Mentalization Psychotherapy for Patients Presenting with a Psychotic Personality Structure: A Contemporary Approach.

Overt psychotic symptoms, currently understood as resulting from both neurobiological and developmental etiological factors, are also associated with deficits in mentalization in a subgroup of patients presenting with psychotic personality structure. Neurodevelopmental and traumatic impairments seen in this subtype of psychotic disorders create a pressure or need for what has been called a transformational mentalizing process. This specific form of mental elaboration focuses explicitly on finding words and images that help patients to grasp their emotional and mental states. It thus differs from mainstream mentalization treatment, which puts a greater emphasis on reflective functioning. A psychodynamically informed mentalization-based individual and group psychotherapy for this subgroup of patients was developed, aiming at augmenting the patient's psychological resources through explicit transformational mentalization, rather than primarily targeting symptom reduction. This program stimulates curiosity about one's mental states, progressively aiming to give shape to and explore affectively charged mental states, and is integrated with other treatment modalities. This article presents a psychological model of psychotic personality structure and its psychotherapeutic implications, as well as clinical illustrations. Preliminary findings from a pilot study provide encouraging support for the model, including emerging reflective capacities and symptom reduction, as well as overall improvement of social and occupational functioning.

A Preliminary Study of the Interactive Effect of Avoidant Personality Disorder Symptoms and Expressive Suppression on the Outcome of a Psychodynamically Oriented Day Treatment Program.

Introduction: Patients with avoidant personality disorder (AvPD) pathology tend to have poor prognosis in psychotherapy, yet there has been little research conducted to better understand why their outcomes are limited, making it difficult to improve treatments for them. Expressive suppression is a dysfunctional emotion regulation strategy that may exacerbate avoidant tendencies, further complicating the therapeutic process. Methods: Using data from a naturalistic study (N = 34) of a group-based day treatment program, we examined whether there was an interactive effect of AvPD symptoms and expressive suppression on treatment outcome. Results: Findings revealed a significant moderating effect of expressive suppression on the association between AvPD symptoms and treatment outcome. The outcome for patients with more severe AvPD symptoms was particularly poor when they engaged in high levels of expressive suppression. Discussion: The findings suggest that the combination of significant AvPD pathology and high expressive suppression is associated with poorer responsiveness to treatment.

Sex in the dark: Sex differences on three measures of dark side personality.

This study examined sex differences in the scores on three different measures of the personality disorders (PDs) all derived from on-line surveys. Two groups (total N = 871) completed the Coolidge Axis-II Inventory which assessed 14 PDs; two groups (total N = 732) completed the Short Dark Tetrad which assessed 4 PDs; four groups (total N = 1558) completed the Personality Inventory for DSM-5-Brief Form which assessed 5 PD dimensions. Cohen's d after ANOVAs, and binary regression analysis revealed consistent findings. In this study we calculated 63 d statistics of which 5 were d > 0.50 and 28 were d > 0.20. In two samples, each using two different instruments, men scored higher than women on Anti-Social, Narcissistic and Sadistic PD which is a consistent finding in the literature. Speculations are made about the origin of these differences. Limitations are acknowledged.

Post-truth epistemic beliefs rooted in the Dark Factor of Personality are associated with higher COVID-19 vaccination refusal.

A substantial number of people refused to get vaccinated against COVID-19, which prompts the question as to why. We focus on the role of individual worldviews about the nature and generation of knowledge (epistemic beliefs). We propose a model that includes epistemic beliefs, their relationship to the Dark Factor of Personality (D), and their mutual effect on the probability of having been vaccinated against COVID-19. Based on a US nationally representative sample (N = 1268), we show that stronger endorsement of post-truth epistemic beliefs was associated with a lower probability of having been vaccinated against COVID-19. D was also linked to a lower probability of having been vaccinated against COVID-19, which can be explained by post-truth epistemic beliefs. Our results indicate that the more individuals deliberately refrain from adhering to the better argument, the less likely they are vaccinated. More generally, post-truth epistemic beliefs pose a challenge for rational communication.

Dialogue With Psychosis: Induced Psychotic Countertransference in Psychotherapy With Psychotically Disturbed Patients.

