Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach

Exposure therapy has demonstrated its efficacy in the treatment of pathological health anxiety—however, psychotherapy research reveals that many patients do not show a clinically significant change. Therefore, improvements are necessary to optimize psychotherapy for pathological health anxiety. Most treatment rationales refer to habituation during exposure as the central mechanism of change. However, there is evidence that extinction learning is mediated by inhibitory learning processes. Targeting these processes may help to improve treatment outcomes in pathological health anxiety. The aim of this review was to adapt, from the inhibitory learning approach and empirical findings, the most promising strategies for the exposure-based treatment of pathological health anxiety. The exposure-optimizing strategies adapted are expectancy violation, combination, variability in contexts and stimuli, affect labeling, and removal of safety signals. A case example illustrates how to implement these methods for patients with pathological health anxiety.     

Role strain among South African seminarians in the Anglican Church: toward a typology of congregational support

This phenomenological study explored student value perceptions of religious participation among nontraditional South African distance learners who persisted in theological distance education. Four basic types of churches emerged including the Equipping Church, the Empowering Church, the Engaging Church, and the Endangering Church. However, in examining religious coping strategies among South African distance learners, it was discovered that the four women interviewed experienced a deep sense of loneliness in their calling and had to rely almost exclusively on resources outside their local church. These Black South African women’s sense of being called alone is both inconsistent with the theoretical framework of role theory and the theological framework of the Anglican Church as expressed by the official Prayer Book.     

A critical analysis of recent work on empowerment: implications for gender

A flurry of publications on empowerment by institutions such as the World Bank that emerged from about 2000–2005 was followed by critiques and then a seeming lull in the popularity of and work on empowerment. However, the concept has reappeared recently in what I take to be an important new development that highlights the relational feature of empowerment. In this paper, I begin with the capabilities approach as delineated by Amartya Sen and, specifically, his application of it to gender. This shapes the background against which I highlight how recent work on empowerment by Jay Drydyk, the World Development Report 2012, Gender Equality and Development, and Patti Petesch utilizes but also departs from Sen. I then argue that insights from this recent research can be developed further through a feminist relational framework. With its focus on relationships, relational theory can better capture possibilities for empowering women in and through an analysis of the relationships they are in.     

When attractiveness demands longer looks: The effects of situation and gender

We investigated how aesthetics guides our exploration of the environment. We embedded attractive and nonattractive faces into complex, real-world scenes and measured eye movements during scene viewing. We examined whether attractive faces would elicit longer looks, which would suggest that the aesthetic response orients people toward the rewarding and pleasing aspects of the environment. Experiment 1 showed that mean fixation, mean first fixation, and total fixation durations were longer to attractive faces, and fixations were longest to female faces and by female perceivers. In Experiment 2, we examined whether these effects of attractiveness are sensitive to situational factors. When perceivers were subjected to a threat or social approach manipulation prior to viewing the scenes, we confirmed specific hypotheses concerning the two manipulations. In accordance with the hypothesis that males have higher aggression potential than females, there were no differences in fixation durations between attractive and nonattractive male faces in the threat condition. On the other hand, in the social approach condition, both female and male attractive faces received longer looks. These results suggest that the aesthetic response orients people not only to the pleasing aspects of their environment, but also to those features that are adaptively relevant.     

Participation in school environment of children and youth with disabilities: a person-oriented approach

This study investigated patterns of interrelated positive subject and environmental factors related to participation in school activities of pupils with different kinds of disabilities. Questionnaires concerning participation were collected from 472 pupils with disabilities and their teachers, parents and special education consultants. A person-oriented approach with the aim to identify patterns of variables related to a high degree of participation of pupils with disabilities was used. Cluster-groups were formed based on scores for individual subjects on factors identified as important for participation. Groups with a high degree of participation were characterized by high scores in autonomy and perceived interaction with peers and teachers and an internal locus of control. Type and degree of disability did not predict cluster group membership. A conclusion is that the outcome participation is better predicted by patterns of interrelated positive subject and environmental factors than by type of disability or any other single factor.     

