The Coming-Out Process and Its Adaptational and Health-Related Associations Among Gay, Lesbian, and Bisexual Youths: Stipulation and Exploration of a Model

A model is proposed and explored that links the coming-out process to the psychological functioning (i.e., self-esteem and distress) and sexual behaviors of gay, lesbian, and bisexual youths recruited from gay-focused community-based and college organizations in New York City. The coming-out process is multidimensional, consisting, as defined here, of involvement in gay/lesbian activities, attitudes toward homosexuality, comfort with homosexuality, self-disclosure of sexual identity to others, and sexual identity. The coming-out dimensions were related to self-esteem, distress, and unprotected sexual behaviors. In addition, the relations between the coming-out dimensions and unprotected sexual behaviors were explained by psychological functioning. In particular, limited involvement in gay/lesbian activities was associated with more unprotected sex. Negative attitudes toward homosexuality were related directly to more unprotected sex, and they were related indirectly to more unprotected sex by means of increasing emotional distress. These and other findings have implications for designing preventive interventions to increase the youths' psychological functioning and reduce their unprotected sexual behaviors.     

Self-Reported Interoceptive Sensibility Does Not Moderate the Relationship Between Eating Disorder Symptoms and Suicidal Thoughts and Behaviors

Past research has demonstrated a strong relationship between eating disorders (EDs) and suicidality (i.e., suicidal thoughts, plans, and attempts), and preliminary work within the framework of the interpersonal psychological theory of suicide (Joiner, 2007) suggests that potentially painful ED behaviors (binge eating, purging, fasting, excessive exercise) may contribute to increased risk of suicide through heightened pain tolerance and increased capability of suicide. However, additional explanations are needed for why only some individuals with EDs actually engage in suicidal behaviors (i.e., attempt suicide), whereas others do not. A growing body of literature suggests that interoceptive deficits (a disconnection from one’s own bodily sensations and emotions; IDs) might be a factor linking eating disorders and suicide. To better understand this relationship, the current study tests the moderating effects of self-reported IDs on the relations between ED behaviors and suicidality and past suicide attempts in a transdiagnostic ED sample (N = 181). We hypothesized that ED behaviors would directly relate to suicidality, but that IDs would moderate the relationship between ED behaviors and past suicide attempts, such that those high in IDs would demonstrate a stronger relationship between ED behaviors and suicide attempts. Contrary to our hypothesis, IDs did not moderate the relationship; instead, fasting and purging had significant and strong main effects on suicidality and past suicide attempts without moderation effects. Results suggest that fasting and purging may be important ED behaviors to consider in the relationship between EDs and suicidality. Future directions include further examining the relationship between IDs, suicidality, and EDs using measures of IDs that better encompass physical (as opposed to emotional) aspects of IDs.     

A systemic model of doping behavior

Human behavior occurs within a system, and as such, so do behaviors in performance-related domains (e.g., athletics, academics). Doping is a performance enhancement behavior that can be problematic because of the negative physical and psychological effects associated with the use of some substances and the common argument that doping is unfair. However, doping continues and may be increasing. Because a firm theoretical or empirical understanding of doping does not exist, this article proposes a conceptual, comprehensive, and innovative systemic model of doping behavior. The model is built from relevant empiricism supporting the idea that contemporary doping behavior is a function of systemic transactions between historical doping practices, the present environment, current antidoping interventions, one's genetic makeup, developmental milestones, social factors, and epigenetics.     

