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Little is known about the role of subjective sexual arousal within romantic relationships. The current paper addresses this limitation using a prospective study design that investigates the direct associations between subjective sexual arousal induced by a romantic partner (partner arousal) and arousal induced by pornography (porn arousal) on changes in relational outcomes. A total of 309 participants who were in a current romantic relationship completed measures of partner and porn arousal as well as relational outcomes (i.e., sexual satisfaction and relationship quality and stability) at baseline (T1) and completed a second assessment of relational outcomes 2 months later (T2). Partner arousal was found to have no significant associations with changes in relational outcomes; however, porn arousal was associated with significant declines in sexual satisfaction and relationship quality and stability over a 2-month period. This paper is the first to examine how feeling sexually aroused by porn may impact relational outcomes for those in romantic relationships.
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Literatura Erótica , Relações Interpessoais , Satisfação Pessoal , Excitação Sexual , Parceiros Sexuais , Humanos , Feminino , Masculino , Estudos Prospectivos , Parceiros Sexuais/psicologia , Literatura Erótica/psicologia , Adulto , Adulto Jovem , Comportamento Sexual/psicologia , Adolescente , Inquéritos e QuestionáriosRESUMO
Exposure to gender-related minority stressors, the negative experiences and beliefs that stem from anti-trans stigma increases transgender and gender diverse (TGD) people's vulnerability to experiencing poor mental health outcomes. This study examined if the relationships between experiences of minority stress and mental health outcomes were mediated by early maladaptive schemas: mental representations shaping the way people view themselves, others and the world. Drawing from a schema therapy perspective, the study additionally examined if caregivers' failure to meet TGD people's core emotional needs was associated with mental health outcomes and if schemas similarly mediated these relationships. A total of 619 TGD adults completed an online survey about early maladaptive schemas, core emotional needs, gender-related minority stress and psychological distress and wellbeing. Causal mediation analyses indicated that caregivers who did not meet TGD people's core emotional needs and greater experiences of minority stress were associated with increased distress and lower wellbeing. These relationships were mediated by schema severity, particularly the disconnection and rejection and impaired autonomy domains. These findings provide empirical support for the schema therapy model's assumption that unmet core emotional needs are associated with schema formation. For TGD people, maladaptive beliefs about the self, others and world can form in response to manifestations of anti-trans stigma within the individual, their interpersonal relationships, community and broader society. Caregivers' failure to meet needs, plus experiences of minority stress throughout the individual's system, leads to greater distress and lower wellbeing; however, clinical interventions targeting schemas may improve outcomes for this at-risk group.
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Estigma Social , Estresse Psicológico , Pessoas Transgênero , Humanos , Feminino , Masculino , Adulto , Pessoas Transgênero/psicologia , Pessoas Transgênero/estatística & dados numéricos , Estresse Psicológico/psicologia , Pessoa de Meia-Idade , Adulto Jovem , Inquéritos e Questionários , AdolescenteRESUMO
BACKGROUND: The evidence base for schema therapy has evolved significantly since it was first developed by Jeffrey Young in the 1990s. The aim of this bibliometric analysis was to summarize the trends and characteristics of the quantitative literature on schema therapy. METHOD: PsycINFO, PubMed and CINAHL Complete databases were last searched on 1 June 2023 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement to identify peer-reviewed journal articles written in English that reported on original quantitative research on schema therapy or schema therapy constructs. NVivo was used to complete a descriptive analysis of the bibliographic, sample and study characteristics, and a coding framework was applied to capture the aspect of the schema therapy model that was the focus of each study, as well as the study context (e.g., the population or outcomes under investigation). SciVal was used to complete citations and authorship analyses. VOSviewer was used to examine co-authorship networks. RESULTS: A total of 704 quantitative studies on schema therapy were published by 483 unique first authors between 1994 and mid-2023. Studies predominantly used correlational designs with small samples (Mdn N = 153) of mostly females aged 18 years or older. The articles tended to focus on early maladaptive schemas, rather than schema domains or schema modes. Schema therapy and its concepts were most frequently studied in the context of depression and personality disorders. SciVal analyses indicated that, on average, articles were cited 27 times, with a Field Weighted Citation Impact of 1.02. CONCLUSIONS: Schema therapy research output appears to have slowed in recent years and several critical research gaps were evident. Areas of high priority for future research include schema modes and coping responses, and the use of developmental and longitudinal designs to evaluate several key causal assumptions in the theory underpinning schema therapy.