The therapeutic encounter with psychotic patients presents therapists with moments in which they may regress, together with the patient, toward primitive and psychotic areas of experience. Within this shared psychotic world, therapists might feel persecuted, as if the ground is slipping from beneath their feet. The author suggests that the psychotic part of the personality, as argued by Bion, is inherent to all of us and may come alive in the psyche of the therapist in response to patients in psychotic states. The psychotic dialogue that emerges between patient and therapist, which involves projective identification and counter-transference mechanisms, must be worked through. Therapists' capacity to survive the psychosis forced upon them and to move through and beyond it is highly significant. By examining clinical material from therapy with a patient diagnosed with schizophrenia, the author discusses this unique countertransference phenomenon, which he terms induced psychotic countertransference.

Psychiatric symptomatology in skin-restricted lupus patients without axis I psychiatric disorders: A post-hoc analysis.

BACKGROUND: Skin-restricted lupus is a chronic inflammatory disease associated with high rates of depression and anxiety disorders. Patients without psychiatric disorders can experience anxiety and depressive symptoms at a subclinical level, which could be risk factors for progression towards psychiatric disorders. It was decided, therefore, to investigate the presence of specific symptoms in skin-restricted lupus patients without axis I psychiatric disorders and their impact on the occurrence of axis I psychiatric disorders during the study follow-up. METHODS: Longitudinal data of 38 patients and 76 matched controls without active axis I psychiatric disorders from the LuPsy cohort were used. Depressive, neurovegetative, psychic and somatic anxiety symptom scores were established from the Montgomery-Asberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating scale (HAMA). RESULTS: None of the participants had any current active axis I psychiatric disorders but the patients had personality disorders more frequently and had received more past psychotropic treatments than the controls. They also had higher MADRS and HAMA scores than the controls, in particular neurovegetative, psychic anxiety and somatic symptoms scores. No dermatological factor tested was associated with these scores, whereas being a lupus patient was associated with higher neurovegetative and somatic symptoms scores, having a current personality disorder with higher depressive and neurovegetative scores and receiving more past psychotropic treatments with psychic anxiety and somatic symptoms scores. The occurrence of psychiatric disorders during the study follow-up was associated with an elevated psychic anxiety score at baseline and past psychotropic treatment but not with history of psychiatric disorder. LIMITATIONS: The LuPsy cohort included a large number of patients with axis I psychiatric disorders, the sample without axis I psychiatric disorders is therefore limited. CONCLUSIONS: We observed numerous psychiatric symptoms among the skin-restricted lupus patients. They should therefore receive special attention in the management of their subclinical symptoms before they progress towards full psychiatric disorders.

Regardless of personality, males show similar levels of plasticity in territory defense in a Neotropical poison frog.

Animal personality traits are sometimes linked to an individual's degree of plasticity, with certain personality types being more plastic than others. In territorial species, consistently high levels of aggression might increase the risk of harmful fights, while consistently low aggression might lead to the loss of a territory. Consequently, reacting plastically with an appropriate territorial response should be beneficial to avoid these risks. An integrative investigation of both personality traits and plasticity can help us better understand the dynamics of aggressive interactions during male-male competition. Here, we used a free-ranging Neotropical poison frog population to investigate the role of plasticity in male territorial aggression towards intruders. We conducted repeated standardized territorial intrusion experiments mimicking frogs of different body sizes via playback calls with different peak frequencies. We found individual repeatability for the latency to reach and approach a simulated intruder and observed that both aggressive and less aggressive males decreased their level of aggression towards big intruders. However, our results do not support a correlation between personality and plasticity in the context of male territory defense during the breeding season. We discuss how such a correlation between personality and plasticity might be conditional on the costs and benefits across contexts.

[Artificial intelligence and psychiatry: questions from psychiatrists to ChatGPT]. / Intelligence artificielle et psychiatrie : questions de psychiatres à ChatGPT.

Psychiatrists and psychotherapists specialising in the fields of addiction, personality disorders, ADHD and suicidal crisis, we questioned the ChatGPT artificial intelligence program in order to form an opinion on the quality of its answers to questions on these subjects. Our aim is to satisfy our curiosity about these emerging tools. On the other hand, we want to assess the relevance of the answers in order to know whether relatives and patients can use them safely. In this article, we comment on the question-and-answer dialogue with the artificial intelligence program in the light of the literature.

