Internal and External Barriers to Help Seeking: Voices of Men Who Experienced Abuse in the Intimate Relationships.

This qualitative study explores internal and external barriers to help seeking among 41 men from four English-speaking countries who self-reported victimization from a female intimate partner. Twelve online focus groups were conducted and themes were identified inductively at a semantic level. Six identified themes represented four internal (blind to the abuse, maintaining relationships, male roles, and excuses) and two external barriers to help seeking (fear of seeking help and nowhere to go). Most participants who avoided seeking help did so due to their own lack of recognition of abuse and ability to assess their risk of harm, attempts to keep the family intact, masculine stereotypes, and excuses for their partner's abuse. Some men who expressed an interest in seeking help were discouraged from it due to fear for their personal safety, a potential revictimization in the legal system, and the lack of support services available to men. This research suggests that the individuals who are abused in relationships, service providers, and the public at large could benefit from professional training about gender inclusive approaches to intimate partner abuse.

Examining Men's Experiences of Abuse From a Female Intimate Partner in Four English-Speaking Countries.

This qualitative study explores the experiences of men who self-report victimization from a female intimate partner in four English-speaking countries. Forty-one men who reported any type of intimate partner abuse (IPA) from a female partner were recruited via targeted advertising in Australia, Canada, the United Kingdom, and the United States. Twelve online focus groups were conducted across countries using a phenomenologically informed design. Thematic analysis was carried out from an inductive and realist epistemological position and themes identified at a semantic level. This approach was taken to directly reflect the men's experiences and perspectives, ensuring the voices of this hard-to-reach and overlooked population were heard. Three themes were identified across the countries: an imbalanced experience of harm; living with sustained abuse; and knowledge is power for men experiencing IPA. It was found that most participants underwent physical harm in the context of coercive control and experienced abuse over long periods of time. They were slow to recognize the magnitude of their partners' behavior and act upon it for a range of reasons that are described in detail. In addition, promoting knowledge about the victimization of men by women, using appropriate language and active learning, was found to be important in helping the men gain autonomy and agency to break the pattern of abuse and aid their recovery. The implications of the findings for developing male-friendly IPA policy, practice, and services are discussed, in addition to the need for innovative research methodology to access hard-to-reach populations.

A qualitative investigation of promotores' perspectives on task-shifting evidence-based mental health care for Latinxs in a rural community.

Promotores de salud (i.e., community health workers) have the potential to provide much-needed mental health services in Latinx communities, particularly in areas with provider shortages. This study used qualitative methods to explore promotor/a perspectives on mental health task shifting, with a focus on developing understanding of their definition of a promotor/a, obtaining feedback on the appropriateness of sample content of an evidence-based intervention for anxiety and depression in their community, and considering concerns regarding potential barriers to future implementation of services to Latinxs in a rural community. Promotores de salud (N = 16) were recruited from a network of primary care practices to participate in three semistructured focus groups. Qualitative analyses revealed that promotores viewed themselves as caretakers of their community and believed that mental health care fell within that role. After being presented with materials of an evidence-based behavioral intervention for anxiety and depression during the focus groups, promotores expressed that the sample materials seemed appropriate for their community, as well as a general perception that they could deliver such strategies with future training. Promotores voiced concerns about potential barriers to patients accessing mental health care, including mental health stigma and poor community mental health literacy, and discussed the potential benefits of involving promotores to address some of these barriers. Overall, results of this study indicate promotor/a support of the idea of mental health task shifting, as well as a perception that their involvement may improve future mental health service utilization and engagement among Latinxs in a rural community. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Preliminary Investigation Into a Range of Implicit and Explicit Offense Supportive Cognitions in Perpetrators of Physical Intimate Partner Violence.

