La thérapie cognitive-comportementale dans le traitement du TDAH chez l'adulte: état des connaissances

Essai doctoral présenté à la Faculté des Arts et des Sciences en vue de l'obtention du grade de doctorat en psychologie clinique (D.psy.)

Le cognitive enhancement en milieu universitaire : entre souffrance psychique individuelle, culture de performance et insécurités sociales

Ce projet de mémoire s’intéresse à la mise en relation du cognitive enhancement observé dans les universités occidentales contemporaines et de la société dans laquelle il s’insère. Nous avons voulu détacher la perspective du phénomène des analyses principalement orientées vers les programmes de sciences de la santé et de droit, ainsi que de l’approche quantitative, clinique, athéorique et somme toute moralisatrice qui lui est usuellement accordée afin d’explorer la nature des pratiques d’usages de psychotropes des étudiants universitaires en sciences humaines et sociales en vue d’augmenter leurs performances cognitives, d’approfondir la compréhension des raisonnements sous-jacents à ces pratiques, puis de resituer ces derniers dans leur contexte élargi. Nous avons interrogé treize étudiants de divers programmes de sciences humaines et sociales consommant, ou ayant déjà consommé, des psychotropes en vue de rehausser leurs performances cognitives en contexte académique. Les résultats suggèrent un écart dans la nature de leurs pratiques d’usage par rapport aux domaines d’études habituellement préconisés en ce sens qu’une grande variété de substances sont considérées comme supports cognitifs ; ensuite, que le recours aux psychotropes dans une visée de performance cognitive s’éloigne des logiques de la nécessité médicale et de la toxicomanie. En premier lieu, le cognitive enhancement est associé par plusieurs à une souffrance psychique liée à une perte de repères existentiels et les étudiants y ont recours dans une optique de compréhension de soi et de quête de repères dans un monde qu’ils ressentent comme instable. En second lieu, la consommation de psychotropes s’apparente davantage à un désir de satisfaire aux conditions incertaines et menaçantes des demandes externes de performance telles qu’ils les appréhendent qu’à un souci de soigner quelque condition médicale de la cognition. Nous pensons que le rapport au psychotrope qu’entretiennent les étudiants universitaires en sciences humaines et sociales s’insère en toute cohérence dans les discours et injonctions contemporaines de performance, en ce sens que leur souffrance psychique individuelle expose les limites de ce que la société attend d’eux.

La thérapie cognitive-comportementale dans le traitement du TDAH chez l'adulte: état des connaissances

Essai doctoral présenté à la Faculté des Arts et des Sciences en vue de l'obtention du grade de doctorat en psychologie clinique (D.psy.)

Vocabulary Learning through Use of the Picture-Word Inductive Model for Young English Learners in China: A Mixed Methods Examination Using Cognitive Load Theory

English has been taught as a core and compulsory subject in China for decades. Recently, the demand for English in China has increased dramatically. China now has the world’s largest English-learning population. The traditional English-teaching method cannot continue to be the only approach because it merely focuses on reading, grammar and translation, which cannot meet English learners and users’ needs (i.e., communicative competence and skills in speaking and writing). This study was conducted to investigate if the Picture-Word Inductive Model (PWIM), a new pedagogical method using pictures and inductive thinking, would benefit English learners in China in terms of potential higher output in speaking and writing. With the gauge of Cognitive Load Theory (CLT), specifically, its redundancy effect, I investigated whether processing words and a picture concurrently would present a cognitive overload for English learners in China. I conducted a mixed methods research study. A quasi-experiment (pretest, intervention for seven weeks, and posttest) was conducted using 234 students in four groups in Lianyungang, China (58 fourth graders and 57 seventh graders as an experimental group with PWIM and 59 fourth graders and 60 seventh graders as a control group with the traditional method). No significant difference in the effects of PWIM was found on vocabulary acquisition based on grade levels. Observations, questionnaires with open-ended questions, and interviews were deployed to answer the three remaining research questions. A few students felt cognitively overloaded when they encountered too many writing samples, too many new words at one time, repeated words, mismatches between words and pictures, and so on. Many students listed and exemplified numerous strengths of PWIM, but a few mentioned weaknesses of PWIM. The students expressed the idea that PWIM had a positive effect on their English teaching. As integrated inferences, qualitative findings were used to explain the quantitative results that there were no significant differences of the effects of the PWIM between the experimental and control groups in both grade levels, from four contextual aspects: time constraints on PWIM implementation, teachers’ resistance, how to use PWIM and PWIM implemented in a classroom over 55 students.

