Dissertations / Theses on the topic 'Mental health|Behavioral psychology|Clinical psychology'

Dialectical Behavior Therapy for Adolescents (DBT-A) is an acceptance and change-based treatment protocol that includes parent participation, and has been shown to be effective with emotionally dysregulated, suicidal, and self-injurious adolescents (Mehlum et al., 2014, 2016) who often show high rates of treatment utilization and subsequent dropout (Groves, Backer, van den Bosch, & Miller, 2012). Despite its demonstrated effectiveness and despite parents’ active role in treatment, there is limited treatment acceptability data for DBT-A, and even less investigation into the parent perspective. Pretreatment expectancies and preferences are two common factors associated with treatment acceptability that have been shown to influence treatment participation, adherence, and outcomes that can inform methods for enhancing evidence-based treatments, yet remain underinvestigated (Nock & Kazdin, 2001; Wymbs et al., 2015). The primary goal of the current study was to assess parent pretreatment expectancies and preferences prior to entering an outpatient DBT-A program with their adolescents. Twenty-three parents completed two self-report assessment measures just prior to starting treatment: The Parent Expectancies for Treatment Scale (PETS; Nock & Kazdin, 2001), and the Parent Preferences for Treatment form developed for this study to assess preferences for eight alternative treatment delivery formats. Results showed that parents had moderately high overall expectancies for DBT-A ( M = 97.78, SD = 9.03). Subscale analyses indicated high parent expectancies for its credibility (Credibility, M = 52.09, SD = 5.44), moderately high expectancies for child improvement (Child Improvement, M = 23.43, SD = 3.49), and moderate expectancies for parent involvement (Parent Involvement, M = 22.17, SD = 2.98). Highest rated expectancies were related to the credibility of DBT-A as a valuable, worthwhile treatment and the large role of parent involvement in treatment. The four most preferred alternative format options were to add weekly skills training for individual families, weekly individual parenting skills sessions, weekly parent-only support groups, and weekly parent therapy sessions. The two least preferred format options involved partially or fully separating parent and teens in multifamily skills group. This study provides preliminary support for the use of assessing parents’ pretreatment expectancies and preferences for DBT-A as an initial step toward understanding the treatment attitudes and desires of parents with teens referred to DBT-A. Clinical implications for the utility of these findings in clinical practice and future research are discussed.

Research on Reactive Attachment Disorder (RAD) is minimal and is limited primarily to describing its nosology and clinical treatment practices. This qualitative, multi-case, case study identified school-based academic and emotional–behavioral interventions and factors which contribute to or hinder progress by conducting open-ended, semistructured interviews with high school students with a diagnosis of RAD and with school personnel who worked directly with them. Participants were from two neighboring school districts in a relatively large western state. Participants included five high school students with a diagnosis of RAD and four school personnel who worked directly them. One staff member had two students who participated in the study and thus interviewed specifically regarding both students. Data is reported holistically, as well as in paired student-staff responses to demonstrate the similarities and differences in the perceptions in relation to interventions and factors which contributed to or hindered student academic and emotional-behavioral progress. Five themes emerged in this study which led to specific implications for professional best practice including: 1) necessity for additional training, 2) development of support systems in the school setting, 3) providing a “go-to” person, 4) provide direct instruction in why and how emotional-behavioral progress will be monitored, and 5) provide direct instruction in how to build and maintain trust. As not all of these practices are currently implemented or intuitive it led to the development of a new theoretical explanation: RAD Teaching Practice.

Although gratitude may seem straightforward, it is a complex construct comprised of cognitive, emotional and behavioral elements. Gratitude has been presented as a positive psychological character trait, coping response, attitude, moral virtue, emotion, and habit (Emmons, McCullough, & Tsang, 2003), and significant overlap exists among these definitional presentations (Lambert, Graham, & Fincham, 2009). Despite definitional limitations, promising evidence indicates that gratitude can help survivors positively process and cope with trauma and contribute to the post-trauma recovery experience (Kashdan, Uswatte, & Julian, 2006; Vernon, Dillon, & Steiner, 2009). Yet, there is a lack of research examining how gratitude is expressed in psychotherapy with those who have experienced trauma.

The purpose of the current study was to qualitatively explore expressions of gratitude by psychotherapy clients who were trauma survivors. A deductive coding system was used, based on existing gratitude literature that allows researchers to comprehensively examine different types of gratitude. This study also compared gratitude expressions that took place during trauma and non-trauma discussions, which is an area of research that had not been examined.

