Inna Rivkin

Harnessing the imagination. Mental simulation, self-regulation, and coping.

Mental simulation provides a window on the future by enabling people to envision possibilities and develop plans for bringing those possibilities about. In moving oneself from a current situation toward an envisioned future one, the anticipation and management of emotions and the initiation and maintenance of problem-solving activities are fundamental tasks. In the program of research described in this article, mental simulation of the process for reaching a goal or of the dynamics of an unfolding stressful event produced progress in achieving those goals or resolving those events. Envisioning successful completion of a goal or resolution of a stressor--recommendations derived from the self-help literature--did not. Discussion centers on the characteristics of effective and ineffective mental simulations and their relation to self-regulatory processes.

The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories.

Child sexual abuse (CSA) is associated with HIV risk behaviors [Bensley, L., Van Eenwyk, J., and Simmons, K. W., 2003.] and more prevalent among women living with HIV than in the general population [Koenig, L. J., and Clark, H., 2004]. This randomized Phase~I clinical trial tested the impact of a culturally congruent psychoeducational intervention designed to reduce sexual risks and increase HIV medication adherence for HIV-positive women with CSA histories. An ethnically diverse sample of 147 women were randomized to two conditions: an 11-session Enhanced Sexual Health Intervention (ESHI) or an attention control. Results based on “intent to treat’’ analysesof pre–post changes are reported here. Additional analyses explored whether theobserved effects might depend on “intervention dose,’’ i.e., number of sessions attended. Women in the ESHI condition reported greater sexual risk reduction than women in the control condition. Although there were no differences between women in the ESHI and control groups on medication adherence, women in the ESHI condition who attended 8 or more sessions reported greater medication adherence at posttest than control women. The findings provide initial support for this culturally and gender-congruent psychoeducational intervention for HIV-positive women with CSA, and highlight the importance of addressing the effects of CSA on sexual risk reduction and medicationadherence in preventive interventions for women.

Child Sexual Abuse: Associations with the Sexual Functioning of Adolescents and Adults

Abstract As we move into the 21st century, information about sex is widespread and more accessible to the general public than ever before. This interest in sex also increases the focus on symptoms and patterns associated with sexual problems. However, the etiology of sexual dysfunction is multifaceted and poorly understood. One factor that has received growing attention is the role that early sexual abuse plays in sexual development and later sexual functioning, and how these associations differ between males and females. Despite high prevalence rates of child sexual abuse (CSA), which occurs to approximately 1 in 3 females and 1 in 10 males under the age of 18, we do not completely understand the complexities of how and to what extent CSA affects sexual functioning. Nonetheless, the research highlights the need to recognize the potentially powerful influence that abusive childhood experiences contribute to sexual health, performance, and satisfaction. We review research on the relationship between CSA and adolescent and adult sexual functioning. We use a developmental framework to guide our understanding of the effects of CSA, as well as gender and ethnic differences, on the sexual functioning of male and female survivors.

The Effects of Mental Simulation on Coping with Controllable Stressful Events

Previous research has revealed that writing or talking about traumatic stressors can improve health and psychological well-being. The present study investigated whether similar benefits may be conferred by mental simulation and whether such simulations can improve coping and affective responses to ongoing stressful events. All participants designated an ongoing stressful event in their lives. One third of the participants visualized the event and the emotions they had experienced (event simulation), one third visualized having resolved the problem (outcome simulation), and one third were simply followed over time (control). Event simulation participants reported more positive affect, both immediately and 1 week later, and indicated higher levels of planned and reported active coping strategies, compared with the other two conditions. Discussion focuses on the potential of structured mental simulation to facilitate coping with stressful events.

