Relating Callous-Unemotional Traits to Physically Restrictive Treatment Measures Among Child Psychiatric Inpatients

We examined the association of callous-unemotional (C/U) traits with the rates of seclusion and restraint among a sample of child psychiatric inpatients (N = 101). Analyses focused on the incremental value of C/U traits as a predictor over and above the influence of other risk factors for physically restrictive treatment measures found in previous research, including gender, age, verbal intelligence, ethnicity, the diagnosis of a conduct disorder or an oppositional defiant disorder, maltreatment history, and the other dimensions of psychopathy (i.e., narcissism and impulsivity). Results of hierarchical multiple regressions indicated that younger age and C/U traits predicted seclusion rates, whereas only C/U traits predicted restraint rates. The discussion of these findings focuses on the necessity of developing effective intervention programs for inpatient children with prominent C/U traits, to help forestall the physically dangerous behavior that necessitates a seclusion or restraint.     

The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital

The widespread use of seclusion and restraint in child psychiatric hospitals to manage aggression and noncompliance is based on the assumption that coercive consequences reduce the frequency of undesirable behaviors exhibited by the patients. We report a study of the use of seclusion and restraint in a public child psychiatric hospital during a 3-year period. Twenty-eight percent of the patients had been secluded or restrained a total of 1670 times. About 25% of these patients had been secluded more than five times during their hospitalization, and 32% had been placed in restraints more than once. Behaviors that typically resulted in repeated seclusion included physical aggression toward staff, verbal aggression toward peers, non-compliant or oppositional behavior, and self-harm. Variables that predicted patients most at risk for repeated seclusion included age, gender, and psychiatric diagnosis. The predictor variables for those most at risk for repeated restraint included age, property destruction, and self-harm. The high rates of use of seclusion and restraint suggest that these methods for controlling the behavior of children and adolescents in this child psychiatric hospital may not have been therapeutic. We suggest that staff in such hospitals engage in a pattern of behavior characterized by an aggression-coercion cycle, in which increasingly aggressive and coercive behaviors are exhibited by both patients and staff.     

Opinion on directive 98/44/EC on the legal protection of biotechnical inventions,and its implementation in Sweden

The following statement is the formal opinion by the Swedish National Council on Medical Ethics concerning the implementation of Directive 98/44/EC of the European Parliament concerning legal protection of biotechnical inventions, and the implications and implementation of this Directive in Sweden.     

Developing a federal policy on research misconduct

Since April 1996, the National Science and Technology Council (NSTC), in collaboration with the Office of Science and Technology Policy (OSTP) in the Executive Office of the President, has been leading the development of a government-wide Federal policy for research misconduct. The author is a Senior Policy Analyst in the Office of Science and Technology Policy and a participant in this process. This paper places the NSTC/OSTP effort in historical context, outlines the process by which the policy will be finalized, and discusses the principal issues raised during the policy development process.     

Reducing Psychotropic Medications in an Intensive Residential Treatment Center

Medication rates in behaviorally disordered children and youth have greatly increased to current high levels and are very controversial. This study examined changes in psychotropic medication use, levels of behavioral disturbance, and use of personal restraint and seclusion in a population of youth with serious behavioral disorders receiving medically directed cognitive-behavioral treatment in an intensive residential setting. The hypothesis was that there would be significant reductions in medication rates, without the unintended consequences of increased rates of problem behavior or offsetting increases in the use of seclusion or personal restraint. Results showed significant reductions in both the number of youth on medication and the average number of psychotropic medications during the residential stay. There were also significant reductions in behavioral disturbance, seclusions, and personal restraints. These results demonstrate that psychotropic medication can be significantly reduced without increases in problem behavior or the use of seclusions or personal restraints. We conclude that it is possible to significantly reduce psychotropic medication rates to far more conservative levels within the context of a clinically directed cognitive-behavioral treatment milieu.     

Responses to the ELCA “Draft social statement on women and justice”

Social statements are social teaching and policy documents in the Evangelical Lutheran Church in America. Created by task forces composed of ELCA members and supported by ELCA churchwide staff members, social statements are developed through a series of participatory steps. Contributors in this work share their feedback on the “Draft Social Statement on Women and Justice” with the task force as part of the process to create a proposed social statement for an assembly vote.     

Psychiatry and religion: consensus reached!

ABSTRACT

In December 2015 the Executive Committee of the World Psychiatric Association accepted a position statement on spirituality and religion in psychiatry. In this contribution the author will (briefly) sketch the background of the development of this position statement, and the criteria it needs to fulfil. The aim of the final result will be explained, and some desiderata with regard to its future will be expressed. The full text of the Position Statement as it has been published in World Psychiatry (February 2016) is added as appendix (permission granted by the editor).     

