Psychology (Functional Area: Clinical Psychology)

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Open Access
Understanding Decisions to Engage in Public Health Measures (PHMs) during COVID-19
(2024-10-28) Halilova, Julia Gyulnara; Rosenbaum, Shayna
Widespread compliance with public health measures (PHMs) has been critical to containing the COVID-19 pandemic as well as other infectious diseases. Vaccination, mask-wearing, handwashing, and physical distancing have been among most recommended PHMs for mitigating the impacts of the pandemic. To facilitate development of public health policies and campaigns to encourage compliance with PHMs, it is necessary to gain insight into factors contributing to decisions to engage in the PHMs. The four studies presented in this dissertation are focused on investigating contributions of well-established cognitive biases, delay discounting and intolerance of uncertainty, to individual’s compliance with PHMs during the COVID-19 pandemic. Approximately 7,000 participants from 13 countries were recruited for an online survey between June and August 2021. Participants completed measures of delay discounting, intolerance of uncertainty, demographics, distress level, and PHM compliance. After controlling for demographic and distress variables, delay discounting (tendency to prefer smaller immediate rewards over larger later rewards) was a negative predictor of vaccination, but a positive predictor of physical distancing and handwashing. The participants were invited to complete a follow-up study between July and August 2022 and respond to questions about engagement in protective behaviors, including vaccination status and willingness to receive a booster dose. In the sub-sample of participants who reported receiving at least one main dose of the vaccine (n=2,547), a greater tendency to discount future rewards was associated with reduced willingness to receive a booster dose, after controlling for demographic and distress variables. In the sub-sample of participants who reported no intention to get vaccinated in 2021 (n=251), an age x intolerance of uncertainty interaction predicted the likelihood of change in vaccination status a year later. Younger participants were more likely to change their mind about vaccination compared to older participants, especially if they were high on intolerance of uncertainty. The results of the four studies advance our understanding of health-related decision-making, offering insights into vaccine hesitancy, compliance with PHMs, and the cognitive processes associated with these choices during a pandemic. The implications extend to theoretical models, public health strategies, and interventions aimed at promoting widespread engagement in PHMs.
Open Access
Conceptualizing and Measuring Trait Boredom as a Lack of Agency
(2024-10-28) Gorelik, Dana; Eastwood, John D.
Trait boredom suffers from conceptual ambiguity, including a lack of agreed upon definition and theoretical understanding. Existing measures of trait boredom have been shown to lack validity and possess psychometric limitations. The present dissertation sought to address these concerns by proposing and evaluating a theory of trait boredom and validating a new assessment tool. Chapter 1 reviews the literature on trait boredom including its causes, self-report measures, and limitations of its literature. Chapter 2 defines trait boredom as the frequent experience of state boredom resulting from a psychological cause and conceptualizes these psychological causes in terms of ‘agency’. Chapter 3 partitions the variance in TBS scores into state, trait, and error components to assess the stability and thus validity of the scale. It also evaluates the TBS by examining its associations with measures of theoretically related constructs. Results confirmed a six-item unidimensional scale with strong psychometric properties, including adequate internal consistency (ω = .89), interindividual stability (69.04% of variance accounted by a trait factor), and expected associations with related measures. Chapter 4 evaluates the definition of trait boredom by examining how well measures of psychological causes of boredom predict state boredom characteristics. It also assesses the predictive validity of the TBS by examining its associations with state boredom. Results showed that measures of psychological causes generally predicted state boredom characteristics. Given the finding that boredom intensity and distress were separate from boredom frequency and pervasiveness, I propose that trait boredom should be defined by both the quality of boredom experience (i.e., its intensity and distress) and its frequency. The TBS predicted all state boredom characteristics (rs range from .18 to .26). The TBS was associated with almost all psychological causes of boredom as expected; large associations were with volitional causes. It was also associated with maladaptive and ineffectual responses to boredom. Findings demonstrated that the TBS captures my theory of trait boredom as a lack of agency. Chapter 5 summarizes key findings and proposes directions for future research. The present work provides a useful theory of trait boredom and further validity for a strong new measure of trait boredom.
Open Access
Examining Daily Associations Between Cannabis Use and Alcohol Use Among People Who Use Cannabis for Both Medicinal and Nonmedicinal Reasons: Substitution or Complementarity?