In contrast to existing assessment and research, the findings from this study revealed that clients tended to express gratitude infrequently, in a Narrow manner or in a manner that was Not Otherwise Specified . Findings revealed that client expressions of gratitude were captured by four of the nine proposed coding categories: personal gratitude, gratitude for specific benefits received from a higher power, gratitude expressions that are not otherwise specified, and generalized gratitude as an attitude, in order of frequency.

It is hoped that the current study will contribute to the definition, understanding and measurement of gratitude in therapy. By demonstrating the extent that gratitude is utilized in psychotherapy with clients who have experienced trauma, the results of this study can be used as a baseline from which to compare results of future studies that evaluate the effects of training therapists in gratitude interventions. This study may also help therapists develop a deeper understanding of a gratitude that emerges as a result of trauma, which can potentially inform their use of gratitude in future assessment and treatment.

The purpose of this dissertation is to examine licensed mental health professionals' attitudes towards rape survivors. Research indicates that the attitudes of police officers, mental health professionals, and the general public may influence the psychological adjustment of rape survivors and, consequently, whether or not that person seeks mental health treatment after the assault (Vincent, 2009). The negative impacts of rape on a person may not be specific only to the act of violence, but may also include secondary victimization from the survivors' negative experiences with authorities such as legal and mental health professionals (Campbell & Raja, 1999) who may hold negative beliefs about sexual assault and rape survivors (Nagel, Matsuo, McIntyre, & Morrison, 2005). Exposure to these negative beliefs held by others may be associated with negative secondary emotions in the survivor, such as guilt; guilt associated with actions taken or not taken in the context of rape has been observed to be positively correlated with posttraumatic stress disorder, depression, low self-esteem, social anxiety, and suicidal ideation (Kubany, Abueg, Owens, Brennan, Kaplan, & Watson, 1995). It is therefore important to examine the attitudes licensed mental health workers hold towards rape survivors, as these rape survivors may seek services from mental health professionals, and the clinicians' attitudes towards these clients' experiences may significantly impact survivors' recovery from a sexual assault. In addition to measuring the acceptance of rape myths in licensed mental health providers, this study aims to explore how demographic variables in mental health professionals, such as gender, type of graduate degree, or participant rape survivor status, are related to the attitudes participants report about sexual assault. It was hypothesized that male study participants would attribute greater responsibility to survivors than female study participants would, based on the results of the updated Illinois Rape Myth Acceptance Scale, and congruent with published research highlighting this gender difference (Grubb & Harrower, 2009). It was hypothesized that mental health providers who have had more years of training in their graduate degree program would report lower levels of rape myth acceptance compared with those who had a shorter degree program. It was also hypothesized that participants who themselves identified as a rape survivor or who had a close friend or family member who is a survivor would attribute less responsibility to rape survivors, as research supports the observation that those who identify as survivors or friends of survivors may reject negative biases towards sexual assault survivors.

After completing both independent t-tests and Mann-Whitney U statistical analyses, gender identity was the only demographic for which statistically significant mean differences were seen in total rape myth acceptance scores (p = .012). This finding is not surprising, as much of the current literature supports that men, in general, attribute more blame to rape survivors than women. Prior to the current study there was no published research using licensed mental health providers as participants in a study using the updated Illinois Rape Myth Acceptance Scale. Data gathered from the current study will therefore offer a valuable contribution to the literature on this topic. Further, it is hoped that this data can be used in the development of graduate programs, continuing education courses, and didactic seminars that debunk rape myths and promote competency around rape survivor issues.

Psychological struggle seems to be an inherent part of the human experience. Unfortunately, the public attitude towards the obese focuses more on negative stereotypes (e.g., undisciplined, ugly, stupid, and lazy) than on the underlying psychological components that lie at the heart of the struggle. Negative stereotypes like these have an affect upon the way the obese think about themselves and may lead to self-stigmatization, which in turn may interfere with a person's attempt to gain control of their health and emotional well-being when eating is used to relieve the associated distress. Many people who struggle with their weight are found to be very rigid in their thought processes regarding food. Perhaps it is not the content of food and body-related cognitions that is important, but the inflexibility with which they are held.

