The Failure to Contain: How Persecutory Anxieties Contribute to Noncompliance in Adult Patients with Congenital Chronic Pain Conditions

ABSTRACT

Patients with sickle-cell disease suffer from lifelong pain. Many prefer to receive emergent rather than managed health care, which results in these people being termed “noncompliant.” This paper explores the contributing factors of such noncompliance in the adult patient with painful chronic illness. In the earliest stages of development, internal pain is attributed to external origins, and the effects of this on the psyche are analogous to those of physical abuse. When the infant's pain cannot be contained, projective identification and persecutory anxieties become deeply ingrained. Interventions that focus on healing from trauma and building trust are preferable to those which most value immediate compliance, as the patterns of behavior are so firmly entrenched.     

Stability and Change of Ego Resiliency From Late Adolescence to Young Adulthood: A Multiperspective Study Using the ER89–R Scale

In this research, we examined the psychometric properties of the Revised Ego Resiliency 89 Scale (ER89–R; Alessandri, Vecchio, Steca, Caprara, & Caprara, 2008), a brief self-report measure of ego resiliency. The scale has been used to assess the development of ego resiliency from late adolescence to emerging adulthood, focusing on different ways to define continuity and change. We analyzed longitudinal self-report data from 267 late adolescents (44% male) using 4 different approaches: factor analysis for testing construct continuity, correlational analysis for examining differential stability, latent growth modeling for analyzing mean level change, and the reliable change index for studying the occurrence of change at the individual level. Converging evidence points to the marked stability of ego resiliency from 16 to 20 years, both for males and females. The scale predicts externalizing and internalizing problems, both concurrently and at 2 and 4 years of distance. Findings suggest that the ER89–R scale represents a valid and reliable instrument that can be fruitfully suited for studying ego resiliency through various developmental stages.     

Same kinematics but different objects during action observation: Detection times and motor evoked potentials

Motor resonance refers to the fact that an observed action is online subliminally reenacted. The aim of the present paper was to verify if, on equal terms of kinematics, the to-be-grasped object's intrinsic properties are influencing the observers' motor behaviour. A detection time and a single pulse transcranial magnetic stimulation experiment were performed to verify the effects of a change of object's intrinsic properties artificially made on a video showing a grasping action. In particular, the object substituting the original one was not graspable by the showed movement. Results indicated an influence of object's intrinsic properties: Detection times were delayed and motor evoked potentials were reduced when the movement shown was not suitable to grasp the object. These results are interpreted as an evidence that during grasping action observation the motor system of the observer is influenced not only by the seen movements but also by the to-be-grasped object.     

Effects of achievement motivation, social identity, and peer group norms on academic conformity

This study investigated whether academic achievement motivation and social identity explain variation in children’s conformity to positive academic behaviors (n = 455 children in grades three through five). Structural equation modeling suggested that academic value and peer group academic norms were positively related to academic conformity. Specifically, children who enjoyed academic pursuits and who belonged to academically-inclined peer groups were more likely to conform to novel academic behaviors than children who did not. Additionally, academic value moderated the relationship between peer group norms and conformity, implying that, for students who do not value academics, belonging to a peer group with high academic norms will lead to more conformity to academic behaviors than belonging to a peer group with low academic norms. In contrast, analyses suggested that some aspects of achievement motivation and social identity are unrelated to academic conformity. Implications for encouraging positive academic behaviors in middle childhood are discussed.     

Are all letters really processed equally and in parallel? Further evidence of a robust first letter advantage

This present study examined accuracy and response latency of letter processing as a function of position within a horizontal array. In a series of 4 Experiments, target-strings were briefly (33 ms for Experiments 1 to 3, 83 ms for Experiment 4) displayed and both forward and backward masked. Participants then made a two alternative forced choice. The two alternative responses differed just in one element of the string, and position of mismatch was systematically manipulated. In Experiment 1, words of different lengths (from 3 to 6 letters) were presented in separate blocks. Across different lengths, there was a robust advantage in performance when the alternative response was different for the letter occurring at the first position, compared to when the difference occurred at any other position. Experiment 2 replicated this finding with the same materials used in Experiment 1, but with words of different lengths randomly intermixed within blocks. Experiment 3 provided evidence of the first position advantage with legal nonwords and strings of consonants, but did not provide any first position advantage for non-alphabetic symbols. The lack of a first position advantage for symbols was replicated in Experiment 4, where target-strings were displayed for a longer duration (83 ms). Taken together these results suggest that the first position advantage is a phenomenon that occurs specifically and selectively for letters, independent of lexical constraints. We argue that the results are consistent with models that assume a processing advantage for coding letters in the first position, and are inconsistent with the commonly held assumption in visual word recognition models that letters are equally processed in parallel independent of letter position.     

