I study how people think about their health and illness: My research is in Health Psychology with a main focus on subjective perceptions of health and illness and their effects on coping with health threats and ultimately on the psychological and physical outcomes. Particular interests include women's health issues - particularly women's reproductive health (infertility, pregnancy and childbirth). I attained my master's degree in social psychology at the Hebrew University of Jerusalem and my PhD in health and social psychology at Rutgers University in New Jersey. I am currently a Professor at the Bob Shapell School of Social Work. I am a Fellow of the European Health Psychology Society.
OBJECTIVES Despite the well-documented negative effects of posttraumatic stress symptoms followin... more OBJECTIVES Despite the well-documented negative effects of posttraumatic stress symptoms following childbirth (PTSS-FC), research on protective factors for PTSS-FC is still missing. Aiming to fill this gap, we proposed and examined a process model through which maternal-infant skin-to-skin contact after birth reduces PTSS-FC by decreasing negative emotions, especially for women who had operative births. METHOD In this longitudinal study, pregnant women (N = 1833) were recruited at community and hospital medical centres in the center of Israel and through internet forums. At Time 1, during pregnancy, they rated their prenatal depressive symptoms which served as an indicator for prenatal vulnerabilities. At Time 2, two-months postpartum (N = 1371, 75% of the sample), they reported their mode of birth, whether they had skin-to-skin contact with their newborn after birth, their emotions during birth, and rated their current PTSS-FC. A moderated mediation analysis was used to examine the proposed model. RESULTS Guilt and fear during birth mediated the association between mode of birth (instrumental or cesarean versus vaginal) and PTSS-FC. Skin-to-skin contact was related to reduced feelings of guilt and fear during birth, especially for women who had a cesarean section. CONCLUSIONS Our results recognize the specific emotions that contribute to the development of PTSS-FC following operative births and show how skin-to-skin contact can possibly reduce them. As such they emphasize the importance of the implementation of skin-to-skin contact following childbirth, and especially following a cesarean section as recommended by the Baby Friendly Health Initiative (World Health Organization & UNICEF, 2009).
Abstract We present the concept of aintegration (not integrated, maintaining incongruence), defin... more Abstract We present the concept of aintegration (not integrated, maintaining incongruence), defined as the human ability to bear cognitive/emotional complexity, manifested in the capability to maintain incongruence and live with inconsistencies, discontinuities, contradictions and paradox, and yet not experience strain or discomfort. After defining aintegration, we present aintegrative-related issues in major psychological areas such as personality, adult development and aging, social and clinical psychology, cognitive processes, and coping with trauma, emphasizing the necessity of aintegration conceptualizations in these theories. We also relate to relevant cognitive, philosophical, and cultural systems of thought. We then present the operationalization of aintegration using a script-type questionnaire [the Aintegration Questionnaire (AIQ)] and three studies that tested its reliability and validity in different contexts: Study 1 revealed that aintegration is higher with age, education, and among divorced/separated people and the non-religious. Study 2 showed that individuals high in aintegration are more likely to report positive life events and to view negative events as not solely negative. Study 3 showed that among adults in middle and old age, aintegration is related to fewer post-traumatic symptoms, even after controlling for the number of traumas. The AIQ showed high internal reliability and divergent validity from need for structure. The findings support the concept of aintegration and its theoretical contribution to adult development and the psychological sciences. Aintegration can serve as an umbrella construct to areas typically investigated separately. Our epilogue emphasizes possible future theoretical evolutions of our concept and further research. The validity of the AIQ measurement supports the importance of the ability to live with incongruence, contradictions and complexity and the potential for this concept to inform research on modern life.
Background: In the modern world women’s perceptions of birth are shaped by culture, myths and abu... more Background: In the modern world women’s perceptions of birth are shaped by culture, myths and abundant information. Although birth has been medicalized, women can take part in the decision-making process regarding how and where to birth. The current study investigates how perceptions of birth relate to birth choices and mode of delivery. Method: 850 Israeli parturients were asked to fill in questionnaires measuring beliefs about birth as a medical or natural process, fear of birth (FoB) and planned birth choices. 6 weeks postpartum actual mode of delivery and birth satisfaction were assessed. Findings: Stronger beliefs about birth as a natural process were related to less FoB and more natural birth choices, such as homebirth and analgesia-free birth. Stronger beliefs about birth as a medical process were related to more FoB, more medical birth choices, such as use of epidural and more unplanned modes of delivery such as assisted vaginal delivery and emergency cesarean section. Discussion: Perceptions of birth are the basic building blocks that shape women’s birth choices. Understanding them could improve psychological and medical interventions and outcomes.
