Showing papers in "Journal of Counseling Psychology in 2015"
TL;DR: The Gendered Racial Microaggressions Scale (GRMS), was developed to assess both frequency and stress appraisal of microagressions, and was significantly related to psychological distress, such that greater perceived gendered racial microaggression were related to greater levels of reported psychological distress.
Abstract: The purpose of this study was to develop a measure of gendered racial microaggressions (i.e., subtle and everyday verbal, behavioral, and environmental expressions of oppression based on the intersection of one's race and gender) experienced by Black women by applying an intersectionality framework to Essed's (1991) theory of gendered racism and Sue, Capodilupo, et al.'s (2007) model of racial microaggressions. The Gendered Racial Microaggressions Scale (GRMS), was developed to assess both frequency and stress appraisal of microaggressions, in 2 separate studies. After the initial pool of GRMS items was developed, we received input from a community-based focus group of Black women and an expert panel. In Study 1, an exploratory factor analysis using a sample of 259 Black women resulted in a multidimensional scale with 4 factors as follows: (a) Assumptions of Beauty and Sexual Objectification, (b) Silenced and Marginalized, (c) Strong Black Woman Stereotype, and (d) Angry Black Woman Stereotype. In Study 2, results of confirmatory factor analyses using an independent sample of 210 Black women suggested that the 4-factor model was a good fit of the data for both the frequency and stress appraisal scales. Supporting construct validity, the GRMS was positively related to the Racial and Ethnic Microaggressions Scale (Nadal, 2011) and the Schedule of Sexist Events (Klonoff & Landrine, 1995). In addition, the GRMS was significantly related to psychological distress, such that greater perceived gendered racial microaggressions were related to greater levels of reported psychological distress. Implications for future research and practice are discussed.
273 citations
TL;DR: Rel relational cultural theory is utilized to situate sexual minority health within a relational framework and finds that the associations between distal and proximal minority stressors and distress were mediated by shame, poorer relationships with a close peer and the LGBT community, and loneliness.
Abstract: Sexual minorities (e.g., lesbians, gay men, bisexual individuals) are at an increased risk for poorer mental and physical health outcomes than heterosexuals, and some of these health disparities relate to minority stressors such as discrimination. Yet, there is little research elucidating pathways that predict health or that promote resiliency among sexual minorities. Building on the minority stress model, the present study utilized relational cultural theory to situate sexual minority health within a relational framework. Specifically, the study tested mediators of the relationships between distal (i.e., discrimination, rejection, victimization) and proximal stressors (i.e., internalized homophobia, sexual orientation concealment) and psychological and physical distress for sexual minorities. Among 719 sexual minority adults, structural equation modeling analyses were used to test 4 models reflecting the mediating effects of shame, poorer relationships with a close peer and the lesbian/gay/bisexual/transgender (LGBT) community, and loneliness on the associations between minority stressors and psychological distress (i.e., depression and anxiety) and physical distress (i.e., distressing physical symptoms). As hypothesized, the associations between distal and proximal minority stressors and distress were mediated by shame, poorer relationships with a close peer and the LGBT community, and loneliness. Findings underscore the possible relational and interpersonal mechanisms by which sexual minority stressors lead to psychological and physical distress.
210 citations
TL;DR: This meta-analysis examines the correlates of self- forgiveness associated with physical and mental health and estimated the relationships between self-forgiveness and specific mental health constructs and relationship outcomes.
Abstract: Self-forgiveness has been conceptualized as a coping strategy that may improve health and well-being. To better understand the functions of self-forgiveness, this meta-analysis examines the correlates of self-forgiveness associated with physical and mental health. For physical health, across 18 samples and 5,653 participants, the correlation was .32. For psychological well-being, across 65 samples and 17,939 participants, the correlation was .45. To augment this primary focus on physical and mental health correlates, we estimated the relationships between self-forgiveness and specific mental health constructs and relationship outcomes. Implications for future basic and applied research on self-forgiveness are discussed.
163 citations
TL;DR: Examination of randomized controlled trials of psychotherapeutic intervention for traumatized adult refugees provides evidence in the efficacy of trauma-focused models for treating refugees, and sheds light on important areas for future research.
Abstract: High levels of trauma-related psychological distress have been documented among ethnically diverse refugees. As the number of refugees worldwide continues to grow, determining the efficacy of established methods of trauma-focused therapy for this population is crucial. This meta-analysis examined the results of randomized controlled trials of psychotherapeutic intervention for traumatized adult refugees. Comparisons of 13 trauma-focused therapies to control groups from 12 studies were included in the analysis. The aggregate effect size for the primary outcome, posttraumatic stress disorder (PTSD), was large in magnitude, Hedge's g = .91, p < .001, 95% CI [.56, 1.52]. The aggregate effect size for depression, assessed in 9 studies, was also large g = .63, p < .001, 95% CI [.35, .92]. We used metaregression to evaluate potential moderators of the PTSD effect size. Number of sessions significantly predicted magnitude of the effect size, and studies that utilized an active control group (e.g., supportive counseling) had significantly smaller effect size than those with a passive control group. There was no difference in outcome for studies where an interpreter was used to facilitate sessions and those where no interpreter was used. There also was no difference in outcome based on type of PTSD assessment. Results provide evidence in the efficacy of trauma-focused models for treating refugees, and also shed light on important areas for future research.
