Spirituality and religion in psychiatry: the impact of policy

ABSTRACT

Research and debate on the importance of spirituality and religion in psychiatry has led to a number of national and international policy initiatives, intended to clarify the boundaries of good practice and improve the way in which such matters are managed for the benefit of patients. Significant amongst these is the 2015 position statement of the World Psychiatric Association, the only such policy statement to date which has been internationally agreed. Preliminary evidence available suggests that this is having good effect in generating professional debate and further national policy initiatives in different countries. There is a need for further research on such policy initiatives to confirm whether or not they have the intended impact upon clinical practice and whether or not this in turn is beneficial for patients.     

A simple intervention for stereotypical engagement with an augmentative alternative communicative device

Although electronic devices may enhance the effectiveness of some behavioral interventions for children with autism spectrum disorders, such devices may also give rise to problem behavior such as repetitious button pressing (i.e., object stereotypy). Results of this study showed that a child with autism spectrum disorder only displayed high levels of object stereotypy on an iPad? when presses generated auditory output. Subsequently, results showed that when the participant used the iPad? without auditory output, his stereotypical behavior decreased and his manding for various items simultaneously increased.     

Meta‐analysis of behavioral self‐management techniques used by students with disabilities in inclusive settings

This comprehensive review synthesizes findings from 29 studies in which students with disabilities utilized behavioral self‐management techniques in inclusive settings. Findings suggest that consistent with 2 earlier reviews of these types of studies, most behavioral self‐management techniques continue to be adaptable in inclusive settings with moderate to strong efficacy. This review identifies strengths as well common limitations of the studies, provides recommendations for future research and practice, and includes behavioral self‐management resources.     

AGSuite: Software to conduct feature analysis of artificial grammar learning performance

To simplify the problem of studying how people learn natural language, researchers use the artificial grammar learning (AGL) task. In this task, participants study letter strings constructed according to the rules of an artificial grammar and subsequently attempt to discriminate grammatical from ungrammatical test strings. Although the data from these experiments are usually analyzed by comparing the mean discrimination performance between experimental conditions, this practice discards information about the individual items and participants that could otherwise help uncover the particular features of strings associated with grammaticality judgments. However, feature analysis is tedious to compute, often complicated, and ill-defined in the literature. Moreover, the data violate the assumption of independence underlying standard linear regression models, leading to Type I error inflation. To solve these problems, we present AGSuite, a free Shiny application for researchers studying AGL. The suite’s intuitive Web-based user interface allows researchers to generate strings from a database of published grammars, compute feature measures (e.g., Levenshtein distance) for each letter string, and conduct a feature analysis on the strings using linear mixed effects (LME) analyses. The LME analysis solves the inflation of Type I errors that afflicts more common methods of repeated measures regression analysis. Finally, the software can generate a number of graphical representations of the data to support an accurate interpretation of results. We hope the ease and availability of these tools will encourage researchers to take full advantage of item-level variance in their datasets in the study of AGL. We moreover discuss the broader applicability of the tools for researchers looking to conduct feature analysis in any field.     

Complexity of online gender confirmation resources surpass patient literacy

Background: Increasing transgender health care coverage has resulted in easier access to gender confirmation surgery. Patients considering surgery consistently access medical information online to improve knowledge regarding surgical options, complications, recovery, and life after transitioning. As a result, national health institutes recommend that patient educational materials be written at a sixth-grade–reading level. The purpose of this study is to assess the complexity of online gender confirmation surgery information.

Methods: An Internet search was performed using the key phrase “transgender surgery”. Health care and non–health care websites were evaluated for pertinent articles regarding gender confirmation surgery. Readability analyses were conducted using Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. A two-tailed z test was used to compare means; significance was set at p ≤ 0.05.

Results: A total of 108 articles from 87 websites were analyzed. The average readability for all online gender confirmation-surgery information was at an 11th-grade reading level. Materials written by health care entities were written at a 12th-grade–reading level compared to non–health care articles, which were written at a 10th-grade level (p < 0.001). Male-to-female surgery materials were written at a 12th-grade level, significantly higher than the 11th-grade reading level of female-to-male surgery materials (p = 0.04).

