On the Ethics of Chatbots in Psychotherapy.

Benosman, M. (2024, January 7).

PsyArXiv Preprints

https://doi.org/10.31234/osf.io/mdq8v

Introduction:

In recent years, the integration of chatbots in mental health care has emerged as a groundbreaking development. These artificial intelligence (AI)-driven tools offer new possibilities for therapy and support, particularly in areas where mental health services are scarce or stigmatized. However, the use of chatbots in this sensitive domain raises significant ethical concerns that must be carefully considered. This essay explores the ethical implications of employing chatbots in mental health, focusing on issues of non-maleficence, beneficence, explicability, and care. Our main ethical question is: should we trust chatbots with our mental health and wellbeing?

Indeed, the recent pandemic has made mental health an urgent global problem. This fact, together with the widespread shortage in qualified human therapists, makes the proposal of chatbot therapists a timely, and perhaps, viable alternative. However, we need to be cautious about hasty implementations of such alternative. For instance, recent news has reported grave incidents involving chatbots-human interactions. For example, (Walker, 2023) reports the death of an eco-anxious man who committed suicide following a prolonged interaction with a chatbot named ELIZA, which encouraged him to put an end to his life to save the planet. Another individual was caught while executing a plan to assassinate the Queen of England, after a chatbot encouraged him to do so (Singleton, Gerken, & McMahon, 2023).

These are only a few recent examples that demonstrate the potential maleficence effect of chatbots on-fragile-individuals. Thus, to be ready to safely deploy such technology, in the context of mental health care, we need to carefully study its potential impact on patients from an ethics standpoint.

The info is here.

Here is my summary:

The article analyzes the ethical considerations around the use of chatbots as mental health therapists, from the perspectives of different stakeholders - bioethicists, therapists, and engineers. It examines four main ethical values:

Non-maleficence: Ensuring chatbots do not cause harm, either accidentally or deliberately. There is agreement that chatbots need rigorous evaluation and regulatory oversight like other medical devices before clinical deployment.

Beneficence: Ensuring chatbots are effective at providing mental health support. There is a need for evidence-based validation of their efficacy, while also considering broader goals like improving quality of life.

Explicability: The need for transparency and accountability around how chatbot algorithms work, so patients can understand the limitations of the technology.

Care: The inability of chatbots to truly empathize, which is a crucial aspect of effective human-based psychotherapy. This raises concerns about preserving patient autonomy and the risk of manipulation.

Overall, the different stakeholders largely agree on the importance of these ethical values, despite coming from different backgrounds. The text notes a surprising level of alignment, even between the more technical engineering perspective and the more humanistic therapist and bioethicist viewpoints. The key challenge seems to be ensuring chatbots can meet the high bar of empathy and care required for effective mental health therapy.

Characteristics of Mental Health Specialists Who Shifted Their Practice Entirely to Telemedicine

Hailu, R., Huskamp, H. A., et al. (2024).

JAMA, 5(1), e234982. 

https://doi.org/10.1001/jamahealthforum.2023.4982

Introduction

The COVID-19 pandemic–related shift to telemedicine has been particularly prominent and sustained in mental health care. In 2021, more than one-third of mental health visits were conducted via telemedicine. While most mental health specialists have in-person and telemedicine visits, some have transitioned to fully virtual practice, perhaps for greater work-life flexibility (including avoiding commuting) and eliminating expenses of maintaining a physical clinic. The decision by some clinicians to practice only via telemedicine has gained importance due to Medicare’s upcoming requirement, effective in 2025, that patients have an annual in-person visit to receive telemedicine visits for mental illness and new requirements from some state Medicaid programs that clinicians offer in-person visits. We assessed the number and characteristics of mental health specialists who have shifted fully to telemedicine.

Discussion

In 2022, 13.0% of mental health specialists serving commercially insured or Medicare Advantage

enrollees had shifted to telemedicine only. Rates were higher among female clinicians and those

working in densely populated counties with higher real estate prices. A virtual-only practice allowing

clinicians to work from home may be more attractive to female clinicians, who report spending more

time on familial responsibilities, and those facing long commutes and higher office-space costs.

It is unclear how telemedicine-only clinicians will navigate new Medicare and Medicaid

requirements for in-person care. While clinicians and patients may prefer in-person care,

introducing in-person requirements for visits and prescribing could cause care interruptions,

particularly for conditions such as opioid use disorder.

Our analysis is limited to clinicians treating patients with commercial insurance or Medicare

Advantage and therefore may lack generalizability. We were also unable to determine where

clinicians physically practiced, particularly if they had transitioned to virtual-health companies. Given the shortage of mental health clinicians, future research should explore whether a virtual-only model

affects clinician burnout or workforce retention.

Young people turning to AI therapist bots

Joe Tidy

BBC.com

Originally posted 4 Jan 24

Here is an excerpt:

Sam has been so surprised by the success of the bot that he is working on a post-graduate research project about the emerging trend of AI therapy and why it appeals to young people. Character.ai is dominated by users aged 16 to 30.

"So many people who've messaged me say they access it when their thoughts get hard, like at 2am when they can't really talk to any friends or a real therapist,"

Sam also guesses that the text format is one with which young people are most comfortable.

"Talking by text is potentially less daunting than picking up the phone or having a face-to-face conversation," he theorises.

Theresa Plewman is a professional psychotherapist and has tried out Psychologist. She says she is not surprised this type of therapy is popular with younger generations, but questions its effectiveness.

"The bot has a lot to say and quickly makes assumptions, like giving me advice about depression when I said I was feeling sad. That's not how a human would respond," she said.

