Sleep disturbances are prevalent in primary care patients and can be exacerbated by interpersonal dysfunction and depression. As well, thwarted interpersonal needs (TIN), including thwarted belongingness and perceived burdensomeness, contribute to depression. However, the presence of gratitude, a cognitive-emotional protective factor, may improve symptoms. We longitudinally examined the mediating role of depressive symptoms on the relation between TIN and sleep disturbances, and the moderating role of gratitude on the TIN-sleep disturbances and depression-sleep disturbances linkages. Our primary care patient sample (N = 223) completed self-report surveys at baseline (T1) and at a one-year follow-up (T2; n = 97). Patients with greater TIN reported more depressive symptoms (T1) and, in turn, increased sleep disturbances (T2). Gratitude did not moderate the belongingness model but, in the burdensomeness model, buffered the linkage between burdensomeness and sleep disturbances and strengthened the relation between depressive symptoms and sleep disturbances. Clinical implications and future research directions are discussed.

Many surgical procedures in the head and neck regions produce visible scarring. The most common of these surgeries are tracheotomies and thyroidectomies. The recent COVID-19 pandemic has caused an increase in tracheotomy scars, particularly in those who survived severe infection with the disease and required long-term ventilation. Individuals with neck scars are at an increased risk of health consequences such as reduced quality of life, depression, and negative body image. Research on attitudes toward and reactions to individuals with such scarring is limited. The purpose of this study is to examine how people rate images of scarred individuals on personality and attractiveness attributions. In addition, dermatography, or medical tattooing, is an emerging cosmetic intervention used to mask scarring, and has demonstrated positive outcomes in cases of breast cancer. This study further aims to examine how people rate images of individuals with scars covered with medical tattoos. Personality attributions were measured using the Five Factor Scale and various dimensions of attractiveness were measured using the Interpersonal Attraction Scale. Acceptability of medical tattooing as a cosmetic intervention for head and neck scars was also examined using the Decision Satisfaction Scale. Participants consisted of 456 young adults and were presented with two series of images, each consisting of a young adult, the young adult with a neck scar, and the young adult with a tattoo covering the scar. Participants were asked to rate each image directly after viewing. We hypothesized that those without scars and those with medical tattoos would be rated more positively on personality and attraction scales than would those with scars. Multivariate analysis confirms scarring and medical tattoos influence personality attributions. Non-scarred individuals were rated more positively in perceived Agreeableness and Conscientiousness traits when compared to scarred individuals. However, when compared to non-scarred individuals, scarred individuals were rated more positively on the Openness to Experience trait. This demonstrates the variability of impressions that a neck scar can elicit. Reactions to scars covered with tattoos were mixed. Medical tattoo recipients were rated more positively on Extraversion and Openness to Experience traits compared to scarred individuals. They were also rated lower on Conscientiousness compared to scarred individuals. Acceptability of medical tattooing was higher in participants who reported lower levels of religiosity and higher levels of social media use. This study highlights the varying effects that head and neck scars can have on appearance and the use of medical tattooing in clinical practice.

