Internet-based Cognitive Behavioral Therapy for DSM-IV Sexual Dysfunctions in Breast Cancer Survivors: Predictors of Treatment Response

Abstract

Objectives: We evaluated factors predictive of the effect of internet-based cognitive behavioral therapy (CBT) in breast cancer survivors with a sexual dysfunction. Methods: Fifty-five women completed questionnaires assessing sexual functioning and distress at baseline and post-CBT. Results: Higher therapy compliance and better partner baseline sexual functioning predicted better post-CBT sexual functioning. Higher therapy compliance and higher partner relationship satisfaction predicted lower sexual distress. Therapy compliance, in turn, was predicted by active partner involvement in therapy and a stronger therapeutic relationship. Conclusions: To increase the effect of internet-based CBT, we recommend partner involvement in therapy and establishing a strong therapeutic relationship.     

Women Survivors of Sexual Abuse:

This article discusses issues that employees bring to the workplace and to the EAP counselor when childhood incest is the refering problem. It examines three broadly related areas of potential difficulty that EAP counselors, employers and coworkers can anticipate from a coworker who is an incest survivor: power, control and connection. The impact of these dynamics on the workplace and the EAP counselor is explored. Treatment goals and interventions emphasize five key areas of intervention: ( I ) therapeutic relationship; (2) rituals; (3) flexible boundaries; (4) recognizing family and workplace patterns; and (5) creating workable realities for the survivor.     

Navigating Sex and Sexuality After Sexual Assault: A Qualitative Study of Survivors and Informal Support Providers

Qualitative interview data from 45 matched pairs of survivors disclosing sexual assaults and their primary informal support providers (e.g., friend, family member, significant other) were used to explore survivor and support provider perspectives on changes in sexuality postassault and how those close to them have been affected as a result. Changes in sexuality included loss of interest in sex, increase or change in sexual partners, engaging in sex work, and increased sexual behavior. Support providers generally regarded promiscuity as a risky sexual behavior. If the support provider was the survivor’s sexual partner, he or she discussed exercising caution when navigating sexual intimacy with the survivor. Not all sexual encounters with romantic partners were positive; some survivors discussed being triggered (i.e., with post-traumatic stress disorder [PTSD] flashbacks) or experiencing the dissolution of their relationships due to the sexual impacts of their assault. Counseling implications are discussed in the context of improving survivors’ sexual experiences in general and in romantic relationships postassault. Implications can also be applied to prevention, scholarship on sex work, and sexuality research.     

Sexual Minority Adolescents

Abstract

Most ethical dilemmas confronting professional school counselors (PSCs) do not involve simple solutions. Therefore, to practice ethically, PSCs need to possess and have the ability to articulate their ethical decision-making process with a clear and defendable professional explanation. Specifically, this article details the ethical decision-making process for PSCs working with lesbian, gay, bisexual, and transgendered (LGBT) adolescents. Additionally, ethical standards and legal statutes relating to counseling LGBT adolescents, ethical decision-making processes, and implications are discussed.     

Sexual Beliefs and Sexual Functioning: The Mediating Role of Cognitive Distraction

Dysfunctional sexual beliefs are vulnerability factors for sexual dysfunction. This cross-sectional study aimed to test the mediating role of cognitive distraction on the relationship between dysfunctional sexual beliefs about sexual functioning shared by men and women and sexual function. The authors used a sample of 421 cisgender heterosexual participants involved in a monogamous relationship. The hypothesized mediation model was tested using a bootstrapped cross product of coefficients approach. Results showed a significant negative, indirect effect between dysfunctional sexual beliefs and women's sexual function through cognitive distraction. The discussion of this study highlights the importance of cognitive factors in sexual functioning.     

Depressed Mood and Sexual Functioning

Abstract

Although some studies have reported substantial correlations between clinical depression and hypoactive sexual desire, thus far only a few studies have addressed the association between depressed mood and different facets of sexuality (such as sexual satisfaction, sexual activity and level of sexual problems) in close relationships. This study sought to fill this gap by examining 198 couples recruited through advertisement. The associations between depressed mood measured by the Beck Depression Inventory (BDI) and sexuality within one person (actor effects) and between partners (partner effects) were analyzed using the Actor-Partner Interdependence Model by Kenny and Cook (1999). Our findings show that actor effects of the BDI score on sexual experiences are somewhat higher than partner effects, and that depressed mood is mainly associated with one's own hyposexual desire, sexual aversion and sexual arousal problems. However, there were no substantial partner effects between depressed mood and sexual arousal problems.     

