Teaching and Learning Guide: Towards a Cultural–Clinical Psychology

The study of culture and mental health is an interdisciplinary endeavor with a long history, but psychology has only been fitfully involved with the ongoing conversation. Cultural psychiatry, by contrast, represents a decades‐long interdisciplinary endeavor primarily involving psychiatrists and anthropologists. One problem is that the anthropological view of culture, not as independent variable but as deep context, has been unfamiliar to psychologists until relatively recently. Although anthropological views have influenced researchers in cultural psychology, at times profoundly, collaborations between cultural and clinical psychologists remain uncommon

THE ROLE OF MICROTRAUMA IN THE DEVELOPMENT OF BACTERIAL CORNEAL ULCERS

Purpose: To study the role of corneal  microtrauma in the development of complications, leading to bacterial ulcers. Performed clinical assessment, conservative therapy, and surgical  interventions for 236 patients with the  complication  of microtrauma, mainly related to  the  prolonged  presence of foreign bodies  in the  cornea (86.1% they  had  a  metallic  nature). Methods included  ophthalmologic investigations  and  laboratory  procedures, which revealed  the  presence of bacterial corneal  ulcer  in 97 cases (41.1%), recurrent erosion  — 62  cases (26.3%), traumatic keratitis — 25 cases (10.6%) and  deep  cornea’s infiltrate  — 52  cases  (22.0%). The development of complications was  due to the  later  removal  of FB (in some  cases more  than  1 month  after  the  trauma), incomplete removal of foreign bodies,  non-compliance  with aseptic and antiseptic rules  during in the removal of FB’s without follow up of patients. Streptococcus,  staphylococcus, pneumococcus, and  isolated  cases of Pseudomonas aeruginosa and  Escherichia  coli were  mainly diagnosed. Conservative therapy  included specific, pathogenetic, symptomatic and antiallergic medications. Nitric oxide (NO) in the gas stream was used  to accelerate the reparative processes, weakening  of the inflammatory exudation and cellular proliferation.  Surgical interventions  were  performed for  preserving  of eyes,  prophylactic  and  therapeutic purposes in the  form  autoconjunctiveal  plast y, deep  lamellar  and  penetrating keratoplast y  (preserved  and  fresh  corneas) and  amniotic  membrane transplantation. According  to the results of treatment of 236 patients with the corneal  erosion  completed with elimination of inflammatory reaction, restoration of corneal  transparency; 52 patients with corneal  infiltrate -development  of opacities  in the stromal cornea layers;  patients with keratitis –formation of corneal  leucoma  and 52%  — keratoplast y were  performed. In cases of corneal  ulcer process ended  with the formation of a  rough  leucoma  in 30 patients (30.9%), surgical  interventions  with a  partial  improvement of visual function  were  observed  in 62 patients (63.9%), the removal of the eye were  done in 5 patients (5.2%)

Cultural variations in ideal and momentary hedonic balance: Does a more negative ideal protect Russian Americans from daily stress?

The association between perceived stress with heightened negative emotions and dampened positive emotions is well established. Much less clear, however, is the extent to which ideal and experienced levels of hedonic balance (i.e., the difference in intensities between positive and negative emotions) predict stress across cultural contexts. There is wide cultural variation in dominant models of emotions; for example, the Russian cultural context is thought to emphasize low hedonic balance relative to European American or Hispanic American cultural contexts. Thirty-two European Americans, 25 Hispanic Americans, 33 Asian Americans, and 20 Russian Americans provided reports of ideal and momentary hedonic balance. Momentary reports were sampled over 10 days. Perceived levels of stress were assessed at the beginning and at the end of the study. There were cultural group differences in ideal and momentary hedonic balance, with Russian Americans reporting lower ideal and momentary hedonic balance than Hispanic Americans. Across cultural groups, lower levels of momentary hedonic balance were predictive of perceived stress. In the Russian American group, but not the other groups, lower ideal hedonic balance was associated with lower levels of perceived stress. These results suggest that the Russian cultural model of emotions shape both ideal and momentary hedonic balance, with lower levels of ideal hedonic protecting against the potentially stressful impact of low experienced hedonic balance

Towards a Cultural–Clinical Psychology

For decades, clinical psychologists have catalogued cultural group differences in symptom presentation, assessment, and treatment outcomes. We know that ‘culture matters’ in mental health – but do we know how it matters, or why? Answers may be found in an integration of cultural and clinical psychology. Cultural psychology demands a move beyond description to explanation of group variation. For its part, clinical psychology insists on the importance of individual people, while also extending the range of human variation. Cultural–clinical psychology integrates these approaches, opening up new lines of inquiry. The central assumption of this interdisciplinary field is that culture, mind, and brain constitute one another as a multilevel dynamic system in which no level is primary, and that psychopathology is an emergent property of that system. We illustrate cultural–clinical psychology research using our work on depression in Chinese populations and conclude with a call for greater collaboration among researchers in this field

