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Item Addressing Formal Thought Disorder in Psychosis through Novel Assessment and Targeted Intervention(2020-08) Marggraf, Matthew P.; Minor, Kyle; Salyers, Michelle; Lysaker, Paul; Stewart, JesseFormal thought disorder (FTD) is a debilitating symptom of psychosis. It is linked to functional deficits and generally demonstrates poor response to interventions. Metacognition has emerged as a potential therapeutic target that may be effective in reducing FTD, as metacognitive deficits and FTD both arise from disruptions in associative thought processes. This study’s primary aim was to determine whether FTD could be reduced with metacognitive therapy. Pre-post changes in FTD severity were assessed using clinician-rated and automated measures in 20 individuals with psychotic disorders who received 12 sessions of evidence-based metacognitive therapy. We also examined whether reductions in FTD were larger when assessed with automated instruments versus clinician-rated measures. Aim two compared associations between FTD and three outcome variables (social functioning, role functioning, metacognition) across FTD-measurement approach. Results indicated that automated FTD, but not clinician-rated FTD, was significantly reduced post-intervention. This effect was more robust within a subsample exhibiting greater levels of FTD. Strength of associations between FTD and outcome variables did not differ across FTD measurement approach. These findings provide initial evidence that a targeted metacognitive intervention can reduce FTD. Effects were strongest for automated instruments, which may be more sensitive to detecting change; however, differences in measurement type did not extend to associations with selected outcome variables. This study provides preliminary support for future efforts to reduce FTD. Large-scale studies with longer intervention periods may further our understanding of the effectiveness of metacognitive intervention on FTD.Item Designing and implementing an intervention for returning citizens living with substance use disorder: discovering the benefits of peer recovery coach involvement in pilot clinical trial decision-making(Taylor & Francis, 2021) Victor, Grant; Sightes, Emily; Watson, Dennis P.; Ray, Bradley; Bailey, Katie; Robision, Lisa; Fears, Gina; Edwards, Rhiannon; Salyers, Michelle; Psychology, School of SciencePeer-facilitated services in behavioral health care remain underutilized within criminal justice-involved community organizations, and there is little guidance for how to best involve peer workers in behavioral health-focused research activities. This paper described lessons learned regarding implementation of peer recovery coaches (PRCs) as part of development and pilot research on Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT), a peer-facilitated substance use disorder (SUD) intervention for returning citizens. Qualitative data were collected from learning meetings with key stakeholders and group interviews with SUPPORT clinical trial participants and PRCs. Transcripts were analyzed to identify key decisions made impacting the development, implementation, and/or revision of the SUPPORT intervention and pilot clinical trial protocols. Analysis demonstrated that PRC involvement drove many of the decisions made regarding modifications to the original intervention and trial protocols, while benefitting client-level interactions and by influencing the non-profit agency and its connection to stakeholders. Moreover, PRCs improved the research design by refining the incentive structure and data collection plans. PRC involvement also contributed to the development of more recovery-oriented resources and catering support services to the unique needs of justice-involved individuals. Discussed were the implications for the role of PRCs in justice-involved behavioral health research and treatment.Item Differential Factors Influencing Hispanic/Latinx Adolescent Engagement in Mind-Body Skills Groups for Depression(2021-08) Salgado, Eduardo F.; Salyers, Michelle; Zapolski, Tamika; Aalsma, MatthewMajor Depressive Disorder is a prevalent and pervasive problem in the United States, and this mental disorder disproportionately affects adolescents of color. In particular, there is little research understanding how Hispanic/Latinx adolescents utilize and engage with mental health services, such as psychotherapy, to reduce their symptoms of depression, including factors that are positively and negatively related to engagement. As such, the aims of this study were to understand whether there were any relationships between presenting characteristics of adolescents seeking therapy for depression and their subsequent engagement with therapeutic services, with a focus on analyses examining trends in Hispanic/Latinx adolescents. To investigate these aims, we utilized data from a pilot study in which adolescents (n=42) received a mind-body intervention for depression called Mind-Body Skills Groups. We examined possible relationships between depression severity, age, Hispanic/Latinx background, and their interactions with engagement, as measured by attendance rates, self-reported motivation, and at-home skills practice. We hypothesized that high depression severity, high age, and being Hispanic/Latinx would all negatively influence engagement; we also hypothesized the depression-engagement and age-engagement relationships would be moderated by Hispanic/Latinx background. Results revealed initial relationships between lower age and being Hispanic/Latinx with higher attendance rates; depression severity was not related to attendance. When these relationships were further