Through perspectives from neuroscience, transpersonal psychology, and transcendentalist philosophy, the art of yoga is proposed as a supporting modality for healing through complex trauma. Personal narrative and original paintings further speak to a process of coming back Home. Where trauma strips one of self, yoga breeds connection back to Self. Yoga is union of individual consciousness with universal consciousness. Yogic philosophy invites one into a space of grey, somewhere between object and subject, physical and spiritual, tangible and ineffable. It is there one comes to find healing by sitting back as a pure observer. In the journey of trauma uncovery, one comes to meet an embodied sense of safety that prevails across levels of body, mind, and soul. The stars begin to shine once again in the universe held within.

The COVID-19 pandemic adversely affected the lives of most Americans. People with Substance Use Disorder (SUD) were particularly vulnerable to the negative effects brought on by the pandemic. This study explored the increase in deaths due to opioid overdose during the pandemic exacerbated by factors such as increased stress, decrease in treatment options due to social distancing requirements and facility closures, social isolation, and an increase in spare time. Access to treatment for opioid use disorder (OUD) was interrupted by the measures meant to mitigate the spread of COVID-19. Through a systematic review of current literature, it was demonstrated that existing patients were able to maintain access to care, while few new patients were able to initiate treatment. Telehealth proved to be a vital means of assuring PWUD were able to access life-saving treatment amid a pandemic. Further research is needed to determine whether SUD treatment measures during the COVID-19 pandemic warrants changing the policies long term.

Introduction: Despite advances in evidence-based smoking cessation approaches, quit rates in people with mental health conditions who smoke have not increased over the past decade. This research explored the role of family or peers in promoting smoking cessation in this population, using three specific aims; 1) examine the association between family or peer views on tobacco use and smoking cessation, 2) identify pathways through which family or peer factors influence smoking cessation, and 3) identify social barriers and facilitators to seeking cessation support when quitting. Methods: We used data from the Population Assessment of Tobacco and Health Study and collected qualitative data from people with mental health conditions who currently smoke or quit within the last five years. Data were analyzed using logistic regression modeling, structural equation modeling, and rapid qualitative analysis. Results: Having family or peers with positive or neutral views on tobacco use significantly reduced the odds of quitting smoking. Higher intentions to quit and changes in smoking behavior mediated the relationship between supportive family or peer behaviors and quitting smoking. Quitting together and encouragement from family or peers were perceived as supportive, while nagging the individual undermined quitting success. Except for individuals who regarded autonomy highly or were not ready to stop smoking, stronger social relationships and tailored support increased willingness to involve family members in cessation interventions. Conclusions: Supportive family or peer attitudes and behaviors can positively influence smoking cessation in people with mental health conditions who smoke. Ways to identify ideal family or peer support partners to involve in cessation interventions are proposed.

An emerging framework, the Identity Pathology (IP) model, partially addresses persistent uncertainties about the primary causes of disparities in cardiovascular health (CVH) between black and white women and men through outlining how identity beliefs associated with social group membership lead to predictable differences in the health-damaging effects of discrimination exposure. Using data from the CARDIA cohort, this doctoral thesis seeks to: 1) propose a novel psychosocial characteristic, identity pathology, that drives the distribution of reported race and gender discrimination in health-relevant ways, 2) assess whether there are group differences in the effects of multiple versus single forms of discrimination on future CVH, and 3) assess variation between these groups in the relationships of reported racial and gender discrimination in a variety of daily life settings with future CVH. The IP framework suggests that beliefs about identity unique to each gendered race group influence the perception of discrimination and whether reported exposure will be associated with CVH. Simultaneous reports of racial and gender discrimination in multiple settings (compared with no discrimination) were negatively associated with future CVH only among white men. Further, the setting in which discrimination was reported appeared to be a significant indicator of whether experiencing multiple forms of discrimination negatively impacted CVH in each group. Our findings contribute to the literature through introducing a novel framework for assessing the effects of interpersonal discrimination. This work also provides preliminary evidence that compounded experiences of interpersonal racial and gender discrimination may not substantially contribute to poorer CVH among black women.

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.

