The importance of trust and altruistic social orientation for COVID-19 distress.

BACKGROUND: The COVID-19 pandemic, the biggest global health crisis in decades, has been a difficult experience for nations all over the world. In the present study we wanted to assess to what extent a positive attitude towards others, expressed in altruistic social orientation and a high level of trust, would be linked to lower levels of COVID-19 distress in infected and non-infected individuals. PARTICIPANTS AND PROCEDURE: A total 405 individuals (180 women, 44%), aged 18-60 (M = 38.91, SD = 11.02) participated in the study. Respondents were recruited by a research platform. The following questionnaires were completed: the Subjective Happiness Scale, Generalized Trust Scale, survey about COVID-19, social value orientations. RESULTS: The analysis showed that in non-infected high trustors the relationship between altruistic social orientation and COVID-19 distress was significant - the more they were willing to benefit others, the less distress they felt. The reverse effect was observed for infected high trustors - the more altruistic social orientation they expressed, the higher the level of COVID-19 distress they declared. CONCLUSIONS: Our findings shed some light on the importance of a positive attitude towards others in assessing the emotional outcomes of the COVID-19 pandemic. They also imply that people who have experienced the COVID-19 disease can suffer from distress differently than people who have not been affected.

Volunteering intentions during social crises: The role of considering the welfare of others and consequences of own behavior.

In the current paper, we investigate how people with experience with volunteering in their lifetime intend to engage in hypothetical crisis volunteering in the future. We took into account two types of hypothetical social crises: a pandemic and a refugee crisis. We suggest that individual differences in considering the welfare of others (social value orientation) and consideration of future/immediate consequences play a role in the volunteer responses to crises. We also control for the willingness to volunteer in the proximal (a month) and distal (3 years) future, gender, age, and length of volunteer experience. We conducted two survey-based online studies in October 2023. We recruited N = 287 people for Study 1 (Poland) and N = 231 for Study 2 (Italy). Our results suggested that people who declare they want to remain volunteers intend to engage during social crises, but not necessarily in a proactive way. Furthermore, consideration of future consequences can result in proactivity, which was especially visible in the Italian sample. Consideration of immediate consequences can have twofold correlates - one might be the engagement in volunteering in case of a sudden emergency or refraining from the voluntary activity. These results can be used by people leading volunteer activities to predict what to expect from their volunteers and plan the volunteer recruitment and retention processes during crises.

Towards the understanding of the core of general personality disorder factor: g-PD and its relation to hostile attributions.

There is a general consensus that personality disorders (PDs) share a general factor (g-PD) overlapping with the general factor of psychopathology (p-factor). The general psychopathology factor is related to many social dysfunctions, but its nature still remains to some extent ambiguous. We posit that hostile attributions may be explanatory for the factor common for all PDs, i.e., interpersonal problems and difficulty in building long-lasting and satisfying relationships of all kinds. Thus, the main objective of the current project was to expand the existing knowledge about underlying factors of g-PD with regard to hostile attributions. We performed a cross-sectional study on a representative, community sample of Poles (N = 1031). Our hypotheses were primarily confirmed as hostile attributions predicted p-factor. However, the relation was positive only for hostile attributions related to ambiguous situations involving relational harm and physical harm done by female authorities and negative in case of hostile attributions in situations involving physical harm done by peers. Additionally, paranoia-like thoughts strongly related to hostile attributions and independently predicted g-PD. The results contribute to the current discussion on the nature of the g-PD, confirm that hostile attributions and paranoia are a crucial aspect of personality pathology, and indicate the importance of working on these cognitions in the course of therapeutic work.

Future of nature, our future. A preregistered report on future time perspective, social value orientation, and pro-environmental outcomes based on data from Poland and Sweden.

