Mental and Social Health Commons^™

The Impact And Spillover Effects Of Hiv Self-Test Technology On Hiv Outcomes Of The South African Working Class, Cyprian Mostert

Brain and Mind Institute

Background: South Africa recently adopted HIV self-test technology (HIVST) to improve HIV testing and encourage earlier treatment initiation in working populations with a low uptake of conventional testing approaches. This study investigates the impact of HIVST on testing outcomes, focusing on both frequent and infrequent working-class testers. The paper also examines the spillover effect of HIVST on antiretroviral (ART) treatment initiation. To identify these effects, the author focused on South Africa and exploited the HIVST distribution data of 6259 beneficiaries of HIVST.

Methods: The author used a two-stage least-squared model to quantify the impact of the HIVST on …

Human-Centered Design Exploration With Kenyan Health Workers On Proposed Digital Mental Health Screening And Intervention Training Development: Thematic Analysis Of User Preferences And Needs, Manasi Kumar, Paul Macharia, Vincent Nyongesa, Joseph Kathono, Obadia Yator, Shillah Mwaniga, Mary Mckay, Keng Yen Huang, Rahul Shidhaye, Simon Njuguna

Brain and Mind Institute

Background: Health providers' perceived sense of knowledge, competency, and self-efficacy to support the needs of their patients contributes to optimal patient health outcomes. With regards to mental health service delivery in Kenya, this area needs further exploration. Guided by the e-health technology acceptance mode, the needs and preferences of health care providers around mental health training for clinical management and their ability to intervene in peripartum adolescent mental health care are explored. We probed how well-equipped service providers are, their engagement with technology to learn and offer services. The health care provider's technology use preferences were also explored.

Method: Guided …

Mental Health Counselors’ Perceptions Of Professional Identity As Correctional Counselors In An Integrated Behavioral Health Care Setting, Jeanel L. Franklin

Counseling & Human Services Theses & Dissertations

This study explores the professional identity of clinical mental health counselors employed as correctional counselors in an integrated behavioral health (IBH) setting. Previous research has documented the attitudes, perceptions, and experiences of mental health counselors working in IBH as well as their experiences engaging in interprofessional collaboration. However, researchers have yet to explore how clinical mental health counselors in correctional settings perceive their professional identity and what aspects of their professional roles impact their identity development. This study utilized an interpretive phenomenological approach (IPA) to describe, understand, and interpret the meaning of four correctional counselors’ perceptions of their professional identities …

An Investigation Of Healthcare Professionals’ Perspectives On The Tasks Of Mental Health Counselors In Hospital Settings, Suelle Micallef Marmara

Counseling & Human Services Theses & Dissertations

With the global mental health implications reported by the spread of COVID 19 (Javed et al., 2020) and the amplified mental health illnesses reported by the State of Mental Health in America (Reinert et al., 2021), there is an increased need to address psychological and emotional health along with physical health. Mental Health Counselors (MHCs) can be the next professional body to support the multidisciplinary teams within hospital settings to complement holistic care focusing on physical and emotional well-being. Researchers have demonstrated addressing the psychological needs of patients from their first admissions to the hospital has significant positive implications on …

Burnout And Wellness Strategies During The Covid-19 Pandemic, Cecilia Salinas Domene

MEDI 9331 Scholarly Activities Clinical Years

During the COVID-19 pandemic, healthcare workers not only had to manage how to treat a new disease but also had to increase their workload to keep up with the patients infected with the new virus. These physicians had to deal with an increase in patients and an increase in patient deaths. In addition, being a frontline worker meant that these physicians had more exposure to the virus than the general population. If they did contract the virus themselves, they had to go into quarantine, many times away from their families (Walton et al., 2020). A national survey done of physicians …

Associations Between Postpartum Depression And Child Overweight And Obesity: Mediating Effect Of Maternal Feeding Behaviors And Beliefs, Michelle Harrison

Theses and Dissertations (ETD)

Purpose. Postpartum depression (PPD) is a mental condition that significantly affects 10% to 25% of women within the first year after the birth of their child. The mother-infant relationship is key to child growth. Previous studies have shown that PPD has a detrimental effect on children’s physical and psychological well-being as it affects the child through the mother’s parenting behavior. Depressed mothers show a lack of engagement with their children, which could extend to feeding practices influencing weight gain. The prevalence and severity of childhood overweight and obesity is a global public health problem. An increase in weight gain in …