Disordered Mood in Cultural-Historical Context

Mood disorders are observed worldwide and represent a major contribution to the global burden of disease. Despite the numerous ways in which these disorders vary across cultural contexts, however, the research literature is dominated by Western concepts. Cultural variations, and the ways in which they can best be understood and studied, comprise the focus of this chapter. We begin with a brief historical overview of disordered mood over different eras. Then, we turn to the contemporary literature on cultural variations in mood disorders, focusing on four domains: (1) etiological beliefs; (2) risk and resilience; (3) incidence and prevalence; and (4) symptom presentation. While many of the studies reviewed highlight intriguing differences across cultural groups, relatively few of them explore empirically the possible explanations for these differences. We thus propose an approach to understanding cultural variations in psychopathology based on a core idea from cultural psychology: the mutual constitution of culture, mind, and brain. Then, we briefly describe some of the ways in which symptoms of disordered mood can be understood as emerging from looping processes in the culture-mind-brain system. From this perspective, we conclude by looking ahead to some future directions for research. First, we emphasize the importance of integrative studies across culture-, mind-, and brain-levels. Second, we consider the possibility that historical changes in descriptions of disordered mood might go beyond shifts in our understanding to include culturally-shaped transformations in normal and abnormal experience

Depression in China: Integrating Developmental Psychopathology and Cultural-Clinical Psychology

With a starting point in John Abela’s groundbreaking developmental psychopathology research on adolescent depression in China, we aimed to review the state of the literature on Chinese depression across the lifespan. We began with Dr. Abela’s published studies relevant to depression in China and our own research with adults before turning to the reference lists of these articles to find additional sources. Then we conducted literature searches using PsycINFO and PubMed to find other relevant studies published between April 2001 and April 2011. There are two distinct literatures on depression in China. Developmental psychopathology research has emphasized adolescent samples and cognitive models of causation; cultural-clinical psychology and cultural psychiatry research have emphasized adult samples and the meanings associated with emotions, symptoms, and syndromes. Both approaches to the study of depression in China have yielded important findings but have also highlighted issues that could be better addressed by incorporating the other approach. Beyond depression in China, the psychological study of culture and mental health more generally would benefit from greater exchange between developmental psychopathology and cultural-clinical psychology

Mechanisms of immune regulation and transplantation immunity in corneal transplants

At the present time, corneal transplantation (keratoplasty) is one of the most frequent modes of solid tissue transplants in the world. Unlike other kinds of transplants, corneal grafting is often performed without tissue typing and systemic immunosuppression.High frequency of transparent corneal engraftment (up to 90% of cases) in the absence of risk factors is due to special immunoprivileged area in the anterior eye segment (functionally, a structural aggregation of the cornea and anterior chamber, AC) accomplished by local and systemic immunoregulatory mechanisms, i.e., phenomenon of immune deviation associated with anterior chamber of the eye (ACAID), components of the internal liquid medium, a watery moisture with immunosuppressive properties, e.g., IL-1ra, TSP-1,TGF-β2, regulatory complement proteins, α-MSH (alpha-melanocyte stimulating hormone), VIP (vasoactive intestinal peptide), indolamine 2,3-dioxygenase (IDO), calcitonin-gene-bound peptide (CGRP), somatostatin, etc.In addition to ACAID and liquid AC components, a contribution to the maintenance of immune privilege which is extremely important for a successful outcome of keratoplasty, is provided by other mechanisms, in particular, immunologically active membrane-associated molecules of corneal endothelium, i.e., PDL-1 (Programmed death ligand 1), and sVEGFR-1, sVEGFR-2, sVEGFR-3 involved in maintaining avascularity of the corneal tissue. Disturbances of the immune privilege of the cornea promotes activation of immune recognition with switching the effector mechanisms of transplantation immunity, thus leading to subsequent development of the tissue incompatibility reaction and clouding of transplanted cornea. Graft rejection can be localized in any of the corneal cell layers, including epithelium, stroma, and endothelium. Endothelial rejection causes the most severe affection of visual functions, due to the inability of local endothelial recovery, and water accumulation due to the endothelial dysfunction.Graft rejection is clinically characterized by edema and the presence of inflammatory cells, either circulating in the anterior chamber, or forming precipitates on the graft endothelial cells.A number of factors are associated with an increased risk of corneal graft rejection, including the degree of inflammation and/or vascularization of the transplant bed i.e., location of the donor cornea, repeated keratoplasty, allosensitization due to other cellular transplants, including bone marrow, blood transfusions, pregnancy, etc., as well as allergic and systemic diseases.This review article considers and systematizes the data from the literature concerning studies of the factors determining the immune privileged state of cornea, and the ACAID phenomenon, their role in development of allotolerance in corneal transplantation, highlights the main conditions required for triggering the tissue incompatibility reactions, discusses the mechanisms of allogeneic recognition and effector stage of the immune response, destruction of corneal allografts

