Chasing Clarity: Rumination as a Strategy for Making Sense of Emotions

Research is needed on the affective mechanisms that motivate people to ruminate. One possibility is that some people might ruminate in response to deficits in emotional clarity because not knowing how they feel might be intolerable to them. We tested the hypothesis that the relationship between low emotional clarity and rumination would be moderated by intolerance of ambiguity. Participants in a longitudinal online study (N = 195) provided self- reports of intolerance of ambiguity and rumination and reported state emotional clarity following an idiographic mood induction; three weeks later they reported on rumination again. As predicted, participants with low emotional clarity at Time 1 ruminated more three weeks later, but only if they were intolerant of ambiguity. Findings support the notion that rumination sometimes functions as a search for answers about emotions. We discuss implications for understanding the affective disturbances perpetuating vicious cycles of rumination and for rumination-focused clinical interventions

Using Serious Games to Train Adaptive Emotional Regulation Strategies

[EN] Emotional Regulation (ER) strategies allow people to influence the emotions they feel, when they feel them, how they experience them, and how they express them in any situation. Deficiencies or deficits in ER strategies during the adolescence may become mental health problems in the future. The aim of this paper is to describe a virtual multiplatform system based on serious games that allows adolescents to train and evaluate their ER strategies. The system includes an ecological momentary assessment (EMA) tool, which allows the therapist to monitor the emotional status of teenagers every day in real time. Results obtained from a usability and effectiveness study about the EMA tool showed that adolescents preferred using the EMA tool than other classical instruments.This study was funded by Vicerrectorado de Investigación de la Universitat Politècnica de València, Spain, PAID-06-2011, R.N. 1984; by Ministerio de Educación y Ciencia, Spain, Project Game Teen (TIN2010-20187) and partially by projects Consolider-C (SEJ2006-14301/PSIC), “CIBER of Physiopathology of Obesity and Nutrition, an initiative of ISCIII” and Excellence Research Program PROMETEO (Generalitat Valenciana. Consellería de Educación, 2008-157). The work of Alejandro Rodríguez was supported by the Spanish MEC under an FPI Grant BES-2011-043316.Alcañiz Raya, ML.; Rodríguez Ortega, A.; Rey, B.; Parra Vargas, E. (2014). Using Serious Games to Train Adaptive Emotional Regulation Strategies. Lecture Notes in Computer Science. 8531:541-549. https://doi.org/10.1007/978-3-319-07632-4_51S5415498531Mennin, D., Farach, F.: Emotion and evolving treatments for adult psychopathology. Clinical Psychology: Science and Practice 14, 329–352 (2007)Serrano, A., Iborra, I.: Informe violencia entre compañeros en la escuela. Spanish Version (2005), http://www.centroreinasofia.esInforme Cisneros X.: Acoso y Violencia Escolar en España, por Iñaki Piñuel y Araceli Oñate. Editorial IIEDDI, Spanish Version (2007)Werner, K., Gross, J.J.: Emotion Regulation and Psychopathology. In: Emotion Regulation and Psychopathology: A Transdiagnostic Approach to Etiology and Treatment. Guildford Press (2010)Berking, M., Wupperman, P., Reichardt, A., Pejic, T., Dippel, A., Znoj, H.: Emotion-regulation skills as a treatment target in psychotherapy. Behaviour Research and Therapy 46, 1230–1237 (2008)Shields, A., Cicchetti, D.: Emotion regulation among school-age children: The development and validation of a new criterion Q-sort scale. Developmental Psychology 33(6), 906–916 (1997)Gross, J.J., John, O.P.: Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology 85(2), 348–362 (2003)Gross, J.J., Levenson, R.W.: Hiding feelings: The acute effects of inhibiting negative and positive emotion. Journal of Abnormal Psychology 106, 95–103 (1997)Winn, et al.: The Effect of Student Construction of Virtual Environments on the Performance of High- and Low-Ability Students. Annual Meeting of the American Educational Research Association (2003)Pantelidis, V.: Reasons to use virtual reality in education. VR in the Schools 1(1) (1995)Playmancer, http://www.playmancer.euBen Moussa, M., Magnenat-Thalmann, N.: Applying affect recognition in serious games: The playMancer project. In: Egges, A., Geraerts, R., Overmars, M. (eds.) MIG 2009. LNCS, vol. 5884, pp. 53–62. Springer, Heidelberg (2009)Replay, http://www.replayproject.euFeldman, L.B., Gross, J.J., Conner, T., Benvenuto, M.: Knowing what you’re feeling and knowing what to do about it: mapping the relation between emotion differentiation and emotion regulation. Cognition and Emotion 15, 713–724 (2001

Does rumination mediate the relationship between emotion regulation ability and posttraumatic stress disorder?