analyzed using hierarchical regression, no significant relationships between predictor and outcomes variables, as well as their interactions, were discovered. In an exploratory analysis investigating factors of adolescent depression using subscales, greater interpersonal problems predicted higher attendance rates. Results are interpreted relative to limitations of the small sample size and possible measurement concerns within this study, including a discussion of possible ways to improve related studies on Hispanic/Latinx youth in the future.Item Evaluating the Impact of Metacognitive Reflection and Insight Therapy on Social Functioning in Schizophrenia(2021-12) Mickens, Jessica L.; Minor, Kyle S.; Salyers, Michelle; Lysaker, PaulObjective: Social functioning encompasses interactions with people across situations of varying complexity. Given the frequency of observed social impairments in individuals with schizophrenia, there is a need to identify mechanisms that influence social functioning impairments. One proposed mechanism is metacognition, a mental process that enables the integration and interpretation of mental states and experiences. Impaired metacognition can inhibit one’s ability to engage and navigate through our social world. In individuals with schizophrenia, both social functioning and metacognitive deficits are profound. This study examined three hypotheses. Following Metacognitive Reflection and Insight Therapy (MERIT), (1) individuals will show improvements in social functioning; (2) individuals will show improvements in metacognitive abilities; and (3) improvements in social functioning will be associated with improved metacognitive abilities. Method: Using secondary data from a MERIT therapy feasibility study, data collected from the active condition groups (e.g., individuals with schizophrenia, n =16) at pre-and post-assessment were analyzed using paired samples t-tests for primary outcomes and hierarchical linear regressions to assess metacognition as an underlying mechanism of change. Results: Paired samples t-tests found no significant improvement in social functioning or metacognition. In contrast to the hypothesis, metacognitive abilities significantly declined. When subscales were examined, two subscales (self-reflectivity and awareness of others) significantly decreased. The post-hoc analysis found significant improvements in overall symptoms and disorganization. Lastly, metacognition did not significantly predict post-intervention social functioning. Conclusions: Measurement modality and the length of intervention may help explain the null findings observed in this study. The improvement in overall and disorganized symptoms could indicate that symptom reductions precede social functioning and metacognition changes. Given that the results from this trial were not aligned with previous studies, further research is needed to determine the effectiveness of MERIT on social functioning and metacognition in schizophrenia.Item Examining the Effects of Contextually-Imposed Cognitive Load on Providers' Chronic Pain Treatment Decisions for Racially and Socioeconomically Diverse Patients(2022-08) Anastas, Tracy; Hirsh, Adam; Salyers, Michelle; Stewart, Jesse; Kroenke, KurtCompared to people who are White and have high socioeconomic status (SES), those who are Black and have low SES are more likely to receive suboptimal pain care. One potential contributor to these disparities is biased provider decision-making—there is compelling evidence that providers are influenced by patient race and SES when making pain treatment decisions. According to the dual process model, people are more likely to be influenced by demographic stereotypes, including implicit beliefs, when they are under high cognitive load (i.e., mental workload). One stereotype belief relevant to pain care is that Black and low SES people are more pain tolerant. Aligned with the dual process model, providers who are under high cognitive load and have strong implicit beliefs that Black and low SES people are more pain tolerant may be particularly likely to recommend fewer pain treatments to them. To test this hypothesis, I recruited physician residents and fellows (n=120) to make pain treatment decisions for 12 computer-simulated patients with back pain that varied by race (Black/White) and SES (low/high). Half of the providers were randomized to the high cognitive load group in which they were interrupted during the decision task to make conversions involving hypertension medications for another patient. Remaining providers completed the task without being interrupted. Providers’ implicit beliefs about race and SES differences in pain tolerance were measured with two separate Implicit Association Tests (IATs). Multilevel modeling indicated that providers recommended stronger medications to low than high SES patients (OR=.68, p=.03). There was also a significant interaction between patient SES and cognitive load (OR=-.56, p=.05) and a trending interaction between patient race and cognitive load (OR=1.7, p=.07). Under low cognitive load, providers recommended more pain treatments to high SES (vs. low SES) and Black (vs. White) patients, but under high cognitive load, providers recommended more pain treatments to low SES (vs. high SES) patients and equivalent treatment to Black and White patients. There were no three-way interactions between patient demographics (race or SES), cognitive load, and providers’ implicit beliefs (race-pain or SES-pain IAT scores). However, there was a trending interaction between patient race and race-pain IAT scores (OR=2.56, p=.09). Providers with stronger implicit beliefs that White people are pain sensitive and Black people