Changes over time in sexual and relationship functioning of people with multiple sclerosis

Relationship and sexual satisfaction among people with multiple sclerosis (MS) has received little research attention. This article reports on a longitudinal investigation of the impact of coping style and illness-related variables among people with MS and the general population on sexual and relationship functioning. Both men (n = 120) and women (n= 201) with MS and men (n = 79) and women (n = 160) from the general population participated in the study at two points in time, 6 months apart. People with MS experienced lower levels of sexual activity, sexual satisfaction, and relationship satisfaction and higher levels of sexual dysfunction. Generally speaking, the time 1 levels of the health and coping variables explained little of the variance in the time 2 sexual and relationship variables. However, sexual activity at time 1 contributed significant unique variance to relationship satisfaction at time 2 for MS men, and coping strategies at time I contributed to relationship satisfaction among general population women at time 2. Furthermore, for those respondents who had been diagnosed with MS for less than 7 years, levels of sexual activity at time 2 were predicted by levels of sexual and relationship satisfaction, as well as levels of sexual activity at time 1. These results suggest that strategies used to cope with illness may not play a major role in sexual and relationship satisfaction. However, an examination of these strategies over a longer time frame is needed.

An integrative model of relationship functioning

This thesis presents an integrative model of relationship functioning, delineating the factors that significantly influence the way in which couples experience lasting and satisfying relationships. Given that marital relationships are complex, multiple intra and interpersonal factors need to be considered in order to better understand the pathways which lead to healthy relationship functioning. The integrative nature of the model is therefore argued to capture the intricate dynamics inherent in couple functioning. The portfolio provides four case studies of different loss experiences which are linked by the theme of disenfranchised grief which is deemed an important issue to deal with in therapy.

The associations among adult attachment, relationship functioning, and sexual functioning

 This thesis examined the associations among adult attachment and multiple aspects of relationship functioning and sexual functioning for a range of partnerships. It was found that anxious and avoidant attachment were associated with more negative relationship experiences (e.g., lower satisfaction, lower intimacy, and higher levels of sexual dysfunction).

Towards an integrative attachment-based model of relationship functioning

Based on attachment theory, this study developed a theory-based model of heterosexual relationship functioning that examined both proximal and distal factors and both actor and partner effects. A particular focus was on the underexplored issue of double-mediated effects between attachment orientation and relationship satisfaction. Data were collected from a community sample of 95 cohabiting and married couples with a mean age of 39.30 years. Participants completed measures of attachment, commitment, provision of partner support, trust, intimacy, destructive conflict management, and relationship satisfaction. The hypothesized model was largely supported. The association between attachment orientation and relationship satisfaction was mediated through a series of actor and partner variables. No gender differences were found across actor paths; however, differences were found in partner effects for men and women. The model has important implications for relationship researchers and practitioners. © 2013 The British Psychological Society.

Impact of average household income and damage exposure on post-earthquake distress and functioning: A community study following the February 2011 Christchurch earthquake.

Post-traumatic stress, depression and anxiety symptoms are common outcomes following earthquakes, and may persist for months and years. This study systematically examined the impact of neighbourhood damage exposure and average household income on psychological distress and functioning in 600 residents of Christchurch, New Zealand, 4–6 months after the fatal February, 2011 earthquake. Participants were from highly affected and relatively unaffected suburbs in low, medium and high average household income areas. The assessment battery included the Acute Stress Disorder Scale, the depression module of the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder Scale (GAD-7), along with single item measures of substance use, earthquake damage and impact, and disruptions in daily life and relationship functioning. Controlling for age, gender and social isolation, participants from low income areas were more likely to meet diagnostic cut-offs for depression and anxiety, and have more severe anxiety symptoms. Higher probabilities of acute stress, depression and anxiety diagnoses were evident in affected versus unaffected areas, and those in affected areas had more severe acute stress, depression and anxiety symptoms. An interaction between income and earthquake effect was found for depression, with those from the low and medium income affected suburbs more depressed. Those from low income areas were more likely, post-earthquake, to start psychiatric medication and increase smoking. There was a uniform increase in alcohol use across participants. Those from the low income affected suburb had greater general and relationship disruption post-quake. Average household income and damage exposure made unique contributions to earthquake-related distress and dysfunction.

Relationship Maintenance in Couples with a Partner Who Has Attention Deficit Hyperactivity Disorder

The body of research on the relationship functioning of adults with attention deficit hyperactivity disorder (ADHD) is relatively small; the aim of the present study is to advance our understanding of this topic. It has been estimated that three to ten percent of children and one to five percent of adults have impairing symptoms of ADHD, which is a total of 4 million children and 4-5 million adults in the U.S. (Wender, 2000). A recent prevalence study found that approximately 4.4% of adults in the U.S. meet the criteria for a diagnosis of ADHD (Kessler et al., 2006). Children with ADHD show innate temperamental characteristics, usually inattentiveness, distractibility, impulsivity, restlessness, demandingness, hyperreactivity, low tolerance for frustration, temperoutbursts, bossiness and stubbornness, and mood lability, along with an innate proclivity for academic underachievement. It has been estimated that one- to two-thirds of children with ADHD have symptoms that continue into adulthood, and for 40-50% of these adults, these symptoms are serious enough to cause impairment in functioning (Everett & Everett, 1999; Wender, 2000). Research suggests that the majority of cases are transmitted genetically, but some may be due to exposure to environmental toxins such as lead. Consumption of excess sugar or allergies to food may exacerbate or mimic ADHD symptoms in some children, but they are not a cause of ADHD (Wender, 2000). One hypothesized cause of the symptoms associated with ADHD is a deficit in the brain's executive functioning (Barkley & Gordon, 2002). Executive functioning can be conceptualized as the ability to inhibit, organize, and plan behaviors. Barkley and Gordon (2002) define it as the abilityto self-direct and regulate behaviors toward future goals, including social behaviors and goals. Other research suggests that executive functioning consists of inhibition, control of interference, verbal and nonverbal working memory, emotional regulation, attention, verbal fluency, visual scanning, and processing speed. Studies have shown impairments in these areas among adults with ADHD (Barkley & Gordon, 2002; Barkley, Murphy & Kwasnik, 1996; Goldstein, 2002).

