The predicting brain: Unconscious repetition, conscious reflection and therapeutic change

Neuroscience indicates that 'repetition' is fundamental to brain function. The brain non-consciously predicts what is most likely to happen and sets in motion perceptions, emotions, behaviors and interpersonal responses best adapted to what is expected-before events occur. Predictions enable individuals to be ready 'ahead of time' so reactions occur rapidly and smoothly when events occur. The brain uses past learning as the guide for what to expect in the future. Because of prediction, present experience and responses are shaped by the past. Predictions from early life can be deeply encoded and enduring. Predictions based on the past allow for more efficient brain function in the present, but can lead to mistakes. When what is predicted does not occur, consciousness can be engaged to monitor and correct the situation. But if a perception or emotion seems reasonable for the situation, a person might not notice an error, and a maladaptive 'repetition' may remain unchanged. The author discusses how predictions contribute to psychological defenses and transference repetition, and how conscious self-reflection facilitates therapeutic change. The neuroscience of prediction indicates why, in certain cases, active engagement by the analyst may be necessary. The author makes the argument for use of a 'neuroscience interpretation'.     

Women with <Emphasis Type="Italic">BRCA1</Emphasis> or <Emphasis Type="Italic">BRCA2</Emphasis> Mutations Renegotiating a Post-Prophylactic Mastectomy Identity: Self-Image and Self-Disclosure.

The Facing Our Risk of Cancer Empowered (FORCE) website is devoted to women at risk for hereditary breast and ovarian cancers. One of the most frequently discussed topics on the archived messaged board has been prophylactic mastectomy (PM) for women with a BRCA1/2 mutation. We reviewed the messages, over a 4 year period, of 21 high risk women and their “conversational” partners who originally posted on a thread about genetic testing, genetic counseling and family history. We used a qualitative research inductive process involving close reading, coding and identification of recurrent patterns, relationships and processes in the data. The women sought emotional support, specific experiential knowledge and information from each other. They frequently found revealing their post PM status problematic because of possible negative reactions and adopted self-protective strategies of evasion and concealment outside of their web-based community. The FORCE message board was considered to be a safe place in which the women could be truthful about their choices and feelings. Results are discussed in terms of Goffman’s concepts “stigma” and “disclosure” and Charmaz’s concepts “interruptions,” “intrusions” and a “dreaded future.”     

Accentuate the Negative: Social Images in the Prediction and Promotion of Condom Use1

Based on the negativity bias in person perception, we argue that behavioral decisions related to condom use are influenced by the social images that an individual has of people who do not use condoms, but that they are not influenced by the social images that an individual has of people who do use condoms. Three studies with college student samples indicated that the negative evaluations of people who do not use condoms predicts willingness to have sex without condoms. In contrast, positive evaluations of people who do use condoms showed no unique predictions. A fourth study demonstrated that a health message emphasizing the negative social consequences of having sex without condoms decreased willingness to have unsafe sex in comparison to a control, whereas a message that emphasized the positive social consequences of using condoms had no such effects on willingness.     

How to Increase Vaccination Acceptance Among Apostolic Communities: Quantitative Results from an Assessment in Three Provinces in Zimbabwe

A worldwide increasing trend toward vaccine hesitancy has been reported. Measles outbreaks in southern Africa in 2009–2010 were linked to objections originating from Apostolic gatherings. Founded in Zimbabwe in the 1950s, the Apostolic church has built up a large number of followers with an estimated 3.5 million in Zimbabwe in 2014. To inform planning of interventions for the 2015 measles–rubella vaccination campaign, we assessed vaccination status and knowledge, attitudes and practices among purposive samples of Apostolic caregivers in three districts each in Harare City, Manicaland and Matabeleland South in Zimbabwe. We conducted structured interviews among 97 caregivers of children aged 9–59 months and collected vaccination status for 126 children. Main Apostolic affiliations were Johanne Marange (53%), Madida (13%) and Gospel of God (11%) with considerable variation across assessment areas. The assessment also showed considerable variation among Apostolic communities in children ever vaccinated (14–100%) and retention of immunization cards (0–83%) of ever vaccinated. Overall retention of immunization cards (12%) and documented vaccination status by card (fully vaccinated = 6%) were low compared to previously reported measures in the general population. Mothers living in monogamous relationships reported over 90% of all DTP-HepB-Hib-3, measles and up to date immunizations during the first life year documented by immunization card. Results revealed opportunities to educate about immunization during utilization of health services other than vaccinations, desire to receive information about vaccinations from health personnel, and willingness to accept vaccinations when offered outside of regular services. Based on the results of the assessment, specific targeted interventions were implemented during the vaccination campaign, including an increased number of advocacy activities by district authorities. Also, health workers offered ways and timing to vaccinate children that catered to the specific situation of Apostolic caregivers, including flexible service provision after hours and outside of health facilities, meeting locations chosen by caregivers, using mobile phones to set up meeting locations, and documentation of vaccination in health facilities if home-based records posed a risk for caregivers. Coverage survey results indicate that considerable progress has been made since 2010 to increase vaccination acceptability among Apostolic communities in Zimbabwe. Further efforts will be needed to vaccinate all Apostolic children during routine and campaign activities in the country, and the results from our assessment can contribute toward this goal.     

The influence of culture on disaster mental health and psychosocial support interventions in Southeast Asia

Southeast Asia (SEA), which has borne the brunt of some of the most severe natural disasters in the past decade, has unfortunately, been largely under-represented in the world literature on disaster mental health. This article describes cultural factors that may inform the design and conduct of disaster-related mental health psychosocial support (MHPSS) interventions. Specifically, it discusses cultural nuances in emotional expression, shame, power distance, collectivism, and spiritual beliefs and their implications on providing post-disaster psychosocial interventions. It describes the MHPSS interventions implemented in the region using the Johns Hopkins Perspectives Model of Disaster Mental Health categories of resistance, resilience and recovery. Given the challenges on the delivery of MHPSS, there is a need for evidence-based interventions and to ensure that disaster responders in SEA understand the cultural factors that impact the delivery of MHPSS interventions.     

Testing predictions of the interactive activation model in recovery from aphasia after treatment

This paper presents preliminary results of pre- and post-treatment error analysis from an aphasic patient with anomia. The Interactive Activation (IA) model of word production (Dell, Schwartz, Martin, Saffran, & Gagnon, 1997) is utilized to make predictions about the anticipated changes on a picture naming task and to explain emerging patterns. Error patterns are viewed in light of two putative mechanisms within the IA network, connection strength, and rate of decay. The results suggest that while these mechanisms can successfully account for the magnitude and order of specific errors (e.g., predominance of semantic paraphasias and nonwords followed by formal paraphasias under the conditions of weak connections), the treatment may have influenced the occurrence/absence of some error types.     

Reconceptualizing Quantitative and Qualitative Methods: A Case Study Dealing with Place as an Exemplar

A useful framework for understanding methods is to think of them as being on a continuum of holistic and pattern focused to particularistic and specific. This paper argues for this conceptualization rather than thinking of quantitative and qualitative methods as oppositional and potentially contradictory. A case study provides an example of using both quantitative and qualitative methods in a holistic and pattern-focused study, while also attending to the values and goals of community psychology. The substantive research goal is to understand a child's experience of places related to school. Methods include ethnographic long-term participation and observation, interviews, multidimensional scaling, and social network analysis. Most quantitative method variables are generated from study participants; no outside structure is imposed. The quantitative methods extend and inform the qualitative methods, just as the qualitative methods extend and inform the quantitative methods. The quantitative and qualitative methods work reciprocally to extend and inform each other.