International Prevalence And Mechanisms Of Sars-Cov-2 In Childhood Arterial Ischemic Stroke During The Covid-19 Pandemic, Lauren A Beslow, Shannon C Agner, Jonathan D Santoro, Dipak Ram, Jenny L Wilson, Dana Harrar, Brian Appavu, Stuart M Fraser, Thomas Rossor, Marcela D Torres, Manoëlle Kossorotoff, Yenny C Zuñiga Zambrano, Marta Hernández-Chávez, Sahar M A Hassanein, Dimitrios Zafeiriou, Michael M Dowling, Ilona Kopyta, Nicholas V Stence, Timothy J Bernard, Nomazulu Dlamini

Faculty, Staff and Student Publications

BACKGROUND: Data from the early pandemic revealed that 0.62% of children hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had an acute arterial ischemic stroke (AIS). In a larger cohort from June 2020 to December 2020, we sought to determine whether our initial point estimate was stable as the pandemic continued and to understand radiographic and laboratory data that may clarify mechanisms of pediatric AIS in the setting of SARS-CoV-2.

METHODS: We surveyed international sites with pediatric stroke expertise to determine numbers of hospitalized SARS-CoV-2 patients <18 >years, numbers of incident AIS cases among children (29 days to <18 >years), frequency …

Management Of Adrenocorticotropic Hormone-Secreting Neuroendocrine Tumors And The Role Of Bilateral Adrenalectomy In Ectopic Cushing Syndrome, Jace P Landry, Uriel Clemente-Gutierrez, Carolina R C Pieterman, Yi-Ju Chiang, Steven G Waguespack, Camilo Jimenez, Mouhammed A Habra, Daniel M Halperin, Sarah B Fisher, Paul H Graham, Nancy D Perrier

Faculty, Staff and Student Publications

BACKGROUND: Neuroendocrine tumors can cause ectopic Cushing syndrome, and most patients have metastatic disease at diagnosis. We identified risk factors for outcome, evaluated ectopic Cushing syndrome management, and explored the role of bilateral adrenalectomy in this population.

METHODS: This was a retrospective study including patients with diagnosis of ectopic Cushing Syndrome secondary to neuroendocrine tumors with adrenocorticotropic hormone secretion treated at our quaternary referral center over a 40-year period (1980-2020).

RESULTS: Seventy-six patients were included. Mean age at diagnosis was 46.3 ± 15.8 years. Most patients (N = 61, 80%) had metastases at ectopic Cushing syndrome diagnosis. Average follow-up was …

Emergency Department Communication In Persons Living With Dementia And Care Partners: A Scoping Review, Christopher R Carpenter, Jesseca Leggett, Fernanda Bellolio, Marian Betz, Ryan M Carnahan, David Carr, Michelle Doering, Jennie Chin Hansen, Eric D Isaacs, Deborah Jobe, Kathleen Kelly, Nancy Morrow-Howell, Beth Prusaczyk, Bob Savage, Joe Suyama, Allan S Vann, Kristin L Rising, Ula Hwang, Manish N Shah

Faculty, Staff and Student Publications

OBJECTIVES: To synthesize published research exploring emergency department (ED) communication strategies and decision-making with persons living with dementia (PLWD) and their care partners as the basis for a multistakeholder consensus conference to prioritize future research.

DESIGN: Systematic scoping review.

SETTINGS AND PARTICIPANTS: PLWD and their care partners in the ED setting.

METHODS: Informed by 2 Patient-Intervention-Comparison-Outcome (PICO) questions, we conducted systematic electronic searches of medical research databases for relevant publications following standardized methodological guidelines. The results were presented to interdisciplinary stakeholders, including dementia researchers, clinicians, PLWD, care partners, and advocacy organizations. The PICO questions included: How does communication differ for …

Detecting Cognitive Impairment And Dementia In The Emergency Department: A Scoping Review, Armin Nowroozpoor, Jeff Dussetschleger, William Perry, Mary Sano, Amy Aloysi, Michael Belleville, Alexandria Brackett, Jon Mark Hirshon, William Hung, Joan Michelle Moccia, Ugochi Ohuabunwa, Manish N Shah, Ula Hwang

Faculty, Staff and Student Publications

OBJECTIVES: To identify research and practice gaps to establish future research priorities to advance the detection of cognitive impairment and dementia in the emergency department (ED).

