Treatment of cognitive impairment in multiple sclerosis

Cognitive impairment in multiple sclerosis is an increasingly recognized entity. This article reviews the cognitive impairment of multiple sclerosis, its prevalence, its relationship to different types of multiple sclerosis, and its contribution to long-term functional prognosis. The discussion also focuses on the key elements of cognitive dysfunction in multiple sclerosis which distinguish it from other forms of cognitive impairment. Therapeutic interventions potentially effective for the cognitive impairment of multiple sclerosis are reviewed including the effects of disease modifying therapies and the use of physical and cognitive interventions.     

Phenomenological reports diagnose accuracy of eyewitness identification decisions

This study investigated whether measuring the phenomenology of eyewitness identification decisions aids evaluation of their accuracy. Witnesses (N = 502) viewed a simulated crime and attempted to identify two targets from lineups. A divided attention manipulation during encoding reduced the rate of remember (R) correct identifications, but not the rates of R foil identifications or know (K) judgments in the absence of recollection (i.e., K/[1 − R]). Both RK judgments and recollection ratings (a novel measure of graded recollection) distinguished correct from incorrect positive identifications. However, only recollection ratings improved accuracy evaluation after identification confidence was taken into account. These results provide evidence that RK judgments for identification decisions function in a similar way as for recognition decisions; are consistent with the notion of graded recollection; and indicate that measures of phenomenology can enhance the evaluation of identification accuracy.     

The age prospective memory paradox: young adults may not give their best outside of the lab

Previous research has identified the age prospective memory paradox of age-related declines in laboratory settings in contrast to age benefits in naturalistic settings. Various factors are assumed to account for this paradox, yet empirical evidence on this issue is scarce. In 2 experiments, the present study examined the effect of task setting in a laboratory task and the effect of motivation in a naturalistic task on prospective memory performance in young and older adults. For the laboratory task (Experiment 1, n = 40), we used a board game to simulate a week of daily activities and varied features of the prospective memory task (e.g., task regularity). For the naturalistic task (Experiment 2, n = 80), we instructed participants to try to remember to contact the experimenter repeatedly over the course of 1 week. Results from the laboratory prospective memory tasks indicated significant age-related decline for irregular tasks (p = .006) but not for regular and focal tasks. In addition, in the naturalistic task, the age benefit was eliminated when young adults were motivated by incentives (F < 1). In conclusion, the present results indicate that the variability of age differences in laboratory prospective memory tasks may be due in part to differences in the features of the prospective memory task. Furthermore, increases in motivation to perform the prospective task seem to help remedy prospective memory deficits in young adults in the naturalistic setting.     

The big, the bad, and the boozed-up: Weight moderates the effect of alcohol on aggression

Most people avoid the “big, drunk guy” in bars because they do not want to get assaulted. Is this stereotype supported by empirical evidence? Unfortunately, no scientific work has investigated this topic. Based on the recalibrational theory of anger and embodied cognition theory, we predicted that heavier men would behave the most aggressively when intoxicated. In two independent experiments (Ns = 553 and 327, respectively), participants consumed either alcohol or placebo beverages and then completed an aggression task in which they could administer painful electric shocks to a fictitious opponent. Both experiments showed that weight interacted with alcohol and gender to predict the highest amount of aggression among intoxicated heavy men. The results suggest that an embodied cognition approach is useful in understanding intoxicated aggression. Apparently there is a kernel of truth in the stereotype of the “big, drunk, aggressive guy.”     

Joel Osteen as Cultural Selfobject: Meeting the Needs of the Group Self and Its Individual Members in and from the Largest Church in America

This paper examines the appeal and success of Joel Osteen, pastor of the largest church in America: Lakewood Church in Houston, Texas. Our guiding theory comes from Heinz Kohut’s Self psychology, especially as elaborated in his interviews with Charles Strozier. We also draw on the work of Indian psychoanalyst Sudhir Kakar, who, using Kohut, argues that the guru in the Indian context functions as a cultural selfobject, and we argue that Osteen functions in an analogous way in the American context—that is, as a cultural selfobject. Specifically, we argue that Osteen’s appeal and success is due to what Kohut refers to as idealizing transferences and mirroring transferences, as well as Osteen’s ability to provide a “calming structure” and a sense of “continuity,” as Kohut uses these terms, for members of the Lakewood community. To demonstrate this thesis, we analyze a recent sermon by Osteen, a chapter in one of his bestselling books, and the airplane incident that involved Victoria Osteen in December 2005. We contextualize our analysis by discussing relevant sociological and demographic data pertaining to Lakewood Church, and we conclude by making the point that cultures can become disillusioned with their own cultural selfobjects and, whatever the fate of Joel Osteen and company, our culture will nevertheless continue to produce new cultural selfobjects.     

On the Edge: Exploring the End of the Analytic Hour

The final moments of the analytic hour are a repetitive reenactment whose symbolic meaning can be both a challenge and an opportunity. Each member of the analytic dyad is vulnerable to the revival of deprivation and loss that is introduced by the end of the hour, and each will handle the experience in a unique way. When this cocreated moment occurs in the absence of awareness, there can be avoidance and enactment. When it occurs in the context of shared understanding, the analytic pair is free to intensify, play with, and confront the limitations and inevitabilities of life that are revived again and again when we approach and reach the end. Integrating theoretical perspectives on mourning, attachment, and self-states, along with clinical vignettes, the paper will show how existential questions are present in many of our analytic encounters. As we help our clients negotiate this moment, we too may acknowledge aspects of ourselves that can intensify our awareness, and facilitate our therapeutic effectiveness. Our capacity to explore this important edge of analytic space with our patients can help them to live and to love and can enrich our work if we can be open to its multifaceted meaning.     

Shaping Medical Students' Attitudes Toward Ethically Important Aspects of Clinical Research: Results of a Randomized,Controlled Educational Intervention

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire for information, hopes about participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics.     

Enhancing the Learning of Sport Skills Through External-Focus Feedback

The authors examined how the effectiveness of feedback for the learning of complex motor skills is affected by the focus of attention it induces. The feedback referred specifically either to body movements (internal focus) or to movement effects (external focus). In Experiment 1, groups of novices and advanced volleyball players (N = 48) practiced “tennis” serves under internal-focus or external-focus feedback conditions in a 2 (expertise) × 2 (feedback type) design. Type of feedback did not differentially affect movement quality, but external-focus feedback resulted in greater accuracy of the serves than internal-focus feedback during both practice and retention, independent of the level of expertise. In Experiment 2, the effects of relative feedback frequency as a function of attentional focus were examined. A 2 (feedback frequency: 100% vs. 33%) × 2 (feedback type) design was used. Experienced soccer players (N = 52) were required to shoot lofted passes at a target. External-focus feedback resulted in greater accuracy than internal-focus feedback did. In addition, reduced feedback frequency was beneficial under internal-focus feedback conditions, whereas 100% and 33% feedback were equally effective under external-focus conditions. The results demonstrate the effectiveness of effect-related, as opposed to movement-related, feedback and also suggest that there is a need to revise current views regarding the role of feedback for motor learning.