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Transtornos da Personalidade , Terapia do Esquema , Feminino , Humanos , Masculino , Transtornos da Personalidade/terapia , Capacidades de Enfrentamento , BibliometriaRESUMO
Strict lockdowns have been employed by many of the world's nations as a public health response to COVID-19. However, concerns have been expressed as to how such public health responses disturb the human ecosystem. In this paper, we report on findings from a longitudinal study of Australian parents in which we investigated how state differences in government-mandated lockdowns affect the relationship well-being (i.e., relationship satisfaction and loneliness) of parents. We situated the study of the relational effects of strict lockdowns within the Vulnerability Stress Adaptation Model (VSAM, Karney & Bradbury, 1995) that considers the role of parents' pre-existing vulnerabilities (i.e., psychological distress and attachment insecurity), life stressors (pre-pandemic and COVID-19 stressors), and adaptive relationship processes (constructive communication and perceived partner support). A total of 1942 parents completed 14 waves of assessments of relationship satisfaction and loneliness over a 13.5-month period as well as baseline assessments of personal vulnerabilities, life stressors, and adaptive relationship processes. Parents with high relationship adaptations and low vulnerabilities evidenced the highest relationship well-being (i.e., high satisfaction and low loneliness) during changes in lockdown restrictions, while parents with moderate relationship adaptations and vulnerabilities experienced the poorest well-being. Differences in state lockdown restrictions (i.e., Victoria [long and strict lockdown policy] vs all other states) were associated with differences in relationship well-being for parents with high relationship adaptations. Specifically, Victorian parents experienced significant declines in relationship well-being compared to non-Victorian parents. Our findings provide novel insights into how government-mandated social restrictions can disrupt the relational ecology of parents.
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COVID-19 , Humanos , Austrália , Controle de Doenças Transmissíveis , Ecossistema , Estudos Longitudinais , PaisRESUMO
Negative, destructive, and abusive behaviors in romantic relationships can vary from explicit kinds of abuse and aggression to more subtle and seemingly innocuous slights against or ways of treating a partner. However, regardless of the severity or explicit nature, these behaviors all, to one extent or another, reflect acts of invalidation, disrespect, aggression, or neglect toward a partner, and could be considered maltreatment of a partner. The current paper proposes the term partner maltreatment as a broad overarching concept, which was used to facilitate a meta-analytic synthesis of the literature to examine the associations between attachment insecurity (i.e., attachment anxiety, attachment avoidance) and perpetration of partner maltreatment. Additionally, this paper situated partner maltreatment within an attachment-based diathesis-stress perspective to explore the moderating role of stress. Five databases were systematically searched for published and unpublished studies that examined the direct association between perpetrator's adult attachment orientation and perpetration of partner maltreatment behaviors. We synthesized effect sizes from 139 studies (N = 38,472) and found the effect between attachment insecurity and acts of partner maltreatment varied between r = .11 to .21. Our findings provide meta-analytic evidence to suggest that attachment insecurity is a significant individual vulnerability factor (diathesis) associated with partner maltreatment; and that when individuals with an insecure attachment orientation experience stress, the tendency to perpetrate partner maltreatment is typically heightened. The findings of this meta-analysis provide empirical evidence for the importance of considering and addressing contextual factors, especially stress, for those individuals and couples seeking therapy for partner maltreatment.
