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.     

Prior experience and patterning in a prisoner's dilemma game

Female college students first played a pseudo-prisoner's dilemma (PPD) game with the experimenter, who followed a fixed strategy. In the first experiment the experimenter's strategies for different groups of subjects were: (a) play tit-for-tat; (b) play randomly; (c) always cooperate; (d) always defect (‘cooperation’ and ‘defection’, defined as in an actual prisoner's dilemma game). Only the tit-for-tat group increased cooperation over trials; other groups decreased cooperation. After playing the PPD with the experimenter, subjects played an actual prisoner's dilemma (PD) game with each other. In the PD game, subjects began cooperating moderately but cooperation deteriorated regardless of what the experimenter's strategy had been in the earlier (PPD) game. In a second experiment, subjects again played a PPD game with the experimenter and then played a PD game with each other. Half played one trial at a time as in the first experiment while half played in patterns of four trials at a time. In the PD game, patterning of trials retarded the development of mutual defection regardless of previous experience. The cooperation-preserving effect of patterning of trials in this social task is compared with similar effects on individual tasks involving self-control and risk-aversion. © 1998 John Wiley & Sons, Ltd.     

Trust,anger, resentment,forgiveness: On blame and its reasons

A discussion of the scope that exists for the normative assessment of blame. The paper starts from the assumption that blame is to be understood in terms of the reactive attitudes. A particular crux is the question of whether blame can be assessed critically if conditions are in place that render the reactive attitudes apt or warranted. The paper argues that even warranted blame can be managed critically and that this is something we often have reason to do, given the oppositional nature of reactive blame. The point is illustrated through a discussion of forgiveness and hypocrisy. A further claim is that, once reasons for reactive blame are distinguished from distinct reasons for managing it in different ways, space opens up for interesting global challenges to reactive blame, even when it is internally apt or warranted.     

Application of Problem Solving Therapy for Late-Life Anxiety

Cognitive behavioral therapy for anxiety has demonstrated lower efficacy in older compared with younger adults. Yet, few other evidence-based options for late-life anxiety have been examined. This case series aimed to demonstrate the application of Problem Solving Therapy (PST) to older adults with anxiety disorders building on PST’s strong empirical support for treating late-life depression. PST was implemented to treat three older primary-care patients diagnosed with anxiety disorders. We present treatment outcomes and discuss the feasibility and acceptability of using PST to treat these patients. Implications and lessons learned from these patients are discussed to inform further development of PST to better meet the needs of older patients suffering from late-life anxiety.     

Repeated Play Reduces Video Games’ Ability to Elicit Guilt: Evidence from a Longitudinal Experiment

Statements supported mostly by correlational and cross-sectional studies suggest that playing violent video games can cause emotional desensitization. A longitudinal experiment examined a) whether repeated violent game play leads to emotional desensitization and b) whether desensitization generalizes to other play and real-life experiences. Participants played alternative versions of the same violent game for the first four days; on these days, the character role was varied between-subjects to be moral (United Nations soldier) or immoral (terrorist soldier). On Day 5, all participants played a novel game as a terrorist. Results indicate two things. First, habituation occurs over repeated game play: Repeated exposure decreased the ability of the original game to elicit guilt. Second, the decreased ability to elicit guilt can generalize to other game-play experiences: Guilt elicited by the novel game on Day 5 was reduced for the immoral character condition compared to the moral character condition. The current study provides causal, longitudinal evidence regarding the potential for video game play to lead to emotional desensitization with regard to future video game-play experiences.