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Using A Single Measure To Assess Adherence And Differentiation In Family Therapy For Adolescent Externalizing Problems, Stephanie Violante

Theses and Dissertations

Family therapy is considered a well-established treatment approach for adolescent externalizing problems; however, research examining its effectiveness when delivered in routine practice settings has produced mixed results. The accurate interpretation of these inconsistent results requires an understanding of what therapeutic techniques were delivered, including those that were prescribed (i.e., adherence) and those that were non-prescribed (i.e., differentiation), suggesting the need for a measure that can concurrently assess treatment adherence and differentiation. The current study examined the extent to which an observational measure of an array of therapeutic techniques for youth emotional and behavioral problems (the Therapy Process Observational Coding System …

Addressing Death Distress In Caregivers Of Patients With Malignant Glioma, Kelcie D. Willis

Theses and Dissertations

The field of psychosocial oncology seeks to improve the quality of life of patients and families affected by cancer. This task becomes increasingly important when there are limited, non-curative treatment options, a high probability of recurrence, and rapid functional decline, such as in the case of a malignant glioma (MG). Indeed, the diagnosis of a MG is associated with negative sequalae that often translates to higher caregiver burden. Caregivers—who must manage the functional decline of the patient, changes within the family, and a complicated medical system—often feel overwhelmed, isolated, and ill-equipped to handle these myriad responsibilities. While they also report …

Profiles Of Family Functioning In Pediatric Hematology-Oncology Patients: Longitudinal Associations With Child Well-Being, Sydney Sumrall

Theses and Dissertations

This study aims to assess 1) patterns of family functioning and 2) longitudinal associations between family functioning patterns and well-being in a vulnerable cohort of children with chronic illness. Caregivers of hematology (16.4%) and oncology (83.6%) patients ages 7-20 (N=55; M_age = 13.3 [SD = 2.7]; 52.7% female; 45.5% non-Latinx White, 38.2% Black or African American, 12.7% Latinx, 1.8% Asian, and 1.8% multi-racial,) reported on family functioning via the Family Assessment Device. Cluster analyses identified three mutually exclusive clusters: one high adaptive group, one moderate adaptive group, and one maladaptive group. Group membership was not significantly …

Witnessing Community Violence And Its Consequences: Changes Across Middle School, Sarah Pittman

Theses and Dissertations

Community violence exposure is prevalent among youth residing in economically marginalized communities that have high rates of violence. Witnessing community violence has been concurrently associated with persistent adverse consequences. However, few studies have applied a developmental psychopathology framework and examined dynamic developmental processes between witnessing community violence and outcomes over time. Moreover, most prior studies have used analyses that assume that associations between witnessing violence and outcomes are the same for all adolescents, which is inconsistent with both developmental theories and theories specific to community violence exposure. The goal of this study was to apply a developmental psychopathological framework to …

Initial Psychometric Evaluation Of An Observer-Rated Measure Of Shared Decision Making Practices In Youth Psychotherapy, Jennifer Lc Herbst

Theses and Dissertations

SDM is a process by which clinicians and clients collaboratively make treatment decisions; this process may improve the alliance and clinical outcomes. SDM in youth psychotherapy is understudied, and a critical gap in the field is the paucity of established measures designed to assess SDM practices in youth psychotherapy. This project aimed to fill this gap by examining the score reliability and validity of a novel observer-rated measure of SDM designed for youth psychotherapy—the Shared Decision Making Practices in Youth Mental Health scale (SDM-YMH)—and using the measure to investigate linkages between SDM practices, the alliance, and clinical outcomes. Therapy tapes …

Examining Genetically-Informed Etiologic Models Of Co-Occurring Posttraumatic Stress Disorder And Recreational Cannabis Use Among College Students, Terrell A. Hicks

Theses and Dissertations

The college years encompass a period of increased risk recreational cannabis use (RCU), as well as a time of increased risk for trauma exposure and developing posttraumatic stress disorder (PTSD). Given the high co-occurrence between RCU and PTSD, and the potentially negative consequences of the two (e.g., worse academic outcomes), there is a need to understand the etiologic mechanisms of these commonly co-occurring conditions. Two primary phenotypic models exist: self-medication model (i.e., PTSD to RCU) and the high-risk model (i.e., RCU to PTSD). To date, there are two existing studies longitudinally examining the etiologic models proposed to explain co-occurring RCU …

