“If We’re Going to Change Things, It Has to Be Systemic:” Systems Change in Children’s Mental Health

Communities that undertake systems change in accordance with the system of care philosophy commit to creating new systems entities for children and adolescents with serious emotional disturbance. These new entities are values-based, voluntary, and cross-agency alliances that include formal child-serving entities, youth, and families. Describing the scope and intent of one such implementation of systems of care, a mental health administrator commented, "If we're going to change things, it has to be systemic" (B. Baxter, personal communication, December 2, 2005). This paper explores the concept of "systemic" in the context of systems of care. Systems theory is used to understand strategies of purposeful systems change undertaken by stakeholders in established system of care communities. The paper presents a conceptual model of systems change for systems of care that is grounded in data from a national study of system of care implementation (Research and Training Center for Children's Mental Health in Case Studies of system implementation: Holistic approaches to studying community-based systems of care: Study 2, University of South Florida, Louis de la Parte Florida Mental Health Institute, Research and Training Center for Children's Mental Health, Tampa, FL, 2004). The model is based on Soft Systems Methodology, an application of systems theory developed to facilitate practical action around systems change in human systems (Checkland in Systems thinking, systems practice, Wiley, Chichester, 1999). The implications of these findings to real world actions associated with systems change in systems of care are discussed.     

The Effect of Rehabilitation on Positive Interpretations of Illness

Postoperative patients received one of the three, alternative pain-management treatments: patient-controlled analgesia (PCA); perceived PCA (PPCA without actual control) and continuous intravenous infusion of analgesics (CII). Pain reports, morphine consumption and satisfaction of the groups were compared, and influences of individual differences in preferences for control and trait anxiety were tested. The main findings were: (1) PCA patients consumed less morphine and reported more pain and somewhat higher satisfaction; (2) PPCA patients were intermediate between the other two groups in pain reports and morphine consumption and lowest in satisfaction and (3) individual differences did not moderate the effects of PCA. The findings were interpreted as indicating that the main effect of PCA is increased pain tolerance, and that a bio-psycho-social framework is most appropriate to explain these effects.     

Behavioral and neural correlates of disrupted orienting attention in posttraumatic stress disorder

Prior work has revealed that posttraumatic stress disorder (PTSD) is associated with altered (a) attentional performance and (b) resting-state functional connectivity (rsFC) in brain networks linked to attention. Here, we sought to characterize and link these behavioral and brain-based alterations in the context of Posner and Peterson’s tripartite model of attention. Male military veterans with PTSD (N = 49; all deployed to Iraq or Afghanistan) and healthy age-and-gender-matched community controls (N = 26) completed the Attention Network Task. A subset of these individuals (36 PTSD and 21 controls) also underwent functional magnetic resonance imaging (fMRI) to assess rsFC. The behavioral measures revealed that the PTSD group was impaired at disengaging spatial attention, relative to the control group. FMRI measures further revealed that, relative to the control group, the PTSD group exhibited greater rsFC between the salience network and (a) the default mode network, (b) the dorsal attention network, and (c) the ventral attention network. Moreover, problems with disengaging spatial attention increased the rsFC between the networks above in the control group, but not in the PTSD group. The present findings link PTSD to both altered orienting of spatial attention and altered relationships between spatial orienting and functional connectivity involving the salience network. Interventions that target orienting and disengaging spatial attention may be a new avenue for PTSD research.     

