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Only when I cough? Adults' disclosure of cystic fibrosis.

Cystic fibrosis has traditionally been conceptualized as a fatal childhood disease. In contrast, survival age has been increasing steadily such that adults now routinely seek to gain employment and form close relationships, situations that might require telling others about the disease. Here, the author examines three situations of disclosure based on interviews with 31 adults with the disease. First, in a low-risk situation, for example a short period of social contact, a low level of intimacy exists between the adult with cystic fibrosis and another. Here the disease may be concealed easily with little risk of discovery. Second, in a medium-risk situation, the perceived reaction of the other begins to influence the decision to disclose, as the level of intimacy becomes higher. Last, in high-risk situations, such as employment, the consequences of disclosing or concealing CF are most severe. However, a multiplicity of factors, including perceived social support and disease progression, are seen to influence adults' decisions to disclose their disease.

Adolescent↗

Lesbian mothers' experiences of maternity care in the UK.

OBJECTIVE: to explore the maternity care experiences of a sample of lesbians in the UK in order to evaluate service delivery to this group. DESIGN: a descriptive study, using both qualitative and quantitative survey methods to elicit 'rich' accounts of women's experiences. PARTICIPANTS: a convenience sample of 50 women, reporting on a total of 65 pregnancies. FINDINGS: while participants were generally appreciative of the care they received, they also reported high levels of anxiety about the implications of disclosure, together with acute awareness of midwives' personal attitudes and prejudices. Their comments demonstrate the extent to which these issues may negatively impact on quality of care, and the study reveals examples of discomfort, inappropriate service delivery and even hostility. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: 'booking in' and antenatal education are identified as the two areas where service delivery is least effective in meeting the needs of this client group. Findings were used in drawing up the Royal College of Midwives' position paper on the care of lesbian mothers.

Attitude of Health Personnel↗

Medical evaluation of the sexually abused child.

Clearly, there are numerous troubling variations in the medical diagnosis of child sexual abuse. These variations include delays in disclosure; rapid healing; maturational changes; variations in normal congenital findings; the technique of the examiner; patient position, relaxation, and cooperation; and additional medical conditions that mimic abuse. For these reasons, physical evidence is often inconclusive and can be an unreliable source of information in child sexual abuse cases. The reader is logically cautioned against attempts to diagnose child sexual abuse based on a single finding, particularly that of the diameter of the hymenal orifice. Emphasis on the child's history in documenting the abuse is increasing. As physicians, we must develop interviewing techniques that will assist in child protection, and we must listen and believe the comments made by our patients.

Child↗

Interviewing the young child sexual abuse victim.

1. Nurses can facilitate the disclosure by a young child of sexual abuse by using developmentally sensitive language, such as through the use of proper nouns, single-idea sentences, and the avoidance of technical terms. 2. Nurses can guide the interview from benign, open-ended questions to context-specific, focused questions. Differentiation is made between being specific versus being suggestive. 3. Rapport-building is an important part of the alliance with the child and the nurse. Interviewers should be matter-of-fact and acknowledge any discomfort the child may demonstrate. 4. Cognitive interviewing is a specific technique designed to access accurate recall of a child's memories through reconstruction and memory-jogging techniques.

Age Factors↗

Interaction structure of husbands' and wives' disclosure of marital conflict to their respective best friend.

Husbands' and wives' conversations with their respective best friend (N = 88) were coded to assess spouses' and friends' mutual influence in regulating support and interference with regard to spouses' marriage and to assess the impact of spouses' sex and marital satisfaction on the conversation processes. Dissatisfied husbands and wives expressed fewer positive and more negative views of marriage than satisfied husbands and wives and the friends in the 2 groups. There were no group and no sex differences in interference sequences. There were group and sex differences in support sequences. Friends of satisfied wives and those of dissatisfied husbands were more likely than satisfied wives and dissatisfied husbands to get support for their positive views of marriage. The findings are discussed with reference to the specific effects of outsiders' support and interference on satisfied and dissatisfied spouses.

Adult↗

Audio-CASI vs interview method of administration of an HIV/STD risk of exposure screening instrument for teenagers.

Previous research conducted to examine the implications of using audio-computerized (A-CASI) procedures to gather sensitive sexual behaviour data has provided mixed results. The purpose of this study was to assess differences in the disclosure of HIV risk behaviours between subjects interviewed face to face and subjects interviewed using A-CASI procedures. An HIV/STD risk of exposure screening instrument was administered to 265 male and female adolescents in the juvenile justice system. T-test analyses revealed that adolescents assessed using A-CASI procedures endorsed fewer items on the HIV/STD screen than those interviewed by an assessor. In addition, those in the A-CASI group endorsed fewer items with explicit sexual or drug content and fewer subtle items. Results of this study suggest that A-CASI may not be suitable for use among adolescents in the juvenile justice system when assessing undesirable and/or illegal behaviours.

