Psychologists as change agents in chronic pain management practice: Cultural competence in the health care system.

Psychologists bring great value to health care systems, but our ethnocentrism regarding the medical community often limits our effectiveness as agents of change. Based on experience in developing pain management services within the Department of Veterans Affairs health care system, we discuss cultural issues as central to effective systems change and provide specific recommendations for psychologists aspiring to change organized health care systems, such as the Department of Veterans Affairs. Consideration is given to the misfit of the biomedical model to chronic pain, “physics envy” affecting the authority accorded psychology, and societal stigmatization of psychopathology. A process-based definition of cultural competence is recommended as improving on psychology’s intrinsic group-based notion of culture in engaging the medical community. The systems thinking literature is sampled in summarizing practical recommendations that include identifying features of local medical culture and power dynamics between psychology and medicine that can be modified by engaging stakeholders in an interpersonally effective manner. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Peritraumatic dissociation has consistently been found to be strongly correlated with PTSD. Yet it was unclear how peritraumatic dissociation affected the physiological responses of individuals with or without PTSD. Eighty-six women with a history of attempted or completed sexual assault were recruited to participate. Script-driven imagery procedures were used to assess changes in heart rate and skin conductance responses of the women during a neutral, positive, fearful, and trauma-related script. The pattern of physiological responses suggested that peritraumatic dissociation was associated with elevated physiological responses. Peritraumatic dissociation also seemed to accentuate physiological responses to general threat cues in sexual assault survivors without PTSD as well as to trauma-specific cues in survivors with PTSD. The pattern of responses during each script was also specific to the participants’ self-reported peritraumatic dissociation and level of PTSD symptoms. These findings suggested that it would behoove clinicians working with survivors of trauma to assess for peritraumatic dissociation even if PTSD is not present, as it may inform decisions about the length of exposure treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

This study examines Black, Latino, Asian American, American Indian and Biracial participants’ (N = 260) emotional and psychological reactions to encounters with racism, and the help-seeking strategies they used to deal with those reactions. This class of participants is important to study because its members are likely to live and/or work in racially diverse environments. Participants who reported direct experiences with racism had higher levels of anxiety, guilt/shame, hypervigilance, and positive emotions than those who did not. Racial harassment (hostility) was associated with more hypervigilant and anxious reactions than racial discrimination (avoidance). Help-seeking patterns indicated that people of Color were more likely to seek help from friends and family than from mental health professionals. Practice and research implications are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

The primary purpose of this study is to determine if recent combat veterans discriminate between different sources of social support, and then preliminarily investigate the relationship of social support source on posttraumatic stress disorder (PTSD) symptomatology. Participants included 83 married male combat veterans. Principal-axis factor analysis with equamax rotation observed four distinct latent factors for each source of support examined. ANOVAs were performed to determine the relationship of each source of support from the distinct latent factors on the level of PTSD. Results indicate that the level of PTSD is related to support received from a significant other, F(1, 81) = 30.36, p F(1, 81) = 8.10, p = .006, and military peers, F(1, 81) = 6.70, p = .011, but not friends, F(1, 81) = 1.79, p = .18. In general, higher levels of support from each category were associated with lower levels of PTSD in combat veterans. The results suggest that combat veterans distinguish between specific sources of social support, which may have a protective effect on the level of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

As exposure to different types of traumatic stressors increases, the prevalence of PTSD increases. However, little is known about the effects of cumulative exposure to traumatic stress on the maintenance and remission from PTSD. In 2006/2007, we investigated 444 refugees from the 1994 Rwandan genocide, assessing exposure to traumatic events, current and lifetime PTSD, and PTSD symptom severity. Higher trauma exposure was associated with higher prevalence of current and lifetime PTSD, with lower probability of spontaneous remission from PTSD, and with higher current and lifetime PTSD symptom severity in clear dose-response effects. The results suggest traumatic load as a root cause of both PTSD chronicity and symptom severity and support the hypothesis of a neural fear network in the etiology of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Exposure to violence and potentially traumatic events (PTEs) is a common experience among children and youth. The assessment of necessary intervention relies upon parental acknowledgment of exposure and recognition of their child’s distress. Early interventions and treatment are most effective when parents are aware of the nature of the traumatic exposure, understand their child’s symptomatic response, and are intimately involved in the treatment process. The present study investigated concordance between parents and exposed children on child trauma history, the subjective report of the impact of the traumas experienced, and presence of posttraumatic stress disorder (PTSD) symptoms. Agreement between parent and child report of traumas experienced was nonsignificant for serious accidents, separation from significant others, and physical assaults. Nonsignificant agreement was also found for avoidance and hyperarousal symptoms of PTSD. Correlations were not significant between parent and child report of the impact of traumas both at the time of the incident and at the time of the interview. Recommendations are suggested for helping parents improve their capacity to understand the potential impact of exposure on the child’s psychological functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)