Deep structure,cognition and rebirth: Propositions for viability and vitality in human systems

This paper describes systems dynamics related to deep structure and development processes in human systems, to the process of arresting entropy or premature death in these systems and to the relationship between the cognition of deep structure, its outward manifestation and human systems viability and vitality. The paper proposes that inherent forces are present in systems that act to bring about alignment between inner deep structure and a system's manifested outer structures and processes, thereby enhancing viability and vitality. Deep structure is seen as a force toward self‐organization and rebirth.     

Timescapes of Security: Clocks,Clouds, and the Complexity of Security Governance

This article pulls together the disjointed complexification of security studies. Such analytical overview suggests that the perspective of “timescapes” allows for exploring the complexity that shapes meanings and practices of security and its governance. In this respect, it is the imperative to change that suggests the significance of complexity thinking to security studies—that is, it is alone in taking the discontinuities of global life seriously. Security, in this regard, is not merely about the clockwork of survival, but is redefined through the cloudlike adaptive contingency of “security as resilience.” In this setting, the security governance of complexity is identified through its dancing to the timescaped rhythms of uncertainty, cognitive challenges, complex risks, and exaptation prompted by the heterogeneity of global life.     

Understanding,respecting and integrating difference in therapeutic practice

The purpose of this paper is to promote thought and discussion around how and why we treat patients in chosen ways. In the present climate practitioners are required to treat patients following NICE guidelines in which cognitive behavioural therapy (CBT) is the treatment of choice in the majority of diagnoses. This paper raises concerns that this may lead to an homogenization of treatment, loss of invaluable skills and understanding from other treatment approaches, and loss to the patient who may be best cared for by a combination of treatments and approaches, most notably patients presenting with complex pathology. This paper aims to present this as a general principle, and by way of example, will focus on coupling two specific treatment orientations, cognitive behavioural therapy with psychodynamic psychotherapy, with the specific diagnosis of obsessive compulsive disorder (OCD).

Methods: Clinical material is drawn from case studies from practice in secondary adult mental health care services within the NHS. All patients were referred to the psychological services for treatment for OCD and provided with 1:1 therapy with UKCP‐registered therapists. Details have been anonymized by describing fictitious cases re‐constructed from clinical material. A theoretical understanding is included which provides both an overview for integrating treatment for the specific example of OCD and is intended by extension to other diagnoses.

Results: Working with the commonalities of therapeutic approaches, and integrating specific skills of CBT and psychodynamic psychotherapy, appears to offer a viable mode of treatment for cases resistant to single‐orientation therapies.

Conclusions: Coupling the skills of different therapies can be effective in treating complex patients that are referred to the secondary mental health services. Conversely, restricting practice to single orientation therapies can lead to an impoverished care for patients and diminution of invaluable therapeutic skills which may become underused, undervalued and lost in the practice of mental health care within the NHS. Acknowledgement of the skills of others, valuing these and learning from each other can help to avoid the defensive reactions of practitioners, where each may defensively retreat to their corners of specialism. Respecting and sharing skills from different orientations, and acknowledging this in the NICE guidelines, is good for both mental health services and patient care and addresses the concerns raised by practitioners exemplified by Bateman (2000 Bateman, A. 2000. Integration in psychotherapy: An evolving reality in personality disorder.. British Journal of Psychotherapy, 17(2): 147–156.  [Google Scholar], p. 147) that ‘psychotherapy continues to be bedeviled by ideological schisms with practitioners apparently ignoring alternative conceptualizations and potentially superior interventions’.     

It is never the right time: How to help a mother to separate from her young child

In this paper I have described a short-psychotherapy treatment with a mother, a 3-year-old girl, and occasionally a father, over the difficulty in separating and settling down at nursery. The mother's unresolved mourning for the early miscarriage of her second baby was one important factor. She held on to the company and comfort provided by the little girl, who had become the vessel of maternal projections. Filled with Poppy's projections, the mother had also felt unable to withstand and process them. Mr Green was a conflictual element in the family, rather than a supportive husband and father, and Poppy's care and problems were left with the mother. Nine sessions unblocked the situation and allowed Poppy to settle down at a private nursery.     

The indirect effect of attention bias on memory via interpretation bias: Evidence for the combined cognitive bias hypothesis in subclinical depression

Little research has investigated functional relations among attention, interpretation, and memory biases in depressed samples. The present study tested the indirect effect of attention bias on memory through interpretation bias as an intervening variable in a mixed sample of non-depressed and subclinically depressed individuals. Subclinically depressed and non-depressed individuals completed a spatial cueing task (to measure attention bias), followed by a scrambled sentences test (to measure interpretation bias), and an incidental free recall task (to measure memory bias). Bias-corrected bootstrapping yielded evidence for the hypothesised indirect effect model, in that an emotional bias in attention is related to a congruent bias in interpretative choices which are in turn reflected in memory. These findings extend previous research and provide further support for the combined cognitive bias hypothesis in depression. Theoretical and clinical implications of our findings are discussed.     