Shame, Dissociation, and Complex PTSD Symptoms in Traumatized Psychiatric and Control Groups: Direct and Indirect Associations With Relationship Distress

Objectives: Elevated shame and dissociation are common in dissociative identity disorder (DID) and chronic posttraumatic stress disorder (PTSD) and are part of the constellation of symptoms defined as complex PTSD. Previous work examined the relationship between shame, dissociation, and complex PTSD and whether they are associated with intimate relationship anxiety, relationship depression, and fear of relationships. This study investigated these variables in traumatized clinical samples and a nonclinical community group.

Method: Participants were drawn from the DID (n = 20), conflict-related chronic PTSD (n = 65), and nonclinical (n = 125) populations and completed questionnaires assessing the variables of interest. A model examining the direct impact of shame and dissociation on relationship functioning, and their indirect effect via complex PTSD symptoms, was tested through path analysis.

Results: The DID sample reported significantly higher dissociation, shame, complex PTSD symptom severity, relationship anxiety, relationship depression, and fear of relationships than the other two samples. Support was found for the proposed model, with shame directly affecting relationship anxiety and fear of relationships, and pathological dissociation directly affecting relationship anxiety and relationship depression. The indirect effect of shame and dissociation via complex PTSD symptom severity was evident on all relationship variables.

Conclusion: Shame and pathological dissociation are important for not only the effect they have on the development of other complex PTSD symptoms, but also their direct and indirect effects on distress associated with relationships.

THE ASSOCIATION OF SOCIAL ANHEDONIA WITH ROMANTIC RELATIONSHIP PROCESSES

Social anhedonia is a deficiency in the capacity to experience pleasure from social interactions. This study examined the implications of social anhedonia for romantic relationship functioning, including the association of social anhedonia with sentiments towards romantic partners that are central to relationship functioning (satisfaction, commitment, regard, and care), analogous perceptions of the partner’s sentiments, hostile behavior during relationship conflict, and perception of the partner’s hostile behavior. Data were collected from 281 participants who were involved in romantic relationships. Support was found for social anhedonia’s hypothesized negative association with satisfaction, regard, and care, as well as all four perceived partner sentiments. These associations were independent of attachment anxiety and avoidance. Additionally, attachment avoidance mediated social anhedonia’s relationship with commitment. However, no support was found for social anhedonia’s hypothesized positive association with actual and perceived partner hostile behavior. Results suggest that social anhedonia may undermine the functioning of interpersonal relationships.

The Impact of Shame on the Therapeutic Alliance and Intimate Relationships

Objectives


This study examined the role of shame coping styles and state shame in predicting the therapeutic alliance and intimate relationship functioning in individuals with mental health problems.


Method


A sample of 50 treatment-receiving adults aged 21 to 67 years with a mix of common mental health difficulties was recruited from a clinical psychology service. Participants were given questionnaire measures of shame states, shame coping styles, intimate relationship functioning, and the therapeutic alliance.


Results


Regression analyses indicated that the shame coping strategy of physical and psychological withdrawal was the primary risk factor for development of a less effective therapeutic alliance. Both withdrawal and attack self coping styles were significant predictors of impaired intimate relationship functioning.


Conclusions


These findings have implications for the theoretical role of shame in mental health presentations as well as the potential for internalizing shame coping styles (i.e., withdrawal, attack self) to act as a barrier to successful therapy and interpersonal relationships. The inclusion of shame-focused assessments and interventions in the initial stages of treatment with clients exhibiting these strategies could improve prognosis.

Internet-based psychological and oral medical treatment compared to psychological treatment alone for ED

Introduction. Sexual function through pregnancy and the postpartum period is an important aspect of quality of life.
Despite this, prospective studies are limited, and the impact of body image on sexual function has not been explored.
Aims. The current study reports on a pilot study that evaluated the effectiveness of a combined Internet-based
psychological treatment program and oral medication compared to an Internet-based psychological program.
Methods. Twelve men with ED participated in the study.
Main Outcome Measures. Assessments were made pre and postintervention on ED, relationship satisfaction, sexual
satisfaction, self-esteem, and quality of life.
Results. Multivariate analyses of variance demonstrated that both treatment conditions showed improvements from
pretest to posttest in sexual functioning, relationships, and personal well-being.
Conclusions. This study indicates the importance of targeting psychological and relationship variables in the
treatment of ED. Further research with larger numbers of participants is necessary for a more rigorous evaluation
of treatment programs that combine psychological and medication interventions for ED.

The effectiveness of internet-based treatment for female sexual dysfunction

There has been limited evaluation of the effectiveness of psychological interventions for female sexual dysfunction (FSD). Further, none of these studies have evaluated the effectiveness of these interventions delivered over the internet. The current study evaluated an internet-based psychological treatment program for FSD. In total, 39 women (17 in treatment group, 19 in control group) completed the program. The results demonstrated that women who completed treatment reported improved sexual and relationship functioning in comparison to those who received no treatment. The portfolio draws on four case studies from the author's placement experience to demonstrate the role of negative life events, social support and psychological adjustment.