RSS 1.0Psychology
Recent Submissions
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I hear what you're saying: evaluating the couple validation training (CVT), a brief behavioral interventionCouple distress has strong implications for individual, couple, and family functioning. Research has found couple relationship education to be an effective tool in alleviating couple distress, thus improving the quality of couple communication and problem-solving skills. Couple relationship education has been shown to be more cost-effective and less likely to provoke the typical fears couples face when considering couple therapy, increasing the likelihood of receiving needed help. This study used a brief, highly structured behavioral intervention to teach partners to identify and code effective and ineffective ways of communicating. The primary research question sought to determine whether learning a structured coding process would lead to observable behavior changes through increased use of validating communication behaviors and decreased use of invalidating communication behaviors during a conflict-based discussion with a partner. Secondary questions pertaining to effective communication, relationship satisfaction, and training satisfaction were also explored. Participants were 16 couples who identified as being in a committed (nonmarried), heterosexual relationship, ages 18-40 (M = 26.00, SD = 6.61), and who were interested in improving their communication skills. The study used a quasi-experimental, three-level multilevel model to assess for dependence and change in the dependent variable (communication behaviors) over time. Hypothesis testing using the multilevel model found a significant difference between intervention and control groups pre to post workshop. However, inconsistent with the hypothesis the control condition increased validations significantly while the intervention condition showed no significant change over time. No other significant difference between groups were found. Other areas of interest emerged from the data. Couples self-reported a benefit from engaging in the study; over 85% of couples reported feeling satisfied with their experiences in the workshop and gave positive feedback about their experience. Future studies may explore the mechanisms of change and the possibility of additional clinically relevant changes which are not measured in this study. Keywords: relationship education, couples, validation, invalidation.
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In pursuit of harm reduction in the Alaskan context: patient cultural explanatory models of addiction and treatment outcomes for a medically-assisted program utilizing a buprenorphine/naloxone formulationThis study explored the process of completing a private-for-profit medically-assisted treatment (MAT) program which treats opioid use disorder in a semi-rural community in Alaska. The goal of the study was to answer two broad research questions: (a) did patients get better during the medically-assisted treatment program, and (b) what characterized patient experiences participating in the MAT program? Limited research has been conducted to understand patient experiences of completing medically-assisted treatment in small communities and how various factors may impact treatment outcomes and recovery trajectories. To achieve this goal, a mixed methods case study approach was conducted to evaluate changes in symptom distress and characterize the experience of patients who participated in the program. Three Phases were implemented. Phase I involved archival data analysis of a 22 patient dataset was conducted to assess pre-post treatment outcomes. In Phase II three participants were interviewed who initiated in the program to explore patient treatment themes. Phase III involved co-interpretation of preliminary findings MAT program providers to synthesize findings and gain insights into systemic factors that may have impacted participant experiences. The three-phase research study revealed three major findings. First, MAT patient program completers in our sample who utilized buprenorphine/naloxone in conjunction with counseling experienced a statistically significant reduction in psychological distress with a large observed effect size (Phase I). Second, themes that emerged from semi-structured interviews suggest motivation and treatment process factors play an important role in treatment success (Phase II). Finally, community stakeholders on the provider treatment team were consulted to more deeply understand why it is important to assess patient needs and co-interpret key study findings (Phase III).
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Stigma, self-efficacy, and adherence behaviors in people with type 2 diabetes: unexpected outcomesType 2 diabetes mellitus is a health condition treated with behavioral modifications including changes in diet, exercise, foot care regimens, and medication. Stigma associated with type 2 diabetes negatively effects health outcomes, whereas patient-provider relationships positively affects health outcomes. The growing literature base on type 2 diabetes stigma and health outcomes is mostly conducted outside of the United States. The present study used online crowdsourcing methods to gather cross-sectional survey data from people (n=152) who have been diagnosed with type 2 diabetes and are living in the United States. Participants completed the survey battery measuring stigma, self-efficacy, patientprovider relationships, and health behaviors. It was predicted that 1) internalized stigma would have a negative impact on self-care behaviors including diet, exercise, foot care, and medication adherence as well as glycated hemoglobin [HbA1C] levels 2) self-efficacy would mediate each of those relationships, and 3) the patient-provider relationship, characterized by trust in providers would moderate the relationship between stigma and self-efficacy thus indirectly moderating self-care behaviors and HbA1C. To test these hypotheses, a set of five moderated-mediation analysis were conducted to test each outcome variable of diet, exercise, foot care, medication adherence, and HbA1C. Main findings of this study revealed paradoxical relationships between stigma, self efficacy, and trust in providers, although consistent with psychological reactance theory. Stigma was associated with medication non-adherence and worse HbA1C, which is consistent with literature. Results of this study suggest that patients who exhibit psychological reactance may struggle to adhere to recommendations despite being more likely to report that everything is okay. This dynamic may make it difficult for providers to accurately gauge patient engagement in care, ability, or progress in health behavior change. However, one could argue responding to stigma with reactance may be protective in other ways. There was some evidence to suggest providers can attend to reactance by attuning to trust within the patient-provider relationship. In summary, this study adds to the pool of literature on stigma and type 2 diabetes, specifically within the US which is important considering variances in social climates and health care systems across nations. Future research should corroborate our suppositions about the relationships between stigma, self-efficacy, and psychological reactance.