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Agressão , Maus-Tratos Infantis , Adulto , Humanos , Criança , Suscetibilidade a Doenças , Ansiedade , Transtornos de AnsiedadeRESUMO
BACKGROUND: Emotion regulation is an integral part of the schema therapy model. The aim of this systematic review and meta-analysis was to synthesize the evidence on the associations between early maladaptive schemas (EMSs), difficulties with emotion regulation and alexithymia. METHOD: PsycINFO, PubMed and CINAHL Complete databases were searched on 28 May 2022 and 3 February 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Included studies were in English, in peer-reviewed journals and reported on the association between one or more of the 18 EMSs or five schema domains and emotion regulation difficulties or alexithymia. Methodological quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Meta-analyses were conducted to examine difficulties with emotion regulation and alexithymia as correlates of each EMS and domain. RESULTS: A total of 19 studies published between 2008 and 2022 were included (Pooled N = 5957). Difficulties with emotion regulation were positively correlated with all 18 EMSs (range: entitlement r(7) = .28, 95% CI [.13, .42] to negativity pessimism r(5) = .53, 95% CI [.23, .74]) and schema domains (range: impaired limits r(5) = .34, 95% CI [.08, .56] to disconnection rejection r(5) = .44, 95% CI [.33, .73]). Alexithymia was positively correlated with the other-directedness domain (r(2) = .40, 95% CI [.09, .64]) and 16 of the 18 EMSs (range: unrelenting standards r(5) = .21, 95% CI [.12, .28] to emotional inhibition r(5) = .50, 95% CI [.34, .63]). CONCLUSIONS: The findings suggested that almost all 18 EMSs are implicated in emotion regulation difficulties and alexithymia, particularly those relating to unmet needs for attachment and autonomy.
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There is an increasing focus on evaluating the effectiveness of Relationship Education (RE) programs on reducing relationship aggression. Nevertheless, there has been little by way of a systematic quantitative synthesis of research to date. The primary aim of this research was to conduct a meta-analysis into the effects of RE programs on relationship aggression and provide a comprehensive assessment as to the moderating effects of various methodological characteristics of studies. A secondary aim was to determine whether RE programs reduce negative aspects of relationship functioning that are known to exacerbate relationship aggression. Thirty-one studies (n = 25,527) were included comprising of pre-post comparison studies and control trials. Overall, RE programs were significantly associated with reductions in relationship aggression (d = 0.11, p = .001). Pre-post studies yielded a significantly larger effect size (d = 0.28, p < .001) than RCT studies (d = 0.05, p = .10). Subgroup analysis revealed that participants who reported moderate to severe relationship aggression upon RE program entry demonstrated large reductions in physical (d = 0.66, p = .01) and psychological (d = 0.85, p < .001) aggression compared to those who reported minimal to low relationship aggression on entry (physical aggression d = 0.07, p = .009; psychological aggression d = -0.04; p = .17). Amongst participants who reported moderate to severe relationship aggression, RE programs were also found to reduce controlling behavior (d = 0.20, p < .01) and conflict behavior (d = 0.40, p < .001). Findings demonstrate the emerging efficacy of RE programs for reducing relationship aggression and conflict behavior, particularly in those with a history of moderate to severe levels of relationship aggression.
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Agressão , Relações Interpessoais , Humanos , Agressão/psicologiaRESUMO
OBJECTIVE: To investigate the medium-term impacts of the COVID-19 pandemic on violence-related offences in Australia, and whether there was evidence of a 'dual pandemic' of family violence in addition to COVID-19. METHODS: Autoregressive Integrated Moving Average time series were conducted to analyse publicly available violent crime statistics data from January 2017 to November 2021. Population rates of homicide, sexual, domestic and non-domestic assault were assessed across each Australian state and territory, with the effects of COVID-19 being modelled using the average monthly World Health Organization COVID-19 stringency rating for each jurisdiction. FINDINGS: All jurisdictions in Australia showed increasing or stable domestic assault trends over the past decade, which were not significantly impacted by COVID-19, nor by the subsequent lockdowns. Non-domestic assaults demonstrated a significant, negative relationship with the stringency index for each jurisdiction, except Western Australia. There was no significant change in the rates of homicide or sexual assault across Australia in relation to COVID-19. CONCLUSION: Overall, there was no evidence of a 'dual pandemic' in Australia, and whilst domestic assaults continue to increase across the country, non-domestic assaults showed a notable but brief decline. However, these have returned to levels at least as high as pre-COVID-19 and some states show a continuing upward trend. The findings also suggest that alcohol availability may have played a role in continuing high violence numbers. Given the ongoing increasing and high levels of family violence in Australia, revised conceptual frameworks and interventions are indicated.