Physical Activity In Adolescents With And Without Adhd: Longitudinal Associations With Sleep, Adhd, And Internalizing Symptoms, Caroline N. Cusick Lowman

Theses and Dissertations

Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) are at risk for developing clinically significant sleep problems and comorbid internalizing symptoms. Physical activity (PA) has significant positive associations with a variety of health outcomes, including sleep and aspects of mental health. As such, the US Department of Health and Human Services recommends adolescents receive at least 60 minutes of moderate-to-vigorous PA (MVPA) per day. However, it is unknown whether adolescents with ADHD have different patterns of physical activity compared to their peers. Importantly, it may be that PA can serve as a buffer between ADHD symptoms and development of comorbid difficulties with sleep …

Examining The Home Interventionist Model Of Care In Pediatric Asthma, Katherine D. Lohr

Theses and Dissertations

Pediatric asthma disproportionately affects children living in urban areas and within families reporting an income below the poverty threshold. Home interventionist models of care, utilizing interventionists from the communities they serve, have been found to improve pediatric asthma symptoms and reduce Medicaid costs. Home interventionists, such as community health workers (CHWs) and Healthy Homes assessors (HHAs), focus on connecting care among schools, providers, and homes, and empowering families in accessing resources to overcome barriers to care. However, research is just beginning to understand how home interventionists create positive change among families within low-income, urban communities. This dissertation study used a …

Psychiatric Diagnostic Decision-Making: Investigating The Theory Of The Dual-Process Model, Christopher S. Kleva

Theses and Dissertations

Diagnostic decision-making is an important component of clinical practice; however, there is substantial diagnostic unreliability within mental health diagnoses. The lack of reliability emphasizes the importance of investigating diagnostic decision-making; however, the research to date is limited, primarily relying on a vague definition of decision-making based on the dual-process model. The present study is an exploratory attempt to apply the dual-process model to explain how mental health clinicians (n = 30, 73.3% cisgender female, 96.7% psychologists) arrive at making diagnostic decisions through the use of an interactive interview mechanism. For each participant, we are able to create a figure …

Predicting Medication Adherence Patterns During The Maintenance Phase Of Treatment For Pediatric Leukemia And Lymphoma: A Model Of Individual- And Family-Level Factors, Stephanie M. Romo

Theses and Dissertations

Adherence during the maintenance phase of pediatric cancer treatment is critical to prevent relapse and ensure long-term, event-free survival. Yet, little research has been done to examine individual- and family-level factors that may relate to adherence during the maintenance phase of treatment, particularly among Latinx patients. This is surprising given findings demonstrating that children who miss more than 5% of their prescribed oral chemotherapy medicine, most commonly 6-mercaptopurine (6MP), are 2.5-2.7 times more likely to relapse than children who take 95% or more of their prescribed 6MP. Pediatric cancer patients face unique adherence challenges given the importance of family involvement …

Sleep Self-Efficacy, Loneliness, And Physical Activity: Assessing The Pathways Between Sleep Quality And Mental Health Using Structural Equation Modeling, Amber M. Fox

Theses and Dissertations

Although there is robust empirical support that poor sleep contributes to declines in mental health, explanations of this relationship remain unclear. The purpose of the present study was to examine the pattern of associations between sleep quality, sleep self-efficacy, loneliness, physical activity, and mental health among U.S. adults across the lifespan, and whether they differed by gender or age group. A structural equation model with invariance analysis was developed and examined data from 2,300 adults (M_age = 44.1, SD = 16.78) participating in the online study Investigating Sleep Longitudinally Across Normal Development (ISLAND). Sleep quality was measured by …

Using Individual Determinants To Predict Behavioral Health Service Use In Integrated Pediatric Primary Care, Alfonso L. Floyd Jr.