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Mental health problems in the mountains: needs, assets, and recommendations for managing mental health problems in mountain-focused wilderness-based education and related fieldsBackground: Through controlled exposure to stress, wilderness-based education programs can buildcapacity for adaptive coping and produce long lasting improvements to participants' quality of life.However, stress can also overwhelm them, resulting in the emergence and exacerbation of mental health vulnerabilities in the field. However, empirically grounded best practices for training, pre-trip screening, and protocol/policy for mental health specific to the wilderness context are not well developed. Aim: The aim of this study was to assess needs and assets, and develop recommendations for training, pre-trip screening, and organizational protocol/policy to assist with successful management of mental health problems in mountain-focused, wilderness-based education and related fields such as outdoor leadership, guiding, environmental education, snow safety, search and rescue, and wilderness therapy. Methods:A pragmatic, two phase, sequential mixed methods approach was utilized to explore this topic within the context of an overarching collaborative community based participatory research (CBPR) framework with organizational partners: National Outdoor Leadership School, Outward Bound USA and Canada, the Wilderness Risk Management Conference, and the Alaska Mountaineering School. A preliminary quantitative study utilized a cloud-based survey to determine baseline characteristics for 64 wilderness-based educators, guides, outdoor leaders, snow safety professionals, and search and rescue personnel. Qualitative interviews with 16 experienced and prepared key informants addressed the study aim in more depth, consistent with partnering organization priorities, in the tradition of CBPR. Findings: Mental health topics and skills are underemphasized in current training, and training was found to be of less value than personal and professional experiences with mental health. In the future, mental health should be increased and emphasized, possibly through the utilization of existing resources such as the stress continuum or curriculum such as Psychological First Aid as well as practical training opportunities that emphasize experiential learning around mental health. Current screening can present both risks and benefits for clients, instructors, and organizations. Nondisclosure and the impacts of stigma and prejudice on the interpretation and utilization of mental health screening information were major concerns. However, screening can guide preventive and proactive efforts, and build working relationships with potential participants. Future screening should be used to inform participants about course stress, encourage disclosure, and direct curriculum development. Multi-step screening, utilizing multiple interactions with participants before the course, was identified as a utilitarian way to facilitate improvements for future screening. In protocol/policy, field management of mental health problems is underemphasized relative to evacuation, resulting in overutilization of disruptive evacuation processes. While many organizations do well at responding to instructor mental health needs after incidents such as a fatality in the line of work, inconsistencies in implementation can create unintended barriers to instructor self-care. Future protocol/policy should prioritize instructor mental health by addressing inconsistencies in implementation, removing barriers to self-care and guiding the deployment of resources such as responsive staffing or free counseling benefits. Implications: This study contributes uniquely to the literature by providing an empirically-based perspective into a little researched topic, and multiple avenues for implementation of findings such as increasing mental health content and experience-based training, utilization of multi-step screening processes, and consistent implementation of organizational protocol/policy in support of client and instructor mental health. Recommendations for implementation address weaknesses and build upon strengths already present in training, screening, and protocol/policy. Overall, practice and research in this area are in need of further investigation and development. Future dissemination, research, and practice development could help develop measures or resources to support the improvement of training, screening, and protocol/policy across wilderness-based education and related fields.
