Why using “consciousness” in psychotherapy? Insight,metacognition and self-consciousness

Since its early development, clinical psychology has questioned the impact of “consciousness” on the determination of human responsibility across psychiatric disorders. In recent years, specific clinical approaches have focused on “consciousness” work that could play a key role in psychotherapy. We focused our research on clinical psychology's consciousness-related concepts of insight, self-consciousness, and metacognition. Insight and metacognition, for example, have prompted increased interest in schizophrenia (SZ), bipolar disorder (BD), and, more recently, borderline personality disorder (BPD) treatments as representative of the latest advances in the cognitive and behavioral therapy field. Here we review cognitive, social, and clinical psychology research measuring “consciousness” in BPD, SZ, and BD, exploring the implications of different conceptualizations of consciousness-like concepts for treatment adherence, symptom evolution, and related aspects of psychotherapy. Our results show the overall relevance of using measures of clinical and cognitive insight, emphasizing the more central role of cognitive insight and metacognition in psychotherapy, as it appears that consciousness can remain useful if understood as a cognitive skill. The inclusion of a conceptualization of self-consciousness is important in order to address the social component of psychotherapy, as it does in biopsychosocial approaches. We discuss the implications of such results for global efficacy, for the relevance of the “consciousness” concept to clinical psychology, and for the potential need to keep operationalizing different conceptualizations of it in psychotherapy. We open the debate on the definition of consciousness to motivational aspects of change and to general considerations of both legal and ethical aspects.     

美国高等临床药学教育体系宏观结构变迁研究（1965年～2015年）

研究了1965年~2015年美国高等临床药学教育体系的层次结构、形式结构和分布结构等宏观结构的变迁情况。从临床药学实践、药师动态短缺、产业结构基础、办学经费来源、人口地理分布等方面,对半个世纪以来美国临床药学教育体系宏观结构变迁情况进行归因分析。在总结并肯定美国高等临床药学教育体系极高的市场敏感性和较强的结构优化灵活性的同时,探讨了美国高等临床药学教育体系宏观结构变迁过程中需要注意的问题。     

美国补充与替代医疗体系的变迁及公众影响力

基于美国对补充与替代医学 (Complementary and Alternative Medicine, CAM) 的政策性文件, 结合美国亚马逊公司旗下产品"亚马逊 (美国) "的CAM图书的种类分布和销量情况, 以及美国公民使用CAM疗法的调查数据, 梳理了美国CAM体系变迁及公众影响力。美国政府对CAM的政策及体系界定经历了数次变迁。中医等传统医学及部分疗法在CAM体系内的归类发生过变化。部分CAM疗法被吸纳入美国医疗卫生保健体系。CAM在美国公众中有着巨大影响力。中医在美国的公众影响力主要在于针灸疗法, 且影响力在CAM疗法中并不突出。     

The borderlands of waking: Quantifying the transition from reflective thought to hallucination in sleep onset

We lose waking consciousness spontaneously and regularly over the circadian cycle. It seems that every time we fall asleep, reflective thinking gradually gives way to our interactions with an imaginary, hallucinatory world that brings multimodal experiences in the absence of adequate external stimuli. The present study investigates this transition, proposing a new measure of hallucinatory states. Reflective thinking and motor imagery were quantified in 150 mentation reports provided by 16 participants after forced awakenings from different physiology-monitored time intervals after sleep onset. Cognitive agency analysis and motor agency analysis – which are objective (grammatical–semantic) tools derived from linguistic theories – show (i) a decrease in reflective thinking which sleepers would need to acknowledge the hallucinatory quality of their state, and (ii) an increase in motor imagery, indicating interactions with a hallucinatory world. By mapping these spontaneous changes in human consciousness onto physiology, we can in the long run explore the conditions of its decline, and possibilities for treatment.     

Comparison of Privacy Consciousness Between Younger and Older Adults

The degree of being conscious about privacy for the self and others is known as privacy consciousness. This study aimed to compare privacy consciousness between younger and older adults. Japanese younger (n = 166) and older (n = 145) adults were requested to rate all items in the Privacy Consciousness Scale, which assessed their degree of consciousness about privacy for the self and others and behaviors for maintaining privacy based on this consciousness. Results indicated that older adults scored lower on Consciousness Regarding Privacy of Others and higher on Behaviors Regarding Privacy of Others than younger adults. However, no significant difference was found in Consciousness and Behaviors Regarding Privacy of the Self between younger and older adults.     

