<p> The purpose of this qualitative, autoethnographic study was to identify and explore the values that promoted personal growth and that emerged out of the clinical training and supervision experience of novice clinicians within one clinical psychology doctoral program. Participants included three first-year doctoral students in clinical psychology, one of whom was the primary researcher. Participants completed journal entries approximately twice monthly for seven months, resulting in a total of 54 entries that were examined using a content analysis approach. Content analysis, conducted by the primary researcher, involved coding data for themes and patterns that were representative of values, as well as indications that these values oriented the participant toward personal growth. Journal entries were first analyzed and coded based on whether they fit the definitional criteria of a value and then coded secondarily for the value itself. Specifically, cited in descending order, content analysis identified the following values: (a) awareness; (b) knowledge; (c) bravery; (d) competence; (e) learning; (f) humility; (g) community; (h) acceptance; (i) openness; and (j) curiosity. Awareness, as it related to self-regulation and to skill development was the most highly identified value. Future researchers may consider expanding on these results with a larger and more heterogeneous sample of novice clinicians.</p><p>

<p> Client preference is defined as &ldquo;specific variables or attributes that clients desire to have in a therapy setting&rdquo; (Thompkins, Swift, &amp; Callahan, 2013, p. 279). The current study expands upon the literature regarding client preference and whether asking clients about their preferences will have a positive impact on their perceived therapeutic relationship and motivation for therapy. This study&rsquo;s methodology randomly exposed participants to one of three conditions: no preference component, assessment of preferences, or assessment and validation that preferences would be met. It was hypothesized that participants who are assessed for their preferences would have higher therapeutic alliance and client motivation ratings than participants in the control condition (no preference exposure). It was also hypothesized that participants who are assessed and validated for their preferences would have higher therapeutic alliance and client motivation ratings than participants who were only assessed for their preferences. The results indicate that implementation of client preferences may be more important and influential than assessment of preferences alone.</p>

<p> The field of psychotraumatology has made significant advancements in elucidating the neurobiological, biobehavioral, and physiological underpinnings of trauma, complex trauma, and implications for treatment. However, these scientific findings have yet to be fully integrated into clinical treatment approaches. A specific facilitation of the highly structured theatrical experience was hypothesized by this researcher to harness several of the components of neurobiological healing from complex traumatic stress. This qualitative investigation explored the experience of individuals with a history of traumatic stress in their participation in a highly structured theatrical experience. A total of six participants with a history of stressful life experiences, including chronic adverse interpersonal experiences beginning in childhood, were interviewed to explore how they experienced elements of healing from traumatic stress in participating in this type of theatrical production. Further, the study explored how individuals with unique stressful life event histories experienced healing differently. Theoretically grounded emergent themes in the data analysis produced six themes: (a) novel integration, (b) corrective emotional experience, (c) physical mastery, (d) interpersonal learning, (e) self-capacities, and (f) locus of control, which laid the foundation for a grounded theory of hierarchical needs and processes of neurobiological healing from traumatic stress. Implications, limitations and recommendations for future research were discussed.</p><p>

<p> The field of psychology has made large strides in evaluating and disseminating evidence-based treatments (EBTs), as well as refuting harmful pseudoscientific treatments, for various childhood mental health disorders. EBTs that meet the gold standard of a well-established treatment provide supportive evidence of treatment effectiveness. However, there are notable limitations to these criteria, particularly in regards to manualization and feasibility. A solution is to use a common elements approach to service delivery, such that the fundamental skills or practices within treatment programs can be used to effectively target treatment goals. As this approach is evolving in the field, it is imperative that future clinicians and researchers are versed in understanding evidence-based common elements (EBCEs) and unsupported elements. The current study examines the impact of teaching undergraduate students EBCEs and uncommon elements across three randomly assigned conditions. Results indicated that students who learned about EBCEs rated EBCEs more effectively post manipulation and students who learned about uncommon elements rated uncommon elements less effectively post manipulation. The results are consistent with previous findings and underscore the importance of educating students on effective and ineffective treatments (Jones-Soto, 2015, unpublished; Hupp et al., 2013). Implications and future directions are discussed.</p><p>

