Medicine and Health Sciences Commons^™

Empowering Providers To Empower Their Patients: One Model To Expand Knowledge, Competency, And Awareness For The Perinatal Substance Use Workforce, Jacqueline Jacobs

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Perinatal substance use (PSU) is a serious and growing public health concern. It is associated with a variety of adverse health outcomes for both mother and child and has been shown to negatively impact the parent-child relationship. Despite the growing prevalence of PSU, there are notable deficits in provider knowledge regarding, and comfortability with, PSU. Moreover, providers report feelings of judgment, resentment, fear, and hesitancy related to their work with women with PSU. Subsequently, women with PSU struggle to find appropriate, compassionate, and effective treatment for their substance misuse. Widespread and accessible training is needed to bolster provider knowledge base, …

An Existential Punchline: How Humor Functions In A Young Adult Friendship Facing Advanced Cancer, Megan E. Solberg

Electronic Theses and Dissertations

Young adults (i.e., age 18-39) only comprise 4% of the total cancer population, yet cancers in this group are commonly found at more advanced stages due to situational factors influencing delayed diagnosis including access to healthcare, quality health insurance and competing life demands that may hinder prioritization of healthcare. Young adults with cancer also face unique challenges including higher rates of psychological distress, which may contribute to increased risk of social disconnection in response to cancer. Research suggests that humor may be a helpful coping approach and communication mechanism for mitigating distress and discussing difficult topics. Grounded within the frameworks …

Older Women’S Stories Of Covid-19 Loss: Communicated Narrative Sense-Making Through Photography, Anne Walker

Electronic Theses and Dissertations

The diverse array of challenges associated with the COVID-19 pandemic make it difficult to assess the full impact of this global health crisis. More than 300,000 older Americans died, leaving a nation of grieving survivors in their absence. This profound loss of life will undoubtedly inform the field’s understanding of grief and grieving for many years to come. Pre-pandemic, older women in the United States understood grief to be part of their life stage; COVID-19 amplified the grief experience through both cumulative losses and the isolation particular to the novel coronavirus response. However, few qualitative studies explore older women’s grief, …

Parental Misattunement And The Production Of Shame Of Existing: How To Address The Shame Of Existing Through An Intersubjective Systems Approach, Tal Ginsburg

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Shame is at the root of many commonly encountered psychopathologies. Its development has often been attributed to early childhood emotional misattunement. In severe cases, individuals can develop an extreme form of shame called the “shame-of-existing”. This paper primarily intends to contribute to the limited research about the shame-of-existing, which includes psychoanalytic perspectives from 1950-1990s, and theoretical analysis in 2014. The concept of shame of existence will be explored through an in-depth case study analysis of a 31-year-old, heterosexual, cisgender, white male who presented to psychotherapy with low-self-worth, and shame in acknowledging his own emotions and needs. This client was treated …

Providing Effective Assessment Feedback To Patients: Lessons Learned From Feedback After A Severe Injury, Kelsie Mcquinn

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

This paper seeks to articulate lessons learned from feedback received after a severe injury in order to help guide neuropsychologists provide effective feedback to patients. Given that there is no agreed upon conceptual framework for providing neuropsychological assessment feedback, parallels are drawn from what works in clinical psychology – the working alliance. I use personal examples to highlight how the working alliance, as well as other psychological principles, can help inform neuropsychologists provide the most effective feedback to patients.

The Intersection Of Traumatic Brain Injury And Homelessness, Stephanie A. Chassman

Electronic Theses and Dissertations

The rates of TBI are significantly higher among individuals experiencing homelessness compared to the general population. Up to half of individuals experiencing homelessness may have a TBI. Accurate prevalence rates of TBI among individuals experiencing homelessness are difficult to obtain due to different methods of sampling participants and differing definitions of TBI; therefore, estimates may be underrepresented. Despite past research that has examined the relationship between TBI and homelessness, there are specific gaps in knowledge such as correlates and risk factors of TBI among individuals experiencing homelessness. This three-manuscript dissertation attempts to address these gaps in knowledge.

