A Single-Subject Evaluation of the Treatment of Morphing Fear

We present a single-subject prospective outcome study of a man with severe morphing fear and long history of OCD who was not helped by previous interventions, and who received an adapted form of cognitive behavior therapy (CBT) as part of this study. Treatment consisted of a cognitively focused approach tailored to address his fear of morphing and included developing a stronger sense of self-stability. We describe the details of the case, the treatment protocol, and the therapeutic outcomes as assessed over 36 weeks by questionnaires, rating scales, and semistructured interviews. The intervention was effective in eradicating the patient’s morphing fears and reducing other symptoms of OCD, anxiety, and depression. The presented case illustrates the need to appropriately conceptualize, assess, and address the specific nature of morphing fear symptoms in treatment.     

Automated respiratory sinus arrhythmia measurement: Demonstration using executive function assessment

Respiratory sinus arrhythmia (RSA) is a quantitative metric that reflects autonomic nervous system regulation and provides a physiological marker of attentional engagement that supports cognitive and affective regulatory processes. RSA can be added to executive function (EF) assessments with minimal participant burden because of the commercial availability of lightweight, wearable electrocardiogram (ECG) sensors. However, the inclusion of RSA data in large data collection efforts has been hindered by the time-intensive processing of RSA. In this study we evaluated the performance of an automated RSA-scoring method in the context of an EF study in preschool-aged children. The absolute differences in RSA across both scoring methods were small (mean RSA differences = –0.02–0.10), with little to no evidence of bias for the automated relative to the hand-scoring approach. Moreover, the relative rank-ordering of RSA across both scoring methods was strong (rs = .96–.99). Reliable changes in RSA from baseline to the EF task were highly similar across both scoring methods (96%–100% absolute agreement; Kappa = .83–1.0). On the basis of these findings, the automated RSA algorithm appears to be a suitable substitute for hand-scoring in the context of EF assessment.     

An Evidence-Based,Community-Engaged Approach to Develop an Interactive Deliberation Tool for Pediatric Neuromuscular Trials

Duchenne/Becker muscular dystrophy (DBMD) and spinal muscular atrophy (SMA) are rare neuromuscular disorders that present challenges to therapeutic and clinical trial decision making. We developed an interactive, evidence-based online tool designed to encourage thoughtful deliberation of the pros and cons of trial participation and to inform meaningful discussions with healthcare providers. Prior research demonstrates the importance of tool availability at the time each family is considering trial participation, which may be prior to the informed consent process. The tool is intended to be easily modified to other pediatric disease communities. Tool development was informed by prior qualitative research, literature reviews, and stakeholder input. Specific items were derived based on an online exploratory questionnaire of parents whose children participated in a trial for DBMD or SMA to understand motivations for participation. Parent participants in the exploratory survey reported strong impact of altruistic and individual benefit motivations and placed much greater emphasis on anticipated trial benefits than on harms when making participation decisions. We used this data to develop the evidence-based deliberation tool using a community-engaged approach. We initially targeted the tool for DBMD while using SMA survey data to evaluate ease of transition to that population. We conducted two iterative sets of activities to inform development and refinement of the tool: (1) community engagement of key stakeholders and (2) user experience testing. These activities suggest that the tool may increase deliberation and the weighing of benefits and harms. Ongoing evaluation will determine the acceptability and efficacy of this online intervention.     

Comparing What to What,on What Scale? The Impact of Item Comparisons and Reference Points in Communicating Risk and Uncertainty

The mandated public availability of individual hospital's audit data for children's heart surgery in the UK creates a challenging scenario for communicating these complex and sensitive data to diverse audiences. On the basis of this scenario, we conducted three experiments with the aim of understanding how best to help lay people understand these data and the practical goal of improving the public presentation of these data. The experiments compared different outcome measures for displaying the survival rate (percentage scale versus the ratio of the predicted/observed rates) and presentation formats (individual hospital versus all hospitals shown) for outcomes data presented relative to prediction intervals generated by a risk model that adjusts for case mix. Our data highlight how easily inappropriate comparisons can influence evaluations of complex data: for instance, both a survival ratio of 1 and the presence of other hospitals seemingly provided reference points that resulted in inappropriately harsh evaluations of some hospitals. By drawing on evaluability theory, we demonstrate how to enhance people's understanding of these complex data while also discouraging inappropriate comparisons, which has implications for communicating risk and uncertainty and for choice architecture design in a range of contexts. Copyright © 2018 John Wiley & Sons, Ltd.     

