Giving meaning to illness: An investigation of self-defining memories in patients with relapsing-remitting multiple sclerosis patients

Multiple sclerosis (MS) patients are often unable to adequately fulfill their established roles due to physical disabilities and cognitive changes, making this chronic illness particularly threatening to personal identity. Twenty-five MS patients and 25 healthy controls were asked to recall five self-defining memories (SDM). Overall characteristics of SDM did not differ between patients and controls; MS patients displayed preserved capacity to draw meaning upon past events. Moreover, almost two-thirds of MS patients mentioned at least one illness related SDM and about 25% of patients’ SDM referred to MS. These memories were experienced as more negative and associated with more tension than other SDM but led toward more positive emotion and less negative emotion over time; they were also more central and more integrated to the personal identity. We concluded that self-challenging events due to MS may trigger both cognitive and emotional processes enabling the integration of illness in patients’ self-representations.     

Assessing the relationship of Type A beliefs to cardiovascular disease risk and psychosocial distress

Investigators have begun to take a multimodal approach to the assessment and treatment of psychosocial risk factors for cardiovascular disease (CVD). For instance, cognitive responses have become the focus of contemporary research along with continued examination of overt Type A behaviors. Price (1982) has outlined a set of beliefs purportedly associated with Type A behavior and subsequent CVD risk. The current study examines the validity of this belief set as represented by a newly developed measure, the Type A Cognitive Questionnaire (TACQ). Subjects were 221 employed adults participating in a worksite CVD risk reduction program. They completed the TACQ as part of a pretreatment CVD risk screening protocol. As hypothesized, TACQ scores were significantly associated with Type A behavior, hostility, physiological mediators of CVD, and psychosocial distress. Discussion addresses continued refinement of the Type A belief construct.     

Choice between reliable and unreliable outcomes: mixed percentage-reinforcement in concurrent chains.

Pigeons' choices between alternatives that provided different percentages of reinforcement in mixed schedules were studied using the concurrent-chains procedure. In Experiment 1, the alternatives were terminal-link schedules that were equal in delay and magnitude of reinforcement, but that provided different percentages of reinforcement, with one schedule providing, reinforcement twice as reliably as the other. All pigeons preferred the more reliable schedule, and their level of preference was not systematically affected by variation in the absolute percentage values, or in the magnitude of reinforcement. In Experiment 2, preference for a schedule providing 100% reinforcement over one providing 33% reinforcement increased systematically with increases in the duration of the terminal links. In contrast, preference decreased systematically with increases in the duration of the initial links. Experiment 3 examined choice with equal percentages of reinforcement but unequal delays to reinforcement. Preference for the shorter delay to reinforcement was not systematically affected by variation in the absolute percentage of reinforcement. The overall pattern of results supported predictions based on an extension of the delay-reduction hypothesis to choice procedures involving mixed schedules of percentage reinforcement.     

Exploring the Context-Sensitivity of Collective Action Motivations and the Mobilizing Role of Social Media: A Comparative Interview Study With Activists in Germany and Turkey

Western scholarship has underlined the relevance of social identity, perceived efficacy, emotions, and cost–benefit assessments as central catalysts of collective action. Little has been done to understand the context-sensitivity of these catalysts by means of cross-culturally comparative designs. The current study explores their context-sensitivity. It aims to find out whether existing opportunity structures in a democratic, nonrepressive country like Germany produce catalysts of collective action different from those produced in an autocratic, repressive country like Turkey. It also aims to understand the role of social media in mobilizing people in these two contexts. Semistandardized interviews with activists were carried out in both countries (n = 18 in Germany and n = 15 in Turkey) and analyzed by means of a cross-culturally comparative inductive coding procedure including initial and focused coding. Results show that collective action is related to different configurations of collective-action catalysts in the two countries. Solidarity concerns at the face of existential risks are more pronounced in Turkey, whereas political-change concerns are more important in Germany. The role of social media accordingly differs, adhering to the different activist goals. Theoretical implications for the role of context in studying collective action are discussed.     

Telehealth parent training for a young child at risk for autism spectrum disorder

The global pandemic has highlighted the importance of telehealth to access behavioral interventions. Face-to-face parent training improves the development and behaviors of young children at risk for autism spectrum disorder (ASD). We evaluated a telehealth parent training intervention for a child at risk for ASD. Two parents identified possible early ASD symptoms in their 30-month-old son (lack of imitation, pointing, and vocal manding). Both parents simultaneously received telehealth behavioral skills training on the Parent Intervention for Children at Risk for Autism program for 1 hour per week over 29 weeks. Multiple baseline designs across parent and child behaviors showed that both parents improved their parent teaching fidelity above 80% and the child improved on all trained behaviors. This study expands the utility of telehealth behavioral parent training to young children at risk for ASD to mitigate early symptoms of ASD.     

