Social phobia in disabled workers with chronic musculoskeletal pain

The present study assessed the prevalence and impact of social phobia and other anxiety disorders in disabled workers with chronic musculoskeletal pain. Potential participants were 200 disabled workers consecutively referred to an interdisciplinary tertiary care centre. A two stage screening process was used in which: (a) a self-report battery was given during a pre-admission visit, and (b) preplanned selection criteria were applied to the self-report instruments to select patients for a structured diagnostic interview. Fifty-four of the 146 patients who provided complete responses on the self-report battery met criteria for interview. Twenty-six patients (17.8%) met DSM-IV criteria for a current anxiety disorder and, of these, 16 (11.0%) were diagnosed with social phobia. Subjects with social phobia rated themselves as having less social support than subjects with no psychiatric disorder, but the groups did not differ in pain-related life interference, personal control, or health care utilization. The results suggest that social phobia is over-represented in disabled workers with chronic musculoskeletal pain and should be noted as a comorbid condition that may compound both suffering and disability.     

Open live supervision in family therapy

This article reviews changes in models of supervision, resulting from technological developments and reflecting a variety of theoretical approaches. The focus is on open live supervision, conducted in the presence of the family. The supervisor and a therapeutic team join the therapist and the family, creating a complex supra-system that opens up several options for therapeutic intervention. Sessions are videotaped, and therapists use recordings for additional supervision and independent study. Therapists may also show recordings to the family as part of the therapeutic process. The advantages and disadvantages of the model are considered, and examples of some of the therapeutic options are described.This model was developed in the course of the author's work teaching and supervising students at the Counseling Department of the School of Education at the Hebrew University of Jerusalem, and supervising a multi-disciplinary team including physicians, psychologists, and social workers engaged in family therapy at the Municipal Psychological Services for Schools in Jerusalem. A shorter version of this article appeared in Hebrew inSihot 5 1991. Appreciation is expressed to Batya Stein for translating the final version of this article from Hebrew. Reprint requests should be addressed to Katrit Ron, Neve Granot 3-B, Jerusalem 93706, Israel.     

Recognition of Facial Expressions of Emotion by Children with Emotional and Behavioral Disorders

Interpreting and responding appropriately to facial expressions of emotion are important aspects of social skills. Some children, adolescents, and adults with various psychological and psychiatric disorders recognize facial expressions less proficiently than their peers in the general population. We wished to determine if such deficits existed in a group of 133 children and adolescents with emotional and behavioral disorders (EBD). The subjects were receiving in-patient psychiatric services for at least one of substance-related disorders, adjustment disorders, anxiety disorders, mood disorders or disruptive behavior disorders. After being read stories describing various emotional reactions, all subjects were tested for their ability to recognize the 6 basic facial expressions of emotion depicted in Ekman and Friesen's (1976) normed photographs. Overall, they performed well on this task at levels comparable to those occurring in the general population. Accuracy increased with age, irrespective of gender, ethnicity, or clinical diagnosis. After adjusting for age effects, the subjects diagnosed with either adjustment disorders, mood disorders, or disruptive behavior disorders were significantly more accurate at identifying anger than those without those diagnoses. In addition, subjects with mood disorders identified sadness significantly more accurately than those without this diagnosis, although the effect was greatest with younger children.     

How Generalizable Are Adolescents' Beliefs About Pro-Drug Pressures and Resistance Self-Efficacy?1

Based on three waves of data from 1261 adolescents, this study examines the nature of resistance self-efficacy vis-a-vis different drugs and social situations, as well as its relationship to perceived pressure to use drugs. We found that both self-efficacy and perceived pressure to use drugs appear to be generalizable across substances (alcohol, cigarettes, and marijuana), but adolescents do tend to distinguish between their capacity to resist drugs in different social situations. Adolescents also discriminate between how much pressure they feel and their ability to resist that pressure, but the great majority report lower levels of self-efficacy in higher pressure situations. This relationship is strongest for alcohol and weakest for marijuana. These results suggest the following implications for prevention programs: (a) adolescents can be taught to resist one or more of the commonly used drugs with a reasonable expectation that the skills will generalize to other drugs; (b) resistance self-efficacy learned in one situation can be expected to have some generalizability to other situations, but it may be important to link resistance training with a range of situations to insure the greatest effectiveness; (c) to be maximally effective, prevention programs may need to help adolescents reduce the amount of pressure experienced as well as develop resistance skills; such efforts are likely to be particularly important for situations involving alcohol.     