<p> Providing care for a frail older adult who is suffering from dementia has been described as a stressful experience that may erode psychological well-being and physical health of caregivers. The burden and stress is increased when the caregivers are themselves elderly. The present study investigated an 8-week stress-reduction program, Mindfulness-Based Stress Reduction (MBSR), and compared it to a similarly structured, alternative behavioral intervention, Progressive Muscle Relaxation (PMR), to determine if MBSR was as effective or more effective than PMR at reducing subjective burden, symptoms of depression, perceived loneliness or perceived stress among middle-aged and older family caregivers of persons with dementia and other neurocognitive disorders. Twenty-eight participants were randomly assigned to either MBSR or PMR. Self-report and biological measures were collected on five occasions: At the beginning and end of intervention training, and at 8 weeks, 6 months and 1 year following the end of intervention training. In addition to a packet of self-report questionnaires and home-collected salivary cortisol, a laboratory controlled emotional stress test was designed to elicit an emotionally stressful response relevant to caregivers&rsquo; experience of caregiving, and facilitate the measurement of stress-related changes in systolic blood pressure and cortisol reactivity. At 1 year post-intervention, the PMR group showed a significantly greater reduction in perceived stress and disruptive patient behaviors. A reduction in emotional reactivity to patient problem behaviors approached significance (p = .08) at 1 year post-intervention for the PMR group. The MBSR group showed significantly greater reductions in self-reported symptoms of depression and perceived isolation from pre- to post-intervention, and those changes remained significant at 8 weeks post-intervention. However, by 1 year post-intervention, interaction effects were non-significant as both groups showed similar decreases in symptoms of depression and perceived isolation. Both groups showed similar decreases in diurnal cortisol, cortisol awakening response, and daily average cortisol (but not laboratory cortisol) from pre- to post-intervention and further decreases at 8 weeks post-intervention, and showed similar reductions in magnitude of change by 1 year post-intervention. This pattern was similar for both groups with systolic blood pressure, showing decreases from pre- to post-intervention, additional decreases at 8 weeks post-intervention, and returning towards baseline by 1 year post-intervention. Both groups also reported similar increases in levels of dispositional mindfulness and self-compassion and similar improvement in overall sleep quality that was sustained at 1 year post-intervention. No changes were seen for perceived burden or loneliness. Significant correlations with amount of daily practice of the instructed stress-reduction approaches were observed for several of the dependent measures from pre- to post-intervention and 8 weeks post-intervention. From pre-intervention to 1 year post-intervention, an overall pattern emerged, where both groups showed similar improvements from pre- to post-intervention, and additional improvements at 8 weeks post-intervention, but displayed a curvilinear reduction in improvements&mdash;with some exceptions&mdash;and a return towards baseline at 6 months and 1 year post-intervention. In general, reductions in the magnitude of changes observed by 1 year post-intervention remained below baseline levels. Results suggest that both MBSR and relaxation-based interventions may be differentially effective in reducing psychological and physiological indices of chronic stress among older caregivers of relatives with neurocognitive disorders. However, further research, employing wait-list control participants, will be necessary for unambiguous interpretation of the present results.</p><p>

<p> The present study aimed to provide literature on community-based programs and correlated participant satisfaction, to examine the factors that contribute to participant satisfaction within community-based programs, and to evaluate outcomes of participant satisfaction for MECCA&rsquo;s O&amp;E program, as well as reflection on components of the O&amp;E program that produce satisfaction ratings. The primary research question of the present study was: Were participants satisfied with their participant in MECCA&rsquo;s O&amp;E program for both fiscal years and if so, what factors may have contributed to their satisfaction? Through use of description analyses on outcomes of the Participant Satisfaction Survey from MECCA&rsquo;s six community-based agencies, findings indicate that MECCA provided culturally-responsive and linguistically congruent services. Additionally, participants were satisfied overall with the O&amp;E services and would elect to obtain services from the O&amp;E program again. O&amp;E&rsquo;s success can be attributed to MECCA&rsquo;s foundation in cultural responsiveness, diversity empowerment, destigmatizing mental health services, and collaboration with the communities to create and provide community-based programs.</p><p>