DESIGN: Literature review and consensus-based rankings by a transdisciplinary, stakeholder task force of experts, persons living with dementia, and care partners.

SETTING AND PARTICIPANTS: Scoping reviews focused on adult ED patients.

METHODS: Two systematic scoping reviews of 7 medical research databases focusing on best tools and approaches for detecting cognitive impairment and dementia in the ED in terms of (1) most accurate and (2) most pragmatic to implement. The results were screened, reviewed, and …

Meeting The Mental Health Needs Of College-Aged Young Adults: Evaluating The Value And Impact Of Digital Mental Health Interventions., Sara Atherton Choate

Electronic Theses and Dissertations

BACKGROUND: The growing prevalence of common mental health problems poses a serious hindrance to young adults, and the majority of those in need of mental health support do not seek professional psychological services. Digital mental health interventions (DMHIs) that allow for self-management of mental health symptoms could provide a useful adjunctiveto traditional one-on-one counseling or therapy and offer a useful prevention tool for students at risk for experiencing mental health crises. This dissertation explored the efficacy of self-guided DMHIs targeting college students, the factors associated with help-seeking in young adults, and the impact of implementing an evidence-based DMHI at a …

Local Broadcast Reporters Maintaining Social Responsibility And Mental Health While Serving A Community Under Lockdown, Mary-Morgan Ellis

Graduate Theses and Dissertations

This study looks at local broadcast news reporters working in Northwest Arkansas before, at the start, and during the COVID-19 global pandemic. Research for this study includes a content study of the tweets and Twitter accounts of eleven local reporters. This study considers the social responsibility theory and examines how these eleven local reporters use the theory in their everyday work. Research found, though these reporters don’t credit the theory by name, they are still putting its guidelines into effect as a sort of moral compass when creating objective and representative news for their communities. The research also found that …

Charting The Proteome Landscape In Major Psychiatric Disorders: From Biomarkers To Biological Pathways Towards Drug Discovery, Brisa S Fernandes, Yulin Dai, Peilin Jia, Zhongming Zhao

Faculty, Staff and Student Publications

Schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD) are major mental disorders that affect a significant proportion of the global population. Advancing our knowledge of the pathophysiology of these disorders and identifying biomarkers are urgent needs for developing objective diagnostic tests and new therapeutics. In this study, we performed a systematic review and then extracted, curated, and analyzed proteomics data from published studies, aiming to assess the proteome in peripheral blood of individuals with SZ, BD, or MDD. Then, we performed pathway and network analyses to illuminate the biological themes concatenated by the differentially expressed proteins by systematically …

Insulin Resistance In Depression: A Large Meta-Analysis Of Metabolic Parameters And Variation, Brisa S Fernandes, Estela Salagre, Nitesh Enduru, Iria Grande, Eduard Vieta, Zhongming Zhao

Faculty, Staff and Student Publications

Increased insulin resistance is recognized in psychiatric disorders, such as schizophrenia and bipolar disorder, but its occurrence in depression is less clear. Our aims were to verify if insulin resistance is altered in depression, to test the metabolic subgroup hypothesis of depression and if there are changes with antidepressants. Inclusion criteria were studies including adult subjects with depression and either a control group or follow-up after treatment with antidepressants, and assessing fasting insulin or glucose levels or the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index. Seventy studies with 240,704 participants were included. Both insulin levels and the HOMA-IR index …

Deep Brain Stimulation For Depression Informed By Intracranial Recordings, Sameer A Sheth, Kelly R Bijanki, Brian Metzger, Anusha Allawala, Victoria Pirtle, Joshua A Adkinson, John Myers, Raissa K Mathura, Denise Oswalt, Evangelia Tsolaki, Jiayang Xiao, Angela Noecker, Adriana M Strutt, Jeffrey F Cohn, Cameron C Mcintyre, Sanjay J Mathew, David Borton, Wayne Goodman, Nader Pouratian

