Educational Psychology Commons^™

A Randomized Trial Of Brief Online Interventions To Facilitate Treatment Seeking For Social Anxiety, Margaret R. Tobias, Lauren N. Landy, Michael E. Levin, Joanna J. Arch

Psychology Faculty Publications

Objective: This study developed and evaluated a brief, single-session online intervention designed to facilitate treatment seeking among adults with clinically significant social anxiety (SA) symptoms, who generally seek treatment at exceptionally low rates.

Method: Adults (N= 267) reporting significant SA symptoms were recruited online and randomized to a brief, single-session online intervention: Education consisted of brief psychoeducation and treatment resources, or Education+Motivation which added treatment seeking-focused motivational content adapted from Motivational Interviewing and Acceptance and Commitment Therapy. Attitudes, intentions, perceived control, and treatment seeking were assessed at Pre, Post, and one-month follow-up (FU).

Results: Both interventions were feasible …

Stimulus Complexity And Chunk Tightness Interact To Impede Perceptual Restructuring During Problem Solving, Zhonglu Zhang, Christopher M. Warren, Yi Lei, Qiang Xing, Hong Li

Psychology Faculty Publications

The mutual influence of stimulus complexity and chunk tightness on perceptual restructuring was examined using a chunk decomposition task (CDT). Participants attempted to remove components of Chinese characters in order to produce new, valid characters. Participants had their electroencephalogram recorded while completing a CDT in conditions of low or high stimulus complexity, crossed with two levels of chunk tightness. Tight chunks overlapped spatially whereas loose chunks did not. Both increasing chunk tightness and increasing stimulus complexity impaired performance (lower accuracy, longer reaction times), and these factors interacted such that highly complex, tight chunks produced the worst performance. These factors also …

Promoting Healthy Decision-Making Via Natural Environment Exposure: Initial Evidence And Future Directions, Meredith S. Berry, Meredith A. Repke, Alexander L. Metcalf, Kerry Jordan

Psychology Faculty Publications

Research within psychology and other disciplines has shown that exposure to natural environments holds extensive physiological and psychological benefits. Adding to the health and cognitive benefits of natural environments, evidence suggests that exposure to nature also promotes healthy human decision-making. Unhealthy decision-making (e.g., smoking, non-medical prescription opioid misuse) and disorders associated with lack of impulse control [e.g., tobacco use, opioid use disorder (OUD)], contribute to millions of preventable deaths annually (i.e., 6 million people die each year of tobacco-related illness worldwide, deaths from opioids from 2002 to 2017 have more than quadrupled in the United States alone). Impulsive and unhealthy …

Natural Categorization: Electrophysiological Responses To Viewing Natural Versus Built Environments, Salif Mahamane, Nick Wan, Alexis Porter, Allison S. Hancock, Justin Campbell, M. S. Lyons, Kerry Jordan

Psychology Faculty Publications

Environments are unique in terms of structural composition and evoked human experience. Previous studies suggest that natural compared to built environments may increase positive emotions. Humans in natural environments also demonstrate greater performance on attention-based tasks. Few studies have investigated cortical mechanisms underlying these phenomena or probed these differences from a neural perspective. Using a temporally sensitive electrophysiological approach, we employ an event-related, implicit passive viewing task to demonstrate that in humans, a greater late positive potential (LPP) occurs with exposure to built than natural environments, resulting in a faster return of activation to pre-stimulus baseline levels when viewing natural …

A Religious Paradox: Can Priming Ideas Of God Reduce Rape Victim Blame?, Emma G. Heath, Kathryn Sperry

Psychology Faculty Publications

Rape victim blame contributes to unreported incidents of sexual assault and failure to support victims (Ahrens in American Journal of Community Psychology, 38(3-4), 263-274, 2006). The present study investigated the relationship between religiosity, religious priming, and rape victim blame. Using an online Qualtrics panel, 247 U.S. participants were randomly assigned to either a neutral prime or a religious prime. They then read a short vignette of an acquaintance rape scenario and answered questions regarding perceptions of victim blame, victim credibility, benevolent and hostile sexism, religiosity, religious fundamentalism, and Rape Myth Acceptance (RMA). Results revealed that the religious prime …

