Fidelity Management: African-American Adolescents' Attempts to Control the Sexual Behavior of their Partners

This qualitative study examined how adolescents conceptualize sexual behavior. Open-ended interviews about sex were conducted with a sample of 21 male and 18 female African- American adolescents. Topics related to health risk virtually never emerged in their responses. The topic of partner infidelity and concerns about control of infidelity, on the other hand, were mentioned extensively. Informants described a cycle in which commitment to a partner often leads to suspicion of infidelity and jealousy. The jealous partner then performs acts of surveillance which can lead either to reassurance or to discovery of infidelity. The article concludes by discussing the degree of uniqueness of fidelity management to African- American adolescents and possible relevance to design of AIDS risk-reduction interventions.     

Clinical issues in psychodynamic psychotherapy with ex‐patriates

This paper addresses certain fundamental issues that frequently emerge in clinical work with ex‐patriates—individuals who have chosen to live in a country other than their own, temporarily or permanently. In particular, internal factors integrally involved in the decision to live abroad are examined using clinical examples. These include efforts to re‐negotiate issues of separation‐individuation, identity formation, narcissistic difficulties, conflicts regarding achievement and/or success and difficulties in proceeding with basic tasks of adulthood. The implications of these motivational factors for psychodynamic psychotherapy are discussed. More specifically, the ways in which these issues appear in treatment and the patient's capacity for insight regarding them1 are considered with respect to the use of optimal treatment technique. Copyright © 2000 John Wiley & Sons, Ltd.     

Personality and emotional performance: extraversion, neuroticism, and self-monitoring

Using an experimental design, the authors linked personality to performance on two emotional regulation tasks requiring the expression of either anger or enthusiasm. Across tasks, self-monitoring was associated with effective emotional performance. High self-monitors reported less stress and more deep acting than low self-monitors and did not experience elevated heart rate during emotional performance. The authors also examined affective traits, positing that emotional regulation would be less stressful for individuals who were asked to perform personality congruent emotions. As expected, individuals high on extraversion experienced elevated heart rates when asked to express personality incongruent emotions (i.e., anger). However, the association between extraversion and emotional performance was not significantly different for the two types of emotional regulation (anger and enthusiasm). Neuroticism was associated with increased heart rate and poor performance in both tasks. Overall, these data provide partial support for our personality congruency hypotheses and suggest that personality plays an important role in effective emotional performance.     

Patterns of Fidelity Between Training and Criterion Situations as Determinants of Performance in Stressful Situations

Abstract

The training of individuals for task performance under stress poses a dilemma concerning the degree to which stressor characteristics of the criterion situation should be represented with a high degree of fidelity during training. High fidelity training is likely to reduce the novelty of the criterion situation and familiarize the trainee with his emotional and physiological reactions to stress. On the other hand, the exposure of the trainee to high stress levels during training might interfere with task acquisition and intensify his fears and emotional sensitivity. This difficulty might be overcome with “graduated fidelity training” whereby the trainee is exposed to gradually increasing stressor intensities, starting with very low intensities and reaching, by the end of training, criterion-level stressor intensities. The empirical evaluation of this method, carried out in the present study, suggested that it is potentially more effective than high fidelity training. However, two conditions are necessary for the realization of this potential effectiveness. First, the trainee must be informed about the upper limit of stressor intensity which he might encounter in the course of training. In the absence of such information, graduated fidelity training might become highly ineffective. Second, the trainee has to perceive high quality performance as being instrumental for the removal or attenuation of stressors.     

Self-Esteem,Internalizing Symptoms,and Theory of Mind in Youth With Autism Spectrum Disorder

Self-esteem is a potent indicator of mental health in typically developing (TYP) individuals. It is surprising that there have been few comprehensive investigations of self-esteem in children and adolescents with autism spectrum disorder (ASD), given that they are at high risk for comorbid mental health problems, such as depression and anxiety. The objectives of the current study were to assess how youth with ASD rate their self-esteem compared to age-matched TYP youth and to examine how self-esteem relates to internalizing psychopathology and theory of mind in the two groups. Seventy-three children and adolescents, ages 9 to 17, were administered a battery of questionnaires assessing self-esteem and internalizing symptoms, as well as tasks designed to measure theory of mind. Results indicated that youth with ASD rated their self-esteem significantly lower than did TYP youth. Self-esteem was strongly related to depression in both groups but was negatively related to theory of mind only for youth with ASD. These results may provide important insights into how individuals with ASD form evaluations of their own self-worth and illustrate how increasing self-awareness in individuals with ASD is not without risks.     

