Reliance on self-reported screening for suicide risk may be contributing to a lack of progress in suicide prevention, in part, because of limitations related to stigma, ambivalence, and deception in responding. One change to potentially mitigate these issues and improve screening effectiveness is to allow for explicit selective disclosure of information, specifically by including a “prefer not to disclose” option in screening items. This study aimed to achieve the following: (1) investigate whether selective disclosure is a valid and reliable construct of suicide risk among high risk populations, (2) identify causal mechanisms and moderators of selective disclosure, and (3) investigate the relationship between selective disclosure and death/suicide implicit association (d/s-IAT). These aims were investigated using online self-report surveys across three independent samples of adults in higher-risk and lower help-seeking populations, and who reported high current distress: Military and veterans (n = 135), men over age 50, (n = 187), and LGBTQ young adults (n = 140). Across groups, results indicated that selective disclosure was highly specific to individuals who reported higher risk for suicide, and was prevalent in approximately one out of four participants who endorsed some level of suicide risk. Above and beyond explicit report of suicide risk, reported inaccuracy of risk disclosure, low help seeking, and hopelessness were the only predictors significantly associated with selective disclosure across all groups. Qualitative results also highlighted the importance of “mistrust,” “misunderstanding,” and “fear of stigmatized consequences” as drivers for selective disclosure. Personality traits and mode of assessment did not appear to affect likelihood for selective disclosure. Implicit association to death/suicide was significantly associated with explicit report of suicide risk across all groups, but was not associated with selective disclosure. These results suggest that adding explicit selective disclosure choices to suicide risk screening items is unlikely to substantially increase screening sensitivity, as nearly all selective disclosers self-reported elevated suicide risk. However, allowing for and evaluating explicit selective disclosure among suicide risk reporters may provide useful information for risk assessment and follow-up, and preemptively addressing drivers for selective disclosure before or during suicide risk screening may increase screening effectiveness. / A Dissertation submitted to the Department of Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester 2018. / July 10, 2018. / IAT, Non-Disclosure, Risk Assessment, Suicidality / Includes bibliographical references. / Thomas E. Joiner, Professor Directing Dissertation; John Taylor, University Representative; E. Ashby Plant, Committee Member; N. Brad Schmidt, Committee Member; Natalie Sachs-Ericsson, Committee Member.

Dysfunctional reward processing and disinhibitory tendencies have been highlighted as central to the development and maintenance of substance use disorders (SUDs). The literature emphasizes two different interpretations of the reward dysfunction observed in individuals with SUDs – one being that substance-free reward dysfunction arises as a consequence of repeated substance use, and the other being that substance-free reward dysfunction is mainly a liability for subsequent substance use. Further complicating these accounts are recent findings demonstrating a moderating role of disinhibition on the relationship between reward sensitivity and SUDs. The proposed work aimed to address these unresolved complexities in the literature by examining interactions between disinhibition and neural reward sensitivity (operationalized via nucleus accumbens [NAcc] activation in the monetary incentive delay [MID] task) in predicting substance problems assessed concurrently and across time. While disinhibition showed to be a robust liability factor for substance problems, demonstrating strong predictive value both concurrently and prospectively, age 14 NAcc activation was not related to substance problems as a main effect nor in an interactive manner. Additionally, dysfunctional NAcc activation was not a consequence of adolescent substance use either, as substance problems from age 14 to 19 was not predictive of the change in NAcc activation between age 14 and 19. However, NAcc activation appeared to be a concurrent co-determinant of substance problems at age 19 – disinhibition and NAcc activation interacted to predict substance problems such that those high in disinhibition with blunted NAcc activation showed the most problems. / A Thesis submitted to the Department of Psychology in partial fulfillment of the requirements for the degree of Master of Science. / Fall Semester 2018. / August 8, 2018. / Drug/Substance Use, Neuroimaging, Reward Sensitivity / Includes bibliographical references. / Christopher J. Patrick, Professor Directing Thesis; Greg Hajcak, Committee Member; Christopher Schatschneider, Committee Member.

