Monday, November 11, 2019

Expert opinion on intelligence: Most respondents supported g factor theory, and were skeptical of the accuracy and trustworthiness of the media

Survey of expert opinion on intelligence: Intelligence research, experts' background, controversial issues, and the media. Heiner Rindermann, David Becker, Thomas R. Coyle. Intelligence, Volume 78, January–February 2020, 101406.

•    The survey reports answers for up to 102 intelligence experts on 38 questions.
•    Questions examined background factors, IQ testing, and perceptions of the media.
•    Most respondents supported g factor theory.
•    Experts were skeptical of the accuracy and trustworthiness of the media.
•    Political perspective and gender correlated with experts' answers.

Abstract: Experts (Nmax = 102 answering) on intelligence completed a survey about IQ research, controversies, and the media. The survey was conducted in 2013 and 2014 using the Internet-based Expert Questionnaire on Cognitive Ability (EQCA). In the current study, we examined the background of the experts (e.g., nationality, gender, religion, and political orientation) and their positions on intelligence research, controversial issues, and the media. Most experts were male (83%) and from Western countries (90%). Political affiliations ranged from the left (liberal, 54%) to the right (conservative, 24%), with more extreme responses within the left-liberal spectrum. Experts rated the media and public debates as far below adequate. Experts with a left (liberal, progressive) political orientation were more likely to have positive views of the media (around r = |.30|). In contrast, compared to female and left (liberal) experts, male and right (conservative) experts were more likely to endorse the validity of IQ testing (correlations with gender, politics: r = .55, .41), the g factor theory of intelligence (r = .18, .34), and the impact of genes on US Black-White differences (r = .50, .48). The paper compares the results to those of prior expert surveys and discusses the role of experts' backgrounds, with a focus on political orientation and gender. An underrepresentation of viewpoints associated with experts' background characteristics (i.e., political views, gender) may distort research findings and should be addressed in higher education policy.

Almost 40% of women in our sample experienced phantom foetal kicks after their first pregnancy, up to 28-years (average 6.8-y) post-partum, nearly 50% saying that they were very "convincing"

Sasan, Disha, Phillip G. Ward, Meredith Nash, Edwina R. Orchard, Michael J. Farrell, Jakob Hohwy, and Sharna Jamadar. 2019. “‘Phantom Kicks’: Women’s Subjective Experience of Foetal Kicks After the Postpartum Period.” PsyArXiv. November 11. doi:10.31234/

Abstract: During pregnancy, a woman will attribute increased abdominal sensations to foetal movement. Surprisingly, many women report that they feel kick sensations long after the pregnancy, however this experience has never been reported in the scientific literature. Here, we show that almost 40% of women in our sample experienced phantom foetal kicks after their first pregnancy, up to 28-years (average 6.8-years) post-partum. Using a qualitative approach, we found that women describe the phantom sensations as ‘convincing’, ‘real kicks’ or ‘flutters’. Twenty-five percent of women described the experience as positive, and 27% reported felt confused or upset by the experience. Our results demonstrate that phantom kicks in the post-partum period are a widely experienced sensation, that may have implications for a woman’s post-partum mental health. The mechanism behind the phantom kick phenomenon is unknown, but may be related to changes in the somatosensory homunculus or proprioception during pregnancy.


Here, we report the first scientific description of the phenomenon of postpartum phantom kicks. In this Australian sample, almost 40% of women reported experiencing kick-like sensations following their first pregnancy. Participants who experienced the sensations, described it as "real kicks" or "flutters", with nearly 50% saying that they were very "convincing". Most women commented on the nostalgia and emotion associated with the sensations. This is unsurprising given that pregnancy is an emotional experience due to the increased female sex hormones that result in increased sensitivity in women's emotional processing systems (11). Taken together, this evidence suggests that there may be an association between the emotional relationship to the baby and the sensations of phantom kicks. Despite this, we found no significant relationship between the kick-like sensations and reports of postpartum cognitive or emotional change. We therefore argue that these sensations are unlikely to be delusions, or hallucinations, or a result of postpartum depression, anxiety, or other mental health issues. Although we found no significant association between phantom kicks and postnatal depression or anxiety, our results suggest that the influence of phantom kicks on mood should not be neglected. Content analysis of women's responses to phantom kicks suggested that the experience could exacerbate symptoms of anxiety, particularly in the case of stillbirth. Additionally, the timing at which the phantom kicks begin could be detrimental to those overcoming depression or anxiety, without having any causal connection to mental health outcomes.

Potential explanations for the phantom kick phenomenon

The subjective experience of phantom kicks is apparently a common sensation post-pregnancy for many Australian women. At this stage, we can only speculate as to the origin or cause of the effect. Here, we will review relevant literature as potential avenues for future research. Attribution of 232 postpartum body recovery We considered the possibility that women could misattribute normal body recovery sensations to a phantom kick sensation. The postpartum restoration of muscle tone and connective tissue to the pre-pregnant state lasts for approximately 6 months (12) and most acute changes are resolved within the first 26 weeks (6 months) (6-months; 13). Thus, we repeated the analysis, excluding women who were 1-year post-birth and found that the frequency of phantom sensations did not change. Rather, in the full sample, 39.7% of women reported experiencing kick-like sensations. Excluding women 1-yr post-birth, 39.1% of women experience the sensations. We believe that in the months post-delivery, some sensations of phantom kicks are probably attributable to bodily recovery. However, as women continue to experience these sensations for many years, postpartum recovery cannot be the only contributor to the experience. Proprioception and Phantom Limbs Phantom kicks appear to have considerable similarities to phantom limb syndrome. Phantom limb syndrome occurs when individuals with a missing or amputated limb feel sensations that suggest the limb is still attached. People with phantom limb syndrome are often said to experience "real" movement (14) and pain (15, 16) suggesting that the phantom limb is still represented in proprioceptive body maps (15). The range of possible phantom phenomena is relatively broad (movement, pain, pins and needles, itching, pressure, etc.), suggesting that "kick" sensations could be possible. It is known that the female somatosensory cortex undergoes reorganisation following mastectomy (17). Around 33% of female mastectomy patients report phantom breast sensations, which emerge soon after amputation and continues up to 12-yrs post-surgery (18, 19). During pregnancy, the innervation of the abdominal region by ongoing foetal movement increases over the ~40week gestation, and rapidly ceases at childbirth. The rapid reduction of abdominal somatosensation at childbirth has some similarities to the rapid cessation of innervation following limb amputation. It is possible that phantom kicks may be phenomenologically like the phantom limb phenomenon.

Similarly, misattribution of normal bodily sensations might explain the phantom kick phenomenon. In the non-pregnant state, most spontaneous abdominal sensations are attributed to a digestive cause, and are likely not regularly attended to. During pregnancy, the largest and most salient 258 somatosensations in the abdominal area are quickly attributed to foetal movements. The mother pays close attention to these sensations and bonds with her baby and obstetric care providers direct her to pay close attention to any reduction in the frequency of movements (e.g., 20). Thus, the mother's self-model of her body, and the origin of sensations within it, is updated. Following childbirth, and the subsequent "resettling" of the body organs to the non-pregnant state, there is a substantial reduction in abdominal innervations. It is no longer appropriate to attribute abdominal sensations to the foetus. Perhaps women who experience phantom kicks do not re-update their conceptual model of the body following childbirth, and attribute normal (digestive) sensations to a foetus that is no longer there. Implications of Results for Peri-Natal and Post-Partum Care Due to our sampling method, we cannot make statements of prevalence of phantom kicks in the postpartum period, but we can say that phantom kicks appear to be a common experience among women following the birth of their first child. In our sample, two in every five women experienced the phenomenon. The experience was described as negative for some women, during a period of high vulnerability for mood disorder and mental illness. Around 16% of participants commented that the experience of phantom kicks was negatively impacting on their wellbeing. Many women described a lack of information and expertise being made available to assuage their fears during a crucial time. The field of medical science should address this shortcoming and inform health care providers of the potential risk that unexpected and unexplained phantom kick sensations may pose.

Women are routinely directed to pay attention to foetal kick rate during late pregnancy, either through the media (e.g., 21), or as directed by their health care provider (20). For example, the Royal College of Obstetricians and Gynaecologists (20) guidelines state that .Women should be advised of the need to be aware of foetal movements up to and including the onset of labour and should report any decrease or cessation of foetal movements to their maternity unit. and that "A significant reduction or sudden alteration in foetal movement is a potentially important clinical sign." Our results raise an intriguing question: if women report sensations of foetal movement postpartum in the absence of a 283 foetus, how reliable is the perception of foetal kicks during pregnancy? In other words, are all maternal perceptions of foetal kicks attributable to the foetus? Early research using Doppler ultrasound suggested that not all maternal perceptions of movement were detectable using ultrasound: Johnson, Jordan, and Paine (22) found that 12% of maternal sensations of foetal movement were undetected by ultrasound. Recent studies with newer technology show great individual variability in maternal perception of foetal movement, between 2.4 to 81% (23). An interesting corollary of the current study is that perhaps not all sensations attributed to foetal movement during pregnancy is due to the foetus. This result therefore has implications for the reliability of maternal perception as an indicator for reduced foetal movement and subsequently foetal health. It may be useful in future studies of maternal perceptions of antenatal foetal kicks to use a psychophysiological approach (e.g., Signal Detection theory, 24) to systematically quantify the occurrence of hits, misses, false positives and false negatives of abdominal interoceptive signals.

