Depression, Contraception, and Ambivalence Concerning Fertility.

Individuals suffering from depression exhibit a higher rate of unintended pregnancies, which are associated with negative outcomes for both parents and children. Often, unintended pregnancies result from contraceptive mistakes. Here, we examine the relationship between depression and the consistency of contraceptive behavior, testing ambivalence as a possible mediator. The analyses were based on cross-sectional data from the second and third waves of the German Relationship and Family Panel Pairfam. A German-speaking sample without children (N = 190; 117 female, 73 male), who reported not attempting to conceive or become pregnant during the last 12 months, was analyzed in comparison with a propensity score matched sample. Ambivalence was operationalized as the difference between the ideal and realistic number of children in wave 2. Data from wave 3 were used to assess contraceptive behavior. Depressed mood in wave 2 and consistency of contraceptive behavior in wave 3 were negatively correlated. After including ambivalence in wave 2 as a mediator in the model, the direct path between depressed mood and consistency of contraceptive behavior remained significant, with no significant mediation found. For men only, we observed a significant negative association of ambivalence with the consistency of contraceptive behavior in the last 3 months. No significant relationship was found between depressed mood and ambivalence. We conclude that future research aiming to better understand the consistency of contraceptive behavior should incorporate measures of ambivalence.

Predictive genetic testing for Huntington's disease: Exploring participant experiences of uncertainty and ambivalence between clinic appointments.

Ambivalence and uncertainty are key themes throughout the psychology of healthcare literature. This is especially so for individuals at risk of Huntington's disease (HD) deliberating the decision to undergo genetic testing because there is currently no treatment that modifies disease progression. A better understanding of the experience of making a decision about genetic prediction will help practitioners support and guide individuals through this process. Our aim was to capture participants' experiences of uncertainty and ambivalence in between their genetic counseling appointments. We explored these issues through the experiences of nine participants who were referred for predictive HD testing at four regional genetics services in England and Wales. Data consisted of recordings of clinic consultations, diaries, and an in-depth interview conducted at the end of the testing process. Data were analyzed thematically. Four themes were identified representing four possible futures, each future dependent on the decision to undergo testing and the result of that test. Our results showed that participants, as well as attending more to a future that represents their current situation of not having undergone predictive testing, also attended more to a distant future where a positive predictive result is received and symptoms have started. Participants attended less to the two futures that were more immediate once testing was undertaken (a future where a positive result is received and symptoms have not started and a future where a negative result is received). The use of diaries gave us a unique insight into these participants' experiences of ambivalence and uncertainty, psychological distress, and the emotional burden experienced. These findings help inform discussions within the clinic appointment as well as encourage researchers to consider diary use as a method of exploring what happens for individuals outside of clinical encounters.

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.

The frequency and determinants of vaccine hesitancy among parents of preschool and kindergarten students in Edirne central district.

PURPOSES: The aim of our study is to determine the frequency of vaccine hesitancy and the associated factors among parents with preschool children in a city center. DESIGN AND METHODS: We conducted a cross-sectional study among parents of preschool children in the central district of Edirne. The cluster sampling method was applied. The data collection tools consisted of a questionnaire designed by the researchers and The Parent Attitudes about Childhood Vaccines (PACV) Scale. The correlations between vaccine hesitancy among parents factos such as the vaccine's content, adverse effects, religious beliefs, media coverage, reliance on community leaders, and the usage of complementary and alternative medical methods were examined. RESULTS: The study group consisted of 315 individuals and the prevalence of vaccine hesitancy among participants was determined to be 13%. The mean PACV scale score of the parents was 29.76 ± 16.62. According to multivariate analyses, the odds ratios (%95 CI) of variables that were statistically significantly associated with parental vaccine hesitancy were as follows: being a mother 8.77 (1.02-75.07), vaccine side effects 2.91 (0.93-9.16), low/equal income level 6.80 (2.45-18.86), low/high income level 5.74 (1.65-20.0), religious reasons 3.33 (1.34-8.25), and media influence 9.53 (3.75-24.18). CONCLUSION: Overall, vaccine hesitancy was observed at one in every 7 parents in the central district of Edirne province, and the main determinants of hesitancy were low-income status, media influence and religious beliefs, advers effects and being mother. Community-based intervention programs should be established to combat vaccine hesitancy. PRACTICAL IMPLICATIONS: The PACV scale is recommended for detecting community-based vaccine hesitancy.

