Valuing the invaluable: Do emotional experiences during fertility treatments affect the willingness to pay for them?

Introduction

This paper extends the accepted economic method of valuation by taking psychological factors into consideration.

On procreating today

This work reflects on the suffering and difficulties that men and women often experience during the process of procreation, beginning with the decision to suspend the use of contraception. The shared project that a child represents involves difficulties that are also a consequence of the culture in which we live: subject to early tests, ultrasound scans and so on, a planned pregnancy is dominated, throughout its development, by the secondary process of monitoring. A delay in conception, at times deriving from intolerance towards a body that does not immediately fulfil one’s own desires, sets in motion the diagnostic inquiry. During this time, while the long‐awaited moment of conception is further delayed, the desire for a son/daughter changes in quality and intensity. In a substantial number of cases, infertility remains unexplained, a situation in turn characterized by the fear that not knowing implies. Although the excessively simplistic and limited notion of psychogenic infertility has faded, a residue of unexpressed horror, difficult to frame even in analysis, persists in the couple. The end of the diagnostic inquiry means that assisted conception must be eventually faced. Fortunately, nowadays in psychoanalytic culture the fundamentalist tendencies that, in the past, led to forecasts of catastrophe, have subsided. Yet this remains a highly problematic area with many questions and few answers.     

“Where Did I Come From?” The Impact of ART on Families and Psychotherapists

ABSTRACT

This article focuses on the field of assisted reproductive technology (ART) and psychoanalysis as it relates to people who’ve struggled emotionally in pursuit of their wish to create a family. Recent medical advances have changed baby-making to the extent that infertility is no longer a terminal diagnosis (Ehrensaft, 2012). New opportunities exist to create a family through introduction of a third party in the process of conception via in vitro fertilization, the use of donor egg and/or sperm, intracytoplasmic sperm injection, and surrogacy. The realities raised by these new methods have challenged usual cultural ideas of what constitutes a family, as well as what it means to become a parent or give birth to a child (Ehrensaft, 2000; Notman, 2011; Samish, 2006). The subject of reproductive medicine has stimulated a wide range of emotions within the community of people who suffer infertility and among psychotherapists who become involved with them in analytic and psychotherapeutic relationships.     

Intrusive and avoidant ideation among females pursuing infertility treatment

Abstract

It was shown that infertility and its treatment constitute a stressful experience for women, reflected particularly in disturbing intrusive ideation about the stress source. Infertility patients reported levels of intrusive ideation significantly higher than routine gynecologic patients and not significantly different from levels of psychiatric outpatients being treated for stress reactions to traumatic events. Intrusive ideation also predicted the degree of self-reported infertility-specific distress and dysfunction, further clarifying the key role of such ideation in the experience. Finally, as hypothesized, the frustration level of the treatment experience (as indexed by the number of infertility treatment methods attempted) predicted avoidant ideation. Implications for managing the psychological distress and disruption associated with the infertility treatment experience were discussed.     

Using Acceptance and Commitment Therapy to Treat Infertility Stress

Women and men diagnosed with infertility experience a variety of infertility-related stressors, including changes to their family and social networks, strain on their sexual relationship, and difficulties and unexpected challenges in their relationship. Infertility stress is linked with depression and psychological distress, and can lead to premature dropout from medical treatments and unresolved feelings of loss and grief. The current study examined the effectiveness of treating infertility stress using Acceptance and Commitment Therapy (ACT), a promising new behavior therapy that targets experiential avoidance through mindfulness, acceptance strategies, and value-directed action. This single-case study followed a couple experiencing infertility-related stress following a failed in vitro fertilization (IVF) procedure. The couple completed 6 self-report measures at 7 time points, including a second failed IVF attempt and a 1-year follow-up. Measures included both distress-focused instruments and therapy process-related questionnaires. The female participant reported higher pretreatment stress and depression scores compared to her partner. She reported significant decreases in global infertility stress, social infertility stress, sexual infertility stress, psychological distress, and depression from pretherapy to 1-year follow-up. She also reported a decrease in infertility stress following her second failed in vitro fertilization (IVF) attempt. The male participant reported significant decreases in sexual infertility stress. The study suggests that acceptance-based therapy shows promise in treating infertility stress in patients experiencing infertility who undergo medical treatments. The data from this preliminary case study also suggest that ACT may be helpful for couples following IVF treatment failure. Treatment gains were maintained 1-year posttherapy, indicating that an ACT approach to treating infertility has the potential to produce lasting change.     

