Challenges of patient‐led mental health services to psychoanalytic clinicians

This paper considers implications to psychoanalytic psychotherapy of the British Government's decision to implement a patient choice agenda for state‐funded mental health services in England and Wales. It places the patient choice agenda in the context of consumerist society and argues that the complex nature of psychoanalytic psychotherapy leaves it more vulnerable than other psychological therapy modalities to compete in the current reality of ‘consumer’‐led public mental health, which, in turn reflects a profoundly changed social context from that to which psychoanalysis traces its roots. Unless psychoanalytic clinicians recognize and find ways to adjust to this context they will jeopardize the survival of psychoanalytic psychotherapy in an increasingly market‐orientated model of mental healthcare provision in the public sector, eager to promote more ‘consumer friendly’ psychological therapy models.     

Dynamic processes in emotion regulation choice

ABSTRACT

Because emotion regulation (ER) processes operate over time, they potentially change the context in which subsequent ER processes occur. To test this proposal, fifty-two healthy participants completed the ER choice task. Thirty standardized low- and high-intensity negative images were used to generate different emotional contexts in which participants selected between distraction or reappraisal strategies to decrease the intensity of their negative emotion. Participants then implemented their selected strategy and rated their negative emotion. Using a dynamic perspective, we examined as predictors of ER strategy choice, in addition to current stimulus intensity, several contextual factors from the immediately preceding trial: preceding stimulus intensity and strategy choice, and the intensity of negative affect following the previous strategy implementation and thus preceding the current trial. Results replicated earlier findings that participants are more likely to choose distraction for high-intensity images. Extending earlier findings, selecting reappraisal in the preceding trial and greater negative affect preceding the current trial were associated with lower odds of choosing distraction. The lack of significant interactions among the current and preceding trial factors suggests that these effects on ER choice were direct and not through moderating the effect of current stimulus intensity. These findings support dynamic theories of ER.     

Using paired-choice assessment to identify variables maintaining sleep problems in a child with severe disabilities

In this study, we used a paired-choice assessment protocol to identify the relative reinforcing value of stimuli and activities for a child with severe disabilities when she failed to settle to sleep at night. The results of this assessment indicated that the child preferred the mother's attention relative to other activities presented. Assessment results were incorporated into an intervention, that produced a reduction in sleep disturbance that was maintained at a 12-month follow up.     

Effects of experience on preference between forced and free choice

Preference between forced choice and free choice in concurrent-chain schedules of reinforcement was investigated in pigeons after exposure to particular combinations of terminal links. In Experiment 1, in which terminal links always ended with reinforcers, one of three pairs of terminal links was arranged as preexposure: (a) both terminal links had only one key (forced choice), (b) both terminal links had two keys (free choice), or (c) a combination of forced and free choice was arranged across sessions. In test sessions following the preexposure, pigeons' preferences rapidly shifted to the terminal links with which they had no recent experience. In Experiment 2, the same procedure was repeated except that each terminal link ended intermittently with reinforcers with a probability of .5 and there was no terminal-link arrangement with a combination of free and forced choice. Pigeons showed the same preference changes as in Experiment 1, but the preference changes did not appear immediately at the beginning of test sessions. These data suggest that recent previous experience was a more important determinant of preference than the difference between forced-choice and free-choice terminal links.     

Independence of terminal-link entry rate and immediacy in concurrent chains

In Phase 1, 4 pigeons were trained on a three-component multiple concurrent-chains procedure in which components differed only in terms of relative terminal-link entry rate. The terminal links were variable-interval schedules and were varied across four conditions to produce immediacy ratios of 4:1, 1:4, 2:1, and 1:2. Relative terminal-link entry rate and relative immediacy had additive and independent effects on initial-link response allocation, and the data were well-described by a generalized-matching model. Regression analyses showed that allowing sensitivity to immediacy to vary across components produced only trivial increases in variance accounted for. Phase 2 used a three-component concurrent-schedules procedure in which the schedules were the same as the initial links of Phase 1. Across two conditions, the relative reinforcer magnitude was varied. Sensitivity to relative reinforcer rate was independent of relative magnitude, confirming results of prior studies. Sensitivity to relative reinforcer rate in Phase 2 did not vary systematically across subjects compared to sensitivity to relative entry rate in Phase 1, and regression analyses confirmed again that only small increases in variance accounted for were obtained when sensitivities were estimated independently compared with a single estimate for both phases. Overall, the data suggest that conditioned and primary reinforcers have functionally equivalent effects on choice and support the independence of relative terminal-link entry rate and immediacy as determiners of response allocation. These results are consistent with current models for concurrent chains, including Grace's (1994) contextual choice model and Mazur's (2001) hyperbolic value-added model.     

The repeated insertion model for rankings: Missing link between two subset choice models

Several probabilistic models for subset choice have been proposed in the literature, for example, to explain approval voting data. We show that Marley et al.'s latent scale model is subsumed by Falmagne and Regenwetter's size-independent model, in the sense that every choice probability distribution generated by the former can also be explained by the latter. Our proof relies on the construction of a probabilistic ranking model which we label the repeated insertion model. This model is a special case of Marden's orthogonal contrast model class and, in turn, includes the classical Mallows -model as a special case. We explore its basic properties as well as its relationship to Fligner and Verducci's multistage ranking model.The authors are grateful to the National Science Foundation for grants SES98-18756 to Regenwetter and Peke, and SBR97-30076 to Regenwetter. This collaborative research was carried out in the context of the conference Random Utility 2000 held at Duke University and sponsored by NSF, the Fuqua School of Business and the Center for International Business Education and Research. We thank the editor and four referees for helpful suggestions and we are grateful to Prof. J. I. Marden for providing useful information on contrast models. We thank Moon-Ho Ho for programming and running the data analyses.     

Modification of slot-machine preferences through the use of a conditional discrimination paradigm

The present experiment investigated the impact of contextually trained discriminations on gambling behavior. Nine recreational slot-machine players were initially exposed to concurrently available computerized slot machines that were each programmed on random-ratio schedules of reinforcement and differed only in color. All participants distributed responding equally across the two slot machines. A conditional discrimination procedure was then used to teach the contextual cues representing the arbitrary relations of "greater than" and "less than." Following contextual cue training, participants were reexposed to the concurrent slot-machine task. After training of the contextual cues, a higher proportion of responses were made to the slot machine that shared formal properties (i.e., color) with the contextual cue representing "greater than."