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While a substantial amount of research has addressed the psychological impact sexual assault has on its victims – as well as subsequent behavioral consequences – little is known regarding the stigma a victim of sexual assault may perceive as a result of her experiences. Perceived stigma may include feelings of shame, exclusion, and self-consciousness. Additionally, there have been no studies to date examining the impact such perceived stigmatization may have on help seeking behavior. To address this lack of data, college undergraduates at East Tennessee State University were recruited and surveyed over the Internet (course credit was provided as compensation for participation). To date, 51 (15%) out of 331 female participants indicated that they had experienced sexual assault (i.e., they had been coerced – physically or otherwise – into engaging in sexual activity against their will). Preliminary results indicated that these women perceived stigma as a result of sexual assault (M=1.40, SD=.87, range=0-3). Although marginally significant, preliminary results further show that with increased levels of perceived stigma women were somewhat less likely to seek help or support from friends and family; for example, participants who perceived themselves as stigmatized were less likely to share details of the incident with others (r=-.284, p=.053) or ask others to share similar experiences (r=-.275, p=.061). Other factors potentially impacting the relationship between perceived stigmatization and help seeking will be addressed; specifically, the impact of religious fundamentalism on perceived stigma and subsequent help seeking behavior. Because these consequences of sexual assault and contributors to help seeking have yet to be addressed in the literature on sexual assault, this study sheds new light on the impact such events have on women.

Pain is the leading cause of Emergency Department (ED) visits making it one of the primary concerns of the emergency medical field. The experience of pain is subjective and unique to every individual making it difficult to effectively manage. As a result, the subjective nature of pain is also commonly associated with drug-seekers often claiming to have pain simply to receive narcotics to support their addiction. There have been numerous studies completed to determine how to effectively recognize drug-seeking. This integrative literature review will identify the common behaviors that have been seen as indicators of drug-seeking in the ED. The evidence collected from articles published between 2001 and 2011 examined the use of assessment tools, drug screening, and prescription monitoring programs for distinguishing drug-seekers. The evidence did not identify a specific evaluation tool used to recognize drug-seekers; however, the research did suggested that using these techniques can help to identify drug-seeking behavior allowing emergency medical staff to effectively manage pain in the ED.

Using variables identified in the social science literature believed to influence attitudes toward seeking professional counseling, an attempt was made to develop a model for predicting Hispanics' willingness to obtain professional help. A second purpose of this study was to compare college students (n = 158) with their parents on their attitudes toward mental illness and toward seeking counseling. Among predictor variables, social stigma and the belief that mental illnesses are untreatable were the primary variables predicting attitudes toward seeking counseling. The more college students and their parents perceived there to be social stigma attached to those seeking therapy, and the more parents believed that mental illnesses are untreatable, the less favorable attitudes they had about seeking professional help. These attitudes were linked to their acculturation levels; in general, the more acculturated they were toward the Hispanic culture, the more pejorative their attitudes were toward mental illness and their willingness to seek professional help. Last, college students in general had significantly more positive attitudes toward mental illness and professional counseling than their parents. Recommendations for providing counseling with Hispanic clients are provided in the context of the present findings.

