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The pre- and post-therapy measurement of communication skills of couples undergoing sex therapy at the Masters & Johnson Institute.

A battery of five paper and pencil questionnaires designed to measure empirically 10 specific skills hypothesized to be involved in effective interpersonal communication was employed to assess the pre- and post-therapy levels of these skills in couples undergoing treatment for sexual dysfunction at the Masters & Johnson Institute in St. Louis, Missouri. The females exhibited significant increases across the 2-week period of therapy for the following skills: positive assertion in intimate heterosexual peer relationships, assertiveness, verbal expression of feelings, and nonmaterial support and evidence of love. For the males significant increases in the following skills were obtained: assertiveness, verbal expression of feelings, self-disclosure, and tolerance of the less pleasant aspects of the loved one. A significant decrease was observed for the skill entitled feelings not expressed verbally to the loved one. Thus, both the females and males became more assertive and more able to express their feelings openly and thus more able to share more of themselves with their partners as a result of the therapy. These results lend empirical support to Masters and Johnson's theoretical model of communication and to the view that much more than simple behavior therapy is involved in a successful sex therapy program.

Adult↗

To be seen and not heard: femininity ideology and adolescent girls' sexual health.

This study used a feminist developmental framework to test the hypothesis that internalizing conventional ideas about femininity in two domains--inauthenticity in relationships and body objectification--is associated with diminished sexual health among adolescent girls. In this study, sexual health was conceptualized as feelings of sexual self-efficacy (i.e., a girl's conviction that she can act upon her own sexual needs in a relationship) and protection behavior (i.e., from both STIs and unwanted pregnancy). A total of 116 girls (aged 16-19) completed measures of femininity ideology, sexual self-efficacy, sexual experiences, and protection behavior. Results revealed that inauthenticity in relationships and body objectification were associated with poorer sexual self-efficacy and sexual self-efficacy, in turn, predicted less sexual experience and less use of protection. Further, the two components of femininity ideology were associated with different forms of protection. The importance of a feminist developmental framework for identifying and understanding salient dimensions of sexual health for female adolescents is discussed.

Adolescent↗

Words and wards: a model of reflective writing and its uses in medical education.

Personal, creative writing as a process for reflection on patient care and socialization into medicine ("reflective writing") has important potential uses in educating medical students and residents. Based on the authors' experiences with a range of writing activities in academic medical settings, this article sets forth a conceptual model for considering the processes and effects of such writing. The first phase (writing) is individual and solitary, consisting of personal reflection and creation. Here, introspection and imagination guide learners from loss of certainty to reclaiming a personal voice; identifying the patient's voice; acknowledging simultaneously valid yet often conflicting perspectives; and recognizing and responding to the range of emotions triggered in patient care. The next phase (small-group reading and discussion) is public and communal, where sharing one's writing results in acknowledging vulnerability, risk-taking, and self-disclosure. Listening to others' writing becomes an exercise in mindfulness and presence, including witnessing suffering and confusion experienced by others. Specific pedagogical goals in three arenas-professional development, patient care and practitioner well-being - are linked to the writing/reading/listening process. The intent of presenting this model is to help frame future intellectual inquiry and investigation into this innovative pedagogical modality.

Affect↗

How to measure self-management abilities in older people by self-report. The development of the SMAS-30.

This paper presents the results of two studies carried out in order to design and test a self-report instrument to measure Self-Management Ability (the SMAS-30) in aging individuals. SMA refers to the core behavioral and cognitive abilities which presumably contribute to sustainable well-being in later life. Robust findings of the studies (n = 275 and n = 1338) showed that SMA could be measured reliably as a composite concept of abilities systematically linked to dimensions of well-being in adults aged 65 and over, with the different sub-scales revealing a profile of inter-related abilities. A sub-sample of participants in Study 2 (n = 86) showed that the SMAS-30 had high reproducibility over a period of 16 weeks. The validity of the SMAS-30 was supported by meaningful associations with other constructs in both studies. As expected, the older and frailer the people, and the poorer their perceived health, the lower their SMA. Moreover, SMA was positively related to several dimensions of subjective well-being and the related concepts of general self-efficacy and mastery.

