Medical Students’ Gender Awareness

Gender awareness in medicine consists of two attitudinal components: gender sensitivity and gender-role ideology. In this article, the development of a scale to measure these attitudes in Dutch medical students is described. After a pilot study and a feasibility study, 393 medical students in The Netherlands responded to a preliminary instrument consisting of 82 items (response rate 61.3%). Reliability and validity were established. A gender awareness scale containing a gender sensitivity subscale (14 items), and gender stereotypes towards patients (11 items) as well as towards doctors (7 items) was developed. The instrument may be used for research purposes to evaluate gender awareness raising courses.     

Awareness Versus Un-Clinging: Which Matters in Mindfulness?

Awareness and un-clinging have been emphasised in Buddhist discourse as important facets of mindfulness practice for over 2500 years. However, there is a lack of rigorous research examining the relationship between these two elements and their importance to well-being. To evaluate these abstract constructs, the current study adopted multiple assessment modalities; namely, a self-report scale, experience sampling (assessing ‘momentary mindfulness’), and semi-structured interviews (assessing ‘rater-rated mindfulness’). A total of 415 participants completed the questionnaire survey. Among them, 71 participants further took part in the experience sampling procedure and semi-structured interviews. The findings reveal that self-reported awareness was mildly correlated with momentary mindfulness (r = .35) but was not significantly correlated with rater-rated mindfulness. Self-reported un-clinging was moderately correlated with rater-rated mindfulness (r = .53) but was not significantly correlated with momentary mindfulness. Un-clinging, but not awareness, can distinguish meditators from non-meditators. Lastly, based on the Buddha’s mindfulness discourse, a path analysis model illustrates that the effects of un-clinging and awareness on stress reduction are mediated by emotional intelligence and non-attachment. Practical implications and future research designs are discussed.     

Do Pro-environmental Behaviors and Awareness Contribute to Improve Subjective Well-being?

In this paper, we study the influence of both environmental awareness and behaviors on subjective well-being (SWB). By using ordered logit techniques in a sample from Granada, a city in southern Spain, we find that concern about the environment and voluntary work actions to preserve it are relevant for SWB. When both are combined, namely when a person is concerned and volunteers, the influence on SWB is greater. These results introduce the SWB dimension in the knowledge-concern-action paradox, which states that even if the individual is concerned about the environment, this concern does not always translate into personal action to preserve it. Actions such as habits related to water saving inside the household are not significant in explaining SWB, but using devices that save water increases it. In summary, our results suggest that actions and awareness have either a positive or no significant influence on SWB, but never a negative influence.     

Can you feel the beat? Interoceptive awareness is an interactive function of anxiety- and depression-specific symptom dimensions

Delineating the differential effects of anxiety versus depression on patterns of information processing has proved challenging. The tripartite model of mood disorders (Clark & Watson, 1991) suggests that one way forward is to adopt a dimensional rather than categorical approach, making it possible to explore the main and interaction effects of depression- and anxiety-specific symptoms on a given cognitive-affective process. Here we examined how the interplay of anxiety-specific arousal and depression-specific anhedonia symptoms in the same individuals relate to interoceptive (bodily) awareness. 113 participants with varying levels of mood disorder symptoms completed a heartbeat perception task to assess interoceptive accuracy. Superior interoception was associated with anxiety-specific arousal symptoms, and this relationship held when controlling for depression-specific anhedonia symptoms and shared general distress symptoms. This main effect was qualified by an interaction between anhedonia and arousal. As anhedonia symptoms increased in severity, the relationship between arousal and interoceptive accuracy became less strong. These results further validate the tripartite framework, help clarify the mixed existing literature on interoception in mood disorders, and suggest that considering the unique and interactive effects of different symptom dimensions is a useful strategy to help identify the cognitive-affective profiles associated with anxiety and depression.     

Interoceptive awareness and unaware fear conditioning: are subliminal conditioning effects influenced by the manipulation of visceral self-perception?

Research has shown repeatedly that attention influences implicit learning effects. In a similar vein, interoceptive awareness might be involved in unaware fear conditioning: The fact that the CS is repeatedly presented in the context of aversive bodily experiences might facilitate the development of conditioned responding. We investigated the role of interoceptive attention in a subliminal conditioning paradigm. Conditioning was embedded in a spatial cueing task with subliminally presented cues that were followed by a masking stimulus. Response times to the targets that were either validly or invalidly predicted by the cues served as index of conditioning. Interoceptive attention was manipulated between-subjects. Half the participants completed a heartbeat detection task before conditioning. This task tunes attention to one’s own bodily signals. We found that conditioned responding was facilitated in this latter group of participants. These results are in line with the hypothesis that a rise interoceptive attention enhances unaware conditioned responding.     

