The Art of Reflection: Turning the Strange into the Familiar

There are a great many useful articles on the dynamics and pragmatics of reflecting teams but few articles address what constitutes a good or inept reflection and why. I provide a conceptual model for thinking about what a good reflection does, distinguishing it from a nice reflection. With some further refinements in place, I then illustrate how reflections can be part of any relationship, not just clinical ones. We have opportunities to make them and to recognize when others make them to us. By using examples from my personal life—as a grandmother, daughter, radio listener, cancer survivor, and client—I attempt to ease the personal/professional binary, a project of mine for the last 35 years. In the second part of the article, I address how writing can serve reflection. Although best offered at the moment one is called for, it is never too late for a reflection. Writing allows people to offer reflections after the fact to those who have shared their stories. Sometimes, it is to ourselves we offer those reflections, when the reflector has long since dropped the thread of obligation or interest. I provide an example of working with iconic imagery to unpack meaning so that reflection can eventually take place, allowing integration to proceed, facilitating the strange becoming the familiar.     

Long-Term Follow-Up of a Randomized Controlled Trial Comparing Acceptance and Commitment Therapy and Standard Cognitive Behavior Therapy for Anxiety and Depression

The present study represents one of the first comparisons of the long-term effectiveness of traditional cognitive behavior therapy (i.e., Beckian cognitive therapy; CT) and acceptance and commitment therapy (ACT). One hundred thirty-two anxious or depressed outpatients were randomly assigned to receive either CT or ACT, and were assessed at posttreatment (n = 90) and at 1.5-year (n = 91) follow-up. As previously reported, the two treatments were equivalently effective at posttreatment according to measures of depression, anxiety, overall (social/occupational/symptom-related) functioning, and quality of life. However, current results suggest that treatment gains were better maintained at follow-up in the CT condition. Clinical significance analyses revealed that, at follow-up, one-third more CT patients were in the clinically normative range in terms of depressive symptoms and more than twice as many CT patients were in the normative range in terms of functioning levels. The possible long-term advantage of CT relative to ACT in this population is discussed.     

Effects of anger, guilt, and envy on moral hypocrisy

In the current article the authors examined the impact of specific emotions on moral hypocrisy, the tendency among people to judge others more severely than they judge themselves. In two studies, they found that (a) anger increased moral hypocrisy, (b) guilt eliminated moral hypocrisy, and (c) envy reversed moral hypocrisy. In particular, these findings were observed in two domains. In Study 1, participants responded to moral dilemmas describing unethical behavior and rated how acceptable it would be if others engaged in the unethical behavior, or alternatively, if they themselves engaged in the unethical behavior. In Study 2, participants were asked how much they would like to donate to research on cancer, or alternatively, how much they think others should donate. The results demonstrate that specific emotions influence moral decision making, even when real money is at stake, and that emotions of the same valence have opposing effects on moral judgment.     

Self–other decision making and loss aversion

In eight studies, we tested the prediction that making choices for others involves less loss aversion than making choices for the self. We found that loss aversion is significantly lessened among people choosing for others in scenarios describing riskless choice (Study 1), gambling (Studies 2 and 3), and social aspects of life, such as likeably and status (Studies 4a–e). Moreover, we found this pattern in relatively realistic conditions where people are rewarded for making desirable (i.e., profitable) choices for others (Study 2), when the other for whom a choice is made is physically present (Study 3), and when real money is at stake (Studies 2 and 3). Finally, we found loss aversion is moderated when factors associated with self–other differences in decision making are taken into account, such as decision makers’ construal level (Study 4a), regulatory focus (Study 4b), degree of information seeking (Study 4c), omission bias (Study 4d), and power (Study 4e).     

Everyday Attention: Variation in Mind Wandering and Memory in a Lecture

Understanding the factors underlying variation in attentional state is critical in a number of domains. Here, we investigate the relation between time on task and mind wandering (i.e., a state of decoupled attention) in the context of a lecture. Lectures are the primary means of knowledge transmission in post secondary education rendering an understanding of attentional variations in lectures a pressing practical concern. We report two experiments wherein participants watched a video recorded lecture either alone (Experiment 1) or in a classroom context (Experiment 2). Participants responded to mind wandering probes at various times in the lecture in an effort to track variations in mind wandering over time. In addition, following the lecture, memory for the lecture material was tested. Results demonstrate that in a lecture mind wandering increases with time on task and memory for the lecture material decreases. In addition, there was a significant relation between mind wandering and memory for lecture material. Theoretical and practical applications of the present results are discussed. Copyright © 2011 John Wiley & Sons, Ltd.     