Conclusion: Online information regarding gender confirmation surgery is written at a level that is too complex for patients to understand. Informational materials should be written at lower grade levels to improve patient education, informed consent, and outcomes.     

Associating a time‐based prospective memory task with an expected context can improve or impair intention completion

Three experiments investigated time‐based prospective memory defined here as remembering to fulfil an intention during a later window of time. When people associated the response window with a future context, time‐based responding was better if that context expectation was correct as compared with having no context expectation at all. By contrast, if the response window occurred in a context that preceded the expected context, time‐based performance was worse than having no context expectation at all. An explicit reminder about the intention was sufficient to ameliorate the decrement found with an incorrect context association. However, successfully completing a different, event‐based prospective memory intention was not sufficient to overcome the incorrect context association. The authors assert that possessing such associations alters normal monitoring of the passage of time which in turn leads to the pattern of results obtained. Copyright © 2004 John Wiley & Sons, Ltd.     

An observation on the spontaneous noticing of prospective memory event-based cues

In event-based prospective memory, current theories make differing predictions as to whether intention-related material can be spontaneously noticed (i.e., noticed without relying on preparatory attentional processes). In 2 experiments, participants formed an intention that was contextually associated to the final phase of the experiment, and lures that overlapped to differing degrees with the features of the intention-related cues were embedded in the initial phase. When participants were outside of the appropriate responding context (i.e., the initial phase), they exhibited slower latencies to lures that exactly matched the features of their intention compared with other types of lures and control words. In addition, on a final remember/know recognition test, participants reported having greater subjective recollection for the occurrence of the exact-match lures. These results suggest that exact-match lures were spontaneously noticed and differentially processed in the absence of any observable preparatory attentional processes. The findings have implications for the theoretical debate over whether preparatory attention must always be relied upon to notice intention-related material.     

Children's beliefs about the fantasy/reality status of hypothesized machines

Four-year-olds, 6-year-olds, and adults were asked to make judgments about the reality status of four different types of machines: real machines that children and adults interact with on a daily basis, real machines that children and adults interact with rarely (if at all), and impossible machines that violated a real-world physical or biological causal law. Adults generally categorized all of the machines accurately. Both groups of children categorized familiar possible machines as real, but were agnostic as to the fantasy status of unfamiliar possible machines. Children generally responded that both kinds of impossible machines were make-believe, but 4-year-olds were more likely to make these accurate judgments for the physical than biological items, different from the older children and adults (whose responses were similar). These data suggest that children's judgments about the possibility of machines are not strictly limited by first-hand experience. Young children's domain-specific causal knowledge interacts with their understanding of the fantasy/reality distinction to constrain their inferences in a rational way.     

Maternal depressive history, teen 5HTTLPR genotype, and the processing of emotional faces: Exploring mechanisms of risk

Variations in the serotonin transporter gene (5HTTLPR) and biased processing of face-emotion displays both have been implicated in the transmission of depression risk, but little is known about developmental influences on these relationships. Within a community sample of adolescents, we examine whether 5HTTLPR genotype moderates the link between maternal depressive history and errors in face-emotion labeling. When controlling for current levels of depression and anxiety among youth, a two-way interaction between maternal depressive history and 5HTTLPR genotype was detected. Specifically, adolescents whose mothers reported a depressive history and who had a low expressing genotype made more errors in classifying emotional faces when compared with adolescents with an intermediate or high expressing genotype, with or without maternal depression history. These findings highlight the complex manner in which maternal depression and genetic risk may interact to predict individual differences in social information processing.     

Where science starts: spontaneous experiments in preschoolers' exploratory play

Probabilistic models of expected information gain require integrating prior knowledge about causal hypotheses with knowledge about possible actions that might generate data relevant to those hypotheses. Here we looked at whether preschoolers (mean: 54 months) recognize “action possibilities” (affordances) in the environment that allow them to isolate variables when there is information to be gained. By manipulating the physical properties of the stimuli, we were able to affect the degree to which candidate variables could be isolated; by manipulating the base rate of candidate causes, we were able to affect the potential for information gain. Children’s exploratory play was sensitive to both manipulations: given unambiguous evidence children played indiscriminately and rarely tried to isolate candidate causes; given ambiguous evidence, children both selected (Experiment 1) and designed (Experiment 2) informative interventions.