Colours sometimes count: Awareness and bidirectionality in grapheme–colour synaesthesia

Three experiments were conducted with 10 grapheme–colour synaesthetes and 10 matched controls to investigate (a) whether awareness of the inducer grapheme is necessary for synaesthetic colour induction and (b) whether grapheme–colour synaesthesia may be bidirectional in the sense that not only do graphemes induce colours, but that colours influence the processing of graphemes. Using attentional blink and Stroop paradigms with digit targets, we found that some synaesthetes did report “seeing” synaesthetic colours even when they were not able to report the inducing digit. Moreover, congruency effects (effects of matching the colour of digit presentation with the synaesthetic colour associated with that digit) suggested that grapheme–colour synaesthesia can be bidirectional, at least for some synaesthetes.     

Sensory Awareness Mindfulness Training in Coaching: Accepting Life’s Challenges

Sensory Awareness Mindfulness Training is a new set of skills to help clients approach a better life/work equilibrium by balancing cognitive and emotional brain activities. This is achieved through regular connection with one’s senses and focusing non-judgementally on the ‘here and now’ experience of life. The exercises are neither difficult to teach nor to learn; it is, however, necessary for the practitioner and student to enter into a regular routine of implementation for change to occur. Mindfulness is, in a nutshell, a way of being, a new life-style. Research shows that mindfulness interventions have resulted in significant improvements in a range of conditions such as anxiety, depression, stress disorders, chronic pain, psoriasis and relapse prevention, to mention but a few. This article gives a brief overview of using mindfulness interventions in the arena of coaching. It also focuses and describes one small pilot project where Sensory Awareness Mindfulness Training is applied and evaluated.

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.     

Awareness of Infants: What Do They,and We,Seek?

I study the biological foundations of human cultural intelligence, and how they are supported. I observe the development of human motives for agency, the emotions that evaluate what is discovered, and the ways interests and discoveries and feelings may be shared with others. Ed Tronick and I have been privileged to study infants closely over several decades in which ideas of the dynamic powers of the human mind have been transformed, principally by recording how infants act in intimate companionship with their mothers in the first year or two. Here I try to clarify the ways we have, for different purposes and in different environments, taken complementary routes to understanding the meaning of infant life. His responsibilities are clinical and occupied with supporting the mental health of both the infant and the mother, and the building of a strong affectionate trust for life with others. My task has been trying to understand the subtle creativity and aesthetic and moral principles that animate a widening circle of relationships for a child, and that lead to cultural learning that is rich and playful. Ed and I are lucky to be discovering what every infant wants, and privileged to be supporting pride in good company, while striving to guard against causes of despair and shame in young children and their families.     

Is There a Simple Argument for Higher-Order Representation Theories of Awareness Consciousness?

William Lycan has articulated “a simple argument” for higher-order representation (HOR) theories of a variety of consciousness sometimes labeled ‘awareness consciousness’ (Lycan, Analysis 61.1, January 3–4, 2001). The purpose of this article is to critically assess the influential argument-strategy of the simple argument. I argue that, as stated, the simple argument fails since it is invalid. Moreover, I argue that an obvious “quick fix” would beg the question against competing same-order representation (SOR) theories of awareness consciousness. I then provide a reconstruction of the argument and argue that although the reconstructed argument deserves consideration, it is also too simple as stated. In particular, it raises several controversial questions about the nature of mental representation. These questions must be addressed before a verdict as to the cogency of the HOR argument-strategy can be reached. But since the questions are controversial, a cogent argument for HOR theories of awareness consciousness is unlikely to be simple.

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Primary Care Physicians’ Awareness, Experience and Opinions of Direct-to-Consumer Genetic Testing

The purpose of this study was to assess primary care physicians’ awareness, experience, opinions and preparedness to answer patients’ questions regarding direct-to-consumer (DTC) genetic testing. An anonymous survey was mailed to 2,402 family and internal medicine providers in North Carolina. Of the 382 respondents, 38.7% (n = 148) were aware of and 15% (n = 59) felt prepared to answer questions about DTC genetic tests. Respondents aged 50 or older were more likely to be aware of DTC genetic testing than those less than 40 years old (OR = 2.42). Male providers were more likely to feel prepared to answer questions than female providers (OR = 2.65). Among respondents who reportedly were aware, family practitioners were more likely than internists (OR = 3.30) to think DTC testing was clinically useful, and 18.9% had patients ask questions or bring in test results. The small percent of physicians who were aware of DTC genetic testing or felt prepared to answer questions about it suggests that education of providers will be necessary if testing becomes more widespread.     