136 citations
TL;DR: Cross-lagged analyses conducted by comparing nested structural equation models found that fixing the causal paths to zero from Time 1 experiences of discrimination to Time 2 alcohol problems and PTSD resulted in a significantly worse fit of the data, but maladaptive alcohol use does not appear to be a risk factor for later experiences ofdiscrimination or PTSD symptoms.
Abstract: Racial/ethnic discrimination has been identified as a risk factor in the development of posttraumatic stress disorder (PTSD) symptoms in persons of color (Carter, 2007). Many persons, regardless of race/ethnicity, with PTSD symptoms resulting from combat, violent crimes, sexual assault, or natural disasters use alcohol in an attempt to cope. This longitudinal study surveyed 203 Hispanic/Latino students twice at approximately a 1-year interval, and used a cross-lagged design to compare Time 1 links from alcohol use and experiences of discrimination with the same variables at Time 2, plus symptoms of PTSD. Each survey included the General Ethnic Discrimination scale and the Alcohol Use Disorders Identification Test. Only Time 2 packets contained the Posttraumatic Stress Disorder Checklist-Civilian. Cross-lagged analyses conducted by comparing nested structural equation models found that fixing the causal paths to zero from Time 1 experiences of discrimination to Time 2 alcohol problems and PTSD resulted in a significantly worse fit of the data. However, fixing the paths to zero from Time 1 maladaptive alcohol use to Time 2 PTSD and experiences of discrimination resulted in no significant difference in model fit. Thus, this pattern of findings is consistent with an inference that Hispanic/Latino college students who experience racial/ethnic discrimination are at risk for developing symptoms of posttraumatic stress and increased maladaptive alcohol use; conversely, maladaptive alcohol use does not appear to be a risk factor for later experiences of discrimination or PTSD symptoms. (PsycINFO Database Record (c) 2015 APA, all rights reserved). Language: en
113 citations
TL;DR: A meta-analysis of the association of client ratings of therapist MC with measures of therapeutic processes and outcome indicated that client age, gender, the representation of racial-ethnic minority clients, and clinical setting were not associated with effect size variability.
Abstract: For decades, psychologists have emphasized the provision of multiculturally competent psychotherapy to reduce racial and ethnic disparities in mental health treatment. However, the relationship between multicultural competencies (MC) and other measures of clinical process and treatment outcome has shown heterogeneity in effect sizes. This meta-analysis tested the association of client ratings of therapist MC with measures of therapeutic processes and outcome, including: (a) working alliance, (b) client satisfaction, (c) general counseling competence, (d) session impact, and (e) symptom improvement. Among 18 studies (20 independent samples) included in the analysis, the correlation between therapist MC and outcome (r = .29) was much smaller than the association with process measures (r = .75), but there were no significant differences in correlations across different types of MC or clinical process measures. Providing some evidence of publication bias, effect sizes from published studies (r = .67) were larger than those from unpublished dissertations (r = .28). Moderator analyses indicated that client age, gender, the representation of racial-ethnic minority (R-EM) clients, and clinical setting were not associated with effect size variability. Based on these findings, we discuss implications and recommendations for future research that might lead to a better understanding of the effects of therapist MC on treatment process and outcome. Primary needs in future research include the development and evaluation of observer ratings of therapist MC and the implementation of longitudinal research designs.
113 citations
TL;DR: The goal of this study was to assess the feasibility and effectiveness of a theory-based online intervention designed to improve stress management in undergraduate students and to represent a potentially valuable tool for college mental health services.
Abstract: The goal of this study was to assess the feasibility and effectiveness of a theory-based online intervention designed to improve stress management in undergraduate students. The intervention focused on present control because it has been found to be associated with a range of positive outcomes, including lower levels of depression, anxiety, and stress, controlling for a range of other variables (e.g., Frazier et al., 2011, 2012). Two pilot studies were first conducted to confirm that our intervention could increase present control. We then randomly assigned psychology students (n = 292) who were prescreened to have lower scores on the present control subscale of the Perceived Control Over Stressful Events Scale (Frazier et al., 2011) to 1 of 3 conditions: the present control intervention, the present control intervention plus feedback, and stress-information only. Seventy-six percent (n = 223) began the intervention, and 87% (n = 195) of those completed the posttest and 3-week follow-up. The 2 present control intervention groups had lower levels of stress, depression, and anxiety symptoms (on the Depression Anxiety Stress Scales; Lovibond & Lovibond, 1995) and perceived stress (on the Perceived Stress Scale; Cohen, Kamarck, & Mermelstein, 1983) relative to the stress-information-only group at posttest and 3-week follow-up (mean between group d at follow-up = .35, mean within group d for intervention groups at follow-up = -.46). Further, mediation analyses revealed that these effects were mediated by changes in present control. Our intervention represents a potentially valuable tool for college mental health services.
110 citations
TL;DR: The role of traumatic stress symptoms underlying the relationship between ethnic microaggressions and depression was examined and it was suggested that the indirect effects were the most robust within low ethnic identity and low self-efficacy.
