The American experience: Lessons learned

This paper discusses ten lessons learned since 1989 about handling allegations of scientific misconduct involving biomedical and behavioral research supported by the U. S. Public Health Service. An earlier version of this paper was presented at a symposium, Scientific Misconduct: An International Perspective, organised by The Medical University of Warsaw, 16 November, 1998. The opinions expressed herein are those of the author and do not necessarily represent the views of the Office of Research Integrity, the U.S. Department of Health and Human Services, or any other federal agency.     

Secondary prevention interventions for young drug users: a systematic review of the evidence

This paper reviews the international scientific evidence on the effectiveness of secondary prevention interventions for young drug users. The review provides insight into the effectiveness of interventions that have been evaluated using moderately strong research designs. Most of the studies included are from the United States of America. Some interventions are effective in reducing drug use and associated problems while others have no or mixed effect. Those successful in reducing drug use include behavior therapy, Minnesota 12-step programs, residential care, and general drug treatment. Those with either no effect or mixed effect include schools interventions. Involving parents and other agencies may enhance an intervention's effect. There is a lack of good quality studies outside the USA. Future interventions should focus on either low- or high-risk groups of young drug users. Future research should be conducted on a wider range of services for young people and include non-medical outcomes such as communication skills, schooling, employment, family relations, and economic costs.     

The impact of enhanced incentives on vocational rehabilitation outcomes for dually diagnosed veterans

This study evaluated the efficacy of adding contingency management techniques to vocational rehabilitation (VR) to improve treatment outcome as measured by entry into competitive employment. Nineteen dually diagnosed veterans who entered VR in the Veterans' Administration's compensated work therapy (CWT) program were randomly assigned to CWT (n = 8) or to CWT with enhanced incentives (n = 11). Over the first 16 weeks of rehabilitation, those in the incentives condition could earn up to dollar 1,006 in cash for meeting two sets of clinical goals: (a) remaining abstinent from drugs and alcohol and (b) taking steps to obtain and maintain a competitive job. Results indicate that relative to participants in the CWT-only group, those in the incentives condition engaged in more job-search activities, were more likely to remain abstinent from drugs and alcohol, were more likely to obtain competitive employment, and earned an average of 68% more in wages. These results suggest that rehabilitation outcomes may be enhanced by restructuring traditional work-for-pay contingencies to include direct financial rewards for meeting clinical goals.     

Reverie: between thought and prayer

Abstract:  Taking inspiration from a quotation by Lao Tzu, this paper considers 'reverie' as a dynamic process of containment as well as a state of mind. Reverie as a quality of thought akin to prayer is explored in the relationship between self and other. In infant observation, the paper contemplates the development of a baby's capacity to reach beyond the personal world to an archetypal experience of being held, where the creation of an internal space in mind could indicate the beginnings of spiritual awareness. 'Maternal/analytic reverie' views the passage of unconscious communication between patient and analyst as the result of a 'window' opening in the meniscus of the analyst's self. 'Paternal/supervisory reverie' reflects on the impact on a patient of an extra containing mind of a supervisor. 'Archetypal reverie' considers the transforming impact of numinous dreams on the psyche, and reflects on the power of prayer. Drawing on clinical examples from these four areas, the aim is to demonstrate the usefulness of the 'void within' and the perceptive function of emptiness in the 'doors and windows' of our mind.     

On bias in magnitude scaling and some conjectures of Stevens

Bias in magnitude scaling can be viewed as involving deviations of judgments from proportionality. A model of bias is shown to provide a theoretical basis for Stevens's conjecture about geometrically averaging magnitude estimation and magnitude production exponents in order to obtain an estimate of the psychophysical exponent. An overlooked result is that one can also obtain an estimate of the magnitude of the bias. Examples from several well-known studies are presented. The bias is also shown to vary in response to experimental manipulation of the stimulus range. Aspects of predicting exponents across experiments are clarified, and a new prediction is examined. The model of bias fills some theoretical gaps in magnitude scaling and clarifies underlying assumptions and predictions.     

The cognitive effects of trauma: reversal of alpha function and the formation of a beta screen

Following a brief review of Freud's writings on trauma, the author discusses relevant theories of Bion, and in particular the concepts of the alpha function and the beta screen. A clinical example is presented in which the patient's relatively recent trauma in adulthood had become fused with prior related experiences, leading to a propensity for repeated enactments in analysis and a failure to learn from experience. Drawing on the analyst's alpha function, the patient was gradually able to use mentalization to transform her rigidly structured traumatic organization. The author highlights the roles of dreams/dream associations and of screen memories in the patient's analysis.     

Greed, death, and values: from terror management to transcendence management theory

Research supporting terror management theory has shown that participants facing their death (via mortality salience) exhibit more greed than do control participants. The present research attempts to distinguish mortality salience from other forms of mortality awareness. Specifically, the authors look to reports of near-death experiences and posttraumatic growth which reveal that many people who nearly die come to view seeking wealth and possession as empty and meaningless. Guided by these reports, a manipulation called death reflection was generated. In Study 1, highly extrinsic participants who experienced death reflection exhibited intrinsic behavior. In Study 2, the manipulation was validated, and in Study 3, death reflection and mortality salience manipulations were compared. Results showed that mortality salience led highly extrinsic participants to manifest greed, whereas death reflection again generated intrinsic, unselfish behavior. The construct of value orientation is discussed along with the contrast between death reflection manipulation and mortality salience.