Behavior and Behavior Mechanisms Commons^™

Manydogs Project: A Big Team Science Approach To Investigating Canine Behavior And Cognition, Daniela Alberghina, Emily E. Bray, Daphna Buchsbaum, Sarah- Elizabeth Byosiere, Julia Espinosa, Gitanjali E. Gnanadesikan, C.-N. Alexandrina Guran, Elizabeth Hare, Daniel J. Horschler, Ludwig Huber, Valerie A. Kuhlmeier, Evan L. Maclean, Madeline H. Pelgrim, Bryan Perez, Dana Ravid-Schurr, Liza Rothkoff, Courtney L. Sexton, Zachary A. Silver, Jeffrey R. Stevens

Center for Brain, Biology, and Behavior: Faculty Publications

Dogs have a special place in human history as the first domesticated species and play important roles in many cultures around the world. However, their role in scientific studies has been relatively recent. With a few notable exceptions (e.g., Darwin, Pavlov, Scott, and Fuller), domestic dogs were not commonly the subject of rigorous scientific investigation of behavior until the late 1990s. Although the number of canine science studies has increased dramatically over the last 20 years, most research groups are limited in the inferences they can draw because of the relatively small sample sizes used, along with the exceptional diversity …

Developing Ecologically Valid Clinical Tools For Persons With Tbi: Understanding The Role And Impact Of Distractions, Deanna Pinnow

Theses and Dissertations--Rehabilitation Sciences

There is a critical need for the development of ecologically valid clinical tools to assess real-life cognitive functioning in persons impacted by traumatic brain injury (TBI). Chronic cognitive impairments that are exacerbated by distractions are one of the core factors contributing to poor home and community re-integration post injury. Simulation-based digital platforms (i.e., virtual reality, augmented reality, and mixed reality) have become potential solutions for eliciting real-world cognitive performance in clinical settings. Yet, there is a paucity of research investigating the role and impact of distractions on cognition. As a result, there is no clear framework of measuring distractions to …

Filipino Physical Therapists’ Practice And Perspectives On Non-Treatment Physical Activity For Older Adults, Frances Rom M. Lunar, Attilah Mae B. Alog, Alexa Ds Tanchuling, Kristen Mari Andal, Beatrice Camille Chan, Daniel C. Chua, Claire Beatrice Martinez, Ma. Anna Carmina D. Orlino, Jem Bettina G. Tan, Koji A. Katakura Jr., Marvin Louie S. Ignacio

Philippine Journal of Physical Therapy

Introduction:

Studies have already investigated the practice of physical therapists (PTs) in promoting non-treatment physical activity (NTPA). However, these were done in the context of mostly western settings or were not specific to older adult practice. It is still unclear if a similar level of practice and perspectives on NTPA promotion exists in a setting where physical therapy is more associated with rehabilitation than health promotion, such as in the Philippines. Therefore, this study aimed to describe Filipino PTs' knowledge of WHO physical activity (PA) guidelines and their use of behavioral change techniques (BCTs) and theories when promoting PA in …

Explicit And Implicit Emotion Processing In The Cerebellum: A Meta‑Analysis And Systematic Review, Jordan E. Pierce, Marine Thomasson, Philippe Voruz, Garance Selosse, Julie Péron

Center for Brain, Biology, and Behavior: Faculty Publications

The cerebellum’s role in affective processing is increasingly recognized in the literature, but remains poorly understood, despite abundant clinical evidence for affective disruptions following cerebellar damage. To improve the characterization of emotion processing and investigate how attention allocation impacts this processing, we conducted a meta-analysis on task activation foci using GingerALE software. Eighty human neuroimaging studies of emotion including 2761 participants identified through Web of Science and ProQuest databases were analyzed collectively and then divided into two categories based on the focus of attention during the task: explicit or implicit emotion processing. The results examining the explicit emotion tasks identified …

The Role Of Reported Affective Symptoms And Anxiety In Recovery Trajectories After Sport-Related Concussion, Bernadette A. D'Alonzo, Abigail C. Bretzin, Douglas J. Wiebe, Ivy League–Big Ten Epidemiology Of Concussion Study Investigators, Arthur C. Maerlender, Cary R. Savage

Center for Brain, Biology, and Behavior: Faculty Publications

Background: There is growing awareness and clinical interest in athletes with affective symptoms after sport-related concussion (SRC), as these symptoms may contribute to overall symptoms and represent a modifiable risk factor of longer recovery. However, evidence of their effects on the entire return-to-play (RTP) trajectory, particularly among women and men, is limited.