(2024-10-28) Coelho, Sophie; Wardell, Jeffrey
People who use cannabis for medicinal reasons tend to report elevated cannabis use and reduced alcohol use, which may reflect a cannabis–alcohol substitution effect. However, it is currently unclear whether cannabis is used as a substitute for or complement to alcohol at the day level among individuals who use cannabis for both medicinal and nonmedicinal reasons. This study used ecological momentary assessment (EMA) to examine day-level cannabis-alcohol associations linked to day-level variation in medicinal (versus nonmedicinal) reasons for cannabis use. People reporting cannabis use for both medicinal and nonmedicinal reasons (N=66) completed daily surveys assessing previous-day reasons for cannabis use, cannabis consumption, and alcohol consumption. Multilevel models revealed that days during which cannabis was used for medicinal (versus exclusively nonmedicinal) reasons were associated with reduced consumption of both cannabis and alcohol, and alcohol use was increased on days involving greater cannabis consumption. Further, the day-level association between medicinal (versus exclusively nonmedicinal) reasons for cannabis use and lower alcohol consumption was mediated by fewer grams of cannabis used on those days. Results suggest that day-level cannabis-alcohol associations may be complementary rather than substitutive among people who use cannabis for both medicinal and nonmedicinal reasons, and reduced (rather than increased) cannabis use may explain the link between medicinal reasons for cannabis use and reduced alcohol use. These individuals may still be at risk for cannabis-alcohol co-use-related harms, especially on days when they use cannabis for nonmedicinal reasons.
Open Access
A Lonely Time to Live: Assessing the Severity and Chronicity of Loneliness in Emerging Adults
(2024-10-28) Rose, Alison Lesley; Goldberg, Joel
Severe and chronic forms of loneliness are thought to contribute to declines in both mental and physical health. Although the impacts of loneliness are well-established, little is known about the extent to which more severe and chronic forms of loneliness impede on individuals’ functioning and well-being. This oversight is in large part due to the lack of an adequate measure that more fully assesses the severity and chronicity of loneliness. By extension, little is understood about the extent to which severe and chronic forms of loneliness affect emerging adults in general and in challenging times (e.g., during the pandemic). Considering these observations, three multi-method studies were conducted to address this gap in the literature. Study One is a qualitative study conducted during the height of the COVID-19 public health crisis which found that both internal (personal) and external (social and situational) mental health concerns emerged as themes related to the perception and experience of loneliness (N = 37). Study Two (N = 289) and Study Three (N = 371) both involved collecting data from two self-report online surveys during ensuing stages of the pandemic to test the psychometric properties of a newly developed scale (the Severe Enduring Loneliness Factors Questionnaire; SELF) and the extent to which it is predictive of risk and resilience indicators above existing loneliness scales with samples exclusively composed of emerging adults. Overall, findings suggest that it is useful to view and use the measure as two separate subscales that individually evaluate the severity and chronicity of loneliness. As well, the majority of regression analyses showed that both factors of the SELF were either individually or simultaneously predictive, although not uniquely predictive, of the majority of outcomes such as higher levels of depression and shame and lower levels of mattering to others. Notably, an enduring sense of loneliness was uniquely predictive of lower levels of total hope. Study Two compared participants identifying no chronic loneliness (N = 29) with those reporting chronic loneliness to a high degree (N = 84), as well as Study Three (no chronic loneliness, N = 33; high chronic loneliness, N = 125). Both studies found significant, consistent group differences in psychological strengths and vulnerabilities between those reporting an absence versus a heightened level of chronic loneliness. Findings from the present series of studies suggest that the SELF questionnaire shows promise not just in terms of demonstrating sound psychometric properties but also with respect to providing a more comprehensive understanding of the kinds of loneliness that are characterized as more extreme and persistent. The implications of these findings and recommendations for further advancements pertaining to the research and clinical applications of this work are outlined and discussed.
Open Access
Subjective and objective spatial memory and navigation abilities in aging and amnesia
(2024-03-16) Pishdadian, Sara; Rosenbaum, R. Shayna
Compared to the extensive research on how older adults evaluate their memory abilities, the evaluation of subjective spatial navigation abilities is understudied. This dissertation was guided by four research objectives: 1) Investigate the psychometric properties of a subjective spatial navigation questionnaire to assess the nature and extent of self-reported changes to spatial navigation in neurotypical aging; 2) Determine the relationship among subjective assessments of spatial navigation and of memory and how they relate to psychological distress and objective memory performance; 3) Understand the impact of hippocampal damage on subjective awareness of areas of spared and impaired episodic and spatial memory; and 4) Identify more precisely the conditions in which spatial memory and navigation depend on hippocampal integrity. In study 1, multidimensional item response theory was used to evaluate the factor structure and item reliability of the novel Changes in Navigation Questionnaire (CNQ) in a community sample of older adults. Results showed that the CNQ has a reliable factor structure, with items falling under typical and atypical changes. In study 2, the relationship between subjective spatial navigation and metamemory in aging was investigated using structural equation modeling. Findings showed that the subjective spatial navigation and metamemory constructs had a positive, weak correlation. Objective episodic memory performance did not load onto metamemory, and allocentric spatial memory performance had a weak loading onto spatial navigation abilities. Psychological distress symptoms had stronger loadings on metamemory than spatial navigation abilities. In study 3, two individuals with hippocampal amnesia completed questionnaires assessing metamemory and spatial navigation abilities and were compared to age-, gender-, and education-matched controls. The individuals with amnesia reported sound awareness of metamemory and spatial navigation difficulties. Lastly, in study 4, these individuals’ performance on a videogame wayfinding measure was compared with that of thousands of well-matched controls. The individuals showed distinct patterns of impairment and preservation on the tasks. These dissertation results show that subjective spatial navigation abilities can be reliably captured with questionnaires, are weakly related to metamemory, and that accurate self-evaluation is not contingent on intact episodic memory. The findings also highlight specific aspects of navigation that are hippocampal dependent.
