Reflections on the process of psychotherapeutic change as applied to medical situations

This article takes the basic ideas on the process of changing implicit knowledge put forward in this special issue, and extends them beyond psychotherapy to include other therapeutic relationships that occur in medicine. One vignette, from an encounter between a medical student and a dying patient, illustrates how a “moment of meeting” changes the student as well as the patient. The second shows how therapeutic interventions for new mothers with their newborn infants involve “moments of meeting” that alter the mother's implicit knowledge of her baby and of herself as a mother. © 1998 Michigan Association for Infant Mental Health     

Associative asymmetry in probed recall of serial lists

For pairs of meaningful items (e.g., words), recall accuracy is nearly identical for forward and backward probes. That is, after studying an A-B pair, subjects can recall A given B as well as they can recall B given A (Kahana, 2002). To assess whether this symmetry property is unique to pairs, we investigated the effects of study direction on probed recall of word triples and serial lists. Two experiments revealed a forward-recall advantage in both triples and serial lists. In addition, compound cues produced better recall than did single-item adjacent cues, which, in turn, produced better recall than did remote cues. These findings suggest a discontinuity between the associative processes supporting memory for pairs and those supporting memory for sequences of three or more items.     

Health service use costs by personality disorder following specialist and nonspecialist treatment: a comparative study

The impact of specialist psychosocial treatment on health service use costs by patients with personality disorder is not yet sufficiently documented. In this prospective study we compare patterns of health service costs by three groups of people with personality disorder treated in a hospital-based program (IPP), a step down program (SDP), and a general psychiatric program (GPP). Total service use costs at follow up, compared with intake costs, showed that significantly higher savings were achieved by SDP and IIP compared with GPP. Cost reductions in SDP were significantly greater than in IPP. Significant cost reductions were found between treatment programs in social worker and community psychiatric nursing and psychotherapy. The cost-effectiveness of the two specialist treatment programs was indicated by the significant association between total cost reduction and clinical outcome in GPP and IPP, but not in GPP. The effect of Major Depression and Borderline Personality Disorder on health service use alone and in combination was also investigated. The finding that Major Depression was found to be more significantly associated with higher health service use costs than Borderline Personality Disorder is discussed.     

Measures of Criminal Attitudes and Associates (MCAA): development,factor structure,reliability, and validity

Recent meta-analysis has demonstrated that attitudes and associates are among the best predictors of antisocial behavior. Despite this finding, there are few psychometrically developed and validated measures of criminal and antisocial attitudes and associates. This study reviews the theoretical and empirical development of the Measures of Criminal Attitudes and Associates (MCAA), which is composed of two parts. Part A is a quantified self-report measure of criminal friends. Part B contains four attitude scales: Violence, Entitlement, Antisocial Intent, and Associates. The MCAA showed reasonable reliability (internal consistency and temporal stability) and appropriate convergent and discriminant validity. Criterion validity was evidenced in the scale's relationship with criminal history variables, and a factor analysis confirmed the four distinct scale domains.     

Affective personality differences in neural processing efficiency confirmed using fMRI

To test for a relation between individual differences in personality and neural-processing efficiency, we used functional magnetic resonance imaging (fMRI) to assess brain activity within regions associated with cognitive control during a demanding working memory task. Fifty-three participants completed both the self-report behavioral inhibition sensitivity (BIS) and behavioral approach sensitivity (BAS) personality scales and a standard measure of fluid intelligence (Raven’s Advanced Progressive Matrices). They were then scanned as they performed a three-back working memory task. A mixed blocked/ event-related fMRI design enabled us to identify both sustained and transient neural activity. Higher BAS was negatively related to event-related activity in the dorsal anterior cingulate, the lateral prefrontal cortex, and parietal areas in regions of interest identified in previous work. These relationships were not explained by differences in either behavioral performance or fluid intelligence, consistent with greater neural efficiency. The results reveal the high specificity of the relationships among personality, cognition, and brain activity. The data confirm that affective dimensions of personality are independent of intelligence, yet also suggest that they might be interrelated in subtle ways, because they modulate activity in overlapping brain regions that appear to be critical for task performance.     

