Intimacy and risky sexual behavior--what does it have to do with death?

Differences in proximal and intimacy-related defense mechanisms among patients with cancer in different psychological stages of dying

Purpose

This study measured three of the psychological stages of dying in patients with cancer and explored the differences in proximal and intimacy-related defense mechanisms at each stage.

Patients and methods

A total of 220 cancer patients were recruited for this study; 168 patients met the inclusion criteria and were included in the data analysis. The participants were divided into three groups using the "Death Attitudes Questionnaire Revised" (1994) and then completed the Death-Thought Accessibility Test, Self-Control Questionnaire, Rumination Reflection Questionnaire, Attachment Type Test, Intimacy Test, External Control Test, and Positive and Negative Affect Scale.

Results

In the death avoidance stage, which represents a defense stage without cognitive processes, patients are in an irrational state with the highest level of self-control and the lowest level of external control; they tend to prefer close relationships with many people while experiencing high levels of fear and depression. In the bargaining stage, which represents a biased cognitive defense stage, the level of rationality increases, the level of fear and depression decreases, and patients tend to prefer relationships with many people that do not involve intimacy. In the neutral death acceptance stage, which represents a defense stage without cognitive bias, self-control is lowest, external control is highest, patients tend to prefer intimate relationships with a few people, and experience the lowest levels of fear and depression.

Conclusion

Three psychological stages of death exist in cancer patients, with differences in proximal and intimacy-related defense mechanisms in each stage. The findings have theoretical and practical implications for psychological interventions for cancer patients.

Death Anxiety is Associated With Less Health Behavior for Individuals Low in Action Orientation

Research has shown that death anxiety relates to less health behavior. The present study proposes that action orientation moderates this association. That is, it is hypothesized that death anxiety and health behavior relate negatively only in individuals low in action orientation. German adults (N = 187; aged 19-86) provided self-reports on health behavior, action orientation, death anxiety, social desirability, and sociodemographics. Analyses yielded a significant moderation effect of action orientation on the link between death anxiety and health behavior over and above significant relationships of action orientation, social desirability, age, and gender, respectively, with health behavior. As hypothesized, a significantly negative association of death anxiety and health behavior was found only given low action orientation but not among high action orientation individuals. This suggests that self-regulation plays a decisive role in whether death anxiety and health behavior relate to each other.

Sexual Health Implications of COVID-19 Pandemic

INTRODUCTION

A novel coronavirus (COVID-19) reached pandemic levels by March 11th, 2020, with a destructive impact across socioeconomic domains and all facets of global health, but little is known of its impact on sexual health.

OBJECTIVE

To review current knowledge on sexual health-related containment measures during pandemics, specifically COVID-19, and focus on 2 main areas: intimacy and relational dynamics and clinical effects on sexual health.

METHODS

We carried out a literature search encompassing sexual health and pandemic issues using Entrez-PubMed and Google Scholar. We reviewed the implications of the COVID-19 pandemic on sexual health regarding transmission and safe sex practices, pregnancy, dating and intimacy amid the pandemic, benefits of sex, and impact on sexual dysfunctions.

RESULTS

Coronavirus transmission occurs via inhalation and touching infected surfaces. Currently, there is no evidence it is sexually transmitted, but there are sexual behaviors that pose a higher risk of infectivity due to asymptomatic carriers. Nonmonogamy plays a key role in transmission hubs. New dating possibilities and intimacy issues are highlighted. Sexual activity has a positive impact on the immune response, psychological health, and cognitive function and could mitigate psychosocial stressors. COVID-19 pandemic affects indirectly the sexual function with implications on overall health.

CONCLUSION

Increased awareness of health-care providers on sexual health implications related to the COVID-19 pandemic is needed. Telemedicine has an imperative role in allowing continued support at times of lockdown and preventing worsening of the sexual, mental, and physical health after the pandemic. This is a broad overview addressing sexual issues related to the COVID-19 pandemic. As this is an unprecedented global situation, little is known on sexuality related to pandemics. Original research is needed on the topic to increase the understanding of the impact the current pandemic may have on sexual health and function. Pennanen-Iire C, Prereira-Lourenço M, Padoa A, et al. Sexual Health Implications of COVID-19 Pandemic. Sex Med Rev 2021;9:3-14.

Themes in experiences of PTSD symptoms and relationships among male veterans with risky sexual behavior

OBJECTIVE

United States veterans with posttraumatic stress disorder (PTSD) symptoms are at elevated risk for high-risk sexual behavior (HRSB). Although quantitative research has examined relationships between PTSD symptoms and HRSB, qualitative research to understand the lived experiences of veterans with PTSD symptoms and HRSB has not been conducted.