Theresa says the bot fails to gather all the information a human would and is not a competent therapist. But she says its immediate and spontaneous nature might be useful to people who need help.

She says the number of people using the bot is worrying and could point to high levels of mental ill health and a lack of public resources.

The info is here.

Here are some important points-

Reasons for appeal:

• Cost: Traditional therapy's expense and limited availability drive some towards bots, seen as cheaper and readily accessible.
• Stigma: Stigma associated with mental health might make bots a less intimidating first step compared to human therapists.
• Technology familiarity: Young people, comfortable with technology, find text-based interaction with bots familiar and less daunting than face-to-face sessions.

Concerns and considerations:

• Bias: Bots trained on potentially biased data might offer inaccurate or harmful advice, reinforcing existing prejudices.
• Qualifications: Lack of professional mental health credentials and oversight raises concerns about the quality of support provided.
• Limitations: Bots aren't replacements for human therapists. Complex issues or severe cases require professional intervention.

This Is Your Brain on Zoom

Leah Croll

MedScape.com

Originally posted 21 Dec 23

Here is an excerpt:

Zoom vs In-Person Brain Activity

The researchers took 28 healthy volunteers and recorded multiple neural response signals of them speaking in person vs on Zoom to see whether face-processing mechanisms differ depending upon social context. They used sophisticated imaging and neuromonitoring tools to monitor the real-time brain activity of the same pairs discussing the same exact things, once in person and once over Zoom.

When study participants were face-to-face, they had higher levels of synchronized neural activity, spent more time looking directly at each other, and demonstrated increased arousal (as indicated by larger pupil diameters), suggestive of heightened engagement and increased mutual exchange of social cues. In keeping with these behavioral findings, the study also found that face-to-face meetings produced more activation of the dorsal-parietal cortex on functional near-infrared spectroscopy. Similarly, in-person encounters were associated with more theta oscillations seen on electroencephalography, which are associated with face processing. These multimodal findings led the authors to conclude that there are probably separable neuroprocessing pathways for live faces presented in person and for the same live faces presented over virtual media.

It makes sense that virtual interfaces would disrupt the exchange of social cues. After all, it is nearly impossible to make eye contact in a Zoom meeting; in order to look directly at your partner, you need to look into the camera where you cannot see your partner's expressions and reactions. Perhaps current virtual technology limits our ability to detect more subtle facial movements. Plus, the downward angle of the typical webcam may distort the visual information that we are able to glean over virtual encounters. Face-to-face meetings, on the other hand, offer a direct line of sight that allows for optimal exchange of subtle social cues rooted in the eyes and facial expressions.

The info is here.

Key findings:

• Zoom meetings are less stimulating for the brain than face-to-face interactions. A study by Yale University found that brain activity associated with social processing is lower during Zoom calls compared to in-person conversations.
• Reduced social cues on Zoom lead to increased cognitive effort. The lack of subtle nonverbal cues, like facial expressions and body language, makes it harder to read others and understand their intentions on Zoom. This requires the brain to work harder to compensate.
• Constant video calls can be mentally taxing. Studies have shown that back-to-back Zoom meetings can increase stress and fatigue. This is likely due to the cognitive demands of processing visual information and the constant pressure to be "on."

Implications:

• Be mindful of Zoom fatigue. Schedule breaks between meetings and allow time for your brain to recover.
• Use Zoom strategically. Don't use Zoom for every meeting or interaction. When possible, opt for face-to-face conversations.
• Enhance social cues on Zoom. Use good lighting and a clear webcam to make it easier for others to see your face and expressions. Use gestures and nonverbal cues to communicate more effectively.

Listen, explain, involve, and evaluate: why respecting autonomy benefits suicidal patients

Samuel J. Knapp (2024)

Ethics & Behavior, 34:1, 18-27

DOI: 10.1080/10508422.2022.2152338

Abstract

Out of a concern for keeping suicidal patients alive, some psychotherapists may use hard persuasion or coercion to keep them in treatment. However, more recent evidence-supported interventions have made respect for patient autonomy a cornerstone, showing that the effective interventions that promote the wellbeing of suicidal patients also prioritize respect for patient autonomy. This article details how psychotherapists can incorporate respect for patient autonomy in the effective treatment of suicidal patients by listening to them, explaining treatments to them, involving them in decisions, and inviting evaluations from them on the process and progress of their treatment. It also describes how processes that respect patient autonomy can supplement interventions that directly address some of the drivers of suicide.

Public Impact Statement

Treatments for suicidal patients have improved in recent years, in part, because they emphasize promoting patient autonomy. This article explains why respecting patient autonomy is important in the treatment of suicidal patients and how psychotherapists can integrate respect for patient autonomy in their treatments.

My lengthy summary, because the article is paywalled here.

Dr. Knapp's article discusses the importance of respecting patient autonomy in the treatment of suicidal patients within the framework of principle-based ethics. It highlights the ethical principles of beneficence, nonmaleficence, justice, respecting patient autonomy, and professional-patient relationships. The article emphasizes the challenges psychotherapists face in balancing the promotion of patient well-being with the need to respect autonomy, especially when dealing with suicidal patients.

Fear and stress in treating suicidal patients may lead psychotherapists to prioritize more restrictive interventions, potentially disregarding the importance of patient autonomy. The article argues that actions minimizing respect for patient autonomy may reflect a paternalistic attitude, which is implementing interventions without patient consent for the sake of well-being.

