抑郁焦虑共病研究及其辩证思维

抑郁、焦虑障碍是临床上很常见的两种疾病,两者之间的症状具有重叠性,共病率很高;目前由于两者的病因和发病机制不太明了,很难做出全面系统的判断。对抑郁、焦虑共病现象采取辩证的思维方法、科学的研究方法,以期探讨共病现象的本质及其规律,为临床诊断、治疗、预防提供更全面、更有效的措施与方案。     

Thinking with,and about,patients too scared to think: Can non‐interpretive maneuvers stimulate refl ective thought?

Patients incapable of higher-order (symbolic) thinking can often not tolerate evidence of the analyst's separate existence, particularly when that 'otherness' becomes evident in the process of the analyst's refl ecting upon and interpreting how the patient experiences or represents the analyst. The patient's intolerance of the analyst's efforts to think (refl ect upon and interpret) renders the usual psychoanalytic maneuvers employed to stimulate refl ective thought ineffective with such patients. Such patients have to learn to tolerate multiple perspectives before they can allow the analyst, or themselves, to think in the other's presence. The author presents two clinical vignettes that illustrate how the analyst's efforts to think about the patient were experienced by the patient as both intolerably distancing and as rejecting of an aspect of the patient's subjective reality. Working psychoanalytically with such patients requires the analyst to forgo the use of narrow interpretations that elucidate unconscious meanings and motives in favor of alternate technical maneuvers capable of facilitating the development of symbolic thinking and refl ective thought (insightfulness). These maneuvers include a demonstration of the analyst's willingness and ability to withstand (rather than 'interpret away') how he is being psychically represented by the patient, without becoming destroyed by, or lost within, the patient's characterization of him. Beside modeling a tolerance of alternate perspectives of one's self, other non-interpretive maneuvers that help facilitate the development of self-refl ective thought include: stimulating the patient's curiosity about the workings of his own mind by identifying incompletely understood behaviors or reactions worthy of greater psychological understanding, and insinuating doubt about the adequacy of the patient's explanations of such phenomena.     

Proximity bias: Interactive effect of spatial distance and outcome valence on probability judgments

Across a range of decision contexts, we provide evidence of a novel proximity bias in probability judgments, whereby spatial distance and outcome valence systematically interact in determining probability judgments. Six hypothetical and incentive-compatible experiments (combined N = 4007) show that a positive outcome is estimated as more likely to occur when near than distant, whereas a negative outcome is estimated as less likely to occur when near than distant (studies 1–6). The proximity bias is explained by wishful thinking and thus perceptions of outcome desirability (study 3), and it does not manifest when an outcome is less relevant for the self, such as the case of outcomes with little consequence for the self (studies 4 and 5) or when estimating outcomes for others who are irrelevant to the self (study 6). Overall, the proximity bias we document deepens our understanding of the antecedents of probability judgments.     

Combining Patient Utility with Health Status Assessment to Improve Medical Decision Making

Physicians often use health status assessment tools to evaluate a patient's condition, then apply established guidelines to determine the most medically effective treatment. Yet additional criteria, such as the appropriateness of the treatment given the particular patient's preferences and attitude toward risk, are also highly relevant to quality care. While such preferences could be addressed via patient utility functions, their use in actual practice is somewhat limited because elicitation is often considered too burdensome for patients, unreliable, or redundant given other measures. For a small group of real patients who have suffered a stroke, we measure both traditional health status and patient utility for the current state to determine whether limited, focused utility assessment is a practical means of obtaining additional and relevant patient information. We find that utility assessment is perceived as reasonable and useful by patients, even when quite ill, and that utilities and health status are not redundant. In fact, investigating apparent inconsistencies between patient utility and observed health status can alert the physician to patient concerns and criteria not captured by more traditional measures. We propose an approach to medical decision making that uses both measures to improve patient–physician communication.     

Can Religious Beliefs be Justified Pragmatically?

One cannot prove the truth of theological statement, but perhaps one can justify believing them because of the good consequences of doing so. It is irrational to believe statements of which there are good reasons to think false, but those of which there is some, albeit inconclusive, evidence can be believed for pragmatic reasons. However, in the interest of simplicity, it must not be possible to achieve those good consequences without such faith. John Bishop and others have argued that one need only assume theological statements to be true to enjoy the good consequences of a religious life, but in fact, faith is needed for most of these consequences to be achieved.