Effects of retirement on cognitive function: A gender and international perspecive

Background: As the global population is ageing, studying cognitive impairments including dementia, one of the leading causes of disability in old age worldwide, is of fundamental importance to public health. As a major transition in older age, a focus on the complex impacts of the duration, timing, and voluntariness of retirement on health is important for policy changes in the future. Longer retirement periods, as well as leaving the workforce early, have been associated with poorer health, including reduced cognitive functioning. These associations are hypothesized to differ based on gender, as well as on pre-retirement educational and occupational experiences, and on post-retirement social factors and health conditions. Methods: A cross-sectional study is conducted to determine the relationship between duration and timing of retirement and cognitive function, using data from the five sites of International Mobility in Aging Study (IMIAS). Cognitive function is assessed using the Leganes Cognitive Test (LCT) scores in 2012. Data are analyzed using multiple linear regressions. Analyses are also done by site/region separately (Canada, Latin America, and Albania). Robustness checks are done with an analysis of cognitive change from 2012 to 2014, the effect of voluntariness of retirement on cognitive function. An instrumental variable (IV) approach is also applied to the cross-sectional and longitudinal analyses as a robustness check to address the potential endogeneity of the retirement variable. Results: Descriptive statistics highlight differences between men and women, as well as between sites. In linear regression analysis, there was no relationship between timing or duration of retirement and cognitive function in 2012, when adjusting for site/region. There was no association between retirement characteristics and cognitive function in site/region/stratified analyses. In IV analysis, longer retirement and on time or late retirement was associated with lower cognitive function among men. In IV analysis, there is no relationship between retirement characteristics and cognitive function among women. Conclusions: While results of the thesis suggest a negative effect of retirement on cognitive function, especially among men, the relationship remains uncertain. A lack of power results in the inability to draw conclusions for site/region-specific analysis and site-adjusted analysis in both linear and IV regressions.

The Concept of Transparency in International Relations: towards a critical approach

Transparency is an important concept in International Relations. The possibility of realizing transparency in practice operates as a central analytical axis defining distinct positions on core theoretical problems within the field, from the security dilemma to the function of international institutions and beyond. As a political practice the pursuit of transparent governance is a dominant feature of global politics, promoted by a wide range of actors across a vast range of issue areas, from nuclear proliferation to Internet governance to the politics of foreign aid. Yet, despite its importance, precisely what transparency means or how the concept is understood is frequently ill-defined by academics and policy-makers alike. As a result, the epistemological and ontological underpinnings of approaches to transparency in IR often sit in tension with their wider theoretical commitments. This article will examine the three primary understandings of transparency used in IR in order to unpack these commitments. It finds that while transparency is often explicitly conceptualized as a property of information, particularly within rationalist scholarship, this understanding rests upon an unarticulated set of sociological assumptions. This analysis suggests that conceptualizing ‘transparency-as-information’ without a wider sociology of knowledge production is highly problematic, potentially obscuring our ability to recognize transparent practices in global governance. Understanding transparency as dialogue, as a social practice rooted in shared cognitive capacities and epistemic frameworks, provides a firmer analytical ground from which to examine transparency in International Relations.

Motivating film title translation: a cognitive análisis

This proposal is a non-quantitative study based on a corpus of real data which offers a principled account of the translation strategies employed in the translation of English film titles into Spanish in terms of cognitive modeling. More specifically, we draw on Ruiz de Mendoza and Galera’s (2014) work on what they term content (or low-level) cognitive operations, based on either ‘stands for’ or ‘identity’ relations, in order to investigate possible motivating factors for translations which abide by oblique procedures, i.e. for non-literal renderings of source titles. The present proposal is made in consonance with recent findings within the framework of Cognitive Linguistics (Samaniego 2007), which evidence that this linguistic approach can fruitfully address some relevant issues in Translation Studies, the most outstanding for our purposes being the exploration of the cognitive operations which account for the use of translation strategies (Rojo and Ibarretxe-Antuñano 2013: 10), mainly expansion and reduction operations, parameterization, echoing, mitigation and comparison by contrast. This fits in nicely with a descriptive approach to translation and particularly with skopos theory, whose main aim consists in achieving functionally adequate renderings of source texts.