Learning and Affect Following Near‐Miss Outcomes in Simulated Gambling

Gambling near‐misses are non‐rewarded events that resemble a winning configuration. Past research using slot machines has shown that moderate rates of near‐misses increase gambling persistence, but the mechanisms supporting this persistence are unclear. One hypothesis is that near‐misses are mistakenly interpreted as signals of skill acquisition, supporting learning and fuelling the ‘illusion of control’. A slot machine simulation was administered to 60 volunteers, with ratings of the perceived chances of winning, pleasure and motivation to play following particular outcomes. Psychophysiological measures (electrodermal activity and heart rate) were taken, and gambling persistence was measured after 30 trials. Near‐misses were similar to full‐miss outcomes in that they were regarded as unpleasant. However, near‐misses were akin to win outcomes in that they increased motivations to play and electrodermal activity. Learning was evidenced by the expectancy of winning increasing following wins and decreasing after losses. Although there was no overall change in expectancy of winning after near‐misses across all participants, those subjects reporting a greater increase in the expectancy of winning following a near‐miss showed more persistent play, consistent with the learning hypothesis. Greater heart rate acceleration following near‐misses was also associated with persistence. We also observed differential effects of near‐misses where the reel stopped either side of the winning position (‘payline’): motivational effects were restricted to near‐misses stopping before the payline, whereas near‐misses that stopped after the payline were primarily aversive. The payline effects are not predicted by the learning hypothesis and may indicate an affective component to near‐misses, possibly linked to counterfactual processing. Copyright © 2012 John Wiley & Sons, Ltd.     

Application of Cognitive Load Theory to Develop a Measure of Team Cognitive Efficiency

Improving human systems integration through technologically advanced training and performance aids has become increasingly important to military transformation. Measures of improved cognitive and coordination processes arising from the employment of transformational tools are necessary to guide the refinement and future development of such technologies. In this article, we describe a cognitive load theory approach to developing a combinatory measure of individual workload and team performance following an experimental intervention involving training and a decision support system. We discuss how indicators of what we term team cognitive efficiency can improve assessing the effectiveness of transformational processes and technologies.     

Treating PTSD in active duty service members using cognitive processing therapy or prolonged exposure therapy: Examining everyday practice at a military outpatient clinic

The Institute of Medicine has stressed the need for evaluations of evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) among active duty service members (AD) using a variety of evaluation approaches (Institute of Medicine, 2012). The current study examined the clinical files of 134 service members who completed treatment for PTSD using either prolonged exposure (PE) or cognitive processing therapy at an outpatient clinic. At the completion of each session, therapists made a clinical rating as to whether or not the session was protocol adherent. The total number of treatment sessions and the proportion of sessions rated as being protocol adherent were calculated. Multi-level models estimated the change in patient PTSD and other psychological symptoms over time as a function of clinician-rated protocol adherence and total number of sessions. Approximately 65% of clinic encounters were rated by therapists as being protocol adherent. Significant reductions in PTSD and psychological symptoms were associated with protocol adherence, and this was particularly true for patients who began treatment above clinical thresholds for both PTSD and other psychological symptoms. However, as the number of sessions increased, the impact of protocol adherence was attenuated. Patient characteristics, including gender, ethnicity, and co-morbidity for other psychiatric disorders were not related to symptom change trajectories over time. These findings suggest that protocol adherence and efficiency in delivery of EBTs for the treatment of PTSD with AD is critical.     

Short‐term cognitive‐behavioral treatment in multicultural primary care of patients with longstanding backache

The efficacy of cognitive‐behavioral therapy in multi‐cultural primary care patients with longstanding backache is not evaluated. The purpose of this study was to investigate the outcome of a four weekly‐treatment given by primary care physicians regarding pain‐related worry, depression and severe pain and to determine which social, clinical or gender factors were associated with outcome.The study group consisted of 245 patients in consecutive order from 19 countries, 18 to 45 years, entering rehabilitation program because of longstanding backache. Prevalences of pain‐related worry and depression and severe pain was counted and compared before and after. Logistic regression was used to calculate the odds (OR; 95% CI) for persistent pain‐related worry and/or persistent depression and severe pain (VAS ≥ 50). The prevalences of pain‐related worry and depression were both significantly lower after treatment (pain‐related worry 83% before vs. 38% after; depression 43% before vs. 31% after). Also the number of patients scoring ≥ 50 VAS was a little, but significantly, fewer (68% vs. 61%). Use of interpreter doubled the risk of having persistent pain‐related worry (OR 2.1; 95% CI 1.1–4.1) but the risk was not significant regarding persistent depression (OR 1.8; 0.6‐5.4). The rating of VAS rating ≥ 50 after treatment was twice as high, OR 2.3 (95% CI 1.1–4.6) in the 38–45 year old age group. To conclude, a focus on pain ideas reduced pain‐related worry and depression in these patients with various sociocultural backgrounds and longstanding backache.