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Explorations of intergenerational healing, resilience, and post-traumatic growth by helpers and healers on the Blackfeet NationThis project explored intergenerational healing, resilience, and post-traumatic growth within the context of the Blackfeet Nation in Montana, the roles of helpers and healers in this setting, and community experiences of familial trauma and the idiosyncratic healing and resilience processes according to their worldview. The central goal of this study was to provide a contemporary public narrative surrounding healing and resilience as these topics related to historical and intergenerational trauma in this specific community. This exploratory study was composed of the narratives of 14 co-participants working as helpers and healers on the Blackfeet Nation. Indigenous narrative and a cosmic relationality were honored and a phenomenological method of Gadamerian hermeneutics was utilized. Seven central themes arose in the process of data analysis including Spirituality, Trauma, Healing, Resilience, Helping Role, Community, and Blackfeet Worldview. Co-participants explored contemporary experiences of collective intergenerational trauma of those they served as well as personal and familial processes of healing and resilience. The centrality of spirituality, cultural immersion and personal cultural identity were discussed as aspects of intergenerational healing and resilience. A holistic and culturally idiosyncratic understanding of personal and intergenerational healing was emphasized including spiritual, emotional, mental, and physical modes of healing. Patterns of healing experienced collectively and synergistically within family systems and between community members were also identified.
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Attributions of blame and social reactions to scenarios of sexual assault of adult womenAlaska consistently has the highest rate of sexual assault in the nation, yet research within the state has focused on stranger rape or assaults which were reported to medical or law enforcement professionals. National research suggests these characteristics are not representative of most victims. The current study fills a gap in research by examining the attitudes and reactions towards victims of stranger and acquaintance rape who have disclosed their assault to friends rather than authorities. Attribution theory was hypothesized to underlie relationships between attributions, emotional reactions, and social behaviors that victims encounter. Using an experimental design, participants were randomly assigned to read either a scenario of realistic acquaintance (common) or stereotypical (rare) stranger rape. The stereotypical assault scenario depicted a victim who was attacked outdoors by a stranger in a physically violent manner. The acquaintance rape scenario, in which a woman experiences assault inside her home by a known acquaintance who uses coercive verbal tactics, reflects characteristics of sexual assault that are experienced by most victims. The influences of type of rape, modern sexism, rape myth acceptance, expected peer rape myth acceptance, gender, training, or experience responding to disclosures of sexual assault on participant reactions were explored. It was hypothesized that participants reading the acquaintance rape scenario, participants with higher acceptance of negative attitudes (rape myths and modern sexism) and expectations that peers accept high levels of rape myths, male participants, and those who lack training or experience responding to disclosures would report more negative attributions (high fault and blame), emotional reactions (low empathy and high anger), and social reactions to the victim and positive reactions towards the perpetrator (low attributions of fault and blame, high empathy and low anger). Results revealed that acceptance of modern sexism, rape myths, and expecting that friends accept rape myths were associated with higher attributions of fault and blame to the victim, more anger towards the victim, more empathy felt for the perpetrator, and increased likelihood of offering the victim negative social responses. When asked what would improve response to sexual assault at UAF, participants indicated that changes in training, the UAF community, Title IX processes, awareness, resources, and demonstrating trustworthiness are important. Given these results, recommendations for stakeholders include communicating that most students do not accept modern sexism or rape myths to combat pluralistic ignorance and targeting the most prevalent rape myths in training. Changes to education and awareness efforts are recommended, including conducting sessions in-person, over several sessions, within single-gender groups, and utilization of pre- and post-training outcomes assessments to measure a variety of biases (such as rape myths). Stakeholders are encouraged to use existing research as a framework for teaching students about different types of reactions to disclosures of sexual assault, emphasizing which reactions victims experience as helpful and hurtful. Limitations and strengths of the study are also discussed.