Open Access
Development and Application of the Narration-Emotion Process Coding System (NEPCS-CBT): Exploratory Analyses of Therapist and Client Narrative-Emotion Markers in Cognitive Behavioural Therapy for Generalized Anxiety Disorder Psychotherapy Sessions
(2023-12-08) Khattra, Jasmine; Angus, Lynne
The narrative-informed, dialectical-constructivist model (Angus & Greenberg, 2011) suggests that narrative contextualization of emotional experiences in which affect, actions, and thoughts are organized as a told story, enables new self-reflection, emotional awareness, and meaning-making for sustained change in psychotherapy sessions. The Narrative-Emotion Process Coding System Version 2.0 (NEPCS; Angus et al., 2017) is a standardized tool that consists of 10 client markers that capture clients’ mode of storytelling, emotional processing, and reflective meaning making, in therapy sessions in addition to a ‘No Client marker’ dominated by therapist-talk. These 10 client markers are classified into three subgroups: Problem (Same Old, Empty, Unstoried Emotion, and Superficial Storytelling), Transition (Reflective, Inchoate, Experiential, and Competing Plotlines Storytelling), and Change Markers (Unexpected Outcome, and Discovery Storytelling). The NEPCS 2.0 (Angus et al., 2017) was applied to a small Cognitive Behavioural Therapy (CBT) for Generalized Anxiety Disorder (GAD) sample (N = 6; 36 therapy sessions; drawn from Westra et al., 2016) in a pilot study (Khattra et al., 2018). Pilot study (Khattra et al., 2018) findings indicated that therapists contributed up to 45% (‘No Client marker’) of all coded minutes in CBT sessions. The exploration of therapist interventions in ‘No Client markers’ was highlighted as a future direction given therapists’ extensive role in guiding session process in CBT treatment for GAD. Additionally, it was noted that nuances of client narrative-emotion processes during CBT session tasks may have been missed and coded homogenously as the ‘Superficial Storytelling’ marker (22.4% of coded session time; second most frequently occurring marker). The present study aimed to address these limitations and future directions, and had two primary goals: 1) The development of the NEPCS-CBT manual, based on NEPCS 2.0 (Angus et al., 2017), including the differentiation of ‘No Client marker’ category into discrete therapist marker interventions, and refinement of client markers with CBT-task criteria; and 2) Application of the NEPCS-CBT manual to a larger CBT for GAD sample (N = 10; 60 therapy sessions; drawn from Westra et al., 2016). Multilevel mixed-effects models demonstrated significantly higher proportions of Client (C)-Problem markers subgroup (specifically, C-Same Old Storytelling marker), and lower proportions of the C-Transition markers subgroup (specifically, C-Reflective Storytelling marker) for unchanged clients (vs. recovered clients) overall, and at the early, middle, and late stages of therapy. Recovered clients narrated significantly higher proportions of the C-Competing Plotlines Storytelling marker overall, and at the late therapy stages, and the C-Unexpected Outcome Storytelling marker at the middle and late therapy stages. Therapists of unchanged clients engaged in significantly higher proportions of the Therapist (T)-Transition marker subgroup at the late therapy stage, and specifically, higher proportions of the T-Competing Plotlines marker (‘Therapist challenges client’s maladaptive patterns’) overall, and at the middle and late therapy stages. Findings are discussed in the context of previous NEPCS research findings, and current CBT and GAD research literature focusing on client ambivalence for change and interpersonal resistance. Clinical implications and the value of the development of the NEPCS-CBT manual are also discussed.
