Evidence-based medicine,psychoanalysis and psychotherapy

SUMMARY

The scientific status of psychoanalysis is a matter of importance to both theorists and clinicians in psychiatry. The empirical evidence for both the theory and the practice of psychodynamic practice is much greater than is generally recognised. There is strong evidence for the effectiveness of psychoanalysis and psychoanalytically oriented therapy. the future of psychoanalysis depends on this evidence. We will discuss both the evidence and reasons why it is overlooked in certain quarters, and review the developing neuro-cognitive understanding of the mechanisms that underlie psychoanalytical processes.     

Evaluating the performance of departments of psychotherapy

Conceptual and practical issues which surround attempts at assessing the efficiency of psychotherapy departments are surveyed and the advantages and disadvantages associated with performance indicators reviewed. The issues of assessing efficiency in general and the selection of appropriate indicators at both national and local levels are discussed. It is concluded that it is possible to find indicators which reflect the value of a psychotherapeutic service to the community within which it is based, and that the identification of a generally agreed set of such parameters is a matter of priority.     

Chance and choice, change and continuity--that's life

Responding to this invitation to write an autobiography, I have tried to put in some order, the jumble of memories that come to mind. There are markers of the journey--the major decisions and changes in direction, many influenced by external events. Despite turns and detours, there is also continuity of interests and behavioral style. My beginnings on a Nebraska farm were a considerable distance in place and character from my current retirement in Oregon. The trail of events was especially marked by the death of my father, early choice of psychology, military service in Germany, marriage in Paris, establishing the university clinic and clinical program at the University of Oregon, starting a school of Community Service and Public Affairs, working with Leona Tyler on books and an extensive research project, and a year going around the world with my family including a long period in India. My principal contributions to personality assessment include cross-cultural studies, development of a boredom scale, community psychology connections, many reviews, books in clinical psychology and assessment, and work with students and others who continue this important branch of psychology.     

The relationship between psychopathic features, violence and treatment outcome: the comparison of three youth measures of psychopathic features

Few studies have compared self-report and clinician-administered measures of youth psychopathic features in juvenile-justice settings in terms of antisocial behavior and treatment indices. In a sample of 85 adjudicated delinquents, the predictive validities of the Antisocial Process Screening Device (APSD), the modified Childhood Psychopathy Scale (mCPS), and the Hare Psychopathy Checklist: Youth Version (PCL:YV) were tested. Three indices of institutional antisocial behavior (physical aggression; verbal aggression; administrative infractions) and two indices of treatment progress (time to treatment level promotion; whether treatment levels were dropped) were used as external correlates. The self-report measures (mCPS more so than APSD) were more consistently and strongly related to antisocial behavior and to the days required to progress in treatment than the PCL:YV. The following issues are discussed: (i) implications of the potential impact of measurement format on the understanding and predictive validity of youth psychopathy features and measures; (ii) the differential predictive validity of self-report versus clinician-administered measures; and (iii) the potential practical utility of measures of psychopathic features in youth.     

Perception of three-dimensional shape from specular highlights, deformations of shading, and other types of visual information

There have been numerous computational models developed in an effort to explain how the human visual system analyzes three-dimensional (3D) surface shape from patterns of image shading, but they all share some important limitations. Models that are applicable to individual static images cannot correctly interpret regions that contain specular highlights, and those that are applicable to moving images have difficulties when a surface moves relative to its sources of illumination. Here we describe a psychophysical experiment that measured the sensitivity of human observers to small differences of 3D shape over a wide variety of conditions. The results provide clear evidence that the presence of specular highlights or the motions of a surface relative to its light source do not pose an impediment to perception, but rather, provide powerful sources of information for the perceptual analysis of 3D shape.     

Gruppenpsychotherapie für Brustkrebspatientinnen

Zusammenfassung  Der Brustkrebs erzwingt geradezu unsere Aufmerksamkeit mit seiner hohen Prävalenz—30% aller Krebsneuerkrankungen bei nordamerikanischen Frauen sind Brustkrebs—, und er ist die zweithäufigste Todesursache bei Frauen in Nordamerika. Weiße nordamerikanische Frauen haben ein Risiko von 1:9, im Laufe ihres Lebens an Brustkrebs zu erkranken. Es gibt zahlreiche Anknüpfungspunkte, darunter genetische und familiäre Prädisposition, primäre Krebserkrankung/Langzeitüberleben und rezidivierende oder metastasierende Krankheit. Brustkrebs ist eine Krankheit, bei der jede Form der Krebsbehandlung eingesetzt wird—Chirurgie, Chemotherapie, Bestrahlung, Hormontherapie und die viel versprechenden, kürzlich entwickelten immunologischen Interventionen. Zugleich ist die Brust als Körperteil kulturell hochgradig besetzt und als Symbol der Weiblichkeit, der Attraktivität, der Sexualität und der Fortpflanzung aufmerksam und emotional viel beachtet. In der vorliegenden Arbeit wird die Anwendung von Gruppenpsychotherapien auf dieses Spektrum klinischer Belange diskutiert.

Intra-amygdala muscimol injections impair freezing and place avoidance in aversive contextual conditioning

Rats were trained by shocking them in a closed compartment. When subsequently tested in the same closed compartment with no shock, normal rats showed an increased tendency to freeze. They also showed an increased tendency to actively avoid the compartment when given access to an adjacent neutral compartment for the first time. Amygdala inactivation with bilateral muscimol injections before training attenuated freezing and eliminated avoidance during the test. Rats trained in a normal state and given intra-amygdala muscimol injections before the test did not freeze or avoid the shock-paired compartment. This pattern of effects suggests that amygdala inactivation during training impaired acquisition of a conditioned response (CR) due either to inactivation of a neural substrate essential for its storage or to elimination of a memory modulation effect that facilitates its storage in some other brain region(s). The elimination of both freezing and active avoidance by amygdala inactivation during testing suggests that neither of these behaviors is the CR. The possibility that the CR is a set of internal responses that produces both freezing and avoidance as well as other behavioral effects is discussed.     

Disruption of latent inhibition to a contextual stimulus with systemic amphetamine

This experiment examined the effects of 0.5 and 1.5 mg/kg doses of amphetamine (AMP) in male Wistar rats, on conditioning to a contextual stimulus that for half the animals has been pre-exposed, in an appetitive conditioning procedure. Amphetamine was administered during both pre-exposure (3 days) and acquisition (15 days). Latent inhibition (LI, reduced conditioning in pre-exposed relative to non-pre-exposed rats) was seen in controls but not at either AMP dose. This abolition of LI was seen under AMP at two levels of responding in acquisition and confirmed in drug free extinction. It suggests that, like conditioning to discrete stimuli, conditioning to contextual stimuli is subject to LI and can be disrupted by AMP.     

Young children who abandon error behaviourally still have to free themselves mentally: a retrospective test for inhibition in intuitive physics

When preschoolers overcome persistent error, subsequent patterns of correct choices may identify how the error had been overcome. Children who no longer misrepresented a ball rolling down a bent tube as though it could only fall vertically, were asked sometimes to approach and sometimes to avoid where the ball landed. All children showed requisite task-switching flexibility. The pattern of 4-year-olds' correct choices among different places showed unnecessary avoidance of any place that would previously have tempted them into a vertical-approach error, 5-year-olds rebounded into a reversal, and 7-year-olds were flexible. The data attest to an inhibition mechanism, ruling out competing possibilities.