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The decision to no longer live on chronic hemodialysis.
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Facing away: mental health treatment with the Old Order Amish.
Mental health treatment of the Old Order Amish is a relatively new phenomenon. Increasingly however, members of this sequestered Christian sect are either voluntarily seeking treatment or finding themselves ordered into treatment. Because they resist acculturation, many of the models of cross-cultural treatment are less than fully applicable; and because their pursuit of counseling is relatively recent, there is little information available to guide the therapist working with these clients. This article provides a practical approach to the more salient experiences and difficulties that arise in treatment of the Old Order Amish.
Caring and coercive aspects of the psychoanalytic situation.
Certain ambivalent reactions to undergoing analysis add content and intensity to the analysand's transference and to some extent to the analyst's countertransference. A significant share of these reactions may be attributed to the structure of the psychoanalytic situation. Among other things, analysands' reactions feature fantasized and sometimes realistic experiences of being coerced by their analyst's counter-transferences. However, to achieve a clear view of these coercive experiences, they must be considered in relation to another, equally weighty structural feature: ambivalent reactions to the analyst's concerned care. Observation suggests that an intervention can be experienced, simultaneously or sequentially, as both coercive and caring, and that, when analyzed, each of these experiences is usually found to be saturated with mixed feelings.
What we regret most... and why.
Which domains in life produce the greatest potential for regret, and what features of those life domains explain why? Using archival and laboratory evidence, the authors show that greater perceived opportunity within life domains evokes more intense regret. This pattern is consistent with previous publications demonstrating greater regret stemming from high rather than low opportunity or choice. A meta-analysis of 11 regret ranking studies revealed that the top six biggest regrets in life center on (in descending order) education, career, romance, parenting, the self, and leisure. Study Set 2 provided new laboratory evidence that directly linked the regret ranking to perceived opportunity. Study Set 3 ruled out an alternative interpretation involving framing effects. Overall, these findings show that people's biggest regrets are a reflection of where in life they see their largest opportunities; that is, where they see tangible prospects for change, growth, and renewal.
A pictorial Stroop paradigm reveals an alcohol attentional bias in heavier compared to lighter social drinkers.
The findings obtained with the textual Stroop paradigm, testing for an attentional bias towards alcohol stimuli in heavier compared to lighter social drinkers, are limited in number and inconsistent in outcome. Using a pictorial rather than textual Stroop paradigm for the first time in alcohol research, a significant alcohol attentional bias is reported in heavier social drinkers compared to lighter social drinking controls. According to Cohen's scheme, the signifant effect size is classified as 'large'. The presence of an alcohol attentional bias helps to explain the perpetuation of abusive/dependent consumption and the frequency of post-treatment relapse. In a similar vein, these results add to the evidence that a differential alcohol attentional bias might also be present between two levels of social drinking and, in heavier social drinkers, has the potential to impact on the contents of awareness and the flow of thought towards alcohol. In this respect, it extends the small group of other perceptual-cognitive effects measured in social drinkers (alcohol cue reactions, alcohol associations and alcohol expectancies) that can influence the initiation of consumption in some social drinkers.
The role of risk and benefit perception in informed consent for surgery.
BACKGROUND: Informed consent relies on patients' ability to understand risk information. Evidence suggests that people may extract the gist of any risk information to make medical decisions. Existing evidence also suggests that there is an inverse relationship between the perception of risk and the perception of benefit. METHOD: Seventy-one patients on the waiting list for carotid endarterectomy (CEA) were surveyed regarding their understanding and recall of the risk and benefit to health of undergoing CEA. Patients were surveyed 1 month after their initial consultation, and a subgroup was surveyed again on the day before their operation. RESULTS: Patients' estimates of their baseline risk of stroke without surgery were significantly different from what they had been told by the surgeon. Patients' estimates of stroke risk due to surgery ranged from 0% to 65% (actual local risk 2%). Patients also had unreasonable expectations about the benefit of the operation for their health. Estimates of stroke risk correlated positively with the degree of expected benefit from the operation (r = 0.29, P = 0.05). When resurveyed the day before the operation, patients' perceptions of both risk and benefit had increased significantly. The risk perception data from some patients appeared to contradict some of the predictions of the fuzzy-trace theory. CONCLUSIONS: Most patients failed to understand the risks and benefits associated with CEA. Some patients' estimates of stroke risk were actually greater than the perceived potential benefit of surgery in terms of risk reduction. The data also suggested a positive correlation between the degree of perceived benefit and the degree of perceived risk.
Attribution retraining with sexually abused children: review of techniques.
