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Purpose: The COVID‐19 pandemic required a rapid transition to online education, including simulations. The current study identified students' perceptions of communicating with standardized patients in a virtual setting. Methods: This qualitative study thematically analyzed 485 reflections submitted by 248 students between Spring 2020 and Spring 2022. Statements describing both the virtual medium and dyadic interactions between students and patients were coded for emergent themes and also coded as positive (facilitative) or negative (critical). Results: Four themes emerged from the data related to the virtual medium: impact on nonverbal communication, patient engagement/rapport, presentation aids, and listening. Within these broad themes, 13 subthemes were identified, nine of which were negative/critical. Technology problems were specifically identified as compromising both engagement and listening. Even when technology worked well, students noted that it reduced the number of message cues received from the patient and complicated the process of sending cues (e.g., by requiring students to look away from a patient's face to make "eye contact" through a camera). Conclusions: Overall, students were critical of Zoom's impact on dyadic factors with standardized patients. However, they did acknowledge some positive aspects regarding the technology. These findings provide a foundation to consider when teaching students how to communicate effectively via teledentistry. [ABSTRACT FROM AUTHOR]

Courses: Qualitative research methods, health communication, organizational communication, or any course that could incorporate advocacy or social change into the content area. Objectives: On completion of this assignment, students will (1) understand why and how action research is undertaken; (2) develop skill in perceiving and representing the social world as a scholar, using both pictures and words; (3) collaborate with others to analyze qualitative data and theorize how a social problem emerges and is reproduced; and (4) give voice to those advocating change. A list of references and suggested readings is provided.

Purpose: To maintain accreditation status, predoctoral dental programs in the United States and Canada are required to train future dentists in the fundamentals of behavioral sciences. Each program independently determines how to fulfill this task, and little information exists on the consistency of training across programs. The purpose of this study was to identify the range of topics currently taught in predoctoral dental programs in the United States and Canada, who teaches them, and the modes of instruction and assessment. Methods: Invitations to complete an online survey were emailed to faculty responsible for, or familiar with, the behavioral sciences curricula at 75 predoctoral dental programs in the United States and Canada. Questions elicited information on behavioral sciences education at each program, including instructor background, topics taught, instructional and assessment methods, and sources of content. Results: Of those invited, 27 (36%) completed surveys. Per the responses, prototypical behavioral sciences programs usually consist of didactic/lecture format teaching, mostly during the first 2 years of the predoctoral program, by a dentist who assesses students using multiple‐choice or true/false exams. The results indicated, however, substantial variation in what is taught, how it is taught, who teaches it, and how it is assessed. Conclusions: While being a requirement for accreditation, this study demonstrated how behavioral and social sciences topics, teaching strategies, and assessments, along with the individuals teaching those topics varied across predoctoral programs. Consistency, coordination, and clinical integration are possible ways of enhancing behavioral science instruction. [ABSTRACT FROM AUTHOR]

The dominant theoretical approach to alcoholism research presumes linear, causal relationships between individual cognitions and behavioral outcomes. This approach has largely failed to account for the recovery some alcoholics achieve in Alcoholics Anonymous (AA) because AA emphasizes the transformation of identity, framed in terms of relationships rather than cognitions and behaviors. George Kelly's personal construct theory (PCT) provides a ready means of theorizing that transformation by explaining how AA helps alcoholics resolve four identity-relevant dialectics. The basic postulate of PCT addresses changes in stigma: normal vs. deviant identity. The construction corollary illustrates changes in perspective: subjective vs. objective view of identity. The individuality corollary informs changes in affiliation: unique vs. common identity. And the organization corollary illuminates changes in stability: fluctuating vs. permanent identity. As an alternative to causal approaches focusing on cognition and behavior, PCT should facilitate further research into alcoholism as a disorder of identity transformation.