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Moderators of bicultural self-efficacy and mental health among Asian AmericansThe relationship between acculturation and mental health among Asian Americans has been established. For example, the integration strategy, often associated with bicultural competence, has been shown to positively predict well-being and self-esteem, and negatively predict various indicators of distress (Nguyen, Messe, & Stollak, 1999; Oh, Koeske, & Sales, 2002; Yoon, Lee, & Goh, 2008). Further, biculturalism (Chen, Benet-Martinez, & Bond, 2008) and bicultural self-efficacy (David, Okazaki, & Saw, 2009) have been associated with positive mental health outcomes among Asian Americans. That is, perceiving oneself as capable of navigating various domains (e.g., values, behaviors) within two cultures is associated with better mental health. Little is known, however, regarding the factors that may influence the strength of this relationship. Thus, the present study aimed to identify some moderating factors of the relationship between bicultural self-efficacy and mental health among Asian Americans. Considering previous research examining the factors associated with acculturation and mental health (Berry, 1980; Nguyen & Benet-Martinez, 2007; Padilla, 2006), it was hypothesized that bicultural identity integration, cognitive flexibility, psychological flexibility, and resilience would each moderate the relationship between bicultural self-efficacy and satisfaction with life, and between bicultural self-efficacy and psychological distress. Results indicated that bicultural identity integration approached significance, indicating that of all the hypotheses presented in this study, it may be the only moderator of the relationship between bicultural self-efficacy and life satisfaction. Thus, viewing two cultures as compatible may act as a protective factor, or buffer, against the negative effects of low bicultural self-efficacy on some aspects of mental health. Further, the null findings suggest that the relationships between the measured variables may be more complex than simple moderation. It is recommended that future research continue to explore and test moderation and mediation models, while considering alternative measures and specific subscales. Recommended service implications for Asian Americans include interventions geared to increase one's level of bicultural identity integration or bicultural selfefficacy, as well as to encourage systems or communities to provide the appropriate resources needed to do so.
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The looking glass effect: the influences of clinical supervision on student attitudes toward evidence based practicesThe current study explored how graduate students' attitudes toward evidence-based practices (EBPs) are influenced through clinical supervision. Despite being widely endorsed by professional entities, such as the American Psychological Association, members of the profession have mixed attitudes toward the EBP approach. Mixed attitudes toward EBPs have potentially detrimental effects, such as resulting in clinicians simply dismissing the notion of evidence-based treatment decision making and instead utilizing interventions that are without scientific support and potentially ineffective and even harmful. Resistance toward EBPs has been studied, but largely unstudied is how negative attitudes toward EBPs are developed and propagated to others. Professional identity solidifies in graduate school by way of clinical supervision. The goal of this study was to illuminate underlying influences of clinical supervision on graduate student attitudes toward EBPs, as clinical supervision may be the root cause of resistance toward EBPs. Perceived supervisor credibility influences professional identity development and may be influenced by a positive supervisory working alliance, theoretical orientation match, and overall acquiescence to a clinical supervisor; and these factors may affect attitudes toward EBPs. However, no previous research exists to directly confirm this notion. This study sampled from Ph.D. and Psy.D. clinical psychology graduate students who had started seeing patients (n = 157). Participants completed an online survey battery measuring perceived supervisor credibility, supervisory working alliance, student attitudes toward EBPs, perceived supervisor attitudes toward EBPs, and dispositional psychological reactance. It was predicted that students would perceive their supervisor as credible when their theoretical orientations matched, a positive supervisory working alliance existed, and students' psychological reactance was low. It was also predicted that supervisor attitudes toward EBPs would predict student attitudes toward EBPs when perceived supervisor credibility is high, students' dispositional psychological reactance is low, supervisory alliance is high, and theoretical orientations matched. Simultaneous linear regression and hierarchical regression was used to test the study hypotheses. The results partially supported the study hypotheses. It was found that a positive supervisory alliance predicted perceived supervised credibility. However, the remaining hypotheses were unsupported. Results contribute to the sparse research base on supervisor credibility in that preliminary support is provided that perceived credibility occurs when students and supervisors have a good relationship. Noteworthy are that results yielded from correlations suggested that students' global appreciation for research was related to theoretical orientation match of their clinical supervisor, supervisors' and graduate program's favorable attitudes toward EBP's, and to multi-faceted supervisory relationships such as having a clinical supervisor also as a research supervisor. These findings suggest that student internalization of supervisor attitudes may have less to do with perceived credibility and more to do with attitudes toward research. Future research should consider exploring attitudes toward research in the context of development of attitudes toward EBPs.
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Self Silencing in Children and AdolescentsSelf silencing is the theorized tendency to abnormally suppress expression of one’s own needs for the sake of a significant relationship Thought to be a predominately female behavior, self silencing has mainly been empirically studied in adults and has been associated with depression in women. To determine the extent, the approximate age of onset and the gender distribution of self silencing behavior in boys and girls, the Silencing the Self Scale (STSS) (Jack & Dill, 1992) was administered to twelfth grade students, and a modified version of this scale for children (STSS-C) was developed, tested and administered to fourth, eighth, and twelfth grade students. No significant differences in self silencing were observed between genders at any grade level. However significant age related differences in self silencing behavior were demonstrated in both boys and girls. In addition, these age related patterns differed significantly between boys and girls.