Purpose/Hypothesis: To examine the relationship between affective symptom reporting and RTP progression after SRC among a cohort of Division 1 student-athletes. We hypothesized that those endorsing affective symptoms, specifically nervous-anxious symptoms, spend more time in RTP progression and recovery.

Study Design: Cohort study; Level of evidence, 3.

Methods: …

Age-Dependent White Matter Disruptions After Military Traumatic Brain Injury: Multivariate Analysis Results From Enigma Brain Injury, Heather C. Bouchard, Delin Sun, Emily L. Dennis, Mary R. Newsome, Seth G. Disner, Jeremy Elman, Annelise Silva, Carmen Velez, Andrei Irimia, Nicholas D. Davenport, Scott R. Sponheim, Carol E. Franz, William S. Kremen, Michael J. Coleman, M. Wright Williams, Elbert Geuze, Inga K. Koerte, Martha E. Shenton, Maheen M. Adamson, Raul Coimbra, Gerald Grant, Lori Shutter, Mark S. George, Ross D. Zafonte, Thomas W. Mcallister, Murray B. Stein, Paul M. Thompson, Elisabeth A. Wilde, David F. Tate, Aristeidis Sotiras, Rajendra A. Morey

Center for Brain, Biology, and Behavior: Faculty Publications

Mild Traumatic brain injury (mTBI) is a signature wound in military personnel, and repetitive mTBI has been linked to age-related neurogenerative disorders that affect white matter (WM) in the brain. However, findings of injury to specific WM tracts have been variable and inconsistent. This may be due to the heterogeneity of mechanisms, etiology, and comorbid disorders related to mTBI. Non-negative matrix factorization (NMF) is a data-driven approach that detects covarying patterns (components) within high-dimensional data. We applied NMF to diffusion imaging data from military Veterans with and without a self-reported TBI history. NMF identified 12 independent components derived from fractional …

Multimodal Approach To Chronic Pain Management And Prevention Of Opioid Use Disorder, Hannah Elston

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background. Chronic pain (CP) is a major public health problem that affects one-third of the population and can interfere with the activities of daily life and cause decreased quality of life. Patients with CP have been increasingly prescribed opioids, contributing to the rise in the opioid epidemic. Due to the long-term nature of CP, the use of opioids as the sole treatment for CP can cause tolerance and increased dosages overtime which can lead to addiction and potentially overdose. Therefore, CP treatment should include multimodal approaches to treatment to prevent opioid misuse, opioid use disorder (OUD), and overdose. Multimodal treatments …

Differential Associations Of Conduct Disorder, Callous‑Unemotional Traits And Irritability With Outcome Expectations And Values Regarding The Consequences Of Aggression, J. Elowsky, S. Bajaj, J. Bashford‑Largo, R. Zhang, A. Mathur, A. Schwartz, M. Dobbertin, K. S. Blair, E. Leibenluft, D. Pardini, R. J.R. Blair

Center for Brain, Biology, and Behavior: Faculty Publications

Background: Previous work has examined the association of aggression levels and callous-unemotional traits with outcome expectations and values regarding the consequences of aggression. Less work has examined the outcome expectations and values regarding the consequences of aggression of adolescents with Conduct Disorder (CD). Also, no studies have examined links between irritability (a second socio-affective trait associated with CD) and these social cognitive processes despite the core function of anger in retaliatory aggression and establishing dominance.

Method: The current study, investigating these issues, involved 193 adolescents (typically developing [TD; N = 106], 87 cases with CD [N = 87]). Participants completed …

Progression Through Return-To-Sport And Return-To-Academics Guidelines For Concussion Management And Recovery In Collegiate Student Athletes: Findings From The Ivy League–Big Ten Epidemiology Of Concussion Study, Douglas J. Wiebe, Abigail C. Bretzin, Bernadette A. D'Alonzo, Ivy League–Big Ten Epidemiology Of Concussion Study Investigators, Arthur C. Maerlender

Center for Brain, Biology, and Behavior: Faculty Publications

Objective To examine the progression of collegiate student athletes through five stages of a return-to- activity protocol following sport-related concussion (SRC).