Comparing Effects Of Acceptance Training And Psychoeducation On Hoarding Symptoms, Clarissa W. Ong, Jennifer Krafft, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Hoarding symptoms include difficulty letting go of possessions, excessive acquisition, and clutter that precludes use of active living spaces. The current study compared the effects of acceptance training to psychoeducation on hoarding severity in a sample of college students with elevated hoarding symptoms. Participants (N = 47) completed self-report measures at baseline, posttest, and one-week follow-up and an in vivo discarding behavioral task at posttest. There were no differences in self-reported outcomes between conditions over time, suggesting acceptance training was not more effective than psychoeducation. Significant and large effect sizes for hoarding severity and maladaptive hoarding cognitions were found …

Lgbtq+ Emerging Adults Perceptions Of Discrimination And Exclusion Within The Lgbtq+ Community, Joshua Glenn Parmenter, Renee Vickerman Galliher, Adam D. A. Maughan

Psychology Faculty Publications

Research on LGBTQ+ emerging adult populations has primarily focused on discrimination that is experienced within the heterodominant culture. Due to systems of oppression and the forces of power and privilege, some sexual and gender minorities experience isolation and discrimination not only within the heterodominant culture, but within the LGBTQ+ community as well. Fourteen lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ+) young adults (20-25 years) with a diverse array of intersecting identities (e.g., gender, racial, ethnic, religious, cultural) participated in semi-structured individual interviews and focus groups. Participants reported on experiences of biphobia, acephobia, transphobia, gatekeeping the community, LGBTQ+ people of colour’s …

Acceptability, Feasibility, And Efficacy Potential Of A Multimodal Acceptance And Commitment Therapy Intervention To Address Psychosocial And Advance Care Planning Needs Among Anxious And Depressed Adults With Metastatic Cancer, Joanna J. Arch, Joel N. Fishbein, Michelle C. Ferris, Jill L. Mitchell, Michael E. Levin, Elizabeth T. Slivjak, David J. Andorsky, Jean S. Kutner

Psychology Faculty Publications

Background: Adults with metastatic cancer frequently report anxiety and depression symptoms, which may impact health behaviors such as advance care planning (ACP).

Objective: The study leveraged acceptance and commitment therapy (ACT), an evidence-based approach for reducing distress and improving health behaviors, and adapted it into a multimodal intervention (M-ACT) designed to address the psychosocial and ACP needs of anxious and depressed adults with metastatic cancer. The study evaluated M-ACT's acceptability, feasibility, and efficacy potential.

Design: The study was designed as a single-arm intervention development and pilot trial.

Setting/Subjects: The trial enrolled 35 anxious or depressed adults with stage IV cancer …

Implementing A Web-Based Cognitive Defusion Program To Target Negative Self-Referential Thoughts In College Students: A Pilot Study, Clarie-Ann Henriques Wollach, Leeann Cardaciotto, Michael E. Levin, Sharon Lee Armstrong

Psychology Faculty Publications

Cognitive defusion may enhance healthy coping with negative self-referential thoughts amongst college students. However, research is needed to examine how to effectively introduce and teach defusion to this population. The current pilot study tested the usability of and satisfaction with the D-FUSE program, a single-session, web-based program for a mixed sample of undergraduates and its effectiveness in producing improvements in cognitive defusion and self-criticism. In an undergraduate sample (N = 141), the D-FUSE program was found to be usable and satisfactory. Program engagement rendered significant reductions in the believability of and emotional discomfort produced by negative self-referential thoughts. Further improvements …

Examining Processes Of Change In An Online Acceptance And Commitment Therapy Dismantling Trial With Distressed College Students, Michael E. Levin, Jennifer Krafft, Michael P. Twohig

Psychology Faculty Publications

This secondary analysis examined the processes of change from a randomized dismantling trial evaluating the Open (i.e., cognitive defusion, acceptance) and Engaged (i.e., values, committed action) components of acceptance and commitment therapy (ACT). Analyses were conducted with 161 distressed college students randomly assigned to a full online ACT program (Full n=40), online ACT targeting the Open components (Open n=41) or targeting the Engaged components (Engaged n=39), or a waitlist condition (Waitlist n=41). The intervention occurred over six weeks followed by a post-treatment assessment with mental health symptoms as the primary outcome. Consistent with predictions, pre- to …

