What predicts depression in cardiac patients: sociodemographic factors, disease severity or theoretical vulnerabilities?

Depression is associated with increased cardiovascular risk in acute coronary syndrome (ACS) patients, but some argue that elevated depression is actually a marker of cardiovascular disease severity. Therefore, disease indices should better predict depression than established theoretical causes of depression (interpersonal life events, reinforcing events, cognitive distortions, type D personality). However, little theory-based research has been conducted in this area. In a cross-sectional design, ACS patients (n = 336) completed questionnaires assessing depression and psychosocial vulnerabilities. Nested logistic regression assessed the relative contribution of demographic or vulnerability factors, or disease indices or vulnerabilities to depression. In multivariate analysis, all vulnerabilities were independent significant predictors of depression (scoring above threshold on any scale, 48%). Demographic variables accounted for <1% of the variance of depression status, with vulnerabilities accounting for significantly more (pseudo R2 = 0.16, χ2(change) = 150.9, df = 4, p < 0.001). Disease indices accounted for 7% of the variance in depression (pseudo R2 = 0.07, χ2 = 137.9, p < 0.001). However, adding the vulnerabilities increased the overall variance explained to 22% (pseudo R2 = 0.22, χ2 = 58.6, df = 4, p < 0.001). Theoretical vulnerabilities predicted depression status better than did either demographic or disease indices. The presence of these proximal causes of depression suggests that depression in ACS patients is not simply a result of cardiovascular disease severity.     

Sensory empathy and enactment1

The authors propose the concept of sensory empathy which emerges through contact between analyst and patient as they get in touch with an area concerning the primary bond. This area is not so much based on thoughts and fantasies as it is on physical sensations. Sensory empathy has to do with that instrument described by Freud as pertaining to the unconscious of any human, which enables one person to interpret unconscious communications of another person. The authors link this concept to that of enactment precisely because the latter concerns unconscious, early elements that fi nd in the act a fi rst meaningful expression. It involves both analyst and patient. In other words, the authors wish to emphasize the importance of the analytical process maintaining contact with that immense fi eld of human interaction that can be defi ned as primary sensory area and which becomes intertwined with the evolution of affects. Clinical examples are provided to clarify these hypotheses.     

Off Belay! The Morality of Free-soloing*

In this paper, we use qualitative and quantitative research, along with reference to current philosophical literature to consider the question of whether the sport of free-soloing is inherently immoral given the unavoidable extreme risk taken by the climber and imposed upon others not directly participating in the sport. The first thing we look at is what kind of values climbers see in free-soloing and show, through interviews we conducted with soloers and through a review of the literature on the philosophy of extreme sports, that climbers derive what might be called ‘higher pleasures’ from free-soloing. We then argue that despite its inherent riskiness, free-soloers ought to be allowed the autonomy and freedom to choose to engage in the sport, provided they are doing so in a conscientious manner. To show that they are, we again appeal to interviews we conducted to demonstrate that soloers decide to attempt a free-solo in a thoughtful manner, as prescribed by philosophers who work on the morality of decision-making under uncertainty. We finally use data that we collected through quantitative research to show that free-soloing does not make those athletes who participate in the sport into risk-taking personalities. Thus, we conclude that the sport of free-soloing is not inherently immoral.     

What role does substance use play in the social world of Australian people who have experienced homelessness? A critical realist mixed‐methods exploration

Substance use is prevalent amongst Australians who have experienced homelessness, but the social impacts of using substances amongst this group are poorly understood. This study uses a relational and critical realist approach to understand the role of substance use on the social lives of people with lived experience of homelessness. A mixed‐methods design was used to explore this question and assess the experiences of people who have exited homelessness. Recruiting across services catering to marginalised populations, 110 participants completed a cross‐sectional survey. Findings showed substance use both socially connected and disconnected participants, and that attempting abstinence required participants to negotiate and alter their social networks. To participants, being a substance “user,” or “non‐user,” was a social identity that they actively negotiated to facilitate competing social, psychological and material/embodied needs. Participants chose to engage and not engage with others to craft a social identity they valued, which had the sometimes‐negative side‐effect of limiting potential relationships, leaving users feeling isolated from their non‐users and a continued imperative to keep using. The impacts of substance use on social networks were similar for currently and formerly homeless participants, suggesting transitioning into housing may not immediately prompt a reduction in substance use or influence from substance‐using peers. Interventions with substance users with lived experience of homelessness would benefit from taking a social identity approach that incorporates an understanding of the material/embodied aspects of addiction to provide a holistic model of care that best supports the relational needs of the client.     

The paedophile and his inner world: Theoretical and clinical considerations on the analysis of a patient1

The main feature of the treatment of the paedophile is the distance that separates the analyst from the patient. However hard the analyst tries to understand his patient, the paedophile's world appears to him, especially at the beginning of the treatment, incomprehensible, disheartening and distant. This paper describes the analytic therapy of a paedophile patient. The psychopathological organization that dominates his inner world originates from a delusional nucleus in which an object (a child or an adolescent) is idealized and worshipped in place of the parents. This object promises all manner of pleasure and happiness. The positive outcome of this patient leads one to believe that, if analytically treated, some paedophile patients are open to therapeutic transformation.     

Personal and participatory socializers of the perceived legitimacy of aggressive behavior in sport

Recent international attention from the media and professional organizations has focused increasingly on violent incidents in sport. The present study developed and used the Sport Behavior Inventory (SBI) to examine personal and participatory variables that influence the socialization of the perceived legitimacy of aggressive sport behavior in children and adolescents ages 8–19 enrolled in public schools. In phase I of this study, the psychometric properties of the SBI as a measure of perceived legitimacy were evaluated in terms of content validity, structural validity, internal consistency, convergent validity, and discriminant validity. A multiple regression analysis in phase II indicated that increases in athletes’ perceptions of the legitimacy of aggressive sport behavior were positively related to age, being male, and contact sport participation. Results were discussed in relation to the social factors that contribute to the development of perceptions of legitimacy for aggressive sport behavior, and future research uses for the SBI. Aggr. Behav. 27:405–418, 2001. © 2001 Wiley‐Liss, Inc.     

Anticipated Regret and Time Perspective: Changing Sexual Risk-taking Behavior

In two studies we test the effects of anticipated affective reactions such as regret on behavioral expectations and behavior. These effects were examined in the context of sexual risk-taking behavior. More specifically, we tested the impact of the anticipated feelings associated with unsafe sex on sexual risk-taking behavior. We assumed a difference between the feelingsabout unsafe sex and the feelings people anticipate to haveafter this behavior. Two studies tested the hypothesis that respondents who are induced to focus on their anticipated, post-behavioral feelings are more likely to report negative feelings such as regret and to adopt safer sexual practices than respondents who are asked to focus on their feelings about the behavior itself. Study 1 shows that anticipated feelings after unsafe sex were more negative than feelings about the behavioral act itself, and that respondents who were asked to consider these anticipated feelings expressed stronger expectations to reduce their risk in future interactions. Thus, asking respondents to take a wider time perspective, and to consider the feelings they would haveafter having had unsafe sex, resulted in ‘safer’ behavioral expectations. Study 2 replicates the findings of Study 1, and also yielded a reliable effect of the time perspective manipulation on actual, self-reported behavior. Respondents who were asked to report on their anticipated feelings after unsafe sex showed less risky behavior in the five months following the experiment than the remaining respondents. Thus, the induced focus on post-behavioral emotions increased the likelihood of preventive behavior. Implications of these findings for behavioral intervention programs are discussed.