<p> Internalized shame, a construct that assesses the extent to which an individual identifies with the experience of feeling deeply flawed, unworthy, and defective (Cook, 1987, 1991, 2001), has been associated with negative clinical outcomes in substance use disorders (SUDs; Harper, 2011). Tolerance for shame-related distress, or shame tolerance, has been associated with other forms of psychopathology (Schoenleber &amp; Berenbaum, 2010, 2012), and may serve to moderate the relationship between internalized shame and SUD treatment outcomes. This mixed-methods study explores internalized shame and shame tolerance in the context of early recovery from SUDs, particularly as they are associated with inpatient treatment success and participant experiences with relapse. Self-report measures and interviews were used, and thematic analysis (Braun &amp; Clarke, 2006) was utilized in analyzing qualitative data. Quantitative analyses did not find support for the moderating effects of shame tolerance on the impact of internalized shame on treatment outcomes in individuals with SUDs in inpatient treatment. However, there was a significant interaction between gender, prior relapse, and internalized shame, such that women with prior relapse presented with higher internalized shame and lower shame tolerance than women with no prior relapse or men in either condition. A semi-structured interview and subsequent qualitative analyses were utilized to explore participant experiences with relapse and treatment. Results revealed superordinate and subthemes related to each of three content areas &ndash; relapse experiences, abstinence in response to craving, and current treatment experiences &ndash; and interview excerpts are included to highlight each theme. Clinical implications, limitations, and future directions are discussed.</p><p>

<p> The current study represents qualitative research exploring the role that the mind plays in an individual&rsquo;s willpower and perseverance during a 100-mile ultramarathon. Through in vivo data collection and follow-up interviews, this study sought to understand the shifting mindsets and mental frameworks which help ultrarunners overcome the variety of challenges and stressors encountered during an ultramarathon. Six ultrarunners were asked to carry a digital recording device during their 100-mile ultramarathon and answer a sequence of questions at regular intervals meant to assess what was happening in their minds, how this was related to willpower, and how it was influencing their ability to persevere. Follow-up interviews were conducted to gather clarification and debrief. </p><p> A total of 6 participants provided data for this study in the form of digital recordings made during the course of a 100-mile ultramarathon and informal post-race interviews. Thematic analysis of the digital recording transcripts revealed 16 themes organized into four encompassing categories. Results indicated that the role of the mind in perseverance and willpower is multi-faceted, with cognitive, attitudinal, social, and affective components. The results from this study hold valuable clinical implications as they increase insight into how humans endure a range of stressors, both physical and psychological. Furthermore, they contribute a new consideration of perseverance and willpower in the context of endurance sports to the literature and the field of sport psychology. Despite various methodological limitations, the results of this study are notable and shed an important light on the under-researched and growing sport of ultrarunning.</p>

