Examining the protective role of self-compassion in the links between daily sexual orientation salient experiences and affect.

Research has shown that minority stress is linked to poorer mental health across a variety of stigmatized populations, including lesbian, gay, bisexual, and queer (LGBQ) people. It is therefore essential to understand factors that can counteract minority stress. To date, most research on LGBQ people's resilience relied on retrospective reports of stressful identity-salient experiences. This limits the understanding about resilience factors that enable LGBQ people to thrive in the face of minority stressors as they occur on a day-to-day basis. The present study addressed this gap by using a daily diary design to test whether self-compassion protects LGBQ people's affective well-being from daily stressful sexual orientation-salient experiences (SOSEs). A sample of 235 LGBQ adults completed a baseline survey that assessed self-compassion, as well as brief online surveys twice daily for a maximum of 17 days that assessed SOSEs and affect, providing a total of 3,310 days of data. As anticipated, results of multilevel modeling showed that negative and positive SOSEs were linked to negative and positive evening affect, respectively, at both the daily and person levels. Self-compassion moderated the link between daily negative SOSEs and positive evening affect, such that daily negative SOSEs were linked to lower positive affect only among those with lower self-compassion. Moderation effect was not observed for negative evening affect as an outcome. Exploratory analysis suggested that the buffering effect of self-compassion could be impacted by contextual factors. Our study showed the importance of self-compassion and access to positive SOSEs for LGBQ people's well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Development and validation of the Barriers to Using Immediacy Scale (BUIS).

Immediacy is a skill therapists use to process the therapeutic relationship in the here and now. Although immediacy has been shown to enhance the therapeutic process, therapists are often reluctant to use it (Hill et al., 2018). In three studies, we developed and tested a measure to assess reasons that therapists avoid using this skill: the Barriers to Using Immediacy Scale (BUIS). In Study 1, 185 North American therapist trainees completed the 45-item pilot measure. Exploratory factor analysis supported a four-factor structure (Concerns About Client Reactions, Concerns About Therapist Reactions, Negative Beliefs About Immediacy, Lack of Skills for Using Immediacy). In Study 2, with an international sample of 352 therapist trainees and professionals, confirmatory factor analyses supported the original four correlated factors model, as well as alternative models. In Study 3, 89 undergraduate students in a helping skills class completed the BUIS at three points during the semester. Students' total barriers and barriers due to a lack of skills decreased, but other perceived barriers did not decrease after training. Across all three studies, predicted correlations of BUIS scores were found with measures of self-efficacy for using immediacy, adherence to different theoretical orientations, communication style, and attachment style. Incremental validity was supported by the association of BUIS scores with measures of open communication and attachment style, after accounting for self-efficacy for immediacy. Limitations and future directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Fat Acceptance Scale: Development and initial validation.

The fat acceptance movement arose to combat the widespread stigmatization of fatness and fat people through personal liberation and political activism. Support for the movement and its underlying ideology has grown rapidly over the past three decades; however, a self-report measure of fat acceptance with strong psychometric properties has not yet been developed. The current studies aimed to develop the Fat Acceptance Scale (FAS), a measure of fat-accepting beliefs, attitudes, and behaviors that was designed to be appropriate for use with people of all sizes. In Study 1, exploratory factor analysis (n = 266) and confirmatory factor analysis (n = 267) supported a three-factor solution assessing fat activism, health beliefs related to weight, and interpersonal respect for fat individuals. In Study 2 (N = 291), FAS scores predicted reactions to fictitious fat women after controlling for an established measure of antifat attitudes. Data from a subsample of 47 participants indicated moderate-to-high stability of the FAS over 4 weeks. In Study 3 (N = 156), health service psychology doctoral students' FAS scores predicted their reactions to a fictional fat psychotherapy client after controlling for antifat attitudes. Taken together, results provided preliminary evidence for the validity and reliability of FAS scores and suggest that the FAS may be a valuable tool for researchers, clinicians, and advocates interested in fat acceptance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Within-person predictors and outcomes of daily sexual orientation self-presentation among plurisexual women.