BackgroundThe effectiveness and long‐term outcomes of spinal cord stimulation (SCS) are not fully... more BackgroundThe effectiveness and long‐term outcomes of spinal cord stimulation (SCS) are not fully established, especially considering that data from patients who withdrew from the trial are rarely analysed, which may lead to overestimation of SCS efficacy. We evaluated short‐ and long‐term effects of SCS on chronic pain and perceived health, beyond natural variability in these outcomes.MethodsIn a prospective design, 176 chronic pain patients referred to SCS were evaluated five times (baseline; retest ~6 weeks later; post‐SCS trial; 8 and 28 weeks post‐permanent implantation). Patients whose SCS trial failed (Temp group) were followed up and compared to those who underwent permanent SCS (Perm group).ResultsAnalyses revealed a non‐linear (U‐shaped) trend significantly different between the two groups. In the Perm group, a significant improvement occurred post‐SCS implantation in pain severity, pain interference, health‐related quality of life and self‐rated health, which was followed by gradual worsening and return to baseline values at end of follow‐up. In the Temp group, only minor changes occurred in these outcomes over time. On average, baseline and end of follow‐up values in the Perm and Temp groups were similar: ~40% in each group exhibited an increase in pain severity over time and 38% and 33%, respectively, exhibited reductions in pain severity over time.ConclusionsSince the greatest improvement in the outcome measures occurred from baseline to post‐SCS trial (T1–T3) followed by a gradual decline in the effect, it appears that SCS may not be effective for the majority of chronic pain patients.SignificanceThis longitudinal study evaluated short and long term effects of spinal cord stimulation (SCS) on chronic pain outcome measures, beyond their natural variation in time. Despite significant short term improvements, by the end of the seven months' follow‐up, the outcomes in the treatment group (people who received the permanent implantation) were similar to those of the control group (people whose SCS trial failed and did not continue to permanent implantation) suggesting SCS may not be cost‐effective for chronic pain patients.
Background: To assess changes in pain levels, self-rated health (SRH) and identity of a pain pati... more Background: To assess changes in pain levels, self-rated health (SRH) and identity of a pain patient in adults with chronic pain from referral to implantation of a spinal cord stimulation (SCS) device to ~6 weeks following implantation. Methods: Patients with chronic pain (N=148) filled in questionnaires at referral to SCS (T1) and ~8 months later (T2; n=119), including ratings of pain and general health (SRH), acceptance of pain (indicating identification with being a pain patient), and the IPQ-R. Findings: 20% did not undergo SCS (no SCS=nSCS), 29% underwent only temporary implantation of a SCS device and discontinued ("disappointed"=dSCS), and 51% continued to permanent SCS (pSCS). Repeated measures ANOVA showed that pain levels significantly decreased in the dSCS and much more so in the pSCS but remained the same in the nSCS. SRH and pain perceptions improved only for the pSCS whereas stronger pain identity was reported only by the dSCS. Discussion: Continuous use of SCS relieves pain and leads to improved SRH yet pain still dominates these patients' lives and thoughts. Failing treatment leads to even stronger pain identity and intrusion, despite some improvement in pain level.
The present study examined the relationship between risk experience and risk perceptions in relat... more The present study examined the relationship between risk experience and risk perceptions in relation to the target (risk to the self vs. others) and for two different types of risk: acute risks (i.e., terrorist attacks) and cumulative health risks (i.e., alcohol consumption, tobacco consumption, and unhealthy eating) in two countries (Israel and Germany). An online survey (N = 571) was conducted to assess participants’ previous personal experience with acute and cumulative risks and their personal and general risk perceptions. The results showed that personal experience with terrorism was related to increased personal and general risk perceptions, while personal experience with cumulative health risks was related to increased personal but not general risk perceptions. It is argued that an increase in risk perception with more risk experience can be explained by the amount of available information about people's personal as well as other people's risk status. The findings emphasize that the experience–risk perception relationship depends on the target of the risk and the type of risk experience.
