A feminist phenomenological approach to the analysis of body maps: Childhood trauma and anorexia nervosa.

Body mapping is an arts-based research technique that uses a life-sized outline of the participant's body and symbols that visually represent their lived experiences. In this article, we describe the methods of body mapping and analytic techniques used in a research inquiry exploring how child abuse influenced the embodied processes in anorexia. We aim to contribute to methodological research practice in anorexia using a method that can potentially add value in other areas of ED research or be adapted for treatment settings. Our research findings suggest that body mapping can add value to the interview method and extend the range of methods for researchers interested in interrogating the hard-to-reach subjective embodied processes.

A systematic review of patient oncofertility support needs in reproductive cancer patients aged 14 to 45 years of age.

OBJECTIVE: Decline in fertility potential brought about by a cancer diagnosis or cancer treatment is one of the biggest impacts to cancer patients' long-term quality of life. As such, the current manuscript aimed to systematically review the literature on oncofertility support needs for cancer patients of a reproductive age (14-45 years of age). METHODS: A systematic review of the literature was conducted in May 2016 through the searching of electronic databases Medline, EMBASE, PSYCH Info, Web of Science and SCOPUS, alongside the screening of relevant reference lists. An initial search identified 351 potentially relevant studies. The papers were divided into 2 categories; papers on patient oncofertility support needs were reviewed for this systematic review, and papers on clinician provision of oncofertility support were reviewed for a separate systematic review. RESULTS: A total of 30 studies were included within the final review. Support needs were categorised as information, service, clinician-patient interactions, psychological, and family. A number of studies indicated that cancer patients place great important on their oncofertility care and have unmet support needs. Patients were satisfied and felt supported when additional care was taken to ensure fertility information and service needs were met. CONCLUSIONS: Patients desire for clinicians to support their concerns through the provision of adequate information, access to oncofertility services, taking time to discuss oncofertility treatment and concerns, specialised psychological support, and responsiveness to individual needs.

Let's talk about gay sex: gay and bisexual men's sexual communication with healthcare professionals after prostate cancer.

Although sexual changes after prostate cancer (PCa) have specific meanings and consequences for gay and bisexual (GB) men, little is known about how GB men navigate sexual well-being support. We surveyed 124 GB men with PCa and 21 male partners, and interviewed a sub-sample of 46 GB men and 7 male partners, to examine GB men's experiences of sexual communication with healthcare professionals (HCPs) since the onset of PCa. GB men perceived a number of deficits in HCPs communication: medical support dominated sexual and psychological support; heterosexuality of GB patients was often assumed; sexual orientation disclosure was problematic; and GB men perceived rejection or lack of interest and knowledge from a majority of HCPs with regard to gay sexuality and the impact of PCa on GB men. Facilitators of communication were acknowledgement of sexual orientation and exploration of the impact of PCa on GB men. In order to target improved support for GB men with PCa, it is concluded that HCPs need to address issues of hetero-centricism within PCa care by improving facilitation of sexual orientation disclosure, recognising that GB men with PCa might have specific sexual and relational needs, and increasing knowledge and comfort discussing gay sexuality and gay sexual practices.

Talking about sex with health professionals: the experience of people with cancer and their partners.

Changes to sexuality can be one of the most difficult aspects of life following cancer. This study examines the experience of discussing sexuality post cancer with health care professionals (HCPs), from the perspective of women and men with cancer (PWC), and their partners (PPWC), across a range of cancer types. A total of 657 PWC (535 women, 122 men) and 148 PPWC (87 women, 61 men) completed a survey containing closed and open-ended items, analysed by analysis of variance and thematic analysis. Discussions about sexuality with a HCP were more likely to be reported by men (68%) compared to women PWC (43%), and by women (47%) compared to men PPWC (28%), as well as by those with a sexual or reproductive cancer. Men PWC and women PPWC were most likely to want to discuss sexuality with a HCP, with men PWC and PPWC reporting highest levels of satisfaction with such discussions. Open-ended responses revealed dissatisfaction with the unwillingness of HCPs to discuss sexuality, unhappiness with the nature of such discussion, and positive accounts of discussions about sexuality with HCPs. These findings lend support to the notion that people with cancer and their partners may have unmet sexual information and support needs.

Talking about fertility in the context of cancer: health care professional perspectives.

