A model for brief assessment of attachment and its application to women in inpatient treatment for trauma-related psychiatric disorders.

We adapted self-report measures of attachment style to the psychological assessment of women in specialized inpatient treatment for trauma-related disorders. The study employed 2 measures of adult attachment style, the Relationship Questionnaire (Bartholomew & Horowitz, 1991) and the Adult Attachment Scale (Collins & Read, 1990) as well as our Current Attachment Relationships questionnaire, which assesses the extent of social support in secure attachments. We administered these measures to 99 patients and to a convenience sample of 154 women in the community. We found modest correspondence between the 2 attachment style measures and substantial relations between attachment styles and range of secure attachment relationships. Women in the trauma sample reported insecure attachment styles and relatively few secure attachment figures. We discuss the implications of these findings for clinical assessment.

Untreated acetabular dysplasia of the hip in the Navajo. A 34 year case series followup.

Patients born in the Many Farms District of the Navajo Indian Reservation from 1955 to 1961 were studied. Five hundred forty-eight of the 628 infants born (87%) received clinical examinations and pelvic radiographs at some time during the first 4 years of their lives. Eighteen (3.3%) of the 548 infants examined had acetabular dysplasia. Because of traditional cultural beliefs, none of these children received medical treatment. Followup evaluations and radiographs were obtained in these 18 patients during early adolescence. In 10 of the original 18 patients followup evaluations and radiographs were obtained at an average age of 35 years. None of the dysplastic hips progressed to frank dislocation. The mean center edge angle improved from 7 degrees when the patients were 1 year of age, to 29 degrees when the patients were 12 years of age, to 30 degrees when the patients were 35 years of age. Despite overall improvement of hip measurements with maturity, eight hips in five of the 10 patients who were in their fourth decade of life and who were available for examination, had radiographic evidence of residual abnormalities. The hips in patients with subluxation during infancy were less likely to be normal as adults. The results of this 34-year followup study of untreated developmental hip dysplasia showed marked radiographic improvement in all patients during childhood; however, subtle abnormalities persisted in the radiographs of 40% of the hips.

Air medical referring customer satisfaction: a valuable insight.

INTRODUCTION: To remain competitive and survive, air medical programs must have a mechanism for obtaining customer feedback, especially when alternate transport options are available. The goal of this survey was to examine the air medical service's performance as perceived by customers requesting the transport. METHODS: Surveys were mailed to 400 referring customers who had contact with the flight crew during the transition of patient care. The survey consisted of 16 statements evaluating the service by using a 4-point Likert scale, three demographic questions, one statement evaluating overall satisfaction, and two open-ended questions for comments or suggestions. RESULTS: Two hundred forty-four surveys were returned for a 61% responses rate. Results indicated referring customers are satisfied with the service provided Written comments and suggestions were divided into two categories, positive comments and suggestions for improvement. Three common themes were identified within the suggestions for improvement: crew rapport, communications, and operations. Suggested improvements were evaluated, and selected strategies were incorporated into program operation. CONCLUSION: Customer feedback furnishes valuable insight into their needs and perception of a service. Comments and suggestions for improvement can promote critical inquiry into service operation and provide a catalyst for improvement.

Empathic responsiveness and affective reactivity to infant stimuli in high- and low-risk for physical child abuse mothers.

Empathic responsiveness and affective reactivity to infant stimuli were examined in matched groups of high- and low-risk for physical child abuse mothers. Hypotheses were generated based on models of aggression and the child abuse literature. Although no between-group differences were found in empathy, within-group differences were observed. Compared to baseline, high-risk mothers reported no change (p > .05) in empathy across infant conditions (baseline, smiling, quiet, and crying), while low-risk mothers reported an increase (p < .0005) in empathy following presentation of the crying infant. Although there was no change in empathy, high-risk mothers reported more sadness, distress, hostility, unhappiness, and less quietness following presentation of the crying infant. Low-risk mothers reported no changes in sadness, distress, and hostility. The data for high-risk mothers are congruent with reports that physical child abusers are less empathic and more hostile in response to a crying child. The findings support aggression models which suggest the lack of empathy and the presence of negative affectivity precede abusive behavior. Post-hoc analyses also provide support for an emotional contagion perspective, where high-risk parents, compared to low-risk parents, are thought to more frequently reflect the emotional state of the infant.

