The epistemology of clinical reasoning: perspectives from philosophy, psychology, and neuroscience.
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Cognitive Science↗
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Strategies to scaffold student learning: applying Vygotsky's Zone of Proximal Development.
Teaching strategies like modeling, feedback, questioning, instructing, and cognitive structuring are applications of Vygotsky's Zone of Proximal Development. These strategies "scaffold" student learning from assistance by others to self-learning toward the goal of internalization. This higher-order learning stems from interactions with those who have more knowledge than the learner. Practical applications of Vygotsky's theory to any basic nursing education program are presented.
Cognitive Science↗
Classic conditioning and dysfunctional cognitions in patients with panic disorder and agoraphobia treated with an implantable cardioverter/defibrillator.
OBJECTIVE: A model for the development of anxiety disorders (panic disorder with or without agoraphobia) is needed. Patients with an implantable cardioverter/defibrillator (ICD) are exposed to repeated electric shocks. If the theory of anxiety development by aversive classic conditioning processes is valid, these repeated shocks should lead to an increased risk of anxiety disorders. To study this hypothesis, we retrospectively studied 72 patients after implantation of an automatic ICD. METHODS: Patients were assessed with the semistructured Diagnostic Interview of Psychiatric Disease 1 to 6 years after implantation of an automatic ICD. Panic disorder and/or agoraphobia was diagnosed in patients who fulfilled all DSM-III-R criteria for those conditions. RESULTS: Anxiety disorder developed in 15.9% of patients after ICD implantation. This was significantly related to the frequency of repeated defibrillation (shocks) to stop malignant ventricular arrhythmias. Dysfunctional cognitions are an additional vulnerability factor. CONCLUSIONS: The data support both the conditioning hypothesis and the cognitive model of anxiety development. These findings suggest that ICD patients are an appropriate risk population for a prospective study of the development of anxiety disorders.
Aged↗
Converging levels of analysis in the cognitive neuroscience of visual attention.
Experiments using behavioural, lesion, functional imaging and single neuron methods are considered in the context of a neuropsychological model of visual attention. According to this model, inputs compete for representation in multiple visually responsive brain systems, sensory and motor, cortical and subcortical. Competition is biased by advance priming of neurons responsive to current behavioural targets. Across systems competition is integrated such that the same, selected object tends to become dominant throughout. The behavioural studies reviewed concern divided attention within and between modalities. They implicate within-modality competition as one main restriction on concurrent stimulus identification. In contrast to the conventional association of lateral attentional focus with parietal lobe function, the lesion studies show attentional bias to be a widespread consequence of unilateral cortical damage. Although the clinical syndrome of unilateral neglect may indeed be associated with parietal lesions, this probably reflects an assortment of further deficits accompanying a simple attentional imbalance. The functional imaging studies show joint involvement of lateral prefrontal and occipital cortex in lateral attentional focus and competition. The single unit studies suggest how competition in several regions of extrastriate cortex is biased by advance priming of neurons responsive to current behavioural targets. Together, the concepts of competition, priming and integration allow a unified theoretical approach to findings from behavioural to single neuron levels.
Attention↗
Attentive tracking of objects versus substances.
Recent research in vision science, infant cognition, and word learning suggests a special role for the processing of discrete objects. But what counts as an object? Answers to this question often depend on contrasting object-based processing with the processing of spatial areas or unbound visual features. In infant cognition and word learning, though, another salient contrast has been between rigid cohesive objects and nonsolid substances. Whereas objects may move from one location to another, a nonsolid substance must pour from one location to another. In the study reported here, we explored whether attentive tracking processes are sensitive to dynamic information of this type. Using a multiple-object tracking task, we found that subjects could easily track four items in a display of eight identical unpredictably moving entities that moved as discrete objects from one location to another, but could not track similar entities that noncohesively "poured" from one location to another-even when the items in both conditions followed the same trajectories at the same speeds. Other conditions revealed that this inability to track multiple "substances" stemmed not from violations of rigidity or cohesiveness per se, because subjects were able to track multiple noncohesive collections and multiple nonrigid deforming objects. Rather, the impairment was due to the dynamic extension and contraction during the substancelike motion, which rendered the location of the entity ambiguous. These results demonstrate a convergence between processes of midlevel adult vision and infant cognition, and in general help to clarify what can count as a persisting dynamic object of attention.