Low target prevalence is a stubborn source of errors in visual search tasks

In visual search tasks, observers look for targets in displays containing distractors. Likelihood that targets will be missed varies with target prevalence, the frequency with which targets are presented across trials. Miss error rates are much higher at low target prevalence (1%-2%) than at high prevalence (50%). Unfortunately, low prevalence is characteristic of important search tasks such as airport security and medical screening where miss errors are dangerous. A series of experiments show this prevalence effect is very robust. In signal detection terms, the prevalence effect can be explained as a criterion shift and not a change in sensitivity. Several efforts to induce observers to adopt a better criterion fail. However, a regime of brief retraining periods with high prevalence and full feedback allows observers to hold a good criterion during periods of low prevalence with no feedback.     

Predicting short-term outcome in well-being following suicidal behaviour: the conjoint effects of social perfectionism and positive future thinking

This study investigated an integrative, psychological model of suicidality involving the relationship between perfectionism and future thinking to predict short-term outcome in well-being following a suicidal episode. Two hundred and sixty-seven adults hospitalized following a self-harm episode completed a range of clinical and psychological measures in hospital and were followed up approximately two months after discharge. Hierarchical regression analyses confirmed that, among the suicidal self-harmers who had a history of repetitive self-harm (n=65), outcome among low social perfectionists changed as a function of positive future thinking such that outcome was better for those high on positive thoughts compared with those low on positive future thoughts. There was no such positive change in outcome among the high social perfectionists. There were also no significant interactive effects evident among the non-repetitive self-harmers (n=61). These findings extend recent research to suggest that socially prescribed perfectionism and positive future thinking (but not negative future thinking) are implicated in outcome following repetitive suicidality. Implications for theory and clinical practice are discussed.     

Reconsidering Relativistic Causality

I discuss the idea of relativistic causality, i.e., the requirement that causal processes or signals can propagate only within the light‐cone. After briefly locating this requirement in the philosophy of causation, my main aim is to draw philosophers’ attention to the fact that it is subtle, indeed problematic, in relativistic quantum physics: there are scenarios in which it seems to fail.

I set aside two such scenarios, which are familiar to philosophers of physics: the pilot‐wave approach, and the Newton–Wigner representation. I instead stress two unfamiliar scenarios: the Drummond–Hathrell and Scharnhorst effects. These effects also illustrate a general moral in the philosophy of geometry: that the mathematical structures, especially the metric tensor, that represent geometry get their geometric significance by dint of detailed physical arguments.     

Interpersonal reactions to suicide attempt: the role of respondent causal attributions

Interpersonal responses to a depressed person with or without a suicide attempt were examined. It was hypothesized that the depressed person who attempted suicide would receive higher negative attributions and interpersonal rejection, and that attributions would mediate the relationship between exposure to a depressed person and rejection. Contrary to hypotheses, respondents were more willing to interact with, held higher esteem for, and endorsed lower negative attributions for the depressed person who attempted suicide. Mediation hypotheses were supported. Findings suggest that a suicide attempt may promote less negative attributions toward depressed individuals, which in turn dampen negative interpersonal reactions.     

A computational model of event segmentation from perceptual prediction

People tend to perceive ongoing continuous activity as series of discrete events. This partitioning of continuous activity may occur, in part, because events correspond to dynamic patterns that have recurred across different contexts. Recurring patterns may lead to reliable sequential dependencies in observers' experiences, which then can be used to guide perception. The current set of simulations investigated whether this statistical structure within events can be used 1) to develop stable internal representations that facilitate perception and 2) to learn when to update such representations in a self-organizing manner. These simulations demonstrate that experience with recurring patterns enables a system to accurately predict upcoming stimuli within an event, to identify boundaries between such events based on transient increases in prediction error, and to use such boundaries to improve prediction about subsequent activities.