The current study assessed a wide range of offense supportive cognitions in relation to the perpetration of physical intimate partner violence (IPV). This research used both implicit and explicit measures in a U.K. sample of 19 male IPV perpetrators recruited from a community-based IPV intervention program and 20 men from the community with no history of IPV. The study also explored the ability of the implicit measures to differentiate between the two groups. The cognitions assessed included gender-role stereotype, attitudes condoning violence against a partner, attitudes condoning violence in general, hostile attitudes toward women, sense of entitlement in the relationship and over the intimate partner (control and dominance), and general sense of entitlement. Participants completed a number of established self-report measures and a series of computer-based reaction time tasks including two implicit association tests, one go/no-go association task, and four sentence judgment tasks. Significant group differences emerged across all measures both at the explicit and at the implicit level. Most implicit measures had very good discriminatory power, and the combination of all implicit measures showed excellent discriminatory power, equal to that of the explicit measures combined. These findings suggest that some IPV perpetrators hold offense supportive cognitions that may have become fairly well established and have started to operate at an automatic level. Implicit measures could be useful tools for risk assessment purposes and identification of treatment needs alongside already established measures.

Cardiac Autonomic Function and Psychological Characteristics of Heterosexual Female Perpetrators of Intimate Partner Physical Aggression.

Intimate partner violence is predominantly viewed as a social problem of men's violence against women. However, a growing evidence base suggests an equal prevalence rate for male and female perpetrated intimate partner physical aggression. Moreover, female perpetrated intimate partner violence is often assumed to be reactive, yet there is limited evidence to support this notion. In this article, we describe the results of two studies that investigated the prevalence of female perpetrated intimate partner physical aggression, and its correlates in heterosexual female university students. The relationships of personality traits, resting heart rate, and heart rate variability (a correlate of vagal activity) were compared between females who did and did not report having engaged in intimate partner physical aggression. In Study 1, we found that 30.9% of participants reported enacting intimate partner physical aggression during the preceding 12 months. This finding suggests that a considerable number of undergraduate females aggress against their intimate partners. Perpetrators, relative to nonperpetrators, scored higher on secondary psychopathic traits. In Study 2, female intimate partner violence was shown to be associated with low resting heart rate and high heart rate variability. Perpetrators, relative to nonperpetrators, scored higher on psychopathic traits that index emotional resilience and unempathic tendencies, and reported increased proactive and reactive aggression. This raises the possibility that some incidences of female intimate partner physical aggression represent proactive aggressive acts. These findings also support the frequently found association between low resting heart rate and aggression, but raise the prospect that the reported aggressive acts reflect high heart rate variability and strong parasympathetic nervous system activity.

Using Technology to Conduct Focus Groups With a Hard-to-Reach Population: A Methodological Approach Concerning Male Victims of Partner Abuse in Four English-Speaking Countries.

Research shows that the experiences of male victims of partner abuse (PA) are often denied by the public and the professionals who are charged to support PA victims. Recruiting female victims for research on PA victimization is relatively easy because there are existing structures to serve this group of victims. Thus, male victims are considered a hard-to-reach (HTR) population, and studying them can be difficult. This article focuses on the use of technology to collect qualitative data from male PA victims in an international study focusing on male victims. The researchers used their own professional networks to recruit and screen a convenience sample of male victims of female-to-male PA, in four different English-speaking countries: Australia, Canada, England, and the United States. Four web-based, video-enabled, focus groups were held for each country-for a total of 12 groups and 41 male participants. This article addresses recruitment methods, the use of technology in data collection, protecting the confidentiality of male victims, methods for informed consent, and lessons learned to facilitate future research.

Perpetrators' Perspectives on Family Violence: An Event Process Model.