Introduction: The objective of the study was to examine the role of social value orientation and future time perspective to account for individual differences in pro-environmental behaviors, intentions, and opinions about the link between pro-environmental action and pandemic threat (three separate models) in Polish and Swedish samples expected to differ in rate of pro-environmental behaviors (higher in Sweden). We hypothesized that for Poland, future time perspective would be linked to pro-environmental outcomes only when social value orientation is average or high. In contrast, for Sweden, we expected a significant link between these variables regardless of social value orientation. Methods: In total, 301 (150 Polish, 151 Swedish) participants completed online surveys via Prolific.co research panel. We controlled for individualizing/binding moral foundations, present time perspectives, and selected demographic variables in the analyses. Results: In line with expectations, the individualizing moral foundations were a significant predictor across all three models. The data did not support our focal hypothesis regarding the interaction between future time perspective and social value orientation. For pro-environmental behaviors in the past 6 months, the future time perspective was a predictor only when social value orientation was low. Discussion: The results suggest that when encouraging more competitive (compared to altruistic) people to behave in a green way, it might be crucial to underline the future consequences and benefits, consistent with the future time perspective. The pro-environmental campaigns could, therefore, highlight how green behavior may bring personal gains in the future, which are typically valued by individualistic people, such as savings or social status.

The Role of Time Perspectives and Impulsivity Dimensions in Coping Styles.

Both time perspectives and impulsivity dimensions are groups of traits that are connected to self-control abilities and might be important for coping styles. However, to date, no study has systematically investigated their utility in predicting coping styles with regard to their multidimensional nature. The current study was correlational and exploratory, aiming to discover what amount of variance in each of the three coping styles, problem-oriented, active emotion-oriented, and avoidant, is accounted for by two groups of predictors: time perspectives and impulsivity dimensions. N = 397 young adults aged 18-35 from the general population took part in the study. Results of a multiple linear regression testing both groups of predictors separately and of hierarchical regression analysis introducing the two predictor groups in subsequent steps suggested that time perspectives accounted for more variance in adaptive coping styles: problem-oriented and active emotion-oriented coping. For avoidant coping, both time perspectives and impulsivity dimensions accounted for a similar amount of variance. The results provide evidence that time perspectives should be investigated in domains related to coping (e.g., mental health issues, substance abuse, and risk-taking behaviors), for which impulsivity has been considered an important predictor. Moreover, impulsivity ought to be tested with regard to its multidimensionality.

Sense of safety and opinions about COVID-19 vaccinations in Polish school teachers: the role of conspiracy theories belief and fear of COVID-19.

The co-occurrence of COVID-19 conspiracy theories (CCT) and fear of the coronavirus (FCV) can be linked to how safe people feel and how much they endorse vaccinations. School teachers were one of the vaccination priority groups in Poland. We conducted three cross-sectional studies (N1 = 1006; N2 = 1689; N3 = 627) to find out the potential interaction effects of CCT belief and FCV in predicting sense of safety (SoS; Studies 1-3), opinions about vaccinations efficacy (Studies 2-3) and endorsement of vaccinations of children (Study 3) among school teachers. In all three studies, the belief in CCT was related to lower SoS only when FCV was low. For low CCT belief, although the belief in vaccination efficacy was higher than for CCT endorsers, it was unrelated to FCV. However, for high and average CCT belief, FCV was linked to belief in vaccination efficacy. FCV was positively related to acceptance of vaccinating children on all levels of CCT endorsement. The results are discussed in light of the available literature and their potential use in public health.

The Mediational Role of Future and Past Time Perspectives in the Relationship Between Negative Affectivity and Sense of Coherence.

Sense of coherence (SoC) can promote positive coping, and one of its most prominent negative correlates is negative affectivity (NA). In the current study, we hypothesized that future and past time perspectives (TPs) will mediate the relationship between sense of coherence and negative affectivity, and the inverse relationship. The study was questionnaire-based, performed online. N = 719 participants aged 25-45 from the general Polish population took part. On the correlation level, NA was negatively related to future and past positive TPs, and positively to past negative TP. Future and past positive TPs were positively related to SoC, whereas the past negative TP was related negatively to SoC. Future and past TPs partially mediated the effect of NA on SoC. The indirect effect was the strongest for past negative TP and very weak for future and past positive TPs. The full model accounted for 52.9% of variance in SoC. Only past negative TP mediated the relationship between SoC and NA. The full model accounted for 29.8% of variance in NA. The results may serve as an inspiration to integrate time perspective aspects within the salutogenic approaches to understanding human behavior and psychological interventions.

Eating Behaviours in Sportswomen from the Silesian Training in Different Sports Disciplines.