The current study will investigate the relationships among avoidant eating behavior, perceived stigmatization, self-stigmatization, and psychological flexibility. Participants will be recruited from a population of obese individuals who are seeking help at a bariatric clinic, and from Facebook. Participants will initially complete a packet of questionnaires on psychological flexibility, perceived stigmatization, self-stigmatization, and eating behavior online. Then for seven days they will receive four text messages a day for seven days, three of which will provide them with a link to the Periodic Assessment of Stigmatizing Experiences, and one text message providing a link to the Daily Eating Survey. It is hypothesized that 1) Perceived stigmatizing experiences (i.e., a fear of enacted stigma from society) will predict disordered eating 2) Weight- and food-related psychological inflexibility will moderate the relationship between perceived stigmatizing experiences and disordered eating 3) Self-stigma (i.e., self-devaluation due to perceived stigmatization from society) will moderate the relationship between perceived stigmatizing experiences and disordered eating 4) Psychological inflexibility will predict increased perceived self-stigma.

This critical analysis of the literature is a comprehensive collection and review of the literature on the strengths-based perspective as it is applied to the treatment of substance use disorders. Literature was collected, analyzed, and critically evaluated to consolidate the existing research on strengths-based treatment approaches, identify ways in which the strengths-based perspective is congruent with culturally competent practice, and to identify strengths, weaknesses, and gaps in the literature. Analyses reveal that there are numerous components of the strengths-based perspective that are congruent with culturally competent practice and that strengths-based treatment approaches may serve as an effective adjunct or alternative to traditional treatment approaches for substance use disorders. While additional research is needed to further our understanding of the effectiveness of this approach, preliminary results indicate that there are numerous therapeutic advantages associated with the strengths-based perspective and its use with substance abusing populations.

Traditionally, mental health professionals have provided psychotherapeutic services through face-to-face sessions. As the Internet has become an increasingly important part of individuals’ personal and professional lives, psychologists and clients have used this medium to expand access to psychotherapy. The purpose of this quantitative correlational design was to investigate whether demographic variables and the personality traits of extroversion/introversion (E/I), as assessed by the Big Five Inventory, predicted clients’ preferences for a specific method of administered psychotherapy. The theoretical framework for this study was social information processing through computer-mediated communication. An online survey site was used to assist in survey design and data collection, and 301 individuals participated in the study. Results of the Pearson correlation indicated that age was negatively correlated with use of online therapy (p = .038). The variables of region, race, and E/I had no statistically significant effect on the use of online versus in-person therapy (all p values > .05). Findings reflected larger social trends that decisions to seek online therapy fall along lines of diversity related to age and technological knowledge. Recommendations include engaging older patients in opportunities for participating in online therapeutic services, as well as further research on the relationship between cultural diversity and online therapy. These results can inform practitioners and the community about the importance of expanding access to psychotherapeutic services for individuals who need them, which will in turn be an important component of positive social change.

This dissertation seeks to understand how five women currently enrolled in doctoral level psychology programs emotionally and relationally experience the process of recovery from an eating disorder. Contemporary interdisciplinary discourses are inconsistent in their discussion of recovery, with differing accounts of what constitutes recovery and the typical course of recovery. Using a voice-centered and relational approach, I interviewed five female doctoral-level students in the fields of clinical and counseling psychology about their experience of recovering from eating disorders. Interview data was analyzed using the Listening Guide Method (Brown & Gilligan, 1992; Gilligan, 2015) in order to emphasize the emotional and relational qualities of informant voices. My interest in this subject is, in part, inspired by my personal eating disorder history and doctoral training experiences. Although my personal experiences no doubt shaped what I asked and how I listened to the women in this study, I found that these courageous and honest women independently corroborated three interrelated themes. One, these women’s stories each directly addressed a controversial issue in the literature: What is the nature of eating disorder recovery? Is it an end-state or an ongoing process? Two, connection and disconnection from the self and others, which in many respects is perpetuated by societal pressures and expectations placed on women, plays a critical role in the development of eating disorders. And three, the informants highlighted the potentially critical role of self-disclosure in addressing the sensed disconnections from self and others, within both clinical-therapeutic and professional-academic relationships.