Abstract: Although ethnic microaggressions have received increased empirical attention in recent years, there remains a paucity of research regarding how these subtle covert forms of discrimination contribute to Latino mental health. The present study examined the role of traumatic stress symptoms underlying the relationship between ethnic microaggressions and depression. Further, ethnic identity and general self-efficacy were tested as moderators between the ethnic microaggressions and traumatic stress link. Among a sample of 113 Latino adults, moderated mediational analyses revealed statistically significant conditional indirect effects in which traumatic stress symptoms mediated the relationship between ethnic microaggressions and depression while ethnic identity and self-efficacy functioned as moderators. The major findings suggested that the indirect effects were the most robust within low ethnic identity and low self-efficacy. The findings are discussed within a stress and coping framework that highlight the internal resources and stress responses associated with experiencing ethnic microaggressions.
108 citations
TL;DR: The U-shape adjustment trajectory (characterized by initial euphoria, distress, and then recovery) did not emerge, and the most consistent predictors of adjustment trajectories were perceived present control over academic stress and Neuroticism.
Abstract: Despite the increasing number of international students in U.S. universities, the temporal course of international students' adjustment has not been adequately tested, and only 1 study to date has examined multiple trajectories of adjustment. Therefore, the first goal of the current study was to explore multiple trajectories of adjustment among first-year international students using a broader range of adjustment measures (i.e., psychological distress, positive psychological adjustment, sociocultural adjustment). The second goal was to identify important predictors of trajectories. A wide range of individual and interpersonal predictor variables was examined, including academic stress and perceived control over academic stress, personality, social relationships, and language-related factors. Undergraduate and graduate international students in their first semester at a large midwestern university participated in this 5-wave longitudinal study (N = 248) that spanned 1 academic year. Multiple trajectories emerged, and the trajectories varied across the 3 adjustment measures. Average trajectories masked the trajectories of small groups of students who maintained or increased in terms of adjustment difficulties across outcomes. Contrary to popular theories, the U-shape adjustment trajectory (characterized by initial euphoria, distress, and then recovery) did not emerge. The most consistent predictors of adjustment trajectories were perceived present control over academic stress and Neuroticism.
104 citations
TL;DR: Targeting insomnia through CBT-I is efficacious for treating comorbid insomnia and depression, and should be considered an important adjunct therapy for patients with depression whose symptoms have not remitted through antidepressant treatment.
Abstract: UNLABELLED Insomnia and depression are highly comorbid conditions that show a complex, bidirectional relationship. This study examined whether cognitive-behavioral therapy for insomnia (CBT-I) delivered by a therapist compared with self-help CBT-I (written materials only) reduces insomnia and depression severity in individuals with comorbid insomnia and depression. A total of 41 participants (18-64 years; 25 females) with comorbid depression and insomnia, treated with antidepressants for at least 6 weeks, were randomized to receive 4 sessions of either CBT-I or self-help CBT-I over 8 weeks. Insomnia (Insomnia Severity Index [ISI]) and depression (Beck Depression Inventory-II [BDI-II]) were assessed at baseline, following each session, and at 3-month follow-up. Secondary outcomes were sleep quality and duration (actigraphy and diaries), anxiety, fatigue, and daytime sleepiness. Compared with self-help CBT-I, BDI-II scores in the CBT-I group dropped by 11.93 (95% confidence interval [CI] [6.60, 17.27], p < .001) more points, and ISI scores dropped by 6.59 (95% CI [3.04, 10.15], p = .001) more points across treatment. At 3-month follow-up, 61.1% of CBT-I participants were in clinical remission from their insomnia and depression, compared with 5.6% of the self-help group. CONCLUSIONS CBT-I administered by a therapist produced significant reductions in both insomnia and depression severity posttreatment and at follow-up, compared with a control condition in which participants received only written CBT-I material. Targeting insomnia through CBT-I is efficacious for treating comorbid insomnia and depression, and should be considered an important adjunct therapy for patients with depression whose symptoms have not remitted through antidepressant treatment.
91 citations
TL;DR: The Self-Criticism/Compassion Mediation Model, in which internalized and comparative self-criticism were both modeled to predict depression, was built and tested via structural equation modeling (SEM) and in the presence of 4 competing models, this model effectively modeled relationships among the study variables.
Abstract: This study was an investigation of the relationships between internalized self-criticism and depression and between comparative self-criticism and depression as these relationships are mediated by the fear of self-compassion, fear of compassion from others, self-compassion, and the perception that one is important to others. To examine these relationships, data were gathered via online survey methods from 206 university students at a large public Midwestern university in the United States. The Self-Criticism/Compassion Mediation Model, in which internalized and comparative self-criticism were both modeled to predict depression, was built and tested via structural equation modeling (SEM). In the presence of 4 competing models, this model effectively modeled relationships among the study variables. In the Self-Criticism/Compassion Mediation Model, the fear of self-compassion, and the perception that one is important to others serially mediated the relationship between comparative self-criticism and depression. Additionally, self-compassion partially mediated both the relationship between internalized self-criticism and depression, and the relationship between comparative self-criticism and depression. Implications include the use of the model as a guide to developing evidence-based practice for highly self-critical, depressed clients.
