The Hard-to-Engage Patient: A Treatment Failure

I discuss the relatedness with certain hard-to-engage patients as a kind of dissociative enactment, and I present a case illustration of a man whom I liked but could not help.     

The Health Behavior of Sri Lankan Buddhist Nuns with Type 2 Diabetes: Duty, Devotion, and Detachment

Sri Lanka has experienced an increase in the rate of type 2 diabetes. Selfmanagement of diabetes among Sri Lanka’s Buddhist nuns, who depend on food donations and limit physical activity in accord with the monastic code of conduct, presents unique challenges and has not been previously studied. The purpose of this focused ethnographic study of 10 Buddhist nuns was to understand how they managed their illness within the restrictions on diet and physical activity. Three themes—duty, devotion, and detachment—explained and described their health behavior regarding type 2 diabetes within the context of their daily routines and obligations.     

Transference Focused Psychotherapy for Patients with Comorbid Narcissistic and Borderline Personality Disorder

Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experience with and research data on patients with comorbid narcissistic personality disorder/borderline personality disorder (NPD/BPD). We briefly review object relations formulations of severe narcissistic pathology, as well as recent research in attachment and the allied concept of mentalization, which have provided a new lens through which to view narcissistic disorders. The research findings from two randomized clinical trials demonstrating the efficacy and effectiveness of TFP are presented. The data from the two Randomized Clinical Trials (RCT) allowed for the study of the characteristics of the subgroup of borderline personality disorder patients who have comorbid NPD/BPD. Findings on comorbidity, attachment status, capacity for mentalization, and level of personality organization of borderline patients with comorbid NPD/BPD, compared with borderline patients without comorbid narcissistic pathology (BPD), are presented. Clinical implications of the observed group differences are discussed, with a focus on refinements in the technique of TFP. Clinical case material is presented to illustrate the specific challenges posed by narcissistic patients to carrying out TFP in each phase of treatment.     

Facilitating Collaborative Knowledge Building

This article describes a detailed analysis of knowledge building in a problem-based learning group. Knowledge building involves increasing the collective knowledge of a group through social discourse. For knowledge building to occur in the classroom, the teacher needs to create opportunities for constructive discourse in order to support student learning and collective knowledge building. In problem-based learning, students learn through collaborative problem solving and reflecting on their experiences. The setting for this study is a group of second-year medical students working with an expert facilitator. The analysis was designed to understand how the facilitator provided opportunities for knowledge-building discourse and how the learners accomplished collective knowledge building. We examined episodes of knowledge-building discourse, the questions and statements that the students and facilitator generated throughout the tutorial, the change in their understanding of the problem that they were solving, and the collective knowledge that was constructed. The results indicate that the group worked to progressively improve their ideas through engaging in knowledge-building discourse. The facilitator helped support knowledge building through asking open-ended metacognitive questions and catalyzing group progress. Students took responsibility for advancing the group's understanding as they asked many high-level questions and built on each others thinking to construct collaborative explanations. The results of this study provide suggestions for orchestrating knowledge-building discourse.     

Examining the Relationships Between the Justice Facets and Turnover Intent: The Mediating Roles of Overall Justice and Psychological Strain

We examined how interpersonal justice from coworkers, the traditional justice facets (i.e., distributive, procedural, interpersonal, informational), and overall justice perceptions relate to employee psychological strain and turnover intentions in Canadian Armed Forces personnel. Specifically, we hypothesized that overall justice would mediate the relationships between the justice facets (including coworker justice) and strain, and strain would mediate the relationship between overall justice and turnover intent. We used a cross-sectional correlational design with personnel from 2 military units (total N = 218) as our sample. A 2-step structural equation modeling technique was used to evaluate our hypotheses. Support for our hypotheses was obtained with 1 exception: informational justice did not predict overall justice judgments. Our results suggest that employees’ reactions to individual justice events and different sources of justice exert their effects on strain and turnover intent indirectly through their impact on a global evaluation of justice in their work environment.     

Abusive interactions and burnout: Examining occupation,gender, and the mediating role of community

Abstract

Two studies examined the association of gender and occupational group (nursing versus non-nursing) with perceived risk of abuse (sexual harassment and verbal and physical abuse) as well as the relationship of perceived abuse risk with burnout and sense of community. Study 1, comprising of two settings (tertiary care hospital, N = 3,062; psychiatric hospital, N = 383), found gender and occupational group associated with perceived risk of abuse (women felt greater risk than men; nurses felt greater risk than non-nurses). It also found a gender/occupational group interaction. Study 2, conducted at an Irish tertiary care hospital (N = 892), found nurses felt at greater risk for all three types of abuse than did non-nurses. Further, women perceived themselves at greater risk for sexual harassment and verbal abuse than did men; the study found no gender difference regarding physical abuse. The analysis identified a gender/occupational group interaction for sexual harassment. The study considers methods of reducing perceived risk in regard to the research literature on abuse at work.     

Age Differences in the Magnitude of the Attentional Blink

When people attend to a target in a rapid sequence of items, their perception of a subsequent target is impaired for about 500 ms. This is termed the attentional blink. In the present experiment, a dual task rapid serial presentation task (Raymond, Shapiro & Arnell, 1992) was used as a measure of inhibitory function of younger and older adults. We found that the attentional blink was larger among older adults as compared to younger adults, supporting Hasher and Zacks' (1988) inhibitory deficit hypothesis and current models of the attentional blink.     

Sex Differences in Cognition are Stable Over a 10-Year Period in Adulthood and Old Age

ABSTRACT

Sex differences in declarative memory and visuospatial ability are robust in cross-sectional studies. The present longitudinal study examined whether sex differences in cognition were present over a 10-year period, and whether age modified the magnitude of sex differences. Tests assessing episodic and semantic memory, and visuospatial ability were administered to 625 nondemented adults (initially aged 35–80 years), participating in the population-based Betula study at two follow-up occasions. There was stability of sex differences across five age groups and over a 10-year period. Women performed at a higher level than men on episodic recall, face and verbal recognition, and semantic fluency, whereas men performed better than women on a task-assessing, visuospatial ability. Sex differences in cognitive functions are stable over a 10-year period and from 35 to 90 years of age.     

Space Fortress game training and executive control in older adults: A pilot intervention

ABSTRACT

We investigated the feasibility of using the Space Fortress (SF) game, a complex video game originally developed to study complex skill acquisition in young adults, to improve executive control processes in cognitively healthy older adults. The study protocol consisted of 36 one-hour game play sessions over 3 months with cognitive evaluations before and after, and a follow-up evaluation at 6 months. Sixty participants were randomized to one of three conditions: Emphasis Change (EC) – elders were instructed to concentrate on playing the entire game but place particular emphasis on a specific aspect of game play in each particular game; Active Control (AC) – game play with standard instructions; Passive Control (PC) – evaluation sessions without game play. Primary outcome measures were obtained from five tasks, presumably tapping executive control processes. A total of 54 older adults completed the study protocol. One measure of executive control, WAIS-III letter–number sequencing, showed improvement in performance from pre- to post-evaluations in the EC condition, but not in the other two conditions. These initial findings are modest but encouraging. Future SF interventions need to carefully consider increasing the duration and or the intensity of the intervention by providing at-home game training, reducing the motor demands of the game, and selecting appropriate outcome measures.