Therapeutic stance towards persons with psychosis - a Grounded Theory study

OBJECTIVE

Over the last decades, psychotherapy of psychosis has increasingly gained attention. The quality of the therapeutic alliance has been shown to have an impact on therapy outcome. Yet, little is know about the influence of the therapeutic stance on the alliance. In this study, we explore psychotherapists' stance towards persons with psychosis with the aim of better understanding its characteristic-hindering and helpful-aspects.

METHOD

6 semi-structured interviews with psychotherapists from three different schools (CBT, PD, ST) were analysed with Grounded Theory. Credibility was checked through external and peer-researcher-supported debriefing.

RESULTS

4 core categories were generated and interrelated in a theoretical model. Therapists' stance was initially characterized by insecurity. Diffent ways of dealing with insecurity yielded different stances: a monological and an open one. A helpful stance was conceived as stemming from openness and was characterized by a dialogical structure. A co-presence (or "dosing") of you and I was conceived as its core aspect.

CONCLUSION

These findings specify the interpersonal dynamics arising from different stances and their impact on the therapeutic alliance and process. Research is still needed to further understand the characteristics of helpful and hindering therapeutic stances, which should also inform the training of psychotherapists.

The Long Shadow of Addiction-Related Nostalgia: Nostalgia Predicts Ambivalence and Undermines the Benefits of Optimism in Recovery

Background: Previous research has shown that nostalgia for the pre-addicted self can motivate people living with addiction to engage in behavior change. Objective: Herein, we explored nostalgia for the addictive behavior-labeled addiction-related nostalgia (ARN)-among people in recovery from engaging in addictive behavior. We tested the novel idea that ARN is positively associated with ambivalence about recovery. We also hypothesized that ARN may counteract the positive influence of optimism on individuals' commitment to recovery. Results: In two studies involving individuals in recovery from a gambling (Study 1; N=301) or alcohol use disorder (Study 2; N=604), ARN was linked to increased ambivalence about recovery, while optimism was associated with decreased ambivalence. As expected, the interaction between optimism and ARN revealed that nostalgia either eliminated (Study 1) or reduced (Study 2) the negative relation between optimism and ambivalence. Conclusions: These findings underscore the challenges posed by ARN in the recovery process and emphasize the importance of interventions that address and mitigate its impact while considering the moderating role of optimism.

Why LGBTQ Adults Keep Ambivalent Ties with Parents: Theorizing "Solidarity Rationales"

Many LGBTQ adults have ongoing relationships with their parents that are ambivalent, typified by both solidarity (e.g., frequent contact, emotional or financial exchange) as well as conflict (e.g., parents' heterosexism and cissexism). Yet, why LGBTQ people remain in-rather than end-their ambivalent intergenerational ties is underexplored. We analyze qualitative in-depth interview data with 76 LGBTQ adults to answer this question. We find that LGBTQ adult children deploy narratives that privilege intergenerational solidarity over strain-what we call "solidarity rationales"- to explain why they remain in their ambivalent intergenerational ties. Four solidarity rationales were identified: 1) closeness and love, 2) parental growth, 3) the unique parent-child role, and 4) the importance of parental resources. Identifying LGBTQ adults' solidarity rationales pulls back the curtain on the compulsory social forces driving persistent intergenerational relationships. This study also advances our thinking about how socially marginalized people cope with complex social ties that include interpersonal discrimination and stigma.

Ambivalence Resolution in Meaning Reconstruction Grief Therapy: An Exploratory Study

In psychotherapy, ambivalence may be conceptualized as a conflict between two distinct motivations: one that is favorable to change (pro-change) and another that favors the maintenance of a problematic pattern (pro status quo). Previous studies identified two processes by which clients resolve this conflict: imposing the innovative part and silencing the problematic one (dominance), and establishing negotiations between the innovative and the pro status quo parts (negotiation). The present exploratory study examined ambivalence resolution in a sample of clients diagnosed with complicated grief. Results revealed that, in recovered cases, negotiation increases and dominance decreases from the beginning until the middle sessions of therapy and the opposite tendency is observed from the middle to the final sessions. Unchanged cases reveal an overall high proportion of dominance and an overall low proportion of negotiation. These results are partially divergent from those reported in previous studies with samples of clients diagnosed with major depression.

Looking on the bright side: the impact of ambivalent images on emotion regulation choice

Previous research has found that people choose to reappraise low intensity images more often than high intensity images. However, this research does not account for image ambivalence, which is presence of both positive and negative cues in a stimulus. The purpose of this research was to determine differences in ambivalence in high intensity and low intensity images used in previous research (experiments 1-2), and if ambivalence played a role in emotion regulation choice in addition to intensity (experiments 3-4). Experiments 1 and 2 found that the low intensity images were more ambivalent than the high intensity images. Experiment 2 further found a positive relationship between ambivalence of an image and reappraisal affordances. Experiments 3 and 4 found that people chose to reappraise ambivalent images more often than non-ambivalent images, and they also chose to reappraise low intensity images more often than high intensity images. These experiments support the idea that ambivalence is a factor in emotion regulation choice. Future research should consider the impact ambivalent stimuli have on emotion regulation, including the potential for leveraging ambivalent stimuli to improve one's emotion regulation ability.

When Objective Ambivalence Predicts Subjective Ambivalence: An Affect-Cognition Matching Perspective

Understanding when people are likely to feel ambivalent is important, as ambivalence is associated with key attitude outcomes, such as attitude-behavior consistency. Interestingly, the presence of conflicting positive and negative reactions (objective ambivalence) is weakly related to feeling conflicted (subjective ambivalence). We tested a novel situation that can influence the correspondence between objective and subjective ambivalence: whether a message and a recipient's topic match in affective versus cognitive orientation. When a person encounters a message with an affective or cognitive match to the topic, conflicting reactions may be more accessible, increasing feelings of ambivalence. Across five studies, greater objective-subjective ambivalence correspondence occurred with an affective-cognitive match between message and topic orientation. Studies 4 and 5 also demonstrated that this primarily occurred when the message was counterattitudinal. This work contributes to the literature explaining the gap between measures of objective and subjective ambivalence as well as how messages can influence attitude strength properties.

Examining expertise: Synthetic biology experts' perceptions of risk, benefit, and the public for research and applications regulation

Scientific experts can play an important role in decision-making surrounding policy for technical and value-laden issues, often in contexts that directly affect lay publics. Yet little is known about what characterizes scientific experts who want lay public involvement in decision-making. In this study, we examine how synthetic biology experts' perceptions of risks, benefits, and ambivalence for synthetic biology relate to views of lay publics, deference to scientific authority, and regulations. We analyzed survey data of researchers in the United States, who published academic articles relating to synthetic biology from 2000 to 2015. Scientific experts who see less risk and are more deferent to scientific authority appear to favor a more closed system in which regulations are sufficient, citizens should not be involved, and scientists know best. Conversely, scientific experts who see more potential for risk and see the public as bringing a valuable perspective appear to favor a more open, inclusive system.

Narrating the caring fatigue: stories of the ambivalence of filial care in a caregivers' self-help group in Italy

This article shows how, within a caregivers' self-help group in Emilia-Romagna, Italy, the narrative of caring fatigue was mobilised to question and negotiate local normative discourses and social norms on affective states and family care responsibilities. The neoliberal discourse on family caregiving in Italy assumes that it comes from authentic affective states and mutual understanding. By showing how intergenerational obligations and shifting parent-child hierarchies constrained the building up of caregiving relations, the narrative of caring fatigue allowed participants to explain the ambivalence they perceived about their filial responsibilities. Therefore, this narrative legitimised the choice of preserving caregivers' wellbeing and delegating aspects of care. This paper argues that stories of caring fatigue contradict the ideal model of family care that shapes academic and institutional discourses. Nevertheless, they play an important role in sustaining caregiver endurance.