METHOD

Qualitative interviews were conducted with N = 29 male veterans of Operation Enduring Freedom or Operation Iraqi Freedom who had PTSD symptoms and reported recent HRSB. The interviews were analyzed using a phenomenological framework.

RESULTS

Six themes emerged: (a) avoiding social contact due to feeling different since return from service; (b) effortful self-management; (c) supportive relationships; (d) sex as a means to an end; (e) sex, risk, and intimacy; and (f) responsibility and growth.

CONCLUSION

Male veterans with PTSD symptoms and HRSB reported engagement in significant self-management to reengage in life, and still reported high levels of difficulty in relationships. They described both wanting to avoid perceived risk associated with intimate relationships and wanting to take risks that caused them to feel alive. Implications for treatment include increased efforts to facilitate coping, to recognize and moderate risk-taking urges, and to build intimacy and trust. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Examining the Complex Relation Among Religion, Morality, and Death Anxiety: Religion Can Be a Source of Comfort and Concern Regarding Fears of Death

This study examined the relationship among religiosity, morality, and fear of death. Students (n = 328, 75% women, M_age = 18.9) completed measures of fear of death, frequency of immoral behavior, discrepancy between ideal and actual religious practices, strength of religious beliefs, views of God as punishing or forgiving, and behavior efficacy (the extent to which fate in the afterlife was perceived to be determined by behavior in this life). Frequency of immoral behavior was not related to fears of death, but both strength of religious views and behavior efficacy were negatively correlated with fears of death. In contrast, perceived failure to live up to religious standards was associated with more death anxiety, especially among those with punishing views of God. These findings support the idea that some aspects of religion can help protect people from death anxiety, whereas other aspects of religion can exacerbate fears of death.

The Role of Close Relationships in Terror Management: A Systematic Review and Research Agenda

Terror management theory outlines how humans seek self-esteem and worldview validation to manage death-related anxiety. Accumulating evidence reveals that close relationships serve a similar role. However, to date, there has been no synthesis of the literature that delineates when close relationships buffer mortality concerns, under what conditions, on which specific outcomes, and for whom. This systematic review presents over two decades of research to address these questions. Findings from 73 reviewed studies revealed that close relationships serve an important role in buffering death-related anxiety. A range of dispositional and situational moderating factors influence either the activation or inhibition of relational strivings to manage heightened death awareness, the most influential being attachment, gender, and relationship-contingent self-esteem. These findings were integrated into an overarching model that highlights some of the conditions under which mortality salience (MS) influences relational outcomes. We conclude by highlighting a range of theoretical and methodological concerns to be addressed by future research.

Delay and death-thought accessibility: a meta-analysis

The dual-process component of Terror Management Theory (TMT) proposes that different types of threats lead to increases in death-thought accessibility (DTA) after different delay intervals. Experimental studies of terror management threats' effect on DTA were collected and coded for their use of explicitly death-related (vs. not explicitly death-related) threats, and for their use of delay and task-switching during the delay. Results reveal that studies using death-related threats achieved larger DTA effect-sizes when they included more task-switching or a longer delay between the threat and the DTA measurement. In contrast, studies using threats that were not explicitly death-related achieved smaller DTA effect-sizes when they included more task-switching between the threat and the DTA measurement. These findings provide partial support for the dual-process component's predictions regarding delay and DTA. Limitations and future directions are discussed.

Deterioration of mental health in bariatric surgery after 10 years despite successful weight loss

BACKGROUND/OBJECTIVE

The present study evaluated the mental health and psychological functioning of bariatric patients before surgery, and after 1 year and 10 year follow-ups, and compared them with participants in a dietary program. Such long follow-up is rare, but strongly recommended by the American Association of Bariatric Surgeons.

SUBJECTS/METHODS

Thirty-six bariatric surgery patients and 34 participants of a weight loss program were weighed and assessed at all 3 points in time. Participants were administered the mental health inventory, neuroticism, sense of control and fear of intimacy scales. Along with these mental and psychological measurements, the medical outcome short form (SF-36) was used.

RESULTS

The surgery group achieved successful weight loss outcomes (27% reduction of pre-operative weight) after 10 years and better than baseline health-related quality-of-life scores. However, their general mental health, neuroticism, sense of control and fear of intimacy scores showed significant deterioration in comparison to pre-operative levels after 10 years. The dietary group participants remained psychologically stable among all three points in time.

CONCLUSIONS

This study highlights the importance of identifying a risk group among bariatric patients for which the dietary and psychological follow-up may be of special significance.

ADHD symptomatology, fear of intimacy, and sexual anxiety and behavior among college students in China and the United States

OBJECTIVE

ADHD is marked by an apparent contradiction in social relationships: Those with the disorder have more difficulty establishing close relationships but report increased rates of risky sexual behavior. Two studies examined the relationship between ADHD symptomatology and fear of intimacy, sexual anxiety, and sexual behavior in college students.

