Medical science, culture, and truth

There is a fairly closed circle between culture, language, meaning, and truth such that the world of a given culture is a world understood in terms of the meanings produced in that culture. Medicine is, in fact, a subculture of a powerful type and has its own language and understanding of the range of illnesses that affect human beings. So how does medicine get at the truth of people and their ills in such a way as to escape its own limited constructions? There is a way out of the closed circle implicit in the idea of a praxis and the engagement with reality that is central to it and the further possibility introduced by Jacques Lacan that signification is never comprehensive in relation to the subject's encounter with the real. I will explore both of these so as to develop a conception of truth that is apt for the knowledge that arises in the clinic.     

An Intensive Outpatient Program for Veterans With Posttraumatic Stress Disorder and Traumatic Brain Injury

Post-9/11 service members may return from military service with a complicated set of symptoms and conditions, such as posttraumatic stress disorder (PTSD), depression, substance misuse, and traumatic brain injury (TBI), that interfere with reintegration and impair functioning. Although evidence-based treatments that facilitate recovery exist, their successful delivery at a sufficient dose is limited. Barriers to accessing treatment combined with challenges compiling a comprehensive treatment team further delay delivery of effective evidence-based care for PTSD, TBI, and co-occurring mental health conditions. This paper describes the development of a comprehensive, multidisciplinary, 2-week intensive day program for post-9/11 veterans with complex mental health concerns. The treatment program combines skill building groups, family education, and integrative health approaches with evidence-based individual PTSD or TBI care. Initial results from the first 132 participants were notable for a 97% completion rate, as well as statistically significant and clinically meaningful reductions in PTSD, neurobehavioral, and depression symptom severity for the 107 veterans who completed the PTSD track and the 21 who completed the TBI track. These data suggest the intensive program approach is an effective, well-tolerated model of treatment for post-9/11 veterans with PTSD and/or TBI. Future controlled studies should examine the effectiveness of this intensive model compared to standard evidence-based therapy delivery, as well as longitudinal outcomes.     

The cognitive functioning of older adult instrumental musicians and non-musicians

This study examined similarities and differences in the cognitive profiles of older adult instrumental musicians and non-musicians. We compared neuropsychological test scores among older adult non-musicians, low-activity musicians (<10 years of lessons), and high-activity musicians (≥10 years of lessons), controlling for self-reported physical and social activity, years of education, and overall health. Significant differences among groups were found on tasks of visual spatial ability, naming, and executive functioning. No significant differences were found on tests of attention/processing speed, or episodic memory. The current study supports late life cognitive benefits of early musical training, but only in select cognitive domains, including language, executive functioning, and visual spatial ability. The results are discussed in the context of cognitive reserve and aging.     

Post-Traumatic Reactions in Adolescents: How Well Do the DSM-IV PTSD Criteria Fit the Real Life Experience of Trauma Exposed Youth?

This study examined the structure and symptom specific patterns of post traumatic distress in a sample of 1,581 adolescents who reported exposure to at least one traumatic event. Symptom reporting patterns are consistent with past literature in that females reported more symptoms than males and older youth reported more symptoms than did their younger peers. Young people reporting exposure to exclusively violent type traumas were also found to be more likely to endorse symptoms than peers exposed exclusively to non violent type traumas. Confirmatory factor analysis provided stronger support for a four-factor model of PTSD than either the DSM-IV model or an alternate model. Further examination of the four factor model revealed gender differences in factor loadings with small to moderate effect sizes for recurrent, distressing memories, flashbacks, restricted affect, difficulty remember details, detachment, limited future orientation, hypervigilance and startle symptoms. Differences in factor loadings with the four factor model were also noted between younger and older adolescents, with medium to large effect sizes on the arousal items. In contract, comparison of the factor loadings revealed only small differences between youth exposed exclusively to violent traumatic stressors and those exposed exclusively to non violent traumatic stressors, suggesting relative similarity between these two groups.     

State-trace analysis of the effects of a visual illusion on saccade amplitudes and perceptual judgments

Visual illusions often appear to have a larger influence on subjective judgments than on visuomotor behavior. Although this effect has been taken as evidence for multiple estimates of stimulus size in the visual brain, dissociations between subjective judgments and visuomotor measures can frequently be reconciled with a singleestimate model. To circumvent this difficulty, we used state-trace analysis in a pair of experiments to examine the effects of the Müller-Lyer illusion on subjective length estimates, voluntary saccade amplitudes, and reflexive saccade amplitudes. All dependent measures were affected by the illusion. However, state-trace analyses revealed nonmonotonic relationships among all three variables, a pattern inconsistent with the possibility of a single underlying estimate of stimulus size.     