Profiling ambivalence in the context of nonsuicidal self-injury

BACKGROUND

We aimed to identify profiles of ambivalence among individuals with a history of non-suicidal self-injury (NSSI) and tested whether profiles differed across various theoretically informed constructs: NSSI-related characteristics, cognitive (outcome expectancies, self-efficacy to resist NSSI), emotional (psychological distress, difficulties in emotion regulation), personality, and incentives to engage/not engage in NSSI.

METHODS

Individuals with a lifetime history of NSSI (n = 224) reported the extent to which they wanted to and did not want to engage in NSSI and completed well-validated measures of the constructs of interest.

RESULTS

Latent profile analysis indicated four ambivalence profiles (avoid: n = 39; moderately ambivalent: n = 85; highly ambivalent: n = 30; approach: n = 70). The profiles differed across a number of NSSI-related characteristics, cognitive, emotional, and incentive-related variables. Differences between the ambivalence profiles and the avoid/approach profiles varied across constructs. For example, the ambivalence and approach profiles were similar for NSSI-related outcome expectancies, but the ambivalence and avoidance profiles were similar for self-efficacy to resist NSSI.

CONCLUSION

Findings highlight variation between the desire to engage or not engage in NSSI that are consistent with the notion of ambivalence. Understanding these differences may allow for a more person-centered approach in treatment for NSSI.

Patient and Caregiver Expression of Reluctance and Ambivalence During Palliative Care Encounters

Context: Patients with serious illness and their caregivers often face challenging decisions. When faced with these decisions, patients and caregivers may display signs of ambivalence and reluctance toward end-of-life decision making. Methods: We recruited 22 palliative care clinicians to participate in a communication coaching study. Clinicians audio recorded four of their palliative care encounters with adult patients and family caregivers. A team of 5 coders used inductive coding methods to create a codebook and then coded instances of patients and caregivers expressing ambivalence and reluctance. They also coded when the decision-making process was initiated and whether a decision was made. The group coded 76 encounters, and 10% (n = 8) of those encounters were double coded to assess inter-rater reliability. Results: We found that ambivalence occurred in 82% (n = 62) of the encounters, while reluctance occurred in 75% (n = 57) of the encounters. The overall prevalence of either was 89% (n = 67). The presence of ambivalence was negatively associated with a decision being made once initiated (r = -0.29, p = 0.06). Conclusion: We found that coders can reliably identify patient and caregiver reluctance and ambivalence. Further, reluctance and ambivalence occur frequently in palliative care encounters. When patients and caregivers have ambivalence, decision making might be hampered.

Feasibility, Acceptability, and Potential Impact of a Novel mHealth App for Smokers Ambivalent About Quitting: Randomized Pilot Study

BACKGROUND

Most smokers are ambivalent about quitting-they want to quit someday, but not now. Interventions are needed that can engage ambivalent smokers, build their motivation for quitting, and support future quit attempts. Mobile health (mHealth) apps offer a cost-effective platform for such interventions, but research is needed to inform their optimal design and assess their acceptability, feasibility, and potential effectiveness.

OBJECTIVE

This study aims to assess the feasibility, acceptability, and potential impact of a novel mHealth app for smokers who want to quit smoking someday but are ambivalent about quitting in the near term.

METHODS

We enrolled adults across the United States who smoked more than 10 cigarettes a day and were ambivalent about quitting (n=60). Participants were randomly assigned to 1 of 2 versions of the GEMS app: standard care (SC) versus enhanced care (EC). Both had a similar design and identical evidence-based, best-practice smoking cessation advice and resources, including the ability to earn free nicotine patches. EC also included a series of exercises called experiments designed to help ambivalent smokers clarify their goals, strengthen their motivation, and learn important behavioral skills for changing smoking behavior without making a commitment to quit. Outcomes were analyzed using automated app data and self-reported surveys at 1 and 3 months post enrollment.

RESULTS

Participants who installed the app (57/60, 95%) were largely female, White, socioeconomically disadvantaged, and highly nicotine dependent. As expected, key outcomes trended in favor of the EC group. Compared to SC users, EC participants had greater engagement (mean sessions 19.9 for EC vs 7.3 for SC). An intentional quit attempt was reported by 39.3% (11/28) of EC users and 37.9% (11/29) of SC users. Seven-day point prevalence smoking abstinence at the 3-month follow-up was reported by 14.7% (4/28) of EC users and 6.9% (2/29) of SC users. Among participants who earned a free trial of nicotine replacement therapy based on their app usage, 36.4% (8/22) of EC participants and 11.1% (2/18) of SC participants requested the treatment. A total of 17.9% (5/28) of EC and 3.4% (1/29) of SC participants used an in-app feature to access a free tobacco quitline. Other metrics were also promising. EC participants completed an average of 6.9 (SD 3.1) out of 9 experiments. Median helpfulness ratings for completed experiments ranged from 3 to 4 on a 5-point scale. Finally, satisfaction with both app versions was very good (mean 4.1 on a 5-point Likert scale) and 95.3% (41/43) of all respondents would recommend their app version to others.

CONCLUSIONS

Ambivalent smokers were receptive to the app-based intervention, but the EC version, which combined best-practice cessation advice with self-paced, experiential exercises, was associated with greater use and evidence of behavior change. Further development and evaluation of the EC program is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04560868; https://clinicaltrials.gov/ct2/show/NCT04560868.

How emotional are words ambiguous on the spaces of valence, origin and activation?

Not all of the stimuli that we encounter are unequivocal; some of them may be ambiguous. In a series of two experiments, we investigated how people perceive and assess the emotionality of the words ambiguous on three emotional spaces: valence (dimensions of positivity and negativity), origin (automaticity and reflectiveness), and activation (arousal and subjective significance). Using two types of measurement - behavioural and webcam-based eye tracking - we compared words of moderate and high ambiguity on each of those spaces with control (uniequivocal) words. The behavioural measurements indicated that reaction times were significantly longer for the control words than for all the ambiguous words; the emotionality of words of ambiguous valence and origin was rated as significantly lower than the control words and words of ambiguous activation. The eye-tracking measurements indicated that words of ambiguous valence and origin caused significantly more and longer eye fixations than control words and words of ambiguous activation. The results showed the visible distinctiveness of the ambiguous words compared with the control words; they also showed differences between words of various ambiguities, verifying the proposed new model for the emotional ambiguity and presenting the behavioral and eye tracking correlates for each of the three ambiguities.

Spousal loss and cognitive function: the importance of gender and multiple dimensions of marital quality

Objectives: Research suggests that the death of a spouse has an adverse effect on a widow(er)'s cognition. However, little research has examined how the marital context before widowhood and gender influence this association. Guided by the social ambivalence and disease (SAD) model, this study examined the associations between spousal loss and cognition , with moderating effects of gender and pre-loss marital quality.Method: We analyzed a national longitudinal data, Midlife in the United States (MIDUS), specifically MIDUS 2 (2004-2005) and MIDUS 3 (2013-2014). The analytic sample consisted of (1) 146 participants who experienced the death of their spouse between MIDUS 2 and MIDUS 3 and (2) 144 age- and gender-matched comparison participants who did not lose their spouse during the period.Results: Adverse influence of widowhood on cognition was more pronounced among bereaved men than bereaved women. Widowed individuals whose relationships with their deceased spouse were ambivalent had poorer cognition than widowed individuals who had aversive relationships with their deceased spouse.Conclusion: Findings suggest that the influence of spousal death on cognitive functioning depends on gender and pre-loss marital quality, emphasizing the importance of considering pre-loss marital relationship and gender dynamics in developing efficient interventions for the widowed.

