Do behavioural self-blame and stigma predict positive health changes in survivors of lung or head and neck cancers?

Survivors of lung or head and neck cancers often change tobacco and alcohol consumption after diagnosis, but few studies have examined other positive health changes (PHCs) or their determinants in these groups. The present study aims to: (a) document PHCs in survivors of lung (n?=?107) or head and neck cancers (n?=?99) and (b) examine behavioural self-blame and stigma as determinants of PHCs. We hypothesised that: (a) survivors would make a variety of PHCs; (b) behavioural self-blame for the disease would positively predict making PHCs; and (c) stigma would negatively predict making PHCs.

Methods: Respondents self-administered measures of PHC, behavioural self-blame, and stigma. Hierarchical multiple regression analysis tested the hypotheses.

Results: More than 65% of respondents reported making PHCs, the most common being changes in diet (25%), exercise (23%) and tobacco consumption (16.5%). Behavioural self-blame significantly predicted PHCs but stigma did not. However, both behavioural self-blame and stigma significantly predicted changes in tobacco consumption.

Conclusions: Many survivors of lung or head and neck cancers engage in PHCs, but those who do not attribute the disease to their behaviour are less likely to do so. Attention to this problem and additional counselling may help people to adopt PHCs.     

Quality-of-life assessment in HIV-infected psychiatric outpatients: Perceived health,functional status,symptoms, and preferences for cardiopulmonary resuscitation

Abstract

The current study had two purposes: (1) to describe the reliability and validity of a measure of quality of life (QOL) in HIV-infected psychiatric outpatients, and (2) to predict cardiopulmonary resuscitation (CPR) preferences from disease stage, depression, and other QOL factors. We studied 63 patients, who were seen in one year at an HIV/AIDS psychiatry clinic. The results provide evidence for the validity of our instrument as a measure of health status in an HIV-infected psychiatric population. Overall symptoms were the strongest associates of functional limitations. disability, and perceived health, but depression was also significantly associated with all measures of QOL. Twenty-two patients (35.5%) would not have wanted to be revived if their heart stopped beating the day of the study. Disease stage and poor mental health were independent predictors of this preference, but severity of depression, social support, fatigue, perceived health, functional limitations, and life satisfaction were not.     

Changes in need satisfaction and motivation orientation as predictors of psychological and behavioural outcomes in exercise referral

Employing Self-Determination Theory (Deci & Ryan, 1985) as a theoretical framework, this study examined psychological need satisfaction and motivational regulations as predictors of psychological and behavioural outcomes in exercise referral (ER). ER patients (N?=?293; mean age 54.49) completed the measures of motivational regulations, psychological need satisfaction, health-related quality of life, life satisfaction, anxiety, depression and physical activity at entry, exit and 6 months following the end of a supervised exercise programme. Change in (Δ) intrinsic motivation during the scheme significantly predicted adherence and Δ habitual physical activity. Δ psychological need satisfaction from entry to exit significantly predicted Δ habitual physical activity from exit to 6-month follow-up. Δ psychological need satisfaction significantly predicted Δ motivational regulation and Δ psychological outcomes. Contrary to expectations, Δ self-determined regulation did not significantly predict Δ psychological outcomes during the structured part of the scheme, however, it did significantly predict Δ in psychological outcomes from exit to 6-month follow-up. These findings expand on cross-sectional research to demonstrate that psychological need satisfaction during supervised ER longitudinally predicts motivational regulation and psychological outcomes up to 6 months after a structured programme.     

Probabilism Today: Permissibility and Multi-Account Ethics

In ethics, ‘probabilism’ refers to a position defended by a number of Catholic theologians, mainly in the sixteenth and seventeenth centuries. They held that, when one is uncertain which of a range of actions is the right one to perform, it is permissible to perform any which has a good chance of being the right one—even if there is another which has a better chance. This paper considers the value of this position from the viewpoint of modern ethical philosophy. The unusual nature of probabilism as a theory focusing upon permissibility, rather than right-making properties, is explored and related to some modern attempts to set out ‘satisficing’ and ‘hybrid’ ethical theories. Such theories try to distinguish between what is best and what is permissible, and probabilism can be understood as an alternative way of supplementing a theory of right-making properties by adding to it a theory of permissibility. But a more radical version is also possible, where one abandons any attempt to identify right actions or right-making properties, and instead considers permissibility alone. Accordingly, a ‘multi-account theory’ of permissibility is proposed and defended as a model of how many people actually make moral decisions.     

