Effects of hearing and vision impairments on the Montreal Cognitive Assessment

Many standardized measures of cognition include items that must be seen or heard. Nevertheless, it is not uncommon to overlook the possible effects of sensory impairment(s) on test scores. In the current study, we investigated whether sensory impairments could affect performance on a widely used screening tool, the Montreal Cognitive Assessment (MoCA). Three hundred and one older adults (mean age = 71 years) completed the MoCA and also hearing and vision tests. Half of the participants had normal hearing and vision, 38% impaired hearing, 5% impaired vision, and 7% had dual-sensory impairment. More participants with normal sensory acuity passed the MoCA compared to those with sensory loss, even after modifying scores to adjust for sensory factors. The results suggest that cognitive abilities may be underestimated if sensory problems are not considered and that people with sensory loss are at greater risk of cognitive decline.     

Internal state of emergency – working with an international student suffering from trauma in a student counselling service

In this paper I look at the suicidal state of mind of an international student who comes from a country at war and has been traumatized by a violent event. The student is tortured by an internal dilemma surrounding unbearable feelings of guilt and shame that arise when she leaves her home country to study abroad. Her dilemma or survivor guilt triggers an internal contract with herself, whereby she is internally persecuted when she makes an attachment to the university and her course. I suggest that an individual in this state of mind, suffering from post-traumatic stress, has regressed to a primary state of unintegration where the self is at the mercy of psychotic anxieties and the student is at risk of suicide. It is suggested that a safety net made up of the student services and the wider health service can provide a symbolic or mental space and containment for the student's state of mind until she can function as a student.     

Student essay competition prize winner a study of the breaking and remaking of affectional bonds

Abstract

This essay was originally presented as the author's final clinical essay for the Advanced Diploma in Psychodynamic Counselling run by the WPF (North) in conjunction with the Tuke Centre, York. It is a reflection on a year's counselling undertaken with a young man struggling with angry and violent impulses which threatened to wreck his relationship with his partner and their children. The work draws on psychoanalytic and attachment theories and examines the process involving client and counsellor as two men working together on issues of loss, relationship and intimacy.     

Nostalgia and lost identity

Nostalgia for the Soviet Union is a major social phenomenon in Russia today due to the irrevocable losses of the recent past in which Soviet citizens involuntarily became immigrants in their own country. With reference to discussions of nostalgia in philosophical and psychoanalytic literature, I suggest that nostalgia may represent either a defensive regression to the past or a progressive striving for wholeness through re‐connecting with what has been lost in the service of a greater integration. I compare this with the processes of adaptation seen in immigrants and provide a clinical illustration of a young man coming to terms with loss and change in the post‐Soviet era. When nostalgia is recognized as a legitimate emotional experience it may facilitate mourning and enable the integration of the past with the present and the development of a new identity.     

Weight maintenance: Self-regulatory factors underpinning success and failure

Objectives: To investigate the differences in the contributing factors involved in weight maintenance success and failure.

Design: Semi-structured interviews were conducted with both successful and unsuccessful weight maintainers. Eighteen participants were recruited (16 women), nine of who had lost 10% of their body weight and maintained this weight for a minimum of 12?months (Maintainers), and nine individuals who met the above criteria for weight loss but had subsequently regained their weight (Regainers). A thematic analysis was employed to compare the differences between the two groups.

Results and conclusions: Two main themes highlighted the differences between the two groups, these were: goal regulation and self-control. Within these overarching themes, successful weight maintenance was related to the following subthemes: long-term, realistic goal setting, consistent use of routines and self-monitoring, avoiding deprivation and effective coping skills. Unsuccessful maintenance was related to short-term unrealistic goal setting, inconsistent routines and self-monitoring, experiencing deprivation and poor coping skills. These factors are explained in terms of the interrelationships that they have on one another and their subsequent impact on weight maintenance success or failure.     

Psychological Aspects of Tinnitus: A Comparison With Hearing Loss and Ear,Nose and Throat Disorders

Abstract

It is well established that tinnitus is sometimes associated with marked psychological distress, including anxiety and depression. As yet, however, it is unclear whether the problems are specific to tinnitus or may occur in other hearing disorders too. A total of 95 patients with tinnitus were compared with 73 people with hearing loss but no tinnitus, and with a further 80 people attending an out-patient clinic for a variety of other ear, nose and throat (ENT) problems. The principal measures were the Hospital Anxiety and Depression Scale and the Eysenck Personality Questionnaire. The tinnitus patients were significantly more anxious, depressed, and neurotic than the hearing loss group, but were equivalent to the ENT group; and, like the hearing loss group, they were significantly less extraverted than the ENT controls. There were no differences between tinnitus patients with severe hearing loss, mild hearing loss, and no hearing loss. Results from Hallam's Short Tinnitus Questionnaire revealed that tinnitus patients without hearing loss reported significantly fewer difficulties with auditory perception than either of the other tinnitus groups, and significantly fewer irrational beliefs than the group with severe hearing loss. It is concluded that patients with tinnitus were more distressed than people with hearing loss, but that their distress was shared by patients with a variety of other ENT problems. People who reported the greatest problems with their tinnitus were generally those who also had severe hearing loss.     

