Objective: Attention Bias Modification Training (ABMT) for anxiety aims to train attention away from threatening stimuli and toward neutral stimuli. Although ABMT shows promising anxiety reduction effects in children and adolescents, no study has examined its influence on neural indicators of attention measured using event-related potentials (ERPs) in children or adolescents (i.e., youths). The present study examined the influence of ABMT on the P1, N170, P2 and P3 ERP components during completion of the emotional faces dot probe task in youths with anxiety disorders who failed to respond to cognitive behavioral therapy. Method: Thirty youths (M age = 11.97, SD = 2.89) with primary DSM-IV-TR anxiety disorders completed the dot probe task while undergoing electroencephalogram (EEG) to obtain ERPs before, immediately after, and eight weeks after eight sessions of either ABMT (n = 14) or a control task regimen (CT), (n = 16). Results: At post-treatment, statistically significant effects were found for P1 and P3 mean amplitudes: P1 was significantly higher during trials showing neutral-neutral (NN) face pairs in the ABMT arm than in the CT arm; P3 was significantly higher during trials showing NN face pairs than during trials showing neutral-threat (NT) face pairs in the ABMT arm, but not the CT arm. At eight-week follow-up, participants in both arms showed significantly higher (more negative) N170 responses for NN trials than for NT trials. Conclusions: Attention Bias Modification Treatment led to increases in neural processing of neutral stimuli in early and late stage attentional processing, as measured by the P1 and P3 components, respectively. These components during the dot probe task are promising neural markers of ABMT’s effects on attentional processing in youth with anxiety disorders.

To investigate whether there are different patterns of development for binge eating and purging behavior among pre-adolescent and early adolescent girls, I conducted trajectory analyses of those behaviors in 938 girls across eight waves of data from the spring of 5th grade (the last year of elementary school) through the spring of 9th grade (the first year of high school). Analyses revealed four separate developmental trajectories for binge eating behavior (labeled none, increasing, decreasing, and high steady) and three separate developmental trajectories for purging behavior (labeled none, dabble, and increasing). Fifth grade scores on risk factors that were both personality-based (negative affect and negative urgency) and learning-based (expectancies for reinforcement from eating and from thinness) differentiated among the trajectory groups, in some cases before the groups differed in the target behaviors. These findings are the first, to my knowledge, to examine developmental trajectories for eating disorder onset in youth as young as elementary school. Clinical implications are discussed.

Chronic obstructive pulmonary disease (COPD) has been recognized as a leading cause of mortality in older adults involving acute exacerbations as life-threatening events that lead to frequent hospitalization for care. Informal caregivers have been essential to helping older adults with COPD during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A lack of empirical knowledge exists regarding the experience of informal caregivers of older adults with AECOPD in situation awareness for recognizing, understanding, and responding to an AECOPD in an emergent situation. This qualitative descriptive study explored situation awareness and its components of perception, comprehension and projection of next steps, including the caregiver’s confidence level during the AECOPD event. Fifteen informal caregivers, ages 31-77 years (mean age 48), who provided care for older adults with COPD were interviewed from an underserved community health center. The overarching theme derived from this study was something was wrong and something needed to be done. Subthemes emerged as a heightened sense of awareness, caregiver tipping point, planning next steps, caregiver confidence, and caregiver commitment. This study utilized situation awareness theory as a relevant guiding framework in exploring the experience of lay informal caregivers caring for older adults with AECOPD events. Study findings provided a description of the complex processes involved, including confidence level, for informal caregiver’s in situation awareness to recognize and respond to an AECOPD event in the older adult. Future targeted interventions need to address strategies to enhance individualized care for older adults with AECOPD events for managing care at home.

Because parental alcohol misuse is associated with numerous negative outcomes for drinkers and other family members, it is important to examine factors predictive of alcohol misuse patterns among parents living with at least one child under the age of 18. Two possible factors include economic insecurity and poverty. This study sought to address whether measures of economic insecurity (i.e., housing and/or food insecurity in the past 12 months) and a dichotomous measure of poverty predict parental binge drinking and parental heavy alcohol consumption in a large population-based sample. It was hypothesized that economic insecurity and poverty, analyzed separately, would predict both occurrence of parental alcohol misuse and amount of alcohol consumed. Results did not support hypotheses; rather, where significant, they indicated that measures of economic insecurity and poverty negatively predicted parental alcohol misuse. However, effect sizes were small and preclude practical application. Findings are discussed and future research directions are identified.