METHOD

In the first study, college students in China (n = 300) and the United States (n = 233) completed a series of questionnaires. In the second, 192 American college students completed a follow-up series of measures.

RESULTS

In the first study, those with more ADHD symptoms did not report lower levels of sexual anxiety but did report greater fear of intimacy. In the second, students partially replicated the results of the first study, reporting greater fear of intimacy in those with more symptoms of ADHD. Those with more symptoms also reported lower expectations for the intimacy in their relationships and lower levels of relationship self-competence on one of four domains.

DISCUSSION

ADHD symptomatology, particularly inattention, was related to multiple aspects of risky sexual behavior.

Existential Threat or Dissociative Response? Examining Defensive Avoidance of Point-of-Care Testing Devices Through a Terror Management Theory Framework

Using a terror management theory framework, this study investigated if providing mortality reminders or self-esteem threats would lead participants to exhibit avoidant responses toward a point-of-care testing device for cardiovascular disease risk and if the nature of the device served to diminish the existential threat of cardiovascular disease. One hundred and twelve participants aged 40-55 years completed an experimental questionnaire. Findings indicated that participants were not existentially threatened by established terror management methodologies, potentially because of cross-cultural variability toward such methodologies. Highly positive appraisals of the device also suggest that similar technologies may beneficially affect the uptake of screening behaviors.

Probabilistic thinking and death anxiety: a terror management based study

Terror Management Theory has been utilized to understand how death can change behavioral outcomes and social dynamics. One area that is not well researched is why individuals willingly engage in risky behavior that could accelerate their mortality. One method of distancing a potential life threatening outcome when engaging in risky behaviors is through stacking probability in favor of the event not occurring, termed probabilistic thinking. The present study examines the creation and psychometric properties of the Probabilistic Thinking scale in a sample of young, middle aged, and older adults (n = 472). The scale demonstrated adequate internal consistency reliability for each of the four subscales, excellent overall internal consistency, and good construct validity regarding relationships with measures of death anxiety. Reliable age and gender effects in probabilistic thinking were also observed. The relationship of probabilistic thinking as part of a cultural buffer against death anxiety is discussed, as well as its implications for Terror Management research.

Ageism and risk-taking in young adults: evidence for a link between death anxiety and ageism

The authors investigated the relationship between ageism and risk-taking in young adults. They hypothesized that young adults may attempt to distance themselves from their future older selves and from an awareness of their mortality by seeking out experiences that make them feel strong, energetic, and invulnerable (i.e., experiences involving risk-taking). We report a study whose results confirmed the hypothesis. Our study involved 408 undergraduates (226 women, 182 men) who completed the Centers for Disease Control's 2007 State and Local Youth Risk Behavior Survey and measures of 2 distinct aspects of ageism: (a) ageist attitudes and (b) ageist behaviors. Both ageist attitudes and behaviors correlated positively with risk-taking (i.e., sexual behavior, alcohol use, cigarette use, and drug use). The results are consistent with terror management theory's view of ageism as a buffer against death anxiety.

The Effect of Mortality Salience on Women's Judgments of Male Faces

Previous research has shown that individuals who are reminded of their death exhibited a greater desire for offspring than those who were not reminded of their death. The present research investigated whether being reminded of mortality affects mate selection behaviors, such as facial preference judgments. Prior research has shown that women prefer more masculine faces when they are at the high versus low fertility phase of their menstrual cycles. We report an experiment in which women were tested either at their high or fertility phase. They were randomly assigned to either a mortality salience (MS) or control condition and then asked to judge faces ranging from extreme masculine to extreme feminine. The results showed that women's choice of the attractive male face was determined by an interaction between fertility phase and condition. In control conditions, high fertility phase women preferred a significantly more masculine face than women who were in a lower fertility phase of their menstrual cycles. In MS conditions, high fertility phase women preferred a significantly less masculine (i.e., more average) face than women who were in a low fertility phase. The results indicate that biological processes, such as fertility phase, involved in mate selection are sensitive to current environmental factors, such as death reminders. This sensitivity may serve as an adaptive compromise when choosing a mate in potentially adverse environmental conditions.

Two decades of terror management theory: a meta-analysis of mortality salience research

A meta-analysis was conducted on empirical trials investigating the mortality salience (MS) hypothesis of terror management theory (TMT). TMT postulates that investment in cultural worldviews and self-esteem serves to buffer the potential for death anxiety; the MS hypothesis states that, as a consequence, accessibility of death-related thought (MS) should instigate increased worldview and self-esteem defense and striving. Overall, 164 articles with 277 experiments were included. MS yielded moderate effects (r = .35) on a range of worldview- and self-esteem-related dependent variables (DVs), with effects increased for experiments using (a) American participants, (b) college students, (c) a longer delay between MS and the DV, and (d) people-related attitudes as the DV. Gender and self-esteem may moderate MS effects differently than previously thought. Results are compared to other reviews and examined with regard to alternative explanations of TMT. Finally, suggestions for future research are offered.

