09 Aug 2017

David Schwebel Taps Virtual Reality to Keep Kids Safe

David Schwebel Taps Virtual Reality to Keep Kids Safe
David Schwebel
APA Fellow David Schwebel not only studies the effects of mobile technology on pedestrian safety, but also harnesses virtual reality to help prevent injuries caused by distracted walking.

A young girl prepares to cross a busy street, her face plastered to a smartphone. Will she step off the curb and run for it or wait for a gap?

It may sound like a phone-happy, distracted pedestrian but it’s actually the reverse: The girl is using a smartphone—coupled with virtual-reality technology—to help her learn how to cross the street safely.

The experiment is the latest brainchild of APA Fellow David Schwebel, a leading researcher in child-injury prevention and professor of psychology at the University of Alabama at Birmingham (UAB), where he directs the UAB Youth Safety Lab.

Schwebel has created a sophisticated street-crossing training application that runs using software for a smartphone retrofitted with Google Cardboard—an inexpensive virtual-reality platform.

The user just places a phone into a cardboard or plastic viewer, and looks through its plastic lenses into a virtual world of traffic—complete with sounds and passing cars. The “traffic” moves at different speeds, with variances for car distances and gap sizes. When students judge it safe, they click a button and step off the virtual curb to cross the street.

“We record absolutely everything,” says Schwebel. “We know exactly when they choose to cross the street, their speed of walking, the speed of vehicles, which gaps they’re choosing, whether they enter soon after a car passes or if there’s a delay—which is a good proxy of their cognitive processing.”

The simulator lets Schwebel and his students study a dangerous task without putting children at risk—and it gives participants great practice for the real world.

While the intervention may be fun, the imperative for his work is deadly serious: Pedestrian fatalities in the U.S. leaped 11 percent to more than 6,000 deaths in 2016. Of the estimated 270,000 pedestrian traffic deaths worldwide, nearly half are youths.

Schwebel is among a surprisingly scant cohort of research psychologists working in the field of youth safety. His Youth Safety Lab is one of the few academic research centers in North America devoted to researching child safety, and is a major locus for research and student training.

“When you take a step back from pedestrian safety and realize that injuries are by a huge margin the leading cause of child death in America—and one of the leading ones globally—it’s pretty remarkable that more psychologists aren’t thinking about the behavioral aspects of it,” notes Schwebel.

Schwebel has published more than 200 peer-reviewed articles and conducts a wide spectrum of research at his lab: pedestrian safety, poisoning prevention, global injury prevention, dog-bite prevention, youth soccer safety, playground safety, lifeguard behavior, car-seat safety, among many others.

It’s enough potential danger to keep any helicopter parent permanently on high spin.

“Clearly at every age there are risks,” acknowledges Schwebel, “. . . but children as young as 18 months can be taught to follow rules and avoid injury.”

Although he has earned a reputation as a technologically innovative researcher, one of his most successful youth-safety interventions was decidedly low tech—and targeted caregivers as much as it did children.

He developed a “Stamp-in-Safety” program to help improve teacher supervision of preschoolers on playgrounds, where nearly 70 percent of preschool injuries occur.

“We said, the teachers are in the shade talking about their weekend and the kids are running around on the playground. How can we change this?” notes Schwebel.

The solution was simple: Give nametags to all kids and equip teachers with self-inking stamps. When teachers see a child playing safely they give him or her an ink stamp as a reward. “On the surface it’s rewarding the child for safe behavior,” notes Schwebel, “but underneath the goal was to change teacher behavior too.”

It was perhaps inevitable that Schwebel would become a psychologist. The son and grandson of psychologists—father Dr. Andrew Schwebel taught at Ohio State University, and grandfather Dr. Milton Schwebel was a dean at Rutgers University—psychology was “the family business.”

“I grew up with psychology as part of my life,” he says. “As a kid, I sometimes even went to APA conventions.”

Schwebel got a taste for applied research as an undergrad at Yale, where he worked with noted psychologist Jerome Singer. His mentor had been hired by creators of the Barney and Friends children’s television show on PBS to evaluate its effectiveness in teaching children.

“As much as parents got sick of the [theme] song, the show actually taught children a lot,” says Schwebel. “We had children watch the show, as well as getting lessons in school. Our research showed that children learned as much from the show as they did from their teachers on the same topics.”

Based on their findings, the show’s creators rewrote some episodes to increase their effectiveness. “That taught me how psychology could really make a difference,” says Schwebel.

He has carried that passion for applied psychology into much of his research, developing interventions that offer real-world tools based on data collected in his lab and in the field. In some cases, his work may have directly saved lives.

Several years ago, for instance, he was approached by an attorney representing a family whose toddler son had died from drinking torch fuel. It became one of several child-poisoning lawsuits against manufacturers.

In a series of studies, Schwebel and his researchers studied the shape, coloring and labeling of a variety of bottles to determine how likely preliterate children were to consider them as something safe to consume—or to avoid.

“We discovered, not surprisingly, that they were more likely to judge an opaque, black bottle as dangerous than a transparent torch-fuel bottle with juice-colored liquid inside,” says Schwebel, adding: “Then the company started packaging the product in a dark-colored bottle. I have to assume that my research played at least some role in that decision.”

Schwebel’s penchant for applied research and social justice also has resulted in many international research partnerships. He has worked with researchers to evaluate kerosene-safety practices in low-income South African communities and in rural Uganda, and conducted extensive research with partners in China.

”I enjoy working with people from other cultures and I also think I have some obligation,” says Schwebel, “because ultimately we conduct science to improve society. There is higher risk of injury in other countries so that’s a priority for me.”

One long-running collaboration with Iranian researchers, which because of political issues was conducted entirely through emails, highlighted self-immolation among young women in Iran.

“It’s devastating, culturally bound, and it tends to be low-educated young wives who . . . often have tough lives,” he says. “It sometimes leads to severe depression, and immolation is in many cases their only means to commit suicide.”

These days, Schwebel is focusing on getting his pedestrian-safety programs to scale big—and even hop continents.

A recent test run with schoolchildren in China was a big hit. The class went wild when the technology was introduced and the trainings netted great results. The PI on several grants from the NIH, Schwebel hopes to expand this work into other rapidly motorizing countries, including South Africa and Iran.

“With Google Cardboard all you need is a smartphone and a $3 piece of cardboard with a couple of plastic lenses and magnets. It’s not a high-priced device. And since smartphones are everywhere, even in low-income communities . . . it’s really feasible anywhere in the world,” he says.

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11 Jul 2017

Nancy Sidun Wants Psychology to Help Prevent Human Trafficking

Nancy Sidun Wants Psychology to Help Prevent Human Trafficking
Nancy Sidun
APA Fellow Nancy Sidun's clinical work has covered international relations and women's issues as well as working with the military.

What Nancy Sidun, PsyD, loves about being a psychologist is that she gets to help people attain a better life than they might otherwise have—her patients, her colleagues and the subjects of her research.

"It's hokey but true," Sidun says. As a girl, "I saw that movie, The Miracle Worker, and I was so taken by the fact that Annie Sullivan didn't give up on Helen Keller. I wanted to be like Annie Sullivan. I wanted to spend my life investing in people others thought were disposable. That's the great thing about clinical psychology. Your job is trying to empower people to be the best they can be." 

 In her own career, Sidun has followed that goal into some tough areas. In 2014, she co-chaired the APA's Task Force on Trafficking of Women and Girls after chairing a similar investigation for Division 52. "They were the ones who gave me voice" for pursuing the issue, Sidun says of the  APA’s Division of International Psychology, but "it became clear that we needed the support of the full APA" to effect any real change. She first got involved with the issue a decade ago, in part because she had adopted a daughter from China. "My God, what if her life had taken a different path?" Sidun says.

She's excited about the influence organized psychology may eventually bring to bear on human trafficking, which the task force report defines as the "economic exploitation of an individual through force, fraud or coercion."

