La terapia de conducta en el tratamiento de la anorexia nerviosa ¿eficaz o peligrosa?

RESUMEN

Por el peligro físico que supone y los delicados matices de sus alteraciones, la anorexia nerviosa constituye un verdadero reto para los procedimientos tradicionales en la práctica clínica. El uso reciente de técnicas de terapia de conducta se ha visto también contestado por su supuesta peligrosidad para las personas que padecen esta importante alteración. En este artículo se revisan los principios fundamentales que sustentan este tipo de terapia y sus implicaciones en la salud del enfermo. Al final del artículo se presenta un breve estudio de casos tratados con terapia conductual.     

Visual search of emotional faces: The role of affective content and featural distinctiveness

We investigated the source of the visual search advantage of some emotional facial expressions. An emotional face target (happy, surprised, disgusted, fearful, angry, or sad) was presented in an array of neutral faces. A faster detection was found for happy targets, with angry and, especially, sad targets being detected more poorly. Physical image properties (e.g., luminance) were ruled out as a potential source of these differences in visual search. In contrast, the search advantage is partly due to the facilitated processing of affective content, as shown by an emotion identification task. Happy expressions were identified faster than the other expressions and were less likely to be confounded with neutral faces, whereas misjudgements occurred more often for angry and sad expressions. Nevertheless, the distinctiveness of some local features (e.g., teeth) that are consistently associated with emotional expressions plays the strongest role in the search advantage pattern. When the contribution of these features to visual search was factored out statistically, the advantage disappeared.     

When does the brain distinguish between genuine and ambiguous smiles? An ERP study

Event-related brain potentials (ERPs) were recorded to assess the processing time course of ambiguous facial expressions with a smiling mouth but neutral, fearful, or angry eyes, in comparison with genuinely happy faces (a smile and happy eyes) and non-happy faces (neutral, fearful, or angry mouth and eyes). Participants judged whether the faces looked truly happy or not. Electroencephalographic recordings were made from 64 scalp electrodes to generate ERPs. The neural activation patterns showed early P200 sensitivity (differences between negative and positive or neutral expressions) and EPN sensitivity (differences between positive and neutral expressions) to emotional valence. In contrast, sensitivity to ambiguity (differences between genuine and ambiguous expressions) emerged only in later LPP components. Discrimination of emotional vs. neutral affect occurs between 180 and 430 ms from stimulus onset, whereas the detection and resolution of ambiguity takes place between 470 and 720 ms. In addition, while blended expressions involving a smile with angry eyes can be identified as not happy in the P200 (175–240 ms) component, smiles with fearful or neutral eyes produce the same ERP pattern as genuinely happy faces, thus revealing poor discrimination.     

Extrafoveal capture of attention by emotional scenes: affective valence versus visual saliency

ABSTRACT

Pairs of emotional (pleasant or unpleasant) and neutral scenes were presented peripherally (≥5° away from fixation) during a central letter-discrimination task. Selective attentional capture was assessed by means of eye movement orienting, i.e., probability of first fixating a scene and the time until first fixation. Static and dynamic visual saliency values of the scenes were computationally modelled. Results revealed selective orienting to both pleasant and unpleasant relative to neutral scenes. Importantly, such effects remained in the absence of visual saliency differences, even though saliency influenced eye movements. This suggests that selective attention to emotional scenes is genuinely driven by the processing of affective significance in extrafoveal vision.     

对现行医疗损害鉴定方式进行改革的探讨

医惠纠纷要顺畅解决必须成立一个独立于卫生行政机关,能独立承担法律责任、能高速运转,医患双方均能认可、中立并且权威的医疗损害鉴定机构,用单一的医疗损害鉴定来取代现行的医疗事故技术鉴定和医疗过错司法鉴定.采用仲裁构架模式设立医疗损害鉴定委员会和成立中国医疗损害鉴定协会对医疗损害进行鉴定是一种可行的方法.     