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Interpersonal Violence in the form of school shootings is prevalent in American society and can negatively impact the mental health of survivors. Black, Indigenous and People of Color (BIPOC) tend to bear the worse outcomes following such events due in part by effects of complex trauma (e.g., minority stress). Using the Andersen Model of Behavioral Healthcare Use within a sample of 4,627 students who were enrolled at the time of the Virginia Tech 4/16 shooting, the current thesis sought to: (1) examine predisposing factors as a mediator of the relationship among racial identity and help seeking, (2) to examine enabling factors as a mediator of the relationship among racial identity and help seeking and (3) to examine need factors as a mediator of the relationship among racial identity and help seeking. Using negative binomial regressions within a mediational framework, the relationships among racial identity and help seeking were assessed, with variables capturing predisposing, enabling, and need components of the Andersen Model of Behavioral Healthcare Use entered as mediators. The results showed that predisposing factors mediated the relationship among racial identity and help seeking behavior in Asian, Black, and White students, but not Latinx students. Enabling factors mediated the relationship among racial identity and help seeking in Asian and Latinx students, but not Black and White students. Need factors mediated the relationship among racial identity and help seeking behavior in White students, but not in Asian, Black or Latinx students. Clinical implications of these results and future directions are discussed. / M.S. / Mass shootings in educational settings negatively impact the mental health of survivors, especially Black, Indigenous and People of Color (BIPOC) who often bear the worst outcomes to these events. Individuals who are survivors of mass shootings don’t often utilize mental healthcare services despite their effectiveness in trauma exposed populations. This study uses the Andersen Behavioral Model of Healthcare Use to examine the help seeking behavior of students following the Virginia Tech 4/16 shooting. The results of this study indicated that Asian, Black and White students’ functioning in several areas of their life (e.g., social life, academic life) prior to the event explained the relationship between racial identity and help seeking behavior. Social support factors also explained the help seeking behavior of Asian and Latinx students. Lastly, students’ need as measured by their posttraumatic stress symptoms explained the relationship among racial identity and help seeking behavior in White students. Clinical implications stressing the importance of widened outreach following mass trauma are discussed.

Part I: Systematic Literature Review. Dysregulation of the motivational and incentive functions that underlie goal setting and goal pursuit is thought to be a key factor implicated in the aetiology of Major Depressive Disorder. Although research over the past two decades has shown that motivational and cognitive factors can play an important role in increasing negative affect and making individuals vulnerable to depression, much of this work has involved dysphoric and non-depressed samples and much less is known about their role in the maintenance of and recovery from clinical depression. The objective of the present study was therefore to identify and synthesize the evidence from studies that examined goals, goal pursuit and goal orientation in clinically depressed individuals. Only 9 studies meeting the inclusion criteria could be identified through systematic literature searches and were heterogeneous in design and quality. The results therefore do not allow strong conclusions to be drawn and need to be interpreted with caution. Bearing this caveat in mind, the findings did not support the idea that depressed individuals set fewer, less valued or more avoidant personal goals than non-depressed individual and suggested that problems were more likely to lie in the motivational and cognitive processes governing goal engagement and goal pursuit. Factors identified by the present studies likely to play a significant role in disrupting motivational processes and promoting maladaptive strategies of goal pursuit were perceived goal attainability, perceived lack of control, personal resources and skills required, type of goal focus, lack of goal specificity and goal engagement and disengagement processes. The results of two randomised clinical trials further suggested that therapies focusing on goal dysregulation in patients identified to lack adaptive strategies for goal pursuit and goal reengagement may be more effective than standard models. These findings identified promising areas for future research and highlight the importance of understanding individual profiles and subtypes of depression in order to target key areas of dysregulation and tailor treatment accordingly and in collaboration with the patient. The review highlighted the paucity of good quality studies involving samples of clinically depressed individuals and the need for more translational work focusing on clinically significant outcomes and developing reliable measures to assess day-to-day goal engagement and pursuit in depressed individuals. Abstract - Part II: Empirical paper. Goal orientation theory suggests that adopting a self-worth goal orientation (seeking self-validation and avoiding proof of worthlessness) may make individuals more vulnerable to depression, whereas pursuing learning goals (seeking personal growth and improving one's abilities) might represent a protective factor. This study examined whether adopting different goal orientations following negative performance feedback and unfavourable social comparison affected mood and performance on a subsequent performance task. Trait goal orientation was assessed in a sample of 86 U.K. university students who were allocated to three experimental groups receiving self-worth goal, learning goal and no instructions after receiving negative feedback on the first performance task. The findings provided some support for the original predictions of goal orientation theory (Dykman, 1998). Validation-seeking was associated with greater anticipatory anxiety following a negative event as well as reduced confidence when faced with a performance challenge. However, the results provided no substantial evidence to suggest that adopting a 'state' learning goal orientation vs. self-worth goal orientation mitigates the experience of negative affect or helplessness responses. Potential implications of the findings regarding the utility of the goal orientation construct as a predictor of depression vulnerability are discussed in the light of methodological limitations of the present study.