Identifying illness perception schemata and their association with depression and quality of life in cardiac patients

The purpose of this paper is to identify groups of cardiac patients who share similar perceptions about their illness and to examine the relationships between these schemata and psychosocial outcomes such as quality of life and depression. A total of 190 cardiac patients with diagnoses of myocardial infarction, stable angina pectoris or chronic heart failure, completed a battery of psychosocial questionnaires within four weeks of their admission to hospital. These included the Brief Illness Perceptions Questionnaire (BIPQ), Beck Depression Inventory II (BDI II) and The MacNew Health-related Quality of Life instrument (MacNew). BIPQ items were subjected to latent class analysis (LCA) and the resulting groups were compared according to their BDI II and MacNew scores. LCA identified a five-class model of illness perception which comprised the following: (1) Consequence focused and mild emotional impact, n?=?55, 29%; (2) Low illness perceptions and low emotional impact, n?=?45, 24%; (3) Control focused and mild emotional impact, n?=?10, 5%; (4) Consequence focused and high emotional impact, n?=?60, 32%; and (5) Consequence focused and severe emotional impact, n?=?20, 10%. Gender and diagnosis did not appear to reflect class membership except that class 2 had a significantly higher proportion of AMI patients than did class 5. There were numerous significant differences between classes in regards to depression and health-related quality of life. Notably, classes 4 and 5 are distinguished by relatively high BDI II scores and low MacNew scores. Identifying classes of cardiac patients based on their illness perception schemata, in hospital or shortly afterwards, may identify those at risk of developing depressive symptoms and poor quality of life.     

Similarity-based interference in a working memory numerical updating task: age-related differences between younger and older adults

Similarity among representations held simultaneously in working memory (WM) is a factor which increases interference and hinders performance. The aim of the current study was to investigate age-related differences between younger and older adults in a working memory numerical updating task, in which the similarity between information held in WM was manipulated. Results showed a higher susceptibility of older adults to similarity-based interference when accuracy, and not response times, was considered. It was concluded that older adults' WM difficulties appear to be due to the availability of stored information, which, in turn, might be related to the ability to generate distinctive representations and to the process of binding such representations to their context when similar information has to be processed in WM.     

Panic-Focused Psychodynamic Psychotherapy–Extended Range

Panic-Focused Psychodynamic Psychotherapy (PFPP) is a 24-session, twice-weekly treatment that has been manualized and has demonstrated efficacy in a randomized controlled trial in the treatment of panic disorder. The treatment has recently been extended to address additional DSM-IV anxiety disorders and Cluster C personality traits and disorders. The manualized approach identifies a set of dynamisms that contribute to panic onset and persistence involving intrapsychic conflicts about separation, autonomy, anger, and guilt. The treatment aims at increasing patients' recognition and understanding of these dynamics through exploration of the meaning and circumstances of their panic attacks, related intrapsychic dynamics, developmental factors, and the transference. The termination of treatment is particularly important in working through conflicts surrounding separation and autonomy. This article describes the formulation and psychotherapeutic approach in greater depth, and a case example is provided. We then provide a summary of the research on this treatment.     

Female Passion and the Matrix of Mother,Daughter, and Body: Vicissitudes of the Maternal Transference in the Working Through of Sexual Inhibitions

The maternal object is rarely seen as a girl's source of identification as a vibrant, sexually desirous woman. In this paper, I propose that the mother's capacity both to convey her own pride and pleasure in her female body, its sexual and procreative capacities, and to confer the privilege of passion on her daughter is requisite for a girl's full, pleasurable possession of her body and sexuality. Using observations from two analyses, I explore ways in which transformations of the negative transference manifestations of thwarted maternal sexuality and its pernicious expressions within the mother–daughter relationship paralleled recovery of a fuller capacity for sexual pleasure and agency. To offer clinical pathways toward development of female analysands' capacities for feminine pride and sexual passion, theories must allow for adaptive resolution of oedipal-period conflicts—resolution that can lead to a mature mutuality between mother and daughter.     

Parenthood and parental functions as a result of the experience of parallel psychotherapy with children and parents

The concept of parenthood as defined in classical theory and later theorizations is discussed. Parenthood is defined as a transformative process, activated by the idea of having a child and by interaction with the child, through which a constellation of affective and psychic capacities is developed, promoting growth and psychic change and evolving over time. Parental functions, rather than being learnable skills, are considered as mind functions linked to character traits that cannot be split from the personality as a whole and are, as such, susceptible to improvement through psychotherapeutic work. The author illustrates this with a model of psychotherapies and parallel analyses of parents and children tested and elaborated in public and private practice, showing its therapeutic and cognitive advantages. The central thesis of the paper is that whatever the approach and working method with the parents, the therapeutic space offered encourages certain processes that are vital for the structuring of the self and the psychic growth of the child: creation of a space for the representation and emotional investment of the child; improvement in the parental functions; and identification with the therapist as a new or reactivated developmental object. Two clinical cases illustrate the parallel evolution of therapeutic relationships and of the parent‐child relationship.     