Aged↗

Self-reported motivations to change and self-efficacy levels for a group of recidivist drink drivers.

The present study reports on a group of 132 recidivist offenders' stages of change and self-efficacy levels for changing and controlling both their drinking and drink driving behaviours. The majority of the sample reported being motivated to change their drink driving, but not their drinking behaviours. The sample also indicated high self-efficacy levels for the two behaviours, although a notable finding was that participants reported higher levels of control over their drinking rather than drink driving behaviours. Examination of the self-reported frequency of drink driving revealed that both motivations and self-efficacy levels were predictors of past offences and future intentions to drink and drive. The findings have direct implications for the management of repeat offenders, such as the inclusion of rehabilitation and alcohol treatment programs in sentencing outcomes for individuals who appear resistant to change.

Alcohol Drinking↗

More normal than not: a qualitative assessment of the developmental experiences of gay male youth.

PURPOSE: To examine gay youth experiences within the context of normal adolescent development. METHODS: Thematic analyses of interviews with 13 self-identified gay male youth, aged 16-22 years, each reporting minimal sexual identity distress, were completed. Interviews focused on: (a) descriptions of developmental changes perceived to occur for all adolescents, (b) descriptions of the participants' developmental experience, and (c) participants' direct comparisons of their perceptions of gay and nongay developmental experience. Data were analyzed by two investigators who, after initial review of the interview transcripts, developed a unified coding template to permit systematic analysis of the transcripts for recurrent themes. RESULTS: (a) Few (2 of 13) participants reported overall developmental experience markedly different from nongay peers. (b) Peer interaction was seen as the domain most different from that of nongay peers. (c) Open gay self-identification altered, generally positively, all peer interaction. (d) Increased peer interaction enhanced maturity in other domains. (e) Family dynamics were not substantively altered by open gay self-identification. (f) Middle and high school were identified as relatively hostile environments in which to openly identify as gay, affecting the timing and the extent of self-disclosure. (g) Developmental progress showed asynchrony across developmental domains. CONCLUSION: General developmental dysfunction is not inevitable for gay adolescents, nor is identifiable personal or family pathology directly related to sexual identity.

Adaptation, Psychological↗

Hypokalemia leading to torsades de pointes. Munchausen's disorder or bulimia nervosa?

A 45-year-old woman traveled over 1000 miles from a major metropolitan area to obtain another opinion for medically refractory diarrhea. She had an extremely complicated medical history with no outside records or family members accompanying her to give collateral history. She had multiple previous diagnostic evaluations including 13 surgical procedures and many therapeutic trials of various medications. She acknowledged a preoccupation with weight and appearance, described previous attempts to diet, and repetitively denied purging, including laxative abuse. During her hospitalization she had two episodes of torsades de pointes requiring cardiac defibrillation. Laboratory testing revealed hypokalemia at the time of these events, and a toxicology screen was positive for bisacodyl, confirming laxative abuse. When confronted by a combined team of cardiology, gastroenterology, and psychiatry specialist, she admitted her laxative abuse and surrendered her supply of Dulcolax tablets. The discussion addresses the procedures employed to detect her surreptitious medication use, the near lethal cardiac complications, and the appropriate psychiatric diagnosis.

Bulimia↗

Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior.