TL;DR: The overall results support the conclusion that sexual orientation is highly resistant to explicit attempts at change and that SOCE are overwhelmingly reported to be either ineffective or damaging by participants.
Abstract: This study examined sexual orientation change efforts (SOCE) by 1,612 individuals who are current or former members of the Church of Jesus Christ of Latter-day Saints (LDS). Data were obtained through a comprehensive online survey from both quantitative items and open-ended written responses. A minimum of 73% of men and 43% of women in this sample attempted sexual orientation change, usually through multiple methods and across many years (on average). Developmental factors associated with attempts at sexual orientation change included higher levels of early religious orthodoxy (for all) and less supportive families and communities (for men only). Among women, those who identified as lesbian and who reported higher Kinsey attraction scores were more likely to have sought change. Of the 9 different methods surveyed, private and religious change methods (compared with therapist-led or group-based efforts) were the most common, started earlier, exercised for longer periods, and reported to be the most damaging and least effective. When sexual orientation change was identified as a goal, reported effectiveness was lower for almost all of the methods. While some beneficial SOCE outcomes (such as acceptance of same-sex attractions and reduction in depression and anxiety) were reported, the overall results support the conclusion that sexual orientation is highly resistant to explicit attempts at change and that SOCE are overwhelmingly reported to be either ineffective or damaging by participants.
TL;DR: Findings indicated that family social support moderated the relationship between problem-focused coping and depression, as well as between avoidant coping and symptoms of anxiety and depression but not posttraumatic stress.
Abstract: With rising numbers of student veterans on today’s college campuses, multicultural competence in college counseling centers increasingly includes an understanding of military culture and its relation to the psychological health and functioning of student veterans. Research on interpersonal and intrapersonal factors associated with college student veterans’ mental health is scarce. The current study examines the contributions of coping style and family social support on symptoms of anxiety, depression, and posttraumatic stress in a student veteran sample. We also tested the moderating role of family social support in the relationship between coping style and psychological symptoms. Data from 136 student veterans were analyzed by using path analysis. Results revealed that avoidant coping and family social support significantly predicted depressive and anxiety symptoms. Avoidant coping also significantly predicted posttraumatic stress symptoms. In addition, findings indicated that family social support moderated the relationship between problem-focused coping and depression, as well as between avoidant coping and symptoms of anxiety and depression but not posttraumatic stress. Implications of results for college and university counselors are discussed.
TL;DR: Investigation of the effects of the 2 interventions on students' PGI and the potential mediating role of psychological capital suggested that participating in both interventions led to increases in PGI over a 3-month period, but that increases were bigger for the strengths intervention group.
Abstract: Personal growth initiative (PGI), defined as being proactive about one's personal development, is critical to graduate students' academic success. Prior research has shown that students' PGI can be enhanced through interventions that focus on stimulating developmental activities. Within this study, we aimed to investigate whether an intervention that stimulates development in the area of one's personal strengths (strengths intervention) has more beneficial effects on students' PGI than an intervention that stimulates development in the area of individual deficiencies (deficiency intervention). We conducted 2 longitudinal field experiments to investigate the effects of the 2 interventions on students' PGI (Experiment 1) and the potential mediating role of psychological capital (PsyCap) in this regard (Experiment 2). In Experiment 1, 105 (N = 105) university students participated in either a strengths intervention or a deficiency intervention. Results indicated that the strengths intervention increased the students' PGI in the short but not in the long term, whereas the deficiency intervention did not affect PGI. Ninety students (N = 90) participated in Experiment 2, in which we slightly refined both interventions by putting a stronger emphasis on the ongoing development of strengths (strengths intervention) or correction of deficiencies (deficiency intervention) by adding posttraining assignments. Results suggested that participating in both interventions led to increases in PGI over a 3-month period, but that these increases were bigger for the strengths intervention group. Furthermore, the relationship between the strengths intervention and PGI was mediated by hope as one component of PsyCap.
TL;DR: Increasing mindfulness on a daily basis can be a beneficial means to improve daily psychological well-being, and changes in mindfulness seem to precede rather than to follow changes in affect during MBSR.
Abstract: Increases in mindfulness are assumed to lead to improvements in psychological well-being during mindfulness-based treatments. However, the temporal order of this association has received little attention. This intensive longitudinal study examines whether within-person changes in mindfulness precede or follow changes in negative affect (NA) and positive affect (PA) during a mindfulness based stress reduction (MBSR) program. This study also examines interindividual differences in the association between mindfulness and affect and possible predictors of these differences. Mindfulness, NA, and PA were assessed on a daily basis in 83 individuals from the general population who participated in an MBSR program. Multilevel autoregressive models were used to investigate the temporal order of changes in mindfulness and affect. Day-to-day changes in mindfulness predicted subsequent day-to-day changes in both NA and PA, but reverse associations did not emerge. Thus, changes in mindfulness seem to precede rather than to follow changes in affect during MBSR. The magnitude of the effects differed substantially between individuals, showing that the strength of the relationship between mindfulness and affect is not the same for all participants. These between-subjects differences could not be explained by gender, age, level of education, average level of mindfulness home practice, or baseline levels of mindfulness and affect. Mindfulness home practice during the day did predict subsequent increases in mindfulness. The findings suggest that increasing mindfulness on a daily basis can be a beneficial means to improve daily psychological well-being.