Leadership style,salesperson's work effort and job performance: the influence of power distance

As multinational organizations increase operations in emerging economies, firms need to understand how cultural values prevailing in a host country can influence leadership practices developed and practiced in Western economies. This study explores the relationships among leadership styles and salespeople's attitudes and behaviours with data from salespeople in India with power distance measured at the individual level. Results suggest that for employees' instrumental leadership is more effective in promoting employee effort and increasing job performance. In addition, the relationship between satisfaction with supervisor and turnover intentions is weaker or insignificant, while the relationship between satisfaction with supervisor and effort is stronger for employees in higher power distance organizations. The study highlights cultural sensitivities that need to be considered in formulating an effective leadership style in emerging market contexts.     

Killing Versus Witnessing Trauma: Implications for the Development of PTSD in Combat Medics

Killing in combat uniquely predicts elevated PTSD symptomatology among military veterans. This study investigated the effects of combat killing in a sample of 345 U.S. Army combat medics who had recently returned from operational deployments to Iraq or Afghanistan. Combat medics provide frontline medical care before, during, and after battles but also fight alongside other soldiers when under attack. Attempting to kill in combat was a significant predictor of PTSD symptomatology even after accounting for passively witnessing trauma in fellow soldiers. Medics may be well prepared to cope with the passive experiencing and witnessing of war-zone trauma, but may benefit from training to cope with the negative consequences of taking actions to kill.     

Agreement between Parents and Children on Ratings of Post-Concussive Symptoms Following Mild Traumatic Brain Injury

The level of parent-child agreement on post-concussive symptoms (PCS) was examined in children following mild traumatic brain injuries (TBI). As part of a larger longitudinal study, 186 children with mild TBI and 99 with orthopedic injuries (OI), from 8 to 15 years of age, were recruited prospectively. Parents and children completed the PCS Interview (PCS-I) and the Health and Behavior Inventory (HBI) at 2 weeks, 1 month, 3 months, and 12 months postinjury. Item-level correlations between child and parent ratings on both measures of PCS were significant but modest in both groups. Parent-child correlations for composite scales on the HBI and the total score on the PCS-I were significant in both groups, but somewhat higher in the OI group than in the mild TBI group. Mean symptom ratings tended to be significantly higher for children as compared to parents, especially for somatic symptoms. Parents and children display modest agreement when reporting PCS; their ratings correlate significantly, but children report higher mean levels of symptoms than parents.     

Enacting Actuarial Fairness in Insurance: From Fair Discrimination to Behaviour-based Fairness

ABSTRACT

In line with developments in the personalisation of risk, the idea that insurance products should above all be ‘fair’ to the policyholders is increasingly voiced by commentators. The performativity thesis in Science and Technology Studies usually used to study economic markets can be used to investigate different enactments of ‘actuarial fairness’ in insurance practice. Actuarial fairness functions as a technical economic concept and was coined by the neoclassical micro-economist Kenneth Arrow (1921–2017). Faced with anti-discrimination legislation, the insurance industry has, since the 1980s, advanced the principle of actuarial fairness to legitimise their medico-actuarial technologies to discriminate between risk groups. In the absence of this actuarial fairness, it is assumed that dynamics of adverse selection—derived from neoclassical assumptions about economic actors— will result in the bankruptcy of insurance providers. The paradigmatic case of Fairzekering, a showcase of contemporary behaviour-based personalisation in car insurance, demonstrates an important shift in how actuarial fairness is enacted through behaviour-based calculative devices. Here, policyholders are enacted as being personally in control of their driving style while an interactive discount-infrastructure is set up to provide real-time feedback to incentivize policyholders towards ‘good behaviour.’ This enactment of behaviour-based fairness simultaneously implies a shift in the enactment of the economic actors involved, constitutive of the making of new economic ideas in behavioural economics.     

Elective mutism in children: A family systems approach

Abstract

Elective mutism in children is a relatively rare symptom which is more prevalent in the kindergarten population and has a higher incidence among immigrant families. Treatment strategies for this silent symptom include speech therapy, behavior modification, psychoanalytic, psychotherapeutic, family systems and a combination of these approaches. This paper reviews the types of elective mutism and proposes common characteristics of elective mutists' families. The potential for a redefinition of the term “elective mutism” is examined. It is concluded that family dynamics are an integral part of the elective mutism problem and need to be considered in a comprehensive treatment plan.