The Infertility Resilience Model: Assessing Individual,Couple, and External Predictive Factors

Resilience in couples experiencing infertility is critical to decrease the impact of infertility-related stress and sustain positive interactions and collective perceptions in couples. The Infertility Resilience Model (IRM) presented in this article provides a framework within which various individual, couple, and external factors that influence resilience can be understood. Although numerous approaches have been applied to infertility, few of them have examined resilience and the interconnections between individual, couple, and external influences. The concepts and connections within the model can be used by clinicians for assessment and interventions when working with couples facing infertility.     

Examining congruence between partners' perceived infertility-related stress and its relationship to marital adjustment and depression in infertile couples

Because studies examining the emotional impact of infertility-related stress generally focus on individuals, there has been little research examining how relationship and individual variables are linked. The purpose of this study was to explore the impact of congruence (e.g., agreement) between partner's perceived infertility-related stress and its effects on depression and marital adjustment in infertile men and women. Couples referred for infertility treatments at a University-affiliated teaching hospital completed the Fertility Problem Inventory (FPI), the Beck Depression Inventory (BDI), and the Dyadic Adjustment Scale (DAS) 3 months prior to their first treatment cycle. Study findings show that men and women in couples who perceived equal levels of social infertility stress reported higher levels of marital adjustment when compared to men and women in couples who perceived the stress differently. In addition, women in couples who felt a similar need for parenthood reported significantly higher levels of marital satisfaction when compared to women in couples where the males reported a greater need for parenthood. While couple incongruence was unrelated to depression in males, incongruence over relationship concerns and the need for parenthood was related to female depression. These findings provide initial support for the theory that high levels of agreement between partners related to the stresses they experience help them successfully manage the impact of these stressful life events. Possibilities for future research examining the construct of couple congruence are discussed.     

Emotional Reactions and Attitudes Prior to In Vitro Fertilization: An Inter-Spouse Study

In this study, spouse's emotional responses and attitudes to in vitro fertilization (IVF) treatment were examined. The participants were 113 childless couples who suffered from infertility of unknown or mechanical (women) cause. Both partners were evaluated prior to IVF treatment. Incompatible emotional responses and attitudes to the treatment between the partners usually reflected the men reporting less distress and worries than women. Women had significantly higher state and trait anxiety and depression scores than normative levels, irrespective of whether they were successful in conceiving. Husbands of conceiving women scored higher on depression than husbands of nonconceiving women. The nonconceiving husbands had depression and trait anxiety scores significantly lower than the normative level. In addition, high emotional responses to the treatment, especially in men, were positively associated with treatment success. Recommendations for family assessment and counseling are suggested on the basis of these results.     

Using Acceptance and Commitment Therapy to Treat Distressed Couples: A Case Study With Two Couples

Although the field of couple therapy has made significant strides in recent years, there continues to be a need for theoretically sound and empirically supported treatments. The current case study examines whether Acceptance and Commitment Therapy (ACT), an experiential acceptance-based behavior therapy, can be effective in treating distressed couples. Although ACT has demonstrated effectiveness in treating a variety of disorders in individuals, it has not been systemically applied to the treatment of couple distress, and the current study is the first empirical examination of ACT for the treatment of couples. Two married couples participated in the study. A number of core ACT interventions were modified to treat couples in a conjoint format. Cognitive defusion exercises were used to help couples reduce their fusion with and the believability of negative thoughts and feelings related to the relationship. Mindfulness and acceptance techniques were used to help couples increase awareness of their reactions to negative relationship cycles. Finally, value-directed action was used to help partners act in ways consistent with relationship values even in the presence of unwanted thoughts and feelings. The results of this preliminary case study suggest that ACT may be effective in increasing marital adjustment and satisfaction, and in reducing interpersonal and psychological distress in couples. Future studies with larger samples and more controlled designs are needed to build on the results from this single-case study.     

