Clinical Psychology Commons^™

A Call To Dismantle Systemic Racism In Criminal Legal Systems, Cynthia J. Najdowski, Margaret C. Stevenson

Psychology Faculty Scholarship

Objectives: In October 2021, APA passed a resolution addressing ways psychologists could work to dismantle systemic racism in criminal legal systems. The present report, developed to inform APA’s policy resolution, details the scope of the problem and offers recommendations for policy and psychologists to address the issue by advancing related science and practice. Specifically, it acknowledges the roots of modern-day racial and ethnic disparities in rates of criminalization and punishment for people of color as compared to White people. Next, the report reviews existing theory and research that helps explain the underlying psychological mechanisms driving racial and ethnic disparities …

Doctor Recommendations Are Related To Patient Interest And Use Of Behavioral Treatment For Chronic Pain And Addiction, Lisa M. Mcandrew, Alexandria Brunkow, Margeaux Cannon, Fiona S. Graff, Jessica L. Martin, Leslie R.M. Hausmann

Educational & Counseling Psychology Faculty Scholarship

The opioid crisis has highlighted the importance of improving patients’ access to behavioral treatments for chronic pain and addiction. What is not known is if patients are interested in receiving these treatments. In this cross-sectional study, over 1000 participants with chronic pain were surveyed using an anonymous online questionnaire on Amazon Mechanical Turk (Mturk) to investigate participants’ use of and interest in pharmacological and behavioral treatments for chronic pain and addiction. Participants also indicated whether their doctor had recommended these treatments. The majority of participants reported using medication for their pain (83.19%) and that their doctor recommended medication (85.05%), whereas …

Coping With Medically Unexplained Physical Symptoms: The Role Of Illness Beliefs And Behaviors, Lisa M. Mcandrew, Nicole Sullivan, L. Alison Phillips, Wilfred R. Pigeon, Karen S. Quigley, Fiona Graff, David R. Litke, Drew A. Helmer, Joseph F. Rath

Educational & Counseling Psychology Faculty Scholarship

Background: Medically unexplained syndromes (MUS) are both prevalent and disabling. While illness beliefs and behaviors are thought to maintain MUS-related disability, little is known about which specific behavioral responses to MUS are related to disability or the way in which beliefs and behaviors interact to impact functioning. The purpose of the present study was to examine the relationship between illness beliefs and disability among patients with MUS, and assess the extent to which behaviors mediate this relationship. Methods: The study examined data from the baseline assessment of a multi-site randomized controlled trial (RCT). Participants were 248 veterans with MUS. Illness …

Concordance Of Illness Representations: The Key To Improving Care Of Medically Unexplained Symptoms, Lisa M. Mcandrew, Myrna L. Friedlander, L. Alison Phillips, Susan L. Santos, Drew A. Helmer

Educational & Counseling Psychology Faculty Scholarship

How can effective patient-provider relationships be developed when the underlying cause of the health condition is not well understood and becomes a point of controversy between patient and provider? This problem underlies the difficulty in treating medically unexplained symptoms and syndromes (MUS; e.g., fibromyalgia, chronic fatigue syndrome), which primary care providers consider to be among the most difficult conditions to treat.¹ This difficulty extends to the patient-provider relationship which is characterized by discord over MUS.¹ In this article, we argue that the key to improving the patient provider relationship is for the patient and provider to develop congruent …

Longitudinal Relationship Between Onset Of Physical Symptoms And Functional Impairment, Lisa M. Mcandrew, Drew A. Helmer, Shou-En Lu, Helena K. Chandler, Sarah Slotkin, Karen S. Quigley

Educational & Counseling Psychology Faculty Scholarship

Patients with chronic physical symptoms (e.g., chronic pain) often have significant functional impairment (i.e., disability). The fear avoidance model is the dominant theoretical model of how the relationship between chronic physical symptoms and functional impairment develops and proposes a cyclical/bidirectional relationship. There has never been a definitive test of the proposed bi-directional relationship. The current study followed 767 Operation Enduring Freedom/Operation Iraqi Freedom soldiers from pre-deployment, when they were relatively healthy, to one year after deployment, when it was anticipated that symptoms would increase or develop. Over the four assessment time points, physical symptom severity consistently predicted worse functional impairment …

High Healthcare Utilization At The Onset Of Medically Unexplained Symptoms, Lisa M. Mcandrew, L. Alison Phillips, Drew A. Helmer, Kieran J. Maestro, Charles C. Engel, Lauren M. Greenberg, Nicole Anastasides, Karen S. Quigley

Educational & Counseling Psychology Faculty Scholarship

Objective: Patients with medically unexplained syndromes (MUS) often do not receive appropriate healthcare. A critical time for effective healthcare is the inception of MUS. The current study examined data from a prospective longitudinal study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans to understand the relationship of increasing physical symptom burden to healthcare utilization.