Parents' Contributions to Children's Knowledge and Attitudes Regarding AIDS: Another Look

Attempted to determine, using a sample of students in Grades3, 5, and 7, whether parent-child communication about AIDS andparent knowledge of AIDS predict children's knowledge, socialattitudes, and worry regarding AIDS, partially replicating testsby Sigelman, Derenowski, Mullaney, and Siders (1993) of maineffects, interaction, and potentiation models of parent-childsocialization. Most parents had talked to their children aboutAIDS but many were susceptible to myths about HIV transmission.Child age was the strongest predictor of accurate knowledgeand positive attitudes, but gender, ethnicity, and parent educationalso made modest contributions. Consistent with the potentiationmodel, parent knowledge of common transmission myths predictedchild knowledge of those same myths (and willingness to interactwith individuals who have AIDS as well) only when parent-childcommunication about AIDS was relatively extensive (and onlywhen child rather than parent reported it). Findings suggestthat both the quantity and quality of parental messages mustbe considered by socialization researchers but that parentsmay not be the primary socializers of knowledge and attitudesregarding AIDS and other health issues.     

Initial cancer genetic counseling consultation: change in counselees' cognitions and anxiety, and association with addressing their needs and preferences

The fulfillment of counselees' expectations in cancer genetic counseling and how this affects the outcome of counseling have received little attention so far. This study investigates how the initial consultation influences counselees' cognitions and anxiety, whether counselors address counselees' prior needs and preferences during the visit, and whether addressing needs is associated with a more positive outcome of the visit. One hundred twenty-eight affected and unaffected counselees from families with no known mutation, who were seen by one of fourteen counselors, participated. Pre- and post-visit questionnaires assessed correct knowledge about hereditary breast or colon cancer, perceived personal control (PPC), anxiety (STAI), risk perceptions, and (fulfillment of) needs (QUOTE-gene(ca)). Results demonstrated a pre- to post-visit significant increase in correct knowledge and PPC, and a significant decrease in STAI and risk perceptions. However, marked overestimation of risks persisted. Decrease in STAI and risk perceptions was significantly less pronounced in affected versus unaffected counselees. The majority of counselees were (very) satisfied about the extent to which their needs were addressed, albeit about one-fifth were not regarding emotional matters and explanations about their own cancer risk. Finally, the better counselees perceived their needs to be fulfilled, the significantly higher their PPC and the significantly lower their STAi scores were. Findings suggest that both unaffected and affected counselees should be counseled carefully. Also, a more effective service may be attained if counselors pay more attention to counselees' emotional needs and detail more inheritance and penetrance of mutated genes in relation to counselees' family history.     

Education about genetic testing for breast cancer susceptibility: patient preferences for a computer program or genetic counselor

The purpose of this study was to describe and compare patient preferences for a genetic counselor or an interactive computer program for various components of genetic education and counseling for breast cancer susceptibility. As part of a randomized intervention study on genetics education and counseling for breast cancer risk, 29 women at moderate risk were educated by both a genetic counselor and an interactive computer program. After both educational interventions, participants completed Likert-style and open-ended questionnaires about what they liked most and least about each intervention, and whether they preferred the counselor or computer for a variety of tasks. Participants were largely satisfied with both the computer program and the genetic counselor. A majority preferred the genetic counselor for addressing their concerns, discussing options and alternatives, being sensitive to emotional concerns, helping to make a decision, being a good listener, assuring understanding, helping to make a good choice, helping to understand genes and breast cancer, telling them what they needed to know, being respectful, setting a relaxed tone, and putting them at ease. However, a majority of the women either preferred the computer program or were neutral about allowing patients to learn at their own pace, helping to avoid embarrassment, making good use of time, explaining genes and breast cancer, and treating the patient as an adult. Qualitative analysis of open-ended questions affirmed that patients valued the personal interactions with the counselors, and liked having their specific questions answered. They liked that the computer was self-paced, informative and private, and could be used without causing embarrassment. We concluded that a computer literate, mostly white group of women at moderate risk for inherited susceptibility to breast cancer preferred interacting with a genetic counselor for personal, individualized components of the genetic counseling process, but accepted or preferred a computer program for being self-paced, private, and informative. By incorporating such a computer program into the genetic education process, it is possible that genetic counselors would be able to spend more time performing the personal, individualized components of genetic counseling.     