Depression is the leading cause of disability among women of reproductive age worldwide. Upwards of 1 in 5 women suffer from perinatal depression. This condition has deleterious effects on several birth outcomes, infant attachment, and children’s behavior/development. Maternal suicide causes 20% of postpartum deaths in depressed women. Although the vast majority of perinatal women are amenable to being screened for depression, screening alone does not improve treatment rates or patient outcomes. Obstetrics/Gynecology (Ob/Gyn) clinics need supports in place to adequately address depression in their patient populations. The primary goal of this thesis is to develop, refine, and pilot test a new low-cost and sustainable stepped care program for Ob/Gyn clinics that will improve perinatal women’s depression treatment rates and outcomes. We developed and beta tested the Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID) Program, to create a comprehensive intervention that is proactive, multifaceted, and practical. RAPPID aims to improve perinatal depression treatment and treatment response rates through: (1) access to immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers; (2) clinic-specific implementation of depression care, including training support and toolkits; and (3) proactive depression screening, assessment, and treatment in OB/Gyn clinics. RAPPID builds on a low-cost and widely disseminated population-based model for delivering psychiatric care in primary care settings. Formative data and feedback from key stakeholders also informed the development of RAPPID. Our formative and pilot work in real-world settings suggests RAPPID is feasible and has the potential to improve depression detection and treatment in Ob/Gyn settings. The next step will be to compare two active interventions, RAPPID vs. enhanced usual care (access to resource provision/referrals and psychiatric telephone consultation) in a cluster-randomized trial in which we will randomize 12 Ob/Gyn clinics to either RAPPID or enhanced usual care.

The purpose of this qualitative study was to explore school nurses’ (SN) perceptions of factors influencing their ability to identify, refer, and provide mental health services to students with early signs of mental, emotional, and behavioral (MEB) needs. The National Research Council and Institute of Medicine have urged a preventive public health approach to decrease adverse outcomes of unidentified and untreated MEB needs among children (O’Connell, 2009). Historically and theoretically based in public health, SN have daily contact with students and are in an optimal location for early identification, referral and provision of services, yet little empirical research describing their role is available. Five focus groups with 29 SN were conducted and four themes emerged through analysis of data: Frequent flyers : student visits to SN offices, the observations that alert SN to potential MEB needs; Digging to get the whole picture : the process SN frequently used to collect information necessary to confirm MEB needs; Road to referral : the resources used and barriers encountered within the referral process; and, Safety zone : the important role SN play in the provision of services to students with early signs of MEB needs. Within the provision of services was a collective subtheme across all five focus groups: What we need to better help our kids. In this category SN identified their educational limitations and learning needs, as well as potential strategies to improve provision of services for students with MEB needs. The findings of this study provide a lens into the complex and little explored are of early identification, referral and intervention processes used by SN to care for students with MEB needs. Understanding the role of the SN is a critical first step towards improving outcomes.

Objective: To examine the relationship between hope, core self-evaluations, physical function, emotional well-being, health risk behaviors, and academic performance in freshman enrolled in their first year of college. Participants: Freshman (N = 495) attending a large public university in the Northeast completed an online survey between February 1 to February 13, 2017. Methods: Cross sectional descriptive survey. Linear regression, path analysis, and structural equation modeling procedures were performed. Results: Core self-evaluations mediated the relationship between hope and emotional well-being and academic performance. Contrary to the hypotheses, higher hope predicted more sexual risk taking behaviors and alcohol use. Conclusions: Core self-evaluations is an important component of hope theory. Hope Theory is useful for predicting emotional well-being, and academic performance, but not as useful for predicting drug use, alcohol use, and sexual risk taking. Hope and core self evaluations interventions are needed to improve academic performance and emotional well-being in university freshman.

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.

Sexual abuse is often associated with long-term distressing effects. The experience of sexual abuse differs between survivors and the disclosure of the abuse is a complicated process that may have many particularities attached. For this study, I conducted an interpretative phenomenological analysis to understand how Afro-Caribbean women who experienced sexual abuse understand and make meaning of their experiences and the particularities attached to disclosure. Although prior research regarding sexual abuse has been conducted, research amongst Afro-Caribbean women has been minimal. Further absent from the sexual abuse literature is the lived experience of this population and the meaning they ascribe to their experience. This study utilized semi-structured interviews to elicit data from a sample of five women who identify as Afro-Caribbean or Afro-American women of Caribbean decent who experienced sexual abuse. The emergent themes from the analysis were identity of self as a sexual abuse victim, protection of self from the perpetrator, release of self during and after disclosure, and resilience of self. Themes from the analysis of the participant interviews revealed the experience of sexual abuse in the context of Afro-Caribbean women. This information provides valuable knowledge that may contribute to the larger field of marriage and family therapy by expanding the horizon of cultural awareness around this specific population.