Offense process models are descriptive theories that provide a temporal outline of an offense-including its cognitive, behavioral, contextual, and motivational components-from a perpetrator's perspective. Offense process models have been developed for a wide range of criminal offending (e.g., alcohol-impaired driving, child sexual offending, rape, aggravated robbery, homicide), but remain underdeveloped for family violence. The purpose of this study was to develop an offense process model of family violence. We conducted individual semistructured interviews with 27 participants-14 men and 13 women-completing community-based family violence perpetrator treatment programs, and systematically analyzed participants' narratives of family violence events using grounded theory methods. The resulting event process model of family violence (FVEPM) contains four sections, arranged temporally from the most distal to the most proximal factors in relation to the family violence event: (1) background factors, (2) event build-up, (3) event, and (4) post-event. Each section outlines the cognitive, behavioral, contextual, and motivational factors that contribute to family violence perpetration. The FVEPM is the first attempt to consider whether a single offense process model can account for a broader range of family violence than that used solely by men toward their female intimate partners. Furthermore, the FVEPM highlights the dynamic nature of family violence events (FVEs), and the salient role of situational and interpersonal factors in contributing to family violence perpetration. We argue that the FVEPM has the potential to accommodate a range of types of family violence perpetration, and makes a useful contribution to theory and research on event-based models from a perpetrator perspective.

Testing the Generalizability of the Event Process Model of Family Violence With an Incarcerated Sample.

The event process model of family violence (FVEPM) presents a descriptive theory of a family violence (FV) event from the perpetrator's perspective. Developed in a community setting, the FVEPM is comprised of four interrelated sections and describes three pathways to FV perpetration (Pathway 1: Conflict escalation, Pathway 2: Automated violence, and Pathway 3: Compliance). This study further developed the FVEPM by testing the generalizability of the model and its pathways with an incarcerated sample of eight men with extensive histories of violent and other offending. Event narratives were gathered during individual semi-structured interviews, and were systematically analyzed using grounded theory methods. Overall, findings suggest that the FVEPM and its pathways can accommodate an incarcerated sample. However, several inconsistencies were found: Event narratives were better represented by splitting Pathway 1 into two sub-types, and no event narratives were assigned to Pathway 3. Implications for FV theories and treatment are discussed.

Pathways to Family Violence: Investigating Patterns in the Event Process of Family Violence Perpetrators.

This study is part of a larger research project that developed the event process model of family violence (FVEPM). The FVEPM was developed by applying grounded theory methods to the event narratives of 14 men and 13 women completing community-based family violence (FV) perpetrator treatment programs. The current study extends this work with the original sample, by examining the routes individual events take through the FVEPM. Three main pathways-comprising 93% of event narratives-were identified: a conflict escalation pathway (n = 14), an automated violence pathway (n = 6), and a compliance pathway (n = 6). Our findings extend existing FV typologies and theories by identifying patterns of features pertaining to the individual, the relationship, and the situation that converge to result in FV perpetration during a FVE. Further validation and development of the pathways may provide FV practitioners with an organizing framework from which to identify more nuanced assessment, treatment planning, and risk management processes for the diverse range of FV perpetrators they are tasked with treating.

Investigating whether controlling and aggressive relationship behaviors are discriminant.

Control is theorized as central to intimate partner aggression (IPA). Tools measuring nonphysical "controlling behaviors" in relationships have therefore been developed to identify the latent construct of control. However, the underlying assumption that "controlling behaviors" form a distinct subset of IPA has not been validated. This study investigates the divergent validity of acts considered as "controlling behaviors" against other aggressive acts used in relationships. The IPA and relationship literatures were reviewed to identify 1,397 items involving "controlling," physical, sexual, and psychologically aggressive acts perpetrated and/or experienced by an intimate partner. In total, 101 item pairs were identified and used to measure IPA tactics across these categories. In Study 1, exploratory factor analysis in a community sample (N = 561) found no evidence of a distinct factor of "controlling behaviors." Behaviors labeled as "controlling" in existing measures were distributed across other factors, including "eclectic aggression," "direct psychological aggression," and "monitoring acts." In Study 2A (N = 424 students), confirmatory factor analysis replicated the results of Study 1 and established configural measurement invariance (Study 2B), indicating no evidence for psychometric differences between samples. These results indicate that behaviors described as "controlling" in existing measures were not statistically distinguishable from other forms of IPA, and suggest that future research should investigate motivational, rather than behavioral, differences in the use of IPA. The findings challenge research to confirm whether a set of discrete behaviors can be used to accurately identify control in relationships and question the validity of tools that adopt this methodology.