Cognitive contours: recent work on cross-cultural psychology and its relevance for education

This paper outlines new work in cross-cultural psychology largely drawn from Nisbett, Choi, and Smith (Cognition, 65, 15–32, 1997); Nisbett, Peng, Choi, & Norenzayan, Psychological Review, 108(2), 291–310, 2001; Nisbett, The Geography of Thought: How Asians and Westerners Think Differently...and Why. New York: Free Press 2003), Ji, Zhang and Nisbett (Journal of Personality and Social Psychology, 87(1), 57–65, 2004), Norenzayan (2000) and Peng (Naive Dialecticism and its Effects on Reasoning and Judgement about Contradiction. University of Michigan, Ann Arbor, Michigan 1997) Peng and Nisbett (Cross-Cultural Similarities and Differences in the Understanding of Physical Causality. Paper presented at the Science and Culture: Proceedings of the Seventh Interdisciplinary Conference on Science and Culture, Frankfort, K. Y. 1996), and Peng, Ames, & Knowles (Culture and Human Inference: Perspectives from three traditions. In: D. Matsumoto (Ed.), Handbook of Cross-Cultural Psychology (pp. 1–2). Oxford: Oxford University Press 2000). The paper argues that the findings on cultural influences on inference-making have implications for teaching and education generally, and specifically for the debate on conceptions and misconceptions of Asian students studying in western tertiary institutions around the world. The position defended is that, while there seems to be compelling empirical evidence for intercultural differences in thought patterns, these patterns are, for the most part, insignificant in everyday exchanges, though language and culture might subtlety modulate our inference-making at the margins. Linguistic determinism however is not defended. Nonetheless, the evidence provides food for thought, and it needs to inform the recent debates about international students studying overseas.

Team allegiance can lead to both optimistic and pessimistic predictions

Although team allegiance is usually associated with optimistic predictions about team performance, the authors hypothesized that preferences for one’s group can also lead to pessimistic predictions. Upon arrival to the laboratory, groups of four participants were split into teams of two based on bogus criteria. Participants were informed that their teammate would compete against a member of the other team in a trivia game consisting of both easy (e.g., “pop culture”) and hard (e.g., “50’s movies”) categories. They provided likelihood estimates regarding outcomes for each category. As predicted, team allegiance inflated participants’ optimism about their teammate winning the easy categories, but deflated optimism about their teammate winning the hard categories. Path analyses supported the proposed account indicating that preferences for a teammate to win led to an enhanced focus on the teammate’s strengths and weaknesses (and neglect of the strengths and weaknesses of the other competitor).     

Using system dynamics modeling to understand the impact of social change initiatives

Community psychologists have a long history of interest in understanding social systems and how to bring about enduring positive change in these systems. However, the methods that community psychologists use to anticipate and evaluate the changes that result from system change efforts are less well developed. In the current paper, we introduce readers to system dynamics modeling, an action research approach to studying complex systems and the consequences of system change. We illustrate this approach by describing a system dynamics model of educational reform. We provide readers with an introduction to system dynamics modeling, as well as describe the strengths and limitations of the approach for application to community psychology.     

Getting the social organism thinking: strategy for systems change

The ability of community researchers/practitioners to facilitate systems change is constrained by social power--particularly the capacity to shape ideology [S. Lukes (1974). Power: A radical view. Hampshire: MacMillan] and frequently power molds ideologies which undermine systems thinking. Following what Mills [C. W. Mills, (1959). The sociological imagination. New York: Oxford University Press] (termed the "sociological imagination", this article makes the case for a strategy of systems change that promotes an integrated focus on systems and their constituent individuals. Both of these components are understood to continuously shape each other. The social imagination is introduced as a way to conceptualize the intersection between individuals' conceptions of systems and the ways that systems work to form individual identities and perceptions of social reality. Examples of attempts at systems change from community organizing and public health are used to illustrate both common fallacies and potential future directions for systems change efforts.     

Science and Theology in the Twenty-First Century

The current interaction of science and theology is surveyed. Modern physics describes a world of intrinsic unpredictability and deep relationality. Theology provides answers to the metaquestions of why that world is rationally transparent and rationally beautiful and why it is so finely tuned for carbon-based life. Biology's fundamental insight of evolutionary process is to be understood theologically as creation "making itself." In the twenty-first century, biology may be expected to move beyond the merely mechanical. Neuroscience will not have much useful interaction with theology until it attains theories of wide explanatory scope. Computer models of the brain do not meet this requirement. A theological style of bottom-up thinking comes closest to scientific habits of thought. Complexity theory suggests that information will prove to be an increasingly important scientific concept, encouraging theology to revive the Thomistic notion of the soul as the form of the body. Another gift of science to theology will lie in providing a meeting point for the encounter of the world faith traditions.