In sum, our study suggests that up to 2 in 5 women experience sensations of foetal movement long after childbirth and the postpartum period. These sensations may have implications for the mother's mental health during a vulnerable time. We have explored potential explanations for the phenomenon to assist in generating hypotheses for further research. Through this study, we hope to build awareness relating to phantom kicks that will ensure that women are given the appropriate information and care they require. Obstetric, gynaecological, and mental health clinicians specialising in postpartum care should be aware of the potential impact that phantom kicks may have on their clients, especially those that experience abortion, miscarriage, stillbirth, or traumatic birth.

Narcissistic people had less warmth toward successful & unsuccessful others; but this reaction was eliminated after controlling for narcissistic people's assumptions that other people are less reactive to success & failure

Why are narcissistic people cold? A cognitive account emphasizing the perceived momentousness of successes and failures. William Hart, Gregory K. Tortoriello, Kyle Richardson. Personality and Individual Differences, Volume 153, January 15 2020, 109596.

•    Narcissism related to less self-reported reactivity after successes and failures
•    Narcissism related to rating targets as less reactive after successes and failures
•    Narcissism related to less concern for a target after failures
•    Narcissism related to less happiness for a target after successes

Abstract: It seems generally accepted that people with elevated narcissism levels (“narcissistic people,” for short) are interpersonally colder. Most often, this coldness has been presumed to originate from “dark” mechanisms or deficiencies. We departed from these focal explanations; instead, we tested whether “narcissistic coldness,” defined here as the narcissistic tendency to feel less happy for successful others and less concern for unsuccessful others, could follow from an apparently innocent process. Specifically, we proposed that narcissistic people anticipate that success and failure is generally less momentous and (a) assume others are less affected by most success and failure and (b) often feel less happy for successful others and less concerned for unsuccessful others. Findings across three studies were consistent with these propositions. Narcissistic people anticipated that both the self and others will be less reactive to successes and failures (Studies 1–3); moreover, although narcissistic people indicated less warmth toward successful and unsuccessful others, these relations were eliminated after controlling for narcissistic people's assumptions that other people are less reactive to success and failure (Study 3). Hence, narcissistic coldness could, in part, have its origin in what we believe is reasonable disagreement about the momentous nature of events.

6. General discussion

Why are narcissistic (vs. non-narcissistic) people interpersonally colder? Common explanations allude to the presence of psychopathology (e.g., a mental deficit) or darkness (e.g., extreme selfishness and low concern for others) associated with narcissism. Regardless of whether these explanations have merit, here, we proposed and tested a theory which did not invoke either of these constructs: Narcissistic people consider success and failure as less momentous. This consideration is a subjective, potentially reasonable, personal reaction that apparently manifests in beliefs that others (who succeed and fail) are less reactive and, naturally, less warmth toward these others. The theory is complex enough to unpack into ideas that had, up to this point, yet to be explicitly tested. Findings from three studies supported these ideas.

In Study 1, narcissistic people indicated that the self would be less hedonically affected by success and failure. This finding accords with the extended agency model's (Campbell & Foster, 2007) postulate regarding narcissistic people's habituating to success and failure and, therefore, anticipating successes and failures as more diminutive than non-narcissistic people. It also coincides with findings that narcissism relates to trait-level indicators of indifference such as reduced fear of negative evaluation and reduced need for validation (Hart, Adams et al., 2017; Glover et al., 2012); furthermore, it is consistent with evidence that narcissism relates to reduced self-reported failure reactivity (Tortoriello & Hart, 2018). In Studies 2 and 3, narcissistic people assumed that another person, like the self, would be less hedonically affected by success and failure. We believe that narcissistic people may have projected their own subjective feelings of indifference for success and failure onto others and also felt less warmth toward these people. Also, in Study 3, narcissism was unrelated to outcomes of reduced warmth after accounting for estimates of other's reactivity. In other words, hypothetically, if narcissistic (vs. non-narcissistic) people did not assume others were less reactive, then narcissistic and nonnarcissistic people would be about equally interpersonally warm (i.e., just as happy for successful people and just as concerned for unsuccessful people). Critically, exploratory analyses examining relations between narcissistic facets (EE, GE, LA) and/or processes (admiration and rivalry) with outcomes showed highly similar relations as when using the unidimensional narcissism indicator (the NPI); such consistency suggests our theory is highly relevant to conventional narcissism constructs, generally.

Broadly, the present findings cohere with other work suggesting that socially-undesirable outcomes associated with so-called dark-personality constructs (e.g., narcissism, Machiavellianism, psychopathy; Paulhus & Williams, 2002) may not always be the result of malicious intent or psychopathological deficits; occasionally, apparently “dark” outcomes may reflect reasonable disagreements that people high vs. low in dark personalities can have about social realities. For example, Tortoriello, Hart, and Richardson (2019) connected relations between dark personalities and heightened use of derogatory language to disagreements about human fragility; people high and low in dark personalities acknowledged that derogatory language is psychologically harmful, but people lower in dark personalities perceived the intent of this language as more harmful (i.e., they perceive people as more fragile). Hart, Adams, and Burton (2016) showed that divergences between narcissistic and non-narcissistic people on bragging can be traced, in part, to disagreements about how much other people value agentic traits and respond positively to self-promotion. To be sure, perhaps dark personalities or behavior may sometimes be associated with malevolence, but, other times, the different outcomes associated with these personalities can merely indicate that reasonable people can disagree about social realities (e.g., how reactive is a person?) and, in turn, respond differently. We think this perspective on dark personality is sometimes neglected but could potentially yield novel insights and provide a more well-rounded understanding of people with sociallyundesirable tendencies.

Future research is required to address shortcomings of our studies. First, although the present studies included well-powered samples utilizing both undergraduate (Study 1) and MTurk participants (Studies 2 and 3), with the latter being rather representative of the US population on personality constructs (McCredie & Morey, 2018), it is unclear how our findings may generalize to other sample frames (e.g., clinical samples) and cultures. For example, across both MTurk and college student samples, the vast majority of the participants scored below the midpoint of the NPI (i.e., ‘20’), which limits our capacity to state that our results apply to populations with absolutely-elevated NPI scores. Second, all measures were self-report, which could enable dishonest or inaccurate responding (e.g., social-desirability response biases); this point is a particularly important consideration for our MTurk samples. Indeed, on occasion, computer programs have masqueraded as MTurk “participants” by emitting random responses (Kennedy et al., 2018). Although random responses are unlikely to yield the theoretically-anticipated effects we obtained, they could result in under-estimation of these theoretically-anticipated effects. Future work may strengthen the present findings by utilizing stricter control over this problem (Kennedy et al., 2018); also, future research might consider using observer reports of narcissism and warmth constructs.

Third, it is critical to acknowledge that our findings do not prove the existence of an egocentric process influencing narcissistic coldness. The evidence, gathered over different studies, shows that narcissistic people assume that success and failure will be less momentous for the self and others, and these assumptions made about others relates to reduced warmth toward these others. Although such evidence is arguably important in its own right, the evidence does not definitively prove that the self's anticipated reactions to success and failure are attributed to others. Nonetheless, as we have discussed, egocentric reasoning processes are utilized in mentalizing (Nickerson, 1999), and the use of egocentric reasoning processes were facilitated—if not ensured—by the design of the study materials (e.g., the target being judged was nondescript). That being said, future work is needed to test the role of egocentric reasoning processes. For example, the present relations between narcissism and warmth should be diminished somewhat if narcissistic and non-narcissistic people were forced, via an experimental manipulation, to agree on the target's reactions to success or failure. Fourth, it is too early to claim that the present data are of practical significance. The present work was designed to validate a theoretical statement, but future work is needed to examine the theory's practical significance and scope. Features of the situation might exert such strong reactions on warmth reactions that beliefs about others' reactivity are rendered moot. For example, beliefs about a target's anticipated reactivity might be less relevant to predicting warmth when this target is a bitter enemy (vs. casual acquaintance).

In closing, narcissism is considered part of a constellation of personalities that are presumed to represent the human propensity for malevolence (Paulhus & Williams, 2002); obviously, the present study cannot settle whether narcissistic people are malevolent or simply misunderstood, but it could suggest a rather innocent explanation for some instances of narcissistic coldness.

Sunday, November 10, 2019

Analysis of inequality aversion in mice

Analysis of inequality aversion in mice using stress-induced hyperthermia. Shigeru Watanabe. Learning and Motivation, Volume 68, November 2019, 101601.

Abstract: Humans have a sense of fairness and consequently have an aversion to inequality condition. Recently, animal researchers have suggested that some non-human animals also exhibit an aversion to inequality. This experiment used stress-induced hyperthermia (SIH) to examine inequality aversion in mice. Aversion was analyzed using inequitable restraint stress in Experiment 1. The mice that were restrained, but had free cage mates (disadvantageous inequality) displayed SIH. In contrast, free mice that had restrained cage mates (advantageous inequality) did not show SIH. Inequitable food delivery was used to induce SIH in Experiment 2. Food deprived mice who were surrounded by cage mates who were consuming food (disadvantageous inequality) displayed SIH. The mice that received food and were surrounded by food-deprived cage mates (advantageous inequality) also showed some increase in body temperature, but the increase was not significantly higher than that in the equality condition (where all mice received food). Pre-feeding of the test mice attenuated SIH in the disadvantageous condition suggesting that satisfied mice do not display disadvantageous inequality aversion. These results showed disadvantageous inequality aversion in mice in both negative (restraint) and positive (food) situations but not advantageous inequality aversion.

