Clinical Psychology Commons^™

The Impossible Situation? Impasse As Psychotherapeutic Paralysis, Possibility, And Progress, Leo Cancelmo

Dissertations, Theses, and Capstone Projects

Psychotherapeutic impasse has long been understood in the clinical literature as treatment stagnation and even failure, both from one-person and two-person psychodynamic perspectives. However, there is a dearth of empirical research that delves deeper to understand this complex and rich phenomenon. Using semi-structured interviews with nine psychodynamic therapists speaking about individual adult patients, this study examined experiences of impasse to better understand treatments that become embroiled in a kind of paralysis. Qualitative analyses revealed dyads where patients were conceptualized as struggling chronically with negative feelings about themselves and others, and who experienced traumatic personal histories. Impasse in and of itself …

Reducing Fear Overgeneralization With Safety Learning: Attention Bias As A Moderator, Boyang Fan

Dissertations, Theses, and Capstone Projects

Anxiety disorders are the most prevalent mental health condition and affect one out of nine individuals around the world. Fear generalization is a neurocognitive mechanism thought to maintain and exacerbate anxiety, and thus is an important target of therapeutic interventions. Yet, intervention research and practice place relatively little emphasis on its importance. Given that a significant proportion of individuals do not respond to extant treatments of anxiety disorders, a strengthened focus on fear generalization may inform the development and personalization of new treatment approaches. Recent notions have linked fear generalization to failures in distinguishing between signals that predict the occurrence …

A Randomized Controlled Trial Of Psychological Outcomes Of Mobile Guided Resonant Frequency Breathing In Young Adults With Elevated Stress During The Covid-19 Pandemic, Al Amira Safa Shehab

Dissertations, Theses, and Capstone Projects

Deep breathing practices have shown promise in reducing stress, anxiety, and depression in different populations, including young adults. Specifically, resonant frequency breathing can exert an impact on stress response systems through the vagus nerve and the hypothalamo-pituitary-adrenal (HPA) axis. This may induce reductions in stress and improvement in emotion regulation. Young adults, including college students, tend to be at a higher risk for psychological distress, as they face several psychosocial challenges. The COVID-19 pandemic has imposed new and unique stressors that resulted in higher levels of stress and emotional symptoms and it has been shown that this may have placed …

Antecedents Of Borderline Personality Disorder And Antisocial Personality Disorder: An Examination Of Gene X Environment Interactions, Amy L. Medina

Dissertations, Theses, and Capstone Projects

Current thinking suggests that genotypes associated with impulse-control disorders and negative emotionality, such as monoamine oxidase-a (MAOA), interact with negative early environmental factors like childhood maltreatment and develop into the disorders know as Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD). Using existing data from a prospective cohort design study of the consequences of child abuse and neglect, participants (N = 896 represent individuals with documented histories of child abuse and neglect and a matched comparison group that were followed up into adulthood and interviewed. A subsample of 631 participants gave permission for DNA extraction and analyses during …

Attachment, Exploration, And Internalized Homonegativity, Gregory J. Gagnon

Dissertations, Theses, and Capstone Projects

Background: Internalized homonegativity (IH; a.k.a. internalized homophobia), has been implicated in health disparities between lesbian, gay, and bisexual persons (LGBs) and their heterosexual peers. Yet, little available research has explored factors that may increase or decrease IH.

Objective: This dissertation investigates relations between child and adult attachment and IH. It further examines the mediating and moderating roles of exploration and mentalization, respectively, in the attachment–IH relation.

Method: One hundred fifty cisgender LGB adults participated in two waves of an online survey. The first assessed recalled child–maternal and child–paternal attachment and current attachment to the romantic partner. The second, conducted two …

Taking It To Heart: Trauma And Cardiovascular Risk In Court-Involved People Of Color, Tanya Erazo

Dissertations, Theses, and Capstone Projects

Research supports that racial disparities in health persist in the United States, with cardiovascular risk and cardiovascular disease remaining particularly high in low-income, communities of color (U.S. Department of Health and Human Services: Centers for Disease Control and Prevention, 2013; Winkleby, Jatulis, Frank, & Fortmann, 1992). Public health literature often focuses on sociodemographic variables when assessing for health disparities without considering trauma or forensic populations. This dissertation provides an overview of literature that examines cardiovascular disease and its relationship to trauma, particularly in low-income, communities of color, and forensic populations. Although the dissertation culminates in providing results for an investigation …

