The Balint group experience for medical students: a pilot project

Loss of empathy has been reported in medical students as they move through the clinical phases of their training. Several researchers have attempted to address this issue by exploring ways of heightening students’ awareness of the emotional, non-biomedical aspects of illness and the dynamics of the doctor–patient relationship, using a variety of reflective group discussion methods. This pilot project employed the specific group method developed by Michael Balint for general practitioners working in London after the Second World War. The pilot was based on one group of six third-year graduate students, meeting weekly over six weeks. Evaluation includes pre- and post-questionnaires, a 1000-word essay and leaders’ observations. The results suggest that the traditional Balint method needs to be modified for students at a point in their training where they have not yet been exposed to patients for long enough to develop meaningful patient relationships. Nevertheless, there was some evidence of a heightened awareness of the dynamics of doctor–patient relationships and the importance of psychological/emotional factors (including their own prejudices) when interacting with a patient. Balint-style groups could be an effective way of encouraging medical students to reflect on the importance of emotions in the doctor–patient relationship.     

A plea for greater recognition and appreciation of our group members' courage

Courage-a mental act that involves a decision to face and deal with emotional pain as honestly as possible without any guarantee of a positive outcome-resides at the heart of the therapeutic alliance and the work of psychodynamic group therapy. The author's experience suggests that group therapists tend to take for granted or underestimate the courage required to join and participate in a psychodynamic therapy group. Written from the perspective of self-psychology, this article provides a theoretical rationale for courage recognition as a central and crucial leadership function. Examples of courage are presented and contrasted with behaviors that appear courageous but are not. A detailed case example discusses the courage it takes for dyads to work through reciprocal negative transferences. Suggestions are offered to assist the group therapist in recognizing and calling attention to courageous behaviors. The author discusses some of the pitfalls of our profession's preference for value-free language and then shows how and why the occasional and judicious use of non-neutral language, courage being an example, can facilitate and deepen group work.     

Group climate in a stress discussion group for medical interns

In order to better characterize group process, the short form of the Group Climate Questionnaire (GCQS) was used to study a stress discussion group for medical interns. This group was found to be significantly different from a normative psychotherapy group sample along three major dimensions: Engaged, Avoiding and Conflict. The group members were cohesive, involved and open, yet respectful of each other's privacy. These results are discussed with respect to the group's goals and leadership.The authors thank George Fein, Ph.D., for statistical assistance.     

A model of aesthetic appreciation and aesthetic judgments

Although aesthetic experiences are frequent in modern life, there is as of yet no scientifically comprehensive theory that explains what psychologically constitutes such experiences. These experiences are particularly interesting because of their hedonic properties and the possibility to provide self‐rewarding cognitive operations. We shall explain why modern art's large number of individualized styles, innovativeness and conceptuality offer positive aesthetic experiences. Moreover, the challenge of art is mainly driven by a need for understanding. Cognitive challenges of both abstract art and other conceptual, complex and multidimensional stimuli require an extension of previous approaches to empirical aesthetics. We present an information‐processing stage model of aesthetic processing. According to the model, aesthetic experiences involve five stages: perception, explicit classification, implicit classification, cognitive mastering and evaluation. The model differentiates between aesthetic emotion and aesthetic judgments as two types of output.     

Lee Acculturation Dream Scale for Korean-American college students

This study examined acculturation as represented in dream narratives of 165 Korean immigrant college students living in the USA. A total of 165 dreams were collected and evaluated using the Lee Acculturation Dream Scale, for which locations of dream contents were coded. 39% of the dreams took place in South Korea, while 38% were in the USA. Also, 16% of the dreams included both locations, whereas 7% had no specific dream location. The dreams contained overlapping dream messages, images, scenes, and interactions in both South Korea and the USA. A two-sample t test on the mean scores of the Lee Acculturation Dream Scale indicated no significant difference between men and women.     

Web-based CBT for the prevention of anxiety symptoms among medical and health science graduate students

ABSTRACT

Medical and health science graduate students report greater anxiety problems than the general population, but they are less likely to seek treatment due to cultural and logistical barriers. One preventative approach that overcomes these barriers is web-based cognitive behavioral therapy (webCBT). It is unknown whether webCBT is effective for preventing anxiety escalation within this population. A randomized controlled trial was conducted, comparing the effects of webCBT versus a control group (CG). Medical university students (n=594; Mage=27; 67% female; 80% Caucasian) completed online baseline measures and four assigned online activities. Measures were re-administered after approximately three months. There was a small interaction effect between time of assessment and treatment condition. Anxiety severity was lower in the webCBT (M[SD]=2.88[3.36]) versus CG condition (M[SD]=3.69 [3.35]) at follow-up. This effect was moderate for students with mild, versus minimal, anxiety at baseline. The proportion of students with possible anxiety disorder was lower in the webCBT (4.5%) versus CG (8.5%) condition, and the proportion of mildly anxious students with a clinically significant increase in symptoms was lower in the webCBT (10%) versus CG (20%) condition. WebCBT may aid in preventing anxiety escalation in this population, particularly for at-risk students who report mild anxiety symptoms.     