Research suggests that plurisexual individuals face ongoing decisions about whether and how accurately to present their sexual orientation to others, in part because of stereotypes and negative attitudes specific to plurisexuality. This study tested a within-person model of theoretical predictors and outcomes of self-presentational accuracy in a sample of 165 cisgender plurisexual women. Participants completed online surveys to report on situations involving self-presentation decisions as they occurred over a 14-day period. Participants also completed nightly surveys assessing facets of well-being. Self-presentational accuracy varied substantially from day to day. Several contextual and relational factors, including acceptance and rejection cues, interaction partners' sexual orientation, and interpersonal closeness, predicted self-presentational accuracy, both directly and through the mediator of anticipated acceptance. Self-presentational accuracy predicted daily life satisfaction, positive affect, and negative affect through the mediator of social support. Finally, exploratory analyses underscored the relevance of goals related to authenticity, closeness, privacy, communication, educating others, and safety in self-presentation decisions. Discussion highlights the importance of context in identity management decisions among plurisexual women and the impact of these decisions on day-to-day well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intersectional experiences: A mixed methods experience sampling approach to studying an elusive phenomenon.

Social scientists are increasingly interested in methodological advances that can illuminate the distinct experiences and health outcomes produced by various systems of inequality (e.g., race, gender, religion, sexual orientation). However, innovative methodological strategies are needed to (a) capture the breadth, complexity, and dynamic nature of moments co-constructed by multiple axes of power and oppression (i.e., intersectional experiences) and (b) keep pace with the increasing interest in testing links between such events and health among underresearched groups. Mixed methods designs may be particularly well suited for these needs, but are seldom adopted. In light of this, we describe a new mixed methods experience sampling approach that can aid researchers in detecting and understanding intersectional experiences, as well as testing their day-to-day associations with aspects of health. Drawn from two separate experience sampling studies examining day-to-day links between intersectional experiences and psychological health-one focusing on Black American LGBQ individuals and another on Muslim American LGBQ individuals-we provide quantitative and qualitative data examples to illustrate how mixed methods investigations can advance the assessment, interpretation, and analysis of everyday experiences constructed by multiple systems of power. Limitations, possible future adaptations, implications for research, and relevance to the clinical context are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Affect and Condom Use Among Men Who have Sex with Men: A Daily Diary Study.

Men who have sex with men (MSM) are disproportionally affected by HIV. Although some theoretical models created to explain why individuals engage in risky sexual behavior contain an affective component, there has been relatively little focus on the influence of affect on sexual risk-taking. The goal of this study is to investigate the association between affect and condom use among MSM using an archival dataset from a survey of users of a popular sex-oriented website. Multilevel modeling was used to analyze daily diary data from 2871 MSM. At the within-person level, positive affect was positively related to condomless anal sex (CAS), whereas negative affect was negatively related to CAS. However, these results were qualified by interactions of trait affect and relationship to sex partner. These findings suggest that interventions focused on emotional regulation may have the potential to reduce CAS among MSM.

Sexual Orientation Self-Presentation Among Bisexual-Identified Women and Men: Patterns and Predictors.

Writing on the experiences of bisexual-identified people has highlighted the potential complexity of the ongoing process of deciding when and how to present one's sexual orientation identity to others (Rust, 2002). The two studies presented here were designed to contribute basic knowledge regarding self-presentation of sexual orientation among bisexual people. In Study 1, bisexual participants (N = 147) were less likely than their lesbian and gay (LG) peers (N = 191) to present their actual orientation to others, and more likely to present themselves as having a sexual orientation different from their actual orientation. These sexual orientation differences were explained by gender of romantic partner and uncertainty about one's sexual orientation. Sexual orientation differences also emerged in links between self-presentation and outness level. For example, bisexual participants who presented themselves as LG had relatively high everyday outness levels; in contrast, LG participants who presented themselves as bisexual had relatively low everyday outness levels. In Study 2, 240 bisexual women and men indicated their levels of outness as a sexual minority person (potentially including identification as gay, lesbian, queer) and specifically as bisexual. Outness was higher with respect to status as a sexual minority compared to status as bisexual; the magnitude of this difference was predicted by gender of romantic partner and uncertainty about one's sexual orientation. Moreover, even controlling for outness as a sexual minority person, well-being was predicted by outness as bisexual to family members.

Circle of Security-Parenting: A randomized controlled trial in Head Start.