Perceptions of COVID-19 Vaccines: Protective Shields or Threatening Risks? A Descriptive Exploratory Study among the Italian Population

Although several quantitative studies have explored vaccine hesitancy, qualitative research on the factors underlying attitudes toward vaccination is still lacking. To fill this gap, this study aimed to investigate the general perceptions of COVID-19 vaccines among the Italian population with a qualitative approach. The sample included 700 Italian participants who completed an online survey. Open questions underwent a descriptive analysis for unveiling meaning categories, while differences in the prevalence of categories were calculated using chi-square or Fisher's exact tests. Vaccination was associated with the following seven main themes: 'safety', 'healthcare', 'vaccine delivery', 'progress', 'ambivalence', 'mistrust', and 'ethics'. Vaccinated individuals more frequently reported words related to the safety theme (χ2 = 46.7, p < 0.001), while unvaccinated individuals more frequently reported words related to mistrust (χ2 = 123, p < 0.001) and ambivalence (χ2 = 48.3, p < 0.001) themes. Working in the healthcare sector and being younger than 40 years affected the general perceptions of vaccination in terms of pro-vaccine attitudes. Unvaccinated individuals were more affected by the negative experiences of their acquaintances and manifested more distrust of scientific researchers, doctors, and pharmaceutical companies than vaccinated individuals. These findings suggest promoting collaborative efforts of governments, health policymakers, and media sources, including social media companies, in order to deal with cognitions and emotions supporting vaccine hesitancy.

Living Ambivalently with Chronic Illness

Mobile health smartphone applications (mHealth apps) enable patients to monitor how chronic illness interconnects with their everyday life. I explore, through focus group discussions, how such monitoring makes sense to pediatric and young patients and parents in Denmark. These groups explicate how they live both with and without chronic illness by distinguishing between when to focus on which aspects of it. I argue that this relationship with chronic illness produces parent's, children's, and young people's ambivalent attitudes toward mHealth apps that promote illness monitoring "anywhere" and at "any time."

Reclaiming Family, Reimaging Queer Relationality

Family is an important issue in imagining queer modes of existence. In this essay, I argue for a queer relationality that is structured around biogenetic family, a site that is often marginalized and negated in dominant Euro-American queer discourse. Informed by queer of color critique and postcolonial feminism, this essay affirms the relational framework in understanding the everyday struggles of queer subjects. Situated in the context of Chinese society, I investigate a queer relationality that centers ambivalence and inbetweenness as queer modes of positioning, challenging the teleological narrative of queerness that is characterized by oppositionality, singularity, and anti-relationality.

Family Pictures: The Queer Relationalities of Multigenerational Queer Family

Combining queer theorizing, autoethnography, and relational dialectics theory (RDT), this essay examines how my lesbian mothers and donor struggle to define family, queer family, and their emerging familial identities as grandparents to my own donor-conceived daughter through the competing discourses of biology and history. I further explore how my parents engage their relational history as queer parents as salient models for understanding their emergent familial identities as queer grandparents, as well as how they talk about an anticipated queer grandparent relationship with my daughter in the future. Ultimately, this essay works to articulate a queer(spawn) relationality-one that possibly exists at the (non-)intersection of multiple liminalities-as a means of building on earlier mappings of queer relationality.

Cross-valence inhibition in forming and retrieving ambivalent attitudes

Many things in life are ambivalent, and it might sometimes be useful or necessary to ignore their positive attributes when judging their negative attributes and vice versa. Cross-valence inhibition may complicate this task, leading people to underestimate the positive and negative attributes of ambivalent stimuli. In three studies (total N = 155), participants learned to associate combined evaluative information (gains and losses) with attributes of unfamiliar objects (size and colour of Chernoff faces). Participants then estimated (Studies 1-3) or experienced and recalled (Study 3) the gains and losses associated with novel ambivalent attribute combinations. As predicted, both in estimation and recall, participants rated gains (losses) to be lower, the higher the losses (gains) associated with the stimulus. The effect occurred only when the two attributes were evaluatively conflicting (Study 2). Cross-valence inhibition might lead to maladaptive behaviour when positive and negative attributes are in fact separable in hedonic experience.

The social tensions felt within: Explaining felt ambivalence about polarized societal debates through perceived opinion discrepancies in the social environment

Within the context of polarized societal debates (e.g. abortion, racism, climate change), scholars often assume that individuals have clear-cut positions, either in favour of or against the debated issue. However, recent work suggests that such debates can also be breeding grounds for felt ambivalence. Moving beyond previous work that mainly focused on ambivalence as internal cognitive conflict, we propose and test a social discrepancy hypothesis, which suggests that the discrepancies ambivalents perceive between and within their own opinion and the opinion of actors in their social network and society (e.g. friends, family, opinion-based groups) positively explain their levels of felt ambivalence. In doing so, we quantitatively extend recent qualitative work by examining whether these social tensions are indeed felt within. To this end, we employed a multi-survey research project (Ns = 184, 181, 187) in the context of different societal debates in the Netherlands. Supporting our hypothesis across different debates, results showed that ambivalents' perceived opinion differences in the social environment explained their felt ambivalence. This suggests that polarized societal debates offer social discrepancies that, for ambivalents at least, can facilitate an internalization of social tensions.

Afraid but misinformed: Conspiracist beliefs cancel the positive influence of fear of COVID-19 on vaccination intentions - Findings from a Romanian sample

Understanding the factors that make people more likely to refuse vaccination against COVID-19 is crucial in order to design public health messages efficient in increasing vaccination rates. As COVID-19 creates risks of seriously damaging health effects, fear of this disease is as a significant determinant of vaccination intentions, as indicated by past research. Nevertheless, this positive influence may be limited in people who do not consider vaccines as a solution to protect against COVID-19, especially those who hold conspiracist beliefs about the new coronavirus and, implicitly, about the newly developed vaccines. The present study examined in a cross-sectional design on a convenience sample (N = 564) the joint effect of fear of COVID-19 and conspiracist beliefs on vaccination intentions, advancing past research on their independent influences. Furthermore, we investigated and controlled the effects of perceived risk of catching COVID-19, trust in medical experts, attitude towards vaccination and socio-demographical characteristics (i.e., gender, age, and education), previously found to be associated to COVID-19 vaccination intentions. We also tested the effect of ambivalence towards vaccination, i.e., the degree to which people simultaneously hold positive and negative evaluations of this intervention, as the widespread misinformation on the new coronavirus and its vaccines may induce ambivalence on this latter issue in many people. The results showed that the positive effect of fear of COVID-19 on vaccination intentions emerged only in participants who tend not to endorse conspiracist ideas on the new coronavirus. Moreover, higher vaccine hesitancy was found in participants with higher ambivalence towards vaccination, in those who perceive the risk of being contaminated by the new coronavirus as low, and in those with more negative attitudes towards vaccines in general. Vaccine ambivalence also emerged as a mediator of the negative effects of conspiracist beliefs about COVID-19 on vaccination intentions. This pattern of findings suggests the public messages emphasizing the risks of COVID-19 should also combat misinformation in order to maximize vaccine uptake.

