Group Cognitive Behavioral Therapy for Delusions: Helping Patients Improve Reality Testing

Group Cognitive Behavior Therapy (CBT) was used to treat residual delusions in patients with schizophrenia. Initially all patients (N = 6) reported delusions of various types, such as persecution, body/mind control, grandiosity, and religious themes. The group format allowed patients to share their experiences and beliefs, thereby eliminating shame and providing support and coping strategies; as well as allowing for peer–peer discussion of irrationalities and inconsistencies in each other's beliefs. After 13 sessions there was a statistically significant reduction in delusional conviction, unhappiness associated with thinking about a delusion, intensity of distress associated with delusion, and an increased ability to dismiss a delusional thought.     

Performance on a face perception task is associated with empathy quotient scores, but not systemizing scores or participant sex

This preliminary study investigated whether individual differences in performance on a difficult social perception task (determining the sex of shape normalized, line drawn dynamic faces) are related to sex of observer, scores on an empathy quotient and scores on a systemizing quotient. Performance in the face perception task (N = 60) was above chance, indicating that participants could judge the sex of the degraded facial stimuli from dynamic information alone. There was a trend for women to be more accurate in their judgments of target sex than men, but regression analyses indicated that EQ scores alone predicted performance on the task. This study suggests that empathy may mediate sex differences in face perception abilities, and potentially other tasks in social perception.     

Metacognitive beliefs across the continuum of psychosis: comparisons between patients with psychotic disorders, patients at ultra-high risk and non-patients

BACKGROUND: Recent models of emotional disorders and psychosis implicate metacognitive beliefs in the development and maintenance of psychological distress. We predicted that patients with established psychotic disorders and those meeting at risk mental state (ARMS) criteria (and, thus, at increased risk of developing psychosis) would show higher levels of metacognitive beliefs than non-patient controls. Furthermore, we predicted that patients with psychosis would show higher levels of such beliefs than the at risk group. METHOD: The Metacognitions Questionnaire was administered to 73 patients with psychotic disorders, 43 ARMS patients and 188 non-patients. RESULTS: As predicted, patients with psychotic diagnoses and those at risk scored higher on metacognitive belief dimensions than non-patients. Patients with psychosis showed higher positive metacognitive beliefs than the at risk patients, indicating a greater range of unhelpful metacognitions overall, when compared to non-patients. CONCLUSIONS: These findings are consistent with metacognitive conceptualisations of psychological disorders. The implications of these findings for clinical practice are discussed.     

Stage-environment fit during adolescence: trajectories of family relations and adolescent outcomes

Within the framework of stage-environment fit theory, the authors examined the contribution of family relations to adolescent outcomes concurrently and longitudinally, as well as the moderating effects of gender and ethnicity in these associations. Data came from a longitudinal study of European American and African American families from a range of socioeconomic backgrounds. Results demonstrated that gender and ethnicity influenced both the level and rate of change in family relations and adolescent outcomes. Family relations contributed either concurrently or longitudinally to at least 1 of the adolescent outcomes. The effects of gender and ethnic moderation differed according to both the time frame and the outcome assessed.     

‘Can you push a camel through the eye of a needle?’ Reflections on how the unconscious speaks to us and its clinical implications

There has been a recent surge of interest in a type of thinking seen in some patients most of the time, and all patients some of the time. In the past it was simply called regressive thinking, but attempts to be more specific have led it to be called by various names, like 'pre-symbolic', 'pre-conceptual' and 'pre-operational'. What these labels attempt to capture is that the patient's thinking, at these times, is without representations and closer to actions. As a clinical phenomena I prefer to use Loewald's term, 'action–language', that is, where words become attempts to bore, seduce, anger, etc. It is different from when words are used to communicate internal states via free association. A case is made for action–language being the primary method by which the unconscious speaks to us in psychoanalytic treatment. This paper explores some of the reasons for this type of thinking, along with the clinical methods to find the thinker where there appears to be none. Distinctions will be made as to the use of the process versus the content, on the goal of interventions as bringing insight versus the capacity for insightfulness, and the model of treatment as leading to transformations in thinking, rather than lifting of repressions. A clinical example is presented to demonstrate these perspectives.     