Evaluating Acceptance And Commitment Therapy And Mindfulness-Based Stress Reduction Self-Help Books For College Student Mental Health, Michael E. Levin, Woolee An, Carter H. Davis, Michael P. Twohig

Psychology Faculty Publications

Objectives: Self-help has the potential to improve access to mental health resources for college students. However, solutions are needed to improve sustainable delivery, cost- effectiveness, and to know which resources are most useful. Methods: A sample of 109 college students were randomly assigned to read either an Acceptance and Commitment Therapy (ACT) or Mindfulness-Based Stress Reduction (MBSR) self-help book through the University library website over 8 weeks with assessments at baseline, midtreatment (4-weeks), and posttreatment (8-weeks). Results: The majority of participants reported reading over half of their assigned book and high satisfaction ratings were given for both books. Both conditions …

Utilizing Act Daily As A Self-Guided App For Clients Waiting For Services At A College Counseling Center: A Pilot Study, Jack Haegar, Carter H. Davis, Michael E. Levin

Psychology Faculty Publications

Objective: Considering increasing demands for mental health services at college counseling centers (CCCs), there is a need for cost-effective solutions that avoid depleting stressed CCC resources. This study examined if ACT Daily, a mobile application based on acceptance and commitment therapy (ACT), could serve as an effective self-guided intervention.

Participants: 11 individuals on a CCC waitlist suffering from anxiety/depression participated in the study over 2 weeks.

Methods: This study implemented a pre-post, open trial design of ACT Daily. Assessments were completed at baseline and 2-week post assessment.

Results: Results indicated that ACT Daily was acceptable and that participants improved on …

The Empirical Status Of Acceptance And Commitment Therapy: A Review Of Meta-Analyses, Andrew T. Gloster, Noemi Walder, Michael E. Levin, Michael P. Twohig, Maria Karekla

Psychology Faculty Publications

The efficacy of Acceptance and Commitment Therapy (ACT) has been evaluated in many randomized controlled trials investigating a broad range of target conditions. This paper reviews the meta-analytic evidence on ACT. The 20 included meta-analyses reported 100 controlled effect sizes across n = 12,477 participants. Controlled effect sizes were grouped by target conditions and comparison group. Results showed that ACT is efficacious for all conditions examined, including anxiety, depression, substance use, pain, and transdiagnostic groups. Results also showed that ACT was generally superior to inactive controls (e.g. waitlist, placebo), treatment as usual, and most active intervention conditions (excluding CBT). Weaknesses …

Moderators And Processes Of Change In Traditional Exposure And Response Prevention (Erp) Versus Acceptance And Commitment Therapy-Informed Erp For Obsessive-Compulsive Disorder, Clarissa W. Ong, Shannon M. Blakey, Brooke M. Smith, Kate L. Morrison, Ellen J. Bluett, Jonathan S. Abramowitz, Michael P. Twohig

Psychology Faculty Publications

The present study evaluated moderators and processes of change in a randomized controlled trial comparing exposure and response prevention (ERP) delivered from a traditional framework versus ERP from an acceptance and commitment therapy framework (ACT+ERP) for obsessive-compulsive disorder (OCD). This paper presents baseline, weekly session, posttreatment, and follow-up data from the study. We examined (a) moderation effects of anxiety, depression, psychological inflexibility, and interpretation of intrusions and (b) the role of psychological inflexibility and interpretation of intrusions respectively as processes of change. Participants with less dysfunctional appraisals at pretreatment performed consistently better in ERP relative to ACT+ERP. In process analyses, …

A Randomized Dismantling Trial Of The Open And Engaged Components Of Acceptance And Commitment Therapy In An Online Intervention For Distressed College Students, Michael E. Levin, Jennifer Krafft, Elizabeth T. Hicks, Michael P. Twohig, Benjamin G. Pierce