Meditation is increasingly integrated into therapeutic interventions. Metta (loving-kindness) meditation, which cultivates compassion, is relatively unstudied. Metta’s emphasis on compassion has spurred speculation that metta meditation may benefit mental health professionals at risk for compassion fatigue, a condition characterized by depression-like symptoms that results from paying witness to others’ trauma. The current study employed psychological phenomenology—a qualitative research methodology which uncovers the essential meaning of an experience—to explore mental health professionals’ lived experiences of metta meditation. Moustakas’s recommendations for phenomenology guided data collection and analysis. Semi-structured interviews with 17 mental health professionals, clinicians and clinical supervisors, yielded 58 invariant components clustered into eight themes regarding metta meditation experience. These themes were used to write textural descriptions for each participant, from which a textural composite was created. Structural mechanisms interwoven into the composite created the essential description of participants’ lived experience of metta meditation. Implications are discussed.

The peripartum period is a potentially difficult time in a woman's life, a time when up to 70% of women experience transient mood symptoms and approximately 15% will suffer from a severe mood event which impacts not just her, but her family as well. The symptoms and clinical features of the mood symptoms are linked to Major Depressive Disorder (MDD) and Bipolar Disorder (BD). Appropriate diagnosis as early as possible has a critical impact on the immediate and long-term health of the peripartum woman, especially in those with a bipolar diathesis. While treatment for BD versus MDD may be markedly different, it can be difficult to distinguish between the two, especially during a depressed episode, with postpartum onset. To date, no study has evaluated the Edinburgh Postnatal Depression Scale (EPDS) for its value as a screening measure for the differentiation of BD versus MDD in the postpartum period.

This study sought to: 1) to describe the demographic differences between women diagnosed with BD versus MDD seeking treatment for a major depressive episode, with postpartum onset; 2) to characterize the features of the major depressive episode; with postpartum onset in women diagnosed with BD versus MDD; and 3) to examine scale characteristics of the EPDS as a predictor of the diagnosis of BD versus MDD.

Results revealed that postpartum depressed women diagnosed with BD reported a) an earlier age of onset, b) a greater number of prior mood episodes, c) greater incidence of psychotic symptoms in the current depressive episode, and d) lower overall scores on the EPDS versus postpartum depressed women diagnosed with MDD. There were no reliable differences between the groups on family history of a) mood disorders; b) number of generations; c) weeks postpartum at symptom onset; d) scores on a 4-item subscale of the EPDS; e) suicidal/homicidal ideation; nor the incidence of symptoms of f) atypical depression, g) generalized anxiety disorder, or h) obsessive-compulsive disorder. The findings support the use of a thorough clinical and demographic history when evaluating postpartum depressed women and the use of a measure in place of or in addition to the EPDS to ensure the appropriate differentiation of BD versus MDD.

Research has shown that being a mental health therapist (MHT) is an extremely stressful vocation and often leads to burnout (Gibson, 2009). Evidence supports that humor and mindfulness assist in mitigating the negative effects of stress and burnout (Malinoski, 2013; Brown & Ryan, 2003). It is also known that the effective use of humor (McGhee, 2010a) and mindfulness practices (Hayes, 2005) can be learned, practiced, and integrated into daily interactions across the lifespan. This research examined humor styles, trait mindfulness, and burnout of 94 licensed MHTs in community mental health centers located in Western Massachusetts in an attempt to add to research regarding burnout and protective factors that may minimize the impact of burnout.

Results found that MHTs with higher scores of trait mindfulness reported reduced levels of burnout, which supports existing research. Additionally, those reporting higher frequency of maladaptive styles of humor tend to report higher levels of Depersonalization. MHTs who reported the regular use of affiliative types of humor reported a lower rate of Emotional Exhaustion. These findings may be used to inform future pre-service and in-service training of MHTs to include attention to the possible protective factors of adaptive humor styles and trait mindfulness in an effort to prevent burnout among practicing MHTs thereby improving longevity in the field.

This depth psychological study explores the possibility that the drawing and subsequent recognition of chaotic looking irregular and misshapen shapes, lines, and marks applied in a lopsided and unbalanced manner within and protruding outside a mandala circle represent the beginning of a psychological development in the patient's psyche. Such a shift in the psyche may set the stage for using mandala psychology to facilitate the psychotherapeutic work of gathering and containing additional destructive and shadowy psychological material.