SIH = stress-induced hyperthermia
BAT = brown adipose tissue

3.2. Results and discussion

Fig. 2 shows the changes in body temperature in the five test conditions. One sample t-tests revealed significant increases in body temperature from baseline in the disadvantageous and the advantageous inequality conditions (t(19)=5.26 and 2.58, P=000004 and P=0.02, respectively). No significant increases were seen in the equality, cheese presentation, disadvantageous inequality after pre-feeding of subjects, or the advantageous inequality with pre-fed cage mates’ conditions (t(19)=1.27, 1.31, 0.24 and 1.66, P=0.22, 0.20, 0.81 and 0.11, respectively). Thus, SIH was observed in both advantageous and disadvantageous inequality conditions without pre-feeding. The disadvantageous inequality condition clearly induced the most profound SIH. This is the first report of inequality aversion in a positive situation in rodents.

A one-way ANOVA revealed a significant effect of the tests (F(5,119)=4.41, P < 0.005). Comparison between the equality condition and cheese presentation condition showed no significant difference (t(19)=0.29, P=0.77) suggesting that the presence of inaccessible cheese did not cause stress/aversion. Comparison between the equality condition and the disadvantageous inequality condition showed a significant difference (paired t-test, t(19)=3.23, P=0.024 after Holm’s correction); however, there were no significant differences between the equality and advantageous inequality conditions (t(19)=1.27, P=0.27). Thus, the mice showed disadvantageous but not advantageous aversion, even though the latter condition caused mild SIH and there was no significant difference between the disadvantageous and advantageous inequality (t(19)=1.44, P=0.17).

The difference between the disadvantageous inequality condition and that after pre-feeding of the subjects was statistically significant (paired t-test, t(20)=3.55, P=0.01 after Holm’s correction); however, there were no significant differences between the advantageous inequality condition and that with the pre-fed cage mates (t(20)=1.44, P=0.17 after correction). Thus, the pre-fed subjects did not display disadvantageous aversion but the pre-fed cage mates did not reduce the advantageous aversion of the subjects. The reduction in SIH by pre-feeding of the subjects in the disadvantageous inequality condition suggests that social comparison of the state of the observer and demonstrators caused the aversion. Cage mates consuming food did not cause aversion when the test subjects were not hungry. Thus, the crucial factor for inequality aversion appears to be the social relationship between one’s own state and that of others. After food deprivation, the mice started eating cheese immediately; however, those who were pre-fed did not. Thus, the subjects easily discriminated states of cage mates, hungry or not, through behavioral expression. In my previous experiment (Watanabe, 2017), the body temperature of mice was measured in a chamber with two compartments, one contained inaccessible cheese and the other a cheese-eating cage-mate. The hungry subject mice displayed significantly higher body temperature in the compartment with the cheese-eating cage mate than in the compartment with inaccessible cheese. Thus, the eating behavior of the cage mate caused SIH in the hungry subjects. The eating behavior of the cage mates had an aversive property for the hungry subjects, because it indicated depletion of food. When the subjects were not hungry in the pre-fed disadvantageous inequality condition, the satiated subjects should not care about the depletion of food; hence, they did not show SIH. Pigeons that previously experienced electric shock displayed suppression of operant behavior when exposed to a pigeon receiving electric shock (Watanabe & Ono, 1986). This phenomenon can be explained in terms of generalization or transfer between their own experience and other’s experiences. Similarly, mice who previously experienced injection with methamphetamine showed conditioned social preference for cage mates injected with the same drug (Watanabe, 2015b). These results suggest that cognition of social comparison, equality or inequality, is possible in animals.

Social comparison of states is common in humans and results in envy (Smith, 2008) and a phenomenon is known as Schadenfreude (Smith, 2013), although Schadenfreude-like behavior has rarely been observed in animals (Watanabe, 2014) (see discussion in Watanabe, 2016). Social comparison is considered a higher-order social cognitive ability in well-developed social animals. The pathway connecting such higher cognition and the thermoregulatory system is unclear. In rats, the stress induced by exposure to an intruder (Mohammed, Ootsuka, & Blessing, 2014) increased BAT temperature. The inhibition of adrenoceptors also reduced the SIH caused by a social intruder (Lkhagvasuren, Nakamura, Oka, Sudo, & Nakamura, 2011). These results suggest that emotional thermoregulation of BAT is controlled by social cognition through the DMH-Raphe system. Given the variety of stressors that result in SIH, it seems likely that many different areas, including higher cognitive areas, project to the DMH; however, the exact circuit controlling the thermoregulatory system remains still unknown.

Check also, about Schadenfreude: The dominant/subordinate relationship between mice modifies the approach behavior toward a cage mate experiencing pain. Shigeru Watanabe. Behavioural Processes, Volume 103, March 2014, Pages 1-4.
•    This study examined the social preference of mice for a conspecific in pain.
•    Subordinate mice preferred a dominant mate in pain to a mid-status mate not in pain.
•    Dominant mice did not display a social preference.
•    The relationship between observer and demonstrator modifies social preference.
Abstract: Many species display approach behavior to conspecifics. This study evaluated approach behavior exhibited by mice toward a cage mate in pain according to the social relationship between the mice. The relative dominant/subordinate relationship among three cage mates was determined using a competitive food retrieval test. Social preference of the subordinate mouse for the mid-status or dominant cage mate was tested with and without pain induced in the dominant cage mate. Social preference of the dominant mouse was similarly tested with and without pain induced in the subordinate cage mate. Subordinate mice spent more time with the dominant cage mate in pain than with the mid-status cage mate but spent a similar amount of time with dominant and mid-status cage mates that were not in pain. Dominant mice spent a similar amount of time with subordinate and mid-status cage mates regardless of pain. The time that subordinate mice spent with the dominant cage mate in pain inversely correlated with dominancy distance between the two mice. These results demonstrate that social relationship can modify perception of the pain of others.

U.S. policymakers are more confident than their Chinese counterparts that the use of nuclear weapons could remain limited; the contrasting views could make easier an escalation to unlimited nuclear war

Dangerous Confidence? Chinese Views on Nuclear Escalation. Fiona S. Cunningham and M. Taylor Fravel. International Security, Volume 44, Issue 2, Fall 2019, p.61-109, October 28, 2019.

Abstract: Chinese views of nuclear escalation are key to assessing the potential for nuclear escalation in a crisis or armed conflict between the United States and China, but they have not been examined systematically. A review of original Chinese-language sources and interviews with members of China's strategic community suggest that China is skeptical that nuclear escalation could be controlled once nuclear weapons are used and, thus, leaders would be restrained from pursuing even limited use. These views are reflected in China's nuclear operational doctrine (which outlines plans for retaliatory strikes only and lacks any clear plans for limited nuclear use) and its force structure (which lacks tactical nuclear weapons). The long-standing decoupling of Chinese nuclear and conventional strategy, organizational biases within China's strategic community, and the availability of space, cyber, and conventional missile weapons as alternative sources of strategic leverage best explain Chinese views toward nuclear escalation. China's confidence that a U.S.-China conflict would not escalate to the use of nuclear weapons may hamper its ability to identify nuclear escalation risks in such a scenario. Meanwhile, U.S. scholars and policymakers emphasize the risk of inadvertent escalation in a conflict with China, but they are more confident than their Chinese counterparts that the use of nuclear weapons could remain limited. When combined, these contrasting views could create pressure for a U.S.-China conflict to escalate rapidly into an unlimited nuclear war.