Obfuscating Child Sexual Abuse II: Listening to Survivors

The reality of the extent and experience of child sexual abuse cannot be revealed while children are unable to ‘stand up and be counted’. Limited alternatives, lack of information and dependence on adults prevent the true scale of the problem being appreciated. Similarly, media and legal treatment of abused children also operate to suppress the truth. The expertise and knowledge of those who have suffered abuse need to be acknowledged and utilized in order that child sexual abuse can no longer be obfuscated. © 1997 John Wiley & Sons, Ltd.     

Holocaust Child Survivors and Child Sexual Abuse

ABSTRACT

This study utilized a qualitative analysis of child survivors of the Holocaust who were sexually abused during World War II. The research study aimed to give this specific group of survivors a voice and to explore the impact of multiple extreme traumas, the Holocaust and childhood sexual abuse, on the survivors. Twenty-two child survivors of the Holocaust who were sexually abused during the war completed open-ended interviews. The data was qualitatively analyzed according to Tutty, Rothery, and Grinnell's (1996) guidelines. Three major themes were found: issues relating to the sexual abuse trauma, survivors' perceptions of the abuse, and survivors' general perspectives towards life. The identity of the offenders, Jewish or non-Jewish, determined the survivors' feelings towards themselves, the perpetrators, and about the worth of life.     

Perceptions of Childhood Sexual Abuse Survivors: Development and Initial Validation of a New Scale to Measure Stereotypes of Adult Survivors of Childhood Sexual Abuse

The Childhood Sexual Abuse Stereotypes Scale was developed to assess stereotypes of adult survivors of childhood sexual abuse. Scale items were derived from two studies that elicited cultural and personal beliefs about, and emotions experienced towards adult childhood sexual abuse survivors among university undergraduates. Two scales, Emotions and Characteristics, were developed and administered online to 182 participants. Exploratory factor analysis produced 7 factors, 4 for the Emotions Scale and 3 for the Characteristics Scale. Study 2 replicated this factor structure using confirmatory factor analysis (N?=?457). Reliability and validity analyses suggest that the Childhood Sexual Abuse Stereotypes Scale has satisfactory psychometric properties. The Childhood Sexual Abuse Stereotypes Scale can be used to examine stereotypes of legal and health care professionals likely to work with survivors as well as in stereotyping research.     

Introduction: Exposing Misinformation Concerning Child Sexual Abuse and Adult Survivors

SUMMARY

This article introduces a special volume on misinformation about child sexual abuse. Despite extensive research findings on the long-term effects and consequences of child sexual abuse, misinformation on this topic is widespread. Several forces have worked to support and disseminate this erroneous information. Because it is difficult to comprehend the horror of sexual crimes against children, society's denial and disbelief have often unwittingly supported the agendas of those who want to discount or minimize the impact of these crimes. The media has also contributed to the aura of skepticism surrounding claims of sexual abuse and its mental health impact, and has reported favorably on controversial and unproven claims such as the “false memory syndrome”. In the hope of countering misinformation and thus raising the level of discourse to the engagement of real scientific issues, a number of well known and respected researchers and clinicians examine various facets of the problem.     

Sexual Abuse and Sexual Functioning in a Chronic Pelvic Pain Sample

ABSTRACT

Sexual abuse, particularly childhood sexual abuse, has been linked to chronic pelvic pain and to sexual dysfunction, though the sexual functioning of survivors of sexual abuse has not been studied in a chronic pain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index of the extent of sexual abuse experiences in childhood and adolescence/adulthood, higher scores were related to lower rates of sexual activity, less satisfaction with orgasm and feelings of closeness with sexual partners, and greater severity of and interference from pain. Findings point to the importance of controlling for relationship status in analyses of long-term effects of sexual abuse and of assessing chronic pelvic pain patients for histories of sexual abuse using measures that address the extent or severity of abuse.     