The problems associated with paternalistic interventions are discussed, emphasizing the importance of patients' internal motivation to change. The article advocates for autonomy-focused interventions, such as cognitive behavior therapy and dialectical behavior therapy, which have been shown to reduce suicide risk and improve outcomes. It suggests that involving patients in treatment decisions, listening to their experiences, and validating their feelings contribute to more effective interventions.

The article provides recommendations on how psychotherapists can respect patient autonomy, including listening carefully to patients, explaining treatment processes, involving patients in decisions, and inviting them to evaluate their progress. The ongoing nature of the informed consent process is stressed, along with the benefits of incorporating patient feedback into treatment. The article concludes by acknowledging the need for a balance between beneficence and respect for patient autonomy, particularly in cases of imminent danger, where temporary prioritization of beneficence may be necessary.

In summary, the article underscores the significance of respecting patient autonomy in the treatment of suicidal patients and provides practical guidance for psychotherapists to achieve this while promoting patient well-being.

Chatbot therapy is risky. It’s also not useless

A.W. Ohlheiser

vox.com

Originally posted 14 Dec 23

Here is an excerpt:

So what are the risks of chatbot therapy?

There are some obvious concerns here: Privacy is a big one. That includes the handling of the training data used to make generative AI tools better at mimicking therapy as well as the privacy of the users who end up disclosing sensitive medical information to a chatbot while seeking help. There are also the biases built into many of these systems as they stand today, which often reflect and reinforce the larger systemic inequalities that already exist in society.

But the biggest risk of chatbot therapy — whether it’s poorly conceived or provided by software that was not designed for mental health — is that it could hurt people by not providing good support and care. Therapy is more than a chat transcript and a set of suggestions. Honos-Webb, who uses generative AI tools like ChatGPT to organize her thoughts while writing articles on ADHD but not for her practice as a therapist, noted that therapists pick up on a lot of cues and nuances that AI is not prepared to catch.

Stade, in her working paper, notes that while large language models have a “promising” capacity to conduct some of the skills needed for psychotherapy, there’s a difference between “simulating therapy skills” and “implementing them effectively.” She noted specific concerns around how these systems might handle complex cases, including those involving suicidal thoughts, substance abuse, or specific life events.

Honos-Webb gave the example of an older woman who recently developed an eating disorder. One level of treatment might focus specifically on that behavior: If someone isn’t eating, what might help them eat? But a good therapist will pick up on more of that. Over time, that therapist and patient might make the connection between recent life events: Maybe the patient’s husband recently retired. She’s angry because suddenly he’s home all the time, taking up her space.

“So much of therapy is being responsive to emerging context, what you’re seeing, what you’re noticing,” Honos-Webb explained. And the effectiveness of that work is directly tied to the developing relationship between therapist and patient.

The info is here.

Here is my take:

The promise of AI in mental health care dances on a delicate knife's edge. Chatbot therapy, with its alluring accessibility and anonymity, tempts us with a quick fix for the ever-growing burden of mental illness. Yet, as with any powerful tool, its potential can be both a balm and a poison, demanding a wise touch for its ethical wielding.

On the one hand, imagine a world where everyone, regardless of location or circumstance, can find a non-judgmental ear, a gentle guide through the labyrinth of their own minds. Chatbots, tireless and endlessly patient, could offer a first step of support, a bridge to human therapy when needed. In the hushed hours of isolation, they could remind us we're not alone, providing solace and fostering resilience.

But let us not be lulled into a false sense of ease. Technology, however sophisticated, lacks the warmth of human connection, the nuanced understanding of a shared gaze, the empathy that breathes life into words. We must remember that a chatbot can never replace the irreplaceable – the human relationship at the heart of genuine healing.

Therefore, our embrace of chatbot therapy must be tempered with prudence. We must ensure adequate safeguards, preventing them from masquerading as a panacea, neglecting the complex needs of human beings. Transparency is key – users must be aware of the limitations, of the algorithms whispering behind the chatbot's words. Above all, let us never sacrifice the sacred space of therapy for the cold efficiency of code.

Chatbot therapy can be a bridge, a stepping stone, but never the destination. Let us use technology with wisdom, acknowledging its potential good while holding fast to the irreplaceable value of human connection in the intricate tapestry of healing. Only then can we mental health professionals navigate the ethical tightrope and make technology safe and effective, when and where possible.

Ethics of psychotherapy rationing: A review of ethical and regulatory documents in Canadian professional psychology

Gower, H. K., & Gaine, G. S. (2023).

Canadian Psychology / Psychologie canadienne. 

Advance online publication.

https://doi.org/10.1037/cap0000372

Abstract

Ethical and regulatory documents in Canadian professional psychology were reviewed for principles and standards related to the rationing of psychotherapy. Despite Canada’s high per capita health care expenses, mental health in Canada receives relatively low funding. Further, surveys indicated that Canadians have unmet needs for psychotherapy. Effective and ethical rationing of psychological treatment is a necessity, yet the topic of rationing in psychology has received scant attention. The present study involved a qualitative review of codes of ethics, codes of conduct, and standards of practice documents for their inclusion of rationing principles and standards. Findings highlight the strengths and shortcomings of these documents related to guiding psychotherapy rationing. The discussion offers recommendations for revising these ethical and regulatory documents to promote more equitable and cost-effective use of limited psychotherapy resources in Canada.

Impact Statement

Canadian professional psychology regulatory documents contain limited reference to rationing imperatives, despite scarce psychotherapy resources. While the foundation of distributive justice is in place, rationing-specific principles, standards, and practices are required to foster the fair and equitable distribution of psychotherapy by Canadian psychologists.