Self-mutilation occurs in 70-80% of patients who meet DSM-IV criteria for borderline personality disorder. Approximately 60% of these patients report that they do not feel pain during acts of self-mutilation such as cutting or burning. Findings of recent studies measuring pain perception in patients with BPD are difficult to interpret since variables such as distress, dissociation or relevant psychotropic medication have not been controlled. The Cold Pressor Test (CPT) and the Tourniquet Pain Test (TPT) were administered to 12 female patients with BPD who reported analgesia during self-mutilation and 19 age-matched healthy female control subjects. All subjects were free of psychotropic medication. The patients were studied on two occasions: during self-reported calmness and during intensive distress (strong urge to cut or burn themselves). Even during self-reported calmness, patients with BPD showed a significantly reduced perception of pain compared to healthy control subjects in both tests. During distress, pain perception in BPD patients was further significantly reduced as compared with self-reported calmness. The present findings show that self-mutilating patients with BPD who experience analgesia during self-injury show an increased threshold for pain perception even in the absence of distress. This may reflect a state-independent increased pain threshold which is further elevated during stress. Interpretation of these findings is limited by their reliance upon self-reports.

Adult↗

Deviant olfactory experiences, magical ideation, and olfactory sensitivity: a study with healthy German and Japanese subjects.

Little is known about the relationship between olfactory hallucinations and olfactory sensitivity in psychiatric populations. However, in healthy subjects, a 'psychotic-like' feature, namely magical ideation, has been linked to deviant olfactory experiences. We thus assessed olfactory sensitivity, magical ideation and deviant olfactory experiences in 42 healthy subjects (21 Germans and 21 age- and gender-matched Japanese). The results show that: (1) Germans had significantly higher magical ideation scores and a higher frequency of deviant olfactory experiences than Japanese, and more Germans than Japanese reported having had deviant olfactory experiences at least once in their lives; (2) in Germans, the occurrence of deviant olfactory experiences was correlated with higher magical ideation scores; and (3) there was no relationship between olfactory sensitivity (olfactory thresholds) and either deviant olfactory experiences or magical ideation, respectively. We conclude that: (1) the lack of deviant olfactory experiences in Japanese may best be explained by cultural differences in the response attitude towards questionnaires requiring self-disclosure; (2) the positive relationship between magical ideation and deviant olfactory experiences strengthens the supposed link between 'psychotic-like' features in healthy populations and real hallucinations of psychiatric patients; and (3) the absence of a relationship between olfactory sensitivity and deviant olfactory experiences suggests that their anatomical-functional correlates within temporo-limbic regions may differ.

Adult↗

General subjective health status or age-related subjective health status: does it make a difference?

This study examines the agreement between two subjective health measures, a general question on subjective health and an age-related question on subjective health. The study identifies specific groups differing in their answer to the two questions. These measures are used frequently in health-related studies where a short measure is needed to estimate health. Therefore, it is important to understand how the population estimates its health. The study based on 793 telephone interviews shows that among respondents aged 65-75 with no reported diseases and those with less than 12 years of education with no reported diseases, the agreement between the two questions was poor. These two groups reported better health when they were asked to compare their health to people of their age and sex. Excellent agreement between the two questions was reported in those aged 55-64 with no diseases. The respondents having more years of education reported better health than the less educated but only when using the age-related subjective health measure. These findings demand caution when using different wordings in questions on subjective health in non-homogeneous populations.

Age Factors↗

The impact of the 9-21 earthquake experiences of Taiwanese nurses as rescuers.

