THE SELF-REFLECTION AND INSIGHT SCALE: A NEW MEASURE OF PRIVATE SELF-CONSCIOUSNESS

Direct and Indirect Effects of Behavioral Inhibition/Activation Systems on Depression and Current Suicidal Ideation Through Rumination and Self-Reflection

This study aimed to evaluate direct and indirect effects of the behavioral inhibition system (BIS) and the behavioral activation system (BAS) on depression and current suicidal ideation through rumination and self-reflection in a sample of suicide attempters. Three hundred suicide attempters completed the Rumination/Reflection Questionnaire (RRQ), the Carver and White BIS/BAS scales, the Beck Scale for Suicide Ideation (BSSI), and the Beck Depression Inventory-II (BDI-II). Results revealed that the BAS and BIS had direct effects on suicidal ideation but not depression. Low BAS had an indirect effect on depression through decreased self-reflection. High BIS had an indirect effect on depression via increased rumination. Low BAS and high BIS had indirect effects on suicidal ideation through decreased self-reflection. The findings suggest that low BAS and high BIS may be associated with depression and suicidal ideation in suicide attempters who have decreased self-reflection and increased rumination. Also, increasing self-reflection and reducing rumination as respectively adaptive and maladaptive self-focused attention strategies may prohibit depression and suicidal ideation.

Could Self-Consciousness Be Enhanced in Alzheimer’s Disease? An Approach from Emotional Sensorial Stimulation

Alzheimer’s disease (AD) provides a valuable field of research into impairment of self-consciousness (SC), because AD patients have a reduced capacity to understand their mental world, to experience and relive previous personal events, as well as to interpret thoughts, feelings, and beliefs about themselves. Several studies observed that AD patients had an altered SC, but not a complete abolition of it. Emotions are an integral part of the construction of personal identity, therefore of Self. In general, most studies on emotion in AD patients have observed that emotion is not completely abolished and it lets them better remember autobiographical events with greater emotional charge. The positive effect of autobiographical memories rich in emotional content, evoked directly/automatically by sensorial stimuli such as familiar odors or music, could be used to reestablish/reinforce the permanence and coherence of the Self in AD. We studied the research of empirical evidence supporting the power of the sensorial cues associated with emotion, which could be capable of enhancing the SC in AD. We presented the studies about “Emotional stimulations” using odor, music, or taste cues in AD. All studies have shown to have a positive impact on SC in AD patients such as odor-evoked autobiographical memories, taste/odor-evoked autobiographical memories, emotional sensorial stimulation using musical cues, and multi-sensorial stimulations using healing gardens. We found research supporting the notion that emotional sensorial stimulations can even temporarily exalt memory, affective state, and personal identity, that is, the SC in AD. The emotional sensory stimulations could be used as a tool to activate the SC in AD and hence improve the quality of life of patients and caregivers.

A Multi-Study Exploration of Factors That Optimize Hardiness in Sport Coaches and the Role of Reflective Practice in Facilitating Hardy Attitudes

Hardiness has been identified as a key personal characteristic that may moderate the ill-effects of stress on health and performance. However, little is known about how hardiness might be developed, particularly in sport coaches. To systematically address this gap, we present two linked studies. First, interviews were conducted with pre-determined high-hardy, elite coaches (n = 13) to explore how they had developed their hardy dispositions through the associated attitudinal sub-components of control, commitment, and challenge. Utilizing thematic analysis, we identified that hardiness was developed through experiential learning, external support, and the use of specific coping mechanisms. Key to all of these themes was the concept of reflective practice, which was thought to facilitate more meaningful learning from the participants' experiences and, subsequently, enhance the self-awareness and insight required to augment hardiness and its sub-components. To investigate further the potential relationship between coaches' reflective practices and their level of hardiness, we conducted a follow-up study. Specifically, a sample of 402 sports coaches completed the Dispositional Resilience Scale-15, the Self-Reflection and Insight Scale, and the Questionnaire for Reflective Thinking. Using latent profile analysis (LPA), we clustered participants into groups based on their reflective profiles (e.g., type of engagement, level of reflective thinking). We then examined differences in hardiness between the five latent sub-groups using multinomial regression. Findings revealed that the sub-group of highly engaged, intentionally critical reflective thinkers reported significantly higher levels of all three hardiness sub-components than all other sub-groups; these effect sizes were typically moderate-to-large in magnitude (standardized mean differences = -1.50 to -0.10). Conversely, the profile of highly disengaged, non-reflective, habitual actors reported the lowest level of all three dimensions. Collectively, our findings offer novel insights into the potential factors that may influence a coaches' level of hardiness. We provide particular support for the importance of reflective practice as a meta-cognitive strategy that helps coaches to develop hardy dispositions through augmenting its attitudinal sub-components. Consequently, our research makes a significant contribution by providing a comprehensive insight into how we might better train and support coaches to demonstrate the adaptive qualities required to thrive in demanding situations.

Self-Reflection as a Support to Evidence-Based Practice: A Grounded Theory Exploration

The purpose of this study was to explore how reflective practice is experienced by occupational therapists. Thirty participants were purposefully sampled to explore reflective practice experiences using a critical reflection inquiry model as a theoretical framework. Grounded theory using a constant comparative analysis method was used to analyze interview data. Three categories emerged: triggers to reflection, depth of reflection, and actions taken. The frequency of statements compared across survey groups showed that participants with high reflection behaviors made more critical reflections, used steps of the EBP cycle, and took actions to correct practice. Results inform practice in three ways: (1) practitioner experiences were analyzed through the complete reflective practice construct, (2) findings indicated that greater depth of reflective thinking promotes EBP use and actions taken to correct practice, and (3) narrative content analysis was found to be a credible method of assessing reflection within practice narratives, suggesting it as useful for education and promoting continuing competency.

Adjust your own oxygen mask before helping those around you: an autoethnography of participatory research

BACKGROUND

There is a need to unpack the empirical, practical, and personal challenges within participatory approaches advocated to optimize implementation. The unpredictable, chaotic nature of participatory approaches complicates application of implementation theories, methods, and strategies which do not address researchers' situatedness within participatory processes. As an implementation scientist, addressing one's own situatedness through critical reflection is important to unearth how conscious and unconscious approaches, including ontological and epistemological underpinnings, influence the participatory context, process, and outcomes. Therefore, the aim of this exploratory work is to investigate the heretofore blind spot toward the lived experience of implementation researchers within the participatory process.