From the recommendations:

Recommendations for Canadian Psychology Regulatory Documents

1. Explicitly widen psychologists’ scope of concern to include not only current clients but also waiting clients and those who need treatment but face access barriers.
2. Acknowledge the scarcity of health care resources (in public and private settings) and the high demand for psychology services (e.g., psychotherapy) and admonish inefficient and cost-ineffective use.
3. Draw an explicit connection between the general principle of distributive justice and the specific practices related to rationing of psychology resources, including, especially, mitigation of biases likely to weaken ethical decision making.
4. Encourage the use of outcome monitoring measures to aid relative utility calculations for triage and termination decisions and to ensure efficiency and distributive justice.
5. Recommend advocacy by psychologists to address barriers to accessing needed services (e.g., psychotherapy), including promoting the cost effectiveness of psychotherapy as well as highlighting systemic barriers related to presenting problem, disability, ethnicity, race, gender, sexuality, or income.

Is the world ready for ChatGPT therapists?

Ian Graber-Stiehl

Nature.com

Originally posted 3 May 23

Since 2015, Koko, a mobile mental-health app, has tried to provide crowdsourced support for people in need. Text the app to say that you’re feeling guilty about a work issue, and an empathetic response will come through in a few minutes — clumsy perhaps, but unmistakably human — to suggest some positive coping strategies.

The app might also invite you to respond to another person’s plight while you wait. To help with this task, an assistant called Kokobot can suggest some basic starters, such as “I’ve been there”.

But last October, some Koko app users were given the option to receive much-more-complete suggestions from Kokobot. These suggestions were preceded by a disclaimer, says Koko co-founder Rob Morris, who is based in Monterey, California: “I’m just a robot, but here’s an idea of how I might respond.” Users were able to edit or tailor the response in any way they felt was appropriate before they sent it.

What they didn’t know at the time was that the replies were written by GPT-3, the powerful artificial-intelligence (AI) tool that can process and produce natural text, thanks to a massive written-word training set. When Morris eventually tweeted about the experiment, he was surprised by the criticism he received. “I had no idea I would create such a fervour of discussion,” he says.

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Automated therapist

Koko is far from the first platform to implement AI in a mental-health setting. Broadly, machine-learning-based AI has been implemented or investigated in the mental-health space in three roles.

The first has been the use of AI to analyse therapeutic interventions, to fine-tune them down the line. Two high-profile examples, ieso and Lyssn, train their natural-language-processing AI on therapy-session transcripts. Lyssn, a program developed by scientists at the University of Washington in Seattle, analyses dialogue against 55 metrics, from providers’ expressions of empathy to the employment of CBT interventions. ieso, a provider of text-based therapy based in Cambridge, UK, has analysed more than half a million therapy sessions, tracking the outcomes to determine the most effective interventions. Both essentially give digital therapists notes on how they’ve done, but each service aims to provide a real-time tool eventually: part advising assistant, part grading supervisor.

The second role for AI has been in diagnosis. A number of platforms, such as the REACH VET program for US military veterans, scan a person’s medical records for red flags that might indicate issues such as self-harm or suicidal ideation. This diagnostic work, says Torous, is probably the most immediately promising application of AI in mental health, although he notes that most of the nascent platforms require much more evaluation. Some have struggled. Earlier this year, MindStrong, a nearly decade-old app that initially aimed to leverage AI to identify early markers of depression, collapsed despite early investor excitement and a high-profile scientist co-founder, Tom Insel, the former director of the US National Institute of Mental Health.

The info is here.

Drowning in Debris: A Daughter Faces Her Mother’s Hoarding

Deborah Derrickson Kossmann

Psychotherapy Networker

March/April 2023

Here is an excerpt:

My job as a psychologist is to salvage things, to use the stories people tell me in therapy and help them understand themselves and others better. I make meaning out of the joy and wreckage of my own life, too. Sure, I could’ve just hired somebody to shovel all my mother’s mess into a dumpster, but I needed to be my family’s archaeologist, excavating and preserving what was beautiful and meaningful. My mother isn’t wrong to say that holding on to some things is important. Like her, I appreciate connections to the past. During the cleaning, I found photographs, jewelry passed down over generations, and my bronzed baby shoes. I treasure these things.

“Maybe I failed by not following anything the psychology books say to do with a hoarding client,” I tell my sister over the phone. “Sometimes I still feel like I wasn’t compassionate enough.”

“You handled it as best you could as her daughter,” my sister says. “You’re not her therapist.”

After six years, my mother has finally stopped saying she’s a “prisoner” at assisted living. She tells me she’s part of a “posse” of women who eat dinner together. My sister decorated her studio apartment beautifully, but the cluttering has begun again. Piles of magazines and newspapers sit in corners of her room. Sometimes, I feel the rage and despair these behaviors trigger in me. I still have nightmares where I drive to my mother’s house, open the door, and see only darkness, black and terrifying, like I’m looking into a deep cave. Then, I’m fleeing while trying to wipe feces off my arm. I wake up feeling sadness and shame, but I know it isn’t my own.

A few weeks ago, I pulled up in front of my mother’s building after taking her to the cardiologist. We turned toward each other and hugged goodbye. She opened the car door with some effort and determinedly waved off my help before grabbing the bag of books I’d brought for her.

“I can do it, Deborah,” she snapped. But after taking a few steps toward the building entrance, she turned around to look at me and smiled. “Thank you,” she said. “I really appreciate all you do for me.” She added, softly, “I know it’s a lot.”