Mindfulness Dampens Cardiac Responses to Motion Scenes of Violence.

Mindfulness is linked with improved regulatory processes of attention and emotion. The potential benefits of mindfulness are vast, including more positive emotional states and diminished arousal in response to emotional stimuli. This study aims to expand of the current knowledge of the mechanisms of mindfulness by relating the latter to cardiovascular processes. The paper describes two studies which investigated the relationship of trait mindfulness to self-report measures of emotions elicited during a violent video clip and cardiovascular responses to the clip. Both studies recruited male and female participants, mainly university undergraduate students. The clip was 5-min-long and evoked mainly feelings of tension and disgust. In study 1, we found that higher scores for trait mindfulness were associated with increased scores for valence (r = .370, p = .009), indicating a more positive interpretation of the clip. In study 2, the average heart rate during the clip was lower than during the preceding (p < .05) and following (p < .01) non-exposure conditions. Higher trait mindfulness was related to diminished heart rate reactivity (r = -.364, p = .044) and recovery (r = -.415, p = .020). This latter effect was obtained only when trait anxiety was used as a statistical covariate. Additionally, increased trait mindfulness was accompanied by higher resting heart rate (r = .390, p = .027). These outcomes suggest that mindfulness is linked with reductions in negative feelings evoked by violent motion stimuli.

The Effects of Prison Visits From Family Members on Prisoners' Well-Being, Prison Rule Breaking, and Recidivism: A Review of Research Since 1991.

The effect of family visits on prisoner well-being and future behavior is an important consideration in the development of prison policy. This review systematically examines current research findings that explore the impact of prison visits from family members on three specific offender outcomes: prisoners' well-being, rule breaking within the prison, and recidivism. The review focuses on visits by family and does not duplicate earlier reviews but rather extends them into current literature, through identification of empirical studies conducted post 1989, published since 1991. Ten studies met the stipulated inclusion criteria. All are case-control and cohort studies. The review of studies used a standardized quality assessment tool. Results show considerable variation in study quality, methods, and findings. However, studies consistently reported positive effects of prisoners receiving visits. Prison visits reduced depressive symptoms in women and adolescent prisoners. There was some evidence of reduction in rule-breaking behavior. One high-quality study suggested that visits reduced recidivism and increased survival in the community. Although there were positive outcomes associated with prison visits, it was not possible to draw strong conclusions for the outcomes of interest due to a lack of research, methodological discrepancies, and variability in outcome measures and results. The discussion considers the implications of the findings for policy, practice, and research.

Cognitive Processing Therapy for Spanish-speaking Latinos: A Formative Study of a Model-Driven Cultural Adaptation of the Manual to Enhance Implementation in a Usual Care Setting.

OBJECTIVE: As part of a larger implementation trial for cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) in a community health center, we used formative evaluation to assess relations between iterative cultural adaption (for Spanish-speaking clients) and implementation outcomes (appropriateness and acceptability) for CPT. METHOD: Qualitative data for the current study were gathered through multiple sources (providers: N = 6; clients: N = 22), including CPT therapy sessions, provider fieldnotes, weekly consultation team meetings, and researcher fieldnotes. Findings from conventional and directed content analysis of the data informed refinements to the CPT manual. RESULTS: Data-driven refinements included adaptations related to cultural context (i.e., language, regional variation in wording), urban context (e.g., crime/violence), and literacy level. Qualitative findings suggest improved appropriateness and acceptability of CPT for Spanish-speaking clients. CONCLUSION: Our study reinforces the need for dual application of cultural adaptation and implementation science to address the PTSD treatment needs of Spanish-speaking clients.

Parent-reported stigma and child anxiety: A mixed methods research study.