METHODS

We developed an integrated research-practice partnership (IRPP) to inform the implementation of a gestational weight gain (GWG) control program. Within this IRPP, one investigator conducted a 12-month autoethnography. Data collection and triangulation included field notes, cultural artifacts, and systematic timeline tracking. Data analysis included ethnographic-theoretical dialogue and restorying to synthesize key events and epiphanies into a narrative.

RESULTS

Analysis revealed the unpredicted evolution of the GWG program into a maternal health fair and three themes within the researchers' lived experience: (1) permeable work boundaries, (2) individual and collective blind spots toward the ontological and epistemological underpinnings of implementation paradigms, and (3) maladaptive behaviors seemingly reinforced by the research culture. These themes contributed to the chaos of implementation and to researchers' experience of inadequate recovery from cognitive, emotional, and practical demands. These themes also demonstrated the importance of contextual factors, subjectivity, and value-based judgments within implementation research.

CONCLUSION

Building on extant qualitative research guidelines, we suggest that researchers anchor their approach to implementation in reflexivity, intentionally and iteratively reflecting on their own situatedness. Through this autoethnography, we have elucidated several strategies based on critical reflection including examining philosophical underpinnings of research, adopting restorative practices that align with one's values, and embracing personal presence as a foundation of scientific productivity. Within the predominant (post-) positivism paradigms, autoethnography may be criticized as unscientifically subjective or self-indulgent. However, this work demonstrates that autoethnography is a vehicle for third-person observation and first-person critical reflection that is transformative in understanding and optimizing implementation contexts, processes, and outcomes.

Which Learning Activities Enhance Physical Therapist Practice? Part 1: Systematic Review and Meta-analysis of Quantitative Studies

OBJECTIVE

Following graduation from professional education, the development of clinical expertise requires career-long participation in learning activities. The purpose of this study was to evaluate which learning activities enhanced physical therapist practice.

METHODS

Eight databases were searched for studies published from inception through December 2018. Articles reporting quantitative data evaluating the effectiveness of learning activities completed by qualified physical therapists were included. Study characteristics and results were extracted from the 26 randomized controlled trials that met the inclusion criteria. Clinician (knowledge, affective attributes, and behavior) and patient-related outcomes were extracted.

RESULTS

There was limited evidence that professional development courses improved physical therapist knowledge. There was low-level evidence that peer assessment and feedback were more effective than case discussion at improving knowledge (standardized mean difference = 0.35, 95% CI = 0.09-0.62). Results were inconsistent for the effect of learning activities on affective attributes. Courses with active learning components appeared more effective at changing physical therapist behavior. The completion of courses by physical therapists did not improve patient outcomes; however, the addition of a mentored patient interaction appeared impactful.

CONCLUSION

Current evidence suggests active approaches, such as peer assessment and mentored patient interactions, should be used when designing learning activities for physical therapists. Further high-quality research focused on evaluating the impact of active learning interventions on physical therapist practice and patient outcomes is now needed.

IMPACT

This study is a first step in determining which learning activities enhance clinical expertise and practice would enable the physical therapy profession to make informed decisions about the allocation of professional development resources.

Can high quality listening predict lower speakers' prejudiced attitudes?

Theorizing from humanistic and motivational literatures suggests attitude change may occur because high quality listening facilitates the insight needed to explore and integrate potentially threatening information relevant to the self. By extension, self-insight may enable attitude change as a result of conversations about prejudice. We tested whether high quality listening would predict attitudes related to speakers' prejudices and whether self-insight would mediate this effect. Study 1 (preregistered) examined scripted conversations characterized by high, regular, and poor listening quality. In Study 2, we manipulated high versus regular listening quality in the laboratory as speakers talked about their prejudiced attitudes. Finally, Study 3 (preregistered) used a more robust measure of prejudiced attitudes to test whether perceived social acceptance could be an alternative explanation to Study 2 findings. Across these studies, the exploratory (pilot study and Study 2) and confirmatory (Studies 1 & 3) findings were in line with expectations that high, versus regular and poor, quality listening facilitated lower prejudiced attitudes because it increased self-insight. A meta-analysis of the studies (N = 952) showed that the average effect sizes for high quality listening (vs. comparison conditions) on self-insight, openness to change and prejudiced attitudes were, ds = 1.19, 0.46, 0.32 95%CIs [0.73, 1.51], [0.29, 0.63] [0.12, 0.53], respectively. These results suggest that when having conversations about prejudice, high-quality listening modestly shapes prejudice following conversations about it, and underscore the importance of self-insight and openness to change in this process.

Occupational Therapists' Implementation of Evidence-Based Practice: A Cross Sectional Survey

Evidence-based practice (EBP) implementation has been associated with quality health care outcomes, yet only a small proportion of occupational therapists implement EBP. We conducted a cross-sectional survey measuring EBP implementation, skill and knowledge, self-reflection behavior, and practice demographics to clarify implementation of EBP and factors acting as supports. A random sample of occupational therapists practicing in the U.S. was invited to participate; 578 surveys were included in the final analysis. Participants implemented EBP less than 1 time over the previous 8 weeks; EBP use was highest in those with a doctorate (p = .002) and high self-reflection behavior (p = .001); EBP use was marginally higher in those with organizational support (p = .008; p = .009), time for EBP (p = .009), and access to full text articles (p = .006). Further investigation of how reflective practice and levels of doctoral education support EBP use are recommended.

Development of a Psychometric Measure of the Propensity to Consciously Control and Monitor Speech Production

Purpose A speech-specific reinvestment scale (SSRS) is a psychometric measure of the propensity to consciously control and monitor speech production. This study develops and validates an SSRS as well as examines its relationship with speech performance with the moderating effects of trait social anxieties (i.e., social interaction anxiety, public speaking anxiety, and social phobia). Method Scale development involves the following stages: (a) initial item generation based on relevant literature, (b) item evaluation through cognitive interviews with 24 healthy respondents, (c) scale reliability and validity tests using cross-sectional survey data from 498 healthy respondents, and (d) test-retest reliability assessment using longitudinal survey data from 185 healthy respondents. Respondents' speech performance is quantified using speech examination scores. Hierarchical moderated regression analyses are conducted to examine the moderating effects of trait social anxieties. Results The validated SSRS comprises 35 items, which can be categorized into four subdimensions, namely, speech movement self-consciousness, public consciousness of speech content, speech manner, and speech movement. Results show that respondents with low trait social anxieties indicate a generally positive relationship between public consciousness of speech movement and speech performance, whereas respondents with high trait social anxieties exhibit a nonsignificant relationship. Conclusions SSRS offers a reliable and valid method for assessing the predisposition for conscious speech control and monitoring, which plays a role in speech performance and is moderated by an individual's level of trait social anxiety. SSRS is a potential assessment tool for speech-language pathologists to evaluate the impacts of conscious speech control and monitoring on individuals with speech impairment.