Upon Further Reflection: View from the Other Side of “Windows on the 21st Century”

Three points discussed in Glenn (1993) are reviewed in the context of current events: the discipline of behavior analysis as a cultural system, the importance of that discipline in the training and regulation of behavior analytic practitioners, and Association for Behavior Analysis International (ABAI) as a cultural subsystem that links to all the other parts and therefore links the other parts to one another. Noting similarities between behavior analysis and biology, I consider the growth of biological sciences as a model for behavior analysis. Of particular importance for biology has been the role of basic biological sciences in the practice of medicine and the resulting feedback loops that have developed among its basic sciences, applied sciences, and medical practice. I suggest that behavior analysis explicitly follow this model and that ABAI has a critical role to play in leading the field to developing the feedback loops that have integrated the biological sciences and medicine.     

Adlerian psychology as an intuitive operant system

Traditional accounts of the Individual Psychology of Alfred Adler tend to sentimentalize his system and obscure its functional flavor. Six basic Adlerian positions on human behavior, including Rudolf Dreikurs' "four goals of misbehavior," are interpreted as a primitive statement of operant principles. Applied techniques long used by Individual Psychology practitioners strongly resemble interventions that applied behavior analysts have developed by more systematic means.     

The Ethical Foundations of Behavior Therapy

In this article, I am concerned with the ethical foundations of behavior therapy, that is, with the normative ethics and the meta-ethics underlying behavior therapy. In particular, I am concerned with questions concerning the very possibility of providing an ethical justification for things done in the context of therapy. Because behavior therapists must be able to provide an ethical justification for various actions (if the need arises), certain meta-ethical views widely accepted by behavior therapists must be abandoned: in particular, one must give up ethical subjectivism, ethical skepticism, and ethical relativism. An additional task is to show how it is possible to provide a nonsubjective, nonskeptical, and nonrelativistic moral justification for an ethical statement. Although this is a monumental task, I provide a rough sketch of such a model, one that is congenial to the value judgments underlying behavior therapy.     

The ethical foundations of behavior therapy

In this article, I am concerned with the ethical foundations of behavior therapy, that is, with the normative ethics and the meta-ethics underlying behavior therapy. In particular, I am concerned with questions concerning the very possibilty of providing an ethical justification for things done in the context of therapy. Because behavior therapists must be able to provide an ethical justification for various actions (if the need arises), certain meta-ethical views widely accepted by behavior therapists must be abandoned; in particular, one must give up ethical subjectivism, ethical skepticism, and ethical relativism. An additional task is to show how it is possible to provide a nonsubjective, nonskeptical, and nonrelativistic moral justification for an ethical statement. Although this is a monumental task, I provide a rough sketch of such a model, one that is congenial to the value judgments underlying behavior therapy.     

Timing and executive function: Bidirectional interference between concurrent temporal production and randomization tasks

A review of interference effects in concurrent temporal/nontemporal dual-task studies suggests that prospective timing may be related to executive cognitive functions. Executive processes play a supervisory role in behavior by controlling attention, coordinating information, and scheduling actions. In the present research, a timing task was paired with an established executive task in a dual-task paradigm. The timing task required subjects t o generate a series o f 5-sec temporal productions,and the executive task was random number generation. These tasks were performed both separately and concurrently. Comparisons of single-task and dual-task conditions showed that (1) the randomization task interfered with timing by making temporal productions more variable and longer and (2) concurrent timing disrupted randomization performance by making responses less random. This pattern of bidirectional interference supports the idea that timing relies on the same attentional resources used by other executive-level tasks.     

Separating discriminative and function-altering effects of verbal stimuli

Ever since Skinner's first discussion of rule-governed behavior, behavior analysts have continued to define rules, either explicitly or implicitly, as verbal discriminative stimuli. Consequently, it is not difficult to find, in the literature on rule-governed behavior, references to stimulus control, antecedent control, or to rules occasioning behavior. However, some verbal stimuli have effects on behavior that are not easily described as discriminative. Such stimuli don't evoke behavior as discriminative stimuli, but rather alter the functions of other stimuli in a manner analogous to operant and respondent conditioning. Hence, this type of control has been called function altering. Any known stimulus function (e.g., evocative, or [conditioned] reinforcing or punishing functions) can apparently be altered by such function-altering stimuli. Describing these stimuli as discriminative stimuli obscures their possible function-altering effects and consequently may retard inquiry into them. This paper encourages behavior analysts to begin separating the discriminative and function-altering effects of verbal stimuli and suggests that by doing so, behavior analysts may better understand what may be most unique about these stimuli. Results from several experiments, especially those in which children served as subjects, are analyzed. Finally, some speculations are offered concerning the genesis of function-altering stimuli.     