Knowledge acquisition and strategic action in “Mastermind” problems

In two experiments, the strategies used by subjects playing the logical-deduction game, Mastermind, were examined. In the first experiment, subjects showed improvement resulting from the continued use of a particular strategic action, and the data suggested that the subjects learned the strategy from their transactions with the task. In the second experiment, the question of changes in underlying strategic knowledge of Mastermind was examined. The accuracy and complexity of the subjects' deductions and their use of the previously identified strategy were used to generate a model of the cognitive operations involved in Mastermind. Although there were improvements in the accuracy and complexity of the subjects' deductions resulting from continued play, these improvements were unrelated to the use of the strategy. Moreover, the likelihood of making accurate and complex deductions was well accounted for by a Markovian model, suggesting that the deployment of the strategy was not driven by any change in the subject's underlying knowledge structures. Rather, the subjects seemed to use the strategy to create Mastermind situations whose interpretation was fairly easy. The implications for previous work on the issue of Mastermind strategies and the development of logical-deduction strategies are discussed.     

Cephalic mechanism for social control of fissioning in planarians: III. Central nervous system centers of facilitation and inhibition.

Previous studies have indicated that asexual reproduction (fissioning) in the planarian Dugesia dorotocephala is socially controlled through a cephalic mechanism: Isolation releases fissioning; grouping inhibits it; decapitation, at the level of the auricles, releases it even in grouped subjects. The brain is not necessary for programming the actual events of fissioning; these are orchestrated by the segmental plexus fissioning (SPF) system. Various surgical cuts were made to ablate selected portions of the central nervous system of isolated and grouped planarians in order to ascertain the inhibitory or facilitatory effects of these in the physiological mediation of such control on the SPF system. These results were synthesized into a model of this control system; the anterior lobes and optic regions of the brain inhibit the SPF system, and the anterior and caudal segmental plexuses facilitate it. These influences are partially tonic and partially contingent upon social stimulation.     

Analysis of the control exerted by a complex cooperation procedure

The study examined the effects of the availability of a non-cooperative response on cooperative responding when cooperation did not have to result in an equal distribution of work or reinforcers. Also, an attempt was made to determine if the cooperative responding was under the control of the cooperation procedure. Pairs of institutionalized retardates were tested in full view of each other. For each subject, reinforcers (money) were contingent upon responses on each of two panels: (1) a matching panel for working matching-to-sample problems, and (2) a sample panel for producing the sample stimulus. The matching panels of the two subjects were 6 m apart, but a subject's sample panel could be placed at different distances from his matching panel. For each subject, either his own or his partner's sample panel could be nearest his matching panel such that less walking was required to reach one sample panel than the other. Subjects could work either individually, by producing their own sample stimulus, or cooperatively, by producing the sample stimulus for their partner. Subjects selected whichever solution involved the least amount of walking. The importance of testing for control by the cooperation procedure was indicated by the findings that cooperative-like responses were not always under the control of the cooperation procedure.     

Testing measures of the quality of residential care: A pilot study

This paper summarizes the results from a pilot study, designed to test a method of measuring the quality of care provided in two residential units for severely mentally handicapped children. The overall aim has been to devise general measures of the learning conditions (the quality of care) within residential units, which relate to groups of clients, and which are equally applicable at different times of the waking day. Such measures will only constitute a helpful monitoring instrument if they are shown to be reliable; to have, at least, face-validity: to be based upon representative and accurate data; and if they differentiate between settings which, intuitively, appear to differ in the extent to which the clients' appropriate behaviour is prompted and reinforced.     

RECREATING THE SCENE: AN EFFECTIVE WAY TO PROVIDE DELAYED PUNISHMENT FOR INAPPROPRIATE MOTOR BEHAVIOR

A mediated punishment procedure that involved recreating a behavioral sequence by guiding the subject through the behavior in the situation in which it occurred was used to suppress several severe problem behaviors in two developmentally delayed children. The mediational procedure was first used with a 4-year-old autistic boy for biting and then for foot stomping. Next the procedure was used for stealing and hoarding behavior with a multiply handicapped 17-year-old girl. Results indicated that the procedure was effective and produced relatively rapid results. One advantage of the procedure is that it provides an opportunity for trained personnel to apply restrictive procedures to low frequency behavior that occurs in their absence rather than relying on less qualified staff to implement the procedure immediately after the behavior occurs.     

Cues-pause-point language training: Structuring trainer statements to provide students with correct answers to questions

This study assessed the applicability of Cues-Pause-Point language training procedures in teaching students to obtain information from the statements of others. Two mentally retarded subjects, one of whom was echolalic, received training on one set of stimuli but not on another. During training the subjects were encouraged to remain quiet before, during, and briefly after the presentation of statements and then verbalize (i.e., answer a question) using the verbal cue(s) that had been presented in the statement. Correct responding reached 100% to the trained stimuli and both subjects' responding improved to the untrained stimuli. Posttests revealed that subjects used the trainer's statements to answer novel questions. The results suggest that Cues-Pause-Point procedures may be useful in teaching severely retarded individuals the functional use of observing and listening to others' verbal behavior.