Process analytic models of creative capacities: Evidence for the combination and reorganization process

Many cognitive processes contribute to the generation of novel problem solutions. One important process involves the combination and reorganization of extant knowledge structures. The present study provided empirical evidence for the significance of this process. Subjects were presented with exemplars drawn from multiple a priori categories. They were asked to (a) combine these a priori categories to generate a new category, (b) provide exemplars of the elements included in this category, and (c) write a story involving this category. The quality and originality of these products was evaluated under conditions where the relatedness of the a priori categories was varied along with exemplar typicality and instructional set. It was found that category relationships and instructional set influenced solution quality and originality. The implications of these findings for understanding creative problem solving and the category combination process were considered     

Self-efficacy and reasoned action: Predicting oral health status and behaviour at one,three, and six month intervals

Abstract

This study tested the usefulness of the theory of reasoned action and the addition of self-efficacy to this model for the prediction of oral health behaviour as part of a larger intervention at the State University of New York at Buffalo School of Dental Medicine. Self-efficacy is a belief in one's ability to perform a particular behavior. The theory of reasoned action is an attitudinal model focused on predicting behavior. One hundred and sixty-six patients volunteered for an intervention and assessment program at the Oral Health Enhancement Clinic. Participants visited the clinic 7 times over a 14 month period. Relationships among social cognitive model variables and clinical and self-report outcome measures were examined at three different time points over increasingly longer time spans. Results indicated that the theory of reasoned action model was useful in predicting oral health behavior, and adding self-efficacy to the model significantly increased the reliability of predictions of outcome measures. Relationships for social cognitive variables were stronger for self-report than for clinical indices. Reasons for these differences are suggested.     

Math Weaknesses in Survivors of Acute Lymphoblastic Leukemia Compared to Healthy Children

Difficulties in math are the most frequently reported area of academic deficit in survivors of acute lymphoblastic leukemia (ALL) and the most frequent academic complaint among parents of ALL survivors. However, previous studies that included measures of math skills have been limited by the use of only a single measure of math skills, most often a measure of written calculations, without any assessment of math reasoning or math application skills. Further, the nature of these math difficulties has not been adequately investigated. The purpose of this study was to examine the performance of ALL survivors using multiple measures of math skills. Performance was compared to a group of healthy controls matched for age and sex as well as to normative levels. Other measures of neuropsychological function were also administered, and the relationships between these measures and the math measures were explored. Converging evidence for math difficulties in ALL survivors compared to healthy controls and normative levels was found. While ALL survivors generally performed within the average range on measures of math skills, math performance was mostly related to memory function and dominant-hand psychomotor speed. By contrast, math performance of healthy children was mostly related to basic reading skills and visual-motor integration. These findings shed light on the nature of math difficulties in ALL survivors and have implications for intervention.     

Parent and Self-Report Ratings of Executive Function in Adolescents with Myelomeningocele and Hydrocephalus

Parent and self-report ratings were obtained for 28 adolescents with myelomeningocele and congenital hydrocephalus using the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1998a, 1998b) and the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000; Guy, Gioia, & Isquith, 1998). Parents rated their children as having significantly more problems, compared to published norms, on the BRIEF but not the BASC. Adolescents rated themselves as having significantly more problems, compared to parent ratings, on scales comprising the BRIEF Behavioral Regulation Index; but not on common scales of the BASC. Parents also reported more problems on the BRIEF Global Executive Composite than on all three primary BASC indices, and more problems on the BRIEF Metacognition Index than on the BRIEF Behavioral Regulation Index. We conclude that the BRIEF captures salient executive dysfunction among individuals with myelomeningocele and hydrocephalus, and may be useful in identifying needs for intervention that might not be identified by broad-band behavior rating scales alone.