The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.     

THE BEHAVIOR OBSERVATION INSTRUMENT: A METHOD OF DIRECT OBSERVATION FOR PROGRAM EVALUATION1

The background and development of a multicategory direct observation system, the Behavior Observation Instrument (BOI), is described. This time-sampling procedure for recording the behavior of persons is demonstrated in several treatment settings and the results applied to issues of program evaluation. Elements that have prevented direct observation from being widely adopted, such as costs, manpower, and training requirements, are systematically analyzed. A basic psychometric analysis of the instrument is used to determine optimum frequency and duration of observation intervals as well as observer agreement. The results imply that direct observation methods, once assumed by some to belong to the special province of the single-subject design, can be used to assess the effects of programs on groups of psychiatric clients in an efficient and economic manner.     

Mathematics of forgiveness

This study was aimed at determining the integration rule--summation or averaging--underlying the forgiveness schema. The main reason for distinguishing between these structures is that they have very different practical implications regarding the influence of various factors specific to each case on the propensity to forgive. In a summative model, the impact of the different factors and the direction of the effects are constant. For example, the presence of apologies always is a positive element even when these apologies assume a very weak form. By contrast, in an averaging model, the apologies can be a positive or a negative element depending on the current level of propensity to forgive and the form of the apologies. Two experiments were conducted using the functional theory of cognition framework. Experiment 1 applied the missing information test. Experiment 2 applied the credibility of information test. In both experiments, clear evidence favored a summative rule for judging willingness to forgive from circumstantial information such as presence or absence of intent, presence of absence of apologies, and degree of cancellation of consequences.     

The Hastings Center and the early years of bioethics

The Hastings Center was founded in 1969 to study ethical problems in medicine and biology. The Center arose from a confluence of three social currents: the increased public scrutiny of medicine and its practices, the concern about the moral problems being generated by technological developments, and the desire of one its founders (Callahan) to make use of his philosophical training in a more applied way. The early years of the Center were devoted to raising money, developing an early agenda of issues, and identifying a cadre of people around the country interested in the issues. Various stresses and strains in the Center and the field are identified, and some final reflections are offered on the nature and value of the contributions made by bioethics as an academic field.     

The Hastings Center and the early years of bioethics

The Hastings Center was founded in 1969 to study ethical problems in medicine and biology. The Center arose from a confluence of three social currents: the increased public scrutiny of medicine and its practices, the concern about the moral problems being generated by technological developments, and the desire of one of its founders (Callahan) to make use of his philosophical training in a more applied way. The early years of the Center were devoted to raising money, developing an early agenda of issues, and identifying a cadre of people around the country interested in the issues. Various stresses and strains in the Center and the field are identified, and some final reflections are offered on the nature and value of the contributions made by bioethics as an academic field.     

A test of the circumvention-of-limits hypothesis in scientific problem solving: the case of geological bedrock mapping

Sources of individual differences in scientific problem solving were investigated. Participants representing a wide range of experience in geology completed tests of visuospatial ability and geological knowledge, and performed a geological bedrock mapping task, in which they attempted to infer the geological structure of an area in the Tobacco Root Mountains of Montana. A Visuospatial Ability × Geological Knowledge interaction was found, such that visuospatial ability positively predicted mapping performance at low, but not high, levels of geological knowledge. This finding suggests that high levels of domain knowledge may sometimes enable circumvention of performance limitations associated with cognitive abilities.     

Liberal bias mediates emotion recognition deficits in frontal traumatic brain injury

It is well-known that patients having sustained frontal-lobe traumatic brain injury (TBI) are severely impaired on tests of emotion recognition. Indeed, these patients have significant difficulty recognizing facial expressions of emotion, and such deficits are often associated with decreased social functioning and poor quality of life. As of yet, no studies have examined the response patterns which underlie facial emotion recognition impairment in TBI and which may lend clarity to the interpretation of deficits. Therefore, the present study aimed to characterize response patterns in facial emotion recognition in 14 patients with frontal TBI compared to 22 matched control subjects, using a task which required participants to rate the intensity of each emotion (happiness, sadness, anger, disgust, surprise and fear) of a series of photographs of emotional and neutral faces. Results first confirmed the presence of facial emotion recognition impairment in TBI, and further revealed that patients displayed a liberal bias when rating facial expressions, leading them to associate intense ratings of incorrect emotional labels to sad, disgusted, surprised and fearful facial expressions. These findings are generally in line with prior studies which also report important facial affect recognition deficits in TBI patients, particularly for negative emotions.     

Perspectives of Adults Living With Autism Spectrum Disorder: Psychosocial and Occupational Implications

The incidence of Autism Spectrum Disorder (ASD) has increased over the past decade suggesting a need for further research. This article describes a two phase phenomenological study which explored the lived experience of ASD and its psychosocial effects on relationships, socialization, and occupational participation. Phenomenological interviews were given to three women and three men with high functioning ASD. Phase two of the research included two additional individual interviews and four focus groups. Results indicated themes regarding participants' desires to engage in social occupations, and barriers caused by the nature of the ASD which may successfully be addressed by occupational therapy.