Treatment choice for PTSD

The impetus for seeking help for assault-related difficulties often rests upon the victims themselves. Yet, we know very little about what factors influence a woman's decision to seek a particular kind of help after an assault. To learn more about these factors, data from 273 women with varying degrees of trauma history and subsequent PTSD symptoms were collected. All participants read a standard, "if this happened to you, what would you do" scenario describing a traumatic event and subsequent trauma-related psychiatric symptoms. Participants were given the same trauma scenario (i.e., sexual assault) and three treatment options to choose from: sertraline (SER), prolonged exposure (PE), or no treatment. Ratings of treatment credibility, personal reactions to treatment options, and treatment choice were examined. Women were more likely to choose PE than SER for the treatment of chronic PTSD. Perceived credibility of the treatment and personal reactions coincided with women's choices. By better understanding who would choose which treatments for PTSD and why, we will improve our ability to tailor how we approach discussing treatment options with these women.     

Providing a treatment rationale for PTSD: Does what we say matter?

Little is understood about the factors that influence a woman's preference for a particular type of treatment after an assault. Furthermore, it remains unclear the extent to which providing detailed information such as the mechanism underlying a treatment or its side effects can affect a client's treatment preference for psychotherapy or pharmacotherapy. The current study of 324 women with varying degrees of trauma exposure and posttraumatic stress symptoms experimentally manipulated the content of treatment rationales for two common PTSD treatments: sertraline (SER) and prolonged exposure (PE). Specifically, both information regarding the hypothesized mechanism of the treatment and treatment side effects were manipulated. In general, personal reactions were more positive and credibility was stronger for psychotherapy than pharmacotherapy. This preference for the psychotherapy persisted regardless of specific information presented in the treatment rationale. For those reporting heightened hyperarousal and those of minority status, there was an increased likelihood of more positive reactions to sertraline. The results highlight assessment of treatment-related beliefs and preferences early on in the therapeutic process. Ultimately, understanding the factors that shape treatment preferences may contribute to the development of personalized treatment strategies that integrate preferences and attitudes about treatment as a way of bolstering adherence and outcome.     

Attributed reasons for support of the feminist movement as a function of attractiveness

Male and female subjects were shown photographs of attractive and unattractive women. They were asked to indicate, for each photograph, the main reason why they thought the woman in the photograph was a feminist. Subjects attributed more positive, flattering reasons to the attractive women than to the unattractive women. In addition, it was found that subjects who did this task after having done a filler task made a greater distinction between the attractive and unattractive women than did subjects who did this task first. Interpretations and limitations of the results are discussed.     

Ethnic Differences in Parental Perceptions of Genetic Testing for Deaf Infants

As genetic testing becomes an integral part of the evaluation of deaf infants and children, it is important to understand parental views on genetic testing. The purpose of this study is to examine parental reasons for, and beliefs about, genetic testing for deafness in early-identified infants, and to determine if they differ as a function of ethnicity. We present baseline data collected from 56 Caucasian, 59 Hispanic, and 24 Asian parents of deaf children participating in a longitudinal, prospective study on genetic testing for connexin-related deafness. The overall finding is that reasons for, and beliefs about, genetic testing for deafness varied as a function of ethnicity. Virtually all parents sought genetic testing to understand why their child is deaf. However, Asian and/or Hispanic parents were more likely than Caucasian parents to view family planning, helping with their child's medical care, and helping the family as other important reasons for testing, and were more likely than Caucasian parents to perceive genetic testing to be useful for these purposes. Asian and Hispanic parents were more likely than Caucasian parents to perceive genetic testing in harmful terms. Genetic testing fulfills a cognitive need for parents to understand why their child is deaf, yet differences in responses suggest that Asian and Hispanic parents may seek testing for other purposes. Understanding different perspectives on genetic testing for deafness will enhance genetic counselors' cultural competence and facilitate the pre-test genetic counseling session.     

The acceptability and preference for the psychological treatment of PTSD

The acceptability and preference of psychological treatments is important in understanding patient treatment seeking, choice, engagement and attrition and possibly treatment response in health care. The acceptability of, and preference for, 14 different types of psychological treatment for posttraumatic stress disorder (PTSD) were investigated in a student population through invitation to participate in a web-based survey. Respondents were asked to rate each treatment on 10 scales and to rank the treatments in order of preference. Respondents were also asked whether they would seek treatment themselves, recommend treatment to friends and family, feel stigmatised by suffering from PTSD, had any prior knowledge of the treatments and if this had been positive or negative and whether they had a history of psychological problems or treatment. A total of 330 respondents completed the survey. A past or current history of psychological problems and treatment was surprisingly high. Almost all respondents indicated that they would seek or recommend treatment in spite of high levels of stigmatisation. Factor analysis of the 10 scales indicated two factors: Endorsement and Discomfort. Rank ordering on preference and Endorsement scores was highly consistent. The highly preferred and endorsed treatments involved cognitive therapy, exposure or psycho-education in spite of high levels of discomfort anticipated with exposure. Treatments involving new technologies, EMDR and psychodynamic psychotherapy received the lowest Endorsement and preference. There was a modest influence of prior knowledge of a treatment.     