The powerful earthquake of September 21, 1999 wrought incalculable havoc on lives and properties in Taiwan. Although the scars of the earthquake can never be erased, the calamity can lead to a more full understanding of the experiences, perceptions and reflections of nurses involved directly in post-rescue situations. The purpose of this study was to compare the impacts of rescue experiences on Taiwanese female and male nurses who worked as rescuers following the earthquake of 21 September. A purposive sample of 46 nurses (40 women, 6 men) (mean age 26) who worked in a renowned hospital with a reputation for high quality of emergency care in Northern Taiwan was obtained. Data were collected by in-depth semi-structured interviews and analyzed by a unique mode of between-method triangulation. The majority of the subjects (38 female, 6 male) reported various impacts from their rescue experiences. They are: (a) recognition of the impermanence of life and wishing to lead a more significant life (32 female, 3 male); (b) more caring relationships with others and for their homeland (19 female, 5 male); (c) a clearer concept of disaster care (19 female, 4 male); (d) a better appreciation of the value of nursing and their own self-worth (11 female, 3 male); (e) enhanced knowledge of the survivors' needs (3 female); and (f) enhanced ability to identify the factors hindering rescue operations (1 female, 2 male). However, one female nurse complained of having been bothered by feelings of fear of earthquake disasters resulting from her rescue experience. Rescue experiences help to strengthen most Taiwanese nurses' professional competency, reinforce their commitment to nursing, and lead them to have positive life goals. The relative weight of the impacts for male and female nurses were somewhat different. The vulnerability of nurses, which was manifested in the post-rescue stage, requires attention and long-term follow-up. A comprehensive and organized pre-rescue training program which recognizes the need to care for both acute and chronic post-disaster conditions, along with spiritual care for the survivors, as well as a "disaster reduction" course for health professionals are suggested.

Adult↗

Task and socioemotional behaviors of physicians: a test of reciprocity and social interaction theories in analogue physician-patient encounters.

The purpose of the present study is to assess social interaction and reciprocity theories as explanations for patient responses to a physician in a medical consultation. Social interaction theory predicts that patients mostly recognize and react to socioemotional behavior of their physicians due to a lack of understanding of physician task behaviors or a preoccupation with anxiety. Reciprocity theory predicts that patients recognize socioemotional and task behaviors of their physicians, and they respond to these behaviors in thematically similar ways. We examined these hypotheses by having subjects view one of four videotapes which varied in physician task behavior (thorough or minimum levels of explanation of etiology, symptoms, and treatment) and physician socioemotional behavior (high or low levels of concern and affection displayed verbally and non-verbally). Results supported the general proposition of social interaction theory in that high levels of socioemotional behavior of the physician increased measures of patient self-disclosure, trust, satisfaction, and likelihood of recommending the physician. Physician task behavior had no effect on patient response to the physician, a finding inconsistent with reciprocity theory.

Adult↗

Boundaries in the doctor-patient relationship.

Boundaries in the doctor-patient relationship is an important concept to help health professionals navigate the complex and sometimes difficult experience between patient and doctor where intimacy and power must be balanced in the direction of benefiting patients. This paper reviews the concept of boundary violations and boundary crossings in the doctor-patient relationship, cautions about certain kinds of boundary dilemmas involving dual relationships, gift giving practices, physical contact with patients, and self-disclosure. The paper closes with some recommendations for preventing boundary violations.

Ethics, Medical↗

Compliance and late acute rejection after kidney transplantation: a psycho-medical perspective.

INTRODUCTION: We examined the relationship between late acute rejection (LAR) after cadaveric kidney transplantation and medical compliance utilizing a modified version of the Long-term Medication Behaviour Self-efficacy Scale (LTMBS-scale), a validated patient self-report questionnaire. The original LTMBS-scale uses a five-point scale, however, our pilot study showed that patients found it difficult to discriminate between the five options. We therefore modified this to a three-point scale. PATIENTS AND METHODS: We carried out a retrospective analysis of all patients who received a kidney transplant in our unit in the cyclosporin (CyA) era. We divided rejections into early and late rejection based on the time interval after transplantation. Graft rejection was confirmed by biopsy; LAR was defined as acute rejection occurring after 90 d. We retrospectively administered the modified LTMBS-scale to determine individual patient confidence and self-efficacy in taking their medications in a variety of situations (home, work, leisure, psychological and physical). Individual patient confidence and self-efficacy was analysed in relationship to compliance behaviour. RESULTS: Twenty-four questionnaires were distributed, 22 (92%) were returned fully completed. The overall results suggested that our patients surveyed were not particularly confident (mean score 2.17 out of maximum possible 3) in taking their medications in a variety of contexts. They demonstrated significantly less confidence (mean score 1.0) when experiencing physical (brittle bones, feeling 'ill') and psychological ('sadness') side-effects of medication and emotional reactions to the experience of chronic illness. CONCLUSION: Negative physical and psychological states were related to low self-efficacy with the taking of immunosuppressive medication, non-compliance and subsequent LAR in our cohort of patients.

