Chapter 12: New Significance and Identity: A Practical Theological Perspective

SUMMARY

This article looks at personal worth and identity, dependence, time and experience, change and loss, death, work and leisure from a distinctively Christian point of view that frees us from the distortions and dread of aging. We are called to embrace life as new creations through the years.     

Cognitive-behavioral therapy for insomnia in alcohol dependent patients: a randomized controlled pilot trial

In a randomized controlled trial, we evaluated the efficacy of cognitive-behavioral treatment for insomnia to improve sleep and daytime symptoms, and to reduce relapse in recovering alcohol dependent (AD) participants. Seventeen abstinent AD patients with insomnia (6 women, mean age 46.2 ± 10.1 years) were randomized to 8 sessions of cognitive-behavioral treatment for insomnia for AD (CBTI-AD, n = 9) or to a behavioral placebo treatment (BPT, n = 8). Subjective measures of sleep, daytime consequences of insomnia and AD, alcohol use, and treatment fidelity were collected at baseline and post-treatment. Diary-rated sleep efficiency and wake after sleep onset, and daytime ratings of General Fatigue on the Multidimensional Fatigue Inventory improved more in the CBTI-AD compared to the BPT group. In addition, more subjects were classified as treatment responders following CBTI-AD. No group differences were found in the number of participants who relapsed to any drinking or who relapsed to heavy drinking. The findings suggest that cognitive-behavioral insomnia therapy benefits subjective sleep and daytime symptoms in recovering AD participants with insomnia more than placebo. The benefits of treating insomnia on drinking outcomes are less apparent.     

More than fair: Outcome dependence, system justification, and the perceived legitimacy of authority figures

Legitimacy is a source of power for authorities because it promotes voluntary deference on the part of followers. From a system justification perspective, there is also reason to believe that power is a source of perceived legitimacy. We report five studies demonstrating that in addition to procedural fairness and outcome favorability, outcome dependence is an independent contributor to perceived legitimacy. In two cross-sectional field studies and one panel study, we hypothesized and found that dependence on an authority figure is positively associated with appraisals of legitimacy, measured in terms of trust and confidence in, empowerment of, and deference to authority. These effects were demonstrated in educational, political, and legal settings. Two additional experiments provided direct causal evidence for the hypothesized effect on both perceived legitimacy and voluntary deference (i.e., acquiescence to additional requests). We also found that participants assigned to a high (vs. low) dependence condition judged their outcomes to be more favorable, despite the fact that the outcomes were identical in the two conditions; this effect was mediated by perceived legitimacy. Taken as a whole, these findings suggest that perceived legitimacy is enhanced not only when authorities exercise fair procedures and deliver favorable outcomes, but also when subordinates are dependent on them. Implications for society and the study of legitimacy and social power are discussed.     

Patterns of moral judgment derive from nonmoral psychological representations

Ordinary people often make moral judgments that are consistent with philosophical principles and legal distinctions. For example, they judge killing as worse than letting die, and harm caused as a necessary means to a greater good as worse than harm caused as a side‐effect ( Cushman, Young, & Hauser, 2006 ). Are these patterns of judgment produced by mechanisms specific to the moral domain, or do they derive from other psychological domains? We show that the action/omission and means/side‐effect distinctions affect nonmoral representations and provide evidence that their role in moral judgment is mediated by these nonmoral psychological representations. Specifically, the action/omission distinction affects moral judgment primarily via causal attribution, while the means/side‐effect distinction affects moral judgment via intentional attribution. We suggest that many of the specific patterns evident in our moral judgments in fact derive from nonmoral psychological mechanisms, and especially from the processes of causal and intentional attribution.     

Silicon in ‘pure gold’? Theoretical contributions and observations on teleanalysis by videoconference

Ideas about psychoanalysis via videoconference—videoconference teleanalysis (VT)—are presented with the general understanding that these settings produce a twofold split between various degrees of recognition/negativisation of the absence of the other, on one hand, and the expectation of physical co‐presence, on the other. This split has been put forward as dismantling the here, now, with me pre‐reflexive unity of the analytic experience. This article suggests that both members of the analytic dyad will seek to reappropriate the experience through a forced ego integration that interferes with accessing states of unintegration in the analytic treatment and produces subtle alterations to symbolisation work. The effort to overcome this condition is illustrated with clinical vignettes and therapists’ comments about feelings of inauthenticity and discontent when trying to sustain evenly‐suspended attention, as well as in the perception of a form of flattening of the alive nature of speech. However, this is not a constant for all VT, and mutual understanding can be an important mitigating feature. The focus of the discussion should be on the capacity of the analytic dyad to overcome such a split and not on a direct extrapolation of the perceptual limitations of VT to possible effects on transference / countertransference.     

Do PTSD symptoms and course predict continued substance use for homeless individuals in contingency management for cocaine dependence?

Homeless individuals (n = 187) entering contingency management (CM) for cocaine dependence were assessed for PTSD diagnosis, and a subset of 102 participants reporting traumatic exposure also periodically completed a self-report measure of PTSD symptoms. Patients with PTSD in full remission at 6 months (end of active treatment) and 12 months (end of aftercare) used substances much less frequently during aftercare than those with no PTSD diagnosis. Those whose PTSD diagnosis improved to full remission status during active treatment, and remained in full remission at 12 months, also had superior substance use outcomes. Severity of PTSD symptoms at 6 months, but not baseline or 2 months, was associated with substance use across treatment phases. Substance use during aftercare, however, was better predicted by changes in PTSD symptom severity. Patients whose PTSD symptoms improved more during active treatment fared better during aftercare than those with less improvement. Findings suggest homeless individuals with comorbid PTSD entering CM for cocaine dependence are not necessarily at increased risk for substance use compared to those without the comorbidity. However, course of PTSD does predict substance use, with the potential for CM to be unusually effective for those who respond with substantial, lasting improvements in PTSD.     

Is A Purely First Person Account Of Human Action Defensible?

There are two perspectives available from which to understand an agent's intention in acting. The first is the perspective of the acting agent: what did she take to be her end, and the means necessary to achieve that end? The other is a third person perspective that is attentive to causal or conceptual relations: was some causal outcome of the agent's action sufficiently close, or so conceptually related, to what the agent did that it should be considered part of her intention? Recent goods based views in ethics are divided as to whether only the first person perspective, or a mix of both perspectives, are necessary to understand intention and action. But resolution of the issue is necessary if goods based views are to be able to deploy to principle of double effect; for that principle requires an account of how to distinguish what is genuinely a matter of intention in human action from what is not. I argue that the pure first person account is better than the mixed account.     

Pharmacologic and Behavioral Withdrawal From Addictive Drugs

ABSTRACT— Recent theories suggest that drug withdrawal does not motivate drug use and relapse. However, data now show that withdrawal produces complex changes over time in at least two symptoms (i.e., negative affect and urges) that are highly predictive of relapse. Evidence suggests that falling levels of the drug in the blood and interruption of the drug self-administration ritual both affect these symptoms. Both of these forms of withdrawal motivate renewed drug use in addicted individuals.