Development and validation of the self-harm reasons questionnaire

Understanding the reasons for self-harm (SH) may be paramount for the identification and treatment of SH behavior. Presently, the psychometric properties for SH reason questionnaires are generally unknown or tested only in non-inpatient samples. Existing inpatient measures may have limited generalizability and do not examine SH apart from an explicit intent to die. The present study examined a newly developed, self-report measure of reason for self-harm. The Self-Harm Reasons Questionnaire (SHRQ) was administered to 143 undergraduate students. Results indicated that SH reasons covaried in meaningful and internally consistent ways, with subgroups of SH reasons correlating with hypothesized concomitants of SH, such as depressive symptoms. Findings have implications for prevention and intervention and the SHRQ offers a new, albeit preliminary, means by which to examine SH reasons in a non-inpatient sample.     

Interpersonal Style and Hypothetical Treatment Choice Among Survivors of Intimate Partner Violence

Individual differences between women victimized by intimate partner violence (IPV) may account for whether they choose to seek treatment and what kind of treatment they might prefer. Recent research has highlighted the importance of interpersonal warmth and dominance on women’s response to IPV, although this has not yet been extended to area of treatment choice in the aftermath of IPV victimization. In this study, we examined the association between interpersonal warmth and dominance on four choices of hypothetical treatment (individual therapy only, medication only, combined therapy and medication, and no treatment) in a sample of young adult women victimized by IPV (N = 117). Results indicated that the majority of women would choose therapy (with or without medication) and that interpersonal warmth was negatively associated, and dominance positively associated, with a preference for medication only. These findings extend previous research on both treatment choice and interpersonal style within the context of IPV.     

Women and Their Body Hair

A major component of "femininity" in the United States today is a hairless body, a norm that developed in the United States between 1915–1945. Little has been written regarding the development of this norm, and virtually no empirical research has been done to assess how universally ascribed to is this standard or why women actually remove their leg and underarm hair. More than 200 women from two national professional organizations responded to a mailed questionnaire (response rate 56%). The majority (around 80%) remove their leg and/or underarm hair at least occasionally. Two types of reasons for shaving emerged: feminine/attractiveness reasons and social/normative reasons. Most women start shaving for the latter reasons but continue to shave for the former reasons. Certain groups, however, were least likely to remove leg and/or underarm hair: strongly feminist women and self-identified lesbians. The results of the study are discussed in terms of the function the hairlessness norm may serve in our culture.     

Factors Underlying Behavioral Choice: Testing a New Reasons Theory Approach1

Many applied studies ask people to rate reasons why they perform a behavior. The assumption is that strongly endorsed reasons are motives underlying behavior. However, this assumption rarely is examined empirically. Moreover, the self-reported reasons literature has lacked theoretical attention. In this study, we presented a formal model of self-reported reasons, entitled reasons theory (RT). RT formally conditions reason type (i.e., reasons for and reasons against) on behavioral frequency/intention. RT was compared to a standard reasons approach that does not present formal reason postulates. Results showed that RT explained variance in behavior over and above that explained by standard reasons, and that correlational coefficients from RT better matched mean reason results than did standard reasons. RT results were also more substantively interpretable than were standard reasons. Lastly, several boundary conditions were discussed, including the relationship between reasons and emotions.     

IS SEXUAL ORIENTATION A MATTER OF CHOICE?

Ninety women in lesbian and heterosexual couples were compared on relationship values, views of same-gender and cross-gender intimate relationships, and perceived choice of sexual orientation. Both groups reported similar values, levels of self-esteem, and capacity for intimacy. The majority in both groups described their relationships with women as more emotionally and intellectually intimate than those with men. A majority of women in lesbian couples (58%) and a third of women in heterosexual couples reported choosing the orientation of their current sexual relationship. Women with male partners did not perceive major differences between homosexual and heterosexual relationships, citing sexual attraction as the primary reason they chose a male partner. In contrast, many women with female partners characterized lesbian relationships as more intimate and equal, and less gender-role stereotyped, frequently citing these characteristics, along with sexual attraction, as reasons for their relationship preference.     