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COVID-19 , Violência Doméstica , Humanos , Austrália/epidemiologia , Pandemias , COVID-19/epidemiologia , Controle de Doenças TransmissíveisRESUMO
Due to the unavailability of assessment tools focused on support recipients, the aged-care literature has not been able to document the support seeking that occurs within familial support contexts. Therefore, we developed and validated a Support-Seeking Strategy Scale in a large sample of aging parents receiving care from their adult children. A pool of items was developed by an expert panel and administered to 389 older adults (over 60 years of age), all of whom were receiving support from an adult child. Participants were recruited on Amazon mTurk and Prolific. The online survey included self-report measures assessing parents' perceptions of support received from their adult children. The Support-Seeking Strategies Scale was best represented by 12 items across three factors-one factor representing the directness with which support is sought (direct) and two factors regarding the intensity with which support is sought (hyperactivated and deactivated). Direct support seeking was associated with more positive perceptions of received support from an adult child, whereas hyperactivated and deactivated support seeking were associated with more negative perceptions of received support. Older parents use three distinct support-seeking strategies: direct, hyperactivated, and deactivated with their adult child. The results suggest that direct seeking of support is a more adaptive strategy, whereas persistent and intense seeking of support (i.e., hyperactivated support seeking) or suppressing the need for support (i.e., deactivated support seeking) are more maladaptive strategies. Future research using this scale will help us better understand support seeking within the familial aged-care context and beyond. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Filhos Adultos , Pais , Humanos , Pessoa de Meia-Idade , Idoso , Pais/psicologia , Inquéritos e Questionários , Apoio Familiar , AutorrelatoRESUMO
Recent reviews of the pornography literature have called for the development of valid and reliable measures that assess multiple facets of pornography use. Moreover, despite pornography use having important implications for romantic relationships, there are currently no self-report assessments of pornography use specifically within the context of romantic relationships. To address these limitations, the current paper reports on two studies regarding the development and psychometric evaluation of a 38-item multidimensional measure of pornography use within the context of romantic relationships: the Pornography Use in Romantic Relationships Scale (PURRS). Study 1 (n = 739) reports on an Exploratory and Confirmatory Factor Analytic approach to determine the factor structure of the PURRS. Study 2 (n = 765) reports on the cross-validation of the factor structure of the PURRS, before assessing the criterion validity of the measure. The PURRS exhibited good internal consistency, construct validity, and criterion validity. The findings suggest that the PURRS is best modeled by 13 first-order factors, though a higher-order factor structure comprising four broad factors may also be used. The PURRS significantly extends on past assessments of pornography use, and in particular, advances the assessment and study of pornography use within the context of romantic relationships.
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Literatura Erótica , Autoavaliação (Psicologia) , Humanos , Autorrelato , Psicometria , Reprodutibilidade dos TestesRESUMO
Despite the popularity of schema therapy, there exist several important gaps in research on the schema therapy model and its effectiveness. The number of gaps makes it difficult to determine the research areas of the highest strategic priority to advance schema therapy. The objective of this study was to establish consensus among schema therapy clinicians and researchers on the priority areas for future schema therapy research. A panel of experts in schema therapy (43 clinicians and 13 researchers) participated in a Delphi consensus study. The research areas rated were developed by interviewing the founder of schema therapy, Jeffrey Young, conducting a focus group with the executive board of the International Society for Schema Therapy and screening recent reviews on schema therapy for recommendations for future research. The panel rated 81 research areas in terms of priority across three rounds. Nineteen research areas were rated by 75% of the panel as 'Very high priority' or 'High priority'. These priorities reflected four broad themes: (1) schema therapy constructs and measures, (2) the theoretical assumptions underlying schema therapy, (3) schema therapy and theory in relation to different contexts and outcomes and (4) schema therapy effectiveness and mechanisms of change. The findings are important for establishing a clear research agenda for the future of schema therapy.
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Pesquisa , Terapia do Esquema , Humanos , Técnica Delphi , Inquéritos e Questionários , ConsensoRESUMO
Research into self-regulation and partner regulation strategies has largely involved parallel lines of research, thus, it is difficult to determine the relative contribution of both forms of regulation when it comes to relationship outcomes. Therefore, the question remains as to which form of regulation is more strongly associated with relationship quality; is it more important to focus on adaptive self-regulation or adaptive strategies to regulate one's partner? The current research addresses this important gap by comparing the relative associations of adaptive self-regulation and adaptive partner regulation strategies on romantic relationship quality. A community sample of mixed gender couples (N = 114) who were predominantly satisfied with their current relationships - but nonetheless still experienced relationship conflict - were administered self-report assessments of various self-regulation and partner regulation strategies as well as a measure of relationship quality. Couples also participated in a videotaped discussion of an unresolved relationship issue that was scored by trained coders for verbal and nonverbal indicators of self-regulation and partner regulation strategies. Actor-partner interdependence modeling revealed that for both men and women, adaptive self-regulation strategies were positively associated with their own evaluations of relationship quality as well as their partner's relationship quality. In contrast, engaging in adaptive partner regulation strategies was not significantly associated with men's or women's own, or their partner's relationship quality. Findings highlight the importance of focusing on self-regulation in relationships, as it is these strategies, over partner regulation strategies, that have more positive implications for the relationship quality experienced by typically satisfied couples.