Air medical transport: what the family wants to know.

INTRODUCTION: The needs of family members of intensive care unit patients are well-documented, but there is little published about the specific needs of family members of air medical patients. PURPOSE: This study was devised to identify family member's information needs regarding air medical transport. METHODS: Using a descriptive correlational design, 100 family members of air medical patients completed a 14-item Likert-format questionnaire. Each item addressed an information need and asked how important the information was to the family member and how much of this information they received. RESULTS: The information needs most frequently ranked as very important related to the patient's condition, the patient's admitting unit at the receiving hospital, and being able to see the patient prior to flight. Information most frequently received by the family related to the patient's condition. CONCLUSION: Flight crews need to be cognizant of families' needs and develop ways to improve communication with the family to meet those needs.

Relation of sympathy and personal distress to prosocial behavior: a multimethod study.

Assessed sympathy and personal distress with facial and physiological indexes (heart rate) as well as self-report indexes and examined the relations of these various indexes to prosocial behavior for children and adults in an easy escape condition. Heart rate deceleration during exposure to the needy others was associated with increased willingness to help. In addition, adults' reports of sympathy, as well as facial sadness and concerned attention, were positively related to their intention to assist. For children, there was some indication that report of positive affect and facial distress were negatively related to prosocial intentions and behavior, whereas facial concern was positively related to the indexes of prosocial behavior. These findings are interpreted as providing additional, convergent support for the notion that sympathy and personal distress are differentially related to prosocial behavior.

The role of sympathy and altruistic personality traits in helping: a reexamination.

The purposes of this study were (a) to examine the role of social evaluative concerns in the self-report of sympathy and in the relation of sympathy to helping; and (b) to determine the role of "altruistic personality" traits and situationally induced vicarious emotional responses in the intention to help. Dispositional and situational self-reports of sympathy and other vicarious emotional reactions were obtained for persons who also were given the opportunity to assist a needy other. Moreover, dispositional measures of concern with social evaluation and an altruistic orientation were obtained, and a bogus pipeline manipulation was instituted for half the study participants. Both dispositional and situational self-reported sympathy were positively related to helping, as were other personality indices viewed as reflecting altruistic characteristics. The relations for the dispositional indices of sympathy were not due solely to social evaluative concerns or to other egoistic concerns. The effects on intended helping of dispositional sympathy, perspective taking, and the tendency to ascribe responsibility for others to the self appeared to be both direct and mediated by situational sympathetic responding. Finally, situational sadness did not mediate the effects of sympathetic responsiveness.

Critical self-reflection and self-perceived altruism: when self-reward fails.

Social learning theory has produced a three-step model of prosocial development: In the young child, prosocial behavior is elicited by material rewards; in the older child, it is elicited also by social rewards; and in the morally mature adult, it is elicited by self-rewards based on an internalized perception of oneself as a kind, caring, altruistic individual. Self-perception theory has complicated this social learning model by demonstrating that once the third step is reached, the continued presence of material and social rewards may undermine intrinsic prosocial motivation based on self-rewards, producing moral regression. We propose a further complication. Critical self-reflection--the desire to know thyself, warts and all--may introduce a self-deprecating attributional bias that can undermine self-perceived altruism, even following helping for which one receives only intrinsic self-rewards. Two experiments are reported in which we manipulated critical self-reflection on one's reasons for helping. Results indicated that self-reflection undermined self-perceived altruism, especially when the salience of the self-rewards for helping was high. Experiment 2 also provided evidence that, as predicted, this self-reflection effect was most apparent for individuals who valued self-knowledge more highly than concern for others. Moral consequences of critical self-reflection are discussed.