TL;DR: Therapists identifying themselves as more integrative in their treatment orientation were able to better utilize good alliances for treatment success, suggesting that the size of the alliance-outcome association can be manipulated by feedback to therapists.
Abstract: Although the alliance-outcome association is one of the most consistent findings in psychotherapy research, it is also highly heterogeneous. Little is known about the factors explaining this variability, and consequently there is a lack of adequate knowledge about how to utilize this association to improve treatment. The present study had the following objectives: (a) to examine the associations between within- and between-individual variability in alliance and outcome, controlling for previous symptomatic levels; (b) to examine the duration of the alliance-outcome association; and (c) to examine potential moderators of the alliance-outcome association. A total of 547 patients treated in a primary care psychotherapy setting in Chile were randomly assigned to 5 feedback conditions. The alliance-outcome association was analyzed using multilevel models, disentangling changes in alliance within-individuals from alliance between-individuals. Patient and therapist characteristics were examined as potential moderators. Findings suggest that patients who reported a better early alliance also reported a better outcome. Furthermore, patients reporting time-specific improvement in alliance also reported a greater reduction in symptoms. The unique effect of alliance on outcome at one point in time is maintained for a period of 2 weeks. Patients with more severe symptoms and longer treatments benefited more from a good alliance. Therapists identifying themselves as more integrative in their treatment orientation were able to better utilize good alliances for treatment success. Finally, the size of the alliance-outcome association can be manipulated by feedback to therapists.
TL;DR: It is indicated that essentializing sexual orientation has mixed implications for sexual identity uncertainty and internalized homonegativity and wellbeing in gay men, and those undertaking educational and clinical interventions with gay men should be aware of the benefits and of caveats of essentialism.
Abstract: The present study examined essentialist beliefs about sexual orientation and their implications for sexual identity uncertainty, internalized homonegativity and psychological wellbeing in a sample of gay men. A combination of targeted sampling and snowball strategies were used to recruit 639 gay identifying men for a cross-sectional online survey. Participants completed a questionnaire assessing sexual orientation beliefs, sexual identity uncertainty, internalized homonegativity, and psychological wellbeing outcomes. Structural equation modeling was used to test whether essentialist beliefs were associated with psychological wellbeing indirectly via their effect on sexual identity uncertainty and internalized homonegativity. A unique pattern of direct and indirect effects was observed in which facets of essentialism predicted sexual identity uncertainty, internalized homonegativity and psychological wellbeing. Of note, viewing sexual orientation as immutable/biologically based and as existing in discrete categories, were associated with less sexual identity uncertainty. On the other hand, these beliefs had divergent relationships with internalized homonegativity, with immutability/biological beliefs associated with lower, and discreteness beliefs associated with greater internalized homonegativity. Of interest, although sexual identity uncertainty was associated with poorer psychological wellbeing via its contribution to internalized homophobia, there was no direct relationship between identity uncertainty and psychological wellbeing. Findings indicate that essentializing sexual orientation has mixed implications for sexual identity uncertainty and internalized homonegativity and wellbeing in gay men. Those undertaking educational and clinical interventions with gay men should be aware of the benefits and of caveats of essentialist theories of homosexuality for this population.
TL;DR: Testing Lent's (2004) social-cognitive model of normative well-being in a sample of first- and non-first-generation college students suggested the hypothesized model provided an adequate fit to the data while hypothesized relationships in the model were partially supported.
Abstract: The present study tested Lent's (2004) social-cognitive model of normative well-being in a sample (N = 414) of first- and non-first-generation college students. A model depicting relationships between: positive affect, environmental supports, college self-efficacy, college outcome expectations, academic progress, academic satisfaction, and life satisfaction was examined using structural equation modeling. The moderating roles of perceived importance of attending college and intrinsic goal motivation were also explored. Results suggested the hypothesized model provided an adequate fit to the data while hypothesized relationships in the model were partially supported. Environmental supports predicted college self-efficacy, college outcome expectations, and academic satisfaction. Furthermore, college self-efficacy predicted academic progress while college outcome expectations predicted academic satisfaction. Academic satisfaction, but not academic progress predicted life satisfaction. The structural model explained 44% of the variance in academic progress, 56% of the variance in academic satisfaction, and 28% of the variance in life satisfaction. Mediation analyses indicated several significant indirect effects between variables in the model while moderation analyses revealed a 3-way interaction between academic satisfaction, intrinsic motivation for attending college, and first-generation college student status on life satisfaction. Results are discussed in terms of applying the normative model of well-being to promote first- and non-first-generation college students' academic and life satisfaction.
TL;DR: Testing 3 mediators in the perceived discrimination-distress link suggested several avenues for prevention and intervention with sexual minority individuals, including expectations of rejection, anger rumination, and self-compassion.