Eating disorders are characterized by abnormal, unhealthy eating habits, and disordered body image. In severe cases, it can cause serious health consequences, including cardiac problems, osteoporosis, infertility, or missing menstrual periods. In women competitively training sports, the main cause for disordered eating behaviours are factors associated with dissatisfaction with their appearance and body image and a need to reduce body weight. Factors related to dissatisfaction with one's own appearance and body image, a need to reduce body weight, a negative perception of themselves and their bodies, the pressure in sports circles, and stress are predictors for eating disorders. The aim of the study was to compare eating behaviours, body satisfaction, and taking various actions related to body mass reduction among women training competitively in volleyball, athletics, gymnastics, and young women not participating in sports. MATERIAL AND METHODS: The study covered a group of girls and young women from the Silesian, Poland, who represented three sports disciplines (volleyball, athletics, and gymnastics), of which 30 girls were used as a control group (B). The study was conducted using a study questionnaire. RESULTS: The study participants ate regularly and consumed all food groups during a week. The majority of girls from A1 (83.33%), A3 (53.33%), and B (80%) groups expressed their dissatisfaction with their body weight. In the group of gymnasts, a positive correlation was noted between the need to reduce body weight and regular eating (r = 0.449; p = 0.013). In the group of volleyball players, it was demonstrated that the higher the competitive experience and the greater the training load, the more regular their eating was (r = 0.475; p = 0.009). CONCLUSIONS: The importance of a diagnosis of early signs of eating disorders in girls and women as a basic component contributing to FAT development implies that further studies in this area, as well as education of the entire sports circle are necessary.

Belief in the importance of socially responsible behaviors - the significance of trust and personal experiences with Covid-19.

A vast number of studies have shown that trust is related to socially desirable traits and behaviors. In the present research we have investigated the relationship between generalized trust and beliefs about the importance of socially responsible behaviors (SRB) during the pandemic - namely, following the sanitary regime and getting vaccinated. Basing on the previous findings we assumed that trustful people would be more convinced of the benefits of complying with the pandemic restrictions and getting vaccinated. The hypothesis stated that people with high levels of trust who had COVID-19 or whose close persons had been infected would be the most likely to believe in socially responsible behaviors. We recruited 405 people from the general population (age range 18-65) to participate in an online study conducted via a research platform. The analysis using linear regression has shown that people, whose close persons had suffered from COVID-19 were more inclined to believe in the importance of SRB. The level of trust also predicted the beliefs about the importance of socially responsible behaviors in mitigating the pandemic. Trust was positively related to SRB, except for people whose close persons had been infected with COVID-19. Regardless of the level of trust, people with such experience tended to assess SRB as important to combat the pandemic. These results have shed light on the importance of trust in developing the strategy of fighting the COVID-19 pandemic.

Hostility bias or sadness bias in excluded individuals: does anodal transcranial direct current stimulation of right VLPFC vs. left DLPFC have a mitigating effect?

Exclusion has multiple adverse effects on individual's well-being. It induces anger and hostile cognitions leading to aggressive behavior. The purpose of this study was to test whether exclusion would affect recognition of anger on ambivalent faces of the excluders. We hypothesized that exclusion would elicit more anger encoding (hostility bias) than inclusion, but this effect would be mitigated by anodal tDCS of right VLPFC or left DLPFC-regions engaged in negative affect regulation. Participants (N = 96) were recognizing emotions (anger, sadness, happiness) on ambiguous faces of individuals who-as they were told-liked them or not. Results showed that exclusion induced more sadness bias. tDCS to VLPFC decreased anger and increased sadness recognition on excluders' faces compared with includers' faces, expressing a mixture of these two emotions. Additionally, stimulation to VLPFC and DLPFC decreased latencies for faces expressing sadness (sad-angry and happy-sad) but increased for happy-angry faces. Stimulation to VLPFC also increased reaction time to excluders faces while stimulation of DLPFC decreased reaction latency to includers faces. Results were discussed with the reference to the form of exclusion, motivational mechanism affected by disliking but also to lateralization (valence vs. arousal theory) and cortical regions engaged in encoding sadness after a threat to belonging.

Volunteerism in the last year as a moderator between empathy and altruistic social value orientation: an exploratory study.