The International Labor Organization has estimated that 12.3 million people worldwide are now living in some kind of forced servitude. Far and away, most victims are women. While many are forced into agricultural work and urban industries like sweat shops, nail salons and domestic service, the overwhelming majority are exploited sexually. In the United States, when women are trafficked for sex, the coercion is most likely psychological, a "grooming" process whereby a woman is lured into a seemingly caring relationship with a man who will put her to work for his benefit in the commercial sex trade, Sidun says.

"Psychology can do so much to help, but we're very late to the table. Every other discipline has been attending to trafficking," Sidun says.

Psychologists can help prevent trafficking by backing empowerment programs for vulnerable women, working to change the public's perceptions about the commercial sex trade to reduce demand, championing the rights of victimized women and identifying at-risk individuals in schools and other settings. Psychologists can also develop effective therapeutic interventions that will address the "extensive and complex" needs of women for whom the very concept of trust has been shredded, and evaluate governmental and nonprofit programs that have been set up to intervene.

One of the most important roles for psychologists is to educate the public and officials in the criminal justice system. People need to know how to recognize trafficking when they see it, and how to follow up with appropriate action that will lead to freeing the women and prosecuting the traffickers. When coercion is psychological, it's not always easy to understand the dynamic without some familiarity with research that has been done on the topic, which psychologists can make available and digestible. They can also testify in court.

U.S. citizens are among both the victims and the perpetrators in the trade, and American Indian women are the most disproportionately trafficked of any U.S. group, Sidun says.

Research on trafficking can be "challenging" to conduct, as there is "no typical case," according to the task force report. What traffickers have in common is their utter willingness to exploit the vulnerable. Any instability creates an opportunity for them, notably poverty, natural disasters and political conflict. Orphans are at particular risk. Only about 6 percent of individuals trafficked into the commercial sex trade in the United States are male.

Sidun says trafficking "runs the gamut from mom and pop operations to organized crime," from sophisticated international enterprises to teenaged boys pimping out their girlfriends. One study that looked at 25 pimps in Chicago found that they often have been "born and raised in an environment where people were exploited. Trafficking is safer and more lucrative than the drug trade, and [pimps] are less likely to get arrested. They often think of themselves as the good guys, protecting the girls. It's quite disturbing," Sidun says.

A New Jersey native, Sidun spent most of her adult life in Chicago, but 17 years ago moved to Hawaii. In Chicago, Sidun taught at a number of colleges, but Hawaii didn't offer the same opportunities. She worked for several years in administration and direct service with Kaiser Permanente, and then went into "telehealth." In a state with a large military presence, Sidun now treats "100 percent" of her clients remotely, via secure clinical video-teleconferencing (VTC) systems. "Most of my clients are in Korea," others are in Japan, Guam, American Samoa, Alaska, and the far-flung islands of Hawaii. Virtually all are military dependents or personnel on active duty she treats through the Pacific Regional Tele-Behavioral Health Hub at Tripler Army Medical Center in Honolulu, Sidun says.     

"For the younger generation, it's the normal way of communicating," she says. "And some of the service members are not as comfortable with emotions, so they don't mind being in an office by themselves during a session. In some ways, for them, that [remote aspect] can enhance treatments. I don't get to read the full body language, but I really like working this way."

She finds the "military culture fascinating. You have to be aware of the culture to be effective [with military clients], and I've enjoyed getting to know about that. I'll say one thing: If I give my military clients homework, it's going to get done!" she says.

In the past, some active-duty personnel may have been concerned their careers might stall if they sought help for such work-related conditions as post-traumatic stress disorder (PTSD), but Sidun thinks that now, "the military is trying to change that mindset. There are good treatments for PTSD," including prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing (EMDR). "They can help people," she says, adding that military officials definitely are beginning to recognize and encourage active-duty personnel to get the help they need.

Sidun is a past president of the Hawaii Psychological Association. She thinks activity in associations is "critical in protecting psychologists' interests. We watch bills in the legislature very closely, and advocate if we think we need to," she says.

Sidun also trains psychologists in self-care, and she's returning to using her early training in art therapy in this sideline. "We psychologists are bad at self-care," she says. "We take care of our patients, not so much of ourselves."

You could say Sidun is pursuing the role that led her into psychology, that of the dauntless teacher.

"I love supervision. I love training. It's my favorite thing," she says. "I think I'm a good clinician, but I have an opportunity to touch more people if I'm teaching."     

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28 Jun 2017

Psychologists Work to Help Communities Adopt, Sustain Evidence-based Treatments

Psychologists Work to Help Communities Adopt, Sustain Evidence-based Treatments
Ten years ago, as a clinical psychology graduate student working at an academic clinic for children with anxiety disorders, Rinad Beidas, PhD, planned to pursue a career running her own lab and identifying treatments that could really help these kids.

"But then I kept seeing kids come to our clinic having already seen lots of different community providers, without getting any better"—most likely, she says, because they weren't receiving evidence-based interventions. What the community had in its toolbox just wasn't working.

But her hope was renewed when children at the clinic participated in an evidence-based treatment for anxiety called Coping Cat, and nearly all of them were able to improve the quality of their lives. That's when Beidas became convinced about the effectiveness of evidence-based practices and the need for them to be more widely available.

"Evidence-based practices need to be available in the community so that kids have access to them and can benefit from them, as a matter of social justice," says Beidas, now an assistant professor of psychiatry at the University of Pennsylvania.

Today, she is one of many psychologists working at the state, county and city levels to make sure evidence-based treatment is available beyond academic medical centers, which aren't accessible to most people. As part of that effort, she sought to find out why more evidence-based practices aren't in wider use. In a study she conducted with clinical psychologist Arthur C. Evans Jr., PhD, commissioner of the city of Philadelphia's Department of Behavioral Health and Intellectual disAbility Services, she found some answers: When it comes to treating children and adolescents with psychiatric disorders, organizational factors—such as the support therapists get from others on the health-care team—are better predictors of the use of evidence-based practices than an individual therapist's knowledge and attitude about therapy techniques (JAMA Pediatrics, 2015).

"Implementation happens at multiple levels," says Beidas, who also directs implementation research at Penn's Center for Mental Health Policy and Services Research. "Even though a provider might be the one in the room with a patient, it's not just about that provider deciding to do an evidence-based practice. It's also about their organization and their supervisor supporting them, and the larger system supporting that process."

Focus on accountability

Serene Olin, PhD, a professor of child and adolescent psychiatry at New York University, is fostering the use of evidence-based treatments in another way: She is exploring how the use of evidence-based practices can help health-care systems establish greater accountability for patient care.

"Care in the real world is so much driven by who pays for what and what you're being held accountable for," she says.

In line with this shift toward more accountability, New York's state mental health department is focusing on what works—and how to train providers in these evidence-based treatments as efficiently and effectively as possible, says Olin, deputy director of New York University's Center for Implementation-Dissemination of Evidence-Based Practices Among States, known as the IDEAS Center. In 2011, the center began training clinical staff to implement evidence-based practices such as the "4 Rs and 2 Ss for Strengthening Families Program," at nearly 350 child-serving outpatient clinics in the state. The trainings vary in intensity, from one-hour webinars to yearlong collaborative learning experiences. The goal is to help clinics develop strong business and financial models, informed by empirical evidence, to ensure sustainability.

The IDEAS research team is using state administrative data to predict who will adopt these business-improvement and evidence-based clinical practices to help the state target its funding. They found that state clinical trainings were more likely to be adopted by clinics with more staff, likely because they're more easily able to release health-care providers for training compared with agencies with smaller staffs. In addition, clinics affiliated with smaller health-care systems were more likely to attend and implement business-practice trainings compared with clinics associated with larger, more efficiently run agencies (Psychiatric Services, 2015). These findings suggest that policymakers should understand the factors that influence the type and amount of training clinics are willing or able to adopt.

Sustaining evidence-based practice

In another effort to understand the use of evidence-based practices in community settings, Anna Lau, PhD, a psychology professor at the University of California, Los Angeles, and Laura Brookman-Frazee, PhD, a University of California, San Diego, psychiatry professor, are working to understand what happens when community therapists are required to deliver these interventions.

