Clinical Psychology Commons^™

Using Structural Equation Modeling To Understand The Role Of The Family In Pediatric Asthma Contexts, Nour Al Ghriwati

Theses and Dissertations

Family factors have long been associated with the psychosocial adjustment of children with chronic illnesses, such as asthma (Minuchin, 1975; Rapee, 1997). Research indicates that negative family factors may also contribute to child disease severity, via bio-behavioral mechanisms of effect (Wood et al., 2006); however, these pathways have yet to be examined with a comprehensive focus on more positive family factors. This study sought to examine whether factors such as family cohesion, problem solving abilities, and communication influence asthma symptom severity in children via their effects on child depression and anxiety symptoms. Using structural equation modeling, we identified significant indirect …

Therapist Adherence To Cognitive Behavioral Therapy For Anxious Youth Across A Case, Julia R. Cox

Theses and Dissertations

The field has developed many evidence-based treatments (EBTs); the integrity of EBTs being delivered, however, has been studied less than rigorously. Because many treatment manuals are developed to be delivered session-by-session, one way to assess treatment adherence, specifically, is across the course of the case: do therapists deliver treatment components in the order prescribed? The goals of this study were to characterize how therapists deviate from prescribed order and how adherence to order relates to child characteristics. Therapy process data were collected from a subsample of children (N = 33, aged 7-15) that received cognitive behavioral therapy (CBT) to address …

Measuring The Coping Efforts Of Grieving Undergraduate Students: Developing The Gcope Through A Mixed-Method Design, Benjamin Dyson Lord

Theses and Dissertations

The current study used a three-phase mixed-methods design to produce a new self-report measure of the strategies that college students use to cope with the death of a loved-one. College students are commonly bereaved and may be in the process of undergoing important developmental tasks related to emerging adulthood. However, the application of grief-specific stress-and-coping theories (i.e., the Dual Process Model of Coping with Bereavement) to this population has been hampered by measurement issues.

The current study aimed to address the flaws asserted above through the use of a mixed-methods scale development design. To this end, the researcher made use …

Adherence To And Competence In Cognitive Behavioral Therapy For Youth Anxiety: Psychometric Evaluation, Cassidy C. Arnold

Theses and Dissertations

Treatment integrity—the extent to which a treatment is delivered as it was intended—has long been recognized as critically important in treatment evaluation research, but has garnered increased attention in recent years within the context of dissemination and implementation science. However, the field’s development has been hindered by inadequate measurement tools. This project is focused on developing and evaluating the psychometric strength of two measures of treatment integrity. To evaluate the psychometric strength of the Cognitive-Behavioral Therapy for Youth Anxiety Therapist Adherence Scale (CBAY-A)and the Cognitive-Behavioral Therapy for Youth Anxiety Therapist Competence Scale (CBAY-C), 954 psychotherapy sessions from two treatment evaluation …

Decreased Sound Tolerance (Dst): Prevalence, Clinical Correlates, And Development Of A Dst Assessment Instrument, Therese Verkerke Cash

Theses and Dissertations

Decreased sound tolerance (DST) conditions, including misophonia and hyperacusis, are emerging clinical conditions in behavioral medicine. Misophonia involves an extreme emotional response (often anger, disgust, or annoyance) to specific sounds (such as people chewing, swallowing, tapping their foot on the floor, etc.), while hyperacusis is defined by high sensitivity to sounds below normal sound sensitivity thresholds. Although research on these DST conditions is increasing, clearly defined prevalence rates, associations with other mental health conditions, and development of assessment tools that can identify and differentiate DST symptoms are needed. Research and clinical reports also suggest that DST problems are more likely …

The Roles Of Gender And Ethnicity In College Student Bereavement, Rachel E. Weiskittle

Theses and Dissertations

The developmental stage of emerging adulthood often poses substantial challenges that negatively impact bereavement experiences (Schultz, 2007; Tanner & Arnett, 2009). Some emerging adults may be even more at risk for adverse grief outcomes due to individual differences such as gender and ethnicity, but very few studies have investigated these variables within the population. We addressed this gap in the literature by investigating the influence of gender and ethnicity on college students’ bereavement experiences using the Hogan Grief Reaction Checklist (HGRC; Hogan, Greenfield, & Schmidt, 2001) Results indicates a significant relationship between ethnicity and levels of personal growth, use of …

