Psychology Department Theses and Dissertations

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Bias in pain care: What patient variables do providers report as influencing their treatment decisions?
(2024-10) Rose-McCandlish, Margaret; Hirsh, Adam; Mosher, Catherine; Stewart, Jesse
Racialized and low socioeconomic status (SES) patients are often under-treated for chronic pain, despite reporting more pain on average. This disparity is likely due to multiple systemic factors, including healthcare provider bias. Providers often treat patients differently for chronic pain depending on the patient’s race and SES, but little is known about providers’ awareness of the extent to which patient demographic variables influence their pain treatment decisions. The present study examined the variables that providers report as influencing their pain treatment decisions, whether these variables group together to form distinct factors, and whether providers who demonstrate racial or socioeconomic bias in their treatment decisions report different patient variables or factors as influencing their treatment decisions compared to providers who did not demonstrate biases. Four hundred thirty-two United States-based physician residents and fellows (“providers”) made treatment decisions for 12 computer-simulated patients with chronic pain who varied by race (Black/White) and SES (high/low). Providers then rated the level to which 15 different variables influenced their treatment decision-making. Robust repeated measures ANOVAs indicated that providers rated patient sex/gender, age, and race as the least influential variables in their pain treatment decisions for the simulated patients. For the factor analysis, I sequentially omitted variables to achieve proper model fit and reliability and arrived at a three-factor solution; I labelled these factors Demographic, Biomedical, and Psychosocial, according to the variables’ conceptual overlap. Robust repeated measures ANOVAs found that reported use of variables did not differ between the providers who demonstrated bias and those who did not demonstrate bias, nor did factor scores for the three factors. The present study suggests that providers have low awareness of the extent to which patient race and SES may influence their clinical decision-making in pain care. Results can help inform future research to improve interventions to reduce the impact of racial and socioeconomic bias on providers’ treatment decisions for patients with chronic pain.
What's in an Ally? Development of the Political Allyship Behavior Scale (PABS) to Explore White Politicians' Genuine and Performative Allyship Toward Black Americans
(2024-08) Mosier, Amanda Elizabeth; Stockdale, Margaret S.; Derricks, Veronica; Johnson, India R.; Cook, Nathan
The racial turnout gap is a significant concern to the integrity of the democratic process in the United States, as it leads to underrepresentation of the perspectives of marginalized racial groups. This dissertation proposes that one way to reduce the turnout gap is by White politicians engaging in genuine allyship to marginalized groups. Across three studies, I explored how Black Americans define genuine and performative allyship from politicians, developed a behaviorally based instrument to measure political allyship, and investigated how experiencing political allyship impacts Black Americans’ intended political participation. First, a sample of Black Americans generated critical incidents of genuine and performative political allyship, which were then thematically analyzed and consolidated. Another sample of Black Americans rated these incidents on allyship, and incidents that did not strongly signal either genuine or performative allyship were dropped. Next, I conducted a card sort task and used k-means cluster analysis to create groups of similar allyship behaviors, which revealed that the construct of political allyship is comprised of three clusters (i.e., themes) of genuine allyship and two clusters of performative allyship. Finally, these clusters were used to create, validate, and test a novel scale to measure political allyship – the Political Allyship Behavior Scale (PABS). After assessing interrater reliability and establishing construct validity of the PABS, I tested the practical utility of the PABS by having Black Americans use the measure to rate a fictional politician. Not only was the PABS able to reliably distinguish between politicians who engaged in genuine versus performative allyship, but it also showed that Black Americans reported higher intended political participation when they experienced genuine allyship from a White politician. This research may help politicians better understand how their allyship is perceived by Black Americans and make strides toward closing the turnout gap and promoting equality in representation.
Modernized Collaborative Care for Depression: Impact on Psychological Risk and Protective Factors for Diabetes and Intervention Outcomes Among Diverse Sociodemographic Groups
(2024-08) Williams, Michelle; 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; bY) indicated that, compared to active control, the intervention group demonstrated clinically meaningful medium-to-large improvements in depressive symptoms (PHQ-9 bY = -0.69), anxiety symptoms (GAD-7 bY = - 0.76), and trait positive affect (PANAS-PA bY = 0.61) as well as small-to-medium improvements in life satisfaction (bY = 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.
