Brief Cognitive-Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated in psychiatric patients following discharge from inpatient care. Despite this vulnerability, there has been limited research investigating suicide prevention protocols that take into account the unique system characteristics of this setting (e.g., short lengths of stay, crisis stabilization treatment model, multidisciplinary team coordination). Cognitive-behavioral therapy (CBT) has demonstrated efficacy for improving suicide risk in outpatients, but has not been validated with inpatients. The current study was a treatment development and pilot feasibility open trial that modified brief cognitive-behavioral therapy (BCBT) for an inpatient setting (BCBT-I). Key treatment modifications included administering up to 10 sessions (depending on patient length of stay), daily, and in a standardized order, with core crisis management skills introduced during the first three sessions. In addition, coordination with the inpatient treatment team was included in BCBT-I implementation. Six adult inpatients with a recent suicide attempt enrolled and completed an average of 4.67 BCBT-I sessions (SD = 1.36). The treatment was highly acceptable (Client Satisfaction Questionnaire total score M = 3.49, SD = 0.73). Pre- to posttreatment effect sizes demonstrated improvements in suicidal ideation (d = 0.97), depression (d = 1.33), and suicidal implicit associations (d = 1.28). All but one of the participants (83%) completed follow-up assessments 1-, 2-, and 3-months postdischarge. Over follow-up, two participants reported suicidal ideation (both without intent), and none reported suicide attempts, preparatory acts or behaviors, or nonsuicidal self-injury. This study provided preliminary evidence supporting the feasibility of CBT to treat suicidal inpatients. Future research is needed to validate BCBT-I in a larger, randomized controlled trial to determine whether BCBT-I reduces suicide risk beyond that afforded by inpatient treatment alone.     

The scientific use of ‘representation’ and ‘function’: avoiding explanatory vacuity

Nearly all of the ways philosophers currently attempt to define the terms ‘representation’ and ‘function’ undermine the scientific application of those terms by rendering the scientific explanations in which they occur vacuous. Since this is unacceptable, we must develop analyses of these terms that avoid this vacuity. Robert Cummins argues in this fashion in Representations, Targets, and Attitudes. He accuses ‘use theories’ of representational content of generating vacuous explanations, claims that nearly all current theories of representational content are use theories, and offers a non-use theory of representational content which avoids explanatory vacuity. One task I undertake in this article is to develop an alternative non-use theory which avoids an objection fatal to that theory. My second task is to adapt Cummins’ argument to criticize most current analyses of ‘function,’ which undermine scientific explanation in an analogous way. Though Cummins does not explicitly argue in this manner, his own analysis of ‘function,’ by avoiding any appeal to use, avoids the explanatory vacuity to which they succumb. Consequently, I endorse Cummins’ notion of function. However, although use theories fail as analyses of the terms ‘representation’ and ‘function,’ they can still make significant contributions to the sciences employing these terms. For, while philosophers seeking to define ‘representation’ and ‘function’ must avoid incorporating representational and functional uses into their definitions, scientists must still find a way to determine which representations and functions are being used. Suitably re-construed use theories of representation and function may in many cases assist them in this task.     

Development and validation of the Achievement Goal Scale for Youth Sports

ObjectiveThe objective was to develop and validate an achievement goal scale for young athletes that was aligned with the 2 (mastery/ego)×2 (approach/avoidance) achievement goal framework.MethodA total of 1675 male and female athletes ranging in age from 9 to 14 years participated in the AGSYS scale development and validation phases. Items having a readability level of grade 4 (age 9) or below were written and evaluated in a series of studies to assess the reliability, factorial validity, and construct validity of the Mastery and Ego scales.DesignBoth correlational and experimental methods were used to assess reliability and validity.ResultsExploratory and confirmatory factor analyses demonstrated factorial validity in samples of 9–10-, 11–12-, and 13–14-year-old athletes, and the subscales correlated in a predicted fashion with one another, with other sport and academic goal orientation measures and with several other theoretically relevant variables, including coach-initiated motivational climate, competitive trait anxiety, sport enjoyment, motivation, and self-esteem. Scores also changed significantly in response to a motivational climate coach intervention.ConclusionThe Achievement Goal Scale for Youth Sports (AGSYS) appears to be a reliable and valid measure of achievement goal approach orientations in children between the ages of 9 and 14 years. We were not successful in developing corresponding avoidance goal orientation scales that were not highly correlated, raising the possibility that children do not cognitively differentiate between mastery-avoidance and ego-avoidance orientations.     

