Stress reactions following acute situations involving moral challenges among health care professionals

Many health care professionals have to make morally difficult decisions during acute, stressful situations. The aim was to explore the applicability of an existing qualitatively developed model of individual reactions among professional first responders following such situations using a quantitative approach. According to the model, the interaction of antecedent individual and contextual characteristics affect the immediate emotional reactions to acute, stressful events involving a moral dilemma. Continuous coping efforts and the quality of social support will also affect the long‐term positive and negative reactions to the event. The participants (n = 204, about 50% response rate) represented three Swedish health care professions stationed at a university hospital and a regional hospital: Physicians (n = 50), nurses (n = 94) and “others” (n =60, mainly social welfare officers and assistant nurses). Except for the personality dimension emotional stability which was measured using an established instrument, all measurement scales were operationalizations of codes and categories from the qualitative study (ten scales altogether). Four multiple regression analyses were performed with long‐term positive and negative reactions in everyday acute and morally extremely taxing situations respectively as dependent variables. The outcome showed that long‐term positive reactions covaried with much use of the coping strategies Emotional distancing and Constructive emotional confrontation and a perception of a well‐functioning Formal social support. Regarding long‐term negative reactions, higher age and little use of Emotional distancing accounted for much of the variance. Immediate emotional reactions also contributed significantly. Conclusion: the results largely supported the model concepts and their assumed relationships.     

智能医疗的伦理困境与治理——基于以病人为中心的考察

智能医疗的研究与应用发展迅速,在医疗检测、诊断与预测等多领域都显示出了更强的技术优越性。与此同时,智能医疗也出现了算法黑箱导致的病人知情权受到侵犯、用户数据泄露、公平正义问题以及责任归属难以界定等亟待解决的各种伦理难题,对“以病人为中心”的医学临床传统造成威胁。智能医疗的广泛应用不仅需要突破技术难题,更加需要构建以病人为中心的伦理治理体系,做出尊重病人需求和权利的理性决策。

     

精神分裂症患者的疾病表达与身份困境——一项基于知乎的实证研究

基于知乎的25起自述文本,研究精神分裂症患者的疾病表达,探究患者病程对叙事类型产生的影响,剖析患者面临的身份困境。研究发现,接受治疗的患者偏向于康复叙事,未治疗的患者偏向于混乱叙事和探寻叙事;同时,精神分裂症患者面临本我、自我与超我相互冲突的身份困境。未来可以在传播层面针对性加强精神疾病类的科普教育以促进患者就医;在叙事层面挖掘以病患作为主体传播模式的潜力、深化叙事疗法中的共情体验以辅助患者建构身份。

     

Tracing the Path from Personality — via Cooperativeness — to Conservation

Ecological behaviour is often conceptualized as an instance of cooperating in a social dilemma situation. Thus, it has been argued to relate to dispositional tendencies of moral virtue and pro‐social orientation. To embed such notions in models of basic personality, we herein predicted that the recently proposed sixth basic personality factor, Honesty–Humility — which specifically pertains to individual differences in cooperativeness — is linked to environmental attitudes and ecological behaviour. Results from two studies (N = 137 and N = 531, respectively) supported these hypotheses and showed that Honesty–Humility explains incremental variance beyond the remaining, more classical five factors of personality. In addition, mediation analyses revealed that Honesty–Humility exerts part of its influence via individual differences in pro‐social value orientations. Individual tendencies to cooperate in social dilemma situations could thus be shown to form a bridge between basic personality dimensions and ecological behaviour. Copyright © 2012 John Wiley & Sons, Ltd.     

Vigilant Self‐regulation and Costly Punishment in Public Goods Situations

Applying regulatory focus theory to the context of social dilemma situations, the present research demonstrates that individual differences in vigilant, prevention‐focused self‐regulation predict the tendency to invest private resources to punish uncooperative interaction partners (costly punishment), a behaviour that typically has strong positive effects on the collective level of cooperation. Analyses further support the distinctiveness of the vigilance system proposed in regulatory focus theory (prevention focus) in comparison with general defensive inhibitory tendencies (measured with Carver and White's Behavioral Inhibition System scale). Results document that individual differences in prevention‐focused self‐regulation but not differences in general defensive inhibitory tendencies are positively related to costly punishment. In sum, the findings indicate that vigilant, prevention‐focused self‐regulation plays a crucial role in the context of sanctions that enforce cooperation. Copyright © 2013 John Wiley & Sons, Ltd.     