In this article, we have argued that China’s strategic community is relatively confident about the ability of China to avoid nuclear escalation in a conflict with the United States. The most important reason is that the members of this community believe that once nuclear weapons are used, subsequent use by either side cannot be controlled. Thus, they do not believe that a limited nuclear warwouldstaylimited. Instead, it would likely escalate into an unlimite done. Chinese experts expect that these features of nuclear war will lead U.S. and Chinese decisionmakers to avoid any nuclear use and resolve any conflict at the conventional level. They also believe that the United States will exercise sufficient control over a crisis involving a U.S. ally or partner so that the use of nuclear weapons is not considered.
China’s operational doctrine for the use of its nuclear weapons and its nuclear force structure are consistent with these views about the difficulty of controlling escalation. That is, China’s operational doctrine does not contain plans to wage a limited nuclear war, which China might pursue if it believed nuclear escalation could be controlled. The focus of China’s nuclear operations remains on how to retaliate after China is attacked with nuclear weapons to deter such attacks in the first place. Similarly, although China’s nuclear arsenal is expanding, China is not developing forces that would be optimized for use in a limited nuclear war, especially tactical nuclear weapons. The long-standing decoupling of conventional and nuclear strategy, theavailabilityofnonnuclear strategic weapons such as cyberweapons, and the organizational biases of nuclear experts and the PLA’s missile commanders explain this relative confidence about avoiding escalation. Chinese experts likely overestimate their leaders’ ability to control escalation, because they underplay the pressures to escalate to a nuclear war that their leaders could not control—for example, if an adversary overreacts or misperceives Chinese signaling with nuclear or nonnuclear strategic weapons.
Several implications follow from our analysis, all of which raise concerns about crisis stability and the ability of the United States and China to prevent nuclear escalation in a crisis between the two states. First, China’s approach to deterrence may be suboptimal—at least from the perspective of deterring either U.S. conventional strikes against its nuclear infrastructure or limited U.S. nuclear strikes against its nuclear arsenal. Although China maintains some ambiguity over whether it would respond to a conventional strike on its nuclear forces with nuclear weapons, China’s overall confidence that a U.S.China conventional conflict would not escalate to nuclear war may reduce the effectiveness of its deterrent against this kind of attack by persuading an adversary that such strikes would not elicit nuclear retaliation. China’s confidence could even embolden an adversary to gamble that a limited nuclear first strike against China would not elicit nuclear retaliation. This, in turn, would increase the odds of such U.S. attacks and create strong pressure for China to retaliate to deter further attacks on its nuclear forces, resulting in nuclear escalation.
Our research, however, does not indicate how the small size of China’s arsenal compared with that of the United States would affect its response to U.S. limited nuclear strikes. China could respond with limited nuclear retaliatory strikes; it could threaten or pursue unlimited nuclear retaliation; it could respond with nonnuclear forces; or it could respond in another way, including terminating the conflict. More research is needed to explore the relationship between the size and vulnerability of China’s arsenal and its views of nuclear escalation control.
Second, the United States and China hold opposing beliefs about escalation above and below the nuclear threshold that may also contribute to instability. U.S. experts worry more than Chinese experts that the two countries might not be able to control the escalation of a conventional war to high levels of intensity, which could push a conflict over the nuclear threshold, but are more sanguineabout(oratleastaredividedaboutthepossibilityof)controllingnuclear escalation after nuclear weapons have been used.174 This likely reflects the overwhelming superiority of U.S. nuclear forces (especially against a smaller nuclear power), decades of nuclear planning for a range of scenarios (including limited nuclear warfighting), and an emphasis on achieving dominance in conventional operations.
As this article demonstrates, however, Chinese experts hold an opposing perspective. They are quite pessimistic about controlling nuclear escalation once the threshold for the use of nuclear weapons has been crossed. By contrast, however, they are quite confident (perhaps overly confident) about controlling conventional escalation before the nuclear threshold is crossed. As noted earlier, almost all of the available literature from Chinese military sources on escalation examines conventional escalation and not nuclear escalation. At least in the post–Cold War era, U.S. conventional operations against other militaries have emphasized seizing and exploiting air superiority, meaning that control of conventional escalation was not a concern for the United States because it had the luxury of fighting adversaries with no plausible means to escalate. Although China has not fought a war since 1979, it has engaged mostly in limited uses of force in local conflicts or displays of force and has certainly not achieved conventional dominance over an adversary to the same extent as the United States.
These contrasting beliefs about the feasibility of controlling conventional and nuclear escalation suggest that a conventional conflict is more likely to escalate to high levels of intensity, increasing the chances of nuclear escalation. China, for example, could take actions it believes will deter the United States at the conventional level, only to be confronted with a U.S. desire to overmatch China in response and establish the same extent of conventional dominance that the United States has enjoyed for several decades against other adversaries.175 Yet, such actions could include steps to degrade China’s nuclear forces, either inadvertently by targeting China’s conventional missiles or intentionally to force China to either surrender or escalate to nuclear war. Those U.S. attacks might create strong pressures on China to engage in nuclear signaling or mobilization of its land-based nuclear missiles and ballistic missile submarines to protect its deterrent or even threaten nuclear use to deter further attacks on its nuclear arsenal. In response, the United States may attempt a large-scale nuclear strike to try to eliminate China’s nuclear forces or at least limit damage from China’s use of nuclear weapons. If the two countries have different views about when the natural firebreaks in a conflict will occur, they may focus on negotiating an end to the conflict at different times in this escalatory spiral and therefore miss opportunities to negotiate an end to the conflict altogether.176 In short, based on differing views about controlling escalation, escalation at both the conventional and nuclear levels may be more likely.
The flip side, however, might be enhanced caution. China may anticipate U.S. efforts to escalate a conventional war to achieve conventional dominance while the United States may anticipate a disproportionate Chinese nuclear response if it were to conduct limited nuclear strikes in a conflict. Both countries may therefore be extremely cautious in a crisis or low-intensity conflict. Further, despite the views outlined above, the two countries have not always acted on their confidence about controlling conventional or nuclear escalation. Historically, China has exercised more caution (most of the time) when facing a superior adversary, based on the imperative of conserving its forces. Despite models that show U.S. nuclear superiority and the ability to limit damage using a nuclear first strike,177 U.S. leaders have appeared reluctant to accept significant nuclear risk, especially in the post–Cold War era.178
Ironically, one factor that contributes to these opposing views is China’s no-first-use policy. Many U.S. analysts do not believe that it is a credible pledge, because China has not stated how it plans to end a conventional war it is losing.179 China perhaps does not feel a need to reveal such plans, either because of its experience in fighting and ending limited wars without achieving its initial ambitions (in Korea and perhaps in Vietnam) or because it would not want to reveal such plans to a stronger adversary that could then exploit them. On the other hand, Chinese experts view the pledge as the guiding principle for the role of Chinese nuclear weapons in any future conflict with the United States. As they do not plan to use nuclear weapons first, even when losing, they may not explore this point in their writings. Chinese experts may also discount the likelihood that its actions in a crisis or conflict could be mistaken by the United States as preparations to use nuclear weapons first.
Third, greater attention to nuclear escalation is needed in China. The gap between its strategic community and the PLARocket Force needs to be bridged. Looking forward, the new Strategic Planning Office under the CMC may endeavor to pursue greater coordination between China’s overall strategy and the role of nuclear weapons in crises and conflicts. A fourth implication of Chinese views of nuclear escalation for U.S.-China crisis stability concerns whether these views may change in the future. We suggest that China’s strategic community is unlikely to change its view that further nuclear escalation cannot be controlled once it is engaged in a crisis or conventional conflict with the United States. Nevertheless, several possibilities should be considered. First, Chinese experts may revise their views about the ability of the United States to control its allies and avoid a nuclear confrontation with China, points on which China’s views currently diverge with the arguments of the Cold War skeptics. The realization in a crisis or conflict that the United States may be unable or unwilling to control its allies, or willing to run the risk of a nuclear war with China to defend them, could deter China from engaging in a highintensity conventional conflict with a U.S. ally. It could also prompt China to engage in nuclear signaling to try to deter a U.S. first strike, which could in turn be misperceived by Washington.
A second possibility is that proponents of nuclear escalation control and limited use, who may exist within the PLA Rocket Force, increase the force’s historically limited influence over nuclear strategy formulation within China, thus changing Chinese views toward escalation control. The availability of precise theater capabilities and tactical delivery systems, currently deployed with conventional payloads only, would allow China to develop options for limited war with relative ease, if a political decision to do so is made.180
A final possibility is that Chinese views could change without a crisis or a conflict as a catalyst. China may change its views that nuclear escalation would not be controlled if current U.S. attention to limited nuclear war leads Chinese experts to agree that preparing for limited retaliatory nuclear strikes is the best way to deter U.S. limited nuclear use and further nuclear use. Any U.S. actions that would encourage China to consider limited nuclear use, whether to deter the United States or to de-escalate a conventional conflict, would likely increase regional instability and risks to the United States and its allies.

Specialized psychological treatment for offending: Treatment was associated with offense-specific & general recidivism reductions; those with consistent input from a qualified psychologist had best results

Does specialized psychological treatment for offending reduce recidivism? A meta-analysis examining staff and program variables as predictors of treatment effectiveness. Theresa A. Gannon et al. Clinical Psychology Review, Volume 73, November 2019, 101752.

• This meta-analysis examined psychological offense treatment and recidivism.
• Overall, 70 studies were identified; including over 55,000 individuals.
• Treatment was associated with offense-specific and general recidivism reductions.
• Programs with consistent input from a qualified psychologist had best results.

Abstract: A meta-analysis was conducted to examine whether specialized psychological offense treatments were associated with reductions in offense specific and non-offense specific recidivism. Staff and treatment program moderators were also explored. The review examined 70 studies and 55,604 individuals who had offended. Three specialized treatments were examined: sexual offense, domestic violence, and general violence programs. Across all programs, offense specific recidivism was 13.4% for treated individuals and 19.4% for untreated comparisons over an average follow up of 66.1 months. Relative reductions in offense specific recidivism were 32.6% for sexual offense programs, 36.0% for domestic violence programs, and 24.3% for general violence programs. All programs were also associated with significant reductions in non-offense specific recidivism. Overall, treatment effectiveness appeared improved when programs received consistent hands-on input from a qualified registered psychologist and facilitating staff were provided with clinical supervision. Numerous program variables appeared important for optimizing the effectiveness of specialized psychological offense programs (e.g., arousal reconditioning for sexual offense programs, treatment approach for domestic violence programs). The findings show that such treatments are associated with robust reductions in offense specific and non-offense specific recidivism. We urge treatment providers to pay particular attention to staffing and program implementation variables for optimal recidivism reductions.

Keywords: Offense treatmentMeta-analysisSexual offendingDomestic violenceGeneral violence

8.4. Future policy and practice directions

The outcomes of this meta-analysis are the first to suggest that specialized psychological programs that target various offending behaviors are effective. Although there was significant heterogeneity across the outcomes of individual studies, our review suggests ways that policy makers and program providers might optimize program outcomes. First, the results indicate that program developers should provide qualified psychologists who are consistently present in hands-on treatment; and second, facilitators should be provided with supervision opportunities that are similar across the program. Interestingly, less than one in five programs consistently used qualified psychologists in hands-on facilitation and the majority of these (83.3%; n = 10) were implemented in the 1970s, 1980s, or 1990s rather than more recently. The provision of supervision was more evenly spread. We recognize the significant pressures that policy makers face providing cost effective programs to large numbers of individuals (Gannon & Ward, 2014). As an indication of this, correctional systems in a number of international jurisdictions have been moving away from the direct involvement of psychologists as treatment providers, with therapeutic activities such as running manual-based groups being delegated to correctional program officers who may have little or no formal clinical training. Ironically, it seems that this variable is correlated with optimum behavioral change and yet qualified psychologist hands-on input is lacking in programs implemented in recent years. This may explain why we did not find more modern treatments to bring about improved outcomes (see also Lösel & Schmucker, 2005). Qualified psychological staff and regular supervision come at a clear financial cost. Program providers could consider the benefits of pruning down staff facilitation numbers as a compensatory financial strategy given that individual and co-facilitated programs seem to be equally beneficial. Program providers might also want to consider methods for tightly controlling program implementation given that we found single site treatments seemed to fare better than multisite treatments.