Abstract: Perceived discrimination is a risk factor for mental health problems among sexual minority individuals. An increasing number of research studies have investigated the mechanisms through which stigma-related stressors such as perceived discrimination are linked with adverse mental health outcomes for sexual minority populations. The integrative mediation framework proposed by Hatzenbuehler (2009) underscores the importance of identifying mediators in the association between stigma-related stressors and mental health outcomes. This study tested 3 mediators--expectations of rejection, anger rumination, and self-compassion--in the perceived discrimination-distress link. Moreover, it examined associations among these mediators. A nationwide sample of 265 sexual minorities responded to an online survey. Structural equation modeling results supported the mediator roles of expectations of rejection, anger rumination, and self-compassion. More specifically, perceived discrimination was associated with expectations of rejection, which, in turn, was associated with increased anger rumination and less self-compassion, resulting in greater psychological distress. The findings suggest several avenues for prevention and intervention with sexual minority individuals.
TL;DR: It is demonstrated that higher mean levels of daily stress did not mediate the relationship between SC perfectionism and depressive and anxious symptoms 4 years later, and the importance of targeting enduring heightened stress reactivity in order to reduce SC perfectionists' vulnerability to depressive and anxiety symptoms over the long term.
Abstract: This study of 150 community adults examined heightened emotional reactivity to daily stress as a mediator in the relationships between self-critical (SC) perfectionism and depressive and anxious symptoms over a period of 4 years. Participants completed questionnaires assessing: perfectionism dimensions, general depressive symptoms (i.e., shared with anxiety), specific depressive symptoms (i.e., anhedonia), general anxious symptoms (i.e., shared with depression), and specific anxious symptoms (i.e., somatic anxious arousal) at Time 1; daily stress and affect (e.g., sadness, negative affect) for 14 consecutive days at Month 6 and Year 3; and depressive and anxious symptoms at Year 4. Path analyses indicated that SC perfectionism predicted daily stress-sadness reactivity (i.e., greater increases in sadness in response to increases in stress) across Month 6 and Year 3, which in turn explained why individuals with higher SC perfectionism had more general depressive symptoms, anhedonic depressive symptoms, and general anxious symptoms, respectively, 4 years later. In contrast, daily reactivity to stress with negative affect did not mediate the prospective relation between SC perfectionism and anhedonic depressive symptoms. Findings also demonstrated that higher mean levels of daily stress did not mediate the relationship between SC perfectionism and depressive and anxious symptoms 4 years later. These findings highlight the importance of targeting enduring heightened stress reactivity in order to reduce SC perfectionists' vulnerability to depressive and anxious symptoms over the long term.
TL;DR: It is suggested that mentoring ethnic minority students can be successful, productive, and satisfying for both mentors and protégés when mentors possess the necessary skills, time, commitment, and multicultural competencies.
Abstract: The aim of the current study was to understand the role of race and culture in successful mentoring relationships in graduate school. We examined the practices of 9 faculty mentors working with 15 ethnic minority doctoral students in counseling and clinical psychology. Grounded theory was used to discern unifying patterns and to formulate a theory of multicultural mentoring. Five overall themes significant to multicultural mentoring emerged: (a) career support and guidance tailored for ethnic minorities, (b) relationality between mentors and proteges, (c) significance of contexts, (d) interconnections across contexts, and (e) multidirectionality of interactions between contexts. The 5 themes combined to form a multicultural, ecological, and relational model of mentoring. Our findings suggest that mentoring ethnic minority students can be successful, productive, and satisfying for both mentors and proteges when mentors possess the necessary skills, time, commitment, and multicultural competencies. Implications for doctoral programs in counseling and clinical psychology are discussed, along with recommendations for future research directions.
TL;DR: Trainees primarily attributed changes to graduate training, individual and group supervision, research participation, and working with clients, while clients did not change in engaging clients, judge-rated psychodynamic techniques in third and ninth sessions across clients, or changes in client-rated symptomatology
Abstract: We investigated changes over 12 to 42 months in 23 predoctoral trainees during their externship training in a psychodynamic/interpersonal psychotherapy clinic. Over time, trainees increased in client-rated working alliance and real relationship, therapist-rated working alliance, client-rated interpersonal functioning, ability to use helping skills (e.g., challenges, immediacy), higher-order functioning (e.g., conceptualization ability, countertransference management), feelings about themselves as therapists (e.g., more authentic, more self-aware), and understanding about being a therapist (e.g., theoretical orientation, curiosity about client dynamics). In contrast, trainees did not change in engaging clients (return after intake or for at least 8 sessions), judge-rated psychodynamic techniques in third and ninth sessions across clients (although trainees used more cognitive-behavioral techniques over time in third but not ninth sessions), or changes in client-rated symptomatology. Trainees primarily attributed changes to graduate training, individual and group supervision, research participation, and working with clients. Implications for training and research are discussed.
TL;DR: Body surveillance, body shame, and features of complementary sociocultural models were assessed as risk factors for and concomitants of eating disturbances over time and heightened T2 body dissatisfaction, media, and interpersonal appearance pressure, negative affect, and body shame predicted concomitant increases in T2 eating concerns.