Non-pharmacological interventions for cognitive impairment due to systemic cancer treatment (Review)

Background

It is estimated that up to 75% of cancer survivors may experience cognitive impairment as a result of cancer treatment and given the increasing size of the cancer survivor population, the number of affected people is set to rise considerably in coming years. There is a need, therefore, to identify effective, non-pharmacological interventions for maintaining cognitive function or ameliorating cognitive impairment among people with a previous cancer diagnosis.
Objectives

To evaluate the cognitive effects, non-cognitive effects, duration and safety of non-pharmacological interventions among cancer patients targeted at maintaining cognitive function or ameliorating cognitive impairment as a result of cancer or receipt of systemic cancer treatment (i.e. chemotherapy or hormonal therapies in isolation or combination with other treatments).
Search methods

We searched the Cochrane Centre Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PUBMED, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PsycINFO databases. We also searched registries of ongoing trials and grey literature including theses, dissertations and conference proceedings. Searches were conducted for articles published from 1980 to 29 September 2015.
Selection criteria

Randomised controlled trials (RCTs) of non-pharmacological interventions to improve cognitive impairment or to maintain cognitive functioning among survivors of adult-onset cancers who have completed systemic cancer therapy (in isolation or combination with other treatments) were eligible. Studies among individuals continuing to receive hormonal therapy were included. We excluded interventions targeted at cancer survivors with central nervous system (CNS) tumours or metastases, non-melanoma skin cancer or those who had received cranial radiation or, were from nursing or care home settings. Language restrictions were not applied.
Data collection and analysis

Author pairs independently screened, selected, extracted data and rated the risk of bias of studies. We were unable to conduct planned meta-analyses due to heterogeneity in the type of interventions and outcomes, with the exception of compensatory strategy training interventions for which we pooled data for mental and physical well-being outcomes. We report a narrative synthesis of intervention effectiveness for other outcomes.
Main results

Five RCTs describing six interventions (comprising a total of 235 participants) met the eligibility criteria for the review. Two trials of computer-assisted cognitive training interventions (n = 100), two of compensatory strategy training interventions (n = 95), one of meditation (n = 47) and one of physical activity intervention (n = 19) were identified. Each study focused on breast cancer survivors. All five studies were rated as having a high risk of bias. Data for our primary outcome of interest, cognitive function were not amenable to being pooled statistically. Cognitive training demonstrated beneficial effects on objectively assessed cognitive function (including processing speed, executive functions, cognitive flexibility, language, delayed- and immediate- memory), subjectively reported cognitive function and mental well-being. Compensatory strategy training demonstrated improvements on objectively assessed delayed-, immediate- and verbal-memory, self-reported cognitive function and spiritual quality of life (QoL). The meta-analyses of two RCTs (95 participants) did not show a beneficial effect from compensatory strategy training on physical well-being immediately (standardised mean difference (SMD) 0.12, 95% confidence interval (CI) -0.59 to 0.83; I2= 67%) or two months post-intervention (SMD - 0.21, 95% CI -0.89 to 0.47; I2 = 63%) or on mental well-being two months post-intervention (SMD -0.38, 95% CI -1.10 to 0.34; I2 = 67%). Lower mental well-being immediately post-intervention appeared to be observed in patients who received compensatory strategy training compared to wait-list controls (SMD -0.57, 95% CI -0.98 to -0.16; I2 = 0%). We assessed the assembled studies using GRADE for physical and mental health outcomes and this evidence was rated to be low quality and, therefore findings should be interpreted with caution. Evidence for physical activity and meditation interventions on cognitive outcomes is unclear.
Authors' conclusions

Overall, the, albeit low-quality evidence may be interpreted to suggest that non-pharmacological interventions may have the potential to reduce the risk of, or ameliorate, cognitive impairment following systemic cancer treatment. Larger, multi-site studies including an appropriate, active attentional control group, as well as consideration of functional outcomes (e.g. activities of daily living) are required in order to come to firmer conclusions about the benefits or otherwise of this intervention approach. There is also a need to conduct research into cognitive impairment among cancer patient groups other than women with breast cancer.