Approaching Temporal Dynamics in the Dimension-Level Associations Between Career Adaptability/Ambivalence and Internalizing Symptoms Among Chinese Adolescents Throughout Their High Middle School Years.

Despite the well-established associations between adolescents' internalizing symptoms and career development, it still remains unclear whether adolescents' internalizing symptoms are precursors or consequences of their career adaptability/ambivalence. Subtler nuance inherent within such association also await to be revealed, because internalizing symptoms and career development have been primarily treated as broad constructs, despite the multifaceted nature of both. To narrow such gaps, this study examined the potentially dynamic associations among career adaptability, career ambivalence, and internalizing symptoms using three-wave longitudinal data. The study collected data from 3196 Chinese adolescents (52.72% girls, mean age = 15.56 years, SD = 0.58) at Wave 1, with 2820 (attrition rate = 11.76%) participating in Wave 2 and 2568 (attrition rate = 8.93%) in Wave 3. The measurement invariance suggested that there were no significant differences across both waves and genders. This study approached associations at both broader construct levels and subtler dimension levels. Results of cross-lagged path models at broader construct levels demonstrated a unidirectional association between internalizing symptoms and career adaptability. Results of models at subtler dimension levels indicated a series of transactional links over time between career adaptability dimensions/ambivalence and depressive symptoms in particular. Career adaptability dimensions and career ambivalence predicted later anxiety symptoms rather than the reverse. Group model comparisons showed no difference across waves and genders. These findings shed light on the dynamic nature of the associations during adolescence between career adaptability/ambivalence and internalizing symptoms, particularly at subtler dimensional levels, which should be considered in relevant clinical and educational practices.

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.

How kindness took a hold: A sociology of emotions, attachment and everyday enchantment.

How are we to understand the contemporary preoccupation-at least in many English-speaking societies-with 'random acts of kindness' and the idea of kindness more generally? Should this be seen as a challenge to the logic of capitalism or reinforcing of it, an example of commodification of emotion within our everyday lives? By introducing and mapping the contours of an emergent 'kindness industry', placing emotion (and enchantment) at the heart of how attachment to the idea of kindness is theorised, and marshalling existing empirical research on contemporary framings of everyday kindness, I argue that there is a need for a critical sociological engagement with the 'pro-social' that does justice to its profound ambivalence. In the case of contemporary kindness this involves understanding both the regulatory nature of the enchantment sold by a kindness industry and the problem-solving potential of the enchantment of kindness in the everyday, where it both helps address contemporary feelings of hopelessness and shame and facilitates the possibility of making life materially liveable.

Self-reported interoception and exteroception are atypical and excessively coupled in psychosis compared to healthy controls.

Although psychotic disorders are characterized by an impaired ability to discriminate internal and external worlds, the role of interoceptive and exteroceptive perceptions in determining this alteration is still unclear. This observational study aimed at investigating (a) increases/decreases in interoceptive and exteroceptive perceptions in patients with psychosis (PSY) compared to healthy controls (HC); (b) the association between interoception and exteroception in HC and PSY. Two hundred and ten HC and 72 PSY completed the Multidimensional Assessment of Interoceptive awareness (MAIA, 8 domains) and the Adolescent-Adult Sensory Profile (AASP, 4 domains). MAIA/AASP differences were evaluated with MANOVA, Kruskal-Wallis and Mann-Whitney tests. MAIA and AASP scores were correlated to quantify the interoceptive-exteroceptive coupling as Spearman's rho coefficients. Subgroup analyses were performed dividing PSY in schizophrenia/schizoaffective versus other psychosis. Compared to HC, PSY showed increased mean scores in four MAIA and two AASP domains (Bonferroni-p < 0.01). The interoceptive-exteroceptive coupling followed two correlation patterns in HC. A first pattern displayed negative correlations between MAIA not-worrying and AASP sensory sensitivity/sensation avoidance, while the second pattern highlighted positive correlations between MAIA scores and AASP sensation seeking. The two correlation patterns between HC and other-PSY subgroup were similar. However, schizophrenia/schizoaffective PSY did not show positive correlations in the second pattern, rather displaying negative correlations between MAIA scores and AASP domains related to passive behavioral responses. Correlation values were more extreme in PSY subgroups, indicating stronger interoceptive-exteroceptive coupling compared to HC. This study demonstrates that interoception and exteroception are atypical and excessively coupled in psychosis compared to the general population.Clinical Trials Registration: Protocol Number 20210003663 (Pavia, Ethical Committee IRCCS Policlinico San Matteo).