Guiding task work in the context of an emotion-focused relationship

In undertaking the complex process of being an emotion-focused therapist, one needs to strike a careful balance between providing a safe relational environment, while navigating with clients through their emotional world. In response to in-session verbal and non-verbal indicators, they invite clients to engage in chair work tasks designed to facilitate emotional exploration and deepening with a goal of emotional transformation. Therapists may be daunted by the prospect of introducing chair work tasks, and concerned about the impact on the relational bond. However, chair work tasks can deepen emotional exploration and shifts, and streamline the process of change. The case of Emma* will illustrate how therapists navigate the interplay between striking an empathic relationship and facilitating chair work tasks. The case will demonstrate how the therapist addresses hesitation or reluctance expressed by the client, while strengthening the bond and deepening emotional processing (*Pseudonym).     

Psychological and genetic counseling implications for adolescent daughters of mothers with breast cancer

Adolescent daughters of women with breast cancer (BC) are themselves at risk for heritable BC. Although some preliminary evidence suggests this group is at an increased risk for emotional problems, evidence is limited to studies with small samples and no comparison groups. This study examined psychological and family functioning, health attitudes and beliefs about genetic risks in adolescent females. A case-comparison design was used to compare 55 mother-daughter pairs in which the mother had been treated for BC (BC group) to 55 families from the general population (GP). Participants completed an assessment battery measuring perceptions of personal risk for BC and attitudes about gene testing for BC susceptibility, family functioning, and adolescent psychological adjustment. Based on manova, no significant differences were found between the two groups on measures of the psychological functioning. However, BC group adolescents reported significant (p < 0.01) worries about their future health and genetic risk for BC. About 68% of BC adolescents compared with 12% of GP adolescents reported being moderately to greatly concerned about their susceptibility to genetic mutations. Further, 85% of BC group adolescents believed they were susceptible to BC compared with 10% of GP adolescents. The results indicated no evidence of emotional, behavioral, or familial distress in these families. However, BC adolescents have significant worries about their future health. The results of this study demonstrate the need to develop a comprehensive model of care where accurate information about genetics and health risks can be provided. The adolescents also need support to help them cope and communicate with their mothers their worries about BC.     

Time estimation ability and distorted perception of sleep in insomnia

Although it is an established finding that people with insomnia characteristically overestimate the time they have taken to get to sleep and underestimate the total amount of time they have slept, little is known about the mechanisms that underpin this phenomenon. Accordingly, this study sought to investigate whether the tendency to misperceive sleep among patients with insomnia is accounted for by (a) a general deficit in time estimation ability or (b) the context in which the time estimates are made. Twenty individuals with insomnia and 20 individuals who did not have insomnia were asked to perform two time estimation tasks; one in the laboratory during the day and one in the participant's own bedroom during the night. The two groups were compared with respect to the accuracy of their performance in estimating unfilled temporal intervals of various lengths. The results indicated that the performance of the insomnia group was no different from that of the noninsomnia group, regardless of the context in which the time estimates were made. Time overestimation correlated positively with cognitive and physiological arousal experienced during the time estimation tasks. These findings argue against the hypothesis that individuals with insomnia misperceive their sleep simply because they are poor estimators of time. Future research is required to test the hypothesis that increased cognitive arousal (worry) and physiological arousal are candidate mechanisms that underpin sleep misperception.     

The emotional effects of genetic diseases: implications for clinical genetics

The aim of this qualitative study was to explore the emotional effects that may be common to many genetic conditions, or risk of genetic conditions, that could be appropriately targeted by clinical genetics services. The study sample comprised 52 individuals. Seven focus groups with patients of clinical genetics services, their representatives from patient support organizations and genetics healthcare providers were conducted. Focus groups were supplemented by 19 face-to-face interviews with patients and patient group representatives. Focus groups and interviews were audio taped, transcribed in full, and analyzed using the constant comparative method. Eight emotional effects of genetic diseases were identified: anxiety, worry about risks to children, guilt, anger, uncertainty, sadness and grief, depression, and redemptive adjustment. Two factors were identified that could modify the emotional effects; these were variability of genetic diseases, and lack of diagnosis/inappropriate care. Despite many negative effects of genetic disease being identified, results also suggest that redemptive adjustment is possible where a genetic condition is present in a family. Interventions designed to (1) adjust the modifying conditions and (2) help manage the emotional effects may facilitate adjustment and improve patient outcomes.     