Gradedness of visual awareness depends on attentional scope: Global perception is more graded than local perception

The gradedness or discreteness of our visual awareness has been debated. Here, we investigate the influence of spatial scope of attention on the gradedness of visual awareness. We manipulated scope of attention using hierarchical letter-based tasks (global: broad scope; local: narrow scope). Participants reported the identity of a masked hierarchical letter either at the global level or at the local level. We measured subjective awareness using the perceptual awareness scale ratings and objective performance. The results indicate more graded visual awareness (lesser slope for the awareness rating curve) at the global level compared to the local level. Graded perception was also observed in visibility ratings usage with global level task showing higher usage of the middle PAS ratings. Our results are in line with the prediction of level of processing hypothesis and show that global/local attentional scope and contextual endogenous factors influence the graded nature of our visual awareness.     

Refuting the unfolding-argument on the irrelevance of causal structure to consciousness

The unfolding argument (UA) was advanced as a refutation of prominent theories, which posit that phenomenal experience is determined by patterns of neural activation in a recurrent (neural) network (RN) structure. The argument is based on the statement that any input–output function of an RN can be approximated by an “equivalent” feedforward-network (FFN). According to UA, if consciousness depends on causal structure, its presence is unfalsifiable (thus non-scientific), as an equivalent FFN structure is behaviorally indistinguishable with regards to any behavioral test. Here I refute UA by appealing to computational theory and cognitive-neuroscience. I argue that a robust functional equivalence between FFN and RN is not supported by the mathematical work on the Universal Approximator theorem, and is also unlikely to hold, as a conjecture, given data in cognitive neuroscience; I argue that an equivalence of RN and FFN can only apply to static functions between input/output layers and not to the temporal patterns or to the network’s reactions to structural perturbations. Finally, I review data indicating that consciousness has functional characteristics, such as a flexible control of behavior, and that cognitive/brain dynamics reveal interacting top-down and bottom-up processes, which are necessary for the mediation of such control processes.     

A Phenomenological Study on the Experience of Syrian Asylum-Seekers and Refugees in the United States

Violence in Syria has displaced an unprecedented number of people from their homes. While couple/family therapy (C/MFT) scholars have explored migration experiences, particularly among refugees, there is still limited research using a bioecological framework. This exploratory study examined the experiences of Syrian asylum-seekers and refugees living in the United States using a qualitative phenomenological approach. Twelve Syrians (n = 8 men, n = 4 women) between 20 and 52 years of age (M = 35.8, SD = 10.7) were interviewed about their experiences across three stages of resettlement: (1) pre-resettlement, (2) resettlement/migration, and (3) post-resettlement. Findings suggest that the effects of conflict-induced displacement and resettlement permeate across multiple ecologies. These range from the individual and his or her interpersonal relationships to their larger community and society. C/MFTs should account for contextual factors while becoming familiar with the sociopolitical impact of displacement and resettlement in their clinical work with this population.     

Blackout of my nights: Contentless,timeless and selfless report from the night in patients with central hypersomnias

At the extreme spectrum of consciousness during sleep, some patients with rare hypersomnias reported experiencing a specific night ‘blackout’ when sleeping, i.e., an absence of experiences or recall of them from sleep onset to offset. Thus, we explored through questionnaires the conscious experiences (dreaming experience, mind, self) during the night in 133 patients with idiopathic hypersomnia, 108 patients with narcolepsy, and 128 healthy controls. The night blackout was more frequent in idiopathic hypersomnia than in narcolepsy and control groups. Patients with idiopathic hypersomnia and frequent night amnesia had lower dream recall frequencies, and felt more often sleep as deep and mind as blank during the night. They had a higher proportion of slow wave sleep on their (retrospectively collected) sleep recordings than those without night blackout. This night blackout provides a new model for studying loss of consciousness during sleep, here as a contentless, selfless and timeless feeling upon awakening.