Talking About Talking About Patients

Several years ago, I talked about a case in a clinical seminar. I presented the work in a style that is different from usual because I was experimenting with how to best evoke the experience of being with this patient for my listeners. This paper is a continuation of that presentation, now through written rather than spoken word. In writing it, I struggled with the same dilemma of how to evoke the ambience, the feel of being with this patient. I begin with a discussion of some of the dilemmas involved in writing up clinical work when the aim is to stay close to the experience rather than to illustrate theoretical or technical points. I present a few sample vignettes of my work with this patient and then an analysis of how my writing style, including use of sounds, grammar, and word placement, contributes to evoking experience. I continue with a brief discussion of my experiences in presenting the case in the seminar and use these experiences to highlight aspects of the case. I ask the reader to become personally involved in the experiment by paying attention to what is evoked when reading the material.     

Associations between heart rate,perceived heart rate,and anxiety during acute psychological stress

ABSTRACT

Background: Acute psychological stress elicits increases in heart rate (HR) and anxiety. Theories propose associations between HR, perceived HR, and anxiety during stress. However, anxiety is often measured as a unidimensional construct which limits a comprehensive understanding of these relationships.

Objectives: This research explored whether HR reactivity or perceived HR change was more closely associated with cognitive and somatic anxiety during acute psychological stress.

Design: Two laboratory-based studies were conducted.

Methods: In a single laboratory session, healthy male (N?=?71; study 1) and female (N?=?70; study 2) university students completed three laboratory psychological stress tasks (counterbalanced), each with a preceding baseline. Heart rate, perceived HR change, and cognitive and somatic anxiety intensity and interpretation of anxiety symptoms were assessed immediately following each task. Data were aggregated across tasks.

Results: Actual HR change was unrelated to anxiety intensity, but was associated with more debilitative interpretations of anxiety (study 2). Perceptions of HR change were consistently associated with greater intensity of cognitive (study 1) and somatic (study 1 and 2) anxiety.

Conclusions: Perceived HR rather than actual HR is more closely associated with anxiety intensity during psychological stress. The findings have implications for stress management and the clinical treatment of anxiety symptoms.     

Eye movements when reading: The importance of the word to the left of fixation

In reading, it is well established that word processing can begin in the parafovea while the eyes are fixating the previous word. However, much less is known about the processing of information to the left of fixation. In two experiments, this issue was explored by combining a gaze-contingent display procedure preventing parafoveal preview and a letter detection task. All words were displayed as a series of xs until the reader fixated them, thereby preventing forward parafoveal processing, yet enabling backward parafoveal or postview processing. Results from both experiments revealed that readers were able to detect a target letter embedded in a word that was skipped. In those cases, the letter could only have been identified in postview (to the left of fixation), and detection rate decreased as the distance between the target letter and the eyes' landing position increased. Most importantly, for those skipped words, the typical missing-letter effect was observed with more omissions for target letters embedded in function than in content words. This can be taken as evidence that readers can extract basic prelexical information, such as the presence of a letter, in the parafoveal area to the left of fixation. Implications of these results are discussed in relation to models of eye movement control in reading and also in relation to models of the missing-letter effect.     

Critical reading effort during text revision

This study concerns one of the processes involved in written verbal production: text revising. Our aim was to experimentally test the specificity of reading for revision as compared to reading for comprehension, and to determine the cognitive cost of initiating and performing critical-reading processes. A two-session experiment was conducted on students who had to perform a comprehension task and a revising task on a text presented in its basic version, or in a version containing either syntax errors or spelling errors. An analysis of the cognitive effort associated with critical-reading and comprehension-reading processes, and of the participants’ comprehension and revising performance, showed that critical reading was more effortful than comprehension reading. It showed also that critical reading was more effortful for the text version with syntax errors than with spelling mistakes. In addition, the working memory span of the readers/revisers had a different impact on effort and performance, depending on the type of errors in the text (spelling or syntax).     

Mother–Infant Joint Attention and Sharing: Relations to Disorganized Attachment and Maternal Disrupted Communication

The normative development of infant shared attention has been studied extensively, but few studies have examined the impact of disorganized attachment and disturbed maternal caregiving on mother–infant shared attention. The authors examined both maternal initiations of joint attention and infants’ responses to those initiations during the reunion episodes of the Strange Situation Procedure at 12 and 18 months of infant age. The mothers' initiations of joint attention and three forms of infant response, including shunning, simple joint attention, and sharing attention, were examined in relation to infant disorganized attachment and maternal disrupted communication. Mothers who were disrupted in communication with their infants at 18 months initiated fewer bids for joint attention at 12 months, and, at 18 months, mothers of infants classified disorganized initiated fewer bids. However, the infant' responses were unrelated to either the infant' or the mother' disturbed attachment. At both ages, disorganized infants and infants of disrupted mothers were as likely to respond to maternal bids as were their lower risk counterparts. Our results suggest that a disposition to share experiences with others is robust in infancy, even among infants with adverse attachment experiences, but this infant disposition may depend on adult initiation of bids to be realized.     

