Physicians' Silent Decisions: Because Patient Autonomy Does Not Always Come First

Physicians make some medical decisions without disclosure to their patients. Nondisclosure is possible because these are silent decisions to refrain from screening, diagnostic or therapeutic interventions. Nondisclosure is ethically permissible when the usual presumption that the patient should be involved in decisions is defeated by considerations of clinical utility or patient emotional and physical well-being. Some silent decisions—not all—are ethically justified by this standard. Justified silent decisions are typically dependent on the physician's professional judgment, experience and knowledge, and are not likely to be changed by patient preferences. We condemn the inappropriate exclusion of the patient from the decision-making process. However, if a test or treatment is unlikely to yield a net benefit, disclosure and discussion are at times unnecessary. Appropriate silent decisions are ethically justified by such considerations as patient benefit or economy of time.     

Treatment of Chronic Major Depression Using the Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

This article presents data from an ABAB single case design study of a 60-year-old Caucasian male diagnosed with chronic major depressive disorder. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was utilized throughout treatment, and both BDI scores and diagnostic interviews revealed states of partial, and ultimately full remission during the course of treatment. A focus was ultimately placed on generalizing what the patient learned in-session to his outside life. Additionally, the unique design of this case illustrated that the patient experienced a moderate reduction in depressive symptoms, prior to the long-term alteration of his coping style. A stable change in his coping style was necessary before full and sustained recovery was evidenced.     

Rumination, fear, and cortisol: an in vivo study of interpersonal transgressions.

The authors sought to examine whether rumination about psychologically painful, though nontraumatic, interpersonal transgressions is associated with increased salivary cortisol. They measured salivary cortisol, rumination about a transgression, fear and anger regarding the transgressor, perceived painfulness of the transgression, and positive and negative mood in 115 undergraduates who had experienced an interpersonal transgression during the previous 7 days. They obtained measurements on as many as 5 occasions separated by approximately 14 days each. On occasions when participants reported that they had been ruminating to a degree that was greater than was typical for them, they had higher levels of salivary cortisol than was typical for them. The rumination- cortisol association appeared to be mediated by fear of the transgressor. Rumination about even moderately painful but nontraumatic life events and associated emotions are related to biological changes that may subserve social goals such as avoiding social threats. Items from the rumination scale are appended.     

Clinical Exchange: The Architectural Failure

The Clinical Exchange invites eminent clinicians of diverse persuasions to share, in ordinary language, their clinical formulations and treatment plans of the same psychotherapy patient—one not selected or nominated by those therapists—and then to discuss points of convergence and contention in their recommendations. This Exchange concerns a Mr. L, a 47-year-old, married man presenting for outpatient individual psychotherapy with chief complaints of depression, anxiety, and a lengthy history of vocational underachievement. Drs. Herbert Fensterheim, Leslie Greenberg, and Leigh McCullough, who anchor their practices in the cognitive-behavioral, experiential, and psychodynamic orientations, respectively, are the featured commentators. Finally, Dr. Jerold Gold, the case contributor and Mr. L's psychotherapist, provides a few closing comments.     

Does Cooperation in the Laboratory Reflect the Operation of a Broad Trait?

The Dictator Game, a face valid measure of altruism, and the Trust Game, a face valid measure of trust and trustworthiness, are among the most widely used behavioural measures in human cooperation research. Researchers have observed considerable covariation among these and other economic games, leading them to assert that there exists a general human propensity to cooperate that varies in strength across individuals and manifests itself across a variety of social settings. To formalize this hypothesis, we created an S‐1 bifactor model using 276 participants' Dictator Game and Trust Game decisions. The general factor had significant, moderate associations with self‐reported and peer‐reported altruism, trust, and trustworthiness. Thus, the positive covariation among economic games is not reducible to the games' shared situational features. Two hundred participants returned for a second session. The general factor based on Dictator Game and Trust Game decisions from this session did not significantly predict self‐reported and peer‐reported cooperation, suggesting that experience with economic games causes them to measure different traits from those that are reflected in self‐assessments and peer‐assessments of cooperativeness. © 2018 European Association of Personality Psychology     

Is gratitude an alternative to materialism?

Materialistic strivings have been implicated as a cause of unhappiness. Gratitude, on the other hand – both in its manifestations as a chronic affective trait and as a more temporary emotional experience – may be a cause of happiness. In the present paper we review the empirical research on the relationships among materialism, gratitude, and well-being. We present new correlational data on the gratitude–materialism relationship and propose that gratitude may have the potential to reduce materialistic strivings and consequently diminish the negative effects of materialistic strivings on psychological well-being. We conclude with some recommendations for future research on the relationships among gratitude, materialism, and well-being.     

The bimodal bilingual brain: effects of sign language experience

Bimodal bilinguals are hearing individuals who know both a signed and a spoken language. Effects of bimodal bilingualism on behavior and brain organization are reviewed, and an fMRI investigation of the recognition of facial expressions by ASL-English bilinguals is reported. The fMRI results reveal separate effects of sign language and spoken language experience on activation patterns within the superior temporal sulcus. In addition, the strong left-lateralized activation for facial expression recognition previously observed for deaf signers was not observed for hearing signers. We conclude that both sign language experience and deafness can affect the neural organization for recognizing facial expressions, and we argue that bimodal bilinguals provide a unique window into the neurocognitive changes that occur with the acquisition of two languages.     

Parents’ and Children’s Religiosity and Child Behavioral Adjustment Among Maltreated and Nonmaltreated Children

We investigated the role of parents’ and children’s religiosity in behavioral adjustment among maltreated and nonmaltreated children. Data were collected on 170 maltreated and 159 nonmaltreated children from low-income families (mean age = 10 years). We performed dyadic data analyses to examine unique contributions of parents’ and children’s religiosity and their interaction to predicting child internalizing and externalizing symptomatology. A four group structural equation modeling was used to test whether the structural relations among religiosity predictors and child outcomes differed by child maltreatment status and child gender. We found evidence of parent-child religiosity interaction suggesting that (1) parents’ frequent church attendance was related to lower levels of internalizing symptomatology among nonmaltreated children with low church attendance and (2) parents’ importance of faith was associated with lower levels of internalizing and externalizing symptomatology among nonmaltreated children with low faith. The results suggest that independent effects of parents’ religiosity varied depending on children’s religiosity and parent-child relationship.