Diversity, equity, and inclusion are frequently espoused as critical priority areas in psychology, including education and training. Professional psychology trainees and psychologists with disabilities experience a unique set of barriers (e.g., inaccessible work environments, lack of relevant mentorship experiences, and cultural competency surrounding disability) that contribute to negative consequences for training, recruitment, and retention. Furthermore, disabled trainees and psychologists with intersecting and marginalized identities possess a nuanced perspective on these challenges that are largely missing from both the data and scholarly literature in the field. To address this disparity, it is imperative that the field of professional psychology takes action to collect more nuanced population-level data but also actively implement change strategies to advance the field. Strategies for identifying unique barriers and perspectives of disabled trainees with intersecting identities include conducting subanalyses of larger data sets that are appropriate for smaller sample sizes, conducting contextual (e.g., qualitative) research centering the voices of multiple marginalized and disabled trainees, creating and reinforcing an antiableist culture at training programs and work environments, amplifying the voices and expertise of trainees and psychologists with disabilities and intersecting identities, and supporting disabled trainees and psychologists who may experience activism fatigue. Such actions are critical for bolstering the representation of disabled trainees and psychologists with intersecting identifies, and ultimately improving our delivery of services to patients who experience similar challenges, barriers, and discrimination in their own lives. Public Significance StatementDiversity, equity, and inclusion are viewed as important in psychology, and disability is increasingly being recognized as part of that diversity. Despite this, very little data or other literature exists on the experiences of psychology trainees who also have other marginalized identities. The contributions of disabled psychologists with multiple marginalized identities are important to the growth and improvement of psychological science and practice, and the experiences and needs of these trainees must be understood and valued.
Virtual reality exposure therapy (VRET) is an efficacious treatment modality for anxiety disorder treatment. Advances within this technology have allowed individuals to experience virtual reality remotely over the Internet; yet little is known about the feasibility of implementing remote VRET. This study compared the effectiveness of conducting VRET remotely to delivering the same treatment in a traditional, in-person format. A sample of 17 aviophobia participants, split over the 2 conditions, received 8 intensive hours of VRET treatment for fear of flying that included virtual exposure to full airplane flights. The VRET was delivered via smartphone technology through a commercial supplier. All participants were administered the Flight Anxiety Situations (FAS) at intake and at the conclusion of treatment. Whereas participants in both conditions demonstrated significant reductions in flight-related anxiety as measured by the FAS, there were no significant differences between treatment conditions on the FAS and completion rates of graduation flights. These findings provide preliminary evidence for the feasibility of remotely conducted VRET as the outcomes for remote and in-person conditions were equally effective. By implementing remote VRET, clinicians may effectively work with phobic individuals whom experience barriers to psychotherapeutic treatment such as prohibitive costs or lack of community accessibility to such services. VRET may become another useful teletherapy modality with additional research supporting its utility.What is the significance of this article for the general public?This study provides preliminary evidence that remote virtual reality exposure therapy (VRET) produces similar treatment gains to in-person VRET for treatment of aviophobia. These results lay the groundwork for using this novel approach to treat individuals with other anxiety disorders, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD) who otherwise might experience barriers to accessing treatment. These findings are particularly timely given the heightened sensitivity of providing teletherapy services stimulated by the COVID-19 pandemic.
Crohn's disease typically affects the small bowel and colon, and it predisposes to an increased risk of various cancers, including small bowel, colorectal, and lymphoma. Ileostomy adenocarcinoma, although technically a cancer of the small bowel despite any skin involvement, is often thought of as a distinct and separate entity from small bowel adenocarcinoma given its different disease course and prognosis. Furthermore, in Crohn's disease, it is an uncommon complication; to date, there are only five reported cases in the literature.Here, we present a 73-year-old female who was diagnosed with adenocarcinoma of her ileostomy approximately 44 years after her last ostomy revision. Her medical history included Crohn's disease, which was in remission at the time of presentation, diabetes, anemia, asthma, and chronic kidney disease stage 3. She was initially diagnosed with Crohn's disease in 1969. She subsequently underwent proctocolectomy with end ileostomy for acute Crohn's colitis. Afterward she underwent approximately 30 additional surgical procedures due to subsequent infection, wound dehiscence, and hernias. Her ileostomy required two revisions, with the most recent performed for stoma necrosis in 1977.She first started to notice peristomal changes in 2008. These persisted despite topical therapies. In 2020, she noted that she was having difficulty pouching her ostomy, initially thought to be due to a skin fold. In 2021, she presented for evaluation after developing purulent drainage from a peristomal skin lesion, followed by development of multiple nodules (Figure 1). An incisional biopsy was performed in the office, which demonstrated moderately differentiated adenocarcinoma, gastrointestinal in origin. Staging workup revealed no evidence of metastatic disease. She underwent en bloc resection of the ileostomy with relocation of the ostomy. Final pathology demonstrated moderately to poorly differentiated adenocarcinoma with extensive invasion of the surrounding soft tissue and the skin at the stoma site. Margins were negative, but no lymph nodes were identified in the specimen. She was discussed in a multidisciplinary group and referred for chemotherapy.
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