Confidentiality in end-of-life and after-death situations

Confidentiality is one of the foundations on which psychotherapy is built. Limitations on confidentiality in the therapeutic process have been explained and explored by many authors and organizations. However, controversy and confusion continue to exist with regard to the limitations on confidentiality in situations where clients are considering their options at the end of life and after a client has died. This article review these 2 areas and provides some suggestions for future research.     

Semantic processing without conscious identification: evidence from event-related potentials

Three event-related potential (ERP) experiments examined whether semantic content can be accessed from visually presented words that cannot be consciously identified. Category labels were shown to participants, followed by masked, briefly exposed words that were either exemplars of the category or not exemplars. The task was to verify the category, by guessing if necessary, and to identify the word, naming it if possible. Exposure durations were selected to allow identification in approximately half the trials. For identified words, there was a marked difference in the ERP response between in-category and out-of-category words because of an N400 component. For unidentified words, there was a similar although smaller difference. Conscious identification was defined using a variety of approaches: verbal report, 6-alternative forced choice, and binary categorization (in the context of the regression method; A. G. Greenwald, M. R. Klinger, & E. S. Schuh, 1995). By any definition, ERPs for unidentified words showed evidence of semantic processing. In addition, there were differences in the neuronal populations recruited to process above-threshold versus below-threshold words, suggesting qualitative differences.     

Comparison of outcomes across low-intensity psychological interventions for depression and anxiety within a stepped-care setting: A naturalistic cohort study using propensity score modelling

Low-intensity interventions for common mental disorders (CMD) address issues such as clinician shortages and barriers to accessing care. However, there is a lack of research into their comparative effectiveness in routine care. We aimed to compare treatment effects of three such interventions, utilizing four years' worth of routine clinical data. Users completing a course of guided self-help bibliotherapy (GSH), internet-delivered cognitive behavioural therapy (iCBT) or psychoeducational group therapy (PGT) from a stepped-care service within the NHS in England were included. Propensity score models (stratification and weighting) were used to control for allocation bias and determine average treatment effect (ATE) between the interventions. 21,215 users comprised the study sample (GSH = 12,896, iCBT = 6862, PGT = 1457). Adherence-to-treatment rates were higher in iCBT. All interventions showed significant improvements in depression (PHQ-9), anxiety (GAD-7) and functioning (WSAS) scores, with largest effect sizes for iCBT. Both propensity score models showed a significant ATE in favour of iCBT versus GSH and PGT, and in favour of GSH versus PGT. Discernible differences in effectiveness were seen for iCBT in comparison with GSH and PGT. Given variance in delivery mode and human resources between different low-intensity interventions, building on these findings would be valuable for future service provision and policy decision making.     

Transformative Learning: A Case for Using Grounded Theory as an Assessment Analytic

Transformative Learning Theory and pedagogies leverage disruptive experiences as catalysts for learning and teaching. By facilitating processes of critical analysis and reflection that challenge assumptions, transformative learning reframes what counts as knowledge and the sources and processes for gaining and producing it. Students develop a broader range of perspectives on and entry points for learning and behavior change engaging cognition, embodiment, aesthetics, emotions, and ethics (see Mezirow 1991 and Figures 1 and 2). The open‐inquiry, multi‐modal nature of transformative learning defies most traditional assessment strategies. This article demonstrates that grounded theory offers the rigorous qualitative analysis needed to document and track transformative learning outcomes in practice. By applying a grounded theory approach to data from over eighty student portfolios across several iterations of a Religion and Ecology course at Emory University, this article demonstrates a successful and replicable assessment of transformative learning pedagogies.     

Call me Alix,not Elix: vowels are more important than consonants in own‐name recognition at 5 months

Consonants and vowels differ acoustically and articulatorily, but also functionally: Consonants are more relevant for lexical processing, and vowels for prosodic/syntactic processing. These functional biases could be powerful bootstrapping mechanisms for learning language, but their developmental origin remains unclear. The relative importance of consonants and vowels at the onset of lexical acquisition was assessed in French‐learning 5‐month‐olds by testing sensitivity to minimal phonetic changes in their own name. Infants’ reactions to mispronunciations revealed sensitivity to vowel but not consonant changes. Vowels were also more salient (on duration and intensity) but less distinct (on spectrally based measures) than consonants. Lastly, vowel (but not consonant) mispronunciation detection was modulated by acoustic factors, in particular spectrally based distance. These results establish that consonant changes do not affect lexical recognition at 5 months, while vowel changes do; the consonant bias observed later in development does not emerge until after 5 months through additional language exposure.     

Direct and Indirect Effects of Caregiver Social Support on Adolescent Psychological Outcomes in Two South African AIDS-Affected Communities

Caregiver social support has been shown to be protective for caregiver mental health, parenting and child psychosocial outcomes. This is the first known analysis to quantitatively investigate the relationship between caregiver social support and adolescent psychosocial outcomes in HIV‐endemic, resource–scarce Southern African communities. A cross‐sectional household survey was conducted over 2009–2010 with 2,477 South African adolescents aged 10–17 and their adult caregivers (18 years or older) in one urban and one rural community in South Africa’s KwaZulu‐Natal province. Adolescent adjustment was assessed using adult caregiver reports of the Strengths and Difficulties questionnaire (SDQ), which measures peer problems, hyperactivity, conduct problems, emotional symptoms and child prosocial behavior. Hierarchical linear regressions and multiple mediation analyses, using bootstrapping procedures, were conducted to assess for: (a) direct effects of more caregiver social support on better adolescent psychosocial wellbeing; and (b) indirect effects mediated by better parenting and caregiver mental health. Direct associations (p < .001), and indirect associations mediated through better parenting, were found for all adolescent outcomes. Findings reinforce the importance of social support components within parenting interventions but also point to scope for positive intervention on adolescent psychosocial wellbeing through the broader family social network.     

Iconic Prosody in Story Reading

Recent experiments have shown that people iconically modulate their prosody corresponding with the meaning of their utterance (e.g., Shintel et al., 2006). This article reports findings from a story reading task that expands the investigation of iconic prosody to abstract meanings in addition to concrete ones. Participants read stories that contrasted along concrete and abstract semantic dimensions of speed (e.g., a fast drive, slow career progress) and size (e.g., a small grasshopper, an important contract). Participants read fast stories at a faster rate than slow stories, and big stories with a lower pitch than small stories. The effect of speed was distributed across the stories, including portions that were identical across stories, whereas the size effect was localized to size‐related words. Overall, these findings enrich the documentation of iconicity in spoken language and bear on our understanding of the relationship between gesture and speech.     

P300 amplitude variations,prior probabilities,and likelihoods: A Bayesian ERP study

The capability of the human brain for Bayesian inference was assessed by manipulating probabilistic contingencies in an urn-ball task. Event-related potentials (ERPs) were recorded in response to stimuli that differed in their relative frequency of occurrence (.18 to .82). A veraged ERPs with sufficient signal-to-noise ratio (relative frequency of occurrence > .5) were used for further analysis. Research hypotheses about relationships between probabilistic contingencies and ERP amplitude variations were formalized as (in-)equality constrained hypotheses. Conducting Bayesian model comparisons, we found that manipulations of prior probabilities and likelihoods were associated with separately modifiable and distinct ERP responses. P3a amplitudes were sensitive to the degree of prior certainty such that higher prior probabilities were related to larger frontally distributed P3a waves. P3b amplitudes were sensitive to the degree of likelihood certainty such that lower likelihoods were associated with larger parietally distributed P3b waves. These ERP data suggest that these antecedents of Bayesian inference (prior probabilities and likelihoods) are coded by the human brain.