Ambivalent complicities and knowledge production: Researching migrant women farmers' reproductive health experiences in the middle belt of Ghana

Using a critical reflexive process (An Invitation to Reflexive Sociology, 1992; Theory, Culture & Society, 13, 1996, 17), this article identifies and examines issues of power, complicity and knowledge production as they emerged in the first author's master's research on migrant women farmers' economic and reproductive health experiences in the middle belt of Ghana. We examine the ambivalent positionality of the international graduate student researcher as "other of the other" (Signs: Journal of Women in Culture and Society, 30, 2005, 2017, p. 2025), and how diverse fields of power, including the researcher's educational institution and cultural norms regarding gender relations, mediated interactions among various actors in the research process. Specifically, we examine how the student researcher was complicit in reinforcing patriarchal standards, perpetuating western saviourism and committing symbolic violence. Situating these reflexive findings in relation to insights from feminist postcolonial theories, we highlight how power relations, gender and social class informed these ambivalent complicities. Rather than erase/silence these tensions in the research process, we argue that such ambivalences may be an inevitable dimension of transnational knowledge creation, and thus, it is imperative that researchers consider how their ambivalent positionalities and complicities may be navigated and leveraged most productively and with the least harm to research participants.

The Role of Maternal Grandmothers' Childcare Provision for Korean Working Adult Daughters

Despite the Korean government's investment in childcare facilities for dual-earner households, maternal grandmothers are increasingly taking on the responsibility of caring for their grandchildren. This trend is examined in the current research. While many studies have been conducted on grandparents' experiences providing childcare for their grandchildren, significantly less research has been conducted on adult daughters' experiences with their mothers' childcare provision. This study utilized the concepts of intergenerational solidarity and a life-course approach to understand the experiences of 24 working adult daughters in Korea (ages 30-43) whose mothers provide childcare. Three major themes were identified following a grounded theory approach: gratitude vs. guilt, dependence vs. independence, and closeness vs. disagreement. The results indicated that adult daughters were found to have ambivalence toward their mothers, reflecting the lack of alternative options for childcare. The results from this study suggest that not only improving the quality of public childcare services, but also diversifying services to reflect the needs of dual-income families.

Cross-cultural analysis of the role of ambivalent feelings for understanding caregivers' depressive symptoms

OBJECTIVES

Behavioral and psychological symptoms of dementia (BPSD) are considered to cause ambivalent feelings in caregivers that may contribute to understanding their depressive symptoms. Transnational research is needed in order to increase our knowledge about the cross-cultural equivalence of theoretical models to understand caregivers' mental health. The aim of this study was to cross-culturally analyze the association between BPSD, ambivalent feelings and depressive symptoms in two samples of family caregivers of people with dementia from Spain and the UK.

METHODS

Participants in this study were 432 caregivers who completed measures of BPSD, ambivalent feelings and depressive symptoms. The association between the assessed variables was tested through path-analysis, with differences between countries tested through multigroup analysis.

RESULTS

The results suggest that the influence of BPSD on caregivers' depressive symptoms is indirect, through ambivalent feelings. The observed associations were equivalent between countries and explained a significant percentage of the variance of depressive symptoms.

CONCLUSION

The findings of this study provide, for the first time, evidence of equivalent cross-cultural paths analyzing the role of ambivalent feelings for understanding caregivers' depressive symptoms. The practical implications of these results are discussed.

Ranges of pregnancy preferences and contraceptive use: Results from a population-based survey in the southeast United States

CONTEXT

Understanding how pregnancy preferences shape contraceptive use is essential for guiding contraceptive interventions and policies that center individuals' preferences and desires. Lack of rigorous measurement of pregnancy preferences, particularly on the population level, has been a methodologic challenge.

METHODS

We investigated associations between prospective pregnancy preferences, measured with a valid instrument, the Desire to Avoid Pregnancy (DAP) scale, and contraceptive use in a representative sample of 2601 pregnancy-capable self-identified women, aged 18-44 years, in Alabama and South Carolina (2017-2018). We used multivariable regression with weighting to investigate how probability of modern contraceptive use, and use of different contraceptive method types, changed with increasing preference to avoid pregnancy.

RESULTS

Desire to Avoid Pregnancy scale scores (range:0-4, 4 = greater preference to avoid pregnancy, median = 2.29, IQR: 1.57-3.14; α:0.95) were strongly associated with contraceptive use among sexually active respondents (aPR = 1.15 [1.10, 1.20]; predicted 45% using contraception among DAP = 0, 62% among DAP = 2, 86% among DAP = 4). Method types used did not differ by DAP score. The most common reasons for nonuse were concern over side effects and not wanting to use a method (32% each) among respondents with mid-range and high DAP scores. Among those with mid-range DAP scores, 20% reported nonuse due to not minding if pregnancy were to occur (vs. 0% among those with high DAP scores).

CONCLUSIONS

Pregnancy preferences strongly influence likelihood of contraceptive use. Providion of appropriate contraceptive care to those not explicitly desiring pregnancy must differentiate between ranges of feelings about pregnancy, perceived drawbacks to contraceptive use, and legitimate psychological and interpersonal benefits of nonuse to promote autonomy in contraceptive decision-making.

The intergenerational relationship patterns between aging parents and their adult children

Background

Older parent-child relations and their impact on the elderly's lives are of importance; thus, the present study aimed to investigate the patterns of the intergenerational relationships between aging parents and their adult children.

Methods

The current cross-sectional study was conducted on 463 elderly men and women, aged ≥60 years who were residing in Tehran City, Iran. The study participants were selected using the stratified cluster sampling method. The Bai's (2017) 13-item Intergenerational Relationship Quality Scale for Aging Parents (IRQS-AP) was used to evaluate the patterns of intergenerational relationships among the study subjects. The obtained data were analyzed in SPSS. The significance level of the tests was set at P ≥ 0.05. The logistic regression model was employed to investigate the factors related to the patterns of intergenerational relationships.

Results

The mean ± SD age of the explored aging parents was 67.93 ± 7.0 years. Besides, the mean ± SD number of children in the study participants was 3.55 ± 1.80. The mean ± SD scores of solidarity (structural, associational, consensual, affectual, functional, and normative) and conflict were measured to be (58.95 ± 17.55) and (64.10 ± 20.92), respectively. Furthermore, the mean ± SD score of the ambivalence pattern was calculated as (51.46 ± 21.61). The mean score of conflict was higher than those of solidarity and ambivalence. Additionally, the mean score of consensual-normative solidarity was higher than those of other dimensions of solidarity. The obtained data suggested a significant difference between age and the patterns of intergenerational relationships (p ≤ 0.05). Moreover, the mean scores of solidarity and conflict in the examined female elderly and their adult children were higher than those of their male counterparts and their adult children; however, the mean score of ambivalence in the male elderly and their adult children was higher than that in their female counterparts. Logistic regression analysis results indicated that aging parents who were literate (OR = 1.5), those who lived alone (OR = 1.2), and those who assessed their general health status as good (OR = 4), reported high levels of solidarity with their adult children.

Conclusion

The present research results demonstrated that the level of conflict between aging parents and their adult children exceeded the solidarity level, indicating the intergenerational gap. Therefore, the necessary implications should be adopted to promote intergenerational relationships within the family by providing family counseling. Further research is recommended to consider the essential role of predictive factors, such as age, gender, educational level, occupational status, living arrangements, health status, and socioeconomic status of aging parents concerning the intergenerational relationships between aging parents and their adult children.

Compassion in dementia caregiving: Psychometric properties of the Caregiving Compassion Scale in Spanish caregivers

Compassion has been suggested as a relevant variable for understanding dementia caregivers' psychological distress. The objectives were to analyse the psychometric properties of the Caregiving Compassion Scale (CCS) and to explore the association between caregivers' compassion and their emotional health. Two hundred and thirty-six dementia caregivers were evaluated for compassion, depressive symptoms, guilt, ambivalence, care-recipient's functional and cognitive status, frequency of behavioural problems and desire to institutionalise the care-recipient. Exploratory factor analyses, correlations and regression analyses were done. Two factors were obtained. The factor labelled "Distress from witnessing the care recipient suffering" was associated with higher stress linked to witness depressive problems in the care-recipient and with caregivers' ambivalence and guilt levels. The factor labelled "Motivation/disposition for helping" was associated with less desire for institutionalisation, and it showed a negative association with ambivalence and guilt feelings. The CCS seems to be a valid and reliable scale for assessing compassion in dementia caregivers.