Background: A single self-rated health (SRH) assessment is associated with clinical outcome and m... more Background: A single self-rated health (SRH) assessment is associated with clinical outcome and mortality, but the biological process linking SRH with immune status remains incompletely understood. Objectives: To examine the association between SRH and inflammation in apparently healthy individuals. Methods: Our analysis included 13,773 apparently healthy individuals attending the Tel Aviv Sourasky Medical Center for periodic health examinations. Estimated marginal means of the inflammation-sensitive biomarkers [i.e., highly sensitive C-reactive protein (hs-CRP) and fibrinogen] for the different SRH groups were calculated and adjusted for multiple potential confounders including risk factors, health behavior, socioeconomic status, and coexistent depression. Results: The group with the lowest SRH had a significantly higher atherothrombotic profile and significantly higher conentrations of all inflammation-sensitive biomarkers in both genders. Hs-CRP was found to differ significantly between SRH groups in both genders even after gradual adjustments for all potential confounders. Fibrinogen differs significantly according to SRH in males only, with low absolute value differences. Conclusions: A valid association exists for apparently healthy individuals of both genders between inflammation-sensitive biomarker levels and SRH categories, especially when comparing levels of hs-CRP. Our findings underscore the importance of assessing SRH and treating it like other markers of poor health.
Aims: This symposium set out to a) investigate the development of physical activity and well-bein... more Aims: This symposium set out to a) investigate the development of physical activity and well-being after transition into retirement and b) to reveal age-related factors associated with decreases or increases in activity and well-being. It further aims to c) investigate active ageing from different perspectives (older adults, exercise programme providers), with different methodologies (quantitative, qualitative, meta-synthetic) and new concepts (effect of vacation) and d) to suggest innovative approaches for health promotion programmes. Rationale: The potential for promoting active ageing and maintained well-being in older adults is often underestimated. The specific needs of this population differ from younger adults, but are not yet well understood. In line with this year’s conference topic "Behaviour change: Making an impact on health and health services" this symposium extracts risk factors and resources for active and successful ageing. All five presentations contribute innovative and age-specific factors associated with active ageing and provide suggestions for activities and services tailored to the specific needs of adults aged 65+. Summary: Lisa Warner investigates trajectories of physical activity after transitions to retirement and possible influencing factors. Angela Devereux-Fitzgerald presents her insights on older adults’ acceptability of physical activity from interviews with older adults with lower socio-economic status as well as exercise programme providers. In her meta-synthesis, Laura McGowan examines older adults’ views and perspectives on being physically active across different qualitative studies. Marlene Melon is interested in the effect of vacations on older adults’ well-being and presents a number of different vacation characteristics as well as vacation activities that predict well-being. Ewa Gruszczynska examines trajectories of well-being after transition to retirement and whether these are related to meaning in life. Yael Benyamini will discuss these findings and suggest future directions for research and for the promotion of an active ageing process with maintained well-being.
OBJECTIVES Despite the well-documented negative effects of posttraumatic stress symptoms followin... more OBJECTIVES Despite the well-documented negative effects of posttraumatic stress symptoms following childbirth (PTSS-FC), research on protective factors for PTSS-FC is still missing. Aiming to fill this gap, we proposed and examined a process model through which maternal-infant skin-to-skin contact after birth reduces PTSS-FC by decreasing negative emotions, especially for women who had operative births. METHOD In this longitudinal study, pregnant women (N = 1833) were recruited at community and hospital medical centres in the center of Israel and through internet forums. At Time 1, during pregnancy, they rated their prenatal depressive symptoms which served as an indicator for prenatal vulnerabilities. At Time 2, two-months postpartum (N = 1371, 75% of the sample), they reported their mode of birth, whether they had skin-to-skin contact with their newborn after birth, their emotions during birth, and rated their current PTSS-FC. A moderated mediation analysis was used to examine the proposed model. RESULTS Guilt and fear during birth mediated the association between mode of birth (instrumental or cesarean versus vaginal) and PTSS-FC. Skin-to-skin contact was related to reduced feelings of guilt and fear during birth, especially for women who had a cesarean section. CONCLUSIONS Our results recognize the specific emotions that contribute to the development of PTSS-FC following operative births and show how skin-to-skin contact can possibly reduce them. As such they emphasize the importance of the implementation of skin-to-skin contact following childbirth, and especially following a cesarean section as recommended by the Baby Friendly Health Initiative (World Health Organization & UNICEF, 2009).
