Association Between Opening a Palliative Care Unit and Hospital Care for Patients With Serious Illness

Background: Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center. Methods: We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation. Results: There were 16,611 patients in the pre-PCU period and 18,305 patients in the post-PCU period. The post-PCU cohort was slightly older, with a higher Charlson index (p < 0.001 for both). Post-PCU, unadjusted rates of DNR and CMO increased from 16.4% to 18.3% (p < 0.001) and 9.3% to 11.5% (p < 0.001), respectively. Post-PCU, median time to DNR was unchanged (0 days), and time to CMO decreased from 6 to 5 days. The adjusted odds ratio was 1.08 (p = 0.01) for DNR and 1.19 (p < 0.001) for CMO. Significant interaction between care period and palliative care consultation for DNR (p = 0.04) and CMO (p = 0.01) suggests an important role for palliative care engagement. Conclusions: The opening of a PCU at a single center was associated with increased rates of DNR and CMO status for seriously ill patients.

The Salience of Children Increases Adult Prosocial Values

Organizations often put children front and center in campaigns to elicit interest and support for prosocial causes. Such initiatives raise a key theoretical and applied question that has yet to be addressed directly: Does the salience of children increase prosocial motivation and behavior in adults? We present findings aggregated across eight experiments involving 2,054 adult participants: Prosocial values became more important after completing tasks that made children salient compared to tasks that made adults (or a mundane event) salient or compared to a no-task baseline. An additional field study showed that adults were more likely to donate money to a child-unrelated cause when children were more salient on a shopping street. The findings suggest broad, reliable interconnections between human mental representations of children and prosocial motives, as the child salience effect was not moderated by participants’ gender, age, attitudes, or contact with children.

Emotion emphasis effects in moral judgment are moderated by mindsets

In two studies, emotion emphasis effects on moral judgment are demonstrated. The studies indicate that emphasizing negative consequences in trolley-type dilemmas with emotional language produces more utilitarian responses if such emphasis is on the consequences of the deontological option, and more deontological responses if it is on the consequences of the utilitarian option. This effect was moderated by action-phase related mindsets. Individuals in an implemental mindset were less susceptible to the emotion emphasis effect than individuals in a deliberative mindset (Studies 1, 2). By also using an eye-tracking task in Study 2, we demonstrated that our implemental mindset participants’ visual attention was more focused—in particular on goal-directed means—than that of the deliberative mindset participants.

Mind-Body Dissonance: A Catalyst to Creativity

Mind-body dissonance (MBD) is the psychological experience of one's bodily expressions contradicting one's mental states. Across four experiments (total N = 887), the current research proposes and demonstrates that MBD can enhance creativity by facilitating an atypicality mind-set. First, two different instantiations of MBD (i.e., assuming a high-power/low-power role while adopting a constricted/expansive posture, or recalling a happy/sad memory while frowning/smiling) increased performance on creative association, insight, and generation tasks (Experiments 1 and 2). A third study showed that an atypicality mind-set was an underlying mechanism for the creativity effect (Experiment 3). Finally, the frequency of past MBD experiences was found to reduce MBD's creativity effect (Experiment 4). The present research offers evidence for the positive functions of bodily expressions that contradict mental states and highlights the significance of understanding the interactive effects of psychological states and their physical analogues in studying creativity.

Neurological evidence for the role of construal level in future-directed thought

The ability to mentally represent future events is a significant human psychological achievement. A challenge that people encounter is that they often lack detailed specifics about distant relative to near future events. Construal level theory proposes that people represent distant future events by their abstract and essential features—a process referred to as high-level construal. As events become temporally proximal, people represent events by their increasingly available and reliable concrete and idiosyncratic features—a process referred to as low-level construal. The present fMRI experiment provides direct neural evidence for these assertions. Using the why–how localizer as a measure of construal level, results revealed brain regions associated with both temporal distance and high-level construal (medial prefrontal cortex), as well as temporal proximity and low-level construal (precuneus). We discuss the implications of these findings for the neuroscience of mental time travel and cognitive representation.

The Benefits of a Mindfulness Exercise in a Performance Situation

Background Mindfulness is a state of nonjudgmental attentiveness to moment-to-moment experiences. Interest in implementing mindfulness-based interventions is growing. Objective We investigated the benefit of a short mindfulness exercise for mindfulness novices in a performance situation. Method Participants ( N = 97) engaged in a mindfulness or relaxation exercise and subsequently worked on an achievement test. Results Participants in the mindfulness condition had fewer distracting evaluative thoughts during and experienced less negative affect after the achievement test. Participants also exerted less self-control (vagal withdrawal measured via heart rate variability) during the mindfulness exercise than on the relaxation exercise. In a subsample ( n = 84), selected on the basis of serious involvement in the exercise, mindfulness eliminated the negative association between distracting evaluative thoughts and performance. Furthermore, beneficial effects of mindfulness on distractive thoughts were found for participants low but not high in trait mindfulness. The mindfulness exercise did not influence performance. Conclusion In performance contexts, even brief mindfulness exercises may have beneficial effects for mindfulness novices and people low in trait mindfulness.

Behavioral Priming 2.0: Enter a Dynamical Systems Perspective

On a daily basis, people are exposed to numerous stimuli, ranging from colors and smells to sounds and words, that could potentially activate different cognitive constructs and influence their actions. This type of influence on human behavior is referred to as priming. Roughly two decades ago, behavioral priming was hailed as one of the core forces that shape automatic behavior. However, failures to replicate some of the representative findings in this domain soon followed, which posed the following question: "How robust are behavioral priming effects, and to what extent are they actually important in shaping people's actions?" To shed a new light on this question, I revisit behavioral priming through the prism of a dynamical systems perspective (DSP). The DSP is a scientific paradigm that has been developed through a combined effort of many different academic disciplines, ranging from mathematics and physics to biology, economics, psychology, etc., and it deals with behavior of simple and complex systems over time. In the present paper, I use conceptual and methodological tools stemming from the DSP to propose circumstances under which behavioral priming effects are likely to occur. More precisely, I outline three possible types of the influence of priming on human behavior, to which I refer as emergence, readjustment, and attractor switch, and propose experimental designs to examine them. Finally, I discuss relevant implications for behavioral priming effects and their replications.

Alpha synchronization as a brain model for unconscious defense: An overview of the work of Howard Shevrin and his team

Howard Shevrin and his team have developed a stringent subliminal priming methodology, which experimentally approximates a situation of an internal, mental triggering of unconscious defense. Through a series of four studies they thus are able to bring evidence for this type of unconscious defense. With event-related potentials, three clinical studies show how synchronization of a specific brain wave, the alpha wave, known for its inhibitory function, is also induced by subliminally presented conflictual subject-specific stimuli. Therefore, alpha synchronization could serve as the brain mechanism of unconscious defense. The results only make sense if we suppose the existence of a dynamic unconscious, which has inherited childhood conflicts, and with privileged connections to neurotic symptom characteristics. Moreover, by showing that the unconscious conflict phrases, inferred by clinicians from clinical interviews, have a similar brain behavior, Shevrin and his team provide evidence that these inferences are not simply clinician-dependent subjective interpretations but also imply some form of independent mental reality. Finally, interpretation of the results has led us to propose two distinct physiological mechanisms for defense: one, unconscious defense, by alpha synchronization in connection with the drive derivatives, and another, repression, based on the indications of reality in connection with the ego.