Staff and Researcher Publications

The success of deep brain stimulation (DBS) for treating Parkinson's disease has led to its application to several other disorders, including treatment-resistant depression. Results with DBS for treatment-resistant depression have been heterogeneous, with inconsistencies largely driven by incomplete understanding of the brain networks regulating mood, especially on an individual basis. We report results from the first subject treated with DBS for treatment-resistant depression using an approach that incorporates intracranial recordings to personalize understanding of network behavior and its response to stimulation. These recordings enabled calculation of individually optimized DBS stimulation parameters using a novel inverse solution approach. In the ensuing …

Stepped Care Versus Standard Care For Children After Trauma: A Randomized Non-Inferiority Clinical Trial, Alison Salloum, Yuanyuan Lu, Henian Chen, Troy Quast, Judith A Cohen, Michael S Scheeringa, Kristen Salomon, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

Objective: Trauma-focused cognitive-behavioral therapy (TF-CBT) is an evidence-based therapist-led treatment for children after trauma. Parents often experience barriers to treatment engagement, including cost. Stepped care TF-CBT (SC-TF-CBT) was developed as an alternative delivery system. Step One is a parent-led therapist-assisted treatment. Step Two provides therapist-led TF-CBT for children who did not benefit from Step One and require more intensive treatment. This study compared SC-TF-CBT to standard TF-CBT in a community-based non-inferiority trial.

Method: A total of 183 children (aged 4-12 years) experiencing posttraumatic stress symptoms (PTSS) and their caregivers were randomly assigned to SC-TF-CBT or standard TF-CBT within 6 community …

The Influence Of Recreation Engagement On Adolescent Health-Risk Behaviors, Krista Thomas

All Dissertations

The number of adolescents who engage in suicidality is staggering. Adolescence is a unique developmental period where engagement in health-risk behaviors is prominent. Factors influencing engagement in suicidality are vast and occur both internally and externally in the adolescent. Substance use during adolescence has shown an association with increased suicidality. Similarly, bullying, both cyberbullying and in-person bullying, have contributed to adolescent suicidality. Alternatively, recreation engagement has yielded benefits in both psychosocial and physical health for adolescents. However, limited research has identified that engaging in recreation can minimize suicidality. Therefore, the purpose of this study was to explore how substance use, …

Association Of Disease Outcomes With Physical Activity In Multiple Sclerosis: A Cross-Sectional Study

Faculty, Staff and Student Publications

Purpose/Objective Research: This study examined combinations of disease outcomes (i.e., walking, cognition, and symptoms) as correlates of physical activity subgroups (insufficiently active vs. sufficiently active) in persons with multiple sclerosis (MS).

RESEARCH METHOD/DESIGN: This study included 213 participants who completed walking and cognitive function tests and self-report measures of symptoms and physical activity. Multivariate analysis of variance and discriminant function analysis identified combinations of MS outcomes associated with physical activity.

RESULTS: The sample had a mean age of 49.6 years (

CONCLUSION/IMPLICATIONS: The findings identified walking endurance and limitations, processing speed, depression, and fatigue as primary correlates of physical activity …

Awareness Of Human Papillomavirus And Reported Human Papillomavirus Vaccine Uptake In A High-Risk Population, Kayo Fujimoto

Faculty, Staff and Student Publications

INTRODUCTION: Disparities in human papillomavirus (HPV) awareness and HPV vaccine uptake are likely exacerbated among racial/ethnic minority populations living in low-income areas. This study aims to determine the prevalence and correlates of HPV awareness and HPV vaccine uptake in an urban, low-income, racial/ethnic minority population.

METHODS: Secondary data analyses were performed in 2021 using 380 participants aged 18-45 years from the 2019 National HIV Behavioral Surveillance for high-risk heterosexuals, which monitors HIV risk behaviors among individuals living in high-poverty, high HIV prevalence neighborhoods. Prevalence estimates and modified Poisson regression models were used to assess the relationship between HPV awareness and …

“My Attitude On Telehealth Has Completely Changed.”: Facilitators And Barriers To Implementing Technology For Care Delivery In Community Mental Health Centers, Suzanne Meller, Justin Tauscher, Dror Ben-Zeev

