Paiges respond 

Discussion 2: Overview of Your Interests

      The topic of mTBI, also commonly known as concussion, interests me and how it is currently being treated. One of the most widely implemented interventions for concussion is clinically advised physiological and cognitive rest (DiFazio, 2016). The rationale for this prescribed intervention is based upon expert consensus that following injury the brain is in a state of neurometabolic crisis, that a second injury midst recovery may magnify behavioral deficits and pathophysiology, and lastly, animals that have exercised too soon post injury have not demonstrated exercise-induced neuroplasticity (DiFazio, 2016). Based on these three primary reasons, rest is hypothesized to be the most efficacious treatment for concussion (DiFazio, 2016). Recently however, clinicians are beginning to see harmful psychological and behavioral effects from this type of intervention as it requires withdrawal from normal life activities such as school and work attendance, sports and exercise, and technology. This prolonged rest and activity withdrawal beyond the first couple of days may exacerbate postconcussion symptoms and in some cases, produce new ones (DiFazio, 2016).
      The previously encouraged recovery model of resting until one feels better is now being challenged with how activity restrictions cascade and prolong recovery (DiFazio, 2016). A substantial amount of evidence is suggesting that discontinuation of daily validating activities has an adverse effect on the ability to cope with illness and foster rehabilitation (DiFazio, 2016). A modification to mTBI guidelines now emphasizes and encourages prompt reengagement in life activities as tolerated (DiFazio, 2016). However, there remains limited practice guidelines on how to successfully rehabilitate this particular population using efficacious behavioral and psychological interventions, especially for those whose symptoms are persisting beyond a year. 
        I believe that there are many more psychological, physiological, and social factors that play a role in prolonged recovery from mTBI such as, the nocebo effect and expecting a prolonged recovery, external incentives including litigation and compensation, physical deconditioning, economic strain, mental health stereotypes, and so much more. The rehabilitation approach for individuals with mTBI needs to be updated to target each of these factors. A research project could analyze whether or not incorporating interventions beyond rest and activity withdrawal would decrease post concussive symptoms. Interventions would be focused on slowly integrating the individual back into their behavioral routine only a couple weeks following the injury, teaching them how to be aware of their somatic symptoms (when to rest and when to preserve as it is natural to feel some pain during rehabilitation), and how to cope with social changes such as others reactions to the injury and potential stigma from others. Self-report measures as well as clinically structured interviews can be used to psychometrically evaluate and measure concussive symptoms (somatic) and psychological well-being (depression and anxiety).
References
DiFazio, M., Silverberg, N. D., Kirkwood, M. W., Bernier, R., & Iverson, G. L. (2016). Prolonged activity restriction after concussion: are we worsening outcomes?. Clinical pediatrics, 55(5), 443-451.

Gail

Hi class! I recognize some students from previous classes here! I don’t have my books yet, but I concur that this will be an exciting short semester about social psychology and how the Covid-19 crisis is playing out!
I am starting my second semester in Ph.D. Clinical Psychology and have enjoyed the challenging, yet enjoyable work it entails. I have been a clinical counselor for 22 years (LPCC) in three different states, and still licensed in Colorado and newly licensed in California. I lived most of my life on the east coast, in New England, but 6 years ago relocated to the Denver area for my youngest daughter’s college (art degree, which she did earn) and because my eldest daughter was living out there with her significant other. I had an excellent experience with clients over the years in the Denver area and miss them tremendously.  I wanted to get away from the snow and the elevation (6000′) was daunting for me, as well as my youngest daughter wanted to try to work with animation companies in California, so we moved here 6 months ago.  I’m glad we didn’t move to the LA region just now, as it has been a hot center of coronavirus since February or so. We are in Bakersfield, for now, and it is pretty good here, but has HOT weather.
My hobbies are gardening, gardening, gardening! I have two raised bed gardens on my patio, as that is the best I can do for planting right now. It is what has been keeping me sane during the shut down, along with my two adult daughters who live with me, baking, reading, walking on safe paths around our complex, and netflix. Therefore, I was getting a little bored and wanted to take two classes online and communicate with our community! Glad to be here!
I am generally most fascinated by personality disorders, but I am looking with great interest into “microaggressions.” I want to learn more about them in several ways: how they are used toward people of color and am I doing it too?; how women of any race get microaggressions on a pretty regular basis; how republicans and democrats are throwing microaggressions (as well as macro-aggressions) at each other during the coronavirus crisis. There is a lot of social psychology themes going on in our world right now!
The syllabus looks fair and straightforward. I’m very glad to be here! Be safe, everyone!