Abstract We present the concept of aintegration (not integrated, maintaining incongruence), defin... more Abstract We present the concept of aintegration (not integrated, maintaining incongruence), defined as the human ability to bear cognitive/emotional complexity, manifested in the capability to maintain incongruence and live with inconsistencies, discontinuities, contradictions and paradox, and yet not experience strain or discomfort. After defining aintegration, we present aintegrative-related issues in major psychological areas such as personality, adult development and aging, social and clinical psychology, cognitive processes, and coping with trauma, emphasizing the necessity of aintegration conceptualizations in these theories. We also relate to relevant cognitive, philosophical, and cultural systems of thought. We then present the operationalization of aintegration using a script-type questionnaire [the Aintegration Questionnaire (AIQ)] and three studies that tested its reliability and validity in different contexts: Study 1 revealed that aintegration is higher with age, education, and among divorced/separated people and the non-religious. Study 2 showed that individuals high in aintegration are more likely to report positive life events and to view negative events as not solely negative. Study 3 showed that among adults in middle and old age, aintegration is related to fewer post-traumatic symptoms, even after controlling for the number of traumas. The AIQ showed high internal reliability and divergent validity from need for structure. The findings support the concept of aintegration and its theoretical contribution to adult development and the psychological sciences. Aintegration can serve as an umbrella construct to areas typically investigated separately. Our epilogue emphasizes possible future theoretical evolutions of our concept and further research. The validity of the AIQ measurement supports the importance of the ability to live with incongruence, contradictions and complexity and the potential for this concept to inform research on modern life.
Background: In the modern world women’s perceptions of birth are shaped by culture, myths and abu... more Background: In the modern world women’s perceptions of birth are shaped by culture, myths and abundant information. Although birth has been medicalized, women can take part in the decision-making process regarding how and where to birth. The current study investigates how perceptions of birth relate to birth choices and mode of delivery. Method: 850 Israeli parturients were asked to fill in questionnaires measuring beliefs about birth as a medical or natural process, fear of birth (FoB) and planned birth choices. 6 weeks postpartum actual mode of delivery and birth satisfaction were assessed. Findings: Stronger beliefs about birth as a natural process were related to less FoB and more natural birth choices, such as homebirth and analgesia-free birth. Stronger beliefs about birth as a medical process were related to more FoB, more medical birth choices, such as use of epidural and more unplanned modes of delivery such as assisted vaginal delivery and emergency cesarean section. Discussion: Perceptions of birth are the basic building blocks that shape women’s birth choices. Understanding them could improve psychological and medical interventions and outcomes.
BackgroundThe effectiveness and long‐term outcomes of spinal cord stimulation (SCS) are not fully... more BackgroundThe effectiveness and long‐term outcomes of spinal cord stimulation (SCS) are not fully established, especially considering that data from patients who withdrew from the trial are rarely analysed, which may lead to overestimation of SCS efficacy. We evaluated short‐ and long‐term effects of SCS on chronic pain and perceived health, beyond natural variability in these outcomes.MethodsIn a prospective design, 176 chronic pain patients referred to SCS were evaluated five times (baseline; retest ~6 weeks later; post‐SCS trial; 8 and 28 weeks post‐permanent implantation). Patients whose SCS trial failed (Temp group) were followed up and compared to those who underwent permanent SCS (Perm group).ResultsAnalyses revealed a non‐linear (U‐shaped) trend significantly different between the two groups. In the Perm group, a significant improvement occurred post‐SCS implantation in pain severity, pain interference, health‐related quality of life and self‐rated health, which was followed by gradual worsening and return to baseline values at end of follow‐up. In the Temp group, only minor changes occurred in these outcomes over time. On average, baseline and end of follow‐up values in the Perm and Temp groups were similar: ~40% in each group exhibited an increase in pain severity over time and 38% and 33%, respectively, exhibited reductions in pain severity over time.ConclusionsSince the greatest improvement in the outcome measures occurred from baseline to post‐SCS trial (T1–T3) followed by a gradual decline in the effect, it appears that SCS may not be effective for the majority of chronic pain patients.SignificanceThis longitudinal study evaluated short and long term effects of spinal cord stimulation (SCS) on chronic pain outcome measures, beyond their natural variation in time. Despite significant short term improvements, by the end of the seven months' follow‐up, the outcomes in the treatment group (people who received the permanent implantation) were similar to those of the control group (people whose SCS trial failed and did not continue to permanent implantation) suggesting SCS may not be cost‐effective for chronic pain patients.