How Identity Conflict and Identity Synergy Influence Innovative Performance of Employees With Multiple Team Membership

Multiple team membership refers to the extent to which team members are engaged in more than one team and switch between different teams. In order to reduce cost and improve efficiency, many organizations or work units allow their employees to work in different teams simultaneously. The purpose of this study is to examine how identity conflict and identity synergy of employees with multiple team membership may influence their innovative performance. Survey data were collected from 149 Chinese employees with multiple team membership. Hierarchical regression was used to test the hypotheses. The results show that identity synergy of employees with multiple team membership has a positive influence on innovative performance, and that self-reflection partially mediates this positive effect. Identity conflict of employees with multiple team membership has a negative impact on innovative performance, and self-reflection partially mediates this negative effect. This study stresses the importance of providing identity synergy and reducing identity conflict to increase the innovative performance of employees with multiple team membership.

Creating a culture of respect and interprofessional teamwork on a labor and birth unit: a multifaceted quality improvement project

Interprofessional teamwork is essential to high-quality healthcare, however disrespect and incivility amongst team members is a challenge to creating and sustaining effective teams. We describe and assess the impact of a multifaceted improvement project with the primary intervention being a Compassionate Communication (CC) training on a Labor and Birth unit. Our hypothesis was this improvement project would increase staff members' capacity for perspective-taking and self-reflection, which would in turn correlate with positive interpersonal interactions, respect and teamwork. Secondly, we hypothesized that enhanced respect and teamwork would correlate with enhanced affective commitment to the organization. Staff was surveyed midway through the project and 6 months after the CC training. A total of 74 (57%) staff completed the initial pre-training surveys and 50 (38%) staff completed post-training surveys. At 6 months post-CC training we saw changes in self-reflection and an awakening of self-awareness. There were no significant changes in perspective-taking. However, we did see changes in staffs' perceptions of respect and teamwork. Team members' affective commitment to the organization increased. In this Labor and Birth setting, a multifaceted improvement project with the primary intervention being CC training was beneficial in improving a culture of respect and interprofessional teamwork.

Developing Self-Awareness in Robots via Inner Speech

The experience of inner speech is a common one. Such a dialogue accompanies the introspection of mental life and fulfills essential roles in human behavior, such as self-restructuring, self-regulation, and re-focusing on attentional resources. Although the underpinning of inner speech is mostly investigated in psychological and philosophical fields, the research in robotics generally does not address such a form of self-aware behavior. Existing models of inner speech inspire computational tools to provide a robot with this form of self-awareness. Here, the widespread psychological models of inner speech are reviewed, and a cognitive architecture for a robot implementing such a capability is outlined in a simplified setup.

Recalling Experiences: Looking at Momentary, Retrospective and Global Assessments of Relationship Satisfaction

Relationship satisfaction can be assessed in retrospection, as a global evaluation, or as a momentary state. In two experience sampling studies (N = 130, N = 510) the specificities of these assessment modalities are examined. We show that 1) compared to other summary statistics like the median, the mean of relationship satisfaction states describes retrospective and global evaluations best (but the difference to some other summary statistics was negligible); 2) retrospection introduces an overestimation of the average annoyance in the relationship reported on a momentary basis, which results in an overall negative mean-level bias for retrospective relationship satisfaction; 3) this bias is most strongly moderated by global relationship satisfaction at the time of retrospection; 4) snapshots of momentary relationship satisfaction get representative of global evaluations after approximately two weeks of sampling. The findings extend the recall bias reported in the literature for retrospection of negative affect to the domain of relationship evaluations and assist researchers in designing efficient experience sampling studies.

Bizarreness of Lucid and Non-lucid Dream: Effects of Metacognition

Dreams are usually characterized by primary consciousness, bizarreness and cognitive deficits, lacking metacognition. However, lucid dreaming (LD) is a type of consciousness state during which the dreamer is aware of the fact that he or she is dreaming, without leaving the sleeping state. Brain research has found that LD shares some common neural mechanisms with metacognition such as self-reflection. With a different metacognition level, the bizarreness of LD would also change. However, the difference in bizarreness between LD and non-LD was seldom explored, and individual differences were often neglected. In the present study, considering LD prevalence in Asia was rarely studied and related results in China and Japan were very different from each other, we first investigated the LD frequency of China in a standardized way. On that basis, we collected dreams of subjects who had relatively higher LD frequency and compared bizarreness density (BD) of LD and non-LD. Moreover, to explore the relationships of metacognition traits and BD, we also measured self-reflection and insight trait by Self-Reflection and Insight Scale. We found that 81.3% of subjects have experienced LD once or more, which is similar to findings in some western countries. Besides, BD was significantly lower in LD than in non-LD. Self-reflection and insight were inversely associated with dream bizarreness. These findings indicate that self-consciousness traits extend from waking to LD and non-LD state. As a particular consciousness state, LD may shed light on the research of consciousness and dream continuity. Future research on dream bizarreness is suggested to take dream types and metacognition differences into consideration.

Alterations of mental defeat and cognitive flexibility during cognitive behavioral therapy in patients with major depressive disorder: a single-arm pilot study

Objective

Mental defeat affects the occurrence and chronicity of depression and cognitive flexibility. This study aimed to examine changes in mental defeat and cognitive flexibility scores after cognitive behavioral therapy including IR. In the intervention group, patients with depression (n = 18, mean age = 37.89 years) received 15 cognitive behavioral therapy sessions. Patients completed the Beck Depression Inventory-II; Mental Defeat Scale; Cognitive Flexibility Scale; EuroQol five dimensions questionnaire; Patient Health Questionnaire-9 and seven-item Generalized Anxiety Disorder Scale before the intervention, after six sessions, and post-intervention. The healthy control group (n = 33, mean age = 37.91) completed all scales once and did not receive treatment.