Health care professionals (HCPs) play a key role in providing information and counselling about the implications of cancer for fertility, however, many patients do not receive such information. The aim of this study was to examine the perspectives and practices of Australian HCPs in relation to discussing fertility with cancer patients. A mixed-methods design, comprising of an online survey of 263 HCPs [41.4% nurses; 25.5% doctors; 31% allied health care professionals (AHP)] and qualitative interviews with 49 HCPs, was utilised. HCPs reported that fertility is an important concern for patients and their partners; however, only 50% of doctors and nurses, and 24% of AHPs reported that they always addressed this issue. The primary barriers to discussing fertility were poor patient prognosis; patient gender or age; time constraints; and absence of appropriate resources and materials. Only a minority of HCPs (29%) had undergone training in discussing fertility with cancer patients. The majority wanted further training or education: including nurses (81.8%), AHPs (80.6%) and doctors (55.4%). HCPs agreed that a number of resources would assist them to raise fertility with their patients, including a list of appropriate referral sources, fact sheets, information booklets, a fertility consultation checklist and on-line resources.

Gender differences in cancer carer psychological distress: an analysis of moderators and mediators.

Women cancer carers report higher rates of distress than men; however, there is little understanding of the mechanisms underlying these gender differences. The aim of this study was to examine the potential mediating roles of burden of care, unmet needs, self-silencing, self-efficacy and optimism, and the potential moderating influence of social support, cancer stage, patient gender, time spent caring and other responsibilities, on gender differences in carer distress. Of 329 informal cancer carers (245 women, 119 men), women reported significantly more anxiety, burden of care and unmet needs than men. In the mediation analysis, gender differences in anxiety were fully explained by both the independent contribution and combination of: Disrupted Schedule, Health Problems and Emotional and Spiritual Unmet Needs. Women cared for both men and women patients, across a broad range of relationships, whereas men predominantly cared for their female partner. There was no gender difference in number of hours spent caring or in companionship, amount of support received, and additional responsibilities for children, housework or studies, and none of these factors acted as moderators of gender differences in anxiety. It is concluded that women's gendered role is associated with unmet needs and burden of care, resulting in greater anxiety.

Sexuality after breast cancer: a review.

It is widely recognised that women's sexuality can be particularly complex after breast cancer, with sexual changes often becoming the most problematic aspect of a woman's life. The impact of such changes can last for many years after successful treatment, and can be associated with serious physical and emotional side-effects. The objective of this paper is to review research on breast cancer and sexuality from the years 1998 to 2010. Research has documented a range of physical changes to a woman's sexuality following breast cancer, including disturbances to sexual functioning, as well as disruptions to sexual arousal, lubrication, orgasm, sexual desire, and sexual pleasure, resulting from chemotherapy, chemically induced menopause, tamoxifen, and breast cancer surgery. Women's intrapsychic experience of changes to sexuality includes a fear of loss of fertility, negative body image, feelings of sexual unattractiveness, loss of femininity, depression and anxiety, as well as alterations to a sense of sexual self. The discursive construction of femininity and sexuality shapes the way women construct and experience their illness and their body - leading many women to try to appear 'normal' to others post-breast surgery. Finally, the quality of a woman's partnered relationship consistently predicts sexual health post-breast cancer - reinforcing the importance of recognising the intersubjective nature of issues surrounding breast cancer and sexuality. It is concluded that analyses of sexuality in the context of breast cancer cannot conceptualise the physical body separately from women's intrapsychic negotiation, her social and relational context, and the discursive constructions of sexuality and femininity: a material-discursive-intrapsychic interaction.

A randomized comparison of psychological (cognitive behavior therapy), medical (fluoxetine) and combined treatment for women with premenstrual dysphoric disorder.

This study examines the relative effectiveness of cognitive behavior therapy (CBT) (ten sessions), fluoxetine (20 mg daily) and combined therapy (CBT plus fluoxetine) in women with premenstrual dysphoric disorder (PMDD). This was a randomized pragmatic treatment trial with three treatment cells. Treatment lasted for 6 months; a naturalistic follow-up was undertaken 1 year post-treatment. One hundred and eight women, satisfying the DSM-IV criteria for PMDD with 2 months' prospective confirmation were recruited into the study; sixty of these had completed 6 months of treatment and all measures before and after treatment. The main outcome measures were premenstrual scores on the Calendar of Premenstrual Experiences (COPE) and percentage of PMDD cases (DSM-IV diagnostic criteria). Significant improvement occurred in all three treatment-groups after 6 months' treatment, assessed by the COPE. Fluoxetine was associated with a more rapid improvement. There were no group differences in the percentage of DSM cases of PMDD post treatment, but at follow-up CBT was associated with better maintenance of treatment effects compared with fluoxetine. In conclusion, CBT and fluoxetine are equally effective treatments for PMDD, but the treatments have some differential effects that can be considered in treatment decisions. There appears to be no additional benefit of combining the treatments.

The nature and long-term effects of childhood sexual abuse: a survey of adult women survivors in Britain.

