Excessive Avoidance Research Articles

From anxious youth to depressed adolescents: Prospective prediction of 2-year depression symptoms via attentional bias measures.

Anxious youth are at heightened risk for subsequent development of depression; however, little is known regarding which anxious youth are at the highest prospective risk. Biased attentional patterns (e.g., vigilance and avoidance of negative cues) are implicated as key mechanisms in both anxiety and depression. Aberrant attentional patterns may disrupt opportunities to effectively engage with, and learn from, threatening aspects of the environment during development and/or treatment, compounding risk over time. Sixty-seven anxious youth (ages 9-14; 36 female) completed a dot-probe task to assess baseline attentional patterns provoked by fearful-neutral face pairs. The time course of attentional patterns both during and after threat was assessed via eye-tracking and pupilometry. Self-reported depressive and anxiety symptoms were assessed 2 years after the conclusion of a larger psychotherapy treatment trial. Eye-tracking patterns indicating threat avoidance predicted greater 2-year depression scores, over and above baseline and posttreatment symptoms. Sustained, postthreat pupillary avoidance (reflecting preferential neural engagement with the neutral relative to the previously threatening location) predicted additional variance in depression scores, suggesting sustained avoidance in the wake of threat further exacerbated risk. Identical eye-tracking and pupil indices were not predictive of anxiety at 2 years. These biobehavioral markers imply that avoidant attentional processing in the context of anxiety may be a gateway to depression across a key maturational window. Excessive avoidance of threat could interfere with acquisition of adaptive emotion regulation skills during development, culminating in the broad behavioral deactivation that typifies depression. Prevention efforts explicitly targeting avoidant attentional patterns may be warranted.

Optimal perioperative fluid management: What is the strategy?

Fluid therapy is a core concept in the management of perioperative patients for maintenance of intravascular volume and organ perfusion. The aim of perioperative fluid therapy is to keep patients at all times in the optimal volume loading, due to both hypovolemia and volume overload may cause organ dysfunction. Intravenous fluid is a drug and because of that, timing and dose is important. 'Liberal' or 'restrictive' strategies and crystalloid or colloid solutions are the unsolved controversies. The term 'restriction' is commonly interpreted to imply hypovolemia, whereas it may simply represent avoidance of the fluid excess seen in the 'liberal' group. The aim of goal-directed fluid therapy is to guide fluid and pharmacological (inotrope) therapy, by using flow-directed hemodynamic parameters, to maintain adequate tissue blood flow, circulating volume, and oxygen delivery. In order to minimize the complications related to fluid administration, preventive strategies and prompt treatments are of utmost importance.

Are Public Commemorations in Contemporary Japan Post-secular?

This paper asks whether public commemorations in contemporary Japan are post-secular or not. More precisely, it investigates the postwar history of the relationship between such commemorations and the principle of keeping religion and government separate, as embodied in the constitution. Referring to several contemporary cases, I provide an overview of the discourses and actual conditions of the separation of religion and state at Chidorigafuchi National Cemetery (Chidorigafuchi Kokuritsu Senbotsusha Boen 千鳥ヶ淵国立戦没者墓苑) and Yasukuni Shrine (Yasukuni Jinja 靖国神社). In conclusion, I point out on one hand that the non-denominational expressions seen in Chidorigafuchi and other facilities show a distinctive kind of religious expression. On the other hand, I underscore that the excessive avoidance of religious participation by government officials derives from the Yasukuni issue and related legal trials. I explain the relationship of those phenomena in terms of two types of secularization: natural secularization and artificial secularization.

Pulgas, leones y otros monstruos de la imprenta ilustrada: de la Poética de Horacio al Tigre de William Blake

La imprenta en el siglo XVIII representa, en libros de zoología, imágenes de animales acompañadas de textos que buscan ser científicos pero que siguen impregnados del discurso prerracionalista; al hacerlo, originan una nueva versión de losmonstruos que poblaron el discurso anterior desde la Antigüedad y la Edad Media hasta la modernidad temprana. Paralelamente, la estética literaria del periodo ensalza la moderación y la mesura y prescribe la evitación del exceso y la discordancia; la reacción romántica a finales del siglo procura rescatar el asombroperdido ante los animales.

