Implementation of a Decedent Affairs Office to Improve Outcomes.

Healthcare facilities are committed to providing high-quality care throughout patients' treatment trajectories. That same obligation continues when patients die. Handling of patients and their belongings safely and respectfully is essential. Despite recognition of this aspect of care, facilities struggle and are confronted with a number of barriers. This article describes the implementation of a Decedent Affairs Office at Emory University Hospital.

Pornography Addiction: An Exploration of the Association Between Use, Perceived Addiction, Erectile Dysfunction, Premature (Early) Ejaculation, and Sexual Satisfaction in Males Aged 18-44 Years.

INTRODUCTION: The way men consume pornography changed over the last decade, with increased numbers of men presenting with self-perceived Internet pornography (IP) addiction and related sexual dysfunction. A lack of consensus and formal recognition in the DSM-5 lead to a variety of definitions of IP addiction. Currently, the majority of evidence linking IP addiction and sexual dysfunction was derived from consumers, case studies, and qualitative research. Where empirical measures were used, researchers found mixed outcomes in sexual response. Inconclusive data appeared to relate to the conflation of IP use and self-perceived IP addiction, and normal variations in sexual response with clinical diagnosis of sexual dysfunction. Thus, further empirical clarification is required to assess the impact of both IP use and self-perceived IP addiction, on men's sexual function. AIMS: This study has 3 aims: First, to assess if there is an association between IP use alone and erectile dysfunction (ED), premature (early) ejaculation (EE) and sexual satisfaction (SS); Second, to assess whether there is an association between self-perceived IP addiction and ED, EE and SS. Third, to assess whether IP use or self-perceived IP addiction uniquely predicts ED, EE, SS in men. METHOD: Correlation and regression analysis was conducted on a cross-sectional sample of 942 heterosexual men aged 18-44 years who participated in an online survey sourced from Reddit IP subgroups. MAIN OUTCOME MEASURES: Cyber-Pornography Use Inventory; International Index Erectile Dysfunction; The Checklist for Early Ejaculation Symptoms; New Sexual Satisfaction Scale; Depression Anxiety Stress Scale-21. RESULTS: There was no evidence for an association between IP use with ED, EE, or SS. However, there were small to moderate positive correlations between self-perceived IP addiction and ED, EE and sexual dissatisfaction. Further, self-perceived IP addiction uniquely predicted increased ED, EE and individual sexual dissatisfaction. Contrary to expectations, self-perceived IP addiction did not predict sexual dissatisfaction with one's sexual partner. CONCLUSION: These results suggest that IP use alone does not predict sexual dysfunction. Rather, self-perception of increased IP addiction was related to negative sexual outcomes. Thus, we concluded that subjective interpretation of ones IP use was a contributor to IP related sexual problems in our sample of males who share IP on social media sites. We recommend that clinicians consider self-perceived IP addiction as a possible contributing factor to sexual dysfunction. Whelan G, Brown J. Pornography Addiction: An Exploration of the Association Between Perceived Addiction, Erectile Dysfunction, Premature (Early) Ejaculation, and Sexual Satisfaction in Males Aged 18-44 Years. J Sex Med 2021;18:1582-1591.

Religious anti-gay prejudice as a predictor of mental health, abuse, and substance use.

Anti-gay, or homonegative, prejudice is generally considered harmful to the wellbeing of sexual minority individuals. However, the origins or nature of such prejudice may vary. Despite a sizable body of literature suggesting homonegative prejudice is frequently religious-based, the psychological impact of exposure to religious anti-gay prejudice remains largely undetermined. Addressing this research gap, the authors examined whether opposition to same-sex sexuality on religious grounds predicted detrimental outcomes among same- and both-sex attracted individuals, as well as their heterosexual counterparts. A nationwide U.S. sample of 1600 individuals-recruited using contemporary online crowd-sourcing techniques designed to limit selection bias-completed a novel inventory assessing interpersonal exposure to religious (as well as nonreligious) homonegative disapproval. Outcome variables assessed included a number of clinically relevant measures spanning general mental health, social support, suicidality, abuse, and substance use. Analyses revealed that greater exposure to religious anti-gay prejudice predicted higher levels of anxiety, stress, and shame; more instances of physical and verbal abuse; and more problematic alcohol use. Furthermore, while sexual minority individuals tended to fare more poorly than their heterosexual counterparts on almost every outcome measure assessed, homonegative prejudice predicted poorer outcomes among all respondents regardless of their sexual orientation or religious identification. Hence, results are among the first to demonstrate that anti-gay religious exposure is associated with substantial threats to wellbeing, and that such effects may be observed beyond religious sexual minorities. Overall, findings imply that homonegative religious social conditions may be of broader health and mental health concern than is conventionally recognized. (PsycINFO Database Record

Specific Techniques Vs. Common Factors? Psychotherapy Integration and its Role in Ethical Practice.

