On the Modification of Clinical Procedures

All sciences depend for their progress on the modification of existing procedures and the clinical sciences arc no exception. The question is raised whether the restriction of modifications of clinical procedures, even though legally defensible, is socially and scientifically helpful.     

Covert communication in laboratories, classrooms, and the truly real world

Hundreds of research studies have demonstrated that one person's expectations for the behavior of another person can actually affect that other person's behavior. These studies implicate the operation of processes of covert communication, communication that is subtle, largely nonverbal, and ordinarily unintended. The earliest studies of these processes showed that through their expectations, laboratory researchers unwittingly affected the responses of their research participants. Later studies showed that teachers' experimentally induced expectations about their pupils affected the pupils' intellectual performance. Most recently, studies of covert communication processes have extended to diverse contexts, such as the judicial and health care systems. For example, research indicates that judges' beliefs about the guilt of trial defendants can be unwittingly communicated to juries by the judges' nonverbal behavior during jury instruction. In addition, studies of covert communication in medical contexts show that physicians' effectiveness in persuading their patients to enter into treatment can be predicted from their tone of voice in talking to or about their patients. For example, one study showed that surgeons who used a bossy tone of voice when talking to their patients were more likely to be sued by their patients than were surgeons who used a more respectful tone. In sum, then, we have learned a great deal about the importance of subtle processes of nonverbal communication, but a great deal more is yet to be learned about these processes as they occur in the relatively sheltered context of laboratories and classrooms and in the rough-and-tumble of the truly real world beyond.     

Comparing the effectiveness of behavioral treatment for chemotherapy-induced nausea and vomiting when administered by oncologists, oncology nurses, and clinical psychologists.

Adequate control of side effects during medical treatment of cancer increases patient compliance and quality of life. Antiemetic drugs are not an effective treatment for the one in three cancer patients on chemotherapy who experience anticipatory nausea and vomiting (ANV); the behavioral treatment of systematic desensitization has been found effective for ANV when delivered by clinical psychologists. This study examined the effectiveness of systematic desensitization when delivered by medical personnel versus clinical psychologists. Seventy-two consecutive cancer patients with ANV were randomly assigned to no-treatment control or to systematic desensitization from 5 behaviorally trained clinical psychologists, 6 clinical oncologists, or 10 oncology nurses. The treatment was found effective in reducing anticipatory nausea, anticipatory vomiting, posttreatment nausea, and posttreatment vomiting compared to control patients, with no significant differences in effectiveness found between clinical psychologists and oncology staff. Although medical personnel should not engage patients in psychotherapy or other interventions that cannot be completed successfully, they can treat patients effectively with systematic desensitization and should be encouraged to learn and use this and other behavioral intervention techniques to benefit total patient care.     

Skin conductance,reaction time,and observational ratings in learning-disabled children

Rates of GSR habituation, reactiontime responses, and observational ratings in normal and learningdisabled children were evaluated. Compared to normals, children with learning disabilities demonstrated faster rates of GSR habituation in a task involving active attention, slower reactiontime responses, and more characteristics of “minimal brain dysfunction” on a rating scale. Within the learningdisability group those subjects with a family history of reading problems showed fewer GSR, reactiontime, and rating responses characteristic of “minimal brain dysfunction.”     

Reactivity to sensations in borderline personality disorder: a preliminary study

Individuals with borderline personality disorder (BPD) are widely considered to have problems with emotional reactivity. However, the specific kinds of stimuli that are associated with heightened emotional reactivity in BPD have not been well characterized. Thus, it is unclear whether the emotional dysfunction in BPD occurs in response to any emotionally evocative stimuli, or to specific classes of stimuli. In this study, we used subjective measures (self-report and interview-based) to compare reactivity to sensations (auditory, gustatory, olfactory, tactile, visual) between participants with BPD (n = 30) and healthy controls (n = 50). Controlling for trait negative emotional reactivity, individuals with BPD reported being significantly more reactive across sensory stimuli. However, the difference between controls and BPD was significantly greater for reactivity to auditory stimuli compared to other sensory stimuli. Findings from this study provide preliminary data suggesting individuals with BPD may be characterized by heightened self-reported reactivity to aversive sounds.     

Perceptual organization without perception. The subliminal learning of global contour

A critical step in visual perceptual processing is integrating local visual elements into contours so that shapes can be derived from them. It is often assumed that contour integration may reflect hardwired coding of low-level visual features. In this study, we present novel evidence indicating that integration of local elements into contours can be learned subliminally, despite being irrelevant to the training task and despite the local properties of the display varying randomly during training. Learning occurred only when contours were consistently paired with task-relevant targets--echoing the findings of previous studies on subliminal learning of low-level features. Our data indicate that task-irrelevant, exposure-based learning extends beyond local low-level visual features and may play a critical role at multiple levels of visual perceptual organization.