Background and objectives: Trauma-related rumination has been suggested to be involved in the maintenance of posttraumatic stress disorder (PTSD). This view has empirically been supported by extensive evidence using cross-sectional, prospective, and experimental designs. However, it is unclear why trauma survivors engage in rumination despite its negative consequences. The current study aimed to explore the hypothesis that low emotion regulation ability underlies trauma-related rumination. Methods: Emotion regulation ability and trauma-related rumination were assessed in 93 road traffic accident survivors 2 weeks post-trauma. In addition, symptom levels of PTSD were assessed at 2 weeks as well as 1, 3, and 6 months follow-up. Results: Emotion regulation ability was significantly related to trauma-related rumination as well as levels of PTSD symptoms. In addition, the association between low emotion regulation ability and PTSD was mediated by rumination. Conclusions: The findings support the view that rumination is used as a dysfunctional emotion regulation strategy by trauma survivors

Community-based distributive medical education: Advantaging society

This paper presents a narrative summary of an increasingly important trend in medical education by addressing the merits of community-based distributive medical education (CBDME). This is a relatively new and compelling model for teaching and training physicians in a manner that may better meet societal needs and expectations. Issues and trends regarding the growing shortage and imbalanced distribution of physicians in the USA are addressed, including the role of international medical graduates. A historical overview of costs and funding sources for medical education is presented, as well as initiatives to increase the training and placement of physicians cost-effectively through new and expanded medical schools, two- and four-year regional or branch campuses and CBDME. Our research confirms that although medical schools have responded to Association of American Medical Colleges calls for higher student enrollment and societal concerns about the distribution and placement of physicians, significant opportunities for improvement remain. Finally, the authors recommend further research be conducted to guide policy on incentives for physicians to locate in underserved communities, and determine the cost-effectiveness of the CBDME model in both the near and long terms

Does a PBL-based medical curriculum predispose training in specific career paths? A systematic review of the literature

Background North American medical schools have used problem-based learning (PBL) structured medical education for more than 60 years. However, it has only recently been introduced in other medical schools outside of North America. Since its inception, there has been the debate on whether the PBL learning process predisposes students to select certain career paths. Objectives To review available evidence to determine the predisposition of specific career paths when undertaking a PBL-based medical curriculum. The career path trajectory was determined as measured by official Matching Programs, self-reported questionnaires and surveys, and formally defined career development milestones. Methods A systematic literature review was performed. PubMed, Medline, Cochrane and ERIC databases were analysed in addition to reference lists for appropriate inclusion. Results Eleven studies fitting the inclusion criteria were identified. The majority of studies showed that PBL did not predispose a student to a career in a specific speciality (n = 7 out of 11 studies, 64%). However, three studies reported a significantly increased number of PBL graduates working in primary care compared to those from a non-PBL curriculum. Conclusions PBL has been shown not to predispose medical students to a career in General Practice or any other speciality. Furthermore, a greater number of similar studies are required before a definitive conclusion can be made in the future

Learning to mark: a qualitative study of the experiences and concerns of medical markers

BACKGROUND: Although there is published research on the methods markers use in marking various types of assessment, there is relatively little information on the processes markers use in approaching a marking exercise. This qualitative paper describes the preparation and experiences of general practice (GP) teachers who undertake marking a written assessment in an undergraduate medical course. METHODS: Semi-structured interviews were conducted with seven of the 16 GP tutors on an undergraduate course. The purposive sample comprised two new markers, two who had marked for a couple of years and three experienced markers. Each respondent was interviewed twice, once following a formative assessment of a written case study, and again after a summative assessment. All interviews were audio-taped and analysed for emerging themes. A respondent validation exercise was conducted with all 16 GP tutors. RESULTS: Markers had internal concerns about their ability to mark fairly and made considerable efforts to calibrate their marking. They needed guidance and coaching when marking for the first time and adopted a variety of marking styles, reaching a decision through a number of routes. Dealing with pass/fail borderline scripts and the consequences of the mark on the student were particular concerns. Even experienced markers felt the need to calibrate their marks both internally and externally CONCLUSION: Previous experience of marking appears to improve markers' confidence and is a factor in determining the role which markers adopt. Confidence can be improved by giving clear instructions, along with examples of marking. The authors propose that one method of providing this support and coaching could be by a process of peer review of a selection of papers prior to the main marking. New markers in particular would benefit from further guidance, however they are influenced by others early on in their marking career and course organisers should be mindful of this when arranging double marking