The Meaning of Childbearing Among IVF Service Users Assessed via Laddering Technique

The psychosocial issues related to infertility have been widely researched. However, the meaning a couple gives to childbearing remains a relatively unexplored area. This study explores the meaning making of Hong Kong Chinese couples who had received in-vitro fertilization (IVF). Eleven IVF-successful and seven IVF-unsuccessful informants were assessed using two complementary constructivist methods: laddering technique and constructivist-grounded theory analysis of in-depth interviews. Findings revealed four aspects of symbolic meaning of childbearing focused on the informant's sense of self, cultural values, existential purpose, and relations with others. The results also depicted infertility as a form of disenfranchised grief, following ambiguous loss, underscoring the need for counselors to explore the meaning of childbearing among IVF service users and the impact on their self-narratives as a function of treatment outcome.     

The Mediator Role of Emotion Regulation Processes on Infertility-Related Stress

The objective of this study is to investigate gender differences regarding the mediator role of self-compassion and self-judgment on the effects of external shame, internal shame, dyadic adjustment, on infertility-related stress. One hundred and sixty-two women and 147 men with a primary infertility diagnosis completed the following set of self-report measures: Others as Shamer, Experience of Shame Scale, Dyadic Adjustment Scale, Self-Compassion Scale, and Fertility Problem Inventory. Path analyses results revealed that in women self-compassion fully mediated the effect of internal shame on infertility-related stress and partially mediated the effect of dyadic adjustment on this variable, while external shame had only a direct effect. In men self-judgment fully mediated the effect of external and internal shame on infertility-related stress. Dyadic adjustment had only a direct effect on infertility-related stress. In conclusion, there is a distinct role of self-compassion and self-judgment on the relationship between shame and infertility-related stress in men and women. Such differences should be taken into account in psychological interventions with these patients. Future research is warranted to further support our results.     

Acceptance and Commitment Therapy for Self-Stigma Around Sexual Orientation: A Multiple Baseline Evaluation

This study evaluated the effectiveness of 6 to 10 sessions of Acceptance and Commitment Therapy (ACT) for self-stigma around sexual orientation linked to same-sex attraction (what has generally been referred to as internalized homophobia; IH) in a concurrent multiple-baseline across-participants design. Three men and 2 women showed sizeable reductions from baseline to posttreatment and to 4- and 12-week follow-ups in daily reports of the degree to which thoughts about sexual orientation interfered in their lives; distress associated with these thoughts also decreased. Positive changes were observed in self-report measures of IH, depression, anxiety, stress, quality of life, and perceived social support. Consistent with the theory underlying ACT, reductions in daily ratings of the believability of thoughts about same-sex attraction (a process variable) were greater than those observed for frequency of such thoughts. Improvements were also observed in questionnaires measuring ACT processes. Mixed regression analyses confirmed outcome and process effects that were apparent through visual inspection. Implications and the distinctiveness of ACT as an approach are discussed.     

GENDER'S ROLE IN RESPONSES TO INFERTILITY

Infertility is a major life stressor that affects approximately 10% of U.S. married couples. Infertile women and men have reported experiencing depression, helplessness, and marital strain. Given U.S. society's emphasis on women's role as mothers, it has been suggested that women's lives are more disrupted by infertility than those of men. This hypothesis was supported in a survey of 185 infertile couples and 90 presumed fertile couples. Infertile wives, as compared to their husbands, perceived their fertility problem as more stressful, felt more responsible for and in control of their infertility, and engaged in more problem-focused coping. Infertile husbands experienced more home life stress and lower home life performance than did their wives. These differences were not found for presumed fertile couples. Both infertile and presumed fertile wives experienced more depression, more sexual dissatisfaction, and lower self-esteem than did their husbands. Theoretical and counseling implications of these findings are discussed.     

