The Relationship of Nondirectiveness to Genetic Counseling: Report of a Workshop at the 2003 NSGC Annual Education Conference

Nondirectiveness has been a guiding principle for genetic counseling since the founding of the profession. However, its efficacy and appropriateness in this role have been frequently questioned. A workshop at the 2003 Annual Education Conference of the National Society of Genetic Counselors provided audience participation in a discussion of these issues. Participants presented arguments for and against nondirectiveness as a central ethos. They described complex personal transitions in adapting what they had learned about nondirectiveness during training to the realities of the workplace. There was support for flexible approaches to genetic counseling, with varying adherence to nondirectiveness, based on client and family needs and values, clinical circumstances, and desired counseling outcomes. The discussion supports the use of clinical experience, outcomes research, and the experience of other professions to move beyond nondirectiveness and more accurately identify the theoretical bases that underlie genetic counseling in the variety of circumstances in which it is currently practiced.     

Cognitive disruption and altered hippocampus synaptic function in Reelin haploinsufficient mice

The heterozygote reeler mouse (HRM) shows many neuroanatomical and biochemical features that are also present in some human cognitive disorders, such as schizophrenia. In the present study, hippocampal dependent plasticity and cognitive function of the HRM were characterized in detail in an attempt to reveal phenotypic functional differences that result from Reelin haploinsufficiency. The HRM and wild type mice show similar levels of overall activity, coordination, thermal nociception, startle responses, and anxiety-like behavior. In addition, both genotypes show similar shock threshold, identical cued freezing behavior and comparable spatial learning in Morris water maze tasks. However, a significant reduction in contextual fear conditioned learning was observed in the HRM. Electrophysiological studies in hippocampal CA1 synapses revealed a plethora of differences between genotypes. The HRM exhibits reduced field excitatory postsynaptic potentials in responses to similar synaptic inputs, lowered paired pulse facilitation ratio and impaired long-term depression and tetanus-induced long-term potentiation (LTP). Also, deficits were detected in LTP elicited by theta burst stimulation or by a whole cell pairing protocol. These physiologic differences could not be accounted for by changes in the overall amount of glutamate receptor subunits. In addition, it was determined that network-driven excitatory and inhibitory activities recorded in CA1 pyramidal neurons showed that the HRM had comparable amplitude and frequency of spontaneous excitatory postsynaptic currents, but a marked reduction in spontaneous inhibitory postsynaptic currents. Thus, the HRM exhibits a specific hippocampal-dependent learning deficit accompanied with a pronounced impairment of hippocampal plasticity and functional inhibitory innervation.     

Cognitive functioning in delusions: a longitudinal analysis

BACKGROUND: This study explored the longitudinal course of the relationship between delusions and different aspects of cognitive functioning. METHODS: Deluded patients were compared to psychiatric and non-clinical controls on three tasks: negative priming, a probabilistic judgement task (the 'beads' task), and the pragmatic inference task (PIT). All groups were tested at two time points, once when actively symptomatic, and once when in remission. RESULTS: Deluded individuals exhibited a 'jump-to-conclusions' (JTC) reasoning bias: i.e., they made decisions on the basis of limited evidence and were more likely to revise their estimates when faced with disconfirmatory evidence. This JTC bias remained stable over time, although probability judgments seemed to normalise in remission. No deficits in cognitive inhibition were found on negative priming. The deluded group displayed an excessive self-focus on the PIT at both time points, but did not show a depressive attributional style. Only a small sub-sample, characterised by the "bad-me" type of paranoia [Trower & Chadwick, 1995 Clinical Psychology: Science and Practice, 2, 263-278.], demonstrated depressive schemas when symptomatic, but no longer did so when remitted. Few relationships were found between tasks, suggesting that different areas of functioning are relatively independent. The only measures associated with delusion symptom scores were from the 'beads' task. CONCLUSIONS: Overall these findings suggest that the JTC bias is a stable factor associated with delusional thinking, while the depressive attributional style characteristic of a small sub-sample of paranoid patients fluctuates with delusional course.     