Important change in competent practice in psychological therapy is increasingly being influenced by evidence-based practice. This paper explores major issues related to the evidence-based literature with regard to specific techniques and common factors. Increasing evidence that support common factors provides validity for the psychotherapy integration movement. This movement is explored in relation to the three waves of behavior therapy that indicate an increasing integration of a wide range of therapies. The discussion concludes with implications for therapists who wish to adopt an ethical and evidence-based approach.

Religion, Sexuality, and Internalized Homonegativity: Confronting Cognitive Dissonance in the Abrahamic Religions.

This research was aimed at investigating how religious beliefs and internalized shame predicted homonegativity. An online survey, which consisted of a self-report questionnaire assessing religious orientation, internalized shame, and internalized homonegativity, was completed by 133 Caucasian and Asian gay men. The respondents also were asked to write a short answer in which they had to explain how they integrated their religion and sexual practices. The quantitative analyses of data demonstrated no significant difference in internalized homonegativity among the two cultural groups. Internalized homonegativity was predicted by the main Abrahamic faiths (i.e. Christianity, Islam, and Judaism) and internalized shame. Qualitative analysis showed that gay men who adhere to a monotheistic religious faith follow a different path to reconciling their religion and homosexuality compared to gay men who adhere to Philosophical/New Age religions or to gay men who have no religious faith. The implications of these findings as well as directions for future research studies were discussed.

Sex and the sinner: comparing religious and nonreligious same-sex attracted adults on internalized homonegativity and distress.

Homonegative prejudice has long been connected with poor psychological outcomes. These have often been purported to include internalized homonegativity (IH), an outcome regarded as especially detrimental given its association with a large number of adverse mental health correlates. Given the evidence that homonegative prejudice often prevails most strongly within many mainstream religious contexts, the current study examined whether religious lesbian, gay, and bisexual (LGB) individuals would possess higher levels of internalized homonegativity than their nonreligious, and formerly religious, LGB counterparts. To test this hypothesis, Christian, formerly Christian, and nonreligious Australian LGB respondents (N = 579), recruited through social media platforms and a diverse range of community groups, completed an online survey assessing IH; religion-sexuality distress; religious and familial homonegativity; sense of self; and outness. Ordinal logistic regressions revealed that Christian LGB respondents possessed significantly more IH than nonreligious respondents. Furthermore, perceiving greater homonegativity in one's religious and familial environments predicted higher levels of distress and IH among Christians specifically. Despite having apostatized, former Christians still reported greater religion-sexuality distress than nonreligious individuals, suggesting that the psychological effects of homonegative religious environments are potentially enduring. Across all respondents, IH was also greater for males, those who were less "out," and those who possessed a weaker sense of self. Findings generally support the premise that religious homonegativity places LGB Christians at additional psychological risk, with particular regard to IH and religion-sexuality identity conflict, and that both personal and interpersonal characteristics may exacerbate this risk.

Male perpetrators, the gender symmetry debate, and the rejection-abuse cycle: implications for treatment.

This review article examined the gender symmetry debate in light of recent research relating to the feminist and family research perspectives on intimate partner violence, providing a context for rethinking perpetrator programs. The concept of coercive control is considered as an explanatory factor in an attempt to integrate the feminist and family research perspectives. The limited effectiveness of perpetrator programs is examined. Research highlighting potential factors that could improve the effectiveness of perpetrator programs is introduced, followed by a discussion of the rejection-abuse cycle, one attempt to incorporate current research into a more inclusive program. The rejection-abuse cycle identifies a pattern of perpetrator behavior, which links rejection, threat to self, defense against threat, and abuse. Finally, suggestions for changing perpetrator programs are elaborated, incorporating past research, which would make them appropriate for both male and female perpetrators. These implications are contextualized within a meta-theory to provide greater clarity for the development of future perpetrator programs.

Homonegativity and its relationship to religiosity, nationalism and attachment style.

This study investigated the relationships between negative attitudes towards homosexuals and two traditional ideologies: religiosity and nationalism, and explored the link with attachment style. An Internet survey yielded 290 participants, of highly diverse ages, nationalities, and religious backgrounds. The participants provided demographic details, and completed measures of adult attachment, nationalism, religiosity, and both explicit and implicit measures of homonegativity. The results indicated that both nationalism and religiosity were highly significant predictors of homonegativity. In the religious group, homonegativity and religiosity were positively related. This finding was greater for less securely attached individuals. Avoidance moderated the relationship in religious females, while anxiety moderated the relationship in religious males. No significant attachment moderation was found between the nationalism-homonegativity relationships.