Further offense specific practice implications are available for those involved in sexual offense and domestic violence policy. Regarding sexual offense programming, the results indicate that best practice guidelines in this area should be revised to include (1) cautionary messages regarding polygraph use within the therapeutic context, and (2) further commentary on—and expansion of—the evidence base around behavioral reconditioning as a treatment tool. Those tasked with developing and managing programs for those who have been domestically violent should seek out the best educational materials possible and consider how such materials can be skilfully woven into program facilitation to produce optimal results.

Longer-term psychotherapies are not always more effective than the initial therapy contact, suggesting that the mere thought that one is being helped counts

The effectiveness of initial therapy contact: A systematic review. Katie Aafjes-van Doorn, Kristen Sweeney. Clinical Psychology Review, November 9 2019, 101786.

• Few empirical studies have examined the direct effect of initial therapy contacts.
• Initial therapy contact is more effective than no treatment or a waiting list.
• Initial therapy contact might be as effective as 6-session treatment.
• Several effective initial therapy formats and approaches reduce patients' symptoms.

‘Initial therapy contacts’, defined as (the first) 3 h or less of face-to-face psychological treatment, encompassing both the early phase of a longer therapy and one-off single session therapies, are seen as a critical phase of treatment. However, little is known about the direct effect of initial therapy contacts on change in common symptoms typically presented by patients in psychological therapy services. Our systematic literature search resulted in 35 identified empirical studies on the effect of initial therapy contacts. These studies were analyzed in three stages: 1) A systematic comparison of study characteristics using the preferred reporting items for systematic reviews and meta-analyses; 2) A domain-based evaluation of methodological rigor of the studies, in line with Cochrane's guidelines on assessing risk of bias; 3) A narrative synthesis of reported findings.

The considerable variability in therapy format (a stand-alone single session, 2 + 1 format, or initial session of multisession therapy) and study design (post/pre-post measurement, with/without control) limited comparability of studies. The quality assessment indicated that the majority of studies had relatively weak methodologies overall. Qualitative synthesis of the effectiveness results suggests that a significant proportion of patients reported benefits, including symptom change. This positive effect is especially clear when compared to no-treatment controls, and appears to be maintained at follow-up. The findings suggest that a broad range of initial therapy formats, could in itself be beneficial to patients in primary care treatment settings, and that further research is warranted.

Keywords: Initial sessionsSingle-sessionEffectSystematicReview


Thirty-five empirical studies on the effectiveness of initial therapy contacts were identified. In line with previous reviews (e.g. Hymmen et al., 2013), our quality assessment indicated that the majority of reviewed studies had relatively weak overall methodologies. Studies widely differed in the rigor of their research design and, for example, included four uncontrolled single-case designs, as well as twentyone controlled studies, of which twelve RCTs and three efficacy studies. Findings of the present review support the conclusion that (the first) 3 hours or less of therapy can possibly be an effective intervention in itself for adults with mild to moderate mental health problems. Importantly, reported effects appeared to last over time. All studies that included a follow-up measurement in their design reported that the positive effect of the initial therapy contact had been maintained several months or even years after the intervention, even if no further therapy occurred after the initial therapy contact. Some studies stated that a proportion of patients (e.g. 30% in Abbass et al., 2008) derived sufficient benefit that they did not require further treatment. Although this was not specifically addressed in any of the studies, there appeared to be no difference in outcomes between the effects of initial therapy contact when it consisted of stand-alone sessions (n = 27) or when it consisted of the start of longer therapy (n = 8). For example, a 3-hour stand-alone therapy spread over different sessions (e.g. 2 + 1) appeared to have comparable outcomes to a 3hour session at the start of a longer treatment (Abbass et al., 2008). This suggests that these very brief interventions may be effective in a variety of different formats. Stand-alone session(s). The majority of studies in this review reported on stand-alone session(s). Two specific types of effective stand-alone therapies were identified. First, a “single session therapy”, referred to a planned single-session intervention. The single session may be previously scheduled or provided in a “walkin counselling clinic” (e.g. Hymmen et al., 2013). Another type of effective standalone initial therapy contact has been developed by Barkham and colleagues (Barkham, Shapiro, Hardy, & Rees, 1999). Their “two-plus-one model” (2+1) reflects a very brief three session intervention, comprising of two 1-hour sessions one week apart, followed by a third 1-hour session three months later. The results of this review are in line with other reviews of single-session therapies (e.g. Bloom, 2001; Cameron, 2007; Rockwell & Pinkerton, 1982) and stand-alone therapeutic assessments (Poston & Hanson, 2010), which showed that stand-alone single session(s) in a variety of therapies are effective in reducing symptoms.  Initial session(s) in multisession therapy. In contrast to stand-alone sessions, “initial sessions” refer to the first session(s) of several, or rather, the start to longer therapy. Of the 35 reviewed studies, only 8 studies examined the effectiveness of initial session(s). As mentioned previously, these studies showed comparable outcomes to stand-alone single session(s) intervention. Notably, only one of these eight studies was conducted as RCT (Dunn, Neighbors, & Larimer, 2006), the others used relatively weaker study designs. This means more research comparing the effect of an initial session to overall pre- post treatment change is needed to identify any “first session gains” (Busch, Kanter, Landes, & Kohlenberg, 2006) that set the course of the therapy as a whole (Lambert & Ogles, 2004).  There are several hypotheses as to why initial sessions of multisession therapy might be particularly effective. Frank’s (1974) theory of remoralization suggests that the first hours of therapy are likely to lead to a decrease in symptoms because they help to clarify a patient’s problems, inspire hope and provide experiences of success (see also Howard’s phase model of change; Howard, Lueger, Maling, & Martinovich, 1993; Stulz & Lutz, 2007). In addition to remoralization, others have drawn on goal-setting theory (Locke & Latham, 2006) and the Theory of Planned Behavior (Ajzen, 1988) and emphasized the importance of early changes in the patient’s expectations of therapy (e.g., anticipatory beliefs about what will happen during or because of therapy) (Constantino, 2012; DeFife & Hilsenroth, 2011). According to Ajzen’s (1988) Theory of Planned Behavior, beliefs about expected outcome, self-efficacy concerning necessary ‘patient role’ behaviors and motivation to achieve improvement determine intention to engage and, therefore, the success of therapy. Locke and Latham’s (2006) goal setting theory similarly suggests that an individual’s expectations of therapy may be linked to how much the individual is motivated to engage in working towards their goals and, therefore, achieve symptom change. It has to be noted, however, that these theories of remoralization, goals, and planned behavior not necessarily explain therapeutic benefits of planned singlesession therapy or very brief interventions as stand-alone treatment. Moreover, these theories do not explain why initial therapy contact seemed to be effective irrespective of treatment modality that was used, with vast theoretical and technical differences. Whilst it should be stressed that no statistical comparison between the different models has been attempted, the findings appear to be congruent with the ‘equivalence paradox’ or ‘Dodo-bird verdict’ (Luborsky et al., 2002). These common factors may have an effect on initial therapy contact irrespective of further therapy offered and thus seem to contradict the expectations hypothesis (Constantino, 2012; Greenberg, Constantino & Bruce, 2006). Similarly, the fact that longer-term therapies were not always more effective than the initial therapy contact is inconsistent with the dose-effect literature which identified a relatively larger effect early in therapy, and continuing but diminishing levels of improvement over time. 