Results

Post-cognitive behavioral therapy, a significant decrease was observed in Beck Depression Inventory-II, Mental Defeat Scale, Cognitive Flexibility Scale, and Patient Health Questionnaire-9 scores. Although mental defeat and cognitive flexibility did not reach the level of the healthy control group, they demonstrated improvement. Therefore, when treating depression, mental defeat and cognitive flexibility should be measured in addition to depressive symptoms.

Trial registration This study was registered retrospectively in the national UMIN Clinical Trials Registry on July 25, 2016 (registration ID: UMIN000023320)

Self-reflection and employee creativity

Purpose

This paper aims to examine the effect of self-reflection on employee creativity in China. The authors identify individual intellectual capital (IIC) as a mediator and concerns for face as a moderator for this relationship.

Design/methodology/approach

A sample of 351 dyads of full-time employees and their immediate supervisors from various Chinese companies were surveyed. Regression analysis and structural equation modeling were used to test the research model.

Findings

Three dimensions of self-reflection significantly affect IIC and subsequently lead to employee creativity; IIC mediates the relationship between three dimensions of self-reflection and employee creativity; concern for face negatively moderates the effect of IIC on employee creativity.

Practical implications

Managers can facilitate employees’ creativity by motivating them to conduct self-reflection and develop IIC, and by nurturing a safe atmosphere that allows individuals to take risks without losing face.

Originality/value

This is one of the first empirical studies to investigate the mediating effects of IIC and the moderating effects of concerns for face on the relationship between self-reflection and creativity.

Instruments to measure the ability to self-reflect: A systematic review of evidence from workplace and educational settings including health care

INTRODUCTION

Self-reflection has become recognised as a core skill in dental education, although the ability to self-reflect is valued and measured within several professions. This review appraises the evidence for instruments available to measure the self-reflective ability of adults studying or working within any setting, not just health care.

MATERIALS AND METHODS

A systematic review was conducted of 20 electronic databases (including Medline, ERIC, CINAHL and Business Source Complete) from 1975 to 2017, supplemented by citation searches. Data were extracted from each study and the studies graded against quality indicators by at least two independent reviewers, using a coding sheet. Reviewers completed a utility analysis of the assessment instruments described within included studies, appraising their reported reliability, validity, educational impact, acceptability and cost.

RESULTS

A total of 131 studies met the inclusion criteria. Eighteen were judged to provide higher quality evidence for the review and three broad types of instrument were identified, namely: rubrics (or scoring guides), self-reported scales and observed behaviour.

CONCLUSIONS

Three types of instrument were identified to assess the ability to self-reflect. It was not possible to recommend a single most effective instrument due to under reporting of the criteria necessary for a full utility analysis of each. The use of more than one instrument may therefore be appropriate dependent on the acceptability to the faculty, assessor, student and cost. Future research should report on the utility of assessment instruments and provide guidance on what constitutes thresholds of acceptable or unacceptable ability to self-reflect, and how this should be managed.

Private Self-consciousness, Self-reflection, Insight and Alcohol Consumption Among Young People and Adults

Abstract Private self-consciousness is a relevant metacognitive capacity in the self-regulation process, with possible implications in alcohol consumption. This research verified the influence of self-reflection and insight, dimensions of private self-consciousness, on drinking behavior. A total of 523 Brazilians, aged from 20 to 39 years old, participated in a survey by answering the Self-Reflection and Insight Scale and the AUDIT test. The results showed that women have higher levels of self-reflection, whereas men have higher levels of insight. With regard to alcohol consumption, young people drink at higher risk levels than adults. Self-reflection and insight were negatively correlated with alcohol consumption. Age and gender differences in the intensity of the correlation between variables and the influence of environmental factors on the regulation of drinking behavior are discussed.

Predictors of treatment response in a web-based intervention for cannabis users

BACKGROUND

Trials demonstrate the effectiveness of web-based interventions for cannabis-related disorders. For further development of these interventions, it is of vital interest to identify user characteristics which predict treatment response.

METHODS

Data from a randomized factorial trial on a web-based intervention for cannabis-users (n = 534) was reanalyzed. As potential predictors for later treatment response, 31 variables from the following categories were tested: socio-demographics, substance use and cognitive processing. The association of predictors and treatment outcome was analyzed using unbiased recursive partitioning and represented as classification tree. Predictive performance of the tree was assessed by comparing its cross-validated results to models derived with all-subsets logistic regression and random forest.

RESULTS

Goal commitment (p < .001), the extent of self-reflection (p < .001), the preferred effect of cannabis (p = .005) and initial cannabis use (p = .015) significantly differentiate between successful and non-successful participants in all three analysis methods. The predictive accuracy of all three models is comparable and modest.

CONCLUSIONS

Participants who commit to quit using cannabis, who at least have moderate levels of self-reflection and who prefer mild intoxicating effects were most likely to respond to treatment. To predict treatment response on an individual level, the classification tree should only be used as one of several sources of information.Trial registration: http://www.isrctn.com/ISRCTN99818059.

Patient experience and reflective learning (PEARL): a mixed methods protocol for staff insight development in acute and intensive care medicine in the UK

INTRODUCTION

Patient and staff experiences are strongly influenced by attitudes and behaviours, and provide important insights into care quality. Patient and staff feedback could be used more effectively to enhance behaviours and improve care through systematic integration with techniques for reflective learning. We aim to develop a reflective learning framework and toolkit for healthcare staff to improve patient, family and staff experience.

METHODS & ANALYSIS

Local project teams including staff and patients from the acute medical units (AMUs) and intensive care units (ICUs) of three National Health Service trusts will implement two experience surveys derived from existing instruments: a continuous patient and relative survey and an annual staff survey. Survey data will be supplemented by ethnographic interviews and observations in the workplace to evaluate barriers to and facilitators of reflective learning. Using facilitated iterative co-design, local project teams will supplement survey data with their experiences of healthcare to identify events, actions, activities and interventions which promote personal insight and empathy through reflective learning. Outputs will be collated by the central project team to develop a reflective learning framework and toolkit which will be fed back to the local groups for review, refinement and piloting. The development process will be mapped to a conceptual theory of reflective learning which combines psychological and pedagogical theories of learning, alongside theories of behaviour change based on capability, opportunity and motivation influencing behaviour. The output will be a locally-adaptable workplace-based toolkit providing guidance on using reflective learning to incorporate patient and staff experience in routine clinical activities.

ETHICS & DISSEMINATION

The PEARL project has received ethics approval from the London Brent Research Ethics Committee (REC Ref 16/LO/224). We propose a national cluster randomised step-wedge trial of the toolkit developed for large-scale evaluation of impact on patient outcomes.