Psychiatres et psychothérapeutes spécialisés dans les domaines de l'addiction, les troubles de la personnalité, le TDAH et la crise suicidaire, nous avons questionné le programme d'intelligence artificielle ChatGPT dans le but de nous faire une opinion sur la qualité de ses réponses à des questions sur ces sujets. Notre objectif est, d'une part, de satisfaire notre curiosité face à ces outils émergents. Nous voulons également évaluer la pertinence des réponses pour savoir si proches et patients peuvent les utiliser en sécurité. Dans cet article, nous commentons le dialogue de questions-réponses avec le programme d'intelligence artificielle à la lumière de la littérature spécialisée.

[Inflammatory markers in organic nonpsychotic disorders]. / Vospalitel'nye markery pri organicheskikh nepsikhoticheskikh rasstroistvakh.

OBJECTIVE: To determine the indicators of systemic inflammation in peripheral blood samples of patients with organic non-psychotic disorders. MATERIAL AND METHODS: The study included 60 patients, aged 56.9±7.7 years, with a disease duration of 7.3±5.55 years, with a verified ICD-10 diagnosis «Organic emotionally labile (asthenic) disorder¼ (F06.6) and «Organic Anxiety Disorder¼ (F06.4). Patients with organic asthenic disorder were divided into two groups according to the prevailing symptoms: 36 patients with asthenic-cephalgic syndrome (AC); 10 patients with astheno-dysthymic syndrome (AD); the third group (n=14) included patients with organic anxiety disorder (AND). The control group consisted of 65 people matched for age and sex with patients. The activity of leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) was determined by the spectrophotometric method, the levels of aAB to S100b and MBP were determined by ELISA. The protease-inhibitory index (PII), i.e., the ratio of LE activity to α1-PI, was calculated. RESULTS: A significant increase in LE (235.4 [216.4; 258.1] nmol/min*ml, p<0.001), the functional activity of α1-PI (43.1 [38.7; 47.6] u/ml, p<0.001), the level of aAB to S100b (0.78 [0.70; 0.89] opt.units, p<0.05) and a decrease in PII (6.19 [5.32; 6.9], p<0.05) in the group of patients with organic non-mental disorders compared with controls were shown. Deviations from the normal values of immune markers of inflammation in blood samples were also found in various syndromes. Clustering of the total group of patients by LE activity made it possible to identify 2 immunotypes with a balanced and unbalanced inflammatory process, confirming the clinical diversity of the disease: 60% of patients with AC syndrome belong to the 1st cluster, in which the ratio of immune markers characterizes a balanced inflammatory process aimed at restoration of homeostasis; 80% of patients with organic AND belong to the second cluster, which characterizes low proteolytic activity and imbalance of inflammation, which is an unfavorable prognostic factor in terms of the further course of the disease and therapy. CONCLUSION: The results confirm the importance of the inflammatory link in the neuroprogression of organic non-psychotic disorders. The identified features of the immune response can serve as an additional paraclinical criterion for differential diagnosis and evaluation of the prognosis of the further development of the disease.

Individual personality predicts social network assemblages in a colonial bird.

Animal personalities manifest as consistent individual differences in the performance of specific behavioural expressions. Personality research has implications for zoo animal welfare, as it can further our understanding of how captive individuals may differ in their resource use and provide insight into improving individual and group social health. For group living species, personality may enable assortment based on similar behaviour and influence an individual's interactions with conspecifics (e.g. social support). This research aimed to document how personality traits (aggressive, exploratory, submissive) influenced the social network structure of highly social animals in a captive environment. Data were collected from separate flocks of captive Caribbean (Phoenicopterus ruber) and Chilean flamingos (Phoenicopterus chilensis) to identify relationships between birds and examine opportunities for social support. The flocks associated non-randomly, and in both cases, personality was a substantial predictor of network structure. Personality also predicted key elements of Caribbean flamingo social role (degree, betweenness and average association strength) conflict outcome, and propensity to provide social support, however these patterns were not replicated within the Chilean flamingo network. While both species appear to assort by personality, the broader relationship between personality and social role may vary depending on species and context.

Hikikomori Syndrome and Digital Technologies: A Systematic Review.

