Does Evidence-Based Medicine Apply to Psychiatry?

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs.     

Laboratory and field observations of attack by the red wood ant Formica lugubris Zett. On Formica cunicularia Latr. (Hymenoptera: Formicidae)

Attack by red wood ants (Formica lugubris Zett.) on an “alien” species (Formica cunicularia Latr.) was analyzed both in the laboratory and in the field. Elements of such attack were recorded. Attack and conflict were observed in each encounter and follow immediately after the first contact. This overt attack was vigorous and generally led to the death of the alien. Laboratory data were confirmed by field observations, although under these conditions aggressiveness of F lugubris appeared increased possibly because of the animal's familiarity with its surroundings.     

Developing an emotion-focused therapy model for fear of cancer recurrence: A case-level task analysis

Fear of cancer recurrence (FCR) involves anxiety about the possible return or progression of the disease. It is common among people surviving cancer, covering a range of adaptive and maladaptive responses including clinical presentations of FCR, for which different psychological interventions have been developed, most within the cognitive-behavioural paradigm. Recently, emotion-focused therapy (EFT) has been proposed as an alternative and has been the subject of research focusing on the cancer population and cancer-related issues, including FCR. In this study, we looked closely at a successful case from a larger exploratory study, carrying out a discovery-phase task analysis aimed at identifying the main components of EFT–FCR. We found that this approach generally followed the usual structure of an EFT intervention, with four distinct phases. However, we identified some specific secondary processes (e.g., hypervigilance and catastrophising) and clarified the nature of the core pain in this presentation as existential (e.g., fear of dying).     

Existential Marital Psychotherapy and the Experience of Managed Care

ABSTRACT

In this article the experience of managed care is over-viewed from the perspective of existential marital therapy. It is concluded that managed care disrupts the experiential nature of participation between couple and therapist, dilutes the authentic nature of the treatment relationship, decreases the importance of subjectivity, disturbs the discovery of meaning and purpose in marital life and deters existential communication.     

Telling lies? An exploration of self-deception and bad faith

If self deception is a lie that one tells to oneself, then paradoxically the deceived is also simultaneously the deceiver. This paper considers two contrasting conceptualizations of self-deception: A.R. Mele's () account of cognitive functioning and J.P Sartre's () existential exploration of ‘bad faith’. Both writers seek to resolve the ‘paradox’ of self-deception or bad faith without recourse to the positing of mental partitioning or the Freudian unconscious. Mele uncovers and lays bare the underlying structure of self-deception, revealing it to consist in desire-driven perceptual and interpretational shortcomings. Sartre's analysis of bad faith emerges from his ontology and is bound up with his notions of ‘being-for’ and the tension between personal ‘transcendence’ and ‘facticity’. Finally, the implications for psychotherapy of Mele's and Sartre's accounts are considered.     

Intrinsic religiosity protects believers from the existential fear of a human Jesus

ABSTRACT

The present study examined the role of internalised religious beliefs in defending against existential concerns aroused from a creaturely Jesus. Prior work has found that biologically human traits (e.g., vomiting, sweating, etc.) can increase death concerns when applied to both humans and a god. Intrinsic beliefs, however, have been shown to reduce mortality awareness. In the current study, religious participants were primed with thoughts of either a human or neutral Jesus followed by a single item measure about fear of death. A moderated regression analysis found that whereas high intrinsic individuals were buffered from existential concerns, low intrinsic individuals experienced a greater fear of death when primed with a human Jesus. These results replicate prior work within terror management theory and the psychology of religion suggesting that internalised beliefs serve a protective function against existential anxieties.     

Universalism and Junk

Those who accept the necessity of mereological universalism face what has come to be known as the ‘junk argument’ due to Bohn [2009 Bohn, Einar D. 2009a. An Argument Against the Necessity of Unrestricted Composition, Analysis 69/1: 27–31.[Crossref], [Web of Science ®] , [Google Scholar]], which proceeds from (i) the incompatibility of junk with universalism and (ii) the possibility of junk, to conclude that mereological universalism isn't metaphysically necessary. Most attention has focused on (ii); however, recent authors have cast doubt on (i). This paper undertakes a defence of premise (i) against three main objections. The first is a new objection to the effect that Bohn's defence of that premise presupposes far too much. I show that one can defend premise (i) from a much weaker set of assumptions. The second objection, due to Contessa [2012 Contessa, Gabriel 2012. The Junk Argument: Safe Disposal Guidelines for Mereological Universalists, Analysis 72/3: 455–7.[Crossref], [Web of Science ®] , [Google Scholar]], is that those who accept unrestricted composition should only accept the existence of binary sums (which are compatible with junk) rather than infinitary fusions. I argue that this conception of unrestricted composition is problematic: it is in conflict with an intuitive remainder principle. The final objection is due to Spencer [2012 Spencer, Joshua. 2012. All Things Must Pass Away, in Oxford Studies in Metaphysics: Volume 7, ed. Karen Bennett and Dean W. Zimmerman, Oxford: Oxford University Press: 67–92.[Crossref] , [Google Scholar]]. His view is that there is no absolutely unrestricted plural universal quantifier; so any statement of the unrestricted fusion axiom will simply not rule out the existence of junky worlds. I argue that the failure of unrestricted quantification will not be enough by itself to establish the existence of junk. Furthermore, it is not clear whether this view counts as a form of mereological universalism. As a result, I suggest that if one wants to reject the junk argument, premise (ii) is the only viable option.     

Going to political extremes in response to boredom

Boredom makes people attempt to re‐establish a sense of meaningfulness. Political ideologies, and in particular the adherence to left‐ versus right‐wing beliefs, can serve as a source of meaning. Accordingly, we tested the hypothesis that boredom is associated with a stronger adherence to left‐ versus right‐wing beliefs, resulting in more extreme political orientations. Study 1 demonstrates that experimentally induced boredom leads to more extreme political orientations. Study 2 indicates that people who become easily bored with their environment adhere to more extreme ends of a political spectrum compared with their less easily bored counterparts. Finally, Study 3 reveals that the relatively extreme political orientations among those who are easily bored can be attributed to their enhanced search for meaning. Overall, our research suggests that extreme political orientations are, in part, a function of boredom's existential qualities.     

The relationship between existential attitudes and professional quality of life among nursing students

This study examined the relationship between existential attitudes and professional quality of life among a sample of South African nursing students (N = 150; mean age = 21.19, SD = 2.77; female = 90%). The student nurses completed the Life Attitudes Profile-Revised (LAP-R) and the Professional Quality of Life Scale (PROQoL). The data were analysed using the Pearson product-moment correlation and multiple regression analysis. Existential attitudes significantly predicted scores on the PROQoL. The findings suggest that existential attitudes are an essential personal resource that could serve as a potential buffer against compassion fatigue and burnout while enhancing compassion satisfaction.