Journal of Technology in Counselor Education and Supervision

The purpose of this study was to explore facilitators and barriers aiding community mental health centers in implementing technology-assisted care during the COVID-19 pandemic. Six key informants were interviewed and 28 clinicians were surveyed from three community mental health centers. Interviews focused on technology-assisted care implementation efforts and factors that facilitated adoption. Surveys focused on clinician beliefs and experience with technology-assisted care in addition to training needs. Barriers to technology-assisted care implementation included beliefs about the quality of virtual services and a lack of technology access. An increase in service utilization was reported. Technology-assisted care facilitators included reimbursement policy changes …

A Tide Of Technical Trends: Technology Competence Among Licensed Counselors, Brittany G. Suggs, Mary Sanderfer Stull, Spencer R. Baker, Kathie T. Erwin, David M. Savinsky

Journal of Technology in Counselor Education and Supervision

The inclusion of technology in mental health care can revolutionize the accessibility, affordability, and effectiveness of counseling services, while furnishing practical solutions to reduce mental health disparities and meet widening care demands. Steered by the Coalition for Technology in Behavioral Science (CTiBS) telebehavioral health (TBH) competencies, this study employed a descriptive survey design to investigate licensed counselors’ (LCs’) perceived technology competence in mental health care. The following research question steered the study’s exploration: What is the nature of perceived technology competence among LCs? The overarching hypothesis speculated that LCs’ exposure, familiarity, and current utilization of various mental health technologies would …

How Does Trauma Experienced During Immigration Affect Mental Health?, Taliyah Sims, Daeja Hinton

Immigration Scholarship: History, Trends and Development in Global Immigration

The research topic being explored focuses on hardships that immigrants face before, during, and after migrating into the US. Over the years immigration has changed in many ways, for better and for worse. Immigration has become such a difficult and tedious process, which can absolutely take a toll on the mental health of the people who just want to move and start better lives. Violence and crimes also play a major role in why people are looking to flee from their home countries in the first place. Moreover, the research will provide a closer look into the violence and crimes …

Successful Aging Through Aging In Place : The Perspectives Of The Elderly And Adult Children In Shenzhen, Feng Huang

Lingnan Theses (Doctoral degree)

Aging in place (AIP) has been adopted to cope with the aging population worldwide. The present research invoked the concept of successful aging as a theoretical perspective on AIP with Shenzhen, China as the backdrop. This study adopted the successful aging model of Rowe and Kahn (1987, 1997, 1998) and employed a mixed methods with qualitative and quantitative research. It examined the AIP policies in China and Shenzhen and how the “users” (the elderly and adult children) perceive AIP and successful aging. It also explored which factors would affect successful aging through AIP. Findings showed that financial security and intergenerational …

Plasma Amyloid-Β Dynamics In Late-Life Major Depression: A Longitudinal Study, Nunzio Pomara, Davide Bruno, Chelsea Reichert Plaska, Jaime Ramos-Cejudo, Ricardo S Osorio, Anilkumar Pillai, Bruno P Imbimbo, Henrik Zetterberg, Kaj Blennow

Faculty, Staff and Student Publications

Depressed individuals are twice as likely to develop Alzheimer’s disease (AD) as compared to controls. Brain amyloid-β (Aβ) deposition is believed to have a major role in AD pathogenesis but studies also suggest associations of Aβ dynamics and depression. The aim of this study was to test if plasma Aβ levels are longitudinally associated to late-life depression. We measured plasma levels of amyloid-β1-40 (Aβ40) and amyloid-β1-42 (Aβ42) peptides longitudinally for three consecutive years in 48 cognitively intact elderly subjects with late-life major depressive disorder (LLMD) and 45 age-matched cognitively healthy controls. We found that the Aβ42/Aβ40 plasma ratio was significantly …

Let's Get Physical: Exploring The Socioemotional Motivators Of Group Exercise For Older Adults, Tessneem S. Hasan, Alyssa R. Minton, Jason Snyder, Joseph A. Mikels

DePaul Discoveries

Approximately 75% of active adults in the U.S. do not meet the recommended levels of overall physical activity (CDC, 2021a). Given the beneficial impact of physical activity on health, an 8-week long, evidence-based group exercise program—Fit & Strong! (F&S!)—was created to improve the health of older adults (Hughes et al., 2004, 2006, 2010). Despite the clear physical benefits of F&S!, it remains unknown what motivates F&S! participants to initially participate in the program and also throughout the program. Drawing from core notions of socioemotional selectivity theory (SST; Carstensen, 2006), research has found that older adults are highly motivated to exercise …

