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Practice principles of cognitive enhancement therapy for schizophrenia.

Cognitive Enhancement Therapy (CET) is a developmental approach to the rehabilitation of schizophrenia patients that attempts to facilitate an abstracting and "gistful" social cognition as a compensatory alternative to the more demanding and controlled cognitive strategies that often characterize schizophrenia as well as much of its treatment. Selected cognitive processes that developmentally underlie the capacity to acquire adult social cognition have been operationalized in the form of relevant interactive software and social group exercises. Treatment methods address the impairments, disabilities, and social handicaps associated with cognitive styles that appear to underlie the positive, negative, and disorganized symptom domains of schizophrenia. Style-related failures in secondary rather than primary socialization, particularly social cognitive deficits in context appraisal and perspective taking, are targeted goals. Illustrative examples of the techniques used to address social and nonsocial cognitive deficits are provided, together with encouraging preliminary observations regarding the efficacy of CET.

Adult↗

Is there violence in the neighbourhood? Ask the children.

BACKGROUND: Community violence is a major public health concern. Much has been written about high intensity community violence such as wars or gang violence. However, chronic low intensity community violence is greatly overlooked. The objective of the following study is to assess how children living in neighbourhoods characterized by chronic low intensity violence perceive their environment. METHODS: Children drew two pictures: one of their physical neighbourhoods and the other representing what goes on in the neighbourhoods. Each child also completed a neighbourhood safety survey. RESULTS: The participants were four hundred and five children (213 girls; 192 boys) 8-12 years old (mean = 9.70; SD = 1.26) who lived in Beirut. 75 drawings contained violent incidents (fist fights and heated verbal arguments were most commonly depicted). 168 children mentioned people fighting or quarrelling in the streets but elected not to draw them. Children reported feeling unsafe and dissatisfaction with the quality of their neighbourhoods. CONCLUSION: Children living in chronic low intensity community violence may feel unsafe and distrustful of their environment but may perceive violent events as regular normal occurrence. The risk of copying such behaviours and propagating violence is to be considered seriously.

Analysis of Variance↗

Short-term intercultural psychotherapy: ethnographic inquiry.

This article examines the challenges specific to short-term intercultural treatments and recently developed approaches to intercultural treatments based on notions of cultural knowledge and cultural competence. The article introduces alternative approaches to short-term intercultural treatments based on ethnographic inquiry adapted for clinical practice. Such approaches allow clinicians conducting short-term intercultural treatments to foreground clients' indigenous conceptions of selfhood, mind, relationship, and emotional disturbance, and thus to more fully grasp their internal, interpersonal, and external worlds. This article demonstrates the uses of clinically adapted ethnographic inquiry in three short-term intercultural cases.

Adolescent↗

Through the eyes of Hollywood: images of social workers in film.

This article reports on research that investigated the images of social workers as portrayed in movies as a major medium of popular culture. Findings from an analysis of 44 movies spanning the period from 1938 to 1998 are presented with particular attention to the themes of gender, race, and class. Using the concept of motivated representations in popular culture, we suggest that these popular constructions of social workers are perhaps motivated by efforts to maintain the status quo of the dominant society, rather than to promote social change and social justice.

Attitude to Health↗

An end to angels.

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Advertising↗

Misconceptions about transmission of AIDS and attitudes toward prevention in the French general public.

A survey of the social perception of AIDS and its prevention was carried out in December 1987 in a representative sample of the adult population of the Paris region (France). A significant part of the general public still holds misconceptions about transmission by casual contact and blood donation. Misbeliefs about modes of transmission clearly encourage individuals' willingness to stigmatize AIDS patients and to support the most coercive measures of prevention (such as quarantine). Advertizing efforts to promote use of condoms, sexual education in schools, and systematic HIV screening for pregnant women are the only measures which create a broad consensus independently of sociocultural differences. Socioeconomic status and even religious or political beliefs strongly influence public opinions toward other preventive measures.

Acquired Immunodeficiency Syndrome↗

Identifying major concerns of persons with acquired immunodeficiency syndrome: a replication.

A descriptive study was conducted at two major medical centers in Boston to identify and categorize major concerns of persons with acquired immunodeficiency syndrome. Thirty-four subjects were interviewed using a semistructured instrument, developed by Spross and her colleagues while at the National Institutes of Health. Obtained by referral from nurses caring for them in inpatient and outpatient settings, the majority of subjects were Caucasian, homosexual males from the Boston metropolitan area. The mean age of subjects was 33.6, with 71% less than 35 years old. Subjects reported an average of 3.2 hospitalizations since the AIDS diagnosis had been made; average time since diagnosis was 8 months. Information obtained from subjects included impact of diagnosis, major concerns and sources/types of support perceived to be helpful. Five themes were identified: uncertainty of the future; desire to maintain health; social unacceptability; fatigue; and weight loss.

