Cognitive extension,enhancement, and the phenomenology of thinking

This paper brings together several strands of thought from both the analytic and phenomenological traditions in order to critically examine accounts of cognitive enhancement that rely on the idea of cognitive extension. First, I explain the idea of cognitive extension, the metaphysics of mind on which it depends, and how it has figured in recent discussions of cognitive enhancement. Then, I develop ideas from Husserl that emphasize the agential character of thought and the distinctive way that conscious thoughts are related to one another. I argue that these considerations are necessary for understanding why forms of cognitive extension may diminish our cognitive lives in different ways. This does not lead to a categorical rejection of cognitive enhancement as unethical or bad for human flourishing, but does warrant a conservative approach to the design and implementation of cognitive artifacts.     

Experiences and engagement with the design features and strategies of an internet-delivered treatment programme for generalised anxiety disorder: a service-based evaluation

Background: Outcome research has highlighted the efficacy of internet-based cognitive behavioural therapy (iCBT). Some process research has examined users experiences of iCBT. Understanding the user experience provides valuable feedback to developers of internet-delivered interventions.

Aim: The present study aimed to evaluate user's experiences and engagement with the design features of an internet-delivered treatment programme for anxiety.

Methods: Semi-structured interviews were conducted with 7 participant users of the Space from Anxiety programme. A thematic analysis framework was employed to analyse the data collected.

Results: Identified themes related to participants engagement and adherence with the programme material, participant's experience of personal development through interaction with the programme content and participants experience of the social features employed in the programme. Another theme investigated the various attributes or conditions necessary for internet-delivered therapy to be helpful to an individual.

Conclusion: Considering the experiences of users of online interventions provides insight into what works for whom both in terms of technological features and the various skills and strategies that may compose the treatment intervention. Knowing more about what design features and strategies/components of the intervention are attractive and keep users involved can only enhance the delivery of effective internet-delivered interventions for anxiety disorders.     

Loving styles: relationships with personality and attachment styles

We investigated the ability of the major personality dimensions, some of their underlying facet scales, and attachment styles to predict primary and secondary loving styles, as conceptualized by Lee. Personality was assessed using the International Personality Item Pool, and attachment styles through an inventory devised by Collins and Read. Respondents were 302 undergraduate students (212 females; 90 males) who participated in the study in exchange for course credit. Results of regression path analysis showed that N was the only personality dimension without direct predictive links to loving styles. Instead, the influence of N was through an anxious attachment style. There were no personality predictors of Agape, and similarities were also observed between these results and those obtained in Hong Kong. The results are discussed with reference to previous studies and some suggestions for further research are also noted. Copyright © 2003 John Wiley & Sons, Ltd.     

Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample

In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD?=?5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR?=?0.85, 95% CI: 0.78-0.93; social support AOR?=?0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR?=?0.79, 95% CI: 0.71-0.89; social support AOR?=?0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR?=?0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.     

Treatment Effects for Common Outcomes of Child Sexual Abuse: A Current Meta-Analysis

The present meta-analysis examined the effects of psychosocial treatments at reducing deleterious outcomes of sexual abuse. The meta-analysis included a total of 35 published and unpublished studies written in English, focusing on youth under the age of 18, and evaluating the effectiveness of treatments for the most common negative outcomes of sexual abuse: PTSD symptoms, externalizing problems, and internalizing problems. Results revealed medium effect sizes for PTSD symptoms, externalizing problems, and internalizing problems following treatment for sexual abuse. This study also examined the potential moderating effects of treatment (e.g., modality, duration, inclusion of caregiver) and participant (e.g., age, gender, ethnicity) characteristics. Results indicated that longer interventions were associated with greater treatment gains while group and individual treatments were equally effective. These findings shed new light on treatment effectiveness and provide useful information regarding the conditions under which treatment may be most effective. Future directions for research in this area are discussed.     