Methods to assess ambivalence towards food and diet: a scoping review.

BACKGROUND: Ambivalence towards food and diet, which favours behavioural inertia, might be a barrier to adopting healthier eating behaviours. Measuring it can help researchers to better understand its relationship with behaviour change and design interventions aimed at resolving it. In this scoping review, we map and describe methods and tools employed in studies to assess, measure or classify the ambivalence of participants towards food- and diet-related attitude objects. METHODS: In accordance with Joanna Briggs Institute guidance for conducting scoping reviews, we retrieved peer-reviewed studies from MEDLINE, CINAHL, PsycINFO, Web of Science, FSTA and Food Science Source and preprints from PsyArXiv and MedRxiv. Two independent reviewers screened the articles. We considered for inclusion peer-reviewed studies and preprints that assessed the ambivalence of participants of any age, sex or sociodemographic group towards food and diet. RESULTS: We included 45 studies published between 1992 and 2022, which included participants from 17 countries. Eighteen methods were employed across the included studies to assess different types of ambivalence (felt, potential or cognitive-affective), the most frequent of which were the Griffin Index, the Subjective Ambivalence Questionnaire, the MouseTracker Paradigm and the Orientation to Chocolate Questionnaire. CONCLUSION: This scoping review identified several methods and tools to assess different types of ambivalence towards food- and diet-related objects, providing an array of options for future studies.

Identity and pregnancy in conflict?: an examination of sexual minority women using qualitative description.

While there is growing documentation of pregnancy among sexual minority women, little research has focused on their perceptions and experiences of conflict between sexual minority identity and pregnancy. Because of this, this study used Social Identity Theory and qualitative descriptive analysis to explore the following questions: do sexual minority women perceive sexual minority identity and pregnancy as in conflict; and if so, from where does this conflict arise and how do sexual minority women experience it? Participants included 21 lesbian, gay, bisexual, queer and other non-heterosexual cisgender women, a third of whom had previously been pregnant. Themes captured internally located conflict, including participants who saw pregnancy as irrelevant and those who experienced pregnancy as acceptable for sexual minority women; imposed conflict from healthcare contexts, including both health provider assumptions and imposed conflict on reproductive autonomy; and ambivalence. Overall, few participants noted internalised conflict between their sexual minority identity and pregnancy. Instead, sexual minority women experienced ambivalence or imposed conflict between their sexual minority identities and pregnancy from their health providers, although this imposed conflict was not limited to sexual orientation.

Exploring ambivalence toward pregnancy among young Inuit women.

Ambivalence toward pregnancy is an important predictor of early pregnancy as documented in diverse Western societies. Inuit women from Nunavik, a northern region of Quebec, Canada, experience a high rate of early pregnancy, yet no study has explored their attitudes toward pregnancy. Grounded in a participatory approach, this study aimed to explore ambivalence toward pregnancy, among other pregnancy-related attitudes, and identify themes underlying ambivalence among young Inuit women from Nunavik. We conducted semi-structured interviews with 15 women aged 16 to 20 years, who became pregnant during the year preceding the interview. We used an inductive approach to analyse the data. Eleven participants were identified as ambivalent toward pregnancy while three were characterised as having a favourable attitude, and one as unfavourable. Four themes related to ambivalence were identified: the value of childbearing/motherhood; the use of contraceptives; the likelihood of becoming pregnant; and the ideal age to become pregnant. A better understanding of young women's attitudes toward pregnancy could contribute to the development of culturally relevant programmes to more effectively support adolescents, pregnant adolescents and young mothers, and to lead to better care.

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.

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.

Hidden in plain sight: how individual ADHD stakeholders have conflicting ideas about ADHD but do not address their own ambivalence.

Psychiatric classifications refer to clusters of behavioral symptoms. We know much about how psychiatric classifications are intended to be used in theory. Yet the scientific study of the practice of classification to date is limited. We aimed to explore how individuals navigate and make sense of the complexity surrounding an ADHD classification. We used thematic analysis to analyse stakeholder perspectives from seven focus groups: adults classified with ADHD, adolescents classified with ADHD, parents of children classified with ADHD, clinicians, researchers, teachers, and policy makers. We found seven themes in how stakeholders navigate the classification ADHD. Yet, what stood out was an overarching discursive pattern: individual stakeholders expressed highly ambivalent ideas about ADHD but did not address their own ambivalence. We suggest that promoting a social kinds perspective on ADHD may help us navigate the complexity and ambivalence associated with ADHD more competently.