According to the American Medical Informatics Association, it can take 17 years for evidence-based practices to trickle down to practice in community-based settings. In a system-driven reform that cuts short that lag time, the Los Angeles County Department of Mental Health is reimbursing contracted agencies for delivering evidence-based practices through a countywide prevention and early intervention initiative. Lau and Brookman-Frazee are investigating how those practices are sustained. The Knowledge Exchange on Evidence-based Practices Study (4KEEPS) examines how community therapists work with evidence-based practices for youth and identifies barriers and facilitators to their implementation with ethnically diverse and disadvantaged communities.

Through the study, Lau and Brookman-Frazee are collecting data from agency leaders and frontline therapists about their experiences implementing six evidence-based interventions for child mental health problems. The pair is studying whether and how these treatments are still being used up to eight years following their adoption.

"We hear a lot about people's concerns that these evidence-based practices aren't equally applicable or equally accessible across different cultural or socioeconomic groups, so we're trying to see if there's evidence of that," she says.

As of September, more than 800 therapists and nearly 200 program managers from 68 agencies have participated in the study with an additional two years of data still to be gathered, says Brookman-Frazee.

"There are huge benefits in learning from what therapists are doing that might inform the intervention development process and allow for a more bi-directional communication process between research and practice," she says.

 

By Amy Novotney


This article was originally published in the January 2017 Monitor on Psychology

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26 Jun 2017

Charlotte Patterson, at the Forefront of LGBTQ Family Studies

Charlotte Patterson, at the Forefront of LGBTQ Family Studies
Charlotte Patterson
APA Fellow Charlotte Patterson has done groundbreaking research on child development, most notably on the topic of children of lesbian and gay parents.

It was her career on the line. Could the publication of one paper “taint” a reputation built on 20 years of child development research? It was the question Charlotte Patterson asked herself when she went to work at her University of Virginia (UVA) office one morning in the 1980s.

“I can still remember walking up to this building, looking up and thinking, well, who else is going to do it if not me?” says Patterson, PhD, APA Fellow, Stanford grad, noted developmental psychology researcher. And lesbian.

The paper in question was her landmark work, “Children of Lesbian and Gay Parents.” It was among the first research that debunked then-prevalent beliefs that children with lesbian or gay parents showed compromised psychosocial development relative to children from heterosexual parents.

Published as the lead article in Child Development in 1992, it blew open doors for mainstream lesbian and gay studies and became a crucible for public and legal discourse about LGBTQ family issues for decades to come.

“In those days, and still today, if you write something on a LGBTQ topic as a professional research psychologist people will assume you have some connection to the topic,” Patterson says. “I was frankly worried that . . . it would be a real problem for my career. Would people let me work with their children?

“A lot of people were shocked that I wrote it,” she continues. “People saw that article as a kind of professional coming out. That won me some friends and lost me some, as you can imagine.”

Since then, Patterson has been at the forefront of LGBTQ family studies, worked as an expert witness on landmark child custody cases involving lesbian parents, and been party to changes in state recognition of gay marriage that paved the way for Obergefell v. Hodges (same-sex marriage ruling by the U.S. Supreme Court).

A major challenge for Patterson and other early LGBTQ researchers was the dearth of available data on lesbian and gay families. In statistics, as in life, these families remained hidden. To amass a review of the scant literature that existed in the 1980s, Patterson literally drove from campus to campus in search of doctoral dissertations.

“Information was strewn across many fields—some in social work, psychology, psychiatry—a few people here and there who didn’t seem to know one another. It wasn’t a coherent field at that point in time. I realized there were lots and lots of interesting things that nobody had studied, to put it mildly.”

As if to emphasize this, Patterson glances at a bookshelf full of gender studies texts at her UVA office, where she has spent her entire academic career. (“I arrived here at 25, when I didn’t even own a couch!” she laughs.) An entire row of publications are her own, including Handbook of Psychology and Sexual Orientation, the 2013 APA Division 44 Book of the Year. “In those days, it was this sense of seeing an open frontier in front of you and wondering where to begin.”

Patterson started by studying what she knew: the relatively large group of lesbians raising children in the San Francisco Bay area in the 1980s, where she was then living on sabbatical.

“This was the perfect place to try to do that work,” recalls Patterson, who later had children with her own partner-then-wife. “It was the only place in the world at that time with a large concentration of lesbian families who had kids together. So it was my great good luck to begin research there . . . to meet families and to interview them.”

Much of the early work highlighted data on similarities between same-sex and opposite-sex parented households.

“The first findings of primary importance to policy issues were that [same-sex] parents in general were pretty well-adjusted people. That doesn’t seem surprising to people today but it did then. A second conclusion was, in general, that the children were also well adjusted, pretty much like their neighbors and peers in school.”

One study that gained wide media attention presented data suggesting that same-sex parents have a more equal division of household labor than their heterosexual counterparts do, findings corroborated by other studies internationally.

“The division of labor was the first big difference we saw,” recalls Patterson. “It’s so dramatic. A lot of people have taken up the finding and said, ‘Look! This is same-sex couples leading the way into a less gendered world!’”

But that was just the beginning of the story as far as she was concerned. Patterson wanted to understand the nuances of family systems—the distinctive qualities of experiences in families of lesbian and gay parents—and the differences among them.

She embarked on wide-reaching research that yielded significant findings: sex-role identity among children of same-sex headed families; adoption issues among gays and lesbians; division of household labor among gay and lesbian parents; and LGBTQ family issues within the context of changing legal and social policy environments.

Interestingly, it was the cross-examination by a prosecutor in her first of many appearances as an expert witness in lesbian-gay family legal battles that prompted Patterson to take her research to the next level.

“There was a 1993 trial that took place in Henrico Co., Va., not far from here,” recalls Patterson. “It involved a lesbian mom being sued for custody of her little boy by her own mother. It was a dramatic case, a sordid tale.

“Testifying as an expert, I was asked by the opposing attorney, ‘This research you’ve done, isn’t it about some crazy people in Berkeley?’ And of course, the research was about people who lived in Berkeley, not people who lived in Henrico. I thought his point was well taken actually, and it led me to want to know more about other groups and more carefully selected samples. It really made a huge impact on me.”

To obtain a more objective sample, Patterson teamed up with a sperm bank that had extensive records of all clients seeking help in getting pregnant. “It made a wonderful sample—singles, couples, straight, gay. We were able to invite every single woman who had come to this clinic to participate.”

A resulting paper in Child Development in 1998, “Psychosocial Adjustment Among Children Conceived via Donor Insemination by Lesbian and Heterosexual Mothers,” showed that these children were developing normally, and that their adjustment was unrelated to parental sexual orientation or the number of parents in the household.

Later, Patterson was able to tap into a large national data set—the National Longitudinal Study of Adolescent Health—to develop a methodological innovation in the study of child development in households headed by same-sex couples. The study didn’t ask parents if they were lesbian or gay. But by teasing out details among their answers—Are you in a marriage-like relationship? What is the gender of your partner?—Patterson was able to identify families with same-sex parents.

“It was very challenging to do that,” she recalls. “There were lots of technical challenges; we were trying to discern the signal from the noise.”

Importantly, this work confirmed her earlier findings.

Patterson takes satisfaction in the role of her work in expanding knowledge and public policy about what determines a family, but expresses something more personal about its effects on her own community: “I sometimes see that my research has made an impact when people tell me that they used the work in many ways when they were considering having children.

“Most people my age in the gay community grew up assuming they wouldn’t have kids. A lot of us were affected with what I would call internalized homophobia,” she explains. “If you’ve heard people around you forever telling you that you’d be a terrible parent you wonder, maybe I shouldn’t have children. A lot of people told me they read my articles and said, ‘Hey, maybe I could be a good parent!’ Or they used the findings to reassure worried grandparents-to-be.”

She looks at a photo of her grinning children on her desk, reflecting on the wonderful adults each has become.

“There are so many stories!” she marvels. “This work on families continues to rivet my attention. I think families are the most interesting thing in the world.”

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01 Jun 2017

Competent, Affirming Practice with Older Lesbian and Gay Adults

Competent, Affirming Practice with Older Lesbian and Gay Adults

With the number of lesbian and gay older adults expected to swell to nearly 7 million in the next decade, psychologists will increasingly be working with these clients.