The first manuscript …

Exploring The Potential For Therapeutic Art-Making In School Psychology Practice: A Single Case Study Of A Training Experience, Alexandra G. Manion

Electronic Theses and Dissertations

The purpose of this study was to investigate the impact of a training experience on the use of therapeutic art-making for school psychologists, with a focus on how to incorporate these concepts into their school-based mental health practice. Therapeutic artmaking includes the use of visual art activities (drawing, painting, clay, and collage) with specific therapeutic intent. Although there are examples of art therapists providing inschool therapeutic art-making services to support the mental health needs of students, there is far less information regarding the use of therapeutic art-making by school-based mental health providers, including school psychologists. This single case study explored …

Understanding And Supporting Asian American Youth’S Mental Health Within Cultural And Family Contexts, In Young Park

Electronic Theses and Dissertations

Mental health problems are a major health issue among East Asian American (EAA) youth. Although previous research has explored the risk and protective factors associated with mental health problems of EAA youth, many studies have employed Eurocentric perspectives, thereby excluding their unique cultural backgrounds, beliefs, and values. To better understand mental health needs and support these youth, further research that identifies different factors associated with mental health problems in their cultural context and assesses evidence-supported and culturally responsive interventions is needed.

This three-manuscript dissertation is presented in three papers. The first manuscript presents an integrative conceptual framework that uses two …

Exploring The Relationship Between Historical Redlining And Place-Based Reproductive Health Inequities: A Qualitative Gis Approach, Kristi L. Roybal

Electronic Theses and Dissertations

Individual-level risk factors and characteristics do not fully explain racial, ethnic, and socioeconomic inequities in preterm birth in the United States, and evidence suggests that medical advancements, increased access to prenatal care, and high per-capita spending on health care have done little to reduce these inequities. Health inequities research has shifted its attention from individual-level factors that influence health outcomes to the social determinants of health. Neighborhoods, considered an important upstream social determinant of health, can influence health outcomes through their social, service, and physical environments, and have been consistently linked to birth outcomes. Despite increased attention to neighborhood influences …

Mitigating Weight Stigma In The Medical System: Self-Compassion For Nursing Students, Ellen C. Joseph

Electronic Theses and Dissertations

Weight stigma is a form of oppression that has been shown to have a detrimental impact on the well-being of people with higher weight. Healthcare providers are one of the most common sources of weight stigma, and their stigmatizing beliefs have been found to be associated with differential care for patients with “obesity”. The current study aimed to explore the feasibility of the loving-kindness meditation (LKM) as a brief intervention that reduces weight bias in nursing students by increasing self-compassion, positive, other-focused emotions, and cognitive flexibility, in order to improve compassionate care for patients with higher weight. Participants (189 nursing …

Attachment Theory To Inform Intervention In Correctional Populations With Adverse Childhood Experiences And Substance Use Disorders, Samantha Mendoza

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Research shows a correlation exists between Adverse Childhood Experiences (ACEs) and poor mental health such as psychiatric and substance use disorders (Adshead, 2018). Research further suggests a correlation between ACEs and insecure attachment in adults (Adshead, 2018). The National Institute on Drug Abuse (2020) estimates 85% of the correctional population either has a substance use disorder or was incarcerated for a drug-related offense. This paper theorizes that those involved in the correctional system with a history of high ACE scores and substance use also experience insecure attachment, which is not currently addressed in correctional SUD programs. Attachment theory moderates the …

Maternal Hpa Axis Function During Parenting Is Associated With Reduced Brain Activation To Infant Cry And More Intrusive Parenting Behavior, Andrew Erhart

Electronic Theses and Dissertations

Previous research indicated that maternal cortisol function and maternal brain response to infant stimuli are separately related to differences in parenting behavior. Evidence from animal models have demonstrated that chronically high cortisol concentration alters brain structure and function, suggesting that studying these two mechanisms together may further improve understanding of parental behavior in human mothers. First time mothers of infants aged 1-7 months old (M age = 3 months) were recruited to participate. Mother’s cortisol concentration was measured during a naturalistic interaction with their infant and their behavior was coded for maternal sensitivity and nonintrusiveness. In a separate session using …