Racial Discrimination and Alcohol Use Among Adolescents: The Role of Emotion Regulation
(2024-08) Khazvand, Shirin; Zapolski, Tamika; Cyders, Melissa; Dir, Ally; Wu, Wei
Background: Racial discrimination has been consistently associated with risk for alcohol use outcomes among racial/ethnic minority groups. This is particularly concerning given that engagement in alcohol use during adolescence has significant downstream effects on an individual's health into adulthood. Understanding factors that influence the relationship between racial discrimination and alcohol outcomes are needed to better understand the risk pathway and to identify malleable targets for interventions to reduce alcohol use among racial/ethnic minority adolescents. One potential candidate is emotion regulation as there is evidence that exposure to discrimination is associated with emotion regulation difficulties, and that emotion regulation difficulties are associated with alcohol outcomes. It is also plausible that emotion regulation is an external factor that strengthens or weakens to direct association between racial discrimination and alcohol use. Thus, the current study examined difficulties in emotion regulation (as measured by the State Difficulties in Emotion Regulation, S-DERS) as a mediator and moderator separately on the relationship between racial discrimination related stress (RDRS) and alcohol outcomes (i.e., use, quantity, frequency, alcohol use disorder, binge drinking, high intensity alcohol use) and risk for problems associated with substance use. To better understand the nuances within the emotion regulation construct, this study also examined the four subscales of the S-DERS (e.g., difficulties in nonacceptance, modulation, lack of awareness, lack of clarity) in a parallel mediation and moderation model to account for each domain’s unique effect on the racial discrimination-alcohol pathway. Methods: 714 self-identifying racial/ethnic minority adolescents aged 10-19 years old (62.9% male, mean age 16.21 years old, 58.1% African American/Black, 19% American, 9.9% Hispanic/Latino, 9.7% Asian American/Pacific Islander, 1.3% Middle Eastern/North African) completed an online questionnaire that included measures assessing experiences of racial discrimination related stress, state difficulties in emotion regulation, and alcohol outcomes. Results: Findings indicated a significant indirect effect of RDRS on alcohol outcomes through total state difficulties in emotion regulation (past year use b = 0.002, p <0.001; frequency b = 0.005, p <0.001; quantity b = 0.003, p <0.001; alcohol use disorder b = 0.056, p <0.001; binge drinking b = 0.004, p <0.001; high intensity alcohol use b = 0.003, p <0.001; risk for problems associated with substance use b = 0.007, p <0.001). When examining the subscales of emotion regulation, a significant indirect effect was found for difficulties in modulation within the relationship between RDRS and past year use, quantity, frequency, alcohol use disorder, binge drinking, and high-intensity alcohol use, but not for risk for problems associated with substance use. There were no significant indirect effects observed for the other subscales of emotion regulation. Additionally, when examining whether S-DERS or the S-DERS subscales moderated the relationship between RDRS and alcohol outcomes, no significant effects were found. Conclusion: These findings expand our understanding on potential mechanisms that underlie the racial discrimination-alcohol risk pathway among racial/ethnic minority adolescents, which may in turn help clarify the multifaceted nature of emotion regulation. As such, findings suggest that a unique effect was found for difficulties in modulation of emotions when accounting for the other domains of emotion regulation when examining the RDRS and alcohol outcomes relationship. Given that this study was cross-sectional, additional research utilizing a prospective study design can build off the current findings to confirm the proposed temporal pathway between RDRS, emotion regulation, and alcohol use outcomes. Moreover, findings suggest that difficulties in modulation and emotion regulation may be important constructs to include within treatments aimed at reducing alcohol use and prevention efforts among racial/ethnic minority adolescents experiencing racial discrimination related distress.
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
Evaluating Social Interactions in Schizotypy Using Ecological Momentary Assessment
(2024-08) Russell, Madisen T.; Minor, Kyle S.; Salyers, Michelle P.; Wu, Wei
Compared to individuals low in schizotypal traits, those with elevated schizotypal traits present with social deficits and are at greater risk for developing schizophrenia-spectrum disorders and other forms of psychopathology. Ecological Momentary Assessment (EMA) is a powerful tool for understanding the real-world behaviors of schizophrenia-spectrum populations. Although studies have effectively utilized EMA to examine important aspects of social interactions (i.e., how often people interact [likelihood], the complexity of the content in these interactions [depth], and how much pleasure they derive from these interactions [enjoyment]) in people with schizophrenia, few have explored differences in social interactions using EMA across schizotypal traits (i.e., positive, negative, and disorganized). In this study, we used EMA to collect data from three universities. Our primary aim was to evaluate if positive, negative, and disorganized schizotypal traits in college students were significantly linked to individuals’ likelihood, depth, and enjoyment of social interactions in their everyday lives. Our secondary aim was to investigate whether affect and stress play a role in individuals’ likelihood, depth, and enjoyment of social interactions. Results revealed that negative schizotypal traits more strongly predicted social interaction depth and enjoyment compared to positive and disorganized traits. Contrary to hypotheses, positive affect was a better predictor of social interaction outcomes than negative affect and stress. Several notable interactions between schizotypal traits and affect also emerged. Overall, this study increases understanding of how schizotypal traits and affect impact daily social interactions. These findings may inform future research aimed at improving and individualizing interventions for social functioning deficits in individuals with elevated positive, negative, and/or disorganized schizotypal traits.
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.
