-efficacy (Stevens, et al., 2010).

This study proposes to quantify the relationships between the "self-system" components of self-efficacy and self-esteem as they help recovering abusers achieve the goal, or self-agency, of abstinence in the context of mutual support groups.

Literature Review

Self-efficacy
Self-efficacy is the perception of one's ability to reach goals, or self-agency, and, according to Bandura (1982), mediates the process of achieving goals. Related to self-efficacy and self-agency (as components of the "self-system") is self-esteem (Phan, 2010), which, as the perception of self-worth, is enhanced by peer appraisals and support (Bracke, Christiaens, & Verhaeghe, 2008).

Self-efficacy is also suggested as a mechanism that reduces the drug craving that leads to abstinence relapse (Matto, Strolin, & Mogro-Wilson, 2008).

Group process
Bracke, Christiaens, and Verhaeghe (2008) show that self-efficacy and related self-esteem can interrelate as mutual mediators among support groups of the mentally ill. Under some circumstances, they show that self-esteem can be detrimental to self-agency in the absence of self-efficacy (especially in men) as it signifies peer dependence rather than self-agency. Also, they specifically show that self-efficacy is achieved when group members take a leadership role by providing support to other members. This study shows increased self-efficacy in a therapeutic context, but, using a cross-sectional design, could not link self-efficacy to self-agency, which would be the patients' progress over time.

Truneckova, & Viney describe group process as the means by which groups provide members with self-system support (2008), and Bandura (1982) describes group efficacy as a group's perception of its ability to reach goals, or group agency. While group efficacy should predict self-agency among members, Groh, et al. (2009) show that recovering abusers who both attend support groups and get further support by living in support communities have the highest self-agency, or abstinence, rate of about 90%. This suggests that these multiple group members are doing something different than single-group members, and it may be that they are taking more supportive roles. Combining these ideas suggests recovering abusers who benefit the most from group support in terms of self-agency tend to do so because they provide support to others as well as benefit from the group's support in terms of self-esteem. Group support benefits members with self-esteem, but it is the individual effort of the participant that is the ultimate predictor of self-agency. Truneckova, & Viney (2008) demonstrated group process as being beneficial for members but failed to connect it to individual efficacy and agency (even though their results seemed to support it), and Groh, et al. (2009) showed self-efficacy, but not in the context of involvement in group process.

Hypotheses to be Tested
This study proposes to show that self-efficacy and self-esteem both directly contribute to self-agency, or abstinence, in the context of mutually supported substance abuse recovery, and that self-efficacy is more predictive of self-agency than self-esteem is. It also proposes to show that self-efficacy is indeed associated with lower drug craving, giving those who participate in groups a higher rate of abstinence.
1. Clients who participate in mutual support groups by contributing support and suggestions to other group participants (self-efficacy), and who receive this kind of support (self-esteem) will have abstinence rates that are higher than those who have low measures in these variables.
2. Clients who have high abstinence will show higher self-efficacy than self-esteem.
3. Clients with high self-efficacy will have lower cravings, which will correlate with higher abstinence (or self-agency).

Method
The two intended goals are to provide support for correlations between concepts of "system of self" through regression analysis of Likert-type self-report scales in relation to self-reports of abstinence, and to implement a flexible self-report and analysis system that can be expanded, or "scaled," either to increase the n-number as recruits are found, or to accommodate future research by enhancing the statistical software.

Participants
Participants will be drug abuse clients who are referred by probation officers or recruited from Narcotics Anonymous-type mutual support groups with the assistance of group leaders.
Leaders of the mutual support groups will act as facilitators by reporting the group attendance of the participants and also that the group is functioning moderately well. They have to be reliable and drug free.

Limiting the study to male clients will solve a control problem which is that women respond to self-esteem at a different rate than men (Bracke, Christiaens, & Verhaeghe, 2008). Participants also need to be frequent mutual support group attendees, and, for abstinence testing purposes, the substances for which they have been referred have to be reliably testable drugs such as cocaine, heroin or methedrine.

There will be no control group primarily because the study will assess for correlations between self-efficacy and abstinence in the participants.

Materials
Self-efficacy, self-esteem, and the group process will each be tested with a separate scale. Self-efficacy will be tested with a modified version of the Alcohol Abstinence Self-Efficacy Scale, and self-esteem will be measured with the Rosenberg Self-esteem Scale. Both these tests are well-studied and have shown reliability and validity adequate for this study (Bogenschutz, Tonigan, & Miller, 2006; Greenberger, Chen, Dmitrieva, & Farruggia, 2003).
Self-report and statistical analysis will be conducted by an information system. It will consist of a cell phone "app" for self-report system, which is a tiny web page that runs on a smart phone. An online server secured with 128 bit encryption and sophisticated password checking will collect the data and an attached statistical program will analyze it on a continual basis.
Restaurant coupons will be supplied to participants as a reward for honesty about abstinence and relapse self-reporting based on drug screens. The choice of restaurant coupons is to involve the community. It is perceived that the business community leaders will support a program that seeks to reduce a major problem cost-effectively, and will be able to convince restaurant owners to donate dinners.

Procedures
Participants and group leaders will register anonymously with the web server and be given the informed consent agreement form in a format that can easily be understood by them. When they have agreed to agreement's terms, they will be asked if they have concerns about the agreement (by the web server) to assure that they understood it.

Using a secret name or number, participants will be asked to access the server via a cell phone "app" after group support sessions and will be asked a few questions from the self-esteem and self-efficacy questionnaires. They will be also be asked to access the "app" if they feel craving, or relapse to drug use. They can also reach the research staff anonymously this way if they have concerns about their participation in the study.

Using the same method, group leaders will insert attendance information into the server database, and will be asked a few questions about the group process to assure that the group is functioning normally. This data is inclusion criteria and not intended to be experimental.
Participants will be given random drug screens solely for the purpose of confirming abstinence or relapse. The test will be kept confidential simply by identifying it with the secret cell phone "app" log-in ID. They will be only tested for "hard" drugs such as cocaine, methedrine, and heroin, as some other substances such as marijuana and alcohol will provide either overly-positive or overly-negative results (DuPont, 2005; Goldberg, 2010).

These sessions will take a few minutes, and the study period will be three months.