Although evidence shows that attachment insecurity and disorganization increase risk for the development of psychopathology (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012), implementation challenges have precluded dissemination of attachment interventions on the broad scale at which they are needed. The Circle of Security-Parenting Intervention (COS-P; Cooper, Hoffman, & Powell, 2009), designed with broad implementation in mind, addresses this gap by training community service providers to use a manualized, video-based program to help caregivers provide a secure base and a safe haven for their children. The present study is a randomized controlled trial of COS-P in a low-income sample of Head Start enrolled children and their mothers. Mothers (N = 141; 75 intervention, 66 waitlist control) completed a baseline assessment and returned with their children after the 10-week intervention for the outcome assessment, which included the Strange Situation. Intent to treat analyses revealed a main effect for maternal response to child distress, with mothers assigned to COS-P reporting fewer unsupportive (but not more supportive) responses to distress than control group mothers, and a main effect for one dimension of child executive functioning (inhibitory control but not cognitive flexibility when maternal age and marital status were controlled), with intervention group children showing greater control. There were, however, no main effects of intervention for child attachment or behavior problems. Exploratory follow-up analyses suggested intervention effects were moderated by maternal attachment style or depressive symptoms, with moderated intervention effects emerging for child attachment security and disorganization, but not avoidance; for inhibitory control but not cognitive flexibility; and for child internalizing but not externalizing behavior problems. This initial randomized controlled trial of the efficacy of COS-P sets the stage for further exploration of "what works for whom" in attachment intervention.

Perceptions of parental secure base support in African American adolescents and young adults: A preliminary study of predictive links to adult C-reactive protein.

Within the field of relationship science there is increasing interest in the connections between close relationships and physical health. In the present study, we examined whether adolescents' (~12 years old) and young adults' (~20 years old) perceptions of their parents as a secure base prospectively predict C-reactive protein (CRP), a commonly used marker of inflammatory activity, at age 32 in a well-characterized sample of African Americans. We utilized existing data collected as part of the Maryland Adolescent Development in Context Study (MADICS) to construct measures of perceptions of parental secure base support (SBS), general parental support, and peer support in early adolescence and early adulthood. In the present study, SBS was operationalized as the perceived ability to depend on parents in times of need. Fifty-nine African American MADICS participants who reported on perceived support in early adolescence and early adulthood participated in a follow-up home visit at age 32 during which serum CRP was measured via a blood draw. After controlling for inflammation-related confounds (e.g., tobacco use, body mass index), adolescents' perceptions of parental SBS, but not peer support or general parental support, predicted lower CRP values at age 32 (b = -.92, SE = .34, p < .05). None of the support variables in early adulthood predicted CRP at 32 years. This study adds to a growing literature on relationships and health-related outcomes and provides the first evidence for a link between parental SBS in adolescence and a marker of inflammatory activity in adulthood.

Daily heterosexism experiences and well-being among LGB young adults: The moderating role of attachment style.

This study examined within-person links between daily heterosexism experiences and well-being among lesbian, gay, and bisexual young adults, and tested the hypothesis that attachment insecurity amplifies the negative impact of heterosexism on well-being. A sample of 82 lesbian, gay, and bisexual young adults completed a measure of attachment style at the start of the study, and then reported on heterosexism experiences and facets of well-being in Internet surveys at the end of each day for 7-10 consecutive days (total of 706 days in the sample). Multilevel regression was used to test the interaction between attachment variables (anxiety and avoidance) and the presence of everyday heterosexism experiences in predicting 3 facets of daily well-being (self-assurance, anger, and fear). Results indicated that attachment variables moderated the within-person link between daily heterosexism experiences and well-being for anger and fear but not for self-assurance. As hypothesized, daily heterosexism was positively related to daily anger and fear for people with higher levels of avoidance but not those with lower levels of avoidance (controlling for previous day levels of well-being). Contrary to hypothesis, however, daily heterosexism was positively associated with anger and fear for participants with low levels of attachment anxiety but not for those with higher levels of attachment anxiety. Analyses also revealed no links between the attachment variables and frequency of heterosexism experiences. (PsycINFO Database Record

The ups and downs of being lesbian, gay, and bisexual: A daily experience perspective on minority stress and support processes.