The article is here.

The article is an important reminder that practicing psychologists cope with their own stressors, family dynamics, and unpleasant emotional experiences.  Psychologists are humans with families, value systems, emotions, beliefs, and shortcomings.

Why do we focus on trivial things? Bikeshedding explained

The Decision Lab

An Explainer

Originally posted: No idea

What is Bikeshedding?

Bikeshedding, also known as Parkinson’s law of triviality, describes our tendency to devote a disproportionate amount of our time to menial and trivial matters while leaving important matters unattended.

Where does this bias occur?

Do you ever remember sitting in class and having a teacher get off track from a lesson plan? They may have spent a large portion of your biology class time telling you a personal story and skimmed over important scientific theory. In such an instance, your teacher may have been a victim of bikeshedding, where they spent too long discussing something minor and lost track of what was important. Even though it may have been more entertaining to listen to their story, it did not help you acquire important information.

Although that scenario is one familiar to most, bikeshedding is an issue most commonly seen as a problem in corporate and consulting environments, especially during meetings. Imagine that at work, you have a meeting scheduled to discuss two important issues. The first issue is having to come up with ways in which the company can reduce carbon emissions. The second issue is discussing the implementation of standing desks at the office. It is clear that the first issue is more important, but it is also more complex. You and your coworkers will likely find it much easier to talk about whether or not to get standing desks, and as a result, a large portion of the scheduled meeting time is devoted to this more trivial matter. This disproportionate time allocation is known as bikeshedding and causes complicated matters to receive little attention.

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How to avoid it?

An awareness of bikeshedding is vital to countering its effects. There are various techniques that can be used in order to ensure that a group or team is being efficient with the time they spend on each topic.

One method to avoid bikeshedding is to have a separate meeting for any major, complex issue. If the topic is brought into a meeting with a long agenda, it can get lost under the trivial issues. However, if it is the main and only purpose for a meeting, it is difficult to avoid talking about it. Keeping meetings specific and focused on a particular issue can help counter bikeshedding.1 It may also be a good idea to have a particular person appointed to keep the team on task and pull back focus if the discussion does get sidetracked.

Another way of pulling the focus onto particular issues is to have less people present at the meeting. Bikeshedding is a big problem in group settings because simple issues entice multiple people to speak, which can drag them out. By only having the necessary people present at a meeting, even if a trivial issue is discussed, it will take up less time since there are fewer people to voice their opinion.

The explainer is here.

This bias may occur in psychotherapy when psychologist and patient focus on trivial issues that are easier to discuss or solve, rather than addressing critical, difficult issues.  There is a difference between creating a therapeutic attachment and bikeshedding.

Political sectarianism in America

Finkel, E. J., Bail, C. A., et al. (2020).

Science, 370(6516), 533–536.

https://doi.org/10.1126/science.abe1715

Abstract

Political polarization, a concern in many countries, is especially acrimonious in the United States (see the first box). For decades, scholars have studied polarization as an ideological matter—how strongly Democrats and Republicans diverge vis-à-vis political ideals and policy goals. Such competition among groups in the marketplace of ideas is a hallmark of a healthy democracy. But more recently, researchers have identified a second type of polarization, one focusing less on triumphs of ideas than on dominating the abhorrent supporters of the opposing party (1). This literature has produced a proliferation of insights and constructs but few interdisciplinary efforts to integrate them. We offer such an integration, pinpointing the superordinate construct of political sectarianism and identifying its three core ingredients: othering, aversion, and moralization. We then consider the causes of political sectarianism and its consequences for U.S. society—especially the threat it poses to democracy. Finally, we propose interventions for minimizing its most corrosive aspects.

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Here, we consider three avenues for intervention that hold particular promise for ameliorating political sectarianism. The first addresses people’s faulty perceptions or intuitions. For example, correcting misperceptions of opposing partisans, such as their level of hostility toward one’s copartisans, reduces sectarianism.  Such correction efforts can encourage people to engage in cross-party interactions (SM) or to consider their own positive experiences with opposing partisans, especially a friend, family

member, or neighbor. Doing so can reduce the role of motivated partisan reasoning in the formation of policy opinions.

A related idea is to instill intellectual humility, such as by asking people to explain policy preferences at a mechanistic level—for example, why do they favor their position on a national flat tax or on carbon emissions.  According to a recent study, relative to people assigned to the more lawyerly approach of justifying their preexisting policy preferences, those asked to provide mechanistic explanations gain appreciation for the complexities involved.

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From the end of the article:

Political sectarianism cripples a nation’s ability to confront challenges. Bolstering the emphasis on political ideas rather than political adversaries is not a sufficient solution, but it is likely to be a major step in the right direction. The interventions proposed above offer some promising leads, but any serious effort will require multifaceted efforts to change leadership, media, and democratic systems in ways that are sensitive to human psychology. There are no silver bullets.

The article is here.

A good reminder for psychologists and those involved in the mental health field.

Telehealth is here to stay. Psychologists should equip themselves to offer it.

Hannah Calkins

The Monitor On Psychology

Vol. 53 No. 7, Print version: page 30

Telehealth continues to play a significant role in the health care industry. However, psychologists who offer both in-person and virtual services are poised to meet increased demand for flexible, accessible mental health care.

In 2020, psychologists responded to the onset of the COVID-19 pandemic by making a nearly universal pivot to telehealth. This rapid and widespread adoption was largely enabled by the federal government’s declaration of a public health emergency (PHE), which prompted several significant policy changes that made telehealth more feasible for both patients and providers.

