Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.     

Personifying the State: Consequences for Attitude Formation

Because states are abstract entities, they often require embodiment for mass publics and elites to understand them. This embodiment often occurs as personification, where the state is associated with the most salient figure in the political system, but embodiment can also occur through political institutions and social groups. Surprisingly, there is virtually no systematic empirical work on the political and psychological consequences of state personification, or other forms of embodiment. In this experiment, we investigate how various ways of embodying the state influence attitude formation processes. Drawing on the on-line/memory-based processing and entitativity literatures, we hypothesize that personification of the state should facilitate on-line processing and stronger attitudes, whereas embodying the state as a parliamentary institution should produce weaker attitudes that are formed in a memory-based fashion. The results support these hypotheses. Embodiment as a social group produced inconsistent results. This study provides the first systematic evidence that the widespread practice of personification of the state has robust and potentially far-reaching attitudinal consequences that have meaningful implications for strategic interaction, perception and learning, and attitude change in the international realm.     

Existential-Hayatological Theism

One of the oldest conceptions of theology is discourse of the poets about the gods and its philosophical interpretation. Judaism and Christianity borrowed this Greek understanding of theology and revised it only slightly to reflect its own monotheistic vision of God and God’s relations to and with the world of nature and human existence. The question as to which philosophy best explicates and justifies the oral and written mythopoetic discourse of the imaginative bards of Israel and the early Christian community became a fundamental issue and has remained so through the centuries. The aim of this essay is to explore this question once again in the context of post-liberal theology in general, the works of Abraham Heschel, Claude Tresmontant, and the Japanese theologian Tetsaturo Ariga on an implicit biblical philosophy and the explicit metaphysical theism of Alfred North Whitehead and Charles Hartshorne. The outcome of this exploration will be a rational reconstruction or ideal type of neo-classical theism or what I have chosen to call existential-hayatological theism.     

How Can Measures of Subjective Well-Being Be Used to Inform Public Policy?

ABSTRACT— The debate surrounding the use of subjective measures of well-being for policy purposes has intensified in recent years. Many social scientists are arguing that the time is right for policymakers to extend their traditional focus on material well-being and economic development to include the impact policies have on how people think and feel about their lives. However, policymakers may have many legitimate goals beyond making people happy. In this article, we begin by presenting three archetypal accounts of well-being that policymakers could use to guide policy (mental-state, objective-list, and desire-fulfillment accounts) and discussing some of the normative and methodological limitations of each. We discuss how a subjective (mental-state) approach could be used to aid the achievement of objective-list and desire-fulfillment policy goals. We then consider ways in which a subjective approach may benefit policymakers in its own right, such as by aiding the valuation of hard-to-quantify costs and benefits, providing a standard unit of measurement for comparisons of well-being across domains, and helping to set policy defaults. We conclude with a discussion of some of the remaining measurement issues and general policy implications.     

Incidental retrieval of emotional contexts in post-traumatic stress disorder and depression: an fMRI study

In the present study, we used fMRI to assess patients suffering from post-traumatic stress disorder (PTSD) or depression, and trauma-exposed controls, during an episodic memory retrieval task that included non-trauma-related emotional information. In the study phase of the task neutral pictures were presented in emotional or neutral contexts. Participants were scanned during the test phase, when they were presented with old and new neutral images in a yes/no recognition memory task. fMRI results for the contrast between old and new items revealed activation in a predominantly left-sided network of cortical regions including the left middle temporal, bilateral posterior cingulate, and left prefrontal cortices. Activity common to all three groups when correctly judging pictures encoded in emotional contexts was much more limited. Relative to the control and depressed groups the PTSD group exhibited greater sensitivity to correctly recognised stimuli in the left amygdala/ventral striatum and right occipital cortex, and more specific sensitivity to items encoded in emotional contexts in the right precuneus, left superior frontal gyrus, and bilateral insula. These results are consistent with a substantially intact neural system supporting episodic retrieval in patients suffering from PTSD. Moreover, there was little indication that PTSD is associated with a marked change in the way negatively valenced information, not of personal significance, is processed.     

Accounting for the Richness of Daily Activities

ABSTRACT— Serious consideration is being given to the impact of private behavior and public policies on people's subjective well-being (SWB). A new approach to measuring well-being, the day reconstruction method (DRM), weights the affective component of daily activities by their duration in order to construct temporal aggregates. However, the DRM neglects the potentially important role of thoughts. By adapting this method to include thoughts as well as feelings, we provide perhaps the most comprehensive measure of SWB to date. We show that some activities relatively low in pleasure (e.g., work and time with children) are nonetheless thought of as rewarding and therefore contribute to overall SWB. Such information may be important to policymakers wishing to promote behaviors that are conducive to a broader conception of SWB.     

The Implicit Relational Assessment Procedure (IRAP) as a Measure of Implicit Relative Preferences: A First Study

The Psychological Record - The Implicit Relational Assessment Procedure (IRAP) was designed to examine implicit beliefs or attitudes. In Experiment 1, response latencies obtained from Irish...     

Sex-typing in infancy: The role of the father

Recent research on mother-infant interaction has provided little empirical support for the role of environmental factors in early sex-role development. In this paper, considerable support for the father's role is presented. Specifically, the research on mother- and father-infant interaction patterns is reviewed in order to describe developmental changes in the nature of differential treatment of the sexes during the first two years of life. Together, the studies reviewed highlight the importance of the father in early sex-role socialization, delineate a developmental model of the early differential treatment of the sexes, and provide clues as to the origins of later childhood sex differences in verbal and visual-spatial abilities.     

Book reviews

Horowitz, M. J. (Ed.) (1988). Psychodynamics and cognition. Chicago: University of Chicago press. Pp. 389. ISBN 0226-35368-0. £ 21.95

Ellis A. W. & Young, A. W. (1988). Human cognitive neuropsychology. Hove: Lawrencve erlbaum Associates Ltd. Pp. 358. ISBN 0-86377-033-9, £ 21.95 9 (hardback), 0-86377-034-7, £ 11.95 (paperback).

Humphreys, G. W., & Bruce, V.(1989). Visual cognition: Computational, experimental and neuropsychological perspectives. Hove & London: Lawrence Erlbaum Associates Ltd. Pp. 330. ISBN 0-86277-124-6, £ 19.95 (hardback), 0-86377-125-4, £ 9.95 (paperback)