Daily diary methods were used to explore identity-related stress and support processes as they occurred from day-to-day in a sample of 61 lesbian, gay, and bisexual (LGB) young adults. At the end of each day for 7-10 consecutive days, participants reported on daily identity-salient experiences (ISEs), proximal minority stressors (internalized stigma, expectations of rejection), and affect (positive, negative). A multilevel latent covariate model was used to examine within- and between-person interrelations among these variables. Participants described a variety of positive and negative ISEs with both heterosexual and LGB people. These ISEs accounted for change in affect from 1 day to the next, even controlling for positive and negative experiences unrelated to identity. For example, relative to the previous day, participants experienced increases in positive affect on days featuring positive ISEs with both heterosexual people and LGB people. ISEs also predicted daily proximal stress variables, and findings differed at the 2 levels of analysis. For example, at the within-person level, participants experienced decreases in internalized stigma on days featuring positive ISEs with heterosexuals. At the between-person level, however, findings indicated that participants who generally had the highest levels of internalized stigma were more likely than others to report negative ISEs with LGB people and less likely to report positive ISEs with LGB people. Finally, proximal stress variables predicted affect at the within-person level: Affect improved on days when levels of internalized stigma and expected rejection were lower than usual. (PsycINFO Database Record

Are you in the mood? Therapist affect and psychotherapy process.

Studies on therapist factors have mostly focused on therapist traits rather than states such as affect. Research related to therapist affect has often looked at therapist baseline well-being or therapist reactions, but not both. Fifteen therapists and 51 clients rated pre- and postsession affect, as well as postsession working alliance and session quality, for 1,172 sessions of individual psychotherapy at a community clinic. Therapists' affect became more positive when clients were initially positive and when clients became more positive over the session, and became more negative when clients were initially negative and when clients became more negative over the session. Furthermore, when therapists were initially positive in affect and when therapists became more positive over the session, clients rated the session quality to be high. Conversely, when therapists were initially negative in affect and when therapists became more negative over the session, clients rated the session quality and working alliance low. On open-ended questions, therapists reported mood shifts in 67% of sessions (63% positive, 50% negative). Positive affect change was attributed to collaborating with the client, perceiving the client to be engaged, or being a good therapist. Negative affect change was attributed to having a difficult client, perceiving the client to be in distress, or being a poor therapist. Thus, therapist state affect at presession and change in affect across a session may independently contribute to the process and outcome of therapy sessions. The examination of within-therapist variables over the course of therapy may further our understanding of therapist factors. (PsycINFO Database Record

When identities collide: Conflicts in allegiances among LGB people of color.

Little research has examined the management of multiple minority identities among lesbian, gay, and bisexual (LGB) people of color, despite a growing theoretical literature on such identity intersections. The present study focused on the intersectional construct of conflicts in allegiances (CIA), defined as perceived incompatibility between one's racial/ethnic and sexual orientation identities. CIA was investigated in relation to experiences of parental heterosexism, racism in LGB communities, outness, and racial/ethnic and sexual orientation group identity. Participants were 124 LGB people of color (main sample) and 124 LGB White people (comparison sample) who completed self-report measures of the main variables as part of a larger survey of same-sex couples. CIA was positively correlated with experiences of racism within LGB communities and perceived heterosexism in one's mother (but not one's father), and negatively correlated with outness to family (but not outness to others in one's everyday life). An interaction was found between racial/ethnic and LGB group identity with respect to behavioral engagement: CIA levels were highest among participants with high racial/ethnic behavioral engagement and low sexual orientation behavioral engagement. Results highlight the role of minority and family contexts in CIA among LGB people of color, and, more broadly, the potential value of studying intersectional variables using quantitative methods. Longitudinal and experimental studies are needed to address questions about direction of influence raised by findings.

Romantic attachment and relationship functioning in same-sex couples.

The present study was designed to investigate links between dimensions of romantic attachment and relationship functioning in a cross-sectional sample of people in same-sex relationships, with the goals of replicating basic findings from research on heterosexual couples and advancing understanding of unique issues faced by same-sex couples. The sample included 274 female couples, 188 male couples, 34 women whose female partners did not participate, and 39 men whose male partners did not participate. Participants were recruited from geographically diverse regions of the United States and Canada and provided data by responding to pencil-and-paper surveys. Attachment insecurity in both self and partner were linked with poor relationship functioning across a range of variables (satisfaction, commitment, trust, communication, problem intensity). The pattern of results was identical for women and men, but the effects were stronger in male couples for some associations between attachment variables and indices of positive relationship functioning. Monogamy was positively associated with relationship quality only when participants or their partners reported moderate or high levels of attachment anxiety. Contrary to hypothesis, attachment did not moderate links between minority stressors and relationship functioning.