Commitment to “Safer” Sex as a Predictor of Condom Use Among 16-20-Year-Olds1

The AIDS risk reduction model (ARRM) is explored in the context of a prospective study of adolescent condom use. This three-stage model characterizes the social and psychological facilitation of change in attitudes and sexual behaviors related to HIV transmission. The social and behavioral consequences of AIDS for 63 adolescents (aged 16-20 years), from an urban part of North West London, were mapped over a one-year period. Indices were created according to the proposed model which reflect (a) labelling of a high risk behavior as problematic (e.g., unprotected sexual intercourse) (b) commitment to change (e.g., desiring and valuing “safe” sex), and (c) seeking and enacting appropriate solutions (e.g., use of condoms). Nested regression analysis enabled the inter-relationship between significant social and psychological predictors (Time 1) and behavior (Time 2) to be traced. Overall the model accounted for 30% of the variance in condom use. Contemporaneous behavior was also modeled to identify baseline social and psychological predictors. Twenty-seven percent of the variance in condom use is explained. The social and psychological patterning of the indices is compared with that evidenced for prospective behavior. It appears that social representations which embody normative and value considerations underlie commitment to safer sex (at a general level) and override intentions (at a specific level) in the explanation of prospective behavior. The methodological and theoretical implications of this are identified and discussed.     

Treating Bulimia Nervosa and Achieving Medically Required Weight Loss: A Case Study

Eating disorder and weight loss interventions have typically been regarded as distinct or antithetical, despite a growing number of individuals with comorbid eating pathology and obesity. This siloing of research and practice has created a clinical conundrum for providers seeking to treat individuals with an eating disorder seeking to lose weight (e.g., required pre-surgical weight loss). To date, integrated treatment research targeting both eating disorders and weight loss is rare and practical guidance is lacking, especially for restrictive/binge-purge subtypes. This case example describes how an integrated approach was applied within a naturalistic outpatient clinical practice setting to successfully treat a client presenting with excess weight and severe bulimia nervosa who was medically required to lose weight for orthopedic surgery. We conclude by reviewing the benefits and challenges of integrating eating disorder and behavioral weight loss treatments and providing practical insights for treatment providers.     

Global model analysis by parameter space partitioning

To model behavior, scientists need to know how models behave. This means learning what other behaviors a model can produce besides the one generated by participants in an experiment. This is a difficult problem because of the complexity of psychological models (e.g., their many parameters) and because the behavioral precision of models (e.g., interval-scale performance) often mismatches their testable precision in experiments, where qualitative, ordinal predictions are the norm. Parameter space partitioning is a solution that evaluates model performance at a qualitative level. There exists a partition on the model's parameter space that divides it into regions that correspond to each data pattern. Three application examples demonstrate its potential and versatility for studying the global behavior of psychological models.     

Beyond self-report in the study of hedonic and eudaimonic well-being: Correlations with acquaintance reports, clinician judgments and directly observed social behavior

Surprisingly little is known about how well-being is related to social reputation, clinician judgments, and directly observed social behaviors. This study presents data that bear directly on these issues, along with comparing the personality and behavioral correlates of subjective happiness, a measurement based on a hedonic conceptualization of well-being, with psychological well-being, a eudaimonic conceptualization. The findings demonstrate remarkable consistency in the pattern of correlates of the two measures across acquaintance ratings, clinician judgments, and directly observed social behaviors. By either conceptualization, people high in well-being enjoy positive social reputations (e.g., cheerful, sociable, satisfied with life), are rated as well-adjusted by clinicians (e.g., consistent, resilient), and can be observed to exhibit adaptive social behaviors (e.g., social skill, expressiveness).     

Why the Psychological Experience of Respect Matters in Group Life: An Integrative Account

The psychological experience of respect has implications for the nature and quality of group life and for the individual's psychological and physical well‐being. However, the manner in which respect has been studied and defined has frequently differed among researchers, making it difficult to connect the various findings. Whereas some researchers have focused on the implications of respectful treatment from group members (e.g., authorities, peers), others have focused on individuals’ perceptions of how they are generally evaluated by the group. We present the dual pathway model of respect in which these various lines of research are integrated within a single framework. Organized around two basic social motives – the need for status and the need to belong – the model describes two pathways (status evaluation and liking) through which respect from the group shapes social engagement, self‐esteem, and health. These evaluative dimensions are informed by interactions with group authorities and peers and differentially predict social psychological outcomes.     