J. S. Mill’s hedonism: activism,experientialism and eudaimonism

Many contemporary scholars defend the position that J. S. Mill was a ‘eudaimonist’, in a sense implying that he was not an ‘experiential’ hedonist. One ‘activist’ argument for this interpretation rests on the claim that Mill’s core axiological uses of ‘pleasure’ in Utilitarianism should be understood to refer to worthy or pleasurable activities rather than mental states. This paper offers a three-stage rebuttal of the activist interpretation. Firstly, in the Analysis, the Examination and the Logic, Mill explicitly identifies pleasures and pains as mental states. Secondly, if we read Mill’s core axiological uses of ‘pleasure’ in Utilitarianism along activist lines, the text’s overall coherence and intelligibility becomes even more questionable than on the traditional experientialist reading. Finally, in his discussions of Plato, Mill seems to distance himself from the axiological view that non-hedonic features of mind or character have intrinsic value in their own right. In consequence, in the small number of cases in Utilitarianism in which Mill clearly speaks of ‘pleasures’ as activities, this is best construed as a derivative usage.     

Bodies in Dialogue: Empathic Connectedness in the Realm of the Unspeakable

ABSTRACT

This article joins in contemporary psychoanalysis’ ever-expanding conversation about the “something more” than spoken language that has long been privileged in our profession. Specifically, the notion is explored that infant research’s conceptualization of mind as dialogic in origin—that we are prewired from birth to participate in nonverbal, affective communication—is consistent with the position that an embodied, dialogic, co-created, empathic connectedness can evolve with severely traumatized, frozen patients whose experience is not just unformulated but unspeakable. This is illustrated with an in-depth account of a challenging therapeutic journey with a highly intelligent man whose social relatedness hid a world of frozen grief and terror of violation. It was only when the therapist could connect with trauma-generated aspects of herself that had remained frozen, could she find an empathic way of being-with and ultimately understanding her patient’s wordless, frozen world.     

Force and Directional Force Modulation Effects on Accuracy and Variability in Low-Level Pinch Force Tracking

The authors investigated how varying the required low-level forces and the direction of force change affect accuracy and variability of force production in a cyclic isometric pinch force tracking task. Eighteen healthy right-handed adult volunteers performed the tracking task over 3 different force ranges. Root mean square error and coefficient of variation were higher at lower force levels and during minimum reversals compared with maximum reversals. Overall, the thumb showed greater root mean square error and coefficient of variation scores than did the index finger during maximum reversals, but not during minimum reversals. The observed impaired performance during minimum reversals might originate from history-dependent mechanisms of force production and highly coupled 2-digit performance.     

Perceptions of Private Market Landlords Who Rent to Tenants of a Housing First Program

The rental of housing units by landlords to participants in Housing First (HF) programs is critical to the success of these programs. Therefore, it is important to understand the experiences of landlords with having these individuals as tenants. The paper presents findings of qualitative interviews with 23 landlords who rented to tenants from a HF program located in a small city and adjoining rural area in eastern Canada and in which approximately 75 % of tenants had been housed for at least six consecutive months at 2 years in the program. Findings showed that landlords are motivated to rent to HF tenants for financial and pro‐social reasons. They reported holding a range of positive, neutral, and negative perceptions of these tenants. They identified problems encountered with some HF tenants that included disruptive visitors, conflict with other tenants, constant presence in their apartments, and poor upkeep of units. On the other hand, landlords perceived HF tenants as being mostly good tenants who are similar to their other tenants. Implications for practice in the context of HF programs are discussed.     

Early maladaptive schemas and non-suicidal self-injury among young adults: A preliminary investigation

Non-suicidal self-injury (NSSI) represents a critical mental health issue among young adults. Accordingly, it is important to understand potentially modifiable processes involved in its enactment. The current investigation built on previous work to better understand the nature of early maladaptive schemas (EMS) in the context of NSSI. One hundred and thirty young adults completed questionnaires assessing NSSI history, EMS and depressive symptoms. Results indicate that EMS may play a role in NSSI engagement after controlling for depressive symptoms. Specifically, higher scores on social isolation and emotional inhibition and possibly lower scores on entitlement/grandiosity schemas may differentiate those who self-injure from those who do not. Furthermore, higher levels of dependence/incompetence schema may differentiate those who report a higher NSSI frequency and those who report a less frequent NSSI history. Although a nascent area of study, our findings suggest that it may be fruitful to consider conceptualizing NSSI within a schema therapy framework.