BACKGROUND: Stigma has been frequently cited as a barrier to service use for various mental health problems. Studies suggest that stigma may be greater for childhood mental health problems that are perceived as more atypical. AIMS: This study utilized a mixed methods research design (qual + QUAN) to examine parental endorsement of stigma and its impact on service utilization among children with significant anxiety-a common childhood problem frequently perceived as normative. METHODS: Semi-structured qualitative interviews were conducted with 29 parents of anxious children. Qualitative data were coded using a grounded theory approach, and stigma-related responses were examined for emergent themes. Quantitative data was analyzed with frequency counts and chi-square analysis. RESULTS: Stigma related to children's anxiety symptoms and seeking mental health services was reported by 41.3% (n = 12) of parents. Emergent themes included: 1) Parental Concern for Negative Consequences, 2) Parent Internalized Stigma, and 3) Negative Associations with Mental Health Treatment. Latino parents discussed stigma more frequently than non-Latino White parents (70% vs. 17.6%, respectively, X2(1, N = 27) = 5.33, p < 0.05). CONCLUSIONS: Although anxiety is a common childhood problem, stigma is still frequently reported by parents and may be an important barrier to mental health service use, especially among Latino youth.

Treating Posttraumatic Stress Disorder in Diverse Settings: Recent Advances and Challenges for the Future.

Racial and ethnic minorities are at high risk for developing posttraumatic stress disorder (PTSD) after experiencing a traumatic event and are less likely to receive evidence-based treatment for their symptoms. There is a growing body of literature showing that culturally appropriate interventions result in greater uptake, symptom reduction, and sustained treatment gains. This article review explores new findings in the cultural understanding of PTSD among racial and ethnic minorities. We first review recent advances in the understanding of PTSD symptomotology. Next, we provide overview of trials demonstrating efficacy and effectiveness of cognitive processing therapy (CPT), prolonged exposure (PE), and trauma-focused cognitive-behavioral therapy (TF-CBT) in diverse communities. Then, we discuss specific implementation strategies common across intervention trials used to increase feasibility, acceptability, adoption, and sustainability. Last, we discuss areas for future research and dissemination efforts.

Mental illness stigma and engagement in an implementation trial for Cognitive Processing Therapy at a diverse community health center: a qualitative investigation.

The present study aimed to describe associations between various types of mental health stigma and help-seeking behaviors among ethnically diverse clients with posttraumatic stress disorder (PTSD) served by an urban community health clinic. The present study draws qualitative data from a parent National Institute of Mental Health Study that aims to identify barriers and facilitators of implementing Cognitive Processing Therapy (CPT) for PTSD. A total of 24 participants from the initial phase of the trial were included in the present study. Mental health stigma emerged as one notable barrier to seeking mental health treatment, as participants described how experiences of environment-level stigma, internalized (self-)stigma and perceived (felt) stigma from their family, friends and previous healthcare providers influenced their decisions to seek care. Despite these barriers to help seeking, many clients also reported that positive interactions with informal and formal support systems, and encouragement from study therapists, helped to combat mental health stigma and facilitate decisions to participate in an implementation trial for CPT. Findings suggest that providers in community health settings may need to attend directly to stigma at the initiation of mental health treatment.

Providers' perspectives of factors influencing implementation of evidence-based treatments in a community mental health setting: A qualitative investigation of the training-practice gap.

This study aims to elucidate relations between provider perceptions of aspects of the consolidated framework for implementation research (Damschroder et al., 2009) and provider attitudes toward the implementation of evidence-based treatments (EBTs) in an ethnically diverse community health setting. Guided by directed content analysis, we analyzed 28 semistructured interviews that were conducted with providers during the pre-implementation phase of a larger implementation study for cognitive processing therapy for posttraumatic stress disorder (Resick et al., 2008). Our findings extend the existing literature by also presenting provider-identified client-level factors that contribute to providers' positive and negative attitudes toward EBTs. Provider-identified client-level factors include the following: client motivation to engage in treatment, client openness to EBTs, support networks of family and friends, client use of community and government resources, the connection and relationship with their therapist, client treatment adherence, client immediate needs or crises, low literacy or illiteracy, low levels of education, client cognitive limitations, and misconceptions about therapy. These results highlight the relations between provider perceptions of their clients, provider engagement in EBT training, and subsequent adoption of EBTs. We present suggestions for future implementation research in this area. (PsycINFO Database Record

PTSD and Romantic Relationship Satisfaction: Cluster- and Symptom-Level Analyses.