Clinicians increasingly use empirically based cognitive-behavioral techniques in their treatment of child victims of sexual abuse. Attribution retraining is often a primary component of this work, and it involves various techniques aimed at decreasing abuse-related self-blame and encouraging the child to attribute responsibility for the abuse to the perpetrator This article reviews literature that highlights the complexity of self and other blame for sexually abused children in terms of developmental status, the multifaceted nature and interrelationships of abuse-specific attributions, and the psychological effects of self-blame and perpetrator blame. A review of written attribution retraining techniques developed by diverse authors for use with sexually abused children and their nonoffending parents is provided, including written and verbal techniques and techniques using games and the arts. The relative utility of different approaches with children of various stages of development is discussed, along with the need for empirical research regarding the effectiveness of these techniques.
What is spiritual? What is spiritual suffering?
The author offers definitions for "spiritual" and for "spiritual suffering," suggesting that human spiritual needs include Love, Faith, Hope, Virtue, and Beauty. Spiritual suffering is experienced when these needs are unfulfilled. Spiritual care involves assisting in the fulfillment of these needs. He considers the constant movement between spiritual needs and fulfillments, encouraging use of fluid (not static) assessment methods using "spiritual spectra." As a model, this outline of basic spiritual needs may serve as the foundation for many current spiritual assessment tools.
Expressed desire for hastened death in seven patients living with advanced cancer: a phenomenologic inquiry.
PURPOSE/OBJECTIVES: To explore the meanings and uses of an expressed desire for hastened death in seven patients living with advanced cancer. DESIGN: A phenomenologic inquiry. SETTING: Urban cancer research center. SAMPLE: Terminally ill patients with cancer who had expressed a desire for hastened death. METHODS: A series of in-depth semistructured interviews were audiotaped, transcribed, coded, and organized into themes. FINDINGS: The expression of desire for hastened death had many meanings and uses and communicated the following: (a) a manifestation of the will to live, (b) a dying process so difficult that an early death was preferred, (c) an intolerable immediate situation, even if not specifically identified by a patient, required immediate action, (d) a hastened death could extract a patient from an unendurable and specific situation, (e) manifestation of the last control the dying can exert, (f) a way of drawing attention to "me as a unique individual," (g) a gesture of altruism, (h) an attempt at manipulation of the family to avoid abandonment, and (i) a despairing cry depicting the misery of the current situation. CONCLUSIONS: Expression of desire for hastened death has many meanings and uses and is a tool of communication. IMPLICATIONS FOR NURSING: Listening to the patient's story will help nurses understand what is being asked for through the expression of a desire for hastened death.
The paranoid optimist: an integrative evolutionary model of cognitive biases.
Human cognition is often biased, from judgments of the time of impact of approaching objects all the way through to estimations of social outcomes in the future. We propose these effects and a host of others may all be understood from an evolutionary psychological perspective. In this article, we elaborate error management theory (EMT; Haselton & Buss, 2000). EMT predicts that if judgments are made under uncertainty, and the costs of false positive and false negative errors have been asymmetric over evolutionary history, selection should have favored a bias toward making the least costly error. This perspective integrates a diverse array of effects under a single explanatory umbrella, and it yields new content-specific predictions.
Psychology 3: 'Don't give me that attitude'!
The relationships between knowledge, emotions and behaviour are complex, and yet it is important to understand how these factors can affect a person's health. This is of particular relevance in relation to a person's lifestyle and his/her response to health promotion strategies. In this article there is a presentation of the psychological conceptualization of attitudes. Issues are raised which can be used to help nurses to understand some of the factors which underpin attitude formation and change. Use of this knowledge can be made to inform nursing assessment and to enhance compliance with professional advice. The main argument to emerge is that any standardized health advice is more effective if it is supplemented with an individualized focus which is directed towards empowerment of the person, and which is sensitive to his/her particular circumstances.
Cognitive approaches to delusions: a critical review of theories and evidence.
PURPOSE: To review critically the evidence for three contemporary theories of delusions. METHODS: The theoretical approaches to delusions proposed by Frith and colleagues ('theory of mind' deficits), Garety and colleagues (multi-factorial, but involving probabilistic reasoning biases) and Bentall and colleagues (attributional style and self-discrepancies) are summarised. The findings of empirical papers directly relevant to these proposals are critically reviewed. These papers were identified by computerised literature searches (for the years 1987-1997) and a hand search. RESULTS: The evidence does not unequivocally support any of the approaches as proposed. However, strong evidence is found to support modifications of Garety and colleagues' and Bentall and colleagues' theories. Studies have replicated a 'jumping to conclusions' data-gathering bias and an externalising attributional bias in people with delusions. There is preliminary evidence for a 'theory of mind' deficit, as proposed by Frith, although possibly related to a more general reasoning bias. Evidence for an underlying discrepancy between ideal and actual self-representations is weaker. CONCLUSIONS: A multi-factorial model of delusion formation and maintenance incorporating a data-gathering bias and attributional style, together with other factors (e.g. perceptual processing, meta-representation) is consistent with the current evidence. It is recommended that these findings be incorporated into cognitive therapy approaches. However, there are limitations to existing research. Future studies should incorporate longitudinal designs and first episode studies, and should not neglect the co-morbidity of delusions, including affective processes, or the multi-dimensional nature of delusions.
