Processes of patient decision making: Theoretical and methodological issues

Abstract

There is a paucity of research studying patients' decision making processes. Traditional normative approaches investigating human decision have presented rational, analytic processing as a ‘gold standard’ for decision making with decision aids developed to facilitate such thinking. This paradigm has been challenged by the recent emergence of naturalistic decision making. Naturalistic approaches argue for techniques modelled closer to how decisions are actually made in ‘real life’. Early work in this evolving field suggests the importance of more automatic, intuitive processing such as the use of heuristic short-cuts. This paper discusses the contribution of naturalistic decision theory and assesses its usefulness as an alternative to classical decision approaches in investigating patient decision making. Approaches for measuring underlying cognitive processes are also critically discussed.     

A longitudinal application of three health behaviour models in the context of skin protection behaviour in individuals with occupational skin disease

Occupational skin disease (OSD) is common, associated with poor prognosis and poses a significant burden to the individual and society. We applied the theory of planned behaviour (TPB), the prototype-willingness model (PWM) and the health action process approach (HAPA) to the prediction and explanation of occupationally relevant skin protection behaviour in individuals with OSD. We used a longitudinal design. In this study, 150 individuals participating in a 3-week inpatient tertiary prevention programme completed measures assessing the constructs of the TPB, PWM and HAPA at admission (T?0), discharge (T?1) and once the individual had returned to work and worked for 4 consecutive weeks (T?2) (n?=?117). Intention was measured at T?0 and skin protection behaviour at T?2. Path analysis was used to assess the longitudinal associations of the models’ constructs with intention and skin protection behaviour. TPB as well as PWM variables accounted for 30% of variance in behaviour, HAPA variables for 33%. While not all predictions were confirmed by the data, all three models are able to inform us about the formation of skin protection intention and behaviour in individuals with OSD. The findings are discussed in light of future interventions and research.     

Where we live: some dilemmas and technical issues for the child psychotherapist in interpretative work with looked-after and adopted children

This paper addresses, from a Kleinian perspective, some of the dilemmas and technical issues faced by the child psychotherapist in work with looked-after and adopted children. A selective review of psychoanalytic literature focusing on the use of transference and countertransference is given. Clinical material provides some examples of different kinds of interpretation, and of the importance of timing and emotional resonance in the interpretations.     

Hand Grip and Load Force Coordination of the Ipsilesional Hand of Chronic Stroke Individuals

Object manipulation depends on a refined control of grip force (GF) and load force (LF). After a brain injury, the GF control is altered in the paretic hand but what happens with the non-paretic hand is still unclear. In this study, we compared the GF control and GF–LF coordination of the non-paretic hand of 10 stroke individuals who suffered right brain damage (RBD) and 10 who suffered left brain damage (LBD), with 20 healthy individuals during lifting and oscillation task, using an instrumented object. GF was recorded with a force transducer, and LF was estimated from the object weight and acceleration. Overall, the ipsilesional hand of stroke individuals, independent of the lesion side, presented similar GF control and GF–LF coordination. However, LBD individuals took longer to start lifting the object, which may be due to the need of more time to obtain somatosensory information from the contact with the object. The findings indicate that stroke individuals preserve their ability to control and coordinate GF and LF when using their ipsilesional hand for object manipulation and the left hemisphere may play an essential role in the processing of somatosensory information needed for the GF control.     

Examining the Preferred Self-Controlled KR Schedules of Learners and Peers During Motor Skill Learning

In many practical situations, learners are provided with feedback in the form of knowledge of results (KR) by a peer. However, when peers provide KR is currently unknown. When given the opportunity to request KR in a self-controlled manner, some participants have reported a preference for requesting KR after good performances. Alternatively, peers may provide KR in a different fashion. Subsequently, a discrepancy between the learner's desire to receive KR and when a peer provides KR may arise. In our study, peer- and self-controlled KR schedules were compared. Participants were peers who controlled KR (PC; 8), learners with peers (P-L; 8), or learners with self-control (SC; 8). Participants in the two learning groups (P-L and SC groups) completed a serial-timing task with a goal time of 2500 ms. Absolute error data on KR and no-KR trials along with self-reports indicate that participants with self-control preferred KR after good trials and peers preferred to provide KR after both good and bad trials equally. Results from the delayed retention test indicated that peer-controlled learners were more consistent (i.e., in terms of variable error) than the self-control group.     

