To test or not to test: A clinical dilemma

This paper argues that clinicians are sometimes justified in not testing diagnoses or in not subjecting them to a full battery of tests. In deciding whether to conduct a test, a clinician may consider and weigh several different factors, including her confidence in her initial diagnosis, the specificity and sensitivity of the test, the consequences of making a false diagnosis, the pain, harm, and inconvenience caused by the test, and the costs of the test to the patient and society. This view suggests that diagnoses are fundamentally different from scientific hypotheses in that they are not always subjected to the same evidential standards.     

Headache triggers: To avoid or not to avoid,that is the question

Abstract

Traditional clinical advice in the management of headaches is to avoid trigger factors. There is a danger, however, that avoidance of triggers results in a sensitisation process whereby tolerance for the triggers decreases, in a manner analogous to increments in anxiety arising from avoidance of anxiety-eliciting stimuli. Reported here are six single-case experiments in which the aim was to desensitise headache sufferers to an experimentally validated trigger, namely “visual disturbance”. The results demonstrated that repeated, prolonged exposure to a headache trigger led to desensitisation with participants experiencing less visual disturbance, less negative affect and less head pain in response to the trigger. These findings have theoretical significance as they speak to the issue of the aetiology of chronic headache, and practical significance as they suggest that a key aspect of current management may contribute to the disorder becoming worse rather than better.     

To be or not to be: Buddhist selves in Toronto

Buddhist identity: a Buddhist by any other name?When we talk about a ‘Buddhist’ or ‘Buddhists’ in Canada and the United States, what exactly is our referent—a label or category, an identity, or perhaps something more? Is the term ‘Buddhist’ signifying a reified object (or subject?), one that subsumes all sorts of practices, beliefs, philosophies, and preconceptions under its umbrella? Or can the term be used to signify choice, personal commitment, motivation, partiality, and perhaps even struggle? We have a great many labels and categorizations of the differences among and between Buddhists, but can we really assume that the term ‘Buddhist’ itself is unproblematic? Calling someone a Buddhist in the West, or ‘naming’ them as such, appears initially and on the surface a fairly straightforward undertaking. And yet, the very act of naming itself is a composite of assumptions and expectations. In much of the anthropological literature on initiation rituals, the act of naming has been construed as more-or-less a societal quest for order and control of the individual. Naming marks who is ‘in’ and who is ‘out’. Being named is an important marker of social identity, socialness, and social belonging (inter alia, Jell-Bahlsen 1989; Jacquemet 1992; Cohen 1994).     

To be me or not to be me: About alienation

This article is about the experiential side of the concept of alienation and its relations to the stress process in the context of work and organization. We distinguish two kinds of alienation: primary alienation, the experience or feeling that something is different from normal, and secondary alienation, the absence of an experience of or feeling about something abnormal. After having gone into everyday reality and how it can be so disturbed that alienation ensues, we go further into the experiences involved in both kinds of alienation and their positive and negative consequences. Secondary alienation is described as a common final path in the second stage of a human stress process. In the discussion, we pay attention to the social scientific tradition of alienation as result of an evil societal influence, which has turned out to be an unfortunate approach. Instead, we advocate an approach that conceives alienation as the outcome of a personal choice. Lastly we indicate shortly what can be done about secondary alienation.     

To grit or not to grit,that is the question!

The current study tested the validity of grit as a non-cognitive construct related to, yet distinct from self-control. Data were collected from N = 1907 adults spanning the life-course (53.1% female, M age = 41.4 years). Associations between grit and present and past goals were very similar to ones observed with self-control. Extensive model tests using structural equation modeling provided evidence of substantial overlap between these two constructs, calling into question the conceptual and empirical distinctiveness of grit vis-à-vis self-control, as well as the importance of grit as a unique and independent characteristic salient for the pursuit and achievement of long-term goals. This finding was consistent and invariant across adult developmental periods. Study implications for grit-investment are discussed.     

To stay or to return: Rapprochement processes in the migration of adolescents and young adults

The migration of adolescents and young adults is analyzed in terms of the separation-individuation process—an attempt at separation, reflecting conflictual feelings around autonomy and dependency needs. This paper focuses on the acute ambivalence typical of the rapprochement phase of personality development during childhood and applying this to understanding the adolescent and young adult during their migration experiences. The young immigrants to Israel are observed to alternate between physical approaching and then distancing in relation to both the new country (Israel) and the country of origin (the homeland). Four clinical examples of young persons are presented to illustrate the rapprochement process in some immigrants.     

Transition in the cotherapy dyad: To wait or not to wait

Transition within the cotherapy dyad is explored and examined in relation to institutional ethos and needs, the attitudes and needs of the psychotherapy group, and the attitudes and needs of the cotherapists. The timing of transition is discussed as are a variety of potential approaches to transition within the cotherapy dyad. Some significant dynamics which underlie the process of transition within the cotherapy dyad are examined and discussed in relation to their potential effects on the psychotherapy group and group process.This is a revised version of a paper presented at the 36th Annual Conference of the American Group Psychotherapy Assn., February, 1979, New York, NY.     

To generalize or not to generalize: spatial categories are influenced by physical attributes and language

The current work explored the conditions under which infants generalize spatial relationships from one event to another. English‐learning 5‐month‐olds habituated to a tight‐ or loose‐fit covering event dishabituated to a change in fit during a containment test event, but infants habituated to a visually similar occlusion event did not. Thus, infants’ responses appeared to be driven by the physical nature of the fit rather than visual similarity. This response pattern was replicated with Korean‐speaking adults, but English‐speaking adults showed no sensitivity to change in fit for either event. These findings suggest that language development links linguistic forms to universal, pre‐existing representations of meaning, and that linguistic experience can shape sensitivity to distinctions that are marked in one's native language.     

To be or not to be at risk: Spontaneous reactions to risk information

Rheumatoid arthritis (RA) is a chronic disease, which can lead to considerable psychological distress. The present study evaluated anxiety and depression symptoms for this chronic and painful illness within the framework of the conservation of resources (COR) theory. Coping strategies, coping self-efficacy, religiousness and social support are very important personal resources, which have been found to protect individuals from psychological distress. The aim of the present study was to examine the predictive values of socio-demographic and illness-related variables, perceived social support, ways of coping, religiousness, arthritis self-efficacy and resource loss for psychological distress in a sample of 117 RA patients from Turkey, a secular, Islamic, non-western developing country. The results revealed that RA patients experience considerable anxiety and depressive symptoms. The results of the regression analysis showed that gender, helplessness coping and resource loss are significant predictors of anxiety, whereas arthritis self-efficacy and resource loss are significant predictors of depression. Resource loss appeared as an important predictor for both anxiety and depression. This finding was consistent with the COR theory. The clinical implications of these findings are discussed.