Open Access
The Ontogenetic Course and Multicomponent Nature of Wise Reasoning Across the Adult Lifespan: Perspectives From Neuropsychology
(2023-12-08) Darboh, Bri Susanna; Turner, Gary
Wisdom has long been revered as a desirable feature of aging in theoretical, folk, and lay discourse. In recent decades, there has been a surge of empirical psychological research on the association between wisdom and age, including the underlying cognitive mechanisms that may contribute to its expression. However, this remains an ongoing area of debate, with diverse and often conflicting views reported in the research literature. Further, less is known about how the cognitive architecture of wisdom may differ in younger and older adults. The current work aimed to empirically examine whether ‘older is wiser’, and the cognitive and neural substrates associated with wise reasoning in younger and older adulthood. We begin with a systematic review and meta-analyses to quantify the current consensus in the literature regarding the relationship between general (insight into life in general) and personal (insight into oneself) wisdom with (i) cognition (Study 1) and (ii) age (Study 2). Study 1 included 22 studies for which outcomes were categorized into six cognitive domains to facilitate domain-specific meta-analyses: i) crystallized intelligence, ii) fluid intelligence, iii) general intellectual functioning, iv) memory, v) attention, and vi) executive function. We observed a significant positive effect of crystallized and fluid intelligence on wisdom, with the most robust effects observed for crystallized intelligence. Aggregate effect sizes in the remaining cognitive domains were null. Study 2 included 52 studies to examine the relationship between wisdom and age. There was a significant positive effect of age on wisdom, with larger effects observed for general versus personal wisdom. Extending from these systematic reviews we next conducted two empirical studies. First, we examined associations among wisdom, age, and specific aspects of cognitive function implicated in wise reasoning (leveraging findings from Studies 1 and 2) in 344 neurologically healthy younger (n = 181) and older (n = 163) adults (Study 3). While older adults scored higher on measures of self-reported personal wisdom, performance-based general wisdom was stable across the adult lifespan. Memory was a stronger predictor of general than personal wisdom in the combined, young, and older adult samples, and this association was more robust in older adults. Finally, in an exploratory analysis (Study 4), we examined relationships among wisdom, memory, and brain function (resting-state functional connectivity) in 286 neurologically healthy younger (n = 157) and older (n = 129) adults. General wisdom was associated with greater integration among frontoparietal (CONT) and default (DN) subnetworks than personal wisdom in the combined age sample. General wisdom in older adulthood was associated with more robust network dedifferentiation than in young, while the opposite pattern was observed for personal wisdom (i.e., greater within-network connectivity of CONT and DN regions in older than younger adulthood). Taken together, these findings illustrate that older may be wiser, and critically depends on the problem-solving context (intra-personal versus extra-personal). Moreover, our findings provide converging evidence that personal and general wisdom are discrete abilities, with distinct age-related trajectories, cognitive determinants, and underlying neural architectures.
Open Access
Impact of Adverse Childhood Experiences and Trauma Exposure Across the Lifespan on Social Cognitive Functioning and Amygdala Volume in a Sample of Precariously Housed Adults
(2023-12-08) Mashhadi, Farzaneh; Gicas, Kristina
Precariously housed individuals are exposed to a multitude of adverse factors, which significantly increase their vulnerability to negative outcomes. The main objective of the current study was to investigate the impact of adverse childhood experience (ACEs) and lifespan trauma exposure on social cognitive functioning, including affective decision-making and theory of mind (ToM) abilities in a sample of precariously housed adults. Furthermore, the study aimed to explore the association between ACEs and lifespan trauma on the amygdala volume. The results revealed that a greater number of traumatic exposures throughout the lifespan were associated with enhanced affective decision-making and ToM abilities. However, it was found that ACEs did not significantly impact social cognitive performances. Furthermore, no significant relationships were observed between ACEs, lifespan trauma, and the volume of the amygdala. These findings shed light on the existence of inherent resilience factors within adverse experiences that can potentially mitigate negative outcomes.
Open Access
A Self-Guided E-Learning Program Improves Metamemory Outcomes in Healthy Older Adults: A Randomized Controlled Trial
(2023-12-08) Yusupov, Iris; Rich, Jill Bee
The majority of older adults will experience normal age-related memory changes. Memory programs offer a promising solution to mitigate decline and promote brain health. Memory programs have evolved over time, progressing from single mnemonic techniques to the combination of mnemonics, then to multicomponent programs offering participants a more holistic approach to enhancing their memory and brain health. A large body of literature demonstrates that in-person memory interventions can increase knowledge, support the acquisition of memory strategies, improve metamemory outcomes, and promote healthy lifestyle behaviors among participants. With the advancement of technology and the goal of attaining scalable and accessible solutions, researchers and clinicians are developing online memory programs. Our team developed a self-guided, e-learning program based on the well-validated, in-person Memory and Aging Program®. The objective of this dissertation was to evaluate efficacy of the e-learning program compared to a waitlisted control group through a randomized controlled trial. The trial was registered at clinicaltrials.gov (identifier: NCT03602768). As part of a larger, multi-arm, controlled trial, 115 healthy older adults (ages 60-84, 71% female) were randomized into an intervention or a delayed-start control condition. Team members involved in data collection were masked to participant grouping. Outcome measures were completed by telephone interviews (assessing memory knowledge) and online questionnaires (assessing metamemory and health-promoting lifestyle behaviors) at three time points (pre-program, post-program, and 6- to 8-week follow-up). Reasons for attrition were explored with a brief feedback survey. Improvements over time in memory knowledge, the acquisition of memory strategies and their use in daily life, and memory satisfaction and ability were larger in the group that completed the intervention than the control group. There was no interaction effect for health-promoting lifestyle changes. Attrition was 43%, and the most common participant-reported reasons for attrition included a breakdown in communication, personal circumstances, dissatisfaction with the e-learning program, and technical/instructional issues. Overall, this self-guided, e-learning memory program may be an effective, accessible, flexible, and potentially cost-effective intervention that has the potential to achieve similar metamemory outcomes as the original in-person version in participants that complete the program. This research identified opportunities to design e-learning interventions to better support healthy lifestyle changes and potentially improve participant retention. Findings are discussed in relation to evidence-based practice in psychology.
