Die Bindungstheorie als Basis psychotherapeutischer Interventionen in der Terminalphase

Recent attachment research has shown that every person develops, already in early childhood, special attachment strategies activated in cases whenever the person cannot cope on his own with dangers. These strategies are classified into four categories: “secure”, “insecure-avoidant”, “insecure-ambivalent/enmasked” and “disoriented/disorganized” attachment patterns. The death of a next person represents a situation of a unique and final separation causing psychical disturbances for the patient himself and his relatives. It is, therefore, an especially effective trigger for the activation of the attachment system. This article aims on relating attachment theory to an attachment-oriented therapy, that would open, particularly in the field of palliative medicine, possibilities of application which have been neglected. Case studies illustrate how these insights may be applied during the psychotheraputic care for patients and their relatives. As dying patients generally are brought by their family to the clinic, physicians have a particularly favourable situation to observe the attachment patterns in the family and integrate these informations into their treatment strategy: for example in case of “avoidant” attachment patterns, to bring cautiously the denied emotions into the communication and to support hopes for the fulfilment of needs for affection and protection; or in case of so-called “ambivalent/entangled” attachment patterns to help to disentangle too close relationships; or in case of “disorganized” attachment patterns to support emotional regulation and help to clear the relationships. It is obvious that this approach based on attachment theory and offering alleviations during the process of dying, is not only on a palliative board relevant, but may be applied with success in the medical care of dying patients and their relatives.     

Examining the Effects of Exercise on Pattern Separation and the Moderating Effects of Mood Symptoms

Aerobic exercise has broad cognitive benefits. One target of interest is enhanced memory. The present study explored pattern separation as a specific memory process that could be sensitive to acute and regular exercise and clinically significant for disorders (e.g., depression) characterized by cognitive-affective deficits and hippocampal impairment. In a within-subjects design, participants (N = 69) attended two visits during which they repeated a behavioral pattern separation task at rest and after an activity (cycling, stretching). Regular exercise habits, demographics, mood and anxiety symptoms, and recognition memory capacity were also measured. More regular exercise predicted better resting pattern separation, t(62) = 2.13, b = 1.74, p = .037. Age moderated this effect, t(61) = 2.35, b = .25, p = .02; exercise most strongly predicted performance among middle-age participants. There was no main effect of activity condition on post-activity performance, t(61) = .67, p = .51. However, with significant heterogeneity in reported mood symptoms and regular exercise habits, there was a three-way interaction between condition, regular exercise, and depression, t(55) = 2.08, b = .22, p = .04. Relative to stretching, cycling appears to have enhanced the benefit of regular exercise for pattern separation performance; however, this was evident among participants with mild to no symptoms of depression, but absent among participants with moderate to severe symptoms. Results have implications for how exercise might protect against declines in pattern separation. Future research should explore exercise’s potential as a prevention tool or early intervention for pattern separation and related clinical outcomes.     

Increasing access to low‐intensity interventions for childhood anxiety: A pilot study of a guided self‐help program for Scandinavian parents

Cognitive Behavior Therapy (CBT) is an effective treatment for child anxiety. However, access to treatment is limited. It has been suggested that low‐intensity formats of parent‐delivered CBT may improve access to treatment. Our aim was to develop and pilot‐test the acceptability and effect of a low‐intensity therapist‐guided parent‐delivered group program for anxious children (age 7–12 years) adjusted to the Scandinavian culture. The program required 1.5 hours of therapist‐time per family. Mothers, fathers and children reported on revised child anxiety and depression scale (RCADS) at referral, pre‐ and post‐treatment. Mothers and fathers also gave a qualitative account of their experiences. Thirty‐one families were enrolled and only one family dropped out. Mean age of the children was 9 years. Intent‐to‐treat analyses revealed significant reductions in anxiety and depressive symptoms from pre‐ to post‐treatment for all informants. Large effect sizes were found for child anxiety symptoms as reported by mothers and fathers, and for child depressive symptoms as reported by mothers. Medium to large effect sizes was found for the self‐reported anxiety symptoms by the children, and for depressive symptoms reported by both children and fathers. More than 93% of the parents would recommend the program. Results suggest that our program may provide a new approach to improve access to treatment for anxious children in Scandinavia; however, further research must be conducted before firm conclusions can be drawn.     