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A humble guest: a phenomenological exploration of success and competence in rural Alaskan mental health careObjective: Rural communities in Alaska face a long list of mental health disparities that are exacerbated by the other challenging factors inherent within the rural context. Rural Alaskan mental health care providers are faced with the tremendous task of providing clinically and culturally competent care to underserved and marginalized populations, with limited personal and professional resources, all while balancing the needs of the community, their own personal boundaries, and the pressure of remaining accountable to the larger system of professional ethics and guidelines. The aim of this study was to explore, identify, and understand from the perspective of rural Alaskan providers what it means to be successful and competent mental health care providers in rural Alaska. The ultimate goal of this study was to develop a deeper understanding of what being successful and competent means from the perspective of providers who have been successful in rural Alaskan practice. Methods: This study utilized an exploratory qualitative methodology grounded in the interpretive/constructivist paradigm. Semi-structured interviews were used to explore the perspectives of 12 mental health providers who have practiced successfully and competently with rural Alaskan patients. Furthermore, a phenomenological-hermeneutic approach was applied in order to work collaboratively with participants to reach a deeper understanding of mental health care success and competence in a rural Alaskan context. Results: Ten contextual themes and 27 subthemes emerged from the interviews that illuminate the experience of success and competence as experienced by rural Alaskan mental health care providers. The implications of this study serve to deepen the current understanding of what it means to practice in rural Alaska with communities and Indigenous people. Furthermore, the findings provide a culture and context specific understanding of success and competence that will help current providers, employers, and communities to better serve rural Alaskan people. The findings contribute to the literature by promoting a salient perspective of practice that is within a context of mental health that is generally disregarded, overlooked, and rarely considered.
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Historical trauma and approaches to healing among Choctaw American IndiansNative Americans have experienced a number of historically traumatic events that are believed to contribute to the development of behavioral health symptoms that negatively affect Native American quality of life across generations. Despite the trajectory of trauma experienced in some Native American communities, Native Americans exhibit extraordinary resilience and cultural strengths. Stress and coping models have been developed to explain how historical trauma is related to current health disparities among Native Americans and how enculturation may serve as a buffer against the negative effects of historical trauma. However, these models apply meta-theories to understanding historical trauma rather than tribally specific conceptualizations of historical trauma and historical trauma responses. Therefore, it is important to understand tribally specific manifestations of historical trauma so that intervention and prevention efforts are culturally appropriate. Choctaws are one of the largest Native American groups in the United States. They have experienced a history of forced removal and relocation from traditional homelands, yet the Choctaw Nation itself exhibits continuous growth and success as a tribe. This study used a qualitative, phenomenological, and community based participatory research (CBPR) approach to explore how Oklahoma Choctaw American Indians experience historical trauma and define well-being and enculturation. Interviews and focus groups were conducted with Choctaw American Indians in three different age categories 18-29; 30-49; and 50 and over to examine generational differences in how concepts of historical trauma, enculturation, and well-being are conceptualized. The theoretical construct of historical trauma was informed by themes of assimilation and colonization; resurgence of the Choctaw identity; awareness of historical losses and affective responses; forms of coping; current barriers to accessing Choctaw Nation services; and varying degrees of cultural involvement among tribal members. The theoretical construct of well-being was described in terms of physical health, faith, family, and culture. The theoretical construct of enculturation included pride in heritage, having Choctaw blood, being involved, and social connectedness. Choctaw participants reported social problems related to substance abuse and a sense of diminishing social connectedness to other tribal members. Recommendations on how to upscale behavioral health treatment and strengthen community ties are described. Adapted measures of historical trauma and enculturation for use in future research endeavors with Oklahoma Choctaw American Indians are also provided.