ABSTRACT: Hikikomori syndrome (HS) is a voluntary prolonged social isolation associated with personal and community impact. Previous evidence pointed out a possible relationship between this syndrome with addiction to digital technologies. Here we aim to understand the relationship between HS and digital technology use, overuse, and addictive behaviors, as well as potential therapeutic approaches.We conducted a systematic review of observational and intervention studies available in PubMed/MEDLINE, LILACS, IBECS, Embase, PsycINFO, and SciELO databases, following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA 2020) criteria. The risk of bias was assessed with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and Consensus-based Clinical Case Reporting Guideline Development (CARE). Eligibility criteria were pre-, at-risk populations, or those with HS diagnosis, and any kind of technological overuse. Seventeen studies were included in the review, of which eight were cross-sectional, eight were case reports, and one was quasi-experimental. Hikikomori syndrome was associated with addition to digital technologies; no cultural differences were found. Environmental factors, such as a history of bullying, low self-esteem, and grief were identified as precursors of addictive behaviors. The included articles addressed addiction to digital technologies, electronic games, and social networks, among others, in HS. HS is cross-culturally associated with such addiction. The management of these patients remains challenging, and no target evidence-based treatments have been developed. The studies included in this review had several limitations, and more studies with a higher level of evidence are needed to support the results.

Personality Pathology in Winter Depression: Prevalence and Treatment Trajectories in Cognitive-Behavioral Therapy and Light Therapy.

Personality disorders are highly comorbid with major depression; however, findings are mixed regarding their impact on depression treatment outcomes and trajectories. Limited research has studied personality pathology in winter depression, specifically. This study (1) explored the prevalence of personality pathology in winter depression and (2) examined its effects on winter depression treatment trajectories. Participants were 174 adults with Major Depression, Recurrent with Seasonal Pattern from a randomized clinical trial comparing group cognitive-behavioral therapy for seasonal affective disorder (CBT-SAD) and light therapy. Participants completed the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon et al., 1994) at baseline. The prevalence of MCMI-III-defined pathological personality traits and personality disorders in this sample was 98/174 (56.3%) with any trait and 65/174 (37.4%) with any disorder. Dependent was the most common elevation (65/174, 37.4%), trait (43/174, 24.7%), and disorder (22/174, 12.6%). Most participants with pathological personality elevations had only one personality disorder (58/174, 33.3%) and one pathological personality trait (82/174, 47.1%). Growth curve analysis revealed personality pathology predicted higher baseline depression scores, but the number of MCMI-III pathological personality elevations (i.e., traits and disorders) and personality disorders did not predict change in depression over the timeframe of pretreatment, weekly during treatment, posttreatment, and follow-ups one and two winters later in CBT-SAD or light therapy. Results suggest that personality pathology is not a negative prognostic indicator or prescriptive factor for winter depression treatment with CBT-SAD or light therapy, which may inform treatment algorithms and decision-making in practice.

Sensitive liberals and unfeeling conservatives? Interoceptive sensitivity predicts political liberalism.

The stark divide between the political right and left is rooted in conflicting beliefs, values, and personality-and, recent research suggests, perhaps even lower-level physiological differences between individuals. In this registered report, we investigated a novel domain of ideological differences in physiological processes: interoceptive sensitivity-that is, a person's attunement to their own internal bodily states and signals (e.g., physiological arousal, pain, and respiration). We conducted two studies testing the hypothesis that greater interoceptive sensitivity would be associated with greater conservatism: one laboratory study in the Netherlands using a physiological heartbeat detection task and one large-scale online study in the United States employing an innovative webcam-based measure of interoceptive sensitivity. Contrary to our predictions, we found evidence that interoceptive sensitivity may instead predict greater political liberalism (versus conservatism), although this association was primarily limited to the American sample. We discuss implications for our understanding of the physiological underpinnings of political ideology.

The role of personality in neighborhood satisfaction.