Conventional breast-cancer prevention strategies tend to focus on the reduction of physical breast-cancer risk factors while neglecting psychosocial factors potentially associated with its development. Yet, there is a wealth of evidence linking psychosocial factors such as the occurrence of and maladaptive coping with bereavement and other stressful life events, certain personality traits, and a lack of social support, to breast-cancer incidence, survival and mortality.This thesis aimed to design, implement and evaluate an electronic Coping-Enhancement Programme for the Bereaved (CEPB), addressing such psychosocial factors. Furthermore, participants’ experiences of the programme were to be explored. An experimental 2x2 independent measures design with triangulation was used, employing qualitative and quantitative methodology. Participants’ experiences were elicited qualitatively through blogs and message boards. The two independent variables were (1) emotional-expression-and-stress-reduction (EESR), and (2) psycho-education. Dependent variables were: (1) maladaptive coping with bereavement, (2) maladaptive coping with stressful life events, (3) social support, and (4) awareness of the connections between psychological and physical health. An additional dependent variable was conformity. A Web site containing message boards and blogs was created. Thirty-one women completed a psychological screening form and were then randomly assigned to one of four conditions (EESR-only, psycho-education-only, EESR-plus-pyscho-education, or the control group who received no intervention). They participated in online exercises designed to aid emotional expression and stress reduction (‘Art and Laughter for Wellbeing’) and/or received psycho-education through the reading of autobiographical accounts of breast-cancer sufferers. Participants were analysed on the dependent variables three times: before the programme to obtain a baseline measurement, after the programme, and at six-week follow-up. Thematic analysis was used to illustrate the process of the CEPB, as well as to confirm or disconfirm quantitative results. Analyses of covariance revealed that after the programme, taking part in ‘Art and Laughter for Wellbeing’ was associated with lower maladaptive coping with bereavement, while reading autobiographical accounts of breast-cancer sufferers was associated with lower maladaptive coping with stressful life events. Participation in both conditions was associated with higher levels of social support, and taking part in either condition was associated with lower levels of conformity. The latter effect persisted at follow-up. Mixed analyses of variance showed changes over time in three dependent variables. The CEPB was generally viewed as useful, helpful and enjoyable by participants. Implications for future research are discussed, and a biopsychosocial model of breast-cancer prevention is proposed.

The goal of this research was to investigate multiple aspects of self-regulation and their relationship to stress, sleep, and behavioral health. Participants (N=89, 55 females, 29 males, and 5 did not list their sex) were recruited from a high-risk Midwest high school. Participants reported their own self-regulatory ability, sleep, stress, and behavioral problems. Nail samples were also collected from a subset of the participants to assay for cortisol and DHEA. Several measures of self-regulation were found to correlate with sleep quality, behavioral problems, and perceived stress. The natural log of the ratio of cortisol to DHEA was positively correlated with multiple measures of self-regulation. These findings demonstrate a relationship a positive relationship among self-regulation, sleep quality, and improved behavioral functioning as indexed by lower levels of externalizing and internalizing behaviors. Better self-regulation also correlated with lower perceived stress, but higher physiological biomarkers of stress. These findings are discussed in the context of theoretical proposals of self-regulation and stress adaption.

<p> Mass shootings that end in suicide at public venues such as schools have become shockingly frequent. In many cases the attackers have left communications indicating envy and bullying as the source of their rage. With healthcare becoming more universally available and the U.S. Surgeon General&rsquo;s focus on bullying as a national healthcare issue, the mental health community would be remiss in failing to adequately address bullying behavior and its effects at this time. Relational aggression is a particular type of bullying that relies on surreptitious gossip and the willingness of participants to accept roles of victim or bully. Using hermeneutic phenomenology, this thesis creates a depth psychological model for exploring the intrapersonal and interpersonal bully&ndash;victim dynamics in relational aggression through the use of the stories of Cinderella and Arachne. The findings demonstrated how archetypal defenses maintain the bully&ndash;victim dynamic and the difficulties in and importance of perspective taking in its resolution.</p>

<p> Millions of people are adversely affected by crises and disasters each year. Response to disasters relies heavily on volunteer organizations to assist in the aftermath of these traumatic events. HOPE Animal-Assisted Crisis Response (AACR) is one organization that provides needed support to those impacted by way of specially trained crisis dogs. Unfortunately, there is a lack of these certified teams able to effectively respond. The research question for this study was how can HOPE AACR expand (recruit and train qualified new teams) into currently unoccupied areas. This question was answered through collaborative action research (AR) with this organization's members, those who possess the specialized knowledge and training for AACR work. Due to the fact that the nature of this AR did not contain sensitive information that posed risk to participants and that written permission was obtained to use the site name, an exemption was granted to name the site in this study. In particular, this study worked with regional directors in charge of various areas of the U.S., elected board of directors responsible for oversight and approval of organizational changes, and a group of current certified volunteer team members. Participants engaged in various interviews and focus groups in order to share perspectives and experiences to solve the identified problem. Through this AR process, this research team determined a plan of action (target area for expansion and strategies to recruit and train new members). The goal of this study was to document a process which can be refined and re-used for future expansion efforts. Implementation of this action plan will also result in expanded territory, increased ability to meet requests for services, and ultimately enhanced recovery for those exposed to crises and disasters. </p><p> <i>Keyword:</i> Animal-Assisted Crisis Response</p>