Need for closure and anxiety in delusions: a longitudinal investigation in early psychosis

This study investigated the role of need for closure (NFC) and anxiety in delusions. The Need For Closure Scale (NFCS) and measures of trait and state anxiety were administered to an early psychosis group with current delusions, a clinical (generalised anxiety disorder--GAD) control group and a non-clinical control group. The battery of questionnaires was repeated at follow-up one year later. The NFCS did not meet criteria for a unidimensional scale and two sub-scales were removed from all further analyses. At baseline the deluded and GAD groups scored significantly higher on the reduced NFCS (NFCS-R) than the control group. Trait anxiety was related to NFCS-R in the GAD and non-clinical control groups, but not in the deluded group. At follow-up all groups scored significantly lower on the NFCS-R, perhaps suggesting a practice effect, although the two clinical groups continued to have higher scores than the non-clinical control group. The recovered and non-recovered deluded groups did not differ on the NFCS-R one year later, unlike in the GAD group where recovered participants had significantly lower scores than the non-recovered. Change scores on the NFCS-R and trait anxiety were correlated at trend level in the GAD and non-clinical control groups, but not in the deluded group. These findings suggest that whilst NFC and trait anxiety are related in non-psychotic groups, NFC may be implicated in the formation of delusions, independently of anxiety, in psychotic individuals.     

The relationship between pre-treatment clinical profile and treatment outcome in an integrated stuttering program

A procedure for subtyping individuals who stutter and its relationship to treatment outcome is explored. Twenty-five adult participants of the Comprehensive Stuttering Program (CSP) were classified according to: (1) stuttering severity and (2) severity of negative emotions and cognitions associated with their speech problem. Speech characteristics (percentage of stuttered syllables, distorted speech score, and the number of correctly produced syllables on a diadochokinesis task) and emotional/cognitive states (emotional reaction, speech satisfaction, and attitudes toward speaking) were assessed before and after treatment, and at a 1- and 2-year follow-up. The results showed that: (a) there was no relationship between stuttering severity and the severity of negative emotions and cognitions, (b) the severe stuttering group had the largest treatment gains but also the highest level of regression, and (c) at post-treatment and both follow-up assessments the differences on measures of emotions between the mild and severe emotional group had disappeared, chiefly due to a large decrease in the latter group's negative emotions and cognitions. Our findings show that, based on treatment gains, specific subgroups can be identified, each requiring different treatment approaches. This underlines the necessity of developing a better understanding of how various dimensions of stuttering relate to treatment outcome. Educational objectives: The reader will be able to: (1) describe why stuttering severity and negative emotions and cognitions that are related to stuttering should be investigated separately and (2) describe how treatment outcome relates to subtypes of persons who stutter.     

Controllability and hindsight components: Understanding opposite hindsight biases for self-relevant negative event outcomes

There is an anomaly in the hindsight bias literature with respect to hindsight effects obtained after self-relevant negative event outcomes: Whereas some studies have reported reduced hindsight bias, others have shown increases. This article contrasts two explanations for the anomaly. The first points to an influence of perceived control over the event outcome: In hindsight, people decrease foreseeability (and hence, responsibility and blame) for controllable events, but they increase the perceived inevitability of uncontrollable events for coping reasons. The second explanation, derived from a reconception of hindsight bias in terms of separate components (Blank, Nestler, von Collani, & Fischer, 2008), traces the anomaly to differences in the observed hindsight components: Hindsight decreases are to be expected for foreseeability, whereas increases are restricted to the inevitability component. Our experiment (N=210) manipulated controllability and the hindsight component orthogonally and showed strong support for the component explanation, but also some influence of perceived control.     