Evaluation Of Behavioral Distress Tolerance Task Stability Across Settings, Cassie Overstreet

Theses and Dissertations

Distress tolerance (DT) is considered to be a trait-like factor encompassing an individual’s behavioral and/or perceived ability to withstand negative affective states. Behavioral measures of DT are being increasingly utilized, however, these tasks have been implemented in studies prior to thoroughly establishing the psychometric properties. The present study aimed to evaluate the reliability of two DT behavioral tasks (Breath-Holding Task [BHT], computer-based Paced Auditory Serial Addition Task [PASAT-C]) in different settings (laboratory, online) among a sample of college students. Participants completed the tasks during two sessions, approximately one week apart. 52 participants were in the laboratory condition, and 65 were …

The Role Of Psychology In Integrated Primary Care For Complex Patients: Effects On Mental Health, Utilization Of Medical Services, And Physiological Markers Of Health, Danielle C. Worthington

Theses and Dissertations

This study served as an initial evaluation of integrated psychology services within a clinic designed to serve uninsured patients with complex medical concerns and high utilization histories at the Medical College of Virginia in Richmond, Virginia. The current study evaluates patient outcomes, and more specifically, it further quantifies and describes the role that psychologists play in the primary care setting and their impact on utilization of medical care and in improved health outcomes. Additionally, the study evaluates psychologists’ success at treating mental and behavioral health conditions within the primary care model. The present study demonstrates that patients with complex medical …

School-Based Sexuality Education, Gender, And Relationship Self-Efficacy: A Moderated-Mediation Analysis Of Sexual Behavior In First-Year College Students, Sara C. Schmidt

Theses and Dissertations

While the effectiveness at abstinence-only versus comprehensive sexuality education in preventing adolescent risky sexual behavior is widely researched, little is known about whether material learned in secondary school sexuality education classes impacts emerging adult sexual behavior in the college environment. Furthermore, research suggests that self-efficacy – or beliefs in one’s abilities to organize and execute actions – may be more critical than knowledge or skills in terms of how individuals enact behavior. We hypothesized a moderated-mediation effect by which the causal impact of type of sexuality education on four different sexual behaviors during the first year in college is transmitted …

Defining And Supporting Organizational Readiness In The Interactive Systems Framework For Dissemination And Implementaion, Jonathan Peter Scaccia

Theses and Dissertations

Introduction. In the implementation literature, organizational readiness is associated with an increased likelihood of achieving innovation outcomes. Organizational readiness consists of organizational capacity (general and innovation-specific) and organization motivation. Organizations who wish to get results from their innovations have an interest in making sure that certain factors and subcomponents are in place. However, having awareness that certain capacities and factors that influence motivation are linked to improved innovation outcomes does not necessarily help organizations to get “more ready.” There is a need for organizations to know if and how they can effectively put these factors and subcomponents into place. This …

The Influence Of Organizational Climate On The Use And Quality Of Evidence-Based Practices In School Mental Health, Katherine Knies

Theses and Dissertations

Organizational climate is defined as the reflection of workers’ perceptions of, and emotional responses to, the characteristics of their work environment (Glisson & James, 2002). While previous research explored the importance of organization climate for the adoption of evidence-based practices (EBPs) in mental health settings, there is a dearth of organizational climate focused research in school mental health settings (SMH). The current study examines the influence of organizational climate on two separate dependent variables: the extent to which EBPs were used and the quality of clinician delivery for the evidence-based practices used in a quality improvement intervention for SMH practitioners. …

What Kills Love? Factors Influencing The Ending Of Love In Romantic Relationships, Michelle Duda

Theses and Dissertations

This thesis reports the results of an online survey study that examined dimensions of love, positive behaviors, negative behaviors, and relationship satisfaction in current romantic relationships where the individual currently had a feeling of being in love with their partner ("still in love" or SIL group) versus in past romantic relationships where the individual once had a feeling of being in love with that person, but ceased loving - essentially, fell out of love with - that person over the course of the relationship ("fell out of love" or FOL group). An MTurk sample of 202 individuals (Mean age = …

Outcome Variables Of Childhood Sexual Abuse As Potential Risk Factors For Sexual Revictimization In Adulthood, Christine Renee Bowles