Psychological and relationship changes of couples undergoing an infertility investigation: Some implications for counsellors

The emotional and psychological aspects of the experience of infertility have been largely ignored by researchers. A study was accordingly undertaken of 43 infertile couples who were undergoing medical investigation of their fertility problems. Preliminary analysis of the data suggests that the infertility investigation was most stressful for the participants at the time of the initial medical interview, and that distress was greater for those who were themselves identified as having an organic fertility problem. A substantial number of the men and women involved indicated a need for the provision of psychological counselling services. The nature of the most appropriate forms of such help is explored.     

Somatization in Chinese American clients: Implications for psychotherapeutic services

Chinese Americans have a tendency to somatize, or complain of physical discomforts, when they experience psychological or emotional problems. Differentiating whether these clients have a mental health problem or a physical ailment is a critical diagnostic and treatment issue. In addition, psychogenic somatic complaints need to be addressed in a culturally congruent manner in the context of psychotherapy. This paper examines the somatic symptoms commonly reported by Chinese American clients. Ways to address these issues in differential diagnosis and in treatment will be discussed along with case examples.Portions of this paper were presented at the 100th Annual Convention of the American Psychological Association, Washington, D.C., August, 1992.     

顾客为什么参与创造？ ——消费者参与创造的动机研究

从消费者参与企业价值创造的角度研究了消费者创造动机与创造意愿之间的关系,结果说明,一般创造性理论所证实的认知需求并未对消费者创造意愿产生显著影响,而独特性产品需求、独特性体验需求以及创造激励对消费者创造意愿产生了显著的正面影响研究还发现,信任和创造激励分别调节了独特性产品需求和独特性体验需求与创造意愿之间的关系     

A MEDIATIONAL MODEL OF AUTONOMY, SELF-ESTEEM, AND EATING DISORDERED ATTITUDES AND BEHAVIORS

This study expands upon existing literature by examining how the relationship between autonomy deficits and low self-esteem may create a psychological environment conducive to the development of eating disordered behaviors. Findings supported a mediational model to account for eating disordered behaviors in 71 college women. In this model, lack of autonomy was related to decreased global self-esteem, which in turn was associated with bulimia, body dissatisfaction, and drive for thinness. Although only tentative and cross-sectional in nature, this study is of particular importance because it links autonomy and self-esteem in a coherent model predictive of eating disordered behaviors in college women. Developmental aspects of eating disorders and treatment implications are discussed.     

Psychological characteristics of infertile couples: can they predict pregnancy and treatment persistence?

The paper describes an exploratory study of the relative importance of different psychological variables for the prediction of (a) pregnancies and (b) treatment continuation in a sample of 140 couples seeking specialized infertility treatment one year after their first contact with an infertility clinic. The couples filled out questionnaires dealing with psychological and interpersonal functioning, marital and life satisfaction, child-related attitudes, causal attribution of infertility and general expectations towards the treatment. It could be shown that the psychological variables explain a relatively small amount of the variance of the pregnancy criterion. Nevertheless, there were some indications supporting the hypothesis that psychological complaints can be seen as a ‘risk factor’ associated with a lower pregnancy rate. Couples who had terminated treatment after one year indicated a higher amount of psychological and interpersonal complaints (females) as well as partner problems (males and females), and a dominance of internal attributions of the fertility problem. This result—which might help to develop strategies for counselling couples making use of the new reproductive technologies—highlights the importance of attribution and cognitive appraisal in coping with infertility. © 1998 John Wiley & Sons, Ltd.     