Urbanists have long been interested in understanding what makes people satisfied with their neighborhoods. However, relatively little is known about how residents' personality traits may affect their neighborhood satisfaction. In this paper, we explore the direct and indirect associations of personality traits with neighborhood satisfaction in a representative sample of adults in Michigan (USA). We find that each of the personality traits in the five factor model are associated with neighborhood satisfaction in the same way that they are known to be associated with subjective well-being. However, we fail to observe evidence that personality traits moderate the association between perceptions of neighborhoods and neighborhood satisfaction, or that personality's association with neighborhood satisfaction is mediated by neighborhood perceptions. We conclude that there is potential for drawing on theoretical and empirical developments in positive psychology for understanding neighborhood satisfaction, but observe that the underlying mechanisms for the association between personality and neighborhood satisfaction remain unknown.

Evaluation of international guidance for the community treatment of 'personality disorders': A systematic review.

BACKGROUND: Guidelines for the treatment and management of 'personality disorders' have been introduced to provide guidance on best practice based on evidence and views of key stakeholders. However, guidance varies and there is yet to be an overall, internationally recognised consensus on the best mental health care for people with 'personality disorders'. AIMS: We aimed to identify and synthesise recommendations made by different mental health organisations from across the world on community treatment for people with 'personality disorders'. METHODS: This systematic review consisted of three stages: 1. systematic literature and guideline search, 2. quality appraisal, and 3. data synthesis. We combined a search strategy involving both systematic searching of bibliographic databases and supplementary search methods of grey literature. Key informants were also contacted to further identify relevant guidelines. Codebook thematic analysis was then conducted. The quality of all included guidelines was assessed and considered alongside results. RESULTS: After synthesising 29 guidelines from 11 countries and 1 international organisation, we identified four main domains, with a total of 27 themes. Important key principles on which there was consensus included continuity of care, equity of access, accessibility of services, availability of specialist care, taking a whole systems approach, trauma informed approaches, and collaborative care planning and decision making. CONCLUSIONS: Existing international guidelines shared consensus on a set of principles for the community treatment of 'personality disorders'. However, half of the guidelines were of lower methodological quality, with many recommendations not backed by evidence.

Self-selection biases in psychological studies: Personality and affective disorders are prevalent among participants.

Respondents select the type of psychological studies that they want to participate in consistence with their needs and individual characteristics, which creates an unintentional self-selection bias. The question remains whether participants attracted by psychological studies may have more psychological dysfunctions related to personality and affective disorders compared to the general population. We investigated (N = 947; 62% women) whether the type of the invitation (to talk about recent critical or regular life events) or the source of the data (either face-to-face or online) attracts people with different psychopathology. Most importantly, participants who alone applied to take part in paid psychological studies had more symptoms of personality disorders than those who had never before applied to take part in psychological studies. The current results strongly translate into a recommendation for either the modification of recruitment strategies or much greater caution when generalizing results for this methodological reason.

Personality Determinants of Exercise-Related Nutritional Behaviours among Polish Team Sport Athletes.

A proper diet increases the effectiveness of training and accelerates post-workout regeneration. One of the factors determining eating behaviour are personality traits, including those included in the Big Five model, i.e., neuroticism, extraversion, openness, agreeableness, and conscientiousness. The aim of this study was to analyse the personality determinants of peri-exercise nutritional behaviours among an elite group of Polish athletes practicing team sports. The study was conducted in a group of 213 athletes, using the author's validated questionnaire of exercise-related nutrition behaviours and the NEO-PI-R (Neuroticism Extraversion Openness-Personality Inventory-Revised). A statistical analysis was performed using Pearson's linear correlation and Spearman's rank correlation coefficients as well as a multiple regression analysis, assuming a significance level of α = 0.05. It has been shown that the level of the overall index regarding normal peri-exercise eating behaviours decreased with increasing neuroticism (r = -0.18) and agreeableness (r = -0.18). An analysis of the relationship between the personality traits (sub-scales) of the Big Five model demonstrated that the overall index of proper peri-exercise nutrition decreased with the intensification of three neuroticism traits, i.e., hostility/anger (R = -0.20), impulsiveness/immoderation (R = -0.18), and vulnerability to stress/learned helplessness (R = -0.19), and four traits of agreeableness, i.e., straightforwardness/morality (R = -0.17), compliance/cooperation (R = -0.19), modesty (R = -0.14), and tendermindedness/sympathy (R = -0.15) (p < 0.05). A multiple regression analysis exhibited that the full model consisting of all the analysed personality traits explained 99% of the variance concerning the level of the proper peri-exercise nutrition index. In conclusion, the index of proper nutrition under conditions of physical effort decreases along with the intensification of neuroticism and agreeableness among Polish athletes professionally practicing team sports.