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.

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.

Mixed emotional variants of gratitude: antecedent situations, cognitive appraisals, action tendencies, and psychosocial outcomes.

This research provides an exploratory investigation of whether gift/help-receiving contexts that elicit mixed emotional variants of gratitude can be distinguished from typical gratitude-eliciting situations in their associated appraisals, action tendencies, and psychosocial effects. We examined 473 participants (159 males, 312 females, 2 others; Mage = 31.07) using a one-way four-conditions between-subjects experiment. Participants were randomly assigned to complete recall tasks describing four different gratitude-eliciting situations. Emotions, cognitive appraisals, action tendencies, and general psychosocial outcomes were assessed. Relative to a control condition involving receiving a gift or help (gift/help condition), receiving something at the expense of a benefactor (benefactor-inconvenience condition) elicited gratitude-guilt; receiving something with an expectation of return (return-favour condition) elicited gratitude-disappointment and gratitude-anger; while receiving a disliked gift or receiving assistance that made things worse (backfire condition) primarily elicited gratitude-disappointment while also eliciting gratitude-anger and gratitude-guilt. Each condition was differentiable from control in their appraisals, action tendencies, and psychosocial effects. Notably, contexts which elicited mixed emotional variants of gratitude were characterised by the co-occurrence of conflicting appraisals such as pleasantness and unpleasantness or goal-congruence and goal-incongruence. Additionally, the return-favour and backfire conditions were most dissimilar from control, and were associated with the most negative action tendencies and psychosocial outcomes.

["In God alone my soul can find rest" (Ps 62:2) : Silence and pain in the Psalms and their narrativizations in Taizé]. / "Zu Gott allein ist meine Seele still" (Ps 62,2) : Stille und Schmerz in den Psalmen und deren Narrativierungen in Taizé.

BACKGROUND: A theological perspective on dealing with crises that focuses on modes of endurance and gestalt, is supported by interdisciplinary resilience research. OBJECTIVE: How can silence contribute to a productive coping with crises and pain? MATERIAL AND METHODS: Texts and practices of the Christian tradition are discussed with respect to their ways of dealing with critical and painful situations, namely a) the Psalm texts of the Old Testament, which are examined by means of exegetical methods for historical and cultural aspects of meaning and b) the practice of silence in the prayers of the Taizé community, which are examined from a narrative hermeneutical perspective. RESULTS: By understanding silence as an ambiguous and ambivalent phenomenon, it can contribute to a productive way of dealing with pain that enables perception, confrontation and acceptance. It is crucial not to regard the silence of a sufferer as a mere endurance, but also to have an eye on the creative potentials. Cultural and religious narratives and practices can help to locate oneself in a "space of silence" in such a way that a resilient way of dealing with experiences of pain becomes possible. CONCLUSION: In order for silence to promote resilience, it is necessary to keep an eye on productive as well as destructive processes of silence as an ambivalent phenomenon: These processes occur in an uncontrollable way and are shaped by implicit normative assumptions. Silence can be experienced as loneliness, isolation and the loss of quality of life, or silence can become a place of encounter, of arrival, of security, and in prayer of trust in God.

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.

Context matters: criticism and accommodation by close others associated with treatment attitudes in those with anxiety.

BACKGROUND: Many people with anxiety do not seek therapy due to negative views of treatment. Although close others (e.g. romantic partners, family members, close friends) are highly involved in treatment decisions, the role of specific relational behaviours in treatment ambivalence has yet to be studied. AIMS: This study examines the relationship between social predictors (perceived criticism and accommodation of anxiety symptoms by close others) and treatment ambivalence. METHOD: Community members who met diagnostic criteria for an anxiety-related disorder (N = 65) and students who showed high levels of anxiety (N = 307) completed an online study. They were asked to imagine they were considering starting cognitive behavioural therapy (CBT) for their anxiety and complete a measure of treatment ambivalence accordingly. They then completed measures of perceived criticism and accommodation by close others. Linear regression was used to examine the predictive value of these variables while controlling for sample type (clinical/analogue) and therapy experience. RESULTS: Greater reactivity to criticism from close others and greater accommodation of anxiety symptoms by close others were associated with greater treatment ambivalence in those with anxiety. These predictors remained significant even when controlling for therapy history and sample type. CONCLUSIONS: When it comes to treatment attitudes, relational context matters. Clients demonstrating ambivalence about starting therapy may benefit from discussion about the impact of their social environment on ambivalence.