Acceptance and Commitment Therapy for generalized anxiety disorder in older adults: a preliminary report

Some evidence suggests that acceptance-based approaches such as Acceptance and Commitment Therapy (ACT) may be well-suited to geriatric generalized anxiety disorder (GAD). The primary goal of this project was to determine whether ACT was feasible for this population. Seven older primary-care patients with GAD received 12 individual sessions of ACT; another 9 were treated with cognitive-behavioral therapy. No patients dropped out of ACT, and worry and depression improved. Findings suggest that ACT may warrant a large-scale investigation with anxious older adults.     

Introducing Spirituality into Psychiatric Care

Spirituality is important to many psychiatric patients, and these patients may be moved toward recovery more effectively if their spiritual needs are addressed in treatment. This, however, is rarely given expression in the psychiatric services of teaching hospitals. In order to develop this potential area of improved care, we (1) evaluated the differential attitudes of patients and psychiatric trainees toward the value of spirituality in the recovery process, (2) established a program of group meetings conducted by psychiatric residents and staff where patients can discuss how to draw on their spirituality in coping with their problems, and (3) established related training experiences for psychiatric residents. The results and implications of these three initiatives are presented.     

'I remember therefore I am, and I am therefore I remember': exploring the contributions of episodic and semantic self-knowledge to strength of identity

The present research explores the relationship between the two components of autobiographical memory--episodic and semantic self-knowledge--and identity strength in older adults living in the community and residential care. Participants (N= 32) completed the autobiographical memory interview and measures of personal identity strength and multiple group memberships. Contrary to previous research, autobiographical memory for all time periods (childhood, early adulthood, and recent life) in the semantic domain was associated with greater strength in personal identity. Further, we obtained support for the hypothesis that the relationship between episodic self-knowledge and identity strength would be mediated by knowledge of personal semantic facts. However, there was also support for a reverse mediation model indicating that a strong sense of identity is associated with semantic self-knowledge and through this may enhance self-relevant recollection. The discussion elaborates on these findings and we propose a self-knowledge and identity model (SKIM) whereby semantic self-knowledge mediates a bidirectional relationship between episodic self-knowledge and identity.     

On the Essence of Education

Educational reforms in developed countries are not successful, because we do not have a clear understanding of what is education. The essence of education is the limits of its improvement. Education is understood as the artificial extension of human ability to learn, as the product of learner's own efforts, and finally, as a series of historic forms of labor arrangements.     

New Strategies for Combining Mindfulness with Integrative Cognitive Behavioral Therapy for the Treatment of Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) severely impacts social functioning, distress levels, and utilization of medical care compared with that of other major psychiatric disorders. Neither pharmacological nor psychotherapy interventions have adequately controlled cardinal symptoms of GAD: pervasive excessive anxiety and uncontrollable worry. Research has established cognitive behavioral therapy (CBT) as the most effective psychotherapy for controlling GAD; however, outcomes remain at only 50% reduction, with high relapse rates. Mindfulness has been integrated with CBT to treat people suffering from numerous psychiatric disorders, with mindfulness based stress reduction (MBSR) being the most researched. Preliminary evidence supports MBSR’s potential for controlling GAD symptoms and key researchers suggest mindfulness practices possess key elements for treating GAD. Classical mindfulness (CM) differs significantly from MBSR and possesses unique potentials for directly targeting process and state GAD symptoms inadequately treated by CBT. This article introduces the theory and practice of CM, its differences from MBSR, and a critical review of MBSR and CBT treatments for GAD. CM strategies designed to complement CBT targeting cardinal GAD symptoms are outlined with a case study illustrating its use.     

TMS effects on subjective and objective measures of vision: stimulation intensity and pre- versus post-stimulus masking

Transcranial magnetic stimulation (TMS) can be used to mask visual stimuli, disrupting visual task performance or preventing visual awareness. While TMS masking studies generally fix stimulation intensity, we hypothesized that varying the intensity of TMS pulses in a masking paradigm might inform several ongoing debates concerning TMS disruption of vision as measured subjectively versus objectively, and pre-stimulus (forward) versus post-stimulus (backward) TMS masking. We here show that both pre-stimulus TMS pulses and post-stimulus TMS pulses could strongly mask visual stimuli. We found no dissociations between TMS effects on the subjective and objective measures of vision for any masking window or intensity, ruling out the option that TMS intensity levels determine whether dissociations between subjective and objective vision are obtained. For the post-stimulus time window particularly, we suggest that these data provide new constraints for (e.g. recurrent) models of vision and visual awareness. Finally, our data are in line with the idea that pre-stimulus masking operates differently from conventional post-stimulus masking.     

Accuracy of Reported Family History and Effectiveness of Medical Record Requests in Genetic Counseling for Alzheimer Disease

The University of British Columbia Hospital Clinic for Alzheimer Disease and Related Disorders (UBCH-CARD) invests significant effort to obtain medical records for the confirmation of patient–reported family histories of dementia. The effectiveness of requesting these records was assessed through a review of the 275 requests made by UBCH-CARD genetic counselors during the 24-month period of January 1, 2005–December 31, 2006. The results were categorized according to outcome. Useful medical records were obtained from 92 (33.5%) requests: 77 (28%) records supported, and 15 (5.5%) records did not support, the patient–reported information. An additional 20 (7.5%) requests yielded only vague information. When verification was possible, patient–reported family histories of Alzheimer disease, dementia, or memory loss were accurate in 84% of cases. During the study period, almost 500 h of genetic counselor work time was spent obtaining, reviewing, and following-up on records received. Changes made to UBCH-CARD procedure in response to these findings are discussed.     

A comparison of ultra-endurance cyclists in a qualifying ultra-cycling race for Paris-Brest-Paris and Race Across America-Swiss cycling marathon

Ultra-endurance events test the adaptation of human physiology to extreme physical and mental demands, high levels of training, motivation, and physical conditioning among participants. To understand basic differences among participants according to the severity of the race, participants in qualifying events for two ultra-endurance cycling races, differing in length and intensity, were compared on measures of anthropometry, training, and support. One race was four times longer, required supporting teams, and racers typically had little sleep, which should lead to the qualifiers being substantially more highly trained than those from the shorter race. The qualifiers in the longer race had greater intensity in training while the qualifiers in the shorter race relied more on training volume. Different strategies and types of training reflected the different demands of the races. Future studies should evaluate personality and motivational differences in ultra-endurance events and between these athletes and athletes in other sports.     

Resemblance theories of properties

The paper aims to develop a resemblance theory of properties that technically improves on past versions. The theory is based on a comparative resemblance predicate. In combination with other resources, it solves the various technical problems besetting resemblance nominalism. The paper’s second main aim is to indicate that previously proposed resemblance theories that solve the technical problems, including the comparative theory, are nominalistically unacceptable and have controversial philosophical commitments.