Commentary: Writing About Clients: Ethical and Professional Issues in Clinical Case Reports

From the standpoint of a former journal editor and long‐time professional, this commentary challenges the direction of the profession as demonstrated in this special section. The ongoing creation of more and more ethical constraints not only harms the profession but also loses sight of fundamental ethical principles.     

Self-Knowledge of Personality: Do People Know Themselves?

The intuition that we have privileged and unrestricted access to ourselves – that we inevitably know who we are, how we feel, what we do, and what we think – is very compelling. Here, we review three types of evidence about the accuracy of self-perceptions of personality and conclude that the glass is neither full nor empty. First, studies comparing self-perceptions of personality to objective criteria suggest that self-perceptions are at least tethered to reality – people are not completely clueless about how they behave, but they are also far from perfect. Second, studies examining how well people’s self-perceptions agree with others’ perceptions of them suggest that people’s self-views are not completely out of synch with how they are seen by those who know them best, but they are also far from identical. Third, studies examining whether people know the impressions they make on others suggest that people do have some glimmer of insight into the fact that others see them differently than they see themselves but there is still a great deal people do not know about how others see them. The findings from all three approaches point to the conclusion that self-knowledge exists but leaves something to be desired. The status of people’s self-knowledge about their own personality has vast implications both for our conception of ourselves as rational agents and for the methods of psychological inquiry.     

A quantitative analysis of the relationship between the Cook-Medley Hostility Scale and traditional coronary artery disease risk factors.

One possible explanation for the association between Cook-Medley Hostility Scale (Ho Scale; W. W. Cook & D. M. Medley, 1954) scores and premature coronary artery disease (CAD) morbidity and mortality is that hostile persons also have elevations on CAD risk factors. Meta-analyses with fixed and random-effects models were used to evaluate the relationship between Ho Scale scores and CAD risk factors in the empirical literature. Ho Scale scores were significantly related to body mass index, waist-to-hip ratio, insulin resistance, lipid ratio, triglycerides, glucose, socioeconomic status (SES), alcohol consumption, and smoking. Although there was also heterogeneity among study outcomes, the results of conservative random effects models provide confidence in the obtained relationships. On the basis of available evidence, researchers might give attention to obesity, insulin resistance, damaging health behaviors, and SES as potential contributing factors in understanding the association between Ho Scale scores and CAD.     

Drinking and Driving: Perceptions and Evaluations as a Function of Level of Intoxication and Weather

Over the past decade, drinking and driving has been a major social problem causing deaths and injuries. The present study examined factors that may encourage this potentially self-destructive behavior. Three hundred and seventy-eight subjects were presented with scenarios describing a night of drinking with friends. Scenarios differed with respect to three levels of intoxication (not at all, slight, and very) and two levels of weather (clear and rain). Subjects were asked to estimate the proportion of their peers who would drive home or choose an alternative form of transportation. Subjects were also asked to evaluate the target who drove home or took an alternative in terms of likability, cautiousness, skillfulness and independence. Driving home was found to be the most common mode of transportation, regardless of state of drunkenness or weather conditions. Alternatives to driving home were seen as being utilized only under extreme conditions (e.g., very intoxicated and rainy weather). Moreover, persons taking one of the more cautious alternatives were perceived as overly cautious and also low in skillfulness. The practical implications for the findings are discussed with respect to enhancing education efforts.     

Single and combined effects of methylphenidate and behavior therapy on the classroom performance of children with attention-deficit hyperactivity disorder

Twenty-four boys with attention deficit-hyperactivity disorder (ADHD) participating in an intensive summer treatment program each received b.i.d. placebo and two doses of methylphenidate (MPH, 0.3 mg/kg and 0.6 mg/kg) crossed with two classroom settings: a behavior modification classroom including a token economy system, time out and daily home report card, and a regular classroom setting not using these procedures. Dependent variables included classroom observations of on-task and disruptive behavior, academic work completion and accuracy, and daily self-ratings of performance. Both MPH and behavior modification alone significantly improved children's classroom behavior, but only MPH improved children's academic productivity and accuracy. Singly, behavior therapy and 0.3 mg/kg PMH produced roughly equivalent improvements in classroom behavior. Further, the combination of behavior therapy and 0.3 mg/kg MPH resulted in maximal behavioral improvements, which were nearly identical to those obtained with 0.6 mg/kg MPH alone.The authors gratefully acknowledge the assistance of Patricia Donovan, Michelle Berry, Mary Ingram, Patricia Wells, Beth Gnagy, Karen Greenslade, Mary Hamilton, and the entire staff of the Western Psychiatric Institute and Clinic ADHD Summer Treatment Program.     

Cardiovascular reactivity and interpersonal influence: active coping in a social context

Previous studies have demonstrated that effortful attempts to secure positive outcomes or avoid negative outcomes produce significant increases in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Although these effects of active coping on cardiovascular reactivity are central in current psychosomatic theories, virtually all of the research to date has used impersonal, asocial tasks. Our two studies examined the cardiovascular effects of effortful attempts to influence other people. In Study 1, male subjects attempting to influence the opinions of their discussion partner to improve their own chances of winning money displayed significantly greater SBP, DBP, and HR reactivity. In Study 2, we obtained similar effects on SBP and DBP reactivity in men and women, while both preparing an influence attempt and making that attempt. Furthermore, reactivity levels were larger as the magnitude of incentive for successful persuasion increased. Implications of this interpersonal equivalent of active coping for the development of cardiovascular disease are discussed.     

Children's affective,behavioral, and cognitive responses to social comparison

Relative outcomes in social commerce with peers are potent determinants of cognitions and behavior in young children. Although there has been considerable attention given to the behavioral consequences of social comparisons following the receipt of rewards, there has been less concern with cognitive or affective consequences. Additionally, little is known about the accrued effects of multiple social comparison experiences that may be consistent or inconsistent with one another. In the present study, young children received a constant level of reward but the amount they saw a peer receive was varied. There were two sequences of reward distribution, and in a given sequence children received either the same number of rewards as the peer (=), more (+), or fewer (?). In a 3 × 3 factorial design all possible combinations occurred. A negative inequality in reward distribution, no matter where it fell in a sequence, made children sad and inclined children to distribute fewer rewards to peers. When a sequence contained an initial experience of positive inequality, children decreased subsequent levels of self-reward. Experiencing a comparison that revealed a negative inequality in reward distribution also disrupted children's accuracy in appraising the overall distribution of rewards: even when an initial negative inequality was completely offset by an equivalent experience of positive inequality, children inaccurately concluded that they had received fewer rewards than their peers.