Three preparatory studies for promoting implementation of outpatient schema therapy for borderline personality disorder in general mental health care

ObjectiveThree studies were conducted to prepare for the implementation of Schema Therapy (ST) for Borderline Personality Disorder (BPD) in general mental healthcare settings. Two were surveys to detect promoting and hindering factors, one was a preliminary test of a training program in ST.MethodsIn 2004, a diagnostic analysis of factors promoting and hindering implementation of a new treatment for BPD was conducted among both managers (n = 23) and therapists (n = 49) of 29 Dutch mental healthcare institutes through a written survey (Study 1). Next, a training program, including a set of DVDs displaying the major therapeutic techniques, was developed and tested among eight therapists. The training program was evaluated by the participants. After the training, three independent raters evaluated therapists' adherence and competence, viewing videos of the therapists completing structured role-plays (Study 2). In 2008, a second written survey was conducted in 22 mental health institutes to study factors for future nationwide implementation of ST (Study 3).ResultsBoth surveys indicated that the situation in most institutes was favorable for implementing a new effective treatment, as participants were not satisfied with the existing treatments, had suitable professional backgrounds, worked in settings with (B)PD-oriented care programs, and expressed a need for change. The surveys yielded clear results for promoting or hindering successful implementation of ST. Promoting factors included scientific evidence for the effectiveness of the treatment, structural changes in the patient's personality, rapidly noticeable effects for the patient, low drop-out rates and a favorable cost-effectiveness. Possible barriers included implementation mandated unilaterally by management, choosing ST based on financial or organizational needs, extending implementation over a lengthy period of time and providing telephone support by therapists beyond office hours. The eight-day training program received very positive ratings. After the training, therapists were rated as sufficiently adherent and competent applying ST to treat BPD patients, with peer supervision and supervision recommended as a supplement to the training.ConclusionThis study showed that the situation in 2005 was advantageous to start implementation of ST. Evaluation of the training and the achieved competence scores of trainees concluded that the training program was a good basis for training therapists in ST. Outcome of the survey in 2008 demonstrated that there was a clear interest for implementation of ST for BPD patients in the future.     

Understanding pregnant women's decision making concerning prenatal screening

OBJECTIVE: This study is aimed at enhancing understanding prenatal screening decision making through testing a hypothesized decision model based on decision theory and health behavior theory. DESIGN: We obtained questionnaires from 1,666 pregnant women who were offered prenatal screening for Down's syndrome. Path analysis (using LISREL) resulted in a final model with reasonable model fit, which was verified by split-sample cross-validation. MAIN OUTCOME MEASURES: These included perceived probability, perceived severity, attitude toward termination, response efficacy, attitude toward prenatal screening, subjective norm, child-related anxiety, and intention to undergo prenatal screening. RESULTS: Attitude toward termination of pregnancy, perceived test efficacy, and subjective norm regarding the desirability of having prenatal screening determined a woman's attitude toward having a prenatal test. Anxiety was influenced by perceived risk and perceived severity of having a child with Down's syndrome, and by subjective norm, but this appeared to be a weak predictor of intention to test. Pregnant women with a positive attitude toward prenatal screening, and who perceived a subjective norm in favor of undergoing prenatal screening, showed a greater intention to have prenatal screening done. CONCLUSION: These findings suggest that more attention should be paid toward the values and social context of pregnant women during the counseling process.     

A case of acquired aphasia and convulsive disorder: some linguistic aspects of recovery and breakdown

Among the cases of acquired aphasia and convulsive disorder several children are reported to have experienced more than one aphasic period. We present such a case in more detail, with emphasis on some characteristics of spontaneous speech. The occurrence of paraphasias, and in particular of neologisms, appeared to be associated with language recovery and breakdown. At the beginning of the period of recovery, a rapid and total disappearance of neologisms was observed, while only literal paraphasias remained. A period of language breakdown was preceded by the return of neologisms. The process was not influenced by drug therapy.     

The man who lost his body: Suboptimal multisensory integration yields body awareness problems after a right temporoparietal brain tumour

Reports on patients who lack ownership over their entire body are extremely rare. Here, we present patient SA who suffered from complete body disownership after a tumour resection in the right temporoparietal cortex. Neuropsychological assessment disclosed selective bilateral ownership problems, despite intact primary visual and somatosensory senses. SA's disownership seems to stem from a suboptimal multimodal integration, as shown by the rubber hand illusion and the beneficial effect during and after simple exercises aiming at multisensory recalibration.     