Open Access
Therapists in training: Brief interventions to ease negative self-evaluations and improve affective well-being
(2023-12-08) Chafe, David Thomas; Mongrain, Myriam
Clinical and counselling psychology trainees take on many different roles throughout the course of their graduate training, including intensive course loads, research, and clinical training. Previous research has identified significant distress and psychological symptoms reported by graduate students in clinical training. Also documented are complex barriers to receiving help for their mental health concerns. The aim of the current study was to better understand the experiences of graduate therapist trainees by tracking them over time to investigate the psychological difficulties they experience, and to examine the efficacy of brief online exercises designed to combat self-criticism and induce self-compassion. 254 clinical and counselling psychology trainees were recruited from 50 graduate programs across Canada and the United States. Participants completed baseline measures assessing self-compassion, self-criticism, positive, negative, and compassionate affect, depression, anxiety, dysfunctional attitudes, fear of negative evaluation, stress, and professional self-doubt. Participants were randomly assigned to one of three groups, a “working with self-criticism” condition, a “loving kindness meditation” condition, or a waitlist control condition. Following the baseline measures, trainees completed the online interventions for eight weeks, then completed measures at post-test and a one-month follow-up. Results indicated that the therapist trainees experienced moderate to severe levels of distress on most psychological outcome measures at baseline. However, it was found that the two active conditions were effective in reducing self-criticism and fear of negative evaluation, while increasing compassionate affect compared to the control condition. The results support the value of self-care and reflective practices among clinical and counselling trainees. Clinical implications and future directions are discussed.
Open Access
Using Thin Slicing to Detect Client Resistance in Psychotherapy
(2023-12-08) Shekarak Ghashghaei, Nazanin; MacDonald, Suzanne
The present study developed and examined the merits of a “thin slice” (Ambady & Rosenthal, 1992) approach for the detection of client resistance in psychotherapy. Thin slice clips presenting resistance (n = 20) and non-resistance (n = 20) were derived from previously resistance-coded sessions (Aviram et al., 2016) of 20 therapist-client dyads from a larger RCT (Westra et al., 2016). Seventeen untrained raters rated the clips in randomized order. Untrained raters’ (1) thin slice ratings on 90-s of client behaviour significantly differentiated resistance from non-resistance, (2) thin slice ratings on resistance strongly predicted expert coder-ratings of resistance for the 1-hr session, and (3) thin slice ratings on resistance moderately predicted client working alliance ratings for the 1-hr session. Key observable client behaviours of “annoyance”, “anger”, and “frustration” were also identified as correlates of resistance. This study demonstrates the utility of “thin slicing” as a novel and efficient approach to resistance-detection.
Open Access
The Slim-Thick Ideal: Its Impact on Women's Body Image and Eating, Exercise, and Body Modification Behaviours
(2023-12-08) Mccomb, Sarah Elizabeth; Mills, Jennifer S.
Past research has widely focused on the impact of idealized images of unrealistically thin or fit women, referred to as the thin- and fit-ideal, on young women’s body image. Recently, a more curvaceous take on the thin-ideal, called the slim-thick-ideal, characterized by a small waist and flat stomach, but large hips, butt, and breasts has gained popularity in mainstream media. Despite an increase in the popularity of this ideal, little is known about the impact of the slim-thick-ideal on women’s body image and which women aspire to this ideal. As such, in three studies I sought to investigate who was likely to aspire to the slim-thick-ideal, and its impact on women’s body image. Study 1 sought to investigate the comparative impact of the slim-thick-ideal on women’s body image, relative to the thin- and fit-ideal, and if physical appearance perfectionism moderated these findings. It was found that exposure to all three body ideals resulted in increased weight and appearance dissatisfaction and lower overall body satisfaction, which was most pronounced for those who saw the slim-thick-ideal, and among those high on physical appearance perfectionism. Study 2 sought to replicate the findings of Study 1, to investigate which body ideal was most preferred among young women, and which personality and behavioural traits were characteristic of women who aspired to each ideal. Study 1 findings were replicated. The slim-thick-ideal was rated as the most attractive and desirable of the three ideals. Those who aspired to the slim-thick-ideal reported greater disordered eating, dietary restraint, physical appearance perfectionism, and body modification behaviours than those who aspired to the thin- or fit-ideal. Study 3 investigated if there was an association between preferred ideal and ethnicity and eating, purging, exercise, and body modification behaviours. Women of colour preferred the slim-thick-ideal most; White women endorsed each ideal in equal proportions. For the most part, there was no association between preferred body ideal and eating, purging, exercise or body modification behaviours, indicating that those who aspire to the slim-thick-ideal are engaging in the same harmful behaviours as those who aspire to the thin- and fit-ideal. Clinical implications are discussed.