Paige

Manage Discussion Entry

Discussion 1: Introduction to Social Psychology     
Hi class,
        My name is Paige and I am just finishing up my 2nd year and will be entering into my 3rd year of the Ph.D Clinical Psychology program this coming fall. After reviewing the syllabus, the course seems like a fair workload. I like how the assignments are different than traditional papers and reviews of literature; learning how to think critically and analytically about the literature is an important clinical skill.
        Finkel and Baumeister (2019) highlight how social psychology is unlike other psychology fields in that there is no specific focus; it pertains to anything regarding how people generally think, feel, and behave and is therefore applicable to many other fields of study (Finkel & Baumeister, 2019). Social psychology is not a novel area of study to me. However, after this weeks readings, I realized that new social psychology, specifically discursive work is. Discourse methods provide an opportunity for interpersonal accounts and interactions to be recorded and critically analyzed (Tuffin, 2004). Discourse analysis is a growing part of critical social psychology that studies social situations involving language (Tuffin, 2004). Discourse methods recognize that talking about emotion, for example, in one way has particular effects versus when talking about emotion in another way; it is recognized that emotion is a social practice that is constructed interactionally (Tuffin, 2004). Therefore, previously believed inner psychological constructs such as emotions, memories, and attitudes are also influenced by the ways in which they are talked and written about (Tuffin, 2004). I am looking forward to developing this new sort of analytical orientation in regard to new social psychology that will alter my interpretation and help me understand thorough analysis.
References
Finkel, E.J. and Baumeister, R.F., (Eds) (2019). Advanced Social Psychology; The State of Science 2nd Edition. New York: Oxford University Press.
Tuffin, K. (2004). Understanding Critical Social Psychology. Thousand Oaks: Sage Publications.

Ron

      The place in which I work as a mental health practitioner is a substance use clinic. The propensity of abuse of psychopharmacological interventions is ubiquitous, many times exhibited in the route of administration. An example that I have encountered is with the medication of Ritalin, which may have been prescribed by the clinics psychiatrist or by the clients doctor.
        Preston, ONeal, and Talaga (2017) discuss Ritalin in the segment dealing with child and adolescent psychopharmacology as a stimulant that may be given for Attention Deficit and Hyperactivity Disorder. The Diagnostic Statistical Manual of Mental Disorders (APA, 2013) does indicate that there is a prevalence of this disorder in adults, which is what I have encountered in my clinic. Ritalin is generally taken orally and there is rapid onset with symptoms abating generally within forty-five minutes after ingestion (Preston et al., 2017). Wolfe (2020) corroborates this point, by advancing that oral administration of medication evokes results in around 30 minutes contingent on stomach contents and breakdown.
        Preston et al. (2017) advance the neurobiological process of how substances generally operate within the body. Kalat (2009) specifies this process for Ritalin by elucidating that it operates by blocking the reuptake of dopamine, yet there are distinctions in dose and time course. For example, depending on dose and time course, people may experience a gradual increase in the drugs concentration overtime followed by a slow decline. However, the route of administration can be part of the abuse of this prescribed medication. In my clinic, it is common for those prescribed Ritalin, to crush it and snort it.  An interesting and novel point which I have learned is that snorting Ritalin means that large doses of methylphenidate has immediate access to the blood and reaches the brain in less time than when taking it orally. Wolfe (2020) indicates that the effects can manifest in 3-5 minutes through this route of administration. Additionally, the effects can be heightened due to direct access to the bloodstream.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub.
Kalat, J. W. (2009). Biological psychology. Belmont, CA: Wadsworth Cengage Learning.
Preston, J. D., ONeal, J. H., & Talaga, M. C. (2017). Handbook of clinical psychopharmacology. Oakland, CA: New Harbinger.
Wolfe, N. (2020). Pharmacology by Wolfe N 2020 PowerPoint [PowerPoint slides]. Retrieved from https://tcsedsystem.instructure.com/courses/78536/files/13549063/download?download_frd=1

Ellie

During one of my practicums I was performing pre-screening evaluations for clients who had chronic pain and wanted to undergo an invasive surgery for a spinal cord simulator. Prior to seeing me, many clients had tried almost every option in the book, physical therapy, back surgeries, ablation, cortisone shots, and medications. Spinal cord simulators are subcutaneous implants. They are commonly surgically implanted beneath the skin on the lower back. It is a small wire that transmits electrical signals via a remote held by the client.
However many clients who were not psychological fit to undergo the surgery were often referred back to the PCP and given various forms of medications for nerve pain. A common medication for nerve pain were anticonvulsants. One of the more common ones was Gabapentin. According to WebMD there are various forms of Gabapentin from capsules, to creams, patches, and powders. More often than not I have come across the capsules. Specifically the Gabapentin extended release tablet so that the drug is released slowly over 24 hours, allowing clients to take them less frequently.
Many are cautioned that with oral medications and extended release medication in particular, if crushed will release all of the drug at once. Here is where a concern for addiction and abuse may come into play.
One thing that I have seen consistently for clients with chronic pain is that many of them will do anything to experience relief. Many start off with the basics and no medications only to use them or an invasive surgery as a last resort. Oral medications are the most common and for those with chronic pain, often come with an additional list of medication that are administered by one way or another.
References
Hamm-Faber, T. E., Aukes, H., Gorp, E.-J., & Gultuna Ismail. (2015). Subcutaneous stimulation as an additional therapy to spinal cord stimulation for the treatment of low back pain and leg pain in failed back surgery syndrome: four-year follow-up. Neuromodulation: Technology at the Neural Interface, 18(7), 618622. https://doi.org/10.1111/ner.12309