Information Seeking and Avoiding in Health Contexts

Information management is an important component of coping with illness and illness‐related uncertainty. Normative theory and research on information seeking and avoiding in health contexts can help explain why some information management activities are more adaptive than others. Challenges and dilemmas of information management include relational demands (e.g., the need to coordinate the behaviors and goals of the participants) and contextual features (e.g., cross‐cultural considerations or channels available for information seeking and providing). Issues that need to be addressed in a normative approach include (a) how information management goals can be accomplished while still accounting for other goals (e.g., identity management or relational maintenance), (b) what roles interpreters can play to facilitate effective cross‐cultural information exchange (e.g., as cultural informants), and (c) how information seekers can best manage conflicting or overwhelming information when confronted with messages from multiple channels.     

A Qualitative Study of Health Professionals' Views Regarding Provision of Information About Health-Protective Behaviors During Genetic Consultation for Breast Cancer

This study aimed to explore health professionals' views and practice regarding the provision of information about health-protective behaviors (e.g., exercise, alcohol consumption, diet) during genetic consultation for breast cancer. Ten genetic counselors participated in three focus groups, and seven medical specialists were interviewed in a focus group or individually. Data was analyzed using the constant comparative method. Findings suggested that health professionals held differing, often opposing, views about the value of health-protective behaviors for women at increased risk of breast cancer. The content and extent of information provided about health-protective behaviors varied widely, and participants expressed a need to form consensus regarding information provision both within and across clinics. The main barriers to providing information regarding health-protective behaviors included the lack of research evidence regarding the impact of these factors and higher priority of other information need to be provided in the limited consultation time. Participants generally did not consider it their role to promote health-protective behaviors, and were concerned about the psychological impact of providing information about behavioral risk factors during genetic consultations.     

Supervision of Psychosocial Skills in Genetic Counseling

Little has been written about how genetic counseling supervisors can help students develop psychosocial skills in their clinical rotations. The authors describe several approaches supervisors can use, ranging from preventive measures (e.g., normalizing anxiety), to skill-enhancing interventions (e.g., modeling and thinking aloud), to more direct approaches (e.g., immediacy, confrontation) that may be necessary for students who are reluctant, or even resistant, to using psychosocial skills with their clients.     

Male sexual abuse: A review of effects,abuse characteristics,and links with later psychological functioning

Despite the increasing awareness of sexual victimization involving males, there remain a number of factors (e.g., stigma of homosexuality, male ethic of self-reliance) that continue to contribute to the underreporting of such cases. Nonetheless, there appears to be growing recognition of male sexual abuse as a serious problem with potentially numerous debilitating consequences. The clinical and research literature presently contains a number of articles on issues pertaining to males who have experienced sexual abuse during childhood. The purpose of the present paper is to review some of the more recent literature on the short- and long-term effects commonly found among sexually abused males. These effects, which include depression, self-blame, low self-esteem, anger, anxiety, and sexuality problems, are also compared with findings commonly reported among sexually abused females. In addition to sexual abuse effects, the present paper also reviews a number of important sexual abuse characteristics (e.g., age of abuse onset, duration of the abuse, nature of the sexual activity), examines the relationship of these characteristics to later psychological functioning, and explores gender similarities and differences. Finally, the implications of the findings with regard to treatment interventions are briefly discussed.     

Teaching psychological knowledge and skills to family physicians

Psychological problems (e.g., anxiety, depression, substance abuse) are prevalent in primary care medical settings. Family physicians (FPs) treat more patients than any other primary care medical specialists. Thus, FPs can play an extremely important role in providing psychological services to their patients. In contrast to other specialists (e.g., internists, obstetricians), FPs are required to complete behavioral science training in their residencies. In this paper, we describe standard undergraduate, graduate, and postgraduate training of FPs. We present our unique program for teaching psychological principles and skills to family practice residents at the University of Kansas Medical Center. And finally, we introduce an instrument, the Interview Rating Scale (IRS), for evaluating the interviewing skills of physicians and residents.     