Severity of Child Sexual Abuse, Post- Traumatic Stress and Risky Sexual Behaviors Among HIV-Positive Women

Child sexual abuse (CSA) has been shown to enhance risk for HIV infection and other adverse outcomes. However, most studies examine the effects of a single incident of CSA rather than the full burden of abuse over the life span in predicting these adverse outcomes. A multi-dimensional approach was used in this study to examine the severity of abuse as a predictor of post-traumatic stress, depression, sexual symptoms, and risky sexual behaviors in a multi-ethnic sample of 147 HIV-positive women. Multivariate models indicated that experiencing both intrafamilial and extrafamilial CSA, adult sexual abuse (ASA) and Latina ethnicity predicted PTSD symptoms. ASA also predicted sexual trauma symptoms. Also, CSA and adult re-victimization contributed independently to risk for PTSD and sexual trauma symptoms, but not for risky sexual behaviors. The results support the need for interventions for HIV-positive women that address the full burden of abuse experienced and its sequelae.

Substance Abuse and Medication Adherence Among HIV-Positive Women with Histories of Child Sexual Abuse

Substance abuse increases the risks for infections and impairs medication adherence among HIV/AIDS patients. However, little is known about the characteristics of substance abuse and its impact on medication adherence among HIV-positive women with a history of child sexual abuse (CSA). In the present study, 148 HIV-positive women with a history of CSA completed a structured interview assessing CSA severity, psychological status, substance abuse, medication adherence, and sexual decision-making. Severity of CSA was significantly associated with substance use but not with adherence. Participants who had used hard drugs and who had lower self-esteem and adherence self-efficacy reported significantly lower levels of adherence. Additional research on how CSA experiences impact health behaviors is needed to help develop culturally congruent interventions to reduce risk behaviors and facilitate better medication adherence for this vulnerable population.

Systemic and individual factors in the buprenorphine treatment-seeking process: a qualitative study

BackgroundOpioid use is a significant problem in Alaska. Medication-assisted treatment for opioid use, including buprenorphine, reduces withdrawal symptoms and the harm associated with opioid abuse. Understanding consumers’ treatment-seeking process is important for addressing barriers to treatment, facilitating effective service utilization, and informing policy.MethodsTo understand treatment-seeking behavior, we examined the attitudes, perceptions, and knowledge of those who would benefit from the medication-assisted treatment (MAT) buprenorphine. Qualitative data from 2 focus groups (each including 4 participants) and 3 in-depth interviews with people who have used or considered using buprenorphine in treatment for an opioid use disorder were analyzed using grounded theory and directed content analysis approaches.ResultsKey findings suggest that individual (withdrawal process, individual motivation) and systemic (sociocultural, political, societal values) factors frame the treatment seeking process. Participants’ progress on the treatment-seeking road was affected by models of addiction and MAT, which related to facilitators and barriers encountered in seeking treatment (e.g. support, resources, treatment structure). These factors shaped the longer-term road to recovery, which was seen as on ongoing process.ConclusionsThe findings of this study suggest it is crucial for interventionists to take a contextual approach that considers individual and systemic factors involved in opioid addiction, treatment, and recovery. This study highlights ways policy makers and treatment providers can address the barriers consumers face in their treatment-seeking process in order to increase treatment access.

Providers' voices on telebehavioral health: survey of an outpatient counseling agency in Alaska.

Hope Counseling Center sought to expand behavioral health services to underserved populations in Alaska by offering telebehavioral health services. Providers completed a questionnaire addressing their experiences, opinions, and training needs as they relate to telebehavioral health. Open conversations about the training needs, limitations, and benefits of telebehavioral health supported program development and led to training on new equipment, rapport building, and telebehavioral health outcome studies.

The Effects of Yoga on Self-Objectification

Objectification theory postulates that women exist in a cultural milieu of sexual messages that serves to socialize women and girls to view themselves as objects to be examined by others (Fredrickson & Roberts, 1997). As a result girls and women internalize an observer’s perspective of themselves, concentrating on how they look at the expense of being aware of how they feel, an effect termed self-objectification. The present study investigated whether yoga can reduce self-objectification. Yoga is a mind-body exercise which emphasizes awareness of internal states at the expense of awareness of outward appearance. A certified Kundalini instructor taught yoga classes to adolescent participants. Participants completed self-objectification measures before and after their yoga classes. Overall, results were promising and provided limited support for the hypothesis that yoga instruction can reduce self-objectification. Implications for future research on yoga interventions for selfobjectification are discussed.