Teaching self-treatment of cold symptoms to an anoxic brain injured adult

Traumatic brain injury can result in behavioral and physical deficits that require intensive post-acute residential rehabilitation. Behaviors targeted by such programs include basic self-care and living skills. We examined the efficacy of a behavioral training strategy to teach appropriate medical treatment of four different groups of simulated cold symptoms to an anoxic brain injured adult. The strategy included instructor prompting and feedback in the use of written task analyses and picture cues as self-administered prompts. Subsequent to baseline, the participant used written generic task analyses combined with picture cues and then, if necessary, written specific task analyses combined with picture cues to prompt appropriate self-treatment of the four types of colds. Written individualized task analyses, tailored to participant errors, were used to fade specific task analysis prompts and transfer stimulus control to the discriminative stimuli present in the picture cues. A multiple baseline design across responses showed that skill acquisition did not occur after generic task analysis training, but did so after specific task analysis training. The participant responded to all four types of colds for three consecutive trials at 100% correct under baseline conditions. Follow-up results indicated that transfer of stimulus control to the cold symptoms simulated by the picture cues alone did not maintain over time. Correct responding was retrained using generic and, if necessary, individualized task analysis training conditions.     

Occult participation: its impact on adolescent development

This study investigated the relationship between occult participation, substance abuse, and level of self-esteem in adolescents. Data were collected from 50 adolescents who ranged in age from 12 to 19 years and who spoke English as their primary language. The combined group of adolescents consisted of 25 clinical and 25 nonclinical youth. Participants completed a three-part questionnaire package which included Rosenberg's Self-Esteem Scale, the Adolescent Magic Questionnaire, and the Drug and Alcohol Assessment Scale. Results indicated that adolescent substance abuse and occult participation were significantly related. High and low occult participation groups were determined, and significant differences were found between the high versus low occult groups when compared on the primary variables of self-esteem and substance abuse. Significant differences were also noted when comparing the high versus low occult groups with various psychosocial developmental variables. Included is a discussion of the impact of occult participation on the psychosocial elements of adolescent self-esteem, self-concept, tolerance for deviance, and religious involvement.     

Acquired affective-evaluative value: conservative but not unchangeable

In a previous study on Evaluative Conditioning it was found that unlike signal-learning, evaluative learning is resistant to extinction. In the present experiment we tried to replicate and corroborate this finding. In addition, we investigated the effectiveness of a counterconditioning procedure to alter acquired evaluative value. On a within-subject base (n = 30), it was found that the mere contingent presentation of neutral with (dis)liked pictures of human faces was sufficient to change the affective-evaluative tone of the originally neutral stimuli in (negative) positive direction. Next, we replicated the finding that an extinction procedure does not have any influence on the acquired evaluative value of the originally neutral stimuli, and this even in subjects fully aware of the extinction presentations. We demonstrated the effectiveness of a counterconditioning procedure to alter acquired evaluative value, and in addition, found some evidence that awareness of the counterconditioning manipulations is not a prerequisite for its effectiveness. The theoretical consequences of these findings are phrased in terms of a fundamental distinction between signal-learning and evaluative learning, and some important implications for the behavioral treatment of affective-emotional disorders are suggested.     

Research-structured vs clinically flexible versions of social learning-based marital therapy

The purpose of this study was to compare our structured research-based version of marital therapy from a social learning perspective with a clinically flexible version of the same treatment where treatment plans were individually-based and there was no specific number of treatment sessions. Thirty distressed married couples were randomly assigned to one of these two treatments. Assessment of outcome was based on global marital satisfaction, spouse reports of functioning in specific areas, and direct observational measures of communication. At posttest there were no differences in efficacy between structured and flexible treatments, although both treatments led to significant improvements. At a 6-month follow-up couples treated with the structured format were more likely to have deteriorated and flexibly treated couples were more likely to have maintained their treatment gains.     