Methods: Data was examined from a prospective study of OEF/OIF veterans assessed before and one year after deployment (n=335). Physical symptom burden was measured with the Patient Health Questionnaire (PHQ-15). Analyses were conducted with polynomial regression and response surface analysis (RSA).

Results: Increases in physical symptom …

The Common Sense Of Counseling Psychology: Introducing, Lisa M. Mcandrew, Jessica L. Martin, Myrna L. Friedlander, Katherine Shaffer, Jessica Y. Breland, Sarah Slotkin, Howard Leventhal

Educational & Counseling Psychology Faculty Scholarship

The goal of therapy is typically to improve clients’ self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving client’s self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal’s Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage …

Telephone-Based Versus In-Person Delivery Of Cognitive Behavioral Treatment For Veterans With Chronic Multisymptom Illness: A Controlled, Randomized Trial, Lisa M. Mcandrew, Lauren M. Greenberg, Donald S. Ciccone, Drew A. Helmer, Helena K. Chandler

Educational & Counseling Psychology Faculty Scholarship

Background:The goal of this randomized clinical trial was to examine the efficacy of a cognitive behavioral stress reduction treatment for reducing disability among veterans with chronic multisymptom illness (CMI).Method: Veterans (N=128) who endorsed symptoms of CMI were randomized to: usual care (n=43), in-person (n=42) or telephone-delivered cognitive behavioral stress management (n=43). Assessments were conducted at baseline, three months, and twelve months. The primary outcome was limitation in roles at work and home (i.e., ‘role physical’). Reductions in catastrophizing cognitions were evaluated as a mechanism of action. Results: Intent-to-treat analyses showed …

Less Engagement In Pleasure Activities Is Associated With Poorer Quality Of Life For Veterans With Comorbid Post-Deployment Conditions, Lisa M. Mcandrew, Held F. Rachel, Abbi Bhavna, Karen S. Quigley, Drew A. Helmer, Radhika V. Pasupuleti, Helena K. Chandler

Educational & Counseling Psychology Faculty Scholarship

Objective: The presence of multiple comorbid conditions is common after combat deployment and complicates treatment. A potential treatment approach is to target shared mechanisms across conditions that maintain poorer health-related quality of life (HRQOL). One such mechanism may be decrements in pleasurable activities. Impairment in pleasurable activities frequently occurs after deployment and may be associated with poorer HRQOL.

Method: In this brief report, we surveyed 126 Veterans who had previously sought an assessment at a Veterans Affairs post-deployment health clinic and assessed pleasurable activities, HRQOL, and post-deployment health symptoms.

Results: Forty-three percent of Veterans met our criteria for all three …

A Historical Review And Resource Guide To The Scholarship Of Teaching And Training In Psychology And Law And Forensic Psychology, Cynthia J. Najdowski, Bette L. Bottoms, Margaret C. Stevenson, Jennifer C. Veilleux

Psychology Faculty Scholarship

The field of psychology and law, including forensic psychology, is an exciting concentration of research activity and student training and has grown rapidly, but to what extent have teaching and training efforts in the field been systematically catalogued and evaluated? We conducted a historical review and content analysis of the American and Canadian literature on the scholarship of teaching and training in the field. This review catalogs (a) information related to the development of training and teaching, (b) descriptions of programs and courses at various levels, and (c) articles on teaching resources or techniques in this field. We hope it …

African American Families' Expectations And Intentions For Mental Health Services, Cynthia J. Najdowski, Richard Thompson, Barbara L. Dancy, Tisha R. A. Wiley, Sylvia P. Perry, Jason Wallis, Yara Mekawi, Kathleen Knafl

Psychology Faculty Scholarship

A cross-sectional qualitative descriptive design was used to examine the links among expectations about, experiences with, and intentions toward mental health services. Individual face-to-face interviews were conducted with a purposive sample of 32 African American youth/mothers dyads. Content analysis revealed that positive expectations were linked to positive experiences and intentions, that negative expectations were not consistently linked to negative experiences or intentions, nor were ambivalent expectations linked to ambivalent experiences or intentions. Youth were concerned about privacy breeches and mothers about the harmfulness of psychotropic medication. Addressing these concerns may promote African Americans’ engagement in mental health services.