The relationship between adolescents’ health decisions and their coping reactions to threat has been the focus of some empirical research. A relevant theoretical perspective is the Conflict-Theory Model (Janis, 1983) which specifies several modes by which people cope with threat, including vigilance (objective appraisals), defensive avoidance (evasion of anxiety) and hypervigilance (panic). Developed to explain adult decision making, Conflict-Theory postulates were applied to health decisions in adolescents, thus extending the model to a new population. Conflict-Theory proposes that coping styles moderate relations between health beliefs and decisions, such that perceptions of threat and response-efficacy better predict health decisions in persons high on vigilance, or low on defensive avoidance or hypervigilance. These postulates were tested in a large-scale cross-sectional survey (Umeh, in press). The study involved 885 adolescents (aged 13-17 years) and focused on several important health behaviours (substance use, regular exercise, dietary fat consumption, unsafe sex). There was little evidence that dispositional coping styles moderate relations between health beliefs and decisions. Beliefs about the efficacy of using protection during sexual intercourse predicted intentions to have unprotected sex as a function of vigilance. However, the pattern of this moderator effect contradicted Conflict- Theory postulates: efficacy beliefs better predicted intentions in participants low on vigilance. There was no evidence that relations between health beliefs and decision are affected by levels of defensive avoidance or hypervigilance. Each coping style predicted intentions to exercise regularly and (vigilance only) have unprotected sex, independent of health beliefs. Conflict-Theory also proposes that high levels of vigilance relate to low levels of health risk-taking, whereas high levels of defensive avoidance and hypervigilance relate to high levels of health risk-taking. These postulates were tested in a secondary survey focusing on cigarette use (using a subsample of 104 participants from the main study). Coping patterns were associated with health risk-taking in accordance with Conflict-Theory. Overall, there was no evidence that the proposed role of coping styles in belief-decision relations apply to adolescents. However, there was some evidence for vigilance as a moderator, and coping styles as predictors of decisions irrespective of health beliefs. Coping also relates to health risk-taking. Overall, the importance of Conflict-Theory coping styles in adolescents’ health decisions, whether as moderator or predictor variables, varies across coping constructs and health behaviours

Oestrogen decline during the menopause leads to decline in cognitive performance because oestrogen receptor sites are found in the prefrontal cortex and hippocampus of the female brain, areas associated with memory and attention functions. Extensive research over the past two decades has tested the effects of administering Hormone Replacement Therapy (HRT) to maintain oestrogen levels. MRI studies have shown improvements in hippocampal volume and frontal functions with HRT, but evidence for associated improvements in verbal memory performance has been mixed. Some studies have even found detrimental effects of HRT, leading to the suggestion of a critical period for HRT administration relative to menopause. Oestrogen receptor sites are found in frontal brain regions associated with working memory (WM) functions including attention. These functions have been researched less than verbal memory, but with similarly mixed findings. The research reported in this thesis tested the critical period hypothesis in relation to WM. Study one tested the prediction that HRT will benefit WM if the therapy is initiated during the peri-menopause, and will harm it if initiated post-menopause. A naturalistic sample of 121 women were recruited, comprising women who varied in the time they had begun taking HRT, and menopausal status-matched controls who had never taken HRT. Participants completed three tests of WM span and the Sustained Attention to Response Task (SART) on two occasions 12 months apart. WM performance supported the critical period hypothesis, with women who had begun the therapy after the menopause displayed worsened WM capacity when compared to peri-menopausal initiators and post-menopausal women with no history of HRT use. At one year follow up, postmenopausal HRT users were still underperforming compared to peri-HRT initiators and those in the post-menopausal stage with no history of HRT use. No significant differences were identified between groups on the SART. The effects of natural supplements on physical symptoms of the menopause have been researched, but there is little research on their effects on cognitive symptoms and none specifically testing the critical period hypothesis. Study two tested the effects of soya isoflavones on WM during peri- and post-menopausal stages. One hundred and twelve peri- and post-menopausal women were randomly allocated to receive either placebo or 100mg soya supplement in capsules daily for three months. Participants and researcher were blind to this allocation. Participants completed two tests of WM span and two Sustained Attention (SA) tasks at baseline, after three months of soya/placebo, and after a further three months without supplement. There was no effect of isoflavones on cognition, regardless of time of initiation of the supplement. This thesis offers a unique contribution to the literature, by establishing empirically that HRT may have long-lasting benefits for WM if administered in the peri-menopause period, and detriments if taken post-menopause. There was no evidence that administration of soya-based phytoestrogens for three months peri- or post-menopause replicated these effects of HRT on cognition.

