Stuck in the middle: the many moral challenges with bariatric surgery

Bariatric surgery is effective on short- and medium-term weight loss, reduction of comorbidities, and overall mortality. A large and increasing portion of the population is eligible for bariatric surgery, which increases instant health care costs. A review of the literature identifies a series of ethical challenges: unjust distribution of bariatric surgery, autonomy and informed consent, classification of obesity and selecting assessment endpoints, prejudice among health professionals, intervention in people's life-world, and medicalization of appearance. Bariatric surgery is particularly interesting because it uses surgical methods to modify healthy organs, is not curative, but offers symptoms relief for a condition that it is considered to result from lack of self-control and is subject to significant prejudice. Taking the reviewed ethical issues into account is important when meeting persons eligible for bariatric surgery, as well as in the assessment of and decision making on surgery for obesity.     

The Affective Style Questionnaire: Development and Psychometric Properties

Affective style is an individual difference variable that refers to tendencies for regulating emotions. The emotion research literature has consistently identified three general strategies to handle emotional reactions: some strategies are aimed at re-adjusting affect to adapt successfully to situational demands; other strategies are intended to conceal or suppress affect; and a third approach is to tolerate and accept emotions, including unwanted and aversive reactions. We conducted two studies to develop a self-report measure to assess these affective styles. In the first study (n = 434), a list of 127 items related to this construct was administered. A factor analysis supported three factors: habitual attempts to conceal or suppress affect (Concealing subscale; 8 items), a general ability to manage, adjust, and work with emotions as needed (Adjusting subscale; 7 items), and an accepting and tolerant attitude toward emotions (Tolerating subscale; 5 items). The scale showed satisfactory internal consistency. Furthermore, the respective subscales showed different patterns of relations with existing instruments measuring similar constructs. Findings were cross-validated in an independent sample (n = 495). The factor structure and results of psychometric analyses were replicated. The final 20-item Affective Style Questionnaire is a brief instrument to measure individual differences in emotion regulation.     

The Importance of Culture in Cognitive and Behavioral Practice

The contributions of this special series highlight the importance of culture in cognitive-behavioral therapies. People who grow up in different cultures not only think about different things, but also seem to think differently. In other words, culture seems to shape and determine a person’s way of perceiving and reasoning. Therefore, cognitive-behavioral therapies need to be adapted to the client's cultural background and beliefs. This maximizes the likelihood that treatment strategies that have been found to be effective in one culture are also effective in another culture.     

The Effect of a Brief Mindfulness Training on Distress Tolerance and Stress Reactivity

Poor distress tolerance (DT) is considered an underlying facet of anxiety, depression, and a number of other psychological disorders. Mindfulness may help to increase DT by fostering an attitude of acceptance or nonjudgment toward distressing experiences. Accordingly, the present study examined the effects of a brief mindfulness training on tolerance of different types of distress, and tested whether trait mindfulness moderates the effect of such training. Undergraduates (n = 107) naïve to mindfulness completed a measure of trait mindfulness and underwent a series of stress tasks (cold pressor, hyperventilation challenge, neutralization task) before and after completing a 15-minute mindfulness training or a no-instruction control in which participants listened to relaxing music. Participants in the mindfulness condition demonstrated greater task persistence on the hyperventilation task compared to the control group, as well as a decreased urge to neutralize the effects of writing an upsetting sentence. No effect on distress ratings during the tasks were found. Overall trait mindfulness did not significantly moderate task persistence, but those with lower scores on the act with awareness facet of mindfulness demonstrated greater relative benefit of mindfulness training on the hyperventilation challenge. Mediation analyses revealed significant indirect effects of mindfulness training on cold pressor task persistence and urges to neutralize through the use of the nonjudge and nonreact facets of mindfulness. These results suggest that a brief mindfulness training can increase DT without affecting the subjective experience of distress.     

How to know one’s experiences transparently

Philosophical Studies - I would like to propose a demonstrative transparency model of our immediate, introspective self-knowledge of experiences. It is a model entirely in line with transparency....     

Are “implicit” attitudes unconscious?

A widespread assumption in recent research on attitudes is that self-reported (explicit) evaluations reflect conscious attitudes, whereas indirectly assessed (implicit) evaluations reflect unconscious attitudes. The present article reviews the available evidence regarding unconscious features of indirectly assessed "implicit" attitudes. Distinguishing between three different aspects of attitudes, we conclude that (a) people sometimes lack conscious awareness of the origin of their attitudes, but that lack of source awareness is not a distinguishing feature of indirectly assessed versus self-reported attitudes, (b) there is no evidence that people lack conscious awareness of indirectly assessed attitudes per se, and (c) there is evidence showing that, under some conditions, indirectly assessed (but not self-reported) attitudes influence other psychological processes outside of conscious awareness. Implications for the concept of "implicit attitudes" are discussed.     

Teaching Old Dogs New Tricks: The Role of Analogies in Bioethical Analysis and Argumentation Concerning New Technologies

New medical technologies provide us with new possibilities in health care and health care research. Depending on their degree of novelty, they may as well present us with a whole range of unforeseen normative challenges. Partly, this is due to a lack of appropriate norms to perceive and handle new technologies. This article investigates our ways of establishing such norms. We argue that in this respect analogies have at least two normative functions: they inform both our understanding and our conduct. Furthermore, as these functions are intertwined and can blur moral debates, a functional investigation of analogies can be a fruitful part of ethical analysis. We argue that although analogies can be conservative; because they bring old concepts to bear upon new ones, there are at least three ways in which they can be creative. First, understandings of new technologies are quite different from the analogies that established them, and come to be analogies themselves. That is, the concepts may turn out to be quite different from the analogies that established them. Second, analogies transpose similarities from one area into another, where they previously had no bearing. Third, analogies tend to have a figurative function, bringing in something new and different from the content of the analogies. We use research-biobanking as a practical example in our investigations.     

Acceptability and suppression of negative emotion in anxiety and mood disorders

The present study investigated perceived acceptability and suppression of negative emotion in participants with anxiety and mood disorders. Sixty participants with these disorders and 30 control participants watched an emotion-provoking film and completed self-report measures of their experience and regulation of emotions. The film elicited similar increases in negative emotion for clinical and nonclinical participants; however, clinical participants judged their resulting emotions as less acceptable and suppressed their emotions to a greater extent. The higher level of suppression in the clinical group was attributable to females in the clinical group suppressing their emotions more than females in the nonclinical group. For all participants, high levels of suppression were associated with increased negative emotion during the film and during a postfilm recovery period. Further analyses showed that appraising emotions as unacceptable mediated the relationship between negative emotion intensity and use of suppression in the clinical group. This study extends the literature on emotion regulation to a clinical sample and suggests that judging emotions as unacceptable and suppressing emotions may be important aspects of the phenomenology of emotional disorders.     

The liebowitz social anxiety scale as a self-report instrument: a preliminary psychometric analysis

The Liebowitz social anxiety scale (LSAS) is a commonly used clinician-administered instrument. The present study reports on the properties of a self-report version of the LSAS (LSAS-SR). About 175 participants diagnosed with social phobia participated in the study. The LSAS-SR showed overall good psychometric properties as indicated by the results of test-retest reliability, internal consistency, and convergent and discriminant validity. Furthermore, the scale was sensitive to treatment change. The construct validity of the LSAS-SR, however, remains to be further explored. These findings support the utility of the LSAS-SR, which has the advantage of saving valuable clinician time compared to the clinician-administered version.