An Integrative Brief Treatment Approach for Obsessive-Compulsive Disorder

This article reports on the integrated application of cognitive therapy, transactional analysis techniques, and the behavioral technique of response prevention using self-instructional training and behavioral substitution in a brief therapy approach. These methods were applied in the case of a young man who presented with compulsions to perform repetitive and ordering rituals with the belief that it would prevent his girlfriend from becoming pregnant. A 21-year-old white male who had performed 3 to 5 hours of rituals daily for several years was able to eliminate the majority of his compulsive behaviors and reduce his level of anxiety after eight clinical therapy sessions. Results were maintained at 6-month follow-up. The clear precipitating factors and the unusual maintaining variables for the disorder in the client are described. The author discusses the case in light of current theoretical, therapeutic, and biomedical understandings of the disorder.     

Cancer Risk Assessment and Genetic Counseling in an Academic Medical Center: Consultands' Satisfaction, Knowledge, and Behavior in the First Year

In 1995, we formally established a multifaceted cancer genetics program of clinical services, research, and education at a general academic medical center. In the first year, 58 families, mostly physician referred, received cancer risk assessment and genetic counseling for a family and/or medical history of cancer. The primary reasons for seeking consultation were to determine their risk or their offspring's risk for developing certain cancers and to inquire about the availability of DNA testing for predisposition to breast, ovarian, or colon cancers. To assess the level of satisfaction with program services, 51 consultands (22% with a personal history of cancer) were interviewed independently by telephone 3–12 months after the session. One goal of the survey was to improve program service. Ninety percent of respondents reported that the consultation was worth their time and money. Forty-two percent stated that their anxiety related to their cancer risk had decreased following counseling and 56% indicated no change. Recall of exact numerical risk was poor and one-third could not remember hearing any risk estimate. More respondents would recommend the service to friends (90%) than to family members (75%). Overall, the service was positively received by the majority of patients.     

Development of the Critical Elements of Genetic Evaluation and Genetic Counseling for Genetic Professionals and Perinatologists in Washington State

We present a method for the development of consensus documents describing the components of genetic evaluation and genetic counseling for various diagnoses. These documents were developed to encourage consistency among genetic professionals in Washington State. Other possible uses of these documents are to provide information regarding genetic evaluations for health care practitioners and payers, and to assist in quality assurance and genetic training programs. A working group of six genetic professionals developed two templates for the critical elements of genetic evaluation and genetic counseling, for clinical (nonprenatal) and prenatal patients. The working group then completed prototype templates for several specific genetic disorders. The templates and prototypes were sent to interested genetic professionals and perinatologists who submitted a total of 76 draft critical elements (CE's) to the working group. At two statewide meetings, participating practitioners modified and unanimously approved the CE templates, then unanimously approved the 21 draft CEs that had been finalized in small group discussions. Approved CE's were distributed to genetic professionals and perinatologists within the state.     

Distinguishing genetic from nongenetic medical tests: Some implications for antidiscrimination legislation

Genetic discrimination is becoming an increasingly important problem in the United States. Information acquired from genetic tests has been used by insurance companies to reject applications for insurance policies and to refuse payment for the treatment of illnesses. Numerous states and the United States Congress have passed or are considering passage of laws that would forbid such use of genetic information by health insurance companies. Here we argue that much of this legislation is severely flawed because of the difficulty in distinguishing genetic from nongenetic tests. In addition, barring the use by insurance companies of a genetic test but not a nongenetic test (conceivably for the same multifactorial disease) raises issues of fairness in health insurance. These arguments suggest that ultimately the problems arising from genetic discrimination cannot be solved by narrowly focused legislation but only by a modification of the entire health care system.     

Moral Responses and Moral Theory: Socially-based Externalist Ethics

The paper outlines a view called social (or two-level) response-dependency as an addition to standard alternatives in metaethics that allows for a position intermediate between standard versions of internalism and externalism on the question of motivational force. Instead of taking psychological responses as either directly supplying the content of ethics (as on emotivist or sentimentalist accounts) or as irrelevant to its content (as in classical versions of Kantian or utilitarian ethics), the view allows them an indirect role, as motivational props to moral teaching and thus to the general institution of moral discourse. However, they are not implied by any particular moral judgment (or speaker), so that amoralism comes out as possible. The response that defines the distinctively moral notion of wrong on this account is the second-level (social) response of forbidding some behavior; but this is ultimately to be understood in terms of (variable) individual reactions. Natural human emotion tendencies thereby constrain the content of ethics, while allowing for some degree of social variation in moral codes.     

弱智儿童在上课时和自由活动时的行为表现

研究了４１名弱智儿童。采用时间样本的方法收集材料,以期从动态角度了解弱智儿童在上课时和自由活动时的行为表现。按园别和智力落后程度两个方面对被试在上课时的８大类行为和自由活动时的７大类行为进行了分析。结果发现：班级人数、不同教学方法和智力落后程度与弱智儿童的行为表现有关。还对收集材料的方法、园别和智力落后程度与弱智儿童的行为表现的关系、高频率的自娱活动等,进行了讨论。最后,根据研究结果对教师提出了教学建议。     

一日龄小鸡的记忆保持及其与脑内加压素（AVP）含量的相关研究

以一日龄小鸡为实验对象,进行一次性厌恶回避反应训练,并应用加压素的放射免疫测定法,分析比较记忆保持测验中,成绩优、劣及对照组动物与其脑内加压素含量的相关。实验结果表明,记忆保持良好的动物,脑内加压素含量明显低于对照组和记忆不良组,而记忆不良组与对照组之间则无明显差异。提示在正常生理状态下,加压素参与记忆过程的调制,并可能在这一过程中有一定的耗竭或合成减少,如适时得以补充,则对记忆的巩固和再现起易化作用。     

The Wall: On the psychology of the reunification of Germany

The fall of the Berlin Wall, which separated West Germans and East Germans for decades, led to emotional catastrophe among the reunited peoples. The authors conducted a psychological research program in Berlin to analyze individual and interpersonal processes in the reunification. They describe four categories used to pinpoint different (largely unconscious) levels of coping and defense strategies used to deal with the changes: control, splitting, symbiosis, and integration.Thomas Krauss, Dr. phil., is a family therapist and teaching supervisor. From 1985–1990 he worked as scientific employee at the Free University Berlin. Angelika Fass, Dr. phil., is a family therapist and teaching supervisor. From 1986–1991 she worked as scientific employee (research and lecturer) at the Technical University in Berlin. Reprint requests should be sent to the authors at Markt 2, D-29493 Schnackenburg, Germany.Translation by Ann Brandt.