Associations Between the DSM-5 Section III Trait Model and Impairments in Functioning in Singaporean College Students

The Alternative Model for Personality Disorders (AMPD) in Section III of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, recommends the joint consideration of personality disorder severity (i.e., dysfunction) and style (i.e., trait profile) in personality disorder diagnosis. The current study examined the association between maladaptive personality dysfunction and traits using a Singaporean student sample (N = 360). A subsample (n = 151) had informant ratings of personality traits on target participants. Results indicated that dysfunctions and traits were substantially correlated, calling into question their distinctiveness. However, the overlap was less pronounced when informant ratings were used. Consistent with prior research, the validity of the PID-5 trait model appeared to be supported, as observed in the meaningful differential relations with different impairment outcomes. These findings represent a preliminary yet critical test of the generalizability of the AMPD to a non-Western cultural group.

Mediational role of rumination and reflection on irrational beliefs and distress

BACKGROUND

The cognitive restructuring of maladaptive beliefs within many cognitive behavioural psychotherapies typically encourages the client to undertake self-reflection. However, whilst self-consciousness can aid self-regulation, it is also implicated in a broad Grange of psychopathologies. The extent to which self-consciousness is associated with psychological distress is yet to be fully determined, but recent literature suggests that irrational beliefs, as proposed within rational emotive behaviour theory (REBT) may play an important role.

AIMS

The aim of the study was to test the mediational effects of self-consciousness, specifically reflection and rumination, on the relationship between irrational beliefs and psychological distress. Based on past research, it was hypothesized that reflection and rumination would mediate the positive relationship between irrational beliefs and psychological distress. We expected irrational beliefs to interact with rumination to positively predict psychological distress, and irrational beliefs to interact with reflection to negatively predict psychological distress.

METHOD

The present research tested a structural equation model (SEM) in which rumination and reflection mediated the relationship between irrational beliefs and psychological distress.

RESULTS

Results indicated that rumination mediates the positive relationship between irrational beliefs and psychological distress. However, in contrast to our hypotheses, significant mediation did not emerge for reflection.

CONCLUSIONS

This study is the first to show how irrational beliefs and rumination interact to predict psychopathology using advanced statistical techniques. However, future research is needed to determine whether similar mediational effects are evident with rational beliefs as opposed to irrational beliefs.

Social cognitive group treatment for impaired insight in psychosis: A multicenter randomized controlled trial

PURPOSE

The majority of people with schizophrenia has impaired insight, which is related to a poorer outcome. In this study, we evaluate a new psychosocial intervention 'REFLEX' aimed at improving insight in people with schizophrenia. REFLEX focuses on targeting stigma-sensitivity, perspective taking and self-reflection in people with schizophrenia and low insight. Primary objective is to improve insight and subsequently to improve functional outcome and symptoms.

METHOD

A total of 121 people diagnosed with schizophrenia according to DSM IV criteria with impaired insight was included in 2012-2015 from seven sites in a multicenter randomized controlled trial. REFLEX was compared to an active control condition consisting of group-wise simplified cognitive remediation training. Primary outcome of the study were the preconditions of insight: internalized stigma, self-reflection, mental flexibility and perspective taking. Clinical insight and cognitive insight were secondary outcomes.

RESULTS

Although perspective taking, self-reflection, mental flexibility and stigma sensitivity remained unchanged after the intervention, results showed a significant improvement of clinical insight in both conditions directly after treatment (SAI-E Rater, p < .001, PANSS G12, p < .005) and at follow-up (SAI-E Rater, p < .01, SAI-E interview, p < .001, PANSS G12, p < .0001). Improvement of clinical insight directly after treatment was larger in the REFLEX condition (SAI-E Rater, p < .05). Other outcomes (self-esteem, quality of life and depression) remained unchanged.

CONCLUSION

Though insight improved in both conditions, REFLEX was not superior to simplified drill-and-practice cognitive remediation training. Nevertheless, this study indicates that structured interventions can significantly improve insight. Further research on the underlying mechanisms of both conditions is needed, as insight is unlikely to improve spontaneously in chronic patients.

Self-reflection and critical thinking: the influence of professional qualifications on registered nurses

Background: Ensuring the delivery of quality care and patient safety requires that nurses improve their self-reflection and insight as well as their critical thinking. To understand the factors that influence self-reflection, insight, and critical thinking, more evidence-based research is needed. Purpose: The purpose of this study was to examine whether professional qualifications (i.e. age, years of job experience, and position on the clinical ladder) would affect self-reflection and critical thinking in the experienced registered nurses (RNs) group. Methods: This quantitative and correlational study included 597 RNs (297 novice nurses and 300 experienced nurses), recruited from one medical center hospital in central Taiwan, as participants. Data were collected on self-reflection and critical thinking, using the Chinese-version of the Self-Reflection and Insight Scale and the Taiwan Critical Thinking Disposition Inventory. A structural equation modeling approach was used to examine the relationships among variables. Findings: The results showed a non-significant mean difference in self-reflection with insight scores between the two groups. Experienced RNs had a significantly higher mean score for critical thinking. Further analysis of the data of experienced nurses revealed that self-reflection with insight significantly affected critical thinking (β = 0.24, t = 4.141, p < .001). Qualifications also affected self-reflection with insight (β = 0.11, t = 1.808, p > .05) and critical thinking (β = 0.18, t = 3.143, p < .001). The correlation between qualifications and self-reflection with insight, however, was non-significant. Discussion: Nurses who perceived that they had greater self-reflection and insight reported more critical thinking in clinical care practice. Nurses' qualifications had more of an effect on critical thinking than on self-reflection and insight.

Developing and evaluating a tool to measure general practice productivity: a multimethod study

Background

Systems for measuring the performance of general practices are extremely limited.

Objectives

The aim was to develop, pilot test and evaluate a measure of productivity that can be applied across all typical general practices in England, and that may result in improvements in practice, thereby leading to better patient outcomes.