Theses and Dissertations

Childhood sexual abuse is a large problem, with research estimates indicating that between 16-25% of women have experienced sexual abuse at some point during their childhood (Dube et al., 2005; Gorey & Leslie, 1997). Even more alarming is the data that suggests that women who have experienced childhood sexual abuse are between 2 to 11 times more likely to experience sexual assault as an adult than individuals with no past history of abuse (Messman-Moore & Long, 2003). To help understand the complex and varied outcomes associated with childhood sexual abuse, Finkelhor and Browne (1985) developed a model conceptualizing the four …

The Role Of Social Information Processing In The Relation Between Interparental Conflict And Child Aggression, Kimberly Parker

Theses and Dissertations

Crick and Dodge’s SIP theoretical model proposes that children use previously stored memories, past experiences, and formed representations that influence six mechanisms that are in turn used in deciding how to act in social situations (Crick & Dodge, 1994). Research has demonstrated a strong link between social information processing (SIP) and child aggression. Furthermore, SIP has been shown to mediate the relation between several parenting practices and child aggression. Research has also shown a strong relation between interparental conflict and child aggression. The focus of the current study was to determine if SIP serves as a mediator between parental conflict …

A Longitudinal Study Of The Bidirectional Relations Between Internalizing Symptoms And Peer Victimization In Urban Adolescents, Tess Drazdowski

Theses and Dissertations

The purpose of this study was to examine the bidirectional relations between anxious and depressive symptoms and two forms of peer victimization (i.e., overt and relational) within a sample of 358 predominantly African-American adolescents living in low-income urban areas across four years. Longitudinal path analyses tested progressively complex models for each type of victimization. For both overt and relational victimization the autoregressive model where only previous levels of each construct predicted future levels of the construct was the most parsimonious explanation. The best fitting model for both types of peer victimization suggested that internalizing symptoms helped to further explain future …

Examining The Role Of Unit Cohesion As A Moderator Of The Relationship Between Warfare Exposure And Ptsd, Shaina Gulin

Theses and Dissertations

The purpose of the current study was to examine the effects of warfare exposure and unit cohesion on posttraumatic stress disorder (PTSD) symptomatology among male and female National Guard and Reserve service members deployed to Iraq or Afghanistan. National Guard and Reserve soldiers and female service members have been shown to be at greatest risk of psychological distress, and thus identification of resiliency factors among this population is worthy of further study. An emerging body of research has identified unit cohesion as a potentially modifiable protective factor against the deleterious effects of warfare exposure; however, such research is in its …

Testing Bidirectional Contextual Effects Of Adolescent Risk Factors On Young Adulthood Outcomes: A Life Course Perspective To Gangs, Andrea E. Lamont

Theses and Dissertations

Leading theories in developmental science emphasize the role of the individual as an active agent in shaping her or his environment. Yet, most empirical work has focused on unidirectional models, ultimately treating the individual as a passive recipient of environmental risk. Part of this gap between theory and analysis is methodological in nature – i.e., classical statistical methods typically do not allow for the modeling of bidirectional influences or complex longitudinal relations. Recent advancements in longitudinal methodologies, however, expand our ability to answer more nuanced developmental questions. In this dissertation, I demonstrate how advanced longitudinal methods could be used to …

Follow-Up Evaluation Of Treatment For Anxiety And Depression Provided In A University-Based Primary Care Clinic, Renée M. Grinnell

Theses and Dissertations

Although integrated primary care psychology services are becoming increasingly common, the literature lacks adequate research support for the longitudinal durability of treatment effects following the conclusion of brief primary care interventions. This study served as a follow-up program evaluation of psychological services for depression and anxiety provided at the Medical College of Virginia’s Ambulatory Care Center in Richmond, Virginia. Data were collected on 47 adult primary care patients who received treatment for depression and/or anxiety between six and 18 months prior to the follow-up telephone call. Data were collected on the trajectory of depression scores throughout and following treatment, treatment …

Evaluation Of Psychological Services For Anxiety And Depression Provided In A University-Based Primary Care Clinic, Elizabeth J. Sadock