Vaginal Dryness and Beyond: The Sexual Health Needs of Women Diagnosed With Metastatic Breast Cancer

While research on the sexual health of women with early stage cancer has grown extensively over the past decade, markedly less information is available to support the sexual health needs of women diagnosed with advanced breast cancer. Semistructured interviews were conducted with 32 women diagnosed with metastatic breast cancer (ages 35 to 77) about questions they had concerning their sexual health and intimate relationships. All participants were recruited from a comprehensive cancer center at a large Midwestern university. Three themes were examined: the role of sexual activity and intimate touch in participants' lives, unmet information needs about sexual health, and communication with medical providers about sexual concerns. Findings indicated that sexual activities with partners were important; however, participants worried about their own physical limitations and reported frequent physical (e.g., bone pains) and vaginal pain associated with intercourse. When women raised concerns about these issues in clinical settings, medical providers often focused exclusively on vaginal lubricants, which did not address the entirety of women's problems or concerns. In addition, women diagnosed with metastatic breast cancer reported needing additional resources about specialized vaginal lubricants, nonpenetrative and nongenitally focused sex, and sexual positions that did not compromise their physical health yet still provided pleasure.     

Men's Sexual and Relational Adaptations to Erectile Dysfunction After Prostate Cancer Treatment

This study investigated how men adapt to erectile dysfunction and other sexual side-effects of prostate cancer treatment. The study recruited nonheterosexual and heterosexual men using an anonymous, international, online survey (N = 558). This article focuses on a qualitative analysis of answers (n = 348) to one open-ended question on sexual practices after treatment. Five themes emerged: (a) recovery of erectile function; (b) reframing sexual practices; (c) the importance of partners; (d) exploring anal sex; (e) the use of masturbation. The findings suggest that men should explore varied sexual options. Partners are also important in the overall recovery of men's sexual lives.     

Psychologists' Attitudes Toward Adult Male Survivors of Sexual Abuse

ABSTRACT

Psychologists' attitudes toward adult male sexual abuse survivors were explored. Psychologists (n = 154) read vignettes describing the sexual abuse of a male victim, then completed the Male Role Norm Scale, the Jackson Incest Blame Scale, a vignette response sheet, and a personal data sheet. Stepwise regression was used to analyze the data. Variables included characteristics of the psychologists, the perpetrator, and the victim. The psychologists' attitudes toward men, rather than the sex of the psychologists, predicted blaming attitudes. Victim responses, sexual abuse treatment experience, and the severity of abuse were also predictors. Practical suggestions for treatment are noted.     

Disclosure of Child Sexual Abuse Among Adult Male Survivors

Men who were sexually abused during childhood are a stigmatized, under-studied, and marginalized population that is at risk for long-term mental health problems. However, many mental health practitioners feel under-prepared and ill-equipped to effectively treat male survivors of child sexual abuse. Furthermore, little is known about factors that may impact the mental health of male survivors such as disclosure of the sexual abuse. The purpose of this study was to (a) describe the disclosure process of male survivors using a lifespan approach, (b) identify disclosure differences based on age and type of abuser, and (c) explore relationships between disclosure attributes and current mental health. Using a large, purposive sample of male survivors (N = 487), the study found that, on average, men delayed telling (M = 21.38 years) and discussing the abuse (M = 28.23 years) for many years. Older age and being abused by a family member (i.e., incest) were both related to delays in disclosure. Most participants who told someone during childhood did not receive emotionally supportive or protective responses and the helpfulness of responses across the lifespan was mixed. Several variables (e.g., timing of disclosure, discussing with a spouse, response to disclosure) were related to current mental health problems. These findings are helpful for clinical social workers who practice with clients from this population. Specific suggestions for improving clinical practice (e.g., assessment, treatment, professional training) are discussed.     

Counseling Competencies for Sexual Minority Clients

Abstract

Being able to work effectively with clients from diverse backrounds has become a necessity in good counseling practice. Professional associations have acknowledged this in recent years by identifying and articulating multicultural competencies that inform both the practice of counseling, but also the training of counselors. Specific attention to competencies in working with LGBT clients has been identified as a sub-set of these overall cultural competencies. In this paper, leaders within the Association for Gay, Lesbian, and Bisexual Issues in Counseling present specific ways in which counselors can provide culturally sensitive counseling to sexual minority clients and their families that are in line with the counselor training guidelines established by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).