Methods

Stage 1 – the approach used was based on the Productivity Measurement and Enhancement System (ProMES). Through 16 workshops with 80 general practice staff and 72 patient representatives, the objectives of general practices were identified, as were indicators that could measure these objectives and systems to convert the indicators into an effectiveness score and a productivity index. This was followed by a consensus exercise involving a face-to-face meeting with 16 stakeholders and an online survey with 27 respondents. An online version of the tool [termed the General Practice Effectiveness Tool (GPET)] and detailed guidance were created. Stage 2 – 51 practices were trained to use the GPET for up to 6 months, entering data on each indicator monthly and getting automated feedback on changes in effectiveness over time. The feasibility and acceptability of the GPET were examined via 38 telephone interviews with practice representatives, an online survey of practice managers and two focus groups with patient representatives.

Results

The workshops resulted in 11 objectives across four performance areas: (1) clinical care, (2) practice management, (3) patient focus and (4) external focus. These were measured by 52 indicators, gathered from clinical information systems, practice records, checklists, a short patient questionnaire and a short staff questionnaire. The consensus exercise suggested that this model was appropriate, but that the tool would be of more benefit in tracking productivity within practices than in performance management. Thirty-eight out of 51 practices provided monthly data, but only 28 practices did so for the full period. Limited time and personnel changes made participation difficult for some. Over the pilot period, practice effectiveness increased significantly. Perceptions of the GPET were varied. Usefulness was given an average rating of 4.5 out of 10.0. Ease of use was more positive, scoring 5.6 out of 10.0. Five indicators were highlighted as problematic to gather, and 27% of practices had difficulties entering data. Feedback from interviews suggested difficulties using the online system and finding time to make use of feedback. Most practices could not provide sufficient monthly financial data to calculate a conventional productivity index.

Limitations

It was not possible to create a measure that provides comparability between all practices, and most practices could not provide sufficient financial data to create a productivity index, leaving an effectiveness measure instead. Having a relatively small number of practices, with no control group, limited this study, and there was a limited timescale for the testing and evaluation.

Implications

The GPET has demonstrated some viability as a tool to aid practice improvement. The model devised could serve as a basis for measuring effectiveness in general practice more widely.

Future work

Some additional research is needed to refine the GPET. Enhanced testing with a control sample would evaluate whether or not it is the use of the GPET that leads to improved performance.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Cognitive behavioural therapy plus standard care versus standard care for people with schizophrenia

BACKGROUND

Cognitive behavioural therapy (CBT) is a psychosocial treatment that aims to re-mediate distressing emotional experiences or dysfunctional behaviour by changing the way in which a person interprets and evaluates the experience or cognates on its consequence and meaning. This approach helps to link the person's feelings and patterns of thinking which underpin distress. CBT is now recommended by the National Institute for Health and Care Excellence (NICE) as an add-on treatment for people with a diagnosis of schizophrenia. This review is also part of a family of Cochrane CBT reviews for people with schizophrenia.

OBJECTIVES

To assess the effects of cognitive behavioural therapy added to standard care compared with standard care alone for people with schizophrenia.

SEARCH METHODS

We searched the Cochrane Schizophrenia Group's Trials Register (up to March 6, 2017). This register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings, with no language, date, document type, or publication status limitations for inclusion of records into the register.

SELECTION CRITERIA

We selected all randomised controlled clinical trials (RCTs) involving people diagnosed with schizophrenia or related disorders, which compared adding CBT to standard care with standard care given alone. Outcomes of interest included relapse, rehospitalisation, mental state, adverse events, social functioning, quality of life, and satisfaction with treatment.We included studies fulfilling the predefined inclusion criteria and reporting useable data.

DATA COLLECTION AND ANALYSIS

We complied with the Cochrane recommended standard of conduct for data screening and collection. Where possible, we calculated relative risk (RR) and its 95% confidence interval (CI) for binary data and mean difference (MD) and its 95% confidence interval for continuous data. We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE.

MAIN RESULTS

This review now includes 60 trials with 5,992 participants, all comparing CBT added to standard care with standard care alone. Results for the main outcomes of interest (all long term) showed no clear difference between CBT and standard care for relapse (RR 0.78, 95% CI 0.61 to 1.00; participants = 1538; studies = 13, low-quality evidence). Two trials reported global state improvement. More participants in the CBT groups showed clinically important improvement in global state (RR 0.57, 95% CI 0.39 to 0.84; participants = 82; studies = 2 , very low-quality evidence). Five trials reported mental state improvement. No differences in mental state improvement were observed (RR 0.81, 95% CI 0.65 to 1.02; participants = 501; studies = 5, very low-quality evidence). In terms of safety, adding CBT to standard care may reduce the risk of having an adverse event (RR 0.44, 95% CI 0.27 to 0.72; participants = 146; studies = 2, very low-quality evidence) but appears to have no effect on long-term social functioning (MD 0.56, 95% CI -2.64 to 3.76; participants = 295; studies = 2, very low-quality evidence, nor on long-term quality of life (MD -3.60, 95% CI -11.32 to 4.12; participants = 71; study = 1, very low-quality evidence). It also has no effect on long-term satisfaction with treatment (measured as 'leaving the study early') (RR 0.93, 95% CI 0.77 to 1.12; participants = 1945; studies = 19, moderate-quality evidence).

AUTHORS' CONCLUSIONS

Relative to standard care alone, adding CBT to standard care appears to have no effect on long-term risk of relapse. A very small proportion of the available evidence indicated CBT plus standard care may improve long term global state and may reduce the risk of adverse events. Whether adding CBT to standard care leads to clinically important improvement in patients' long-term mental state, quality of life, and social function remains unclear. Satisfaction with care (measured as number of people leaving the study early) was no higher for participants receiving CBT compared to participants receiving standard care. It should be noted that although much research has been carried out in this area, the quality of evidence available is poor - mostly low or very low quality and we still cannot make firm conclusions until more high quality data are available.

A realist informed mixed-methods evaluation of Schwartz Center Rounds® in England

Background

Schwartz Center Rounds®(Rounds) were introduced into the UK in 2009 to support health-care staff to deliver compassionate care, something the Francis report (Francis R.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013) identified as lacking. Rounds are organisation-wide forums that prompt reflection and discussion of the emotional, social and ethical challenges of health-care work, with the aim of improving staff well-being and patient care.

Objectives

How, in which contexts and for whom Rounds participation affects staff well-being at work, increases social support for staff and improves patient care.

Design

(1) A scoping review of Rounds literature and comparison with alternative interventions; (2) mapping Rounds providers via a survey, telephone interviews and secondary data; (3) a two-wave survey of (i) new attenders/non-attenders in 10 sites to determine the impact on staff engagement and well-being; and (ii) interviews with Rounds attenders, non-attenders, facilitators, clinical leads, steering group members, board members and observations in nine case study sites to (4) describe experiences and (5) test candidate programme theories by which Rounds ‘work’ (realist evaluation).