Generalization of socially transmitted and instructed avoidance.

Excessive avoidance behavior, in which an instrumental action prevents an upcoming aversive event, is a defining feature of anxiety disorders. Left unchecked, both fear and avoidance of potentially threatening stimuli may generalize to perceptually related stimuli and situations. The behavioral consequences of generalization mean that aversive learning experiences with specific threats may lead to the inference that classes of related stimuli are threatening, potentially dangerous, and need to be avoided, despite differences in physical form. Little is known however about avoidance generalization in humans and the learning pathways by which it may be transmitted. In the present study, we compared two pathways to avoidance—instructions and social observation—on subsequent generalization of avoidance behavior, fear expectancy and physiological arousal. Participants first learned that one cue was a danger cue (conditioned stimulus, CS+) and another was a safety cue (CS−). Groups were then either instructed that a simple avoidance response in the presence of the CS+ cancelled upcoming shock (instructed-learning group) or observed a short movie showing a demonstrator performing the avoidance response to prevent shock (observational-learning group). During generalization testing, danger and safety cues were presented along with generalization stimuli that parametrically varied in perceptual similarity to the CS+. Reinstatement of fear and avoidance was also tested. Findings demonstrate, for the first time, generalization of socially transmitted and instructed avoidance: both groups showed comparable generalization gradients in fear expectancy, avoidance behavior and arousal. Return of fear was evident, suggesting that generalized avoidance remains persistent following extinction testing. The utility of the present paradigm for research on avoidance generalization is discussed.

"Corporate Social Responsibility, Risk Taking, and Firm Value"

We hypothesize that CSR serves as a control mechanism to curb excessive risk taking and to reduce excessive risk avoidance. Firms with CSR focus must balance the interests of multiple stakeholders,...

State-of-the-art fluid management in the operating room.

The underlying principles guiding fluid management in any setting are very simple: maintain central euvolemia, and avoid salt and water excess. However, these principles are frequently easier to state than to achieve. Evidence from recent literature suggests that avoidance of fluid excess is important, with excessive crystalloid use leading to perioperative weight gain and an increase in complications. A zero-balance approach aimed at avoiding fluid excess is recommended for all patients. For major surgery, there is a sizeable body of evidence that an individualized goal-directed fluid therapy (GDFT) improves outcomes. However, within an Enhanced Recovery program only a few studies have been published, yet so far GDFT has not achieved the same benefit. Balanced crystalloids are recommended for most patients. The use of colloids remains controversial; however, current evidence suggests they can be beneficial in intraoperative patients with objective evidence of hypovolemia.

Direct perception biases with maritime navigation displays of collision risk

Maritime navigation systems need to assist judgments about safe separations and avoidance manoeuvres. Collision Danger Sectors (CDS) are a proposed visualisation for radar displays intended to support the direct perception of impending traffic separation violations. We report an evaluation of the CDS display format in a laboratory study of navigation decision-making involving judgments of safe separations. Contrary to prediction, the CDS display did not bias decision making towards neglecting rules about track crossing. The CDS display did encourage excessive avoidance manoeuvres at higher angles of approach. A marked increase in response time with angle of approach was also evident, indicating a need for decision-aiding.

Enhanced Avoidance Habits in Obsessive-Compulsive Disorder

BackgroundObsessive-compulsive disorder (OCD) is a psychiatric condition that typically manifests in compulsive urges to perform irrational or excessive avoidance behaviors. A recent account has suggested that compulsivity in OCD might arise from excessive stimulus-response habit formation, rendering behavior insensitive to goal value. We tested if OCD patients have a bias toward habits using a novel shock avoidance task. To explore how habits, as a putative model of compulsivity, might relate to obsessions and anxiety, we recorded measures of contingency knowledge, explicit fear, and physiological arousal.MethodsTwenty-five OCD patients and 25 control subjects completed a shock avoidance task designed to induce habits through overtraining, which were identified using goal-devaluation. The relationship between habitual behavior, erroneous cognitions, and physiological arousal was assessed using behavior, questionnaires, subjective report, and skin conductance responses.ResultsA devaluation sensitivity test revealed that both groups could inhibit unnecessary behavioral responses before overtraining. Following overtraining, OCD patients showed greater avoidance habits than control subjects. Groups did not differ in conditioned arousal (skin conductance responses) at any stage. Additionally, groups did not differ in contingency knowledge or explicit ratings of shock expectancy following the habit test. Habit responses were associated with a subjective urge to respond.ConclusionsThese data indicate that OCD patients have a tendency to develop excessive avoidance habits, providing support for a habit account of OCD. Future research is needed to fully characterize the causal role of physiological arousal and explicit fear in habit formation in OCD.