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The effects of volitional laughter on positive and negative affect and depressive symptomsThe effects of volitional laughter on positive affect, negative affect, and day-to-day depressive symptoms among college students were investigated utilizing a non-equivalent control group design. The laughter group (n = 23) participated in daily volitional laughter treatments (three treatments of 30 seconds each) while the control group (n = 40) received no treatment. Both groups were pre- and post-tested using the PANAS (Positive And Negative Affect Schedule) and the CES-D (Center for Epidemiological Studies -Depression Inventory). A significant difference was found for the laughter group in negative affect. An additional post-hoc analysis, after eliminating a group of subjects from the control group, indicated a significant difference for the volitional laughter treatment group in increasing positive affect. No significant difference in depressive symptoms was detected.
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The impact of the use of active imagery on labor and deliveryThis clinical investigation assessed the impact of the use of active imagery during labor and delivery to: assist in pain control, facilitate the physiological processes of labor, reduce anxiety, and improve feelings of control and self worth in the parents. Multiple designs including descriptive, Wilcoxon signed-rank test, and ANOVA using the General Linear Model were employed. After approval by monitoring authorities and informed consent, multipara couples responded to the State Trait Anxiety Inventory, the Pregnancy Attitude Index or Levenson's Locus of Control Scales, and the Adjective Checklist. Gender differences in the late third trimester were assessed. Experimental group couples were taught active imagery, given an audiotape for daily practice, and used imagery in labor and delivery. After delivery, tests were readministered, subjective comments recorded, and vividness of imagery assessed in the imagery group mothers. In the 15 couples studied, all were Internally controlled. Men felt more Internally controlled, women more manipulation by Powerful Others. There were no differences on the STAI or ACL. After delivery, no change was found on the STAI, or in Internal control. The eight couples in the Control group and women had greater control by Powerful Others. Control by Chance increased in the Control group, particularly the women. On the ACL, the Experimental group had significant change in Favorable scores with more feelings of internal control, confidence and less need for support and sympathy compared to the Control group. There was no significant difference in time in labor from 7-10 cm. However, Experimental group mothers had shorter labor periods in the hospital. They required less medication, and their babies had higher one minute Apgar scores and significantly higher arterial oxygen concentration in umbilical cord blood gas analysis. Subjectively, mothers voiced greater feelings of control after using imagery, adopting the procedure and generalizing it to other life situations. This study provided an initial look at men's feelings during their wives' pregnancies. The use of active imagery resulted in greater feelings of control and self worth, shorter total labor periods and improved neonatal outcome in this group. Imagery offers a potential for improvement in the birth process which merits further study.
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A statewide training model for supported employment using master trainersAlaska's vast land mass and diversified urban, rural, and remote communities require innovative training curricula to meet training needs in supported employment. A competency-based training program using an independent learning format and master trainers was developed to meet these extreme needs. These training methods were evaluated with survey instruments at the time of training and at 3 months, 6 months, and 1 year follow up. The data demonstrate that the training materials as well as the independent study format and master trainer model were effective training methods. We conclude that the training methods developed are effective in meeting the diverse training needs of urban, rural, and remote sites.
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Concurrent Validation Of Alaska's Juvenile Justice Suicide Risk Screening MeasureIncarcerated youth face elevated rates of mental health problems and are at greater risk for suicide. The Alaska Division of Juvenile Justice (AKDJJ) uses the Mental Health/Suicide Screening (MHSS) measure to screen incoming youth for mental health problems and current suicide risk. This research examined the concurrent validity of the MHSS, exploring the relationships of the MHSS with the Beck Depression Inventory 2nd Edition (BDI-II; Beck, Steer, & Brown, 1996) and a measure of current suicidal ideation, the Positive and Negative Suicidal Ideation Inventory (PANSI; Osman, Guiterrez, Kopper, Barrios, & Chiros, 1998b). Statistically significant correlations were found between the MHSS, BDI-II, and negative ideation subscale of the PANSI; however, the effect sizes were not large enough to suggest concurrent validation within the study sample or to advise the continued use of the MHSS as a suicide risk measure. Future research directions and practical implications are provided.