Object Relations, Identity Formation, And Transitional Space In Religious Conversion, Arielle Rubenstein

Dissertations, Theses, and Capstone Projects

Conversion between broad religious groups is a life transformation undertaken by 15% of Americans, yet it has seldom been studied closely from a psychodynamic perspective. The psychological study of conversion began with a Protestant paradigm of sudden and total transformation of the self, and over time came to characterize different manifestations of conversion to more diverse religious groups. Research on conversion has primarily sought to understand whether conversion is essentially a psychopathological phenomenon, and has led to a multiplicity of both positive and negative, at times contradictory, findings. Research has shown that conversion is associated with insecure attachment, neurotic personality …

Neurodevelopmental Mechanisms Of Adverse Trauma Outcomes In Emerging Adulthood, Olena Kleshchova

Dissertations, Theses, and Capstone Projects

Background: Exposure to traumatic stress and adversity during the formative years of development can have adverse effects on mental health, neuroendocrine stress system function, and the brain, that persist into adulthood. One candidate mechanism that might confer vulnerability to enduring adverse outcomes of early life trauma is disruption of normal brain maturation. As the brain matures, functional interactions among brain regions change until the functional brain architecture (i.e., the functional connectome) reaches a mature state in adulthood. Given that different neural circuits have distinct developmental trajectories and sensitive periods, traumatic stress at a given point in development might have …

Sex/Gender Differences In Serial Position Profiles In Patients With Mild Cognitive Impairment And Healthy Controls, Emnet Z. Gammada

Dissertations, Theses, and Capstone Projects

Introduction: Alzheimer’s disease disproportionately affects more women, but paradoxically, men have a higher incidence of Mild Cognitive Impairment (MCI). Researchers have suggested that women’s verbal memory advantage across the lifespan reflects better premorbid skills, which then require more neurodegeneration to manifest early clinical impairment. To date, measurement of sex differences in verbal memory have used total list scores. We proposed that a granular examination of serial position effects (SPE) in list-learning can refine the source of sex/gender differences.

Methods: A cross-sectional analysis of participants with Mild Cognitive Impairment (MCI) and Healthy Controls (HC) was examined from the Alzheimer’s Disease Neuroimaging …

Electroencephalographic Asymmetry, Emotion Regulation, And Their Relationships With Depression Risk, Aliza Jacob

Dissertations, Theses, and Capstone Projects

Background: Research investigating patterns of electroencephalographic (EEG) brain asymmetry aids our understanding of neural systems involved in the processing of emotion, motivation, and psychopathology. Withdrawal-motivated negative emotions characteristic of depression are associated with relative right prefrontal cortex (PFC) activity, whereas approach- motivated positive emotions are associated with relative left PFC activity. Styles of emotion regulation (ER), or modulation of the intensity and duration of emotional responses, are also associated with presence (e.g., suppression, or maladaptive ER) versus absence (e.g., cognitive reappraisal, or adaptive ER) of depression vulnerability. Most PFC asymmetry studies of emotion, depression, and/or ER rely upon EEG recorded …

The Development Of Face Morphing Task To Assess Self Other Differentiation, Esen Karan

Dissertations, Theses, and Capstone Projects

Self-Other Differentiation (SOD) refers to a developmental process of acquiring a consolidated, integrated, and individuated sense of self. SOD develops at a) perceptual (e.g., facial perception) and b) representational (e.g., traits, mental states, and beliefs) levels. Impairments in representational SOD (R-SOD) are associated with many forms of psychopathology, particularly borderline personality disorder (BPD) and narcissistic personality disorder (NPD). Few studies to date have examined the perceptual aspects of SOD (P-SOD), which are hypothesized to develop from infancy onwards in tandem and in interaction with R-SOD. Given that the human face is one of the key characteristics that humans use to …