A cognitive distortion associated with eating disorders: thought-shape fusion.
OBJECTIVES: The primary objective of this study was to describe and investigate a cognitive distortion associated with eating psychopathology. This distortion, termed 'thought-shape fusion', is said to occur when merely thinking about eating a forbidden food increases the person's estimate of their shape or weight, elicits a perception of moral wrongdoing and makes the person feel fat. DESIGN: Two studies were conducted. The first was a psychometric study and the second utilized a within-participants experimental design. METHODS: In Study 1, thought-shape fusion was assessed in a sample of 119 undergraduate students using a questionnaire. In Study 2, 30 students with high thought-shape fusion scores participated in an experiment designed to elicit the distortion. RESULTS: Thought-shape fusion was found to be significantly associated with measures of eating disorder psychopathology. The questionnaire used to measure thought-shape fusion had high internal consistency, a good factor structure accounting for 46.2% of the variance and predictive validity. The results from Study 2 indicated that the distortion can be elicited under experimental conditions, produces negative emotional reactions and prompts the urge to engage in corrective behaviour (e.g. neutralizing/checking). This corrective behaviour promptly reduces the negative reactions. CONCLUSION: The results of the two studies indicate that the concept of thought-shape fusion is coherent, unifactorial and measurable. It is associated with eating disturbance and elicits negative emotional and behavioural responses.
Pattern of disconfirming information and processing instructions as determinants of stereotype change.
This experiment examined the effects of pattern of disconfirming information (concentrated vs. dispersed) and processing instructions (focus on similarities vs. differences vs. control) on stereotype change. If subtyping and perceived typicality are central to the stereotype change process, then processing instructions designed to affect these processes should affect stereotyping. There was lower stereotyping when perceivers focused on similarities between group members, and after exposure to a dispersed pattern of disconfirming information. Only the main effect of pattern was mediated by the perceived typicality of disconfirmers, but not by an index of subtyping based on clustering of information from disconfirmers in recall. Results support a model of stereotype change in terms of the impact of disconfirming group members who are also seen as typical of the group; subtyping of extreme disconfirmers may work in parallel, or later, and contribute to the long-term maintenance of a stereotype.
Cognitive anchoring on self-generated decisions reduces operator reliance on automated diagnostic aids.
Automation users often disagree with diagnostic aids that are imperfectly reliable. The extent to which users' agreements with an aid are anchored to their personal, self-generated diagnoses was explored. Participants (N = 75) performed 200 trials in which they diagnosed pump failures using an imperfectly reliable automated aid. One group (nonforced anchor, n = 50) provided diagnoses only after consulting the aid. Another group (forced anchor, n = 25) provided diagnoses both before and after receiving feedback from the aid. Within the nonforced anchor group, participants' self-reported tendency to prediagnose system failures significantly predicted their tendency to disagree with the aid, revealing a cognitive anchoring effect. Agreement rates of participants in the forced anchor group indicated that public commitment to a diagnosis did not strengthen this effect. Potential applications include the development of methods for reducing cognitive anchoring effects and improving automation utilization in high-risk domains.
Negotiating cultural consensus in a breast cancer self-help group.
This article describes a shared model of the breast cancer experience negotiated by the members of a spontaneously organized breast cancer self-help group in eastern North Carolina. In the course of sharing their personal experience narratives with one another, these women worked to negotiate points of agreement among the varying sources of knowledge and oftentimes conflicting belief systems they held about breast cancer. The synthetic model they created rejected many of the assumptions underlying the dominant biomedical view of cancer "survivorship," particularly its emphasis on the autonomous individual as decision maker and its attendant male-gendered sports and military imagery--assumptions that often implicitly structured the agendas and topics discussed in the formal, medically sanctioned support groups these women found unappealing. The implications for theories about the construction of shared cultural models and for continuing efforts to design support groups to meet the needs of a diverse patient population are explored.
[Diagnosis in health education: a model for analyzing relationships between attitudes and practices in the field of public health].
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