Setting

(1) International literature (English); (2) all Rounds providers (acute/community NHS trusts and hospices) at 1 September 2014 (survey/interview) and 15 July 2015 (secondary data); (3) 10 survey sites; and (4 and 5) nine organisational case study sites (six of which also took part in the survey).

Participants

(1) Ten papers were reviewed for Rounds and 146 were reviewed for alternative interventions. (2) Surveys were received from 41 out of 76 (54%) providers and interviews were conducted with 45 out of 76 (59%) providers. (3) Surveys were received from 1140 out of 3815 (30%) individuals at baseline and from 500 out of 1140 (44%) individuals at follow-up. (4 and 5) A total of 177 interviews were conducted, as were observations of 42 Rounds, 29 panel preparations and 28 steering group meetings.

Results

(1) The evidence base is limited; compared with 11 alternative interventions, Rounds offer a unique organisation-wide ‘all staff’ forum in which disclosure/contribution is not essential. (2) Implementation rapidly increased between 2013 and 2015; Rounds were implemented variably; challenges included ward staff attendance and the workload and resources required to sustain Rounds; and costs were widely variable. (3) There was no change in engagement, but poor psychological well-being (12-item General Health Questionnaire) reduced significantly (p < 0.05) in Rounds attenders (25% to 12%) compared with non-attenders (37% to 34%). (4 and 5) Rounds were described as interesting, engaging and supportive; four contextual layers explained the variation in Rounds implementation. We identified four stages of Rounds, ‘core’ and ‘adaptable’ components of Rounds fidelity, and nine context–mechanism–outcome configurations: (i) trust, emotional safety and containment and (ii) group interaction were prerequisites for creating (iii) a countercultural space in Rounds where staff could (iv) tell stories, (v) self-disclose their experiences to peers and (vi) role model vulnerability; (vii) provide important context for staff and patient behaviour; (viii) shining a spotlight on hidden staff and patient stories reduced isolation and enhanced support/teamwork; and (ix) staff learned through reflection resulting in ripple effects and outcomes. Reported outcomes included increased empathy and compassion for colleagues and patients, support for staff and reported changes in practice. The impact of Rounds is cumulative and we have identified the necessary conditions for Rounds to work.

Limitations

Rounds outcomes relied on self-report, fewer regular attenders were recruited than desired, and it was not possible to observe staff post Rounds.

Conclusion

Rounds offer unique support for staff and positively influence staff well-being, empathy and compassion for patients and colleagues.

Future work

The adaptation of Rounds to new contexts and to increase reach needs evaluation.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

The role of emotion regulation, coping, self-reflection and insight in staff interaction with patients with a diagnosis of personality disorder in forensic settings

WHAT IS KNOWN ON THE SUBJECT?: Interaction between staff and patients with a diagnosis of personality disorder in forensic settings is important for quality of care, but research is lacking on what determines this interaction. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Insight, emotion-focused coping and emotion regulation of staff influence the interaction between staff and these patients. Staff who understand their own thoughts, feelings and behaviour better (more insight) needed less support, encouragement or back-up from their patients. Staff who cope by getting upset, blaming themselves or fantasizing about solutions (emotion-focused coping) on the contrary needed more support from their patients. Emotion regulation had an impact on the relation between coping and hostile staff behaviour. When staff get upset (emotion-focused coping) and try to think differently about the situation (reappraisal), this makes them behave in a more hostile manner towards their patients. When staff suppress their emotions and also distract themselves or engage in social activities (avoidance-focused coping), they behave in a less hostile manner towards their patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In order to provide compassionate care for their patients, staff ought to be trained in self-compassion. This may help them not to get upset, blame themselves or fantasize about solutions and to understand their own thoughts, feelings and behaviour better. As a result, staff may need less support, encouragement or back-up from their patients. Context is important: Staff ought to suppress their emotions when emotions run high, but only when they also care for themselves by distracting themselves or engaging in social activities. Facing and regulating their emotions by changing what they think about the situation (reappraisal) may be more appropriate once emotions have settled down. This may help staff to remain compassionate towards their patients in the long run and avoid burn-out or compassion fatigue due to ignoring their own needs and boundaries. ABSTRACT: Introduction Research is lacking on what determines interaction between staff and patients with a diagnosis of personality disorder in forensic settings. Aim To test whether coping, self-reflection, insight and emotion regulation are related to the behaviour of staff towards these patients, and to test the possible moderating and mediating effect of emotion regulation. Method Using a cross-sectional design, 76 direct care staff of a forensic clinic completed questionnaires on all variables. Relations were tested using simple linear regression, mediation and moderation analyses. Results Insight and emotion-focused coping of staff were related to seeking less and more support from patients, respectively. Emotion regulation by reappraisal combined with emotion-focused coping was associated with more hostile behaviour by staff, and suppression combined with avoidance-focused coping with less hostile behaviour. Conclusion Insight, emotion-focused coping and emotion regulation of staff influence the quality of care of patients with a diagnosis of personality disorder in forensic settings. Future research ought to include contextual factors. Implications for practice Enhancing self-compassion may improve insight and reduce emotion-focused coping. Context is important: Taking the needs of staff into account may involve suppressing emotions combined with avoidance in a highly emotional situation while facing and reappraising the situation when emotions are low.

Clients' experience of change: An exploration of the influence of reformulation tools in cognitive analytic therapy

Case formulation is considered important in both the development of the therapeutic relationship and in starting the process of therapeutic change. Cognitive analytic therapy (CAT) describes the developmental origins and maintenance of a client's problems in both written (reformulation letter) and diagrammatic form (sequential diagrammatic reformulation). This study aimed to investigate the effects of these reformulation tools on insight and symptom change. A small-N repeated measures design was employed with quantitative and qualitative measures collected from six therapist/client dyads. Participating therapists kept a record of their delivery of CAT reformulation tools. Participating clients completed the insight subscale of the Self-Reflection and Insight Scale every fourth session and the Clinical Outcomes in Routine Evaluation-10 every session. Qualitative data from client change interviews regarding their experiences of CAT and attributions of change was explored using template analysis. Participants demonstrated improvements (symptom reduction and insight increases) over the course of the intervention. Administration of reformulation tools did not consistently result in significant changes on insight and symptom measures. However, the tools were identified by participants as leading to insight and emotional change within the context of a good therapeutic relationship. These findings suggest that a genuine therapeutic relationship is an important change mechanism operating through, and strengthened by, CAT-specific tools.