Methods In a multisite prospective cohort study, we identified the frequency of initial 24–48 hours physical and cognitive rest, and the sequence of (1) symptom resolution and return to (2) exertion activity, (3) limited sport, (4) full sport and (5) full academics. In resulting profiles we estimated the likelihood of return to full sport ≤14 days or prolonged >28 days and tested for variability based on timing of the stages.

Results Among 1715 athletes with SRC (31.6% females), 67.9% …

Head Impact Exposure In Youth And Collegiate American Football, Grace B. Choi, Eric P. Smith, Stefan M. Duma, Steven Rowson, Eamon Campolettano, Mireille E. Kelley, Derek A. Jones, Joel D. Stitzel, Jillian E. Urban, Amaris Genemaras, Jonathan G. Beckwith, Richard M. Greenwald, Arthur C. Maerlender, Joseph J. Crisco

Center for Brain, Biology, and Behavior: Faculty Publications

The relationship between head impact and subsequent brain injury for American football players is not well defined, especially for youth. The objective of this study is to quantify and assess Head Impact Exposure (HIE) metrics among youth and collegiate football players. This multiseason study enrolled 639 unique athletes (354 collegiate; 285 youth, ages 9–14), recording 476,209 head impacts (367,337 collegiate; 108,872 youth) over 971 sessions (480 collegiate; 491 youth). Youth players experienced 43 and 65% fewer impacts per competition and practice, respectively, and lower impact magnitudes compared to collegiate players (95th percentile peak linear acceleration (PLA, g) competition: 45.6 vs …

Constructing Neural Network Models From Brain Data Reveals Representational Transformations Linked To Adaptive Behavior, Takuya Ito, Guangyu Robert Yang, Patryk Laurent, Douglas H. Schultz, Michael W. Cole

Center for Brain, Biology, and Behavior: Faculty Publications

The human ability to adaptively implement a wide variety of tasks is thought to emerge from the dynamic transformation of cognitive information. We hypothesized that these transformations are implemented via conjunctive activations in “conjunction hubs”—brain regions that selectively integrate sensory, cognitive, and motor activations. We used recent advances in using functional connectivity to map the flow of activity between brain regions to construct a task-performing neural network model from fMRI data during a cognitive control task. We verified the importance of conjunction hubs in cognitive computations by simulating neural activity flow over this empirically-estimated functional connectivity model. These empiricallyspecified simulations …

Affective Flexibility As A Developmental Building Block Of Cognitive Reappraisal: An Fmri Study, Jordan E. Pierce, Eisha Haque, Maital Neta

Center for Brain, Biology, and Behavior: Faculty Publications

Cognitive reappraisal is a form of emotion regulation that involves reinterpreting the meaning of a stimulus, often to downregulate one’s negative affect. Reappraisal typically recruits distributed regions of prefrontal and parietal cortex to generate new appraisals and downregulate the emotional response in the amygdala. In the current study, we compared reappraisal ability in an fMRI task with affective flexibility in a sample of children and adolescents (ages 6–17, N = 76). Affective flexibility was defined as variability in valence interpretations of ambiguous (surprised) facial expressions from a second behavioral task. Results demonstrated that age and affective flexibility predicted reappraisal ability, …

Peer-Led Building Resilience And Enhancing Social-Emotional Skills Program, Danielle K. Enrico

Department of Occupational Therapy Entry-Level Capstone Projects

The purpose of the Capstone experience was to develop and implement a five-week peer-led building resilience and social-emotional skills training program at a public high school. This program addressed high school students' knowledge, skills, and attitudes regarding resources, social-emotional skills, and resilience. A questionnaire was administered pre and post-program to measure effectiveness. The results indicated an increase in scores, demonstrating a clearer understanding in all three areas.