Theses and Dissertations

Primary care clinics are increasingly integrating psychological services into their service programs, however few studies have used a comparison group to demonstrate the effectiveness of these services. This study evaluated the psychological services provided at the Ambulatory Care Clinic (ACC) at the Virginia Commonwealth University Health System (VCUHS) by comparing changes in 147 patients’ PHQ-9 depression scores and GAD-7 anxiety scores over time to the scores of 139 patients at the Hayes E. Willis Health Center, a comparison clinic with demographically similar patients but no integrated psychological services. Assessment data were collected from participants in the ACC at VCUHS during …

Project Shine: A Family-Based Intervention For Improving Physical Activity, Sedentary Behavior, And Diet In African American Adolescents, Sara M. St. George

Theses and Dissertations

This study examined the effects of a family-based intervention for improving moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB), and fruit and vegetable (F&V) intake in African American adolescents. The intervention (Project SHINE: Supporting Health Interactively through Nutrition and Exercise) integrated Social Cognitive (SCT), Self Determination (SDT), and Family Systems Theories (FST) to improve healthy physical activity and dietary behaviors. Behavioral strategies from SCT (i.e., self-monitoring, goal-setting, self-regulatory skill-building), elements involved in facilitating intrinsic motivation for health behavior change from SDT (i.e., autonomy, competence, belongingness), and positive parenting practices from FST for integrating parent and peer systems (e.g., parental monitoring, parent-adolescent …

Does Growth In Childhood Adhd And Depression Symptoms Predict Binge-Eating During Adolescence, Kathryn Van Eck

Theses and Dissertations

Binge-eating disorder (BED) refers to experiencing a loss of control while eating high quantities of food in a short period of time. A serious public health concern, BED is highly comorbid with other psychological disorders and increases risk for obesity and other health concerns, such as metabolic disorder and diabetes. Little is known about what mental health symptoms contribute to the development of BED for children and adolescents. Research with adults indicates that two strong predictors of binge-eating behavior include impulsivity and depression, and these symptom areas may contribute to BED for youth, as well. In the current study, I …

Development And Preliminary Validation Of The Youth Therapist Observational Cultural Competence Scale, Carrie Tully

Theses and Dissertations

The increasing diversity of the United States creates a pressing public health need to investigate methods to increase the engagement, retention, and efficacy of mental health services for racial/ethnic minority (REM) youth. Evidence from the adult psychotherapy treatment literature suggests that enhancing therapist cultural competence leads to increases in client satisfaction, alliance, and retention (Constantine, 2002; Sodowsky, Kuo-Jackson, Richardson, & Corey, 1998; Worthington, Soth-McNett, & Moreno, 2007). However, this relationship has not been adequately explored in youth mental health services, due in part, to a lack of valid and reliable measurement. This research project included measure development and initial validation …

Parenting Practices And Parenting Stress In African American Families Of Children With And Without Adhd, Annie Rabinovitch

Theses and Dissertations

This study examined differences in parenting practices and parenting stress between 44 African American maternal caregivers of children ages 6-10 with Attention-Deficit/Hyperactivity Disorder (ADHD) and 25 caregivers of children without ADHD. Results indicated significant group differences on inconsistent discipline, as child ADHD significantly predicted this parenting construct. There were no mean group differences in positive parenting. Parenting stress was related to parenting practices for the caregivers of children without ADHD, but was unrelated to parenting practices among control caregivers. Child ADHD predicted several subscales of the Parenting Stress Index. However, child ADHD failed to be a significant predictor when a …

Longitudinal Relations Between Peer Victimization And Delinquency: The Mediating Roles Of Sadness, Fear, And Anger, Lisa J. Ulmer

Theses and Dissertations

Peer victimization is a common occurrence among youth, and it has been linked to a number of negative outcomes, including delinquent behaviors (e.g., physical aggression, theft/property damage, and substance use). Several studies examined relations between peer victimization and delinquency, though few have done so longitudinally or examined whether negative emotions are underlying processes that explain associations between these constructs. The current study’s purpose is to examine whether several negative emotions (i.e., anger, fear, and sadness) mediate relations between several types of peer victimization and delinquency among middle and high school youths. The study’s sample of 318 youths was predominately African …

The Contribution Of Parent Psychosocial Functioning To Parental Monitoring, Youth Adherence, And Glycemic Control During Adolescence, Elizabeth M. Robinson