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Secondary Trauma In Mental Healthcare Providers In AlaskaSecondary trauma (ST) is vicarious traumatization caused by empathetic engagement with another's trauma, which may lead to burnout/turnover for mental healthcare providers (MHPs). ST and associated risk or protective factors have not been studied in Alaska. This research explored the prevalence and predictors of ST. The study population was 450 licensed MHPs and 14 Behavioral Health Aides (BHAs) who were randomly selected to complete the Secondary Traumatic Stress Scale (STSS) and a questionnaire created for this research, which inquired into aspects of their work. Bivariate analyses, mediator analyses, and multiple regressions tested which variables were associated with levels of overall ST and three sub-types of ST labeled Intrusion, Avoidance, and Arousal. 4 of the MHPs who responded to the survey also participated in a focus group to explore the survey results in greater detail. In total, 232 (50% response rate) licensed professionals and BHAs (47.08% urban and 48.15% rural) responded to the online survey. The Total STSS score across all participants indicated a "mild" level of ST among the MHPs. Approximately 20% of the sample met criteria for posttraumatic stress disorder as a result of their work; 47.6% experienced intrusion, 32.9% experienced arousal, and 29.9% experienced avoidance symptoms. As hypothesized, MHPs who reported working in rural locations, treating long-term and casual acquaintances, being less satisfied with their social support and self-care levels, and feeling more embarrassed to discuss ST reported higher levels of ST. Spending a higher percentage of one's workweek providing direct client services, however, was associated with less ST. Other hypothesized predictors of ST, including being younger, time spent debriefing, having a trusted supervisor, hours spent in self-care, treating a family member or friend, having a similar trauma history as a client, and gender were not associated with ST. Focus group participants shared that all clinicians may be susceptible to ST, that MHPs cope with ST by emotionally withdrawing, and that organizations can help reduce ST by providing support that reduces overall job-related stress. The information obtained can assist training programs, organizations, and providers in addressing ST, which may help reduce burnout/turnover rate.
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Factors Contributing To Weight Gain Among College Freshman And BeyondBackground: Linked with a higher risk of life threatening illnesses, obesity in the United States has become an epidemic, with a prevalence rate of overweight and obese adults of nearly 68%. Obesity rates have accelerated over the past two decades and one crucial developmental period for weight gain is among emerging adults attending college. Using an explanatory mixed-method design, this study examined contributing factors to weight gain among college students, including eliciting university stakeholders' perceptions of supports and barriers to exercising and healthy eating among students. Method: Data collection for the quantitative phase of the study consisted of two waves, baseline and 2-year follow-up. Students completed psychosocial and anthropometric measures (height, weight, and body fat percentage). Data collected for the qualitative phase of the study consisted of key informant interviews with university administrators (n=15) and seven student focus groups (n=34 students). Qualitative analyses were conducted with NVivo software and multiple coders, using a grounded theory approach to elicit major themes. Results: Students gained 1.5lbs (p>.05), with 34% of participants gaining over 5 lbs and 17% over 10 lbs. Participants who gained weight were men, ate more calories from sweets or desserts, and consumed fewer calories from fats. Increase in calories from desserts or sweets increased odds of weight gain (OR=1.075, CI=1.01-1.14) and body fat (OR=1.106, CI=1.036-1.181). Contextualizing the quantitative findings, students and administrators identified several themes that support healthy living, including access to nutritious food and physical amenities. Both groups also identified barriers, including easy access to high-calorie foods, limited recreation facilities, and policy challenges. Administrators spoke of extant health promotion efforts; however, students did not perceive active health promotion initiatives on campus. Conclusions: Dietary habits were identified drivers of weight gain among students. Extant campus supports and barriers to exercise and healthy eating among students were equally identified by students and administrators with great reliability. Implications for future health promotion efforts, food availability, recreation, and physical amenities are discussed in the context of clears sets of recommendations for stakeholder groups. Future research should explore specific dietary foods that are increasing weight and develop targeted preventions/interventions for individuals at risk.