"I am gay." A 65 year-old man, newly admitted to a nursing home, scribbled this statement on a piece of paper and slid it across the table to his new psychologist. The man held his finger up to his lips, looked cautiously out into the hallway and whispered "shhh" before taking the paper back and ripping it into tiny pieces.

This incident happened just three years ago, despite significant strides in gay rights in the United States. Fear of stigma and outright discrimination in a variety of health-care, institutional and social service settings continue to be documented among aging lesbian and gay (LG) adults, even among those who live in more socially progressive urban areas.

The number of people facing such discrimination is quite large: Approximately 3 million older adults in the United States identify themselves as lesbian or gay, and that number is expected to swell to more than 7 million by 2025.

And research shows these clients are not getting the care they need. The APA Task Force on Bias in Psychotherapy with Lesbians and Gay Men, for example, found that older LG clients may even be inadvertently mistreated by providers due to a lack of knowledge about this population and heterocentrism — the negative attitudes and behaviors associated with any deviation from heterosexuality. Compounding these challenges is that older LG adults are one of the least empirically studied populations in terms of their mental health needs and adaption of psychotherapy to best address those needs.

Historical and cohort effects

Among the most important concepts to consider when working with LG clients over age 50 is that all of them lived through a time when their sexual orientation was labeled immoral, illegal and pathological. Homosexuality was only officially removed from the Diagnostic and Statistical Manual in 1973. Gay and lesbian people who revealed their sexual orientation in their younger years often suffered significant psychological and physical abuse from the larger community, including verbal harassment and social isolation, as well as sexual and physical assaults. These experiences may present themselves in later life as diffuse anxiety, depression, somatic distress or even post-traumatic stress disorder.

APA Guidelines for Psychological Practice with Older Adults encourage psychologists to take into account the impact of being part of a generational age cohort (e.g., baby boomers) because experience and attitudes vary among age cohorts, including attitudes toward mental health services. LG baby boomers experienced significantly different historical events than did earlier age cohorts. For example, the oldest LG elders came of age in the 1950s when President Eisenhower's 1953 Executive Order #10450 called for homosexuals to be fired from government jobs. Few LG individuals openly discussed their status for fear of discrimination and violence since people who were found to be engaging in same-sex behavior could be and were sent to prison or mental hospitals. No federal or state laws protected LG individuals from victimization. The mental health establishment offered "treatments" to change homosexual orientation through certain psychotherapies, electroconvulsive therapy and hormones.

Previous generations of LG persons clearly experienced enormous social pressure to suppress sexual expression or hide sexual orientation. As a result, earlier generations of LG elders — the now oldest-old LG elders — are more likely to have married opposite-sex partners, and in late life have ex-spouses, adult children and grandchildren when compared with LG baby boomers. Compared with their oldest-old heterosexual peers, however, these oldest LG elders have fewer biological relatives available to assist them with instrumental and financial needs related to long-term health care.

In contrast, baby boomers came of age during the gay rights movement catalyzed by the 1969 Stonewall riot in New York City. These baby boomers grew up with the American Psychiatric Association's (1973) policy statement that homosexuality was no longer regarded as a mental disorder and the repeal of many states' laws that criminalized homosexual behavior. Due in part to these events, LG baby boomers may represent the first LG age cohort to be more inclined to seek mental health care. Future cohorts of LG elders (e.g., the millennials) will likely have different experiences compared with current generations of LG older adults, since they came of age when states began to recognize same-sex marriages. In summary, although every individual's experience of stigma and discrimination in relation to minority sexual orientation is unique, cohort effects remain influential.

Diversity among lesbian and gay elders

Aging LG adults who are members of ethnic and cultural minority groups, conservative religious affiliations or rural communities often face additional social stressors. For example, a 74-year-old black lesbian in Chicago may experience ageism, heterocentrism, sexism and racism, whereas a 62-year-old gay Latino man in rural Pennsylvania may face significant social isolation as well as ageism, heterocentrism and racism. Cultural or ethnic-minority LG elders may face additional forms of heterocentric discrimination within their own ethnic, cultural and religious communities. In contrast, some LG minority elders may be assigned positive qualities; Native American "two spirit" elders were traditionally revered and granted special social status.

Most research on LG adults has been collected from white, highly educated gay men living in urban areas. Very little is known about older LG minority elders, particularly in rural areas, who are black or Hispanic or the oldest-old. As a result, practitioners should never make broad assumptions about an older gay or lesbian adult. Similarly, practitioners should never make global assumptions about any client from any minority group.

The influence of ageism, heterosexism and racism (among other stigmatizing factors) upon aging sexual minority group members is likely to be cumulative and perhaps exponential beyond the negative impact of each individual type of discrimination. A study of older gay black men reported significantly higher levels of perceived ageism than older gay white men, significantly higher levels of racism than younger gay black men, and significantly higher levels of homonegativity (overt negativity and hostility in relation to their gay sexual orientation) than both younger black and white gay men (David & Knight, 2008). Unfortunately, stigma, discrimination and social isolation may substantially contribute to health disparities, barriers in long-term care and legal inequalities evident among LG people.

Physical, mental and sexual health disparities

According to the Centers for Disease Control and Prevention (2011), LG adults experience significant physical and mental health disparities compared with their heterosexual peers. Awareness of such discrepancies is vital when working with older LG clients. Concealing one's sexual identity from health-care providers can lead to ineffective or deleterious health care. Various reports indicate that more than 40 percent of LG adults age 50 and older suffer from at least one disability or chronic illness, and are more likely to smoke and engage in binge drinking than their heterosexual peers.

LG elders are also more likely to delay seeking treatment for physical health problems, and to experience increased risk of elder abuse and neglect. LG elders are two times more likely to live and age alone and four times less likely to have adult children to call upon for help and support. In fact, one in five older LG adults reported having no one to call on in a time of crisis, compared with only one in 50 older heterosexual adults (Brookdale Center on Aging, 1999).

Within the context of such limited social support, older U.S. LG adults appear to experience more mental distress than their same-age, heterosexual peers. Nearly one in three older LG adults from a large-scale study of more than 2,300 LGBT U.S. older adults reported that they lacked companionship and felt lonely, and met criteria for clinical depression on a standardized measure. In addition, nearly one in three older LG study participants indicated that they seriously considered committing suicide at some point in their lives, often in response to concerns about their sexual orientation. A study of older LG Europeans revealed similar findings, in which internalized homonegativity and social stigma contributed to mental health issues.

In terms of sexual health, older women in general often encounter vaginal dryness and older men experience erectile dysfunction and prostate changes. Gay male elders face increased risk of infection for HIV and other STDs, and both older gay men and older lesbian women face challenges in terms of poor or limited preventative screenings and clinical care. Although gay men represent about 2 percent of the general population, they account for nearly half of all AIDS related deaths and new HIV infections. Specifically, more than 17 percent of new HIV/AIDS cases occur among adults over age 50, with older men having sex with men, and older black and Latino men, at greatest risk. In addition, within the last decade, new HIV diagnoses among adults over age 50 increased by more than 30 percent. Regrettably, no national HIV/AIDS education programs exist for older adults, much less an aging gay male population.

Older gay men in committed relationships also are more likely to face the diagnosis and treatment of prostate cancer than older heterosexual men. A committed gay man may have to face both his own and his partner's diagnosis of prostate cancer. Like their heterosexual peers, older gay men often have limited and incorrect knowledge about prostate disease, and older black gay men possess the least accurate knowledge. Therapists can encourage older gay men to discuss their prostate health openly with both their medical providers and their own partners. Education about prostate health, as well as its treatment options, remains essential.

A primary concern for older lesbians is a failure to disclose information about their sexual orientation and history to their health-care providers. Despite prevalent myths held by both older lesbians and health-care providers that lesbians are immune to the transmission of STDs, nearly half of older lesbians report having heterosexual intercourse at some point in their lives, and 20 percent of all women who never had heterosexual intercourse are infected with the HPV virus, the primary cause of cervical cancer. Older lesbians should receive educational messages about their individual risk factors for STDs and screenings when appropriate. Therapists can encourage older LG individuals to discuss concerns about their sexual health, and help them communicate more effectively with their health-care providers, who are unlikely to discuss STDs with their older patients, regardless of their sexual orientation.