Theses and Dissertations

Mental health problems (e.g., attention, externalizing, internalizing) are commonly observed in youth and are often associated with significant impairment and an increased need for mental health services. Conceptual frameworks, such as Andersen’s Behavioral Model of Health Service Utilization, have proposed that several individual determinants (e.g., predisposing, enabling, and need factors) may influence service use for mental health problems among youth. Despite the glaring need for mental health treatment among youth with mental health problems, studies indicate that many affected youths do not receive mental health care. Integrated pediatric primary care (IPPC) settings provide an ideal setting for youth and families …

Alcohol And Other Addictive Behaviors Among Bariatric Surgery Patients, Rachel M. Arnold

Theses and Dissertations

Research has repeatedly highlighted a high rate of comorbidity of addictive behaviors in both clinical and non-clinical samples. While polydrug use has received significant attention in recent years, less is known about rates of comorbidity with behavioral addictions such as eating, work, exercise, or sex. Individuals with a history of bariatric surgery may provide a unique opportunity to examine the potential co-occurrence of addictive behaviors. High rates of food addiction symptoms and changes in alcohol use patterns post-surgically have highlighted a potential gap in our understanding of bariatric patients and their needs post-surgically. Using a composite measure of addictive behaviors, …

Western Clinicians’ Diagnostic Accuracy Of Culture-Bound Syndromes, Lisa Y. Chung

Theses and Dissertations

Culture-bound syndromes are of increasing importance in today’s more diverse world. The current study measured the ability of clinicians trained in a western setting to accurately diagnose culture-bound syndromes from cultures outside of their background. Eight-four clinicians were recruited through the American Psychological Association (APA) membership directory. All recruited clinicians were asked to read three vignettes. In two vignettes a patient was suffering from either Hwabyung or Ataque de Nervios and the third vignette represented a control GAD vignette. The clinicians were asked to diagnose the patient in the vignette, to explain what information informed their diagnosis, to complete two …

A Psychometric Evaluation Of The Best In Class Adherence And Competence Scale, Katrina A. Markowicz

Theses and Dissertations

It is critical to utilize treatment integrity instruments to support the evaluation of evidence-based programs in early classroom contexts. However, in the early childhood field, guidelines for collecting treatment integrity data are underdeveloped. Consequently, most treatment integrity instruments employed in the field solely assess adherence, vary in design features and have little psychometric evidence supporting their use. As such, this represents a gap in the field that might slow efforts to implement evidence-based programs. The current study examines the score reliability and validity of an observational treatment integrity instrument (The BEST in CLASS Adherence and Competence Scale [BiCACS]; Sutherland et …

The Buffering Effects Of Resilience On Alcohol Use: A Phenotypic And Genotypic Investigation, Shannon Cusack

Theses and Dissertations

The college years encompass a time of vulnerability for problematic alcohol use/alcohol use disorder (AUD) and exposure to traumatic events (TE), which is a transdiagnostic risk factor for AUD, posttraumatic stress disorder (PTSD), and comorbid AUD-PTSD. However, not all who experience a TE develop these disorders, highlighting the need to identify factors that impact post-trauma outcomes. Resilience has been shown to be associated with lower alcohol consumption and related problems following TE, though the buffering effects of resilience on alcohol use have not yet been examined. Further, twin studies demonstrate that resilience is moderately heritable, but further research is needed …

Genetics And Alcohol Interventions In Youth, Zoe E. Neale

Theses and Dissertations

Alcohol is the most commonly used substance among youth, and risky alcohol use is associated with harmful consequences such as accidents, academic consequences, and physical and emotional health problems. Alcohol use disorders are approximately 50% heritable, yet most efforts to prevent and intervene upon youth alcohol use focus only on environmental factors. Furthermore, current prevention and intervention programs tend to have modest effects and are not uniformly effective for all individuals. Gene-by-intervention (GxI) studies offer an opportunity to expand current understanding of interventions by examining whether underlying genetic risk may contribute to differential program effects. Much of the current GxI …

Mobile-Based Contingency Management To Promote Daily Self-Monitoring Of Pain Severity And Related Measures In An Online Sample Of Individuals With Chronic Pain, Kathryn Polak`

Theses and Dissertations

Between 11% and 40% of the US population experience chronic pain. One promising pain management solution is remote self-monitoring. Unfortunately, low rates of adherence have impeded the use of remote self-monitoring among chronic pain patients. One robust strategy for improving adherence is contingency management (CM). This project pilot tested a fully-automated CM app (DynamiCare Rewards) programmed with an escalating variable-ratio reinforcement schedule for promoting daily self-monitoring of pain symptom severity, related variables (e.g., sleep), and prescription opioid use over a 28-day period in a sample of individuals with chronic pain. A pilot RCT compared participants randomized to CM (n …

E-Cigarette Use And Perceptions Among Adolescents With Attention-Deficit/Hyperactivity Disorder: The Role Of Parental Messages About Tobacco, Mayra S. Ramos