People who help people: A needs assessment of those who provide interpersonal support to individuals with chronic illnesses

Social support during an ongoing illness has been shown to be beneficial for both the provider and the receiver, but people often struggle with offering effective, appropriate support. There is a lack of communication-focused training not specifically tied to caregiving or training that is designed for all social network members of a person experiencing a chronic illness, which we call interpersonal support providers (ISPs). We conducted a concurrent mixed-methods needs assessment, surveying both ISPs and support receivers, to understand communicative challenges and inform an evidence-based intervention. Analysis of results from an online survey (N_providers = 91, N_receivers = 97), consisting of five open-ended and 15 quantitative items, suggests that ISPs have difficulty managing their worries and emotions while providing comfort to others, which may impact support quality. In addition, ISPs and receivers both identify “listening” as a key skill for ISPs to hone, though ISPs feel they are more skilled at listening than receivers say they are. Lastly, ISPs feel they are good at sharing information and advice, but receivers often perceive it as patronizing or unhelpful. These results will inform the creation of an intervention for everyone offering emotional, esteem, and informational support to individuals with chronic illnesses.     

Ambiguity attitudes in qualitative contexts: The role of prior beliefs

Most studies of ambiguity aversion rely on experimental paradigms involving monetary bets. Thus, the extent to which ambiguity aversion occurs outside of such contexts is much less understood, particularly when the situation cannot easily be reduced to numerical terms. The present work seeks to understand whether people prefer to avoid ambiguous decisions in a variety of different qualitative domains (e.g., work, family, love, friendship, exercise, study, and health), and, if so, to determine the role played by prior beliefs in those domains. Across three studies, we presented participants with 24 vignettes and measured the degree to which they preferred risk to ambiguity in each. We also asked them for their prior probability estimates about the likely outcomes in the ambiguous events. Ambiguity aversion was observed in the vast majority of vignettes, but at different magnitudes. It was predicted by whether the vignette involved gain or loss as well as by people's prior beliefs; however, the heterogeneity between people meant that the role of prior beliefs was only evident in an individual-level analysis (i.e., not at the group level). Our results suggest that the desire to avoid ambiguity occurs in a wide variety of qualitative contexts but to different degrees for different people and may be partially driven by unfavorable prior estimates of the likely outcomes of the ambiguous events.     

The associations of cultural worldviews,political orientation,and trust with COVID-19 risk beliefs in the U.S.

Given that risk beliefs predict engagement in behaviors to prevent disease, it is important to understand the factors associated with risk beliefs. In the present paper, we conducted path analyses to investigate the associations of belief systems (political orientation and cultural worldviews of individualism and hierarchy) with COVID-19 risk beliefs (i.e., perceived likelihood, perceived severity, and worry about disease; Studies 1 and 2), and the indirect effect through trust in information sources in these relationships (Study 1). Two online panels of U.S. adults were surveyed at three timepoints during the COVID-19 pandemic (Study 1: baseline n = 1,667, 1-year follow-up n = 551; Study 2: n = 404). Results of path analyses indicated that, across studies and timepoints, when controlling for political orientation, trust, and demographic factors, greater individualism had consistent significant direct effects on lower perceived severity and worry about COVID-19, whereas greater hierarchy had consistent significant direct effects on lower perceived severity. However, after accounting for cultural worldviews of individualism and hierarchy (and trust and demographic factors), none of the associations among political orientation and any of the three COVID-19 risk beliefs were significant. The test of indirect effects indicated that individualism and hierarchy were indirectly associated with lower perceived severity of and worry about COVID-19 through less trust. The findings suggest that cultural worldviews of individualism and hierarchy play a role in shaping people's risk beliefs.     

Toward a new conceptualization and operationalization of risk perception within the genetic counseling domain

The purpose of this paper is twofold. First, it provides an historical overview of studies of risk, risk perception, and decision making under risk within the genetic counseling domain. Second, it proposes an alternative conceptualization and operationalization for the study of risk perception. The conceptualization involves probability, adversity, incompleteness, and ambiguity. Prior studies of risk perception focus on the recurrence risk and operationalize risk perception by asking for interpretations of the magnitude of the probability of the outcome. Their focus is on the probability of a particular outcome. We formulate the problem in terms of a gamble and suggest that risk perception be operationalized in terms of the riskiness of the gamble. Our focus is on the riskiness of a decision option which entails two or more outcomes.     

Praxis makes perfect: Illness as a bridge between biological concepts of disease and social conceptions of health

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory are outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy.