Efficacy of a Manualized and Workbook-Driven Individual Treatment for Social Anxiety Disorder

Social anxiety disorder is a prevalent and impairing disorder for which viable cognitive-behavioral therapies exist. However, these treatments have not been easily packaged for dissemination and may be underutilized as a result. The current study reports on the findings of a randomized controlled trial of a manualized and workbook-driven individual cognitive-behavioral treatment for social anxiety disorder (Hope, Heimberg, Juster, & Turk, 2000; Hope, Heimberg, & Turk, 2006). This treatment package was derived from an empirically supported group treatment for social anxiety disorder and intended for broad dissemination, but it has not previously been subjected to empirical examination on its own. As a first step in that examination, 38 clients seeking treatment for social anxiety disorder at either the Adult Anxiety Clinic of Temple University or the Anxiety Disorders Clinic of the University of Nebraska-Lincoln were randomly assigned to receive either immediate treatment with this cognitive-behavioral treatment package or treatment delayed for 20 weeks. Evaluation at the posttreatment/postdelay period revealed substantially greater improvements among immediate treatment clients on interviewer-rated and self-report measures of social anxiety and impairment. Three-month follow-up assessment revealed maintenance of gains. Clinical implications and directions for future research are discussed.     

Mishandling the Gift of Life: Noncompliance in Renal Transplant Patients1

Two studies investigating renal transplant patients compliance with their post-transplant medical regimen are presented. Compliance was operationalized as a multidimensional construct incorporating behaviors that represent adherence to the regimen. Study 1 examined the association of noncompliance with clinically significant outcomes and the medical and demographic predictors of noncompliance. Noncompliance was associated with rejection episodes, graft loss, and multiple transplants. The best predictors of noncompliance were medication side effects, age, education, and insurance coverage. Study 2 examined the psychosocial predictors of noncompliance. After age and side-effects complaints, self-efficacy and threat appraisal were the best predictors of compliance. The implications of these results for expectancy-value models of health behaviors (e.g., protection motivation theory; Rogers, 1983) and their ability to predict compliance in patients following long-term regimens are discussed.     

A precision tooth-pulp stimulation technique for the assessment of pain threshold

Accurate and consistent pain threshold measurements for the tooth pulp can be achieved with careful preparation of a moisture-proof appliance and the use of a high-quality constant-current stimulator. Using an extant dental filling as the cathode, the usual problems associated with the control of the stimulation area and locus and, consequently, current density can be overcome. Repeated measurements showing less than ±5% variation over many months can be routinely achieved on the same individual. The technique has shown a high degree of sensitivity to common analgesic agents and is potentially useful for the investigation of variations in pain threshold over extended periods of time.     

The ethics of enforced medical treatment: the balance model

ABSTRACT When is it right to enforce medical treatment on a patient who is refusing that treatment? English law recognises two ethical principles as of paramount importance: the autonomy of the patient; and the consequences of not treating compared with treating. The law, by and large, operates these principles in succession. Thus, in the case of a patient refusing treatment, the law asks first, is the patient competent? Only if the answer is no, are the consequences considered. We criticise the position taken by English law and argue, first, that competence is a graded and not a binary concept, and secondly, that the two ethical principles should be applied not sequentially but at the same time. These two ideas form what we have called the balance model. This model could be used for an empirical study of individuals’ ethical beliefs, and in particular to test the hypothesis that the ethical beliefs of most individuals conform to the balance model rather than to the position taken by English law.     

Health care need: three interpretations

The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need, the three interpretations provide a starting-point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs-based priority setting to social welfare maximisation.     

The path of visual attention

Visual cuing is one paradigm often used to study object- and space-based visual selective attention. A primary finding is that shifts of attention within an object can be accomplished faster than equidistant shifts between objects. The present study used a visual cuing paradigm to examine how an object's size (i.e., internal distance) and shape, influences object- and space-based visual selective attention. The first two experiments manipulated object size and compared attentional shift performance with objects where the within-object distance between cued and uncued target locations was either equal to the between-object distance (1:1 ratio condition) or three times the between-object distance (3:1 ratio condition). Within-object shifts took longer for the larger objects, but an advantage over between-object shifts was still evident. Influences associated with the shapes of the larger objects suggested by the results of the first two experiments were tested and rejected in Experiment 3. Overall, the results indicate that within-object shifts of attention become slower as the within-object distance increases, but nevertheless are still accomplished faster than between-object shifts.     

Reclaiming “Mydentity”: Counterstorytelling to challenge injustice for racially and economically marginalized emerging adults

Emerging adulthood is an important period for identity development, the development of sociopolitical beliefs, and establishment of social roles and responsibilities. As a part of this development, counterstorytelling—narrative processes that contrast and challenge dominant oppressive narratives—may be used within counterspaces to facilitate positive identity development and to challenge injustice. In this qualitative study, we analyse interviews with and poetry from 12 emerging adults who were facilitators within a youth critical literacy program to understand how counterstorytelling functions to both facilitate identity development and challenge injustice. We found evidence of two superordinate themes: reclaiming identity, taking ownership of identity through counterstorytelling; and co-creating a narrative community, collectively building community through counterstorytelling. Findings support counterstorytelling promotes emergent identity development and works as a strategy for challenging injustice and oppression for marginalized emerging adults. Implications for practitioners and future research are discussed.     

Why Research and Teach Early Modern Women Philosophers?

This paper makes explicit some issues of gender that have been implicitly raised in recent discussions concerning the recovery of European women's contributions to the history of seventeenth- and eighteenth-century philosophy. A useful way to bring these issues to light is to distinguish between the project of recovering women's contributions and the project of justifying their inclusion. The former project is an important effort to provide a more accurate understanding of the history of philosophy. Within the latter project, there is a distinction between justifying the inclusion of a specific author and justifying women's inclusion in general. The suggestion that we need to justify women's inclusion in general is fundamentally illegitimate because it presumes that either women's philosophical ability is up for debate or that their contributions require special explanation, both of which are misogynist.     

Validation of the Black Community Activism Orientation Scale with racially and ethnically diverse college students

This study fills a methodological gap in racial justice research by assessing the utility and validity of the Black Community Activism Orientation Scale (BCAOS) in a racially and ethnically diverse sample of college-going young adults (N = 624, M = 19.4 years, SD = 1.89) from 10 colleges in the United States. Confirmatory factor analysis was conducted to estimate the goodness of fit of the proposed three-factor model and assess the validity of the BCAOS. Findings from the confirmatory factor analysis provide statistical support for use of the BCAOS as a measure of racial justice activism in support of Black communities among racially and ethnically diverse college-going young adults. Findings from the study also suggest that White college students and men are less oriented toward racial justice activism than women and racially marginalized students. Convergent and discriminant validity were established through bivariate correlations of the BCAOS factors with other civic development measures. As more and more young people consider the importance of standing against racial oppression, the BCAOS has utility as an assessment instrument in future racial justice research, education, intervention, and youth programming efforts.