Enhancing the care of children with chronic diseases through the narratives of patient,physician, nurse and carer

We tested the hypothesis that a narrative approach may enhance a bio‐psycho‐social model (BPS) in caring for chronically ill children. Forty‐eight narratives were collected from 12 children with six different medical conditions, their mothers, physicians, and nurses. By a textual analysis, narratives were classified on their predominant focus as disease (biological focus), illness (psychologic focus), or sickness (social focus). Sixty‐one percent of narrative’ text were classified as illness, 28% as disease and 11% as sickness. All narratives had a degree of illness focus. Narratives by patients and physicians on the one hand, and nurses’ and mothers’ on the other were disease focused. Narratives were also evaluated with respect to the type of medical condition: Illness was largely prevalent in all but Crohn’s disease and HIV infection, the latter having a predominance of sickness most probably related to stigma. Narrative exploration proved a valuable tool for understanding and addressing the needs of children with complex conditions. Narrative approaches allow identification of the major needs of different patients according to health conditions and story tellers. In the narratives, we found a greater illness and disease focus and surprisingly a low sickness focus, except with HIV stories. Narrative medicine provides a tool to strengthen the BPS model in health care.     

Joseph Margolis on Pragmatism

This paper begins with a memoir of the author’s interactions with Joseph Margolis that delineates both Margolis’s importance as a teacher and their disagreements on aspects of American philosophy. It then turns to Margolis’s discussions of pragmatism as a philosophical movement, with an emphasis on his understanding of John Dewey. The paper considers, third, Margolis’s account of the decline and rebirth of pragmatism, the latter process attributed largely to the work of Richard Rorty. The paper concludes with an examination of what it sees as Margolis’s most valuable work: his explorations of the nature of the self and of human society.     

被动性社交网站使用与青少年体像烦恼的关系:体像比较和体像自我差异的中介作用

为探讨被动性社交网站使用和青少年体像烦恼的关系,基于社会比较理论和自我差异理论,采用被动性社交网站使用问卷、社交网站体像比较量表、理想体像问卷和体像烦恼量表,对789名初、高中生进行调查。结果表明：（1）被动性社交网站使用对青少年体像烦恼具有显著的正向预测作用;（2）体像比较和体像自我差异能在被动性社交网站使用和体像烦恼的关系中起中介作用;（3）在被动性社交网站使用与体像烦恼的关系中,女生的体像比较和体像自我差异起并行中介作用,而对男生而言,体像比较和体像自我差异起链式中介作用。研究结果表明被动性社交网站使用不仅能直接影响青少年的体像烦恼,还可通过体像比较和体像自我差异的间接作用对青少年体像烦恼产生影响,且中介路径存在性别差异。     

初中生友谊质量与孤独感的变化轨迹:一项多元潜变量增长模型分析

为考察初中生友谊质量与孤独感的变化轨迹及两者间的关系,采用关系网络问卷、孤独感量表对西安市的875名初中生（M=12.73±0.18;男生494名）进行三年追踪测量,使用多元潜变量增长模型进行分析。结果发现：（1）初中三年,中学生的友谊质量逐渐提高,孤独感水平逐渐下降;（2）初一时的友谊质量和孤独感水平存在显著的个体差异,初中三年期间二者的发展速度也存在个体差异;（3）初一时的友谊质量可显著预测初一时的孤独感水平（β=-1.77,p<0.001）及随后的发展速度（β=0.20,p<0.05）;（4）男生的孤独感水平初始值高于女生,友谊质量的初始值则低于女生;高SES个体孤独感的起始值高于低SES个体。本研究结果揭示了初中三年期间个体友谊质量与孤独感的动态变化关系及友谊质量对孤独感的预测作用,对改善青少年孤独感的现状有一定的现实指导意义。     

右侧颞顶联合区及道德加工脑网络的功能连接预测社会性框架效应：来自静息态功能磁共振的证据

社会性框架效应指个体进行社会性决策时, 描述方式(即框架)对其选择倾向的影响。采用“伤害/帮助框架”范式, 本研究在行为上发现了显著的框架效应：被试在伤害框架下比帮助框架下, 更倾向于选择利他选项, 这可能是由于伤害框架凸显了伤害他人的后果及有意性, 从而提高了道德冲突水平。在神经活动上发现(1)静息态下, 右侧颞顶联合区(TPJ)的低频振荡振幅(ALFF)与框架效应强度存在显著正相关; (2)道德加工相关脑区构成的局部脑网络内部的功能连接强度(FC)能够有效预测框架效应强度。本研究首次利用静息态功能连接探讨个体的社会性决策受到语言表述方式影响的神经机制, 为进一步揭示社会决策中的个体差异提供了神经学证据。     