Adult↗
Do traumatic events influence cognitive schemata?
Within the field of crisis psychology empirical research on the subject whether cognitive schemata are influenced by victimization, and whether possible changes in cognitive schemata are related to post-traumatic stress disorder (PTSD) is somewhat sparse. In the present study cognitive processing of 602 parents, who had lost an infant, were examined. Among other things results showed a significant relationship between level of cognitive processing and symptoms of PTSD. When items selected to reflect fundamental assumptions about the self and the world were assessed, there were only few differences between parents who had lost an infant, and the control group. Furthermore, there were numerous significant relations between items selected to reflect fundamental assumptions and symptoms of PTSD. The results are discussed in relation to central theories within the cognitive area of crisis psychology and recommendations for future research are offered.
Abortion, Induced↗
Novice construction of chess memory.
Novice acquisition of skilled recall of chess positions was studied in an experiment in which two novices studied a series of five hundred chess positions during a period of several months. They spent fifteen minutes to half an hour a day teaching themselves these positions. As a result their skill in recalling chess positions rose from sixteen percent to somewhere between forty to fifty percent. The learning curve proved to have a shape which indicates that in the beginning learning is very fast but after some 100-150 studied positions the speed of learning decreases substantially. A computer simulation was used to model the results and analyse alternative explanations. Two alternative ways of thinking were tested. In the first, chunk construction was assumed to be based on the neighbourhood of associated pieces. The second model assumed a frequency-based correlative association process. Although the learning curves of the two models are very similar in shape to those of the subjects, the frequency-based associative model gave a better explanation for the data. This is why it is natural to suggest that common co-occurrence in addition to easily recognizable chess-specific characteristics, like colour and type of pieces, guide associative processes during chess players' learning of chess-specific chunks.
Association Learning↗
What do computer models of cognition explain: a reply to Gobet.
The differences between Gobet's views and ours call attention to some points concerning the argumentative status of computational models. If we have two fundamentally different models which reasonably accurately simulate a phenomenon, we must ask, what is the argumentative status of the models in psychological terms. Moreover, if it is possible to present different models of same phenomena, what is the general argumentative power of models in psychology? As the kind of differences between our views and the ones of Gobet's are common in modelling, we briefly call attention to these foundational issues in our paper.
Cognition↗
Functional neuroimaging of cognition: state-of-the-art.
This paper presents a brief overview of functional neuroimaging studies of cognitive processes. A "publication profile" is identified for PET and fMRI studies of cognitive functions. It is shown that the number of publications has increased exponentially over the last ten years, and that a set of ten journals accounts for the vast majority of publications. It is argued that the field has moved from a state of explorative character to a state of high theoretical sophistication. With special reference to the contributions in this issue of Scandinavian Journal of Psychology, methodological, topical, regional, and clinical implications of cognitive neuroscientific studies are discussed.
Brain↗
Transcranial magnetic stimulation as a tool for cognitive studies.
Transcranial Magnetic Stimulation (TMS) is a tool for the non-invasive stimulation of the human brain. It allows the activation of arbitrary sites of the superficial cortex and, combined with other brain-imaging techniques such as EEG, PET, and fMRI, it can be used to evaluate cortical excitability and connectivity. This is of major importance in, for example, the study of cognitive processes such as language, learning, memory and self-representation, which are thought to be represented in multiple brain areas. The mechanisms of action of TMS are known on a basic level, but its effect on the activation state of brain tissue is still poorly understood. Clinical applications of TMS have also been proposed and guidelines for its safe use drafted.
Brain↗
SPR Award, 2002. For distinguished contributions to psychophysiology: Michael G. H. Coles.
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Awards and Prizes↗
Is social cognitive theory becoming a transtheoretical model? A comment on Dijkstra et al. (2006).
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Behavior, Addictive↗
'Like me': a foundation for social cognition.
Infants represent the acts of others and their own acts in commensurate terms. They can recognize cross-modal equivalences between acts they see others perform and their own felt bodily movements. This recognition of self-other equivalences in action gives rise to interpreting others as having similar psychological states such as perceptions and emotions. The 'like me' nature of others is the starting point for social cognition, not its culmination.