Dilemmas in brief therapy

This paper examines three central concerns for the short-term therapist at a time when therapy is widely available free of charge in the community, in a model that has been called ‘ serial life-span therapy’. Issues of referral-on, topping-up or extending contracts are experienced as dilemmas or as temptations, depending on what therapists believe their clients need and what their clients may demand of them. Short-term therapy has become accepted in many contexts, with therapy no longer used as a once-and-for all solution to clinical problems, but as a serial method over time which includes topping up and re-contracting. After an initial agreement of brevity, depending on the client's disturbance levels at assessment and on availability, there may be the need for referral-on at the end of a brief contract, when clients may be offered a different, long-term service, or they may be recommended to return later in life for more, if and when this becomes necessary. Flexible contracts rather than rigid rules about the termination of therapy are being practiced in many contexts, depending on ‘what works’ and how methods can be adjusted to new evidence. There is danger of collusion or control, and this can lead to therapeutic dilemmas, which involve taking acceptable risks, or to therapeutic temptations, which are due to the desire for narcissistic gratification, benefiting the therapist rather than the client in terms of power or Eros. Being able to let go of clients and manage issues of loss, grief and greed requires a measure of maturity in the therapist that aims for good-enough results rather than striving for perfect endings.     

A randomised Monty Hall experiment: The positive effect of conditional frequency feedback

The Monty Hall dilemma (MHD) is a notorious probability problem with a counterintuitive solution. There is a strong tendency to stay with the initial choice, despite the fact that switching doubles the probability of winning. The current randomised experiment investigates whether feedback in a series of trials improves behavioural performance on the MHD and increases the level of understanding of the problem. Feedback was either conditional or non-conditional, and was given either in frequency format or in percentage format. Results show that people learn to switch most when receiving conditional feedback in frequency format. However, problem understanding does not improve as a consequence of receiving feedback. Our study confirms the dissociation between behavioural performance on the MHD, on one hand, and actual understanding of the MHD, on the other. We discuss how this dissociation can be understood.     

Anaesthesia or psychotherapy: Eradicating thoughts or working them through

The author presents two sessions from the analysis of a depressive narcissistic doctor, which are characterised by a mixture of co-operation and pseudo-co-operation. The dialogue is in parts intellectualised, complicated, lifeless and schizoid. Points at which the patient shows surprising insights are then partly denigrated by him, on the basis that change is not to be expected. Semi-lifeless contact assists the defensive claustrophobia that he experiences in meaningful contact. It becomes very clear that he is then afraid of entering into an openly aggressive conflict that entails the existential threat of object loss. However, this has so far been avoided. The secret pleasure in an anal-narcissistic, sadomasochistic addiction to doubt persists in the partial denigration. The patient's artificially maintained self-doubt and doubt of the object reinforce a genuine confusion that consists in never knowing exactly what lies behind the helpful and needed object.     

Probability of reciprocation in repeated prisoner's dilemma games

Both social cooperation and self‐control require reciprocation. In social cooperation situations a single person's cooperative act, if not reciprocated by others, would be unreinforced both immediately and in the long term. Similarly, a single act of self‐control (refusing a single cigarette, for example), if not followed up by other such acts, would also be unreinforced immediately and in the long term. The present experiments varied probability of reciprocation in a prisoner's dilemma‐like game that could resemble a social cooperation or a self‐control situation. Participants earned points by playing against a computer. The computer offered the participant a choice between 5 or 6 points (‘cooperation’ by the computer) or between 1 or 2 points (‘defection’ by the computer). The participant's choice of the lesser alternative (‘cooperation’) or the greater alternative (‘defection’) on the current trial led, respectively, to cooperation or defection by the computer on the next trial with a probability (probability of reciprocation, PR) which could vary. When PR was greater than 63%, consistent cooperation maximized the participant's earnings. When PR was less than 63%, defection maximized earnings. Three conditions were studied: PR signaled by spinners; PR unsignaled; PR unsignaled with participants believing that they were playing with another person, not the computer. With PR = 100% (‘tit‐for‐tat’) and PR = 50%, the modal participant maximized earnings under all three conditions. With PR = 75%, participants maximized earnings only when PR was signaled. These results indicate that differences between people's tendency to cooperate with other people (social cooperation) and their tendency to cooperate with their own future interests (self‐control) may lie in differences in subjective PR. Copyright © 2001 John Wiley & Sons, Ltd.     

动机的概率意义——概率归并定理与Monty Hall问题的非贝叶斯解

本文探讨Monty Hall问题认知困惑的形成因素。通过对该问题数学结构的分析,导出一个与该问题的解密切相关的定理——概率归并定理;并依据该定理给出了Monty Hall问题的一种更直观的数学解。