are pain tolerant recommended more pain treatments to White patients and fewer pain treatments to Black patients. Lastly, there was a trending effect that providers with stronger implicit beliefs that high SES people are pain sensitive and low SES people are pain tolerant recommended stronger medications in general (OR=13.03, p=.07). Results support that provider cognitive load is clinically relevant and impacts clinical decision-making for chronic pain for racially and socioeconomically diverse patients. Future studies are needed to further understand the impact of cognitive load on providers’ pain care decisions, which may inform evidence-based interventions to improve pain care and reduce disparities.Item Examining the Role of Dysfunctional Beliefs in Individuals with Schizotypy(2015) Luther, Lauren; Salyers, Michelle; Minor, Kyle; Rand, KevinIn accord with the cognitive model of poor functioning in schizophrenia, defeatist performance beliefs, or overgeneralized negative beliefs about one’s ability to perform tasks, have been linked to poor functional outcomes, cognitive impairment, and negative symptoms in schizophrenia and are a suggested therapeutic target in Cognitive Therapy for Schizophrenia. However, there is a paucity of research investigating these beliefs in schizotypy, or those exhibiting traits reflecting a putative genetic liability for schizophrenia. This study had three aims: to examine whether defeatist performance beliefs 1) are elevated in schizotypy compared to non-schizotypy, 2) are associated with functioning-related outcomes (i.e., quality of life, working memory, negative schizotypy traits), and 3) mediate the relationships between working memory and both negative schizotypy traits and quality of life. Schizotypy (n = 43) and non-schizotypy (n = 45) groups completed measures of schizotypy traits, defeatist performance beliefs, quality of life, and working memory. Results revealed that the schizotypy group reported significantly more defeatist performance beliefs than the non-schizotypy group. Within the schizotypy group, defeatist performance beliefs were significantly positively associated with negative schizotypy traits and significantly inversely associated with quality of life. No associations were observed between defeatist performance beliefs and positive schizotypy traits and working memory. Further, defeatist performance beliefs did not mediate the relationships between working memory and either quality of life or negative schizotypy traits. Findings are generally consistent with the cognitive model of poor functioning in schizophrenia and suggest that defeatist performance beliefs may be an important therapeutic target in early intervention services.Item Implementation of a Brief Dialectical Behavioral Therapy Skills Group in High Schools for At-Risk Youth: Protocol for a Mixed Methods Study(JMIR, 2022-05-12) Zapolski, Tamika; Whitener, MacKenzie; Khazvand, Shirin; Crichlow, Queenisha; Revilla, Rebecca; Salgado, Eduardo F.; Aalsma, Matthew; Cyders, Melissa; Salyers, Michelle; Wu, Wei; Psychology, School of ScienceBackground: Adolescence is a developmental period marked by engagement in risk-taking behaviors, especially among impulsive or emotionally dysregulated youth. Thus, interventions that teach skills to reduce the risk of negative outcomes associated with emotional dysregulation are required. Social and emotional learning (SEL) programs have been developed to address both adolescent emotional dysregulation and risk-taking behaviors; however, current programs have mostly been implemented among younger youth and are used as a tier 1 universal intervention rather than a targeted tier 2 intervention for youth identified with emotional regulation difficulties. Objective: This study aimed to address the need for SEL programming that can be delivered in schools, particularly for older youth who have difficulties with emotional or behavioral dysregulation, to reduce the risk of health-risk behaviors among this population. Methods: Here, we outline the implementation of an SEL intervention titled Going 4 Goals, a 9-session adaptation of the Dialectical Behavioral Therapy for Adolescents (DBT-A) program delivered to at-risk high school students in a school setting. The primary objectives of the study are to test whether participating in the skills group intervention produces significant increases in the core DBT-A skills of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, while also producing significant decreases in substance use and risky behaviors. These primary outcomes are based on changes in participant scores between baseline and after the intervention and follow-ups at 1, 3, and 6 months compared with a control group of youth participating in the school's health curriculum at the same time points. Qualitative interviews will also be conducted with intervention participants and school staff to examine acceptability and facilitators of and barriers to the intervention. Results: A total of 171 participants across 13 groups had been enrolled in the intervention, with data collection ending December 2021. Data analysis will begin in the spring of 2022, with expected results to be published in the spring of 2023. Conclusions: This paper describes the protocol of the 9-session school-based adaptation of the DBT-A intervention and discusses the strengths and limitations of the study and future directions.Item Interaction of social support and core self-evaluations on work-family conflict and burnout(2017-05) O'Mera, Bridget K.; Stockdale, Margaret S.; Pietri, Evava; Salyers, MichellePrevious research has established that supportive work and family environments are critical in helping