A retrospective single case study design is combined with a heuristic approach to discover the effects of producing an asymmetrical mandala, as described above, while following the chaotic mandala images through a change in the plot line of the research/participant's psychological story. Information is collected and outlined for the depth psychotherapy community that describes the process of mandala psychology from this vantage point of unbalanced and chaotic mandalas, illustrating the mandala's usefulness as a container for psychological and emotional chaos. The change in the plot line of the subject's mandala story is compared to and amplified with the structure of the plot line of the prototypical fairytale narrative at the moment when the darkly woven female character of the witch enters the narrative. This mythological component is introduced to enrich the telling of this case study. The archetypal analysis hypothesizes that at the moment the research/subject engaged her chaotic mandalas, the shift she experienced represented the collective and empowering primal energy of the dark energies of the feminine, personified for this study as the witch. Key words include: asymmetrical, mandala, chaos, case study, witch, art therapy, creative, container, chaotic images, destructive psychological material, dark feminine, fairy tale.

Throughout the United States are institutions abundant with violent offenders who have been found not guilty by reason of insanity (NGI). The decision to release these insanity acquittees into the community is a vital one, both for the patient and the larger community. While these decisions should be informed by evaluations that combine clinicians’ opinions with validated tools of assessment, no standard of care regarding such evaluations exists. Forensic specialists are thus often left to base discharge decisions on clinical judgment alone. This dissertation assumed a critical review of the theoretical and empirical literature relevant to conditional release decisions of NGI patients, including the research on structured assessment of risk of future violence. Based on this critical review, the author proposed recommendations for five standards to enhance conditional release decision-making for violent offenders in forensic settings: (a) Adherence to professional and ethical conduct; (b) documentation of patient progress; (c) incorporation of empirically-validated risk assessment tools; (d) creation of a comprehensive release plan; (e) verification of patient’s commitment to successful reintegration. This dissertation additionally examined the strengths and limitations of the critical review strategy, as well as delineated areas for research to empirically evaluate the recommended standards and promote improved quality of conditional release evaluation for NGI acquittees.

Research on microaggressions has consistently lacked focus on microaggressions experienced by persons with mental illness. What little research has been conducted has examined microaggressions as reported by the victim. The current study aimed to explore mental illness microaggressions by examining the view of the committer (i.e., the person enacting the microaggression), the role specific prejudicial beliefs (i.e., authoritarianism, social restrictiveness, benevolence) play in microaggressive behavior, and whether level of intimacy of interpersonal contact is related to reduced mental illness microaggressions. Participants for this study were recruited using Amazon’s Mechanical Turk; they completed a series of questionnaires and were compensated for their work. Results indicated there is a positive relationship between the likelihood of mental illness microaggression perpetration and the prejudicial beliefs authoritarianism and social restrictiveness while there is an inverse relationship between mental illness microaggression enactment and the prejudicial belief benevolence. This study determined that social restrictiveness accounts for the most variance when predicting potential perpetration of mental illness microaggressions. Additionally, results of this study determined there is a negative relationship between mental illness microaggression enactment and level of intimacy of interpersonal contact with mentally ill individuals, suggesting that interpersonal contact may be an effective strategy for reducing mental illness microaggressions.

The aim of this study was to contribute to the literature on the relationship between client pretreatment expectations and psychotherapy attendance. It investigated the construct validity of the Milwaukee Psychotherapy Expectancy Questionnaire - Brief (MPEQ-B; Marsden, 2014) and the value of Therapeutic Relationship Expectations and Change Expectations as predictors of intake attendance and the number of therapy sessions attended. Adult clients (n = 102) calling to schedule an intake appointment at a local community mental health center completed a survey of pre-treatment expectations (MPEQ-B) and psychological distress (Outcome Rating Scale, Miller & Duncan, 2000). Other variables (e.g., wait-time, previous therapy experience, number of sessions attended, and demographic variables) were collected from the clients' electronic medical record (EMR). Confirmatory factor analysis of the MPEQ-B supported a two-factor model, which was consistent with previous research (Marsden, 2013; 2014). Logistic regression revealed that client Change Expectations was the only variable to uniquely predict intake attendance. Pre-therapy attrition was more likely for clients with higher ratings of Change Expectations. Multiple regression results indicated that only previous therapy attendance was a statistically significant predictor of number of sessions attended. Overall, these findings advance the literature on client expectations as a multidimensional common factor related to client therapy attendance (intake session and total number of sessions attended). These results also highlight the need for programmatic research using the Milwaukee Psychotherapy Expectancy Questionnaire (MPEQ; Norberg, Wetterneck, Sass, & Kanter, 2011) and MPEQ-B, as well as measures of other types of client expectations, to better understand the influence of client expectations on a range of clinical variables.