BACKGROUND: Volunteerism is a sustained prosocial activity, and young adults are one of the most important targets for organizations recruiting volunteers. Empathy and altruistic social value orientation measured by a decomposed game are dispositional traits that might foster engagement in volunteerism. PARTICIPANTS AND PROCEDURE: Using a self-report online-based questionnaire study on two groups of young adults (aged 18-35, N = 224 non-volunteers and N = 178 volunteers in the last year) the relationship between empathy and altruistic social value orientation in both of these groups was explored. RESULTS: The results showed that volunteers scored significantly higher on empathy and altruistic social value orientation than non-volunteers. In non-volunteers, empathy is positively linked to altruistic social value orientation, whereas for volunteers the relationship is inversed. CONCLUSIONS: The results provide evidence that volunteers, when high on empathy, might not necessarily be ready to share financial resources with others, as operationalized by a decomposed game.

Defense Mechanisms and Borderline Personality Organization Among COVID-19 Believers and Non-believers During Complete Lock-Down.

The aim of the current study was to investigate whether a specific social perception of the pandemic-believing or not in COVID-19-predicts borderline personality organizations and whether this relationship is mediated by more primitive maladaptive mechanisms-splitting, denial, and dissociation. The online study included 720 organization aged 25-45. Participants were diverse in terms of place of residence, being in a relationship, and education level. Approximately 30% of the general population reported not believing in the COVID-19 pandemic. Non-believers scored slightly higher on borderline symptoms and used more maladaptive defense mechanisms than believers. Individuals who deny COVID-19 are more likely to show characteristics of borderline personality organization. Splitting is an important mechanism in this relationship.

Age, frequency of volunteering, and Present-Hedonistic time perspective predict donating items to people in need, but not money to combat COVID-19 during lock-down.

Restrictions due to COVID-19 necessitated staying at home, but in some cases, encouraged charitable behavior, e.g., donating items to people in need (e.g., clothes, food), or money to support combatting COVID-19. Drawing on the previous findings regarding helping during disastrous situations and roles of time perspective in helping behaviors, the study tested the predictive value of age, gender, previous volunteering, altruistic social value orientation, and time perspectives of donating items to people in need or money to combat COVID-19. The study is pioneering in terms of including time perspectives as individual differences which might contribute to making donations during COVID-19 circumstances. The study was questionnaire-based and conducted online in the eighth week of social distancing in Poland. 150 young adults (age 18-35) took part in the study. Results of multivariable logistic regression analysis indicated that age, frequency of volunteering before the epidemic, and Present-Hedonistic time perspective predict donating items to people in need, but none of the tested variables predicted donating money to combat COVID-19. The findings suggest that charitable behavior, especially in the context of extraordinary social situations, needs to be treated as a multifaceted phenomenon. The study indicates that a Present-Hedonistic time perspective would be a promising individual difference to test in future studies on prosociality.

Remote learning among students with and without reading difficulties during the initial stages of the COVID-19 pandemic.

This article presents the results of a survey on yet under-researched aspects of remote learning and learning difficulties in higher education during the initial stage (March - June 2020) of the COVID-19 pandemic. A total of 2182 students from University of Warsaw in Poland completed a two-part questionnaire regarding academic achievements in the academic year 2019/2020, living conditions and stress related to learning and pandemic, as well as basic demographic information, and Dyslexia Diagnosis Questionnaire (DDQ). The analyses were carried out in three sub-groups of students: who self-reported having a formal diagnosis of dyslexia (CDYS), self-reported reading difficulties, but had no formal diagnosis of dyslexia (SIDYS), and who reported no reading difficulties (CON). The results of the survey revealed that compared with the CON group, more students from CDYS and SIDYS groups did not pass at least one exam in the summer semester. CDYS and SIDYS groups experienced higher stress due to epidemiological restrictions, they had more difficulties than CON with the organisation of learning and obtaining credit during the COVID-19 pandemic. The results indicate a need for special consideration of additional support for students experiencing reading difficulties (whether or not they have a formal diagnosis).

Microcrystalline paclitaxel-coated balloon for revascularization of femoropopliteal artery disease: Three-year outcomes of the randomized BIOPAC trial.