Proposed Statistics
The test measures are self-efficacy and self-esteem as independent/predictor variables; and abstinence and craving as dependent criteria. As the relationship between the variables is expected to be linear, multiple regressions will be used to create the "r" value that will indicate the level of association between variables (Meyers, 2006).
In the second hypothesis, the multiple regression analysis may not be able to determine whether self-efficacy or self-esteem are more correlated with abstinence if they are closely correlated to each other: the condition of multicollinearity (Berry, 1985). Solutions may include obtaining more data or implementing other statistical formulations.

Ethical Considerations
The informed consent agreement (Appendix A) has been developed to meet United States federal government and American Psychology Association ethical guidelines (Goodwin, 2010; Kitchener, 2000). It is in terms clients can understand, their privacy rights are fully protected, and their individual concerns will be solicited and accommodated. They will be informed about the content and purpose of the study, its duration, how confidentiality will be protected, that they are volunteers, there will be no consequences for withdrawing, how they can withdraw, and that there are no deceptions in this study.

Group leaders will likewise be given informed consent material with the addition that they agree to protect the privacy of the other participants, and that they agree to attempt to stay with the program as they are needed to monitor participant attendance and group process.

Anticipated Results
It is expected that the three hypotheses will be confirmed, though the relationship between self-efficacy and self-esteem in terms of abstinence may need further statistical analysis to magnify the differences to show a relationship. Likewise the technical innovations are expected to produce data efficiently with little chance of response bias such as response acquiescence and social desirability, as the self-reports are anonymous and supplied to a device rather than a person.

Implications
The material provided can be directly applied by researchers interested in manualizing group support strategies that leverage "system of self" components as they are enhanced by the normal group process (Stevens, et al., 2010). The research material will be presented in such a way that it can be further analyzed with the online software with which it is presented.
The anticipated success of the technology innovations will encourage similar efforts. The system will not be "taken down," but will be made available to researchers who have participants willing to self-report with cell phones at a cost of pennies per transaction. Statistical software, which is already in the public domain, will be made available for modification.

Discussion
Summary
The study will provide needed evidence of the relationships between "systems of self" and the group process for the purposes of policy-making and future research. The technology experience will show that self-report effectiveness can be enhanced by many factors and that collected material and statistical services can be made universally available at little cost.

Conclusion
This study will help define and "tease apart" the different components of the structures of the "system of self" and use quantitative data to define them in the context of group experience in ways that have largely been qualitative, and hence conflicting and often ambiguous.
It shown that good group process, or group efficacy, will enhance self-efficacy and self-agency (Stevens, et al., 2010), but it is important to understand that the individual may benefit from the group process in ways that are independent of the group's goal-reaching success, or group-agency. Individuals do this by contributing to the group in a way that reinforces their self-system. Presumably all the group members will benefit (especially in terms of self-esteem), but not as much as individuals who actively contribute.

Limitations
This second hypothesis (which is that self-efficacy and self-esteem are important to self-agency, but self-efficacy is more important) presents a possible limitation in that there may be statistical difficulties if the self-efficacy and self-esteem variables are found to be too closely correlated (Berry, 1985; Meyers, 2006).

Perceived limitations also relate to relapse and abstinence. Self-reports for drug use have been shown to be inaccurate (Tourangeau & Yan, 2007), though measures are being implemented to control for this through drug screening and with rewards for honesty. The craving variable data may be used in the first and second hypotheses if abstinence self-reporting is too problematic. Another limitation may be the influence of drug screening as they have been shown to mediate abstinence (Sánchez-Hervás, et al., 2010). Assured privacy and the reward for honesty should minimize this effect. Ultimately, these potential problems would best be resolved in future research by developing other variables to use as measures of self-agency.

Future Research
An intuitive next step is to apply the study to women. It has been shown that women are motivated differently by self-esteem, self-efficacy, and also social cohesiveness in terms of group process and especially abstinence (Bracke, Christiaens, & Verhaeghe, 2008; Figueira-McDonough & Sarri, 2002). This research should provide better definitions for the "system of self" in terms of gender differences.

The strongest rationale for this study is the initiation of future research. Evidence is building in different areas for a self-system and group process model, but terminology is unclear (and often defined in the context of a single study), and only a small percentage of studies have been applied to major disorders (rather than, say, business dynamics), and often by the same researchers. Real world effectiveness needs to be shown in a variety of environments such as different countries to win general support.

With implementation of a cell phone "app" that operates at nearly no cost, technical focus should move towards the statistical services. While most researchers cite most commonly-used "self-system" tests as having high reliability and validity, many researchers criticize their use such as in multi-cultural contexts (Schmitt, & Allik, 2005). A general solution is to implement factor analysis software (which is also in the public domain) in place of regression software so that test questions can be used at random (within the scope of self-system and mutual group support) and then "clustered" using Likert-type scales into categories that will relate to components of the self-system (DeCoster, 1998; Hojat, 2007). Further, participants could be asked open-ended questions such as "how do you feel?" These responses could be converted into questions to be categorized.

This will create real-world connections to theoretical abstractions in much the way that the Five Factor Model has been developed. (A Five Factor Model project can supply much of the software and expertise (J. A. Johnson, personal communication, December 6, 2010)). Ultimately, the greatest benefit may be the ability to interrelate variables to predict the all-important abstinence, or self-agency, so that abstinence success can be used to load variables that simulate group process; these, in turn, can contribute to developing outcomes that can be used to formulate therapeutic strategies.

Future software should be developed to further resolve privacy issues by deleting personal data as it is processed, and hopefully accurately predict abstinence honesty (using self-system variables) so as to eliminate drug screening as a potential mediator, source of participant concern, and expense. Also, research should attempt to transcend the singular focus on the "system of self," to move towards a group-oriented agency model as group agency will presumably yield a greater volume of beneficial outcomes than individual agency.