Cognition↗
An exploratory study of clinical decision-making in five countries.
PURPOSE: To identify the cognitive processes nurses use in their decision-making in long- and short-term care settings in five countries, and the demographic variables associated with their decision-making. METHOD AND SAMPLES: The instrument used was a 56-item questionnaire that has been shown to be reliable in earlier studies. The sample consisted of five convenience samples of registered nurses working in either geriatric wards (n = 236) or acute medical-surgical wards (n = 223) in hospitals or nursing homes in Canada, Finland, Sweden, Switzerland, and the United States. FINDINGS: Five models of decision-making were identified on the basis of factor analysis. They represent both analytical and intuitive cognitive processes. Analytical cognitive processes were emphasized in information collection, problem definition, and planning of care, and intuitive cognitive processes were emphasized in planning, implementing, and evaluating care. Professional education, practical experience, field of practice, and type of knowledge were significantly associated with decision-making models as well as with country of residence of the participants. The highest proportion of analytically oriented decision-makers was found among nurses in long-term care, the decision-making of nurses in short-term care was more intuitively oriented. CONCLUSIONS: The results indicate that decision-making of participants varied from country to country and in different nursing situations. Future research should be focused on reasons for these differences, the relationship between the task and the nurses' type of knowledge, and how nurses use their knowledge to make decisions in different nursing situations.
Canada↗
Do agoraphobics interpret the environment in large shops and supermarkets differently?
Agoraphobics typically have difficulties in visiting supermarkets. The brief report presents results of a survey investigating the properties of supermarkets which provoke or ease anxiety-related responses in shoppers (N = 500) and two further groups: agoraphobics (N = 40) and participants responding to a local press advert (N = 54). Results showed that layout features, stairways and diminished access were rated as more anxiety provoking in the agoraphobic-type groups compared to general shoppers. The safety-signal model of agoraphobic behaviour was supported although some evidence of dysfunction of spatial orientation was found.
Activities of Daily Living↗
Monitoring of intrusions in post-traumatic stress order: a report of single case studies.
The effect of monitoring on frequency and duration of intrusions, and on reported symptomatology in patients with a diagnosis of post-traumatic stress disorder (PTSD) was investigated. Six patients were asked to monitor their intrusions over a period of two months. The patients were reassessed after completing the monitoring and followed up after three months. Four patients recovered and no longer met criteria for PTSD, one patient was still experiencing some symptoms, and one still met criteria for a diagnosis of PTSD.
Adult↗
Procedures as dialogical sequences: a revised version of the fundamental concept in cognitive analytic therapy.
Problematic action patterns that patients are unable to abandon or modify are important treatment targets in cognitive analytic therapy. They are called procedural sequences in the conceptual model underlying the approach. Interpersonal events in the patients' lives, and in the consulting room as well, frequently display such patterns. They are called reciprocal role procedures. In the present paper the sequential description of problem procedures will be examined by using Bakhtin's dialogical understanding of mental phenomena. A restatement of the original concept will be presented with the aim of integrating the sequential and reciprocal aspects of problematic action patterns. The revised concept of dialogical sequences will be illustrated by a number of case vignettes. The analysis of dialogical sequences provides a clear conceptual basis for early description of problem procedures in therapy. It also provides an effective tool for a detailed supervision of therapy sessions. Finally, dialogical sequence analysis may be used as a psychotherapy process research method to examine the interpersonal patterns in patient narratives.
Adult↗
Improving clinical communication: a view from psychology.
Recent research has studied the communication behaviors of clinical hospital workers and observed a tendency for these workers to use communication behaviors that were often inefficient. Workers were observed to favor synchronous forms of communication, such as telephone calls and chance face-to-face meetings with colleagues, even when these channels were not effective. Synchronous communication also contributes to a highly interruptive working environment, increasing the potential for clinical errors to be made. This paper reviews these findings from a cognitive psychological perspective, focusing on current understandings of how human memory functions and on the potential consequences of interruptions on the ability to work effectively. It concludes by discussing possible communication technology interventions that could be introduced to improve the clinical communication environment and suggests directions for future research.
Attitude of Health Personnel↗