Open Access
Therapist Emotional Reactivity and Performance Following a Motivational Interviewing Workshop With and Without Deliberate Practice
(2023-12-08) Poulin, Lauren Elizabeth; Westra, Henny
Some individuals are more reactive to emotional stimuli than others, and this is particularly relevant to psychotherapists due to their frequent interaction with emotionally evocative material. Therapist reactivity can be particularly triggered during challenging clinical moments such as resistance, leading to negative therapy process which can be detrimental to client outcome. Motivational Interviewing (MI) is a therapeutic approach that specifically focuses on exploring ambivalence about change and minimizing resistance in psychotherapy, and therefore is a beneficial strategy to address many challenging interpersonal moments in psychotherapy. Therapists would benefit from training in MI to specifically address these challenging clinical moments, and this may be especially important for therapists who are highly emotionally reactive. Deliberate Practice (DP) has shown promise as a training approach that may result in greater maintenance of skill, and therefore may be explored as a more impactful and long-lasting way to train therapists in MI. The present study involved both traditional and DP training in the context of a continuing education workshop. The impact of training type on therapist reactivity to challenging clinical moments was examined immediately following training, and four months later. The relationship between therapist reactivity, performance, and type of training was also investigated. Eighty-eight community therapists participated in training to use MI principles to effectively manage client ambivalence and resistance. Therapists were randomly assigned to receive a 2-day training workshop based on DP principles, or to receive a 2-day traditional didactic workshop. Self-reported arousal to video vignettes of difficult scenarios was collected prior to the workshop, immediately following the workshop, and 4 months later, and therapists participated in 20-minute interviews with ambivalent volunteers at both post-workshop and follow-up. Therapist dynamic Respiratory Sinus Arrhythmia (dynamic RSA) was measured during these interviews as a psychophysiological measure of emotional reactivity, and interviews were coded for resistance to measure therapist performance. Results demonstrated a decrease in self-reported arousal only for those who engaged in DP training, though this was not maintained at follow-up. There was a difference in dynamic RSA between groups at post-treatment, where the DP group uniquely demonstrated quadratic change, indicating the training had a differing effect. Despite this differing trajectory, RSA showed an overall increase at both post-workshop and follow-up in both groups. This suggests that regardless of training type, therapists were regulating their emotions and possibly having a compassionate response, rather than a stress response, to these interviews. Dynamic RSA between workshop groups was unable to be assessed at follow-up due to a smaller sample size for psychophysiological assessment. In the investigation of the impact of training on performance, greater self-reported arousal was found to predict less resistance in interviews, but there was no relationship observed between psychophysiological arousal and resistance. This study supports the efficacy of DP training in reducing therapist arousal to difficult clinical scenarios, and the importance of continued DP in order to maintain one’s skills. Clinical and training implications are discussed.
Open Access
Specifying the Effects of an Online, Self-Help Couples' Intervention on PTSD Clusters and the Influence of Improvements in Relationship Satisfaction
(2023-12-08) Siegel, Ashley Nicole; Fitzpatrick, Skye
Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction; CH) is an online dyadic intervention for individuals with posttraumatic stress disorder (PTSD) and their partners. Initial analyses provide support for the efficacy of CH in improving general PTSD symptoms and relationship satisfaction, but it is unclear which symptom clusters of PTSD are improving (i.e., intrusions, avoidance, cognitions and mood, and/or arousal). Moreover, there is a potent association between PTSD symptoms and relationship distress, such that improvements in relationship satisfaction are associated with improvements in PTSD symptoms. However, it is unclear whether this is true in CH, and if so, for which clusters. This information is pertinent to identify when relationship satisfaction requires direct targeting to promote recovery from PTSD symptoms. The current study was a secondary data analysis of the CH case series and uncontrolled trial (N = 27 dyads) and had two aims: (1) to identify which clusters of PTSD are impacted by CH, and (2) to examine whether changes in relationship satisfaction was associated with changes in PTSD clusters. Hierarchical multilevel modelling revealed that CH led to improvements in intrusions, cognitions and mood, and arousal symptom clusters, but not in the avoidance cluster. Avoidance symptoms did improve when changes in relationship satisfaction were moderate to high. Changes in relationship satisfaction were not associated with changes in intrusions, cognitions and mood, or arousal. This study suggests that CH effectively targets intrusion, cognition and mood, and arousal symptoms, but changes in avoidance symptoms are dependent on changes in relationship satisfaction.