Transgender and gender-nonconforming (TGNC) individuals in the United States experience significant marginalization due to stigma enacted at the structural, interpersonal, and individual levels. As a result, this population has reported increased behavioral and physical health needs, as well as unique barriers to healthcare. Moreover, TGNC individuals have reported greater experiences of childhood abuse compared to cisgender individuals. The cumulative experiences of stigma-related stressors and adverse childhood experiences put this population at risk for the development of mental and physical health problems, increasing need for health services. However, TGNC individuals have reported being denied medical care and postponing seeking care due to fear of discrimination, which may increase complications and severity of illness, and result in increased hospitalizations and healthcare costs. Utilizing the Andersen Behavioral Model of Health Services Use and Theory of Planned Behavior, the current study examined robust associations among stigma-related stressors, adverse childhood experiences, personal and physician-related enabling factors, mental, behavioral, and physical health needs, and healthcare utilization, intention, and delay among an online convenience sample of 109 TGNC adults in the United States. A series of multivariate and mediational analyses were conducted to determine the connections among predisposing factors, enabling resources, needs, health beliefs, and healthcare intention, delay, and behavior. Although predisposing factors were not directly associated with healthcare behavior, they were directly associated with healthcare delay. Moreover, mediation analyses indicated an indirect effect of victimization and adverse childhood events to decreased healthcare utilization and increased delay through mental health needs, internalized stigma, negative personal beliefs, perceived TGNC-inclusivity of healthcare providers, and finally, behavioral intention. Thus, the present study illuminated a possible cascade of detrimental effects that are initiated by stigma-related stress and adverse childhood experiences through enabling resources, needs, and beliefs, that ultimately are associated with healthcare utilization intent, behavior, and delay. These findings highlight the need to address both TGNC individuals’ timely use of care, and the quality of care they receive. It is imperative that future research takes a multi-level approach by creating and testing evidence-based interventions to improve both healthcare providers’ competency, as well as for TGNC individuals’ ability to coping with stressors.

It is widely supported that participation in athletics is positively correlated with increased overall health. However, some research indicates that participation in increased levels of competition is positively correlated with higher levels of depression and anxiety. This means, that if compared, athletes competing nationally or internationally would report higher levels of both depression and anxiety than athletes competing at the intercollegiate level. Research indicates that this could be caused by increased amounts of pressure, personal cost, and expectation. This study examines potential differences between intercollegiate, intramural, and non-athletes in these areas on a college campus. The first hypothesis is that depression symptoms will be more present in intercollegiate athletes than in intramural participants. The second hypothesis states that anxiety symptoms will be more prevalent in intercollegiate athletes than in intramural participants. The third hypothesis states that life satisfaction will be greater in intramural participants than in intercollegiate athletes. Lastly, the fourth hypothesis states that perceived social support and athletic identity will mediate the relationship between level of athletic participation and psychopathology. Participants in this study gave informed consent, completed a demographics questionnaire, and scales measuring depression and anxiety, life satisfaction, athletic identity, and perceived social support. The participants were recruited from intercollegiate teams, intramural teams, and psychology courses at Western Kentucky University. The first and second hypotheses were not supported since intramural participants did not have significantly different levels of depression compared to intercollegiate athletes and non-athletes. Results revealed intramural participants are more satisfied with life than intercollegiate and non-athletes, which supports the third hypothesis. The results also revealed that life satisfaction is mediated by both athletic identity and perceived social support, which shows partial support for the fourth hypothesis. The fourth hypothesis was not supported for depression and anxiety because these factors did not have significant differences between the groups so finding a mediating factor was not possible.