Automated respiratory sinus arrhythmia measurement: Demonstration using executive function assessment

Respiratory sinus arrhythmia (RSA) is a quantitative metric that reflects autonomic nervous system regulation and provides a physiological marker of attentional engagement that supports cognitive and affective regulatory processes. RSA can be added to executive function (EF) assessments with minimal participant burden because of the commercial availability of lightweight, wearable electrocardiogram (ECG) sensors. However, the inclusion of RSA data in large data collection efforts has been hindered by the time-intensive processing of RSA. In this study we evaluated the performance of an automated RSA-scoring method in the context of an EF study in preschool-aged children. The absolute differences in RSA across both scoring methods were small (mean RSA differences = –0.02–0.10), with little to no evidence of bias for the automated relative to the hand-scoring approach. Moreover, the relative rank-ordering of RSA across both scoring methods was strong (rs = .96–.99). Reliable changes in RSA from baseline to the EF task were highly similar across both scoring methods (96%–100% absolute agreement; Kappa = .83–1.0). On the basis of these findings, the automated RSA algorithm appears to be a suitable substitute for hand-scoring in the context of EF assessment.     

An Evidence-Based,Community-Engaged Approach to Develop an Interactive Deliberation Tool for Pediatric Neuromuscular Trials

Duchenne/Becker muscular dystrophy (DBMD) and spinal muscular atrophy (SMA) are rare neuromuscular disorders that present challenges to therapeutic and clinical trial decision making. We developed an interactive, evidence-based online tool designed to encourage thoughtful deliberation of the pros and cons of trial participation and to inform meaningful discussions with healthcare providers. Prior research demonstrates the importance of tool availability at the time each family is considering trial participation, which may be prior to the informed consent process. The tool is intended to be easily modified to other pediatric disease communities. Tool development was informed by prior qualitative research, literature reviews, and stakeholder input. Specific items were derived based on an online exploratory questionnaire of parents whose children participated in a trial for DBMD or SMA to understand motivations for participation. Parent participants in the exploratory survey reported strong impact of altruistic and individual benefit motivations and placed much greater emphasis on anticipated trial benefits than on harms when making participation decisions. We used this data to develop the evidence-based deliberation tool using a community-engaged approach. We initially targeted the tool for DBMD while using SMA survey data to evaluate ease of transition to that population. We conducted two iterative sets of activities to inform development and refinement of the tool: (1) community engagement of key stakeholders and (2) user experience testing. These activities suggest that the tool may increase deliberation and the weighing of benefits and harms. Ongoing evaluation will determine the acceptability and efficacy of this online intervention.     

Bodies in Dialogue: Empathic Connectedness in the Realm of the Unspeakable

ABSTRACT

This article joins in contemporary psychoanalysis’ ever-expanding conversation about the “something more” than spoken language that has long been privileged in our profession. Specifically, the notion is explored that infant research’s conceptualization of mind as dialogic in origin—that we are prewired from birth to participate in nonverbal, affective communication—is consistent with the position that an embodied, dialogic, co-created, empathic connectedness can evolve with severely traumatized, frozen patients whose experience is not just unformulated but unspeakable. This is illustrated with an in-depth account of a challenging therapeutic journey with a highly intelligent man whose social relatedness hid a world of frozen grief and terror of violation. It was only when the therapist could connect with trauma-generated aspects of herself that had remained frozen, could she find an empathic way of being-with and ultimately understanding her patient’s wordless, frozen world.     

Early maladaptive schemas and non-suicidal self-injury among young adults: A preliminary investigation

Non-suicidal self-injury (NSSI) represents a critical mental health issue among young adults. Accordingly, it is important to understand potentially modifiable processes involved in its enactment. The current investigation built on previous work to better understand the nature of early maladaptive schemas (EMS) in the context of NSSI. One hundred and thirty young adults completed questionnaires assessing NSSI history, EMS and depressive symptoms. Results indicate that EMS may play a role in NSSI engagement after controlling for depressive symptoms. Specifically, higher scores on social isolation and emotional inhibition and possibly lower scores on entitlement/grandiosity schemas may differentiate those who self-injure from those who do not. Furthermore, higher levels of dependence/incompetence schema may differentiate those who report a higher NSSI frequency and those who report a less frequent NSSI history. Although a nascent area of study, our findings suggest that it may be fruitful to consider conceptualizing NSSI within a schema therapy framework.     

The (Non) Religion of Mechanical Turk Workers

Social science researchers have increasingly come to utilize Amazon's Mechanical Turk (MTurk) to obtain adult, opt‐in samples for use with experiments. Based on the demographic characteristics of MTurk samples, studies have provided some support for the representativeness of MTurk. Others have warranted caution based on demographic characteristics and comparisons of reliability. Yet, what is missing is an examination of the most glaring demographic difference in MTurk—religion. We compare five MTurk samples with a student convenience sample and the 2012 General Social Survey, finding that MTurk samples have a consistent bias toward nonreligion. MTurk surveys significantly overrepresent seculars and underrepresent Catholics and evangelical Protestants. We then compare the religiosity of religious identifiers across samples as well as relationships between religiosity and partisanship, finding many similarities and a few important differences from the general population.     

The translational metaphor in psychoanalysis

The translational metaphor in psychoanalysis refers to the traditional method of interpreting or restating the meaning of verbal and behavioral acts of a patient in other, presumably more accurate terms that specify the forces and conflicts underlying symptoms. The analyst translates the clinical phenomenology to explain its true meaning and origin. This model of analytic process has been challenged from different vantage points by authors presenting alternative conceptions of therapeutic action. Although the temptation to find and make interpretations of clinical material is difficult to resist, behaving in this way places the analyst in the position of a teacher or diagnostician, seeking a specific etiology, which has not proven fruitful. Despite its historical appeal, I argue that the translational model is a misleading and anachronistic version of what actually occurs in psychoanalysis. I emphasize instead the capacity of analysis to promote the emergence of new forms of representation, or figuration, from the unconscious, using the work of Lacan, Laplanche, and Modell to exemplify this reformulation, and provide clinical illustrations of how it looks in practice.     

Exemplarist Environmental Ethics

This article argues that environmental ethics can deemphasize environmental problem‐solving in preference for a more exemplarist mode. This mode will renarrate what we admire in those we have long admired, in order to make them resonate with contemporary ethical needs. First, I outline a method problem that arose for me in ethnographic fieldwork, a problem that I call, far too reductively, “solution thinking.” Second, I relate that method problem to movements against “quandary ethics” in ethical theory more broadly. Third, I discuss some interpretive work I am engaged in about Henry David Thoreau and how it bears on the methodological issues my fieldwork raised. I argue that some of the most important icons of right relation to environment, especially Francis of Assisi and Thoreau, should be envisioned as far more politically invested than they usually are. They demonstrate to scholars of religious ethics that an exemplarist ethic focused on character need not neglect politics.