Exercise therapy for depression in middle-aged and older adults: predictors of early dropout and treatment failure.

Psychosocial factors predicting treatment dropout or failure to benefit from treatment were identified in a randomized trial of exercise therapy and pharmacotherapy for major depression. One hundred fifty-six men and women over age 50 diagnosed with major depressive disorder were assigned to a 16-week program of aerobic exercise, medication (sertraline), or a combination of exercise and medication. Thirty-two patients (21%) failed to complete the program and were considered treatment "dropouts." At the end of 16 weeks, 83 patients (53%) were in remission; the remaining patients not in remission were considered treatment "failures." Baseline levels of self-reported anxiety and lift satisfaction were the best predictors of both patient dropout and treatment success or failure across all treatment conditions.     

If at first you don't succeed. False hopes of self-change

Despite repeated failure at attempts to change aspects of their behavior, people make frequent attempts at self-change. The generally negative outcome of many such self-change efforts makes it difficult to understand why so many individuals persist at these attempts. The authors have described this cycle of failure and renewed effort as a "false hope syndrome" characterized by unrealistic expectations about the likely speed, amount, ease, and consequences of self-change attempts. In this article, the authors further develop their conceptualization of this syndrome and review its evidential basis. They review the reasons why so many people tend to fail in their self-change attempts and then examine how people interpret these failures in such a way that they are led to keep trying repeatedly despite apparently overwhelming odds. Finally, the authors discuss the psychological consequences of repeated failure and analyze the distinction between confidence and overconfidence.     

Care, communication and conversation

The professionalisation of care has resulted in ever increasing specialisation, use of technical innovations and informatisation. This has had consequences for the level and way of involvement of the care provider vis-a-vis the patient. The result has been growing alienation on the part of the patient and flight into non-classical medicine, as well as frustration on the part of medical personnel, likewise with respect to the reactions of patients. A solution is usually sought in more communication. This might be styled the professional answer to alienation and frustration, whereby 'the human factor', it is hoped, can be better accounted for. Enhanced communication implies two elements: 1) to better cater for the feelings of patients by trained communicators, i.e. more openness, more client satisfaction; 2) to better take into account patient rights and to actually implement them. The question is whether measures in terms of communication, geared at enhancing client satisfaction and the implementation of patient rights, are the real answer to the above mentioned alienation and frustration. Perhaps the trouble has deeper reasons and requires taking other dimensions into account such as decency and human dignity, which cannot be captured simply in terms of satisfaction and rights. This would mean that the answer must be sought at a deeper level than communication. This level might be called 'conversation' (using a concept analysed by Michael Oakeshott). In the second part of the paper, the possible relationship between care and conversation will be briefly analysed.     

Nietzsche's agon with ressentiment: towards a therapeutic reading of critical transvaluation

This paper examines the therapeutic implications of Nietzsche's critique of ressentiment and revenge as our signature malady. §I examines the obstacles to a therapeutic reading of Nietzsche's thought, including his anti-teleological tendencies and the value he places on sickness. Then there is the energetic problem of finding resources to tackle ressentiment, given the volitional exhaustion of modern nihilism. Finally, the self-referential implications of Nietzsche's critique of slave values threaten to trap his thought in a futile ressentiment against ressentiment. If the impulse to cure or redeem us from revenge through critical destruction repeats the logic of revenge, then the challenge for a therapeutic reading is to think through the transformation of revenge on the basis of repetition.An agonal reading of Nietzsche's philosophical practice is proposed to tackle these problems in §II.In Homer's Contest (1872), Nietzsche describes the transference (Übertragung) of Hesiod's evil Eris – goddess of war and destruction – into the good Eris of the contest or agon: destructive impulses are affirmed as stimulants, but also transformed into culture-building forces through an agonal regime of limited aggression. By superimposing this regime, as a model for Nietzsche's textual confrontations, on their unconscious text of embodied ressentiment, a therapeutic perspective emerges, based on three principles: affirmation; mutual empowerment; and externalisation. The agon performs an affirmative transformation of revenge on the basis of a fertile repetition: destructive affects (as in ressentiment) are transferred into constructive deeds of mutual antagonism. Through Nietzsche's agonal discourse, a reactive regime of internalised aggression is externalised in active deeds of limited philosophical aggression – a therapeutic transformation of (self-)destructive into constructive, philosophical impulses.     