Cardiovascular responses to occupational stress in male medical students: a paradigm for ambulatory monitoring studies.

Hemodynamic responses to systematic variations in occupational stress were examined using ambulatory blood pressure monitors (ABPMs). The goals of this study were (a) to illustrate the effectiveness of employing naturally occurring, controlled variations in psychological stress levels in studies incorporating ABPMs and (b) to document the patterns of cardiovascular responses to acute examination stress in medical students. Heart rate, systolic blood pressure, diastolic blood pressure, rate-pressure product, and mood states were measured before, during, and after low-stress (lecture) and high-stress (examination) work in 44 healthy male medical students. The lecture day was characterized by stable patterns of cardiovascular activity across all three periods. Hemodynamic activity and reports of activation and distress were greater on the examination day than on the lecture day. Cardiovascular activity during the preexamination period was as high as that seen during the examination period itself, indicating an anticipatory stress effect. Pressor activity decreased after the examination, although some residual chronotropic activity was seen. Systematic changes in physiological responses to controlled variations in the level of this naturalistic stressor support the use of this paradigm for other ABPM studies. The elevations in preexamination responses seen here suggest the need to consider prestressor experiences in such studies.     

Stress-coping-support in rural communities: A model for primary prevention

Conclusion Because of the relatively small and homogeneous population in rural communities, community-wide prevention efforts are often more manageable than in urban areas. Community needs and resources can be identified more easily, and the feasibility of different interventions can be assessed more readily.To guide the rural prevention agent in developing community programs, the stress-coping-support framework has been proposed here. The value of this model is that it delineates the aspects of community life that must be assessed, and it outlines several different intervention goals. The model in its most general form proposes that prevention activities should reduce stress, increase coping, and build support. While this model can be applied to any community or target group, the framework has been elaborated here to address the unique physical, occupational, and societal characteristics of rural communities.Although some of the issues in applying this model to rural, as opposed to urban, areas have been pointed out here, the variation among rural communities has not been addressed fully. The different types of rural communities, e.g., the mining town, the isolated farmlands, the Indian reservation, have unique characteristics which may determine whether a proposed prevention program is needed, feasible, and effective.It is hoped that rural practitioners, long sensitive to the need for prevention, will use this model to devise additional prevention directions and to generate useful and culturally syntonic programs for their communities.     

Increasing family members' appreciation of family caregiving stress

Participants read a message discussing the duties of a typical family caregiver (for example, a woman taking care of her elderly mother) and the associated psychological, physical, social, and financial stresses. The message was accompanied by an appeal that was either a control or was altruistic (other-oriented: focusing on the mother/caregiver's well-being) or egoistic (self-oriented: focusing on the child of the caregiver's needs and feelings). Participants who received an altruistic appeal were more appreciative of caregiving stresses than were those given an egoistic or a control appeal. Increasing family members' awareness of the stress involved in family caregiving is a first step in encouraging them to personally intervene on behalf of the caregiver.     

Caffeine enhances the physiological response to occupational stress in medical students

Caffeine (3.3 mg/kg) was tested against a placebo in 20 male medical students during periods of low (no exams) versus high (final exams) work stress. On each of 8 test days, heart rate and blood pressure were measured at baseline and over a 40-min postdrug interval; immediately afterward, blood was drawn to test plasma cortisol and serum lipid concentrations. Exams increased heart rate (p less than .005) and systolic blood pressure (p less than .02). Caffeine decreased heart rate (p less than .0001) and increased systolic blood pressure (p less than .005), diastolic blood pressure (p less than .0001), plasma cortisol levels (p less than .01), and serum cholesterol levels (p less than .02). Caffeine effects were additive with those of exams, and together they increased the number of men showing systolic blood pressures in the borderline hypertensive range. Thus, caffeine use during periods of increased occupational stress may enhance the cumulative stress response.     

Transferring cues for cooperation: Helping students follow group instructions

In this study, we piloted a teaching procedure to help a learner attend to group pronouns (calls), such as “Everyone,” as precursors for cooperating with instructions. A student was first taught to attend to the teacher when a bell rang; the teacher then paired the bell with group call words and faded the bell out to transfer stimulus control to the calls. This antecedent intervention led to increased attending to group calls and cooperation with the instructions. We used a hybrid design of alternating treatments and multiple baselines to evaluate the effects of the intervention. We briefly assessed maintenance after the systematic fading of the intervention and again after 2 weeks. The results suggest that attending occurred through listener responding rather than through the traditional measures of eye gaze and orienting. We explore the effects in terms of stimulus control, behavioral classes, component skills, chaining, and high‐p and low‐p effects.