“Phobie à deux” and other reasons why clinicians do not apply exposure with response prevention in patients with obsessive–compulsive disorder

Meta-analyses suggest that exposure with response prevention (ERP) is the most efficacious treatment for obsessive–compulsive disorder (OCD) and treatment guidelines for the disorder accordingly recommend ERP. Despite this, many therapists, including those with a cognitive-behavioral therapeutic background, do not perform ERP in patients with OCD. The present study aimed to elucidate the reasons why. German therapists (N = 216) completed an anonymous online survey, the newly developed Reasons for Not Performing Exposure in OCD Scale (REPEX), that inquired whether, to what extent, and how they perform ERP in the treatment of OCD. We also asked their reasons for not applying ERP in the past. Most therapists considered ERP an efficient treatment for OCD. Marked differences emerged between physicians and psychologists, however. The former used exposure less often and for a shorter period, preferred in sensu to in vivo exposure, and conducted exposure less often in the personal environment of the patient than did psychologists. Both groups were familiar with clinical guidelines to a similar extent. A factor analysis of the REPEX scale revealed five factors. Patient lack of motivation, preference for exposure to be self-help as well as alleged organizational difficulties were endorsed most often. The latter was correlated with the age of the therapist and was far more often affirmed by physicians. Fear of side effects was named by a subgroup of clinicians; in the context of patient ambivalence, this may foster “phobie à deux”. Unlike prior research, lack of expertise was rarely identified as a reason not to use ERP. Recommendations for improving adherence to guidelines are discussed.     

Reasons as explanations

Can a normative reason be understood as a kind of explanation? I here consider and argue against two important analyses of reasons as explanations. John Broome argues that we can analyze reasons in terms of the concepts of explanation and ought. On his view, reasons to ? are either facts that explain why one ought to ? (what he calls “perfect reasons”) or facts that play a for-? role in weighing explanations (what he calls “pro tanto reasons”). I argue against Broome’s account of both perfect and pro tanto reasons. Other philosophers, including Joseph Raz, analyze reasons in terms of the concepts of explanation and good. On this view, some fact is a reason to ? if and only if that fact explains why ?-ing would be good in some respect, to some degree. This view avoids the objections to Broome’s view, but should be rejected since not all explanations of why ?-ing would be good constitute reasons to ?.     

"Replacing" problem behavior: an analysis of tactical alternatives

A number of textbooks and professional volumes in applied behavior analysis suggest that interventions designed primarily to decrease a problem behavior should routinely be accompanied by efforts to increase the frequency of at least one appropriate behavior. Some sources describe the objective of this tactic as "replacing" the problem behavior. This paper considers rationales that might underlie this advice, as well as reasons why a general rule to this effect is inappropriate. This review reveals that although there may well be good reasons for considering this tactic, their rationales are often not well articulated and may even be unsound. It is also the case that there are good reasons why this tactic may not always be necessary, thus conflicting with an argument for a general rule.     

Ovulation leads women to perceive sexy cads as good dads

Why do some women pursue relationships with men who are attractive, dominant, and charming but who do not want to be in relationships--the prototypical sexy cad? Previous research shows that women have an increased desire for such men when they are ovulating, but it is unclear why ovulating women would think it is wise to pursue men who may be unfaithful and could desert them. Using both college-age and community-based samples, in 3 studies we show that ovulating women perceive charismatic and physically attractive men, but not reliable and nice men, as more committed partners and more devoted future fathers. Ovulating women perceive that sexy cads would be good fathers to their own children but not to the children of other women. This ovulatory-induced perceptual shift is driven by women who experienced early onset of puberty. Taken together, the current research identifies a novel proximate reason why ovulating women pursue relationships with sexy cads, complementing existing research that identifies the ultimate, evolutionary reasons for this behavior.     

Reasons for substance use among people with psychotic disorders: method triangulation approach

Substance use disorders (SUD) are common among people with psychotic disorders and are associated with many negative consequences. Understanding the reasons for substance use in this population may allow for the development of more effective prevention and intervention strategies. We examined reasons for tobacco, alcohol, or cannabis use among people with psychotic disorders. Sixty-four participants with a diagnosed psychotic disorder completed a self-report reasons for use questionnaire. A subset of eight participants completed semi-structured qualitative interviews. Both the qualitative and quantitative data indicated that reasons for use of tobacco, alcohol, and cannabis differed considerably. Tobacco was primarily used for coping motives, alcohol for social motives, and cannabis for pleasure enhancement motives. Prevention and intervention strategies targeting coexisting psychotic disorders and SUD may improve in effectiveness if they address the perceived beneficial effects of tobacco use, the strong social pressures influencing alcohol use and if they encourage cannabis users to seek alternative pleasurable activities.     