On the alleged connection between moral evil and human freedom: A response to Trakakis’ second critique

In this essay, I answer Nick Trakakis’ second critique of my argument against the adequacy of traditional free will theodicy. I argue, first, that Trakakis errs in his implicit assertion that my argument relies upon our being strongly malevolent by nature. I argue, second, that Trakakis errs in thinking that our being weakly benevolent, morally bivalent, or weakly malevolent by nature is sufficient to refute my critique of the traditional freewill theodicy. I still maintain that the argument from freedom of the will offers an explanation of moral evil that is, in the final analysis, manifestly inadequate. I thank Nick Trakakis for his continuing interest in my essay, “On the Alleged Connection Between Moral Evil and Human Freedom.” The exchange of ideas in an atmosphere of mutual respect is the very heart of philosophy and I am grateful for the opportunity to participate in such an exchange. I believe, as a consequence, that my thinking concerning the inadequacy of the traditional free will theodicy has become more fully articulated.     

The Effect of Genetic Counseling on Knowledge and Perceptions Regarding Risks for Breast Cancer

In 1994, a clinic for cancer risk counseling was opened at Hadassah University Hospital in Jerusalem. Most of the counselees have been women who had breast cancer and/or a relative with breast cancer. In order to evaluate the effect of this counseling on women's knowledge and perceptions regarding the risks for breast cancer, a questionnaire was given before and after the counseling session to 60 healthy women who came to the clinic because they have relatives with breast cancer. According to the genetic counselors' estimations, most of these women had a significantly increased risk (compared to the general population) of developing cancer. Before counseling, the women overestimated the population risk for breast cancer, the contribution of heredity to morbidity of cancer, and their own risks to get cancer. After counseling session, they gave reduced estimates, closer to the real ones. The subjective perceptions regarding these risks were reduced after counseling, except for the perceptions regarding their relativerisks which have not changed after the counseling. About 90% of the women who came to the clinic wanted to be tested for genetic predisposition to cancer. For most of these women, the expectations that the test can rule out a genetic predisposition to cancer became more realistic after the counseling. The option to first test an affected relative was offered to all families, and a test was actually conducted in 75% of the families.     

Conformity in a generative linguistic task: the role of category and strategic nonword use.

Marsh, Ward, and Landau (1999) demonstrated that participants asked to create novel words use elements of sample nonwords they are given, even when instructed to avoid use of the examples. In four studies, we replicated the effect of conformity to sample nonwords and found the effect was not influenced by the semantic category of the words unless those words shared orthographic characteristics. We found that although we could increase conformity to examples when word exemplars were grouped by category, it was likely that much of this increase was strategically driven. We propose that the presence of the sample non-words, presented in groups with the same word rules, created an orthographic category used by participants in the word creation task.     

Descartes on the Identity of Passion and Action

According to the standard Aristotelian doctrine of the identity of passion and action (I_pa), a passion and the action with which it is identified are distinguished through a distinction of reason, and both passion and action are located in the patient. Descartes has recently been interpreted by some scholars to be rejecting I_pa in favor of a view that throws into contention a dualistic interpretation of his philosophy of mind. This article contends that Descartes did hold I_pa, albeit expressed in his own metaphysical vocabulary of substance and mode. On this interpretation, (1) a passion and the action with which it is identified are distinguished through a conceptual distinction or distinction of reason and (2) the passion and the action constitute one and the same mode which is locatedin the patient. This result is significant first, because it shows Descartes's retention of a fundamentally Aristotelian understanding of the metaphysical categories of passion and action and second, because it removes some of the support for recent interpretations on which Descartes is seen in the Passions of the Soul to diverge from a dualistic view of mind and body.     

Interference with spatial working memory: An eye movement is more than a shift of attention

In the present experiments, we examined whether shifts of attention selectively interfere with the maintenance of both verbal and spatial information in working memory and whether the interference produced by eye movements is due to the attention shifts that accompany them. In Experiment 1, subjects performed either a spatial or a verbal working memory task, along with a secondary task requiring fixation or a secondary task requiring shifts of attention. The results indicated that attention shifts interfered with spatial, butnot with verbal, working memory, suggesting that the interference is specific to processes within the visuospatial sketchpad. In Experiment 2, subjects performed a primary spatial working memory task, along with a secondary task requiring fixation, an eye movement, or an attention shift executed in the absence of an eye movement. The results indicated that both eye movements and attention shifts interfered with spatial working memory. Eye movements interfered to a much greater extent than shifts of attention, however, suggesting that eye movements may contribute a unique source of interference, over and above the interference produced by the attention shifts that accompany them.