A Psychometric Pilot Study Examining the Functions of Suicidal Communications Using IRT and Factor Analysis

BACKGROUND

Suicide prevention, an important public health issue, relies on suicidal communications to identify and intervene with those at risk. Scant research tests explicit theories of suicidal communication impeding applications to prevention science. The current study pilots a new measure assessing the functions of suicidal communications using factor analysis and item response theory.

METHODS

MTurk workers (n = 898) completed an anonymous survey. The original scale included 35 items refined using exploratory and confirmatory factor analysis, bifactor modeling, and item response theory.

RESULTS

The initial EFA identified a two-correlated-factor solution. The two-correlated-factor and unidimensional models yielded a poor fit. A bifactor model yielded a borderline to acceptable fit. The final four items were identified using a bifactor model and item response theory graded response models capturing ambivalence resolution defined as behaviors aimed to aid in suicide decision making. The final model yielded an excellent fit: 𝝌²(2) = 1.81, CFI (1.00), TLI (1.00), RMSEA (0.00), and SRMR (0.01).

CONCLUSIONS

There may be one function of suicidal communications. Disclosure may elicit connection and reasons for living that serve as barriers to suicide and resolve ambivalence. Key limitations include convenience sampling and limited validity measures. Future research should partner with participants to improve scale and theory development efforts.

The impact of career-related parental behaviors on career decision-making self-efficacy and ambivalence-A latent growth model

INTRODUCTION

The current study investigated the developmental trajectory of adolescents' career decision-making self-efficacy (self-efficacy) and ambivalence in career decision-making (ambivalence) as well as the longitudinal impact of career-related parental behaviors (parental behaviors) on self-efficacy and self-efficacy on ambivalence.

METHODS

We recruited 588 students from two elementary schools and three middle schools from city of Guangzhou, Province Guangdong in China. Participants were from Grade 4 to Grade 9 with an average age of 11.88 (SD = 1.63), 321 (54.6%) were male, and 9 (1.53%) were missing for gender. We applied a latent growth model using data from all three waves.

RESULTS AND CONCLUSION

After applying a latent growth model using data from all three waves, the results have indicated that self-efficacy decreased as these participants transitioned from childhood to early adolescence, and that their ambivalence fell on an increasing trajectory. Cross-sectionally, it indicated that "support" of parental behaviors was positively associated with self-efficacy, and "interference" of parental behaviors was positively associated with ambivalence. Longitudinally, "interference" of parental behaviors was negatively predicting the change rate of self-efficacy. A predictive relation did not exist between self-efficacy and ambivalence, such that a negative correlation was observed on a cross-sectional level. Implications and limitations are discussed as well.

Write and Let Go: An Online Writing Program for University Students

Background

There are a plethora of studies on expressive writing and positive writing interventions, but few have addressed the combination of both paradigms. Additionally, research on the role of ambivalence toward change in the context of writing-based interventions is lacking. Ambivalence toward change is a natural movement of approaching and avoiding change that may occur in various situations. In psychotherapy, its resolution is associated with successful outcomes.

Aim

This study tested the efficacy of a combination of expressive and positive writing paradigms in an internet-based intervention to improve university students' mental health. Additionally, focusing participants on a current, unresolved problem allowed us to explore the possible role of ambivalence toward change as a mediator of the intervention's results.

Methods

We recruited 172 participants who were randomly divided into experimental (n = 85) and control (n = 87) groups. The intervention consisted of the identification of a current problem and four writing tasks on consecutive days. Assessment was conducted at baseline and posttest in both groups and at follow-up in the experimental group. Participants in the experimental condition were also assessed after each task. Measures of anxiety, depression, rumination, ambivalence toward change, distress, and wellbeing (optimism, affect, and satisfaction with life) were collected.

Results

Multivariate analysis of variance (MANOVA) showed that participants in the experimental group had a significant decrease from baseline to posttest in ambivalence toward change and rumination when compared with the control group. These results were maintained at follow-up. No differences were found in the remaining measures. Within the experimental group, ambivalence toward change, rumination, and distress significantly decreased throughout the intervention and the exploratory mediation analysis indicated that ambivalence toward change partially mediated the improvements in rumination and distress.

Discussion

Considering different perspectives about a current problem and using a combination of expressive and positive writing fostered the reduction of ambivalence toward change and rumination. Ambivalence toward change reduction after the second writing task may have created optimal conditions for the subsequent decrease in rumination and distress. Future studies should replicate this finding and dismantle the components that are more adequate in changing these variables.

Two Minds, One Patient: Clearing up Confusion About "Ambivalence"

Patients who experience difficulty making medical decisions are often referred to as "ambivalent." However, the current lack of attention to the nuances between a cluster of phenomena that resemble ambivalence means that we are not always recognizing what is really going on with a patient. Importantly, different kinds of "ambivalence" may call for different approaches. In this paper, we present a taxonomy of ambivalence-related phenomena, provide normative analysis of some of the effects of-and common responses to-such mental states, and sketch some practical strategies for addressing ambivalence. In applying lessons from the philosophical literature and decision theory, our aim is to provide ethicists and clinicians with the tools to better understand and effectively intervene in cases of ambivalence.

Taking Stock and Moving Forward: A Personalized Perspective on Mixed Emotions

Research on mixed emotions is flourishing but fractured. Several psychological subfields are working in parallel and separately from other disciplines also studying mixed emotions, which has led to a disorganized literature. In this article, we provide an overview of the literature on mixed emotions and discuss factors contributing to the lack of integration within and between fields. We present an organizing framework for the literature of mixed emotions on the basis of two distinct goals: solving the bipolar-bivariate debate and understanding the subjective experience of mixed emotions. We also present a personalized perspective that can be used when studying the subjective experience of mixed emotions. We emphasize the importance of assessing both state and trait emotions (e.g., momentary emotions, general levels of affect) alongside state and trait context (e.g., physical location, culture). We discuss three methodological approaches that we believe will be valuable in building a new mixed-emotions literature-inductive research methods, idiographic models of emotional experiences, and empirical assessment of emotion-eliciting contexts. We include recommendations throughout on applying these methods to research on mixed emotions, and we conclude with avenues for future interdisciplinary research. We hope that this perspective will foster research that results in the organized accumulation of knowledge about mixed emotions.

Are Benevolent Attitudes More Closely Related to Attitudes toward Homosexuals than Hostile Ones? Cases of Belarus, Kazakhstan, and Russia

Previous studies have shown that ambivalent gender attitudes are associated with attitudes toward homosexuals. However, most of these studies have primarily considered ambivalent attitudes toward women and attitudes toward gay men, and have been carried out in countries with progressive laws regarding homosexuality. In this study, we examined the connection between ambivalent attitudes toward men and women and attitudes toward gay men and lesbian women in countries with conservative sexual legislation. In the first study, participants were residents of Russia (N = 163) and Kazakhstan (N = 194), while the second study used residents of Russia (N = 496) and Belarus (N = 123). Results indicated that benevolent attitudes predicted attitudes toward gays and lesbians better than the hostile ones. At the same time, attitudes toward men and women similarly predicted attitudes toward gays and lesbians. These patterns were manifested among different components of attitudes toward homosexuals. The results are discussed within the social context of the countries.