Introduction to special issue on contributions of mathematical psychology to clinical science and assessment

Evolution of clinical mathematical psychology, exemplifying integrative, translational psychological science, is considered in light of target, idealized scientific systems. It is observed that mutual benefits to psychological clinical science, and quantitative theory, potentiated through their interlacing as exemplified in this special issue, stand to parallel the historical symbiosis between older disciplines and mathematics. Enumerated are the range of psychological processes and clinical groups addressed, forms of modeling implemented, and clinical issues engaged, the latter ranging from intervention, to elucidation of deviant basic processes. A denouement comprising cogent quotations from historical figures in science concludes this Introduction.     

THE DYNAMICS OF THE LAW OF EFFECT: A COMPARISON OF MODELS

Dynamical models based on three steady‐state equations for the law of effect were constructed under the assumption that behavior changes in proportion to the difference between current behavior and the equilibrium implied by current reinforcer rates. A comparison of dynamical models showed that a model based on Navakatikyan's (2007) two‐component functions law‐of‐effect equations performed better than models based on Herrnstein's (1970) and Davison and Hunter's (1976) equations. Navakatikyan's model successfully described the behavioral dynamics in schedules with negative‐slope feedback functions, concurrent variable‐ratio schedules, Vaughan's (1981) melioration experiment, and experiments that arranged equal, and constant‐ratio unequal, local reinforcer rates.     

The Relationship Between Momentary States of Therapist Self-Awareness and Perceptions of the Counseling Process

To investigate the role of momentary self-awareness, beginning therapists and their volunteer clients participated in a postsession process recall in which therapist helpfulness and momentary self-awareness were assessed along with client reactions. Therapist anxiety levels and strategies used to manage hindering self-awareness were also examined. Results suggest that momentary states of heightened therapist self-awareness may be hindering. Specifically, when therapists rated themselves as more self-aware from moment to moment during counseling sessions, they also rated themselves as more anxious before the session and their clients rated them as less helpful during the session. In addition, therapists reported using a variety of strategies to manage distracting self-awareness, including focusing on intervention planning and focusing on the client. Implications for therapist training are discussed.     

面孔吸引力研究方法综述

面孔吸引力研究是目前西方认知心理学、社会心理学以及文化心理学研究者们所共同关注的一个崭新的研究领域。众多研究表明,面孔的平均化、对称性和性别二态性是影响面孔吸引力的三个主要生物学因素。这些发现得益于各种面孔图像处理技术的发展和应用,其中包括多次曝光摄影技术、漫画和反漫画技术、Morph技术、“凯米拉”合成法以及面部特征测量法等。     

汉语单音节词汇产生中的激活反馈

采取图画-词汇干扰实验范式,探索汉语词汇产生中词条选择和音韵编码两个阶段之间是否存在激活的反馈。实验一探索的是字形激活能否反馈至语义层产生语义激活,结果发现,与无关条件相比,目标图画(如“锯”)的字形中介(“镇”)的语义相关字(“村”)条件显著地延长了图画命名的时间。这表明在汉语词汇产生过程中,字形层的激活能反馈至语义层。实验二探索的是语音激活能否反馈至语义层产生语义激活,结果发现,与无关条件相比,目标图画(“梨”)的语音中介(“厘”)的语义相关字(“毫”)条件并未显著地影响图画命名的时间。这表明语音层的激活不能反馈至语义层,或者反馈回的激活太微弱不能影响图画命名过程。实验一和二的结果更倾向于支持词汇产生中词条选择和音韵编码两个阶段独立的观点。