Training in clinical ethics: launching the clinical ethics immersion course at the Center for Ethics at the Washington Hospital Center

In May 2011, the clinical ethics group of the Center for Ethics at Washington Hospital Center launched a 40-hour, three and one-half day Clinical Ethics Immersion Course. Created to address gaps in training in the practice of clinical ethics, the course is for those who now practice clinical ethics and for those who teach bioethics but who do not, or who rarely, have the opportunity to be in a clinical setting. "Immersion" refers to a high-intensity clinical ethics experience in a busy, urban, acute care hospital. During the Immersion Course, participants join clinical ethicists on working rounds in intensive care units and trauma service. Participants engage in a videotaped role-play conversation with an actor. Each simulated session reflects a practical, realistic clinical ethics case consultation scenario. Participants also review patients' charts, and have small group discussions on selected clinical ethics topics. As ethics consultation requests come into the center, Immersion Course participants accompany clinical ethicists on consultations. Specific to this pilot, because participants' evaluations and course faculty impressions were positive, the Center for Ethics will conduct the course twice each year. We look forward to improving the pilot and establishing the Immersion Course as one step towards addressing the gap in training opportunities in clinical ethics.     

Affect-biased attention as emotion regulation

The affective biasing of attention is not typically considered to be a form of emotion regulation. In this article, we argue that 'affect-biased attention' - the predisposition to attend to certain categories of affectively salient stimuli over others - provides an important component of emotion regulation. Affect-biased attention regulates subsequent emotional responses by tuning one's filters for initial attention and subsequent processing. By reviewing parallel research in the fields of emotion regulation and affect-biased attention, as well as clinical and developmental research on individual differences in attentional biases, we provide convergent evidence that habitual affective filtering processes, tuned and re-tuned over development and situation, modulate emotional responses to the world. Moreover, they do so in a manner that is proactive rather than reactive.     

Reasonable Trust

Abstract: Establishing trust among individual agents has defined a central issue of practical reasoning since the dawning of liberal individualism. Hobbes was convinced that foolish self‐interest always threatens to defeat uncompelled cooperation when one can gain by abandoning a joint effort. Against this philosophical background, scientific studies of human beings display a surprisingly cooperative species. It would seem to follow that biologically inherited characteristics impair our reason. The response proposed here distinguishes rationality and reasonableness as two forms of good reasoning. One is consistent with the model of strategic rationality, the other with a model of emotional relationship. From the Hobbesian perspective trusting agents are not rational if their makeup discourages advantageous defection even when one knows it will not be detected or punished. The point is indecisive because reasonable trust insulates cooperative action from the factors that have appeared to make it chancy or unstable without some enforcing power. A critical theme is that trust does not simply rest upon a biological disposition to conform to norms. That would explain but not justify aversion to defection. In fact, trust can survive reasoned challenges to norm‐conforming dispositions, displaying the responsible social animal living along with the rational individual.     

Concurrent and Longitudinal Relationships Between Development in Graphic,Language and Symbolic Play Domains from the Fourth to the Fifth Year

This research investigated the developing inter‐relationships between language, graphic symbolism and symbolic play both concurrently and longitudinally from the fourth to the fifth year of childhood. Sixty children (n = 60) aged between 3 and 4 years completed multiple assessments of language and assessments of graphic symbolism, symbolic play and non‐verbal intelligence. A year later, 31 children (n = 31) were re‐tested using the same assessments. The findings revealed that skills within each symbolic domain were inter‐related during the fourth year, appearing to develop in a domain‐general type fashion based upon a common underlying symbolic mechanism. However, between the fourth and the fifth years, only language had predictive validity, suggesting a shift towards the verbal mediation of symbolic play and graphic symbolism as language becomes progressively internalized (Vygotsky, 1962, 1978). Copyright © 2012 John Wiley & Sons, Ltd.     

Developing an Acceptance-Based Behavioral Treatment for Binge Eating Disorder: Rationale and Challenges

Binge eating disorder (BED), characterized by recurrent eating episodes in which individuals eat an objectively large amount of food within a short time period accompanied by a sense of loss of control, is the most common eating disorder. While existing treatments, such as cognitive behavioral therapy (CBT), produce remission in a large percentage of individuals with BED, room for improvement in outcomes remains. Two reasons some patients may continue to experience binge eating after a course of treatment are: (a) Difficulty complying with the prescribed behavioral components of CBT due to the discomfort of implementing such strategies; and (b) a lack of focus in current treatments on strategies for coping with high levels of negative affect that often drive binge eating. To optimize treatment outcomes, it is therefore crucial to provide patients with strategies to overcome these issues. A small but growing body of research suggests that acceptance-based treatment approaches may be effective for the treatment of binge eating. The goal of the current paper is to describe the development of an acceptance-based group treatment for BED, discuss the structure of the manual and the rationale and challenges associated with integrating acceptance-based strategies into a CBT protocol, and to discuss clinical strategies for successfully implementing the intervention.