Yet in the following year, an APA survey found that 50% of psychologists had moved to offering both in-person and virtual services to their patients, up from 30% in 2020. Additionally, Pew Research Center data showed that 25% of adults with ­low incomes do not own smartphones, and 40% of this group do not have broadband internet or computers at home, signaling significant concerns about telehealth equity.

This means that psychologists should prepare for a hybrid future in which they deliver services via both modalities.

“Telehealth is here to stay. In-person isn’t going away,” said Robin McLeod, PhD, a licensed psychologist and president and chief business development officer at Natalis Psychology in St. Paul, Minnesota. “I believe it is vital for most psychologists to be able and willing to provide both options for patients. It just makes good business sense.”

Meeting demand for telehealth

Like many other providers, those at McLeod’s large practice made a quick pivot to virtual care during the pandemic and now offer hybrid options.

“[Our] providers have returned to providing in-person care, which many of our patients welcomed,” said McLeod. “However, most every provider in our organization continues to provide telehealth services for those clients who prefer that.”

Similarly, Zixuan Wang, PsyD, of Encounter Psychotherapy in Gaithersburg, Maryland, also has a robust hybrid practice. However, prior to spring 2020, she had never seriously considered offering telehealth.

“I am so appreciative that technology has enabled us to provide telehealth services, as they have been proven to be effective and beneficial for so many people who need care,” she said.

Wang and McLeod’s stories are scaled-down versions of the broader narrative of telehealth during the pandemic: Rapid and sustained implementation out of necessity has led to a permanent change.

The info is here.

Functional neural changes associated with psychotherapy in anxiety disorders - A meta-analysis of longitudinal fMRI studies

Schrammen E, Roesmann K, Rosenbaum D, et al.

Neuroscience and Biobehavioral Reviews. 2022 

Sep;142:104895.

Abstract 

Successful psychotherapy for anxiety disorders is thought to be linked to functional neural changes in prefrontal control areas and fear-related limbic regions. Thus, discovering such therapy-associated neural changes might point to relevant mechanisms of action. Using AES-SDM, we conducted a coordinate-based meta-analysis of 22 whole-brain datasets (n = 419 anxiety patients) from 18 studies identified by our systematic literature search following PRISMA criteria (preregistration available at OSF: https://osf.io/dgc4p). In these studies, fMRI data was collected in response to negative stimuli during cognitive-emotional tasks before and after psychotherapy. Post-psychotherapy, activation decreased in the right insula, the anterior cingulate cortex, and the dorsolateral prefrontal cortex; no region had increased activation. A subgroup analysis for CBT revealed additional decrease in the supplementary motor area. Reduced activation in limbic and frontal regions might indicate therapy-associated normalization regarding the perception of internal and external threat, subsequent allocation of cognitive resources, and changes in cognitive control. Due to the integration of diverse treatments and experimental tasks, these changes presumably reflect global effects of successful psychotherapy.

Highlights

• We conducted a coordinate-based meta-analysis of studies assessing fMRI pre- and post-therapy in anxiety disorders.

• Our results are based on whole-brain findings and include more than 50% original statistical maps.

• From pre to post, activation decreased in the insula, the anterior cingulate cortex, and the dorsolateral prefrontal cortex.

• Subgroup-analysis for CBT and exposure revealed an additional cluster of activation decrease in the supplementary motor area.

The research is here.

Frequently asked questions about abortion laws and psychology practice

American Psychological Association

Updated 1 SEPT 2022

Since the U.S. Supreme Court issued its decision to overturn Roe v. Wade, many states have proposed, enacted, or resurrected a range of laws to either prohibit, significantly restrict, or protect reproductive rights and health care. Currently, the main targets of these laws appear to be medical providers who provide abortions or individuals seeking to obtain an abortion.

APA and APA Services Inc. are striving to provide psychologists with accurate and adequate information about the potential impact on them of reproductive health care laws. Since psychologists have embraced telehealth and many use technology to provide services across state lines, it’s important to be familiar with the laws governing the jurisdiction(s) where you are licensed as well as the jurisdiction(s) where your patients live.

In addition to this FAQ and other APA resources, psychologists will want to be familiar with guidance issued by federal and state agencies, their state licensing board(s), and their liability carrier. Some frequently asked questions follow.

While the situation is dynamic, good psychological practice remains unchanged. The changing landscape in states regarding access to reproductive health care does not change the fundamental approach to psychological care. Psychologists should continue to prioritize the welfare of their patients, protect confidentiality, and ensure their patients’ safety.

Practicing in states with changing abortion laws

Am I practicing in a state where abortion is, or is soon to be, illegal under all or certain circumstances?

The Supreme Court’s decision to overturn Roe v. Wade has put the regulation of abortion in the hands of states. In anticipation of the ruling, 13 states enacted “trigger laws,” designed to ban or restrict abortion upon the Supreme Court’s reversal of Roe v. Wade. Not all trigger laws immediately kicked in, and some that did were immediately challenged in court, delaying their enforcement.

Staying current on laws affecting the states where you practice is important. For a list of existing abortion bans and restrictions within each state, the Center for Reproductive Rights has provided a map that is updated in real time. The Guttmacher Institute, a well-respected research group that collects information on abortion laws across the United States, also tracks current state abortion-related laws.

The information is here.

Sexuality Training in Counseling Psychology: A Mixed-Methods Study of Student Perspectives

Abbott, D. M., Vargas, J. E., & Santiago, H. J. (2022).

Journal of Counseling Psychology. 