The Place And Role Of Pharmacy Benefit Management (Pbm) Companies In Us Healthcare System, George Mattis Ii

Electronic Theses and Dissertations

On average, prescription drugs cost US consumers more than any other developed country in the world. US drug makers claim that intermediaries in the prescription drug supply chain, companies called pharmacy benefit managers (PBM), are forcing them to increase their drug prices. PBMs counter that the discounts they receive from drug makers are channeled to insurers. This thesis will examine the role that PBMs play in the prescription drug supply chain and determine what effect they have on drug prices. This thesis will utilize a comparative static model, Structure, Conduct, Performance (SCP) framework to analyze the pharmaceutical manufacturing and the …

Stagnation In Psychotherapy: A Transtheoretical Approach, Kristine Mccormick

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Doctoral training in clinical psychology emphasizes the importance of utilizing empirically supported psychotherapy methods in pursuit of effective psychotherapy. When treatment is stagnant or ineffective, the focus of training and supervision is often geared toward searching the evidence-base for alternative psychotherapy approaches, or referring to a provider with expertise in a specific method. Using a case example, this paper offers guidance on possible roadblocks to effective psychotherapy treatment, and clear areas to explore before concluding whether psychotherapy is the most helpful intervention for a patient.

From Military Service To Diakonia: A Training Program For Clergy Ministering To Veterans, Danielle Xanthos

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Many veterans opt to seek the support of clergy before mental health professionals. Most clergy, however, are unfamiliar with the nuances of the veteran culture and experience. Mental health professionals who specialize in working with the veteran population can collaborate with clergy to bridge this gap of care to mutually develop a better understanding of veteran culture and symptoms of mental health conditions common among the veteran population, and by equipping clergy with basic tools that promote psychological and spiritual wellbeing. Special consideration is given to the concept of moral injury and the application of Acceptance and Commitment Therapy, illustrating …

Canine-Assisted Exposure Therapy, Stephanie B. Bono

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Fear and anxiety are natural reactions to actual threat conditions but can become “pathological” when over-generalized avoidance interferes with long-term wellbeing and valued living. Pervasive experiential avoidance hinders natural extinction processes as it reduces repeated contact with feared stimuli, a condition necessary for extinction to occur. Exposure therapy (ET) is a clinical analogue of extinction, and one of the best evidence-based treatments for fear and anxiety. However, ET’s usefulness suffers in real-world clinical conditions. The current conceptual paper proposes that ET’s limitations may be overcome through a tailored approach that integrates animal-assisted therapy (AAT), specifically the use of dogs, to …

Co-Constructing Stigma: Treating Trauma In Adolescence, Isabelle Sanderson

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Public stigma and self-stigma are major factors that impede the seeking of mental health treatment as well as the development of an effective therapeutic alliance. This paper explores the co-creation of stigma dynamics from an intersubjective systems theory lens suggesting these dynamics may play a role for adolescent clients who have experienced significant trauma. Specifically, the potential overlooking and/or misdiagnosis of trauma-related experiences and symptoms often occurring with adolescents diagnosed with ADHD may be contributing to a co-constructed dynamic between the therapist and client to avoid an exploration of trauma that would be experienced as more stigmatizing, more threatening, and …

The Risks For Eating Disorders/Disordered Eating In Refugee & Immigrant Experiences And The Imperative Of Culturally Alert Screening, Chantal A. Bushelle

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Eating Disorders (ED)/Disordered Eating (DE) largely remain outside of global mental health agendas. There are limited data on the epidemiology EDs/DE in refugee and immigrant populations, and there is a paucity of research on refugee and immigrant experiences of EDs/DE. Study of acculturation issues in refugee and immigrant populations have historically missed investigating what role and impact experiences of stress and trauma (e.g., historical, chronic) along with cultural change and transition may have on their food attitudes and eating behaviors. While there has been some study of eating habits within refugee and immigrant populations, the focus is typically on food …

Mothers Know Best: Guidance For Healthcare Providers On Early Identification Of Perinatal Mental Health Disorders, Klarissa I. Garcia Orellana