Adult↗

Alcohol and social behavior I: The psychology of drunken excess.

Drinking alcohol clearly has important effect on social behaviors, such as increasing aggression, self-disclosure, sexual adventuresomeness, and so on. Research has shown that these effects can stem from beliefs we hold about alcohol effects. Less is known about how alcohol itself affects these behaviors. A cognitive explanation, that alcohol impairs the information processing needed to inhibit response impulses--the abilities to foresee negative consequences of the response, to recall inhibiting standards, and so on--has begun to emerge. We hypothesize that alcohol impairment will make a social response more extreme or excessive when the response is pressured by both inhibiting and instigating cues--in our terms, when it is under inhibitory response conflict. In that case, alcohol's damage to inhibitory processing allows instigating pressures more sway over the response, increasing its extremeness. In the present meta-analysis, each published test of alcohol's effect on a social, or socially significant behavior was rated (validated against independent judges) as to whether it was under high or low inhibitory conflict. Over low-conflict tests, intoxicated subjects behaved only a tenth of a standard deviation more extremely than their sober controls, whereas over high-conflict tests they were a full standard deviation more extreme. The effect of conflict increased with alcohol dosage, was shown not to be mediated by drinking expectancies, and generalized with few exceptions across the 34 studies and 12 social behaviors included in this analysis.

Cognition↗

Effects of talking about a stressful event on arousal: does what we talk about make a difference?

In Study 1, 30 male and 30 female undergraduates viewed an affect-neutral stimulus and a stress-inducing stimulus. Ss then talked about either their emotional reactions to the stressful stimulus (emotion condition), the sequence of events within it (fact condition), or the sequence of events within the neutral stimulus (distraction condition). Emotion-condition Ss were more autonomically aroused during a 2nd exposure to the stressful stimulus than were fact-condition Ss. In Study 2, 48 hr separated Ss' talking about their 1st exposure to the stressful stimulus from their 2nd exposure to it. Emotion-condition Ss had lower levels of autonomic arousal while viewing the stimulus again and reported more positive affect after watching it than did fact-condition Ss. These results are discussed in the context of cognitive appraisal, perceptual-motor, and self-disclosure views of emotion.

Adaptation, Psychological↗

Self-concealment, social self-efficacy, acculturative stress, and depression in African, Asian, and Latin American international college students.

The primary purpose of this exploratory investigation was to examine self-concealment behaviors and social self-efficacy skills as potential mediators in the relationship between acculturative stress and depression in a sample of 320 African, Asian, and Latin American international college students. The authors found several differences by demography with regard to the study's variables. After controlling for regional group membership, sex, and English language fluency, they found that self-concealment and social self-efficacy did not serve as mediators in the relationship between African, Asian, and Latin American international students' acculturative stress experiences and depressive symptomatology. Implications of the findings are discussed.

Acculturation↗

Transcending the physical: spiritual aspects of pain in patients with HIV and/or cancer.

Spirituality is an important though often neglected aspect of pain in patients with human immunodeficiency virus (HIV) and/or cancer, for both patients and nurses. The spiritual domain involves: (1) meaning, (2) hope and (3) love and relatedness. The author examines spiritual aspects of pain in persons with HIV and/or cancer, as supported by the literature. Understanding spiritual aspects of pain carries implications for nursing. One of these implications is that it is important for the nurse to be closer to his/her own spirit in order to be there for the patient in pain. Other nursing implications include spiritual assessment and interventions, such as presence, attentive listening, acceptance and judicious self-disclosure, for promoting comfort and diminishing pain.

HIV Infections↗