IU Indianapolis ScholarWorks :: Browsing by Author "Salyers, Michelle"

Browsing by Author "Salyers, Michelle"

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A Pilot Study Of A Mental Health Education Program (AMUSE) For Restaurant Employees
(2024-08) Muth, A. J.; Salyers, Michelle; Cyders, Melissa; Williams, Jane; Rand, Kevin
Restaurant workers in the United States (US) face multiple stressors and mental health concerns. Additionally, there are indications that restaurant workers may hold stigmatizing mental health beliefs and are less likely to seek help for mental health concerns. Despite this, there have been no interventions assessed that target restaurant workers’ mental health, well-being, and mental health stigma. The purpose of this study is to provide an initial evaluation of one such intervention, a mental health education course (AMUSE) developed by a restaurant nonprofit (CHOW) focused on mental health in the restaurant industry. As an initial pilot study, we assessed the feasibility and acceptability of AMUSE, and sought to identify potential outcomes, and explore potential moderators and confounds. A combination of quantitative (pre and post measures) and qualitative (follow-up interviews) methods were utilized to collect data. Initial indications show that AMUSE is feasible to deliver and well accepted by those who have taken it. Additionally, participants demonstrated positive changes in help-seeking and self-efficacy after completing the course. Positive changes appeared to be moderated by characteristics of participants’ restaurant work. Despite our expectations, no significant changes were observed for stigma, motivation, social support, well-being, psychological distress, or stress. Future directions and recommendations for AMUSE were discussed based on these findings
Addressing Formal Thought Disorder in Psychosis through Novel Assessment and Targeted Intervention
(2020-08) Marggraf, Matthew P.; Minor, Kyle; Salyers, Michelle; Lysaker, Paul; Stewart, Jesse
Formal 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.
Availability of Behavioral Health Crisis Care and Associated Changes in Emergency Department Utilization
(2024-06) Burns, Ashlyn Brooke; Yeager, Valerie; Menachemi, Nir; Vest, Joshua R.; Mazurenko, Olena; Salyers, Michelle
One in eight emergency department visits involves a behavioral health crisis. Yet, emergency departments are rarely equipped to meet the needs of patients experiencing a behavioral health crisis. Innovative care delivery models, such as behavioral health crisis care services delivered by mental health treatment facilities, offer a promising alternative to the emergency department. As decisions are being made around reimbursement and expansion of behavioral health crisis care models, empirical evidence on the relationship between these services and emergency department utilization is needed. The purpose of this dissertation is to 1) assess availability of behavioral health crisis care services across the United States; 2) identify community-level characteristics associated with availability of behavioral health crisis care services; and 3) quantify changes in emergency department utilization associated with availability of behavioral health crisis care services. In doing so, this dissertation identifies gaps in the nation’s existing behavioral health crisis care system and highlights the value of ensuring access to these life-saving services. As national implementation of the new 988 Suicide and Crisis Lifeline is underway, findings from this dissertation may help inform efforts to transform the crisis continuum and ensure access to care for all individuals experiencing a crisis.
Can Hope and Optimism Interventions Be Delivered Online? A Pilot Study in College Students
(2024-08) Ahamadeen, Naheeda; Rand, Kevin L.; Hirsh, Adam; Salyers, Michelle
Hope and optimism are associated with many positive life outcomes, including better physical functioning (Cherry et al., 2017), less psychological dysfunction (Shanahan et al., 2021), and general well-being and better academic achievement in college students (Rand et al., 2020). College students in particular are known to struggle with a variety of issues and could benefit from increased hope and optimism. Interventions have been developed to increase hope and optimism, but these have largely been delivered in person. The purpose of this pilot study was to examine the feasibility and acceptability of delivering hope and optimism interventions in an online format to college students. There was mixed evidence of feasibility, but results did suggest online hope and optimism interventions are acceptable to college students. Although 94.3% of participants were retained, only 23% of participants met the active engagement word count requirement across conditions, and only 52.2% of participants adhered to intervention instructions in the hope condition. Acceptability was met across conditions with most participants reporting engagement (89.6%), vividly imagining their scenario (94.3%), thinking carefully about the prompt (95.4%), and putting effort into the task (93.1%). Examining the preliminary efficacy of these interventions showed no differential changes in state measures across conditions, although there were overall changes for hope and optimism across all conditions. Thus, it may be useful to examine these findings further in a fully powered study to determine the efficacy of these interventions.
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 Science
Peer-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.
Differential Factors Influencing Hispanic/Latinx Adolescent Engagement in Mind-Body Skills Groups for Depression
(2021-08) Salgado, Eduardo F.; Salyers, Michelle; Zapolski, Tamika; Aalsma, Matthew
Major 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.
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, Paul
Objective: 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.
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, Kurt
Compared 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.
Examining the Role of Dysfunctional Beliefs in Individuals with Schizotypy
(2015) Luther, Lauren; Salyers, Michelle; Minor, Kyle; Rand, Kevin
In 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.
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 Science
Background: 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.

Browsing by Author "Salyers, Michelle"

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