References
Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37(2), 122-147. doi:10.1037/0003-066X.37.2.122
Berry, W. (1985). Multiple regression in practice. Beverly Hills, CA: Sage Publications.
Bogenschutz, M. P., Tonigan, S., & Miller, W. R. (2006). Examining the effects of alcoholism typology and AA attendance on self-efficacy as a mechanism of change. Journal of Studies on Alcohol, 67(4), 562-567.
Bracke, P., Christiaens, W., & Verhaeghe, M. (2008). Self-esteem, self-efficacy, and the balance of peer support among persons with chronic mental health problems. Journal of Applied Social Psychology, 38(2), 436-459. doi:10.1111/j.1559-1816.2008.00312.x
DeCoster, J. (1998). Overview of factor analysis. Retrieved from http://www.stat-help.com/notes.html
DeFulio, A., & Silverman, K. (2011). Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: post-intervention outcomes. Addiction, 106(5), 960-967. doi:10.1111/j.1360-0443.2011.03364.x
DuPont, R. (2005). Drug testing in schools: guidelines for effective use. Center City, MN: Hazelden.
Figueira-McDonough, J. & Sarri, R. (2002). Women at the Margins: Neglect, Punishment, and Resistance. New York: Routledge
Goldberg, R. (2010). Drugs across the spectrum. Belmont, CA: Wadsworth, Cengage Learning.
Goodwin, C. J. (2010). Research in psychology: Methods and design (6th ed.). Hoboken, NJ: John Wiley and Sons, Inc.
Gossop, M., Stewart, D., & Marsden, J. (2008). Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: A 5-year follow-up study. Addiction, 103(1), 119–12
Greenberger, E., Chen, C., Dmitrieva, J., & Farruggia, S. P. (2003). Item-wording and the dimensionality of the Rosenberg Self-Esteem Scale: Do they matter?. Personality & Individual Differences, 35(6), 1241. doi:10.1016/S0191-8869(02)00331-8
Groh, D. R., Jason, L. A., Ferrari, J. R., & Davis, M. I. (2009). Oxford House and Alcoholics Anonymous: The impact of two mutual-help models on abstinence. Journal of Groups in Addiction & Recovery, 4(1/2), 23-31. doi:10.1080/15560350802712363
Hasin, D. S., Stinson, F. S., Ogburn, E., & Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and cependence in the United States. Archives of General Psychiatry, 64(7), 830-842.
Hojat, M. (2007). Empathy in patient care: antecedents, development, measurement, and outcomes. New York: Springer.
Jowett, S. & Lavallee, D. (2007). Social psychology in sport. Champaign, IL: Human Kinetics.
Kitchener, K. (2000). Foundations of ethical practice, research, and teaching in psychology. Mahwah, N.J: L. Erlbaum Associates.
Matto, H. C., Strolin, J. S., & Mogro-Wilson, C. (2008). A pilot study of a dual processing substance user treatment intervention with adults. Substance Use & Misuse 43(3-4), 285-294.
Meyers, L. (2006). Applied multivariate research: Design and interpretation. Thousand Oaks, CA: Sage Publication
Phan, H. (2010). Students' academic performance and various cognitive processes of learning: an integrative framework and empirical analysis. Educational Psychology, 30(3), 297-322. doi:10.1080/01443410903573297
Sánchez-Hervás, E., Romaguera, F., Santonja Gòmez, F., Secades-Villa, R., García-Rodríguez, O., & Yanez, E. (2010). Urine testing during treatment predicts cocaine abstinence. Journal of Psychoactive Drugs, 42(3), 347-352.
Schmitt, D. P., & Allik, J. (2005). Simultaneous administration of the Rosenberg Self-Esteem Scale in 53 nations: exploring the universal and culture-specific features of global self-esteem. Journal of Personality and Social Psychology, 89(4), 623-642. doi:10.1037/0022-3514.89.4.623
Stevens, E. B., Jason, L. A., Ferrari, J. R., & Hunter, B. (2010). Self-efficacy and sense of community among adults recovering from substance abuse. North American Journal of Psychology, 12(2), 255-264.
Terry-McElrath, Y. M., Johnston, L. D., O'Malley, P. M., & Yamaguchi, R. (2005). Substance abuse counseling services in secondary schools: A national study of schools and students, 1999-2003. Journal of School Health, 75(9), 334-341. doi:10.1111/j.1746-1561.2005.00047.x
Tourangeau, R., & Yan, T. (2007). Sensitive questions in surveys. Psychological Bulletin, 133(5), 859-883. doi:10.1037/0033-2909.133.5.859
Truneckova, D., & Viney, L. L. (2008). Small-group counselling with primary school children. Personal Construct Theory & Practice, 5, 139-148.

Tuesday, January 18, 2011

Schizophrenia's genetic signalling protein and receptors

A search for genetic information about schizophrenia shows that a genetically expressed protein, NRG1, and two of its receptors, ErbB3 and ErbB4, are central to schizophrenia. Recent studies implicating NRG1 in schizophrenia often implicate it in bipolar disorder with the same evidence. But different studies focus on two different areas, myelin and neurotransmitters, and hence seem contradictory. Myelin implies neural speed, and neurotransmitters bring to mind, as an example, dopamine as a component of stress.

A myelin, or ErbB3, study (McIntosh, 2009), shows that NRG1/ErbB3 signaling failures cause oligodendrocyte activity to be impaired so that less "white matter" is produced resulting in a diminished "anterior internal capsule in subjects with both disorders" (p. 2). This effect is assumed to be developmental, and myelin formation in "frontal lobes, continues into late adolescence and beyond" (p. 3), giving optimism that new drugs based on NRG1 could reinforce myelination (p. 4).

Genetic loading for psychosis and the internal capsule (McIntosh, 2009)

Neurotransmitter, or ErbB4, studies have a brain-wide view with a focus on neuron development and transmitter activities such glutamatergic hypofunction (Li, 2007), failures in the formation of inhibitory synapses (Fazzari, 2010), and the "wiring" of GABA-mediated circuits (Fazzari, 2010), all in the context of schizophrenia. While bipolar disorder can be linked to schizophrenia in the context of ErbB4 (Chong, 2007), the more detailed material on neural activity focuses on schizophrenia.

As dopamine hyperactivity is part of the schizophrenia pharmacological model (Stone, 2007), and methamphetamine is used to simulate it experimentally (Homayoun, 2008), studies concentrating on stimulants may give clues about the neural activity of schizophrenia and bipolar disorder in relation to behavior.

The "white matter" study is optimistic that new drugs may reinforce myelination, and so raises an idea about myelination and plasticity with respect to maturity: could such drugs help the elderly retain plasticity?



