Development and Feasibility of a Group Cognitive-Behavioral Therapy for Fear of Cancer Recurrence

This paper describes the development, content, and preliminary results of a group cognitive-behavioral therapy (CBT) for fear of cancer recurrence (FCR). A manualized CBT intervention was developed and offered to 38 patients with various cancer types and stages in two hospitals. Four weekly group CBT sessions were administered by two licensed psychologists as part of routine care. Patients completed self-report scales before the first treatment session and, a second time, 1 month after the last session.Overall, 33 patients had clinical levels of FCR at baseline. The participants’ satisfaction toward the group CBT for FCR was high. Significant reductions on the total score and most subscales of the Fear of Cancer Recurrence Inventory (FCRI) were observed, as well as significant improvements on most of the other psychological variables measured (i.e., insomnia, anxiety, depression, dysfunctional beliefs about cancer, and intolerance of uncertainty). In addition, 52% of the patients with clinical levels of FCR (FCRI-severity subscale score ≥ 13) at baseline no longer reached this clinical threshold at posttreatment.These preliminary results suggest that our group CBT for FCR is well accepted and feasible, and shows promising efficacy for decreasing FCR and improving other psychological variables among cancer patients. The next step is to investigate the efficacy of this minimal intervention in larger and controlled clinical trials, as well as its usefulness as part of a stepped care approach.This low-cost intervention is easy to implement in various clinical settings and has a strong potential to help large numbers of patients with FCR.     

Effective interactions: Communication and high levels of marital satisfaction

Of all the significant relationships in the lives of human-beings, the marital relationship remains one of the most central and important to their well-being. For this rapid review the authors accessed four online databases (PsycINFO, PsychARTICLES, JSTOR Journals, and ScienceDirect) to examine the evidence on aspects of communication which contribute to high levels of marital satisfaction and to synthesise these findings. The search yielded 103 unique articles, of which 15 were ultimately included. Principal results found the following activities to relate to high marital satisfaction: 1) communication activities such as engaging in small talk and providing verbal and non-verbal messages of affection; 2) “positive” exchanges which include any interactions perceived by both parties as constructive; 3) effective conflict management including the use of responses of recalibration and reaffirmation (R-R response), the use of we-pronouns, and the Listener-Speaker technique; 4) possessing and implementing effective communication skills such as using “I” instead of “you” messages; and 5) using “positive” communication skills such as clarification to elicit “positive” affect such as feeling understood. The evidence suggests that mental health professionals working with married couples should seek to promote quality dyadic communication as part of treatment interventions.     

Portugal’s Immigration and Integration Policies: a Case Apart?

Most countries in Europe have seen the rise of anti-immigrant political parties in recent years and many have implemented more restrictive immigration measures. Portugal has moved in the opposite direction, seeking to produce some of the best practices and laws on immigration and immigrant integration. Traditional theories of immigration policy fail to account for the Portuguese case, and regional models of immigration overlook ways in which Portugal diverges. Instead, Portuguese policies are best understood as the product of (1) a political consensus on immigration that derives in part from Portugal’s social-revolutionary democratic transition; (2) innovative institutions that enjoy both autonomy and political support, enable a “whole-of-government” approach, and mediate social pressures created by immigration; and (3) leadership choices made by politicians, bureaucrats, and civil society groups to forge consensus and seek inclusion. The Portuguese case signals the importance of adopting other lenses for the comparative study of immigration policies that go beyond regional models and highlight policy similarities among countries from distinct regions.     

Non-binary youth: Access to gender-affirming primary health care

ABSTRACT

Background: Transgender (trans) youth who identify outside the gender binary are a growing subpopulation. In this article, we document differences in access to gender-affirming health care between binary and non-binary identified trans youth and explore ways of meeting the health needs of non-binary youth within primary care settings.

Methods: The Canadian Trans Youth Health Survey is a national online survey of trans youth, 14–25 years, conducted in 2013–2014. Among the 839 participants who responded to gender identity items in the survey, 41% identified as non-binary. We compared demographic, health outcome, and health care access responses between non-binary and binary (trans girls/women and trans boys/men) youth.

Results: Non-binary and binary youth were similar in most demographics, including age, geographic distribution, and ethnocultural backgrounds, however a larger proportion (82%) of non-binary youth were assigned female at birth. Older non-binary youth (aged 19–25) were significantly more likely to forego needed healthcare than older binary youth; no significant differences were found between younger (14–18) non-binary and binary youth in foregoing healthcare. Overall, non-binary youth (13%) were significantly less likely than binary youth (52%) to access hormone therapy, but they were more likely than binary youth to report experiencing barriers to accessing hormone therapy when needed.

Conclusions: Non-binary trans youth in Canada report challenges in accessing needed gender-affirming healthcare. Primary care providers are well-situated to integrate a broad range of gender-affirming care services into practice in order to address the unique needs of non-binary youth. Future research is warranted to explore experiences of non-binary youth related to barriers to care and to explore how services can be designed and delivered to better meet the needs of non-binary youth seeking gender-affirming primary care.     

