Articles:  Psychologists will be on front lines of helping recovering COVID patients &
 Posting of test questions online: Both ill-advised & illegal {Below}

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Psychologists will be on front lines of helping recovering COVID patients

By Kathy Lynn Gray, Associate Editor
August 3, 2021 - Last updated: August 2, 2021

With news from a United Kingdom study that 1 out of 3 COVID-19 survivors suffer from psychiatric or neurological problems, the burden for psychologists grew even greater this spring.

“The effect across the whole population may be substantial for health and social care systems due to the scale of the pandemic,” University of Oxford Professor Paul Harrison, who led the study, noted in a press release.

The study included a review of the records of 236,379 COVID-19 patients, mostly from the United States, examining 14 neurological and mental health disorders, according to The Lancet Psychiatry, which published the results.

The study also found that brain diseases and psychiatric disorders were more common after COVID than after flu or other respiratory infections, said co-author Max Taquet, also from the University of Oxford.

Abigail Hardin, Ph.D., a rehabilitation psychologist at Rush University Medical Center in Chicago, has seen the aftereffects of COVID since March 2020, helping patients hospitalized with the disease deal with acute delirium, anxiety, hallucinations and post-traumatic stress disorder (PTSD), among other issues.

“These are all common post-intensive care symptoms, but what’s been surprising is the severity of these problems,” Hardin said. She attributes some of the severity to high doses of medication used to fight off COVID symptoms, as well as the fact that the global pandemic meant patients couldn’t have family or friends with them during their hospitalizations.

“They went through a very traumatic experience without the support of their loved ones and that made the anxiety symptoms I saw much worse,” she said. “There was no one there to make them feel grounded.”

Megan Hosey, Ph.D., an inpatient rehabilitation psychologist at The Johns Hopkins Hospital in Baltimore, also has seen clinically significant depression among recovering COVID patients.

“It’s highly variable as to how people’s bodies and minds are going to respond to the disease,” she said. “That’s what’s so hard about COVID.”

Writing in Nature Reviews about survivorship after a COVID-19 stay in intensive care, Hosey noted that stressors reported by survivors from the 2002-03 SARS epidemic could be similar for COVID survivors. Those include the fear of infecting others, guilt and high death rates.

“Such stressors may have important implications for psychological outcomes in survivors of COVID-19,” she wrote.

Hosey and Hardin say much of what they’ve learned working with COVID patients could be helpful to clinical psychologists who are seeing clients who have recovered from COVID.

Hosey suggested that psychologists first make sure that recovering clients have been fully evaluated by medical professionals for such common post-COVID issues as endocrine dysfunction, pulmonary or lung challenges and cardiac problems.

“The next step would be to screen for all the classic mental-health symptoms that we always do and then ask: ‘What are your most troubling symptoms now?’ ” Hosey said. Those might include fatigue or headaches or breathlessness, all of which could contribute to anxiety. But, Hosey said, those issues also could be the result of ongoing medical issues, so working closely with a patient’s primary physician or specialists to determine the source of problems is essential.

Some physicians, she said, dismiss a patient’s symptoms and tell them they’re fine.

“But physicians and psychologists need to say: ‘I hear what you’re saying,’ ” Hosey said.

Hardin, too, encourages psychologists to validate their patients’ symptoms and let them

know they are real, not just in their head.

“They need to make sure the psychologist is in their corner,” she said. “That can’t be overemphasized.”

She suggests psychologists ask clients to talk about their COVID experience and, if they can’t remember portions of their illness (such as when they were hospitalized), help them fill in the gaps through their medical records.

“I have noticed that these patients were less likely to have a good understanding of what happened to them,” Hardin said, “And they can feel very distressed by that.”

Clinical psychologist Ann Steffen, Ph.D. heads up an effort at the University of Missouri to treat recovering COVID patients through its Community Psychological Service, which offers both individualized and group therapy. Organized in late summer 2020, the clinic first aimed its post-COVID services at patients who had been hospitalized at least three days.

Eventually Steffen realized that people who had had milder cases of COVID often suffered from the same long-term side effects as those who had severe cases.

COVID, she said, passes the blood brain barrier and can cause symptoms such as difficulty concentrating, memory issues and brain fog. She’s also seen a great deal of chronic fatigue in patients and PTSD in a small number of patients.

