成瘾的生物心理社会模型

成瘾的易感因素和维持因素是一个复杂的因果网络系统．有三种研究取向。生物学取向综述了成瘾的脑机制和遗传基因观。心理学模式主要介绍成瘾人格的研究现状,以及成瘾的强化观。社会因素则阐述了创伤性事件、父母及同伴压力对成瘾的影响。本文支持三个因素的相互作用导致了成瘾行为的发生,以期从成瘾易感和维持因素的探析上为生物心理社会模型(BPS)提供依据。     

Anxiety, Attributional Thinking, and the Primary Process

In earlier publications, experimental evidence was provided for the existence of the primary vs. secondary process mental organization posited by Freud. A well-established cognitive categorization test based on attributional and relational similarity was found to map on to primary and secondary principles of mental organization respectively, thus offering the opportunity to test hypotheses drawn from psychoanalytic theory independent of the clinical situation. In prior work, primary process shifts occurred under three different conditions-all predicted by psychoanalytic theory: (1) when stimuli were (subliminal) unconscious; (2) when participants were 3-5 years of age; and (3) when tasks were implicit. In the current study, a fourth condition is examined dealing with the relationship of conscious anxiety to primary and secondary processes. In a naturalistic study, 120 patients waiting in medical center waiting rooms rated how anxious they felt on a 10-point scale and then completed a version of the categorization test alluded to above. Those who reported any anxiety at all showed a signifi cant shift toward primary process categorization over those participants who rated themselves as calm. The implications of this fourth fi nding are discussed with respect to signal anxiety and symptom formation.     

Oneiric activity and the analytical process A semiotic perspective on Willy Baranger's theory of dreams1

This author reconsiders, from a semiotic perspective, the theoretical and technical ideas developed by Willy and Madeleine Baranger, especially W. Baranger's views on the function of dreams, the status of oneiric symbols and the further clinical‐technical use of dreams in the context of the intersubjective dynamic fi eld, together with the basic unconscious fantasy that emerges in the analytic situation. She attempts to relate the Barangers' ideas to others arising from Peirce's analytic semiotics that would support a triadic conceptualization of dreams. The need to incorporate a pragmatic view of communication and of the processes of production of sense as contributions to dream metapsychology and interpretation in the case of non‐neurotic patients is particularly emphasized. On the basis of the hypothesis of a described series of triads underlying the production and retelling of dreams, the acknowledgment of these produced/told dreams as intentional signs allows the presence of a continuous process of semiosis to be proposed. The author introduces clinical material to illustrate the communicative value of dreams through the textual analysis of the report and accompanying associations of three dreams. Such analysis takes a linguistic pragmatics approach that examines those aspects of meaning not accounted for by a restricted semantic theory.     

SPIRIT HEALING,MENTAL HEALTH,AND EMOTION REGULATION

Abstract. Spirit healing is widespread across societies in diverse world regions. Its ritual forms appear in local, popular religions as well as a variety of organized churches. Although aspects of ritual, suchas the identification of spirits and use of symbols and paraphernalia, vary with culture and type of religion, there appear to be basic components of ritual healing process shared by its diverse forms. Using data on Spiritist healing in Puerto Rico as a case example, I first examine aspects of the interface between mental illness as defined by psychiatry and spirit healing. I then raise the question: If spirit healing is effective with some emotional disorders (as I have discussed in previous reports), how does it work? Emotional transactions could be considered foundational to most or all spirit healing rituals as they are to some psychotherapeutic and alternative‐medicine modalities. One model of emotion regulation is proposed as a lens through which to view specific processes of change in feelings and emotions in the context of culturally specified ritual structures.     

Establishing visual category boundaries between objects: a PET study

Individuals with Alzheimer's disease (AD) often have problems in recognizing common objects. This visual agnosia may stem from difficulties in establishing appropriate visual boundaries between visually similar objects. In support of this hypothesis, showed that AD subjects have difficulties in establishing visual category boundaries between continuously graded shapes. In an attempt to investigate the neural basis of these impairments, the current study required a group of neurologically healthy elderly participants to categorically classify a series of ellipses varying in width while regional blood flow changes were measured using positron emission tomography (PET). Two categorization conditions were compared in order to isolate changes in cortical activity that dissociated the categorization of shapes situated either near or far from a category boundary that divided the width continuum. The participants produced a discontinuity in the probability and speed of categorizing the shapes at some point along the continuum, suggesting that the objects were classified into distinct categories. Moreover, a comparison of the PET scans obtained while the subjects were categorizing the shapes situated near vs. far form the category boundary revealed significant differences in cortical activity in the parietal and frontal brain areas. These findings suggest that both visuo-spatial and decision making mechanisms may be involved in establishing categorical distinctions between continuously graded stimuli. It is proposed that the functional role of the parietal and frontal cortical regions in establishing visual boundaries between categories of objects may be relevant for understanding object recognition impairments in AD.     

