The Problematization of Sexuality among Women Living with HIV and a New Feminist Approach for Understanding and Enhancing Women’s Sexual Lives

In the context of HIV, women’s sexual rights and sexual autonomy are important but frequently overlooked and violated. Guided by community voices, feminist theories, and qualitative empirical research, we reviewed two decades of global quantitative research on sexuality among women living with HIV. In the 32 studies we found, conducted in 25 countries and composed mostly of cis-gender heterosexual women, sexuality was narrowly constructed as sexual behaviours involving risk (namely, penetration) and physiological dysfunctions relating to HIV illness, with far less attention given to the fullness of sexual lives in context, including more positive and rewarding experiences such as satisfaction and pleasure. Findings suggest that women experience declines in sexual activity, function, satisfaction, and pleasure following HIV diagnosis, at least for some period. The extent of such declines, however, is varied, with numerous contextual forces shaping women’s sexual well-being. Clinical markers of HIV (e.g., viral load, CD4 cell count) poorly predicted sexual outcomes, interrupting widely held assumptions about sexuality for women with HIV. Instead, the effects of HIV-related stigma intersecting with inequities related to trauma, violence, intimate relations, substance use, poverty, aging, and other social and cultural conditions primarily influenced the ways in which women experienced and enacted their sexuality. However, studies framed through a medical lens tended to pathologize outcomes as individual “problems,” whereas others driven by a public health agenda remained primarily preoccupied with protecting the public from HIV. In light of these findings, we present a new feminist approach for research, policy, and practice toward understanding and enhancing women’s sexual lives—one that affirms sexual diversity; engages deeply with society, politics, and history; and is grounded in women’s sexual rights.     

The Differential Role of Anxiety Sensitivity and its Components in the Relation between Emotional Nonacceptance and Anxiety and Depressive Symptoms and Disorders among Latinos in Primary Care

The present investigation examined anxiety sensitivity (AS) in the relation between emotional nonacceptance (unwillingness to experience unwanted emotions) and mood and anxiety symptoms among Latinos seeking health services at a primary healthcare facility. Participants included 267 adult Latinos (85.4% female; Mage = 38.8 years, SD = 10.7, and 95.9% used Spanish as their first language). Results indicated that emotional nonacceptance was indirectly related to number of mood and anxiety disorders, anxious arousal, social anxiety, and depressive symptoms through AS. The observed effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and negative affectivity. Using a multiple mediation model revealed that the AS cognitive, physical, and social concerns demonstrated unique incremental explanatory effects (above and beyond the other two AS sub-scales) for depressive, anxious arousal, and social anxiety symptoms, respectively. Thus, specific sub-scales of AS were uniquely related with the expression of particular affective symptom domains. Overall, the present findings suggest that there is merit in focusing further scientific attention on the interplay between nonacceptance and AS in regard to better understanding and intervening to reduce anxiety/depressive vulnerability among Latinos in primary care.     

Sleep Quality and the Subjective Experience of Autobiographical Memory: Differential Associations by Memory Valence and Temporality

The primary goal of the present research was to examine associations between sleep quality and the subjective experience of autobiographical events. In an online study, 141 university students reported on past events that varied by valence (positive or negative) and temporality (most significant or from the previous 2 weeks); they also completed measures of sleep quality and depression. Relative to participants with good sleep quality, participants with poor sleep quality thought more about their negative experiences, reported negative events that occurred more frequently, and used more negative emotion words when describing recent negative events. In some instances, depressive symptoms mediated the relation between sleep quality and elements of autobiographical reports. Future experimental work should examine the directionality of these effects, with the ultimate goal of improving sleep quality, mental health, and the manner in which individuals discuss and make meaning of their negative life events. Copyright © 2017 John Wiley & Sons, Ltd.     

A Rapid Systematic Review of Outcomes Studies in Genetic Counseling

As healthcare reimbursement is increasingly tied to value-of-service, it is critical for the genetic counselor (GC) profession to demonstrate the value added by GCs through outcomes research. We conducted a rapid systematic literature review to identify outcomes of genetic counseling. Web of Science (including PubMed) and CINAHL databases were systematically searched to identify articles meeting the following criteria: 1) measures were assessed before and after genetic counseling (pre-post design) or comparisons were made between a GC group vs. a non-GC group (comparative cohort design); 2) genetic counseling outcomes could be assessed independently of genetic testing outcomes, and 3) genetic counseling was conducted by masters-level genetic counselors, or non-physician providers. Twenty-three papers met the inclusion criteria. The majority of studies were in the cancer genetic setting and the most commonly measured outcomes included knowledge, anxiety or distress, satisfaction, perceived risk, genetic testing (intentions or receipt), health behaviors, and decisional conflict. Results suggest that genetic counseling can lead to increased knowledge, perceived personal control, positive health behaviors, and improved risk perception accuracy as well as decreases in anxiety, cancer-related worry, and decisional conflict. However, further studies are needed to evaluate a wider array of outcomes in more diverse genetic counseling settings.     