Individuals employed in first responder professions are at risk for the development of psychiatric symptoms. Two of these professions, firefighting and military service, demonstrate a strong overlap of employees. Prior research has demonstrated increased prevalence rates of psychiatric symptoms, including suicide-related behaviors among firefighters. Subpopulations within this occupation provide an opportunity to inform tailored prevention and intervention tactics. One such subpopulation are firefighters with military service history (concurrent and prior). The current study looks to investigate psychiatric symptom differences between firefighters with and without military service history. We hypothesized an additive effect of military service, such that firefighters with a history of military service will be at increased risk for various psychiatric symptoms compared to their civilian-only counterparts. In addition, potential theoretically-based explanatory constructs will be used to investigate mechanisms of significant relationships between military service and psychiatric outcomes. Results did not support an additive effect of military service history within the firefighting profession, as firefighters with military service history were not more likely to endorse various psychiatric symptoms. Military service history was found to be significantly related to career NSSI, such that firefighters with a history of military service were 2.52 times more likely to report a career history of NSSI. Emotion dysregulation did not explain this relationship. Further investigation into the type of military service history suggests firefighters who are also reservists in the armed forces are at particular risk for suicide-related behaviors. Compared to civilian-only firefighters, firefighters with a history of active duty service and national guard service also demonstrated increased risk for suicide-related behaviors. The present study’s results indicate the type of military service, rather than military service in general, is particularly relevant for suicide-related behaviors within a firefighter population. Future directions for further investigation into this unique population are discussed. / A Thesis submitted to the Department of Psychology in partial fulfillment of the requirements for the degree of Master of Science. / Fall Semester 2017. / October 23, 2017. / Firefighters, Military, Psychiatric Symptoms, Risk, Suicide / Includes bibliographical references. / Thomas E. Joiner, Professor Directing Thesis; Colleen Ganley, Committee Member; Joseph Franklin, Committee Member.

The ability of transcranial alternating current stimulation (tACS) to augment underlying rhythmic fluctuations of neuronal activity provides meaningful implications in the treatment of neuropsychiatric disorders characterized by aberrations in neural oscillations. However, in evaluating its clinical utility, evidence is lacking for the efficacy of tACS to induce long-term (> 24 hours) plastic changes that translate to lasting behavioral outcomes. Here, we repeatedly administered alpha-frequency tACS across 4 consecutive days in 38 healthy adults to evaluate lasting changes in local alpha power and directed connectivity as well as clinically-relevant indices of anxious arousal and affective sensory processing. Replicating previous findings, participants who received active stimulation (vs. a sham control group) demonstrated transient increases in resting occipito-parietal alpha power that lasted 30 minutes post-stimulation, reflecting acute entrainment to the exogenous electrical stimulation. However, these effects were short-term, returning to baseline levels 24 hours after stimulation. Conversely, long-term increases in intrinsic posteriorfrontal alpha-frequency connectivity emerged and persisted across all 4 days, reflecting plastic-changes in directed cortico-cortical networks. These lasting connectivity changes were paralleled by sustained decreases in anxious arousal and increases in perceived pleasantness of auditory stimuli. These findings suggest that while local oscillatory activity may be constrained by a self-sustaining thalamo-cortical loop that restores cortical oscillations to baseline, long-range oscillatory connectivity may strengthen over time through plastic synaptic changes in intrinsic cortico-cortical networks. The lasting augmentation of this inter-areal oscillatory network via tACS provides meaningful implications in an array of affective and cognitive processes that are orchestrated through the integrity of these global networks. This provides novel extensions of tACS applications, shifting neuromodulatory targets from local oscillations to global oscillatory networks to progress the clinical utility of this technology. / A Thesis submitted to the Department of Psychology in partial fulfillment of the requirements for the degree of Master of Science. / Fall Semester 2017. / September 27, 2017. / Includes bibliographical references. / Wen Li, Professor Directing Thesis; Natalie Sachs-Ericsson, Committee Member; Lisa Eckel, Committee Member.

This portfolio thesis contains three separate parts; a systematic literature review, an empirical study and corresponding appendices. Part one is a systematic literature review, in which the theoretical, conceptual and empirical literature relating to the experiences of individuals with Intellectual Disabilities (ID) in the post-secondary transitional period is reviewed. A systematic database search was carried out which identified 11 papers suitable for review. Thematic synthesis was used to analyse the data and a quality assessment was completed. Four themes were derived from the data which were, ‘Transition’, ‘Influential roles’, ‘Role of students with ID’, and ‘Outcomes’. Implications of the findings and considerations for future review are discussed. Part two is an empirical paper, which explores the lived experiences of people with ID, utilising theories from Second Wave Positive Psychology and a Dual-System’s Model. Nine adults with ID were interviewed. Interpretive Phenomenological Analysis (IPA) was used to analyse the data. Three superordinate and six subthemes were identified. The superordinate themes were, ‘Identity’, ‘Managing Life’s Difficulties’, and ‘Approaches to Life’. Implications, considerations for future research, strengths and limitations are discussed. Part three comprises the appendices, which contain the approval letter from the Faculty of Health and Social Care Research Ethics Committee at the University of Hull, documents used in the empirical research, a reflective statement considering the research process and an epistemological statement.

This portfolio thesis is divided into three parts: a systematic literature review, an empirical study and a set of appendices. Part one is a systematic literature review, exploring the existing literature relating to the barriers men report when accessing mental health services. A total of 8 studies were critically reviewed, evaluated and assessed for quality. The results from these were then explored to consider the themes that men described in the barriers they experienced. The findings from this review are discussed regarding the clinical implications of barriers to care. Part two is an empirical paper exploring the constructions of masculinity in the language Army veterans use around accessing mental health services. The study utilised a combination of grounded theory and Foucauldian discourse analysis to explore the discourses used by the five veterans. Results looked at the different positions the men took in their discourse and the different actions this allowed them, as well as how they negotiated their masculinity when accessing support. The findings are considered and discussed in relation to their clinical implications. Part three contains a comprehensive set of appendices from parts one and two; this also contains epistemological and reflective statements to add context to the research that was undertaken.

Research suggests that people who experience mental health problems and people who hear voices are likely to experience stigmatising attitudes and discrimination. This portfolio considers the experiences and impact of disclosing these stigmatised experiences, both to immediate family, friends, and partners, and to people in wider society. The portfolio has three parts. Part one is a systematic literature review which considers the impact/effect of disclosing mental health problems by reviewing the literature base. Twelve articles which aimed to answer the research question were quality assessed, then compared and contrasted in order to provide conclusions and offer recommendations for future research and clinical practice. Part two is an empirical study which enquires into the personal experiences of people who hear voices using Interpretative Phenomenological Analysis (IPA). Six participants were interviewed about their experiences of talking about hearing voices with family, friends, and other people they considered close to them. Themes were developed from the interviews and conclusions were drawn about future research and clinical implications. Part three of this portfolio contains the appendices, consisting of supporting documents from the literature review and empirical study, along with both epistemological and reflective statements.

<p> Emotion dysregulation, or difficulties regulating one's emotions, has been increasingly identified as a transdiagnostic factor that can increase risk for and maintain a wide range of psychiatric disorders (Fernandez, Jazaieri, &amp; Gross, 2016). Emotion malleability beliefs represent a potent psychological factor that relates to emotion regulation and, relatedly, holds important clinical implications for our conceptualizations of and treatment for a range of psychiatric disorders. The current dissertation includes one literature review and four empirical investigations that used an array of methodological approaches and possess different clinical and theoretical emphases to deepen and broaden the established influence of emotion malleability beliefs on emotion regulation and mental health.</p><p> Chapter 2 provides a theoretical model and discussion of how emotion malleability beliefs could aid in our understanding of several clinical disorders and could be harnessed to enhance motivation for and engagement in psychological treatment. The study described in Chapter 3 is an experimental investigation in which we demonstrate that emotion malleability beliefs can be experimentally manipulated and such an induction can exert a significant influence on individuals' state emotion regulation when coping with unwanted negative affect. The study presented in Chapter 4 consists of a longitudinal investigation that examines how emotion malleability beliefs relate to emotional experiences, emotion regulation, and clinical symptoms in first-year college students. The investigation included as Chapter 5 is of a daily diary study that elucidates how emotion malleability beliefs are tied to daily emotional experiences and emotion regulation as currently depressed individuals. Finally, the experimental study described in Chapter 6 clarifies how beliefs about emotion's malleability relate to treatment willingness, perceptions of agency over depression, and beliefs regarding prognosis. Overall, the work presented in this dissertation complement and extend past work on the role of emotion malleability beliefs in how individuals navigate their emotional worlds and cope with unwanted emotional experiences with the ultimate goal of promoting psychological adjustment and attenuating psychological distress. Future directions for theoretical and empirical work in this domain are presented in Chapter 7.</p><p>

Making evidence-based treatment recommendations is very important for clinicians across all medical specialties. This becomes increasingly difficult when taking into consideration the specific characteristics of each individual patient. Most evidence-based knowledge comes from randomized control trials, which often overlooks unique individual concerns. A single case methodology, which assesses treatment responses in individual patients, allows clinicians to collect statistically rigorous data, but also assess improvement in individual patients. In our investigation we show that a single case methodology, using four different analyses, can be applied to assess the efficacy of a CBT intervention delivered to pediatric chronic pain patients. We demonstrate that such a methodology, when we combine results from multiple statistical tests, allows us to make conclusions about treatment responses. Furthermore, we show that our intervention targets several different issues chronic pain patients face, in particular the avoidance of painful activities. While we did see congruence of results across the different statistical analyses, there were also several examples of inconsistency. These inconsistencies seem to occur when patients show considerable variability in their responses to the questions on the daily measures, introducing ‘noise’ that made detecting ‘true signal’ (treatment response) quite difficult.

Human and non-human animal studies indicate that the reconsolidation of conditioned fear memories can be interrupted, and return of fear attenuated, using a paradigm of memory retrieval coupled with extinction called post-retrieval extinction (PRE). This series of studies examined the efficacy of PRE for attenuating the return of fear in healthy and anxious individuals in order to inform translation of PRE to the clinic. Study 1 was a meta-analysis of 16 comparisons of PRE versus extinction in healthy human participants. My hypothesis that PRE would be more efficacious than extinction in attenuating the return of fear was supported (effect size g = 0.40). This effect was moderated by factors potentially related to memory strength. Accordingly, in Study 2, I tested a strategy to strengthen fear memories using a compound unconditioned stimulus for use in a subsequent study of PRE (Study 3). I hypothesized that the use of a compound unconditioned stimulus would improve rates of acquisition and differential conditioning levels in healthy participants (N=143, M(SD) age=23.0 (9.8), 59% female). My results confirmed that the use of a compound unconditioned stimulus enhanced rates of acquisition, but contrary to my hypothesis, did not enhance differential conditioning levels among those meeting threshold values for conditioning. In Study 3, I tested the relative efficacy of PRE in 49 healthy and 43 anxious participants (M(SD) age=23.0 (8.0), 71% female) who received either one day of acquisition followed by PRE or extinction, or three days of acquisition followed by PRE. I hypothesized that PRE would be more efficacious than extinction in attenuating the reinstatement of fear for memories conditioned over one day, but not for stronger fear memories conditioned over three days. Contrary to my hypothesis, no effect of PRE was observed on reinstatement of fear for participants who received one day of acquisition. Furthermore, PRE was not more beneficial for anxious participants who received one day versus three days of acquisition. In sum, the PRE effect size from this study was near zero and at the 11th percentile of those observed by meta-analysis; future research should continue to examine moderators of PRE effects.