Caregiving and long-term care

A survey of more than 1,200 LG adults found that LG elders are twice as likely to serve as a caregiver for a parent, family member, partner, friend or neighbor, and spend significantly more hours per week providing that care, compared with their heterosexual counterparts. This finding supports the notion that older LG adults maintain a "family of choice" well beyond biological and legal boundaries. The psychological, physical and financial demands on this population should not be overlooked.

Significant challenges also exist for LG adults in long-term care facilities. Discrimination, including outright hostility and substandard care, is well documented among LG residents in nursing homes and other institutional settings. Professional caregivers hold significantly more negative attitudes toward sexual activity among same-sex than heterosexual residents. Such negativity and hostility can even take the form of physical abuse.

Challenges to living authentically

Both fear of discrimination and fear of living an asexual lifestyle within a long-term care setting lead the majority of older LG adults to report that they want to live independently in their own homes, for as long as possible. To complicate matters, only 22 states have passed laws that prohibit discrimination based on sexual orientation in public or private housing. In other states, a nursing home or public housing administrator can simply refuse to admit an LG individual with no legal recourse available to that individual.

As a result, many LG residents in long-term care, including those who have lived authentically, feel compelled to "go back into the closet." Some LG partners legally change their last name to match that of their partner's, so they can live in the same room as "brothers or sisters." Other LG residents decide to act straight, while others hide personal photos of partners and other mementos to avoid revealing their LG status. A therapist's knowledge of these unique challenges and information about available resources is essential.

Legal issues and a call for advocacy

It is also vital for psychologists and their LG clients to become familiar with changing federal and individual states' laws regarding same-sex marriage, civil unions and discrimination on the basis of sexual orientation so that they understand the benefits they are entitled to in care facilities as well as through government programs including Social Security and Medicare.

In 2013 the U.S. Supreme Court struck down Section 3 of the Defense of Marriage Act (DOMA; United States v. Windsor, 2013). That ruling granted same-sex married couples access to more than 1,000 federal rights, including 401(k) survivor and hardship withdrawal benefits, coverage under the Family and Medical Leave Act (FMLA), COBRA benefits, savings on federal inheritance taxes, veteran's benefits and green cards for binational couples. The DOMA ruling also granted same-sex married partners access to federal Supplemental Security Income, disability, death and spousal benefits. In addition, the federal provisions for Medicaid spend-downs — which are designed to keep a healthy spouse from losing his or her home and becoming bankrupt when paying for the nursing home care of an ill or disabled partner — also now apply to same-sex married couples. In 2015, the Supreme Court further ruled that individual states could no longer deny same-sex couples the right to become married.

Studies show, however, that lesbian and gay adults who live in states that fail to provide protection against hate crimes and employment discrimination based on sexual orientation were significantly more likely to be diagnosed with depression, dysthymia, generalized anxiety, and post-traumatic stress and alcohol abuse disorders than those living in states that did provide such legal protection. Allowing LG clients to express their anger and frustration in therapy about such legalized forms of discrimination is essential. The need for psychologists to advocate for public policies and state and federal laws that prohibit discrimination based upon sexual orientation is urgent and clear.

Adaptation and resilience

Although LG elders represent a unique, at-risk population, they also display evidence of significant adaptation and resilience. More than 80 percent of LG adults report that they engage in some type of wellness activity. A qualitative study of older LG adults suggests that many learn to cope with a stigmatized identity by developing a strong sense of independence, autonomy and inherent self-worth, as well as by establishing interests outside of their families and careers. Some researchers posit that successful coping in response to the stress of coming out may better prepare LG adults for life in an ageist society.

Social support is a critically important part of life that allows someone to adapt and adjust more easily to life changes and crises. One difference observed between LG and heterosexual elders is that LG elders typically garner more social support from friends and "family members by choice" than legal or biological family members. Although long-standing social norms suggest that family members are expected to provide instrumental support (such as financial help and caregiving), LG individuals have historically developed meaningful, supportive friendship networks, in part because their own families may be unsupportive of their sexual orientation. With a broader social network, LG elders are often better equipped to gather different types of support from multiple sources compared with their heterosexual peers.

Implications for practice, advocacy and research

Clinical settings can help LG elders feel more comfortable and accepted in a variety of ways. For example, therapists can change the language on intake and other forms to ask about one's relationship versus marital status, and about family members by choice. They can also alter the physical environment in offices, waiting areas and websites by displaying or linking to magazines that reflect both LG and aging readership (such as Out More and AARP), or with pictures featuring LG couples and families from a variety of ages, racial, ethnic and cultural backgrounds. Therapists also can celebrate National Coming Out Day, World LGBT Pride Day and other LG-affirming events. For example, psychologists played a key role in U.S. Department of Veterans Affairs efforts to make VA health-care facilities more welcoming for LGBT veterans by working to develop more inclusive hospital visitation policies and establishing a policy on respectful care for transgender veterans.

To provide competent practice, psychologists themselves must examine their own attitudes toward both older and LG adults, particularly if coming from a culture or religious affiliation that does not affirm an LG orientation. Therapists also are advised to train staff and post a nondiscriminatory statement that equal care will be provided to all clients regardless of their age, sexual orientation, ethnicity, race, religion, physical ability and attributes, and gender identity. Simple exposure and familiarity with LG elders can reduce stigma and alert minority clients that options are available for competent, affirming care. Fostering the resilience of LG elders, including the nonfamilial exchange of care, participation in formal and informal LG and aging support groups, and increased health advocacy for HIV/AIDS, is highly desirable.

Consistent with the APA Practice Guidelines for older adults as well as those for LG adults, psychologists are encouraged to engage in advocacy for their clients as well as for LG elders at large to promote social justice and civil rights. Specifically, psychologists can advocate for changes in individual states to pass antidiscrimination laws that benefit older LG adults. Such laws would include protections against hate crimes and discrimination in private and public housing, including both nursing homes and assisted-living facilities. Of course, simply passing an antidiscrimination law does not prevent such discrimination; it only provides legal recourse for those affected.

To provide a safe and welcoming environment for LG elders in long-term care, same-sex couples should be able to share a room. To make this happen, staff training and even resident education are likely to be necessary. The VA training model and a staff training curriculum on LGBT elders developed by the National Resource Center on LGBT Aging are good resources.

Conclusion

Significant physical, sexual and mental health disparities exist among older LG adults when compared with their heterosexual peers. As more egalitarian same-sex laws are adopted by a variety of individual states in the United States, psychologists can play a critical role in advocacy for state and local legislation that prohibits discrimination based upon sexual orientation and will benefit the growing population of aging LG adults. Therapists also are encouraged to seek education and training on the unique challenges often faced by older LG adults, and to provide an LG-affirming practice to better serve this burgeoning, diverse population.

Jennifer Hillman, PhD, is professor of psychology at the Pennsylvania State University, Berks Campus.

Gregory A. Hinrichsen, PhD, is assistant clinical professor in the department of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai and clinical associate professor in the department of psychiatry and behavioral sciences at the Albert Einstein College of Medicine.

By Dr. Hillman and Dr. Hinrichsen, both whom are board certified in geropsychology.


This article is adapted from "Promoting an affirming, competent practice with older lesbian and gay adults" from Professional Psychology: Research and Practice, Vol. 45(4), August 2014, 269–277. The full article, which includes case studies and citations, appears at http://www.apa.org/pubs/journals/affirming-competent-practice.pdf.

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23 May 2017

Crossing Cultural Borders with Kenneth Wang

Crossing Cultural Borders with Kenneth Wang
Ken Wang
APA Fellow Kenneth Wang's interests include perfectionism, cross-national psychological adjustment, cross-cultural and multicultural psychology, and Asian and Asian American mental health.