Adolescent↗

Transfer of communication skills training from workshop to workplace: the impact of clinical supervision.

OBJECTIVE: Recent studies have recognised that the communication skills learned in the training environment are not always transferred back into the clinical setting. This paper reports a study which investigated the potential of clinical supervision in enhancing the transfer process. METHODS: A randomised controlled trial was conducted involving 61 clinical nurse specialists. All attended a 3-day communication skills training workshop. Twenty-nine were then randomised to 4 weeks of clinical supervision, aimed at facilitating transfer of newly acquired skills into practice. Assessments, using real and simulated patients, were carried out before the course, immediately after the supervision period and 3 months later. Interviews were rated objectively using the Medical Interview Aural Rating Scale (MIARS) to assess nurses' ability to use key skills, respond to patient cues and identify patient concerns. RESULTS: Assessments with simulated patients showed that the training programme was extremely effective in changing competence in all three key areas. However, only those who experienced supervision showed any evidence of transfer. Improvements were found in the supervised groups' use of open questions, negotiation and psychological exploration. Whilst neither group facilitated more disclosure of cues or concerns, those in the experimental group responded more effectively to the cues disclosed, reduced their distancing behaviour and increasing their exploration of cues. CONCLUSIONS: The study has shown that whilst training enhances skills, without intervention, it may have little effect on clinical practice. The potential role of clinical supervision as one way of enhancing the clinical effectiveness of communication skills training programmes has been demonstrated. PRACTISE IMPLICATIONS: This study raises questions about the effectiveness of training programmes which do not incorporate a transfer element, and provides evidence to support the need for clinical supervision for clinical nurse specialist.

Adult↗

Expressive writing can increase working memory capacity.

The effect of emotional disclosure through expressive writing on available working memory (WM) capacity was examined in 2 semester-long experiments. In the first study, 35 freshmen assigned to write about their thoughts and feelings about coming to college demonstrated larger working memory gains 7 weeks later compared with 36 writers assigned to a trivial topic. Increased use of cause and insight words was associated with greater WM improvements. In the second study, students (n = 34) who wrote about a negative personal experience enjoyed greater WM improvements and declines in intrusive thinking compared with students who wrote about a positive experience (n = 33) or a trivial topic (n = 34). The results are discussed in terms of a model grounded in cognitive and social psychological theory in which expressive writing reduces intrusive and avoidant thinking about a stressful experience, thus freeing WM resources.

Adaptation, Psychological↗

Bosom Buddies: a practical model of expressive disclosure.

BACKGROUND: A writing and theatre workshop, conducted in northern New Hampshire with 8 posttreatment breast cancer survivors, utilized expressive disclosure in a nonscientific environment. METHOD: Through writing, the participants have explored both negative and positive feelings about cancer and its impact on their lives. Through theatre games and rehearsals, the participants have had the opportunity to learn new expressive skills. In performance, they have helped others by telling their own stories. RESULTS: Participants reported a feeling of transformation and a renewed sense of well-being as a result of the workshop, as well as an ongoing desire to positively affect others with their work. CONCLUSIONS: The facilitators and participants agreed that the results of this work have been transformative for all involved. The facilitators are encouraged by the idea of further practical exploration of these methods. This article is a blueprint for this type of work and an exploration of the scientific background that supports this method as a valid tool to aid in emotional recovery.

Breast Neoplasms↗

An integrative intervention for promoting recovery from extramarital affairs.

The discovery or disclosure of an extramarital affair can have a devastating impact on partners, both individually and on the relationships. Research suggests that affairs occur relatively frequently in relationships and are a common presenting problem in couple therapy. However, despite their prevalence, there is little empirical treatment research in this area, and most therapists describe this problem as one of the more difficult to treat. In this study, we used a replicated case-study design to explore the efficacy of an integrative treatment designed to help couples recover from an affair. Six couples entered and completed treatment. The majority of these couples were less emotionally or maritally distressed at the end of treatment, and the injured partners reported greater forgiveness regarding the affair. Details of the intervention, suggested adaptations of the treatment, and areas for future research are discussed.

Adaptation, Psychological↗

The psychophysiology of confession: linking inhibitory and psychosomatic processes.