大学生信任倾向与心理健康的关系：个体差异的视角

通过对203名大学生进行人际信任量表（ITS）和新版明尼苏达多相人格问卷（MMPI-2）的施测,从个体差异的角度来考察大学生信任倾向与各心理健康症状之间的关系。结果表明,MMPI-2临庆量表中的抑郁、精神衰弱、精神分裂症和社会内向性,内容量表中的焦虑、恐惧、强迫性、抑郁、怪异思维、愤怒、愤世嫉俗、反社会行为、A型行为、低自尊、社会不适、家庭问题、工作障碍、治疗反感,均与信任倾向呈负相关。此外,四类不同心理健康特征的被试在信任倾向上存在差异,适应良好型被试的信任倾向得分显著高于其他三类,适应不良型的信任倾向显著低于其他三类,精神敏感型和外向冲动型的信任倾向居中．且这两娄之间没有显薯差异。     

Young Tennis Players’ Competitive Task Involvement and Performance: The Role of Goal Orientations,Contextual Motivational Climate,And Coach-Initiated Motivational Climate

The purpose of this study was to examine the role of situational and dispositional factors in contributing to competitive task involvement and performance in young tennis players. One hundred fifty-one adolescent tennis players and their coaches participated in the study. Participants responded to instruments measuring pre-game dispositional goal orientations and perceptions of the motivational climate and post-game task involvement in the competition by assessing concentration, loss of self-consciousness, and autotelic experience, perceptions of coach-initiated motivational climate in competition, and self-evaluation of game performance. In addition, coaches evaluated the players’ performance. Results showed that task involvement was predicted by players’ perceptions of a coach-initiated learning motivational climate in competition. Loss of self-consciousness was predicted by the players’ perceptions of a coach-initiated performance climate in competition. Finally, coaches’ and players’ assessment of performance were predicted by autotelic experience, concentration, and by perception of coach-initiated learning and performance orientation in competition.     

Effects of test anxiety on motor learning: The processing efficiency hypothesis

Abstract

The hypothesis that, under test (stress) conditions, high trait-anxious individuals invest extra processing resources to reach motor learning levels similar to those of low-anxious individuals was investigated. A transfer procedure (practice trial, rest interval, and transfer trial) was employed to analyse motor learning effects. In Experiment 1, a secondary task (click detection) was used to measure the extra processing resources expenditure on motor learning during the practice trial. Neither motor performance in the transfer trial nor secondary task performance differed as a function of test condition or anxiety trait. A critical analysis of the secondary task paradigm suggested that it was not sensitive enough to reflect the amount of processing capacity expended on the primary motor tasks. In Experiment 2, subjects performed a loading task (verbal shadowing of sentences) concurrently with the motor tasks during the practice trial to prevent extra resources from being allocated to motor learning. Results showed that anxiety trait was associated to performance time increments on the high-demanding motor tasks in the transfer trial. A plausible explanation is that anxiety impairs learning because it reduces the efficiency of processing. An alternative interpretation, concerning an ability deficit of high trait-anxious individuals, is discussed.     

Test anxiety and ego-threatening stress: Over- (and under-) estimation of emotional reactivity

Abstract

This study examined discrepancies between subjective and objective measures of state anxiety as a function of test anxiety in undergraduates. Under evaluative stress conditions, state anxiety was assessed in terms of (a) self-reported cognitive and somatic anxiety, (b) behavioral reactivity (motor and facial tension, avoidance comments and avoidance of eye contact), (c) physiological arousal (heart rate and skin resistance), and (d) cognitive and motor task performance. Participants high in test anxiety showed disproportionately greater self-reported than objective state anxiety. In contrast, those low in test anxiety showed lower self-reported than objective anxiety. The high- and the low-test-anxiety groups differed only in self-reported emotional reactivity. In line with current cognitive theories of anxiety, overestimation of reactivity in high-test anxiety, as well as underestimation in low-test anxiety, are conceptualized as a hypervigilance bias and an avoidance bias, respectively, in processing internal cues, i.e., prioritization and inhibition of attention to one's own behavioral and physiological signs of distress.