Religious conversion among high security hospital patients: a qualitative analysis of patients’ accounts and experiences on changing faith

Research has shown the importance of religion in recovery from mental illness. Previous studies have investigated why individuals change faith during custody in prison, but there has been no research to date on religious conversion in forensic-psychiatric hospitals. The aim of this study was to understand the experience of religious conversion among patients detained in a UK secure hospital. Thirteen patients who had converted their religion were interviewed and the resultant data were analysed using thematic analysis. Three superordinate themes (“reasons for changing faith”, “benefits of having a new faith” and “difficulties with practising a faith”), incorporating eight subordinate themes, emerged. Understanding patients’ reasons for religious conversion is important for the treatment and support not merely of these individuals, but more broadly with patients in forensic-psychiatric care.     

Reasons and impossibility

In this paper, I argue that a person can have a reason to do what she cannot do. In a nutshell, the argument is that a person can have derivate reasons relating to an action that she has a non-derivative reason to perform. There are clear examples of derivative reasons that a person has in cases where she cannot do what she (non-derivatively) has reason to do. She couldn’t have those derivative reasons, unless she also had the non-derivative reason to do what she cannot do. I discuss a number of objections to this view, in particular two: (1) The objection that if there were reasons to do what one cannot do, many of those would be ‘crazy reasons’, and (2) the worry that if there were such reasons, then agents would have reasons to engage in futile deliberations and tryings. I develop an explanation of ‘crazy reasons’ that shows that not all reasons to do the impossible are crazy and only those that are need to be filtered out, and, regarding the second objecting, I show that the reasons for trying as well as for taking the means to doing something—instrumental reasons in a broad sense—are different from the reasons for performing the action in the first place. They are affected by impossibility, and we can explain why that is so. The view I argue for is that a person may have a reason to do what she cannot do, but she does not have a reason to try to do so or to take means to realizing the impossible.     

Large,Prospective Analysis of the Reasons Patients Do Not Pursue <Emphasis Type="Italic">BRCA</Emphasis> Genetic Testing Following Genetic Counseling

Genetic counseling (GC) and genetic testing (GT) identifies high-risk individuals who benefit from enhanced medical management. Not all individuals undergo GT following GC and understanding the reasons why can impact clinical efficiency, reduce GT costs through appropriate identification of high-risk individuals, and demonstrate the value of pre-GT GC. A collaborative project sponsored by the Michigan Department of Health and Human Services prospectively collects anonymous data on BRCA-related GC visits performed by providers in Michigan, including demographics, patient/family cancer history, GT results, and reasons for declining GT. From 2008 to 2012, 10,726 patients underwent GC; 3476 (32.4%) did not pursue GT. Primary reasons included: not the best test candidate (28.1%), not clinically indicated (23.3%), and insurance/out of pocket cost concerns (13.6%). Patient disinterest was the primary reason for declining in 17.1%. Insurance/out of pocket cost concerns were the primary reason for not testing in 13.4% of untested individuals with private insurance. Among untested individuals with breast and/or ovarian cancer, 22.5% reported insurance/out of pocket cost concerns as the primary reason for not testing and 6.6% failed to meet Medicare criteria. In a five-year time period, nearly one-third of patients who underwent BRCA GC did not pursue GT. GT was not indicated in almost half of patients. Insurance/out of pocket cost concerns continue to be barriers.     

"Moralism" and the Gender Gap: Judgments of Political Ethics in Japan

This article investigates whether women are, as many claim, "moralists"—that is, moral and ethical standard-setters who seek clean politics and have strict standards for public officials. An analysis of data from the 1996 Japanese Elections and Democracy Study survey and from 18 focus groups conducted in 1996 indicates that women in Japan are not moralists. As elsewhere, there is a gender gap in Japan on "issue preference sets," with women favoring a "care" agenda, but women assign political ethics less importance than do men, even though women are more likely to see adverse effects from political corruption. Studying people's judgments of four ethics scenarios reveals minimal gender gaps; controlling for education and age, women's judgments overall are less, not more, strict than men's. Among women, age is a better predictor of moralism than education; older women are stricter than younger women on political ethics. This is attributed to gender-based differences in moral reasoning: Japanese women and men both rely heavily on a "relation-based" frame (which is situation-specific and requires extensive social information), but gender stratification patterns create information inequalities. Younger women lack social information necessary for judging political misconduct, whereas older women overcome the information deficit through life experience.