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Autocontrole , Parceiros Sexuais , Masculino , Humanos , Feminino , Relações Interpessoais , Inquéritos e Questionários , AutorrelatoRESUMO
OBJECTIVE: The current study provides a proof of concept for an aspect of the trauma and attachment model outlined in Marshall and Frazier (2019), which argues that attachment insecurity is associated with PTSD symptoms via hyperactivating/deactivating coping strategies, especially in the context of high trauma severity. METHOD: 302 participants who had experienced a traumatic event(s) completed a survey. RESULTS: The results showed significant indirect effects between attachment insecurity and PTSD symptoms via hyperactivating/deactivating coping strategies, especially in the context of high trauma severity. In low trauma severity, hyperactivating strategies were not as strongly associated with PTSD symptoms and deactivating strategies not associated with PTSD symptoms. Hyperactivating and deactivating strategies were the mediators for attachment anxiety models and deactivating strategies was the mediator for attachment avoidance models. CONCLUSIONS: This proof of concept for Marshall and Frazier (2019) provides a platform for future research to better understand PTSD symptoms from an attachment framework. Interventions are likely to benefit by assisting people high on attachment avoidance and anxiety to modify their deactivating tendencies following a trauma of high severity and also assisting people high on attachment anxiety to modify their hyperactivating tendencies posttrauma, especially following a high trauma severity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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BACKGROUND: Despite its integral role in normative sexual functioning, there is a dearth of research into the role of subjective sexual arousal within romantic relationships. AIM: The current proof-of-concept study addresses this gap by investigating the associations between partner-induced sexual arousal, sexual arousal induced by others, and sexual satisfaction and relationship quality. METHODS: One hundred and sixteen heterosexual couples who had been together for an average of three and a half years completed an online survey. An Actor-Partner Interdependence Modelling framework was applied to analyze the dyadic data. OUTCOMES: Participants completed the Perceived Relationship Quality Components (PRQC) Inventory and a single item global measure of sexual satisfaction derived for the current study. RESULTS: Feeling sexually aroused by one's romantic partner was positively associated with one's own sexual satisfaction and relationship quality. However, feeling sexually aroused by people other than one's romantic partner was negatively associated with one's own sexual satisfaction and relationship quality. These associations were found for both men and women. CLINICAL TRANSLATION: Therapists and practitioners may need to place an emphasis on using strategies and techniques that specifically facilitate or heighten partner-induced sexual arousal, whilst helping couples to move away from those behaviors and situations which typically lead to sexual arousal induced by those other than their partner. STRENGTHS & LIMITATIONS: This proof-of-concept study provides novel findings that address the absence of research investigating the associations between sexual arousal and outcomes in romantic relationships. The well-powered dyadic study design enabled a rigorous test of the hypotheses. However, the study was cross-sectional in nature, the sample was somewhat homogenous, and assessments included brief measures of sexual arousal and sexual satisfaction. CONCLUSION: The findings offer the first evidence to suggest that partner-induced sexual arousal and non-partner-induced sexual arousal have differential effects in terms of sexual satisfaction and relationship quality. This not only has a raft of clinical implications, but it provides the basis for several important avenues of future research on the role of subjective sexual arousal in romantic relationships. Lawless NJ, Karantzas GC, Mullins ER, et al. Does it Matter Who You Feel Sexually Aroused By? Associations Between Sexual Arousal, Relationship Quality, and Sexual Satisfaction. Sex Med 2022;10:100523.