Psychotherapy integration: systems theory and self-psychology.

This article highlights the distinction between integration and eclecticism, arguing for an integration in teaching psychotherapy by using a meta-theory. The traditional approach of presenting a sequential range of therapy models may inadvertently advocate an eclectic approach. It begins with a brief consideration of the integration literature, elaborating a meta-theory for integration. This is followed with the presentation of a meta-theory as an integrative tool for teaching the divergent models of systems theory and self-psychology. Using this meta-theory, an example is presented which conceptualizes the presenting problems of a couple. Finally, a plan for using the integration is discussed.

The experience of altered states of consciousness in shamanic ritual: the role of pre-existing beliefs and affective factors.

Much attention has been paid recently to the role of anomalous experiences in the aetiology of certain types of psychopathology, e.g. in the formation of delusions. We examine, instead, the top-down influence of pre-existing beliefs and affective factors in shaping an individual's characterisation of anomalous sensory experiences. Specifically we investigated the effects of paranormal beliefs and alexithymia in determining the intensity and quality of an altered state of consciousness (ASC). Fifty five participants took part in a sweat lodge ceremony, a traditional shamanic ritual which was unfamiliar to them. Participants reported significant alterations in their state of consciousness, quantified using the 'APZ' questionnaire, a standardized measure of ASC experience. Participants endorsing paranormal beliefs compatible with shamanic mythology, and those showing difficulty identifying feelings scored higher on positive dimensions of ASC experience. Our findings demonstrate that variation in an individual's characterisation of anomalous experiences is nuanced by pre-existing beliefs and affective factors.

Shame, internalized homophobia, identity formation, attachment style, and the connection to relationship status in gay men.

This study reports on a survey of 166 gay men in Sydney, Australia, that explores the links between internalized shame, internalized homophobia, and attachment style. These variables were linked to the age of coming out, family and peer acceptance of their sexuality, relationship status, and previous marriage. Findings suggest a strong relationship between shame, internalized homophobia, and anxious and avoidant attachment style. Shame was predicted by internalized homophobia and anxious and avoidant attachment style. A significant proportion of gay men reported that they were not easily accepted when they first came out. There was a significant relationship between coming out and internalized homophobia but not with shame and attachment style. Furthermore, men who had never come out to family and friends reported higher levels of internalized homophobia but not higher levels of shame and attachment style. Of particular significance was the connection between previous marriage and higher levels of shame and internalized homophobia. Finally, gay men who were not currently in a relationship reported higher levels of shame anxious and avoidant attachment style. These findings are related to therapeutic work with gay men who have previously been married and those who are concerned with their current single status.

Poker mania and problem gambling: a study of distorted cognitions, motivation and alexithymia.

This study examines the relationships between distorted cognitions, motivation, and alexithymia on problem gambling in poker players (n = 96). Respondents completed questionnaires containing the Canadian Problem Gambling Index, Gambling Motivation Scale, Gambler's Beliefs Questionnaire, and Toronto Alexithymia Scale-20. The results suggest that problem gambling is significantly related to distorted cognitions, non-self-determined motivation, and difficulty identifying feelings. Implications are drawn for the development of more relevant intervention, prevention, and treatment strategies.

The Maudsley model of family-based treatment for anorexia nervosa: a qualitative evaluation of parent-to-parent consultation.

This article describes the qualitative analysis of a randomized control trial that explores the use of parent-to-parent consultations as an augmentation to the Maudsley model of family-based treatment for anorexia. Twenty families were randomized into two groups, 10 receiving standard treatment and 10 receiving an additional parent-to-parent consultation. Parents of all families were interviewed regarding their experience of treatment and transcripts were analyzed with the assistance of QSR N-Vivo. Parents described parent-to-parent consultations as an intense emotional experience that helped them to feel less alone, to feel empowered to progress, and to reflect on changes in family interactions. These results suggest that parent-to-parent consultations are seen as a useful augmentation to the Maudsley model of family-based treatment for anorexia nervosa.

Fusion or internalized homophobia? A pilot study of Bowen's differentiation of self hypothesis with lesbian couples.

Bowen, using the concept of differentiation, hypothesized that the way individuals learn to deal with their relationships with families of origin will influence the way they manage their relationships with their partners. This study surveyed a group of 53 lesbian couples on differentiation of self, internalized homophobia, and relationship satisfaction. We found that lesbian couples were not significantly different in their level of differentiation than random pairs. We also found that there was a positive relationship between differentiation of self and relationship satisfaction and that when considered together, internalized homophobia had the more significant connection to relationship satisfaction than did differentiation of self Implications for therapy are drawn from these findings.