Shedding light on attitudes towards pregnancy among Inuit adolescents from Nunavik

Better understanding attitudes toward pregnancy – a potent predictor of adolescent pregnancy – could help explain the high adolescent pregnancy rate in Nunavik, Canada. The objective of this study was to assess the distribution of different attitudes toward pregnancy and the factors associated with high pregnancy likelihood attitudes (HPLA; favourable, indifferent, and ambivalent), focusing on the perceived benefits of childbearing (BOC). T-tests, chi-square tests, and logistics regressions were performed based the answers of 159 Inuit women aged 16 to 20 years from the Qanuilirpitaa? survey. About 43% were ambivalent, 16% favourable, 5% indifferent, and 35% unfavourable toward pregnancy. Bivariate analysis indicate that the HPLA group was more likely to work, to report less frequent positive interactions, and to show a higher BOC score compared to others. Multivariate analysis show that an increased BOC score was associated with HPLA (OR = 1.09, 95% CI = 1.01 − 1.18). Perceiving that a baby would strengthen the relationship with the other parent (OR = 1.65, 95% CI = 1.15 − 2.37) and that it would help to access housing were individually associated with HPLA (OR = 1.45, 95% CI = 1.02 − 2.10). Findings provide evidence to support Inuit adolescents’ reproductive choices.

Cognitive and emotional factors associated with the desire to cease non-suicidal self-injury

Background

Due to cognitive and emotional differences between individuals who have and have not stopped self‐injuring, we explored these in the context of desire to stop.

Method

Australian university students (n = 374) completed cognitive and emotional measures. Comparisons were made between those who had self‐injured in the past 12 months and those who had not, and between individuals who reported wanting to stop self‐injuring and those who did not.

Results

Approximately 20% of participants did not want to stop self‐injuring. Cognitive emotional factors (psychological distress, self‐efficacy to resist, difficulties regulating emotion, interpersonal functions, and outcome expectancies) differentiated individuals who had and had not stopped, but could not explain differences in desire to stop.

Conclusion

Factors associated with desire to stop are not the same as factors underlying behavioural cessation. Motivational approaches to changes in self‐injurious behaviour would be beneficial for clinicians and their clients.

General practitioners' reflections on using PSA for diagnosis of prostate cancer. A qualitative study

OBJECTIVE

To investigate how GPs use the PSA test as a diagnostic tool in daily practice.

DESIGN

Qualitative study using focus group interviews, the transcripts being analyzed by systemic text condensation.

SUBJECTS

A total of 17 Norwegian GPs in three CME groups.

MAIN OUTCOME MEASURES

Exploring GPs' attitudes to national guidelines and the practical use of the PSA test.

RESULTS

Detecting prostate cancer in general practice is a common and important, but difficult diagnostic issue. Our participants experienced uncertainty regarding the test when to use it, how to interpret the results and when to refer to specialist health services.

CONCLUSION

The study revealed a general ambivalence to the use of PSA. Many patients present urological problems, and many are afraid of having cancer. PSA is commonly used, but sometimes generates problems rather than solving them.

IMPLICATIONS

The use of the PSA test should be based on a thorough clinical assessment and in close collaboration with the patient.Key pointsMany patients in general practice present urological problems, and many are afraid of having cancer.GPs have a general ambivalence to the use of PSA when to use it, how to interpret the results and when to refer to specialist health services.The use of PSA sometimes generates problems rather than solving them.

The Resistance Vignette Task: Validating a rapid measure of therapist skill at managing resistance

BACKGROUND

Therapist appropriate responsivity to client ambivalence and resistance is considered an important interpersonal skill to avoid disengagement and ensure a continued collaborative, productive process. The present study examined the predictive validity of the newly developed Resistance Vignette Task (RVT), a 10-item rapidly administered measure of therapist ability to appropriately respond to various presentations of client resistance.

METHODS

Following a resistance management workshop, the concurrent and prospective predictive capacity of RVT scores were examined through test interviews with ambivalent simulators and volunteers.

RESULTS

Prospectively, in test interviews with ambivalent interviewees, higher RVT scores immediately postworkshop were associated with significantly greater responsivity (appropriate responsivity and fewer responsivity errors) at 4-month follow-up. RVT scores at the 4-month follow-up point were also concurrently associated with significantly greater therapist responsivity and lower levels of interviewee resistance.

CONCLUSIONS

These findings provide further validation for the RVT as a measure of therapist responsivity in vivo, in actual interviews by predicting and being concurrently associated with therapist performance in response to client resistance. Thus, the RVT holds promise in advancing therapist training, as well as research on resistance as it represents an efficient measure of this key therapist skill.

Approach-Avoidance pattern of attentional bias in individuals with high tendencies toward problematic Internet pornography use

Attentional bias plays a vital role in the occurrence and development of addictive behaviors. However, little is known about attentional processes in problematic Internet pornography use (PIPU), and previous studies have reported mixed results. The current study examined the components of attentional processing to sexual stimuli using an exogenous cueing task designed to differentiate between attentional engagement and disengagement. Two different stimulus presentation times (100 and 500 ms) were used to present the pornographic and neutral images to differentiate the early and late stages of attentional bias. Individuals with high (n = 40) and low (n = 40) PIPU tendencies were compared. The results demonstrated that individuals with high tendencies toward PIPU showed enhanced attentional engagement with pornographic stimuli in the early stage of attentional processing (100 ms), followed by attentional avoidance in the late stages of attentional processing (500 ms). Moreover, the severity of PIPU symptoms was positively correlated with attentional engagement scores in the short picture-time trials (100 ms) and weakly negatively correlated with attentional disengagement scores in the long picture-time trials (500 ms). This approach-avoidance pattern of attentional biases is in line with a recent theoretical model that emphasizes that appetitive and aversive motivational processes jointly determine attentional bias.

Searching for diagnostic certainty, governing risk: Patients' ambivalent experiences of medical testing

Diagnosis is pivotal to medicine's epistemic system: it serves to explain individual symptoms, classify them into recognizable conditions and determine their prognosis and treatment. Medical tests, or investigative procedures for detecting and monitoring disease, play a central role in diagnosis. While testing promises diagnostic certainty or a definitive risk assessment, it often produces uncertainties and new questions which call for yet further tests. In short, testing, regardless of its specific application, is imbued with meaning and emotionally fraught. In this article, we explore individuals' ambivalent experiences of testing as they search for diagnostic certainty, and the anxieties and frustrations of those for whom it remains elusive. Combining insights from sociological work on ambivalence and the biopolitics of health, and drawing on qualitative interviews with Australian healthcare recipients who have undergone testing in the context of clinical practice, we argue that these experiences are explicable in light of the contradictory impulses and tensions associated with what we term 'bio-subjectification'. We consider the implications of our analysis in light of the development of new tests that produce ever finer delineations between healthy and diseased populations, concluding that their use will likely multiply uncertainties and heighten rather than lessen anxieties.