From nihilism to monism

McDowell has argued that external world scepticism is a pressing problem only in so far as we accept, on the basis of the argument from illusion, the claim that perceiving that p and hallucinating that p involve a highest common factor--something which functions, in the manner of the classical 'veil of ideas', as a perceptual intermediary. McDowell traces the power of this argument to disputable Cartesian assumptions about the transparency of subjectivity to itself. I argue, contra McDowell, that the reflections to be found in, paradigmatically, Descartes's First Meditation are better interpreted as offering a causal argument for scepticism that depends upon a naturalistic conception of sense experience. This is more powerful than the argument from illusion, since it requires no commitment to a highest common factor in perception, nor to the transparency of the mental. The availability of this alternative route to scepticism raises serious problems for McDowell's quietism, which aims to earn the right to avoid, rather than answer, the sceptic. Since the appeal to externalism about content cannot settle the matter, I conclude that there is, at present, an unsatisfactory stand-off between the sceptic and McDowell's position.     

Disunity defended: A reply to Bayne

In this paper, I critically examine the two dominant views of the concept of luck in the current literature: lack of control accounts and modal accounts. In particular, I argue that the conditions proposed by such views—that is, a lack of control and the absence of counterfactual robustness—are neither necessary nor sufficient for an event's being lucky. Hence, I conclude that the two main accounts in the current literature both fail to capture what is distinctive of, and central to, the concept of luck.     

Explaining the Instrumental Principle

The Wide-Scope view of instrumental reason holds that you should not intend an end without also intending what you believe to be the necessary means. This, the Wide-Scoper claims, provides the best account of why failing to intend the believed means to your end is a rational failing. But Wide-Scopers have struggled to meet a simple Explanatory Challenge: why shouldn't you intend an end without intending the necessary means? What reason is there not to do so? In the first half of this paper, I argue that the Wide-Scope view struggles to meet this challenge because it takes the principles of instrumental reason to have unlimited application—to apply to all agents, in all circumstances. I then go on to offer a new account of these principles. The new account is very much in the spirit of the Wide-Scope view, and shares its central advantages, but lacks its unlimited application. This view should, therefore, find the Explanatory Challenge more tractable. In the second half of the paper, I argue that this prediction is confirmed. If the requirements of instrumental reason apply only when a means is, or is believed to be, necessary for your end, then plausible independent claims, about reasons, rationality, and intentions, explain why failing to intend the necessary means to your ends is a rational failing.     

Psychometric Properties and Factorial Structure of the State Trait Anxiety Inventory-Trait Version (STAI-T) in Caribbean University Students

The study investigated the psychometric properties of the State Trait Anxiety Inventory—Trait Scale (STAI-T: Spielberger, 1983) in a Caribbean university student sample. Participants were 415 undergraduate students (75% female) who completed the State-Trait Anxiety Inventory-Trait Version (STAI-T; Spielberger, 1983), Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996), the Zung Self-Rating Depression Scale (SDS; Zung, 1965), the Ego Resiliecy-89 (ER-89; Block, 1989), and the Perceived Stress Scale-Ten Item Version (PSS-10; Cohen et al., 1983). Confirmatory factor analysis (CFA) was conducted to examine the construct validity of the trait anxiety scale in terms of factor structure, convergent, discriminant, and nomological validities. CFA results revealed that a two-factor solution (trait anxiety absent and trait anxiety present) provided significantly better fit than the one-factor model of trait anxiety. There was clear evidence of convergent validity, discriminant validity, and nomological validity of the scale. Results support the psychometric adequacy of the STAI-T for use with Caribbean university students.     

Brief encounters and available places to land

In this paper the author addresses the process of ending in brief therapy. While recognizing the importance of attending to the symbolic meaning of the ending itself and the need to interpret this as it manifests in the transference, he points out the limitations of such an approach. He highlights the significance of the environment of interpersonal relationships and family systems and the wider communities in which the client lives. He suggests that the therapist needs to assess the extent to which these can provide an environment that facilitates the client's development and working through as the therapy ends. The therapist needs to establish whether the patient will have an available place to land, and one that provides sufficient security and safety for the client's onward journeying and exploration without the therapist. The author's conceptualization of 'landing at the end of brief therapy' links together Malan's triangles of insight with Sullivan's concept of the ordinary solution and selective inattention and Gustafson's concept of dilemmas to add depth to the therapeutic effectiveness with which the practitioner can approach brief therapy in general, and the ending in particular. The article concludes with a case example that illustrates these themes.