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Introduction: The perinatal period has been associated with an increased risk of developing psychiatric disorders among women. Perinatal mental health disorders (PMHD) are highly prevalent, yet highly underrecognized and untreated. The involvement of medical providers, especially obstetrics/gynecology and pediatric providers, in the early identification of PMHD is critical to ensure women with PMHD receive appropriate supports. However, providers lack the education, training, and ability to identify and screen for PMHD as well as the knowledge of appropriate referrals. Objective: This study explores the existing issues with healthcare providers’ early identification practices of PMHD from the perspective of ten mothers and …

Mechanisms Of Sensory Adaptation In The Primate Visual System, Boris Isaac Peñaloza Rojas

Electronic Theses and Dissertations

Under ecological conditions, the luminance impinging on the retina varies within a dynamic range of 220 dB. Stimulus contrast can also vary drastically within a scene, and eye movements leave little time for sampling luminance. In addition, the amount of information reaching our visual system far exceeds the brain’s information processing capacity. Given the limited dynamic range of its neurons and its limited capacity in processing visual information in real-time, the brain deploys both structural and functional solutions that work in tandem to adapt to the surroundings. In this work, employing visual psychophysics and computational neuroscience, we study the mechanisms …

The Colored Pill: A History Film Performance Exposing Race Based Medicines, Wanda Lakota

Electronic Theses and Dissertations

Of the 32 pharmaceuticals approved by the FDA in 2005, one medicine stood out. That medicine, BiDil®, was a heart failure medication that set a precedent for being the first approved race based drug for African Americans. Though BiDil®, was the first race specific medicine, racialized bodies have been used all throughout history to advance medical knowledge. The framework for race, history, and racialized drugs was so multi-tiered; it could not be conceptualized from a single perspective. For this reason, this study examines racialized medicine through performance, history, and discourse analysis.

The focus of this work aimed …

A Phenomenological Study Of The Experiences Of Military Families, Who Have Children With Disabilities And Maladaptive Behavior, With School-Based Mental Health Personnel, Londi J. Segler

Electronic Theses and Dissertations

This qualitative study used a phenomenological approach to capture the lived experiences of military families who have children with disabilities and maladaptive behavior to note risk and protective factors that might impede the mental health development of that population of student. Through interviews with at-home-caregivers, I explored their experiences with public school staff, outside mental health services, and school psychologists. Study findings revealed that participants felt they were going to battle with school staff who were not willing to incorporate culturally responsive practices when working with their children. School staff who implemented regular bi-directional communication were more likely to gain …

How 6-12th Grade Staff Support Students With Depression: A Pilot Study To Develop Measures Of Implicit Associations, Explicit Attitudes And Helping Behavior, Paul M. Thompson

Electronic Theses and Dissertations

Students with emotional disabilities are disproportionately suspended and expelled in K-12 schools. Attribution theory suggests individuals are less likely to provide assistance to others if they believe the individuals are responsible for their own difficulties. To test attribution theory, this study created new measures of explicit attitudes and implicit associations of licensed 6-12th grade staff regarding students with depression as well as a helping behavior measure of staff toward students with depression. The survey was distributed within a single school district in the western United States. A majority of the sample (N = 52) held a mental health license (60%), …

The Role Of Awareness In Traumatic Brain Injuries: Interviews With Experts, Dominique Chao

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Approximately 2.8 million US citizens sustain a traumatic brain injury (TBI) annually, with more than 275,000 requiring inpatient rehabilitation (Taylor, Bell & Breiding, 2013). As rehabilitation techniques are refined and adapted to increase the speed of recovery and functional independence following TBIs, there is an ongoing need for better prognostic assessment tools. Research has shown that a lack of self-awareness following TBI is associated with poorer outcomes (e.g. employability, community reintegration) following discharge from inpatient hospitalizations (Cheng & Man, 2006; Robertson & Schmitter, 2016) and can result in decreased motivation (Simmonds & Fleming, 2003), compromised safety, poor community re-integration, and …

Treating Substance Use Disorders Through An Attachment Lens: A Case Example, Kathleen Locker

