Community Context for Teaching

Summary

A Community Oriented Primary Care (COPC) methodology can assist Family Practice faculty in implementing clinical and teaching activities designed to address interpersonal violence against adult women. The traditional COPC steps are as follows: (1) define the practice population; (2) assess a specific health problem; (3) develop and implement a strategy to address the issue; and (4) evaluate the impact of the intervention. At Ramsey Family Medicine we've developed a conceptual tool we call “the wheel” of community medicine which depicts the five arenas where resident physicians can work to end domestic violence: in the exam room; within the clinic; as part of a network of providers; within the larger community; and, as a part of a state or national initiative. We've also developed an operational tool called “the matrix” of community medicine which outlines specific COPC activities in each of the aforementioned arenas. We've arranged the matrix to apply to clinical practice and resident education activities regarding abuse intervention and prevention at Ramsey. This approach stresses partnerships with community organizations with expertise and commitment to ending domestic violence.     

Recurrent involuntary imagery in people who stutter and people who do not stutter

Objective

To compare intrusive memories in groups of people who do (PWS), and who do not (PWNS), stutter.

Method

Twenty-one participants who stuttered and 21 matched controls were given a semi-structured interview which explored imagery in speaking situations. The data were analyzed using a Content Analysis approach. Other outcome measures were the Beck Anxiety Inventory, the Beck Depression Inventory, the Post Traumatic Stress Disorder, PTSD, Symptom Scale: Self-Report Version.

Results

Significantly more stuttering participants than control participants indicated both recurrent imagery and associated memories. Content Analysis revealed themes of disfluency, anxiety, negative social evaluation, self-focus and pressure to speak that were common to both groups’ reports. Additional themes of helplessness, shame, sadness and frustration were found only in the images and memories of the stuttering group. No group differences were evident for the number of sensory modalities involved in images and memories, or for ratings of their vividness or strength of associated emotions, or on self-reports of depression, anxiety and trauma.

Conclusions

Recurrent imagery about events in childhood is a potent factor in the memories of PWS. It is worth modifying interventions that have been successfully applied for treating social anxiety for use with people who stutter.Educational objectives: After reading this article, participants will be able to: (a) identify the role of intrusive memories in psychiatric disorders and stuttering; (b) investigate how DSM criteria can be employed with people who stutter; (c) employ anxiety instruments used for assessing psychiatric disorders for stuttering; (d) distinguish between the intrusive memories experienced by people who stutter, and people who do not stutter; (e) apply treatments for intrusive memories in psychiatric disorders to work with people who stutter.     

The role of objective versus perceived life threat in the psychological adjustment to cancer

Several studies in the oncology literature have used disease stage as a measure of life threat. According to the transactional model of stress (Lazarus and Folkman, ), however, the individual's perception of a threatening situation is more strongly related to distress than the objective event itself. Thus, the present study examined whether cancer patients’ perceived life threat (PLT) is more strongly associated with psychological adjustment than a more objective index of disease prognosis (i.e., cancer stage). In addition, based on cognitive processing theories, this study examined whether intrusive thoughts and avoidance, cognitive characteristics of posttraumatic stress disorder (PTSD), mediate the relationship between PLT and distress. Patients diagnosed with various types of cancer (N = 97) completed questionnaires assessing PLT, cancer-related intrusive thoughts and avoidance, distress, and quality of life. Consistent with theoretical predictions, regression analyses showed that PLT, but not disease stage, was significantly related to psychological distress and quality of life. In addition, intrusive thoughts and avoidance mediated the relationship between PLT and distress. Taken together, these findings suggest that cancer patients’ PLT is more strongly related to distress than is cancer stage and that this association is partly due to cognitive symptoms that are part of PTSD symptomatology. Thus, patients who appraise their illness as life threatening may benefit from cognitive interventions aimed at reducing distress associated with intrusive thoughts.     

Look into my eyes: Gaze direction and person memory

The current research considered the effects of gaze direction on a fundamental aspect of social cogition: person memory. It was anticipated that a person's direction of gaze (i.e., direct or averted) would impact his or her subsequent memorability, such that recognition would be enhanced for targets previously displaying direct gaze. In Experiment 1, participants were presented with faces displaying either direct or averted gaze in a person‐classification (i.e., conceptual) task. Then, in a surprise memory test, they were required to report whether a presented face had been seen before. As expected, a recognition advantage was observed for targets displaying direct gaze during the initial classification task. This finding was replicated and extended in a second experiment in which participants initially reported the spatial location (i.e., perceptual task) of each face. We consider the implications of these findings for basic aspects of social‐cognitive functioning and person perception.     

The role of tonic immobility and control in the development of intrusive memories after experimental trauma

ABSTRACT

Tonic immobility (TI; state of motor inhibition during threat) has been implicated in the onset of intrusive trauma memories, while controllability was associated with reduced anxiety. The present study investigated the interaction between TI and control in the development of intrusive memories of an analogue trauma. Sixty-four participants watched negative pictures while being allowed to close their eyes (InControl) or not (NoControl). They completed measures for spontaneous TI afterwards and recorded intrusive memories of the pictures in a diary in the subsequent week. Bayesian analyses were used to test informative hypotheses. Spontaneous TI during picture viewing was positively associated with increased intrusion frequency. Intrusion frequency did not differ for InControl versus NoControl. Moderation (control x TI) and non-moderation (main effect of TI only) were both adequate models, with no preference. Our results confirm the importance of TI in PTSD development. Implications of the findings regarding control merit more research.     

There is more to life stories than memories

Current theories focus on the role of specific memories in organising the life story. However, temporally extended structures of autobiographical memory, like lifetime periods and mini-narratives (here termed chapters), may also play a central role in the organisation of the life story. Here, 30 elderly participants were asked to tell their life story in a free format. The life stories were divided into components and coded as chapters, specific memories, categoric memories, facts, chapters about other people, and autobiographical reasoning categories, i.e., reflections, evaluations, life lessons, and inferences about personality. The results show that chapters were much more common than specific memories in the life stories, indicating that chapters may play a role in the structuring of life stories. The number of chapters and specific memories in the life stories were unrelated, suggesting that the recounting of chapters versus specific memories does not reflect a preferred recall style.     

Investigating the structure of autobiographical memory using reaction times

The study investigated the structure of autobiographical memory using reaction time measures. A total of 18 participants took photographs over their summer holidays and then reacted to pairs of these photographs displayed via a computer. They also subsequently sorted their photographs according to the autobiographical themes and events with which they were associated. When photographic sequence and the physical similarities in the photographs were controlled for by considering the results of “stranger” participants who were unfamiliar with the photographs, reaction times were significantly faster to pairs of photographs from the same theme or event. The results are consistent with currently held assumptions about the structure of autobiographical memory. Furthermore, the results suggest that reaction time measures may provide a valuable means by which aspects of autobiographical memory can be explored.     

Reversed mnemic neglect of self-threatening memories in dysphoria

Previous research has suggested that people have difficulties remembering information which is threatening to the self—an effect known as mnemic neglect. Three experiments are presented that examined mnemic neglect in dysphoria and whether dysphoric individuals show enhanced memory for self-threatening information. Pilot work determined that dysphoric participants rated central negative traits as more important than nondysphoric participants. In Experiment 1, dysphoric participants were found to have better memory for self-threatening information than nondysphoric participants. Enhanced recall of self-threatening memories was also found for unmodifiable (Experiment 2), and highly diagnostic (Experiment 3) self-threatening traits. The findings suggest that dysphoric participants show reversed mnemic neglect effects indicating enhanced access to negative information relating to the self.