The extent to which conclusions can be drawn from the reviewed studies was limited by their respective internal validity (i.e. whether the study results can be attributed to the effect of the initial therapy contact, or whether they might be a result of other factors, such as concurrent treatments, type of control group or therapist effects unrelated to the model of treatment) and external validity (i.e. whether the findings can be legitimately generalized to other people and situations in clinical practice). First, it is possible that we have underrated the overall quality of the reviewed studies in our methodological assessment. For example, two welldesigned efficacy studies (Gellis et al., 2013; Goerling et al., 2014), received an overall weak quality rating, due to their reported low participation rates. Also, attempts to assess risk of bias are often hampered by incomplete reporting of what happened during the conduct of the study (Higgins & Green, 2008). It is therefore possible that the reviewed studies were of higher internal validity than indicated in our systematic review, because important details of the applied study methodologies were left out in the final publications of the studies. Second, publication bias may have impacted the results of this systematic review by alluding to a treatment efficacy when non-published studies failed to replicate such findings (Liberati et al., 2009). Whilst a publication bias should be considered within any systematic review, the existence of negative reporting (e.g. Hutchinson & Krippner, 1988) suggests that it is unlikely a publication bias would have significantly impacted the findings of the current review. Notably, the majority of the more robust study designs were reported in the most recent publications, possibly indicating the current focus in psychotherapy research on evidence-based practice and increased standards of peer-reviewed journals. Third, some of the results of the descriptive studies might have been affected by a response bias, when patients’ inclination to give positive feedback when contacted by the service (Battaglia, Shapiro & Zell, 1996), which could explain why the patients in both the longer-term therapy control groups and the initial therapy contact reported symptom improvement/ recovery in the phone-interviews. Alternatively, in the case of the study by Askevold (1983), the results might also have been affected by patients’ memory of the content, as there was an extraordinary nine years between intervention and follow-up.  Besides these aspects of internal validity, evidence for the external validity of the findings also appears to be mixed. The populations in the studies appear representative of mainstream adult mental health services with respect to age and gender balance (Barkham et al., 2001). However, many relevant patient and therapy
characteristics were not reported. Future research would, for example, benefit from detailed descriptions of treatment setting (e.g., outpatient, crisis clinic), level of therapist training, therapist orientation and location of services (e.g., rural/urban). Moreover, the majority of the studies involved patients with mild to moderate mental health problems, often subclinical, which means that the conclusions are confined to treatments for patients with relatively mild problems, that is, consistent with the severity of problems of patients seen in primary care mental health services (Barkham et al., 2001; Haaga, 2000). However, this also resulted in a small scope for reduction in scores on standardized measures, and might thus understate the potential efficacy of initial therapy contacts. The impact of initial therapy contacts on interpersonal or personality problems was not addressed in the majority of studies reviewed and, therefore, the current studies cannot challenge the existing notion that these difficulties take longer to change (Hardy et al., 1995; Lambert & Ogles, 2004; Merbaum & Butcher, 1982). It may be useful, in future research, to explore the impact of initial therapy contacts for more severe presentations, such as those seen in, for example, secondary and tertiary care services. To know beforehand for whom ultra-brief therapy is enough (e.g. patient factor) would be extremely important knowledge for the cost-effectiveness and efficiency of mental health services.  In order to develop the evidence-base of initial therapy contact further, it is crucial to determine not only the patient and treatment moderators but also the mediators of improvement. An important next step could be to examine the relative benefits of key process elements, such as alliance (Hilsenroth & Cromer, 2007), expectations and hope (Constantino, Arnkoff, Glass, Ametrano, & Smith, 2011) that form early in therapy and are assumed to mediate the effectiveness of initial sessions (Messer & Wampold, 2002). Given that the reviewed empirical studies did not report on moderation or mediation analyses, future researchers should address this gap in the psychotherapy literature.  As next step in future research, the effectiveness as well as relevant moderators and mediators of initial therapy contact should be examined in a metaanalysis. In this review, meta-analytic strategies could not be applied because only a small number of studies (n = 13) (e.g. Abbass et al., 2008; Armento et al., 2012) reported significance levels, and the vast majority of studies did not provide enough information to enable calculation of effect sizes. When researchers ensure that the intervention and treatment effect (or effect size) is reported consistently from one study to the next, meta-analysis can be used to numerically pool the results of the studies and arrive at a summary estimate to identify this effect of initial therapy contact. Subgroup analyses and meta regression can then be conducted to test if there are subsets of research that capture the summary effects. This next step will then help test hypotheses around the relative importance of the length, format or therapy model of the initial therapy contact in determining symptom change.  Further research might illuminate whether patients who substantially improve during the initial sessions of longer therapy would have done so even if treatments were planned to be only ultra-brief (3 hours or less). Building on our findings, future researchers may clarify if initial therapy contacts with varying total treatment dose are equally effective (see dose-effect model; Howard et al., 1986), or if rate of change is related to total dose of therapy (see the good-enough level model of change; Baldwin, Berkeljon, Atkins, Olsen & Nielsen, 2009).

Clinical Implications.

The reported risks of bias in the reviewed studies precludes drawing any strong conclusions about the effectiveness of each specific intervention. However, for clinicians it will be important to know that, in contrast to the review of single-session debriefing after trauma (Bisson, 2010; Rose et al., 2003), there were no indications of any significant harm or distress following the initial therapy contacts applied in general outpatient services. In other words, initial therapy contacts (as a stand-alone intervention or as part of longer treatment) may constitute a beneficial therapeutic intervention in itself. The self-reported patient outcomes suggest that there might be a number of initial therapy formats (singlesession, 2-1, & initial session), which could potentially benefit patients in primary care treatment settings, more than no treatment or being on a waiting list.  Understanding the direct effect of these initial therapy contacts is thus of great significance to clinicians who, in this managed-care era, are under pressure to provide effective relief in the shortest time possible. Clinicians will want to know who gets better and what it is that leads to that improvement, to stratify selection or alter therapy content accordingly. Moreover, by identifying the most important factors associated with change in initial therapy contacts, we may aid the development of therapist training to maximize the beneficial impact of this critical stage in therapy. Ultimately, effective initial treatment sessions might not only benefit patients, but might also aid service providers, when these early outcomes translate into lower non-attendance or drop-out rates in clinical services. Similarly, the very brief 2+1 therapies are likely to harness the effects of elapsed time within the service context and may thus be both cost effective and clinically effective. Service administrators may view single session therapy as a less risky and more long term cost-effective alternative to lengthy waitlists and may argue that one session of therapy may be all that many patients need (Boyhan, 1996; Talmon, 1990). Therefore, the application of these very brief interventions in clinical services also raises ethical concerns that decisions to limit the number of sessions available to patients may be based on budgetary constraints rather than clinical judgements (Campbell, 2012; Hurn, 2005).

Recent research has revealed that the Visual Aesthetic Sensitivity Test (VAST) has several psychometric problems; these authors introduce a new conception of visual aesthetic sensitivity

A new conception of visual aesthetic sensitivity. Guido Corradi  Erick G. Chuquichambi  Juan Ramón Barrada  Ana Clemente  Marcos Nadal. British Journal of Psychology, October 6 2019.

Abstract: Aesthetic sensitivity has been defined as the ability to recognize and appreciate beauty and compositional excellence, and to judge artistic merit according to standards of aesthetic value. The Visual Aesthetic Sensitivity Test (VAST) has often been used to assess this ability, but recent research has revealed it has several psychometric problems. Such problems are not easily remedied, because they reflect flawed assumptions inherent to the concept of aesthetic sensitivity as traditionally understood, and to the VAST itself. We introduce a new conception of aesthetic sensitivity defined as the extent to which someone's aesthetic valuation is influenced by a given feature. Experiment 1 aimed to characterize aesthetic sensitivity to four prominent features in visual aesthetics: complexity, symmetry, contour, and balance. Experiment 2 aimed to replicate the findings of Experiment 1 and to assess the test–retest reliability of an instrument designed to measure aesthetic sensitivity to these features using an abridged set of stimuli. Our results reveal that people differ remarkably in the extent to which visual features influence their liking, highlighting the crucial role of individual variation when modelling aesthetic preferences. We did not find clear relations between the four measures of aesthetic sensitivity and personality, intelligence, and art interest and knowledge. Finally, our measurement instrument exhibited an adequate‐to‐good test–retest reliability.

We should not assume that women equally pursue orgasm in their sexual encounters, and that this important individual difference can help explain differences in orgasm occurrence between women

The role of women's orgasm goal pursuit in women's orgasm occurrence. Staci Gusakova et al. Personality and Individual Differences, November 8 2019, 109628.

Abstract: Heterosexual women's low orgasm rates are widely acknowledged within sexuality research. However, researchers have not accounted for whether women are even pursuing orgasm (actively and purposefully attempting to orgasm) in their sexual encounters with men. Given that heterosexual sexual scripts often deprioritize women's pleasure, women may vary in their orgasm goal pursuit – whether they set orgasm as a goal and strive to have an orgasm – in any given sexual encounter, with some women being less likely to pursue orgasm than others. Across two studies, we investigated the association between women's orgasm goal pursuit and orgasm occurrence. By examining the variations in women's orgasm goal pursuit, we aimed to explain why some women orgasm in their sexual encounters and other women do not. Women who reported greater orgasm pursuit were more likely to report that they orgasmed in their most recent sexual encounter. These findings suggest that researchers should not assume that women equally pursue orgasm in their sexual encounters, and that this important individual difference can help explain differences in orgasm occurrence between women.