References

Chong, V., Thompson, M., Beltaifa, S., Webster, M., Law A., and Weickertad, S. (2007). Elevated Neuregulin-1 and ErbB4 protein in the prefrontal cortex of schizophrenic patients: Schizophr Res. 2008 March ; 100(1-3): 270–280. doi:10.1016/j.schres.2007.12.474.

Fazzari, P., Paternain, A., Valiente, M., Pla, R., Luján, R., Lloyd, K., et al. (2010). Control of cortical GABA circuitry development by Nrg1 and ErbB4 signalling. Nature, 464(7293), 1376-1380. doi:10.1038/nature08928.

Homayoun, H., & Moghaddam, B. (2008). Orbitofrontal cortex neurons as a common target for classic and glutamatergic antipsychotic drugs. Proceedings of the National Academy of Sciences of the United States of America, 105(46), 18041-18046. doi:10.1073/pnas0806669105.

Li, B., Woo, R., Mei L., Malinow, R., (2007, May 24). The neuregulin-1 receptor ErbB4 controls glutamatergic synapse maturation and plasticity. Neuron, 54(4), 583-597.

McIntosh, A., Hall, J., Lymer, G., Sussmann, J., and Lawrie, S. (2009). Genetic risk for white matter abnormalities in bipolar disorder. International Review of Psychiatry, 21(4), 387-393. doi:10.1080/09540260902962180.

McIntosh, A., Hall, J., Lymer, G., Sussmann, J., and Lawrie, S. (2009).
Genetic loading for psychosis and the internal capsule disorder. International Review of Psychiatry, 21(4), 387-393. doi:10.1080/09540260902962180.

S
tone, J., Morrison, P., and Pilowski, L. (2007, January 26). Review: Glutamate and dopamine dysregulation in schizophrenia — a synthesis and selective review. Journal of Psychopharmacology June 2007 vol. 21 no. 4 440-452

Executive function in depression

Conduct disorder, ADHD, and anxiety disorder” (Sigelman & Rider, p. 482) are often comorbid with depression in children, showing an overlap between depression and ADHD in children.  In my writing about ADHD in children (van Vlaanderen, 2010), I describe evidence of an executive function (EF) component to ADHD, and James (2008) supports an EF component for depression because depressive hyper-activity occurs in the executive function regions.  He promotes the idea that EFs for the depressed can be enhanced with CBT in ways that are similar to my speculation that EF functioning can be enhanced for children with ADHD through psychoeducation. 

In depressed adults, James finds "rigid and concrete thinking, attentional problems" and "memory difficulties" (p. 10) associated with executive function deficit (EFD).  In adults with ADHD who had it as children, Barkley (2004) shows socialization problems that are similar to conduct disorder (CD) and oppositional defiant disorder (ODD) such as arrests and other anti-social behaviors, and Clark (2002) confirms that socialization problems are related to EFD in ADHD-affected children--even for children not diagnosed with CD or ODD.

Speculating along these lines, psychoeducational and -therapeutic strategies may be developed to help with depression (and adult ADHD) that will focus directly on EFD and can be evaluated by their efficacy with respect to EF.  With time, EF monitoring and imaging will improve, perhaps to the point where it can be part of individual evaluation.

References
Barkley, R., Fischer, M., Smallish, L., & Fletcher, K. (2004). Young adult follow-up of hyperactive children: antisocial activities and drug use. Journal of Child Psychology & Psychiatry, 45(2), 195-211. doi:10.1111/j.1469-7610.2004.00214.x.

Clark, C., Prior, M., & Kinsella, G. (2002). The Relationship Between Executive Function Abilities, Adaptive Behaviour, and Academic Achievement in Children with Externalising Behaviour Problems. Journal of Child Psychology & Psychiatry & Allied Disciplines, 43(6), 785-796. Retrieved from Academic Search Premier database.

James, I., Reichelt, F., Carlsonn, P., & McAnaney, A. (2008). Cognitive Behavior Therapy and Executive Functioning in Depression. Journal of Cognitive Psychotherapy, 22(3), 210-218. doi:10.1891/0889-8391.22.3.210.

Mckinley, C., (2010). The Treatment of Depression in Children. Retrieved October 19, 2010 from http://campus.yorkvilleu.ca/mod/forum/discuss.php?d=87127&parent=556350
http://campus.yorkvilleu.ca/mod/forum/discuss.php?d=87127&parent=556350

Sigelman, C.K., & Rider, E.A. (2009). Life-Span Human Development, 6th edition . Thomson Wadsworth.

van Vlaanderen, J., (2010). Executive function, working memory control, and ADHD. Retrieved October 19, 2010 from http://campus.yorkvilleu.ca/mod/forum/discuss.php?d=85380&parent=544331




Body work

Wohlrab reports that tattoos and piercing (collectively here as "body work") are mainstream for adolescents (Wohlrab, 2007). Those with body work are largely "Sensation Seekers," with multiple sexual relationships. "Previously" he says, body work was seen as "showing antisocial, aggressive, high-risk or deviant behaviours."

Koch reports that body work is still deviant, as multiple tattoos or piercings are likely to mean "regular marijuana use, occasional use of other illegal drugs, and a history of being arrested" (Koch, 2010).

Tattooing is tribal, having been introduced to modern society by crew of the explorer, James Cook (Utanga, 2006). Native tribes decorate their bodies for the "aesthetic and symbolic" and to show a connection with nature (Jefkin-Elnekave, 2006). The majority of contemporary tattoos are tribal- or nature-based, perhaps showing a desire for a natural connection as part of a rebellious expression rather than behavioral deviance (Wohlrab, 2007).

To show the extremes of body work as rebellious expression, the conceptual artist Orlan had herself physically reconstructed to represent the ideal "in classical works of art" (Mullis, 2006). With eight operations she represented "the body as meat" for audiences around the world via satellite.

Pain
While society has sanctioned piercings and tattoos as "socially normative practices" (Toste, 2010), and separates them from self-injury, pain still links them. Siorat says that tattoos are symbols of the pain of the "many hours under the needles" necessary to create them (Siorat, 2006). Tribal scarring can be different different from tribal body decorations in that it often represents the pain of war (Jefkin-Elnekave, 2006).