Theses and Dissertations

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of using e-cigarettes compared to their neurotypical peers. Parent-adolescent communication about tobacco use and number of ADHD symptoms can influence adolescents’ perceptions of e-cigarettes and their e-cigarette use. Adolescents with ADHD (n = 80) completed questionnaires assessing parental messages about tobacco use; e-cigarette harm perceptions; susceptibility to use e-cigarettes; and e-cigarette use. Parents reported on messages about tobacco use, adolescent’s ADHD symptomatology, and completed demographic questionnaires. Twenty-percent of adolescents reported e-cigarette ever use. Adolescent girls were significantly more likely to report higher e-cigarette harm perceptions than boys. Parents reported providing messages …

Expand Your Horizon: Investigating An Online Intervention For Weight Bias Internalization, Alexandria Davies

Theses and Dissertations

Weight bias internalization (WBI; i.e., self-directed weight stigma or the degree to which individuals apply negative weight-based stereotypes to themselves), is problematic because it is associated with increased stress, emotional eating, healthcare avoidance, and exercise avoidance. Thus, WBI exacerbates health disparities and there is an urgent need to create treatments that address this concern. The current study examined the preliminary effectiveness of a previously developed online body gratitude journaling intervention (i.e., Expand Your Horizon) compared to an active control writing condition in emerging adult women with WBI. Racially/ethnically diverse women (N=100; n=49) or Expand Your Horizon ( …

Breaking The Cycle: A Longitudinal Study Of Factors That Disrupt Peer Selection And Influence Processes Among Urban Youth, Kelly E. Oconnor

Theses and Dissertations

Having friends who engage in problem behavior (i.e., aggression, substance use, delinquency) has consistently been linked to adolescents’ own engagement in problem behavior. There are, however, several key gaps in the literature on peer influence. Few studies have considered the influence of friends’ prosocial behavior and there has been limited research to identify promotive factors that influence urban youths’ affiliation with peers who engage in problem and prosocial behavior across early adolescence, a time of heightened susceptibility to peer influence. The purpose of this study was to identify modifiable promotive factors that reduce adolescents’ problem behavior by decreasing exposure to …

Exploring Whether Contextual Factors Relate To The Hoped-For And Feared Possible Selves Of Latinx Youth, Stephanie M. Romo

Theses and Dissertations

Youth’s hopes and fears for their future (i.e., hoped-for and feared possible selves) are related to their academic and health behavior outcomes. Much of the literature on possible selves focuses on African-American and European-American youth. In a sample of 132 Latinx youth, the present cross-sectional study utilized widely-used measures (i.e., Possible Selves Questionnaire, Beliefs about Education, Youth Risk Surveillance Survey) to identify the content and characteristics (e.g., strategies, balance) of their possible selves; investigate the relationship between contextual factors (e.g., sex, immigrant status) and possible selves; and, explore whether possible selves predicted youth’s beliefs about education and sexual risk behaviors. …

A Randomized Trial Of Cbt4cbt For Women In Residential Treatment For Substance Use Disorders, Sydney S. Kelpin

Theses and Dissertations

Women with substance use disorders (SUD) face unique barriers to substance use treatment, and as a result, are less likely than their male counterparts to seek treatment for the disorder. Cognitive behavioral therapy (CBT) is an evidence-based treatment known to reduce relapse rates by teaching clients to recognize and respond to their cues for substance use. Recent research suggests CBT may be particularly of benefit to women. Despite the effectiveness of CBT, its dissemination in clinical practice is limited due to a range of barriers (e.g., time, cost). Computer-based training for cognitive behavioral therapy (CBT4CBT) offers an opportunity to improve …

Bidirectional Associations Between Passive And Active Technology Use And Sleep: A Longitudinal Examination In Young Adolescents With And Without Adhd, Elizaveta Bourchtein

Theses and Dissertations

Many adolescents do not receive recommended amounts of sleep, and prevalence rates of sleep problems are particularly high among adolescents with attention-deficit/hyperactivity disorder (ADHD). One factor that may contribute to these sleep difficulties is technology use, and there is some evidence that the association between technology use and sleep may be bi-directional. Further, type of technology use (i.e., passive versus active) may be differentially associated with sleep. To date, most studies have evaluated these associations cross-sectionally and relied upon global and subjective ratings of technology use and sleep, which masks important day-to-day variability. The present study evaluated bi-directional associations between …