A theory of inhibition and psychosomatic disease suggests that the failure to confide traumatic events is stressful and associated with long-term health problems. We investigated the short-term autonomic correlates of disclosing personal and traumatic experiences among two samples of healthy undergraduates. In Experiment 1, subjects talked into a tape recorder about extremely stressful events that had occurred in their lives, as well as what they planned to do following the experiment. Skin conductance, blood pressure, and heart rate were continuously measured. Based on judges' ratings of subjects' depth of disclosure, subjects were classified as high or low disclosers. Talking about traumatic events was associated with decreased behavioral inhibition, as measured by lower skin conductance levels among high disclosers. Disclosing traumatic material was also associated with increased cardiovascular activity. In Experiment 2, subjects both talked aloud and thought about a traumatic event and about plans for the day. Half of the subjects were alone in an experimental cubicle and talked into a tape recorder; the remaining subjects talked to a silent "confessor" who sat behind a curtain. Among high disclosers, both talking and thinking about traumatic events produced lower skin conductance levels than did thinking or talking about plans for the day. The presence of a confessor inhibited subjects' talking. Implications for understanding the nature of confession and the development of an inhibitory model for psychosomatic processes are discussed.

Arousal↗

Parental consent: factors influencing adolescent disclosure regarding abortion.

Four hundred thirty-nine females (ages 12-21) seeking abortions were surveyed concerning support networks they utilized during their pregnancy crisis. Fifty-one percent of this sample reported confiding in their parents, while 49% reported that they did not confide in their parents. The relationship between perceived dependence, as well as family communication, and the teenagers' decision to seek parental advice regarding their pregnancy crisis was examined. The following variables were used to study the characteristics of these two groups: age, marital status, living arrangements, employment status, maturity, general family communication, and family communication regarding sexuality. The results revealed that the degree of financial and emotional dependence and the quality and nature of family communication were closely related to the teenagers' decision to confide in their parents about the decision to seek an abortion. Implications of the findings include the need for more empirical information before making legislative decisions regarding parental consent. Suggestions for further research include an investigation of the effects of parental responses on teenagers who choose abortion and a comparative examination of the characteristics of families of confiders with those of nonconfiders.

Abortion, Legal↗

Emotional repression, stress disclosure responses, and Epstein-Barr viral capsid antigen titers.

Based on the theory of psychosomatic inhibition, we hypothesized that subjects who abstained from disclosing emotional material on a laboratory task would have poorer control of latent Epstein-Barr virus (as evidenced by high titers for the viral capsid antigen), and similarly, those subjects with psychometrically derived repressive interpersonal styles would show the highest Epstein-Barr viral capsid antigen titers (EBV-VCA). Eighty first-year undergraduates completed a personality inventory and were asked to write an essay/letter for 30 minutes about a stressful event that had happened in their life. Blood was collected from each subject immediately after writing. Essays were scored for degree of emotional disclosure according to the ratio of emotional-to-total words used. Degree of disclosure was found to be associated with impaired control of latent EBV (high antibody titers to the EBV-VCA) controlling for medication use, recent sleep loss, physical activity, lean body mass, caloric intake, and alcohol and recreational drug use. Further, individual differences in interpersonal style (characterized by emotional suppression) related to this immunologic marker in a similar fashion, and these two factors interacted in determining EBV-VCA titers. That is, Repressors who were either high or low disclosers had high levels of antibody titer to EBV-VCA, whereas only those Sensitizers who did not disclose had high antibody titers to EBV-VCA. In addition to supporting the hypothesis that emotional repression is associated with some aspects of host-virus interaction, the present findings highlight the importance of obtaining behavioral and psychometric assessments in psychoimmunologic investigations of this abstract affective construct (i.e., repression).

Adolescent↗

A comparison of Hispanic and African-American sexually abused girls and their families.

OBJECTIVE: To study the differential effects of sexual abuse on Hispanic (HN) and African-American (AA) girls. METHOD: Sexually abused girls and their caretakers (N = 159), of which 52% (n = 82) were AA (mean age 9.8 years, SD = 3.4, R = 6-17) and 48% (n = 77) were HN (mean age 10.1 years, SD = 3.8, R = 6-18), were included in the study. The mother/caretaker was administered a demographic form, the Achenbach's Child Behavior Checklist (CBCL), and the Family Assessment Measure (FAM-P). The child completed the FAM-C and the Trauma Symptom Checklist for Children (TSCC). The clinician completed the Parental Reaction to Incest Disclosure Scale (PRIDS). RESULTS: HN girls were found to have a greater number of sexually abusive episodes and waited longer to disclose their abuse while AA girls were more likely to have experienced vaginal penetration. The perpetrators of HN girls were older and more likely to be fathers or stepfathers. The mothers/ caretakers of HN girls perceived their children as having significantly more aggressive behavior, anxiety/depression, somatic complaints, internalizing and externalizing behaviors, and had a higher total score on the CBCL than did AA girls. The HN girls were more likely to see their family as dysfunctional with confusion regarding family values and rules. HN mothers/caretakers perceived their families as more conflicted regarding adaptability and family controls. CONCLUSIONS: HN girls experienced more emotional and behavioral problems, and both HN girls and their mothers/caretakers perceived their families as more disturbed and dysfunctional.