Thermal sensitivity and cardiovascular reactivity to stress in healthy males

This paper examines the association of cardiovascular reactivity with thermal thresholds (detection and unpleasantness). Heart period (HP), systolic (SBP) and diastolic (DBP) blood pressure of 42 health young males were recorded during a cardiovascular reactivity task (a videogame based upon Sidman's avoidance paradigm). Thermal sensitivity, assessing detection and unpleasantness thresholds with radiant heat in the forearm was also estimated for participants. Participants with differential scores in the cardiovascular variables from base line to task > or = P65 were considered as reactors and those how have differential scores < or = P35 were considered as non-reactors. Significant differences were observed between groups in the unpleasantness thresholds in blood pressure (BP) but not in HP. Reactors exhibited significant higher unpleasantness thresholds than non-reactors. No significant differences were obtained in detection thresholds between groups.     

Doping in sport and enhancement medicine

The reason that gives doping in sport a deeper philosophical and ethical dimension is the emergence of a new medical paradigm: enhancement medicine. The question of enhancing performance in sport has become part of a broader societal debate on human enhancement. The gradual blurriness of the boarders between therapeutic medicine and enhancement medicine constitutes the most spectacular and the most troublesome form of these modifications. In the contemporary biomedicine, the new medicines and technologies can be used not only to cure the patients but also to enhance human capacities. This evolution represents a paradigmatic change in the medical practice: it is not the mere restoration of health which is expected anymore, nor the promotion of health. What is required is the improvement of performance and the perfectibility of the human being, including in the field of sport. Competitive sport could become the main laboratory of enhancement medicine. The intersection of science and sport raises fundamental philosophical, ethical and policy issues that cannot be answered easily. The prohibition and the war on doping is not the only solution.     

Contextual conditioning in rats as an animal model for generalized anxiety disorder

Animal models of psychiatric disorders are important translational tools for exploring new treatment options and gaining more insight into the disease. Thus far, there is no systematically validated animal model for generalized anxiety disorder (GAD), a severely impairing and difficult-to-treat disease. In this review, we propose contextual conditioning (CC) as an animal model for GAD. We argue that this model has sufficient face validity (there are several symptom similarities), predictive validity (it responds to clinically effective treatments), and construct validity (the underlying mechanisms are comparable). Although the refinement and validation of an animal model is a never-ending process, we want to give a concise overview of the currently available evidence. We suggest that the CC model might be a valuable preclinical tool to enhance the development of new treatment strategies and our understanding of GAD.     

Virtual/real transfer of spatial knowledge: benefit from visual fidelity provided in a virtual environment and impact of active navigation

The purpose of this study was to evaluate the effect the visual fidelity of a virtual environment (VE) (undetailed vs. detailed) has on the transfer of spatial knowledge based on the navigation mode (passive vs. active) for three different spatial recall tasks (wayfinding, sketch mapping, and picture sorting). Sixty-four subjects (32 men and 32 women) participated in the experiment. Spatial learning was evaluated by these three tasks in the context of the Bordeaux district. In the wayfinding task, the results indicated that the detailed VE helped subjects to transfer their spatial knowledge from the VE to the real world, irrespective of the navigation mode. In the sketch-mapping task, the detailed VE increased performances compared to the undetailed VE condition, and allowed subjects to benefit from the active navigation. In the sorting task, performances were better in the detailed VE; however, in the undetailed version of the VE, active learning either did not help the subjects or it even deteriorated their performances. These results are discussed in terms of appropriate perceptive-motor and/or spatial representations for each spatial recall task.     

Cognitive and affective Theory of Mind in mild to moderate Alzheimer's disease

Theory of Mind (ToM) allows one's own and others' cognitive and emotional mental states to be inferred. Although many patients with Alzheimer's disease (AD) display impaired social functioning as their disease progresses, very few studies have investigated ToM in AD. Those that have done so suggest that patients' ToM deficits are the consequence of other cognitive impairments. The aim of this study was thus to investigate changes in both the cognitive and the affective dimensions of ToM in AD, using tasks designed to circumvent the patients' comprehension difficulties. Sixteen mild to moderate AD patients and 15 healthy controls matched on age, sex and education level underwent cognitive (preference judgment and first‐ and second‐order false belief) and affective (Reading the Mind in the Eyes) ToM assessments. Comprehension of false belief stories was verified and an additional neuropsychological examination was undergone. We observed impaired performances by AD patients on all the ToM tasks. While working memory and executive functioning impairments contributed to the deterioration in the more complex aspects of cognitive ToM abilities as highlighted by a correlation analysis, we failed to observe any comprehension difficulties in patients who performed poorly on simple cognitive ToM tasks, which suggests that AD truly affects cognitive ToM.