The semantic side of decision making

The research reported in this paper follows the perspective that decision making is a meaningful act that conveys information. Furthermore, the potential meanings associated with decision options may affect the decisions themselves. This idea is examined in the contexts of compensation, donation, and exchange. In general, judgments were relation dependent and meaning dependent. Furthermore, the results show nonmonotonicities and limited substitutability in a pattern that challenges straightforward ways of mapping decisions onto a common currency of utility.     

Full statistical mediation of the relationship between trauma and depressive symptoms

Owing to the potentially devastating effects of trauma‐induced depression, explaining the relationship between trauma and depressive symptoms is important. In this study, we measured lifelong exposure to potentially traumatic events and depressive symptoms in 370‐female undergraduates. We also measured anxiety, past negative time perspective and dissociation as potential mediators. Trauma exposure and depressive symptoms were related with a small but significant effect size (r = .16). Trauma was not associated with dissociation. We found that past negative time perspective and anxiety were full statistical mediators of this trauma‐depressive symptoms relationship. These two mediators combined accounted for all of the variance in that association. Anxiety accounted for more of the variance than past negative time perspective. A proposed explanation is that trauma both affectively elevates anxiety and cognitively creates an enduring focus on the events. Chronic anxiety and a past negative time perspective may lead to depression over time. The clinical implications are possible explanations as to why some treatments work.     

Putting families in the center: family perspectives on decision making and ADHD and implications for ADHD care

Objective: To examine components of family-centered care in families' stories about treatment decision making for their child with ADHD. Method: Twenty-eight families participated in qualitative interviews that addressed families' perspectives on (a) the treatment decision-making process, (b) the cause and impact of their child's symptoms, and (c) treatment goals and preferences. Results: The majority of families preferred to be primary or shared decision makers regarding treatment decisions. Families' perspectives on the cause of the child's symptoms varied and often were not consistent with a biomedical framework. Families described multiple areas of impairment on child, family relationships, and family functioning. Perspectives toward evidence-based treatments were mixed, with families also expressing interest in and pursuing interventions not delineated in current treatment guidelines. Conclusion: These findings reinforce the importance of eliciting families' perspectives and involving these important stakeholders in shared decision making as critical components of family-centered care for children with ADHD.     

Bion’s discovery of alpha function: Thinking under fire on the battlefield and in the consulting room

This paper has traced Bion’s discovery of alpha function and its subsequent elaboration. His traumatic experiences as a young tank commander in World War I (overlaid on, and intertwined with, childhood conflicts) gave him firsthand exposure to very painful emotions that tested his capacity to manage. Later, in the 1950s, after his analysis with Melanie Klein and marriage to Francesca Bion, he undertook the analysis of psychotic patients and learned how they disassembled their ability to know reality as a defense against unbearable emotional truths in their lives. This led Bion to identify an aspect of dreaming that was necessary in order for reality experience to be given personal meaning so that one may learn from experience. Simultaneous with working out this new theory of dreaming, Bion also revisited his World War I experiences that had remained undigested and all these elements coalesced into a selected fact – his discovery of alpha function. In subsequent writings, Bion explored the constituent factors of alpha function, including the container/contained relationship, the PS?D balance, reverie, tolerated doubt and other factors which I have termed the ‘Constellation for Thinking’.     

High Behavioral Approach System (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: a prospective behavioral high-risk design

A prospective, behavioral high-risk design provided a theoretically guided examination of vulnerability to first onset of bipolar spectrum disorder based on the Behavioral Approach System (BAS) model. Adolescents (ages 14-19) at an "age of risk" for bipolar disorder onset were screened on BAS sensitivity by interviewers blind to current symptoms, lifetime history, and family history of psychopathology. Participants were selected with high versus moderate levels of BAS sensitivity and administered a lifetime diagnostic interview. Those with a bipolar spectrum disorder, psychosis, or hypomanic episode with onset prior to the BAS sensitivity assessment were excluded. High BAS (n = 171) and moderate BAS (n = 119) sensitivity participants in the final sample completed baseline measures of symptoms, goal-setting, and reward responsiveness and were followed prospectively with semistructured diagnostic interviews every 6 months. Consistent with the vulnerability hypothesis of the BAS model of bipolar disorder, high BAS participants had a greater likelihood, and shorter time to onset, of bipolar spectrum disorder than moderate BAS participants across an average of 12.8 months of follow-up (12.9% vs. 4.2%), controlling for baseline depressive and hypomanic symptoms, and family history of bipolar disorder. High reward responsiveness on a behavioral task and ambitious goal-striving for popular fame and financial success (but not impulsivity) also predicted first onset of bipolar spectrum disorder controlling for the covariates and BAS risk group, and ambitious goal-striving partially mediated the BAS risk group effect. We discuss implications of the findings for the BAS model of bipolar disorder and early intervention efforts.     

Extreme Asceticism: Confucian Practice and Riesebrodt's Religious Virtuoso

The ascetic ideals initially established by Confucius are moderate and rational. Yet, virtuoso asceticism became a social phenomenon when the state desired to institute a more powerful channel to disseminate Confucian values in the broader populace beyond the literati. The reason that the cult of the virtuoso particularly served this purpose was that the enshrinement of virtuoso generated social power within community. That social power, somewhat equivalent to charisma, derived from the enshrined spirit's connection with transcendence having official and public offerings from community. The social process in the formation of the ascetic virtuoso and its social function in the Confucian tradition follow a pattern similar to that laid out by Martin Riesebrodt: denial of the physical self, restructuring of social relations, and spiritual transformation. Ascetic virtuosos stemming from the tradition of “inner‐worldly” asceticism closed a gap between a rationalized system of behavior‐regulating practices and interventionist practice with reference to transcendence.     

Prospective Examination of Self‐Regulatory Efficacy in Predicting Walking for Active Transportation: A Social Cognitive Theory Approach

Walking for transportation is associated with health benefits. Minimal theory‐based research has examined social cognitive and environmental predictors. This study examined social cognitions (self‐regulatory efficacy to plan/schedule and overcome barriers; distance and travel time cognitions) and an environmental factor (proximity) as predictors of walking for transportation. Participants (n = 105) were university students, faculty, and staff, living within a walkable distance to campus. Social cognitions and proximity measures were completed at baseline, followed by walking for transportation to/from the campus over 2 weeks. A hierarchical multiple regression analysis predicted walking (R²_adjusted = .55; p < .05). Self‐regulatory efficacy to plan/schedule and overcome barriers were independent predictors (p's < .01). Findings supported theoretical contentions that self‐regulatory efficacy predicts walking for transportation.     

Hierarchical integration of agency and communion: a study of influential moral figures

The purpose of this research is to (a) identify which of recent history's influential figures did and which did not personify moral excellence, and (b) to examine the motives that drove these individuals along such divergent paths. In Study 1, 102 social scientists evaluated the moral qualities of influential figures from Time Magazine's lists. In Study 2, we selected the 15 top ranking of these figures to comprise a moral exemplar group and the bottom 15 to comprise a comparison group of similarly influential people. We measured the motivational aspects of their personality (agency and communion) by content-analyzing extant speeches and interviews. Moral exemplars exhibited the hierarchical integration of agency and communion by treating agentic motives as a means to an end of communal motives. Comparison subjects, by contrast, personified unmitigated agency by treating motives of agency as both a means to an end and an end unto itself. These results imply that both the strength and structure of a person's motives account for moral behavior.     

Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.