Must the Reality of Death Be Unspeakable?

Attention to the manifestations of death anxiety in the clinical context is often absent in the discourse of psychoanalytic training. This exchange addresses some of the causes of such an absence: a fraught relation between privacy and secrecy, primacy of psychic reality and interpretation, and cultural underpinnings of sanitization of death.

Dream lucidity positively correlates with reality monitoring.

Dream lucidity, the awareness of consciousness in dreams, is linked to functions that support reality monitoring in differentiating between internally and externally generated memories. However, lucid dreams have been argued to result from thin reality-fantasy boundaries that lead to reality monitoring errors. To examine the relationship between dream lucidity and reality monitoring, we recruited 31 college students to rate their dream lucidity for 7 days and then complete a reality monitoring test in Experiment 1, observing a positive correlation between dream lucidity and reality monitoring. In Experiment 2, 109 participants rated dream lucidity and the memory characteristics of perceived and imagined events. Dream lucidity was negatively correlated with differences in sensory details between the memories of perceived and imagined events. The findings indicate that individuals with high dream lucidity have a superior ability to discriminate between externally and internally generated events that are susceptible to reality monitoring errors.

Race and Analytic Neutrality: Clinical and Theoretical Considerations.

Neutrality remains a key concept underpinning the psychoanalytic attitude, but its operation in the clinical setting must be reconfigured if the countertransference is to be used as a source of data, conveyed by projective identification. Subjective responses thus mobilized in the analyst need to be processed before attention can return to the evenly suspended state, from which greater objectivity flows. Theory, internalized as part of the analyst's emotional learning, operates preconsciously in the session; in clinical work with racial matters this includes, crucially, familiarity with internal racism, of which a model is briefly described. These ideas are illustrated via two clinical vignettes in which these themes are traced.

Confident memory errors and disrupted reality testing in early psychosis.

Schizophrenia is a psychiatric disorder characterized by a disruption in reality testing most often manifest in the form of delusions and hallucinations. Because determining the reality-basis of prior experiences is dependent on episodic and associative memory, deficits in mnemonic processes could be involved in the genesis of impaired reality testing. In the present study, we used an associative memory paradigm incorporating confidence ratings to examine whether patients with a recent onset of schizophrenia (n = 48) show a greater propensity for confident, yet incorrect responses during retrieval testing than healthy controls (n = 26) and whether such confident incorrect responses, specifically, are more strongly associated with positive symptoms than with negative symptoms. Using an analysis of variance design, we found that first-episode schizophrenia patients made a significantly greater number of confident errors than controls (i.e. they expressed high confidence in having seen pairs of items that were not paired at encoding and high confidence in having not seen pairs of items that were paired at encoding). We also found that the number of confident errors was specifically and differentially associated with positive symptom severity, to a significantly greater degree than with negative symptom severity and psychosocial functioning, and this association was not found between positive symptoms and uncertain responses, nor positive symptoms and overall task performance. These findings suggest that the propensity for incorrect memory judgements with high confidence, specifically, may be uniquely associated with disrupted reality testing and that this type of cognitive impairment is distinct from general deficits in memory and cognition in this respect.

A Bifactor Model of Personality Organization.

The aim of this study was to explore the viability of a bifactor model for the Inventory of Personality Organization (IPO), which is a self-report measure of personality functioning based on Kernberg's model of personality organization. A heterogeneous, predominantly clinical sample (N = 616) completed the German 83-item version of the IPO. Confirmatory and Exploratory Factor Analyses were applied to explore the factor structure of the IPO. We were able to establish a bifactor model with a general factor of personality functioning and three specific factors (Aggression, Reality Testing, Moral Values), which represent additional dimensions of personality organization. Virtually all items showed substantial positive loadings on the general factor, explaining roughly 66% of the common variance. Furthermore, we found support for convergent and discriminant validity of general and specific factors with regard to interview-based assessments of personality disorders and personality organization. The results lend support to a bifactor approach to Kernberg's model of personality organization. We also present a 30-item brief form of the IPO that efficiently implements the bifactor approach and may be further validated in future studies.

Screen and Virtual Reality-Based Testing of Contrast Sensitivity.