Depression and anxiety during pregnancy can have a host of negative effects on mothers and their infants, such as premature delivery and increased risk for postpartum depression. Few studies have examined whether levels of the sex hormones progesterone and estradiol, which rise dramatically over the course of pregnancy, are associated with depression and anxiety. This study examined whether higher salivary progesterone and estradiol levels were associated with self-reported depression and anxiety scores among a sample of 128 low-income pregnant women, and whether these relationships were moderated by social support. The results showed that only social support levels had significant negative associations with both depression and anxiety levels. Sex hormones were not significantly associated with depression and anxiety, and social support was not a significant moderator in these relationships. Future studies should continue to address the dearth of research on assessing the roles of sex hormones in relation to mental health during pregnancy.

Psychotherapy is only as effective as the quality of its provider-patient discourse (Poland, 1968; Schwartz, 2009). It is arguable that, in the practice of psychotherapy, theoretical orientations will encapsulate common understandings of the attitude-intention-behavior process, in order to assist in the promotion and prediction of positive health outcomes; and, that personality traits, and professional and demographic characteristics will similarly influence the kind and quality of the therapeutic relationship.

The current research was interested in investigating whether there were meaningful relationships between the language or labels used to describe consumers of mental health services and the primary theoretical orientation of the clinician. This was accomplished through examination of descriptor preference of consumers. Descriptors that were examined varied in terms of personable descriptors (e.g., the use of a client's initials) versus more traditional labels (e.g., patient and client abbreviations). Participants indicated preference by selecting descriptor words in case study vignettes in two repeated measures of least and most preferred options. Theoretical orientations surveyed were categorized as action-based (e.g., CBT, SBT, ABA, and systemic), insight-based (e.g., psychodynamic and humanistic), and other, which included integrative and crisis-based interventions used in medical environments.

Results indicated there were differences in the patterns of most and least preferred, depending on theoretical orientation. Insight-based practitioners demonstrated a greater bias against the use of initials and a bias away from the use of patient, whereas Action-based practitioners most preferred initial descriptors. These findings were in direct contrast to previous health care quality studies on physician provider populations, which, in general, opted for maintaining the use of traditional monikers. Further results indicated trends in term preference and demographic and professional variables. For example, related to Gender, men showed a preference for the term patient, whereas women did not. Additionally, older and more experienced clinicians were less biased against the use of the more traditional client. Findings were explained in terms of the differences in the primary foci of services between mental health and physician providers and in terms of the underlying objective in the training of psychotherapy to cultivate heightened listening skills and sensitivity towards the quality of therapeutic discourse.

Anxiety disorders are the most prevalent mental health concern in the United States. Yet, many who suffer from anxiety do not receive treatment or fail to respond to well-established cognitive and behavioral interventions. Mindfulness- and values-based strategies are possible alternatives for these individuals. However, values-based approaches have not been adequately studied in anxious populations and it is unclear how they may interact with mindfulness-based approaches. Moreover, little is understood about the mechanisms of action underlying behavioral changes resulting from mindfulness meditation (MM) practices. Acceptance and Commitment Therapy (ACT) is one approach that employs values clarification (VC) and mindfulness to bring about improvements in quality of life (QOL). ACT also provides a behavioral account of human vitality that may increase specificity of mediating and moderating variables that are critical for good outcomes following mindfulness-based treatment. The present investigation aimed to evaluate the effects of MM and VC on QOL and anxiety symptomology and to elucidate significant mediators and moderators of the relations between MM and VC and positive outcomes. In so doing, highly anxious participants (N = 120) were randomly assigned to a 10-min MM practice + control task or a 10-min MM practice + VC task. Pre, post, and daily diary assessments were employed over the course of 16 days and included several well-established process and outcome measures. Results suggest that 2-weeks of MM practice leads to decreases in anxiety symptom frequency and increases in QOL during the previous 24-hour cycle. VC did not significantly affect primary outcomes. Acceptance appears to be the most important mediator assessed herein of the daily effects of mindfulness on anxiety symptoms, though valued action was a numerically stronger mediator between mindfulness and QOL. Practice quality was related to daily reductions in anxiety symptoms and improvement in daily QOL. However, it did not moderate response to MM. Surprisingly, MM practice time, when controlling for average practice quality, was related to worse QOL outcomes for those who participated in VC. Results are discussed in terms of enhancing the impact of psychological treatments for the anxiety disorders, in addition to implications for personal mindfulness meditation practices.

