Legal briefing: futile or non-beneficial treatment

This issue's "Legal Briefing" column covers recent legal developments involving futile or non-beneficial medical treatment. This topic has been the subject of recent articles in JCE. Indeed, it was the subject of a "Legal Briefing" in fall 2009. Accordingly, this column focuses on legal developments from the past two years. These developments are usefully grouped into the following 11 categories: 1. Texas Advance Directives Act, 2. Ontario Consent and Capacity Board, 3. Surrogate selection, 4. Ex post cases for damages, 5. Ex ante cases for injunctions, 6. Coercion and duress, 7. Assent and transparency, 8. Brain-death cases, 9. Criminal and administrative sanctions, 10. Conscientious objection, 11. Penalties for providing futile treatment.     

Emotion in Schizophrenia: Where Feeling Meets Thinking

Our understanding of the nature of emotional difficulties in schizophrenia has been greatly enhanced by translational research over the past two decades. By incorporating methods and theories from affective science, researchers have been able to discover that people with schizophrenia exhibit very few outward displays of emotion but report experiencing strong feelings in the presence of emotionally evocative stimuli or events. Recent behavioral, psychophysiological, and brain imaging research has pointed to the importance of considering the time course of emotion in schizophrenia. This work has shown that people with schizophrenia have the ability to experience emotion in the moment; however, they appear to have difficulties when anticipating future pleasurable experiences, and this perhaps affects their motivation to have such experiences. While advancements in our understanding of emotional experience and expression in individuals with schizophrenia have been made, these developments have led to a new collection of research questions directed at understanding the time course of emotion in schizophrenia, including the role of memory and anticipation in motivated behavior, translating laboratory findings to the development of new assessment tools and new treatments targeting emotional impairments in people with this disorder.     

Safety in work vehicles: a multilevel study linking safety values and individual predictors to work-related driving crashes

Although work-related driving is associated with high accident rates, limited research has investigated the factors influencing driving crashes in the work setting. This study explored multilevel influences on self-reported crashes in the workplace by surveying a sample of work-related drivers (n = 380), their workgroup supervisors (n = 88), and fleet managers (n = 47). At the driver level of analysis, safety motivation predicted self-reported crashes. In turn, drivers' perceptions of their fleet managers' safety values (but not drivers' perceptions of their supervisors' safety values), their own attitudes, and their own efficacy beliefs predicted motivation to drive safely. Furthermore, the influence of supervisors and fleet managers interacted such that drivers were more motivated to drive safely if they perceived both their supervisor and fleet manager to value safety. This study also explored the cross-level relationships between supervisors' and fleet managers' perceptions of organizational safety values and drivers' perceptions of managerial safety values and found a relationship between fleet managers' perceptions of organizational safety values and drivers' perceptions of fleet managers' safety values. These results illustrate that perceptions of workplace safety values are transmitted across levels of the organization.     

Dimensions of response to novelty are associated with social engagement and aggression in adult male rhesus macaques (Macaca mulatta)

In this study, the authors tested the hypothesis that behavioral response across social and nonsocial, novel and familiar conditions may be guided by the same trait(s) related to impulsivity in adult male rhesus macaques. The authors assessed 23 individuals' behavioral response to a series of nonsocial novel scenarios, as well as aggression and sociality within familiar and novel social contexts. Factor analysis of responses to nonsocial novelty identified two factors: Caution, which reflected latency to engage different novel situations, and Interest in Novelty, which consisted of duration and quality of exploration. Each dimension was associated with different social manifestations. Caution was negatively correlated with social aggression in novel and familiar social circumstances; Interest in Novelty was positively associated with social engagement in familiar, but not novel, social circumstances. The authors conclude that traits influencing impulsive response to novelty contribute to risky and normal social behavior across social contexts.     

Emotional states alter force control during a feedback occluded motor task

The aim of the current experiment was to determine the extent to which pleasant and unpleasant emotional states altered the ability of men and women to control force production on a feedback occluded motor task that was not direction specific. Participants produced a precision pinch grip with visual feedback. After 5 s, feedback was occluded and replaced with a pleasant, unpleasant, or neutral image. The amplitude, variability, and structure of force production were calculated. As expected, the removal of visual feedback led to progressive force decay. More important, relative to neutral conditions, pleasant and unpleasant emotional states led to greater force production, resulting in attenuated force decay. The variability and structure of force production were not altered by affective state. In addition, men and women performed similarly across all conditions for all measures. We conclude that when sustained force production is not directed toward or away from the body, pleasant and unpleasant emotional states similarly excite the motor system. Neurobiological mechanisms are proposed to account for these findings. Implications and future research directions are discussed.     

Attributing the sources of accuracy in unequal-power dyadic communication: Who is better and why?

A study was conducted to assess accuracy of deliberate nonverbal communication of affective messages between individuals assigned to different power roles within dyads. In phase 1, participants (N = 158) were assigned to unequal- or to equal-power roles and asked to send positive, negative, and neutral messages to their partner using nonverbal cues while the partner guessed which kind of message it was. In phase 2, naïve decoders (N = 294) made judgments of the videotapes from phase 1 to resolve the confounding of sender and decoder factors in the within-dyad communication paradigm. Results showed that subordinates were more accurate at decoding superiors than vice versa, and that this difference was due to subordinates sending less clear messages to superiors than superiors sent to subordinates. Comparison with the equal-power group’s expressions revealed that the subordinates’ expressions were also less clear than those sent by the equal-power group.     

Can CBT Be Effective for Aboriginal Australians? Perspectives of Aboriginal Practitioners Trained in CBT

The objective of the study was to investigate whether high and low intensity versions of cognitive behaviour therapy (CBT) might be an effective therapeutic approach for enhancing the mental health of Aboriginal Australians. Five university‐educated Aboriginal counsellors received in‐depth training in CBT. Over the following year, they used CBT strategies with their clients, and met 10 times as a participatory action research group. The group addressed three key questions: (a) Does CBT appear to be useful for Aboriginal Australians? (b) If so, what elements of CBT are perceived to be effective? (c) What adaptations might be made to CBT to enhance its effectiveness with Aboriginal Australians? The resulting qualitative data were transcribed and analysed. Counsellors perceived CBT to be very useful for their Aboriginal clients and for themselves. They reported that it enhanced their clients' well‐being, their own clinical skills, and their own well‐being, and it reduced burnout. The qualities of CBT that were perceived to be effective were its adaptability, pragmatic here‐and‐now approach, capacity for low‐intensity interventions, safe containing structure, promotion of self‐agency, and valuable techniques. It was suggested that the prime requirement for adaptations to CBT were that they would need to fit different social and cultural contexts.     

Dissociating motivational direction and affective valence: specific emotions alter central motor processes

We aimed to clarify the relation between affective valence and motivational direction by specifying how central and peripheral components of extension movements are altered according to specific unpleasant affective states. As predicted, premotor reaction time was quicker for extension movements initiated during exposure to attack than for extension movements initiated during exposure to all other valence categories (mutilation, erotic couples, opposite-sex nudes, neutral humans, household objects, blank). Exposure to erotic couples and mutilations yielded greater peak force than exposure to images of attack, neutral humans, and household objects. Finally, motor reaction time and peak electromyographic amplitude were not altered by valence. These findings indicate that unpleasant states do not unilaterally prime withdrawal movements, and that the quick execution of extension movements during exposure to threatening images is due to rapid premotor, rather than motor, reaction time. Collectively, our findings support the call for dissociating motivational direction and affective valence.