Patterns of sedentary behavior among adolescents.

OBJECTIVE: Reducing certain sedentary behaviors (e.g., watching television, using a computer) can be an effective weight loss strategy for youth. Knowledge about whether behaviors cluster together could inform interventions. STUDY DESIGN: Estimates of time spent in 6 sedentary behaviors (watching television, talking on the telephone, using a computer, listening to music, doing homework, reading) were cluster analyzed for a sample of 878 adolescents (52% girls, mean age = 12.7 years, 58% Caucasian). MAIN OUTCOME MEASURES: The clusters were based on the sedentary behaviors listed above and compared on environmental variables (e.g., household rules), psychosocial variables (e.g., self-efficacy, enjoyment), and health behaviors (e.g., physical activity, diet). RESULTS: Four clusters emerged: low sedentary, medium sedentary, selective high sedentary, and high sedentary. Analyses revealed significant cluster differences for gender (p < .002), age (p < .002), body mass index (p < .001), physical activity (p < .01), and fiber intake (p < .01). CONCLUSIONS: Results suggest a limited number of distinct sedentary behavior patterns. Further study is needed to determine how interventions may use cluster membership to target segments of the adolescent population.     

Visuospatial working memory in Turner's syndrome

Turner's syndrome is a genetic disorder, specific to women, in which one of the X chromosomes is partially or completely deleted. This syndrome is associated with physical features such as short stature or failure in primary and secondary sexual development, together with a specific pattern of cognitive functions. It has been suggested that women affected by Turner's syndrome perform poorly in tasks measuring visuospatial abilities and have a verbal IQ significantly higher than performance IQ. Although this result has received strong empirical support, the nature of the visuospatial deficit is still unclear. Recent studies on visuospatial processes have highlighted that the underlying cognitive structure is more complex than previously suggested and several dissociations have been reported (e.g., visual vs spatial, sequential vs simultaneous, or passive vs active processes). In the present study we analyze in detail the characteristics of the visuospatial deficit associated with Turner's syndrome by presenting four young women with a comprehensive battery of tasks designed to tap all aspects of visuospatial working memory. Results confirm that Turner's syndrome is associated with a general visuospatial working memory deficit, but the pattern of performance of different cases can be different, with a greater emphasis on active visuospatial processes. and on either sequential or simultaneous spatial processes.     

A psychology of the human brain–gut–microbiome axis

In recent years, we have seen increasing research within neuroscience and biopsychology on the interactions between the brain, the gastrointestinal tract, the bacteria within the gastrointestinal tract, and the bidirectional relationship between these systems: the brain–gut–microbiome axis. Although research has demonstrated that the gut microbiota can impact upon cognition and a variety of stress‐related behaviours, including those relevant to anxiety and depression, we still do not know how this occurs. A deeper understanding of how psychological development as well as social and cultural factors impact upon the brain–gut–microbiome axis will contextualise the role of the axis in humans and inform psychological interventions that improve health within the brain–gut–microbiome axis. Interventions ostensibly aimed at ameliorating disorders in one part of the brain–gut–microbiome axis (e.g., psychotherapy for depression) may nonetheless impact upon other parts of the axis (e.g., microbiome composition and function), and functional gastrointestinal disorders such as irritable bowel syndrome represent a disorder of the axis, rather than an isolated problem either of psychology or of gastrointestinal function. The discipline of psychology needs to be cognisant of these interactions and can help to inform the future research agenda in this emerging field of research. In this review, we outline the role psychology has to play in understanding the brain–gut–microbiome axis, with a focus on human psychology and the use of research in laboratory animals to model human psychology.     

