Psychology Department Theses and Dissertations

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A Mixed-Methods Approach to Testing Stigma's Impact on Stress Processes in Substance Use Recovery
(2025-08) Liu, Melissa A.; Cyders, Melissa; Barthlow-Potkanowicz, Deanna; Derricks, Veronica; Fry, Melissa; Wu, Wei
Although individuals with substance use disorder (SUD) often cite stigma as one of the biggest barriers to treatment, it is unclear how the effects of stigma extend to those in recovery. The aims of this study were to 1a) examine the longitudinal relationship between substance-use related stigma and functional markers of recovery, 1b) test stress, measured via anxiety symptoms, as a mediating mechanism of this relationship, and perceived social support and post-traumatic stress disorder (PTSD) symptoms as moderators on the indirect effects of stigma, and 2) identify qualitative themes surrounding perceptions of substance use-related stigma, social support, and trauma on recovery processes. The first aim included a longitudinal sample of 370 community adults (51.1% male, Mage=41.6 years, ±11.0 SD) in recovery from SUD, while the second aim included a sample of 44 adults (52.3% male, Mage=40.6 years, ±12.2 SD) in recovery from SUD. Structural equation modeling was used to test the longitudinal moderated-mediation model, using baseline, 6-month, and 12-month timepoints. Qualitative analyses were conducted on focus group transcripts using grounded theory approach to identify emergent themes surrounding the roles of stigma, perceived social support and trauma on recovery processes. Quantitative results did not support the direct relationship or moderated mediation model tested (p’s>.05). However, qualitative results identified higher-order categories of how social support and trauma helped, hurt, and had no effect on recovery, while stigma codes were categorized into impact on recovery treatment, and perceptions of self and others. Integration of findings suggest that mixed effects identified in qualitative themes were likely masked in quantitative analyses due to broad assessments of constructs. Recommendations are made for future work, such as improving measurement specificity, content validity, and domains assessed, as well as using existing theoretical models to inform viable alternative pathways and mediators.
Decisional Capacity in Psychiatric Inpatient Settings: Understanding and Addressing Key Barriers to Shared Decision Making
(2025-08) Bass, Emily Logan; Minor, Kyle; Salyers, Michelle; Hirsh, Adam; Rand, Kevin; McGuire, Alan
Research indicates that the degree to which shared decision making (SDM) is implemented within inpatient care across the VHA varies significantly. International literature on this topic suggests that clinicians' concern around patients’ reduced decisional capacity is a frequently reported barrier to SDM implementation, yet determining decisional capacity for SDM is complex. To date, it is unclear how clinicians within the US are currently determining patients’ ability to participate in decisionmaking, particularly in situations when there is less certainty around this determination (e.g., concerns of reduced decisional capacity, acute symptoms, liability concerns). While solutions have been proposed, the literature remains divided on the best approach in adapting SDM to address these barriers, and none have been explicitly implemented within the United States. As such, the current study interviewed 25 acute mental health inpatient psychiatrists across 17 unique VHA sites to: 1) determine how psychiatric inpatient psychiatrists are determining patients’ ability to make medication management decisions and, 2) gather psychiatric inpatient psychiatrists’ perspectives on the perceived acceptability and adaptability of key elements proposed as possible solutions in the literature (i.e., capacity-adjusted sliding scale SDM, SDM-PLUS, Shared Risk Taking). Through emergent thematic analysis, the current study identified a complex relationship between risk, capacity, and mental health law that influences providers’ level of collaboration within medication management decisions. Further, providers indicated a preference for a combination of approaches to address reduced decisional capacity as a barrier to SDM. The current study proposes elements for future SDM interventions and future directions to further address reduced decisional capacity and facilitate SDM within acute mental health inpatient care.
