Act First and Look Up the Law Afterward?: Medical Malpractice and the Ethics of Defensive Medicine

This essay examines the so-called phenomenon of "defensive medicine" and the problematic aspects of attempting to maintain the safest legal position possible. While physicians face genuine litigation threats they frequently overestimate legal peril. Many defensive practices are benign, but others alter patient care and increase costs in ways that are ethically suspect. Physicians should learn to evaluate realistically the legal risks of their profession and weigh the emotional, physical, and financial costs to the patient before employing a defensive measure.     

Evaluative Conditioning Is a Form of Associative Learning: On the Artifactual Nature of Field and Davey's (1997) Artifactual Account of Evaluative Learning

Field and Davey (1997) claimed that evaluative conditioning (EC), rather than being a genuine type of Pavlovian associative learning, represents nothing but an experimental artifact. They come to this conclusion by first identifying the prototypical experimental procedure of EC research, by next pointing to the potential methodological shortcomings of this prototypical procedure in order to infer associative learning, and by finally demonstrating that when the appropriate controls are added to this prototypical procedure, it becomes clear that apparent EC results represent nothing but an experimental artifact. In this paper, we first demonstrate that what Field and Davey identify as the “prototypical procedure” is, as a matter of fact, the exception rather than the rule in EC research, such that the potential scope of their criticism is rather limited. Next, we show how the results of their own experiment are actually due to an artifact that is not present in any EC study. Finally, we discuss how Field and Davey's criticism of EC research has its roots in a misconception of the appropriate within or between subject controls for Pavlovian associative learning.     

Psychological correlates of salivary cortisol secretion among unemployed men and women

The aim of the present study was to examine the association between psychological factors and salivary cortisol secretion (baseline level, reactivity to laboratory stressors) in a sample of 59 long-term unemployed men and women (mean age 42±10 years). Subjects were divided into four groups according to their basal levels of salivary cortisol as well as their reactivity to experimental stress (stress level minus baseline): (1) low base/low reactivity; (2) high base/low reactivity; (3) low base/high reactivity; and (4) high base/high reactivity. The low base/low reactivity group was characterized by significantly higher somatic anxiety, muscular tension, irritability, and depression (Beck’s Depression Inventory) and lower perceived control (mastery) than the other groups. The low base/high reactivity group was also characterized by depression and low perceived control. The high base/low reactivity group was higher in terms of monotony avoidance, Type-A behavior (JAS) and mastery, but lower in depression. The results indicate that (1) individuals with personality traits reflecting emotional distress are more vulnerable to exhaustion of the HPA-axis following long-term unemployment and (2) monotony avoidance and Type-A behavior, at least temporarily, seem to exert a beneficial influence on mental well-being among long-term unemployed individuals.     

Frustration and instrumentality of aggression

The influence of two different reinforcers of aggression was investigated: Frustration (intrinsic primary reinforcement) and instrumental value of aggression (extrinsic primary reinforcement). In the first part of the experiment frustration was manipulated on two levels by having the stooge interfere very often or seldom in the ?building a village' task of the subject. In the second part of the study the stooge had to judge distances in traffic while the subject was allowed to give him electrical shocks in order to startle and hinder the stooge in his estimation task. The aggression score of the subject was formed by the number and the intensity of the shocks delivered. Instrumentality of aggression was manipulated on two levels by indicating or not that the subjects could earn more money the more and stronger they shocked their partner. Confirming the predictions, significantly more aggression was expressed when this could lead to earning more money than in those conditions where this was not the case. Also confirming predictions, the impact of instrumentality on aggression was stronger than the influence of frustration. Frustration did not lead to a significant increase in the level of aggression.     

Conditioning two types of enuretics

Acquired enuretics (children who resume wetting after a period of dryness) have been distinguished from persistent enuretics (children who were never dry) in that the wetting of the former has been viewed as symptomatic of conflict and not modifiable by conditioning procedures. The present study compares these two types on measures of conditioning outcome and effectiveness, initial pathology and post-treatment adjustment.     

Riding the waves: A functional‐cognitive perspective on the relations among behaviour therapy,cognitive behaviour therapy and acceptance and commitment therapy

Different types of therapy explain psychopathology and the effects of psychotherapy differently. Different explanations are, however, not necessarily mutually exclusive. Based on the idea that functional and cognitive explanations are situated at different levels, we argue that functional therapies such as traditional Behaviour Therapy (BT) and Acceptance and Commitment Therapy (ACT) are not necessarily incompatible with Cognitive Behaviour Therapy (CBT). Whether a functional and a cognitive therapy actually align depends on whether they highlight the same type of environmental causes. This functional‐cognitive perspective reveals various differences and communalities among BT, CBT and ACT.