Abstract: Body surveillance and body shame are features of objectified body consciousness (OBC) that have been linked to disordered eating, yet the evidence base is largely cross-sectional and limited to samples in certain Western countries. Furthermore, it is not clear whether these factors contribute to the prediction of eating disturbances independent of conceptually related risk factors emphasized within other sociocultural accounts. In this prospective study, body surveillance, body shame, and features of complementary sociocultural models (i.e., perceived appearance pressure from mass media and close interpersonal networks, appearance social comparisons, negative affect, body dissatisfaction) were assessed as risk factors for and concomitants of eating disturbances over time. University-age, mainland Chinese women (n = 2144) and men (n = 1017) completed validated measures of eating-disorder pathology and hypothesized risk factors at baseline (T1) and 1-year follow-up (T2). Among women, elevations on T1 measures of sociocultural-model features predicted more T2 eating disturbances, independent of T1 disturbances. After controlling for other T1 predictors, body surveillance and shame made modest unique contributions to the model. Finally, heightened T2 body dissatisfaction, media, and interpersonal appearance pressure, negative affect, and body shame predicted concomitant increases in T2 eating concerns. For men, T1 features of sociocultural accounts (negative affect, body dissatisfaction) but not OBC predicted T2 eating disturbances, along with attendant elevations in T2 negative affect, interpersonal appearance pressure, and body shame. Implications are discussed for theory and intervention that target disordered eating.
TL;DR: In summary, the workbook appeared to facilitate self-forgiveness among perpetrators of interpersonal wrongdoing, though replication trials are needed to build from these preliminary findings.
Abstract: The present study tested the efficacy of a 6-hr self-directed workbook intervention designed to increase self-forgiveness and reduce self-condemnation among perpetrators of interpersonal offenses. University students (N = 204) were randomly assigned to either an immediate treatment or wait-list control condition, and assessments were administered on 3 occasions. Treatment led to increases in self-forgiveness and decreases in self-condemnation. Stronger treatment effects were associated with (a) lower levels of dispositional self-forgivingness, (b) higher levels of transgression severity, and (c) higher dose of treatment. In summary, the workbook appeared to facilitate self-forgiveness among perpetrators of interpersonal wrongdoing, though replication trials are needed to build from these preliminary findings.
TL;DR: Results were consistent with stress-generation and stress-enhancement hypotheses regarding perfectionists and suggested implications for prevention and intervention with perfectionistic STEM students that should be implemented early in their college experience.
Abstract: Complementary hypotheses suggest that perfectionism may (a) cause later stress (stress generation) and (b) moderate the effects of stress on subsequent outcomes (stress enhancement). The present study tested these hypotheses with a sample of 432 first-time college freshmen pursuing science, technology, engineering, and math (STEM) majors. Students completed baseline perfectionism scales and repeated measures for perceived academic stress at monthly intervals 3 times in the fall semester and 3 times in the spring semester. Course grade data from institutional records were used to calculate first-year STEM grade point average (GPA) as the distal outcome in analyses. Gender, high school GPA, SAT math scores, and university were covariates. Latent profile analyses supported adaptive, maladaptive, and nonperfectionist classes and latent class growth mixture models identified distinctly low, moderate, and high patterns of academic stress over the year. Latent transition analyses indicated that maladaptive perfectionists were likely to experience moderate or high stress (none transitioned to low stress), and adaptive perfectionists were likely to have low or moderate stress (only 4% transitioned to high stress). Women were substantially more likely than male maladaptive perfectionists to experience high stress. Low-stressed adaptive perfectionists followed by moderately stressed maladaptive perfectionists had relatively higher GPAs than other groups. Subgroups of perfectionists who transitioned to the next higher stress level had substantially lower GPAs than other groups. Overall, results were consistent with stress-generation and stress-enhancement hypotheses regarding perfectionists. Findings suggested implications for prevention and intervention with perfectionistic STEM students that should be implemented early in their college experience.
TL;DR: Support is found for the reciprocal model being superior to the unidirectional models over the individual therapy course and the ideas of relationship as strategy and relationship as outcome along with the reciprocal pattern revealed in the findings were discussed.
Abstract: A reciprocal influence model of the working alliance and the therapeutic outcome was examined in a sample of clients (n = 638) seen by novice therapists. Past researchers have found a relation between the working alliance and symptom improvement and this relation has been interpreted as the alliance leading to such symptom change. The current study was an examination of whether the alliance does indeed lead to symptom change, or whether symptom change leads to subsequent alliance change, or whether each is related to the other in a reciprocal way over time. By modeling the longitudinal development of the working alliance and the symptomatic severity over the individual therapy course, we found support for the reciprocal model being superior to the unidirectional models. The ideas of relationship as strategy and relationship as outcome along with the reciprocal pattern revealed in the findings were discussed with respect to the theoretical and clinical implications. We also discussed the limitations of the study and provided suggestions for future research.
TL;DR: The authors synthesized over 40 years of research from 36 studies, from 1970 to 2011, in which the confidence ratings of 1,485 clinicians were assessed in relation to the accuracy of their judgments about mental health or psychological issues, finding that confidence is better calibrated with accuracy than previously assumed.
