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’.     

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.     

What is Wrong with Rational Suicide

Recently, the ‘right to die’ became a major social issue. Few agree suicide is a right tout court. Even those who believe suicide (‘regular’, passive, or physician-assisted) is sometimes morally permissible usually require that a suicide be ‘rational suicide’: instrumentally rational, autonomous, due to stable goals, not due to mental illness, etc. We argue that there are some perfectly ‘rational suicides’ that are, nevertheless, bad mistakes. The concentration on the rationality of the suicide instead of on whether it is a mistake may lead to permitting suicides that should be forbidden.     

The three latent classes of adolescent delinquency and the risk factors for membership in each class

This study used latent class analysis to examine subpopulation membership based on self-reports of delinquent behaviors obtained from Australian youth. Three discrete identifiable classes were derived based on 51 indicators of physical violence, property damage, minor infractions, drug use, and social delinquency. One class of youth engaged in primarily rule breaking and norm violations including underage alcohol use, typical of this age period. A second class was more actively delinquent emphasizing drug use, trespassing, and various forms of disobedience. A third class of highly delinquent youth differed from their counterparts by endorsing drug use, thievery that involved stealing money, goods, and cars, property damage, gambling, precocious sexual experiences, involvement with pornographic materials, and fighting. Multinomial logistic regression predicting class membership indicated highly delinquent youth were more likely to be older males, use venting coping strategies, and be fun or novelty seeking compared with rule breakers. Findings are discussed in terms of refining current taxonomic arguments regarding the structure of delinquency and implications for prevention of early-stage antisocial behavior.     

Perceptual adaptation to sinewave-vocoded speech across languages

Listeners rapidly adapt to many forms of degraded speech. What level of information drives this adaptation, however, remains unresolved. The current study exposed listeners to sinewave-vocoded speech in one of three languages, which manipulated the type of information shared between the training languages (German, Mandarin, or English) and the testing language (English) in an audio-visual (AV) or an audio plus still frames modality (A + Stills). Three control groups were included to assess procedural learning effects. After training, listeners' perception of novel sinewave-vocoded English sentences was tested. Listeners exposed to German-AV materials performed equivalently to listeners exposed to English AV or A + Stills materials and significantly better than two control groups. The Mandarin groups and German-A + Stills group showed an intermediate level of performance. These results suggest that full lexical access is not absolutely necessary for adaptation to degraded speech, but providing AV-training in a language that is similar phonetically to the testing language can facilitate adaptation.