A Mixed Methods Approach to How Reasons for Quitting Might Predict Recovery Outcomes Among Those in Recovery from Alcohol Use Disorder
(2025-08) Prestigiacomo, Christiana J.; Cyders, Melissa; Wu, Wei; Rand, Kevin; Fry, Melissa
Recent work has characterized specific reasons for quitting alcohol use that are important to those who have received treatment for alcohol use disorder (AUD). However, the measurement of reasons for quitting is heterogeneous, which affects which reasons are reported and hampers the ability to determine which reasons are most influential in predicting recovery outcomes. The aims of this study were to 1) compare how scale and open-ended measures impacted specific reasons for quitting reported and 2) evaluate if reasons reported via a scale vs. open-ended questions differentially predicted recovery outcomes. I examined this across a six-month longitudinal sample of 203 individuals in recovery (Mean age=42.89, 52.2% male, 77.8% White) who have had treatment for AUD. Thematic coding following a directed content analysis approach identified nine themes of one’s “Top Three” reasons for quitting: health reasons, people focused reasons, legal concerns, does not fit lifestyle, financial/work reasons, religious reasons, avoid disapproval from others, fear of consequences, and hit rock bottom. There were significant differences in endorsement of themes across the two measures. Latent class analysis identified three groups with similar Top Three reasons; path analysis found that neither the latent classes based on the open-ended measure nor the scale-based measure of reasons predicted alcohol use recovery outcomes. However, avoid disapproval from others reasons reported via the scale had a small positive association with alcohol problems. This study was the first to directly compare the types, and predictive nature, of reasons reported via different measures, which identified the need for standardization in the measurement of this construct as the type of measure affected the reasons being reported. Future research should focus on developing a standardized scale informed by the types of reasons identified via open-ended questioning to most accurately capture themes of reasons. This study is a key early step in a program of research aimed at developing and testing interventions targeting reasons for quitting in order to improve recovery outcomes. Should this line of work be successful, it would contribute to research efforts to identify active components of successful recovery, which can then be leveraged to improve recovery outcomes.
Operant Drinking in Crossed High Alcohol Preferring x High Drinking in the Dark (cHAPxHDID) Mice
(2025-08) Nguyen, Thanh Thi; Grahame, Nicholas; Neal-Beliveau, Bethany; Czachowski, Cristine
Selectively bred cHAPxHDID mice were used to investigate if an alcohol drinking history affects operant oral alcohol self-administration. I hypothesized that mice with a history of drinking alcohol via the 2-bottle choice (2BC) procedure would respond at a higher rate for alcohol than mice with a water drinking history. The cHAPxHDID mice were first trained to lever press for 5% ethanol (EtOH) until they consumed at least 0.2 mL on a fixed ratio (FR) of 32. After training, the mice were split and counterbalanced into drinking history and water groups based on the baseline data from the last three consecutive FR32; the history group got access to 20% EtOH and water while the water group only had access to tap water. The 2BC procedure lasted for 15 days, followed by 6 tests performed on different days. Day 1 and 2 were reinforced tests where active lever presses resulted in a reward of 20% EtOH for 5 seconds and inactive lever presses resulted in no outcome. Day 3 was a non-reinforced test, where an active lever press resulted in the sipper coming down, but no reinforcer. On Day 4, all mice received a 1.75 g/kg injection i.p. of 20% EtOH, followed 10 minutes later by placement on the static dowel for ataxia testing; foot slips were recorded. Days 5 and 6 were additional reinforced test days. The animals did not show any escalation in alcohol consumption during 2BC. The active and inactive lever presses showed that the groups did not differ in the number of presses for reward. Additionally, alcohol intake (g/kg) during the test days did not differ. The only difference observed was in foot slips. Animals with a drinking history had significantly fewer foot slips compared to water animals. Overall, the data suggest that chronic alcohol pre-exposure does not affect alcohol reinforcement; it only affects behavioral tolerance.
Modernized Collaborative Care for Depression: Impact on Psychological Risk and Protective Factors for Diabetes and Intervention Outcomes Among Diverse Sociodemographic Groups
(2025-07) Williams, Michelle K.; Stewart, Jesse; Hirsh, Adam; Johnson, India; Gupta, Samir
Objective: We examined the effect of a modernized collaborative care intervention for depression on multiple psychological risk and protective factors for diabetes and characterized intervention process outcomes using data from the eIMPACT-DM trial. Methods: Forty-six primary care patients with depression and elevated diabetes risk from a safety net healthcare system (Mage = 50 years, 78% women, 72% Black, Meducation = 13 years, 33% with income <$10,000/year) were randomized to 6 months of the eIMPACT-DM intervention (our modernized collaborative care intervention for depression involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants; n=24) or active control (depression education, depressive symptom monitoring, and usual primary care for depression; n=22). Depressive symptoms (Patient Health Questionnaire-9 [PHQ-9], anxiety symptoms (Generalized Anxiety Disorder-7 [GAD-7]), trait positive affect (Positive and Negative Affect Schedule-Positive Affect Subscale [PANAS-PA]), life satisfaction (Satisfaction With Life Scale [SWLS]), and intervention process outcomes were measured across the treatment period. Results: Effect size metrics (standardized regression coefficients; ϐY) indicated that, compared to active control, the intervention group demonstrated clinically meaningful medium-to-large improvements in depressive symptoms (PHQ-9 ϐY = -0.69), anxiety symptoms (GAD-7 ϐY = -0.76), and trait positive affect (PANAS-PA ϐY = 0.61) as well as small-to-medium improvements in life satisfaction (ϐY = 0.43). Although only 27% of participants assigned to iCBT had good engagement and 60% had good iCBT comprehension, the intervention group reported high skills implementation and treatment satisfaction. Conclusion: These findings demonstrate the potential of a modernized collaborative care intervention to improve multiple psychological risk and protective factors for diabetes in a diverse primary care population. Such an intervention could ultimately serve to bolster future diabetes prevention in diverse groups, helping to reduce diabetes-related health disparities.