If we allow for gray area between body work and self-injury defined by pain, perhaps we can speculate about a biopsychological connection: depression. For this speculation, let's allow for a link through pain. The physical pain of self-injury can be an escape from the pain of depression (Dickstein, 2009) where the most common diagnosis for self-injury is depression followed by PTSD. If we allow for the "old school" view that body work, specifically tattooing, is representative of lower and criminal classes, and we can show depression at these social levels: "increased frequency of child exposure to poverty is a consistent predictor of adolescent and young adult anxiety and depression" (Ying, 2010). More challenges, and hence stresses, exist for the present adolescent generation than did for previous generations (TODAY Health, 2010), so perhaps body work is a way to cope and express the increasing stresses of the adolescent contemporary experience.

JefkiElnekave, D. (2006). Tribal identity through body art: Extraordinary people living in the remnants of itme. PSA Journal, 72(7), 22-25.

Koch, J., Roberts, A., Armstrong, M., & Owen, D. (2010). Body art, deviance, and American college students. Social Science Journal, 47(1), 151-161. doi:10.1016/j.soscij.2009.10.001.
Mullis, E. (2006, May). The violent aesthetic: A reconsideration of transgressive body art. Journal of Speculative Philosophy, pp. 85-92. Retrieved from Academic Search Premier database.

Wohlrab S, Stahl J, Rammsayer T, Kappeler P. Differences in personality characteristics between body-modified and non-modified individuals: associations with individual personality traits and their possible evolutionary implications. European Journal of Personality [serial online]. November 2007;21(7):931-951.

Dickstein, D. (2009). A closer look at non-suicidal self-injury in adolescents. (Cover story). Brown University Child & Adolescent Behavior Letter, 25(12), 1-6.

Siorat, C. (2006). The Art of Pain. Fashion Theory: The Journal of Dress, Body & Culture, 10(3), 367-380. Retrieved from Academic Search Premier database.
TODAY Health (2010). Students report more serious stress. Retrieved September 29, 2010, from http://today.msnbc.msn.com/id/34803404/ns/health-kids_and_parenting/

Ying, S., Fangbiao, T., Jiahu, H., & Yuhui, W. (2010). The Mediating Effects of Stress and Coping on Depression Among Adolescents in China. Journal of Child & Adolescent Psychiatric Nursing, 23(3), 173-180. doi:10.1111/j.1744-6171.2010.00238.x.

fMRI of recognition

Schulte-Rüther (2007) provides graphic evidence of the emotional processes of identifying emotions in others, using fMRI, in terms of empathy.   He pinpoints simpler recognition and related processing to specific parts of the brain.  He connects the empathic reaction to facial expressions with the areas used for theory-of-mind processing that utilize mirror neurons.

"self- (relative to the other-) task differentially activated the" (p. 1):
  • medial prefrontal cortices (MPFC)
  • Posterior cingulate cortex (PCC)/precuneus
  • temporo-parietal junction bilaterally

Covariation of mirror neuron activation and empathic ability.

References

Schulte-Rüther, M., Markowitsch, H., Fink, G., & Piefke, M. (2007). Mirror Neuron and Theory of Mind Mechanisms Involved in Face-to-Face Interactions: A Functional Magnetic Resonance Imaging Approach to Empathy. Journal of Cognitive Neuroscience, 19(8), 1354-1372. Retrieved from Academic Search Premier database.

Cognitive agility

Executive function and memory rehabilitation

As dementia effectively means the loss of cognitive and memory abilities, helping the elderly maintain these abilities is a direct approach that forestalls dementia (Barclay, 2009) and should help the elderly maintain other aspects of their lives.  Cognitive rehabilitation, also cognitive remediation, focuses on executive function (EF) and memory in a way that creates common strategies for diverse therapies concerned with the prefrontal cortex--brain injuries, angioma, ADHD, schizophrenia, and dementia--with its cognitive flexibility, working memory, and planning functionalities.

As cognitive rehabilitation is time-costly, it tends to focus only on the immediate needs of lower-functioning cognitive abilities, and higher executive dysfunctions may never get addressed.  A universal antidote for high cost is, of course, computer automation, and this has not gone unnoticed by cognitive rehabilitators.  Virtual reality (VR) is emerging as a supportive strategy (Castelnuovo, 2003) that is being received with enthusiasm by both clinicians (Weiss, 2009) and patients (da Costa, 2004).  Efficacy-testing, which is also in early stages, is showing benefits for schizophrenics so far (Chan, 2010). 

Interestingly, Web surfing has been shown through imaging to stimulate decision-making components of EF in the elderly, though the benefit only comes with Internet experience (Parker-Pope, 2008).


References

Barclay, L. , Hall, C., Lipton, R., Sliwinski, M., Katz, MJ, Derby, C., Verghese, J. (2009). Cognitive activities delay onset of memory decline in persons who develop dementia. Neurology 73, 356-361

Castelnuovo, G., Lo Priore, C., Liccione, D., 3, Cioffi, G. (2003). Virtual Reality based tools for the rehabilitation of cognitive and executive functions: the V-STORE. PsychNology Journal, 1(3), 310-325.

Chan, C., Ngai, E., Leung, P., & Wong, S. (2010). Effect of the adapted virtual reality cognitive training program among Chinese older adults with chronic schizophrenia: a pilot study. International Journal of Geriatric Psychiatry, 25(6), 643-649. Retrieved from Academic Search Premier database.

da Costa, R., & de Carvalho, L. (2004). The acceptance of virtual reality devices for cognitive rehabilitation: a report of positive results with schizophrenia. Computer Methods & Programs in Biomedicine, 73(3), 173. doi:10.1016/S0169-2607(03)00066-X.

Parker-Pope, T. (2008, October 16). Surfing the Internet boosts aging brains. New York Times. Retrieved October 20, 2008, from http://well.blogs.nytimes. com/2008/10/16/does-the-internet-boost-your-brainpower

Weiss, P., Sveistrup, H., Rand, D., & Kizony, R. (2009). Video capture virtual reality: A decade of rehabilitation assessment and intervention. Physical Therapy Reviews, 14(5), 307-321. doi:10.1179/108331909X12488667117339.