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Meeting The Needs Of Breast Cancer Survivors In Alaska: Survivors' And Healthcare Providers' PerspectivesCancer is the leading cause of death in the state of Alaska and female breast cancer ranks second highest for incidence and mortality compared to all other cancers. Due to high incidence rates of women diagnosed with breast cancer each year and a growing number of survivors, it is important to examine the unmet needs of breast cancer survivors living in Alaska. The purpose of this study was to gather data about the needs of Alaskan breast cancer survivors across the continuum of breast cancer care. Study goals were accomplished via an explanatory mixed methods research design involving three distinct phases; namely, a quantitative, qualitative, and application phase. In the quantitative phase, the study drew upon an existing needs assessment dataset collected from breast cancer survivors living in Alaska to identify and bring awareness to the physical, psychological, and daily living challenges secondary to diagnosis and treatment for breast cancer. Augmenting secondary data analyses of this dataset, key informant interviews were used to elicit information from healthcare providers about their perception of breast cancer survivors' needs and how to meet these needs in Alaska. Results based on the survey responses from 309 breast cancer survivors and interviews with 31 healthcare providers revealed key barriers and services gaps along with ways to improve services for Alaskan breast cancer survivors. Broad recommendations based on all data included: 1) addressing service gaps and improving communication; 2) meeting psychosocial needs; 3) attending to needs specific to rural breast cancer survivors; 4) improving coordination of care; and 5) implementing established survivorship care plan(s) within Alaska's healthcare system. Many challenges and obstacles identified by interviewees are beyond individual providers' control and need to be addressed not only as independent practice issues, but as larger medical education and healthcare systems issues. Given these realities and findings, the study concludes with recommendations aimed toward providers serving the oncology community, hospital groups, and other key community stakeholders with the goal of providing comprehensive medical and support services to breast cancer survivors living in Alaska.
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Successful Aging Through The Eyes Of Alaska Native Elders: What It Means To Be An Elder In Bristol Bay, AlaskaAlaska Natives view aging from a holistic perspective, an approach not typically found in the existing literature on successful aging. There is little research on Alaska Native (AN) Elders and how they subjectively define a successful older age. The lack of a culturally specific definition often results in the use of a generic definition that portrays AN Elders as aging less successfully than their non-Native counterparts. This research explores the concept of successful aging from an AN perspective and what it means to age well in AN communities. An Explanatory Model (EM) approach was used and adapted to focus on the health and well-being of AN Elders and to gain a sense of their beliefs about aging. Qualitative, in-depth interviews were conducted with 26 Elders in six participating communities to explore the concept of successful aging and the role of their community in the aging process. Focus groups were held in specific communities to present the findings and receive feedback; this ensured the findings and report would be reflective of the unique perspectives of the communities and region. This study highlights four domains of successful aging, or "Eldership": emotion, spirituality, community engagement, and physical health. One aspect of successful aging seen in each of these four domains is optimism, or having a positive outlook on life. These four domains serve as the foundation of how communities define who is an Elder and what is important when considering whether someone has aged successfully or not. Research findings also indicate that aging successfully is based on local understandings about personal responsibility and making the conscious decision to live a clean and healthy life. Most Elders stated that Elder status is not determined by reaching a certain age (e.g., 65 years), but instead is designated when an individual has demonstrated wisdom because of the experiences he or she has gained throughout life. This research seeks to inform future studies on rural aging that will prioritize the perspectives of Elders to impact positively on the delivery of health care services and programs in rural Alaska.
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The Role Of Social Paradigm In Human Perception And Response To Environmental ChangeThe role of social paradigms in resilience to change is poorly understood. Past research suggests that social paradigms shape human values through socialization, including those for our environment and alter an individual's attentiveness to information. Thus, there is a relationship among personal cognition, the objective environment, social paradigm, and human behavior, which I posit may affect perception of and response to change, hence human adaptive capacity. The western industrialized dominant social paradigm (WISP) is a set of assumptions, concepts, values, and practices that influence our relationship to the environment. It includes beliefs in continuous economic growth; limited governmental intervention in free market systems; and faith that technology will resolve environmental problems. Past research indicates that the WISP correlates negatively with environmental concern and with belief in the need to change behaviors. In this work, measures for environmental values, the WISP, and environmental behaviors were developed from the General Social Survey and analyzed using mediation. The relationship between WISP, environmental concern and environmental behaviors was tested. Regression analysis suggested that WISP reduces environmental concern, thereby reducing environmental behaviors. The spatial relationship between built environment and environmental values and built environment and the WISP was also investigated. The results suggest that geographic regions with less built environment are significantly more environmentally concerned and have higher values of the WISP. Medium-sized cities exhibited significantly lower values of the WISP. Finally, extensive and diverse literature was reviewed to compare other paradigms affecting the relationship between humans and the biophysical environment. Other paradigms foster links between humans and their environment and also serve the purpose of incorporating ritual, myth and story-telling to conform human behavior to the limits of the biophysical environment rather than conforming the biophysical environment to human desires. Accurate perception of environmental feedback and appropriate responses to change increase resilience. This work suggests that the currently predominant social paradigm may reduce our resilience by impairing our perception of change and our willingness to adapt.