Advance online publication.

https://doi.org/10.1037/cou0000641

Abstract

Counseling psychologists are a cogent fit to lead the movement toward a sex-positive professional psychology (Burnes et al., 2017a). Though centralizing training in human sexuality (HS; Mollen & Abbott, 2021) and sexual and reproductive health (Grzanka & Frantell, 2017) is congruent with counseling psychologists’ values, training programs rarely require or integrate comprehensive sexuality training for their students (Mollen et al., 2020). We employed a critical mixed-methods design in the interest of centering the missing voices of doctoral-level graduate students in counseling psychology in the discussion of the importance of human sexuality competence for counseling psychologists. Using focus groups to ascertain students’ perspectives on their human sexuality training (HST) in counseling psychology, responses yielded five themes: (a) HST is integral to counseling psychology training, (b) few opportunities to gain human sexuality competence, (c) inconsistent training and self-directed learning, (d) varying levels of human sexuality comfort and competence, and (e) desire for integration of HST. Survey responses suggested students were trained on the vast majority of human sexuality topics at low levels, consistent with prior studies surveying training directors in counseling psychology and at internship training sites (Abbott et al., 2021; Mollen et al., 2020). Taken together, results suggested students see HST as aligned with the social justice emphasis in counseling psychology but found their current training was inconsistent, incidental rather than intentional, and lacked depth. Recommendations, contextualized within counseling psychology values, are offered to increase opportunities for and strengthen HST in counseling psychology training programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Impact Statement

The present study suggests that counseling psychology graduate students perceive human sexuality training (HST) as valuable to their professional development and congruent with counseling psychology values. Findings support the integration of consistent, comprehensive, sex-positive HST in doctoral counseling psychology training programs. 

Conclusion

Comprehensive training in human sexuality represents a notable omission from counseling psychology training, particularly in light of the discipline’s values including emphases on diversity, social justice, and contextual, holistic perspectives. In the present study, the first to explore counseling psychology student perceptions of sexuality training, participants outlined the importance of HST to counseling psychology training, specifically, and providing psychotherapeutic services, broadly, outlined the current nature of their training, or lack thereof, and conveyed their desire for HST including recommendations for how programs may successfully implement HST in ways that benefitted students and the public they serve. Therefore, we call on faculty in counseling psychology training programs to reevaluate their commitment to developing sexuality competence among their students, invest in their own sexuality training as needed, and invoke creative strategies to make HST accessible and comprehensive in their programs.

9th Circuit Upholds Ban on Conversion Therapy for Minors in First Amendment Challenge

Debra Cassens Weiss

ABA Journal

Originally published 7 SEPT 22

Washington state’s ban on conversion therapy for minors does not violate the First or 14th Amendments, a federal appeals court ruled on Tuesday.

The San Francisco-based 9th U.S. Circuit Court of Appeals upheld the law, which subjects licensed therapists to discipline if they practice therapy that seeks to change the sexual orientation or gender identity of a person under age 18.

The appeals court said the law was intended to prevent psychological harm to LGBTQ minors subjected to conversion therapy, including depression, self-stigma and emotional distress.

The appeals court ruled against Christian marriage and family counselor Brian Tingley, who claimed the ban on conversion therapy for minors violated his free speech and free exercise rights under the First Amendment. He also claimed the Washington state law was unconstitutionally vague under the 14th Amendment.

The appeals court noted its 2014 decision, Pickup v. Brown, upheld a nearly identical law in California. Tingley had argued, however, that the U.S. Supreme Court abrogated the Pickup decision in 2018 when it ruled for anti-abortion crisis pregnancy centers challenging California’s required notice on the availability of state-subsidized abortions.

The Supreme Court held the abortion-notice law was a content-based restriction that was likely unconstitutional. The case was National Institute of Family & Life Advocates v. Becerra.

The info is here.

Talking with strangers is surprisingly informative

Atir, S., Wald, K. A., & Epley, N. (2022).

PNAS, 119(34). 

https://doi.org/10.1073/pnas.2206992119

Abstract

A meaningful amount of people’s knowledge comes from their conversations with others. The amount people expect to learn predicts their interest in having a conversation (pretests 1 and 2), suggesting that the presumed information value of conversations guides decisions of whom to talk with. The results of seven experiments, however, suggest that people may systematically underestimate the informational benefit of conversation, creating a barrier to talking with—and hence learning from—others in daily life. Participants who were asked to talk with another person expected to learn significantly less from the conversation than they actually reported learning afterward, regardless of whether they had conversation prompts and whether they had the goal to learn (experiments 1 and 2). Undervaluing conversation does not stem from having systematically poor opinions of how much others know (experiment 3) but is instead related to the inherent uncertainty involved in conversation itself. Consequently, people underestimate learning to a lesser extent when uncertainty is reduced, as in a nonsocial context (surfing the web, experiment 4); when talking to an acquainted conversation partner (experiment 5); and after knowing the content of the conversation (experiment 6). Underestimating learning in conversation is distinct from underestimating other positive qualities in conversation, such as enjoyment (experiment 7). Misunderstanding how much can be learned in conversation could keep people from learning from others in daily life.

Significance

Conversation can be a useful source of learning about practically any topic. Information exchanged through conversation is central to culture and society, as talking with others communicates norms, creates shared understanding, conveys morality, shares knowledge, provides different perspectives, and more. Yet we find that people systematically undervalue what they might learn in conversation, anticipating that they will learn less than they actually do. This miscalibration stems from the inherent uncertainty of conversations, where it can be difficult to even conceive of what one might learn before one learns it. Holding miscalibrated expectations about the information value of conversation may discourage people from engaging in them more often, creating a potentially misplaced barrier to learning more from others.