Disorganization and Disintegration in Schizophrenia: Metacognitive Capacity and Speech Content Across Levels of Conceptual Disorganization
(2025-07) Myers, Evan J.; Minor, Kyle S.; Salyers, Michelle P.; Rand, Kevin L.; Bonfils, Kelsey A.
Disorganized speech can disrupt effective communication in schizophreniaspectrum disorders (SSDs). Recent work has tied disorganized speech to deficits in metacognition, or one’s ability to integrate experiences to form complex mental representations. Specifically, recent work has shown that metacognitive deficits may emerge only at higher levels of disorganized speech, suggesting a possible exponential relationship. Additionally, lexical analysis studies have linked word use in SSDs (e.g., pronoun use) to both metacognition and speech organization. The present study aims to 1) broadly characterize the nature of the relationship between metacognitive capacity and disorganized speech; 2) compare metacognitive capacity across levels of speech disorganization; and 3) examine word use across levels of speech disorganization. Results provide limited, preliminary support that the relationship between metacognitive capacity and speech disorganization is exponential. Results also show that as levels of speech disorganization increase, there are small, clinically relevant decreases in metacognitive capacity, especially in metacognitive mastery. Similarly, there are small, unexpected changes in speech across social words, first-person pronouns, and time orientation words. Although associations are correlational, results have some clinical implications, especially to tailor metacognitive interventions for use with patients with high levels of disorganized speech. Future research should address limitations of this study by including participants with extreme disorganized speech and by including multidimensional measures of disorganized speech.
Examining Psychological Moderators of the Relationships between Financial Toxicity and Symptoms in Patients with Cancer
(2025-05) Snyder, Stella; Mosher, Catherine E.; Derricks, Veronica S.; Stewart, Kendra R.
Financial toxicity, which includes both the objective financial burden and subjective financial distress related to cancer treatment, has been linked to decrements in patient well-being. Drawing on the Transactional Model of Stress and Coping, this study examines relationships between cancer-related financial toxicity and changes in physical and psychological symptoms over time. Additionally, perceived injustice and acceptance-based coping were examined as potential moderators of these relationships. Patients (N=200) with early-stage solid tumors and at least mild financial toxicity were recruited from Indiana hospitals. Patients were undergoing cancer treatment or had completed treatment within the past 6 months. Assessments were completed at baseline and two months later and included self-report measures of financial toxicity, perceived injustice, acceptance-based coping, and symptoms (anxiety, depressive symptoms, fatigue, sleep disturbance, and pain). I used path analysis to evaluate direct and moderated relationships between financial toxicity and symptoms while adjusting for theoretically relevant demographic and medical covariates. Results showed that higher financial toxicity was significantly correlated with increased depressive symptoms over time (B=-0.19, p<.01) but was not associated with changes in pain, fatigue, sleep disturbance, or anxiety. Contrary to hypotheses, perceived injustice and acceptance-based coping did not moderate these relationships. However, perceived injustice was significantly associated with heightened anxiety (B=2.16, p<.01), depressive symptoms (B=2.41, p<.01), and sleep disturbance (B=1.27, p=.02), and acceptance-based coping was linked to reduced depressive symptoms (B=-1.19, p=.03). Findings contribute to limited longitudinal findings on the detrimental effect of financial toxicity on mental health. Other symptoms were relatively stable over time, and limited variance may have contributed to null findings. Limitations include the primarily non-Hispanic White sample, short follow-up duration, and potential self-report biases. Despite these limitations, results underscore the prevalence of financial toxicity and the need to develop and evaluate interventions that jointly address financial and mental well-being. Next steps also include examining mechanisms linking financial toxicity to mental health outcomes.