Hypothesizing and evidence-gathering: the nexus of understanding

Prior discussion of hypothesizing as a session "guideline" has not fully clarified the derivation of hypotheses. Reviewing relevant philosophy of science literature, the authors develop the notions of evidence and evidence-gathering in systemic family therapy. The authors claim evidence-gathering and hypothesizing are interdependent, reciprocal elements of scientific understanding. The structure of evidence is described along with practical and qualitative rules for collecting and using evidence. This model is applied to a case example illustrating the logic of clinical process. Implications are discussed for family therapy training and supervision.     

Violence and the systemic view: the problem of power

Violence is a strikingly lineal concept that is difficult to address from a systemic perspective. Bateson's epistemological disqualification of the concept of power is often understood to imply a corresponding systemic disqualification of the concept of violence. This position is examined in light of recent feminist criticism. It is argued that (a) violence and power belong essentially to the domain of human experience and (b) human experience cannot be invalidated by theory. Accordingly, it is suggested that the (appropriate) invalidation of power and violence in the domain of systemic explanation should probably be understood both as a deliberate choice that necessarily follows from adopting a systemic perspective, and as a fundamental limitation of that perspective. In neither case, however, should the systemic view be considered to be a valid disqualification of the human experience of violence and power.     

Defining a family heritage and a new relationship identity: two central tasks in the making of a marriage

The roles of origin family environmental characteristics and couple consensus-building process within the development of marital relationships were examined prospectively in 16 premarital couples. Three important findings emerged. First, significant correlations were found between dimensions of origin family environment and the reported level of satisfaction within the couple's current relationship. Second, measures of the couple's ability to reach consensus concerning important interpersonal relationships appeared to be important mediators of the association between origin family environment and current relationship satisfaction. Third, important gender differences emerged that replicate and extend prior findings that portray women in the role of "relationship specialist" within their marriages. As a group, these findings were best explained by a developmental model of early marriage that envisions the young couple as facing two entwined tasks: to define both their family heritage and their new relationship identity. Overall, the importance of examining family-of-origin characteristics and consensus-building process as critical determinants of the fate of intimate relationships received strong support. The gender differences found in the literature reviewed, as well as the results of this study, have largely been overlooked by the theory and practice of family therapy. Efforts on both the research and theory construction fronts are needed to increase our understanding of the mechanisms whereby prior family experience is brought forward into current intimate relationships.     

A sermon from hell: Toward a theology of loneliness

Loneliness as part of the human condition is first explored from an experiential-philosophical perspective. A biblical survey suggests loneliness is normative to the faith experience and may portray a more realistic religiosity. Desert imagery in Scripture indicates a strong association among solitude, spiritual development, and potential dangers of spiritual deception. God's not yet-ness-itself a cause of existential loneliness—is paradoxically the way in which communion with God functions in the here and now. The creative use of solitude may enhance social, psychological, and spiritual well-being, and provide a way to theologize about personal isolation and disorientation.He is also editor of theHarding Journal of Religion and Psychiatry.     

Cerebral laterality and depression: differences in perceptual asymmetry among diagnostic subtypes

Examined the influence of diagnostic subtype of depression on perceptual asymmetry for dichotic listening and visual tachistoscopic tasks. A total of 65 unmedicated patients with major depressive disorders and 30 normal controls were tested on a verbal and nonverbal task in each modality. Patients diagnosed according to the DSM-III with melancholia had abnormal perceptual asymmetry for dichotic nonsense syllable and complex tone tasks. In contrast, patients having a nonmelancholic "atypical depression" (reactivity of mood with preserved pleasure capacity and associated features) did not differ from normal controls on these tasks, but had an increased incidence of left handedness. Bipolar depression (history of hypomania) differed from unipolar depression in showing abnormal perceptual asymmetry for a tachistoscopic dot enumeration task. Alterations of perceptual asymmetry in melancholia and bipolar depression were consistent with hypothesized right hemisphere dysfunction.