Thoughts and feelings and things: A new psychiatric epistemology

Epistemology — the study of knowledge — is a philosophical discipline with close ties to psychiatry. When epistemologists address specific questions about how knowledge is actually realized by human beings, their philosophy must be informed by empirical studies of the sort psychiatrists now take up in a variety of forms. As this paper describes, psychiatrists can likewise improve their understanding of human psychology through a deeper appreciation of philosophical analysis in epistemology.The aim of this article is to introduce a unifying framework within which the experience from different approaches to psychiatry — (1) the conceptual schemas of cognitive psychiatry, (2) the mental structures of psychoanalytic psychiatry, (3) the categorical forms of existential psychiatry, and (4) the neural pathways of biological psychiatry — can all be applied productively to the central question of epistemology. By establishing a broad understanding of the problem of knowledge, this new view of epistemology is developed within the idiom of each psychiatric approach. In addressing themselves to a unitary problem, these diverse psychiatric approaches are themselves revealed, not as competing points of view, but as complementary views of a single subject. The result is a new epistemology that can not only bring the insights of psychiatry to philosophy, but can also contribute to the care of patients when psychiatrists bring this broader view to their clinical work.     

THE GENERALIZATION EFFECTS OF PARENT TRAINING ACROSS STIMULUS SETTINGS

Five parents of nonverbal children were trained in two home settings to modify antecedents and consequences to their children's vocalizations. Generalization effects of the parent training on both the parent's and children's behaviors under different stimulus conditions were investigated using multiple-baseline designs. Increases in parent prompting and reinforcing their children's vocalizations generalized only minimally to a new setting in the home where parent training had not occurred. Child increases in vocalizations produced by the parents in the training settings did generalize to this new setting in the home. There was minimal generalization of child vocalizations to a free-play setting at school. In a formal speech session conducted by a behavior specialist at school, only one child showed definite increases in acquisition rate as a function of the parents starting to train the sound at home.     

城市儿童超级英雄游戏的尴尬处境及其指导

超级英雄游戏是儿童最喜爱的游戏之一，城市儿童的超级英雄游戏由于游戏中的暴力成分、狭窄的游戏场地等原因遭到成人的反对。而成人合理管理和指导儿童的超级英雄游戏能促进儿童积极发展，完全禁止儿童的超级英雄游戏可能会对儿童的发展产生消极的影响。     

Are Individuals Always Aware of Their Trauma-Related Intrusive Thoughts? A Study of Meta-Awareness

Individuals are not always aware of their mental content. We tested whether lack of awareness occurs in those who have experienced trauma, with and without posttraumatic stress disorder (PTSD). We also examined the role of proposed cognitive mechanisms (working memory and inhibition) in explaining unnoticed intrusions. Individuals with PTSD (n = 44), and varying levels of symptoms (high posttraumatic stress [PTS]: n = 24; low PTS: n = 37) reported on intrusive thoughts throughout a reading task. Intermittently, participants responded to probes about whether their thoughts were trauma related. Participants were “caught” engaging in unreported trauma-related thoughts (unnoticed intrusions) for between 24 and 27% of the probes in the PTSD and high PTS groups, compared with 15% of occasions in the low PTS group. For trauma-related intrusions only, participants lacked meta-awareness for almost 40% of probes in the PTSD group, which was significantly less than that observed in the other groups (～60%). Contrary to predictions, working memory and response inhibition did not predict unnoticed intrusions. The results suggest that individuals who have experienced significant trauma can lack awareness about the frequency of their trauma-related thoughts. Further research is warranted to identify the mechanisms underpinning the occurrence of unnoticed intrusions.     

Comparing Traditional and Ebook-Augmented Parent-Child Interaction Therapy (PCIT): A Randomized Control Trial of Pocket PCIT

Disruptive behavior in young children is one of the most common referrals to behavioral health providers. While numerous effective parenting programs, such as parent–child interaction therapy (PCIT), exist for improving children’s behaviors, challenges with treatment engagement and retention limit the intended positive impact on child and caregiver outcomes, particularly for racial and ethnic minority families. In an effort to address barriers contributing to poor engagement and retention in traditional PCIT service delivery and among ethnic and racial minority families, a multimedia PCIT ebook was developed and evaluated. In a sample of the general public that utilized the ebook, users were found to be more engaged in viewing embedded videos within the ebook that were related to expert skill explanations and skill demonstrations than caregiver testimonies. A randomized controlled trial was also conducted to evaluate the extent that the ebook + PCIT improved treatment engagement, retention, parenting skills, skill acquisition efficiency, and child behavior above and beyond traditional PCIT. Participating families were randomly assigned to either the traditional PCIT (n = 71) or ebook + PCIT (n = 107) group using an online random number generator. Forty-nine caregivers (traditional PCIT n = 24, ebook + PCIT n = 25) were excluded from analyses because they were lost to follow-up during the intervention. Families in both the traditional PCIT and ebook + PCIT groups demonstrated generally equivalent positive outcomes in treatment engagement (i.e., attendance, treatment length, completion rate) and caregiver skill acquisition efficiency at midtreatment, posttreatment, and 3-month follow-up. The addition of the ebook to PCIT also reduced child disruptive behavior at midtreatment, above and beyond traditional PCIT, but not at posttreatment or follow-up. Clinical implications and future directions are discussed.     