Maternal Iron Deficiency Programs Rat Offspring Hypertension In Relation To Renin-Angiotensin System And Oxidative Stress, Ya-Hui Chang, Wan-Hsuan Chen, Chung-Hao Su, Hong-Ren Yu, You-Lin Tain, Li-Tung Huang, Jiunn-Ming Sheen

Faculty, Staff and Student Publications

Hypertension is an important public health challenge, affecting up to 30-50% of adults worldwide. Several epidemiological studies indicate that high blood pressure originates in fetal life-the so-called programming effect or developmental origin of hypertension. Iron-deficiency anemia has become one of the most prevalent nutritional problems globally. Previous animal experiments have shown that prenatal iron-deficiency anemia adversely affects offspring hypertension. However, the underlying mechanism remains unclear. We used a maternal low-iron diet Sprague Dawley rat model to study changes in blood pressure, the renal renin-angiotensin system, oxidative stress, inflammation, and sodium transporters in adult male offspring. Our study revealed that 16-week-old …

Evaluating Burnout, Secondary Traumatic Stress, And Sleep Disturbances In Healthcare Professionals During A Global Pandemic, Laura K. Miller, Sarah Pehlke

Journal of Wellness

Introduction: For healthcare workers, the COVID-19 pandemic resulted in increased workload, work related stress and patient acuity potentially leading to burnout, secondary traumatic stress (STS), and sleep disruptions. This study aims to assess the prevalence of burnout and STS symptoms, as well as sleep disturbances among healthcare personnel working in the United States during the pandemic.

Methods: Healthcare workers from all disciplines and settings in the United States completed a cross-sectional survey about work and personal characteristics from January 20-March 1, 2021. Participants reported on symptoms of burnout, STS, and sleep disruptions.

Results: A total of 360 participants in the …

Stakeholders’ Perspectives On The Safety Of An Adaptive Riding Program For Adults Living With Dementia And Care Partners, Alicia A. Oestreich, Beth E. Fields

People and Animals: The International Journal of Research and Practice

The purpose of this qualitative community-based participatory research was to explore the safety perspectives of stakeholders involved in an adaptive horseback riding program designed to enhance the quality of life of adults living with dementia and their care partners. Human–animal interactions are becoming increasingly popular therapeutic interventions; however, there is still a lack of understanding about the safety considerations for providing adults living with dementia opportunities to interact with horses and the equine environment. To advance our understanding, researchers analyzed 10 semistructured interviews and two focus groups with therapeutic riding program instructors and staff, aging network specialists, and care partners …

Comparing Substance Use Outcomes By Sexual Identity Among Women: Differences Using Propensity Score Methods, Katherine J. Karriker-Jaffe, Laurie Drabble, Libo Li, Cat Munroe, Amy A. Mericle, Karen F. Trocki, Tonda L. Hughes

Faculty Research, Scholarly, and Creative Activity

Background: Differences in alcohol, tobacco, and other drug (ATOD) use by sexual identity vary across samples of women recruited using different sampling methods. We used propensity score (PS) weighting methods to address two methodological questions: (1) Do disparities between sexual minority women (SMW) and heterosexual women persist when differences in risk and protective factors are similarly distributed between groups, and (2) Does accounting for SMW-specific resiliency factors impact differences between non-probability samples of SMW? Methods: Four samples included SMW from a longitudinal study with a nonprobability sample (n = 373), a national general population panel sample (n = 373), …

Internalized Homophobia: A Spiritually Integrated Psychotherapeutic Approach Using The Principles Of Complex Thinking, Daniel Rzondzinski

Consensus

This article describes the construction and application of a complex spiritually integrated psychotherapeutic model for assessment and treatment of internalized homophobia. Homophobia is a complex phenomenon because it includes multiple dimensions: personal, interpersonal, institutional, cultural, political, social, and historical. Internalized homophobia is a mental health problem that affects the subjectivity of 2SLGBTQ+ people. The model explained in this article is a product of the integration of principles from psychoanalytic psychotherapy, 2SLGBTQ+ affirmative framework, narrative therapy, and spiritually integrated psychotherapy. The integration is facilitated by the principles of complex thinking. This article emphasizes the problem of internalized homophobia and the coming …