Cognitive Component Skills of Reading Comprehension in Developing Readers

Die Fähigkeit, geschriebene Texte zu verstehen, d.h. eine kohärente mentale Repräsentation von Textinhalten zu erstellen, ist eine notwendige Voraussetzung für eine erfolgreiche schulische und außerschulische Entwicklung. Es ist daher ein zentrales Anliegen des Bildungssystems Leseschwierigkeiten frühzeitig zu diagnostizieren und mithilfe zielgerichteter Interventionsprogramme zu fördern. Dies erfordert ein umfassendes Wissen über die kognitiven Teilprozesse, die dem Leseverstehen zugrunde liegen, ihre Zusammenhänge und ihre Entwicklung. Die vorliegende Dissertation soll zu einem umfassenden Verständnis über das Leseverstehen beitragen, indem sie eine Auswahl offener Fragestellungen experimentell untersucht. Studie 1 untersucht inwieweit phonologische Rekodier- und orthographische Dekodierfertigkeiten zum Satz- und Textverstehen beitragen und wie sich beide Fertigkeiten bei deutschen Grundschüler(inne)n von der 2. bis zur 4. Klasse entwickeln. Die Ergebnisse legen nahe, dass beide Fertigkeiten signifikante und eigenständige Beiträge zum Leseverstehen leisten und dass sich ihr relativer Beitrag über die Klassenstufen hinweg nicht verändert. Darüber hinaus zeigt sich, dass bereits deutsche Zweitklässler(innen) den Großteil geschriebener Wörter in altersgerechten Texten über orthographische Vergleichsprozesse erkennen. Nichtsdestotrotz nutzen deutsche Grundschulkinder offenbar kontinuierlich phonologische Informationen, um die visuelle Worterkennung zu optimieren. Studie 2 erweitert die bisherige empirische Forschung zu einem der bekanntesten Modelle des Leseverstehens—der Simple View of Reading (SVR, Gough & Tunmer, 1986). Die Studie überprüft die SVR (Reading comprehension = Decoding x Comprehension) mithilfe optimierter und methodisch stringenter Maße der Modellkonstituenten und überprüft ihre Generalisierbarkeit für deutsche Dritt- und Viertklässler(innen). Studie 2 zeigt, dass die SVR einer methodisch stringenten Überprüfung nicht standhält und nicht ohne Weiteres auf deutsche Dritt- und Viertklässler(innen) generalisiert werden kann. Es wurden nur schwache Belege für eine multiplikative Verknüpfung von Dekodier- (D) und Hörverstehensfertigkeiten (C) gefunden. Der Umstand, dass ein beachtlicher Teil der Varianz im Leseverstehen (R) nicht durch D und C aufgeklärt werden konnte, deutet darauf hin, dass das Modell nicht vollständig ist und ggf. durch weitere Komponenten ergänzt werden muss. Studie 3 untersucht die Verarbeitung positiv-kausaler und negativ-kausaler Kohärenzrelationen bei deutschen Erst- bis Viertklässler(inne)n und Erwachsenen im Lese- und Hörverstehen. In Übereinstimmung mit dem Cumulative Cognitive Complexity-Ansatz (Evers-Vermeul & Sanders, 2009; Spooren & Sanders, 2008) zeigt Studie 3, dass die Verarbeitung negativ-kausaler Kohärenzrelationen und Konnektoren kognitiv aufwändiger ist als die Verarbeitung positiv-kausaler Relationen. Darüber hinaus entwickelt sich das Verstehen beider Kohärenzrelationen noch über die Grundschulzeit hinweg und ist für negativ-kausale Relationen am Ende der vierten Klasse noch nicht abgeschlossen. Studie 4 zeigt und diskutiert die Nützlichkeit prozess-orientierter Lesetests wie ProDi- L (Richter et al., in press), die individuelle Unterschiede in den kognitiven Teilfertigkeiten des Leseverstehens selektiv erfassen. Hierzu wird exemplarisch die Konstruktvalidität des ProDi-L-Subtests ‚Syntaktische Integration’ nachgewiesen. Mittels explanatorischer Item- Repsonse-Modelle wird gezeigt, dass der Test Fertigkeiten syntaktischer Integration separat erfasst und Kinder mit defizitären syntaktischen Fertigkeiten identifizieren kann. Die berichteten Befunde tragen zu einem umfassenden Verständnis der kognitiven Teilfertigkeiten des Leseverstehens bei, das für eine optimale Gestaltung des Leseunterrichts, für das Erstellen von Lernmaterialien, Leseinstruktionen und Lehrbüchern unerlässlich ist. Darüber hinaus stellt es die Grundlage für eine sinnvolle Diagnose individueller Leseschwierigkeiten und für die Konzeption adaptiver und zielgerichteter Interventionsprogramme zur Förderung des Leseverstehens bei schwachen Leser(inne)n dar.

