Treating Guilt-Inducing Self-Talk in Ocd with Dramatized Socratic Dialogue: A Step by Step Intervention.

Objective: Fear of moral guilt and conseque:nt increased attention to personal actions and intentions are the main ingredients of the self-criticism in patients suffering from obsessive-compulsive disorder (OCD). This pathogenic attitude takes shape in a typical guilt-inducing self-talk.The purpose of this work is to describe in detail a novel cognitive therapeutic procedure for OCD called "Dramatized Socratic Dialogue" (DSD). Method: DSD is a theory-oriented intervention that combine elements of Socratic dialogue, chairwork, and cognitive acceptance strategies derived from Mancini's model, which posits that obsessive-compulsive (OC) symptoms stem from a fear of deontological guilt. Results: DSD appears to have many strengths, being a theory-oriented treatment and focusing, as a therapeutic target, on the cognitive structures that determine pathogenic processes and OC symptoms. Furthermore, it is a short, flexible and tailor-made intervention. Conclusions: Detailed description of the intervention could foster future research perspectives and thus be used in evidence-based effectiveness studies to establish whether DSD reduces OC symptoms and to investigate its mechanism of action.

Ausubel's meaningful learning re-visited.

This review provides a critique of David Ausubel's theory of meaningful learning and the use of advance organizers in teaching. It takes into account the developments in cognition and neuroscience which have taken place in the 50 or so years since he advanced his ideas, developments which challenge our understanding of cognitive structure and the recall of prior learning. These include (i) how effective questioning to ascertain previous knowledge necessitates in-depth Socratic dialogue; (ii) how many findings in cognition and neuroscience indicate that memory may be non-representational, thereby affecting our interpretation of student recollections; (iii) the now recognised dynamism of memory; (iv) usefully regarding concepts as abilities or simulators and skills; (v) acknowledging conscious and unconscious memory and imagery; (vi) how conceptual change involves conceptual coexistence and revision; (vii) noting linguistic and neural pathways as a result of experience and neural selection; and (viii) recommending that wider concepts of scaffolding should be adopted, particularly given the increasing focus on collaborative learning in a technological world.

Developing Organizational Diversity Statements Through Dialogical Clinical Ethics Support: The Role of the Clinical Ethicist.

In pluralist societies, stakeholders in healthcare may have different experiences of and moral perspectives on health, well-being, and good care. Increasing cultural, religious, sexual, and gender diversity among both patients and healthcare professionals requires healthcare organizations to address these differences. Addressing diversity, however, comes with inherent moral challenges; for example, regarding how to deal with healthcare disparities between minoritized and majoritized patients or how to accommodate different healthcare needs and values. Diversity statements are an important strategy for healthcare organizations to define their normative ideas with respect to diversity and to establish a point of departure for concrete diversity approaches. We argue that healthcare organizations ought to develop diversity statements in a participatory and inclusive way in order to promote social justice. Furthermore, we maintain that clinical ethicists can support healthcare organizations in developing diversity statements in a more participatory way by fostering reflective dialogues through clinical ethics support. We will use a case example from our own practice to explore what such a developmental process may look like. We will critically reflect on the procedural strengths and challenges as well as on the role of the clinical ethicist in this example.

When Is an Interview an Inter View? The Historical and Recent Development of Methodologies Used to Investigate Children's Astronomy Knowledge.

This paper provides a historical review of the interview research that has been used by science educators to investigate children's basic astronomy knowledge. A wide range of strategies have been developed over the last 120 years or so as successive teams of researchers have endeavoured to overcome the methodological difficulties that have arisen. Hence, it looks critically at the techniques that have been developed to tackle the problems associated with interviews, questionnaires and tests used to research cognitive development and knowledge acquisition. We examine those methodologies which seem to yield surer indications of how young people (at different ages) understand everyday astronomical phenomena-the field often referred to as children's cosmologies. Theoretical ideas from cognitive psychology, educational instruction and neuroscience are examined in depth and utilised to critique matters such as the importance of subject mastery and pedagogical content knowledge on the part of interviewers; the merits of multi-media techniques; the roles of open-ended vs. structured methods of interviewing; and the need always to recognise the dynamism of memory in interviewees. With illustrations and protocol excerpts drawn from recent studies, the paper points to what researchers might usefully tackle in the years ahead and the pitfalls to be avoided.

Toward an experimental analysis of verbal shaping in psychotherapy.

AbstractObjective. Some authors have suggested that verbal shaping is an active component in cognitive restructuring. The goal of the current study was to provide experimental evidence in support of the shaping hypothesis. METHOD: Three consecutively admitted adults with symptoms of anxiety and depression participated in the study. Participants underwent baseline, treatment comparison, crossover, and follow-up phases as part of an experimental single-case study. We selected two target irrational beliefs and praised either the client's approximations to a terminal (more adaptive) class of verbalizations (differential reinforcement of approximations) or just the terminal class of verbalizations (terminal reinforcement). RESULTS: Irrational beliefs exposed to differential reinforcement of approximations was a more effective approach to reducing irrational beliefs. CONCLUSION: The study provides experimental evidence in support of the verbal shaping hypothesis. Our findings suggest that it may be possible to enhance clinical outcomes by actively engaging in verbal shaping during client-therapist verbal interaction.

The ambiguity of altruism in nursing: A qualitative study.