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Substance use treatment addresses addiction behaviors, increasing coping skills, and sobriety but current modalities do not address the insecure attachment styles that may contribute to substance use for many individuals. Insecure attachment styles seemingly have a bidirectional relationship with substance use and are therefore are likely an important aspect of treatment. This case example focuses on an attachment therapist’s work with a young man with a substance use disorder and attachment insecurity. Attachment theory interventions are proposed to address potential contributors of continued substance use. This paper proposes that using attachment theory in combination with existing treatment modalities for substance …

Feminist Therapy With Severe Mental Illness And Complex Trauma: A Case Example, Mimiko Watanabe

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Feminist therapy emphasizes empowerment through an egalitarian therapeutic relationship and collaborative approach of understanding symptoms and treatment. Feminist therapy can be used with all types of clients, including those with severe mental illness (SMI) as well as complex posttraumatic stress disorder (complex PTSD) which refers to the unique presentation of those who have experienced chronic developmental trauma (Herman, 1992). This case example focuses on a feminist therapist’s work with a young woman who has both SMI and complex PTSD, resulting in struggles across several domains. Feminist therapeutic interventions of developing an egalitarian relationship, exploration of intersectional multicultural dynamics, building empowerment, …

Fostering Trauma-Informed Schools By Considering The Experiences Of Teachers In Working With Trauma-Exposed Students, Allison A. Stiles

Electronic Theses and Dissertations

High rates of trauma exposure among youth in the United States and the detrimental effects of trauma on students’ psychosocial and academic outcomes are well-established. Such findings have engendered the emergence of trauma-informed schools across the nation. While research regarding trauma-informed schools has understandably focused on the needs of students, shockingly little is known about teachers’ experiences in working with trauma-exposed students. In particular, very few studies have examined the relationship between teachers’ indirect exposure to student trauma and related symptoms of secondary traumatic stress (STS), as well as factors that may predict STS levels or explain variation in the …

Evaluation Of A Sexual Health Training For Child Welfare Workers, Katie Massey Comsb

Electronic Theses and Dissertations

Background: Elevated rates of early pregnancy and parenting among youth in foster care (YFC) are well documented. Training child welfare workers to provide sexual health information and resources is stated throughout the extant literature as a pressing need in efforts to prevent unintended pregnancy among YFC. However, few child welfare agencies offer such training to their workers, and little is known about the extent to which conversations about sexual and reproductive health already occur between child welfare workers and youth. Thus, this study aimed to: a) assess baseline attitudes, knowledge, and communication among child welfare workers regarding sexual health of …

Social Aspects Of Food-Sensitive Adults, Jean Elizabeth Duane

Electronic Theses and Dissertations

People living with food-related illnesses find themselves subjugated by commonly held ideologies causing awkwardness in social situations. The current study is a qualitative analysis addressing how people with celiac disease (CD) navigate social situations in light of dominant beliefs that influence behaviors. Initially, I identify macro-level patriarchal, religious, sexist, ableist and etiquette-related commensality ideologies that disadvantage those with CD. Drawing from the communication narrative sense making (CNSM) theory that supports storytelling and memorable messages as a sense-making tool for individuals diagnosed with chronic illness and their family members, this work highlights retrospective stories and memorable messages from 20 randomly selected …

Exploring Early Temperament Predictors Of Maladaptive Behavior In A Group Of Elementary School Age Children With Autism Spectrum Disorder, Caren D. Rhodes-Doudna

Electronic Theses and Dissertations

The current study is an ex post facto nonexperimental design analyzing archival data collected from previous trials of a large-scale longitudinal study conducted by researchers at JFK Partners, Center of Excellence in Autism and Neurodevelopmental Disabilities in collaboration with the University of Colorado Anschutz Medical School (Principal Investigator: Susan Hepburn, Ph.D.). Specifically, the study looked at the temperament characteristics of mood, intensity, adaptability, and approach measured within early childhood and how they relate to later maladaptive behavior within a group of elementary age children diagnosed with ASD. Maladaptive behavior is a particularly salient outcome, as it impacts the child and …