The effects of anxiety and depression on in vitro fertilisation outcomes of infertile Chinese women

The object was to assess anxiety and depression during in vitro fertilisation (IVF) treatment and determine IVF-related psychological factors in infertile Chinese women. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate anxiety and depression among 842 patients, respectively. A univariate analysis was used to compare variables among three SAS groups and three SDS groups. Anxiety and depression were both represented in 21.3% of the cases. Patients <35 years tended to be more anxious. In women <35 years, the SDS scores were higher with lower educational backgrounds and female or couple’s infertility, while the SAS scores were higher in female or couple’s infertility. In older ones, the SDS scores were higher in those with lower educational backgrounds and longer time for infertility, while the SAS scores were higher in those with lower educational backgrounds. In SAS groups 1–3, the embryo availability was 5.0 (3.0–8.0), 5.0 (3.0–8.0), and 3.0 (2.0–4.5) (p = .013); and the fertilisation rate was 91.9, 90.4, and 81.8% (p < .001), respectively. We concluded that infertile women experience anxiety and depression during IVF treatment, especially in women <35 years. Younger women with female infertility would be more anxious and depressive while higher education can protect them from depression. In older ones, they would experience more depressive with longer time for infertility and be less anxious and depressive with higher education. Anxiety affects the fertilisation rate and embryo availability.     

Improvements in Depression and Mental Health After Acceptance and Commitment Therapy are Related to Changes in Defusion and Values-Based Action

Acceptance and commitment therapy (ACT) has been found to be effective for various mental health disorders but the processes through which it affects change remain unclear. Much process research in the area is on physical rather than mental health, and focuses on the broad concept of psychological flexibility with little research on specific mechanisms identified in theory such as fusion and values. This study explored whether there was a relationship between two of the main ACT processes (cognitive defusion and values) and levels of depression and distress. Thirty-three participants completed questionnaires at the start and end of their treatment measuring general mental health and distress, depression, levels of cognitive fusion and how much they were living in line with their values and how important their values were to them. Results showed reductions in levels of fusion and increases in values-based action were significantly related to reductions in distress and depression. There was no correlation between changes in values importance and changes in distress or depression. This study therefore suggests decreased defusion and increased values-based action is an important mechanism in the efficacy of ACT in those with depression and mental health problems. The study is however limited by a small sample size and future research with a sample large enough for mediation analysis would be beneficial.     

Attitudes of Employed Women Toward Parents Who Choose Full-Time or Part-Time Employment Following Their Child's Birth

Perceptions of married parents were examined as a function of their gender and their employment status following their child's birth. Women employed in hourly staff positions at a university (92% White, 8% African American, Asian American, or Hispanic American) evaluated a briefly described married employed parent on thirty-one 7-point bipolar scales that described nurturance behaviors, job performance characteristics, role overload variables, and personal adjustment characteristics. Each participant rated one of four parents portrayed as either a mother or a father who, following their child's birth, either continued to work full-time or reduced her/his work hours. Full-time employees were perceived as experiencing more stress and as being less family-oriented than reduced-hour employees. Mothers were viewed as better adjusted but as experiencing more stress than fathers.     

Using Acceptance and Commitment Therapy During Methadone Dose Reduction: Rationale,Treatment Description,and a Case Report

Many clients who undergo methadone maintenance (MM) treatment for heroin and other opiate dependence prefer abstinence from methadone. Attempts at methadone detoxification are often unsuccessful, however, due to distressing physical as well as psychological symptoms. Outcomes from an MM client who voluntarily participated in an Acceptance and Commitment Therapy (ACT)–based methadone detoxification program are presented. The program consisted of a 1-month stabilization and 5-month gradual methadone dose reduction period, combined with weekly individual ACT sessions. Urine samples were collected twice weekly to assess for use of illicit drugs. The participant successfully completed the program and had favorable drug use outcomes during the course of treatment, and at the 1-month and 1-year follow-ups. Innovative behavior therapies, such as ACT, that focus on acceptance of the inevitable distress associated with opiate withdrawal may improve methadone detoxification outcomes.     

Assessing Couple Therapy as a Treatment for Individual Distress: When is Referral to Couple Therapy Contraindicated?

