Should DBS for Psychiatric Disorders be Considered a Form of Psychosurgery? Ethical and Legal Considerations

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community’s interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS—though a much more precise and refined treatment than its predecessors—is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older forms of psychosurgery can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS.     

Brief Behavioral Activation Treatment for Depressed Adolescents Delivered by Nonspecialist Clinicians: A Case Illustration

Behavioral activation (BA) can be as effective as cognitive-behavioral therapy for the treatment of depression in adults, but to date there is little research with adolescents. This is problematic given the recognized need to increase access to evidence-based interventions for depression in young people. We have developed a new adaptation of brief Behavioral Activation (Lejuez, Hopko, Acierno, Daughters, & Pagoto, 2011) specifically for young people: Brief BA for depressed adolescents. In this paper, we use a case example with session-by-session measurement to show how a nonspecialist clinician can deliver this intervention successfully. We discuss the key themes arising from this training case, challenges the clinician faced, and how these were managed through training and supervision.     

The effects of a behavioral skills training and general‐case training package on caregiver implementation of a food selectivity intervention

We used behavioral skills training with general‐case training to teach 3 caregivers to implement a behavioral feeding intervention with their children. The percentage of correctly performed steps of the feeding intervention increased for all 3 caregivers and was maintained at follow‐up. For all 3 children, the number of bites consumed increased and the number of bites with inappropriate mealtime behavior decreased across treatment. Increases in bites consumed and bites without behavior problems were maintained for 2 participants at follow‐up.     

I became adult when … Pathways of identity resolution and adulthood transition in Italian freshmen’s narratives

Defining and consolidating identity in order to acquire fulfilling adult roles may be more difficult than in the past for a significant proportion of youth cohorts, especially for youth in ‘post-industrial’ countries. This study was focused on the intersection between processes and contents of both identity and adulthood through the narrative approach in the Italian context. Participants were 105 Italian freshmen aged 18–21, attending the first year university. We adopted a narrative approach based on autobiographical memories. Findings confirm the relationship between identity resolution processes and adulthood reaching in Italian freshmen and they identify five student’s profiles (Resolved or closed keepers, Travelers, Uninvolved, On the way, Big babies). Suggestions for future research and limitations are discussed.     

Brief Counseling for Alcohol Misuse Among Trauma Patients: Two Interventions and Influence of Baseline Use

This study examined whether baseline trauma patient characteristics and randomized participation in 1 of 2 brief interventions predicted changes in alcohol use at 6 months postintervention. Higher total Alcohol Use Disorders Identification Test (AUDIT) scores predicted greater changes, and specific AUDIT items were significant predictors.     

Autonomic and subjective responsivity to emotional images in people with dissociative seizures

People with dissociative seizures (DS) report a range of difficulties in emotional functioning and exhibit altered responding to emotional facial expressions in experimental tasks. We extended this research by investigating subjective and autonomic reactivity (ratings of emotional valence, arousal and skin conductance responses [SCRs]) to general emotional images in 39 people with DS relative to 42 healthy control participants, whilst controlling for anxiety, depression, cognitive functioning and, where relevant, medication use. It was predicted that greater subjective negativity and arousal and increased SCRs in response to the affective pictures would be observed in the DS group. The DS group as a whole did not differ from controls in their subjective responses of valence and arousal. However, SCR amplitudes were greater in ‘autonomic responders’ with DS relative to ‘autonomic responders’ in the control group. A positive correlation was also observed between SCRs for highly arousing negative pictures and self‐reported ictal autonomic arousal, in DS ‘autonomic responders’. In the DS subgroup of autonomic ‘non‐responders’, differences in subjective responses were observed for some conditions, compared to control ‘non‐responders’. The findings indicate unaffected subjective responses to emotional images in people with DS overall. However, within the group of people with DS, there may be subgroups characterized by differences in emotional responding. One subgroup (i.e., ‘autonomic responders’) exhibit heightened autonomic responses but intact subjective emotional experience, whilst another subgroup (i.e., ‘autonomic non‐responders’) seem to experience greater subjective negativity and arousal for some emotional stimuli, despite less frequent autonomic reactions. The current results suggest that therapeutic interventions targeting awareness and regulation of physiological arousal and subjective emotional experience could be of value in some people with this disorder.     

To Brexit or not to Brexit: The roles of Islamophobia,conspiracist beliefs,and integrated threat in voting intentions for the United Kingdom European Union membership referendum

We used an identities approach to examine voting intentions in the June 2016 UK referendum on membership of the European Union (EU). In April 2016, 303 British adults (58.7% women, age M = 34.73) indicated their voting intentions for the referendum and completed measures of identification with the national in-group, perceived threat from Muslim immigrants, belief in Islamophobic conspiracy narratives, Islamophobia, general conspiracist beliefs, ambiguity tolerance, and belief in a clash of civilizations. Path and mediation analyses indicated that greater belief in Islamophobic conspiracy theories mediated the link between Islamophobia and intention to vote to leave. Islamophobia and Islamophobic conspiracist beliefs also mediated the effects of perceived threat from Muslims on voting intentions. Other variables acted as antecedents of perceived threat or Islamophobic conspiracy narratives. These findings highlight the role that identity-based cognitions may have played in shaping voting intentions for the UK EU referendum.     

Why Externalist Representationalism is a Form of Disjunctivism

Externalist representationalism is touted as a superior rival to naïve realism, and yet a careful analysis of the externalist representationalist's analysis of our ordinary perceptual experiences shows the view to be far closer to naïve realism than we might have expected. One of the central advertised benefits of representationalist views in general is that they are compatible with the idea that ordinary, illusory and hallucinatory perceptual experiences are of the same fundamental kind. Naïve realists are forced to deny the ‘common fundamental kind claim’ and adopt disjunctivism. However, I argue that externalist representationalism is also a version of disjunctivism. Consequently, one of the main rivals to naïve realism turns out not to be a rival at all.     

Trajectories of Italian Children’s Peer Rejection: Associations with Aggression,Prosocial Behavior,Physical Attractiveness,and Adolescent Adjustment

In the present study, the predictors and outcomes associated with the trajectories of peer rejection were examined in a longitudinal sample of Italian children (338 boys, 269 girls) ages 10 to 14 years. Follow-up assessments included 60% of the original sample at age 16–17. Low, medium, and high rejection trajectory groups were identified using growth mixture models. Consistent with previous studies, we found that (a) being less prosocial and more physically aggressive at age 10 was characteristic of those children with the high rejection trajectory; (b) being less attractive was related to higher peer rejection from age 10 to 14; and (c) boys with a high rejection trajectory showed high levels of delinquency and anxiety-depression and low levels of academic aspiration at age 16–17, whereas girls with a high rejection trajectory showed low levels of academic aspiration and social competence at age 16–17. Our findings indicate the detrimental consequences of peer rejection on children’s development and adjustment and shed light on the mechanisms that contribute to maintaining or worsening (e.g., being attractive, prosocial, and aggressive) a child’s negative status (e.g., being rejected) within his or her peer group over time.