Making concrete construals mindful: A novel approach for developing mindfulness and self-compassion to assist weight loss

Research on the usefulness of mindfulness and self-compassion for dieting has focused on meditative practices. However, meditation can be difficult to maintain, especially while dieting. Thus, the present research attempted to induce mindfulness and self-compassion by using food diaries that required the participant to either focus on concrete (i.e. how they are eating) construals or abstract (i.e. why they are eating) construals. The concrete construals were expected to increase mindfulness and self-compassion, as well as decrease avoidance and negative thoughts (which would further aid the development of mindfulness and self-compassion). Study 1 found that mindfulness and self-compassion mediated the inverse relationship of avoidance and negative thoughts with weight loss. Study 2 showed that concrete construal diaries increased mindfulness and self-compassion, decreased avoidance and negative thoughts, and supported weight loss significantly more than the abstract construal diaries. Study 3, then, compared the concrete construal diaries with a mindful self-compassionate meditation programme. There was no difference in weight loss at the end of the intervention, but at a three-month follow-up, the diaries performed better at weight maintenance. Thus, the concrete construal diaries may promote mindfulness and self-compassion and potentially promote long-term weight loss.     

Negotiating control: Patients’ experiences of unsuccessful weight-loss surgery

Interviews were carried out with 10 men and women who had undergone weight-loss surgery (WLS) up to 10 years ago and felt that it had failed. Seven had had a further successful procedure. Data were analysed using Interpretative Phenomenological Analysis. Weight regain following surgery was explained in terms of either the mechanics of the operation or with participants describing ways to ‘cheat’ as food continued to be used for emotional regulation. Everyone spoke of how surgery neglected their mind. Following the second successful surgery, participants described changes in both their eating behaviour and cognitions emphasising how their mind had been brought ‘in gear’ through the investment of two invasive procedures. Transcending all accounts was the mind/body relationship and the issue of control with attributions for both failed and successful surgery shifting from the self to the surgical mechanism as the participants negotiated the pathway between self-blame and responsibility and utilised conflicting frameworks in which the mind and body were either divided or united. Whereas failed surgery is characterised by a battle for control, successful surgery involves handing control over to their restricted stomachs or considering WLS as a tool to be worked with.     

Revisiting the Gain–Loss Separability Assumption in Prospect Theory

A fundamental assumption of prospect theory is gain–loss separability (GLS)—the assertion that the overall utility of a prospect can be expressed as a function of the utilities of its positive and negative components. Violations of GLS may potentially limit the generalization of results from studies of single‐domain prospects to mixed prospects and systematically distort the predictions of the theory. Violations also have implications for how choices with positive and negative components should be presented to decision makers. Previous studies, using different elicitation methods, have documented different rates, and types, of systematic violations of GLS. We discuss the differences between two specific elicitation methods—binary choice and certainty equivalents—and report results of a new study of GLS using both methods and randomly generated prospects. We compare the extent and nature of GLS violations under the two elicitation methods using between‐subject and within‐subject analyses. We find (i) systematic violations of GLS under both methods, (ii) higher rates of violations under choice, (iii) higher sensitivity to the outcomes for the certainty equivalents, which is consistent with the predictions of the scale‐compatibility hypothesis, and (iv) different patterns of violations under the two methods, which are explained by method‐specific preferences. We discuss the psychological mechanisms underlying the findings and the implications for presenting information with gain and loss components. Copyright © 2012 John Wiley & Sons, Ltd.     

Learning to say goodbye. An essay on Philip Pullman's The Amber Spyglass Volume 3 of His Dark Materials

This paper discusses the third volume of Pullman's remarkable trilogy. The two main child characters, Lyra and Will, are now entering adolescence, and the novel explores their intense and ambivalent feelings towards the parents and the variously protective or hostile parental figures who surround them. The novel devises remarkable imaginary worlds – for example the land of the mulefa, and the underworld visited by Will and Lyra – through which to explore issues of considerable intellectual and emotional depth. The ‘realism’ to which Pullman is committed is apparent in the conclusion of the book, where the two child characters, who have fallen in love with one another, have to accept the necessity of separation.