Sib risks for nonspecific mental retardation in British Columbia

Cases of nonspecific mental retardation (MR) born in British Columbia between 1952 and 1970 ascertained through the British Columbia Health Surveillance Registry were linked by birth registration number to family sibships from computer-linked groupings of birth and marriage records in British Columbia. It was possible to retrieve family information for 97% of the cases by this method. Because of good ascertainment and relatively large sample size, the 1952–1965 birth cohort comprising 2,209 index cases was selected for calculations of overall risks and recurrence risks to sibs categorized by sex, MR level, associated neurological disability, and singleton versus multiple birth. The overall risk of affected individuals among all sibs was 4.4 ± 0.6%, which was about ten times greater than the minimum population incidence of nonspecific MR. The risk among subsequent sibs of the first affected case in a family was 3.7 ± 0.8%. These risks varied depending on sex, MR level, and whether the mental retardation was associated with hydrocephalus, microcephalus, cerebral palsy, or epilepsy. The recurrence risk after two affected individuals was 12 ± 7% – about three times greater than after one affected individual. Even though the frequency of MR is greater among twins than in the overall population, the recurrence risk of nonspecific MR was not significantly different for index cases from either singleton or multiple births.     

Women and AIDS Support Network: mutual support to change community norms

A group of women formed the Women and AIDS Support Network (WASN) in Zimbabwe in June 1989 to improve women;s self-esteem and confidence and to bring about changes in attitudes and reactions toward AIDS-related problems. Both HIV-positive and HIV-negative women are WASN members. Women have limited control over sexual relationships. Women who know their partners are having intercourse with other women have few options, e.g., they may depend on their partners. A family council settles marital disagreements, but husbands do not always cooperate. Increased peer pressure could change societal acceptance of male infidelity to positive attitudes toward friendship and partnership in marriage. Therefore, WASN explores sexual relationships, especially control and power in them. These discussions should lead to affirmation of positive behavior. For example, men can promote condom use and monogamy to their male peers. They can also talk to their partners and their sons about HIV. Rural women should not blame urban women for their partner's HIV status. WASN also targets schoolgirls. Most early and some current messages of AIDS campaigns reinforces the dichotomy of good and bad women, supported by an earlier link between urban women and sexually transmitted diseases. Yet, they ignored men's role in HIV transmission. WASN speaks out against such negative images, e.g., dramas that depict the HIV-infected woman as evil and the innocent as good while the man worries about which woman infected him instead of feeling awful about infecting other women. WASN also addressee AIDS-related discrimination on the job and stigmatization issues. It now is conducting 2 research projects: information needs of urban and rural women and capacities of family support systems to assist HIV-positive women.     

The Prevention of Extramarital Involvement: Steps Toward "Affair Proofing" Marriage

In this paper I provide comments on the Allen et al. paper (this issue). I note that it provides the first critical, comprehensive, and integrative review of extramarital involvement (EMI) to appear in the literature, and I summarize some of its major contributions to the field. I then focus on how the review stimulated my thinking about current and future best practices in marriage education for the prevention of EMI. I conclude by suggesting several directions for future research and practice. Key words: affair prevention, infidelity, couples.     

DNA-testing for Huntington's disease in The Netherlands: a retrospective study on psychosocial effects.

Presymptomatic DNA-testing for Huntington's disease has made it possible to predict whether or not at-risk individuals are gene-carriers with a reliability of about 98%. In our retrospective study of 18 tested individuals, most of the newly identified carriers function apparently well. They use avoidance and repression of affect as psychological defense strategies. However, 8 out of 9 non-carriers do not experience the expected relief about their test results. They experience survivor guilt and emotional numbness and find it difficult to cope with the effects of the test results on the family system. The partners of gene-carriers are at risk of becoming emotionally isolated by putting aside their own feelings for fear of seeming self-centered. Appreciation of these effects on tested individuals is important and professional support is needed to prevent post-traumatic stress disorders. Whatever the test result may be, the working through process may take years rather than months. These findings have important implications for patient care and necessitate an extended period of observation after presymptomatic testing.     