Does Ethnic Identity, In-Group Preference, And Acculturation Protect Latinas With A History Of Interpersonal Trauma From Developing Symptoms Of Ptsd?, Evelyn M. Ramirez

Dissertations, Theses, and Capstone Projects

Previous research suggests ethnic identity, a sense of belonging to a particular cultural group, may be protective against symptoms of post-traumatic stress disorder (PTSD). However, the role of ethnic identity, in-group preference (i.e., an individual’s preference for interactions with members of their own ethnic group) and acculturation (i.e., the level of comfort with the mainstream culture) have not been investigated as protective factors for Latinas with a history of interpersonal and sexual trauma. In this study, ethnic identity, in-group preference and acculturation were assessed via self-report on the Scale of Ethnic Experience in two samples of undergraduate Latina and non-Latina …

The Social Cost Of Pain: Rejection Sensitivity, Social Rejection, And Cannabis Use In Young Adults, Naomi Dambreville

Dissertations, Theses, and Capstone Projects

Cannabis has been implicated in relieving distress and social pain, an important area of research in young adult samples, given the saliency of peer and social networks to addiction. Cannabis, via opioid pathways, has been shown to reduce, or potentially buffer, the effects of social pain and rejection. Thus, cannabis may be protective against the painful feelings of social stress, particularly for heavier or more frequent users. However, findings are not wholly positive, as other research indicates cannabis may blunt affective responses and impair social processing. The effects of cannabis use in young adults are understudied, as well as its …

Clinical Characteristics And Neuroanatomical Predictors Of Acute Antidepressant Outcome For Patients With Comorbid Depression And Mild Cognitive Impairment, Jeffrey N. Motter

Dissertations, Theses, and Capstone Projects

Background: Older adults presenting with both a depressive disorder (DEP) and cognitive impairment (CI) represent a unique, understudied population. The classification of cognitive impairment severity continues to be debated though it has recently been subtyped into late (LMCI) versus early (EMCI) stages. Previous studies have found associations between treatment outcome and both cortical thickness and white matter hyperintensities (WMH), though report inconsistent directionality and affected regions. In this study, we examined baseline clinical characteristics and neuroanatomical features as prognostic indicators for older adults with comorbid DEP and CI participating in an open antidepressant trial. EMCI is hypothesized to have greater …

Mindfulness In Medicine: Modified Mindfulness-Based Stress Reduction (Mbsr) Program Among Future Doctors, Virtue Sankoh

Dissertations, Theses, and Capstone Projects

Medical trainees are at particular risk for stress-related illness, including mental health problems such as suicidal ideation, substance abuse, and mood disorders. A vast literature on mindfulness-based stress reduction (MBSR), consisting of mindfulness education and structured meditative practices, has consistently demonstrated that MBSR and related mindfulness-based interventions improve mental and physical health, as well as one’s overall sense of well-being. Moreover, theorists and researchers have begun to suggest further that mindfulness plays a particular role in social cognition, or social-emotional learning. Medical schools have long been interested in ways to improve the “soft skills” related to interpersonal connectedness that are …

Casualties Of Racism: Racial And Ethnic Discrimination And Suicidal Thoughts And Behaviors Among Racial And Ethnic Minority Emerging Adults, Lillian Anais Polanco

Dissertations, Theses, and Capstone Projects

The evidence demonstrating that experiences of racial/ethnic discrimination is detrimental to the mental health of racial/ethnic minority youth is unequivocal. What remains unclear, however, is whether racial/ethnic discrimination increases vulnerability for suicidal thoughts and behaviors in particular, and if so, what are the underlying mechanisms to explain this relation. Drawing upon the Race-based Traumatic Stress Theory (Carter, 2007), which suggests that some individuals may experience racial/ethnic discrimination as a traumatic stressor, and thus, eliciting a traumatic stress response, the present study examined posttraumatic stress reactions (i.e., posttraumatic stress, depression, dissociation, stress sensitivity) as mediators in the relation between racial/ethnic discrimination …

Underlying Contribution Of Executive Functioning To Cognition And Academic Achievement In Individuals With Dystrophinopathy, Robert Fee