Differential Identification Of Hyperacusis And Misophonia: Implications Of Discrete Decreased Sound Tolerance (Dst) Condition Subtypes, Rachel E. Wallace

Theses and Dissertations

Hyperacusis and misophonia are two conditions of decreased sound tolerance (DST) studied in the psychological literature due to their association with psychological symptoms and mechanisms. DSTs are differentiated from normal sound sensitivity due to the reported impairment and distress individuals experience. Researchers suggest that DSTs are differentiated by types of sounds and emotional reactions elicited, such that hyperacusis is a fear and pain response to ordinary environmental sounds perceived as uncomfortably loud, and misophonia is an anger and disgust response to human-made sounds, but these distinctions, and associated characteristics, have not been empirically demonstrated. Undergraduate students (N = 1572) …

Predictors Of Mental Health Need And Treatment In Safety Net Primary Care, Kristen O'Loughlin

Theses and Dissertations

Many mental health (MH) needs go unidentified in primary care, and certain patients appear to be at higher risk of needs going unidentified and subsequently untreated. Little is known about patterns of detection and treatment in clinics with integrated mental health services. The purpose of this study was to characterize the prevalence of MH needs and evaluate patient characteristics as predictors of both the presence of a MH need and type of MH services received. Subjects were patients receiving care at two safety net primary care clinics with integrated mental health services (N=816; 52.7% Latinx, 15.9% African American), …

Profiles Of Adjustment Among Children In Institutional Care In Ghana: Predictors Of Positive Functioning, Anna W. Wright

Theses and Dissertations

Worldwide, approximately 2-8 million children reside in institutional care, which can lead to developmental setbacks. Given the need for institutional care persists, it is important to continue investigating which improvements can be made to provide optimal care. The current mixed-methods study included participants from Accra, Ghana. Study 1 involved cluster analyses to determine patterns of adjustment for 100 children in institutional care (CIC) (M age = 13.31 years, SD = 3.14; 40% female) and 100 children in families (CIF) (M age = 13.37 years, SD = 3.08; 40% female) across several domains. ANOVA was used to evaluate whether …

A Meta-Analysis Investigating The Correlation Between Treatment Integrity And Youth Client Outcomes, Ruben G. Martinez

Theses and Dissertations

Objective: The relation between treatment integrity and youth client outcomes in psychosocial treatment research has implications for therapist training, study design, and study interpretation. Despite work done in this area, this relation remains unclear. The aim of the current study was to meta-analyze and describe characteristics of investigations of integrity and outcome in youth.

Method and Analytic Plan: A total of N = 30 studies were identified. Conceptual and methodological factors were coded. Pearson’s r represented the magnitude of the integrity-outcome correlation. Robust variance estimation was used to account for dependency of within-study effect sizes. Two models were run with …

The Moderating Role Of Developmental Assets On Relations Between Child Maltreatment, Trauma, And Dating Violence, Stephanie A. Hitti

Theses and Dissertations

Teenage dating violence (TDV) is prevalent and associated with an array of psychosocial and health problems. Thus, numerous studies have focused on the identification of risk and protective factors for TDV. Child maltreatment has been consistently identified as a risk factor for TDV victimization and perpetration. However, potential underlying mechanisms that may partially explain the relations between child maltreatment and TDV victimization and perpetration are not well understood. The present study explored indirect relations between child maltreatment and TDV victimization and perpetration via trauma symptoms, and examined whether internal and external developmental assets moderated relations between (a) child maltreatment and …

Adverse Childhood Experiences In Children Presenting To Integrated Pediatric Primary Care, Irene A. Jacobs

Theses and Dissertations

The prevalence of adverse childhood experiences (ACEs) has created a significant public health concern in the United States. A vast body of literature examining adult populations has displayed a dose-response association between cumulative ACEs and chronic illnesses (Chapman et al., 2004; Felitti et al., 1998). ACEs research conducted with children and adolescents has indicated higher ACE scores associated with learning and behavioral problems (Burke et al., 2011), health risk behaviors (Garrido et al., 2018), and mental health challenges (Mackner et al., 1997). However, ACEs research and subsequent interventions have largely relied upon retrospective data retrieved from adults (Felitti et al., …