Psychology Faculty Publications

This dismantling trial compared the effects of a full online Acceptance and Commitment Therapy (ACT) intervention to the isolated effects of the Open (i.e., acceptance, cognitive defusion) and Engaged (i.e., values, committed action) components of ACT. A sample of 181 distressed college students were randomized to one of four conditions: a 12-session full ACT website (Full), a version targeting the Open components (Open), a version targeting the Engaged components (Engaged), or waitlist. Participants in active conditions were also randomized to receive phone coaching or just email prompts to increase program adherence. All three ACT conditions significantly improved over time relative …

Experiential Avoidance And Negative Affect As Predictors Of Daily Drinking, Jason B. Luoma, Benjamin G. Pierce, Michael E. Levin

Psychology Faculty Publications

People who drink alcohol to cope with negative affect tend to drink more and experience more frequent negative alcohol-related consequences. Experiential avoidance, the tendency to avoid, suppress, or otherwise attempt to control unwanted inner experiences, is a largely pathological process that may help account for how negative affect is linked to increased alcohol consumption. However, research to-date has typically used global, trait-like measures, which limit our understanding of the conditions under which experiential avoidance is problematic. The current study tested both between-person (trait) and within-person (daily) variation in experiential avoidance and negative affect as predictors of solitary and social drinking …

Pilot Evaluation Of The Stop, Breathe & Think Mindfulness App For Student Clients On A College Counseling Center Waitlist, Michael E. Levin, Elizabeth T. Hicks, Jennifer Krafft

Psychology Faculty Publications

Objectives: College counseling centers face significant challenges meeting the mental health needs of their students and waitlists are common. Mobile apps offer a promising solution to increase access to resources while students wait for services. Methods: This pilot randomized controlled trial evaluated the feasibility and acceptability of a publicly available mindfulness app. Students on a counseling center waitlist (n=23) were randomized to use the app or not, with assessments completed over four weeks. Results: Recruitment over three semesters was slow, leading to an underpowered trial. Participants reported high satisfaction and moderate app usage. Very preliminary support was found for potential …

Tracking Valued And Avoidant Functions With Health Behaviors: A Randomized Controlled Trial Of The Acceptance And Commitment Therapy Matrix Mobile App, Michael E. Levin, Jennifer Krafft, Seth Seifert, Jason Lillis

Psychology Faculty Publications

This randomized controlled trial evaluated the acceptability and additive effects of self- monitoring avoidant and valued functions of behavior, in the context of self-monitoring physical activity and dietary behavior in a mobile app. The self-monitoring approach was based on the Acceptance and Commitment Therapy (ACT) Matrix. A sample of 102 adults interested in improving their diet and physical activity were randomized to a Health Behavior Tracking app (HBT), HBT plus ACT matrix app (HBT+ACT), or waitlist condition. Online self-report assessments were completed at baseline, mid (2 weeks), and post-intervention (4 weeks). Participants reported high usability, but mixed satisfaction with both …

Beyond Acceptance And Commitment Therapy: Process-Based Therapy, Clarissa W. Ong, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

This article describes process-based therapy (PBT) as a natural evolution toward more effective and efficient mental healthcare. Using acceptance and commitment therapy as an example of an early prototype of PBT, this paper explicates the broader features of PBT and the shift in mindset researchers and clinicians will need to take to fully embrace PBT with respect to assessment, conceptualization, and intervention. In addition, the paper enumerates challenges to implementing the PBT model and proposes recommendations for circumventing these challenges in the areas of theory development, research methodology, and clinical practice. Finally, we make the argument shifting to PBT is …

Comparing The Efficacy Of Defusion, Self-As-Context, And Distraction Strategies For Getting Rid Of Possessions, Clarissa W. Ong, Carina L. Terry, Michael P. Twohig

Psychology Faculty Publications

Interventions for hoarding disorder need to target difficulty letting go of items to reduce clutter and improve functioning. The present studies were designed to test the efficacy of brief cognitive interventions for letting go of possessions and self-report outcomes. Participants (N = 67 in Study 1; N = 110 in Study 2) received training on defusion or distraction in Study 1 and defusion, self-as-context, or distraction in Study 2 and completed measures at pre- and postintervention. Study 1 found no differences between defusion and distraction on saving, self-rated discomfort with discarding, or perceived importance of the target belonging. In …

A Randomized Trial Of Acceptance And Commitment Therapy And Traditional Cognitive-Behavioral Therapy Self-Help Books For Social Anxiety, Jennifer Krafft, Michael P. Twohig, Michael E. Levin

Psychology Faculty Publications

Background: Self-help resources such as books may help meet critical mental health needs in college students, but there is insufficient evidence on whether and how such books work. This randomized trial compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (tCBT) self-help books for social anxiety, a common concern with notable barriers to treatment seeking.