Dissertations, Theses, and Capstone Projects

Dystrophinopathy is a genetic disorder that results in the lack of or abnormal expression of the protein dystrophin. It is a disorder that alters cell structure and function, impacts the developing brain and brain function, presents with multi-domain cognitive deficits, and influences both mood and behavior. Cognitive impairments appear to be more localized to specific areas of functioning rather than a global deficit; however, deficits have been identified across multiple cognitive domains including language and aspects of executive functioning. A careful examination of the cognitive phenotype and its association to mutations affecting CNS isoforms is necessary to clarify the neuropsychological …

What’S Your Story? Assessing Childhood Maltreatment Using The Thematic Apperception Test In An Adult Inpatient Population., Thachell C. Tanis

Dissertations, Theses, and Capstone Projects

There is a robust evidence that childhood maltreatment contributes to the development of adult psychopathology (Brown & Anderson, 1991; Johnson, Cohen, Brown, Smailes, & Bernstein 1999; Johnson, Smailes, Cohen, Brown, & Bernstein, 2000; Ruggiero et al., 1999). However, the identification of childhood maltreatment remains a methodological problem that results in inconsistencies in the reported incidence and psychological sequelae of maltreatment. A primary method for identifying histories of childhood maltreatment among adults is retrospective self-report measures which are susceptible to multiple biases (Briere, 1992; Cicchetti & Rizley, 1981; Shaffer, Huston, & Egeland, 2008). This present study suggests that childhood maltreatment can …

Linking Hostile/Helpless Maternal Representations In Pregnancy And Later Child Protection Involvement: A Pilot Study, Madeleine Terry

Dissertations, Theses, and Capstone Projects

The present pilot study examined whether there are reliable indices in the narratives of pregnant women that can be used to identify child abuse and neglect potential before the birth of the child. The Hostile/Helpless (HH) Classification system (Lyons-Ruth et al., 1995-2005), which detects mental states associated with trauma, disturbances in early attachment, and severe pathology, was adapted for use with the Pregnancy Interview (PI), a semi-structured clinical interview (Slade, 2003) that assesses a woman's emotional experience of pregnancy, and quality of her developing relationship with her baby. The study sample was drawn from a replication study of the Minding …

A Conceptualization Of The Body In Psychodynamic And Body-Based Psychotherapies: Areas Of Overlap And Possibilities For Integration, Aleksandra Rayska

Dissertations, Theses, and Capstone Projects

The distinction between verbal and nonverbal psychotherapies is clearly visible in theory and clinical practice. Moreover, this duality of approaches promotes a split between the body and the mind, defining them as separate from each other. This dissertation helps bridge the divide between the literature in body-based therapies and verbally-based psychotherapy by (i) exploring the conceptual frame used to understand the body in psychodynamic therapy (ii) identifying the areas of overlap between psychodynamic theory and theories that underlie body-based psychotherapies, and (iii) proposing ways in which psychodynamic and body-based theories can inform one another. A clinical case was used to …

Women’S Sexual Fantasies In Context: The Emotional Content Of Sexual Fantasies, Psychological And Interpersonal Distress, And Satisfaction In Romantic Relationships, Sarah Constantine

Dissertations, Theses, and Capstone Projects

Background: Psychoanalytic thinkers propose that aspects of an individual’s sexual fantasies are related to her psychological and interpersonal functioning. The present study aims to elucidate the significance of sexual fantasies with respect to women’s emotional and interpersonal lives. The study evaluated a model, which hypothesized that internal representations of self and others (e.g. attachment security, maturity of object relations) along with psychological and interpersonal factors would predict both the emotional content (guilt, fear, affection) of written sexual fantasy narratives, and overall romantic satisfaction in heterosexual women. Methods: Five hundred and thirty four women completed self-report questionnaires online. Subsequently, the sexual …

Cortical Thickness Abnormalities Within The Salience And Reward Networks In Older Depressed Adults With Apathy, Monique A. Pimontel

Dissertations, Theses, and Capstone Projects

Background and Significance: Apathy is a common comorbidity in late-life depression. Among older depressed adults, apathy is associated with a number of adverse outcomes, including increased disability, comorbid illness, and mortality. The etiological substrates of apathy in late-life depression nonetheless remain poorly understood, and little is known about its optimal treatment. To this end, the aim of the current study was to examine cortical abnormalities within the salience (SN) and reward networks (RN), two brain systems involved in the processing of incentive salience that may underlie the syndrome of apathy in older depressed adults.