ADHD and parenting

A study about ADHD and parenting styles reports that "aspects of the family environment and parental limit setting" appear to correlate with the growth of "executive functions in children" (Schroeder, 2009). But while it is recognized that children with ADHD suffer from executive function impairments such as "inhibition, working memory, set shifting, and planning" (Toplak, 2009), the improved parenting did not help them (Schroeder, 2009). Interventions in schools are effective (Fabiano, 2003), so presumably similar strategies could be used by parents too.

The Incredible Years program uses parent training intervention program to help "children with early onset conduct problems" (Incredible Years, 2010). An efficacy study of it reports that it should be considered as "a first-line intervention" that has "lasting positive effect on ADHD symptoms in pre-school children" (Jones, 2007, p. 9). Children retained a significant portion of the program's benefits "18 months after the end of intervention" (p. 9). But the study notes limitations: the children were pre-school (ADHD is not typically diagnosed until elementary school), and there are limitations to parent self-reporting (their biases will affect their reports). The benefits of the program, he persuasively argues, are significant if it can be used in lieu of, or forestalls, stimulant medication. Criticism of intervention programs that avoid medication should be balanced against the liabilities associated with stimulants: expense, possible negative side-effects, resistance to stimulant medication based on ethical issues. Fabiano echos this (Fabiano, 2003).

The program seeks to improve family communication with affective involvement by using less-harsh and consistent discipline (Incredible Years, 2010):
  • using "attention and appreciation" to build "self-esteem"
  • playing with children
  • "ignoring negative behavior" by not making eye contact
  • avoiding criticism and demands
  • developing friendship and empathy skills
References

Incredible years (2010). Retrieved September 19, 2010 from http://www.incredibleyears.com/

Incredible years (2010). Agendas and Checklists for ADHD Protocol Retrieved September 19, 2010 from http://www.incredibleyears.com/Library/items/parent-training-program-ADHD-montreal_08.pdf

Jones, K., Daley, D., Hutchings, J., Bywater, T., & Eames, C. (2007). Efficacy of the Incredible Years Basic parent training programme as an early intervention for children with conduct problems and ADHD.
Child: Care, Health & Development, 33(6), 749-756. doi:10.1111/j.1365-2214.2007.00747.x.

Schroeder, V., & Kelley, M. (2009). Associations Between Family Environment, Parenting Practices, and Executive Functioning of Children with and Without ADHD.
Journal of Child & Family Studies, 18(2), 227-235. doi:10.1007/s10826-008-9223-0.

Toplak, M., Bucciarelli, S., Jain, U., & Tannock, R. (2009). Executive Functions: Performance-Based Measures and the Behavior Rating Inventory of Executive Function (BRIEF) in Adolescents with Attention Deficit/Hyperactivity Disorder (ADHD).
Child Neuropsychology, 15(1), 53-72. doi:10.1080/09297040802070929.

Self-esteem in youth

Kutob reports low self-esteem in elementary and middle school girls in California and Arizona manifested as "low academic performance, social isolation, depression, anxiety, fatigue, headaches, and stomachaches"  (Kutob, 2010).   The low self-esteem was largely caused by cruel teasing and bullying associated with appearance: body weight.  Kutob promotes "zero tolerance" for teasing.  He blames society for allowing a "mindless acceptance and promotion of stereotypic definitions of personal value based on 'Hollywood' appearance standards."

Self-esteem issues can be cultural
Self-esteem for White and Hispanic girls declined by age 11, but, for Black girls, self-esteem remained the same "between the ages of 9 and 14."  The Black girls were immune.  As global self-esteem for Black and White children is equal (Jackson, 2009), the difference appears to be cultural.

Chinese children with "absent migrant parents" suffer low self-esteem (Li-Juan, 2010).  Loneliness predicts low self-concept, which is restored when their parents spend quality time with them.  Here, family affection links to self-esteem and -concept rather than appraisal.

Top down (social) and bottom up (biopsychological)
Low self-esteem for White and Hispanic girls in California and Arizona resulted from negative appraisal rather than self-concepts of appearance.  There seem to be distinct internal and external components of low self-esteem and poor self-concept.  Mentoring improves self-concept and reduces anxiety, but may not improve school behavior or relationships, and depression may remain (Schmidt, 2007).  Bonding in group therapy benefits self-esteem (Marmarosh, 2005), but those who attempt bonding to reduce depression often become more depressed (Cambron, 2010).

Top down
Low self-esteem includes normal reactions (Hendel, 2006):
  • need to win
  • pleasing others
  • perfectionism
  • self-criticism
  • withdrawing

Bottom up
It is also associated with three indicators of psychological distress (Huajian, 2009):
  • depression
  • anxiety
  • "low subjective well-being"

Exercise improves self-concept, and hence self-esteem
Psychomotor programs "correlated with increased global self-esteem and decreased depression and anxiety levels" (Peter PV Van de, 2005).  Increased physical self-concept elevates low self-esteem--whatever its cause.


Reference

Cambron, M., & Citelli, L. (2010). Examining the link between friendship contingent self-esteem and the self-propagating cycle of depression. Journal of Social & Clinical Psychology, 29(6), 701-726. Retrieved from Academic Search Premier database.

Hendel, A. (2006). Restoring Self-Esteem in Adolescent Males. Reclaiming Children & Youth, 15(3), 175-178. Retrieved from Academic Search Premier database.

Huajian, C., Qiuping, W., & Brown, J. (2009). Is self-esteem a universal need? Evidence from The People's Republic of China. Asian Journal of Social Psychology, 12(2), 104-120. doi:10.1111/j.1467-839X.2009.01278.x.

Jackson, L., Yong, Z., Witt, E., Fitzgerald, H., von Eye, A., & Harold, R. (2009). Self-concept, self-esteem, gender, race, and information technology use. CyberPsychology & Behavior, 12(4), 437-440. doi:10.1089/cpb.2008.0286.

Kutob, R., Senf, J., Crago, M., & Shisslak, C. (2010). Concurrent and longitudinal predictors of self-esteem in elementary and middle school girls. Journal of School Health, 80(5), 240-248. doi:10.1111/j.1746-1561.2010.00496.x.

Li-Juan, L., Xun, S., Chun-Li, Z., Yue, W., & Qiang, G. (2010). A survey in rural China of parent-absence through migrant working: The impact on their children's self-concept and loneliness. BMC Public Health, 101-8. doi:10.1186/1471-2458-10-32.