Risk-taking behaviors of gay and bisexual men in New York City post 9/11

Until now, the reactions of gay and bisexual populations have been largely overlooked in response to terror and disaster. This study assesses risk-taking behaviors in gay and bisexual men two weeks before and after the 9/11 attacks in Manhattan. For the purposes of this study, risk-taking behaviors include drug use and unprotected anal sex. These behaviors and associated desires were examined in relation to race/ethnicity, age, geographic location, and HIV status, within and across time. The results of this study demonstrate that HIV status may be a pivotal demographic feature in understanding risk-taking behaviors post disaster. No changes in drug use were reported pre and post 9/11. However, there was an increase in risky sexual behaviors in relation to serostatus, with HIV-positive men reporting a higher number of sexual partners post 9/11. In contrast, the number of sexual partners remained constant in HIV-negative men. There was also an interaction effect, demonstrating that HIV-positive men were more likely than HIV-negative men to act on their desire for sex. Thus, as a population already faced with the prospect of death, HIV-positive men may be a population more vulnerable in the face of terror and disaster.

Gender, Intimacy, and Risky Sex: A Terror Management Account

Three studies tested whether mortality salience would lead men to be more sexually risky than women. In Study 1, men reported greater intentions to engage in risky sexual behaviors than did women after a mortality prime, but not after a control prime. In Study 2, men desired more future sexual partners and had a lower need for intimacy than did women, but again, only when mortality was salient. Furthermore, need for romantic intimacy mediated the relationship between mortality salience, gender, and desired number of future partners. Using a behavioral rather than a self-reported dependent measure, Study 3 showed that men primed with mortality were less likely than women to select a package of condoms (versus a pen) as a free gift after the experiment. Implications for gender differences in responses to mortality salience, as well as for how to design effective safe-sex interventions, are discussed.

Threat to life and risk-taking behaviors: a review of empirical findings and explanatory models

This article reviews the literature focusing on the relationship between perceived threat to life and risk-taking behaviors. The review of empirical data, garnered from field studies and controlled experiments, suggests that personal threat to life results in elevated risk-taking behavior. To account for these findings, this review proposes a number of theoretical explanations. These frameworks are grounded in divergent conceptual models: coping with stress, emotion regulation, replenishing of lost resources through self-enhancement, modifications of key parameters of cognitive processing of risky outcomes, and neurocognitive mechanisms. The review concludes with a number of methodological considerations, as well as directions for future work in this promising area of research.

Death awareness, maternal separation anxiety, and attachment style among first-time mothers--a terror management perspective

Two studies explored the interplay between death awareness, attachment style, and maternal separation anxiety among first-time mothers of infants aged 3-12 months. In Study 1 (N = 60), a higher accessibility of death-related thoughts was found following induction of thoughts about separation from the infant. In Study 2 (N = 100), a mortality salience induction led to higher maternal separation anxiety. Contrary to expectations, these findings were not moderated by mother's attachment style. The results are explained in terms of Terror Management Theory, and demonstrate its applicability to maternal emotions and cognitions.

Psychological defenses against death anxiety: integrating Terror Management Theory and Firestone's Separation Theory

The author attempts to integrate Terror Management Theory (TMT) and R. W. Firestone's Separation Theory (1984, 1994). Both theories emphasize defense against death anxiety as a key human motive. Whereas TMT focuses extensively on self-esteem and cultural worldview, Firestone posited additional defenses such as gene survival, self-nourishing behaviors, addictive couple bonds, and adopting an anti-sexual approach to life. TMT offers a strong base of experimentally validated ideas and the experimental paradigms to test the broad array of defenses enumerated in Firestone's Separation Theory. Therefore, an integration of the two theories would be beneficial to a fuller understanding of psychological defenses against death anxiety.

Self-regulatory processes defend against the threat of death: Effects of self-control depletion and trait self-control on thoughts and fears of dying

Nine studies (N = 979) demonstrated that managing the threat of death requires self-regulation. Both trait and state self-control ability moderated the degree to which people experienced death-related thought and anxiety. Participants high (vs. low) in self-control generated fewer death-related thoughts after being primed with death, reported less death anxiety, were less likely to perceive death-related themes in ambiguous scenes, and reacted with less worldview defense when mortality was made salient. Further, coping with thoughts of death led to self-regulatory fatigue. After writing about death versus a control topic, participants performed worse on several measures of self-regulation that were irrelevant to death. These results suggest that self-regulation is a key intrapsychic mechanism for alleviating troublesome thoughts and feelings about mortality.