Validation of the pathological narcissistic inventory (PNI) and its brief form (B-PNI) in the Arabic language.

BACKGROUND: The Pathological Narcissism Inventory (PNI) is a multidimensional measure developed to assess narcissistic grandiosity and narcissistic vulnerability. We aimed to validate the Arabic version of the original Pathological Narcissistic Inventory (PNI) and its brief form (B-PNI) in a community sample of Lebanese adults. METHODS: The English language PNI items were translated into Arabic following a rigorous translation, back-translation, and linguistic evaluation. A total of 401 participants were administered the translated PNI, as well as previously validated Arabic versions of the Big Five Inventory-2, the Rosenberg Self-esteem Scale, the Patient Health Questionnaire (PHQ-9), and the Impulsivity-8 Scale. RESULTS: Exploratory and confirmatory analyses supported the existence of seven first-order and two second-order factors of the PNI and B-PNI. Except for exploitativeness where females scored lower than males, no other significant differences by gender were observed for the remaining PNI subscale scores. Additionally, scores on all the subscales exhibited good reliability, while the associations with external measures supported the concurrent validity of the translated instrument. CONCLUSION: The results of this study suggest that scores on the PNI and B-PNI are highly reliable with satisfactory concurrent and factorial validity, providing an assessment of broadly defined pathological narcissism among the Lebanese young adult population. The availability of the Arabic PNI and its brief form should facilitate improved understanding of pathological narcissism in Arabic cultures and the different factors that govern narcissistic personality pathology.

Personality disorders in patients with newly diagnosed bipolar disorder, their unaffected first-degree relatives and healthy control individuals.

OBJECTIVE: Bipolar disorder (BD) is often a progressive mood disorder with a high prevalence of comorbid personality disorder (PD) ranging from 25 to 73 %. Previous studies have included patients with various illness duration of BD. Longer illness duration may be associated with increased prevalence of comorbid PD. This study investigated the prevalence of comorbid personality disorders in patients with newly diagnosed BD and their unaffected first-degree relatives (UR) compared with healthy control individuals (HC). METHODS: We included 204 patients with newly diagnosed BD, 109 of their UR and 188 HC. To assess comorbid PD according to DSM-IV, the SCID-II-interview was performed in full or partial remission. Subthreshold PD was defined as scores above cut-off in the SCID-II self-report questionnaires. Functioning was assessed using the Functioning Assessment Short Test. RESULTS: In total 52 (25.5 %) of the patients with newly diagnosed BD fulfilled criteria for a comorbid PD. Regarding UR, 7 (6.4 %) fulfilled the criteria for a PD. Subthreshold PD were more prevalent in BD (82.8 %) and UR (53.0 %) than in HC (35.1 %), p-values < 0.003). Patients with comorbid PD presented with impaired functioning compared with patients without PD. LIMITATIONS: Clinical diagnostic distinction between PD and BD is challenged by overlapping symptoms. CONCLUSION: A quarter of patients with newly diagnosed BD fulfill criteria for a comorbid PD, already at the time of the diagnosis with BD. A comorbid PD is associated with larger functional impairments. This emphasizes the need for early assessment of comorbid PD at time of BD diagnosis.

Attention to faces in images is associated with personality and psychopathology.

Humans show a robust tendency to look at faces in images, but also differ consistently in the strength of this attentional preference. Previous research remained inconclusive as to how a stronger face preference may be indicative of an individual's personality or clinical characteristics. Here we investigated face preferences in 120 participants (primarily drawn from a student population) who freely viewed photos in an internet browser showing a person in the context of a visually rich environment while attention was assessed using a cursor-based technique. Participants differed consistently in the strength of their face preference across images. A stronger preference for faces was correlated positively with openness to experience, extraversion, agreeableness and empathizing and was correlated negatively with social anxiety, depression levels and alexithymia. Trait measures were linked through a strong common factor which was additionally correlated with face preference. We conclude that face preferences may be linked to personality traits and to psychopathology but that an attribution to a specific facet of psychopathology may not be warranted. Future research should investigate links between face preferences and personality features in more diverse samples and across differing social situations.