An evaluation of support groups for patients with long-term chronic pain and complex psychosocial difficulties

There is a significant group of chronic pain patients with complex psychosocial needs who are frequent users of hospital outpatient departments and who do not participate in or benefit from traditional pain management treatments and are convinced there is a medical solution to their problems. They are a particularly challenging group of patients to help, often shunned by medical and psychological professionals. A new type of ten-session psycho-social group for these patients that is less demanding than traditional pain management group programmes is investigated. It is designed to foster the development into community-based self-help groups and reduce the need for professional support and unnecessary medical intervention. Accounts of four groups of patients who participated in support groups and successfully established their own groups is presented. To assess changes in motivation, mood and pain disability standardized questionnaire measures were given before and after group attendance. Findings suggest that patients benefited and took increased responsibility for their pain management but did not demonstrate positive changes on measures of mood or level of pain disability. Patients experienced satisfaction with the groups and established their own self-help community groups. The positive experience of participants and staff suggests further work with support groups would be productive for this group of patients.     

Personality,epistemology and psychotherapists' choice of theoretical model: a review and analysis

This article reviews a body of research, empirical and speculative, describing variables thought to determine a psychotherapist's choice of theoretical orientation. The review finds two types of variables (1) the influences of training, colleagues, supervisors, initial clinical experience and (2) the effects of personality traits and epistemological values, beliefs and philosophy. The weight of evidence from the reviewed studies of cognitive behavioural/behavioural and psychodynamic psychotherapists, and an analysis of the data, suggests that personality and epistemic traits are significantly involved in orientation choice. This has implications for training, practitioner and client outcome satisfaction, and understanding the poor communication that exists between these two major orientations.     

Recognition of psychopathology with religious content by clergy members: a case vignette study

Clergy members (CMs) frequently offer support and counselling for people with mental health problems. The current study aims to obtain insight into the ability among CMs to recognise psychopathology and need for psychiatric treatment. A random sample of CMs (N?=?143) and a control sample of mental health professionals (MHPs, N?=?73), were compared as to their evaluations of four vignettes. CMs considered the psychiatric states to be related to religious or spiritual problems to a similar degree as they did for the non-psychiatric states. Sensitivity of CMs with regard to the need of psychiatric care for the psychiatric states was modest (66%) and differed significantly from MHPs (96%). Specificity of the CMs was 89%, which was significantly lower than the MHPs (97%). The CMs did recognise psychopathology with religious content but clearly to a lower extent than MHPs. Requests by CMs for education about recognising psychopathology may be considered as justified.     

Priming of Pop-out in Visual Search: A Comparison of Young and Old Adults

An experiment examined potential age-related differences in priming of pop-out (Maljkovic & Nakayama, 1994, 1996, 2000; McPeek, Maljkovic & Nakayama, 1999), an implicit, memory-based phenomenon that facilitates repeated gaze or attention shifts between visually similar stimuli. Older and younger adults performed a visual search task requiring them to judge the orientation of a color singleton target. Trial-to-trial repetition of target color and/or target position primed attentional selection for both age groups, producing faster and more accurate responses. Age-related increases in the strength of priming by target color appeared to arise from generalized slowing in older observers’, but marginal age-related increases in the strength of priming by target position remained even after transformation to account for generalized slowing.     

A green Augustine: On learning to love nature well

Augustine of Hippo has expressed a vision of beauty in nature that could, if better known, encourage traditional Christians and secular ecologists to affirm the ground they have in common. For Augustine the ideal would be to see nature as God sees it, feeling deeply both its beauty and its impermanence, loving nature without clinging to it. With such clear seeing would come love and the motivation for sustained and skillful action. This paper discusses Augustine's paradigm and what blocks us from seeing it, and then frames principles for an authentically Augustinian response.     

Facing Ourselves

At the time of this writing, a widely publicized, waived-consent trial is underway. Sponsored by Northfield Laboratories, Inc. (Evanston, IL) the trial is intended to evaluate the emergency use of PolyHeme^®, an oxygen-carrying resuscitative fluid that might prevent deaths from uncontrolled bleeding. The protocol allows patients in hemorrhagic shock to be randomized between PolyHeme^® and saline in the field and, still without consent, randomized between PolyHeme^® and blood after arrival at an emergency department. The Federal regulations that govern the waiver of consent restrict its applicability to circumstances where proven, satisfactory treatments are unavailable. Blood—the standard treatment for hemorrhagic shock—is not available in ambulances but is available in hospitals. The authors argue that the in-hospital stage of the study fails to meet ethical and regulatory standards.     

Using Multilevel Mixtures to Evaluate Intervention Effects in Group Randomized Trials

There is evidence to suggest that the effects of behavioral interventions may be limited to specific types of individuals, but methods for evaluating such outcomes have not been fully developed. This study proposes the use of finite mixture models to evaluate whether interventions, and, specifically, group randomized trials, impact participants with certain characteristics or levels of problem behaviors. This study uses latent classes defined by clustering of individuals based on the targeted behaviors and illustrates the model by testing whether a preventive intervention aimed at reducing problem behaviors affects experimental users of illicit substances differently than problematic substance users or those individuals engaged in more serious problem behaviors. An illustrative example is used to demonstrate the identification of latent classes, specification of random effects in a multilevel mixture model, independent validation of latent classes, and the estimation of power for the proposed models to detect intervention effects. This study proposes specific steps for the estimation of multilevel mixture models and their power and suggests that this model can be applied more broadly to understand the effectiveness of interventions.     

The Influence of Voluntarily Induced Tension on Rational Problem Solving

Subjects (N = 152) were administered the Conceptual Systems Test (CST) and the Ross Educational Philosophical Inventory (REPI). The subjects were then classified into one of four conceptual systems, or considered to be an admixture. An analysis of variance was then performed on each of the REPI scales: Idealism, Realism, Pragmatism, and Existentialism. Significance was found among the conceptual systems on each philosophical subtest. System 1 subjects (who are most concrete on a concrete-abstract continuum) had the highest mean on the Idealism subtest; System 2 subjects (who are only slightly more abstract than System 1 subjects) were higher on the remaining three philosophical subtests. Also, the highest correlation occurring among the CST and the REPI occurred between Divine Fate Control and Idealism (r = .53).     

Book review section

The Emergence of Philosophy of Religion James Collins New Haven: Yale University Press, 1967 Pp. 517, $12.50