Sketches from a design process: creative cognition inferred from intermediate products

Novice designers produced a sequence of sketches while inventing a logo for a novel brand of soft drink. The sketches were scored for the presence of specific objects, their local features and global composition. Self-assessment scores for each sketch and art critics' scores for the end products were collected. It was investigated whether the design evolves in an essentially random fashion or according to an overall heuristic. The results indicated a macrostructure in the evolution of the design, characterized by two stages. For the majority of participants, the first stage is marked by the introduction and modification of novel objects and their local and global aspects; the second stage is characterized by changes in their global composition. The minority that showed the better designs has a different strategy, in which most global changes were made in the beginning. Although participants did not consciously apply these strategies, their self-assessment scores reflect the stages of the process.     

Risk-Reduction Surgery Decisions in High-Risk Women Seen for Genetic Counseling

Women at greatest risk for hereditary breast and ovarian cancer may consider prophylactic removal of breasts or ovaries as a risk-reduction measure. This report describes uptake of risk-reduction mastectomy (RRM), risk-reduction oophorectomy (RRO), and related factors in 62 high-risk women who received genetic counseling. Seven (11%) participants underwent RRM and 13 (21%) underwent RRO. Of these women, 37% did not have BRCA testing, suggesting other factors influence decisions to undergo surgery. Women who had indicated (pre-genetic counseling) their intent not to have surgery chose not to have surgery. Information received during genetic counseling that women perceived as being most important for influencing risk-reduction surgery decisions was BRCA test result (positive or negative), followed by discussion of family cancer history. Reasons for indecision about risk-reduction surgery included genetic testing results, concerns about surgery, timing in life, and early menopause. The findings enhance our understanding of information that is helpful to women considering this surgery.     

Diverse Phases of Collaboration: Working Together to Improve Community-Based HIV Interventions for Adolescents

Although alliances between community-based organizations (CBOs) and university-based evaluators provide opportunities to enhance community-based interventions, such partnerships may be fraught with challenges and obstacles. This paper focuses on the "story" behind a collaborative partnership between a Latino-focused CBO and a team of university-based evaluators that was formed to evaluate HIV prevention interventions for Mexican American female adolescents and gay/bisexual/questioning (GBQ) Latino male adolescents. A developmental trajectory of the partnership is detailed, with a focus on the creation and enhancement of a reciprocal and mutually beneficial relationship. In tracing this history, the paper explores challenges that were faced and presents ways in which the partnership attempted to overcome obstacles. Recommendations are offered to assist in the formation and maintenance of collaborative partnerships between CBOs and university-based evaluators/researchers.     

Systematic Changes in Families Following Prevention Trials

A selective prevention design was applied to 238 recently separated families. Of these, 153 mothers randomly assigned to the experimental (E) group participated in 14 group sessions focused on Parent Management Treatment (PMT). Prior analyses showed that, over time, the group of families in the untreated group deteriorated in both parenting practices and in child outcomes. In keeping with the classic prevention pattern, families in the E group showed modest improvements in parenting and in child outcomes. Improvements in parenting were associated with significant reductions in problem behavior. The data showed that those mothers who improved their parenting skills during the first 12 months also showed significant reductions in maternal depression during that same interval. A cross-lagged panel analysis showed that a reduction in maternal depression during the first year of the study was a significant predictor of maintenance or improvements over the next 18 months. The findings are consistent with the concept of the family as a system.     

Multiple memory systems: the power of interactions

Two relatively simple theories of brain function will be used to demonstrate the explanatory power of multiple memory systems in your brain interacting cooperatively or competitively to directly or indirectly influence cognition and behaviour. The view put forth in this mini-review is that interactions between memory systems produce normal and abnormal manifestations of behaviour, and by logical extension, an understanding of these complex interactions holds the key to understanding debilitating brain and psychiatric disorders.