The experience of chronic illness: Issues of loss and adjustment

Abstract

The impact of a long-term illness creates a pervasive dilemma for individuals in regard to maintaining both emotional and social well-being. Dealing with the medical ramifications of illness may be only one small part of the challenge. Too often, a number of personal losses are encountered in addition to functional limitations. Chronic illness may affect an individual's sense of self-worth, relationships with family and friends, and future goals and plans. The acceptance of these losses and adaptation to the illness are shaped in part by the meaning the individual ascribes to the event. It is further influenced by societal reactions and interactions with others. Unfortunately, persons with chronic illness often find themselves alone in their struggle to adapt. The purpose of this article is to discuss the issues relevant to such persons and to identify ways in which counseling can facilitate this difficult process.     

Altered working memory capacity for social threat words in high versus low social anxiety

ABSTRACT

Background and objectives: Differences in working memory capacity (WMC) have been suggested in individuals with high levels of social anxiety (SA). Specifically, these individuals may preferentially maintain socially threatening material in working memory.

Design and methods: We adapted the digit span task to a series of word span tasks. We assessed WMC for lists of words that varied in terms of their threat-relatedness, in individuals either high or low in SA.

Results: Experiment 1 revealed reduced WMC for socially threatening words in those with high compared to low SA. Importantly, this relative reduction in WMC was driven by the low SA group showing expanded capacity for socially threatening words relative to neutral or generally threatening words. Furthermore, reductions in WMC for social threat were uniquely predicted by SA, and not by other theoretically related constructs such as state general anxiety, trait general anxiety, or depression. Experiment 2 showed that the semantic similarity of the words within each list was not responsible for the differences in WMC between list type or SA group.

Conclusions: Our findings suggest that individuals high in SA may fail to upregulate WMC for social information due to the activation of, or rumination upon, socially threatening concepts.     

An Island in a Sea of Development: An Examination of Place Attachment,Activity Type,and Crowding in an Urban National Park

ABSTRACT

As more people move to urban areas there will be increased pressure on existing green spaces to offer places for recreation, contemplation, historic interpretation, exercise, and nature appreciation. Development and a rise in population has led to too few public recreation sites available in many regions of the world resulting in unsustainable pressure being applied to parks. The objective of this study was to examine how place attachment may be related to type and frequency of park use and management issues regarding crowding. Data for this study were obtained via intercept survey of a random sample of visitors (N = 1088) at a park in the Metro Atlanta area, Georgia. Results suggest that place attachment had a significant relationship with frequency of visits and types of activities that visitors engaged in. There was, however, no significant relation between place attachment and crowding. First-time visitors and less frequent visitors felt most crowded, which may support the idea that the most frequent visitors expect it to be crowded and are, therefore, less sensitive to it. This study sheds light on how visitors to an urban park view their experience while recreating, and may inform policies and regulations that will help mitigate the unique management situations that urban parks present.     

Males' Reactions to Participating in Research on Dating Violence Victimization and Childhood Abuse

Childhood abuse and dating violence victimization are prevalent and devastating problems. Although there has been an abundance of research on these topics in recent years, researchers and institutional review boards often struggle with determining whether asking respondents questions on previous violence will result in increased emotional distress or other negative research outcomes. Empirical data are therefore needed that examine the research reactions of individuals who participate in research on childhood abuse and dating violence. This study examined this topic among a sample of male college students (N?=?193). Results showed that victims of childhood sexual abuse had more negative emotional reactions and victims of physical dating violence had more negative perceived drawbacks to research participation than nonvictims. However, victims and nonvictims did not differ on positive research reactions. These findings suggest that there are few differences between victims and nonvictims on research reactions.     

Does prospective memory influence quality of life in community-dwelling older adults?

Older adults commonly experience declines in prospective memory, which describes one’s ability to “remember to remember,” and can adversely affect instrumental activities of daily living and healthcare compliance. However, the extent to which prospective memory failures may influence quality of life in typically aging older adults is not well understood. One-hundred and four community-dwelling older Australians (aged 50 to 82 years) were administered a comprehensive, neuropsychological battery that included the Memory for Intentions Screening Test (MIST), Prospective and Retrospective Memory Questionnaire (PRMQ), Instrumental Activities of Daily Living Questionnaire (IADLQ), and World Health Organization Quality of Life-8 (WHOQOL-8). Multiple regressions controlling for negative affect, medical comorbidities, and other neurocognitive functions revealed an interaction between prospective memory and instrumental activities of daily living in the concurrent prediction of quality of life. Among the 39 older adults who reported multiple problems on the IADLQ, lower performance-based prospective memory (MIST) and higher self-reported prospective memory failures in daily life (PRMQ) were significantly associated with lower quality of life (WHOQOL-8). Conversely, no significant associations were observed between prospective memory and quality of life in the 65 participants without IADL problems. Prospective memory difficulties adversely impact quality of life in community-dwelling older adults who experience problems independently managing their instrumental activities of daily living. These findings extend prior literature showing that prospective memory plays a unique role in the real-world outcomes of older adults and clinical populations and highlight the need to develop effective strategies to enhance prospective memory functioning in these vulnerable groups.     