Keywords: OrgasmOrgasm gapWomen's sexualityOrgasm goal pursuitSexual scripts

Women who have sex with men (WSM) report that they frequently do not have orgasms in their partnered sexual encounters (Frederick, John, Kate, Garcia, & Lloyd, 2018; Richters, DeVisser, Rissel, & Smith, 2006). In two national samples of U.S. adults, researchers found that only 65% of heterosexual women reported that theyusually or always orgasm during heterosexual sexual encounters (Fredericketal.,2018) and only 69% of women reported that they orgasmed in their most recent sexual encounter with a man (Richters et al., 2006).Thepatterns for bisexual women's orgasm rates are similar, with only 66% of bisexual women reporting that they usually or always orgasm during their sexual encounters with men (Frederick et al., 2018). Moreover, research has found that, compared to women who have sex with women, WSM are less likely to orgasm across various sexual activities (including clitoral manipulation by self and by partnerandoralsexbut not during vaginal intercourse); however, these results were not examined based on participants’ self-reported sexual orientations (Blair, Cappell & Pukall, 2018). In contrast to the orgasm rates for heterosexual and bisexual women, 95% of heterosexual men and 88% of bisexual men reported that they usually or always orgasm during sexual encounters (Frederick et al., 2018) and 95% of heterosexual men orgasmed in their most recent sexual encounter with a woman (Richters etal.,2006). The low frequency of orgasm in women has led some researchers to draw conclusions about women's anatomy, biology and health, with the implication that women's bodies are simply not designed to have orgasms at the same frequency as men (Brody & Costa, 2017; Emhardt, Siegel & Hoffman, 2016). Likewise, the findings about WSM's low orgasm rates have created the assumption that the problem of low orgasm frequency lies in women themselves because they are difficult to please, their bodies are difficult to navigate, their biology is to blame(Bell& McClelland, 2018; Butler, 2013; Matsick, Conley & Moors, 2016; Nicolson & Burr, 2003). Thus, WSM often end up internalizing beliefs that they are sexually dysfunctional (at least vis-a-vismen),particularly if they do not orgasm during penile-vaginal intercourse. These instances of self-blame most likely occur because women compare themselves against their perception that “normal” women should be capable of orgasming (Nicolson & Burr,2003). Given these messages about women's orgasmic abilities, it is conceivable that WSM end up with differing levels of investment in and desire to pursue orgasm.Although some women do not considerorgasm to be essential to their sexual satisfaction (McClelland, 2014), many women still consider orgasm to be important with research showing that approximately 80% of the women surveyed considered orgasm to be rather important or very important (Kontula & Miettinen, 2016). Moreover, the women who considered orgasm to be important were more likelyto orgasm compared to womenwho reported orgasm was not important to them (Kontula & Miettinen, 2016). However, it remains unclear why ascribing importance to orgasm is associated with orgasms occurring and what mechanisms may be behind this association. For example, although the types and variety of sexual acts that women engage in influence whether they orgasm (Frederick et al., 2018; Fugl-Meyer, Öberg, Lundberg, Lewin & Fugl-Meyer, 2006;  Herbenick et al., 2010), no research to our knowledge has explored whether women are engaging in specific sexual acts or in a greater variety of sexual activities with the goal of pursuing orgasm. In the present research we pose the question: do WSM work to make orgasm possible? If orgasm is something some WSM consider important, do they then pursue orgasm, thereby acting in accordance with their belief that orgasm is important? To answer this question, we integrate research on goal pursuit to offer the conceptual framework of orgasm goal pursuit. Orgasm goal pursuit is defined as the setting and striving towards having an orgasm in a given sexual encounter. In examining WSM's orgasm goal pursuit, we measure whether they are purposefully acting in ways that they believe will result in orgasm for them. In the present study, we examined the association between orgasm goal pursuit and orgasm occurrence in WSM's most recent sexual encounters. Our goal was not to explainhow or why WSM pursue orgasm, but whether they pursueit–that is, whether they engagedinany actions for the purpose of improvingtheir chances of orgasm. 'We expected orgasm goal pursuit would explain WSM' slow rates of orgasm: women who are not pursuing orgasm–perhaps because they do not feel entitled to pursueit–are almost certainlyless likely to orgasm. In this research, we predicted that orgasm goal pursuit maybe an individual difference among women that can explain why some WSM orgasm in theirsexual encounters and others do not.

Given the societal importance placed on orgasm as a proxy for healthy and pleasurable sex, we extended research to address how women differ in the extent to which they perceive orgasmas important and the degree towhich theypursueorgasm.We foundthat women's endorsement of orgasm goal pursuit predicted whether a woman orgasmed in her most recent encounter. These findings suggest that orgasm is not simply something that happens to women but, instead, women can have different intentions for their sexual experiences with some women more actively pursue orgasm than others. We suggest that future researchers consider orgasm goal pursuit as a critical individual difference when trying to understand assumptions about women's orgasmic capabilities and the orgasm gap between WSM and men who have sex with women.

Overlooked reproductive function of the clitoris: It has both procreative (reproductive) and recreative (pleasure) functions of equal importance, contrary to mainstream opinion until recently

The Clitoris—An Appraisal of its Reproductive Function During the Fertile Years: Why Was It, and Still Is, Overlooked in Accounts of Female Sexual Arousal. Roy J. Levin. Clinical Anatomy, November 5 2019.

Abstract: Stimulating the clitoris activates the brain to instigate changes in the female genital tract, namely, the enhancement of vaginal blood flow that increases vaginal luminal pO2, vaginal transudate (lubrication) facilitating painless penile penetration and partial neutralization of the basal luminal acidic pH, vaginal tenting, and ballooning delaying sperm transport and allowing semen de‐coagulation and capacitation (sperm activation) factors to act until arousal ends (often by orgasm induction). All these genital changes taken together are of major importance in facilitating the possibility of reproductive success (and thus gene propagation) no matter how or when the clitoris is stimulated—they reveal its overlooked reproductive function. Of course, also commensurate with these changes, is its activation of sexual pleasure. The clitoris thus has both procreative (reproductive) and recreative (pleasure) functions of equal importance. Clitoridectomy creates not only sexual disability but also a reproductive disability.

Freud (1905) stated that the function of the clitoris was “namely, of transmitting the excitation of the adjacent female sexual parts, just as—to use a simile—pine shavings can be kindled in order to get a log of harder wood on fire.” His main bias against the clitoris was because it facilitated sexual arousal far too easily in the early formative female years and that for so‐called sexual maturity or full femininity to occur it had to be replaced by penile‐vaginal dominated sexual arousal, namely, “The elimination of clitoral sexuality is a necessary precondition for the development of femininity.” Remarkably, similar concepts are still promoted by a few contemporary neo‐Freudians whose simplistic concept of women's orgasmic sexuality is that it has but three stages of development, namely, clitoral orgasm is best an intermediate state between global anorgasmia and being fully vaginally orgasmic (Brody, 2007). An even more draconian claim by Brody (2010) is that using clitoral stimulation for sexual arousal, because it avoids the possible gene‐propagating features of PVI, is “punished” by evolution resulting in “noxious consequences” (see Levin, 2014, 2018 for full discussion). This is a misrepresentation of evolution as a “judging mechanism,” as Kauth (2006) pointed out “Nature is not moral and takes no position on what ‘ought’ to be.” Costa and Brody (2014) speculated further that “vaginal orgasm evolved to promote PVI and consequent gene transmission in the situations of better fitness potential” but they completely overlooked the pre‐orgasmic “better fitness potential” created in the female reproductive tract for facilitating sperm fertilizing potential induced by clitoral stimulation per se despite the fact that all the changes were well documented in the current literature.

In relation to Freud (1915), during the time that he practiced, the detailed physiological responses of the female genital tract to sexual arousal were not yet identified and described. It would also be some 36 years later before the details of sperm capacitation, independently discovered by Austin (1951) and Chang (1951), the process essential to their becoming fertile, and some 60 years later when Masters and Johnson (1966) described the changes in the female genital tract activated during sexual arousal. As these are now current and scientifically accepted, Freud's proposal can be reassessed in light of these essential reproductive mechanisms. Namely, the reproductive task of the clitoris is to activate the brain to induce the combination of changes needed in the female genital tract to ensure with pleasure that if, in any ensuing following sexual scenario, coitus with semen ejaculation occurs into the vagina, then the best possible conditions are created for it to achieve reproductive success and thus maintain reproductive fitness. In terms that evolutionists employ, this reproductive function of the clitoris is its “proximate” function with regards to facilitating “ultimate” reproductive success in the female's fertile years. While challenging major belief and values may prove to be difficult for some, the reappraisal of the functions of the clitoris as both reproductive as well as recreative are of equal importance is clearly now unavoidable.

Data from China: When parents leave behind the children to work afar there is a significant negative effect on children’s non-cognitive development

Parental Migration, Investment in Children, and Children’s Non-cognitive Development: Evidence from Rural China. Hanchen Jiang and Xi Yang.

Abstract: Many children worldwide are left behind by parents who are migrating for work. While previous literature has studied the effect of parental migration on children’s educational outcomes and cognitive achievements, this study focuses on how parental migration affects children’s non-cognitive development. We use longitudinal data of children in rural China and adopt labor market conditions in destination provinces as instrumental variables for parental endogenous migration choice. We find that parental migration has a significant negative effect on children’s non-cognitive development. Differentiating inter- and intra-provincial migrations suggests that the negative effect of parental migration is mainly driven by inter-provincial migrations. We test four different mechanisms of how parental migration affects child development including parental financial inputs, parental time inputs, household bargaining, and children’s own time input. Our results provide insights into the relative importance of different mechanisms in determining the effect of parental migration on children’s non-cognitive skill formation.

Keywords: Left-behind Children, Parental Migration, Parental Input, Non-cognitive
Development, China
JEL Classification: J12, J13, J24, J61, R23

Full text, notes, references in the link above. Excerpts follow.

6.5 Parenting Style and Parental Health

In addition to the mechanisms we have tested so far, the literature has emphasized other
important determinants of child development. One is parenting style (Dooley and Stewart,
2007; Fiorini and Keane, 2014; Doepke and Zilibotti, 2017). Although there are no consistent
measurements of parental style so far, the few papers that considered these kinds of variables
commonly find that parenting style has an impact on child developmental outcomes. For
example, Dooley and Stewart (2007) find that different aspects of parenting (positiveness,
hostility, consistency, and punitiveness) are more important than family income in terms of
determining children’s behavior and emotional outcomes. Fiorini and Keane (2014) find that
parental warmth and effective discipline lead to better non-cognitive outcomes for children.
More recently, Doepke and Zilibotti (2017) develops a theory to explain how parenting style
plays an important role in determining children’s welfare and economic success. Parenting
style can be an important channel through which parental migration affects child develop
ment. The GSCS provides limited information on parenting style. Nevertheless, we define
harsh parenting style by the mother’s and child’s answer to the question “whether you beat
your child/you are beaten when misbehaved.” Using the baseline fixed effects model with
instrumental variables, our results in Appendix Table A7 show that the effect of the father’s
migration on parenting style is insignificant. These results, however, do not imply that par
enting style is not important in terms of explaining the link between a father’s migration
and his children’s development outcomes. Future work needs to measure parenting styles in
a more comprehensive way to better test this mechanism.

