An Evolutionary Perspective on Family Studies: Differential Susceptibility to Environmental Influences

An evolutionary perspective of human development provides the basis for the differential‐susceptibility hypothesis which stipulates that individuals should differ in their susceptibility to environmental influences, with some being more affected than others by both positive and negative developmental experiences and environmental exposures. This paper reviews evidence consistent with this claim while revealing that temperamental and genetic characteristics play a role in distinguishing more and less susceptible individuals. The differential‐susceptibility framework under consideration is contrasted to the traditional diathesis‐stress view that “vulnerability” traits predispose some to being disproportionately affected by (only) adverse experiences. We raise several issues stimulated by the literature that need to be clarified in further research. Lastly, we suggest that therapy may differ in its effects depending on an individual's susceptibility.     

Disorganization and Individual Psychotherapy for Schizophrenia: A Case Report of Metacognitive Reflection and Insight Therapy

Despite being a characteristic symptom of schizophrenia, implications for therapy with persons experiencing prominent disorganization have received less attention in the psychotherapy literature than have other aspects of the disorder. As such, formal thought disorder may be viewed largely as a barrier to effective participation in therapy. In contrast, though, a range of writers from varied traditions have stressed that this feature of schizophrenia is meaningful and improved coherence of speech is an important and viable component of treatment and recovery. This paper suggests that an emergent integrative psychotherapy, metacognitive reflection and insight therapy (MERIT), may be well-suited for work with persons experiencing disorganization symptoms. A brief overview of MERIT is provided, followed by a case report of an 18-month course of therapy with a man with severely disorganized speech.     

Visuospatial cueing by self-caused features: Orienting of attention and action–outcome associative learning

The effect of a salient visual feature in orienting spatial attention was examined as a function of the learned association between the visual feature and the observer’s action. During an initial acquisition phase, participants learned that two keypress actions consistently produced red and green visual cues. Next, in a test phase, participants’ actions continued to result in singletons, but their color could be either congruent or incongruent with the learned action–color associations. Furthermore, the color singletons now functioned as valid or invalid spatial cues in a visual search, in which participants looked for a tilted line (“/” or “\”) among distractors (“X”s). The results showed that an action-congruent color was more effective as a valid cue in the search task (increased benefit), but less effective as an invalid cue (reduced cost). We discuss our findings in terms of both an inhibition account and a preactivation account of action-driven sensory bias, and argue in favor of the preactivation account.     

Pop-out and pop-in: Visual working memory advantages for unique items

Attentional control is thought to play a critical role in determining the amount of information that can be stored and retrieved from visual working memory (VWM). We tested whether and how task-irrelevant feature-based salience, known to affect the control of visual attention, affects VWM performance. Our results show that features of a task-irrelevant color singleton are more likely to be recalled from VWM than non-singleton items and that this increased memorability comes at a cost to the other items in the display. Furthermore, the singleton effect in VWM was negatively correlated with an individual’s baseline VWM capacity. Taken together, these results suggest that individual differences in VWM storage capacity may be partially attributable to the ability to ignore differences in task-irrelevant physical salience.     

Resilient Response to Battering

Spouse abuse remains an important social problem. Recent research has begun to explore resiliency in a variety of areas: Why, despite harsh life circumstances, do some people survive and later thrive after experiencing trauma? What are the processes associated with a successful departure from abuse? The authors worked with a local shelter to identify three groups of women: (a) those currently at the shelter; (b) those who had been away from an abusive relationship for at least one year; and (c) those who were identified by shelter staff as having demonstrated a resilient response to battering, and compared experiences and recommendations between groups and discuss clinical and service implications.     

A taxometric study of the Adult Attachment Interview

This study is the first to examine the latent structure of individual differences reflected in the Adult Attachment Interview (AAI; C. George, N. Kaplan, & M. Main, 1985), a commonly used and well-validated measure designed to assess an adult's current state of mind regarding childhood experiences with caregivers. P. E. Meehl's (1995) taxometric methods (i.e., MAXCOV-HITMAX) were applied to data from 504 AAIs. Analyses revealed that the variation underlying secure versus dismissing states of mind was more consistent with a dimensional than a taxonic model. (Taxometric analyses of preoccupation were indeterminate.) In addition, variation in secure adults' (n=278) reports about their early experiences revealed little evidence for qualitative groups of earned- and continuous-secures. Rather, the inferred life experiences of secure adults appeared to be distributed continuously. Findings are discussed in terms of their theoretical implications regarding the phenomenon of earned-security specifically and variation underlying secure and insecure states of mind more generally. The consequences of these analyses for AAI reliability training and coding are also explored.     

Creative Writing as a Medical Instrument

Listening and responding to patients’ stories for over 20 years as an emergency physician has strengthened my appreciation for the many ways that the skills and principles drawn from writing fiction double as necessary clinical skills. The best medicine doesn’t work on the wrong story, and the stories patients tell sometimes feel like first drafts—vital and fragile works-in-progress. Increasingly complex health challenges compounded by social, financial, and psychological burdens make for stories that are difficult to articulate and comprehend. In this essay, I argue that healthcare providers need to think like creative writers and the skills and sensitivities necessary to story construction deserve a vital space in medical education. A thorough understanding of story anatomy and the imaginative flexibility to work stories into open spaces serve as antidotes to the reductive nature of clinical decision making and have implications as patient safety and risk management strategies. The examples that I have selected demonstrate how thinking like a creative writer functions at the bedside, providing tools for clinical excellence and empathy. This approach asks that we re-imagine the importance of story in clinical care: from a vehicle to a diagnosis to its place as a critical destination.