The aim of the BIOPAC trial was to determine long-term safety and efficacy of a novel microcrystalline paclitaxel-coated balloon (mcPCB) with a biocompatible polymer as an excipient in the treatment of occlusive femoropopliteal lesions. In this first-in-human prospective controlled randomized trial, 66 patients with femoropopliteal, symptomatic (Rutherford stages 2B to 5) occlusive arterial disease were randomized to either mcPCB (study group) or POBA (plain old balloon angioplasty) (control group) on a 1:1 basis. Late lumen loss (LLL) at 6 months was the primary endpoint of the study and serious adverse events (SAE: death, amputation, repeated revascularization) were considered a composite secondary endpoint. Routine angiography was scheduled for all study subjects at 6-month follow-up; outpatient appointments were scheduled at 12 and 36 months after intervention. At 6 months, the LLL was 63% lower in the mcPCB group compared to the POBA group (0.52 ± 1.2 vs 1.39 ± 1.1 mm; psup < 0.01). Binary restenosis occurred in 23% vs 52% of patients (p = 0.02). At 3 years, the prevalence of SAE was significantly lower in the mcPCB group (33.3 vs 63.3%; p = 0.02), which mainly resulted from a twofold reduction in target vessel revascularization rate (28.6 vs 59.3%; p = 0.02). The difference in mortality was nonsignificant (7.4 vs 14.3%; p = 0.42). Patients with mcPCB were less symptomatic and less likely to adhere to secondary prevention measures. In this pivotal trial, a novel mcPCB proved superior to POBA concerning LLL at 6-month follow-up, and SAE at 12 months. This result was sustained up to 3 years. There was no difference between groups regarding mortality. ClinicalTrials.gov Identifier: NCT02145065.

Frequency of use, moral incongruence and religiosity and their relationships with self-perceived addiction to pornography, internet use, social networking and online gaming.

BACKGROUND AND AIMS: Moral incongruence involves disapproval of a behavior in which people engage despite their moral beliefs. Although considerable research has been conducted on how moral incongruence relates to pornography use, potential roles for moral incongruence in other putative behavioral addictions have not been investigated. The aim of this study was to investigate the role of moral incongruence in self-perceived addiction to: (i) pornography; (ii) internet addiction; (iii) social networking; and (iv) online gaming. DESIGN: A cross-sectional, preregistered, online survey using multivariable regression. SETTING: Online study conducted in Poland. PARTICIPANTS: 1036 Polish adults aged between 18 and 69 years. MEASUREMENTS: Measures included self-perceived behavioral addiction to pornography, internet use, social networking and online gaming and their hypothesized determinants (moral incongruence, frequency of use, time of use, religiosity, age and gender). FINDINGS: Higher moral incongruence (ß = 0.20, P < 0.001) and higher religiosity (ß = 0.08, P < 0.05) were independently associated with higher self-perceived addiction to pornography. Additionally, frequency of pornography use was the strongest of the analyzed predictors (ß = 0.43, P < 0.001). A similar, positive relationship between high moral incongruence and self-perceived addiction was also present for internet (ß = 0.16, P < 0.001), social networking (ß = 0.18, P < 0.001) and gaming addictions (ß = 0.16, P < 0.001). Religiosity was uniquely, although weakly, connected to pornography addiction, but not to other types of addictive behaviors. CONCLUSIONS: Moral incongruence may be positively associated with self-perception of behavioral addictions including not only pornography viewing, but also internet use, social networking and online gaming.

Gender as a moderator between Present-Hedonistic time perspective and depressive symptoms or stress during COVID-19 lock-down.

Although numerous studies have addressed the impact of the COVID-19 lock-downs on psychological distress, scarce data is available relating to the role of Present-Hedonistic (PH) time perspective and gender differences in the development of depressive symptoms and stress during the period of strict social distancing. We hypothesized that gender would moderate the relationship between PH and depressiveness or stress levels, such that PH would negatively correlate with psychological distress in women but correlate positively in men. The present study was online and questionnaire-based. N = 230 participants aged 15-73 from the general population took part in the study. The results of moderation analysis allowed for full acceptance of the hypothesis for depression as a factor, but for stress the hypothesis was only partially confirmed, since the relationship between PH time perspective and stress was not significant for men (although it was positive, as expected). The findings are pioneering in terms of including PH time perspective in predicting psychological distress during the COVID-19 lock-down and have potentially significant implications for practicing clinicians, who could include the development of more adaptive time perspectives and balance them in their therapeutic work with people experiencing lock-down-related distress.

Compulsive Sexual Behavior and Dysregulation of Emotion.