Contrast sensitivity is a key visual ability for everyday tasks, as well as a potential indicator of important optical and neurological diseases. Current clinical standards, based on visual discrimination performance on printed charts, present problems that could be bypassed using electronic devices. This work describes the development of new tests for contrast sensitivity, based on the detection of a moving target on a computer screen and in virtual reality headset. It presents preliminary evaluation of these innovations by comparison of their performance, using healthy adults with normal vision and by artificially altering their contrast sensitivity. The results demonstrate consistent correlation between all test modalities explored.

Shared reality and abstraction: The social nature of predictive models.

We propose that abstraction is an interpersonal process and serves a social function. Research on shared reality shows that in communication, people raise their level of abstraction in order to create a common understanding with their communication partner, which can subsequently distort their mental representation of the object of communication. This work demonstrates that, beyond building accurate models, abstraction also functions to build accurate models but also to build socially shared models - to create a shared reality.

Inducing lucid dreams by olfactory-cued reactivation of reality testing during early-morning sleep: A proof of concept.

The reliable induction of lucid dreams is a challenge in lucid dream research. In a previous study by our research group we were able to induce in about 50% of the participants a lucid dream in a single sleep laboratory night by combining a wake-up-back-to-bed sleep protocol and a mnemonic technique. In the present study, we extended our previous procedure by additional presentation of an odor during sleep to reactivate memory traces about reality testing. In total 16 male participants spent a single night in the sleep lab whereas the procedure induced in two participants a lucid dream (12.5%). The induction rate stays below the success rate of our previous study and therefore odor-cueing seems not a promising technique for inducing lucid dreams. Beside the odor presentation, several other methodological changes have been made, which will be discussed and hopefully help further dream engineering to improve induction techniques.

Beliefs About Gambling Mediate the Effect of Cognitive Style on Gambling Problems.

Problem gambling is often accompanied by a range of irrational cognitions that promote excessive gambling. The cognitive basis for these beliefs has been largely overlooked in the gambling literature. Dual process theory suggests there are two parallel cognitive processing systems, an intuitive and an analytic system, and that there are potential individual differences in preference for one or the other cognitive style. The current study explored whether people's cognitive styles are an important factor in the development of specific beliefs about gambling that in-turn contribute to gambling problems. The sample consisted of 1168 regular gamblers (539 female, ranging from 18 to 78 years of age; M = 35.47, SD = 10.78) recruited via Mechanical Turk. Participants completed a survey assessing cognitive style, problem gambling severity, and measures of protective and erroneous beliefs. In a path model, greater analytical thinking and lower intuitive thinking was associated with fewer erroneous gambling beliefs, which in turn were related to fewer gambling problems. A second model showed that protective beliefs also mediated the relationship between cognitive style and gambling, demonstrating that greater analytical thinking and lower intuitive thinking was associated with protective beliefs that similarly reduced problem gambling severity. Results suggest that a person's cognitive style influences peoples gambling by contributing to the endorsement of irrational or unsafe beliefs about gambling. Encouraging people to think more analytically may be useful in reducing erroneous beliefs about gambling that promote problematic gambling behaviour.

Assessing Reality Testing in Mice Through Dopamine-Dependent Associatively Evoked Processing of Absent Gustatory Stimuli.

Impairments in reality testing are core features of numerous neuropsychiatric conditions. However, relatively few animal models have been developed to assess this critical facet of neuropsychiatric illness, thus impeding our understanding of the underlying central systems and circuits. Using mice in which dominant-negative Disrupted-in-Schizophrenia-1 is expressed throughout central nervous system circuitry (DN-DISC1-PrP), the capacity for an auditory conditioned stimulus (CS) to evoke perceptual processing of an absent sucrose solution was examined. At test, during CS presentations, DN-DISC1-PrP mice consumed more water and displayed a licking profile that is more typically revealed while ingesting a sweet-tasting solution. DN-DISC1-PrP mice also displayed greater c-fos expression in the insular (gustatory) cortex when consuming water in the presence of the CS. This capacity for the CS to more readily substitute for the taste features of the absent sucrose solution in DN-DISC1-PrP mice was attenuated following systemic treatment with the antipsychotic haloperidol. Conversely, social isolation during adolescence promoted the manifestation of these effects. These results provide strong validation for using associative learning procedures to examine dopamine-mediated reality testing associated with insular cortex activation.