Many patients, she said, feel that friends and family don’t realize that their recovery from COVID is a lengthy process, and that they aren’t back to normal even months later.
“People have told me, ‘My recovery feels invisible to other people,’ ” and they wonder how to convince family members that they still need help, Steffen said. She and her colleagues work with them to set expectations and learn how to ask for help and how to differentiate between reasonable and unproductive worries.

Steffen said she’s encouraging clinical psychologists in general practice to learn the basics of chronic health management so they can help those recovering from COVID practice good sleep hygiene and life balance.

Hardin said learning more about treating chronic fatigue syndrome is a good place for psychologists to start, because rehabilitation psychologists have found the same techniques often can help recovering COVID patients.

One source of information is Survivor Corps, a group developed to help COVID patients. The group has links on its website located at www.survivorcorps.com to post-COVID care centers around the country.

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Writing on Tablet

Posting of test questions online: Both ill-advised & illegal

By Pamela Becker
August 2, 2021

The ubiquitous nature of the internet has resulted in an uptick in the posting of psychological and educational assessment questions online.

Some of these sites have good intentions: They want to help individuals, parents or students understand (and in some cases prepare) for upcoming testing sessions. And they believe they are helping when they post the questions (or test items) on a website or app. But the copying and posting of published test items (and in some cases the answers) is not just against the law. It threatens the validity of the results for tests used in a secure setting.

As psychologists and test publishers, we are obligated to do all we can to prevent these occurrences and to contest them when brought to our attention.

        Prevention

Prevention of the occurrences of intellectual property infringement many times begins with the psychologist who is administering the assessment.

According to the APA Ethical Principles and Code of Conduct (2010), psychologists must "make reasonable efforts to maintain the integrity and security of test materials and other assessment techniques consistent with law and contractual obligations, and in a manner that permits adherence to this Ethics Code (p. 13)." This means not sharing materials outside of the testing session, as well as keeping materials in a secure location.

Sharing items and/or answers with an individual after testing, or with the parents while explaining test results, is of course permissible. But this sharing must not extend to allowing that individual or parent to leave a session with a copy of the test items or answers.

Psychologists are warned that replicating and including test items in academic and scientific publications or presentations could be a violation. Sample items can be provided by a test publisher or items that have previously appeared in research studies could be used as examples instead – all so that actual content is not exposed.

Test publishers also bear some responsibility to prevent test item release. Thus they go

to great lengths to explain the terms and conditions for purchasing tests to psychologists,

including statements pointing out that, "the copying, duplication, distribution or other use

of test materials without specific written permission is not allowed." Those terms and

conditions note that any such action constitutes copyright infringement. Publishers

include these notices on websites and in print and online materials.

    Legal recourse

Unfortunately, preventative measures are sometimes not enough. In cases where test items are persistently uploaded and shared, legal recourse may be the only remedy.
A test publisher typically will approach the website or app owner and alert them to a copyright violation; sometimes, people are unaware that copying and posting materials belonging to publishers are a problem. Most of the time, this resolves the matter.

If this outreach does not result in the assessment questions being deleted promptly, publishers may have no choice but to take legal action.

As a general matter, under U.S. copyright law, infringement occurs when a copyrighted work is reproduced, distributed, performed, publicly displayed, or made into a derivative work without the copyright owner's permission. Posting either items or answers online is a public display of the questions and is thus illegal without permission from the publisher.

The penalties for copyright infringement can be costly, especially if the psychologist ignores the publisher's notice. The court may order the "infringer" to pay statutory or punitive damages or both as well as all attorney fees and court costs.

Increased access to information and transparency concerning psychological and educational assessments are positive steps towards helping individuals/students and parents understand testing and its utility. But with this openness comes the responsibility of the psychologist, the test taker and the test publisher.

Working together, we can keep our test items and answers secure, and ensure that assessments continue to be a valid and reliable tool for psychologists.

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Pamela Becker has her advanced degree in psychology from the University of Notre Dame and has worked in test publishing for more than 35 years. She is currently on the group executive board at Hogrefe Publishing and is secretary of the Association of Test Publishers, Security Committee. Her email is: pamela.becker@hogrefe.com

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