Premature termination of the unified protocol for the transdiagnostic treatment of emotional disorders: The role of ambivalence towards change

Ambivalence towards change is an expected, recurrent process in psychological change. However, the prolonged experience of ambivalence in psychotherapy contributes to client disengagement, which could result in treatment dropout. Considering the negative effects of premature termination of therapy and the convenience of the identification of clients who are at risk of dropping out before achieving good-outcome, the current study explored the predictive power of ambivalence for premature therapy termination using a multilevel time-backwards model (i.e., considering the session of the dropout as session zero and then modelling what occurred from the dropout until session 1). Participants included a total of 96 psychotherapy clients (38 dropouts) treated in a university-based clinic following the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Multilevel modelling using a time-backwards model to analyse dropout data provided evidence of the predictive power of ambivalence evolution throughout treatment on the decision to prematurely discontinue treatment (p < .0001; R² _adj  = .29). Specifically, good-outcome dropouts presented a decreasing ambivalence trend throughout treatment, whereas poor-outcome dropouts tended to experience the same levels of ambivalence before deciding to drop out (time × dropout; β₁₁  = .64, p = .014). Additionally, poor-outcome dropouts presented higher levels of ambivalence (β₀₁  = 9.92, p < .0001) in the last session. The results suggest that the pattern of client ambivalence towards change is a predictor of premature termination of therapy. Implications for clinical and research contexts are discussed.

The role of dialecticism in objective and subjective attitudinal ambivalence

Although attitudes are often considered positive or negative evaluations, people often have both positive and negative associations with a target object or issue, and when people are ambivalent, they are typically presumed to find the experience aversive because they are motivated to hold clear, univalent attitudes. Cross-cultural research, however, has shown cultural variation in the propensity for dialectical thinking, which is characterized by a tolerance for contradiction. Two studies examined the role of dialectical thinking tendencies in the occurrence of attitudinal ambivalence and how much people subjectively experience their state of ambivalence. Study 1 measured individual differences in dialectical thinking within a culture, and Study 2 compared participants across two cultures (United States and Taiwan) that differ in dialecticism. Across studies, greater dialectical thinking was associated with holding both positive and negative evaluations of the same topic (objective ambivalence) and weaker correlations between objective ambivalence and subjective reports of being conflicted (subjective ambivalence).

Exploring Hostility Toward Women in High-Risk Rapists: The Relevance of Ambivalence and Relational Experience

Hostility toward women is an established risk factor for sexual violence and is often found to be present in men prone to sexual transgression. There are also clinical indications that high-risk rapists may have more ambivalent attitudes toward women, including the strong desire to be positively evaluated by women. We investigated attitudes toward women in high-risk male rapists (n = 42), nonsexual male offenders (n = 65), and matched male community controls (n = 42), by means of self-report (hostility toward women, benevolent sexism, hostile sexism) and implicit measures assessing associations (Implicit Association Test [IAT]) with "women are deceitful" and "women are prestige objects," and the approach tendency (Approach-Avoidance Task [AAT]) toward women. Results showed that high-risk rapists had a lesser implicit notion of women as deceitful and more explicit benevolent sexism than the community controls. These differences seemed most prevalent in the subgroup of high-risk rapists without any relationship history. It is hypothesized that unrealistically positive attitudes toward women may lead to rejection and frustration, which may influence sexual offending.

The path not taken: Distinguishing individuals who die by suicide from those who die by natural causes despite a shared history of suicide attempt

OBJECTIVES

This study aimed to identify variables that distinguish suicide risk among individuals with previous suicide attempts.

METHOD

Using psychological autopsy procedures, we evaluated 86 decedents who had at least one lifetime suicide attempt before eventual death by suicide (n = 65) or natural causes (n = 21).

RESULTS

The Suicide Death group was more likely to be male, to have alcohol in the toxicology report at time of death, and to have a depression diagnosis, while the Natural Cause Death group was more likely to have personality disorder traits, a polysubstance use disorder, higher reported health stress, and an antidepressant in the toxicology report at time of death. Hopelessness and ambivalence were found to distinguish between groups during the 6 months before death.

CONCLUSIONS

These findings suggest important differences between individuals with a shared history of a suicide attempt who die by suicide versus natural causes.

Pregnancy Intention: Associations with Maternal Behaviors and Experiences During and After Pregnancy

Background: The associations between levels of pregnancy intention and adverse behaviors or experiences during pregnancy and postpartum have not been well described. Materials and Methods: We used 2018 Pregnancy Risk Assessment Monitoring System data from 31 jurisdictions in the United States (n = 32,777) to estimate prevalence of inadequate prenatal care (PNC), inappropriate gestational weight gain, depression during pregnancy, intimate partner violence (IPV) during pregnancy, third trimester smoking, no breastfeeding, no postpartum visit, postpartum depressive symptoms, and postpartum smoking by categories of pregnancy intention: unwanted, ambivalent (i.e., unsure), mistimed (i.e., wanted later), or wanted (i.e., wanted then/sooner). Regression models estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) of associations between pregnancy intention and maternal behaviors or experiences. Results: Approximately 16% of women reported pregnancy ambivalence. Women with pregnancy ambivalence (versus wanted pregnancies) had higher prevalence of all adverse maternal behaviors and experiences. Separate models found women with unwanted pregnancy (vs. ambivalent) had higher prevalence for depression during pregnancy (aPR: 1.40, 95% CI: 1.21-1.63), IPV (aPR: 1.75, 95% CI: 1.11-2.77), no breastfeeding (aPR: 1.22, 95% CI: 1.04-1.44), no postpartum visit (aPR: 1.28, 95% CI: 1.06-1.55), and postpartum depressive symptoms (aPR: 1.19, 95% CI: 1.00-1.42); Women with mistimed pregnancy (vs. ambivalent) had lower prevalence for inadequate PNC (aPR: 0.89, 95% CI: 0.81-0.98), third trimester smoking (aPR: 0.68, 95% CI: 0.57-0.80), no breastfeeding (aPR: 0.85, 95% CI: 0.74-0.98), and postpartum smoking (aPR: 0.83, 95% CI: 0.73-0.95). Discussion: The results emphasize the importance of recommended screening and care during the preconception, prenatal, and postpartum periods.

Ventromedial Prefrontal Cortex Activity and Sympathetic Allostasis During Value-Based Ambivalence

Anxiety is characterized by low confidence in daily decisions, coupled with high levels of phenomenological stress. Ventromedial prefrontal cortex (vmPFC) plays an integral role in maladaptive anxious behaviors via decreased sensitivity to threatening vs. non-threatening stimuli (fear generalization). vmPFC is also a key node in approach-avoidance decision making requiring two-dimensional integration of rewards and costs. More recently, vmPFC has been implicated as a key cortical input to the sympathetic branch of the autonomic nervous system. However, little is known about the role of this brain region in mediating rapid stress responses elicited by changes in confidence during decision making. We used an approach-avoidance task to examine the relationship between sympathetically mediated cardiac stress responses, vmPFC activity and choice behavior over long and short time-scales. To do this, we collected concurrent fMRI, EKG and impedance cardiography recordings of sympathetic drive while participants made approach-avoidance decisions about monetary rewards paired with painful electric shock stimuli. We observe first that increased sympathetic drive (shorter pre-ejection period) in states lasting minutes are associated with choices involving reduced decision ambivalence. Thus, on this slow time scale, sympathetic drive serves as a proxy for "mobilization" whereby participants are more likely to show consistent value-action mapping. In parallel, imaging analyses reveal that on shorter time scales (estimated with a trial-to-trial GLM), increased vmPFC activity, particularly during low-ambivalence decisions, is associated with decreased sympathetic state. Our findings support a role of sympathetic drive in resolving decision ambivalence across long time horizons and suggest a potential role of vmPFC in modulating this response on a moment-to-moment basis.