Sensitivity of Reality Monitoring to Fluency: Evidence from Behavioral Performance and Event-Related Potential (ERP) Old/New Effects.

BACKGROUND Item memory and source memory are differently processed with both behavioral and event-related potential (ERP) evidence. Reality monitoring, a specific type of source memory, which refers to the ability to differentiate external sources from internal sources, has been drawing much attention. Among factors that have an impact on reality monitoring, fluency has not been well-studied. Therefore, the current study aimed to investigate whether fluency could affect reality monitoring, through observations on both behavioral performance and electrophysiological patterns. MATERIAL AND METHODS Adopting ERP techniques, participants were required either to watch the presentation of a name/picture pair, or to imagine a picture for each displayed name, once (low fluency) or twice (high fluency). Later they completed a reality monitoring task of identifying names as perceived, imagined, or novel items. Behavioral performance was measured, and ERP waveforms were recorded. RESULTS Behaviorally, high fluency items were faster and more accurately attributed to the sources than low fluency items. ERP waveforms revealed that late positive component (LPC) occurred for all 4 types of items, while imagined items of low fluency did not record a robust FN400 or late frontal old/new effect. CONCLUSIONS As results revealed, the factor of fluency does influence reality monitoring in terms of accuracy and responding speed. Meanwhile, for imagined items of low fluency, the absence of FN400 and frontal old/new effect also suggests the sensitivity of reality monitoring to fluency, because these representatives of familiarity-based processing and post-retrieval monitoring are inevitably involved in the process of differentiating internal source from external source.

Reality-monitoring deficits and visual hallucinations in schizophrenia.

The presence of visual hallucinations in addition to auditory hallucinations (V + AH) is associated with poor prognosis in patients with schizophrenia. However, little consideration has been given to these symptoms and their underlying cognitive bases remain unclear. Based on cognitive models of hallucinations, we hypothesized that V + AH are underpinned by an impairment in reality-monitoring processes. The objective of the present study was to test whether reality-monitoring deficits were associated with V + AH in schizophrenia. This study examined reality-monitoring abilities in two groups of patients with schizophrenia: a group of patients with V + AH (n = 24) and a group of patients with AH only (n = 22). Patients with V + AH were significantly more likely to misremember imagined words as being perceived from an external source, compared to patients with AH only (p = 0.008, d = -0.82). In other words, V + AH patients display a larger externalization bias than patients with AH only. One explanation for these results could be that experiencing hallucinations in two sensory modalities may contribute to increased vividness of mental imagery and, in turn, lead to disruption in reality-monitoring processes. This study helps to refine our understanding of the cognitive processes underlying the presence of both auditory and visual hallucinations in patients with schizophrenia.

Source monitoring task in a sample of in-patients with verbal auditory hallucinations compared to control sample.

Patients with psychosis, especially those with specific positive symptoms such as auditory verbal hallucinations, show a source monitoring deficit, the cognitive process involved in the recognition of the information source. This defect can lead to the erroneous conclusion that self-generated thoughts are not "proper" but derive from an external source. We evaluated 37 patients diagnosed with psychotic disorder and 40 healthy controls using a modified version of the Reality Monitoring Task developed by Larøi et al. in 2004. The patients were also evaluated with PANSS, VGF, PSP. We have found that the performance of the Source Monitoring Task differs between patients with hallucinations and controls. According to the literature we can therefore state that patients with hallucinations are characterized by a difficulty in identifying the source of the information they perceive. Our study also adds a new finding to the literature: the source monitoring dysfunction is not due to the presence of current hallucinatory symptomatology but could be considered a stable trait in psychotic patients.

Fixity of thinking and the foundations of identity: An argument for the evolutionary adaptiveness of delusions.