INTRODUCTION: Dysregulation of emotion (DE) is commonly seen in individuals suffering from compulsive sexual behavior (CSB), as well as represents a crucial element of its common comorbidities like mood, anxiety, and substance use disorders. AIM: To investigate the links between CSB and DE. METHODS: A review of pertinent literature on CSB and DE was performed using EBSCO, PubMed, and Google Scholar databases. MAIN OUTCOME MEASURE: Patterns of DE were evaluated as a common clinical feature, underlying mechanisms, as well as a target for psychological and pharmacological interventions in CSB. RESULTS: Across different conceptualizations of CSB, DE represents the core element of a failure to cope with sexual impulses, thoughts, urges, or resulting uncontrolled sexual behaviors. DE may contribute to the occurrence of CSB while for individuals affected by this condition, sexual arousal and release act as an easier/learned (yet uncontrolled and leading to negative consequences) way of coping with negative mood states. CSB may represent a delusive form of self-regulation. Experience of child sexual abuse and insecure attachment patterns are considered risk factors for CSB (likely to be mediated by DE) but require further investigation. DE is also positively associated with CSB symptom severity. Pharmacological treatments affecting mood regulation, anxiety, impulsivity, and regulation within the brain reward system have been reported to help people with CSB achieve better control over their sexual urges and behavior. However, the available data are scarce and well-powered randomized controlled trials are needed to support these observations. Although improvement in one's emotional self-regulation is considered as an important healing factor in treatment, its benefit in psychological therapies specific to CSB requires further investigation. CONCLUSION: DE represents a core symptom of compulsive sexual behavior disorder and related comorbidities as well as a predisposing factor to the development of compulsive sexual behavior disorder. Addressing DE may facilitate better treatment outcomes for patients with CSB. Lew-Starowicz M, Lewczuk K, Nowakowska I, et al. Compulsive Sexual Behavior and Dysregulation of Emotion. J Sex Med 2020;8:191-205.

Evaluating Pornography Problems Due to Moral Incongruence Model.

INTRODUCTION: To date, multiple models of problematic pornography use have been proposed, but attempts to validate them have been scarce. AIM: In our study, we aimed to evaluate the Pornography Problems due to Moral Incongruence model proposing that self-appraisals of pornography addiction stem from (i) general dysregulation, (ii) habits of use, and (iii) moral incongruence between internalized norms and behavior. We investigated whether the model can be used to adequately explain the self-perceptions of addiction to pornography (model 1) and a broader phenomenon of problematic pornography use (model 2). METHODS: An online, nationally representative study was conducted on a sample of 1036 Polish adult participants, of whom, 880 declared a lifetime history of viewing pornography. MAIN OUTCOME MEASURE: The outcomes were self-perceived pornography addiction, problematic pornography use, avoidant coping, frequency of pornography use, religiosity, moral disapproval of pornography, and related variables. RESULTS: Our results indicated that avoidant coping (an indicator of general dysregulation), frequency of pornography use (indicator of habits of use), and the distress connected with incongruence between own sexual behavior and internalized norms, attitudes and beliefs positively contributed to self-perceived addiction (model 1) as well as problematic pornography use (model 2). This broadly confirms the basic shape of the PPMI model. There were, however, notable differences between the models. Moral incongruence related distress was only weakly related to self-perceived addiction (ß = 0.15, P < .001), with a stronger relation for problematic pornography use (ß = 0.31, P < .001). When controlling for other factors, religiosity weakly predicted problematic pornography use (ß = 0.13, P < .001), but not self-perceived addiction to pornography (ß = 0.03, P = .368). Frequency of pornography use was the strongest predictor of both self-perceived addiction (ß = 0.52, P < .001) and problematic pornography use (ß = 0.43, P < .001). CLINICAL IMPLICATIONS: Factors proposed within the PPMI model are distinctly relevant intervention targets, and they should be considered in the process of diagnosis and treatment. STRENGTHS & LIMITATIONS: The presented study is the first to evaluate PPMI model. Its main limitation is that it has a cross-sectional design. CONCLUSION: The PPMI model is a promising framework for investigating the factors related to self-perceived addiction and problematic pornography use. Despite the differences between the models and in the strength of specific predictors, (i) dysregulation, (ii) habits of use, and (iii) moral incongruence all uniquely contribute to self-perceived addiction and problematic pornography use. Lewczuk, K., Glica, A., Nowakowska, I., et al. Evaluating Pornography Problems Due to Moral Incongruence Model. J Sex Med 2020;17:300-311.