Grief and mourning gone awry: pathway and course of complicated grief

Complicated grief is a recently recognized condition that occurs in about 7% of bereaved people. People with this condition are caught up in rumination about the circumstances of the death, worry about its consequences, or excessive avoidance of reminders of the loss. Unable to comprehend the finality and consequences of the loss, they resort to excessive avoidance of reminders of the loss as they are tossed helplessly on waves of intense emotion. People with complicated grief need help, and clinicians need to know how to recognize the symptoms and how to provide help. This paper provides a framework to help clinicans understand bereavement, grief, and mourning. Evidence-based diagnostic criteria are provided to help clinicians recognize complicated grief, and differentiate it from depression as well as anxiety disorder. We provide an overview of risk factors and basic assumptions and principles that can guide treatment.

Monogamous order and the avoidance of chaotic excess

In Western culture, sexual fidelity is widely regarded as a prime source of relationship stability and personal happiness and thus a worthy practice. This article is an empirical and critical account of monogamous coupledom as a privileged relational experience. Data are drawn from 14 in-depth interviews with Australian men and women who self-identified their cross- or same-sex partnerships as sexually and emotionally monogamous. Monogamy, as participants construct it, is critiqued as an action and policy that produces an exclusive and contained essence of relationships and that guards against a perceived chaotic excess that is set-up in opposition to it. Such action is seen to impel a sense of mastery in relationships and selves that are properly enclosed, channelled and thereby ordered. The sociohistoric binary arrangement of an ordered inside and chaotic outside is focused on as enabling a superior monogamous order while also underpinning its precariousness and psychological frailty. Drawing on Deleuzian ideas about a non-privileged and non-hierarchical system of relating, an alternative way of intimately connecting with others is brought into theoretical view, one that does not favour contained and fixed essences as foundations for relationships, intimate connections and life.

Continuity control method of cutter posture vector for efficient five-axis machining

During five-axis machining of impeller, the excessive local interference avoidance leads to inconsistency of cutter posture, low quality of machined surface and increase of processing time. Therefore, in order to improve the efficiency of five-axis machining of impellers, it is necessary to minimize the cutter posture changes and create a continuous tool path while avoiding interference. By using an MC-space algorithm for interference avoidance, an MB-spline algorithm for continuous control was intended to create a five-axis machining tool path with excellent surface quality and economic feasibility. A five-axis cutting experiment was performed to verify the effectiveness of the continuity control. The result shows that the surface shape with continuous method is greatly improved, and the surface roughness is generally favorable. Consequently, the effectiveness of the suggested method is verified by identifying the improvement of efficiency of five-axis machining of an impeller in aspects of surface quality and machining time.

A Continuous Control of Cutter Posture Change for Efficient 5-Axis Machining of Impeller

In 5-Axis Machining of impellers, interference problems with tool and neighboring surfaces often take place due to the narrow and deep gap between blades, so the problem of avoiding interference is very important. Also, because the efficiency of turbo machines can be maximized only when fluids smoothly flow due to the characteristics of the impeller, high quality of the machined surface is required. During 5-Axis machining of these impellers, the excessive local interference avoidance, necessary to avoid interference, leads to inconsistency of cutter posture, low quality of machined surface and increase of processing time. Therefore, in order to increase the efficiency of 5-Axis Machining of impellers, it is necessary to minimize the cutter posture changes and create a continuous tool path while avoiding interference. This study, by using an MC-space algorithm for interference avoidance and an MB-spline algorithm for continuous control, is intended to create a 5-Axis machining tool path with excellent surface quality and economic feasibility; finally, this study will verify the effectiveness of the suggested method through verification processing.