Counseling for the transition to adulthood as joint, goal-directed action

Transition is important in the career literature as it identifies times at which people are often likely to consult counselors about issues for which they need help. However, the counseling literature has not provided a conceptualization of, or research on, the joint, goal-directed actions and projects of the counselor and the client, which explicitly reflect the goal-directed nature of the transition itself. To address this issue, 12 counseling dyads, representing 37 counseling sessions, were studied. In these dyads, counseling was observed as the joint, goal-directed action between professional counselors and youth who sought assistance with their transition to adulthood. The data were collected using the action-project method. The counseling sessions were video-recorded, then immediately played back for the counselor and client separately to gather their recalled thoughts and feeling during counseling. Detailed qualitative analysis of the data set addressed the research question, “What are the goal-directed projects that counselors and their clients jointly construct, articulate, and enact relevant to the transition to adulthood?” The findings indicated the relationship and identity are intertwined goal-directed projects within counseling as well as outside of it. These projects contributed to the reframing and reorganization of clients' transition projects outside of counseling in occupational, educational, and familial domains. The findings suggest important implications for counseling youth in transition, that is, counselors and clients explicitly address their joint relationship and identity goals in an effort to realize a mutually satisfactory and important transition to adulthood.     

Bimanual reaching across the hemispace: Which hand is yoked to which?

When both hands perform concurrent goal-directed reaches, they become yoked to one another. To investigate the direction of this coupling (i.e., which hand is yoked to which), the temporal dynamics of bimanual reaches were compared with equivalent-amplitude unimanual reaches. These reaches were to target pairs located on either the left or right sides of space; meaning that in the bimanual condition, one hand's contralateral (more difficult) reach accompanied by the other hand's ipsilateral (easier) reach. By comparing which hand's difficult reach was improved more by the presence of the other hand's easier ipsilateral reach, we were able to demonstrate asymmetries in the coupling. When the cost of bimanual reaching was controlled for the contralateral reaching left hand's performance was improved, suggesting that the left hand is yoked to the right during motor output. In contrast, the right hand showed the greatest improvements for contralateral reaching in terms of reaction time, pointing toward a dominant role for the left hand in the processes prior to movement onset. The results may point toward a mechanism for integrating the unitary system of attention with bimanual coordination.     

Subjective discriminability of invisibility: A framework for distinguishing perceptual and attentional failures of awareness

Conscious visual perception can fail in many circumstances. However, little is known about the causes and processes leading to failures of visual awareness. In this study, we introduce a new signal detection measure termed subjective discriminability of invisibility (SDI) that allows one to distinguish between subjective blindness due to reduction of sensory signals or to lack of attentional access to sensory signals. The SDI is computed based upon subjective confidence in reporting the absence of a target (i.e., miss and correct rejection trials). Using this new measure, we found that target misses were subjectively indistinguishable from physical absence when contrast reduction, backward masking and flash suppression were used, whereas confidence was appropriately modulated when dual task, attentional blink and spatial uncertainty methods were employed. These results show that failure of visual perception can be identified as either a result of perceptual or attentional blindness depending on the circumstances under which visual awareness was impaired.     

LGB-Affirmative Cognitive Behavioral Treatment for Social Anxiety: A Case Study Applying Evidence-Based Practice Principles

Guided by the American Psychological Association's principles of evidence-based practice, this article reviews a single-case treatment outcome study whereby a client characteristic, sexual identity, was integrated into the assessment and treatment of social anxiety symptoms. The case involved a young adult European-American male who presented to a training clinic with a primary diagnosis of social anxiety disorder as well as secondary symptoms of excessive worry and concerns of sexual identity confusion. Recent evidence suggests that gay men report more symptoms of social anxiety when compared to heterosexual men, and those who make more efforts to conceal their sexual identity experience increased anxiety and have greater difficulty committing to a personal identity. Further, it has been hypothesized that fear of rejection from heterosexual individuals underlies this anxiety. The client attended 50 sessions over the course of 18 months. Treatment progress was assessed via self-report questionnaires assessing social anxiety and worry. Consistent with principles of evidence-based practice, a cognitive behavioral treatment protocol was employed at the outset of therapy and resulted in a decline in the client's social anxiety scores. However, once the case conceptualization and treatment focus shifted to focus on sexual identity, his scores continued to decline at an even steeper rate. He ultimately came to identify himself as having a same-sex sexual orientation, began living his life in a manner consistent with that identification, and reported a number of positive outcomes at termination of therapy. Implications for treatment of social anxiety in sexual minorities are discussed.     

Stress management interventions for HIV+ adults: a meta-analysis of randomized controlled trials, 1989 to 2006.

OBJECTIVE: Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults. DESIGN: This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress management interventions for HIV+ adults (N=3,077). MAIN OUTCOME MEASURES: Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue). RESULTS: Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d+s=0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls. CONCLUSION: Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week postintervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and White participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration.