<p> Adolescent treatment has come to rely on behavioral correctives with an emphasis on autonomy. This emphasis neglects the importance of healing the relational capacity in order to build internalized security. Addressing insecure attachments enables adolescents to transform their internal working model established in their early life experiences, potentially enabling them to move forward confidently in the relational world ahead of them. Utilizing both hermeneutic and heuristic methodology, this thesis considers existing research and theory combined with personal experience to examine the far-reaching effects of attachment styles and the neurological and therapeutic importance of right-brain attunement as the basis of emotional healing. This thesis also explores traumatizing practices in residential adolescent treatment, which may be more aligned with business models instead of optimum clinical models. The cultural collective unconscious is considered as operating from patriarchal principles, emphasizing obedience and punishment over building both trust and relationality.</p>

<p> The aim of the present study was to generate a set of therapy suggestions specifically for use in the treatment of creative individuals diagnosed with bipolar disorder. In order to achieve this end, the author collected information from bodies of literature that focused on three general research areas: (a) the relationship between bipolar illness and creativity, (b) the treatment of bipolar individuals, and (c) psychotherapy treatment of creative individuals. The information gleaned from these three areas was synthesized and used to inform the general treatment suggestions. This study examined several of the existing approaches to the treatment of bipolar disorder and provided suggestions for ways in which those treatments could be tailored for use with creative clients who are diagnosed with bipolar disorder. Effective psychiatric and psychological (i.e., psychotherapeutic) interventions have been developed for the treatment of individuals diagnosed with bipolar disorder, though additional research can be conducted to better understand how these interventions can be adapted to improve outcomes with certain clinical subgroups. Creative individuals with bipolar disorder reflect one such subgroup, and it is hoped that the suggestions for therapeutic adaptations contained within this dissertation begin to draw more attention to an under-researched group.</p>

<p> Text messaging may offer a useful tool for shaping psychotherapy homework compliance. Patients may send text messages to report compliance and psychotherapists may respond with text messaged verbal praise. In this analog study, the effects of text message reporting and reinforcement on homework compliance behavior were examined. Ninety-four college students, who agreed to attend two lectures about stress management, were asked to complete a daily, five-minute online relaxation exercise between lectures. Participants were randomly assigned to one of three conditions. In one group, they were not asked to report on completion of the exercise. In the second group, they were asked to report their daily completion of the exercise via text message. They did not receive responses. In the third group, they were asked to send text message reports and they also received text message responses containing praise. Compliance was measured through objective monitoring of online relaxation exercise use. It was expected that receiving text messaged praise would lead to greater homework compliance. It was also anticipated that simply being asked to send text message reports would improve compliance. As predicted, homework compliance was significantly greater in the group that received text messaged praise. However, significant differences were not found between the other two groups. Rapport did not differ between the groups and there was no relationship found between rapport and compliance. Based upon these results, it was concluded that text message reporting with reinforcement may be helpful in improving psychotherapy homework compliance.</p>

<p> Multiple campaigns geared towards reducing public and self-stigma associated with depression, and increasing help-seeking behaviors have been launched in the past two decades. There has been an increase in promoting psychoeducation on the biological bases of mental illness. Recent international studies have documented that this increase in public knowledge has not reduced stigma. Indeed, growing evidence suggests that biological models, in comparison to other causal models of mental illness, decrease people&rsquo;s sense of self-efficacy and self-control, and decrease positive expectancies of treatments and prognosis&ndash;among those with and without mental illness. Individuals who have come in contact with health services, however, hold more positive and realistic expectancies of treatments than those who have not. Therefore, adequate education about mental illness and its treatment by providers is key at improving treatment expectancies and engagement. Results documented that biological explanations increased biological causes and reduced endorsement of social and psychological causes, led to decreases in endorsement of non-professional help, and increased endorsement of positive outcome expectancies for attending psychotherapy. Second, psychosocial explanations increased endorsement of social causes, increased likelihood in engaging in psychotherapy, and increased endorsement of positive outcome expectancies for attending psychotherapy and taking psychiatric medications. Third, biopsychosocial conditions produced increases in endorsement of taking psychiatric medications and increased endorsement of positive outcome expectancies for attending psychotherapy. Fourth, control condition increased endorsement of taking psychiatric medications and increased endorsement of positive outcome expectancies for attending psychotherapy. There was no interaction effect of self-stigma for attending psychotherapy or taking psychiatric medications; however, main effects of time suggest that self-stigma for attending psychotherapy and taking psychiatric medication reduced across time. Moreover, after treatment education there were no interactions between time and condition. However, main effects of time showed increased likelihood taking psychiatric medications and decreased likelihood seeking non-professional help, increases positive outcome expectancies of treatment, and decrease in self-stigma for seeking treatment. The findings of the current study suggest that biologically based psychoeducation of depression may hinder patients. It is most optimal to include and highlight the effect of psychosocial factors of depression through psychoeducation campaigns.</p>