Graph analysis of verbal fluency test discriminate between patients with Alzheimer’s disease, Mild Cognitive Impairment and normal elderly controls

Verbal fluency is the ability to produce a satisfying sequence of spoken words during a given time interval. The core of verbal fluency lies in the capacity to manage the executive aspects of language. The standard scores of the semantic verbal fluency test are broadly used in the neuropsychological assessment of the elderly, and different analytical methods are likely to extract even more information from the data generated in this test. Graph theory, a mathematical approach to analyze relations between items, represents a promising tool to understand a variety of neuropsychological states. This study reports a graph analysis of data generated by the semantic verbal fluency test by cognitively healthy elderly (NC), patients with Mild Cognitive Impairment – subtypes amnestic(aMCI) and amnestic multiple domain (a+mdMCI) - and patients with Alzheimer’s disease (AD). Sequences of words were represented as a speech graph in which every word corresponded to a node and temporal links between words were represented by directed edges. To characterize the structure of the data we calculated 13 speech graph attributes (SGAs). The individuals were compared when divided in three (NC – MCI – AD) and four (NC – aMCI – a+mdMCI – AD) groups. When the three groups were compared, significant differences were found in the standard measure of correct words produced, and three SGA: diameter, average shortest path, and network density. SGA sorted the elderly groups with good specificity and sensitivity. When the four groups were compared, the groups differed significantly in network density, except between the two MCI subtypes and NC and aMCI. The diameter of the network and the average shortest path were significantly different between the NC and AD, and between aMCI and AD. SGA sorted the elderly in their groups with good specificity and sensitivity, performing better than the standard score of the task. These findings provide support for a new methodological frame to assess the strength of semantic memory through the verbal fluency task, with potential to amplify the predictive power of this test. Graph analysis is likely to become clinically relevant in neurology and psychiatry, and may be particularly useful for the differential diagnosis of the elderly.

Anticipating future risk in social-ecological systems using fuzzy cognitive mapping: the case of wildfire in the Chiquitania, Bolivia

Understanding complex social-ecological systems, and anticipating how they may respond to rapid change, requires an approach that incorporates environmental, social, economic, and policy factors, usually in a context of fragmented data availability. We employed fuzzy cognitive mapping (FCM) to integrate these factors in the assessment of future wildfire risk in the Chiquitania region, Bolivia. In this region, dealing with wildfires is becoming increasingly challenging because of reinforcing feedbacks between multiple drivers. We conducted semistructured interviews and constructed different FCMs in focus groups to understand the regional dynamics of wildfire from diverse perspectives. We used FCM modelling to evaluate possible adaptation scenarios in the context of future drier climatic conditions. Scenarios also considered possible failure to respond in time to the emergent risk. This approach proved of great potential to support decision making for risk management. It helped identify key forcing variables and generate insights into potential risks and trade-offs of different strategies. The “Hands-off” scenario resulted in amplified impacts driven by intensifying trends, affecting particularly the agricultural production under drought conditions. The “Fire management” scenario, which adopted a bottom-up approach to improve controlled burning, showed less trade-offs between wildfire risk reduction and production compared with the “Fire suppression” scenario. Findings highlighted the importance of considering strategies that involve all actors who use fire, and the need to nest these strategies for a more systemic approach to manage wildfire risk. The FCM model could be used as a decision-support tool and serve as a “boundary object” to facilitate collaboration and integration of different perceptions of fire in the region. This approach also has the potential to inform decisions in other dynamic frontier landscapes around the world that are facing increased risk of large wildfires.

An Interdisciplinary Approach to the Management of Vocal Cord Dysfunction in an Elite Female Swimmer: a Case Study

Acute pulmonary disorders are commonplace within the athletic population, with exercise induced bronchoconstriction (EIB), and vocal cord dysfunction (VCD) common diagnoses. VCD is a condition that causes the adduction of the vocal folds during inhalation, causing obstruction at the larynx and thereby a severely impaired sporting performance. VCD can be brought on by laryngeal irritants, emotional and psychological stress and asthma. The gold standard of treatment for VCD centres on an interdisciplinary approach from specialists that often include a respiratory consultant, speech and language therapist (SLT) and a psychologist. The present case study details the interdisciplinary approach to the treatment of an elite female swimmer with VCD with an intervention programme that lasted nine weeks, instigated by a local general practitioner (G.P.) who chose to engage a Sport Psychology Consultant (SPC) due to the sport-specific nature of the psychological stress experienced by the individual. The steps involved in the design of the sport psychology interventions are outlined and the relationship of those interventions to the work of the other specialists is discussed. The 9 week intervention programme was aimed at reducing perfectionist tendencies and competitive state anxiety using a combination of cognitive behavioural therapy (CBT), goal-setting and imagery. Overall, the treatment programme was deemed a success as perfectionism and competitive state anxiety levels reduced over time along with the frequency of VCD occurrence. This case study demonstrates the breadth of roles that can be undertaken by a SPC and raises awareness of a complex respiratory disorder that is not yet fully understood.