The other determinant that was mentioned in the literature is parent’s health condition,
which may have an impact on the quality of time parents spend with their children. For
example, Ronda (2016) and Herbst (2017) find that maternal psychological distress and de
pression may have a negative impact on children’s outcomes. In the meantime, the migration
literature has provided some evidence that migration increases the probability of being in
poor physical and mental health (Antman, 2010; Barrett and Mosca, 2013). To test this
mechanism, we investigate whether the father’s migration has an impact on the self-assessed
health status of the father and mother.41 Appendix Table A7 provides the estimation re
sults, showing that the father’s migration does not increase the probability of parents in
poor health condition. However, we are reluctant to conclude that parent health status
is not an important mechanism behind the link between parental migration and a child’s
development, considering that our measure of health status is self-reported and does not
differentiate between mental health and physical health. This is a mechanism worth testing
in the future. 42

7 Discussion of Sub-sample Results

Table 15 reports the sub-sample estimation results and highlights some interesting patterns.43
First, columns (1) and (2) show that the effects of father’s migration are larger among male
children (-0.057 and -0.028) than those for female children (-0.065 and -0.047). We hypoth
esize that there are several explanations for this gender difference. First, the left-behind
mother communicates better with girls while having difficulty dealing with teen boys. Sec
ond, lacking a positive male role model has a negative impact on a boy’s development. Thus,
maternal input could be a poorer substitute for the lack of paternal inputs when it comes to
raising a boy. Third, as proposed in Bertrand and Pan (2013), the non-cognitive development
of boys, unlike that of girls, appears extremely responsive to the quality of parental inputs,
which is negatively associated with parental migration.44 Nonetheless, we are not intending
to decompose these different channels, and we leave it for future studies. This kind of gender
difference has also been documented in recent child development literature, which finds that
father absence, usually caused by divorce, has a greater influence on boys than girls. For
example, Bertrand and Pan (2013) find that boys do especially poorly and are much more
likely to develop behavior problems in broken families, which are usually associated with
worse parental inputs. Figlio et al. (2019) find that family disadvantage disproportionately
impedes the development of boys by using birth certificates matched to schooling records in

Columns (3)-(6) divide the sample children by their parents’ education levels. We find
that the negative effect of the father’s migration is more evident if parents, especially mothers,
are less educated. For example, if the mother has not graduated from elementary school,
then the father’s migration reduces internalizing and externalizing scores by 0.036 and 0.071
points. But if the mother has graduated from elementary school, the two coefficients are
reduced to 0.025 and 0.05. These results suggest that mothers with better education are
more likely to engage in high-quality parenting and can better mitigate the adverse effect
caused by the father’s absence (Carneiro et al., 2013).

Moreover, as previously discussed, lack of time inputs seems to be the major mechanism
through which the father’s migration affects his children’s development. In that sense, it is
possible that better infrastructure, such as having access to a telephone service, may help
left-behind children connect and communicate with their fathers. In columns (7) and (8)
of Table 15, we divide our sample children by whether their resident village has telephone
services, but the negative effect of father’s migration does not vary much across the two
groups. This may be because telephone communication is not a good substitute for face-to
face communication in terms of parenting or because the telephone is not widely used among
migrant families to maintain effective communication between the migrant father and his
children left behind.

8 Conclusion
This paper sets out to identify the effects of a father’s migration on his children’s non
cognitive development. By exploiting a longitudinal data set and using instrumental variables
based on the destination provinces, we identify a negative effect of a father’s migration.
We explore several possible mechanisms behind this negative effect. First, we find that a
fathers’ migration is associated with an increase in family income, which, however, does
not lead to an increase in child-related spending. In the meanwhile, our results show that
a fathers migration increases his decision power on financial allocation within the family,
which provides a potential explanation of the observed divergence in family income and
spending. More important, a father’s migration reduces the time both parents spend talking
and playing with their children. Overall, the father’s migration reduces both parent financial
and time inputs, which might be the two major driving forces behind the negative effect of
a father’s migration on left-behind children.

These results expand the scope of current literature by uncovering negative consequences
of parental migration that is rarely studied in the literature. More important, our discussion
on potential mechanisms suggest that relevant policies are urgently needed to help migrant
parents improve their financial and time inputs on children. Considering that non-cognitive
skill is a vital dimension of human capital, these policies would have an important impact
on increasing inter-generational mobility and on reducing rural-urban inequality.

Saturday, November 9, 2019

Oct 2019: India is trying to build the world's biggest facial recognition system

India is trying to build the world's biggest facial recognition system. Julie Zaugg. CNN Business, October 18, 2019.


In July, Bhuwan Ribhu received some very good news.

The child labor activist, who works for Indian NGO Bachpan Bachao Andolan, had launched a pilot program 15 months prior to match a police database containing photos of all of India's missing children with another one comprising shots of all the minors living in the country's child care institutions.

He had just found out the results. "We were able to match 10,561 missing children with those living in institutions," he told CNN. "They are currently in the process of being reunited with their families." Most of them were victims of trafficking, forced to work in the fields, in garment factories or in brothels, according to Ribhu.

This momentous undertaking was made possible by facial recognition technology provided by New Delhi's police. "There are over 300,000 missing children in India and over 100,000 living in institutions," he explained. "We couldn't possibly have matched them all manually."

Locating thousands of missing children is just one of the challenges faced by India's overstretched police force in a nation of 1.37 billion people.


[India's federal] government now has a much more ambitious plan. It wants to construct one of the world's largest facial recognition systems. The project envisions a future in which police from across the country's 29 states and seven union territories would have access to a single, centralized database.

The potential role of illness expectations in the progression of medical diseases

The potential role of illness expectations in the progression of medical diseases. Francesco Pagnini. BMC Psychology, volume 7, Article number: 70 (2019). Nov 8 2019.

To what extent can one’s mind promote direct changes to the body? Can one’s beliefs about the body become a physical reality, without mediating effects from behaviors? Specifically, can medical symptoms and the course of a disease be directly affected by a person’s mindset about the illness?
There is a vast literature about placebo and nocebo effects, that promote physical changes by creating the expectation of a change through a primer (for example, a fake pill). Placebos, however, often imply deception, or at least ambiguity, to be effective. The concept of Illness Expectation describes the expectations, both implicit and explicit, that a person who has received a diagnosis makes about the course of the disease. It can be characterized by different degrees of rigidity, and it is argued here that these expectations can ultimately lead to changes in the disease progression. These changes may happen through behavior modifications, or through a non-behavioral pathway, which may deserve exploration efforts from the scientific literature.

Effects of expectations on the body

One of the main operational mechanisms of placebos is represented by cognitive expectations, which in turn are expected to promote the occurrence of physiological changes in the body [11]. In general, placebo and nocebo effects have been studied with a primer, such as a sugar pill, that influences or conditions the person to anticipate an effect. The expectation of a medical effect promotes both subjective and objective (physiologic) changes, with clinical improvements or worsening [12]. However, expectations are not only prompted by drugs or interventions. In fact, every individual with a medical condition develops a certain mindset toward the illness [13], with expectations that spontaneously emerge. These expectations, which represent the result of the elaboration process of the information collected about the disease [14], can promote different physiological effects [15]. For example, blood glucose levels in people with type II diabetes are influence by perceived time and expected values, rather than being a mere physiological process [16]. Furthermore, expectations can influence the ageing process: older adults who think about ageing as associated with negative characteristics tend to experience a greater loss of physical function and a reduced survival, compared to those who held positive expectations [17].

Illness perceptions and health beliefs

Expectations about the disease are a central component of illness perceptions and health beliefs, which are well-established concepts in health psychology [18]. Illness Perception is often explored within the theoretical framework of the Common Sense Model (CSM) of Illness Representation [19]. In the CSM theory, patient’s illness perceptions include beliefs about what precipitated the illness (causes), how long it will last (timeline), the impact on the patient’s life (consequences), which symptoms are attributed to the illness (identity), and how the condition can be controlled or cured by the patient’s behavior (personal control) or by the treatment (treatment control). In the CSM, expectations are considered as an underlying component of the different beliefs [20, 21]. Emotional components are another key aspect of the CSM, which may interfere with cognitive processing, and it could be a source of confusion during the assessment process. For example, one of the most utilized instruments for the assessment of illness perception, the Brief Illness Perception Questionnaire [22] includes items like “How much does your illness affect you emotionally?”, which are somehow related to the expectations, but refer directly to the emotional domain. The same concern deals with questions about consequences in everyday life (e.g., “My illness has serious economic and financial consequences”, from the Illness Perception Questionnaire Revised [23]).

Thus far, most published research referencing the Illness Perception construct focuses on the role of disease representations in explaining both coping and outcomes in patients with a wide range of health conditions [24, 25]. Specifically, health psychologists have explored how disease representations can lead to lifestyle modifications, eventually leading to changes in the medical outcomes [26]. For example, adherence to the medical treatment, or lifestyle choices like eating, exercising, or smoking, can be influenced by illness representations. A person who perceives that nothing can change the course of the disease, for example, may be more prone to avoid exercising or taking prescribed medicine [27]. In other words, the effects of Illness Perceptions on the body (namely, on the course of the disease or its symptoms) have been mainly explored as mediated by behavior changes [28]. The main difference between the construct of Illness Perception and Illness Expectation is their specificity: while the former is a multifaceted concept that includes several aspects of the illness experience, the latter is a specific element, the anticipation of the future illness-related scenarios, which is merely cognitive.

Emotions and somatic changes

[...] Briefly, we know that negative emotions (e.g., depression, stress) have, among other effects, a strong impact on human physiology [29], often reflecting on poorer medical outcomes, in the case of chronic diseases. For example, depressive states and stress have been associated with reduced survival rate in patients with cancer [30]. The mechanisms underlying these associations are still under investigation.

[Full free text in the link above]