자연주의적 탐구조사(Naturalistic Inquiry)

Examines whether the positive association between social support and well-being is attributable more to an overall beneficial effect of support (main- or direct-effect model) or to a process of support protecting persons from potentially adverse effects of stressful events (buffering model). The review of studies is organized according to (1) whether a measure assesses support structure (the existence of relationships) or function (the extent to which one's interpersonal relationships provide particular resources) and (2) the degree of specificity (vs globality) of the scale. Special attention is given to methodological characteristics that are requisite for a fair comparison of the models. It is concluded that there is evidence consistent with both models. Evidence for the buffering model is found when the social support measure assesses the perceived availability of interpersonal resources that are responsive to the needs elicited by stressful events. Evidence for a main effect model is found when the support measure assesses a person's degree of integration in a large social network. Both conceptualizations of social support are correct in some respects, but each represents a different process through which social support may affect well-being. Implications for theories of social support processes and for the design of preventive interventions are discussed.

/pdf/stress-social-support-and-the-buffering-hypothesis-37b7abjbst.pdf

Stress, social support, and the buffering hypothesis.

The development of a self-report measure of subjectively assessed social support, the Multidimensional Scale of Perceived Social Support (MSPSS), is described. Subjects included 136 female and 139 male university undergraduates. Three subscales, each addressing a different source of support, were identified and found to have strong factorial validity: (a) Family, (b) Friends, and (c) Significant Other. In addition, the research demonstrated that the MSPSS has good internal and test-retest reliability as well as moderate construct validity. As predicted, high levels of perceived social support were associated with low levels of depression and anxiety symptomatology as measured by the Hopkins Symptom Checklist. Gender differences with respect to the MSPSS are also presented. The value of the MSPSS as a research instrument is discussed, along with implications for future research.

The Multidimensional Scale of Perceived Social Support

It is proposed that motivation may affect reasoning through reliance on a biased set of cognitive processes—that is, strategies for accessing, constructing, and evaluating beliefs. The motivation to be accurate enhances use of those beliefs and strategies that are considered most appropriate, whereas the motivation to arrive at particular conclusions enhances use of those that are considered most likely to yield the desired conclusion. There is considerable evidence that people are more likely to arrive at conclusions that they want to arrive at, but their ability to do so is constrained by their ability to construct seemingly reasonable justifications for these conclusions. These ideas can account for a wide variety of research concerned with motivated reasoning. The notion that goals or motives affect reasoning has a long and controversial history in social psychology. The propositions that motives may affect perceptions (Erdelyi, 1974), attitudes (Festinger, 1957), and attributions (Heider, 1958) have been put forth by some psychologists and challenged by others. Although early researchers and theorists took it for granted that motivation may cause people to make self-serving attributions and permit them to believe what they want to believe because they want to believe it, this view, and the research used to uphold it, came under concentrated criticism in the 1970s. The major and most damaging criticism of the motivational view was that all research purported to demonstrate motivated reasoning could be reinterpreted in entirely cognitive, nonmotivational terms (Miller & Ross, 1975; Nisbett & Ross, 1980). Thus people could draw self-serving conclusions not because they wanted to but because these conclusions seemed more plausible, given their prior beliefs and expectancies. Because both cognitive and motivational accounts could be generated for any empirical study, some theorists argued that the hot versus cold cognition controversy could not be solved, at least in the attribution paradigm (Ross & Fletcher, 1985; Tetlock & Levi, 1982). One reason for the persistence of this controversy lies in the failure of researchers to explore the mechanisms underlying motivated reasoning. Recently, several authors have attempted to rectify this neglect (Kruglanski & Freund, 1983; Kunda, 1987; Pyszczynski & Greenberg, 1987; Sorrentino & Higgins, 1986). All these authors share a view of motivation as having its effects through cognitive processes: People rely on cognitive processes and representations to arrive at their desired conclusions, but motivation plays a role in determining which of these will be used on a given occasion.

/pdf/the-case-for-motivated-reasoning-2ki9tjbrr6.pdf

The case for motivated reasoning.

In an attempt to explain how and why some individuals with musculoskeletal pain develop a chronic pain syndrome, Lethem et al. (Lethem J, Slade PD, Troup JDG, Bentley G. Outline of fear-avoidance model of exaggerated pain perceptions. Behav Res Ther 1983; 21: 401-408).ntroduced a so-called 'fear-avoidance' model. The central concept of their model is fear of pain. 'Confrontation' and 'avoidance' are postulated as the two extreme responses to this fear, of which the former leads to the reduction of fear over time. The latter, however, leads to the maintenance or exacerbation of fear, possibly generating a phobic state. In the last decade, an increasing number of investigations have corroborated and refined the fear-avoidance model. The aim of this paper is to review the existing evidence for the mediating role of pain-related fear, and its immediate and long-term consequences in the initiation and maintenance of chronic pain disability. We first highlight possible precursors of pain-related fear including the role negative appraisal of internal and external stimuli, negative affectivity and anxiety sensitivity may play. Subsequently, a number of fear-related processes will be discussed including escape and avoidance behaviors resulting in poor behavioral performance, hypervigilance to internal and external illness information, muscular reactivity, and physical disuse in terms of deconditioning and guarded movement. We also review the available assessment methods for the quantification of pain-related fear and avoidance. Finally, we discuss the implications of the recent findings for the prevention and treatment of chronic musculoskeletal pain. Although there are still a number of unresolved issues which merit future research attention, pain-related fear and avoidance appear to be an essential feature of the development of a chronic problem for a substantial number of patients with musculoskeletal pain.