In order to better understand the effects of initial level of psychological disturbance on treatment outcome, a retrospective case control study of 95 couples who received couple therapy was conducted by sorting couples into one of four groups based on the degree of distress reported by individuals at intake: Neither distressed; both distressed; male distressed, female not distressed; female distressed, male not distressed. When partners started treatment with similar levels of disturbance both responded well in couple therapy. However, if the female reported clinical levels of disturbance at intake but her partner did not, outcome for the female was especially poor in contrast to outcomes for females receiving individual therapy. Clinically disturbed males showed significant gains in treatment even when their partners were not disturbed. These suggestive results argue for the possible value of conducting controlled studies of treatment assignment decisions that maximize positive outcomes.     

Infertility-Related Stress and Life Satisfaction among Chinese Infertile Women: A Moderated Mediation Model of Marital Satisfaction and Resilience

The present study investigated the effects of infertility on Chinese women’s life satisfaction. Infertile women (n?=?466) who were seeking medical help completed a survey that included the Fertility Problem Inventory (FPI), the Dyadic Adjustment Questionnaire (DAS), the Connor-Davidson Resilience Scale (CD-RISC), the Satisfaction with Life Scale, and demographic variables. We used a moderated mediation model to test our hypotheses, with life satisfaction as the dependent variable, representations about the importance of parenthood as the independent variable, the impact of infertility on life domains as a mediator, and marital satisfaction and resilience as moderators. Results showed that representations about the importance of parenthood and the impact of infertility on life domains are two main types of infertility-related stress, which could play independent roles in predicting life satisfaction. Representations about the importance of parenthood had a negative indirect effect on life satisfaction through the impact of infertility on life domains, and the indirect effect of the impact of infertility on life domains was moderated by marital satisfaction and resilience. Specially, representations about the importance of parenthood had a weaker indirect effect (through the impact of infertility on life domains) on life satisfaction in individuals with higher marital satisfaction or resilience. Therefore, the type of infertility-related stress and both marital satisfaction and resilience should be addressed in psychological interventions for women coping with infertility in mainland China.

     

Improving Psychological Adjustment Among Late-Stage Ovarian Cancer Patients: Examining the Role of Avoidance in Treatment

Data suggest that individuals dealing with a cancer diagnosis are less likely to suffer from depression, anxiety, and psychological distress when they cope with their condition from a stance of emotional and cognitive acceptance (e.g. Dunkel, et al., 1992; Stanton, et al., 2000). Although traditional CBT often includes some acceptance-oriented elements, recent variants of CBT, such as Acceptance and Commitment Therapy (ACT), have acceptance as a central focus. ACT targets emotional distress directly through acceptance of difficult thoughts and emotions. The current study is a preliminary comparison of ACT and treatment as usual (TAU) in the treatment of emotional distress among women with late-stage ovarian cancer. Forty-seven women diagnosed with Stage III or IV ovarian cancer were randomly assigned to one of two treatment conditions. Treatment consisted of 12 face-to-face meetings with a therapist, each following a TAU or ACT protocol. Results indicate that both groups showed improved mood and quality of life following the intervention. The ACT group showed significantly greater improvements compared to the TAU group. Furthermore, mediation analyses indicate that the effects of treatment were mediated by cognitive avoidance. Although the study is limited by the implementation of treatment in both conditions by a single therapist, the TAU group showed improvements that were consistent with effect sizes available in the literature, suggesting that the intervention was a credible and effective control treatment. These findings provide preliminary support for the use of ACT in ovarian cancer populations. Further work is needed to investigate the effectiveness in other oncology populations as well as investigate potential patient characteristics which may interact with these interventions.     

A First-Person Account of Using Mindfulness as a Therapeutic Tool in the Palestinian Territories

This is a personal account of the clinical work done in the Palestinian Territories by a clinical psychologist working with an international medical Non Governmental Organization (NGO). In her interventions the author used mindfulness-based therapy with people who suffered from severe psychological distress due to the political conflict. Such interventions can be therapeutic and heal deep suffering, whilst offering clients coping strategies when possibly facing other traumatic events in a situation of “chronic emergency” such as the one that people have to face in a country that has been under military occupation for over 40 years. Using a case study approach, the author discusses the intervention with two women, one suffering from post-traumatic stress disorder (PTSD) following the loss of her baby after being kept at a military check-point, and the other suffering from depression following the killing of her son. The mindfulness-based intervention allowed them to explore a therapeutic approach which helped them to overcome their symptoms and “get unstuck”.     