Kenneth Wang, PhD, now based in Pasadena, Calif., struggled to navigate two cultures growing up. Born and raised in Taiwan, he spent five years in Tuscaloosa, Ala., as a young boy. Even today, Wang says, "I'm not 100 percent comfortable" in either China or the United States.

From his experience, Wang is convinced that leaving one culture behind to live in another, even temporarily, can shake a person's identity. His sense of the potential impact of that common transition has shaped his work. An associate professor in the School of Psychology at the Fuller Theological Seminary in Pasadena, Calif., Wang specializes in educational counseling, and he does much of his research with students. He also has a private practice.

"I've conceptualized crossing cultural borders as experiencing loss — the loss of relevant knowledge and a sense of belonging," he says. "This is not an original idea, but I draw on my own experience and observations of that."

Wang and his colleagues have specifically addressed the adjustment trajectories of hundreds of international students in the United States, as well as factors that might affect their transitions, like perfectionistic tendencies. He's also studied the constellation of traits that can help students find their feet, which has been dubbed cultural intelligence, or CQ. His research shows that some students fret most before they ever leave home; others are blindsided by culture shock, then adjust. ​​Yet another group suffers psychological distress that's more about them as individuals than their transition to another culture.

"International students are not all alike in the way they adjust" to new situations, Wang says. He'd like to be part of an effort to identify and encourage supports to help students and other visitors, refugees and immigrants achieve "belongingness" quickly in their new societies.

Wang is also known for his work assessing perfectionism among individuals in different groups. These are not necessarily people from other countries; for example, he has looked at perfectionism and identity issues in African-American and religious students as well.​ Still, these people can experience a tremendous amount of stress when mainstream values conflict with those of the subculture they grew up in.

The child of professor parents, Wang lived in Tuscaloosa between the ages of 5 and 10 while his father pursued a PhD at the University of Alabama. Wang was the first Asian student ever to attend his Tuscaloosa elementary school. When soccer teams formed along racial lines, the white kids versus the black kids, it was up to him to decide which team to join. He felt he didn't fit in, and he experienced some bullying, he says. His struggles continued even after his return to Taiwan. While he looked like everyone else, "I felt different. I didn't know the songs or games, and I struggled to learn to read and write Chinese, to fit in, to function in that cultural context. I thought there was something wrong with me," he says.

A number of basic values were different as well, Wang says. "Self-promotion is critical in the United States," for example, but humility is important in Taiwan. And always, Wang was held to tough standards, no matter where he was.

For Asians and Asian-Americans, perfectionism is "not just individual but collectivistic," he says. Instructors in Asian schools tend to "focus on where people have gone wrong, where they can improve," in contrast with mainstream American society, which may try to reinforce "feeling good about yourself," even if a student's performance is below par. Asian students have a "more realistic view" of how they're doing and "where they fit in," Wang says, but the Asian approach can take a toll. Even if the culture views the student's distress as constructive, the individual may not get much satisfaction from his or her own success, which can lead to anxiety and depression.

As an adult, Wang worked for years in business, first in marketing and then in planning, until he noticed he was more interested in a colleague's marital problems than in his work. The most frustrating part of that for Wang was that he wasn't able to offer any helpful advice.

His future wife was taking a counseling class as part of her education curriculum, and introduced him to the idea of empathy, "of being in another person's shoes, and reflecting," he recalls. That changed his life. Wang decided to go into a helping profession and came back to the United States, to Wheaton College, a small Christian school in Wheaton, Ill. Deciding against the ministry, he got a master's degree in counseling. When he finished, he returned to Taiwan and went to work in the Disability Resources Center at National Dong Hwa University in Hualien.

But counseling in Taiwan was not what it might have been in the United States. Wang had few clients and his time was taken up with administrative work. "I might as well have stayed in business," he says. Restless again, looking at various PhD programs, he noticed that at Pennsylvania State University in State College, some professors were studying perfectionism, including Robert Slaney, PhD, who had created the influential Almost Perfect Scale–Revised.

"That resonated with me," Wang recalls. The high standards he had grown up with, the "constant striving and pressure to perform well" made him want "to learn more about how that impacts a person." Wang's first publication, in 2006, was a paper he wrote with Slaney on perfectionism among Taiwanese students.

For Wang, his present job at the seminary affords him the opportunity to continue to explore cross-cultural differences, but with the added benefit of being able to travel to China several times a year. Fuller has strong ties to China and Taiwan through its China Initiative ministry, and that connection offers research and other collaborative opportunities.

Wang says, "Psychology encourages us to be who we are, and accepting of who we are. I've come to accept that I'm a cross-cultural person."

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26 Apr 2017

Gregory Ball and the Adaptiveness of Behavior

Gregory Ball and the Adaptiveness of Behavior
Gregory Ball
APA Fellow Gregory Ball has spent most of his academic career studying animals and birds, and using the findings to develop understanding about the human brain and behavior.

Growing up, Gregory Ball, PhD, learned a lot about birds from his father, who did his undergraduate and graduate studies in zoology. “He wanted to be an ornithologist,” he recalls, speaking to the American Psychological Association from his office at the University of Maryland, where he is a professor and dean of the College of Behavioral and Social Science and APA Fellow.

That experience helped shape Ball’s own future interest and research on the interrelation of hormones, the brain, and reproductive behavior. By studying nonhuman animals, in Ball’s case birds, “you can study relationships between the brain and physiology in a way that you can’t in primates and humans,” he said.

In his lab at the University of Maryland, his team is studying how the perception of song induces gene expression in the brain of birds and how early experience with different kinds of song might affect that gene expression. They also recently published a study looking at how hormones interact with the dopamine system to affect sexual motivation. “Hormones do their work by modulating neurotransmitters and we’re trying to understand the circuit that they interact with to do that,” he said. According to the study, the projection from the preoptic area of the brain to the ventral tegmental area, where the dopamine of one of four major dopamine systems originates, to the accumbens, which plays a significant role in the cognitive processing of aversion, motivation, reward, and reinforcement learning, is very important in that process.

One of the Ball’s favorite recent findings to come out of his lab is related to steroids. “People think that a steroid has a very general effect on behavior – that it just makes you more motivated, or stimulated to do something,” Ball said enthusiastically.

“And we’ve done experiments where we’ve put tiny amounts of hormones or hormone blockers on the brain and we’ve shown that hormones actually act in multiple parts of the brain in specific ways to modulate behavior. For instance, the desire to sing is controlled in one part of the brain, but the control of how well you produce song in a temporal fashion is modulated in another part of the brain.”

Ball first got swept up in the studies of brain function and behavior in animals while studying at Columbia University. He took his introduction to psychology course with Dr. Herbert S. Terrace, who, among other things, led the famous study of animal language acquisition in the chimpanzee Nim Chimpsky. Ball began working with Terrace, who had studied under B.F. Skinner, the year after he began working with Chimpsky. He was intrigued by the studies of brain function and behavior in animals at Columbia (along with the then-contentious, now-settled debate between behavioral and cognitive psychologists) and began his longtime specialization in experimenting on pigeons.

Under Terrace, they employed the Skinnerian approach, which doesn’t take into the account private events – like thinking, perceptions, and unobservable emotions – as causes of an organism’s behavior. Ball said he sensed something was missing in studying the pigeons this way.

“They didn’t know if they were males or females, they didn’t know anything about pigeons. They were just animals that you put in the box and you saw how the stimuli affected them. And this is that Skinnerian notion that the organism didn’t really matter – that the contingencies of reinforcement were so powerful that the same thing that happens in a pigeon could be programmed to happen in [other animals].”

Despite disagreeing with the Skinnerian approach, he learned in his early work in Terrace’s lab that he could parse and further understand many topics related to the brain and behavior by looking at nonhuman animals. He began to understand the potential for studying animals other than humans and use the findings to develop understanding about the human brain and behavior.

Around that time, he met Dr. Rae Silver, who had just come to Columbia University and was studying the parental behavior of doves in their natural habitat. He became her first research assistant at the university, which he said was a key event in his career as a psychologist.

