Religion in Public Health‐Care Institutions: U.S. and U.K. Perspectives

In this article, we consider the role that religion plays in the health‐care institutions of the United States and the United Kingdom. Religion has played a significant role in the development of health‐care institutions in both countries and continues to be present in them in important ways. To capture the range of involvement of religious groups in various sectors of the health‐care institution, we propose a continuum for their relationship, from completely merged identities at one end (“faith‐saturated”) to entirely separate ones at the other (“faith‐secular partnerships”). Versions of this scheme have appeared in both U.S. and U.K. reports that describe the faith component of faith‐based organizations that work in global contexts. We apply this framework to identify specific U.S. and U.K. exemplars, finding that examples of all types exist in both societies, despite the more secular nature of the United Kingdom. Accurately characterizing the relationship between religion and public health‐care institutions can inform future policy and research.     

Ethics and Science: Is Plausibility in the Eye of the Beholder?

This paper argues that morality is objective in a specific sense that accords with a broadly expressivist stance in metaethics. The paper also explains that although there is a kind of subjectivity in moral inquiry, the same holds for other kinds of normative inquiry, including epistemic and even scientific inquiry, and moreover that this kind of subjectivity is no threat to morality’s objectivity. The argument for the objectivity of morality draws strong parallels between ethics, epistemology, and science, but does not depend on equally strong parallels between ethics and mathematics. I argue that there is more to learn from a comparison between ethics and mathematics than I used to think, but the difference between the issues that come up in thinking about objectivity in ethics and those that come up in thinking about objectivity in mathematics is substantial, and we cannot carry over results from the philosophy of mathematics to the case of morality.     

Narrative and embodiment – a scalar approach

Recent work on the relation between narrative and selfhood has emphasized embodiment as an indispensable foundation for selfhood. This has occasioned an interesting debate on the relation between embodiment and narrative. In this paper, I attempt to mediate the range of conflicting intuitions within the debate by proposing a scalar approach to narrative and an accompanying concept of a split-self (Waldenfels 2000). Drawing on theoretical developments from contemporary narratology, I argue that we need to move away from a binary understanding of narrative as something an entity (the self) strictly is or is not; rather, we need to see narrative as an attribute admitting of degrees. I suggest that the relation between narrative and embodiment should be seen along these lines, proposing three levels of the narrativity of embodied experiencing: 1) the unnarratable, 2) the narratable and 3) the narrative. Finally, I discuss the implications this framework has for the general question of the narrative constitution of selfhood.     

Enhancing Interpersonal Psychotherapy for Mothers and Expectant Mothers on Low Incomes: Adaptations and Additions

Intervening with depressed women during their childbearing years, especially with those on low incomes, is critically important. Not only do mothers and expectant mothers suffer unnecessarily, but their untreated depression has critical negative consequences for their families. Despite this, these women have proven especially difficult to engage in psychotherapy. In this paper we describe several adaptations and additions we have made to a brief form of Interpersonal Psychotherapy (IPT) to meet the needs of mothers and expectant mothers living on low incomes in the community who suffer from depression, but face significant practical, psychological, and cultural barriers to engaging in and staying in treatment. In addition, we present some preliminary data on the extent to which our enhanced, brief IPT approach promotes improvements in treatment engagement and retention relative to usual care for expectant mothers on low incomes.     

Psychometric properties of Scheier and Carver's Life Orientation Test in a sample of Australian prisoners

The psychometric properties of Scheier and Carver's 1985 Life Orientation Test (LOT), which is a measure of optimism, were examined as part of a study of education, training, work experience, and expectations of sentenced adult prisoners in Western Australia. All prisoners at five metropolitan public prisons were invited to participate and 453 accepted. This represented a response rate overall of about 41%, with response rates at each of the individual prisons ranging from 13% to 90%. The average age of the prisoner sample was 34.4 yr. (SD = 10.2 yr.). The proportion of men in the sample was 79.7%. Mean sentence length was 66.9 mo. (58.5 for women and 69.2 for men), and the number of months of sentence remaining averaged 44.4 mo. (41.0 for women and 45.3 for men). Means and standard deviations of the LOT scores for prisoners were similar to those of other groups, and demographic differences between prisoners were not statistically significantly related to scores. The internal reliability of the LOT scores was acceptable. Confirmatory factor analyses indicated that the two-factor item-keying model fitted the prisoner data better than a one-factor model. However, the two factors did not simply reflect underlying optimism and pessimism constructs but were substantially affected by item keying.     

