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Results for “Reality Testing”

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PubMed2004

Acceptance of the unpleasant reality of chronic pain: effects upon attention to pain and engagement with daily activities.

This paper investigates whether acceptance was related to less attention to pain, and to more engagement with daily activities. The results of two studies are reported. In a first cross-sectional study, 501 chronic pain patients completed self-report instruments on pain severity, attention to pain and acceptance. In a second diary study, 62 patients with chronic pain reported pain intensity, attention to pain and characteristics of goal-directed behaviour 8 times a day using an experience sampling method. Acceptance was measured using a self-report instrument. It was found that acceptance was related to less attention to pain (study 1 and study 2), more engagement with daily activities, a higher motivation to complete activities and a better efficacy to perform daily activities (study 2). Results are discussed in terms of how a positive life despite pain may be preserved by a flexible adjustment of personal goals to current limitations and adversities.

Activities of Daily Living↗
PubMed2005

Management of allergic problems in primary care: time for a rethink?

Allergic diseases affect 20-30% of the UK population and when severe are associated with considerable morbidity and occasional mortality. Initiatives to improve allergy services in the UK have been led by consultant allergists and have focussed on increasing the number of hospital training posts to improve access to specialist services. A high profile campaign to raise awareness of the lack of allergy services has so far failed to generate further training numbers for allergy as a single specialty. Although the campaign to improve tertiary allergy services continues, most mild or moderate allergy symptoms (e.g. hayfever, allergic asthma, urticaria and some food allergy problems), can be managed successfully in primary care with appropriate interest and training. Despite the high and increasing numbers of patients with allergy and the ease with which the majority of symptoms can be controlled, many doctors in primary care are reluctant to take a more proactive approach to managing allergic conditions. This appears to be due to concerns about overburdening an already busy service, but may also be due to recommendations from allergy specialists which have implied that high quality allergy care is not possible without identification of specific allergic triggers using skin prick tests or blood tests. In reality, symptoms can usually be controlled using pharmacotherapy, although a working knowledge of the appropriate guidelines is helpful. In this paper, we propose minimum levels of knowledge for all practitioners in order to raise the standards of primary care allergy management, and provide recommendations for training for those wishing to manage successfully more difficult allergy cases and allergy diagnosis.

Journal Article↗
PubMed2005

Comparisons between psychosis samples with different patterns of substance use recruited for clinical and epidemiological studies.

Despite high rates of comorbid substance use disorders and smoking among people with psychotic disorders, previous studies have not examined differences in socio-demographic, clinical or disability characteristics between psychosis sub-groups with different patterns of substance use. This study compared the characteristics of five groups of people with psychosis and varying patterns of substance use (n=1152), including groups entering treatment studies for substance use or smoking, epidemiological samples of substance users and smokers, and people without such problems. Data were drawn from several recent Australian studies using comparable structured interviews and scales. There were moderate group differences in illness and symptom profiles, with substance users tending to have higher depression and reality distortion scores. Unexpectedly, personal disability was considerably lower among those seeking treatment for their substance use compared with the epidemiological groups, raising concerns about the appropriateness of traditional recruitment approaches in treatment studies and highlighting the need for more assertive treatment engagement and referral strategies in routine clinical settings. As a consequence of uncertainty about links between substance use and everyday functioning, it is suggested that health messages to young people may need to strike a better balance between the potential harms and benefits associated with substance use in pursuing broader harm minimization goals.

Adolescent↗
PubMed2006

A generalized bias against disconfirmatory evidence in schizophrenia.

Fixation onto false/unrealistic beliefs is a core feature of schizophrenic delusions. A recent study conducted by our research group has provided evidence for the presence of a bias against disconfirmatory evidence (BADE) in patients with schizophrenia. Importantly, this bias was found with delusion-neutral material. To further validate a BADE as an underlying component of schizophrenic delusions, we recruited 34 presently deluded and non-deluded patients with schizophrenia, along with 26 healthy and 46 mixed psychiatric control participants. Participants were administered a closure task. On each trial, a common object (e.g., elephant) was increasingly disambiguated (i.e., shown in decreasing degrees of fragmentation). The participants were required to assess the plausibility of different interpretations at each of the up to eight stages in each trial. In line with the main hypothesis, patients with schizophrenia downgraded the ratings for incorrect interpretations significantly less over the course of task completion than did healthy and psychiatric controls. In contrast, the gradual upgrading of correct interpretations was similar across all groups, suggesting that the pattern of results obtained for incorrect interpretations reflects a BADE and not a mere repetition of prior responses or a lack of attention to the task at hand. The present study suggests that a BADE is a core feature of schizophrenia, and that this style of thinking is not confined to delusion-congruent scenarios.

Adult↗
PubMed2007

A cognitive bias against disconfirmatory evidence (BADE) is associated with schizotypy.

