First-Person Perspectives of Gender-Affirming Voice Feminization Training: A Mixed Methods Approach.

OBJECTIVES: Despite evidence for the validity of using client-led outcome measures in gender-affirming voice training (GAVT), the existing body of research on voice feminization relies heavily on acoustic-perceptual measures without additional qualitative exploration of client experience. Additionally, the authors are not aware of any existing studies prompting client input on the voice feminization methods they find most helpful in achieving their voice goals. The current study focuses on crucial client perceptions of GAVT for voice feminization and identifies the methods clients find most helpful. METHODS: Using a mixed-methods approach, we gathered numeric and qualitative survey data from 21 individuals who engaged in GAVT supporting voice feminization. We conducted follow-up interviews with five survey participants to gather additional qualitative data on client experiences and perceptions of GAVT. RESULTS: Quantitative and qualitative data reveal that clients are satisfied with GAVT supporting voice feminization, perceive their clinicians as being culturally inclusive, and identify oral/forward resonance work as one of the most helpful voice training methods. Interestingly, however, frequency of work on oral/forward resonance during training did not predict voice satisfaction post-training. CONCLUSIONS: Clients identified oral/forward resonance as one of the most helpful methods of voice feminization and found their GAVT experiences to be supportive of their voice goals. These findings emphasize the importance and value of client-led outcome measures when investigating effective approaches to GAVT.

Is Low Power Associated with Submission During Marital Conflict? Moderating Roles of Gender and Traditional Gender Role Beliefs.

Lower power during marital interactions predicts greater aggression by men, but no research has identified women's response to lower power. We tested whether women who experienced lower situational power during conflict exhibited greater submission, especially if they held traditional gender role beliefs and thus accepted structural gender differences in power. Newlywed couples (Time 1 N = 204 couples) completed questionnaires and discussed an area of conflict 3 times over 3 years. Individuals who perceived lower power during couples' discussions evidenced greater submission, but this effect was more pronounced for wives, especially wives who held traditional gender role beliefs. Among those with traditional gender role beliefs, greater submission together with lower power predicted lower marital adjustment over time. These results highlight that the low power-submission link, and associated implications for marital adjustment, need to be evaluated in the context of power-relevant situations, gender, and broader power-related beliefs about gender roles.

Choosing to enter or avoid diagnostic social situations.

Three studies suggest that people control the nature of their relationships, in part, by choosing to enter (or avoid) situations providing feedback about other people's social interest. In Study 1, chronically avoidant individuals (but not others) preferred social options that would provide no information about other people's evaluations of them over social options that would, but did not prefer nondiagnostic situations more generally. In Study 2, chronically avoidant students (but not others) in a methods class preferred to have their teacher assign them to working groups (a nondiagnostic situation) over forming their own groups (a diagnostic situation). In Study 3, individuals experimentally primed to feel avoidant were less likely than those primed to feel secure to choose to receive feedback about how another person felt about them. Overall, the research suggests that choices of socially diagnostic versus socially nondiagnostic situations play an important role in guiding people's social relationships.

Adult attachment and physical health.

This article examines how individual differences in adult attachment shape regulatory strategies and relationship behaviors, which in turn influence health-related responses, behaviors, and outcomes. We review links between attachment and physiological responses to stress (e.g., hypothalamic-pituitary-adrenal axis responses, cardiovascular responses, immune responses), health behavior (e.g., substance use, diet), and downstream health and disease outcomes. Recent evidence suggests that attachment insecurity (attachment anxiety and/or attachment avoidance) is associated with dysregulated physiological responses to stress, risky health behaviors, susceptibility to physical illness, and poorer disease outcomes. These associations depend, in part, on the relationship context, including the other partner's attachment style and behavior. We suggest that a dyadic approach considering both partners' attachment styles and behaviors will enhance interventions to promote health.

Attachment predicts cortisol response and closeness in dyadic social interaction.

The present study examined how the interplay of partners' attachment styles influences cortisol response, actual closeness, and desired closeness during friendship initiation. Participants provided salivary cortisol samples at four timepoints throughout either a high or low closeness task that facilitated high or low levels of self-disclosure with a potential friend (i.e., another same-sex participant). Levels of actual closeness and desired closeness following the task were measured via inclusion of other in the self. Results from multi-level modeling indicated that the interaction of both participants' attachment avoidance predicted cortisol response patterns, with participants showing the highest cortisol response when there was a mismatch between their own and their partners' attachment avoidance. Further, the interaction between both participants' attachment anxiety predicted actual closeness and desired closeness, with participants both feeling and wanting the most closeness with partners when both they and their partners were low in attachment anxiety.

Congruence between spouses' perceptions and observers' ratings of responsiveness: the role of attachment avoidance.

Although close relationships require partners to depend on one another for mutual responsiveness, avoidantly attached individuals are especially averse to risking such dependency. The authors propose that both avoidant and non-avoidant individuals perceive signs of their own and their partners' responsiveness in ways that reflect motivated perceptions of dependency. The present research examined how the interplay between spouses' attachment avoidance and observed responsive behaviors during marital conflict shaped perceptions of their own and their partners' responsiveness. Newlywed couples attempted to resolve a relationship conflict and then reported perceptions of their own and their partners' responsiveness during the conflict. Observers also coded both partners' responsive behaviors during the conflict. Avoidant spouses perceived themselves as less responsive, especially when observers rated them as more responsive; avoidant spouses also perceived their partners as less responsive. The discussion highlights the role of attachment in understanding links between responsiveness-related perceptions and behaviors.

Spouses' attachment pairings predict neuroendocrine, behavioral, and psychological responses to marital conflict.

This research investigated how spouses' attachment styles jointly contributed to their stress responses. Newlywed couples discussed relationship conflicts. Salivary cortisol indexed physiological stress; observer-rated behaviors indexed behavioral stress; self-reported distress indexed psychological stress. Multilevel modeling tested predictions that couples including 1 anxious and 1 avoidant partner or 2 anxious partners would show distinctive stress responses. As predicted, couples with anxious wives and avoidant husbands showed physiological reactivity in anticipation of conflict: Both spouses showed sharp increases in cortisol, followed by rapid declines. These couples also showed distinctive behaviors during conflict: Anxious wives had difficulty recognizing avoidant husbands' distress, and avoidant husbands had difficulty approaching anxious wives for support. Contrary to predictions, couples including 2 anxious partners did not show distinctive stress responses. Findings suggest that the fit between partners' attachment styles can improve understanding of relationships by specifying conditions under which partners' attachment characteristics jointly influence individual and relationship outcomes.