The psychophysics of contingency assessment

The authors previously described a procedure that permits rapid, multiple within-participant evaluations of contingency assessment (the "streamed-trial" procedure, M. J. C. Crump, S. D. Hannah, L. G. Allan, & L. K. Hord, 2007). In the present experiments, they used the streamed-trial procedure, combined with the method of constant stimuli and a binary classification response, to assess the psychophysics of contingency assessment. This strategy provides a methodology for evaluating whether variations in contingency assessment reflect changes in the participant's sensitivity to the contingency or changes in the participant's response bias (or decision criterion). The sign of the contingency (positive or negative), outcome density, and imposition of an explicit payoff structure had little influence on sensitivity to contingencies but did influence the decision criterion. The authors discuss how a psychophysical analysis can provide a better understanding of findings in the literature such as mood and age effects on contingency assessment. They also discuss the relation between a psychophysical approach and an associative account of contingency assessment.     

Factors affecting self-referral to counselling services in the workplace: a qualitative study

The benefits of psychological support in the workplace (also known as workplace counselling) are well documented. Most large organisations in the UK have staff counselling schemes. However, it is unclear what, if any, factors affect employee decisions to use such schemes. This study has used a qualitative methodology to explore the reasons that make employees use workplace counselling. Eleven employees of a university in the north of England who had used the staff counselling service of their employer took part in the study. The employer had two schemes available: an internal staff counselling service and an external Employee Assistance Programme (EAP). A semi-structured interview was used with each participant and grounded theory techniques were used to analyse the interviews. The analysis resulted in the construction of a model of psychological help-seeking in the workplace. The main findings indicate that most participants were motivated to use their employer's counselling service by their prior positive experiences of similar or other type of mental health services. Other encouraging factors were: recommendation of service by others, a supportive environment and trust in the confidential ethos of the service. Conversely, negative preconceptions of psychological help-seeking and a perception of the employing environment as unsafe were shown to have been discouraging factors. The study concludes with suggestions for practice and for further research.     

Adding motivational interviewing to exposure and ritual prevention for obsessive-compulsive disorder: an open pilot trial

Exposure and ritual prevention (EX/RP) is an efficacious treatment for obsessive-compulsive disorder (OCD), but high dropout rates and variable treatment adherence limit its effectiveness. Motivational interviewing (MI) has shown promise as an adjunct to symptom-focused treatments for improving treatment adherence and outcomes. The authors developed a manual integrating MI with EX/RP, consisting of three information-gathering/motivational enhancement sessions and 15 EX/RP sessions with an optional MI module to be used as needed. Six patients with moderate to severe OCD symptoms (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score> or =16) underwent treatment. Five showed a decrease in their baseline Y-BOCS scores and an increase in their quality of life, with three achieving an excellent response (i.e. Y-BOCS< or =12 at Session 18). The authors briefly describe the motivational strategies used in the six cases and suggest that integrating MI with standard EX/RP is a promising method to increase and sustain patient engagement with EX/RP. Challenges in combining these treatments and maintaining the integrity of each as well as limitations of the study are discussed.     

Everyday attention lapses and memory failures: the affective consequences of mindlessness

We examined the affective consequences of everyday attention lapses and memory failures. Significant associations were found between self-report measures of attention lapses (MAAS-LO), attention-related cognitive errors (ARCES), and memory failures (MFS), on the one hand, and boredom (BPS) and depression (BDI-II), on the other. Regression analyses confirmed previous findings that the ARCES partially mediates the relation between the MAAS-LO and MFS. Further regression analyses also indicated that the association between the ARCES and BPS was entirely accounted for by the MAAS-LO and MFS, as was that between the ARCES and BDI-II. Structural modeling revealed the associations to be optimally explained by the MAAS-LO and MFS influencing the BPS and BDI-II, contrary to current conceptions of attention and memory problems as consequences of affective dysfunction. A lack of conscious awareness of one's actions, signaled by the propensity to experience brief lapses of attention and related memory failures, is thus seen as having significant consequences in terms of long-term affective well-being.