Ethics is everybody's business, especially in regard to confidentiality

...Every hospital needs a policy statement devoted to confidentiality. This task is a good assignment for a hospital ethics committee. In drafting such a statement, one area that should not be overlooked is respect for confidentiality in cases used for teaching, patient conferences, and interdisciplinary meetings, including the teaching of clinical ethics! The University of Virginia's (UVA) Hospital Ethics Committee is considering a new policy statement on confidentiality....     

Crafting a policy statement: Some observations

In 2016, a task force appointed by the Evangelical Lutheran Church in America began drafting a policy statement which in 2018 appeared with the title “A Declaration of Inter‐Religious Commitment.” This article explains the production of that document and explores its main themes. The document appeals to vocation—that is, the calling to serve one's neighbor and community—as its framework. It encourages engagement, resisting stereotypes, cooperation for the common good, and standing up for those who are harassed or mistreated. It goes on to explore the relationship between evangelism and inter‐religious understanding, affirming both the Great Commandment and the Great Commission.     

The Force of Truth1

The theme of the paper is that what is true cannot be false and conversely. This position was anticipated by Aristotle in De Interpretatione and by G. H. von Wright. The latter calls it “a truth of the logic of relative modalities.” Aristotle has been taken to task by Susan Haack and others for arguing fallaciously from the Principle of Bivalence, that every statement is either true or false, to fatalism. The implication holds, but we show that it is unreasonable to assume that Aristotle grounded his argument on this implication rather than on what we call the force of truth.     

The effect of restraint beliefs on alcohol-seeking behavior

Individuals who believe that they have high levels of restraint over motivated behaviors such as cigarette smoking are, paradoxically, more likely to engage in those behaviors when tempted (Nordgren, Van Harreveld, & Van Der Pligt, 2009). Our aim was to experimentally manipulate heavy drinkers' beliefs about their drinking restraint to examine the effect on drinking behavior. Sixty heavy drinkers completed an implicit association test and a stop-signal task before receiving bogus feedback on their task performance that indicated that they had either high or low levels of drinking restraint. Participants then completed a bogus taste test in which they were able to consume beer and a soft drink. Results indicated that the group falsely led to believe that they had a high level of drinking restraint subsequently consumed more beer than the group led to believe that they had a low level of drinking restraint. This study demonstrates that beliefs about drinking restraint can influence drinking behavior, in that individuals who overestimate their control over drinking are at greater risk of drinking to excess when exposed to tempting situations.     

Corporate funding and conflicts of interest: a primer for psychologists

A presidential task force on external funding was established by the American Psychological Association (APA) in 2003 to review APA policies, procedures, and practices regarding the acceptance of funding and support from private corporations for educational and training programs; continuing education offerings; research projects; publications; advertising; scientific and professional meetings and conferences; and consulting, practice, and advocacy relationships. This article, based on the Executive Summary of the APA Task Force on External Funding Final Report, presents the findings and unanimous recommendations of the task force in the areas of association income, annual convention, research and journals, continuing education, education, practice, and conflicts of interest and ethics. The task force concluded that it is important for both APA and individual psychologists to become familiar with the challenges that corporate funding can pose to their integrity. The nature and extent of those challenges led the task force to recommend that APA develop explicit policies, educational materials, and continuing education programs to preserve the independence of psychological science, practice, and education.     

Together toward Life

The Commission on World Mission and Evangelism (CWME) has since 2006, after the WCC Porto Alegre Assembly, been working and contributing toward the construction of the new ecumenical mission affirmation. The new statement will be presented to the WCC 10th Assembly at Busan, Korea, in 2013. Since the integration of the International Missionary Council (IMC) and the World Council of Churches (WCC) in New Delhi, 1961, there has been only one official WCC position statement on mission and evangelism, which was approved by the central committee in 1982, “Mission and Evangelism: An Ecumenical Affirmation.” It is the aim of this ecumenical discernment to seek vision, concepts and directions for a renewed understanding and practise of mission and evangelism in changing landscapes. It seeks a broad appeal, even wider than WCC member churches and affiliated mission bodies, so that we can commit ourselves together to fullness of life for all, led by the God of Life!     

The effectiveness and ethical justification of psychiatric outpatient commitment

Studies link involuntary outpatient commitment with improved patient outcomes, fueling debate on its ethical justification. This study compares inpatient utilization for committed outpatients in the 1990s with those who were not under outpatient civil commitment orders. Findings reveal committed outpatients had higher utilization of inpatient services and restraint episodes prior to their commitment compared with a control group. Committed outpatients also were more likely to have been on discharge status at the time of admission, have been admitted involuntarily under emergency legal procedures, and have had a greater number of admissions and hospital days prior to their commitment. Following commitment, patients had fewer hospitalizations, shorter lengths of stay, fewer seclusion episodes and hours, and fewer restraint episodes and hours. Findings are discussed within the context of parens patriae and therapeutic jurisprudence, and support medical and public policy justifications for ethical uses of outpatient civil commitment laws for seriously mentally ill patients.