The research is here.

Direct applications to psychotherapy.

A study gave cash and therapy to men at risk of criminal behavior

Sigal Samuel 

vox.com

Originally posted 31 MAY 22

Here is an excerpt:

Inspired by the program in Liberia, Chicago has been implementing a similar but more intensive program called READI. Over the course of 18 months, men in the city’s most violent districts participate in therapy sessions in the morning, followed by job training in the afternoon. The rationale for the latter is that in a place with a well-developed labor market like Chicago, the best way to improve earnings is probably to get people into the market, whereas in Liberia, the labor market is much less efficient, so it made more sense to offer people cash.

“We’ll have more results this summer,” said Blattman of the READI program, which he is helping to advise. So far, “it doesn’t look like a slam dunk.”

Still, Chicago is eager to try these therapy-based approaches, having already had some success with them. The city is also home to a program called Becoming a Man (BAM), where high schoolers do CBT-inspired group sessions. A randomized controlled trial showed that criminal arrests fell by about half during the BAM program. Even though effects dissipated over time, the program looks to be very cost-effective.

But this isn’t just a story about the growing recognition that therapy can play a useful role in preventing crime. That trend is part of a broader movement to adopt an approach to crime that is more carrot, less stick.

“It’s all about a progressive, rational policy for social control. Social inclusion is the most productive means of social control,” David Brotherton, a sociologist at the City University of New York, explained to me in 2019.

Brotherton has long argued that mainstream US policy is counterproductively coercive and punitive. His research has shown that helping at-risk people reintegrate into mainstream society — including by offering them cash — is much more effective at reducing violence.

The info is here.

Abuse case reveals therapist’s dark past, raises ethical concerns

Associated Press

Originally posted 11 JUN 22

Here is an excerpt:

Dushame held a valid driver’s license despite five previous drunken driving convictions, and it was his third fatal crash — though the others didn’t involve alcohol. The Boston Globe called him “the most notorious drunk driver in New England history.”

But over time, he dedicated himself to helping people recovering from addiction, earning a master’s degree in counseling psychology and leading treatment programs from behind bars.

Two years later, he legally changed his name to Peter Stone. He was released from prison in 2002 and eventually set up shop as a licensed drug and alcohol counselor.

Last July, he was charged with five counts of aggravated felonious sexual assault under a law that criminalizes any sexual contact between patients and their therapists or health care providers. Such behavior also is prohibited by the American Psychological Association’s ethical code of conduct.

In a recent interview, the 61-year-old woman said she developed romantic feelings for Stone about six months after he began treating her for anxiety, depression and alcohol abuse in June 2013. Though he told her a relationship would be unethical, he initiated sexual contact in February 2016, she said.

“‘That crossed the line,’” the woman remembers him saying after he pulled up his pants. “‘When am I seeing you again?’”

While about half the states have no restrictions on name changes after felony convictions, 15 have bans or temporary waiting periods for those convicted of certain crimes, according to the ACLU in Illinois, which has one of the most restrictive laws.

Stone appropriately disclosed his criminal record on licensing applications and other documents, according to a review of records obtained by the AP. Disclosure to clients isn’t mandatory, said Gary Goodnough, who teaches counseling ethics at Plymouth State University. But he believes clients have a right to know about some convictions, including vehicular homicide.

The info is here.

Why So Many Middle-Aged Women Are on Antidepressants—Scientists are gaining a better understanding of women’s midlife depression

Andrea Petersen

The Wall Street Journal

Originally posted 2 APR 22

For years, middle-aged women have had some of the country’s highest rates of antidepressant use. Now, scientists are starting to better understand why—and to develop more targeted treatments for women’s midlife depression.

About one in five women ages 40 to 59 and nearly one in four women ages 60 and over used antidepressants in the last 30 days during 2015 to 2018, according to the latest data from the National Center for Health Statistics. 

Among women ages 18 to 39, the figure was about one in 10. 

Among men, 8.4% of those ages 40 to 59 and 12.8% of those 60 and older used antidepressants in the last 30 days, according to the NCHS data.

The figures are drawing increasing attention from scientists and doctors. Many are alarmed at how high depression rates were among midlife women even before the pandemic, now that the past two years have exacerbated mental-health issues for many Americans. 

(cut)

Researchers at NIMH who have been following 90 women since 1988 have found that the incidence of women’s midlife depression is concentrated in the two years before and after the last menstrual period, says Dr. Schmidt. 

The quality of women’s midlife depression is distinct, too, Dr. Schmidt says, in that it often involves intense anxiety, irritability and sleep problems along with the more typical sadness and loss of pleasure in once-enjoyed activities.

Doctors speculate that antidepressant use among middle-aged women is being driven in part by the reluctance of women—and many of their physicians—in recent decades to use hormone-replacement therapy for menopausal symptoms. In 2002, a large study, the Women’s Health Initiative, was stopped after women taking hormone therapy had an increased risk of breast cancer, heart attacks and strokes. 

Later analyses found that the risks were largely concentrated among women who were older when they started hormone therapy. For women in their 50s, hormone therapy actually reduced the risk of heart disease and death from any cause. 

Hormone therapy, either estrogen alone or combined with a progestogen, is the most effective treatment for hot flashes and night sweats, according to the North American Menopause Society and the American College of Obstetricians and Gynecologists. 

Some research has found that it can also improve mood.

The info is here, behind a paywall.