Maintaining Physical Activity During Covid-19: The Influence Of Psychosocial Variables In Individuals With Back Pain, Heidi Stabbert

Student Scholar Symposium Abstracts and Posters

Stressor events, such as COVID-19, may trigger adaptive or maladaptive pain management strategies among individuals with persistent low back pain (LBP). Individuals with lower fear avoidance, depression and anxiety, and greater positive affect and quality of life may better maintain positive pain management strategies during stressor events. This study investigated psychosocial characteristics of individuals with LBP who demonstrated adaptive pain management strategies during COVID-19, indicated by maintenance of physical activity (PA). Individuals with persistent LBP (age 22.4 (3.4) years, n=25) from an existing longitudinal cohort participated. Participants completed a baseline survey prior to COVID-19 quantifying demographics, pain characteristics, the Physical …

In-Season Concussion Symptom Reporting In Male And Female Collegiate Rugby Athletes, Emily E. Kieffer,, P. Gunnar Brolinson, Arthur C. Maerlender, Eric Smith, Steven Rowson

Center for Brain, Biology, and Behavior: Faculty Publications

Symptom inventories are generally only collected after a suspected concussion, but regular in-season monitoring may allude to clinical symptoms associated with repetitive subconcussive impacts and potential undiagnosed concussions. Despite sex-specific differences in symptom presentation and outcome of concussion, no return-to-play protocol takes sex into account. The objective of this study was to monitor a cohort of contact-sport athletes and compare the frequency and severity of in-season concussion-like symptom reporting between sexes. Graded symptom checklists from 144 female and 104 male athlete-seasons were administered weekly to quantify the effect of subconcussive impacts on frequency and severity of in-season symptom reporting. In-season, …

Deep-Learning-Based Multivariate Pattern Analysis (Dmvpa): A Tutorial And A Toolbox, Karl M. Kuntzelman, Jacob M. Williams, Phui Cheng Lim, Ashtok Samal, Prahalada K. Rao, Matthew R. Johnson

Center for Brain, Biology, and Behavior: Faculty Publications

In recent years, multivariate pattern analysis (MVPA) has been hugely beneficial for cognitive neuroscience by making new experiment designs possible and by increasing the inferential power of functional magnetic resonance imaging (fMRI), electroencephalography (EEG), and other neuroimaging methodologies. In a similar time frame, “deep learning” (a term for the use of artificial neural networks with convolutional, recurrent, or similarly sophisticated architectures) has produced a parallel revolution in the field of machine learning and has been employed across a wide variety of applications. Traditional MVPA also uses a form of machine learning, but most commonly with much simpler techniques based on …

Resting Cerebral Oxygen Metabolism Exhibits Archetypal Network Features, Nicholas A. Hubbard, Monroe P. Turner, Kevin R. Sitek, Kathryn L. West, Jakub R. Kaczmarzyk, Lyndahl Himes, Binu P. Thomas, Hanzhang Lu, Bart Rypma

Center for Brain, Biology, and Behavior: Faculty Publications

Standard magnetic resonance imaging approaches offer high-resolution but indirect measures of neural activity, limiting understanding of the physiological processes associated with imaging findings. Here, we used calibrated functional magnetic resonance imaging during the resting state to recover low-frequency fluctuations of the cerebral metabolic rate of oxygen (CMRO2). We tested whether functional connections derived from these fluctuations exhibited organization properties similar to those established by previous standard functional and anatomical connectivity studies. Seventeen participants underwent 20 min of resting imaging during dual-echo, pseudocontinuous arterial spin labeling, and blood-oxygen-level dependent (BOLD) signal acquisition. Participants also underwent a 10 min normocapnic and hypercapnic …

Somatosensory Dysfunction Is Masked By Variable Cognitive Deficits Across Patients On The Alzheimer’S Disease Spectrum, Alex I. Wiesman, Victoria M. Mundorf, Chloe C. Casagrande, Sara L. Wolfson, Craig M. Johnson, Pamela E. May, Daniel L. Murman, Tony W. Wilson

Center for Brain, Biology, and Behavior: Faculty Publications

Background: Alzheimer’s disease (AD) is generally thought to spare primary sensory function; however, such interpretations have drawn from a literature that has rarely taken into account the variable cognitive declines seen in patients with AD. As these cognitive domains are now known to modulate cortical somato-sensory processing, it remains possible that abnormalities in somatosensory function in patients with AD have been suppressed by neuropsychological variability in previous research. Methods: In this study, we combine magnetoencephalographic (MEG) brain imaging during a paired-pulse somatosensory gating task with an extensive battery of neuropsychological tests to investigate the influence of cognitive variability on estimated …

Exploring Accessibility And Social Inclusion For Children With Hearing Impairments In Residential Camps Through The Occupational Therapy Lens, Tiffany Coles

Student Capstone Papers

Children are encouraged to engage in various play, leisure, and social participation activities to enhance the development of life skills, independence, and social skills. A common leisure and social participation activity for children aged 6 to 18-years-old is to attend residential camp. Residential camps provide children a structured opportunity to engage in leisure activities while learning to become independent and self-confident when socializing and making new friends. Attending camp can be a fun and engaging environment to help accelerate growth in key developmental outcomes, such as positive identity, social skills, physical skills, positive values, and spirituality.