Exploring Emotion Regulation and Trait Mindfulness within the Relationship between Racial Discrimination and Emotional Eating among Black Women
(2025-03) Whitt, Devin Michael; Cyders, Melissa; Stewart, Jesse; Wu, Wei
Obesity is more prevalent among Black adults, particularly Black women, compared to other minority groups. Emotional eating has been identified as a potential modifiable behavior that has been linked to increased rates of obesity for Black women. Stress resulting from racial discrimination, also known as race-related stress, is as a potential risk factor for emotional eating. However, research has yet to examine the mechanisms by which race-related stress may impact emotional eating among Black women, as well as factors that may moderate these relationships. Therefore, the current aim of this study was to examine whether emotional regulation strategies mediate the relationship between race-related stress and emotional eating, and whether mindfulness may moderate these mediational pathways, among Black women. Black women across the United States (n=558, Mage= 39.88, SD =13.47) completed an online survey. Results found that race-related stress was significantly associated with emotional eating (β = 0.151; p < .001). Rumination was found to be the only emotional regulation strategy to significantly mediate the relationship between race-related stress and emotional eating (β = .035; 95%CI [.018, .055]). Trait mindfulness moderated one path; at higher levels there was an inverse relationship between race-related stress and emotional suppression (β = -1.110; 95%C [ -2.101, -.119]). This extends previous literature suggesting a relationship between race-related stress and emotional eating through rumination beyond emerging adulthood. These findings serve as a foundation for future researchers to investigate the impacts of specific race-related stressors on emotional eating through rumination and avoidant emotional regulation strategies for Black women. The long-term impacts of this body of research are to reduce disparities in obesity for black women within the broader context of systemic, cultural, intervention and policy changes.
Coping is Complicated: Examining the Roles of Coping Strategies and Pain Self-Efficacy for Black Veterans with Chronic Pain
(2024-12) Procento, Philip Matthew; Hirsh, Adam T.; Matthias, Marianne S.; Rand, Kevin L.; Stewart, Jesse C.
Black patients with chronic pain routinely receive insufficient pain management, which contributes to myriad worse outcomes. This inadequate care stems from various factors, including systemic marginalization, provider bias, and patient-level factors. The present study focused on two patient factors: pain self-efficacy and coping strategies. It explored whether the relationship of pain intensity and pain interference was explained by active (less interference) and passive (greater interference) coping strategies, and it investigated if pain self-efficacy strengthened or weakened these mediating relationships. As part of a larger study, Black veterans with chronic pain completed measures assessing pain interference, coping strategies, and self-efficacy. Simple mediation analyses indicated that the relationship between pain intensity and interference was mediated by passive, but not active, coping. Higher pain intensity predicted greater passive coping, which led to worse pain interference. A parallel mediation analysis affirmed this mediating effect when controlling for active coping. Moderated mediation analyses found that pain self-efficacy moderated the mediating effect of passive, but not active, coping. Participants with lower (vs. higher) pain self-efficacy used more passive coping (in absolute terms) across pain intensity levels, but those with higher (vs. lower) self-efficacy experienced greater increases in their passive coping as their pain intensity increased. A parallel moderated mediation analysis affirmed this moderated mediation effect when controlling for active coping. These results suggest that passive coping is a possible mechanism by which pain intensity leads to interference among Black veterans with chronic pain, and that self-efficacy modulates this effect. Future research should replicate these results in other patient samples, investigate other possible moderators (e.g., PTSD), and design interventions to reduce the use of passive coping strategies while simultaneously increasing pain self-efficacy.
Being Pushed and Pulled in Different Directions: Examining People's Ambivalence Toward Transgender-Specific Policies
(2024-12) Abdul Karim, Muhammad Fazuan; Williams, Jane; Ashburn-Nardo, Leslie; Salyers, Michelle; Stockdale, Margaret (Peggy); Daniel, Jamie Levine
Objectives: This work examines the dynamic relationships between people’s ambivalence and support for specific transgender policies, namely the bathroom bill and the transgender sports participation policy. Even though attitude ambivalence has been studied extensively in the social psychological research, our current understanding of this topic as it relates to attitudes toward transgender policies remains scant. Method: In Study 1, cisgender participants were surveyed about their values, ambivalence, likelihood of seeking new information, and attitudes toward transgender policies. In Study 2 and Study 3, cisgender participants were asked to report their ambivalence (distinguishing between potential and felt ambivalence), likelihood of seeking new information, and attitude toward the bathroom bill. In Study 4, cisgender participants were randomly assigned to reflect on either one-sided arguments or two-sided arguments of the transgender sports participation policy. Lastly, Study 5 investigated the extent to which cisgender participants’ endorsement of the transgender sports participation policy was a function of social norms. Results: Studies 1-3 revealed that there exist relationships among potential ambivalence, felt ambivalence, likelihood of seeking new information, and attitudes toward the bathroom bill, and these relationships were consistent with the extant literature. Study 4 demonstrated that when asked to reflect on both sides of the transgender sports participation policy, participants reported greater ambivalence than when they were asked to reflect on only one side of the policy arguments. Study 5 revealed that regardless of ambivalence levels, participants’ attitudes toward the transgender sports participation policy changed in accordance with social norms. Conclusion: This body of work allows us to understand the impact of attitudinal ambivalence in predicting support for specific transgender policies. The current work documents how ambivalence could be leveraged to mobilize support for transgender policies but may be less influential compared to social norms, especially in the context of bathroom bill and transgender sports participation policies.

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