Previous studies have demonstrated bidirectional associations between posttraumatric stress disorder (PTSD) and romantic relationship dissatisfaction. Most of these studies were focused at the level of the disorder, examining the association between relationship dissatisfaction and having a diagnosis of PTSD or the total of PTSD symptoms endorsed. This disorder-level approach is problematic for trauma theorists who posit symptom-level mechanisms for these effects. In the present study, we examined the prospective, bidirectional associations between PTSD symptom clusters (e.g., reexperiencing) and relationship satisfaction using the data from 101 previously studied individuals who had had a recent motor vehicle accident. We also conducted exploratory analyses examining the prospective, bidirectional associations between individual PTSD symptoms and relationship satisfaction. Participants had completed the PTSD Checklist-Civilian Version and the Relationship Assessment Scale at 4, 10, and 16 weeks after the MVA. We performed time-lagged mixed-effects regressions to examine the effect of lagged relationship satisfaction on PTSD clusters and symptoms, and vice versa. No cluster effects were significant after controlling for a false discovery rate. Relationship satisfaction predicted prospective decreases in reliving the trauma (d = 0.42), emotional numbness (d = 0.46), and irritability (d = 0.49). These findings were consistent with the position that relationship satisfaction affects PTSD through symptom-level mechanisms.

New and emerging technologies for the diagnosis and monitoring of chronic obstructive pulmonary disease: A horizon scanning review.

There is a need for straightforward, novel diagnostic and monitoring technologies to enable the early diagnosis of COPD and its differentiation from other respiratory diseases, to establish the cause of acute exacerbations and to monitor disease progression. We sought to establish whether technologies already in development could potentially address these needs. A systematic horizon scanning review was undertaken to identify technologies in development from a wide range of commercial and non-commercial sources. Technologies were restricted to those likely to be available within 18 months, and then evaluated for degree of innovation, potential for impact, acceptability to users and likelihood of adoption by clinicians and patients with COPD. Eighty technologies were identified, of which 25 were considered particularly promising. Biomarker tests, particularly those using sputum or saliva samples and/or available at the point of care, were positively evaluated, with many offering novel approaches to early diagnosis and to determining the cause for acute exacerbations. Several wrist-worn devices and smartphone-based spirometers offering the facility for self-monitoring and early detection of exacerbations were also considered promising. The most promising identified technologies have the potential to improve COPD care and patient outcomes. Further research and evaluation activities should be focused on these technologies.

Delivering cognitive processing therapy in a community health setting: The influence of Latino culture and community violence on posttraumatic cognitions.

Despite the applicability of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) to addressing sequelae of a range of traumatic events, few studies have evaluated whether the treatment itself is applicable across diverse populations. The present study examined differences and similarities among non-Latino, Latino Spanish-speaking, and Latino English-speaking clients in rigid beliefs-or "stuck points"-associated with PTSD symptoms in a sample of community mental health clients. We utilized the procedures of content analysis to analyze stuck point logs and impact statements of 29 participants enrolled in a larger implementation trial for CPT. Findings indicated that the content of stuck points was similar across Latino and non-Latino clients, although fewer total stuck points were identified for Latino clients compared to non-Latino clients. Given that identification of stuck points is central to implementing CPT, difficulty identifying stuck points could pose significant challenges for implementing CPT among Latino clients and warrants further examination. Thematic analysis of impact statements revealed the importance of family, religion, and the urban context (e.g., poverty, violence exposure) in understanding how clients organize beliefs and emotions associated with trauma. Clinical recommendations for implementing CPT in community settings and the identification of stuck points are provided.