Marmarosh, C., Holtz, A., & Schottenbauer, M. (2005). Group cohesiveness, group-derived collective self-esteem, group-derived hope, and the well-being of group therapy members. Group Dynamics: Theory, Research, and Practice, 9(1), 32-44. doi:10.1037/1089-2699.9.1.32.
 
Peter PV Van de, V., Herman HV Van, C., Ans AD, D., Joseph JP, P., Guido GP, P., & Koen KK, K. (2005). Comparison of changes in physical self-concept, global self-esteem, depression and anxiety following two different psychomotor therapy programs in nonpsychotic psychiatric inpatients. Psychotherapy & Psychosomatics, 74(6), 353-361. Retrieved from Academic Search Premier database.

Schmidt, M., McVaugh, B., & Jacobi, J. (2007). Is mentoring throughout the fourth and fifth grades associated with improved psychosocial functioning in children?. Mentoring & Tutoring: Partnership in Learning, 15(3), 263-276. doi:10.1080/13611260701201943.

Ethical issues surrounding anxiety disorders

Many adolescents (and children) require proactive care for anxiety disorders.  In the most optimistic cases, early intervention can stem serious problems later on.  But for many suffering from anxiety disorders, proactive care means that their rights are limited, and they may be coerced into therapy and medications that they don't want.  There is endless ethical "gray area" between the two extremes: a happy alliance with the therapist, and an  apparent removal of basic rights.

In the happier purely voluntary form of therapy the counselor/client relationship is called the therapeutic alliance, "a collaborative nature of the partnership between counselor and client" (Hawaii State Department of Health), counseling ethics are easily applied as boundaries to the relationship to assure that the therapy is beneficial and that no harm comes to the client.

This is described succinctly as the "four principles for biomedical ethics" (Westra, 2009): respect for autonomy, nonmaleficence, beneficence, and justice.

The phrase "no harm" (Sheppard, 1999), may be added to stress nonmaleficence.  When clients are harming themselves or may be harmed, this comes to mean "preventing harm," and ethical issues become difficult.

Another more subtle situation that equally relevant situation involves what treatment is used, specifically prescribed drugs, rather than if treatment is used.

An approach to these contradictions is to show that adolescents that need to be controlled, have that need because they are victims.  Adolescents who have been sexually assaulted are at risk for PTSD (Lawyer, 2006), and PTSD as often as not leads to anger (Saigh, 2007).  That may require involuntary treatment if the anger is externalized as violence.  Angry adolsecents usually come from angry families (Avci,  2010), and  "school refusal" is most often positively reinforced by family members or cohorts from the surrounding environment (Kearney, 2004).  Other adolescents who "refuse school" are anxiously reacting to real threats at school (Dube, 2009).  Professionals agonize when young assault victims have to be placed in forensic units, really prisons, when they become threatening or self-injurious as a result of their victimization (Welsh, 1998).

Self-injury may be the most dramatic of issues, along with often related suicide, and it is usually an effort to distract from the pain of depression, or the result of low self-esteem depression (Dickstein, 2009) from negative appraisal by others, or assault (Weismoore, 2010).  Effectively, they have neurotransmitter dysfunctions (Dickstein, 2009).

Perhaps the best information is that adolescent "delinquents" have normal empathy, and that they apparently suffer from executive function disorders (Lardén, 2006).  The stresses that they face force them to limit their cognizance of others' feelings, and there is no self-reported empathy gap between girls and boys. 

References

Avci, R., & Güçray, S. (2010). An Investigation of violent and nonviolent adolescents' family functioning, problems concerning family members, anger and anger expression. Educational Sciences: Theory & Practice, 10(1), 65-76. Retrieved from Academic Search Premier database.

Dickstein, D. (2009). A closer look at non-suicidal self-injury in adolescents. (Cover story). Brown University Child & Adolescent Behavior Letter, 25(12), 1-6. Retrieved from Academic Search Premier database.

Dube, S., & Orpinas, P. (2009). Understanding excessive school absenteeism as School Refusal Behavior. Children & Schools, 31(2), 87-95. Retrieved from Academic Search Premier database.

Hawaii State Department of Health (2010). Therapeutic alliance curriculum activity quiz. Retrieved September 16, 2010, from http://www.amhd.org/About/ClinicalOperations/MISA/Training/Therapeutic%20Alliance%20Curriculum%20activity%20quiz.pdf

Kearney, C. (2007). Forms and functions of school refusal behavior in youth: an empirical analysis of absenteeism severity. Journal of Child Psychology & Psychiatry, 48(1), 53-61. doi:10.1111/j.1469-7610.2006.01634.x.

Lardén, M., Melin, L., Holst, U., & Långström, N. (2006). Moral judgement, cognitive distortions and empathy in incarcerated delinquent and community control adolescents. Psychology, Crime & Law, 12(5), 453-462. doi:1068-316X print/ISSN 1477-2744.

Lawyer, S., Ruggiero, K., Resnick, H., Kilpatrick, D., & Saunders, B. (2006). Mental health correlates of the victim-perpetrator relationship among-interpersonally victimized adolescents. Journal of Interpersonal Violence, 21(10), 1333-1353. Retrieved from Academic Search Premier database.

Saigh, P., Yasik, A., Oberfield, R., & Halamandaris, P. (2007). Self-Reported Anger Among Traumatized Children and Adolescents. Journal of Psychopathology & Behavioral Assessment, 29(1), 29-37. doi:10.1007/s10862-006-9026-9.

Sheppard, G., Schulz, W. and McMahon, S. (1999). The code of ethics. Canadian Counselling and Psychotherapy Association: Ottawa.

Weismoore, J., & Esposito-Smythers, C. (2010). The Role of Cognitive Distortion in the Relationship Between Abuse, Assault, and Non-Suicidal Self-Injury. Journal of Youth & Adolescence, 39(3), 281-290. doi:10.1007/s10964-009-9452-6.

Welsh, J. (1998). In whose ‘best interests’? Ethical issues involved in the moral dilemmas surrounding the removal of sexually abused adolescents from a community-based residential treatment unit to a locked, forensic adult psychiatric unit. Journal of Advanced Nursing, 27(1), 45-51. doi:10.1046/j.1365-2648.1998.00502.x.

