Mental and Social Health Commons^™

Association Between Stress Mindset, Psychological Symptoms, And Psychosocial Risk In Liver Transplant Patients, Sarah Kay Brill

Dissertations

Psychosocial functioning is a central component of liver transplant evaluation, yet less is known about how cognitive factors, such as stress mindset, relate to transplant readiness. The present study examined the association between stress mindset and psychosocial risk, as well as its relationship with depressive symptoms, anxiety, and perceived stress among patients undergoing liver transplant evaluation. Patients included 62 adults completing standard pre-transplant assessment measures, including the Stress Mindset Measure–Specific (SMM-S), Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Perceived Stress Scale (PSS). Hierarchical logistic regression analyses indicated that stress mindset was …

The Primary Care Brief Intervention Competency Assessment Tool (Bi-Cat): Examining Reliability And Validity, Arielle Guillod

Dissertations

Within primary care, the Primary Care Behavioral Health (PCBH) model integrates behavioral health services into medical settings through brief, population‑based interventions delivered by behavioral health consultants (BHCs). Although effective performance in this role requires competencies distinct from traditional mental health practice, few psychometrically sound tools exist to assess clinical skills in primary care. The Brief Intervention Competency Assessment Tool (BICAT) is commonly used for this purpose but lacks published evidence supporting its reliability and validity. This dissertation examined the psychometric properties of the BICAT across two studies. Study 1 evaluated factor structure, internal consistency, and construct validity in a heterogeneous …

An Attachment Perspective For Help-Seeking Intentions Among Emerging Adult Women Child Sexual Abuse Survivors, Dominique Giroux

Dissertations

Child sexual abuse (CSA) is an adverse childhood experience and a global health issue. Approximately one in four girls encounter CSA per year. Research evidence suggests approximately 50% of CSA survivors encounter sexual revictimization during adulthood (Walker & Wamser-Nanney, 2023), but formal help and intervention can mitigate further psychosocial harm experienced by CSA survivors (Widom et al., 2008). Attachment theory has provided a theoretical framework for identifying individuals at risk for revictimization and help-seeking patterns, such that individuals who have insecure attachment styles report more revictimization frequency, but the literature is mixed about attachment styles and help-seeking (Brenner et al., …

Exploring How Therapist Trainees’ Mentalization, Attachment Styles, And The Working Alliance Impact Treatment Outcomes In Psychotherapy, Hanali Gilbert

Dissertations

A burgeoning area of research within the past 30 years has sought to identify which specific therapist factors contribute to differential treatment outcomes (Barkham et al., 2017). The purpose of the current naturalistic study was to explore how two personal characteristics of therapist trainees, mentalization capacity and attachment styles, impact early treatment outcomes at two Midwestern psychology training clinics. This study also examined whether therapist mentalization and the working alliance interacted to influence client outcomes. Therapists completed the Mentalization Scale (MentS; Dimitrijević et al., 2018) and the Experiences in Close Relationships scale (ECR; Brennan et al., 1998), while the Working …

Addressing Mental Health Issues And The Effectiveness Of Cognitive Behavioral Therapy And Mindfulness-Based Interventions Among Athletes, Shelby Jones-Stachnik

Dissertations

This literature review identifies mental health concerns among competitive athletes and evaluates psychological interventions to address these challenges. Specifically, the review explores the mental health concerns experienced by athletes engaged in high-level sport. It examines whether cognitive behavioral therapy and mindfulness-based interventions are effective approaches for improving psychological outcomes in this population. A systematic review of peer-reviewed research was conducted, and findings were synthesized to evaluate the effectiveness of cognitive behavioral therapy and mindfulness-based interventions. The review included randomized controlled trials, quasi-experimental studies, and meta-analyses examining psychological interventions in athletic populations. Findings across the literature indicate that both cognitive behavioral …

Attachment Style, The Working Alliance, And Client Self-Disclosure In Individual Psychotherapy, Jennifer S. Baar

Dissertations

Client self-disclosure is a core component of the psychotherapy process and increased levels of client self-disclosure have been shown to predict more positive therapeutic outcomes (Pattee & Farber, 2008; Sloan & Kahn, 2005). Similarly, the working alliance and attachment are constructs that have been studied in psychotherapy research and are consistently associated with therapeutic outcomes. Specifically, stronger working alliance ratings and higher levels of secure attachment have been found to predict more positive therapy outcomes (e.g., Flückiger et al., 2018; Mallinckrodt et al., 2005; Sauer et al., 2010). As these three constructs have been found to influence psychotherapy outcomes, the …