Background. Primary and secondary prevention trials have shown that implantable cardioverter-defibrillators (ICD) reduce the risk of cardiac death, but concerns have been raised regarding the psychological well-being of ICD patients. Anxiety can affect a significant proportion of these patients, but there is limited information about prevalence and determinants of anxiety after the implementation of the more recent guidelines for ICD implantation. Several behavioral interventions have been effective in improving anxiety in these patients, however the efficacy of mindfulness-based interventions (MBI) has not been investigated in ICD patients, and there is limited information regarding the characteristics of pre-intervention, “dispositional” mindfulness in patients with cardiovascular disease never exposed to mindfulness training. The aims of this dissertation project were: 1) To determine the feasibility of a randomized clinical trial of a phone-administered, mindfulness-based training program, as measured by recruitment and retention rates, treatment adherence and fidelity; 2) To evaluate the current baseline prevalence and determinants of anxiety in the study population and 3) To describe the correlates of dispositional mindfulness in the study population. Methods. The study was conducted at the Electrophysiology Service at the UMass Memorial Medical Center. All consecutive patients who recently underwent an ICD procedure or received ICD shocks were screened for eligibility to participate in a pilot randomized controlled trial in which an eight session, phone-delivered, weekly MBI was compared to a usual care condition. Assessments were performed at baseline and post-intervention. A cross-sectional design was used for aims 2 and 3. Anxiety was assessed using the Hospital Anxiety and Depression Scale; a shortened version of the Five Facets of Mindfulness questionnaire was used to evaluate mindfulness. Results. Thirty patients (21 M, 9 F; mean age 63.1 ±10.3 years) were enrolled in the study. The methods ultimately adopted to screen, recruit, and retain study participants were feasible to conduct and satisfactory to ICD outpatients, and the study intervention was safe. Phone delivery resulted in excellent retention rates and limited costs. Assessments of treatment fidelity showed that the content of the intervention was delivered as intended in almost 100% of cases. The study findings do not show a decrease in the overall prevalence of anxiety in ICD patients compared with earlier cohorts; anxiety was associated with young age, low socio-economic status and previous psychological morbidity, but not with ICD-related factors including prior shock delivery. Finally, baseline mindfulness was most strongly associated with previous psychological morbidity (in particular, depression), and current anxiety symptoms. Conclusion. Psychological morbidity appears to be the major determinant of anxiety in the patients currently enrolled in the study. Dispositional mindfulness is inversely associated with current anxiety and depression and with prior psychological morbidity, supporting the hypothesis of a modulating role of mindfulness on the processing of negative emotions. A phone-delivered, individual MBI is feasible, acceptable to patients and can be adequately delivered by trained instructors. The findings from this dissertation work support the need for larger clinical trials of MBI in ICD patients.

The purpose of this applied dissertation was to explore the lived experiences of teens aging out of foster care, in an effort to better understand their needs. While the child welfare system is geared towards family preservation, reunification, and adoption, most young adults transitioning from the foster care system are not reunited with family members or are only reunited as a last resort. Unfortunately, every year, thousands are leaving the support of the foster care system, unprepared. Youth departing the child welfare system are not gradually transitioned into becoming self-sufficient. They do not have an effective support system available if they fail or need help. Instead, when they leave foster care, they are simply released from the system they have become accustomed to and most struggle during this transition. The researcher conducted three 60-minute interviews with nine former foster youth. Questions were based on a set of interview questions (Appendix C), developed and used by Dr. Lee (2010), to assist in understanding the lived experiences of former foster youth. From an analysis of the data gathered from the young adults’ interviews and the researcher’s observations, four prevalent themes emerged: 1) Looking for the ‘care’ in foster care, 2) the threat of mental disability, 3) pick of the draw, and 4) navigating emotionally alone. This study will allow the state and foster care system to examine the highlighted issues and to consider appropriate corrections. Gaps have been identified in the system, as it currently operates, and there is a need to examine the current practices with internal and external lenses, in order to recommend possible changes.