Theses and Dissertations

Objective: Type 1 diabetes is one of the most common pediatric chronic illnesses. Adolescents are at risk for poorer adherence and in turn, poorer glycemic control; however, youth whose parents remain involved in diabetes care are in better control. A parent’s level of involvement is dependent in part upon his or her own social and emotional functioning. Much is known about the link between separate aspects of parent psychosocial functioning (e.g., depressive symptoms, parental stress) and parent involvement in diabetes care, adherence, and glycemic control. However, no study to our knowledge has examined these constructs simultaneously as they interrelate …

Todo En La Familia: Examining The Relationships Among Ms Impairments, Family Needs, And Caregiver Mental Health In Guadalajara, Mexico, Melody N. Mickens

Theses and Dissertations

Individuals with multiple sclerosis (MS), especially those living in Latin America, often require assistance from family caregivers throughout the duration of disease. Previous findings suggest that family caregivers may experience positive and negative effects from providing care to individuals with MS, but few studies have examined the impact of MS caregiving on caregivers from Latin America. The current study examined the relationships between MS impairments (functional, neurological, cognitive, behavioral and emotional), unmet family needs (household, informational, financial, social support, health), and caregiver psychosocial functioning (satisfaction with life, anxiety, burden, and depression) in a sample of 81 MS caregivers from Guadalajara, …

Caregiver Impact Of Autism Spectrum Disorder: Assessing Stress, Sense Of Competence, And Relationship Satisfaction, Nicole M. Kline

Theses and Dissertations

While the impact of psycho-social variables has been evaluated for children with chronic illness and related disabilities, questions remain unanswered for families affected by ASD. Participants included 68 primary caregivers seeking services for a child aged fifteen months to 12 years suspected of or diagnosed with an ASD. Assessment tools included: 1. Parenting Stress Index-Fourth Edition-Short-Form (PSI-4-SF; Abidin, 2012), 2. Parenting Sense of Competence Scale (PSOC; Johnston and Mash, 1989), and 3. Relationship Assessment Scale (Hendrick, 1988). Independent samples t-tests were conducted to determine differences with a nonclinical control population (60 participants with a typically-developed child) regarding perceptions of stress, …

Satisfaction With Ability And Reported Functional Impairment In Cancer Survivors With Chronic Illness-Related Fatigue, Jessica Dawn Eversen Pike

Theses and Dissertations

Long-term consequences of cancer have assumed more importance than ever before as cancer survival rates have increased over the past few decades. As a result, cancer has been conceptualized more recently as a chronic illness, meaning it can require some form of management. Cancer-related fatigue (CRF) is the most frequent and distressing symptom that cancer survivors face. There is limited research on CRF to date, therefore, it is important to examine the influence of factors that affect cancer-related fatigue as CRF's impact on quality of life can be strongly negative, pervasive, and even chronic. In research on other chronic illnesses, …

Where Does Electronic Aggression Fit?: A Comparison Of Dimensional And Categorical Models Of Adolescent Aggression, Krista R. Mehari

Theses and Dissertations

Electronic aggression is a rapidly growing focus of research, but it lacks a unifying theoretical framework that is necessary to advance the field. The lack of a theoretical framework has led to inconsistencies in measurement of electronic aggression, making it difficult to draw conclusions across studies. In general, researchers have assumed that electronic aggression constitutes a new form of aggression, a counterpart to physical, verbal, and relational aggression, due to unique features surrounding the perpetration of electronic aggression. Furthermore, researchers have treated electronic aggression as a categorical variable based on the assumption that “cyberbullies” constitute a distinct group of adolescents. …

The Impact Of A Primary Care Psychology Training Program On Medical Utilization In A Community Sample, Autumn Lanoye

Theses and Dissertations

Mental illness and psychological distress is associated with higher rates of medical service usage and treatment of these issues results in more appropriate medical utilization rates. Little research has been conducted in an integrated care clinic, wherein health psychologists or behavioral health specialists work together with physicians to provide patient care. The current study examines the effects of brief behavioral and mental health interventions on patient medical utilization in this setting with care delivered by medical residents and doctoral psychology trainees. Access to the health system’s electronic billing records allowed for objective measures of annual healthcare utilization in terms of …