Abstract: The overconfidence bias occurs when clinicians overestimate the accuracy of their clinical judgments. This bias is thought to be robust leading to an almost universal recommendation by clinical judgment scholars for clinicians to temper their confidence in clinical decision making. An extension of the Meta-Analysis of Clinical Judgment (Spengler et al., 2009) project, the authors synthesized over 40 years of research from 36 studies, from 1970 to 2011, in which the confidence ratings of 1,485 clinicians were assessed in relation to the accuracy of their judgments about mental health (e.g., diagnostic decision making, violence risk assessment, prediction of treatment failure) or psychological issues (e.g., personality assessment). Using a random effects model a small but statistically significant effect (r = .15; CI = .06, .24) was found showing that confidence is better calibrated with accuracy than previously assumed. Approximately 50% of the total variance between studies was due to heterogeneity and not to chance. Mixed effects and meta-regression moderator analyses revealed that confidence is calibrated with accuracy least when there are repeated judgments, and more when there are higher base rate problems, when decisions are made with written materials, and for earlier published studies. Sensitivity analyses indicate a bias toward publishing smaller sample studies with smaller or negative confidence-accuracy effects. Implications for clinical judgment research and for counseling psychology training and practice are discussed.
TL;DR: The overall purpose of the present 4 studies was to develop the Sources of Spirituality (SOS) Scale to measure these different elements of spirituality, and found 5 distinct patterns of spirituality based on SOS subscales.
Abstract: Most measures of spirituality privilege religious spirituality, but people may experience spirituality in a variety of ways, including a sense of closeness, oneness, or connection with a theistic being, the transcendent (i.e., something outside space and time), oneself, humanity, or nature. The overall purpose of the present 4 studies was to develop the Sources of Spirituality (SOS) Scale to measure these different elements of spirituality. In Study 1, we created items, had them reviewed by experts, and used data from a sample of undergraduates (N = 218) to evaluate factor structure and inform initial measurement revisions. The factor structure replicated well in another sample of undergraduates (N = 200; Study 2), and in a sample of community adults (N = 140; Study 3). In a sample of undergraduates (N = 200; Study 4), we then evaluated evidence of construct validity by examining associations between SOS Scale scores and religious commitment, positive attitudes toward the Sacred, and dispositional connection with nature. Moreover, based on latent profile analyses results, we found 5 distinct patterns of spirituality based on SOS subscales. We consider implications for therapy and relevance of the findings for models of spirituality and future research.
TL;DR: The results showed that individuals experienced similar increases for racial and nonracial stressors when events occur and similar decreases in the following two days and Implications for the understanding of racial discrimination's role in the well-being of African Americans are discussed.
Abstract: Scholars agree on the negative impacts of racial discrimination on the mental health of African Americans (Brondolo et al., 2008). Yet research is needed to explore the impacts of everyday discrimination over time, especially compared to nonracial daily hassles, in an ecologically valid manner. It is also widely accepted that racial identity can moderate the impact of racial hassles (Sellers, Copeland-Linder, Martin, & Lewis 2006), but few studies have examined this moderating effect over time. The current study addresses gaps in the current literature by analyzing the relationship between reported racial and nonracial stressors over the course of four days. Participants were 225 college students at three institutions who participated in a 20-day daily diary study. Each day, participants reported whether they had experienced a stressful event and their depressive symptoms. We compared reports of depressive symptoms the day an event occurred and two days after for racial and nonracial stressors and examined whether racial identity served as a moderator. The results showed that individuals experienced similar increases for racial and nonracial stressors when events occur and similar decreases in the following two days. Additionally, symptom trajectories varied by racial identity. Implications for the understanding of racial discrimination's role in the well-being of African Americans are discussed.
TL;DR: Experiencing breast cancer at a young age was viewed by participants as contributing to an increased desire for work to provide a sense of meaning as well as financial security and insurance, and interpersonal difficulties connecting within and outside of work.
Abstract: Breast cancer survivors represent the largest proportion of cancer survivors, and the rate of young breast cancer survivors who are diagnosed before the age of 40 is increasing. Cancer survivorship scholarship has begun to address many aspects of survivors' quality of life, yet the role of work and career issues have been understudied, particularly for young survivors. To explore the work lives and career development of young breast cancer survivors, this study used consensual qualitative research methodology (Hill, Thompson, & Williams, 1997) to analyze data from qualitative interviews with 13 young women diagnosed with breast cancer before the age of 40. The 4 career-related domains that emerged from the data were (a) cancer-related work challenges, (b) coping with cancer-related work challenges, (c) reappraisal of career development after cancer, and (d) components of career and life satisfaction after cancer. Experiencing breast cancer at a young age was viewed by participants as contributing to an increased desire for work to provide a sense of meaning as well as financial security and insurance. Cancer was further viewed as contributing to lost control over career success and work choices, treatment side effects that interfere with work self-efficacy and capabilities, and interpersonal difficulties connecting within and outside of work. Women with more extensive cancer treatment and side effects reported greater work struggles. Despite this, participants' cancer narratives were characterized by a range of coping strategies, including reframing and seeking control, and by evidence of persistence, resilience, and hope. Implications for research and practice are discussed.