New Directions in the Cognitive-Behavioral Treatment of OCD: Theory,Research, and Practice

The beneficial effects of cognitive-behavioral interventions (particularly exposure and response prevention) for OCD are among the most consistent research findings in the mental health literature. Nevertheless, even after an adequate trial, many individuals experience residual symptoms, and others never receive adequate treatment due to limited access. These and other issues have prompted clinicians and researchers to search for ways to improve the conceptual and practical aspects of existing treatment approaches, as well as look for augmentation strategies. In the present article, we review a number of recent developments and new directions in the psychological treatment of OCD, including (a) the application of inhibitory learning approaches to exposure therapy, (b) the development of acceptance-based approaches, (c) involvement of caregivers (partners and parents) in treatment, (d) pharmacological cognitive enhancement of exposure therapy, and (e) the use of technology to disseminate effective treatment. We focus on both the conceptual/scientific and practical aspects of these topics so that clinicians and researchers alike can assess their relative merits and disadvantages.     

Is the centralization of potentially traumatic events always negative? An expansion of the Centrality of Events Scale

The autobiographical memory model of posttraumatic stress disorder (PTSD) argues that centralizing a traumatic event into one's life story is a maladaptive process associated with increased PTSD symptoms. Current measures of event centralization make no reference to whether individuals centralize the event in a positive or negative way. This study examined 400 undergraduate participants using a modified version of the Centrality of Events Scale composed of 2 factors measuring both positive and negative event centralization. Exploratory factor analysis confirmed the 2‐factor structure. Negative event centralization was associated with PTSD symptoms to a greater degree than was positive event centralization, and negative event centralization mediated the relationship between neuroticism and PTSD symptoms. Combined, these results suggest that the effect of event centralization is dependent on the valence with which the individual centralizes the event. The relationship shown between negative event centralization and PTSD symptoms supports the autobiographical memory model of PTSD.     

Emotional responding in NSSI: examinations of appraisals of positive and negative emotional stimuli,with and without acute stress

Non-suicidal self-injury (NSSI) is commonly used by young adults to regulate emotional responses. Yet, experimental examination of how people who self-injure appraise and respond to emotional stimuli is limited. We examined appraisals of, and responses to, emotive images in young adults who did and did not self-injure, and assessed whether these were impacted by exposure to a stressor. Study 1 (N?=?51) examined whether participants differed in their appraisals of emotional images. Study 2 (N?=?78) assessed whether appraisals of images changed after exposure to the Trier Social Stress Test. Ratings of emotional valence and arousal were collected in both studies; skin conductance was measured as an indicator of physiological arousal in Study 2. In Study 1 participants reporting NSSI rated positively valenced images as less pleasant than participants not reporting NSSI. In Study 2, after acute stress, participants reporting NSSI displayed dampened physiological reactions to positive images whereas participants who did not self-injure displayed heightened physiological reactions to these and rated them as more pleasant. Individuals who self-injure seem less able to engage in strategic mood repair after exposure to stress compared to people who do not self-injure.     

Associations between childhood biomedical factors,maternal smoking,personality traits,Body and Mass Index and the prevalence of asthma in adulthood

Objective: The study set out to investigate socio-economic, biomedical, health and behavioural and psychological factors in childhood and adulthood associated with the prevalence of asthma in adulthood, drawing data from The National Child Development Studies (NCDS), a birth cohort in the UK.

Design: The National Child Development Study, a nationally representative sample of 17,415 babies born in Great Britain in 1958 and followed up at 7, 11, 33 and 50 years was used.

Main Outcome Measure: The prevalence of asthma at age 50 was the outcome measure. The analytic sample consists of 5118 participants with complete data on a set of measures at birth, at ages 7, 11, 33 and 50 years.

Results: Using logistic regression analyses, results showed that childhood asthma (OR = 6.77: 4.38–10.48, p < .001) and respiratory symptoms (OR = 1.83: 1.18–2.86, p < .01), maternal smoking during pregnancy (OR = 1.26: 1.00–1.59, p < .05), Body and Mass Index (BMI) (OR = 1.03: 1.02–1.05, p < .001), traits Neuroticism (OR = 1.13: 1.01–1.21, p < .05) and Conscientiousness (OR = 0.76: 0.76–0.96, p < .01), as well as sex (OR = 1.49: 1.15–1.94, p < .001) were all significantly associated with the prevalence of asthma in adulthood.

Conclusion: The study shows that both childhood and adulthood psychological and sociological factors are significantly associated with the prevalence of asthma in adulthood, though more work need to be done in this area.     

A Systematic Review: Non‐Suicidal Self‐injury in Australia and New Zealand's Indigenous Populations

Objective

To undertake a systematic review of non‐suicidal self‐injury (NSSI) prevalence, patterns, functions, and behavioural correlates for the Indigenous populations of Australia (Aboriginal and Torres Strait Islanders) and New Zealand (NZ; Maori).