Mood Induction in Children: Effect of the Affective Valence of a Text on Phonological Working Memory

The influence of mood on working memory capacity has been investigated in adults, albeit with conflicting results, but remains relatively unexplored in children. The present study examined the effect of a mood induction procedure on phonological working memory capacity in fourth and fifth graders. An initial working memory span test was followed first by a collective mood induction procedure, then by a second working memory span test. Results showed an effect of mood induction procedure on phonological working memory performances, with decreasing scores in the case of negative mood. These results suggest that, in certain contexts and situations, negative emotion has an impact on children’s cognitive abilities.     

Adaptation and Acculturation: Experiences of Internationally Educated Social Workers

Transnational mobility of internationally educated social workers has been on the rise for the past 20 years, with little empirical study regarding their experiences of professional adaptation. This paper contextualises and presents data from a study with 15 social workers who undertook their professional education outside Canada and have migrated to Canada within the past 10 years, regarding their professional acculturation and adaptation. The analysis focuses on elements that facilitated and mitigated their professional acculturation and the resulting adaptations participants have experienced in their practice in the Canadian context. The paper's discussion outlines the importance of a stronger grounding in professional values of social work in order to facilitate professional acculturation and adaptation of internationally educated social workers.     

A Strengths-Based Longitudinal Career Intervention for Junior Secondary School Students with Special Educational Needs: a Mixed-method Evaluation

The mixed-method study reported here was designed to evaluate a strengths-based career intervention program for secondary school students with mild special educational needs (SEN). A sample of 32 SEN students (19 boys: 13 girls) from 5 inclusive schools in Hong Kong were recruited to a treatment group. An additional 32 SEN students (19 boys: 13 girls) were selected to form the control group matched for age, gender and parents’ education level. The special needs exhibited by both groups were in areas of literacy and numeracy, attention deficits, and social-emotional problems, but did not include severe or complex disabilities. Participants in both groups responded to pre- and post-intervention questionnaires covering career development self-efficacy, personal and social development self-efficacy, and meaning in life. As a follow-up, two teachers and three social workers providing support to SEN students, and the 32 participants were interviewed several months after the intervention. Interviews also took place with teachers, social workers and students to evaluate the perceived effects of the intervention. Findings indicated significant interactions between Time 1 and Time 2, and between groups (control vs. treatment) in personal goal-setting, career goal-setting, and the presence of meaning in life. Additionally, several themes were identified from the interviews suggesting that the intervention did have positive effects on SEN students’ career, personal and social development self-efficacy, and acquisition of meaning in life.

     

Addressing complex hospital discharge by cultivating the virtues of acknowledged dependence

Theoretical Medicine and Bioethics - Every day around the country, patients are discharged from hospitals without difficulty, as the interests of the hospital and the patient tend to align: both...     

Changes in sleep quality and levels of psychological distress during the adaptation to university: The role of childhood adversity

Stress-related sleep disturbances are common, and poor sleep quality can negatively affect health. Previous work indicates that early-life adversity is associated with compromised sleep quality later in life, but it is unknown whether it predicts greater declines in sleep quality during stressful life transitions. We propose and test a conceptual model whereby individuals who reported experiencing greater levels of child maltreatment would experience greater psychological distress during a stressful life transition, which in turn would contribute to greater declines in sleep quality, relative to their quality of sleep before the stressful transition. Controlling for potential confounding variables (e.g., age, gender), structural equation modelling demonstrated that psychological distress experienced during a stressful transition (i.e., beginning life at university) mediated the relationship between childhood emotional neglect and changes in sleep quality. The hypothesized model demonstrated a good overall fit to the data, χ ² (15) = 17.69, p = .279, CFI = .99, TLI = .97, SRMR = .04, RMSEA = .04 (90% CI <0.001–0.09). Emotional neglect (β = .22) was positively associated with psychological distress which in turn was positively associated with poor sleep quality (β = .31) during a stressful transition. Future research should aim to understand the specific stressors in the university environment that are most challenging to individuals who faced early-life emotional maltreatment. These findings will help inform interventions to facilitate adaptation to a new environment and improve sleep quality for these university students.