The psychologist's role in assessing and facilitating patients' knowledge of advance directives in medical settings: A preliminary investigation

In a time of budgetary shortfalls in the medical industry, an aging population, and an increased emphasis on health care choices, psychologists are being called upon to administer advance medical directive programs to patients. This study reports preliminary findings from a program to assess and facilitate patients' knowledge of advance directives (ADs) by the Psychology Service at the Ann Arbor VA Medical Center. The participant pool included 243 male veteran patients admitted to medical and surgical wards at the hospital. The intervention included the use of a computer-generated prompt for consultation, which was sent to the psychology staff in response to a patient inquiry regarding ADs. It also involved an increased emphasis on the delivery of written material on ADs by the admissions clerks. The intervention appeared to result in a modest increase in patients' knowledge of advance directives. Suggestions are offered for areas that should be emphasized in future attempts to increase patients' knowledge and utilization of advance directives.     

Multidimensional same--different judgments: evidence against independent comparisons of dimensions

Commonly discussed models of performance in the multidimensional same-different task are based on the assumption that independent same-different decisions are reached for each of the stimulus dimensions used in an experiment. In these models, a higher level mechanism examines th outcome of these independent decisions in order to determine whether the stimuli are the same or different overall. Previous evidence indicating that these models are inconsistent with results from same trials is summarized, and a new test of the above assumption using data from different trials is proposed. Detailed analysis of reaction times from different trials is shown, at least for some pairs of dimensions, to be incompatible with the view that separate same-different decisions are reached for each dimension. The major finding is that there are more relatively fast responses in a condition with two dimensions different, compared with the two conditions with only one of the dimensions different, than any processing model treating the dimensions separately could predict. The results suggest that partial information may be combined across dimensions in order to reach a "different" judgment.     

The effect of set size on hemifield asymmetries in letter recognition

Single letters were presented tachistoscopically in the left or right hemifield to right-handed observers. Superior recognition of letters on the right was found for letters chosen from subsets containing four items, but no differences were found when any letter, or any symmetrical letter, could appear. In a second experiment, the right hemifield advantage was found under conditions requiring the subject to determine the subset only when the subset chosen was appropriate. Results were discussed in terms of the adequacy of language-based explanations of hemifield asymmetries in letter recognition.     

Contextual potentiation of acquired behavior after devaluing direct context-US associations

In two experiments, water-deprived rats were exposed to tone-footshock pairings in a particular conditioning context. In Experiment 1, the training parameters were selected on the basis of parametric pilot data so as not to produce direct associations between the conditioning context and footshock. Despite independent evidence of no appreciable direct association between the conditioning context and footshock, animals tested in the conditioning context exhibited more lick suppression to the tone than other animals tested with the tone outside of the conditioning context. Thus, the conditioning context potentiated suppression to the tone in the absence of appreciable fear of the conditioning context. In Experiment 2, training parameters were used that permitted the formation of direct associations between the conditioning context and footshock; however, for half the animals, these associations to the context were then extinguished. With the tone absent, a comparison of extinguished animals tested either in the conditioning context or outside the conditioning context detected no differences in suppression, demonstrating the effectiveness of the extinction manipulation. However, other animals also subjected to extinction of direct context-footshock associations displayed greater suppression to the tone within the conditioning context than comparable animals tested outside the context. Collectively the data indicate that the superior retention-test performance seen within the training context can arise both from the commonly assumed direct associations between the training context and the unconditioned stimulus and from the potentiation by the training context of the associations between the nominal conditioned stimulus and unconditioned stimulus.     

Accommodation fatigue and dark focus: The effects of accommodation-free visual work as assessed by two psychophysical methods

Past studies of accommodation fatigue have yielded inconsistent results, partly because they have not used direct measures of accommodation, and partly because they may have been based on a misleading conception of the nature of accommodation. The dual-innervation theory of accommodation suggests that the resting position of accommodation may be neuromuscular rather than just muscular, and that it lies not at optical infinity, as assumed by older conceptions, but at some intermediate position (dark focus). Among the predictions that may be deduced from this theory is that long-term visual work not requiring active accommodation will not induce fatigue. The present study involved continuous measurements of dark focus for 10 young adults over a 3-h period, using the laser optometer with two psychophysical procedures Ibracketing and staircase. Consistent with the prediction, no changes in dark focus were found, in spite of the demanding visual task. Furthermore, it was found that both psychophysical methods yielded essentially identical results. The practical and theoretical implications of these results are discussed, and recommendations are given regarding situations in which each of the psychophysical methods is likely to be most useful.     

Social intimacy: An important moderator of stressful life events

Two studies were conducted to explore the role of social intimacy in predicting the individual's response to stress. In the first study the experimenter reinforced the experimental subjects' verbalizations during an interview on a fixed schedule for the first 3 minutes, withdrawing reinforcement for the final 4 minutes. The control group received reinforcement on a fixed schedule for the total 7 minutes. Subjects scoring low on a measure of intimacy disclosed less personal material during the withdrawal period in the experimental condition than in the control condition in contrast to high scoring subjects who maintained their level of disclosure for both parts of the interview. In the second study, previously experienced life change events were assessed. Individuals lacking a current intimacy were found to be prone to higher levels of emotional disturbance especially when many previous negative or few positive life change events had occurred.     

The Predictors of Post-Sterilization Regret in Married Women1

We interviewed a sample of 317 married women prior to a tubal sterilization (195) or a husband's vasectomy (122) and then reinterviewed them yearly for 5 years. Using these women's responses to six questions about their feelings and desires following sterilization, we fitted a latent-variable model of post-sterilization regret to the data by means of a linear structural equation analysis. The results confirmed our view that post-sterilization regret was not a simple psychological state but rather was a complex process with different, causally linked manifestations. This process began with a renewed interest in having a baby, proceeded to the development of negative feeling about the three decisions that lead to sterilization, and concluded with a desire to reverse the surgery. This sequence was affected by the negative, post-sterilization effects of the sterilization and by the Occurrence of divorce. Next, we identified the pre-sterilization predictors of six regret variables from our model by means of a series of linear regression analyses. The major pre-sterilization predictors of the regret process included being relatively young, ambivalence about future childbearing, negative attitudes toward sterilization, dominance of the decision making by the woman's husband, and conflict with her husband during decision making. Finally, we divided the sample into quintiles on the basis of their scores on a Pre-Sterilization Predictor Scale and assessed the performance of our predictor variables as indicators of risk of regret by determining the level of negative feelings toward sterilization in each quintile. The results confirm the discriminatory power of our predictors. The overall findings indicate a number of psychological and marital issues, the exploration of which might help counselors provide anticipatory and preventative services to couples seeking sterilization.