The nature and long-term effects of childhood sexual abuse (CSA) were examined in 775 women survivors who responded to a survey in a women's magazine. Compared to existing research, there was a high rate of CSA involving sexual intercourse (46%), a high rate of intra-familial abuse (80%), a younger age of onset of abuse (8.5 years), and a longer duration of abuse (5.2 years). In univariate analyses, the reporting of a range of long-term psychological effects was significantly related to experience of abuse involving sexual intercourse or sexual contact, abuse perpetrated by a father or stepfather, abuse which was repeated or prolonged, presence of threats or violence, blaming of the child, saying disclosure would split the family, and a younger age of onset. In logistic and multiple regression analyses, the most important predictor variables were presence of threats or violence, and verbal coercion, followed by abuse being repeated or prolonged. It is suggested that future researchers should use a range of assessment instruments and multivariate analyses to examine the nature and long-term effects of child sexual abuse in both women and men.

Restraint and perception of body weight among British adults.

A sample of 533 adults (268 women and 265 men) representative of the general population of Great Britain were interviewed so that the extent and effects of restraint, using the Dutch Eating Behaviour Questionnaire (DEBQ; Van Strien, Frijters, Bergers, & Defares, 1986) and the extent of overestimation of body weight could be examined. High-restraint subjects reported more guilt about food and eating and a greater likelihood of overeating in reaction to dysphoric mood, and they were more apt to overestimate their body size. Women reported significantly higher restraint, more guilt after eating in various types of social situations, and more overeating in reaction to dysphoric mood. Higher social class was associated with reports of guilt about a greater number of foods and with reports of more overeating when under stress or tired. Age was positively associated with guilt and negatively associated with overeating in reaction to being under stress, tired, or depressed.

Research and theory related to female reproduction: implications for clinical psychology.

Reproduction has been proposed as a cause of debilitation and psychological disturbance for centuries, recently reified through the three reproductive syndromes, the premenstrual syndrome, postnatal depression and the menopausal syndrome. The evidence for the existence of these syndromes is critically reviewed, and the different aetiological theories examined, with particular reference to biological and psychological theories. It is argued that whilst bio-medical therapies presently dominate the literature, their efficacy is questionable owing to the lack of clear evidence for a hormonal substrate underlying symptomatology. Psychological interventions are reviewed, and multifactorial or individualized interventions recommended for adoption by clinical psychologists. The role of preventative work, through education, information provision and development of self-help strategies, is discussed. It is concluded that whilst menstruation, childbirth and the menopause do not inevitably have a deleterious effect on women, and the validity of the reproductive syndromes may be questioned, reproduction does act as a salient source of attribution and is a possible contributory factor to distress. Reproduction thus needs to be considered by clinical psychologists, but not privileged above other factors which may contribute to difficulties which individual women may experience.

Performance and state changes during the menstrual cycle, conceptualised within a broad band testing framework.

Using a broad band testing framework, indices of performance and state were examined in 10 women during one menstrual cycle, over six separate testing sessions. Indices of state were heart rate, the Cruickshank self-report questionnaire and time to basal skin potential. Results showed that self reported arousal was increased premenstrually. There was dissociation between indices of state, supporting the contention that simple models of arousal are inadequate. Performance tests of cognitive processing, tracking skill, reaction time and vigilance, dual task, speed and accuracy, and short term memory capacity showed only one significant result: semantic processing on a word matching task improved premenstrually. There was no significant relationship between state and performance: with high individual differences found between subjects. It was concluded that menstruation was not acting as a stressor for these subjects, and that there was no evidence for a decrement in performance in the menstrual or premenstrual phases of the cycle. Results are discussed in terms of coping with perceived increase in demand premenstrually, resulting in utilisation of compensatory effort and it is suggested that future work should examine womens ability to cope with perceived increase in demand and attribution of arousal during the menstrual cycle. The implications of the findings in terms of the critique of PMS as a valid construct are discussed, and it is concluded that future work should be carried out within an integrated multi-variate framework.

Cognitive behavioural couples therapy with gay men referred for counselling in an AIDS setting: a pilot study.

Counselling and psychological therapy is now an established part of health care in most AIDS settings, yet intervention has thus far tended to focus on the individual. It is argued that there is a need for greater development of therapy for couples in the AIDS field, based on the results of a pilot study of cognitive-behavioural couples therapy with 10 couples referred to a clinical psychologist working in an AIDS setting. Results suggest that satisfaction with the relationship significantly improved over the course of therapy, and the problem for which the clients were initially referred were resolved. One individual case report of a couple is presented, in order to illustrate the method of therapy used. The limitations in this pilot study, in addition to general problems in carrying out research in this area, which make generalisations from the data difficult, are discussed. It is concluded that there is preliminary evidence to illustrate the efficacy of cognitive-behavioural couples therapy for gay couples in an AIDS setting, and that counselling interventions should not solely focus on the individual.