Westra, A., Willems, D., & Smit, B. (2009). Communicating with Muslim parents: “the four principles” are not as culturally neutral as suggested. European Journal of Pediatrics, 168(11), 1383-1387. doi:10.1007/s00431-009-0970-8.


Emotion

Emotion and cognition are interrelated in creating meaning (Elliot & Greenberg, 2007).  People continually analyze their emotional reactions to experiences to make sense of them and to understand their environments.  This "affective-cognitive" process happens at automatic, or unconscious, levels just as it does at concious levels. 
 
Greenberg (2010) explains that emotion is "fundamental to the construction of self" but is "detrimental" to "self-organization."  Emotion is different from thought; it operates independently in its own sphere that includes the lymbic system and connections to the body's functioning systems including the organs and the immune system.  The limbic system has a native process that quickly produces emotion in the amygdala, and a slower complex process that combines emotion with thought through connections to the prefrontal cortex in the neocortex--where the executive function, well, executes its process.
 
Emotion-focused therapy (EFT) leverages emotion by attempting to substitute maladaptive, or bad, emotions with adaptive, or good ones.  Resilient people, EFT theory holds, use positive emotions to displace negative ones, and hence have better lives.  Anger, in EFT, can be adaptive or maladaptive.  In depression (where EFT is most commonly used), anger may be elicited as a response to a depression-causing emotion such as shame (perhaps caused by negative appraisal as we previously discussed), and the anger pushes out the shame because, as emotion-focused therapists believe, these two types of emotions cannot coexist.  The client will likely leave therapy feeling empowered.  When anger is maladaptive, such as in feelings of revenge, compassion is used as a substitute emotion, and the client feels soothed and, presumably, happy.
 
Because EFT uses a switching strategy, it is much like cognitive and behavioral therapies, except that it substitutes emotions rather than thoughts and behaviors.  It also has a speedy success rate as does CBT (Ellison, 2009), but because it is rooted in client-centered therapy, the client can naturally implement the process as part of basic self-actualization, making the process permanent.
 
References
 
Elliott, R., & Greenberg, L. (2007). The Essence of Process-Experiential/Emotion-Focused Therapy. American Journal of Psychotherapy, 61(3), 241-254. Retrieved from Academic Search Premier database.
 
Ellison, J., Greenberg, L., Goldman, R., & Angus, L. (2009). Maintenance of gains following experiential therapies for depression. Journal of Consulting and Clinical Psychology, 77(1), 103-112. doi:10.1037/a0014653.
 
Greenberg, L. (2010). Emotion-focused therapy: A clinical synthesis. Retreived October 3, 2010 from http://www.emotionfocusedclinic.org/documents/Emotion-FocusedTherapy_AClinicalSynthesis.L.S.Greenberg.Jan2010.doc

Phobias and behavioral conditioning

This writing shows the influence of pain in psychology; I don't think I would ever use such an example in real life as a child being burned with hot metal.

Phobias are learned behaviors, and can be unlearned.  Classical conditioning typically initiates a phobia, and operant conditioning maintains the phobia.  The first three examples are fictionalized scenarios developed from Dyce's lecture material (J. Dyce, personal communication, n.d.). 

In classical conditioning, unconditioned and conditioned processes are parallel:
  1. Cherry-red hot metal is in the pre-learning phase of a conditioned stimulus.  As it has a pretty color, a person, perhaps a child, may be attracted rather than fearful.
  2. The person touches it (unconditioned stimulus), and gets burned badly (unconditioned response), and learns that cherry-red metal inflicts pain when touched.
  3. The sight of cherry-red metal (conditioned stimulus) results in fear (conditioned response) because of the injury.

In operant conditioning, an initial stimulus of fear is necessary to create phobic behavior:
  1. Discriminative stimulus: The learning from the consequence of a previous experience creates a fear.
  2. Operant response: A person avoids the activity.
  3. Reinforcement: The consequence is a feeling of comfort from avoiding the activity (that reinforces the stimulus and response).

A person may have a minor car accident, and hence fear driving as conditioned response to the accident.  By avoiding driving, he further reinforces the influence of the minor accident, which makes the phobia more difficult to overcome.

In classical conditioning therapy, a new parallel conditioned stimulus is added by teaching someone how to correctly use hot metal.  Beneficial experiences of working with the hot metal without getting burned extinguish the fear of the hot metal.  This example might be found in the historical context of the "cottage blacksmith."

The person who suffered a burn, perhaps as a child, is introduced to the tools necessary for working with hot metal.  Then, using cold metal for practice to gradually reduce the fear, or desensitize the conditioned response, the person is taught how to pick up the metal.  After some practice, the person successfully holds the hot metal with the tools.  This begins the extinguishing process so that, with more experience, the fear reduces to normal, but necessary, caution, rather than acting as a phobia.

As reinforcement is a component of the operant model, operant therapies for phobias in children require that parents stop reinforcing the phobia, which presumably happens when parents help the child avoid the fear-causing stimulus (Lazarus, Davison, & Polefka, 1965) and reinforce the desired behavior (Glasscock, & MacLean, 1990).  In a case study of a girl who had developed a fear of dogs, the parents were asked to give social praise when the girl spent time playing with dogs recruited for her therapy. 

Assuming that the girl who had developed a fear of dogs had liked dogs prior to having a bad experience such as being bitten by a dog, then she, at a certain point, would like dogs again with the success of her therapy, which was classical desensitization (Glasscock, & MacLean, 1990).  At this point, another operant scenario takes place; her improved experiences with dogs reinforce her interactions with her family dog.  This develops an encouraging discriminative stimulus that further supports positive interactions that, in turn, provide further reinforcement.

References

Glasscock, S., & MacLean Jr., W. (1990). Use of contact desensitization and shaping in the treatment of dog phobia and generalized fear of the outdoors. Journal of Clinical Child Psychology, 19(2), 169. Retrieved from Psychology and Behavioral Sciences Collection database.

Lazarus, A., Davison, G., & Polefka, D. (1965). Classical and operant factors in the treatment of a school phobia. Journal of Abnormal Psychology, 70(3), 225-229. doi:10.1037/h0022130.