Within the residential camp …

Developing A Computer-Controlled Treat Dispenser For Canine Operant Conditioning, Walker Arce, Jeffrey R. Stevens

Center for Brain, Biology, and Behavior: Faculty Publications

When performing canine operant conditioning studies, the delivery of the reward can be a limiting factor of the study. While there are a few commercially available options for automatically delivering rewards, they generally require manual input, such as using a remote control, in accordance with the experiment script. This means that human reaction times and transmission distances can cause interruptions to the flow of the experiment. The potential for development of non-supervised conditioning studies is limited by this same factor. To remedy this, we retrofitted an off-the-shelf treat dispenser with new electronics that allow it to be remotely controllable as …

Core Neuropsychological Measures For Obesity And Diabetes Trials: Initial Report, Kimberlee D'Ardenne, Cary R. Savage, Dana Small, Uku Vainik, Luke E. Stoeckel

Center for Brain, Biology, and Behavior: Faculty Publications

Obesity and diabetes are known to be related to cognitive abilities. The Core Neuropsychological Measures for Obesity and Diabetes Trials Project aimed to identify the key cognitive and perceptual domains in which performance can influence treatment outcomes, including predicting, mediating, and moderating treatment outcome and to generate neuropsychological batteries comprised of well-validated, easy-to-administer tests that best measure these key domains. The ultimate goal is to facilitate inclusion of neuropsychological measures in clinical studies and trials so that we can gather more information on potential mediators of obesity and diabetes treatment outcomes. We will present the rationale for the project and …

Flexible Coordinator And Switcher Hubs For Adaptive Task Control, Carrisa V. Cocuzza, Takuya Ito, Douglas H. Schultz, Dabielle D. Bassett, Michael W. Cole

Center for Brain, Biology, and Behavior: Faculty Publications

Functional connectivity (FC) studies have identified at least two large-scale neural systems that constitute cognitive control networks, the frontoparietal network (FPN) and cingulo-opercular network (CON). Control networks are thought to support goal-directed cognition and behavior. It was previously shown that the FPN flexibly shifts its global connectivity pattern according to task goal, consistent with a “flexible hub” mechanism for cognitive control. Our aim was to build on this finding to develop a functional cartography (a multimetric profile) of control networks in terms of dynamic network properties. We quantified network properties in (male and female) humans using a high-control-demand cognitive paradigm …

Validating Tackle Mechanics In American Football: Improving Safety And Performance, Arthur C. Maerlender, Caitlin J. Masterson, Rex Norris, Adam Hinthorne

Center for Brain, Biology, and Behavior: Faculty Publications

Research has helped to understand the risks of injuries of tackling in American football and rugby; however, approaches to teaching and analysis are not well-documented. Shoulder-led tackling has been proposed as a safer approach to tackling even though data on the effectiveness for safety and defensive performance is limited. Additionally, some have argued that safety and effectiveness are incompatible. The purpose of the study was to validate a specific sequence of tackling actions as a tool for teaching safer and more effective tackling skills. Results suggested tackle scores help predict presence of head contact, and that higher tackle scores were …

Caregiver Perspective On Sensory Diet And Therapeutic Listening For Children With Autism Spectrum Disorder And/Or Sensory Processing Disorder, Mikayla M. Brett, Lynette Zulquairnain, Katlyn Ribant

Pediatrics

Due to the high prevalence of Autism Spectrum Disorder (ASD) and Sensory Processing Disorder (SPD), there is a high demand for more research on effective interventions in order to improve quality of life and engagement in meaningful occupations for individuals with ASD and/or SPD. Sensory Diet (SD) and Therapeutic Listening © (TL) are interventions commonly utilized with individuals with ASD and/or SPD, however, there is limited research on their combined use. The purpose of this study is to determine the effectiveness of the combined occupational therapy (OT) interventions of SD and TL on the occupational performance of children with ASD …

Mental Associations And Music Therapy: Including The History Of Associationism And The Neurology Of Associations, Dianna Rose