Aims: To test the effectiveness of an intervention, Al-Anon Intensive Referral (AIR), to facilitate participation in Al-Anon Family Groups (Al-Anon). Design, Setting and Participants: Multi-site, randomized controlled trial of AIR versus usual care (UC), with follow-up assessments at 3, 6 and 12 months. The 12-month follow-up rate was 74%. Residential alcohol use disorder (AUD) treatment programs in three US locations. Concerned others (COs) of patients in treatment for AUD. COs were mainly women (77%) who were patients' spouses (33%) or parents (25%). Intervention and Comparator: AIR (n = 128) consisted of four sessions over 3 months with an Al-Anon coach. UC (n = 151) was the treatment program's offer of educational sessions for COs. Measurements: Primary outcome: COs' self-reports of any Al-Anon attendance (yes or no) at 3 months. Secondary outcomes: number of Al-Anon meetings and the CO-patient relationship (stressors, resources). Potential predictors of outcomes examined in generalized linear mixed models were their baseline value, time, CO-patient relationship type (marital or non-marital), treatment program and condition. Findings: There was no effect of condition for the primary outcome (28% in AIR, 21% in UC; Bayes factor = 1.86). Relationship stressors at follow-ups were more severe for COs in a marital relationship with the patient than for COs in a non-marital relationship [ß = 2.19, 95% confidence interval (CI) = 1.07, 3.32]. For CO-patient relationship resources at follow-ups, the main effect for condition was significant (ß = 1.33, 95% CI = 0.04, 2.61). COs assigned to the AIR condition had more resources than COs who were in the UC condition. Conclusions: Relative to usual care, Al-Anon Intensive Referral was not associated with increases in participation of concerned others in Al-Anon, but was associated with more resources in the concerned other-patient relationship. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) dramatically increases the risk of both substance use disorder (SUD) and suicide in veterans. Military-related trauma, however, may not be the only or most significant trauma experienced by veterans. Trauma exposure is high among those joining the military. This study sought to identify the prevalence of five types of childhood trauma (emotional, physical, and sexual abuse and emotional and physical neglect) and three adult trauma symptom clusters (intrusive thoughts, avoidance, and hyperarousal) among veterans seeking SUD treatment and to clarify the associations between types of trauma and specific symptom clusters. Veterans at three Veterans Affairs (VA) SUD treatment facilities in the Midwest completed surveys at treatment entry (n 1 = 195) and at 6-month follow-up (n 2 = 138). Measures included the Childhood Trauma Questionnaire-Short Form and the PTSD Checklist, either a military or a civilian version, depending on whether the most traumatic event occurred in or out of the military. The prevalence of childhood trauma was high, ranging from 40.5% experiencing physical abuse down to 22.8% experiencing sexual abuse. At baseline, 60.2% of the military trauma group met criteria for PTSD, compared with 33.9% of the civilian trauma group, a significant difference, χ2(1, N = 195) = 14.46, p <.01. Childhood emotional and physical abuse were moderately associated with intrusion and hyperarousal in the military trauma group, but in the civilian trauma group a broader spectrum of childhood traumas were associated with a broader array of symptom clusters, including avoidance. At follow-up, symptoms improved and were less associated with childhood trauma. These findings illuminate the persistence of effects of childhood trauma and recommend more targeted PTSD treatments. [ABSTRACT FROM AUTHOR]

Despite growing recognition of the high rates of sexual violence experienced by men serving in the U.S. military, male victimization, specifically sexual assault in military (SAIM), is an understudied topic. We qualitatively describe servicemen's awareness and perceptions of male SAIM, and their understanding of common barriers to servicemen reporting sexual assault. Participants included Midwestern Active Component and Reserve and National Guard servicemen, actively serving or Veteran, who had returned from Iraq or Afghanistan deployments during Operation Enduring/Iraqi Freedom eras. Eleven focus groups were held with 34 servicemen (20 Reserve/National Guard and 14 Active Component). Qualitative analyses used inductive and deductive techniques. Servicemen reported a lack of awareness of male SAIM, a tendency to blame or marginalize male victims, and substantial barriers to reporting sexual assault. Reserve/National Guard participants emphasized barriers such as a perception of greater stigma due to their unique status as citizen-soldiers, an ethos of unit conformity and leadership modeling, and a lack of confidence in leadership and the SAIM reporting process. In contrast, Active Component servicemen emphasized the deployment location and sex of victim and perpetrator as key reporting barriers. Findings make an important contribution to the scant literature on risk and protective factors for male SAIM and servicemen's perceptions of sexual violence and assault reporting barriers by their service type and location. This work has implications for routine screening for sexual violence experiences of male service members and Veterans. Providers' knowledge of gender stereotypes regarding sexual assault, assault risks and experiences of deployed servicemen, and potential barriers to SAIM disclosure is vital for patient-centered care delivery. Additional research to address factors that influence post-SAIM care engagement of males is indicated. [ABSTRACT FROM AUTHOR]

Among veterans, sexual trauma's associations with addiction problems and treatment effectiveness are unclear. Veterans at three Midwest Veterans Affairs treatment sites were interviewed at baseline (NBL = 193) and six-month follow-up (NFU = 137) using the Life Events Checklist (LEC) and Addiction Severity Index–Lite (ASI-L). Those with sexual trauma had more severe baseline drug use, medical, and psychiatric status. Treatment improved all domains except employment and legal, but drug use and psychiatric disparities remained at follow-up. A family and social disparity emerged, and was the only follow-up domain predicted by sexual trauma (β = 0.21, p < 0.05). [ABSTRACT FROM AUTHOR]