A long-standing challenge for public health and safety is that motor vehicle crashes (MVCs) are the leading cause of death for U.S. teenagers, a population with disproportionately high crash involvement relative to other road users. Quantitative and qualitative research has identified distracted driving as a significant contributor to young drivers’ overrepresentation in MVCs. This study was designed in the context of this notable public health concern, and the primary goal was to examine psychological factors that are hypothesized, via the Theory of Planned Behavior, to underlie teenage drivers’ decisions to text-while-driving (TWD) with a focus on the influence of ADHD symptoms. The psychological factors of interest were attitudes toward TWD, perceptions of crash risk while TWD, self-perceptions of competence as a driver, and perceptions of task performance. The aims of this project were addressed through a program evaluation of an experiential driver training program designed to educate young novice drivers on the dangers associated with TWD. This program, Turn Off Texting (TOT), was designed and run by the Youth Safety Council of Vermont and the Vermont Department of Motor Vehicles, Safety and Education Unit. Participants included 1203 high school teenagers who participated in 42 TOT program demonstrations across Vermont. The first aim of this study was to examine the influence of ADHD symptoms on psychological factors and behavioral intentions while controlling for and examining the effects of age, gender, and driving experience. ADHD symptoms were associated with more favorable attitudes toward TWD, greater intentions to TWD in the future, and lesser intentions to intervene on a distracted driver in the future. Male gender and increased driving experience also tended to be associated with riskier attitudes, perceptions, and intentions. The second aim of this work was to examine if the psychological factors mediate the associations between ADHD symptoms and the two behavioral intention variables. Results from multiple mediation models showed that only attitudes toward TWD mediated the relations for both intentions to TWD and to intervene in the future. ADHD symptoms continued to have a direct effect on behavioral intentions even when accounting for the indirect effects of the psychological factors; these findings suggest a direct relation of ADHD symptoms and an indirect relation via attitudes. The third and final aim of this study was to investigate the influence of ADHD symptoms, as well as age, gender, and driving experience, on the rate of change in the psychological factors and behavioral intention variables over the course of the TOT program. Findings from two-level regression models showed that the TOT program generally was effective in its goal to produce safer views in regards to the psychological factors and intended behaviors. As hypothesized, ADHD symptoms were associated with less change toward safer attitudes, perceptions of crash risk, and both intentions to TWD and intentions to intervene in the future; the influences of male gender and increased driving experience were similar in their associations with less change toward safer attitudes, perceptions, and intentions. The findings from this study’s three aims have important implications for the development and continued evaluation of specialized driver training programs. Namely, attitudes toward TWD are a viable target for intervention given this factor’s direct and indirect (in the association of ADHD symptoms) effect on intended behavior. Increasing ADHD symptoms and male gender were associated with less change over the course of the program, which represent two areas for more specialized intervention and study.

Self-injurious thoughts and behaviors are life-threatening, prevalent, and challenging clinical outcomes to predict. This dissertation explores the use of behavioral measures to improve prediction of nonsuicidal self-injury (NSSI) and suicidal ideation. This builds on the growing body of literature supporting the clinical application of behavioral measures such as the Implicit Association Test (IAT) and emotional Stroop Task with self-injurious and suicidal individuals. I tackle three questions to inform continued research and application. First, can the Self-Injury IAT be used in acute care settings to predict NSSI? Study 1 shows that the Self-Injury IAT can be used for short-term prediction: it predicted NSSI occurring during hospital stays above and beyond other risk factors, but did not predict NSSI occurring after hospital discharge. Surprisingly, patients’ explicit self-report was a more robust predictor of NSSI than the Self-Injury IAT. Admission-to-discharge change in patients' explicit self-report, but not IAT performance, predicted whether they engaged in NSSI after hospital discharge. Second, how does transient mood affect the predictive validity of the Suicide IAT and Stroop task? In Study 2, suicide ideators demonstrated significantly stronger implicit identification with death after (vs. before) the mood induction, as indicated by post-induction IAT performance. Controlling for history of suicidal ideation, post-induction performance was most predictive of suicidal ideation when assessed categorically (i.e., identification with Death vs. Life). Suicide Stroop performance remained unrelated to suicidal ideation on its own, but enhanced prediction of suicidal ideation when combined with Suicide IAT performance. All baseline suicide ideators who achieved one particular type of IAT/Stroop scoring profile experienced suicidal thoughts six months later. Third, is it safe to administer behavioral measures related to self-injurious thoughts and behaviors? Study 3 reveals that there is minimal change in self-injurious or suicidal urges from before to after completing Suicide and Self-Injury IATs. This was found across three distinct samples. A small to moderate mood decline was consistently detected, which was isolated to female respondents and one type of IAT that presented NSSI-related images. Female participants’ negative mood after viewing NSSI-related images appeared to be transient in nature--possibly be alleviated by viewing positive images. This collection of studies balances clinical application and psychological science, and presents a number of important considerations for future research and practice. / Psychology