Promoting infant well‐being in the context of maternal depression by supporting the father

Maternal depression is recognized as posing a significant risk to the healthy development of infants. Guided by attachment theory, interventions have focused on the distressed mother's relationship with her infant. While interventions which include fathers are reported in the literature, the processes involved in the fathers' support of a distressed mother and in his interactions with his infant in the context of maternal depression remain unexplored. In the case study described here, home‐visiting support was directed to the father in a couple in which the mother had been treated for depression after the birth. The observed effects of the intervention on father–infant interaction and the “knock‐on” effects on the mothers' parenting suggest that targeting support to fathers in distressed families should be considered. Points for a service protocol are provided to incorporate fathers into the identification and treatment of maternal distress.     

In vitro fertilization and the family: quality of parenting, family functioning, and child psychosocial adjustment

This study examined associations between homologous in vitro fertilization (IVF) and quality of parenting, family functioning, and emotional and behavioral adjustment of 3-7-year-old children. A cross-sectional survey was conducted in Taiwan with 54 IVF mother-child pairs and 59 mother-child pairs with children conceived naturally. IVF mothers reported a greater level of protectiveness toward their children than control mothers. Teachers, blind to condition, rated IVF mothers as displaying greater warmth but not overprotective or intrusive parenting behaviors toward their children. Teachers scored children of IVF as having fewer behavioral problems than control children. In contrast, IVF mothers reported less satisfaction with aspects of family functioning. Family composition moderated parenting stress: IVF mothers with only 1 child perceived less parenting stress than did those in the control group.     

Coping and psychological distress for men with substance use disorders

Coping with stress is a major focus for chemically dependent persons in relapse prevention programs. The relationships among coping and psychological distress were investigated in 71 men with substance use disorders, at both pre—and post-treatment. It was predicted that low task-oriented coping, high emotion-oriented coping, and high avoidance-oriented coping would predict psychological distress (e.g., anxiety and depression). It was also expected that use of task-oriented coping would increase following treatment and that use of emotion-oriented coping and avoidance-oriented coping, and reported levels of psychological distress would all decrease following treatment. Participants completed the Coping Inventory for Stressful Situations and the General Health Questionnaire, took part in an intensive treatment program (e.g., relaxation, drug education, stress management) and completed these questionnaires again following treatment. Results indicated that high emotion-oriented coping predicted hypochondriasis, anxiety and depression. Task-oriented and avoidance-oriented coping did not predict psychological distress, although task-oriented coping was negatively related to hypochondriasis, anxiety and depression. The results regarding change in coping styles and levels of psychological distress were as hypothesized, except that avoidance-oriented coping did not significantly change following treatment. Theoretical and practical implications of the research are discussed.     

Coping and psychological distress for men with substance use disorders

Coping with stress is a major focus for chemically dependent persons in relapse prevention programs. The relationships among coping and psychological distress were investigated in 71 men with substance use disorders, at both pre—and post-treatment. It was predicted that low task-oriented coping, high emotion-oriented coping, and high avoidance-oriented coping would predict psychological distress (e.g., anxiety and depression). It was also expected that use of task-oriented coping would increase following treatment and that use of emotion-oriented coping and avoidance-oriented coping, and reported levels of psychological distress would all decrease following treatment. Participants completed the Coping Inventory for Stressful Situations and the General Health Questionnaire, took part in an intensive treatment program (e.g., relaxation, drug education, stress management) and completed these questionnaires again following treatment. Results indicated that high emotion-oriented coping predicted hypochondriasis, anxiety and depression. Task-oriented and avoidance-oriented coping did not predict psychological distress, although task-oriented coping was negatively related to hypochondriasis, anxiety and depression. The results regarding change in coping styles and levels of psychological distress were as hypothesized, except that avoidance-oriented coping did not significantly change following treatment. Theoretical and practical implications of the research are discussed.