Ambivalent anticipation: How people with Alzheimer's disease value diagnosis in current and envisioned future practices

Emergent biomarkers for Alzheimer's disease (AD) are expected to provide earlier and more precise diagnoses. However, even if biomarkers live up to these expectations, it cannot be taken for granted that patients actually would value an earlier and more precise AD diagnosis. Based on an interview study, we aim to give more insight into the value of an AD diagnosis for patients, in existing as well as future practices, by describing how a diagnosis enables or may enable knowing, foreseeing, and acting in relation to one's illness. Our findings show that how people with AD value a diagnosis is not only characterised by great variety, as previous studies have shown, but also by profound ambivalence for the individual. With lack of treatment and poor prognostics as the status quo, this ambivalence and the way people deal with it are particularly linked to the far-from-straightforward capacity of an AD diagnosis to support anticipation of the future. We argue that in otherwise unchanged practices the envisioned future biomarker-based diagnostics are unlikely to reduce the ambivalence about receiving an AD diagnosis and, in particular, the challenges of anticipation that it entails. Rather, biomarker-based innovations may even reinforce some of the main issues involved.

Intergenerational Ambivalence and Loneliness in Later Life

OBJECTIVE

This brief report examined the relationship between intergenerational ambivalence and loneliness in later life among a group of older adults with at least one child.

BACKGROUND

Previous work has explored the links between intergenerational ambivalence and other indicators of well-being but has not examined loneliness. Although studies show an association between positive and negative relationship quality with children and loneliness, there are conflicting findings, and there is also insufficient exploration of the role of gender.

METHOD

Utilizing pooled data from the 2012 and 2014 waves of the Health and Retirement Study (HRS) (n = 10,967) (https://hrs.isr.umich.edu/documentation), structural equation models were used to examine the hypothesized relationships, and multiple group analysis was utilized to assess potential gender differences.

RESULTS

The results indicated that greater intergenerational ambivalence was associated with increased loneliness in later life. However, there were no significant gender or marital status differences in the relationships.

CONCLUSION

This study adds to the existing literature on ambivalence and well-being by showing that ambivalent relationships are related to loneliness. Results underscore the emotional complexity of parent-child relationships and suggest the need for investigating the consequences of holding contradictory feelings.

Ambivalent Food Craving and Psychobiological Characteristics in Individuals With Weight Suppression

This study investigated the effects of psychobiological characteristics of non-obese women with a high level of weight suppression (H-WS) on explicit-implicit and approach-avoidance response toward food cues, depending on hunger-satiety states. The 634 participants were divided into two groups according to their weight history. If the difference between their highest weight over the last year and their current weight (a difference sustained at least for 1 year) was more than 5%, they were assigned to the "H-WS" group (N = 25). If the difference in weight was less than 5%, they were assigned to the "low level of weight suppression" (L-WS) group (N = 29). Explicit approach and avoidance toward food were measured by self-report questionnaires. Implicit approach and avoidance toward food cues were measured using an eye-tracker. Fasting blood samples were obtained to measure fasting serum leptin levels. After this, participants consumed a standard breakfast to control the satiety level. After breakfast, explicit-implicit approach-avoidance responses were repeatedly measured at the satiety states. Self-reported body shape concerns, drive for thinness, ambivalent food craving, and bulimic behavior were also assessed. The results showed that the H-WS group had lower leptin levels, and higher body shape concerns, drive for thinness, ambivalent food craving, and bulimic behaviors compared to the L-WS group. At the explicit level, the H-WS group reported lower approach and higher avoidance to food compared to the L-WS group, regardless of hunger-satiety state. Whereas, at the implicit level, the H-WS group showed higher approach during satiety rather than during hunger states. Regardless of the hunger-satiety state, there were no significant group differences with regard to implicit avoidance between the two groups. Thus, we confirmed that a high level of avoidance toward foods was observed in the H-WS group at the explicit level but not at the implicit level. Moreover, in contrast with a high level of explicit avoidance toward palatable foods, inhibition for implicit approach toward high-calorie foods seemed to be blunted after food consumption in the H-WS group. These inconsistencies may be associated with ambivalent food craving and vulnerability to bulimic behavior among H-WS individuals.

Motivation-Enhancing Psychotherapy for Inpatients With Anorexia Nervosa (MANNA): A Randomized Controlled Pilot Study

Patients with anorexia nervosa (AN) are frequently characterized by an unstable readiness to change and high ambivalence toward treatment. Enhancing readiness to behavioral change therefore plays an essential role for adherence to treatment especially for severely ill patients treated in inpatient settings. Therefore, a novel 10 week program for the individual psychotherapy sessions was designed using elements from motivational interviewing to be applied within the multidisciplinary inpatient treatment for patients with AN. In a randomized controlled pilot trial, N = 22 patients with AN received either the new intervention or treatment as usual in one of two recruiting university hospitals. Readiness to change, eating disorder pathology, therapeutic alliance as well as acceptance and feasibility of the new intervention were measured from patients and therapists in week 1, 5, and 10 of inpatient treatment. Results confirm acceptance and feasibility of the MANNA intervention as evaluated by patients as well as therapists. Patients receiving the new intervention completed their inpatient treatment significantly more often on regular terms than patients receiving treatment as usual. No differences between the groups could be found concerning therapeutic alliance during and at the end of treatment and readiness to change. Absolute numbers of BMI increase indicate a larger increase in the intervention group albeit not significant in this pilot study sample. Limitations of the study such as the small sample size as well as possible adaptions and advancements of the intervention that need to be examined in a larger clinical trial of efficacy are discussed. This phase II study is registered with the German Clinical Trials Register (DRKS) under the trial number DRKS00015639.

Contraception: what is the resistance all about?

PURPOSE

The aim of this study is to identify the aspects associated with resistance to contraception, providing healthcare workers with the necessary tools to increase compliance with contraception and, ultimately, reduce the rate of voluntary abortions.

MATERIAL AND METHODS

We performed a review of the literature published in Medline between 1st January 2000 and 31st July 2020. We included studies based on qualitative analyses, describing women's perception and attitudes towards contraception, including a population aged 15 years or older and conducted in either Europe or North America.

RESULTS

A total of 23 articles were included in the study. Resistance to contraceptive uptake was most frequently due to ambivalence about pregnancy, with up to 54% of ambivalent women reporting not using any means of contraception, and communication issues with the partner and/or health care provider, with a positive association found between communication with the partner and contraceptive use (OR 1.07; p < .050). Additional barriers to contraceptive use were the quality of the relationship with the partner, the perception of the risk of becoming pregnant after unprotected sexual intercourse, and unfamiliarity with contraception.

CONCLUSIONS

Family planning consultations should acknowledge the aspects that influence contraceptive uptake and address them as part of their consultations.

Ambivalence and Interpersonal Liking: The Expression of Ambivalence as Social Validation of Attitudinal Conflict

Literature on attitude similarity suggests that sharing similar attitudes enhances interpersonal liking, but it remains unanswered whether this effect also holds for ambivalent attitudes. In the present research, we shed light on the role attitudinal ambivalence plays in interpersonal liking. Specifically, we examine whether people express ambivalence strategically to generate a positive or negative social image, and whether this is dependent on the attitudinal ambivalence of their perceiver. We test two alternative hypotheses. In line with the attitude-similarity effect, people should express ambivalence toward ambivalent others to enhance interpersonal liking, as sharing ambivalence might socially validate the latter’s experience of attitudinal conflict. On the other hand, people might express more univalence, as ambivalence may drive ambivalent others toward the resolution of their attitudinal conflict, and univalent stances could help to achieve that goal. In two studies (N = 449, 149), people expressed similar attitudes to those of their perceivers, even when the latter experienced attitudinal conflict (Studies 1 and 2). Moreover, they composed an essay, the message of which validated their perceiver’s attitudinal conflict (Study 2). In line with these results, we further observe that the more people experienced their ambivalence as conflicting, the more they liked others who similarly experienced attitudinal conflict (Study 1). These findings suggest that the expression of ambivalence can have important interpersonal functions, as it might lead to an enhanced social image when interacting with those coping with attitudinal conflict.