Measuring General Indecisiveness

Although indecisiveness seems to be a widespread problem, little empirical research has addressed its measurement. Frost and Shows (1993; Behaviour Research and Therapy, 31, 683–692) introduced the Indecisiveness Scale (IS) as a measure of individual differences in general indecisiveness. Although these authors conducted various psychometric analyses, some properties (e.g., factor structure, test-retest reliability) were not investigated. In the present studies, several reliability and validity indices were computed. First, four of the fifteen items of the IS were found to be omissible. Second, 4-week test-retest reliability was found to be satisfactory. Third, scores on the IS were found to correlate meaningfully with a concurrent measure of decision making, and with various scales of psychopathology. Lastly, in Study 4, the IS was found to predict scores on a behavioural measure of decision making, suggesting good predictive validity. Overall, these findings suggest that the IS has good psychometric properties.     

Using the Networked Fire Chief for Ego-Depletion Research: Measuring Dynamic Decision-Making Effort and Performance

This study replicated ego-depletion predictions from the self-control literature in a computer simulation task that requires ongoing decision-making in relation to constantly changing environmental information: the Network Fire Chief (NFC). Ego-depletion led to decreased self-regulatory effort, but not performance, on the NFC task. These effects were also buffered by task enjoyment so that individuals who enjoyed the dynamic decision-making task did not experience ego-depletion effects. These findings confirm that past ego-depletion effects on decision-making are not limited to static or isolated decision-making tasks and can be extended to dynamic, naturalistic decision-making processes more common to naturalistic settings. Furthermore, the NFC simulation provides a methodological mechanism for independently measuring effort and performance when studying ego-depletion.     

Optimal Self‐esteem is Contingent: Intrinsic Versus Extrinsic and Upward Versus Downward Contingencies

We argue that noncontingent, unconditional self‐esteem is not optimal but defensive. We introduce the concept of intrinsic contingency, where self‐esteem is affected by whether one's actions are self‐congruent and conducive to personal growth. Whereas external contingencies, especially social and appearance, were negatively correlated with authenticity, self‐compassion, and personal well‐being, intrinsic contingencies were positively correlated with these measures, and uncorrelated with aggression and self‐esteem instability. Participants with high intrinsic contingency rated higher on measures of psychological adaptiveness than noncontingent participants. In addition, we distinguish upward from downward contingencies, the latter being more harmful in case of external contingencies but not for intrinsic contingencies. We conclude that intrinsic contingency, rather than noncontingency, may reflect true self‐esteem as implied in self‐determination theory. Copyright © 2011 John Wiley & Sons, Ltd.     

From self-reliers to expert-dependents: identifying classes based on health-related need for autonomy and need for external control among mobile users

ABSTRACT

Mobile health apps are seen as promising tools to support autonomous consumers in their quest for better health. However, individual differences in the need for autonomy and need for external control may impact the degree to which individuals perceive mobile health apps to be useful in their daily life. Using data from a representative sample of the Dutch population (N = 1,027), we applied latent class analysis to identify subtypes among mobile users based on their need for autonomy and need for external control, and to examine differences among these subtypes. We identified four subgroups: the self-reliers, confirmation-seekers, expert-dependents, and indifferents. Next to demographic differences, self-reliers and confirmation-seekers were generally more e-health literate and expressed more privacy concerns than the expert-dependents and indifferents. Our findings demonstrate that subgroups of people express different degrees of health-related need for autonomy and need for external control, which should be taken into account in online and mobile health communication efforts.     

Kant’s “I think” and the agential approach to self-knowledge

ABSTRACT

This paper relates Kant’s account of pure apperception to the agential approach to self-knowledge. It argues that his famous claim ‘The I think must be able to accompany all of my representations’ (B131) does not concern the possibility of self-ascribing beliefs. Kant does advance this claim in the service of identifying an a priori warrant we have as psychological persons, that is, subjects of acts of thinking that are imputable to us. But this warrant is not one to self-knowledge that we have as critical reasoners. It is, rather, an a priori warrant we have, as thinkers, to prescribe to given representations their conformity to principles of thinking inherent in our capacity of understanding itself.     

The Bishop and his/her Eucharistic Community: A Critique of Jean–Luc Marion's Eucharistic Hermeneutic

In the essay the hermeneutical views of Jean–Luc Marion, as they are expressed in his God without Being: Hors–Texte in relationship with the Eucharist and the story of Luke 24, are presented and critically assessed. The criticisms registered touch in the first place upon the concept of in persona Christi , which concerns the relation between the celebrant and Christ. Furthermore, the issue of the relationship between the eucharistic minister and his (or her) community and thereby the hermeneutical function of the Eucharist as a celebration of the whole community is discussed in dialogue with Marion's views.