Understanding And Enhancing Suicide Prevention Strategies In The Military: The Roles Of Culture, Leadership, And Command Climate, Kelly Johanna Pires

Dissertations

Military service members are shaped and molded to fit a military culture that emphasizes mission readiness and continuous preparedness. Countless hours are spent training for various situations that can arise. Many trainings are geared toward worst-case scenarios that can cause an increase in stressors and traumatic events. They are expected to demonstrate resilience and overcome adversity to remain mission-ready. This expectation to be mission-ready creates the space for mental health difficulties as well as stigma and avoidance of help-seeking behaviors. In many cases, the desire to stay mission-ready creates a barrier for conversations around mental health. The military emphasizes qualities …

Evaluation Of Neuroplastic Changes In Psychological Intervention And Contemporary Treatments Of Depression, Taylor Severance

Dissertations

Major depressive disorder is one of the most prevalent mental health disorders worldwide. There is a vast range of treatment options for depression, with varying levels of effectiveness. Recent treatments for depression have expanded, increasing alternative treatments, and it is unknown which treatments have the largest impact on depression. This research was designed to examine the treatments of depression, with a focus on psychotherapy and contemporary treatments such as ketamine, psilocybin, and transcranial magnetic stimulation. A literature review was conducted to assess treatment outcomes and neuroplastic changes in these interventions, as well as combinations of the interventions. Data were evaluated …

Diverse Families Navigating Mental Health At The Pediatrician’S Office: A Mixed Methods Exploration Of The Interplay Of Stress, Culture, And Child Mental Health In The Primary Care Setting, Sara B. Budowsky

Dissertations

Low-income and ethnic minority youth experience high psychiatric need but persistently low participation in traditional mental health care. General pediatricians are often the first and only healthcare providers with whom many families engage around their child’s emotional and behavioral development. Using both quantitative analysis of retrospective secondary data and Interpretative Phenomenological Analysis (IPA) of in-depth interviews with diverse caregivers, this project explored influencers of child mental health and family utilization of pediatric primary-care-based mental health services in the context of a uniquely multicultural clinic serving a predominantly Medicaid population. Three key findings include: 1) Caregiver Stress was a highly significant, …

Silent Struggles: A Qualitative Study On Mental Health Stigma And Help- Seeking Among African Individuals In The U.S, Ololade Ekwere

Dissertations

Approximately one-third of African Americans and Caribbean Blacks who require mental health services seek and utilize them (Evans & Sheu, 2019). Research has shown that stigma surrounding mental health treatment contributes to lower rates of professional help-seeking among Black Americans (Pederson, 2023). Despite the growing diversity within the Black community, limited research exists on how stigma influences professional mental health help-seeking among Africans living in the United States.

The purpose of this qualitative descriptive study was to explore the effect of public stigma on the mental health help-seeking behaviors of Africans living in the United States. Demographic data were collected, …

Understanding The Lived Experience Of Mental Health Following An Alpha-Gal Syndrome Diagnosis: A Phenomenological Study Grounded In Maslow’S Hierarchy Of Needs, Heather L. Hargis

Dissertations

Alpha-gal syndrome is a tick-borne food allergy that triggers delayed allergic reactions to mammalian products and profoundly alters daily life. While growing research examines the physiological aspects of alpha-gal syndrome, little is known about its psychological impact. This phenomenological study explored the lived experiences of individuals with alpha-gal syndrome to understand how the condition influences mental health through the lens of Maslow’s Hierarchy of Needs. Data was collected through semi-structured virtual interviews with adults medically diagnosed with alpha-gal syndrome. Thematic analysis revealed significant challenges in meeting Maslow’s lower-tier needs—physiological, safety, and love/belonging—due to dietary restrictions, medical uncertainty, social isolation, and …

The Residual Impact Of Slavery On How Enslaved Black Females Defined And Made Meaning Of Sexual Violence: A Content Analysis, Suzanne R. Bates

Dissertations

Thompson-Miller & Picca (2016) and Feimster (2023) argued that enslaved African American women, and even free African Americans after the Civil War were victims of non-consensual sexual activity and rape. The NISVS report revealed that before the age of 18 years old, 35.5% of African American women experienced contact sexual violence, 29.5% experienced non-contact unwanted sexual encounters, and 20.7% experienced rape (Basile et al., 2022). Researchers of slave scholarship have made the case for the importance of including discourse on slavery and enslaved Black females’ experiences when discussing present day sexual violence among Black women in the US today (Balfour, …

