Predictors of posttraumatic stress disorder and other psychological symptoms in trauma-exposed firefighters

Firefighters are exposed to a range of potentially traumatic stressors, yet studies examining the impact of this exposure are equivocal. Although some studies suggest increased risk for mental health problems, others suggest unusual resilience. Type of assessment methodology may contribute to the lack of consistent findings. We assessed 142 trauma-exposed, professional firefighters utilizing a standardized clinical interview and self-report measures and found low rates of posttraumatic stress disorder (PTSD) diagnoses (4.2%), and depressive, anxiety, and alcohol-abuse symptoms. Frequency of trauma exposure did not predict psychological symptoms. Perceived social support, occupational stress, coping, as well as the interaction between perceived social support and self-blame were significant predictors of symptoms. Firefighters reporting low-perceived social support and high self-blame demonstrated the highest levels of clinically significant symptoms. These findings may inform education, treatment, and resilience training for emergency personnel.     

Nature and role of change in anxiety sensitivity during NRT-aided cognitive-behavioral smoking cessation treatment

This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M (age) = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.     

Psychopharmacological enhancement: a conceptual framework

The availability of a range of new psychotropic agents raises the possibility that these will be used for enhancement purposes (smart pills, happy pills, and pep pills). The enhancement debate soon raises questions in philosophy of medicine and psychiatry (eg, what is a disorder?), and this debate in turn raises fundament questions in philosophy of language, science, and ethics. In this paper, a naturalistic conceptual framework is proposed for addressing these issues. This framework begins by contrasting classical and critical concepts of categories, and then puts forward an integrative position that is based on cognitive-affective research. This position can in turn be used to consider the debate between pharmacological Calvinism (which may adopt a moral metaphor of disorder) and psychotropic utopianism (which may emphasize a medical metaphor of disorder). I argue that psychiatric treatment of serious psychiatric disorders is justified, and that psychotropics are an acceptable kind of intervention. The use of psychotropics for sub-threshold phenomena requires a judicious weighing of the relevant facts (which are often sparse) and values.     

Fear Associated With September 11 Television Coverage in Oklahoma City Bombing Survivors

This study explored television viewing of the September 11 attacks in 99 survivors of the Oklahoma City bombing and examined the relationships of event-related television viewing with concerns about safety and danger in survivors with and without bombing-related posttraumatic stress disorder. The number of hours of viewing September 11 television coverage was related to worry about personal and family danger and to increased checking on loved ones but not to September 11–related posttraumatic responses. Some bombing survivors discontinued September 11 media contact due to fear. The findings suggest the importance of monitoring television viewing in survivors of prior incidents.     

当事人眼中的团体辅导效果：基于协商一致的质性研究

目的：本文从当事人的视角,深入研究团体辅导对于团体成员所产生的作用。方法：采用协商一致的质性研究（CQR）方法,对15个来自不同团体的当事人的深度访谈材料进行分析。结果：发现与团体辅导效果相关的域有4个,即团体辅导的过程效果、团体辅导效果获得的过程和体验、团体辅导效果的影响因素,团体辅导的后续效果。结论：当事人眼里团体辅导效果的内容广泛且丰富,团体依恋既是团体辅导效果的内容也是基础性的疗效因子。     

Selfless or Selfish? Generativity and Narcissism as Components of Legacy

Erikson’s concept of generativity, or caring for the next generation, acknowledges the presence of narcissism or any type of self-preoccupation as potentially negative. However, other theories articulate generativity as including features of self-involvement, such as a drive for symbolic immortality (McAdams and de St. Aubin J Pers Soc Psychol 62(6):1003–1015. doi:10.1037/0022-3514.62.6.1003, 1992). Recent empirical research also supports this view by identifying generativity and narcissism as both incorporating the beneficial components of agency and communion (Frimer et al. J Pers Soc Psychol 101(1):149–163. doi:10.1037/a0023780, 2011; Gebauer et al. J Pers Soc Psychol 103(3):854–878. doi:10.1037/a0029629, 2012). Moreover, creating a legacy—something left behind when one dies—entails levels of both generativity and narcissism; thus, in the presence of generativity, narcissism may be seen as positive rather than negative. The current study examined generativity and narcissism, and their association with legacy, which was coded from midlife adults’ narratives concerning the future (age 55–58; N = 155). The findings indicated that a combination of high generativity and high narcissism was associated with the highest level of composite legacy, one in which both self and other are implicated. Results are discussed in light of the potentially positive outcomes of narcissism and its synergistic properties for legacy creation when combined with generativity.     