Reasoning under uncertainty: heuristic judgments in patients with persecutory delusions or depression

OBJECTIVE: The substantial literature examining social reasoning in people with delusions has, to date, neglected the commonest form of decision making in daily life. We address this imbalance by reporting here the findings of the first study to explore heuristic reasoning in people with persecutory delusions. METHOD: People with active or remitted paranoid delusions, depressed and healthy adults performed two novel heuristic reasoning tasks that varied in emotional valence. RESULTS: The findings indicated that people with persecutory delusions displayed biases during heuristic reasoning that were most obvious when reasoning about threatening and positive material. Clear similarities existed between the currently paranoid group and the depressed group in terms of their reasoning about the likelihood of events happening to them, with both groups tending to believe that pleasant things would not happen to them. However, only the currently paranoid group showed an increased tendency to view other people as threatening. CONCLUSION: This study has initiated the exploration of heuristic reasoning in paranoia and depression. The findings have therapeutic utility and future work could focus on the differentiation of paranoia and depression at a cognitive level.     

Posed prosodic emotional expression in unilateral stroke patients: recovery, lesion location, and emotional perception.

Recovery of emotional functioning following stroke has received limited attention in the neuropsychological literature. By emotional functioning, we refer to a range of processing modes, including perception, expression, experience, and behavior. The aim of the current study was to evaluate the course of prosodic emotional expression over time in individuals with stroke. Posed prosodic expression tasks from the New York Emotion Battery were administered to right brain-damaged (RBD), left brain-damaged (LBD), and demographically matched normal control (NC) participants at two separate testing times (median interval of 25 months). Posers (i.e., individuals producing the emotional expressions) were required to produce neutral-content sentences using four different emotional tones (happiness, sadness, anger, and fear). Raters judged poser output for accuracy, intensity, and confidence. For accuracy ratings, RBDs and LBDs were impaired relative to NCs at baseline. In terms of recovery, there was a tendency for LBDs to improve over time, and there was a significant decline for RBDs. Inspection of the group mean data suggested that frontal lesions had a negative impact on prosodic emotional expression in RBDs and that lesion extent did not systematically influence performance at baseline or over time. Participants maintained their relative standing on the NYEB expression tasks over time. Finally, no significant relationships were found between participant performance on prosodic emotional perception and expression tasks at either testing time, suggesting that these two processing modes are relatively independent.     

Folate and the methylenetetrahydrofolate reductase 677C-->T mutation correlate with cognitive performance

Low folate status has been associated with cognitive decline. We investigated the association of folate status and the 5,10-methylenetetrahydrofolate reductase (MTHFR) 677C-->T polymorphism with performance on a battery of neuropsychological tests. Furthermore, we investigated whether the association of folate with cognitive performance was mediated by plasma homocysteine or risk of vascular disease. We used cross-sectional data from 818 individuals aged 50-70 years old. Low concentrations of erythrocyte folate but not serum folate were associated with poor performance on complex speed and memory tasks, independent of educational level and conventional risk factors of vascular disease. These associations were not mediated by homocysteine concentrations or carotid intima-media thickness. Subjects with the MTHFR 677TT genotype tended to perform better on cognitive tasks than CC/CT subjects, although this was significant for sensorimotor speed only (differences in Z-scores between MTHFR 677TT homozygotes and CC homozygotes -0.15, 95% CI: -0.30 to 0.00). Low concentrations of erythrocyte folate are associated with decreased cognitive performance, possibly through a homocysteine-independent mechanism such as DNA infidelity and mitochondrial decay.     

Ambiguity of Monogamy as a Safer-sex Goal Among Single, Pregnant, Inner-city Women: Monogamy by Whose Definition?

We examined the ambiguity of monogamy as a safer-sex goal in a sample of young, inner- city women (N = 447), of whom 58 percent were African- American and 42 percent European-American. It was our premise that women may be misperceiving and underestimating their risk due to differences in their definition and beliefs about monogamy, and thus are not changing their behavior. When compared to long-term monogamous women (self-reporting one partner in the past year), serially monogamous women (reporting two or more partners in the past year) perceived themselves at greater risk but did not report more frequent use of condoms. It is possible that a suggestion of monogamy may be subject to multiple interpretations and thus could be providing women with a false sense of safety. Risk reduction should be defined in specific behavioral terms.