Adolescent Students’ Adaptability During The Covid-19 Pandemic Impacting Their Academic Preparedness In College: A Qualitative Exploration Of Resilience In Secondary School Disruptions, Nicole Tyanne Jameson

Dissertations

This study, conducted several years after the onset of the COVID-19 pandemic, takes a unique approach to investigating the long-term effects of the pandemic-induced disruptions on adolescents during secondary schooling and their academic preparedness in college. The study combined a descriptive qualitative analysis of academic routine data with quantifiable resilience scores, providing a comprehensive understanding of the challenges students faced, their adaptability and resilience, and the overall impact on their education journey into college. This comprehensive descriptive qualitative study utilizes triangulation of quantitative data and qualitative approaches to understand the subject matter thoroughly. The quantitative scores meticulously analyzed resiliency and …

How Was Rehab? A Follow-Up To A Randomized Effectiveness Control Trial Of A Brief Acceptance And Commitment Therapy Protocol For Inpatient Detoxification Patients, Alexander J. Twohy

Dissertations

Residential treatment for Substance Use Disorders (SUD) is a common treatment modality. However, the literature is sparse on modifiable predictors that affect change during the residential treatment stay. Acceptance and Commitment Therapy (ACT) has been shown to be an effective treatment for SUDs. Weststrate et al. (2023), in a randomized controlled effectiveness trial, compared ACT plus medication management to medication management during detoxification. The addition of ACT increased consumer satisfaction and ACT skills use, while decreasing psychological inflexibility and reducing withdrawal symptoms.

This study explored whether the brief ACT intervention had impacts during participants' subsequent residential stay. Forty out of …

Evaluation Of A Behavioral Response Team To Decrease Use Of Violent Restraint, Katherine Skrade

Dissertations

Abstract Introduction: The purpose of this Quality Improvement project was to evaluate the implementation of the Behavioral Assessment and Response Team (BART) and evaluate its effect on occurrence and duration of violent restraints on non-psychiatric floors in a pediatric hospital. This QI project also aimed to correlate the use of the Broset Violence Checklist (BVC) to the utilization of the BART as a means of predicting patient escalation, as well as to assess the effect of booster education on the BVC and BART on bedside staff confidence in utilization of these resources.

Methods: Data was collected across three time periods: …

Implementing Behavioral Management And Social Skills Training For Pediatric Patients With Adhd And Their Caregivers, Meagan A. Conwell

Dissertations

Problem: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 11.4% of children in the United States. Patients diagnosed with ADHD struggle with focus, hyperactivity, and impulsivity, resulting in executive and emotional dysfunction, poor social skills and quality of relationships, and poor school performance.

The American Academy of Pediatrics guidelines recommend that school-age children diagnosed with ADHD should receive both medication management and behavioral management training (BMT) for the best treatment outcomes. Research over the last decade has found that combining social skills training (SST) with BMT results in even better outcomes for these patients. Less than half of pediatric …

A Program Evaluation: Insomnia In Adults With Major Depression Disorder With Cognitive Behavioral Therapy For Insomnia (Cbt-I), Taylor E. Wilson

Dissertations

Abstract

Problem: In 2023, Compass Health Network (CHN) data analysts found that 91% of CHN patients in the United States who have died by suicide reported problems with sleep, which was the highest risk factor for suicide. The objective of this program evaluation project is to evaluate CHN CBT-I effectiveness on patients ‘suicidality by improving their insomnia.

Methods: CHN quality improvement (QI) project used a quantitative method pre/post score design. Quantitative aggregate data was collected on the participants who met the inclusion criteria via retrospective and prospective chart review prior to CHN implementing the intervention. CBT-I clinicians collected PHQ-9, Columbia-Suicide …

Evaluating Depression In Adults Undergoing Substance Abuse Treatment: A Program Evaluation Of Intensive Outpatient Program, Chidochomoyo E. Zvirawa

Dissertations

Problem: Depression and substance use disorders (SUDs) frequently co-occur, complicating recovery outcomes. Despite screening recommendations, depression remains underdiagnosed in many SUD treatment settings.

Methods: This mixed-methods program evaluation examined depressive symptoms among adults in an Intensive Outpatient Program (IOP) using the Patient Health Questionnaire (PHQ-8). Depression screenings were conducted at intake, four weeks, and eight weeks. Eight participants meeting inclusion criteria were assessed. Data included demographics, treatment engagement, and PHQ-8 scores.