Induction when rats lick for 1% liquid-sucrose reinforcement

Previous research reported that rats responding for 1% liquid-sucrose reinforcement when 32% sucrose reinforcement is upcoming will decrease their response rate (contrast) if licking is the dependent measure and increase their response rate (induction) if pressing a lever is the dependent measure. The present study investigated whether induction could be observed when licking served as the dependent measure and whether induction in lever pressing and contrast in licking behaviour could be concurrently observed. Experiment 1 found induction when rats licked to earn the rewards but consumed them at a location separate from the spout licked to earn them. Experiment 2 also found induction when rats earned (and consumed) rewards by licking the same spout throughout the session. Experiment 3 separately measured instrumental lever pressing for sucrose rewards and licking the sucrose during the reward period. We found that both measures increased for 1% sucrose when 32% sucrose reinforcement was upcoming. The present results indicate that the type of response is not the sole determinant of whether contrast or induction is observed. Rather, they suggest that other procedural details, such as the location of reinforcer delivery, influence which effect is observed. The results also indicate that associative processes underlie the appearance of induction in responding for 1% sucrose.     

The moral psychology of rationing among physicians: the role of harm and fairness intuitions in physician objections to cost-effectiveness and cost-containment

Introduction

Physicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called “moral foundations.” The objective of this study was to determine if “harm” and “fairness” intuitions can explain physicians’ judgments about cost-containment in U.S. health care and using cost-effectiveness data in practice, as well as the relative importance of those intuitions compared to “purity”, “authority” and “ingroup” in cost-related judgments.

Methods

We mailed an 8-page survey to a random sample of 2000 practicing U.S. physicians. The survey included the MFQ30 and items assessing agreement/disagreement with cost-containment and degree of objection to using cost-effectiveness data to guide care. We used t-tests for pairwise subscale mean comparisons and logistic regression to assess associations with agreement with cost-containment and objection to using cost-effectiveness analysis to guide care.

Results

1032 of 1895 physicians (54%) responded. Most (67%) supported cost-containment, while 54% expressed a strong or moderate objection to the use of cost-effectiveness data in clinical decisions. Physicians who strongly objected to the use of cost-effectiveness data had similar scores in all five of the foundations (all p-values?>?0.05). Agreement with cost-containment was associated with higher mean “harm” (3.6) and “fairness” (3.5) intuitions compared to “in-group” (2.8), “authority” (3.0), and “purity” (2.4) (p?<?0.05). In multivariate models adjusted for age, sex, region, and specialty, both “harm” and “fairness” were significantly associated with judgments about cost-containment (OR?=?1.2 [1.0-1.5]; OR?=?1.7 [1.4-2.1], respectively) but were not associated with degree of objection to cost-effectiveness (OR?=?1.2 [1.0-1.4]; OR?=?0.9 [0.7-1.0]).

Conclusions

Moral intuitions shed light on variation in physician judgments about cost issues in health care.

     

“Where Are You?” Defensive Dissociation and Fragments of Annihilated Faith

This article addresses the relation between defensive dissociation and faith. Defensive dissociation is understood as a response to severe trauma. In this response there is no interpreting subject to process the event linguistically and the result is fragments of unformulated memory that continue to be painfully present long after the original trauma. The victim of severe trauma alternates between the need to be here in the presence of other human beings and the dissociative isolation of not being here. There are two related claims in this article. First, defensive dissociation stands for an event where faith is annihilated. As a defense it protects a person's remnant sense of faith, subjectivity, agency, and personhood by creating a space of non-experience. Fragments of annihilated faith continue to be present in the person's present formulations of faith and concomitant behaviors, relationships, and use of objects. The second claim is that the core of severe trauma remains outside the victim and community's capacities to represent it symbolically. This incommunicable core of annihilated faith can be contained by a community of faithful persons who are willing to face the horror of non-being and being nowhere without succumbing to despair.