Competencies of Process: Toward a Relational Framework for Integrated Care

As integrated care (IC) has gained more traction within both the psychosocial and medical fields, the need to train medical family therapy students and established professionals in this care typology has increased in tandem. To address this stated need, there is a large body of literature pertaining to models of care, typologies of intervention, clinical and financial effectiveness, and now a burgeoning discussion related to the academic and practice-based competencies necessary for IC practice. While the ability of the medical family therapist as behavioral health provider (MedFT/BHP) to practice in integrated settings may rely on an understanding of population-based medicine, disease etiology, medication and psychopharmacology, as well as augmentations to patient conceptualization and practice, all of the specifics related to that care are ultimately leveraged on the relationships formed by the MedFT/BHP with their healthcare colleagues. What this means is while we have attempted to distill the gestalt of integrated care into its major practice-based parts (e.g., model development and implementation, competencies, financial viability, efficacy/effectiveness, mechanisms of activation, and marketing), we have not adequately described the competencies necessary to set the stage for these types of close working relationships: relationships that make integration, of any kind, a possibility. The following paper was written to discuss three competencies related to the relational process of integration: (a) conceptual flexibility, (b) understanding and acceptance, and (c) acknowledgment and appreciation, as well as how these competencies provide the backdrop against which integrated care, as a practice, can emerge.     

Insights into sleep's role for insight: Studies with the number reduction task

In recent years, vibrant research has developed on “consolidation” during sleep: To what extent are newly experienced impressions reprocessed or even restructured during sleep? We used the number reduction task (NRT) to study if and how sleep does not only reiterate new experiences but may even lead to new insights. In the NRT, covert regularities may speed responses. This implicit acquisition of regularities may become explicitly conscious at some point, leading to a qualitative change in behavior which reflects this insight. By applying the NRT at two consecutive sessions separated by an interval, we investigated the role of sleep in this interval for attaining insight at the second session. In the first study, a night of sleep was shown to triple the number of participants attaining insight above the base rate of about 20%. In the second study, this hard core of 20% discoverers differed from other participants in their task-related EEG potentials from the very beginning already. In the third study, the additional role of sleep was specified as an effect of the deep-sleep phase of slow-wave sleep on participants who had implicitly acquired the covert regularity before sleep. It was in these participants that a specific increase of EEG during slow-wave sleep in the 10-12 Hz band was obtained. These results support the view that neuronal memory reprocessing during slow-wave sleep restructures task-related representations in the brain, and that such restructuring promotes the gain of explicit knowledge.     

Choice as a Moderator of Placebo Expectation Effects: Additional Support From Two Experiments

Two experiments investigated the hypothesis that treatment choice enhances placebo treatment efficacy. In Experiment 1, prior to a pain task, participants were given either an expectation that two (inert) products could reduce pain or no expectation. In addition, participants either selected between the two products or were assigned a product to use. Participants given both the placebo expectation and treatment choice reported the lowest pain. Experiment 2 conceptually replicated this finding using a placebo paradigm with aversive auditory stimuli. Additional control conditions indicated that a choice availability (rather than choice restriction) explanation best accounted for these results.     

Husserl's noema and the internalism‐externalism debate

In a number of papers, Hubert Dreyfus and Ronald McIntyre have claimed that Husserl is an internalist. In this paper, it is argued that their interpretation is based on two questionable assumptions: (1) that Husserl's noema should be interpreted along Fregean lines, and (2) that Husserl's transcendental methodology commits him to some form of methodological solipsism. Both of these assumptions are criticized on the basis of the most recent Husserl‐research. It is shown that Husserl's concept of noema can be interpreted in a manner that makes his theory far more congenial to a certain type of externalism, but ultimately it is argued that his phenomenological analysis of intentionality entails such a fundamental rethinking of the very relation between subjectivity and world that it hardly makes sense to designate it as being either internalist or externalist.