Results: PHQ-8 scores significantly declined from baseline (M = 11.75, SD = 6.52) to eight weeks (M = 5.13, SD = 5.05), t(7) = 2.76, p = .028, indicating …

Intersecting Inequities: Latinx Access To Mental Health Services, Melissa Thorson

Dissertations

This study examined barriers to mental health service utilization among Latinx populations using data from the 2022 National Survey on Drug Use and Health (NSDUH). Through the theoretical frameworks of Minority Stress Theory and Toxic Stress Theory, the study investigated the relationships between age, language proficiency, socioeconomic status, and mental health service access among different Latinx subgroups. Statistical analyses included chi-square tests, multiple regression, and mediation analyses on a sample of Latinx adults (N = 9,852). Results indicated associations between age and English proficiency (χ² = 145.23, p < .001, Cramer's V = 0.38), with 45% of adults aged 50 and older reporting limited English proficiency. Socioeconomic analysis revealed that 32% of older Latinx adults reported family incomes below $20,000, with insurance status partially mediating the relationship between income and service utilization (indirect effect = 0.15, 95% CI [0.08, 0.23]). differences in utilization rates emerged among Latinx subgroups (F(6, 1243) = 8.76, p < .001, η² = 0.12), with Mexican-origin individuals showing higher utilization (10%) compared to Puerto Rican individuals (2-3%). Age and socioeconomic status demonstrated interaction effects (β = 0.18, p < .01), while language proficiency moderated the relationship between age and service utilization (β = 0.24, p < .001). These findings suggest that barriers to mental health service utilization among Latinx populations are complex and interconnected, requiring multilevel interventions that address linguistic, cultural, and socioeconomic factors simultaneously. Implications for healthcare policy and service delivery are discussed, emphasizing the need for culturally responsive and linguistically appropriate mental health services.

Assessing The Relationship Between Combat Exposure, Wartime Service, And Barriers To Substance Use Disorder Treatment In Post 9/11 Veterans., Robert Near

Dissertations

Substance use disorders (SUDs) represent a critical public health concern, particularly within military and veteran populations. The complex interplay of mental health challenges, combat exposure, and the unique stressors associated with military service contribute to a heightened vulnerability among veterans. Research from the United States Department of Veterans Affairs (USDVA) underscores the prevalence of these issues, indicating that approximately 1 in 10 veterans from the Iraq or Afghanistan wars treated by the VA are diagnosed with a SUD (Veterans Affairs, 2023). Additionally, veterans from all eras show a higher propensity for binge drinking when compared to the general population, further …

The Rose That Grew From Concrete: Exploring The Romantic Experiences Of Black Men With Histories Of Childhood Sexual Abuse, Tatyana Nichelle Smith

Dissertations

Contemporary research typically characterizes Black heterosexual relationships by dismal marriage and divorce rates, largely ignoring the reality of how Black men develop attachments with their romantic partners and therefore continuing to perpetuate deficit perspectives of Black men (e.g., the cause of conflictual romantic relationships and “broken” Black families). What may be less understood about these relationships is the influence of childhood trauma, such as childhood sexual abuse, and Black men’s experiences of gender role conflict. Research shows that Black men’s experiences of childhood sexual abuse and socialization about masculinity have important implications for how they come to view themselves and …

Useful Measures Of Adult Attachment And Object Relations In Psychotherapy, Matilde A. Torallas Huerta

Dissertations

This is a literature review of objective and projective measures of attachment and object relations in adults, with the objective of reviewing outstanding research to identify the key factors for adult attachment assessment considered within attachment and object relations theories, what measures of adult attachment styles and dysfunction work best, and to provide key themes of assistance in the measurement of attachment and object relations in adult clients in psychotherapy. Theoretical foundations of attachment and object relations theory are reviewed as well as objective and projective instruments grouped by format. The 10 themes found to be useful in the assessment …

Self-Awareness And Self-Efficacy In The Novice Professional Phase Of Marriage And Family Therapists After Person Of The Therapist Training, A Comparative Survey, Rubio Betsabé

Dissertations

The study focuses on examining the influence of person-of-the-therapist or self-of-the-therapist training on therapists’ self-reports of self-awareness (as a conscious awareness of one’s internal states and interactions with others) and self-efficacy (perceived beliefs in personal capabilities to perform in ways that give control over events that affect their lives) at the novice professional stage of their career. The study will examine the experiences reported by mental health providers actively providing clinical care by utilizing a survey design focusing on person of the therapist connecting through alumni lists and online solicitation. This research adds to the current literature by using a …