Mindfulness to Manage Moral Injury: Rationale and Development of a Live Online 7-Week Group Intervention for Veterans with Moral Injury

BACKGROUND: Military service puts service members at risk for moral injury. Moral injury is an array of symptoms (e.g., guilt, shame, anger) that develop from events that violate or transgress one\u27s moral code. OBJECTIVE: We describe adaption of in-person mindfulness training program, Mindfulness to Manage Chronic Pain (MMCP), to address symptoms of moral injury to be delivered live via the web. We discuss how we will assess benchmarks (i.e., recruitment, credibility and acceptability, completion rates, and adherence) of the Mindfulness to Manage Moral Injury (MMMI) program. METHODS: Aim 1: To develop and then adapt the MMCP program based on feedback from experts and veterans who took part in Study 1. Aim 2: To develop an equally intensive facilitator-led online Educational Support (ES) program to serve as a comparison intervention and conduct a run-through of each program with 20 veterans (10 MMMI; 10 ES). Aim 3: To conduct a small-scale randomized controlled trial (N = 42 veterans; 21 MMMI; 21 ES) in which we will collect pre-post-test and weekly benchmark data for both refined intervention arms. RESULTS: Study 1 and 2 are completed. Data collection for Study 3 will be completed in 2022. CONCLUSION: MMMI is designed to provide a live facilitated mindfulness program to address symptoms of moral injury. If Study 3 demonstrates good benchmarks, with additional large-scale testing, MMMI may be a promising treatment that can reach veterans who may not seek traditional VAMC care and/or who prefer a web-based program

Lessons learned from multisite implementation and evaluation of Project SHARE, a teen health information literacy, empowerment, and leadership program

Background: This case study describes the implementation and evaluation of a multisite teen health information outreach program. The objectives of the program were to increase health knowledge, health information literacy, interest in health careers, community engagement, and leadership skills of teens in disadvantaged communities. Case Presentation: Teens at six sites across the country participated in a multi-week curriculum that focused on various aspects of health literacy, information literacy, and leadership. Lesson topics addressed personal health, social determinants of health, information quality, and communication and advocacy skills. Program evaluation included both quantitative and qualitative components and focused on multiple knowledge and skills outcome variables. Results suggested that while teens at all sites showed improvement, particularly with respect to engagement and interest in the topics, the degree of gains in knowledge and information literacy measures varied significantly from site to site. Conclusion: On-site implementation planning, cohesive integration of added activities, and emphasis on retention can contribute to implementation and evaluation effectiveness. This work also underscores the limitation of a purely quantitative approach to capturing the impact of health information and stresses the importance of supplementing numerical scores and statistics with qualitative data.  This article has been approved for the Medical Library Association’s Independent Reading Program

Anxiety symptom presentations in Han Chinese and Euro-Canadian outpatients: Is distress always somatized in China?

Background: Cultural variations in the relative emphasis on somatic versus psychological symptoms of distress are a common topic in cultural psychopathology. The most well-known example involves people of Chinese heritage, who are found to emphasize somatic symptoms in presenting depression as compared with people of Western European heritage. It remains unknown whether a similar cultural difference is found for anxiety disorders. Methods: Euro-Canadian (n = 79) and Han Chinese (n = 154) psychiatric outpatients with clinically significant concerns about both depression and anxiety were selected from a larger dataset based on their responses to a structured interview. They also completed two self-report questionnaires assessing somatization of depression and anxiety. Results: As expected, Chinese participants reported a greater tendency to emphasize somatic symptoms of depression, as compared to the Euro-Canadians. Contrary to expectations, the tendency to emphasize somatic symptoms of anxiety was higher among the Euro-Canadians as compared to the Chinese participants. Limitations: Characteristics of our participants limit the generalizability of our findings. The current study is preliminary and requires replication. Conclusions: Despite the exploratory nature of this study, the results suggest that the popular notion of ‘Chinese somatization’ should not be over-generalized. Our findings also imply that there may be important differences in the cultural understanding of depression and anxiety in both Chinese and ‘Western’ contexts. Future studies should seek to unpack potential cultural explanations for why Euro-Canadian outpatients may emphasize somatic symptoms in the presentation of anxiety to a greater degree than Chinese outpatients. © 2011 Elsevier B.V. All rights reserved