Methods: We examined the association between …

Spatial-Relational Learning And Memory Deficits Associated With Nmdar Autoantibodies In Systemic Lupus Erythematosus, Brittany L. Bascetta

Dissertations, Theses, and Capstone Projects

Individuals with Systemic Lupus Erythematosus (SLE) experience inflammation that may target any organ within the body, including the central and peripheral nervous systems. Additionally, these individuals often demonstrate psychological dysfunctions including emotional and cognitive deficits; however, research is inconsistent as to the nature and cause of these dysfunctions. While there are multiple factors that may increase risk for variability in cognitive function, such as population differences, socioeconomic status (SES), mood disorders (depression and anxiety), medication effects, and disease activity, these factors do not reliably predict the severity and extent of cognitive deficits. A growing body of animal research associates autoantibodies …

Providing Care For Many In The Context Of Few Resources: Secondary Traumatic Stress, Burnout And Moral Distress Experienced By Healthcare Providers In Rural Uganda, Lauren Michelle Dewey

Dissertations, Theses, and Capstone Projects

In the context of the global nursing shortage, and particularly in low-resource settings, nurses are at an increased risk for work-related stress problems like secondary traumatic stress (STS), burnout, and moral distress. These three work-related mental health consequences, sometimes associated with absenteeism and intent to leave the profession, could potentially contribute further to the shortage of nurses. This two-part study is a longitudinal examination of the work-related mental health consequences experienced by healthcare providers in rural Uganda. In Study 1, participants (n=208; 159 students and 49 experienced health workers) completed self-report, psychosocial measures at baseline and 134 of the students …

Observational Assessment Of Empathy In Parent-Child Verbal Exchanges And Their Influence On Child Behavior, Patty Carambot

Dissertations, Theses, and Capstone Projects

Empathy, the ability to both experientially share in and understand others’ thoughts, behaviors, and feelings, is vital for human adaptation. Deficits in empathy development have implications across the lifespan for the development of prosocial behavior, social functioning, mental health disorders, and risk for antisocial behavior (e.g., Guajardo, Snyder, & Petersen, 2009; Moreno, Klute & Robinson, 2008). In light of these societal and individual burdens, it is imperative to foster and strengthen the development of this ability early in life to prevent or ameliorate such negative outcomes. This type of prevention can take a variety of forms, but parent and child …

Let Fall: Hysteria And The Psychoanalytic Act, Matthew W. Oyer

Dissertations, Theses, and Capstone Projects

This text proposes to examine the contemporary crisis of psychoanalysis by taking seriously feminist critiques of the theory’s phallocentrism, but arguing that the phallus cannot be metaphorically or metonymically replaced by any substitutive term, as most revisionist theories of psychoanalysis have sought to do. Castration is the central psychoanalytic concept, though the theory always seeks to cover it over. In order to develop a psychoanalysis that can confront this castration that is always repressed and yet, in its persistent return, continuously disrupts the continuity of psychoanalytic theory, a detour is proposed, returning to the origins of psychoanalysis and taking hysteria …

Characterization Of Somatosensory Processing In Relation To Schizotypal Traits In A Sample Of Nonclinical Young Adults, Maureen Patricia Daly

Dissertations, Theses, and Capstone Projects

A core feature of schizophrenia spectrum disorders (SSDs) is a basic sensory (e.g., visual, auditory) processing disruption, yet few studies have examined somatosensation. The current dissertation project examined somatosensory processes among individuals at varying degrees of psychometric risk for psychosis using tactile texture and spatial discrimination and letter recognition tasks. Differential patterns of associations of somatosensory abilities with schizotypal trait dimensions (positive, negative, disorganized), independent of anxiety and depressive symptoms, and the relative contributions of bottom-up (peripheral and morphologic features) versus top-down (error types) processing were examined. It was hypothesized that: 1) performance on somatosensory tasks would account for significant …