HiTOP-based Optimal Personalized Assignment to Abstinence from Alcohol: A Precision Medicine Approach
(2024-08) Argyriou, Evangelia; Cyders, Melissa; Wu, Wei; Stewart, Jesse; Plawecki, Martin
Abstinence from drinking has traditionally been the primary goal of alcohol use disorder (AUD) treatment; however, there is evidence that individuals respond differently when trying to be abstinent from alcohol. The main goal of my study was to use a novel precision medicine approach to optimize assignment to short-term abstinence from alcohol based on a variety of individual characteristics. The sample consisted of 97 moderate-to-heavy drinkers aged 21-35. A within-subjects design was employed where each participant completed two counter-balanced intravenous alcohol sessions (one following abstinence and one during usual drinking). For the primary aim of this study (N = 47), crossover generalized outcome weighted learning was used to estimate an optimal individualized assignment rule to short-term abstinence based on prescriptive factors, including HiTOP-relevant dimensions and other characteristics. For a secondary aim (N = 50), logistic regression was used to test whether the subgroups estimated by the optimal rule were associated with a set of genetic and behavioral factors related to AUD, and subjective perceptions to alcohol intoxication. Findings showed that an estimated rule with higher granularity – higher-specificity traits and demographics – led to lower alcohol consumption overall compared with one-size-fits-all rules (i.e., assigning everyone to abstinence or assigning no one to abstinence). The effect sizes of the difference were small-to-medium and fell short of statistical significance. Family history of AUD had a positive trend association with benefit from abstinence, with one standard deviation increase in family history of AUD being associated with twice as high odds of being assigned to abstinence. Due to the limited sample size, the results should be interpreted with caution. Study results provided preliminary evidence that an individualized assignment rule based on relatively simple and easily accessible individual characteristics can lead to lower alcohol consumption than that observed if everyone or no one was assigned to abstinence (i.e., one-size-fits-all approach). Genetic predispositions reflected in family history of AUD may be a potential mechanism linking the assessed prescriptive factors with abstinence response, which is worth further exploration.
Race and Gender Disparities in Physician Judgements of Opioid-related Risk in Patients with Chronic Pain
(2024-08) Grant, Alexis; Hirsh, Adam T.; Cyders, Melissa; Kroenke, Kurt; Wu, Wei
Opioid-related risk assessment is a key component of safe and effective pain care. Prior opioid misuse is a known predictor of opioid-related risk, but its predictive quality depends on the specific behavior – some behaviors confer high risk (red flag), whereas others confer medium (yellow flag) or low risk (green flag). Race and gender disparities in opioid prescribing are well documented, but little is known about how patient race and gender interact with prior opioid misuse to impact physicians’ risk assessments. One hundred physicians were presented 12 virtual patients (videos and text vignettes) with chronic pain who varied by race (Black, White), gender (female, male), and prior opioid nonadherence (red, yellow, green flag). Physicians made assessment decisions about patients’ risk for future opioid-related adverse events, abuse/misuse, diversion, and opioid use disorder (OUD). Linear mixed effects models examined the independent and interactive effects of patient race, gender, and prior opioid misuse on physicians’ risk assessments. Results indicated that severity of prior opioid nonadherence significantly impacted physicians’ risk assessments for future opioid-related adverse events, prescription misuse/abuse, diversion, and OUD. However, these effects differed based on patient gender. Men with yellow flag behaviors were rated at higher risk for adverse events, abuse/misuse, and OUD relative to women with yellow flag behaviors. Conversely, among patients with red flag behaviors, women were rated at higher risk for adverse events, abuse/misuse, and OUD relative to men. Patient race did not impact physicians’ risk assessments. These findings inform efforts to enhance equity and outcomes in chronic pain care.
Are Black, Male Leaders Expected to Help Other Black Americans in the Workplace?
(2024-08) Yan, Sisley; Williams, Jane; Ashburn-Nardo, Leslie; Derricks, Veronica
Experimental vignette methodology was utilized to investigate the relationships between leader group prototypicality, identity denial, and three leader outcomes (i.e., charisma, trust, and endorsement). Participants were randomly assigned to one of three experimental conditions: general advocacy (control), ingroup advocacy, and ingroup anti-advocacy. We hypothesized that a Black, male target displaying ingroup advocacy behaviors would be perceived most favorably while a Black, male target displaying ingroup anti-advocacy behaviors would be perceived most poorly. Furthermore, we predicted that identity denial, measured via perceived racial identification, would serve as a mediator. Overall, we found support for our hypotheses, with the exception being that there were no significant differences in leader outcome ratings when comparing the general advocacy condition to the ingroup advocacy condition, even despite the significant mediation throughout all conditions. In summary, Black Americans on average do not expect a Black, male leader to help other Black employees, but he is expected to not devalue or trivialize his Black identity. Doing so would lead to identity denial and less positive evaluations. In contrast, standing in solidarity with the ingroup increases the leader’s perceived racial identification the most and this in turn helps to bolster leader outcomes. Although future research should test climate change as a valid control condition, our pattern of findings suggests that environmental sustainability should be a safe topic for a Black, male leader to advocate for if he wishes to remain more neutral on matters pertaining to race.

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