The Effects Of Revictimization On Coping And Depression In Women Sexual Assault Victims, Cynthia J. Najdowski, Sarah E. Ullman

Psychology Faculty Scholarship

On two mail surveys completed 1 year apart, 555 women reported their experiences of sexual assault, the strategies they used to cope with those experiences, and feelings of depression. Path analyses controlling for baseline coping and depression revealed that victims who were revictimized during the study reported using more maladaptive and adaptive coping strategies than did victims who were not revictimized. Further, women who were revictimized reported more depression than others. This effect was explained in part by revictimized women’s increased maladaptive coping. Implications for understanding coping and recovery in women who experience multiple sexual assaults in adulthood are discussed.

Women, Alcoholics Anonymous, And Related Mutual Aid Groups: Review And Recommendations For Research, Sarah E. Ullman, Cynthia J. Najdowski, Ericka B. Adams

Psychology Faculty Scholarship

Recent literature reviews and meta-analyses have supported the effectiveness of Alcoholics Anonymous (AA) in helping members stop drinking and maintain sobriety. Despite the extensive body of research on AA, less attention has focused on differences in the efficacy of the program for and experiences of women as compared to men. Such a focus is warranted given that there are significant gender differences in the development and progression of alcoholism, impact of drinking, and response to treatment. This review synthesizes results of extant research on women in AA and similar mutual aid groups focused on problem drinking to describe the state …

Trauma Severity And Defensive Emotion-Regulation Reactions As Predictors Of Forgetting Childhood Trauma, Bette L. Bottoms, Cynthia J. Najdowski, Michelle A. Epstein, Matthew J. Badanek

Psychology Faculty Scholarship

Using a retrospective survey, we studied a sample of 1679 college women to determine whether reports of prior forgetting of sexual abuse, physical abuse, and other traumas could be explained by trauma severity and individual differences in the use of defensive emotion-regulation reactions (i.e., repressive coping, dissociation, and fantasy proneness). Among victims of physical abuse (but not sexual abuse or other types of trauma), those who experienced severe abuse and used defensive reactions were sometimes more likely to report temporary forgetting of abuse, but other times less likely to report forgetting. We also found unanticipated main effects of trauma severity …

The Effects Of Revictimization On Coping And Depression In Female Sexual Assault Victims, Cynthia J. Najdowski, Sarah E. Ullman

Psychology Faculty Scholarship

To examine the effects of being revictimized, 555 women completed 2 mail surveys 1 year apart, reporting their experiences of sexual assault, the strategies they used to cope with those experiences, and feelings of depression. Path analyses, controlling for baseline coping and depression, revealed that those who were revictimized during the study reported using more maladaptive and adaptive coping strategies than did those who were not revictimized (β = .11 and β = .16, respectively). Further, women who were revictimized reported more depression than others (β = .15). This effect was explained in part by revictimized women's increased maladaptive coping. …

Prospective Changes In Attributions Of Self-Blame And Social Reactions To Women’S Disclosures Of Adult Sexual Assault, Cynthia J. Najdowski, Sarah E. Ullman

Psychology Faculty Scholarship

The present longitudinal study examined relations between self-blame attributions and social reactions to disclosure in a community sample of adult sexual assault victims (N = 555). Cross-lagged panel analyses showed that neither characterological self-blame nor behavioral self-blame related to negative social reactions over the 1-year follow-up period. In contrast, characterological but not behavioral self-blame predicted fewer positive reactions over time. Although positive reactions did not reduce self-blame, negative reactions led to greater characterological, but not behavioral, self-blame during the course of the study. Thus, relations between self-blame and social reactions were not reciprocal but rather quite complex. The effects …

The Experience Of Mental Health Service Use For African American Mothers And Youth, Richard Thompson, Barbara L. Dancy, Tisha R. A. Wiley, Sylvia P. Perry, Cynthia J. Najdowski

Psychology Faculty Scholarship

Little is known about African American families’ experiences with mental health services. A purposive sample of 40 dyads of African American youth (aged 13 to 19) and their mothers participated in a cross-sectional qualitative research design using semi-structured interviews that elicited information about their past experiences and satisfaction with mental health services. Though rarely received, group and family therapy were perceived favorably. However, both mothers and youth reported dissatisfaction centered on medication and lack of professionalism, confidentiality, and concern by providers. The failure of mental health services providers to meet basic standards of quality and professionalism may explain the low …

Vulnerability And Protective Factors For Sexual Assault, Sarah E. Ullman, Cynthia J. Najdowski

Psychology Faculty Scholarship

Approximately 1 in 5 women experience sexual assaults in adulthood during their lives (see Post, this volume, for review), including experiences of unwanted sexual contact, sexual coercion, attempted rape, and completed rape that result from threat, force, or incapacitation from alcohol or drugs (either willingly or unwillingly consumed).