A bias against disconfirmatory evidence (BADE) has been observed in schizophrenia, and in the present study we evaluated whether this extends to a nonclinical sample scoring high on a schizotypy scale. Thirty-seven high and 32 low schizotypy healthy participants were sequentially presented with three sentences that increasingly disambiguated the true content of a delusion-neutral scenario and were asked to rate the plausibility of four interpretations for this scenario. Relative to low schizotypy participants, high schizotypy participants continued to endorse their initial beliefs, even in the face of evidence that disconfirmed these beliefs. This result provides support for the "schizophrenia spectrum" account of psychosis.

Adolescent↗
PubMed2004

Becoming symbol-minded.

No facet of human development is more crucial than becoming symbol-minded. To participate fully in any society, children have to master the symbol systems that are important in that society. Children today must learn to use more varieties of symbolic media than ever before, so it is even more important to understand the processes involved in symbolic development. Recent research has greatly expanded what we know about early symbol use. We have learned, for example, that infants initially accept a wide range of entities as potential symbols and that young children are often confused about the nature of symbol-referent relations. During the first few years of life, however, children make rapid progress towards becoming competent symbol users.

Child↗
PubMed2005

Domain-specificity and theory of mind: evaluating neuropsychological evidence.

Humans' unique aptitude for reasoning about mental states, known as Theory of Mind (ToM), can help explain the unique character of human communication and social interaction. ToM has been studied extensively in children, but there is no clear account of the cognitive basis of ToM in adults. Evidence from functional imaging and neuropsychology is beginning to address this surprising gap in our understanding, and this evidence is often thought to favour a domain-specific or modular architecture for ToM. We present a systematic approach to this issue for the paradigmatic case of belief reasoning, and argue that neuropsychological data provide no clear evidence for domain-specificity or modularity. Progress in understanding ToM requires new tasks that isolate potentially distinct components of this complex ability.

Adult↗
PubMed2004

Medication management by the person with epilepsy: perception versus reality.

PURPOSE: In an attempt to understand if perception of medication management matched actual medication management, we examined epilepsy patients' perceptions of their overall medication management and their actual management. METHODS: The investigators interviewed 25 adults with refractory epilepsy regarding perceptions of their past overall medication management. Following the interview, each subject received the Medication Event Monitoring System (MEMS) and was asked to use it for 1 month. For the 21 persons who used and returned the caps, a score for compliance was calculated by dividing the number of compliant days by the total number of days. RESULTS: Four participants stated that they may sometimes forget to take their medications, and three patients said that they self-regulated their medications to fit their lifestyle. The self-regulation was not reflected in the MEMS cap data. Fourteen participants reported that it was not difficult to manage their medication regimen. MEMS cap data showed that 11 participants had a compliance score greater than 80% and 10 had a compliance score lower than 34%, but patients' perceptions of their past overall compliance did not differ between these groups. CONCLUSION: Although 14 of the participants reported that managing their medications was not a problem, MEMS cap data suggested that 10 of the participants did have difficulties managing their medication.

Attitude to Health↗
PubMed2001

Distinguishing obsessive features and worries: the role of thought-action fusion.

Obsessions are a key feature of obsessive-compulsive disorder (OCD), and chronic worry is the cardinal feature of generalized anxiety disorder (GAD). However, these two cognitive processes are conceptually very similar, and there is a need to determine how they differ. Recent studies have attempted to identify cognitive processes that may be differentially related to obsessive features and worry. In the current study we proposed that (1) obsessive features and worry could be differentiated and that (2) a measure of the cognitive process thought-action fusion would distinguish between obsessive features and worry, being strongly related to obsessive features after controlling for the effects of worry. These hypotheses were supported in a sample of 173 undergraduate students. Thought-action fusion may be a valuable construct in differentiating between obsessive features and worry.

Adult↗
PubMed2003

Reality monitoring and metacognitive beliefs related to cognitive confidence in obsessive-compulsive disorder.

The present study investigated general reality monitoring ability, and selective reality monitoring ability for anxiety relevant actions in a group of individuals with obsessive-compulsive disorder (OCD) and a group of non-anxious controls. In addition, reality monitoring confidence was assessed, as well as specific meta-cognitive beliefs related to cognitive confidence (by means of the Meta-Cognitions Questionnaire (MCQ)). No differences were found between both groups in actual reality monitoring ability. Unlike previous studies, the reality monitoring task included actions that were related to the individual concerns of the OCD patients and were ideographically selected. Nevertheless, no differential reality monitoring effect was observed for the anxiety relevant stimuli. Data from the MCQ, however, revealed that OCD patients had less overall confidence in their memory for actions and their reality monitoring ability. Analysis of the confidence ratings of the reality monitoring task showed that this reduced confidence was restricted to the neutral actions. No differences were observed for patients that reported low or high frequencies of checking behaviour. The whole of these data do not support memory deficit models of OCD, but are in line with recent emphasis on the importance of memory confidence and other meta-cognitive beliefs in OCD.

