The horizontal-vertical delusion

Most people can correctly apply the concepts of horizontal and vertical in describing objects, but a simple demonstration shows that they are confused about how these concepts work. The nature of the confusion and its possible causes are briefly discussed.     

Introduction

The United States is a profoundly multiethnic country. Increasingly, it is realized that the presentation of psychological distress, and its treatment, is influenced in important ways by culture. The current special issue aims to explore how culture impacts on the treatment process—from distress presentation to mechanisms generating distress to the manner in which mechanisms generating distress must be addressed. In this Introduction to the special issue, I will summarize the contributions, and give some sense of how they illustrate the importance of culture in the treatment process.     

Modifying Exposure-Based CBT for Cambodian Refugees with Posttraumatic Stress Disorder

Cambodian refugees represent a severely traumatized population living in the United States. In this paper, we describe the modification of a cognitive-behavior therapy program to facilitate delivery of an exposure-based treatment for posttraumatic stress disorder while addressing some of the challenges brought by differences in language and culture between providers and patients. Our treatment modifications include the use of metaphors and culturally relevant examples to aid the communication of core concepts by interpreters, an emphasis on teaching the “process” of exposure therapy rather than relying on specific exposure practice in the group setting, a focus on interoceptive exposure to allow more effective group practice and to address culturally specific symptom interpretations, attention to the way in which treatment procedures interacted with culturally specific beliefs, and efforts to integrate treatment services within the community. Although data are limited, results to date suggest that this modified treatment was acceptable to patients and offered benefits on the order of large effect sizes.     

Cognitive-Behavior Therapy for Vietnamese Refugees With PTSD and Comorbid Panic Attacks

For Vietnamese refugees, we describe (a) how headache- and orthostasis-focused panic attacks are generated, (b) a culturally sensitive treatment for PTSD with comorbid headache- and orthostasis-focused panic attacks, and (c) the outcome of a treatment series. In a multiple-baseline, across-subjects design (N = 3), all patients demonstrated treatment-related improvement of headache- and orthostasis-associated panic attacks; and in the repeated-measures, within-subjects design, all patients greatly improved across treatment on measures of psychopathology. One treatment case is presented.     

Distributive Justice in the State of Nature: An Egalitarian View

Abstract

This paper proposes a novel egalitarian answer to the question: what initial distribution of the world’s resources could possibly count as just? Like many writers in the natural rights tradition, I take for granted that distributive justice consists in conformity to pre-political principles that apply to property regimes. Against the background of that assumption, the paper distinguishes between broadly Lockean and broadly Grotian conceptions of distributive justice in the state of nature. After an extended critique of various versions of the Lockean approach, it argues for a particular, egalitarian version of the Grotian view. My position is based on what I call the common ownership formula, which says: each human being, as an equal co-owner of the world’s resources, may use those resources provided that the terms of their use are in conformity with principles that no co-owner could reasonably reject as the basis of an informed, unforced general agreement between all of the world’s co-owners who sought to find equitable principles of resource division. Using this principle, I suggest how an unequivocally egalitarian view of pre-political entitlement can be justified without recourse to any alleged duty to ameliorate the effects of brute bad luck on people’s lives.     

Pregnant Women’s Perspectives on Expanded Carrier Screening

Expanded carrier screening (ECS) is a relatively new carrier screening option that assesses many conditions simultaneously, as opposed to traditional ethnicity-based carrier screening for a limited number of conditions. This study aimed to explore pregnant women’s perspectives on ECS, including reasons for electing or declining and anxiety associated with this decision-making. A total of 80 pregnant women were surveyed from Northwestern Medicine’s Clinical Genetics Division after presenting for aneuploidy screening. Of the 80 participants, 40 elected and 40 declined ECS. Trends regarding reasons for electing or declining ECS include ethnicity, desire for genetic risk information, lack of family history, perceived likelihood of being a carrier, and perceived impact on reproductive decisions. Individuals who declined ECS seemed to prefer ethnicity-based carrier screening and believed that ECS would increase their anxiety, whereas individuals who elected ECS seemed to prefer more screening and tended to believe that ECS would reduce their anxiety. These findings provide insight on decision-making with regard to ECS and can help guide interactions that genetic counselors and other healthcare providers have with patients, including assisting patients in the decision-making process.     

Adaptation of CBT for Traumatized South African Indigenous Groups: Examples from Multiplex CBT for PTSD

This article describes how Culturally Adapted Multiplex CBT, a treatment that emphasizes somatic processing and emotion regulation, was adapted for a traumatized South African indigenous group, the Sepedi. A model of psychopathology is presented, the Multiplex Model of Trauma-Related Disorder, which depicts the processes that generate multiple comorbidities and prominent somatization in minority, refugee, and other non-Western populations. The nine dimensions of Culturally Adapted Multiplex CBT are discussed, and so too the “cultural adaptation diamond.” Concepts such as “explanatory model bridging” are presented. A culturally sensitive assessment measure of local somatic complaints and cultural syndromes (the Sepedi Symptom and Syndrome Addendum, or Sepedi SSA) is detailed, as well as how CBT techniques were implemented with this group—for example, modification of culturally specific catastrophic cognitions, doing exposure (e.g., interoceptive exposure), teaching attentional control and mindfulness techniques, and teaching “loving kindness.” Case examples with clinical outcomes are provided to further illustrate how Multiplex CBT was adapted for the South African indigenous group.     

Word-frequency and phonological-neighborhood effects on verbal short-term memory

Immediate memory span and maximal articulation rate were assessed for word sets differing in frequency, word-neighborhood size, and average word-neighborhood frequency. Memory span was greater for high- than low-frequency words, greater for words from large than small phonological neighborhoods, and greater for words from high- than low-frequency phonological neighborhoods. Maximal articulation rate was also facilitated by word frequency, phonological-neighborhood size, and neighborhood frequency. In a final study all 3 lexical variables were found to influence the recall outcome for individual words. These effects of phonological-word neighborhood on memory performance suggest that phonological information in long-term memory plays an active role in recall in short-term-memory tasks, and they present a challenge to current theories of short-term memory.