Open Access
Distinct Profiles of Memory Performance as a Function of Serial Position Recall in a Sample of Homeless and Precariously Housed Adults
(2023-12-08) Benitah, Katie Camilla; Gicas, Kristina
Poor cognition is prominent in persons who are homeless, and memory dysfunction frequently emerges at the most pervasive impairment. The nature of this impairment is poorly understood, though prevalent issues of medical and psychiatric multimorbidity in homeless adults suggests that multiple factors may be contributing. This study investigated memory dysfunction in a homeless and precariously housed sample by subtyping unique profiles of serial position recall on a verbal learning and memory test using a latent profile analysis (LPA; N = 411). Subsequent logistic regression analyses were conducted in a subsample (N = 175) to examine whether regional brain volumes (i.e., dorsolateral prefrontal cortex, hippocampus, entorhinal cortex) and pathological markers (i.e., cerebral small vessel disease burden, hippocampal cavity volume) predicted serial position class membership. Secondary analyses explored between-class differences in attention, processing speed, cognitive control, and mental flexibility using linear regression. LPA identified two classes characterized by (1) reduced primacy relative to recency recall (RP); and (2) reduced recency relative to primacy recall (RR). Neuroanatomical and pathological markers did not emerge as significant predictors of class membership in the regression model. The RR class outperformed the RP class on measures of processing speed, sustained attention, and cognitive control. The present findings have implications for the way memory dysfunction is conceptualized in this complex group, supporting the substantial heterogeneity in their cognition and memory functioning and may aid in the development of discernible targets for interventions and strategies for rehabilitation.
Open Access
Mismatch Negativity as a Marker of Auditory Pattern Separation Integrity in Aging
(2023-12-08) Chow, Ricky Ka Lok; Rosenbaum, Shayna
How does auditory perception interact with precision in memory (i.e., mnemonic discrimination) in aging? This study examined how the mismatch negativity (MMN), an electrophysiological marker of change detection and encoding, relates to age differences in mnemonic discrimination. The MMN was recorded from 33 young (18–32 years, 18 females) and 30 older (55–86 years, 14 females) adults in a passive oddball paradigm using tone sequences. Participants then completed an incidental recognition test for old targets against similar lures and dissimilar foils. Older adults showed attenuated MMN amplitudes and poorer performance discriminating targets from lures and foils than young adults. Across participants, smaller MMN amplitude predicted worse recognition performance. Notably, MMN amplitude partially explained age-related declines in target-lure discriminability, but not target-foil discriminability. Findings reinforce the MMN as a marker of pattern separation integrity, and clarify how age-related declines in mnemonic discrimination are explained by age differences at encoding.
Open Access
Learning to Manage Resistance and Ambivalence: Can Deliberate Practice Training Reduce the Influence of Differences in Pretraining Empathic Skill?
(2023-12-08) Norouzian, Nikoo; Westra, Henny
Motivational Interviewing (MI) is an evidence-based approach for appropriately responding to client expressions of resistance to, and ambivalence about, change. Existing MI training programs typically produce only modest improvements to observer-rated MI skill; improvements that quickly erode without post-training enrichments and which are largest for therapists with high pretraining empathic skill. This study examines whether the relationship between baseline therapist empathy and sustained MI skill is moderated by training type: a deliberate practice (DP) workshop, versus a traditional workshop with fewer opportunities for practice and feedback. Data were derived from an MI training study in which these workshops were delivered to 88 randomly assigned therapists (44 per group). Before training, therapists completed measures of general empathy (across client contexts) and responsive empathy (for the specific context of resistance). At 4-month follow-up, therapists completed test interviews with ambivalent individuals to assess three observer-rated training outcomes: level of resistance, errors in responsivity to ambivalence, and appropriate responsivity to ambivalence. Workshop type was a significant moderator of only the relationships between baseline responsive empathy and follow-up outcomes of resistance and responsivity errors. While higher levels of baseline responsive empathy were associated with better outcomes for the traditional training group (less resistance, fewer errors), DP-trained therapists achieved superior outcomes regardless of their initial level of responsive empathy. Results suggest that DP training may lessen the importance of possessing strong pretraining responsive empathy skills. This research has implications for facilitating dissemination of MI through clarifying which training procedures are most effective for which therapists.