Mediating relationship between body mass index and the direct measures of the Theory of Planned Behaviour on physical activity intention

This research examines (a) the interrelationships between body mass index (BMI), the direct measures of the Theory of Planned Behaviour (TPB) and physical activity intention and (b) the potential mediation effects of the direct measures of the TPB in the relationship between BMI and physical activity intention in a sample of Australian adults. A total sample of 1,062 respondents participated in a computer-assisted telephone-interview (CATI) survey comprised of a standardised introduction; questions regarding TPB and physical activity; and standard demographic questions. BMI for each participant was calculated from self-reported height and weight. Separate regression analyses were performed to examine the mediating effects of each of the direct measures of the TPB on the predictive relationship between the BMI and physical activity intention, as proposed by Baron and Kenny (Journal of Personality and Social Psychology, 51(6), 1173 - 1182, 1986). Findings indicated that the direct measure of attitude and perceived behavioural control mediated the relationship between BMI and physical activity intention. However, the direct measure of subjective norm failed to act as a mediating mechanism. To date there has been no research that has examined the mechanism by which body mass may affect physical activity behaviour. Given the current focus for health promotion specialists on promoting physical activity as a strategy for reducing overweight and obesity, a theoretical understanding of weight-related barriers to physical activity may aid in the development of future interventions and community physical activity programs, particularly those targeting overweight and obese populations.     

Constructive conversations: Revisiting selected developments with clients and counsellors

Aim: to examine client and counsellor experiences in using and responding to social constructionist (e.g. solution‐focused, narrative and collaborative approaches) questions and other conversational interventions. Method: retrospective comments were elicited from 32 clients and 12 counsellors (trained in social constructionist counselling approaches) in reviewing their videotaped use of (or response to) questions and interventions from the social constructionist approaches in single session lifestyle consultations. These comments were transcribed then analysed using the constant comparison method of grounded theory. Results: five common themes (but with different emphases for clients and counsellors) were identified: exploring and adopting the client's perspective; identifying alternative perspectives; identifying strengths, possibilities, and solutions; developing a shared understanding; struggling to talk in a different way. Conclusions: the findings will be useful to counsellors interested in improving their responsive use of questions and interventions in dialogues with clients.     

The significance of task significance: Job performance effects, relational mechanisms, and boundary conditions

Does task significance increase job performance? Correlational designs and confounded manipulations have prevented researchers from assessing the causal impact of task significance on job performance. To address this gap, 3 field experiments examined the performance effects, relational mechanisms, and boundary conditions of task significance. In Experiment 1, fundraising callers who received a task significance intervention increased their levels of job performance relative to callers in 2 other conditions and to their own prior performance. In Experiment 2, task significance increased the job dedication and helping behavior of lifeguards, and these effects were mediated by increases in perceptions of social impact and social worth. In Experiment 3, conscientiousness and prosocial values moderated the effects of task significance on the performance of new fundraising callers. The results provide fresh insights into the effects, relational mechanisms, and boundary conditions of task significance, offering noteworthy implications for theory, research, and practice on job design, social information processing, and work motivation and performance.     

Resourceful Dialogues: Eliciting and Mobilizing Client Competencies and Resources

Within the social constructionist (narrative, solution-focused and collaborative language systems) therapies, therapists have increasingly focused on identifying and mobilizing clients’ resources and competencies. How such client resources and competencies are identified and elaborated can be considered empirical matters for analysts of therapeutic discourse. The present paper examines resourceful sequences of dialogue in 12 single session lifestyle consultations for how counsellors conversationally engaged consultees, and for what transpired within these sequences of dialogue. These sequences were micro-analyzed using conversation analysis and retrospective comments from consultees and therapists involved in these sequences were solicited using a videotaped replay procedure known as comprehensive process analysis [Elliott (1989). In M. Packer & R. B. Addison (Eds.), Entering the circle: Hermeneutic investigation in psychology (pp. 165–184). Albany, NY: SUNY Press]. The combined conversation analyses and related comments for three of the 23 videotaped passages analyzed are reported with the aim of enhancing therapists’ conversational practices in hosting resourceful dialogues with clients.