Metalexical Awareness: Development, Methodology or Written Language? A Cross-linguistic Comparison

This study explores the ability to access word boundaries of pre-school children, using an on-line methodology (Karmiloff-Smith, Grant, Sims, Jones, & Cockle (1996). Cognition, 58, 197–219.), which has hardly been used outside English-speaking countries. In a cross-linguistic study in the Netherlands and Norway, four and five-year-old children were asked to repeat the last word every time a narrator stopped reading a story. In total 32 target-words were used, both closed and open class words, and both monosyllabic and disyllabic words. The outcomes in both countries were different from those of the original English study (Karmiloff-Smith et al., 1996): four- and five-year-olds were successful in only about 26% of the cases, whereas the success rate in the former English experiment was 75% for the younger and 96% for the older children. No differences were found between age groups and between open and closed class words. This methodology does reveal the ability to access word boundaries, but probably not because of the ease of the on-line methodology in itself, but rather because literacy introduces new representations of language, even in on-line processing. The outcomes implicate that the ability to mark word boundaries does not seem to be a valid indication of who is ready for reading.     

Monitoring Emotion Through Body Sensation: A Review of Awareness in Goenka’s Vipassana

Awareness is one of the two most important abilities cultivated in Goenka’s Vipassana meditation, which refers to sensitivity to subtle bodily sensations and the associated psychological processes. This sensitivity and its derived function of monitoring emotion are not of notable concern in modern mindfulness-based psychotherapies. Evidence supports that Vipassana meditation truly enhances sensitivity to bodily sensations, but further study is required to assess the awareness of psychological processes. The value of monitoring mental processing has been widely accepted in psychology, as has enhanced sensitivity along with the potential dangers to mental health. Implications for practice and future studies are discussed.     

Family Physicians’ Awareness and Knowledge of the Genetic Information Non-Discrimination Act (GINA)

Historically, physicians have expressed concern about their patients’ risk of genetic discrimination, which has acted as a barrier to uptake of genetic services. The Genetic Information Nondiscrimination Act of 2008 (GINA) is intended to protect patients against employer and health insurance discrimination. Physicians’ awareness and knowledge of GINA has yet to be evaluated. In 2009, we mailed surveys to 1500 randomly selected members of the American Academy of Family Physicians. Questions measured physicians’ current knowledge of GINA and their level of concern for genetic discrimination. In total, 401 physicians completed the survey (response rate 26.9%). Approximately half (54.5%) of physicians had no awareness of GINA. Of physicians who reported basic knowledge of GINA, the majority were aware of the protections offered for group health insurance (92.7%), private health insurance (82.9%), and employment (70.7%). Fewer physicians were aware of GINA’s limitations regarding life insurance (53.7%) and long-term care insurance (58.8%). Physicians demonstrated highest levels of concern for health insurance, life insurance, and long-term care insurance discrimination, with less concern for employer and family/social discrimination. Level of concern for the risk of genetic discrimination did not correlate significantly with awareness of GINA. Approximately 17 months after GINA was signed into federal law, physicians’ knowledge remained limited regarding the existence of this legislation and relevant details. Physicians who are aware of GINA continue to have significant concerns regarding the risk of genetic discrimination. This study reveals the need to further educate physicians about the existence of GINA and the protections offered.     

Awareness of Death Among Children: Does a Life-Threatening Illness Alter the Process of Discovery?

The authors review studies on death awareness among children who are healthy, chronically ill, and terminally ill. The review suggests that children with life-threatening diseases demonstrate increased understanding of death compared with children who are either healthy or chronically ill. In particular, children with terminal illness, especially during the end stage of their disease, show an advanced understanding of the death concepts of irreversibility and finality. In contrast, healthy and chronically ill children appear to require certain age, cognitive developmental level, or intelligence thresholds to understand these concepts. Possible explanations for the findings in this literature are discussed. The implications of death awareness research for counselors are used as a base for suggesting counseling strategies.