Methods: A sample of college students (n = 102) with social anxiety was randomly assigned to use one of the two self-help books over eight weeks.

Results: Improvements were observed in both conditions across all outcomes (social anxiety, general well-being, and social …

A Psychometric Comparison Of Psychological Inflexibility Measures: Discriminant Validity And Item Performance, Clarissa W. Ong, Benjamin G. Pierce, Julie M. Petersen, Jennifer L. Barney, Jeremiah E. Fruge, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Psychological inflexibility is a rigid behavioral pattern that interferes with engagement in personally meaningful activities; it is the hypothesized root of suffering in acceptance and commitment therapy (ACT). Thus, the quality of its measurement affects the research, theory, and practice of ACT. The current study aimed to evaluate the discriminant validity and item performance of four measures of psychological inflexibility: the Acceptance and Action Questionnaire—II (AAQ-II), a revised version of the AAC-II (AAQ-3), the Brief Experiential Avoidance Questionnaire (BEAQ), and the Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT). We analyzed data from community (n = 253), student …

An Examination Of The Relationship Between Perfectionism And Neurological Functioning, Julie M. Petersen, Clarissa W. Ong, Allison S. Hancock, Ronald B. Gillam, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Clinical perfectionism is the rigid pursuit of high standards, interfering with functioning. Little research has explored neural patterns in clinical perfectionism. The present study explores neural correlates of clinical perfectionism, before and after receiving ten 50-minute, weekly sessions of acceptance and commitment therapy (ACT), as compared to low-perfectionist controls, in specific cortical structures: the dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex (MPFC), right inferior parietal lobule (IPL). Participants in the perfectionist condition (n = 43) were from a randomized controlled trial evaluating ACT for clinical perfectionism and low-perfectionist controls were undergraduate students (n = 12). Participants completed three tasks (editing …

A Preliminary Investigation Of The Effect Of Acceptance And Commitment Therapy On Neural Activation In Clinical Perfectionism, Clarissa W. Ong, Allison S. Hancock, Tyson S. Barrett, Eric B. Lee, Nicholas Wan, Ronald B. Gillam, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Clinical perfectionism is associated with various cognitive processes including performance monitoring and emotion regulation. This exploratory study analyzed neurological data from a randomized controlled trial for clinical perfectionism that compared acceptance and commitment therapy (ACT) to a waitlist control. The objective was to assess the effect of ACT on neural activation. Twenty-nine participants underwent a functional near-infrared spectroscopy assessment during which they completed behavioral tasks designed to elicit error detection and error generation at pre- and posttreatment. The hemodynamic response function (HRF) in the dorsolateral prefrontal cortex, dorsomedial prefrontal cortex, and right inferior parietal lobe was analyzed using mixed effects …

Comparison Of Skin Biomechanics And Skin Color In Puerto Rican And Non-Puerto Rican Women, Yadira Regueira, Jamison D. Fargo, Deborah Tiller, Kathleen Brown, Carla Clements, Barbara Beacham, Emily Brignone, Marilyn S. Sommers

Psychology Faculty Publications

Objective: Skin biomechanics are physical properties that protect the body from injury. Little is known about differences in skin biomechanics in racial/ethnic groups and the role of skin color in these differences. The purpose of this study was to determine the relationship between skin biomechanics (viscoelasticity, hydration) and skin color, when controlling for demographic and health-related variables in a sample of Puerto Rican and non-Puerto Rican women.