/pdf/fear-avoidance-and-its-consequences-in-chronic-25jwj42o35.pdf

Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art

Context.—African American adolescents are at high risk of contracting sexually
transmitted infection with human immunodeficiency virus (HIV), but which behavioral
interventions to reduce risk are most effective and who should conduct them
is not known.Objective.—To evaluate the effects of abstinence and safer-sex HIV risk-reduction
interventions on young inner-city African American adolescents' HIV sexual
risk behaviors when implemented by adult facilitators as compared with peer
cofacilitators.Design.—Randomized controlled trial with 3-, 6-, and 12-month follow-up.Setting.—Three middle schools serving low-income African American communities
in Philadelphia, Pa.Participants.—A total of 659 African American adolescents recruited for a Saturday
program.Interventions.—Based on cognitive-behavioral theories and elicitation research, interventions
involved 8 1-hour modules implemented by adult facilitators or peer cofacilitators.
Abstinence intervention stressed delaying sexual intercourse or reducing its
frequency; safer-sex intervention stressed condom use; control intervention
concerned health issues unrelated to sexual behavior.Main Outcome Measures.—Self-reported sexual intercourse, condom use, and unprotected sexual
intercourse.Results.—Mean age of the enrollees was 11.8 years; 53% were female and 92.6%
were still enrolled at 12 months. Abstinence intervention participants were
less likely to report having sexual intercourse in the 3 months after intervention
than were control group participants (12.5% vs 21.5%, P=.02), but not at 6- or 12-month follow-up (17.2% vs 22.7%, P=.14; 20.0% vs 23.1%, P=.42, respectively).
Safer-sex intervention participants reported significantly more consistent
condom use than did control group participants at 3 months (odds ratio [OR]=3.38;
95% confidence interval [CI], 1.25-9.16) and higher frequency of condom use
at all follow-ups. Among adolescents who reported sexual experience at baseline,
the safer-sex intervention group reported less sexual intercourse in the previous
3 months at 6- and 12-month follow-up than did control and abstinence intervention
(adjusted mean days over prior 3 months, 1.34 vs 3.77 and 3.03, respectively; P≤.01 at 12-month follow-up) and less unprotected intercourse
at all follow-ups than did control group (adjusted mean days, 0.04 vs 1.85,
respectively, P<.001, at 12-month follow-up).
There were no differences in intervention effects with adult facilitators
as compared with peer cofacilitators.Conclusion.—Both abstinence and safer-sex interventions can reduce HIV sexual risk
behaviors, but safer-sex interventions may be especially effective with sexually
experienced adolescents and may have longer-lasting effects.

https://jamanetwork.com/journals/jama/articlepdf/187546/JOC80091.pdf

Abstinence and Safer Sex HIV Risk-Reduction Interventions for African American Adolescents A Randomized Controlled Trial

Psychosocial factors, immunologic mediation, and human susceptibility to infectious diseases: how much do we know?

The role of mother–daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: a prospective study

Academic stress, power motivation, and decrease in secretion rate of salivary secretory immunoglobulin a

In this article, we show that people's evaluations of the seriousness of a health disorder are influenced by the perceived prevalence and personal relevance of that disorder. As part of a study ostensibly concerned with college students' health characteristics, 60 undergraduates were "tested" for the presence of a fictitious enzyme deficiency. The subjects discovered either that they had the deficiency (deficiency-present subjects) or that they did not have it (deficiency-absent subjects), and were led to believe either that 1 of the 5 people in the laboratory had the deficiency (low-prevalence subjects) or that 4 of them had it (high-prevalence subjects). As predicted, the low-prevalence subjects evaluated the deficiency as more serious than did the high-prevalence subjects. In addition, consistent with the view that personal relevance affects perceptions of health disorders, the deficiency-present subjects evaluated the deficiency as less serious than did the deficiency-absent subjects. The deficiency-present subjects also derogated the validity of the test ostensibly used to diagnose the deficiency compared with other subjects. Finally, the deficiency-present subjects requested more information about the deficiency than did the deficiency-absent subjects.

John B. Jemmott

Papers

Abstinence and Safer Sex HIV Risk-Reduction Interventions for African American Adolescents A Randomized Controlled Trial

Psychosocial factors, immunologic mediation, and human susceptibility to infectious diseases: how much do we know?

The role of mother–daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: a prospective study

Academic stress, power motivation, and decrease in secretion rate of salivary secretory immunoglobulin a

Judging health status: effects of perceived prevalence and personal relevance.