Empathy-based helping: is it selflessly or selfishly motivated?

A substantial body of evidence collected by Batson and his associates has advanced the idea that pure (i.e., selfless) altruism occurs under conditions of empathy for a needy other. An egoistic alternative account of this evidence was proposed and tested in our work. We hypothesized that an observer's heightened empathy for a sufferer brings with it increased personal sadness in the observer and that it is the egoistic desire to relieve the sadness, rather than the selfless desire to relieve the sufferer, that motivates helping. Two experiments contrasted predictions from the selfless and egoistic alternatives in the paradigm typically used by Batson and his associates. In the first, an emphatic orientation to a victim increased personal sadness, as expected. Furthermore, when sadness and empathic emotion were separated experimentally, helping was predicted by the levels of sadness subjects were experiencing but not by their empathy scores. In the second experiment, enhanced sadness was again associated with empathy for a victim. However, subjects who were led to perceive that their moods could not be altered through helping (because of the temporary action of a "mood-fixing" placebo drug) were not helpful, despite high levels of empathic emotion. The results were interpreted as providing support for an egoistically based interpretation of helping under conditions of high empathy.

Distress and empathy: two qualitatively distinct vicarious emotions with different motivational consequences.

The construct of empathy may be located conceptually at several different points in the network of interpersonal cognition and emotion. We discuss one specific form of emotional empathy--other-focused feelings evoked by perceiving another person in need. First, evidence is reviewed suggesting that there are at least two distinct types of congruent emotional responses to perceiving another in need: feelings of personal distress (e.g., alarmed, upset, worried, disturbed, distressed, troubled, etc.) and feelings of empathy (e.g., sympathetic, moved, compassionate, tender, warm, softhearted, etc.). Next, evidence is reviewed suggesting that these two emotional responses have different motivational consequences. Personal distress seems to evoke egoistic motivation to reduce one's own aversive arousal, as a traditional Hullian tension-reduction model would propose. Empathy does not. The motivation evoked by empathy may instead be altruistic, for the ultimate goal seems to be reduction of the other's need, not reduction of one's own aversive arousal. Overall, the recent empirical evidence appears to support the more differentiated view of emotion and motivation proposed long ago by McDougall, not the unitary view proposed by Hull and his followers.

Social evaluation and the empathy-altruism hypothesis.

Archer, Diaz-Loving, Gollwitzer, Davis, and Foushee (1981) suggested that feeling empathy for a person in need may lead to increased helping because the empathic individual wants to avoid negative social evaluation. As support for this suggestion, they claimed that empathy leads to increased helping only under socially evaluative circumstances. We conducted two studies to test this claim. In Study 1 subjects were led to believe that no one--including the person in need--would ever know if they declined to help. In this situation, which was designed to be totally devoid of the potential for negative social evaluation for not helping, there was still a positive relationship between self-reported empathic emotion and offering help. In Study 2 empathy (low versus high) and social evaluation (low versus high) were manipulated in a 2 X 2 design. Once again there was a positive relationship between empathy and offering help when the potential for social evaluation was low as well as high. Results of both studies, then, suggest that the motivation to help evoked by empathy is not egoistic motivation to avoid negative social evaluation. Instead, the observed pattern was what would be expected if empathy evokes altruistic motivation to reduce the victim's need.

Guidelines for the management of hospitalized narcotics addicts.

Opiate-dependent patients who are hospitalized for medical, surgical, or obstetrical reasons require proper management of their addiction to care of their presenting illness. Guidelines are offered for methadone support during hospitalization for the patient enrolled in a treatment program and for the street addict. The important clinical features of withdrawal reactions are outlined, and a method is presented for establishing an initial and supportive dose of methadone for street addicts. The use of analgesics in the addicted patient, the treatment of methadone overdose, and some problems in the management of mixed-drug abuse are discussed.