Expressive Therapies Capstone Theses

Associations are formed in our minds based upon three elements: sensory experience, emotions, and memories. These associations, unique to each individual, dictate thoughts, beliefs, behaviors, and actions. Some are necessary and supportive, while others can be maladaptive. Established associations can be changed, and new associations can be formed, to align with a client’s goals. The literature presents a strong history of associationism, as well as a body of research that demonstrates the neurological processes of how mental associations are formed. There are also studies showing how music activates the brain. However, there is a lack of research which draws direct …

Language, Motor, And Cognitive Outcomes Of Toddlers Who Were Born Preterm, Diane Frome Loeb, Caitlin M. Imgrund, Jaehoon Lee, Steven Barlow

Center for Brain, Biology, and Behavior: Faculty Publications

Purpose: The purpose of this study was to examine the language, motor, and cognitive abilities of children born preterm in four categories: (a) healthy preterm infants, (b) infants of diabetic mothers, (c) infants with respiratory distress syndrome, and (d) infants with chronic lung disease when the children were 30 months, uncorrected age. Comorbidity of language, motor, and cognitive skills was examined, along with predictor variables.

Method: A total of 148 children who were born preterm participated and were assessed using bivariate tests and logistic regression on standardized assessment scores.

Results: Controlling for the children’s gestational age (GA), overall language ability …

Physical Inactivity: A Behavioral Disorder In The Physical Therapist’S Scope Of Practice, Matthieu P. Boisgontier, Maura D. Iversen

SHU Faculty Publications

In health, the gold standard is a state of complete physical, mental, and social well-being.This state is weakened by physical inactivity, which involves a higher risk of cardiovascular disease, hypertension, diabetes, cancer, depression, and obesity. Moreover, 6% to 10% of all deaths from non-communicable diseases worldwide can be attributed to physical inactivity. These adverse effects of physical activity provide evidence that physically active individuals are closer to the gold standard of health than inactive individuals. Therefore, physical activity – not inactivity – should be the standard reference behavior. In this framework, physical inactivity is a clinically significant disturbance in an …

Promoting Resilience In Self-Management (Prism): Adverse Childhood Experiences And Impacts On Emotion Regulation, Kasey Ann Macedo

Honors Scholar Theses

PRISM (Promoting Resilience in Self-Management) is a mindfulness-based intervention that aims to strengthen emotion regulation skills among individuals by employing cognitive behavioral therapy components. The purpose of the current study is to identify the relationship between adverse childhood experiences (ACEs) and depression, as well as to examine the changes in emotion regulation strategies of participants by comparing pre and post test data. The participants were voluntarily recruited from the Cornerstone Foundation, a homeless shelter, food pantry, and community center in Vernon, CT. The 13 participants completed PRISM through four weeks of two-hour workshop sessions in a small-group format. Results indicate …

Alexithymia Symptoms Are Not Associated With Childhood Trauma Or Crhr1 Rs110402 Genotype, Emily Wiatr, Grace Sullivan, Scott Stoltenberg

Center for Brain, Biology, and Behavior: Faculty Publications

Alexithymia is associated with difficulties in emotional self-regulation, and alexithymia is specifically associated with an absence of emotional experience and cognition of emotion. Past research has indicated a potential association between alexithymia and the CRHR1 gene . Situational factors may also impact the expression of the CRHR1 gene within an individual. Berenbaum (1996) found associations between PTSD/childhood trauma and alexithymia. This study examined these associations using the Online Alexithymia Questionnaire-G2 (OAQ-G2) as well as DNA samples gathered from 657 participants at the University of Nebraska-Lincoln (72% women; 78.6% white; mean age= 20.34; standard deviation of 2.6). It was hypothesized that …

Loss Of Self In Dissociation In Prostitution; Recovery Of Self In Connection To Horses: A Survivor's Journey, Sandra Norak

Dignity: A Journal of Analysis of Exploitation and Violence

This narrative is about dissociation in the lives of women who have been exploited through prostitution. When we speak about prostitution, we do not speak often enough about the dissociation needed for women and girls to survive sexual exploitation. The author challenges the wisdom of governments such as Germany that legalize prostitution, treating it as a “job” and ignoring the violence and subsequent dissociation in women. The author describes her personal journey, explaining how women are traumatized even after the first commercial sex act, which is a sexual assault. They dissociate which makes their lives bearable, but they fail to …