Discerning Mouse Trajectory Features With the Drift Diffusion Model

Mouse tracking, a new action-based measure of behavior, has advanced theories of decision making with the notion that cognitive and social decision making is fundamentally dynamic. Implicit in this theory is that people's decision strategies, such as discounting delayed rewards, are stable over task design and that mouse trajectory features correspond to specific segments of decision making. By applying the hierarchical drift diffusion model and the Bayesian delay discounting model, we tested these assumptions. Specifically, we investigated the extent to which the “mouse-tracking” design of decision-making tasks (delay discounting task, DDT and stop-signal task, SST) deviate from the standard “keypress” design of decision making tasks. We found remarkable agreement in delay discounting rates (intertemporal impatience) obtained in the keypress and mouse-tracking versions of DDT (ρ = 0.90) even though these tasks were given about 1 week apart. Rates of evidence accumulation converged well in the two versions (DDT, ρ = .86; SST, ρ = .55). Omission/commission error in SST showed high agreement (ρ = .42, ρ = .53). Mouse-motion features such as maximum velocity and AUC (area under the curve) correlated well with nondecision time (ρ = −.42) and boundary separation (ρ = .44)—the amount of information needed to accumulate prior to making a response. These results indicate that the response time (RT) and motion-based decision tasks converge well at a fundamental level, and that mouse-tracking features such as AUC and maximum velocity do indicate the degree of decision conflict and impulsivity.     

Linguistic Distributional Knowledge and Sensorimotor Grounding both Contribute to Semantic Category Production

The human conceptual system comprises simulated information of sensorimotor experience and linguistic distributional information of how words are used in language. Moreover, the linguistic shortcut hypothesis predicts that people will use computationally cheaper linguistic distributional information where it is sufficient to inform a task response. In a pre-registered category production study, we asked participants to verbally name members of concrete and abstract categories and tested whether performance could be predicted by a novel measure of sensorimotor similarity (based on an 11-dimensional representation of sensorimotor strength) and linguistic proximity (based on word co-occurrence derived from a large corpus). As predicted, both measures predicted the order and frequency of category production but, critically, linguistic proximity had an effect above and beyond sensorimotor similarity. A follow-up study using typicality ratings as an additional predictor found that typicality was often the strongest predictor of category production variables, but it did not subsume sensorimotor and linguistic effects. Finally, we created a novel, fully grounded computational model of conceptual activation during category production, which best approximated typical human performance when conceptual activation was allowed to spread indirectly between concepts, and when candidate category members came from both sensorimotor and linguistic distributional representations. Critically, model performance was indistinguishable from typical human performance. Results support the linguistic shortcut hypothesis in semantic processing and provide strong evidence that both linguistic and grounded representations are inherent to the functioning of the conceptual system. All materials, data, and code are available at https://osf.io/vaq56/ .     

Word Order Variation is Partially Constrained by Syntactic Complexity

Previous work suggests that when speakers linearize syntactic structures, they place longer and more complex dependents further away from the head word to which they belong than shorter and simpler dependents, and that they do so with increasing rigidity the longer expressions get, for example, longer objects tend to be placed further away from their verb, and with less variation. Current theories of sentence processing furthermore make competing predictions on whether longer expressions are preferentially placed as early or as late as possible. Here we test these predictions using hierarchical distributional regression models that allow estimates of word order and word order variation at the level of individual dependencies in corpora from 71 languages, while controlling for confounding effects from the type of dependency (e.g., subject vs. object), and the type of clause (main vs. subordinate) involved as well as from trends that are characteristic of individual languages, language families, and language contact areas. Our results show the expected correlations of length with position and variation only for two out of six dependency types (obliques and nominal modifiers) and no difference between clause types. These findings challenge received theories of across-the-board effects of complexity on word order and word order variation and call for theoretical models that relativize effects to specific kinds of syntactic structures and dependencies.     

Reflections on the role of the analytic setting in the light of COVID-19

There have been many reflections, both individual and collective within our Institutes, on the effects on our work with patients caused by COVID-19 and the requirement to move suddenly from the setting of our own consulting rooms to working with patients online (see also, the previous issue of this Journal). This paper focuses on what we have learned from these experiences that can add to our knowledge about the role of the setting in analytic work. Drawing on Bleger’s (1967) seminal paper highlighting the usual setting as a mute projection carrier for primitive wishes and affects, the paper explores how different patients have reacted to the loss of the analyst as the guardian of the setting and in particular as an embodied presence. Some key questions and challenges for both patients and analysts during the pandemic, when ‘the setting begins to weep’, are explored.     

自发性知觉经络反应中产生刺麻感和积极情绪的原因

自发性知觉经络反应(autonomous sensory meridian response,ASMR)是指在特定的视听刺激下,某些个体(ASMR敏感个体)在头皮后部、颈部乃至全身体验到一种令人极度愉快和放松的刺麻感的现象。其中,刺麻感的产生可能是个体大脑中负责感觉和肌肉运动的脑区高度激活引起的; 而与情绪和奖赏有关脑区的高度激活以及心率和呼吸频率的下降可能是产生愉快和放松感的重要原因。相比普通个体,ASMR敏感个体具有较高的神经质、共情特质、感觉受暗示性和特质正念。这可能说明ASMR敏感个体的感觉敏感性较高,情绪稳定性较弱,且比较关注自己身体的内外感受。这些个性特质可能导致ASMR敏感个体对某些视听刺激中所包含的一些感觉和情绪信息更加敏感,对其反应也更加强烈。目前,ASMR已经被用于抑郁,压力,失眠和慢性疼痛等的临床治疗以及商业广告之中。但ASMR可能会干扰个体的执行功能,在认知控制需求较高的情景下应尽量避免接触ASMR刺激。