<p> The rate of youth suffering from untreated emotional and behavioral problems has risen in recent years. Various barriers to treatment utilization of youth and their families have been identified in the literature, including logistical factors (i.e. transportation, lack of child care), financial barriers, as well as system barriers (i.e. limited knowledge of mental health difficulties among parents of young children). Parents/caregivers are often the primary gatekeepers to treatment for children suffering from mental health problems. Additionally, psychoeducational programs have increasingly gained support as an effective evidence-based practice that may bolster treatment utilization among youth. A psychoeducational program for parents of school-aged children was developed to teach empirically-based strategies for managing common childhood problems and to help parents understand when and how to refer to professional services. A mixed methods study was conducted as a means to gain teacher impressions of the program&rsquo;s effectiveness in disseminating evidence-based home strategies that can be used by parents to manage common childhood problems. Qualitative data analysis procedures based on grounded theory were undertaken to code collected data from narrative interviews. Major themes that emerged included importance of parent psychoeducation, need for social skills training, need for effective discipline techniques, preference for modular training, and scheduling with consideration for parental time constraints. Quantitative data analysis revealed that usefulness of behavioral interventions received the highest average rating between <i>very much</i> and <i> extremely</i> (<i>M</i> = 4.67, <i>SD</i> = 0.52) from participants, while knowledge increase post program overview had a medium level impact between somewhat and <i>very much</i> (<i>M</i> = 3.83, <i>SD</i> = 0.98). Limitations, strengths, and recommendations for future directions are discussed.</p><p>

Clinical wisdom suggests that adults with histories of childhood trauma will have difficulty engaging in psychotherapy. I examined the relationship between early childhood trauma and treatment response in the form of rate of symptom decline among a group of 202 adults recruited into the longitudinal Austen Riggs Center Follow-Along Study. Participants were recruited at admission to the hospital and provided extensive demographic and clinical data at baseline, including retrospective recall of childhood traumatic experiences using the Traumatic Antecedents Interview (TAI) and narrative responses to the Relationship Anecdote Paradigm (RAP) used to generate ratings on the Social Cognition and Object Relations Scale (SCORS). Participant symptoms were assessed at baseline and again every six to eight months for up to four years using the Symptom Checklist-90-Revised (SCL-90-R). Hierarchical Linear Modeling (HLM) was used to perform growth curve modeling of the symptom change data, which demonstrated an overall linear rate of decline and significant unexplained variability. The hypothesis that degree of childhood trauma would predict rates of symptom change failed to receive support, as did other related hypotheses. Only participant age predicted differences in rates of symptom decline, with younger participants' symptoms declining more rapidly than those of older participants. The findings indicate the following: (1) symptom severity tends to decline linearly after hospital admission, (2) individual rates of symptom change vary considerably, and (3) rates of symptom decline may slow as people age. Implications for clinical research and practice are discussed.

<p> This project involved the development of a funding database and grant library for the organization Project Pink Ink. Interviews with stakeholders in the organization were conducted to garner information to inform grant selection as well as program need. Content analysis was applied to the transcripts of the interviews. The interviews suggest a great need for a complementary program for oncology patients. After all of the information garnered was synthesized, a grant application was completed and a grant was submitted to obtain funding for the Project Pink Ink organization.</p>