Vindication of the Humpty Dumpty attitude towards language

Effective objective (sachlich) verbal communication is dependent upon the use of linguistic locutions which are: a) suitable for some special purposes, b) clear (i.e., having a satsifactorily high degree of subsumability), and c) in accordance with some ordinary (i.e., frequently occurring) language usages. Only in so far as point c is concerned is a study of actual language usage of (indirect) value to philosophers. And this holds true regardless of whether one's underlying assumption tends towards the view: 1) that ordinary language is perfect (Oxford), or: 2) that ordinary language is a mess (Oslo). In any case, one needs to know about the most ordinary usages to prevent unnecessarily drastic deviations from them. Drastic deviations may mislead the sender, as well as the receiver, create communicational disturbances, misunderstandings, and confusion (vide: Strawson's use of “presupposition"). However, considerations of a) suitability for special purposes, and b) clarity (subsumability) will most often, if not always, prevent a communicator from flatly adopting any one of the existing language usages of a given important linguistic locution. He would feel the need for: “explications,”; “rational reconstructions”; or conceptual alterations of one kind or another. In fact, there are instances where the sender finds it most advantageous to disregard completely ordinary language (vide: Einstein's use of “simultaneity"): He “makes words mean what he wants them to mean.”; This is the Humpty Dumpty sender attitude towards language. The corresponding receiver attitude manifests itself as awareness of and tolerance for language ambiguities.     

Increased forefoot loading is associated with an increased plantar flexion moment

The aim of this study was to identify the cascade of effects leading from alterations in force generation around the ankle joint to increased plantar pressures under the forefoot. Gait analysis including plantar pressure measurement was performed at an individually preferred and a standardized, imposed gait velocity in diabetic subjects with polyneuropathy (n = 94), without polyneuropathy (n = 39) and healthy elderly (n = 19). The plantar flexion moment at 40% of the stance phase was negatively correlated with the displacement rate of center of pressure (r = ?.749, p < .001 at the imposed, and r = ?.693, p < .001 at the preferred gait velocity). Displacement rate of center of pressure was strongly correlated with forefoot loading (r = ?.837, p < .001 at the imposed, and r = ?.731, p < .001 at the preferred gait velocity). People with a relatively high plantar flexion moment at 40% of the stance phase, have a faster forward transfer of center of pressure and consequently higher loading of the forefoot. This indicates that interventions aimed at increasing the control of the roll-off of the foot may contribute to a better plantar pressure distribution.     

Xenophobia and Tolerance Toward Immigrants in Adolescence: Cross-Influence Processes Within Friendships

To what extent do adolescents and their friends socialize each others’ attitudes toward immigrants? Can friends’ positive attitudes toward immigrants counter adolescents’ negative attitudes toward immigrants, and do friends’ negative attitudes decrease adolescents’ positive attitudes? These questions were examined by following a large (N?=?1,472) friendship network of adolescents (49.2 % girls; M _age?=?13.31 at first measurement) across three annual measurements. Selection and influence processes regarding tolerance and xenophobia were distinguished with longitudinal social network analyses, controlling for effects of age, gender, and immigrant background. Findings showed that friends’ tolerance predicted increases in adolescents’ tolerance and friends’ xenophobia predicted increases in adolescents’ xenophobia. Moreover, friends’ tolerance predicted a lower likelihood of adolescents’ xenophobia increasing. The current results suggest that interventions should distinguish between tolerance and xenophobia, as these appear to represent two separate dimensions that are each influenced in specific ways by friends’ tolerance and xenophobia.     

A CHRISTIAN NATURALISM: DEVELOPING THE THINKING OF GORDON KAUFMAN

This essay develops a theological naturalism using Gordon Kaufman's nonpersonal idea of God as serendipitous creativity in contrast to the personal metaphorical theology of Sallie McFague. It then develops a Christian theological naturalism by using Kaufman's idea of historical trajectories, specifically Jesus trajectory₁ and Jesus trajectory₂. The first is the trajectory in the early Christian church assuming a personal God in the framework of Greek philosophy that results in the Trinity. The second is the naturalistic‐humanistic trajectory of creativity (God) that evolves from nonpersonal interactions in the universe and life to creativity in persons and is manifested in Jesus as love. This is elaborated further with Dean Keith Simonton's Darwinian understanding of genius and Marcus Borg's analysis of Jesus as Jewish mystic, teacher of alternative wisdom, and nonviolent resister to the domination system of the Roman Empire. What makes Jesus a religious genius is his exemplifying unconditional, universal love—a new mode of creativity (God) that has evolved from nonhuman to a human form.