Power control in cognitive radios, Internet-of Things (IoT) for factories and industrial automation

Cognitive radio (CR) is fast emerging as a promising technology that can meet the machine-to machine (M2M) communication requirements for spectrum utilization and power control for large number of machines/devices expected to be connected to the Internet-of Things (IoT). Power control in CR as a secondary user can been modelled as a non-cooperative game cost function to quantify and reduce its effects of interference while occupying the same spectrum as primary user without adversely affecting the required quality of service (QoS) in the network. In this paper a power loss exponent that factors in diverse operating environments for IoT is employed in the non-cooperative game cost function to quantify the required power of transmission in the network. The approach would enable various CRs to transmit with lesser power thereby saving battery consumption or increasing the number of secondary users thereby optimizing the network resources efficiently.

New tools for cognitive and motor rehabilitation: development and clinical validation

Nervous system disorders are associated with cognitive and motor deficits, and are responsible for the highest disability rates and global burden of disease. Their recovery paths are vulnerable and dependent on the effective combination of plastic brain tissue properties, with complex, lengthy and expensive neurorehabilitation programs. This work explores two lines of research, envisioning sustainable solutions to improve treatment of cognitive and motor deficits. Both projects were developed in parallel and shared a new sensible approach, where low-cost technologies were integrated with common clinical operative procedures. The aim was to achieve more intensive treatments under specialized monitoring, improve clinical decision-making and increase access to healthcare. The first project (articles I – III) concerned the development and evaluation of a web-based cognitive training platform (COGWEB), suitable for intensive use, either at home or at institutions, and across a wide spectrum of ages and diseases that impair cognitive functioning. It was tested for usability in a memory clinic setting and implemented in a collaborative network, comprising 41 centers and 60 professionals. An adherence and intensity study revealed a compliance of 82.8% at six months and an average of six hours/week of continued online cognitive training activities. The second project (articles IV – VI) was designed to create and validate an intelligent rehabilitation device to administer proprioceptive stimuli on the hemiparetic side of stroke patients while performing ambulatory movement characterization (SWORD). Targeted vibratory stimulation was found to be well tolerated and an automatic motor characterization system retrieved results comparable to the first items of the Wolf Motor Function Test. The global system was tested in a randomized placebo controlled trial to assess its impact on a common motor rehabilitation task in a relevant clinical environment (early post-stroke). The number of correct movements on a hand-to-mouth task was increased by an average of 7.2/minute while the probability to perform an error decreased from 1:3 to 1:9. Neurorehabilitation and neuroplasticity are shifting to more neuroscience driven approaches. Simultaneously, their final utility for patients and society is largely dependent on the development of more effective technologies that facilitate the dissemination of knowledge produced during the process. The results attained through this work represent a step forward in that direction. Their impact on the quality of rehabilitation services and public health is discussed according to clinical, technological and organizational perspectives. Such a process of thinking and oriented speculation has led to the debate of subsequent hypotheses, already being explored in novel research paths.

Medications, youth therapeutic cultures and performance consumptions: a sociological approach

This article analyses performance consumptions among young people. The theme is explored along two main axes. The first concerns the social heterogeneity in this field, considered on two levels: the different purposes for those investments - cognitive/mental and physical performance; and the different social contexts - university and work - where performance practices and dispositions may be fostered. The second axis explores the roles of pharmacological and natural consumptions, and their interrelationship, in the dissemination of these practices. The empirical data for this analysis were drawn from an ongoing research project on performance consumptions among young people (aged 18-29 years) in Portugal, including both university students and young workers without university education. The results correspond to the stage of extensive research, for which a questionnaire was organised at a national level, using non-proportional quota sampling. On the one hand, they show that (a) there is a hierarchy of acceptance of consumptions according to their purposes, with cognitive/mental performance showing higher acceptance and (b) both pharmaceuticals and natural products are consumed for every type of performance investment. On the other, the comparison between students and workers introduces a certain heterogeneity in this general backdrop, both in terms of the purposes for their consumptions and their opting for natural or pharmacological resources. These threads of heterogeneity will prompt a discussion of the dynamics of pharmaceuticalisation within the field of performance, in particular how therapeutic cultures may be changing in terms of the way individuals relate to medications, expanding their uses in social life.