<p> Although approximately 60%-80% of detained adolescents have a psychiatric disorder, little is known about their utilization of mental health and substance-related treatment services upon release from detention. Given that treatment can potentially reduce symptomology and recidivism, the study examined detained adolescents&rsquo; post-detention treatment utilization and longitudinal patterns of use. Data were abstracted from the electronic juvenile justice records and medical records of 9664 detained adolescents (62.7% male; 34.8% White, 65.2% Black; 72.6% with disorder) with Medicaid coverage held in a Midwestern detention center at some time during 1998-2011. A series of statistical tests (e.g., chi-square, ANOVA, logistic regression, Kaplan-Meier survival analyses, Cox regression) were conducted to identify group differences in treatment utilization during the 14-year follow-up period. Following detention release, approximately 66.2% of adolescents were re-arrested and 54.9% were re-detained or incarcerated. Treatment utilization within two years post-detention was 36.7%; 31.4% obtained mental health treatment, 10.4% obtained substance-related treatment, 36.0% obtained outpatient treatment, and 6.2% obtained non-outpatient treatment. Among treatment users, 22.5% dropped out of treatment within 1-3 sessions and 40.6% experienced gaps (>45 days) between treatment services. Treatment utilization was significantly higher among males, White (vs. Black) adolescents, younger adolescents, violent (vs. non-violent) offenders, recidivists (vs. non-recidivists), and adolescents with mental disorders (vs. substance-related disorders). Variables associated with increased likelihood of post-detention treatment included: male gender, psychiatric disorder(s), pre-detention arrest(s), charge severity, violent offender, incarceration, and pre-detention treatment; age and Black race were associated with decreased likelihood of treatment. As one of the only longitudinal studies to examine treatment utilization among detained adolescents upon community reentry, findings suggest limited service utilization, as well as treatment gaps and disparities. Future research should focus on the treatment needs of detained adolescents, factors associated with disparities, and programs/policies to ensure consistent identification, referral, and connection to care for detained adolescents.</p>

<p> Tinnitus and hyperacusis are related auditory disorders that frequently interact. However, little is known about the subjective impact of tinnitus that is exacerbated by sound exposure. Tinnitus is the perception of sound in the absence of auditory stimuli and is frequently associated with auditory system damage. Hyperacusis involves heightened sensitivity or intolerance to sound that can manifest as pain or physical discomfort and is not limited to specific sound qualities other than loudness level. Although tinnitus exacerbated by sound exposure poses increased challenges with treatment prognosis as well as mental health and quality of life factors, there are no objective measurements for assessing areas of impact unique to this specific tinnitus subtype. In the present study, a 20-item Sound-Sensitive Tinnitus Index (SSTI) was created and administered in an online survey. Results were analyzed with data from 277 participants in 32 countries. Analysis showed excellent internal consistency reliability (Cronbach&rsquo;s alpha = .89), and convergent validity was demonstrated through statistically significant correlations with established measures of tinnitus, depression, anxiety, quality of life, and hyperacusis. Rotated factor analyses revealed four dimensions to the SSTI. Qualitative analysis of open-ended responses also provided insights into respondents&rsquo; subjective experience, and the operational definition of sound-sensitive tinnitus was proposed. High levels of mental health and quality of life impact reported by participants underscore the need to differentiate this subtype and to better understand clinical implications in providing care to this underserved population.</p><p>

<p> This research explored the use of mindfulness to confront mortality. Through attention, curiosity and non-judgment, mindfulness increases awareness of thoughts, feelings and sensations. Given the automaticity of fear and the suffering that can arise in response to death, this study piloted two mindfulness exercises. </p><p> It employed a convergent parallel design to analyze qualitative and quantitative data collected from 20 adults, born between 1946 and 1964. After being interviewed about their mortality, participants were randomly assigned to receive either a mindfulness of breath induction, or a mindfulness of mortality induction. Interviews captured responses to the two exercises. Participants completed a demographics questionnaire, and the 21-item State Mindfulness Scale, administered post-induction. Data was analyzed to identify themes, and develop theory about using mindfulness to confront mortality.</p><p> Results from the research illuminated the overwhelming value for reflecting on death, and appreciation for a facilitated contemplative exercise. Pre-induction interviews revealed that, in response to thinking about death, subjects oriented around life values and living with purpose. Memories of loss, and relationships were salient. They articulated ambivalence toward thinking about death due to a lack of control, but were able to hold multiple emotions including fear, gratitude and curiosity. </p><p> It was concluded that both mindfulness exercises were meritorious, but had somewhat differing effects. Both inductions produced metacognitive and meta-affective awareness, reflective of the construct of mindfulness; both inductions stimulated memories, emotions, cognitive activity, and body awareness. The mindfulness of breath induction seemed to be calming, with more awareness of the body, associations to other meditative practices, and less cognitive activity. Results suggested that it was effective in stimulating state mindfulness in terms of the present condition of the mind and of the body. The mindfulness of mortality exercise evoked a more challenging experience, that most participants found beneficial. It was associated with a variety of emotions, including sadness, fear, peace, and gratitude. It stimulated cognitive processing, and associations to participants&rsquo; diverse religious and spiritual identities. As interventions for a population that feels there is value in reflecting on mortality, both may be applied successfully in clinical practice.</p><p>