Open Access
Examining the Real World Effectiveness of Combined Cognitive and Physical Activity Interventions in Healthy Older Adults: A Systematic Review and Clinical Trial
(2021-08) Van Den Brink, Christina Joanne; Rich, Jill Bee
Dementia risk reduction is one of seven aims of the World Health Organization’s Dementia Plan (WHO, 2018). Specifically, risk reduction encompasses the development and delivery of interventions, and a greater emphasis on health promotion programs, with training aims to proactively manage modifiable risk factors. Recent research suggests that combined physical and cognitive activity interventions yield more significant treatment gains than single modality interventions. However, early research has focused upon determining efficacy of these interventions with regard to cognition, examining these interventions under optimal conditions on outcomes closely related to the trained task. As a result, two questions of generalizability remained unanswered: do these interventions impact outcomes related to everyday life, and can they be translated into accessible, community-based interventions? This research addresses these questions. In Study 1, I conducted a systematic review and meta-analysis evaluating the everyday impact of combined interventions. I found that combined interventions lead to improvements in quality of life relative to a mixed group of passive and active controls, but these improvements do not extend to domains of mood, activities of daily living, or self-efficacy. In Study 2, I designed and evaluated a replicable, community-based intervention to investigate the effectiveness of a combined approach in a real-world setting. Specifically, I added a physical activity component, facilitated by wearable activity trackers, to a well-established memory intervention. The combined intervention was determined to be feasible and acceptable to participants who demonstrated an increase in physical activity, a decrease in sedentary behavior, and an improvement in subject knowledge of memory and aging. Relative to the original program, the combined program did not yield additional benefits on quantitative measures of metamemory, objective memory, psychological well-being, or health and lifestyle. With respect to the two types of generalizability addressed in this research, the findings indicate that combined interventions do impact everyday life and can be translated into accessible, community-based interventions. This research also underscores the importance of investigating patient-centered outcomes and conducting research with generalizability in mind to help with the translation from research to patient-centered care.
Open Access
Understanding the Nature, Extent, and Brain Dynamics of Deficient Pattern Separation
(2021-08) Baker, Stevenson Walkley; Rosenbaum, R. Shayna
Recent research suggests that the specificity and precision in long-term declarative memory depend on pattern separation. Subfields within the mammalian hippocampus have been shown to mediate this neurobiological process, particularly the dentate gyrus (DG). This subfield interacts with other parts of the medial temporal lobe and neocortex to differentiate highly similar details belonging to separate, yet overlapping, events into discrete episodes at encoding. In humans, the brain-behavior correlates of pattern separation have been explored in modified associative memory tests, which tax the mnemonic discrimination of previously learned images of everyday objects from visually similar lures. Older individuals with reduced hippocampal volumes and patients with hippocampal lesions are impaired relative to controls on these tests. Based on this evidence, researchers have concluded that visual mnemonic discrimination tests are functionally sensitive to the process of hippocampal pattern separation. This assertion may be premature. Despite the preponderance of studies of visual pattern separation over the past 15 years, little is known about whether hippocampal pattern separation works 1) in other modalities or cognitive domains; 2) through interacting with prior knowledge or pre-experimentally novel information, and 3) in concert with activities of perceptual categorization. The present research addresses these issues. In Study 1, I examine whether presumed deficits in pattern separation apply to perception as they do to memory and are evident, even within vision, for stimuli such as faces, which presumably do not crucially depend on the hippocampus. In Study 2, I pursue whether pattern separation extends to modalities other than vision, notably audition. In Study 3, I aim to quantify the impact of prior knowledge on pattern separation and whether discrimination of abstract inputs can be measured at encoding and retrieval. Three groups of participants were tested throughout these studies: young adults, middle-older adults, and older adults. In addition, a rare individual with focal hippocampal lesions to his DG helped to contextualize hippocampal involvement in Studies 1 and 2. The research I conducted on memory and perception combines novel behavioral paradigms and electrophysiological (EEG) techniques sensitive to the temporal dynamics involved in oddity detection to understand better the nature, extent, and brain dynamics of deficient pattern separation. The data analyzed allowed me to make inferences about the nature, scope, and brain dynamics of pattern separation in younger, middle-older, and older adults and in a hippocampal patient. The research addresses unanswered questions about pattern separation and the role of the hippocampus in learning and memory across other processing domains, modalities and involving different types of stimuli. As our population ages, so will the number of individuals who will suffer age-related cognitive impairment. One of the most common among them is a decline or loss of episodic memory, characterized by an inability to recall past personal experiences in detail, specificity, and precision. Similar losses of detail, specificity, and accuracy are observed in perception. Knowledge gained from this research helps to inform the development of tools for clinical assessment and intervention.
Open Access
Choice Bracketing: Determinants and Mechanisms
(2021-07) Hunter, Andrew Grant; Eastwood, John D.
Choice bracketing refers to whether an individual considers choices separately (narrow choice bracketing) or together (broad choice bracketing). This manuscript investigates two key questions that have been under investigated in the choice bracketing literature. The first is “what prompts people to bracket choices broadly?”. The second question is “by what mechanism does choice bracketing affect decision making?”. The results of two experiments indicate that association between choices can prompt people to bracket broadly, and that non-computational mechanisms likely underly choice bracketing effects on risk-taking. These results are used to advocate for a view of choice bracketing that positions it as a key decision making process that helps people structure decision problems and respond to situational needs.