What Works In Telehealth Play Therapy? An Appreciative Heuristic Inquiry, Veronica Ann Ball

Dissertations

With the onset of coronavirus disease 2019 (COVID-19) in the United States in March 2020 (World Health Organization, 2020), professional counselors providing traditional in-person play therapy found themselves in a quandary regarding the delivery of services during a global pandemic (Evans, 2022; Mitchell, 2020; Whaibeh et al., 2020). Online counseling proffered a means to prevent the disruption of services, respond to the need for emerging counseling services, and comply with social restrictions (Evans, 2022). Prior to the pandemic, telehealth play therapy was used sparingly (Haslam & Harris, 2011; Smith et al., 2021), and many child-serving mental health professionals lacked training …

What About The Children? An Exploration Of Family Counselors' Play Therapy Training And Preparedness To Integrate Children Into Family Counseling, Patricia J. Walker Monical

Dissertations

Children are an important part of families, yet family counselor education programs often do not incorporate training for including children in family counseling. At some point in their careers, family counselors and therapists will encounter clients who have children 3–12 years old. The problem is that since these professionals often receive little to no training in play therapy and thus do not typically include young children in family therapy, these younger family members are often overlooked. Research has confirmed that, due to a lack of sufficient training and supervision in play therapy, many family therapists report feeling unprepared to work …

Screening, Brief Intervention, And Referral To Treatment For Pregnant Women, Rebekah Feeney

Dissertations

Abstract

Background: In the United States, 10-20% of pregnant women reported using drugs during pregnancy. Current recommendations are to screen for drug use in all patients and provide a brief intervention and referral to treatment. The purpose of this quality improvement project was to evaluate the impact of implementing a standardized screening, brief intervention, and referral to treatment (SBIRT) protocol for first-trimester pregnant patients who are seen in the obstetrical department.

Methods: The Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) screening tool was administered to first-trimester pregnant women, 13-45 years of age, seen in the obstetrical department from …

Infertility’S Impact On Couples’ Functioning, Elizabeth Sanders

Dissertations

Historically, infertility has been a taboo topic of discussion and is often avoided in conversation because of the stigmatization of the diagnosis. According to the World Health Organization (2022), infertility affects 186 million individuals globally. However, there seems to be a gap in the research as it pertains to the psychological well-being and treatment of men and women diagnosed with this condition. While it has become less of a feared topic, it still is not discussed or researched enough, thus further exacerbating the gap in research on mental health and treatment options. The following dissertation completed a critical review of …

Reclaiming Healing Spaces: A Phenomenological Study On The Transformative Power Of Outdoor Therapy From The Lived Experiences Of Black Clinicians Working With Black Clients, Lynn Murphy

Dissertations

This phenomenological study involved assessing the experiences of Black therapists who engaged Black clients in outdoor therapeutic contexts. The study was founded on the existing literature that shows the quality of the therapeutic relationship is pivotal for client retention and the Western standards that have historically favored treatment within indoor environments. To contextualize this research, a comprehensive literature review was commenced, covering topics such as the decolonization of therapy, the historical and present-day relationship between Blacks and the outdoors in the United States, sedentary lifestyles, the psychological benefits of time spent in nature, various types of outdoor therapy, and the …

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard

Dissertations

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. If undiagnosed or untreated, ADHD can lead to severe psychosocial issues such as academic failure, substance abuse, unplanned pregnancy, and incarceration. The financial burden in the U.S. from diagnostic errors creates an immense, rising fiscal impact. Early diagnosis and management are crucial to prevent these complications.

Females with ADHD, particularly those with the inattentive subtype, often face diagnostic challenges due to symptom masking and over-compensation. This results in poorer cognitive functioning and self-esteem compared to males with ADHD. ADHD is linked to autonomic nervous …

Improving Identification Of Complicated Alcohol Withdrawal Syndrome Using The Prediction Of Alcohol Withdrawal Severity Scale, Kristin Hagopian

Dissertations

Problem: Individuals who drink alcohol excessively are at great risk for alcohol withdrawal syndrome (AWS) when hospitalized. Symptoms and their severity differ for everyone, and research shows that the identification and treatment of AWS is challenging and often inadequate. Mild AWS is often overtreated, while moderate to severe AWS is often underdiagnosed and undertreated, placing individuals at risk for longer hospital stays, more time needed in critical care units, and a variety of unintended consequences.

Methods: This evidence-based practice project had a pre-post intervention design in which the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) was implemented to promptly identify …