Interactive effects of social network centrality and social identification on stress

The present study aimed to integrate the social identity approach to health and well-being with social network analysis. Previous research on the effects of social network centrality on stress has yielded mixed results. Building on the social identity approach, we argued that these mixed results can be explained, in part, by taking into account the degree to which individuals identify with the social network. We hence hypothesized that the effects of social network centrality on stress are moderated by social identification. Using a full roster method, we assessed the social network of first-year psychology students right after the start of their study programme and three months later. The effects of network centrality (betweenness, closeness, eigenvector centrality) and social identification on stress were examined using structural equation models. As predicted, our results revealed a significant interaction between network centrality and social identification on stress: For weakly or moderately identified students, network centrality was positively related to stress. By contrast, for strongly identified students, network centrality was unrelated to stress. In conclusion, our results point to the perils of being well-connected yet not feeling like one belongs to a group.     

Childhood Maltreatment,Emotional Response Inhibition,and Suicide in Psychiatric Inpatients

Childhood abuse and/or neglect adversely influences development of neurocognitive systems that regulate affect and behavior. Poor inhibitory control over emotional reactions is thus one potential pathway from maltreatment to suicide. Adult psychiatric inpatients completed the Childhood Trauma Questionnaire and an emotional stop-signal task indexing negative emotional action termination (NEAT): the ability to inhibit ongoing motor reactions to aversive stimuli triggered by negative affect. Clinical interviews assessed suicidal thoughts and behaviors during hospitalization (n = 131) and at follow-up assessments 6 months later (n = 87). Our primary aim was to examine whether maltreatment history and NEAT explain overlapping variance in suicidal behaviors (1) retrospectively and (2) 6 months following hospital discharge. Contrary to prediction, childhood maltreatment was unrelated to history of suicidal behaviors. However, NEAT was consistently associated with prior suicidal acts, even controlling for suicidal ideation and demographic covariates. NEAT similarly contributed to the prediction of post-discharge suicidal behaviors, whereas we found no effect of maltreatment history. The present study suggests that NEAT captures suicide risk independently of childhood maltreatment. Results implicated NEAT impairment specifically, rather than broader response inhibition deficits (e.g., to positive stimuli), in past and future suicidal behaviors. These findings provide preliminary support for NEAT as a behavioral vulnerability marker for suicide, with implications for understanding links between maltreatment history and suicidal acts.     

Trauma exposure and post-traumatic stress symptoms among Syrian refugee youth in Jordan: Social support and gender as moderators

This study assessed relations between exposure to trauma and post-traumatic stress (PTS) symptoms, and whether perceived social support from family and friends and gender moderated these associations. Syrian refugee youth (N = 418, 55.0% female) attending public schools in Jordan participated. Boys reported more age-adjusted PTS symptoms than girls. Analyses revealed that family support and gender moderated the association of trauma on PTS symptoms. For males, the benefits of family support were most evident under conditions of high traumatic stress exposure, while for females, benefits of family support were evident when no loss or injury to family members had been reported. Support from friends was not helpful for either gender. School- or family-based interventions designed to treat PTS symptoms need to consider the different needs of boys and girls, particularly within the Syrian Muslim cultural context.     

The contribution of school experience to students' resilience following a terror-related homicide

Schools have a significant effect on students' development, and serve as important social agencies for interventions for students facing disasters. However, little is known about the effect of students' school experience itself on their resilience when facing extreme negative events. The present study focused on students who were exposed to terror-related homicide with the aim of investigating the contribution of school climate resources to their resilience. Since resilience is associated not only with fewer negative outcomes, but also with positive change, the contribution of schools was studied as both inhibiting post-traumatic stress symptoms (PTS) and enhancing post-traumatic growth (PTG). A mixed-methods research design was used. The participants included 117 (52% girls) high school students (mean age = 14.54; SD = 1.49). Twenty-five of them were interviewed in addition to responding to the research questionnaires. Different aspects of the school climate were found to be associated with students' PTS and PTG, yielding two overarched factors explaining the school's role as a protective resource: sheltering and supporting. The former is associated with fewer PTS and the latter with higher PTG. The use of different resources for different forms of resilience is discussed.