Community-based support group participation protects against substance use disorder (SUD) relapse, but referrals during treatment are inconsistently delivered and may not acknowledge barriers facing rural patients. This formative evaluation of a rural intensive referral intervention (RAIR) to community-based support groups for Veterans seeking SUD treatment surveyed patients (n = 145) and surveyed and interviewed treatment staff (n = 28). Patients and staff did not differ significantly on quantitative ratings of the helpfulness of, or satisfaction with, seven RAIR components, but staff did not deliver the intervention consistently or as designed, citing two themes: lack of commitment and lack of resources. [ABSTRACT FROM AUTHOR]

Background: Codependence is an ambiguous and disputed term often used to characterize both those who maintain relationships with alcoholics and those who seek help through resources such as Al-Anon Family Groups. Objectives: The purpose of this article is to better understand non-pathological reasons for maintaining alcoholic relationships and for help-seeking by detailing the costs and benefits of those choices. Methods: The costs and benefits both of remaining in an alcoholic relationship and of seeking help in Al-Anon were identified through a review of available research on alcoholic family systems, Al-Anon, and other mutual-support groups. Results: Alcoholic relationships may benefit concerned others by preserving self-identity, social identity, values, security, stability, and hope. Costs of alcoholic relationships include physical symptoms, injury, mental problems, financial difficulty, legal troubles, and relational distress. Al-Anon is perceived beneficial for six primary reasons: Al-Anon philosophy, format, social support, accessibility, effectiveness, and potential to change the drinker's behavior. Possible costs of Al-Anon include marginalization of the concerned other, blame, codependent pathology, sexist stereotyping, substitute dependency, and perpetuating victimization. Conclusions/Importance: The identified costs and benefits of alcoholic relationships and help-seeking in Al-Anon can help to model decision-making processes using existing behavioral health frameworks without defaulting to the stigmatized and ambiguous codependence terminology. [ABSTRACT FROM AUTHOR]

A literature review was conducted to identify research into multiple-contact (i.e. extended) telemedicine interventions for substance-use disorder. The goals were: (1) to describe the methodology used to evaluate telemedicine interventions; (2) to identify the range of interventions which have been formally evaluated; and (3) to summarize the findings. Fourteen databases and Google Scholar were searched, as well as bibliographies of relevant papers and online conference abstracts. There were 50 studies which met the inclusion criteria, of which 50% were randomized controlled trials. The studies most frequently reported the effect on substance use and 61% of those findings fully supported telemedicine interventions. Although the studies reported persistent challenges in sustaining participation, 76% of the studies reporting on satisfaction indicated that participants were enthusiastic supporters of telemedicine. Only 30% of reviewed studies addressed the effect on resource utilization. The majority of studies reported evidence of clinical effectiveness, which justifies continued research in the field. [ABSTRACT FROM AUTHOR]

Motivational interviewing (MI), cognitive-behavioral therapy (CBT), and Alcoholics Anonymous (AA) are the most common therapeutic approaches for alcoholism recovery. Whereas the former two are clinical treatments grounded in scientific theory, AA emerged as a peer-led program grounded in an array of scientific, social, and spiritual concepts. Researchers have failed to comprehensively identify AA's therapeutic mechanisms or to definitively link them to recovery outcomes. This failure may result from the false assumption that AA frames identity in the same way evidence-based psychological treatments do. This article explores the significance of identity to recovery from alcoholism. MI presumes a personal identity and CBT presumes a social identity. Measures of personal and social attributes are appropriate to these interventions. AA, however, promotes a relational identity which cannot be fully captured using measures of individual attributes. The implications for this shortcoming are presented, along with several suggestions to enhance future research. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study is to determine whether rural residence is associated with trauma exposure or posttraumatic stress disorder symptoms among military veterans seeking treatment for substance use disorder (SUD) through the Department of Veterans Affairs (VA), Delivering mental health services to veterans in rural areas is a challenge, so identifying differences in the causes and outcomes of trauma exposure would assist in effectively targeting service delivery., Methods: Veterans (N = 196) entering SUD treatment at 3 Midwestern VA treatment centers were designated as either urban or rural, based on rural-urban commuting area (RUCA) codes. The veterans completed the Life Events Checklist, the Posttraumatic Stress Disorder Checklist, and the Addiction Severity Index's psychiatric status subscale. Hypothesized relationships between rural-urban residence and both trauma exposure and symptomology were tested using independent samples t tests, chi-square tests, and ordinary least squares regression., Findings: The range of traumatic experiences was similar between rural and urban veterans, and rural-urban residence was not significantly associated with the overall array of traumas experienced or the symptom measures' overall scores or subscores. Of 17 possible traumatic lifetime experiences, rural veterans differed from urban veterans on only 2, reporting significantly lower rates of transportation accidents and unwanted sexual experiences., Conclusions: In both the causes of trauma and the need for treatment, veterans residing in rural areas differ little from their urban counterparts., (© 2016 National Rural Health Association.)