Adult↗
PubMedDate not supplied

The predelusional state: a conceptual history.

The predelusional state (PDS) is defined as the set of psychopathologic events preceding the crystallization of delusions, and includes strange cognitions, moods, conations, and motor acts that may be fleeting and defy description. This review exclusively deals with the historic aspects of PDS. It is noted that during PDS the patient is expected to report experiences for which, on account of their novelty, he may not even have a name. Thus, it is quite likely that according to culture and personal codes and to the conceptual brief of the interviewer, similar experiences might be reported as depersonalization, bodily sensations, dysphoria, changes in perception of reality or time, dissolution of "ego boundaries," etc. It is therefore not surprising that since the 19th century, PDS has been considered a disorder of cognition, emotions, volition, and consciousness.

Consciousness Disorders↗
PubMedDate not supplied

Dissociative detachment relates to psychotic symptoms and personality decompensation.

Previous studies have addressed the prominence of psychotic symptoms in conjunction with multiple personality disorder (now dissociative identity disorder). The present study examines the relation between psychotic symptoms and a more pervasive form of dissociative disturbance, namely dissociative detachment. Two hundred sixty-six women in inpatient treatment for severe trauma-related disorders completed the Dissociative Experiences Scale (DES), and 102 of these patients also completed the Millon Clinical Multiaxial Inventory (MCMI-III). A factor analysis of the DES yielded two dimensions of dissociative detachment: detachment from one's own actions and detachment from the self and the environment. Each of these DES dimensions relates strongly to the thought disorder and schizotypal personality disorder scales of the MCMI-III. We propose that severe dissociative detachment, by virtue of loosening the moorings in inner and outer reality, is conducive to psychotic symptoms and personality decompensation.

Adult↗
PubMedDate not supplied

Underconstrained perception: a theoretical approach to the nature and function of verbal hallucinations.

We do not see the world as it is. Perception forms a subjective image of the world in a language that has proven to be adaptive to our interaction with the external world. Perception is mainly determined by current needs of the organism and goals of behavior. Sensory processing itself does not culminate in perception and is not essential for perception, since perception derives from representations of internal symbols and their features. The current stimulation of sensory organs does, however, constrain our perception. Perception might be less constrained by the external world in cases of (1) increased attention, (2) decreased sensory stimulation, or (3) facilitated formation of cortical associations between representations of expectations and internal symbols. Hallucinations are perceptions that are underconstrained by external sensory stimulation. Verbal hallucinations that allow the patient to infer about his self-image might constitute the core psychopathology in a subset of schizophrenia. Commenting and discussing voices might be perceived under the pressure of increased attention to environmental factors that relate to the patient's social fears and wishes. Secondarily, delusions about the possession of thoughts and disorders of self-experience may develop.

Association↗
PubMedDate not supplied

Origins of theory of mind, cognition and communication.

There has been a revolution in our understanding of infant and toddler cognition that promises to have far-reaching implications for our understanding of communicative and linguistic development. Four empirical findings that helped to prompt this change in theory are analyzed: (a) Intermodal coordination--newborns operate with multimodal information, recognizing equivalences in information across sensory-modalities; (b) Imitation--newborns imitate the lip and tongue movements they see others perform; (c) Memory--young infants form long-lasting representations of perceived events and use these memories to generate motor productions after lengthy delays in novel contexts; (d) Theory of mind--by 18 months of age toddlers have adopted a theory of mind, reading below surface behavior to the goals and intentions in people's actions. This paper examines three views currently being offered in the literature to replace the classical framework of early cognitive development: modularity-nativism, connectionism, and theory-theory. Arguments are marshaled to support the "theory-theory" view. This view emphasizes a combination of innate structure and qualitative reorganization in children's thought based on input from the people and things in their culture. It is suggested that preverbal cognition forms a substrate for language acquisition and that analyzing cognition may enhance our understanding of certain disorders of communication.

Age Factors↗
PubMed2003

When can children handle referential opacity? Evidence for systematic variation in 5- and 6-year-old children's reasoning about beliefs and belief reports.

Five- and 6-year-olds (N=51) heard stories in which a character sorted items into two locations. Either the character had a false belief about one of the items (e.g., thought a tin contained biscuits, not Lego), or was only partially informed of an item's dual identity (e.g., did not know that a tie was a present). Children found it easier to reject a report of the character's belief that described the true state of affairs when the character had a false belief (e.g., Is Fred's uncle thinking "where shall I put this Lego?"), than to reject one in which an object known to the character was described using a term of which she was ignorant (e.g., Is Mum thinking "where shall I put this present?"). Similarly, children found it easier to predict the character's incorrect sorting of the target items for false belief (with food not toys) than for dual identity (in the wardrobe not with things to take on a visit). Correct reasoning about beliefs and reports of beliefs that misrepresent an object does not imply mastery of the fact that beliefs represent an object in a particular way.

Child↗