Problem-based learning in dental education: what's the evidence for and against... and is it worth the effort?

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.All Australian dental schools have introduced problem-based learning (PBL) approaches to their programmes over the past decade, although the nature of the innovations has varied from school to school. Before one can ask whether PBL is better than the conventional style of education, one needs to consider three key issues. Firstly, we need to agree on what is meant by the term PBL; secondly, we need to decide what “better” means when comparing educational approaches; and thirdly, we must look carefully at how PBL is implemented in given situations. It is argued that PBL fulfils, at least in theory, some important principles relating to the development of new knowledge. It also represents a change in focus from teachers and teaching in conventional programmes to learners and learning. Generally, students enjoy PBL programmes more than conventional programmes and feel they are more nurturing. There is also some evidence of an improvement in clinical and diagnostic reasoning ability associated with PBL curricula. The main negative points raised about PBL are the costs involved and mixed reports of insufficient grounding of students in the basic sciences. Financial restraints will probably preclude the introduction of pure or fully integrated PBL programmes in Australian dental schools. However, our research and experience, as well as other published literature, indicate that well-planned hybrid PBL programmes, with matching methods of assessment, can foster development of the types of knowledge, skills and attributes that oral health professionals will need in the future.T Winning and G Townsen

A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine

BACKGROUND: A variety of methods exists for teaching and learning evidence-based medicine (EBM). However, there is much debate about the effectiveness of various EBM teaching and learning activities, resulting in a lack of consensus as to what methods constitute the best educational practice. There is a need for a clear hierarchy of educational activities to effectively impart and acquire competence in EBM skills. This paper develops such a hierarchy based on current empirical and theoretical evidence. DISCUSSION: EBM requires that health care decisions be based on the best available valid and relevant evidence. To achieve this, teachers delivering EBM curricula need to inculcate amongst learners the skills to gain, assess, apply, integrate and communicate new knowledge in clinical decision-making. Empirical and theoretical evidence suggests that there is a hierarchy of teaching and learning activities in terms of their educational effectiveness: Level 1, interactive and clinically integrated activities; Level 2(a), interactive but classroom based activities; Level 2(b), didactic but clinically integrated activities; and Level 3, didactic, classroom or standalone teaching. SUMMARY: All health care professionals need to understand and implement the principles of EBM to improve care of their patients. Interactive and clinically integrated teaching and learning activities provide the basis for the best educational practice in this field

Amygdala functional connectivity as a longitudinal biomarker of symptom changes in generalized anxiety

Generalized anxiety disorder (GAD) is characterized by excessive worry, autonomic dysregulation and functional amygdala dysconnectivity, yet these illness markers have rarely been considered together, nor their interrelationship tested longitudinally. We hypothesized that an individual's capacity for emotion regulation predicts longer-term changes in amygdala functional connectivity, supporting the modification of GAD core symptoms. Sixteen patients with GAD (14 women) and individually matched controls were studied at two time points separated by 1 year. Resting-state fMRI data and concurrent measurement of vagally mediated heart rate variability were obtained before and after the induction of perseverative cognition. A greater rise in levels of worry following the induction predicted a stronger reduction in connectivity between right amygdala and ventromedial prefrontal cortex, and enhanced coupling between left amygdala and ventral tegmental area at follow-up. Similarly, amplified physiological responses to the induction predicted increased connectivity between right amygdala and thalamus. Longitudinal shifts in a distinct set of functional connectivity scores were associated with concomitant changes in GAD symptomatology over the course of the year. Results highlight the prognostic value of indices of emotional dysregulation and emphasize the integral role of the amygdala as a critical hub in functional neural circuitry underlying the progression of GAD symptomatology