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To lose one's sense of what it means to be human reflects a profound form of loss. Recent research in the study of dehumanization highlights that the loss of humanness can be experienced at the hands of close others. Moreover, acts of dehumanization can take many forms in close relationships. In this paper, we review the emerging literature on the study of dehumanization within interpersonal relationships, placing a specific emphasis on adult romantic relationships. We situate our review of the literature within a newly developed model of interpersonal dehumanization. This model outlines how many destructive relationship behaviors reflect forms of dehumanization, which can result in a vast array of personal and relational losses.
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Desumanização , Relações Interpessoais , Adulto , HumanosRESUMO
This article reports on the first meta-analysis of studies on the association between government-imposed social restrictions and mental health outcomes published during the initial year of the COVID-19 pandemic. Thirty-three studies (N = 131,844) were included. Social restrictions were significantly associated with increased mental health symptoms overall (d = .41 [CI 95% .17-.65]), including depression (d = .83 [CI 95% .30-1.37]), stress (d = .21 [CI 95% .01-.42]) and loneliness (d = .30 [CI 95% .07-.52]), but not anxiety (d= .26 [CI 95% -.04-.56]). Subgroup analyses demonstrated that the strictness and length of restrictions had divergent effects on mental health outcomes, but there are concerns regarding study quality. The findings provide critical insights for future research on the effects of COVID-19 social restrictions.
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COVID-19 , Ansiedade/psicologia , Humanos , Solidão/psicologia , Pandemias , SARS-CoV-2RESUMO
OBJECTIVES: The aim of this study was to use the ADKAR model of organizational change to gain an understanding of why a training program designed to equip staff with the skills to provide a Consumer Directed Care (CDC) model in nursing homes produced little change in the outcome variables, including resident quality of life. METHODS: We collected and analyzed various forms of site-specific data including CDC implementation plans developed by staff trained in 21 facilities, and their training facilitators' records. RESULTS: Staff trained in the principles of CDC produced well-developed, facility-specific plans to introduce a CDC model of care, yet they faced many barriers to the implementation of these plans. These barriers were spread across multiple stages of the ADKAR model and included staff turnover (including managers), lack of engagement by management, lack of or inconsistent availability of a CDC champion, and disruptions to the training program. CONCLUSIONS: We identified several organizational factors contributing to the failure of the training program to produce anticipated changes. CLINICAL IMPLICATIONS: Without organizational commitment and full management support, attempts to implement CDC training programs are likely to fail, leading to negative consequences for residents' autonomy and control over how they are cared for.
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Instituição de Longa Permanência para Idosos , Qualidade de Vida , Idoso , Humanos , Casas de SaúdeRESUMO
Attachment security priming has important theoretical and practical implications. We review security priming theory and research and the recent concerns raised regarding priming. We then report the results of a meta-analysis of 120 studies (N = 18,949) across 97 published and unpublished articles (initial pool was 1,642 articles) investigating the affective, cognitive, and behavioral effects of security priming. A large overall positive effect size (d = .51, p < .001) was found across all affective, cognitive, and behavioral domains. The largest effect was found for affect-related outcomes (d =.62, p < .001), followed by behavioral (d = .44, p < .001), and cognitive (d = .45, p < .001). Trait attachment anxiety and avoidance moderated the effects of subliminal security priming for behavioral outcomes-security priming effects were larger among people higher on attachment anxiety and avoidance. Assessment of publication bias revealed mixed evidence for the possible presence of asymmetry.
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Ansiedade , Apego ao Objeto , Ansiedade/psicologia , Humanos , Atividade MotoraRESUMO
OBJECTIVES: This study evaluated a training program to support the delivery of consumer directed care (CDC). It was hypothesized that both interventions, compared to the control condition, would demonstrate increased levels of CDC in nursing homes, increased staff practice of CDC, and improved resident QoL. The training plus support group was expected to show greater gains, compared to the training only group. MATERIALS AND METHODS: In a cluster RCT design, 33 nursing homes were randomly allocated to one of three conditions: training plus support, training only, and care as usual. Outcome measures included level of CDC within each home, staff practice of CDC, and resident QoL. RESULTS AND DISCUSSION: Hypotheses for this study were partially supported. Nursing homes became more CDC-oriented but with minimal changes in staff practice of CDC. Resident QoL also demonstrated limited change. The findings are discussed in terms of organizational barriers to change within nursing homes.