We will hunt them down: How social dominance orientation and right-wing authoritarianism fuel ethnic persecution of immigrants in fundamentally different ways

Despite the fact that SDO and RWA are correlated with one another and both predict support for ethnic persecution of immigrants, it is argued that this aggression is provoked for very different reasons. For authoritarians, outgroup aggression against immigrants should primarily be provoked by immigrant refusal to assimilate into the dominant culture because this violates ingroup conformity. In contrast, SDO should be associated with aggression against immigrants who do assimilate into the dominant culture because this blurs existing status boundaries between groups. Using samples of American and Swiss college students, the data were consistent with this status boundary enforcement hypothesis regarding social dominators and largely consistent with the ingroup conformity hypothesis regarding authoritarians. National and ethnic identification did not account for these results. The results further support the argument that outgroup prejudice and discrimination is most fruitfully seen as an interactive function of individual differences and situational constraints.     

Frühe Störungen aus der Sicht zunehmender Mentalisierung

The term “mentalization” describes the capacity to judge other humans in terms of their mental activities such as wishes, hopes, beliefs and intentions, as well as the ability to think about one’s own thinking. Mentalization and reflective function are equivalent to each other. They play an important role in selforganization, impulse control, and affect regulation. Mentalization develops during approximately the first five years of life on the basis of attachment in Bowlby’s sense. Around the 9th month of life the child begins to understand her mother as an intentional agent. Mirroring by the mother, in a way of reproducing the child’s state of mind but in a slightly different “marked” manner, enables the child to establish a second “objectified” representation of her condition besides her primary unreflected one. Consequences of lacking, unmarked, or distorted mirroring for later narcissistic or borderline personality are discussed. The child begins now thinking, i.e. playing with representations, but the state of brain development allows to conceive of only one reality. Internal world and external reality appear undistinguishably identical. This is called the “equivalence mode” of psychic functioning. As-if-games open, in a further developmental step, the possibility of including a second reality, namely a pretended one. This is called the “pretend mode” of psychic functioning. At age four to five the child has reached the capacity to take multiple realities into consideration, to take the perspective of an other and to decentrate. She now has a “theory of mind”. Patients with early disturbances have reached this stage only partially. They may also regress to one of the earlier modes of psychic functioning as a consequence of stress or trauma. The knowledge of these early mechanisms helps to identify and understand them when they appear in our clinical practice.     

The revelation effect for autobiographical memory: A mixture-model analysis

Participants provided information about their childhood by rating their confidence about whether they had experienced various events (e.g., “broke a window playing ball”). On some trials, participants unscrambled a key word from the event phrase (e.g., wdinwo—window) or an unrelated word (e.g., gnutge—nugget) before seeing the event and giving their confidence ratings. The act of unscrambling led participants to increase their confidence that the event occurred in their childhood, but only when the confidence rating immediately followed the act of unscrambling. This increase in confidence mirrors the “revelation effect” observed in word recognition experiments. In the present article, we analyzed our data using a new signal detection mixture distribution model that does not require the researcher to know the veracity of memory judgments a priori. Our analysis reveals that unscrambling a key word or an unrelated word affects response bias and discriminability in autobiographical memory tests in ways that are very similar to those that have been previously found for word recognition tasks.     

Perceived Academic Competence and Overall Job Evaluations: Students' Evaluations of African American and European American Professors

Despite the fact that few people appear to endorse negative stereotypes of Blacks, such stereotypes are widely disseminated in our culture. Consequently, such stereotypes can have pervasive consequences on one's impressions of African Americans, even by low-prejudice Whites and by Blacks themselves. Thus, we predicted that student judgments of intellectual competence would be more important when students were making global performance evaluations of Black faculty than of White faculty. Furthermore, to the extent that intellectual competence is more salient in the judgment of Black faculty, such judgments should be essentially the same among Black and White students, and for low- and high-prejudice students. For the most part, analyses of instructor evaluations at a major American university supported these expectations.