Alcohol-Related Help Seeking In Problem Drinking Women Sexual Assault Survivors, Sarah E. Ullman, Cynthia J. Najdowski

Psychology Faculty Scholarship

Correlates of alcohol-related help seeking were studied in women sexual assault survivors who were current problem drinkers (N = 526) in a large metropolitan area in 2002-2003. Volunteer participants completed several valid and reliable instruments, which assessed alcohol use and misuse and related help seeking (i.e., the TWEAK, GFM, and MAST). Data were analyzed using logistic regression models. Results suggest that correlates of women survivors’ alcohol-related help seeking vary depending on the specific source. Limitations and implications are noted and recommendations for future research are made. This study was funded by the National Institutes on Alcohol Abuse and Alcoholism.

Understanding Alcohol-Related Sexual Assaults: Characteristics And Consequences, Sarah E. Ullman, Cynthia J. Najdowski

Psychology Faculty Scholarship

Sexual assaults commonly involve alcohol use, but little is known about alcohol’s effects on many aspects of assaults and their aftermath. We investigated characteristics of victims, perpetrators, and assaults as a function of whether alcohol was involved in the assault, as well as differences in women’s post-assault experiences. Assaults prior to which only perpetrators were drinking differed not only from non-alcohol-related assaults, but also from those prior to which both perpetrators and victims were drinking. Understanding the effects of alcohol-related assaults is important for identifying victims who should be targeted for mental health and substance use interventions.

Child Sexual Abuse, Ptsd, And Substance Use: Predictors Of Revictimization In Adult Sexual Assault Survivors, Sarah E. Ullman, Cynthia J. Najdowski, Henrietta Filipas

Psychology Faculty Scholarship

This study examined the unique effects of child sexual abuse simultaneously with post-traumatic stress disorder symptom clusters, problem drinking, and illicit drug use in relation to sexual revictimization in a community sample of female adult sexual assault victims. Participants (N = 555) completed two surveys a year apart. Child sexual abuse predicted more post-traumatic stress disorder symptoms in adult sexual assault victims. Posttraumatic stress disorder numbing symptoms directly predicted revictimization, whereas other post-traumatic stress disorder symptoms (reexperiencing, avoidance, and arousal) were related to problem drinking, which in turn predicted revictimization. Thus, numbing symptoms and problem drinking may be independent risk …

Prospective Effects Of Sexual Victimization On Ptsd And Problem Drinking, Cynthia J. Najdowski, Sarah E. Ullman

Psychology Faculty Scholarship

Posttraumatic stress disorder (PTSD) and problem drinking are common and often co-occurring sequelae experienced by women survivors of adult sexual assault, yet it remains unclear whether survivors drink to cope with PTSD symptoms or whether PTSD symptoms are exacerbated by drinking. Thus, we used a cross-lagged panel design with a large (N = 555), ethnically diverse sample of women assault survivors to determine whether PTSD prospectively led to problem drinking or vice versa. We also examined whether cumulative sexual victimization experiences related to greater PTSD and problem drinking. Structural equation modeling revealed that child sexual abuse was associated with …

Correlates Of Suicidal Ideation And Attempts In Female Sexual Assault Survivors, Sarah E. Ullman, Cynthia J. Najdowski

Psychology Faculty Scholarship

Relations between (a) serious suicidal ideation and attempts and (b) demographics, trauma history, assault characteristics, post-assault outcomes, and psychosocial variables were examined among female adult sexual assault survivors. Younger, minority, and bisexual survivors reported greater ideation. More traumas, drug use, and assault disclosure related to greater attempts, whereas perceived control over recovery was related to fewer attempts. Child sexual abuse and some assault characteristics predicted suicidal behavior. Depression was related to suicidal behavior until psychosocial variables were accounted for. Specifically, using substances to cope and self-blame predicted greater ideation, whereas receiving aid/information support was related to less ideation. Implications for …

Ptsd Symptoms And Self-Rated Recovery Among Adult Sexual Assault Survivors: The Effects Of Traumatic Life Events And Psychosocial Variables, Cynthia J. Najdowski, Sarah E. Ullman

Psychology Faculty Scholarship

Prior research has demonstrated that self-blame is predictive of more PTSD symptoms and poorer recovery (Frazier, 2003; Koss, Figueredo, & Prince, 2002), and perceived control over recovery is associated with less distress (Frazier, 2003) in adult sexual assault (ASA) survivors. A structural equation model was tested to examine the role of traumatic events, self-blame, perceived control over recovery, and coping strategies on PTSD symptoms and self-rated recovery in women ASA survivors. Adaptive coping partially mediated the effects of other traumas, self-blame, and perceived control over recovery on PTSD symptoms, and showed a small positive association with increased PTSD symptoms. As …