Neural circuitry of emotion regulation: Effects of appraisal,attention, and cortisol administration

Psychosocial well-being requires effective regulation of emotional responding in context of threat or stress. Neuroimaging studies have focused on instructed, volitional regulation (e.g., reappraisal or distancing), largely ignoring implicit regulation that does not involve purposeful effort to alter emotional experience. These implicit processes may or may not involve the same neural pathways as explicit regulatory strategies. We examined the neurobiology of implicit emotional regulation processes and the impact of the stress hormone cortisol on these processes. Our study task employed composite pictures of faces and places to examine neural activity during implicit emotional processing (of emotional faces), while these responses were implicitly regulated by attention shift away from the emotionally evocative stimuli, and while subjects reflectively appraised their own emotional response to them. Subjects completed the task in an fMRI scanner after random assignment to receive placebo or hydrocortisone (HCT), an orally administered version of cortisol. Implicit emotional processing activated insula/IFG, dACC/dMPFC, midbrain and amygdala. With attention shifting, we saw diminished signal in emotion generating/response regions (e.g., amygdala) and increased activations in task specific attention regions like parahippocampus. With appraisal of emotions, we observed robust activations in medial prefrontal areas, where activation is also seen in instructed reappraisal studies. We observed no main effects of HCT administration on brain, but males and females showed opposing neural effects in prefrontal areas. The data suggest that different types of emotion regulation utilize overlapping circuits, but with some strategy specific activation. Further study of the dimorphic sex response to cortisol is needed.     

Pentecostal Dynamics of African Initiated Churches

This essay is a historical consideration of the body of churches known as African Initiated Churches (AICs). The key research questions I am investigating are whether this church can be classified as Pentecostal and how it employs transnational networking in its mission strategy. I have approached this question by exploring the Pentecostal dynamics and transnational networking of the Cherubim and Seraphim Church as an example of an AIC. To this end, I analyze the Pentecostal and transnational nature of an international ecumenical conference organized by the church in London in 2017. This essay is written from the perspective of someone who was born and raised within the church movement, but has also studied the movement as part of African Christianity. The originality of this essay is in its analysis of the transnational nature of the international ecumenical conference.     

Inaction Inertia in the Stock Market1

Based on the inaction inertia effect, it was hypothesized that investors who missed an opportunity to leave a “bear market” will be less likely to sell the stock at a later opportunity when facing a grave loss. Participants in a stock‐market computer game were given an opportunity to sell their stock for a moderate gain. Having missed this initial opportunity and now facing a grave loss, these participants were less likely to sell their stock compared to participants whose potential loss was not as grave, or compared to participants facing the same magnitude of loss who had no previous opportunity to leave the market. Analysis of the time spent by participants on reading relevant information concerning the stock market suggests that this tendency toward continued inaction was not the result of careful deliberation over market trends. The results are discussed in terms of counterfac‐tual thinking and anticipated regret.     

Life and teleology

A comprehensive definition of the phenomenon called life led to the addition of many dimensions to the natural sciences, and especially the conscious mental dimension. Historical attention is paid not only to those employing the natural philosophical paradigms, but also to evolutionary theories and to the Kantian teleological philosophy. The belief that science can solve the riddle of life is a category of purposal thinking. A revised version of critical teleology is essential for comprehension of life.     

Projective identification: Pros and cons. An essay review of Samuel Slipp,the technique and practice of Object Relations Family Therapy

This paper is a critical appraisal of Samuel Slipp's book on Object Relations Family Therapy (ORFT), which uses the concept of projective identification as a central thesis in explaining interpersonal influence. Slipp's book is praised for its excellent review of the literature of object relations theory and the major schools of family therapy, classification of families according to complementary projections, and revealing case material. Interpersonal-Systemic (I-S) theory and methodology with its use of the concepts of empathy, interpersonal influences, search for intimacy, maintenance of self-esteem, selective inattention, and reflected appraisals is offered as an alternative view to projective identification.     

Developmental aspects of visual hemifield differences in perception of verbal material

The effect of acquisition of reading on visual field asymmetries for verbal material was investigated in school-age children. Contrary to the expectation that acquisition of differential scanning tendencies will operate on perceptual asymmetries, it was found that right visual field superiority which was independent of scanning direction appeared at the fifth grade. This, and the presence of slight left field superiority at the age when reading is initially acquired, suggests that hemispheric dominance and its attributes, parallel and sequential pattern recognition processes, is the major factor which determines the field preference for verbal material.