employees manage stressors that lead to work-family conflict. However, little is known about alternate ways that work-family conflict can be reduced in situations where support is insufficient. Drawing on Conservation of Resources theory, this study examines whether individual differences in personality, specifically core self-evaluations (CSE), can relieve work-family conflict when external sources of support (i.e., family-supportive organizational perceptions (FSOP), supervisor support, family support) are low. Results from 453 men and women in various industries and organizations suggest that FSOP and supervisor support reduce work-to-family conflict (WFC), and that family support reduces family-to-work conflict (FWC). In addition, work-family conflict mediated the negative relationships between social support and employee burnout. Contrary to predictions, however, instead of compensating for low FSOP, WFC was reduced especially for individuals, particularly men, who had both strong FSOP and high CSE. This implies that men who hold more positive views toward their self-worth and competence stand to gain more from family-supportive work environments than individuals who lack the same internal resources. CSE did not have this boosting influence for women. CSE also moderated the indirect relationship between FSOP and burnout through WFC, meaning that individuals with high CSE who also perceived their organization as family-supportive experienced significantly less burnout than those with low CSE.Item Investigation of Social Dysfunction and Affect in Schizophrenia(2020-08) Beaudette, Danielle M.; Minor, Kyle S.; Salyers, Michelle; Wu, WeiSocial dysfunction is a hallmark of schizophrenia and leads to significant disability and distress. Decreased positive and increased negative affect predict poorer social functioning in those with schizophrenia. Social functioning and affect have traditionally been measured in the laboratory; yet, these methods are limited. Experience sampling methods (ESM) offer more immediate, ecologically valid assessments of these constructs. The purpose of this study was to examine social functioning and affect in schizophrenia using a novel form of ESM that passively collects audio data. The two primary hypotheses were: 1) clinical status (schizophrenia versus control) will predict social functioning, level of positive affect, and level of negative affect; and 2) the relationship between clinical status and affect will be moderated by context (social versus non-social). Additional exploratory aims tested the convergent validity between traditional, laboratory-based assessments of social functioning and this novel ESM. Data was collected from 38 people with schizophrenia and 36 control participants; Results partially supported the hypotheses. As expected, laboratory measures of social functioning revealed that those with schizophrenia performed worse than controls. ESM measures of social functioning found that the schizophrenia group interacted with others at the same rate as the control group but did not exhibit as much social engagement. ESM measures of affect revealed the schizophrenia group reported more negative affect than controls, but no differences in positive affect were found. Social context did not moderate the relationship between clinical status and affect. Lastly, correlations between laboratory measures and ESM measures of social functioning were significant for the schizophrenia group but not the control group. Results further our understanding of social functioning and affect in those with schizophrenia and yield important implications for future work.Item Mapping recovery: A qualitative node map approach to understanding factors proximal to relapse among adolescents in a recovery high school(Elsevier, 2022-07) Whitt, Zachary T.; Sturgeon, Taylor; Rattermann, Mary Jo; Salyers, Michelle; Zapolski, Tamika; Cyders, Melissa A.; Psychology, School of ScienceIntroduction Despite data suggesting that recovery high schools are largely effective in reducing substance use, relapse in these settings is common. The goal of the current study was to characterize factors proximal to relapse among adolescents in a local recovery high school. Method Data for this study were 200 de-identified node maps (i.e., graphical break downs of a relapse event; randomly chosen from 600 available node maps) from the charts of students at a local recovery high school in a large Midwest city (Mean Age = 16.8 ± 1.9 years, 64.1% male, 89.1% White). A four-phase process of qualitative data sorting examined features most frequently described in relapse episodes. Results The most common elements reported were using with others ( n = 153, 76.5%), away from home ( n = 156, 78.0%), and in response to negative affect ( n = 93, 48.4%). Six relapse pathways emerged: coping ( n = 30), acting out (n = 15), unexpected temptation (n = 30), planned lapse ( n = 19), resistant to recovery ( n = 27), and passive agency (n = 30). The pathways identified represent three critical failures in the recovery system: failure to cope, failure to guard against temptation, and failure of belief. Identifying these system failures can contribute to increased rapport and engagement, as well as planning for detailed and specific factors proximal for relapse for any given individual, both on the individual and system levels. Conclusion The use of node maps aligned with previous work, showed good face and content validity, can be used to reduce blame and increase engagement in substance use treatment among adolescents, and produced novel micro-frames with new vocabulary to accurately understand common factors associated with relapse among adolescents.