BACKGROUND:: For a long time, altruism was the basis for caring. Today, when society is more individualized, it is of interest to explore the meaning of altruism in nursing. METHODS:: In all, 13 nurses from a Swedish acute care setting participated in two focus group interviews performed as Socratic dialogues. Data were analyzed using a phenomenological hermeneutical method. ETHICAL CONSIDERATIONS:: Ethical issues were considered throughout the process according to established ethical principles. Informed consent was obtained from all participants, confidentiality regarding the data was guaranteed and quotations anonymized. FINDINGS:: Altruism created a sense of ambivalence and ambiguity, described as a rise of sovereign expressions of life caused by "the other's" need, but also unwillingness to take unconditional responsibility for "the other." CONCLUSION:: Society's expectations of altruism and nurses' perception of their work as a salaried job collide in modern healthcare. Nurses are not willing to fully respond to the ethical demand of the patients. In case of a disaster, when nurses personal safety, life and health may be at risk, there might be reasons to question whether the healthcare organization would be able to fulfill its obligations of providing healthcare to an entire population.

The Care Dialog: the "ethics of care" approach and its importance for clinical ethics consultation.

Ethics consultation in institutions of the healthcare system has been given a standard form based on three pillars: education, the development of guidelines and concrete ethics consultation in case conferences. The spread of ethics committees, which perform these tasks on an organizational level, is a remarkable historic achievement. At the same time it cannot be denied that modern ethics consultation neglects relevant aspects of care ethics approaches. In our essay we present an "ethics of care" approach as well as an empirical pilot project-"Ethics from the bottom up"-which organizes ethics consultation based on this focus. Findings and philosophy of the project will be discussed as far as relevant for ethics consultation in the healthcare system.

Reflection: A Socratic approach.

Reflection is a fuzzy concept. In this article we reveal the paradoxes involved in studying the nature of reflection. Whereas some scholars emphasize its discursive nature, we go further and underline its resemblance to the self-biased dialogue Socrates had with the slave in Plato's Meno. The individual and internal nature of the reflection process creates difficulty for studying it validly and reliably. We focus on methodological issues and use Hans Linschoten's view of coupled systems to identify, analyze, and interpret empirical research on reflection. We argue that researchers and research participants can take on roles in several possible system couplings. Depending on who controls the manipulation of the stimulus, who controls the measuring instrument, who interprets the measurement and the response, different types of research questions can be answered. We conclude that reflection may be validly studied by combining different couplings of experimenter, manipulation, stimulus, participant, measurement, and response.

Efectividad de un programa de prevención en salud mental mediante el diálogo socrático y el pensamiento crítico / Effectiveness of a prevention program in mental health by socratic dialogue and critical thinking

Objetivo: El propósito de este estudio fue analizar el impacto del programa de prevención mediante el diálogo socrático y el pensamiento crítico, en la depresión y la ansiedad. Materiales y métodos: Participaron 110 universitarios que accedían al primer año de la carrera; se utilizó un diseño experimental aleatorizado con grupo experimental y control. La variable independiente fue el diálogo socrático y el pensamiento crítico, y las variables dependientes fueron la sintomatología depresiva y/o ansiosa y los pensamientos negativos, positivos y ansiosos. Como instrumentos se utilizaron la Escala de depresión del Centro de Estudios epidemiológicos (CES-D), el Cuestionario revisado de 90 síntomas (SCL-90R), el Cuestionario de Pensamientos Automáticos Revisado (ATQ-TP), y el Cuestionario de Automanifestaciones Ansiosas (ASSQ). Resultados: Al comparar los resultados entre los dos grupos, se observó que el programa resultó efectivo en la reducción de los pensamientos negativos para el grupo experimental, aunque no se identificaron otros efectos. Conclusiones: El dialogo socrático y el pensamiento crítico - en el marco de un programa de prevención, reducen los pensamientos negativos en los universitarios de primer año.

Objective: The purpose of this study was to analyze the impact of the prevention program by Socratic dialogue and critical thinking, on depression and anxiety. Method: Participants were 110 students who entered their freshman year; an experimental design with experimental and control group was used. Independent variable was Socratic dialogue and critical thinking, and dependent variables were depression and/or anxiety symptoms, and negative, positives and anxious thoughts. Applied instruments consisted on Center for Epidemiologic Studies Depression Scale (CES-D), Symptom Check List - 90 Revised (SCL-90R), Automatic Thoughts Questionnaire - Revised (ATQ-RP), and Anxious Self-Statements Scale (ASSQ). Results: By comparisons between the two groups, it was observed the effectiveness of the program in negative thought reduction, although no other effects were identified. Conclusions: Socratic dialogue and critical thinking - like a prevention program - can change negative thoughts in students at freshman year.

Teaching Ethics to Engineers: A Socratic Experience.

In this paper we present the authors' experience of teaching a course in Ethics for Engineers, which has been delivered four times in three different universities in Spain and Chile. We begin by presenting the material context of the course (its place within the university program, the number of students attending, its duration, etc.), and especially the intellectual background of the participating students, in terms of their previous understanding of philosophy in general, and of ethics in particular. Next we set out the objectives of the course and the main topics addressed, as well as the methodology and teaching resources employed to have students achieve a genuine philosophical reflection on the ethical aspects of the profession, starting from their own mindset as engineers. Finally we offer some results based on opinion surveys of the students, as well as a more personal assessment by the authors, recapitulating the most significant achievements of the course and indicating its underlying Socratic structure.