Effective interventions and the Good Lives Model: Maximizing treatment gains for sexual offenders

The effective risk management of sexual offenders is arguably one of the most contentious social issues of our day. The community is justifiably outraged by what it perceives to be a failure of correctional and mental health practitioners to demonstrate that rehabilitative and supervisory methods promote public safety. Those who treat offenders and attempt to manage risk are often frustrated by what appear, at times, to be emotion-based reactions to low base-rate incidents. The literature on effective correctional programming has produced a workable model—Risk/Needs/Responsivity (RNR)—in which interventions match intensity of treatment to level of risk, specifically target criminogenic needs, and tailor treatment to the personal and interpersonal needs and capacities of participants. However, this model has been criticized regarding an apparent failure to appreciate the totality of client needs, specifically with respect to offender responsivity concerns. The Good Lives Model (GLM) suggests that treatment for sexual offenders must regard participants as whole beings in need of focus in many principal life areas (e.g., family, employment, leisure, community, personal well-being). This article proposes that RNR and GLM are complementary and that, by emphasizing the merits of each, offender management and general well-being can be maximized while community safety is increased.     

From symptom to process: how the PDM alters goals and strategies in psychological assessment

In many respects the Psychodynamic Diagnostic Manual (PDM) P and M Axes represent psychoanalytic versions of Diagnostic and Statistical Manual of Mental Disorders (DSM) Axes II and V: Whereas the DSM axes focus on surface behaviors and their associated mental states (e.g., thought patterns, affective responses), the PDM axes emphasize underlying psychodynamic processes (e.g., implicit motives, conflicts, defenses), with more modest attention to expressed behavior. The paradigmatic shift envisioned by the PDM creates tremendous opportunities for clinicians and researchers, and significant assessment challenges as well. This article discusses those opportunities and challenges. After briefly contrasting the DSM and PDM conceptualizations of personality pathology and global psychological functioning, I discuss the implications of these contrasting perspectives for diagnosis and psychological assessment, outline strategies for documenting the construct validity of DSM and PDM symptom criteria using symptom-focused and process-focused methods, and offer suggestions for how DSM symptom-focused data can be integrated with PDM process-focused data to facilitate case conceptualization and treatment planning.     

Asian American Women Sexual Assault Survivors’ Choice of Coping Strategies: The Role of Post-Assault Cognitive Responses

ABSTRACT

Even though approximately one in three Asian American (AA) and Pacific Islander women experience sexual assault victimization, there is a dearth of literature examining how AA women sexual assault survivors cope with this traumatic experience. This study examined AA female sexual assault survivors’ choice of coping strategies post-assault and how their cognitive responses toward sexual assault victimization (e.g., attributions of self-blame, perceived control over the recovery process) relate to their use of coping strategies. Using the AA subsets of two large community studies, a total of 64 AA women ages 18 to 58 with unwanted sexual experiences after the age of 14 years were included in the analyses. Results indicated that AA survivors used Acceptance and Self-Distraction the most to cope with sexual assault. In addition, those who perceived they had less control over their recovery process tended to use more maladaptive coping strategies, such as substance abuse and behavioral disengagement (e.g., giving up). The discussion includes clinical implications and recommendations for using language, modalities, and foci of interventions that are consistent with clients’ and their families’ worldviews (e.g., indirect inquiries, solution-focused).     

Pharmacologic management of sexual dysfunction: benefits and limitations

What is the current knowledge concerning the pharmacologic treatment of human sexual dysfunction? A number of interventions, including oral phophodiesterase inhibitors and intracorporeal agents with vasodilatory effects, are available to treat male erectile disorder. Serotonergic drugs have been shown to be effective in the treatment of rapid ejaculation. Various lines of research suggest that high dosages of androgenic agents may eventually have a role in the treatment of decreased libido in females. There may be a role for phophodiesterase inhibitors in the treatment of a subgroup of women with arousal disorders. Normal sexual function involves successful integration of biological, psychological, and interpersonal influences. Clinical psychiatry with its biopsychosocial model should incorporate the treatment of human sexual dysfunction within its purview.