“It was another milestone in my career because I realized ‘Oh, this is it!’ You study the animal on its own terms, you study the natural behavior of the animal, and try to glean what you can about the general principles of physiology and the brain related to behavior,” Ball said. “And that’s when I sort of saw that by studying these relationships in animals, you can understand the evolution, the adaptiveness of behavior and put it in the broader natural context.”

After his formative years at Columbia, he earned a PhD in psychobiology at Rutgers University, and completed his postdoctoral work in comparative neuroendocrinology and ethology at Rockefeller University. Prior to getting hired by the University of Maryland in 2014, he taught at Rutgers, Boston College, and Johns Hopkins University.
Today, as dean of the College of Behavioral and Social Science, much of his time is filled with administrative tasks, but he still finds time to pop over to the lab and check on his staff’s research while sharing encouraging stories to inspire the next generation of academics to follow their dreams.

One story he always enjoys retelling is about growing up right down the street from the University of Maryland and how on one summer break from his studies at Columbia, he took a job cutting the institution’s grass.

 “[I tell them] I used to mow the lawn of the building that I’m now dean of,” he says with a chuckle.

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25 Apr 2017

Adventures in Dog Research with Stanley Coren

Adventures in Dog Research with Stanley Coren
APA Fellow Stanley Coren's research on dog behavior has brought him worldwide acclaim. (Photo: SC & Ripley UBC photo)

He wrote the textbook on sensory processes, published hundreds of papers on wide-ranging neuropsychological topics—and wrote a groundbreaking book on problems associated with left-handedness.

But it was his 1994 book, The Intelligence of Dogs, which ultimately brought psychologist and APA Fellow Stanley Coren, PhD, worldwide acclaim.

The Intelligence of Dogs was the first popular book to apply multiple intelligences to dogs—including instinctive, adaptive, and working and obedience intelligence—and it blended colorful personal anecdotes with a scientist’s understanding of the dog’s natural history, evolutionary relationship to humans, and trainability.

Notably, the book included data Coren collected from North American dog obedience judges that ranked 110 breeds by intelligence. (Unsurprisingly, Border Collies topped the list, while beautiful, but pea-brained, Afghan Hounds rounded out the bottom.)

It also employed aspects of the MacArthur-Bates Communicative Development Inventories to begin measuring canine language comprehension, an innovative adaptation of human psychological testing.

Speaking from his home in British Columbia, with his Toller pup Ranger whining for attention, Coren reflects on the meandering pathways his scientific explorations have taken him on, and the new concepts of canine research his work has unleashed.

“It used to be the case that you didn’t do research on dogs . . . because they were not considered a natural species,” says Coren, adding: “After my book came out, people began to see . . . what a wonderful genetics lab dogs could be because the breeds have been kept so pure that you actually can have genetically determined behavior differences.

“And then the later books that suggested that dogs have a mind of roughly a human equivalent of a 2- to-3-year-old began to impel people to think that maybe dogs are an important species to study.”

The dog book wasn’t his first brush with renown. Just a year earlier, Coren had published a bestseller on left-handedness, The Left-Hander Syndrome, which included nearly a decade of work on handedness.

His research indicated that left-handedness might be associated with birth stress and could cause some psychological and health problems—a highly controversial assertion that spurred new research in the field. Eventually, it also led to design changes in machinery to reduce hazards for left-handers, an accomplishment for which Coren enjoys obvious pride.

The book shot to the top of the bestseller list and landed Coren a spot on talk show couches from Oprah to Larry King to Charlie Rose. “I had been teaching monster-sized classes, hundreds of kids. That’s basically show biz, so I had lots of practice,” quips Coren.

What the two books shared was a deft, natural writing style that blended extensive scientific research with colorful personal anecdotes, examples from history, mythology, physiology and, in the case of handedness, advocacy. “All of my [popular] books are written as though I’m sitting across the table telling a story to my Aunt Sylvia,” he says, laughing. “She had a short attention span.”

Coren says he always knew he wanted to study the human-canine bond even as an undergrad in the 1960s, but in those days there was no precedent for “studying the critter at either end of the leash.”

“Anybody who claimed they wanted to study the human-animal bond at that time was looked at as if they had just gotten out of a flying saucer with a beanie [and] propeller on top,” says Coren. “There was no way for funding for that sort of thing.”

And so Coren pursued research in sensory processing, publishing his first paper in Science before earning a doctorate in psychology from Stanford. He established a prolific research career, publishing on wide-ranging topics that included vision and hearing, perception, laterality, birth stress, sleep, handedness, behavior genetics and cognitive processing.

“I always believed that a good scientist had to follow his interests and the questions which intrigued him,” notes Coren, who has amassed roughly 300 publications in publications including The New England Journal of Medicine, Nature, and American Journal of Public Health.

His body of neuropsychological work earned him the title of Fellow of the Royal Society of Canada, the highest honor bestowed on a scientist. But even then, Coren was dogged by his “other” life.

“At the induction ceremony the governor general—who is the queen’s representative in Canada—shook my hand,” recalls Coren. “And all she wanted to do was talk about her Golden Retrievers. But, they’re the fourth smartest dogs in all of dogdom and they’re kissy-faced . . . so it’s an irresistible package.”

Coren has heard tales by besotted dog owners from movie stars to presidents. George Bush, Sr., once told Coren that First Dog Millie, his famed Springer Spaniel, routinely took showers with him at the White House.

“For a psychologist like me it was absolute proof of just how strong our bonds can be with our dogs . . .  that we would talk about these intimate moments with people we don’t know all that well when they involve our dog,” Coren chuckles.

Naturally, Coren has been a lifelong dog owner and longtime competitive dog obedience trainer—several of his dogs have won obedience titles. His books are filled with stories of pups he has loved and trained, and he even devoted an entire book to a clever Cairn Terrier, Flint, who could perform counting tasks and operate an answering machine.

Probably not surprising in the often siloed world of science, Coren’s success as a scientist-communicator would eventually undercut his work as a researcher.

“When I published The Intelligence of Dogs I was told by my colleagues it would be the end of my career,” says Coren, who nonetheless balanced his popular writing with neuropsychological research, until funding dried up in 2001. Undaunted, he continued research with his own funds before retiring from academics in 2007.

Coren has made peace with the price of success. He harnessed his own devotion to dogs to publish more than a dozen books on the subject. He writes a regular column on dogs for Psychology Today, and is a frequent contributor to the Canadian TV show “Pet Central.”

Coren says he’s excited about the explosion of dog research taking place internationally since his first book was published and the growing understanding of capabilities of service and therapy dogs. “In 1972, I remember there were 16 assisted-animal programs in all of America. In the year 2000, when I stopped monitoring, there were well over 1,000.”

All of Coren’s dogs are certified therapy dogs, he says, and he also trains them for competition-level obedience trials, whether they compete or not. But even in his household, dogs will be dogs. He confesses: “When my wife is not around they sometimes sneak on the sofa.”

At this Coren lets out a roaring laugh, which Ranger answers with an urgent whimper. “Okay puppy,” he says. “Okay. Time to go out.”

Dog Tips

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28 Mar 2017

Jeremy Wolfe Wants to Understand How We See Things

Jeremy Wolfe Wants to Understand How We See Things
Jeremy Wolfe
APA Fellow Jeremy Wolfe's research looks into how people use sight to process information that's out there in the world.

After four decades of investigating how the human eye works, Jeremy Wolfe, PhD, still finds plenty to keep him curious.

“I never get bored,” says Wolfe, head of the Visual Attention Lab at Harvard Medical School (HMS) and Brigham and Women’s Hospital, in Boston, Mass., and an APA Fellow. “There’s always something new to consider. My elevator speech is that for the last 25 years, most of my lab’s work has involved studying visual search. Or, how do you find what you’re looking for? We move back and forth between basic science issues and real-world problems.”

How do you locate the mustard in the refrigerator, pick out the weeds from the posies in your garden, or home in on the cereal you like best from the dozens arrayed on the shelf in your local supermarket? Because your eye conveys so much information in a glance, according to Wolfe, professor of ophthalmology and radiology at HMS, that information has to be processed to make perceptual sense. “If we want to know if a specific object is present, we will often need to search for it, even if it is easily visible,” Wolfe says.