Throughout history, people suffering from a mental illness or emotional crisis have been treated quite differently. The accepted treatments of the day could be cruel, and sometimes deadly. Within these times, there have also been people who questioned treatment-as-usual, particularly when they viewed that treatment as either unhelpful or dangerous. Alternative treatment programs have been developed with varying success. CooperRiis is a therapeutic healing community in North Carolina that opened in 2003. It is providing an alternative to treatment-as-usual to inpatient psychiatric hospitalization. This case study aimed to investigate whether there was a flexibility within the organization that allowed it to adapt to the changing needs within its own community, as well as to continue operating within the larger mental health community, to remain operational. The findings resulted in different revelations. It was discovered that the process of how decisions are made impact the community differently. Also, whether a leader is connected or disconnected from the community has a significant impact on it. These aspects, in particular, can influence feelings of empowerment or disempowerment within the community. Recommendations are provided both for where CooperRiis could benefit from more focus, as well as aspects of the programming it is doing well. In many of the alternative programs that are developed, a common thread is the focus on connection, as well as finding the humanity within both the providers and recipients of help. CooperRiis is yet another example of how this community, connection, and humanity is the therapy that heals.

This study brings attention to the growing body of literature examining the role of culture and context in the study of generation-status differences in cross-cultural coping and physical well-being among immigrants to the United State. Prior literature on the unique challenges, stressors, coping strategies, and health outcomes for immigrants provides a basis for hypothesized generation status differences on cross-cultural coping (collectivistic, avoidance, and engagement) and physical well-being (health, safety, and environmental). A sample of 118 male and female first, 1.5, and second-generation immigrants of non-European backgrounds, between the ages of 18 and 35, were recruited from the local community to complete an online questionnaire. Results from the cross-sectional study did not yield support for the hypothesized generational status differences. However, exploratory analyses yielded several significant correlations including a positive relationship between collective coping and the safety dimension of physical well-being. Within-generation exploratory analyses yielded several significant correlations and differences on measures of coping strategies and physical well-being for demographic/contextual factors such as religiosity, age, SES, English fluency, connection to the U.S. culture, education, and ethnicity amongst 1.5 and second-generation immigrants. The empirical investigation of cross-cultural dimensions of coping and physical well-being among immigrants represents a new direction for research. This study also has potential implications for more nuanced understandings of the immigrant paradox, the socioecological perspective of acculturation, collective coping, and inclusion of both objective and subjective experiences of the environment. Implications for theory and practice, methodological limitations, and suggestions for future research are also discussed.

A workplace critical incident is any event which disrupts or impacts the functioning of a business, e.g., death of an employee, downsizing or robbery. Critical incident responders (CIRs) are specially trained licensed mental health professionals who respond to workplace critical incidents as support to both the employees and the business organization through applied crisis theory and as a business continuity resource. The goal of a workplace response is to return employees to their pre-crisis level of functioning. CIRs are required to become certified in a multi-component crisis intervention technique. Prior to this study, no data existed regarding how closely CIRs adhered to intervention models or what theoretical frameworks informed their practice. This study sought to understand, from the perspective of the workplace CIR, what practices they employ and why. The design was a two phased, sequential, mixed method explanatory design. Phase one was a quantitative internet based survey (n = 110) and phase two was a qualitative phone interview (n = 12) designed to enhance the understanding of phase one results and provide rich data on the experiences of workplace CIRs. The conceptual frameworks for this study were theories of crisis, crisis intervention and constructivism. The results found that CIRs demonstrate autonomy in deciding which interventions to apply during a response. Type and nature of the crisis as well as timing of response from the event influenced the CIRs’ approach. CIRs are informed by brief treatment modalities and even though CIRs have limited understanding of the phrase business continuity, they still provide the services. CIRs described modifying Mitchell’s CISD Model to address the needs of civilians in the workplace. Primary activities are assessing, normalizing and educating. Results will further the understanding of critical incident response and enhance the current best practice models.