Comparing Latent Structures of the Grade of Membership,Rasch, and Latent Class Models

This paper focuses on model interpretation issues and employs a geometric approach to compare the potential value of using the Grade of Membership (GoM) model in representing population heterogeneity. We consider population heterogeneity manifolds generated by letting subject specific parameters vary over their natural range, while keeping other population parameters fixed, in the marginal space (based on marginal probabilities) and in the full parameter space (based on cell probabilities). The case of a 2 × 2 contingency table is discussed in detail, and a generalization to 2^J tables with J ≥ 3 is sketched. Our approach highlights the main distinction between the GoM model and the probabilistic mixture of classes by demonstrating geometrically the difference between the concepts of partial and probabilistic memberships. By using the geometric approach we show that, in special cases, the GoM model can be thought of as being similar to an item response theory (IRT) model in representing population heterogeneity. Finally, we show that the GoM item parameters can provide quantities analogous to more general logistic IRT item parameters. As a latent structure model, the GoM model might be considered a useful alternative for a data analysis when both classes of extreme responses, and additional heterogeneity that cannot be captured by those latent classes, are expected in the population. This work was supported by Award #1R03 AG18986-01 from the National Institute on Aging and NIH grant #1R01 CA94212-01. The presentation of the ideas in this paper owes much to discussions with Stephen Fienberg and Brian Junker, Carnegie Mellon University. The author thanks Jim Ramsay and two anonymous reviewers for their valuable comments on earlier drafts of this paper.     

A conversation with Dr Michael Fordham. Interview by James Astor

In this interview in Dr Fordham's 83rd year he describes how he started to work with children, and how Mrs Jung was supportive. He talks about the initial suspicion this interest generated in the wider Jungian community. He refers to his acceptance of and interest in the psychotic elements in child analysis and his transference-based approach to working with these elements. He reflects on his own birth, his work with evacuee children in hostels during the war years and the politics of supervision. He describes the core Jungian concepts which underpinned his work and the theoretical differences from the Kleinian and Anna Freudian positions.     

Distinguishing Between Causes and Enabling Conditions—Through Mental Models or Linguistic Cues?

The mental model theory of naive causal understanding and reasoning (Goldvarg & Johnson-Laird, 2001, Cognitive Science, 25, 565–610) claims that people distinguish between causes and enabling conditions on the basis of sets of models that represent possible causal situations. In the tasks used to test this hypothesis, however, the proposed set of models was confounded with linguistic cues that frame which event to assume as given (the enabling condition) and which to consider as responsible for the effect under this assumption (the cause). By disentangling these two factors, we were able to show that when identifying causes and enabling conditions in these tasks, people rely strongly on the linguistic cues but not on the proposed set of models and that this set of models does not even reflect people's typical interpretation of the tasks. We propose an alternative explanation that integrates syntactic and causal considerations.     

Controlled and automatic uses of memory in depressed patients: effect of retention interval lengths

The present study examines controlled and automatic uses of memory in clinically depressed patients by applying the Process Dissociation Procedure developed by Jacoby (1991) to a stem completion memory task with short and long retention intervals. The results show that the contribution of controlled processes is lower in depressed patients than in controls, especially for the longest retention interval, whereas the contribution of automatic processes is equivalent in both groups and unaffected by the length of the retention interval. These findings are discussed in a cognitive control framework.     

The Props are Falling Down and We Want to Make Music: A Narrative Perspective on Organisations in Transition (Violins/Violence in Organisations)

While South African society finds itself in the throes of political changes, therapists working within organisations in transition find themselves challenged by the turbulence of transformation. The authors are a group of therapists attempting to understand, from a narrative perspective, the organisational context within which they work. This paper recounts the processes around the design, implementation, and outcomes of a workshop on this theme. The main body of the paper consists of a letter that was sent to participants after the workshop. The reader is invited to join collaboratively in our reflections so as to continue an open-ended, creative process.