How resilience is strengthened by exposure to stressors: the systematic self-reflection model of resilience strengthening

BACKGROUND

Exposure to demands is normally considered to drain resources and threaten wellbeing. However, studies have indicated a resilience-strengthening role for stressors.

OBJECTIVES

This paper introduces a unifying model, including five testable hypotheses regarding how resilience can be strengthened progressively via exposure to life-stressors.

METHODS

We review and synthesize relevant scholarship that underpins the Systematic Self-Reflection model of resilience-strengthening.

RESULTS

The model highlights the importance of a specific meta-cognitive skill (self-reflection on one's initial stressor response) as a mechanism for strengthening resilience. The Systematic Self-Reflection model uniquely proposes five self-reflective practices critical in the on-going adaptation of three resilient capacities: (1) coping resources, (2) usage of coping and emotional regulatory repertoire, and (3) resilient beliefs. The self-reflective process is proposed to strengthen a person's resilience by developing insight into their already-present capacities, the limitations of these capacities, and by stimulating the search for person-driven alternative approaches.

CONCLUSION

This model extends the existing scholarship by proposing how the experience of stressors and adversity may have resilience-strengthening opportunities. The implication of this model is that engaging with stressors can have positive consequences for longer-term healthy emotional development if scaffolded in adaptive reflective practices.

Personality Assessment for Employee Development: Ivory Tower or Real World?

The acceptance and popularity of personality assessments in organizational contexts has grown enormously over the last 40 years. Although these are used across many applications, such as executive coaching, team building, and hiring and promotion decisions, the focus of most published research on the use of personality assessments at work is biased toward assessment for employee selection. Reviews have therefore tended to use criteria that are appropriate for selection, neglecting the additional and different criteria that are important in relation to employee development. An illustration of the often-discussed scientist-practitioner divide is that the Myers-Briggs Type Indicator is the most widely known and used personality assessment in organizations, despite harsh criticism by the academic community. This article reviews this debate, and draws implications for the appropriate choice of personality assessments for use in individual and team development, and a new direction for scientific research.

Motivational Reasons for Biased Decisions: The Sunk-Cost Effect’s Instrumental Rationality

The present study describes the mechanism of need regulation, which accompanies the so-called “biased” decisions. We hypothesized an unconscious urge for psychological need satisfaction as the trigger for cognitive biases. In an experimental study (N = 106), participants had the opportunity to win money in a functionality test. In the test, they could either use the solution they had developed (sunk cost) or an alternative solution that offered a higher probability of winning. The selection of the sunk-cost option (SCO) was the most chosen option, supporting the hypothesis of this study. The reason behind the majority of participants choosing the SCO seemed to be the satisfaction of psychological needs, despite a reduced chance of winning money. An intervention, which aimed at triggering self-reflection, had no impact on the decision. The findings of this study contribute to the discussion on the reasons for cognitive biases and their formation in the human mind. Moreover, it discusses the application of the label “irrational” for biased decisions and proposes reasons for instrumental rationality, which exist at an unconscious, need-regulative level.

The relationship between semantic access and introspective awareness

There have long been speculations about the relationship between consciousness and language. This study aimed to determine whether an individual's level of introspective awareness, based on self-report, relates to accessibility of their semantic system as evaluated by the N400. Thirty-five university students completed the study. All were right-handed, with normal or corrected-to-normal vision, without known neurological or psychological health issues. They first performed on a lexical decision task while their brain electrophysiological responses were recorded. Then, they provided assessment ratings about their levels of introspective awareness. Analysis revealed moderate to strong correlations (Pearson's rs = 0.49-0.62) between awareness self-ratings and ease of semantic access as indexed by the N400. Correlation between the self-report measure and the objective neurophysiological measure suggests that subjective assessment of awareness may deserve more credibility, which in addition to reflecting subjective perception and evaluation about one's own higher order mental functioning, may also interact with the neurophysiological processes contributive and subject to such awareness. Implications for future research on the role of semantic network in the mechanism of introspective awareness are discussed.

Trait self-awareness predicts perceptions of choice meaningfulness in a decision-making task

Objective

Seminal theorists such as Erikson, Bruner, Frankl and Rogers have underscored the importance of meaning in psychological life. However contemporary scholars interested in meaning have noted that further investigation of the individual differences associated with meaning-making is still needed. In the present study we explored whether individual differences in trait self-awareness were associated with perceptions of choice meaningfulness in a decision-making task.

Results

All participants engaged in a decision-making task wherein they were asked to choose their preferred painting out of pairs of sequentially presented abstract paintings. Participants in the experimental condition were provided with feedback that their choices had been diagnostic of important personality characteristics whereas those in the control condition were not. All participants were then prompted to reflect on their choices before rating the subjective meaningfulness that they associated with their choices and completing measures to assess trait self-awareness. As anticipated, persons with higher levels of trait self-awareness tended to seek out and find more meaning compared to those lower in trait self-awareness. However contrary to expectations, feedback about the self-relevance of choices did not moderate perceptions of choice meaningfulness. Implications of these findings as well as directions for future research are also discussed.

The Effect of Trait Self-Awareness, Self-Reflection, and Perceptions of Choice Meaningfulness on Indicators of Social Identity within a Decision-Making Context

Theorists operating from within a narrative identity framework have suggested that self-reflective reasoning plays a central role in the development of the self. Typically, however, narrative identity researchers have investigated this relationship using correlational rather than experimental methods. In the present study, leveraging on a classic research paradigm from within the social identity literature we developed an experiment to test the extent to which self-reflection might have a causal impact on the self-concept within a decision-making context. In a minimal group paradigm participants were prompted to reflect on their painting choices either before or after allocating points to in-group∖ out-group members. As anticipated, self-reflection augmented social identification, but only when participants felt their choices were personally meaningful. Participants who reasoned about their choices and felt they were subjectively meaningful showed stronger similarity and liking for in-group members compared to those who did not reflect on their choices or found them to be subjectively meaningless. Hence, reflecting on and finding meaning in one’s choices may be an important step in linking behavior with in-group identification and thus the self-concept in turn. The absence of any effects on in-group favoritism (a third indicator of social identification measured) as well as implications of the study’s findings for self-perception, cognitive dissonance and social identity processes are also discussed.

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.