Bereavement, Complicated Grief, and DSM, Part 2: Complicated Grief

The Case of Ms B Ms B is a 65-year-old woman who comes for an evaluation because she isn’t getting past her intense grief over her deceased husband, who died of a myocardial infarction 4 years ago. Ms B is tearful, recalling how wonderful her husband was, that he was her soulmate, and that he loved her in a way no one else ever did. Although she thinks about her husband daily, she avoids looking at pictures, visiting the gravesite, or even going to places they used to enjoy together to try to ward off the intense bouts of misery these reminders provoke. At times, she seems angry, stating emphatically that he shouldn’t have died. She is plagued by thoughts about the doctors who did not diagnose the impending heart attack. Even though she knows that it is irrational, she can’t get the idea out of her mind that his doctor should have suspected that he had blocked arteries during a routine visit 1 week prior to his death and done something to save him. She often neglects to take her hypertension medication, knowing that this could be dangerous, and agrees that she is leaving life and death to chance. Religion used to be a source of comfort, but she no longer attends church regularly or finds companionship or support from the church community. Ms B maintains that no one can help her because no one can bring her husband back. Many clinicians don’t know quite what to make of Ms B’s continued suffering. Her symptoms clearly reflect grief, yet the excessive avoidance and preoccupation with thoughts that her husband need not have died and the persistence of intense acute grief symptoms over a 4-year period seem atypical. She has some mood symptoms, but does not meet criteria for major depressive disorder (MDD). Her avoidance behaviors and preoccupation with her husband’s death resemble the symptoms of PTSD, but the focus of her thoughts is related to her loss rather than reexperiencing a dangerous event, and she feels sadness rather than fear. She does not meet criteria for posttraumatic stress disorder (PTSD). Her grief symptoms have not changed much since her husband died 4 years ago. She and her family feel she is stuck in her grief. Does she have a definable, serious, treatable disorder? Not according to the DSM-IV-TR.1 The rest of this review will describe the syndrome of complicated grief, a condition that describes Ms B’s state and that also requires a specific, targeted treatment.

Frigidity, Gender and Power in French Cultural History

This paper interrogates the commonplace view of frigidity as a notion always founded upon the misogynist failure to understand female sexual specificity. As an historical explanation, this view fails to take into account the contextual parameters of late nineteenth- and early twentieth-century debates about female desire within which the notion of la femme frigide emerged and developed. This paper discusses the work of a range of French medical and psychoanalytic thinkers across the turn of the twentieth century and through the interwar period, showing how ‘frigidity’ was developed at this time by those who saw themselves precisely as contesting prevailing notions of normative feminine desire, or as defending the rights of women to maximum pleasure. But the inventors of frigidity were no feminist avengers either. Their demands for female pleasure assumed a delicate axis between the avoidance of excess, on the one hand, and the dangers of perversion that would result from any attempt to deny sexuality generally, on the other. Viewed within the context of early twentieth-century French gender anxieties, thinkers like Fauconney and Marie Bonaparte are ambivalent exemplars of the ‘management’ of sexuality referred to by Michel Foucault.

The role of current mood and stop rules on physical task performance: An experimental investigation in patients with work-related upper extremity pain

Patients with work-related upper extremity pain (WRUED) experience disability in daily life activities. The factors that influence levels of disability are still unclear. Both excessive avoidance and persistence have been suggested, but the affective and motivational processes that underlie these behaviours have not been scrutinized. This study was aimed at examining the role of current mood and stop rules on physical task performance, controlling for gender, pain severity, pain catastrophizing, and pain-related fear. An additional focus was the role of the interaction between current mood and stop rules as predicted by the novel Mood-as-Input (MAI) model. Following MAI, it is the informational value of current mood within a goal context (stop rule), rather than mood per se that predicts behaviour. A 2 (mood) × 2 (stop rule) × 2 (physical task order) factorial design was used in which 62 WRUED patients performed an upper and lower extremity physical task. A stress interview was used to induce positive and negative mood. Patients received either an “as-much-as-can (AMAC)” stop rule instruction, or a “feel-like-discontinuing (FLDC)” stop rule instruction. Results showed that physical task performance was predicted by pain-related fear, current mood, stop rule. However, the predicted mood × stop rule interaction was not found, and there was no influence of gender, pain severity, and pain catastrophizing on task performance. The findings suggest that not only pain-related fear, but current mood and goal context factors independently affect physical performance in patients with WRUED.