Acquired Immunodeficiency Syndrome↗

Moral valuation: a third domain of conscience functioning.

OBJECTIVE: To assess development of moral valuation in normal children and adolescents, that is, how moral rules for living are derived and justified, and to examine the relationship of this progression with previously identified stages of conceptualization of conscience. METHOD: Using three semistructured questions from the Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were assessed. All moral valuation responses were examined within three aspects of social reference: authority-derived, self-derived, and peer-derived. Each aspect was scaled for complexity into six anchored levels. RESULTS: The levels of all three aspects correlated positively with conceptualization stages as well as with each other. When the covariate, age, was taken into consideration, peer-derived valuation was significantly correlated with both age and stage. CONCLUSIONS: Moral valuation is a domain of conscience functioning in which moral rules and their justifications are socially referenced in relationship to authority, self, and peers. Anchored levels of these three aspects of moral valuation provide developmental guidelines for mental status examinations in patients between 5 and 17 years of age as well as providing criteria for future comparative studies in various diagnostic categories of psychopathology.

Adolescent↗

The role of teasing in development and vice versa.

This study was undertaken because there are almost no reports in the scientific literature on the subject of teasing. Teasing changes as it expresses developmental issues from playing peek-a-boo in infancy to expressing personal issues, such as boy/girl relationships, in adolescence. The form also changes as the cognitive capacity of the child changes. Two hundred fifty children from 1st, 3rd, 6th, 8th, and 11th grades were asked to describe teasing, its motive, and the reaction of the victim. The form of teasing was organized into hurtful (hitting or spitting), mean (calling a burn victim ugly) and symbolic, which allows the victim to realize that the provocation is "just words." The forms correlated with age and suggest that progression through these forms can be understood in terms of the theories of psychological stages drawn from Piagetian and psycholinguistic studies. The dominant motivation for the child doing the teasing seemed at every age to be sadistic pleasure in the discomfort of the child being teased, although one sees some playful, benign teasing by late adolescence.

Adolescent↗

A longitudinal study of psychological distress in a cohort of gay men. Effects of social support and coping strategies.

This study presents analyses on questionnaire data collected from a panel of 520 gay men at risk for acquired immune deficiency syndrome, enrolled in the Coping and Change Study (1985-1987). The data were assessed to determine the association of social support and coping styles with subsequent depression and global distress and to investigate whether these predictors of mental health are stable or transient over time. Three different measures of the subjective, qualitative nature of social support were significantly associated with subsequent mental health. Those who reported a subjective sense of isolation experienced significantly more adverse mental health 6 months later at all three measurement periods. Scattered effects were found for perceived social conflict and perceived social support from others. These results indicate that certain types of social support appear to influence mental health in this cohort and, furthermore, that some associations are transient and others more stable over time.

Acquired Immunodeficiency Syndrome↗

Self-valuation and societal valuations of health state differ with disease severity in chronic and disabling conditions.

OBJECTIVES: We sought to determine the relationship between self-reported ratings of health-related quality of life (HRQoL) by people with 3 chronic and disabling conditions and population estimates of those health states and to model factors that might explain the disagreement between these 2 ratings. RESEARCH DESIGN: A cross-sectional postal survey was sent in which each participant completed a set of questionnaires addressing HRQoL. Data from self-valuation on a visual analog scale (VAS) was compared with a population-based VAS-equivalent valuation, using the EQ-5D instrument. Different ways of scaling the 2 VAS scores were also explored. Data were analyzed using descriptive statistics and analysis of covariance. SUBJECTS: A community sample of 1036 people took part in the study (rheumatoid arthritis n = 142, stroke n = 585, multiple sclerosis n = 309). MEASUREMENT INSTRUMENT: The EQ-5D health state profile and accompanying visual analog scale were used. RESULTS: Self-ratings were significantly different than the population-based ratings, and agreement was poor, both on the original scale of the data and by analyses of rescaled data. On the original scales the mean difference was 0.13 (95% confidence interval 0.117-0.143). Diagnosis, health state severity, and its square explained 35.3% of the variation in the differences between self and population ratings with a curvilinear relationship suggesting that the differences increased as the health state worsened, but at a decreasing rate as health state severity increased. CONCLUSIONS: This study provides evidence that EQ-5D population valuation estimates of treatment benefit for people with disabling and chronic conditions may well be inaccurate representations of the degree of change actually experienced by the individual with the condition. The varying magnitude of difference between the 2 forms of valuation has important implications for interpreting shifts in health status valuation following interventions for these populations.

Adult↗