The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM ?C whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.     

Regional cortical volume and cognitive functioning following traumatic brain injury

There has been limited examination of the effect of brain pathology on subsequent function. The current study examined the relationships between regional variation in grey matter volume, age and cognitive impairment using a semi-automated image analysis tool. This study included 69 individuals with mild-to-severe TBI, 41 of whom also completed neuropsychological tests of attention, working memory, processing speed, memory and executive functions. A widespread reduction in grey matter volume was associated with increasing age. Regional volumes that were affected also related to the severity of injury, whereby the most severe TBI participants displayed the most significant pathology. Poorer retention of newly learned material was associated with reduced cortical volume in frontal, parietal, and occipital brain regions. In addition, poorer working memory and executive control performance was found for individuals with lower cortical volume in temporal, parietal, and occipital regions. These findings are largely in line with previous literature, which suggests that frontal, temporal, and parietal regions are integral for the encoding of memories into long-term storage, memory retrieval, and working memory. The present study suggests that automated image analysis methods may be used to explore the relationships between regional variation in grey matter volume and cognitive function following TBI.     

Control of the Mind Edited by Seymour M. Farber and Roger H. L. Wilson

Abstract

This article describes an innovative model of couples therapy designed to mitigate marital instability. The authors suggest that combining ongoing couples therapy with a separate relationship-focused group for each partner favorably impacts each person’s neuropsychophysiological regulation and their ability to participate in a stable intimate marriage.

The neurobiology of attachment theory is seen as providing understanding of the affect regulation issues operational in many couple relationships. The safe and secure attachments worked out in the relationship-focused group therapy are seen as improving neuropsychophysiological integration and regulation.     

Small Groups: Studies in Social Interactions Edited by A. Paul Hare,F. Borgatta,and Robert F. Bales

Abstract

A large body of literature has supported the application of attachment theory to the understanding of psychotherapy. In addition, a more recent social psychological literature is exploring the application of attachment theory to the area of group dynamics and group process. The current study is designed to integrate these two distinct bodies of literature. In a preliminary fashion, we examined the relationship between group therapists’ group attachment styles and their assumptions and expectations of their patients’ attitudes about group psychotherapy. Seventy–six therapists completed the Smith, Murphy &; Coats (1999) measure of group attachment style. They also completed the Revised Group Therapy Survey (Carter, Mitchell, &; Krautheim, 2001) from the viewpoint of a typical patient they treat. As hypothesized, therapists with more group attachment anxiety assumed that patients would hold more negative myths and misconceptions about group treatment than therapists with less group attachment anxiety. The utility of a group attachment construct in future research and practice is discussed.     

Self-efficacy Manipulation and State Anxiety Responses to Exercise in Low Active Women

The present study manipulated self-efficacy in an exercise context and examined its effect on the state anxiety of low active women. Participants ( N = 59) were randomly assigned to a low or high efficacy condition, and self-efficacy was manipulated by presentation of computer-generated false feedback after a graded exercise test. Participants returned for a second exercise bout several days later. Efficacy was successfully manipulated and participants in the high efficacy condition reported significantly less anxiety than those in the low efficacy condition both after the graded exercise test and before and after an acute bout of exercise. Results are discussed in terms of the effect of exercise intensity and manipulation condition on anxiety.     

Theoretical developments in decision field theory: comment on Tsetsos, Usher, and Chater (2010)

Tsetsos, Usher, and Chater (2010) presented several criticisms of decision field theory (DFT) involving its distance function, instability under externally controlled stopping times, and lack of robustness to various multialternative choice scenarios. Here, we counter those claims with a specification of a distance function based on the indifference and dominance dimensions. Using this distance function, we show that the instability problems do not arise when using the internally controlled stopping rule. In conclusion, we argue that the predictions of DFT do not conflict with the data presented and that the model yet provides a coherent and accurate account of multialternative choice phenomena.     

False positives in psychiatric diagnosis: implications for human freedom

Current symptom-based DSM and ICD diagnostic criteria for mental disorders are prone to yielding false positives because they ignore the context of symptoms. This is often seen as a benign flaw because problems of living and emotional suffering, even if not true disorders, may benefit from support and treatment. However, diagnosis of a disorder in our society has many ramifications not only for treatment choice but for broader social reactions to the diagnosed individual. In particular, mental disorders impose a sick role on individuals and place a burden upon them to change; thus, disorders decrease the level of respect and acceptance generally accorded to those with even annoying normal variations in traits and features. Thus, minimizing false positives is important to a pluralistic society. The harmful dysfunction analysis of disorder is used to diagnose the sources of likely false positives, and propose potential remedies to the current weaknesses in the validity of diagnostic criteria.     

Relationships Between Meaning in Life,Social and Achievement Events,and Positive and Negative Affect in Daily Life

Research on meaning in life has generally focused on global meaning judgments. This study examined how people's daily experiences, represented by events that occur in daily life, influence their perceived sense of meaning on a daily basis. One hundred sixty‐two college students completed daily reports for 2 weeks. We examined the relationships among daily social and achievement events, daily positive and negative affect, and daily meaning in life. In addition, we tested the possible moderating influence of depressive symptoms on these relationships. Positive daily social and achievement events were related to greater daily meaning, above and beyond the contributions of daily positive and negative affect. Negative social and achievement events were related to less daily meaning, and negative achievement events covaried with daily meaning above and beyond positive and negative affect. Depression moderated the relationships between positive events and meaning, such that people who reported more depressive symptoms had greater increases in daily meaning in response to positive social and achievement events than individuals who reported fewer symptoms. These findings suggest the important role that daily events may play in fluctuations in people's affective experiences and sense of meaning in life.