Adaptive Tasks in Multiple Sclerosis: Development of an Instrument to Identify the Focus of Patients' Coping Efforts

Objective : Adaptive tasks, referring to the subjective evaluation of disease-related stressors in relation to personal concerns, have been neglected in the extensive literature on coping with chronic disease. In this study, the development of an instrument for measuring adaptive tasks is described: the Questionnaire Adaptive Tasks in Multiple Sclerosis (QuAT-MS). Method : The QuAT-MS is based on a bottom-up categorization of patients' statements on the losses, threats, and challenges brought about by their disease, and employs 10 scales to measure the importance attached to particular disease-related stressors. Validity and reliability of this bottom-up categorization were established in a sample of MS patients ( N = 259) by examining their associations with related concepts relevant in adaptation to disease, such as coping (CISS), coping resources (LOT, self-efficacy), and quality of life (SIP). We also investigated whether patients' backgrounds and disease characteristics were related to adaptive tasks. Results : Adaptive tasks are more closely related with concepts relevant for adaptation (coping and coping resources) than with physical functioning (SIP) and disease-related characteristics (illness duration). Adaptive tasks are also associated with gender and level of education. Conclusion : It is concluded that adaptive tasks can be distinguished from related concepts like coping and quality of life. Furthermore, the QuAT-MS offers a reliable and patient-centred instrument for measuring the tasks which MS patients identify in their adaptation process.     

Empirical,Logical and Philosophical Arguments Against Cigarette Smoking as a Pharmacologically Compelled Act

The fundamental hypothesis of the disease model of nicotine addiction states that, following a regime of chronic smoking, further smoking becomes a pharmacologically compelled rather than a chosen act. Despite it’s public and professional popularity as an explanation for why people continue to smoke in spite of a deteriorating quality of life, the validity of this hypothesis has been critically undermined by the state of evidence in four domains: inconclusive empirical evidence of withdrawal severity as a potent predictor of quit outcome; methodological problems concerning the measurement of factors which maintain smoking; logical problems with the interpretation of factors which maintain smoking, in particular, failures to discriminate reflexive and mediated actions in explanations of why people smoke; and philosophical problems with conceptualisations of human action as determined rather than willed. In light of these problems, it is argued that evidence on the nature of nicotine addiction is not well explained by the disease model, but rather, posits smoking primarily as a decision-making process influenced peripherally by the pharmacologic effects of nicotine on the brain and body.

A pox on the mind: Disjunction of attention and memory in the processing of physical disfigurement

The unfavorable treatment of people with physical disfigurements is well-documented, yet little is known about basic perceptual and cognitive responses to disfigurement. Here, we identify a specialized pattern of cognitive processing consistent with the hypothesis that disfigurements act as heuristic cues to contagious disease. Disfigurements are often invariant across time and difficult to conceal, and thus observers can detect the presence of such cues without necessarily remembering the particular individuals bearing these cues. Indeed, despite the fact that disfigured faces were especially likely to hold disease-sensitive perceivers’ attention (Study 1), disfigured individuals were often confused with one another and thus not well remembered later (Study 2), revealing a disjunction of the typical relationship between elevated attention and elevated memory. We discuss the implications of our results for stigmatization of people with and without physical abnormalities and suggest the possibility that cognitive mechanisms for processing social information may be functionally tuned to the variant nature of important cues.     

Menstrual cycle effects on task performance examined in the context of stress research

The study examined the effects of degree of paramenstrual distress, signal frequency, task load and time on task on psychomotor performance across the menstrual cycle. Simple reaction time, choice reaction time and pursuit tracking were the tasks employed, and performance was assessed using the metrics of mean level, variability, and errors of omission and commission. The results showed performance as a function of menstrual cycle phase and paramenstrual distress to be highly task and metric specific, a finding typical of stressor variables: pursuit tracking was affected by phase, with mean performance at its worst premenstrually; choice reaction time was dependent on a complex interaction of experimental variables and measurement metrics; simple reaction time showed no significant effects. Patterns of attention allocation in a time-sharing situation combining both pursuit tracking and choice reaction time components were also investigated. Trends here indicated relatively better performance both menstrually and intermenstrually as components increased in signal/response frequency, with a corresponding deterioration premenstrually. Overall performance capacity appeared to be greatest at menstruation, and the degree of attentional selectivity was least. High distress women performed better on low frequency components, whereas asymptomatic women did better at higher signal rates.     

Cerebral lateralization in bilinguals: Methodological issues

The literature on lateralization for language in bilinguals manifests two apparent contradictions. Some papers demonstrate differences in lateralization between bilinguals and monolinguals; others demonstrate none. In studies with exclusively bilingual subjects, some papers demonstrate differences between the lateralization for the two languages, while others demonstrate none. This paper discusses the range of methodological parameters which must be borne in mind when conducting or evaluating studies of lateralization for language in bilinguals. These include issues of subject selection, language and stimulus selection, testing procedures, data analysis, and interpretation of results.     

Reversal operations after brain damage

The ability to perform reversals—that is, the appreciation of the relationship between original and transformed states of knowledge—is critical to human thought processes. In order to assess whether a number of “special-purpose processors” are responsible for reversal operations, depending on the particular context in which the reversal is couched, or whether a single “core processing mechanism” subserves a critical aspect of reversal operations regardless of the specific context, patients with localized brain damage were asked to solve eight reversal problems. Visual and auditory reversals mediated by linguistic and non-linguistic symbol systems were presented. The findings demonstrate that patients with insult to the anterior portion of the right hemisphere encounter more difficulty performing reversals than patients with right posterior insult, Broca's aphasics, and fluent aphasics. This is regardless of the symbol system mediating the reversal, regardless of the modality of presentation, and regardless of the amount of available processing time. Subjects with insult to the posterior region of the left hemisphere or the right hemisphere also exhibit some difficulty solving reversal problems, although their difficulties appear modality specific. These data lend support to the claim that a core processing mechanism may play a critical role in the performance of reversal operations.     

Surprise but not coherence: Sensitivity to verbal humor in right-hemisphere patients

Verbal humor deficits were investigated in right-hemisphere-damaged patients. It was hypothesized that the appreciation of jokes presupposes two elements: sensitivity to the surprise element entailed in the punch line of a joke and apprehension of the coherence which results when the punch line has been integrated with the body of the joke. The possible dissociation between these elements was tested by asking subjects to select from four alternatives the appropriate ending to a joke. Right-hemisphere patients exhibited a selective attraction to endings which contained an element of surprise but which were not otherwise coherent with the body of the joke. This finding suggests that right-hemisphere patients have difficulty in integrating content across parts of a narrative and confirms the psychological reality of the proposed distinction between the surprise and coherence elements of humor processing.     

Profiles of symbol-reading skills in organic patients

One (unitary) school of thought views all symbolic competences as closely related, while a rival (pluralistic) approach underscores the relative differences among modes of symbolic processing. To secure information on the plausibility of these competing hypotheses, matched groups of left- and right-hemisphere patients were given a visual symbol-recognition test. Subjects were required to choose the correctly depicted symbol among a set of four. The results challenge a strong version of the “unitary” hypothesis. What emerges instead is a view of symbol systems as a continuum: relatively linguistic symbol systems prove challenging for left-hemisphere patients, relatively nonlinguistic systems pose comparable difficulties for right-hemisphere patients. Contrary to hypothesis, the processing of numerical symbols poses special difficulty for right-hemisphere patients. Performance on trademarks—items which can be processed by linguistic or nonlinguistic strategies—suggests that organic patients with contrasting pathologies may adopt different processing strategies when confronting identical physical stimuli.