Background: To assess changes in pain levels, self-rated health (SRH) and identity of a pain pati... more Background: To assess changes in pain levels, self-rated health (SRH) and identity of a pain patient in adults with chronic pain from referral to implantation of a spinal cord stimulation (SCS) device to ~6 weeks following implantation. Methods: Patients with chronic pain (N=148) filled in questionnaires at referral to SCS (T1) and ~8 months later (T2; n=119), including ratings of pain and general health (SRH), acceptance of pain (indicating identification with being a pain patient), and the IPQ-R. Findings: 20% did not undergo SCS (no SCS=nSCS), 29% underwent only temporary implantation of a SCS device and discontinued ("disappointed"=dSCS), and 51% continued to permanent SCS (pSCS). Repeated measures ANOVA showed that pain levels significantly decreased in the dSCS and much more so in the pSCS but remained the same in the nSCS. SRH and pain perceptions improved only for the pSCS whereas stronger pain identity was reported only by the dSCS. Discussion: Continuous use of SCS relieves pain and leads to improved SRH yet pain still dominates these patients' lives and thoughts. Failing treatment leads to even stronger pain identity and intrusion, despite some improvement in pain level.
The present study examined the relationship between risk experience and risk perceptions in relat... more The present study examined the relationship between risk experience and risk perceptions in relation to the target (risk to the self vs. others) and for two different types of risk: acute risks (i.e., terrorist attacks) and cumulative health risks (i.e., alcohol consumption, tobacco consumption, and unhealthy eating) in two countries (Israel and Germany). An online survey (N = 571) was conducted to assess participants’ previous personal experience with acute and cumulative risks and their personal and general risk perceptions. The results showed that personal experience with terrorism was related to increased personal and general risk perceptions, while personal experience with cumulative health risks was related to increased personal but not general risk perceptions. It is argued that an increase in risk perception with more risk experience can be explained by the amount of available information about people's personal as well as other people's risk status. The findings emphasize that the experience–risk perception relationship depends on the target of the risk and the type of risk experience.
Background: A single self-rated health (SRH) assessment is associated with clinical outcome and m... more Background: A single self-rated health (SRH) assessment is associated with clinical outcome and mortality, but the biological process linking SRH with immune status remains incompletely understood. Objectives: To examine the association between SRH and inflammation in apparently healthy individuals. Methods: Our analysis included 13,773 apparently healthy individuals attending the Tel Aviv Sourasky Medical Center for periodic health examinations. Estimated marginal means of the inflammation-sensitive biomarkers [i.e., highly sensitive C-reactive protein (hs-CRP) and fibrinogen] for the different SRH groups were calculated and adjusted for multiple potential confounders including risk factors, health behavior, socioeconomic status, and coexistent depression. Results: The group with the lowest SRH had a significantly higher atherothrombotic profile and significantly higher conentrations of all inflammation-sensitive biomarkers in both genders. Hs-CRP was found to differ significantly between SRH groups in both genders even after gradual adjustments for all potential confounders. Fibrinogen differs significantly according to SRH in males only, with low absolute value differences. Conclusions: A valid association exists for apparently healthy individuals of both genders between inflammation-sensitive biomarker levels and SRH categories, especially when comparing levels of hs-CRP. Our findings underscore the importance of assessing SRH and treating it like other markers of poor health.
Aims: This symposium set out to a) investigate the development of physical activity and well-bein... more Aims: This symposium set out to a) investigate the development of physical activity and well-being after transition into retirement and b) to reveal age-related factors associated with decreases or increases in activity and well-being. It further aims to c) investigate active ageing from different perspectives (older adults, exercise programme providers), with different methodologies (quantitative, qualitative, meta-synthetic) and new concepts (effect of vacation) and d) to suggest innovative approaches for health promotion programmes. Rationale: The potential for promoting active ageing and maintained well-being in older adults is often underestimated. The specific needs of this population differ from younger adults, but are not yet well understood. In line with this year’s conference topic "Behaviour change: Making an impact on health and health services" this symposium extracts risk factors and resources for active and successful ageing. All five presentations contribute innovative and age-specific factors associated with active ageing and provide suggestions for activities and services tailored to the specific needs of adults aged 65+. Summary: Lisa Warner investigates trajectories of physical activity after transitions to retirement and possible influencing factors. Angela Devereux-Fitzgerald presents her insights on older adults’ acceptability of physical activity from interviews with older adults with lower socio-economic status as well as exercise programme providers. In her meta-synthesis, Laura McGowan examines older adults’ views and perspectives on being physically active across different qualitative studies. Marlene Melon is interested in the effect of vacations on older adults’ well-being and presents a number of different vacation characteristics as well as vacation activities that predict well-being. Ewa Gruszczynska examines trajectories of well-being after transition to retirement and whether these are related to meaning in life. Yael Benyamini will discuss these findings and suggest future directions for research and for the promotion of an active ageing process with maintained well-being.
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