Epidemiological evidence suggests that psychosis occurs along a continuum of severity in the general population. Although clinical psychotic symptoms are associated with distress and impairment, less is known about sub-threshold delusion-like experiences. The present paper conceptually explores the possibility that fixed ideas or mildly illogical thinking may be adaptive at low to moderate severity levels. Strongly held beliefs that are resistant to reality checking may facilitate identification with particular social groups. For example, tenaciously maintaining one-sided political beliefs even in the face of contrary evidence may not be fully logical, but may provide a shared sense of group identity with others who share similar beliefs. Identifying with a group provides both emotional and instrumental sources of support in the face of adversity. Maintaining illogical fixed ideas or mildly delusion-like thoughts may be evolutionarily adaptive relative to overly logical thought or, at the other end of the spectrum, clinical delusions.

Expectations vs reality: The expectations and experiences of psychiatric treatment reported by young adults at a mood and anxiety outpatient mental health program.

AIM: To compare young adults' expectations of psychiatric treatment to their actual experiences and identify myths and assumptions that youth might hold prior to receiving care. METHODS: We interviewed youth who engaged in at least 4 months of treatment at the First Episode Mood and Anxiety Program to theme saturation (N = 20). They were asked about their experience of treatment and the expectations they had prior to care. Transcribed interviews were analysed for themes. RESULTS: Results indicated that participants often expected a cold, serious atmosphere, a "quick fix," and a directive therapeutic relationship. Although most patients had a negative experience at some point in their care, they overall described a welcoming environment with engaged providers and a collaborative therapeutic relationship. Participants found treatment more complex than they had anticipated, but ultimately experienced strengthening of agency and a change in perspective. CONCLUSIONS: These results identify a need to recognize assumptions held by young adults seeking treatment for mental health symptoms. Addressing these preconceptions might reduce apprehension and improve readiness for treatment. This research provides direction on how to dispel myths and better prepare youth for the work involved in effective psychiatric care.

The time to remember: Temporal compression and duration judgements in memory for real-life events.

Recent studies suggest that the continuous flow of information that constitutes daily life events is temporally compressed in episodic memory, yet the characteristics and determinants of this compression mechanism remain unclear. This study examined this question using an experimental paradigm incorporating wearable camera technology. Participants experienced a series of real-life events and were later asked to mentally replay various event sequences that were cued by pictures taken during the original events. Estimates of temporal compression (the ratio of the time needed to mentally re-experience an event to the actual event duration) showed that events were replayed, on average, about eight times faster than the original experiences. This compression mechanism seemed to operate by representing events as a succession of moments or slices of prior experience separated by temporal discontinuities. Importantly, however, rates of temporal compression were not constant and were lower for events involving goal-directed actions. The results also showed that the perceived duration of events increased with the density of recalled moments of prior experience. Taken together, these data extend our understanding of the mechanisms underlying the temporal compression and perceived duration of real-life events in episodic memory.

Shared social identity in leadership.

In this paper we review recent evidence on the social identity model of leadership. First, we explain how this model is rooted in the social identity approach in social psychology and, specifically, the notion that shared reality and joint action in groups derives from shared social identity. We then show how effective leadership is a process of social identity management and we examine both the antecedents, the psychological and the political consequences of managing social identities.

Cognitive Therapy for Dementia Patients: A Systematic Review.

BACKGROUND: Cognitive therapy is a well-established intervention for treating elderly suffering from dementia. In particular, reality orientation and skills training seem to be effective interventions for reversing cognitive impairment among elderly, although findings are inconclusive. Therefore, a systematic update of the existing evidence of cognitive therapy for people suffering from dementia is needed. AIM: To review existing scientific evidence regarding the efficacy of cognitive therapies for elderly suffering from dementia. METHODS: Studies were retrieved from several bibliographic databases (January 2009 to December 2017) with prespecified selection criteria, data extraction, and methodological quality assessment. RESULTS: In total, 10 reality orientation, 25 skills training, and 12 mixed trials were identified as meeting the inclusion criteria and were systematically reviewed. Results from reality orientation trials showed minor effects for cognitive assessments, while skills training trials and mixed trials showed contradicting effects on cognition. Effects on other outcomes (e.g., daily functioning, depression, language) were limited or not found. CONCLUSIONS: Skills training trials and mixed trials seem to affect cognitive impairment in a positive way, although the results are inconclusive. Comparison between studies was difficult due to differences in form of intervention. Because findings are inconclusive, more structuralized and comparable randomized controlled trials are needed.