Method

We searched the following electronic databases: PubMed, MedLine, Scopus, Web of Science, ScienceDirect, PsycInfo, and PsycArticles, CINAHL, and the Informit Health and Indigenous Peoples collections. Studies were included for review if they were published within the last 25 years and reported on NSSI in Australia and NZ's Indigenous populations.

Results

Seven studies were included, six of which came from Australia. The prevalence of NSSI in Australia ranged from 0.9% up to 22.50%; statistics varied by the different samples, types of prevalence, and relationship to alcohol. Several studies found that Aboriginal and Torres Strait Islander peoples had higher rates of NSSI than other Australians, but that this was not significantly higher. Two studies indicated that NSSI was linked to alcohol use, incarceration, and a younger age. The one NZ study was of injury and not specifically NSSI.

Conclusions

Findings are limited due to a small pool of literature. Cultural variations in NSSI presentation should be considered when working with Indigenous populations. Further research is required to help determine what cultural variations may exist.     

Counter‐intuitive moral judgement following traumatic brain injury

Several neurological patient populations, including traumatic brain injury (TBI), appear to produce an abnormally ‘utilitarian’ pattern of judgements to moral dilemmas; they tend to make judgements that maximize the welfare of the majority, rather than deontological judgements based on the following of moral rules (e.g., do not harm others). However, this patient research has always used extreme dilemmas with highly valued moral rules (e.g., do not kill). Data from healthy participants, however, suggest that when a wider range of dilemmas are employed, involving less valued moral rules (e.g., do not lie), moral judgements demonstrate sensitivity to the psychological intuitiveness of the judgements, rather than their deontological or utilitarian content (Kahane et al., Social Cognitive and Affective Neuroscience, 7, 2011, 393). We sought the moral judgements of 30 TBI participants and 30 controls on moral dilemmas where content (utilitarian/deontological) and intuition (intuitive/counter‐intuitive) were measured concurrently. Overall TBI participants made utilitarian judgements in equal proportions to controls; disproportionately favouring utilitarian judgements only when they were counter‐intuitive, and deontological judgements only when they were counter‐intuitive. These results speak against the view that TBI causes a specific utilitarian bias, suggesting instead that moral intuition is broadly disrupted following TBI.     

EMPIRICAL MINDFULNESS: TRADITIONAL CHINESE MEDICINE AND MENTAL HEALTH IN THE SCIENCE AND RELIGION DIALOGUE

As science and religion researchers begin to engage questions of mental health, mindfulness may prove to be a fruitful area of investigation. However, quantifying the physical effects of mindfulness on the brain is difficult because mindfulness deals with the problem of mental and physical interaction or, the mind/body problem. One system of understanding which may aid science and religion scholars in the pursuit of mindfulness is traditional Chinese medicine (TCM). Within TCM, heart Qi manages the body's present connection to time and space. If the “being in the moment” is disrupted, then the heart Qi is blocked and mental illness or various neurological disorders occur. Succinctly, within TCM, mindfulness is understood as a nonphysical phenomenon (Qi) which directly affects physical systems, resulting in empirical data. This is tracked and treated through the TCM understanding of Qi. The TCM view of Qi in mental health may therefore provide a helpful new paradigm to investigations concerning mindfulness and the human brain.     

"仁"——医德的元德

医德是医学道德的简称,具言之,它是指医务人员在医疗卫生服务的职业活动中应该具备的仁爱、救死扶伤等的品德,是道德德目在医务人员身上的内化,也是对医务人员必须具备的最起码的要求.我们评价一个医生,首先是直面他的医德,医德是医生形象的体现,没有医德的医生即使技艺再高超,也算不上一个完整意义上的医生,"无德不成医".事实上一个医德低下的医生,他的技艺也不会高超的.     

基层医院口腔科如何构建和谐医患关系

基层医院口腔科容易引起医患纠纷,本文从基层医院口腔科以及口腔医生的角度谈谈如何构建和谐的医患关系。基层医院口腔医生要掌握扎实的专业理论知识和操作技能以及加强自身修养,并进行良好的医患沟通;基层医院口腔科要营造舒适的就医环境,合理收费,严格的消毒灭菌。构建和谐医患关系在口腔治疗中的起重要作用。     

传媒介入医患纠纷的原因及作用探析

探讨传媒介入医患纠纷的原因及作用。经过分析发现,竞争的需要、经济的需要和受众的需要是传媒介入医患纠纷的主要动机和原因。总体而言,对传媒介入医患纠纷应持肯定态度。它在将医患矛盾进行公开化,唤起公众对医患纠纷问题的重视,提升公众参与意识,以及促进解决结果的公平性与公正性等方面发挥了积极作用。