Methods: We performed a secondary analysis of data from 545 women in a longitudinal, observational study of skin injury in Puerto Rico and the United States. Data included measures of skin viscoelasticity, skin …

The Role Of Psychological Inflexibility And Self-Compassion In Acceptance And Commitment Therapy For Clinical Perfectionism, Clarissa W. Ong, Jennifer L. Barney, Tyson S. Barrett, Eric B. Lee, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

The current study examined psychological inflexibility and self-compassion as theoretically relevant mediators and moderators of outcomes following acceptance and commitment therapy (ACT) for clinical perfectionism. Fifty-three participants with clinical perfectionism were randomized to either a 10-session ACT condition or a 14-week waitlist control condition (only 39 completed the post treatment assessment). Outcomes tested include concern over mistakes, doubting of actions, personal standards, quality of life, symptom distress and functional impairment, and valued action. Multilevel modeling analyses showed reduced psychological inflexibility mediated the relationship between condition and higher quality of life and increased self-compassion mediated the relationship between condition and decreased …

Associations Between Relationship Maintenance Behaviors And Marital Stability In Remarriages, Ron C. Bean, Thomas Ledermann, Brian Higginbotham, Renee Vickerman Galliher

Psychology Faculty Publications

Nearly half of adults in the U.S. indicated they had a close step-relative that included stepparents, stepchildren, and other close relationships. The prevalence of stepfamilies is rapidly increasing and represents a population that remains largely understudied. This study explored the roles of socioemotional behaviors (positivity, negativity, and sexual interest) on marital stability for different remarriage constellations (depending on which of the couple, both partners, or neither had previous children). This study uses dyadic relationship data from 879 couples. It was hypothesized that positivity and sexual interest would be inversely related to marital instability, while negativity will be correlated with marital …

The Influence Of Perceived Parenting On Substance Initiation Among Mexican Children, Alejandro L. Vázquez, Melanie M. Domenech-Rodriguez, Nancy G. Amador Buenabad, Marycarmen N. Bustos Gamiño, María De Lourdes Gutierrez López, Jorge A. Villatoro Velázquez

Psychology Faculty Publications

Parents shape their children's behaviors and impact their developmental trajectories. Despite this, few studies have examined the potential relationship between child reported parenting factors and lifetime substance use and use intentions. The current study examined the potential impact of parenting factors (i.e., positive parenting, supervision, parental illicit substance use, substance-specific communication) on early substance use and intentions among Latinx children. Data for the present study utilized a representative sample of Mexican children (n = 52,171; 5th and 6th grades) who participated in a national survey on substance use. Children reported their demographics, lifetime substance use/intentions, and perceived parenting characteristic …

An Iranian Study Of Group Acceptance And Commitment Therapy Versus Group Cognitive Behavioral Therapy For Adolescents With Obsessive-Compulsive Disorder On An Optimal Dose Of Selective Serotonin Reuptake Inhibitors, Mohammad Javad Shabani, Hamid Mohsenabadi, Abdollah Omidi, Eric B. Lee, Michael P. Twohig, Afshin Ahmadvand, Zahra Zanjani

Psychology Faculty Publications

Conducted in Iran, participants included 69 adolescents with obsessive-compulsive disorder (OCD) who were on a stable selective serotonin reuptake inhibitor (SSRI) dose and were randomly assigned to one of three conditions: group acceptance and commitment therapy (ACT)+SSRI, group cognitive behavioral therapy (CBT)+SSRI, or continued SSRI treatment. Assessment occurred at pre-, post-treatment, and three-month follow-up and included the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Children’s Depression Inventory (CDI), Avoidance and Fusion Questionnaire for Youth (AFQ-8), Valued Living Questionnaire (VLQ), and Child and Adolescent Mindfulness Measure (CAMM). ACT+SSRI and CBT+SSRI conditions demonstrated significant reductions in OCD severity that were maintained at follow-up …

Baseline Cultural Competence In Physician Assistant Students, Melanie M. Domenech-Rodriguez, Paula B. Phelps, H. Cathleen Tarp

Psychology Faculty Publications

Purpose

Cultural competence is a critical component in health care services. The relationship between health disparities and prejudice and discrimination is well documented. Prejudicial attitudes and discriminatory behavior are modifiable through training yet few programs have evidence-based training. No published data has reported on baseline levels of cultural competencies in medical trainees which is necessary for tailoring programs appropriate to the audience. This manuscript fills that gap by reporting on data from three cohorts of first-year Physician Assistant (PA) students (N = 216). We examined students’ baseline levels with special attention to differences in cultural competence constructs across age, …