Adolescent↗

Complementary and alternative medicine (CAM) use patterns and disclosure to physicians in acute coronary syndromes patients.

This study assessed the frequency and types of CAM therapies used by patients hospitalized with acute coronary syndromes for general health purposes and cardiac reasons. We profiled CAM users including gender differences and degree of disclosure with treating physicians'. Data collection occurred via semi-structured interview and included demographics, past medical history, CAM use, physician visits, and patient-physician communications. Eight hundred and forty-six patients were screened for eligibility with 223 patients meeting eligibility criteria and completing data collection. Sixty-three percent of this sample used at least one CAM therapy for general health purposes in the year prior to the index hospitalization. Only 11.7% of patients reported using CAM for cardiac specific reasons. Women were more likely to use CAM relative to men and also tended to use a greater number of CAM therapies. More than one third (35.9%) of the patients that used CAM therapies did not inform their physician. Only a small fraction of CAM use was specific to cardiovascular health. These data suggest that a significant portion of patients do not report CAM use to their physicians and physicians seldom ask.

Aged↗

Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong.

This research examines the experience of stigma associated with psychiatric treatment among Chinese patients with schizophrenia in Hong Kong. In focus groups patients described stigma experiences related to clinic visits and the side effects of antipsychotic medications. Additionally, they revealed various adverse treatment experiences during hospitalization which point to the presence of structural discrimination. Based on the focus group findings, a questionnaire was developed and completed by 320 and 160 patients with schizophrenia and diabetes mellitus, respectively. Results showed that patients with schizophrenia were more likely to anticipate stigma, conceal illness, and default on clinic visits than patients with diabetes. Medication-induced stigma occurred in 48% of patients with schizophrenia. It brought about the unwelcome disclosure of illness, workplace difficulties, family rejection, and treatment non-adherence. Adverse experiences during hospitalization were reported by 44% of patients with schizophrenia. They included negative staff attitudes, excessive physical/chemical restraints, inadequate information/complaint systems, and limited rights. We conclude that stigma, at both individual and structural levels, represents a central experience of the treatment of schizophrenia in Hong Kong. Because inequitable health policy, resource allocation, and service organization privilege service providers' control over users, treatment-related stigma may be a prime example of the social production of stigma and discrimination based on power difference between the stigmatizers and the stigmatized. To examine this critically we need to redirect stigma research to tractable clinical circumstances and structural mechanisms that produce and maintain stigmatizing and discriminatory psychiatric practice. Destigmatization programs must be evaluated not only by change in public attitudes but also by how much they reduce structural stigma and improve patients' lives.

Adolescent↗

Written emotional disclosure following first-episode psychosis: effects on symptoms of post-traumatic stress disorder.

OBJECTIVE: This paper examined whether written emotional disclosure reduces psychosis-related post-traumatic stress disorder symptoms in a small clinical sample recovering from a first episode of psychosis. METHOD: Approximately 2.5 years after their first episode of psychosis, 22 people completed measures of traumatic symptoms, recovery style, insight, anxiety and depression. Participants then wrote about the most stressful aspects of their illness (N = 12) or about emotionally neutral topics (N = 10) for 15 minutes on three separate occasions. Approximately 5 weeks later, participants re-completed the same dependent measures. RESULTS: Participants who wrote about their psychotic experiences showed less overall severity and avoidance of traumatic symptoms compared with participants who did not write about their psychotic experiences. There were no effects on the other dependent measures. CONCLUSIONS: Preliminary evidence with a small clinical sample suggests that providing people who are recovering from a psychotic episode with an opportunity to disclose the most stressful aspects of their illness and treatment may lessen the traumatic impact of these experiences. However, this finding requires replication with a larger sample.

Adaptation, Psychological↗

Disclosure of distress among anxiety-disordered youth: differences in treatment outcome.

The present study evaluated treatment outcome differences in anxiety-disordered youth who differed in their disclosure of internal distress as measured in a structured diagnostic interview. One hundred and seventy-one clinic-referred, anxiety-disordered children served as participants. Participants' primary diagnoses were one of three anxiety disorders: separation anxiety, generalized anxiety/overanxious, or social phobia/avoidance. At a pretreatment assessment, children and their parents were interviewed separately using the Anxiety Disorders Interview Schedule (ADIS) to determine the child's diagnosis. The child's status as a discloser of high distress or discloser of low distress was determined by the parents' endorsement of an anxiety disorder and the child's endorsement or lack of endorsement of an anxiety disorder, respectively. Parents, teachers, and children also completed measures assessing the child's psychopathology (e.g., Revised Children's Manifest Anxiety Scale, Child Behavior Checklist). In general, findings indicated that the level of distress reported by the children moderated treatment outcome. Although both groups benefited from treatment, the children disclosing high distress experienced greater treatment gains than the children disclosing low distress.

Adolescent↗