Mediating and Moderating Processes in the Relation between Maltreatment and Psychopathology: Mother-Child Relationship Quality and Emotion Regulation

The present study investigated underlying processes of the effect of maltreatment on psychopathology (i.e., internalizing and externalizing problems) in a group of 111 maltreated and 110 nonmaltreated 7–10 year-old children (60% boys). We tested the moderating and/or mediating roles of emotion regulation and the mother-child relationship quality (pattern of relatedness) using Structural Equation Modeling. Emotion regulation, but not the pattern of relatedness, mediated the relation between maltreatment and psychopathology. This mediation was moderated by the pattern of relatedness: For the group of children with an insecure pattern of relatedness, maltreatment was related to lower levels of emotion regulation, which was predictive of higher levels of internalizing and externalizing symptomatology. In contrast, for the secure relatedness group, there was no mediation by emotion regulation since the impact of maltreatment on emotion regulation was not significant. Implications of the mediating role of emotion regulation and the buffering role of the mother-child relationship quality were discussed.

An empirical analysis of driver perceptions of the relationship between speed limits and safety

In recent decades, it has become more common for speed limits to be set for political reasons rather than for safety reasons. As a consequence, the motoring public seems to have increasingly begun questioning the rationality of speed limits. This is evident in observed speed data that show that the majority of drivers routinely exceed posted speed limits. A key motivating factor in drivers’ tendency to exceed the speed limit is that they believe that the excess speed does not threaten safety. This paper, specifically studies this matter by using a survey that asked drivers how fast above the speed limit they feel they can drive before safety is threatened. A probabilistic model is estimated using data gathered from 988 drivers in Indiana. Estimation findings show that drivers’ perception of the speed above the speed limit at which they will receive a speeding ticket is a critical determinant of what they believe is a safe speed – suggesting that enforcement plays an important role in safety perceptions. Other variables found to be significant factors in determining the speed above the speed limit at which safety is first threatened include age, gender, being previously stopped for speeding, and drivers’ ethnicity.     

Target-tilt and vertical-hemifield asymmetries in free-scan search for 3-D targets

In this study, asymmetries in finding pictorial 3-D targets defined by their tilt and rotation in space were investigated by means of a free-scan search task. In Experiment 1, feature search for cube tilt and rotation, as assessed by a spatial forced-choice task, was slow but still exhibited a characteristic “flat” slope; it was also much faster to upward-tilted cubes and to targets located in the upper half of the search field. Faster search times for cubes and rectangular solids in the upper field, an advantage for upward-tilted cubes, and a strong interaction between target tilt and direction of lighting (upward or downward) for the rectangular solids were all demonstrated in Experiment 2. Finally, an advantage in searching for tilted cubes located in the upper half of the display was shown in Experiment 3, which used a present-absent search task. The results of this study confirm that the upper-field bias in visual search is due mainly to a biased search mechanism and not to the features of the target stimulus or to specific ecological factors.     

LISTENING AND SPEAKING PSYCHOANALYTICALLY ‐ WITHWHAT IN MIND?*

In this paper, the proposition is developed that multi‐model thinking with respect both to theories of mind and to theories of technique has always been implicitly present in psychoanalytic practice as a response to the demands of the clinical moment. But this has gone unnoticed and untheorised, in part because it is hidden in general considerations regarding tact, timing and (less discussed) variations in voice tone and also because our psychoanalytic practices, without our awareness but as adaptations to the clinical moment, do not always match our theories. The author offers reasons from the broad culture of psychoanalysis why this is so. He also offers a conceptualisation and a strategy for raising the implicit and untheorised to heightened levels of awareness; he does this by highlighting the place of patient characteristics as the underpinning of theory variation and the place of a vast array of clinical possibilities as the backdrop of analytic listening. Clinical examples are used throughout.