The dolphin's (Tursiops truncatus) understanding of human gazing and pointing: knowing what and where

The authors tested whether the understanding by dolphins (Tursiops truncatus) of human pointing and head-gazing cues extends to knowing the identity of an indicated object as well as its location. In Experiment 1, the dolphins Phoenix and Akeakamai processed the identity of a cued object (of 2 that were present), as shown by their success in selecting a matching object from among 2 alternatives remotely located. Phoenix was errorless on first trials in this task. In Experiment 2, Phoenix reliably responded to a cued object in alternate ways, either by matching it or by acting directly on it, with each type of response signaled by a distinct gestural command given after the indicative cue. She never confused matching and acting. In Experiment 3, Akeakamai was able to process the geometry of pointing cues (but not head-gazing cues), as revealed by her errorless responses to either a proximal or distal object simultaneously present, when each object was indicated only by the angle at which the informant pointed. The overall results establish that these dolphins could identify, through indicative cues alone, what a human is attending to as well as where.     

School-Associated Problem Behavior in Childhood and Adolescence and Development of Adult Schizotypal Symptoms: A Follow-Up of a Clinical Cohort

How school-associated behavioral problems in childhood and adolescence precede distinctive adult schizotypal symptoms was examined. Gender specific findings were explored. After 11.6 (SD?=?3.1) years, 159 patients of the Department of Child and Adolescent Psychiatry of the University Medical Centre Utrecht, the Netherlands were reassessed for adult schizotypal symptoms. Severity of behavioral symptoms in childhood and adolescence using Teacher Report Form (TRF; Verhulst et al. 1997) and adult schizotypal symptoms using Schizotypal Personality Questionnaire-Revised (Raine in Schizophrenia Bulletin 17:555–564, 1991) were examined by Spearman’s bivariate correlations. Multiple regression analyses were performed to determine the combined predictive value of significant TRF subscales for schizotypal symptomatology. Moderation was tested by adding the interactions of gender with TRF subscales to the models. Disregarding gender, correlational analyses revealed that TRF Total problems, in specific thought problems, social problems, and attentional problems were associated with disorganized schizotypal symptoms in adult life. TRF thought problems was also associated with future positive schizotypal symptoms. When gender was taken into account, for boys only thought problems was associated with adult positive schizotypal symptoms, whereas for girls externalizing problems, specifically attentional and aggressive problems, were associated with the higher levels of adult disorganized schizotypal symptoms. Moderated regression analyses provided trend significant evidence confirming that in girls externalizing problems were positively associated with general and disorganized schizotypal symptoms. When using teachers as informants, it was found that juvenile behavioral abnormalities were differentially associated with type of adult schizotypal symptoms, with these associations being further modified by gender.     

Influences Between Online‐Exclusive,Conjoint and Offline‐Exclusive Friendship Networks: The Moderating Role of Shyness

Prior research has indicated that shy adolescents are more motivated to form friendships online than to form friendships offline. Little is known about whether having friendships found exclusively online may impact self‐esteem and forming offline friendships for these adolescents. This study therefore aimed to provide insight into the moderating role of shyness in the longitudinal interplay between friendships in online and offline contexts in early adolescence. Adolescents and their friends (193 girls, 196 boys; M_age = 13.29) were followed with three consecutive measurements with intervals of eight months. Results showed that particularly for shy adolescents, having friends exclusively online predicted increases in self‐esteem. Self‐esteem, in turn, was found to predict forming more friendships found both offline and online and forming more friendships found exclusively offline. Thus, findings supported the social compensation perspective that shy adolescents may benefit from having friends exclusively online, as these friendships may increase self‐esteem, thereby facilitating the formation of friendships found partially and completely offline. Copyright © 2013 John Wiley & Sons, Ltd.     

When Evaluative Adjectives Prevent Contradiction in a Debate

Argumentation - This paper argues that some words are so highly charged with meaning by a community that they may prevent a discussion during which each participant is on an equal footing. These...