The mechanics of those quotidian quests have fascinated Wolfe for his whole career. In 1989, he first published his influential analysis of the process, which he called Guided Search, building on “the two-stage architecture” — preattentive and attentive — of Anne Treisman’s pioneering feature integration theory, and other works. Guided Search tracks the complex process, conducted in fractions of seconds, by which we find “targets” among the “distractors” in our field of vision by applying certain fairly coarse criteria, such as color, shape, size, orientation and curvature, and then “binding,” or assembling, those traits into a “single representation of an object,” according to Wolfe. Some objects are fairly easy to find, while others, like the proverbial needle in a haystack, can take quite a bit of time and attention.

 “The core of GS was the claim that information from the first (preattentive) stage could be used to guide deployments of selective attention in the second (attentive stage),” Wolfe wrote. He is now tinkering with the fifth iteration of Guided Search, to incorporate new data.

Wolfe’s latest research studies some of the limitations on our ability to see what’s in front of us, specifically problems that arise when people are tasked with looking for “rare events,” or things they are not likely to find — the radiologist examining X-rays for breast cancer, or the airport inspector looking for weapons or bombs in luggage. Radiologists miss 20 to 30 percent of visible cancers; for security purposes, the government doesn’t like to share how airport scanners are doing, Wolfe notes. One of the things that happens to expert “searchers” over time is that their vigilance flags, because most of the time what they’re looking for isn’t there.

“There are really profound limits on the human search engine,” Wolfe says.

Computers do much better, typically finding 100 percent of tumors, for example. However, a very high false positive rate is the computers’ downfall (and also for programs designed to improve searchers’ find rate). That’s a serious problem, because identifying nonexistent cancers activates an expensive, irksome and, for the patients, a terrifying recall process, to no useful end. So, people are better prospects for these jobs than computers, at least for now, and Wolfe’s research is aimed at figuring out how to improve humans’ overall performance on screening for rare events.

What Wolfe calls his own “origin story,” or how he got his start in visual research, begins when he was in high school in New Jersey, at a summer job his solid-state physicist dad got him at his workplace, the Bell Labs facility in Murray Hill, N.J.

“He sold me to his tennis buddy, who was a color vision researcher,” Wolfe recalls. He spent stretches of that summer immobilized in a chair, “looking at barely visible spots of light. My job was to say what color they were. What was cool about that was that I didn’t think I could tell. I thought [I]was guessing,” he says, but the experiment showed that he was able to identify the colors more often than he would have if he were merely guessing. On his many necessary breaks from the tedious work, Wolfe roamed the labs’ halls. He spent hours that summer talking to scientists he later discovered were famous in their fields.

“Many of the issues that have been important to my career I was introduced to then,” he recalls. That exposure was so important to him that Wolfe himself now has “an absolute commitment” to bringing high school students into his own lab, providing internships for half a dozen of them every summer.

Wolfe went on to graduate summa cum laude from Princeton in 1977. His doctorate, in 1981, was from the Massachusetts Institute of Technology, where his doctoral thesis was entitled, “On Binocular Single Vision.” Wolfe taught at MIT for 10 years and won the Baker Memorial Prize for teaching there in 1989. He was denied tenure the following year.

 “I was not the first person to win that prize and the following year lose a tenure battle,” he recalls. “It was seen as a zero-sum game, that if you were devoting the kind of time to your teaching to be winning that prize, you couldn’t really be a serious researcher.”

That episode ended with Wolfe moving his lab to Harvard in 1991 (though he was also a popular lecturer at MIT for 25 years; the podcast version of his “Introduction to Psychology” has been a top offering on iTunes U), and he’s had “quite a nice career, but a rather different career” from the one he had in mind. He’s a medical school professor, not a psychology professor, and “I live entirely on grant money, which is an exciting way to live. I’ve done basic research and use-inspired basic research. I’ve gotten grants every which way.”

Wolfe doesn’t mind that his scientific research is expected to lead to useful applications. He says, “When we’re working on the public dime, we ought to be able to make a decent case for why this is a sensible use of taxpayers’ hard-earned money."

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08 Mar 2017

Norweeta Milburn Wants to Prevent Teenage Homelessness

Norweeta Milburn Wants to Prevent Teenage Homelessness
APA Fellow Norweeta Milburn, PhD, has developed a psychosocial behavioral program to help homeless adolescents.

Chronic homelessness among young people often is traced to factors such as family violence, substance abuse and negative peer pressure—issues that are difficult to address and whose impact is hard to measure.

Leading community psychologist and APA Fellow Norweeta Milburn, PhD, thinks she may have developed a surprisingly simple intervention: She is teaching teenagers and their families how to fight fair.

Milburn and colleagues at UCLA’s Nathanson Family Resilience Center have developed an innovative, on-the-ground behavioral intervention that brings together young people and their parents/guardians for training on some basic communication and problem-solving skills.

“We argue that when a young person leaves home there is an unresolved conflict,” says Milburn. “The intervention is devised so that young people can argue with their parent or guardian in a more effective way so that they don’t have to leave home. We’re teaching them how to communicate better.”

The five-part psychosocial behavioral program, called STRIVE (Support to Reunite, Involve and Value Each Other), is highly adaptable and can be delivered on the teenager’s home turf—it’s been field tested in living rooms, teen centers and fast-food restaurants—wherever a client agrees to meet up with his or her guardian and a trained facilitator.

A STRIVE facilitator helps individuals identify family strengths while pinpointing sources of conflict. The facilitator introduces tools for emotional regulation, such as feeling thermometers, to help them gauge their levels of emotional arousal.

By setting small, winnable goals, the family members learn to identify a conflict, apply some problem-solving strategies, and work through concrete solutions. In the process, they often create a more positive family atmosphere—as evidenced by the “before” and “after” photographs facilitators take of participants, the latter often showing parents and children with their arms around each other.

Parents need the skills just as much as the kids, notes Milburn. “It may be a mother who is really exhausted, and part of her homework is to just get an hour of her own space. We’re trying to help them be the parent, be in control, but to do it in a way that is positive for their child and age appropriate.”

The idea for the intervention came out of her years of research on homelessness. Milburn, currently Professor-in-Residence at UCLA’s Department of Psychiatry and Biobehavioral Sciences, was among the first social scientists to establish differences among homeless young people.

Her 1999 study of homeless adolescents in the Los Angeles area showed that newly homeless youth who still maintained some ties to family had fewer risk behaviors than did their more chronically homeless counterparts. More than two-thirds returned home within six months, particularly if they had maintained contact with mainstream peers and with family.

Milburn cut her teeth on social research as a postdoc at the University of Michigan, Ann Arbor. It was the 1970s, and she was among the first wave of students working with pioneering social research psychologist Richard Price in what was then the nascent field of community psychology.

“It was the aftermath of the Vietnam War and we were still dealing with the tumultuousness of the ‘60s,” she recalls. “Social action, political action and social movements were important areas. What community psychology did, and part of its appeal, was to really understand people’s behavior in the social context within which they lived or experienced the world.”

In 1977, Milburn contributed several survey questions to the groundbreaking National Survey of Black Americans (NSBA).

The large, National Institute of Mental Health (NIMH) -funded study was the first to use cutting-edge social research methods to understand the behavior and life experiences of black people in the U.S. and has shaped public policy for decades.

“A lot of work prior to that talked about how dysfunctional black families were, how underachieving black children were,” recalls Milburn. “There was a lot of negative focus in the psychological and sociological literature.”

The NSBA greatly expanded measures relevant to the quality of life for black Americans and identified cultural and social strengths including family relationships, community involvement and religious supports.

“It really shaped my work, even now with homeless adolescents,” says Milburn, adding: “Even in the poorest communities, you still have good things that are going on. How do you capture some of the good, the strength, to build interventions?”

For her work on homelessness Milburn is building on the strongest, and most vulnerable, support of all: family love. It is a bond that too often is obscured in layers of blame and misunderstanding.

“So many are highly dysfunctional families but we try to take them back to their last positive experience with each other, to the point where the love was much more visible,” notes Milburn. “We know it’s there.”

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