Competence to make treatment decisions in anorexia nervosa: thinking processes and values

This paper explores the ethical and conceptual implications of the findings from an empirical study of decision-making capacity in anorexia nervosa. In the study, ten female patients aged 13 to 21 years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semi-structured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient participants were also tested using the MacCAT-T test of competence. This is a formalised, structured interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief self-administered questionnaires to assess their levels of psychopathology.The issues identified from the interviews are described under two headings: difficulties with thought processing, and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches or current standardised tests of competence.     

EVALUATION OF A TRAINING MANUAL FOR THE ACQUISITION OF BEHAVIORAL ASSESSMENT INTERVIEWING SKILLS

Two procedures were used to teach behavioral assessment interviewing skills: a training manual and one-to-one instruction that included modeling, rehearsal, and feedback. Two graduate students and two advanced undergraduates were trained with each procedure. Interviewing skills were recorded in simulated assessment interviews conducted by each student across baseline and treatment conditions. Each training procedure was evaluated in a multiple baseline across students design. The results showed that both procedures were effective for training behavioral interviewing skills, with all students reaching a level of 90%-100% correct responding. Finally, a group of experts in behavior analysis rated each interviewing skill as relevant to the conduct of an assessment interview and a group of behavioral clinicians socially validated the outcomes of the two procedures.     

On the nature of processes governing defensive burying of aversive flavors and odors in rats

Four experiments are reported which investigated the processes which contribute to the failure of rats to bury fluids that have acquired aversive properties through pairings with lithium chloride toxicosis. Fluids that failed to provide strong olfactory stimulation were avoided but not buried. These solutions, however, produced higher order conditioning of odor-bearing solutions which were buried readily. Various control experiments indicated that these effects depended upon the odorous qualities of the stimulus and not upon simple novelty effects or changes in gustatory stimulation. These data indicate that the inability of aversive gustatory cues to produce burying reflects a constraint on motivational or S-R learning processes.     

TAOISM AND BIOLOGICAL SCIENCE

Abstract. The seemingly disparate systems of philosophical Taoism and modern biological science are compared. A surprising degree of similarity is found in their views on death, reversion (cyclicity of phenomena), complementary interactions of dichotomous systems, and the place of humans in the universe. The thesis is advanced that these similarities arise quite naturally, since both systems base their knowledge upon objective observation of natural phenomena. Substantial differences between the two systems are recognized and examined regarding verbal argument, machinery, and experimentation. The Taoists' relationship to Chinese alchemy and the biologists' to technology are claimed to mitigate their attitudes toward experimentation.     

Objective and subjective dimensions of travel impedance as determinants of commuting stress

The stressful characteristics of commuting constraints are conceptualized in terms of both physical and perceptual conditions of travel impedance. This study develops and operationalizes the concept of subjective impedance, as a complement to our previously developed concept of impedance as a physically defined condition of commuting stress. The stress impacts of high-impedance commuting were examined in a study of 79 employees of two companies in the follow-up testing of a longitudinal study. Subjective impedance was overlapping but not isomorphic with physical impedance, and these two dimensions have differential relationships with health and well-being outcomes. The physical impedance construct received further confirmation in validational analyses and in predicted effects on various illness measures and job satisfaction. The newly constructed subjective impedance index was significantly related to evening home mood, residential satisfaction, and chest pain. Job change was also influenced primarily by commuting satisfaction. The results are discussed within an ecological framework emphasizing interdomain transfer effects and situational moderators of commuting stress.     

Community Development in Rural Mexico: The Social Psychological Effects of Adult Education1

A field study compared the social-psychological impact of two traditional adult education programs (certification and literacy) with a socio-ecologically oriented approach in three rural Mexican community types (Ejido, Hacienda, Cabecera) varying in structure and degree of isolation. The primary findings revealed interactions between community and program for the luck/fate dimension of locus of control and for a measure of social efficacy. Community type was the critical factor affecting program impact on luck/fate locus of control beliefs: Residents of the most unstructured and isolated community (Ejido) showed the greatest shift toward internality. Program focus produced significant changes in feelings of social efficacy in two of the three communities. The socio-ecological program contributed most to social competence in the Hacienda community, whereas the certification program had the greatest positive impact in the Cabecera community. The findings are discussed in terms of the relevance of the ecological approach to community intervention in developing countries such as Mexico.