Psychological interventions for infertile patients: a review of existing research and A new comprehensive approach

The usefulness of psychological support for infertile patients has been highlighted in the literature over the past number of years. This article provides a review of existing research on psychological interventions for infertile patients, and presents the Fertility Group Intervention as an example of the application of existing research. There is clear empirical evidence of high levels of depressive symptoms, anxiety, and distress among infertile patients undergoing assisted reproductive treatment (ART). Infertile patients need and require increased psychological support. Various studies indicate the efficacy of psychological interventions for infertile patients with respect to their mental health and, in part, pregnancy rates. However, many such studies exhibit methodological problems. Therefore, in future research, additional studies of high‐quality design are needed to achieve more definitive answers on the efficacy and indication of psychological interventions for infertile patients. Currently, the Fertility Group Intervention represents a comprehensive therapeutic approach integrating established empirical and theoretical approaches with the aim of helping infertile patients – particularly those undergoing ART – cope with distress related to their infertility and medical treatment. This article further outlines the therapeutic background and structures, treatment goals, practical implications, and feasibility of the Fertility Group Intervention.     

Culture and the cognitive and neuroendocrine responses to speech

The present research investigated cultural differences in the psychological and biological effects of verbalization of thoughts. Three studies tested how verbalization of thoughts requires a different amount of effort for people from cultures with different assumptions about speech and examined implications for the cognitive performance and stress hormone response to the task. The results showed that verbalization impaired East Asians/East Asian Americans' performance when the task was difficult but not when the task was easy, whereas the effect of verbalization on European Americans' performance was neutral or positive regardless of task difficulty. Moreover, verbalization decreased the level of cortisol response to the task among European Americans but not among East Asian Americans. The results demonstrate how the same act that is intended to create the same psychological experience could inadvertently lead to systematically different psychological experiences for people from different cultures.     

笔迹与人格关系研究的回顾及评价

西方心理学者对笔相学家的笔迹分析提出质疑,研究表明需要我们重新考虑笔迹分析的适用性,而其利用因素分析技术对笔迹与人格关系的大量研究发现,笔迹特征与EPQ中的E因素、N因素相关显著。我国古代丰富的笔迹学思想和当代笔相学家的实践经验为我们从心理学角度研究笔迹与人格之间的关系,提供了宝贵的资料,但我们在这一领域运用心理学方法的研究还刚刚起步。目前国内外心理学者在研究取向、笔迹特征选择和研究目的上还存在一定局限,对此加深认识,将会对我们具有重要的借鉴意义。     

Perceptions of informal sanctioning and the stigma of involuntary childlessness

This study systematically examines the role of informal social response in the emergence of involuntary childlessness or infertility as a stigmatizing attribute. Seventy‐one involuntarily childless women provide detailed instances of perceived informal social sanctions related to their infertility. Subjects perceive that normals consider infertility to be caused by psychological or sexual malfunctioning, or by the woman in the dyad. Infertility is also seen by some to act as a master status. Subjects categorize other infertile individuals in terms of stigma and consider male infertility to be more stigmatizing than female infertility. Social sanctions and social control are shown to be relevant to an understanding of the experience of involuntary childlessness.     

The Role of Dyadic Coping on the Marital and Emotional Adjustment of Couples With Infertility

Infertility is a challenging experience, affecting individual and couples’ adjustment. However, the way the members of the couple support each other may affect the experience of infertility and their adjustment. This study aimed to investigate the role of dyadic coping by oneself and by the partner in the association between the impact of infertility and dyadic and emotional adjustment (anxiety and depression) to infertility. In this cross‐sectional study, a total of 134 participants (67 couples with infertility) completed self‐report questionnaires assessing infertility‐related stress, dyadic coping, dyadic adjustment, and depression and anxiety symptoms. A path analysis examined the direct and indirect effects between the impact of infertility in one's life and dyadic and emotional adjustment. There is an indirect effect of the impact of infertility in one's life on dyadic adjustment through men's perceived dyadic coping efforts employed by the self (dyadic coping by oneself) and women's perceived dyadic coping efforts of the partner (dyadic coping by the partner). Regarding the emotional adjustment of infertile couples, infertility stress impact had an indirect effect only on depressive symptoms through men's dyadic coping by oneself. The results highlight the importance of men's dyadic coping strategies for the marital adjustment of couples as well as for men's emotional adjustment. Findings emphasize the importance of involving men in the fertility treatment process, reinforcing the dyadic nature of infertility processes.     