Postoperative ileus—an update on preventive techniques

This article reviews techniques currently used to prevent or reduce the duration of postoperative ileus (POI), which is considered an undesirable stress response to major abdominal surgery that leads to discomfort, morbidity and prolonged hospital stay. In several randomized studies, a number of techniques have been demonstrated to reduce the occurrence and/or duration of POI: thoracic epidural analgesia with local anesthetics, peripheral opioid antagonists, laxatives, chewing gum, intravenous and incisional local anesthetics, and avoidance of routine nasogastric intubation and fluid excess. Early institution of oral feeding and laparoscopic surgery might also be effective, but there is less clear evidence available to support their use. When some of these techniques are combined as part of the concept of multimodal postoperative rehabilitation (fast-track surgery), the duration of POI after open or laparoscopic abdominal surgery can be reduced to 24-48 h in most patients. There is a need for data on the effect of these techniques on POI when applied to major upper abdominal surgeries and emergency abdominal operations (e.g. trauma, peritonitis, etc.).

Optimizing perioperative management of patients undergoing colorectal surgery: what is new?

This review highlights recent developments in individual perioperative interventions in colorectal surgery, and progress in so-called fast-track or enhanced-recovery programmes. A new survey from five northern European countries has revealed that best clinical practice in perioperative care, based on previously published high-grade evidence, is only partially in use in daily clinical practice. Recently, a number of trials contrasting clinical results in enhanced-recovery protocols versus traditional care clearly show that such protocols indeed enhance recovery, although effects on morbidity are less obvious. Further evidence supporting preoperative oral carbohydrate treatment, avoidance of oral bowel preparation and wound drainage in elective colonic surgery and avoidance of intraoperative fluid excess has emerged. The oral opioid antagonist alvimopan has recently been shown to limit postoperative gastrointestinal paralysis. The role of laparoscopic surgery in the era of enhanced-recovery programmes is unclear. There is strong evidence on how to enhance recovery after colorectal surgery, but many interventions are not utilized in daily practice. Further evidence has emerged supporting several perioperative treatments, and successful experiences of enhanced-recovery programmes have now been reported from several centres.

NATURALISM AND THE TRANSCENDENTAL TURN

AbstractThis paper is to a large extent an exercise in philosophical geography. It traces the way in which a resilient naturalist orientation has derived support, specifically in the analytic tradition, from a central structuring tenet of transcendental idealism. It attempts to bring out the philosophical reasons that drive this Kantian alliance. Attention then turns to the identification of two salient problems that confront this alliance in its most acceptable form. To the extent that a resilient naturalism is desirable, these problems need to be addressed.While the philosophical issue is brought into focus by attending specifically to developments in the analytic tradition, this is primarily a convenience. The preference for a resilient naturalism and the avoidance of metaphysical excess is not by any means confined to that tradition.

Ketotic hypoglycemia in patients with allergic diseases.

Ketotic hypoglycemia is the most common cause of recurrent hypoglycemia in early childhood but its etiology is poorly understood. Elimination diets have been used for the prevention or treatment of some allergic diseases; however, these diets entail a risk to the normal nutrition and growth of children. The present study investigated whether elimination diets are related to the occurrence of ketotic hypoglycemia. The prevalence of allergy treated with elimination diet therapy was retrospectively investigated in 18 patients with ketotic hypoglycemia seen in Yamaguchi University Hospital between January 1995 and September 1999. Data were gathered by reviewing the patients' medical charts. Ten (55.6%) of 18 patients with ketotic hypoglycemia had allergic diseases. Six (60%) of the patients had been treated with strict elimination diets and the others were on incomplete elimination diets for the prevention of allergy. The ketotic hypoglycemia patients with allergic diseases had experienced fewer pre-existing infectious diseases than those without allergic diseases. Patients with allergic diseases treated with elimination diets have a relatively high tendency towards developing ketotic hypoglycemia. They might have a lower capacity to tolerate fasting due to their excessive avoidance of many foods, even during periods when they are not undergoing strict elimination diets.