Revised Provisional Diagnostic Profile: 2016

ABSTRACT

In Anna Freud’s and other previous versions of the diagnostic profile, drive theory and the structural model were the central organizing concepts. Though these are retained in the current version, greater emphasis has been made of other conceptual perspectives. In particular, the importance of understanding the impact of the child’s external world and the child’s attachment security; also the central importance of affects, both their recognition and management. These changes are seen in such sections as those on the ego which has been expanded to include a section on play and affects. The developmental line of anxiety and the concept of theory of mind have also been added.     

Comparison of scores for abused and nonabused young adults on the Psychological Trauma and Resources Scale

The Psychological Trauma and Psychological Resources Scale has been developed to identify adolescents and adults who have experienced traumatic events, i.e., physical, sexual, or emotional abuse and neglect. The scale also attempts to identify the presence of compensatory or resource factors such as social support that may serve to ameliorate the effects of traumatic events. 98 college participants who reported a history of abuse were compared with 464 nonabused students on the seven subscales. As predicted, the abused participants reported significantly more incidents of abuse and neglect than the nontraumatized group. In addition, the abused group reported receiving less emotional support, and they were less likely to use positive self-talk as a way to decrease emotional distress. These results provide empirical support for using the Psychological Trauma and Psychological Resources Scale to identify individuals with a history of abuse. Findings underscore the importance of assessing resource variables that may moderate the effects of abuse.     

Death anxiety and sexual risk-taking: different manifestations of the process of defense

College students(n = 162) completed measures of death anxiety and sexual risk-taking, with a thought listing procedure in-between. Those who completed the death anxiety measure first (Death Salient condition) reportedgreater willingness to engage in high-risk sexual behavior than the Non-Death Salient group. This result was consistent with the hypothesis that evoking death anxiety would produce denial-based defensive activity. Also, Death Salient participants reporting more death thoughts were lower on risk-taking, as predicted. Interestingly, Death Salient participants reporting stressful thoughts about issues unrelated to personal mortality (displacement) were also less willing to engage in high-risk sexual behavior. The results are discussed in relation to a new, avowal-based model of the process of psychological defense.     

One process is not enough! A speed-accuracy tradeoff study of recognition memory

Speed-accuracy tradeoff (SAT) methods have been used to contrast single- and dual-process accounts of recognition memory. In these procedures, subjects are presented with individual test items and are required to make recognition decisions under various time constraints. In this experiment, we presented word lists under incidental learning conditions, varying the modality of presentation and level of processing. At test, we manipulated the interval between each visually presented test item and a response signal, thus controlling the amount of time available to retrieve target information. Study— test modality match had a beneficial effect on recognition accuracy at short response-signal delays (≤300msec). Conversely, recognition accuracy benefited more from deep than from shallow processing at study only at relatively long response-signal delays (≥300 msec). The results are congruent with views suggesting that both fast familiarity and slower recollection processes contribute to recognition memory.     

Neuroimaging studies in eating disorders

The understanding of the eating disorders (EDs) anorexia (AN) and bulimia nervosa (BN) has undergone remarkable advancements in the past decade. Most studies that have been done in AN show brain gray and white matter volume loss during the ill state that, at least in part, remit with recovery. Similar patterns occur for brain phospholipids assessed using magnet resonance spectroscopy (MRS). Imaging studies have been used to provide functional information regarding serotonin neuroreceptor dynamics, regional cerebral blood flow, or cerebral glucose metabolism. Such studies have implicated cingulate, frontal, temporal, and parietal regions in AN. Investigators have found that challenges such as food and body image distortions may activate some of these regions, raising the possibility that such studies may shed light on puzzling AN symptoms, such as body image distortions or extremes of appetitive behaviors. Emerging data suggest these disturbances persist after recovery from AN, suggesting the possibility that these are traits that may create a vulnerability to develop an ED. While fewer studies have been done in BN or binge eating disorder, there may be disturbances of serotonin metabolism in similar brain regions. Taken together, these findings give promise for future investigations with the hope of delineating brain pathways that contribute to the etiology of EDs