An Infertility Primer for Family Therapists:

A seemingly "self-evident truth" in most people's lives is that one day they will have children. This universal, biopsychosocial assumption goes unchallenged until a couple faces infertility. Although the effects of such a challenge are profound, infertility is often treated as a nonevent — both within our society as a whole, and within the field of family therapy in particular. To assist clinicians who work with this numerically increasing population, and the many others who have been affected by their encounter with infertility in the past, this article discusses the biological/medical, psychological, and social factors that shape the experience of infertility in our society.     

Evidence for the efficacy of the MORI technique: Viewers do not notice or implicitly remember details from the alternate movie version

The MORI technique provides a unique way to research social influences on memory. The technique allows people to watch different movies on the same screen at the same time without realizing that each of them sees something different. As a result, researchers can create a situation in which people feel as though they share an experience, but systematic differences are introduced into their memories, and the effect of those differences can be tracked through a discussion. Despite its methodological advances, the MORI technique has been met with criticism, mostly because reviewers are worried that the MORI technique might not completely block the alternate movie version from view, leading people in these studies to see their partner’s version of the movie as well as their own. We addressed these concerns in two experiments. We found no evidence that subjects noticed the alternate movie version while watching a movie via the MORI technique (Experiment 1) and no evidence that subjects remembered details from the alternate movie version (Experiment 2). Taken together, the results provide support for the MORI technique as a valuable research tool.     

Counselling needs of patients receiving treatment with gamete donation

Couples experiencing infertility may be offered treatment with gamete donation where other methods of treatment have failed or are inappropriate. This paper examines a range of concerns related to gamete donation. The paper does not attempt to present a comprehensive and critical review of the literature but concentrates on selecting from the literature, in addition to clinical material, issues which have been identified as contributing to an understanding of patients' experience of treatment with donated gametes. The concerns include feelings and attitudes towards the donor, the role the donor plays in the couple's relationship, feelings about not being the genetic parent and whether to disclose the donation to the potential child and others. These concerns form a basis for counselling couples about the implications of gamete donation for themselves and any children born as a result. The difficulties faced by some people are illustrated by consideration of a single case where the experience of donation linked up with unique aspects of that individual. Therapeutic counselling offers couples faced with such difficulties the opportunity to explore in a more extensive way the underlying dynamics of their concerns, enabling them to think about and make sense of their experience. © 1998 John Wiley & Sons, Ltd.     

ECO‐ANXIETY,TRAGEDY, AND HOPE: PSYCHOLOGICAL AND SPIRITUAL DIMENSIONS OF CLIMATE CHANGE

This article addresses the problem of “eco‐anxiety” by integrating results from numerous fields of inquiry. Although climate change may cause direct psychological and existential impacts, vast numbers of people already experience indirect impacts in the form of depression, socio‐ethical paralysis, and loss of well‐being. This is not always evident, because people have developed psychological and social defenses in response, including “socially constructed silence.” I argue that this situation causes the need to frame climate change narratives as emphasizing hope in the midst of tragedy. Framing the situation simply as a threat or a possibility does not work. Religious communities and the use of methods which include spirituality have an important role in enabling people to process their deep emotions and existential questions. I draw also from my experiences from Finland in enabling cooperation between natural scientists and theologians in order to address climate issues.     

Treatment fearfulness and distress as predictors of professional psychological help-seeking

Only a small proportion of people who experience psychological distress seek professional psychological help. Treatment fearfulness is one of a number of factors thought to influence people's tendency to seek or avoid mental health treatment. The aim of the present study was to provide additional validity information on the Thoughts About Therapy Survey (TAPS) (Kushner & Sher, 1989), and to determine whether fear of therapy and psychological distress were predictive of help-seeking. A non-clinical student sample completed measures of their treatment fears, expectations, anxiety, psychological distress and help-seeking likelihood. Concurrent and construct validity was confirmed for TAPS. Image Concerns, Stigma Concerns, Coercion Concerns and psychological distress were related to the likelihood that subjects would seek professional psychological help. Results are discussed in relation to educational approaches for reducing treatment fearfulness and the potential for increasing appropriate professional help-seeking.