In March 2020, Tom Hanks announced he had contracted COVID-19 while shooting the Elvis Presley Biopic in Australia. On Instagram, he encouraged fans to take the disease seriously and be aware of how severe of a disease it was. Character brands and nostalgia have been found to foster trust in products and encourage relationships with those brands. Using the lens of nostalgia and uses and gratification to examine Tom Hanks as a character brand, the researcher analyzed five blockbuster films with Tom Hanks as the lead character. The study used narrative thematic analysis to observe Hanks and the depictions of character identity, trauma, mortality, affectional emotion, memory, and catharsis in these films. The goal was to better understand how nostalgia might contribute to brand trust between the audience and the celebrity.

The intent of this thesis was to examine compassion fatigue in nurses through analysis of research studies conducted within the past five years in an effort to identify predisposing factors to the experience of compassion fatigue. Individual and institutional factors were identified as well as current strategies to assist with management of compassion fatigue. Findings indicated that being new to practice, having a trait negative affect, being younger in age, having a history of exposure to trauma and working in high emotionally stressful units predisposed individuals to the experience of compassion fatigue. Institutional factors included a lack of managerial support, organizational commitment, group cohesion, work engagement and conflicting expectations of the nurse. Institutional interventions to assist in mitigating compassion fatigue include improving managerial support, developing group cohesion and communication and providing continuing education opportunities. Institutions can also assist by offering training in resiliency techniques such as negative thought pattern identification, meditation, peer-to-peer discussions, journaling about traumatic experiences, identification and maintenance of personal/professional boundaries and physical wellness through exercise and yoga. These proposed interventions address institutional accountability in health care worker wellness as defined by the quadruple aim. Such interventions also address use of Watson’s Caring Theory to emphasize the importance of nurse wellness as essential to creating caring nurse-patient relationships.

<p><strong>Objectives: </strong>To examine associations between macrosomia, maternal body mass index (BMI) during pregnancy, and psychopathology in youth, and to determine if these are due to prenatal environmental exposures or confounding variables.</p> <p><strong>Methods: </strong>Study 1 reviewed studies examining associations between macrosomia and mental health. Data from the Ontario Child Health Study (OCHS) were then used to explore these links in youth (Study 2). A second review summarized studies assessing associations between maternal pregnancy BMI and psychopathology in offspring (Study 3). Data from the Western Australia Pregnancy Cohort were then used to quantify associations between maternal pre-pregnancy BMI and child behaviour at age 1 and 2 (Study 4), and from 5-17 years of age (Study 5).</p> <p><strong>Results: </strong>Seven of the 15 studies that had examined associations between macrosomia and psychopathology supported a link. In the OCHS, youth born macrosomic had elevated externalizing scores compared those born at appropriate birth weights. Eight of 12 studies suggested that links exist between elevated maternal BMI during pregnancy and psychopathology in offspring. Maternal pre-pregnancy BMI was positively associated with offspring externalizing problems from age 2 to 17 and linked to less favourable trajectories of internalizing symptoms from 5-17. These findings persisted despite adjustment for confounders.</p> <p><strong>Conclusions: </strong>Youth born macrosomic have elevated levels of externalizing symptoms, though a more robust association was noted with maternal pre-pregnancy BMI. The data comprising this thesis suggest that associations between macrosomia/maternal BMI and externalizing and internalizing problems in youth may be due to intrauterine exposures rather than confounding variables.</p> / Doctor of Philosophy (PhD)

Adolescence and young adulthood are the periods of development associated with the highest amount of risk-taking. One theory, the Dual-Systems model, suggests that this could be due to an imbalance in the maturation of two brain systems: reward appraisal, which matures first, and cognitive control, which matures later. This imbalance may be the cause of adolescents’ tendency to favor immediate rewards, disregarding consequences. Depressed adolescents, however, behave differently. While it is not exactly clear whether they take more risks or fewer risks, depressed adolescents display different interactions and decision making with their peers than non-depressed adolescents. This study attempted to use these patterns of behavior already identified in previous research to predict where an adolescent would fall on a depression continuum based on their Self-Focused and Other-Focused risk behaviors. Results did not find a link between depression and either type of risk. Results may be inconclusive due to issues within the data and data collection process.