Revision and extension of a multidimensional measure of sexual minority identity: the Lesbian, Gay, and Bisexual Identity Scale.

Two studies were conducted to investigate a revised and extended version of the Lesbian and Gay Identity Scale (Mohr & Fassinger, 2000): the 27-item Lesbian, Gay, and Bisexual Identity Scale (LGBIS). This revision features more inclusive and less stigmatizing language than the previous version and includes 2 new subscales assessing identity affirmation and centrality. In Study 1, an exploratory factor analysis (n = 297) and a confirmatory factor analysis (n = 357) supported an 8-factor solution assessing acceptance concerns, concealment motivation, identity uncertainty, internalized homonegativity, difficulty with the identity development process, identity superiority, identity affirmation, and identity centrality. Predicted associations with measures of identity-related constructs and psychosocial functioning provided preliminary validity evidence for LGBIS scores in a college student population. Study 2 (N = 51) provided evidence of the test-retest and internal consistency reliability of LGBIS scores. These studies suggest that the LGBIS may offer researchers an efficient means of assessing multiple dimensions of sexual orientation minority identity.

Gay and bisexual male clients' perceptions of counseling: the role of perceived sexual orientation similarity and counselor universal-diverse orientation.

A recurring question in multicultural counseling is whether client-counselor similarity on sociodemographic characteristics benefits counseling. A related issue is how counselor orientation to diversity relates to counseling process and outcome, both as a main effect and in interaction with counselor-client sociodemographic match. This cross-sectional study investigated these questions in relation to gay and bisexual male clients' counseling experiences by examining clients' perceived similarity to their counselor in sexual orientation, as well as counselors' self-reported orientation to diversity (assessed in terms of level of universal-diverse orientation [UDO]). Data were from 83 male-male client-counselor dyads recruited from lesbian/gay/bisexual-affirming counseling practices, where clients identified as gay or bisexual and counselors identified as gay, bisexual, or heterosexual. Counselor UDO was positively and uniquely associated with client ratings of the working alliance, session depth, and session smoothness. Perceived sexual orientation similarity was not directly related to any of the counseling-related criterion variables. Moreover, when counselors reported low levels of UDO, perceived similarity was negatively associated with the client-rated alliance and perceived improvement. Client religious commitment-a control variable in all analyses--was uniquely and negatively associated with client ratings of perceived improvement in counseling.

Partner Attractiveness and Perceived Sexually Transmitted Infection Risk Among Sexual Minority Men.

Men who have sex with men (MSM) are disproportionately impacted by sexually transmitted infections (STIs), but many engage in condomless sex. One factor contributing to condomless sex may be an assumption of low risk of STIs from physically attractive partners. The present study tested the effect of partner attractiveness on perceived STI risk and condom use intentions and examined two mechanisms believed to underlie this effect: implicit personality theory and motivated reasoning. Participants were 197 MSM who viewed photos of attractive and unattractive men and responded to items assessing perceptions of the men's positive traits and STI risk, as well as motivation to have sex with the men and condom use intentions. Sexual arousal was manipulated. Attractiveness reduced perceived STI risk and condom use intentions by increasing both positive perceptions of and motivation to have sex with the person. Findings were not influenced by arousal.

How far can stigma-based empathy reach? Effects of societal (in)equity of LGB people on their allyship with transgender and Black people.

The shared experience of societal discrimination and affirmation can provide a basis for empathy among members of different marginalized groups. However, the potential mechanisms and moderating conditions involved in this process have been little studied. This experiment examined how perceived societal (in)equity of one's own group may influence one's reaction to other marginalized groups. We randomly assigned 310 cisgender White lesbian, gay, and bisexual (LGB) adults to conditions varying in LGB (in)equity salience (discrimination, affirmation, control) and in the target outgroup identity (transgender, Black). Participants completed a survey assessing thoughts, feelings, and behaviors related to the outgroup, that is, indicators of allyship. Based on the emerging theory of stigma-based solidarity, we expected LGB discrimination to improve intergroup relations with transgender people (i.e. a group readily sharing a common superordinate identity with LGB people) but worsen relations with Black people (i.e. a group not readily sharing a common superordinate identity). Counter to expectations, allyship variables were not predicted by discrimination as a main effect or in interaction with outgroup identity. However, we found support for the mediating role of emotions in explaining the indirect effect of discrimination on allyship. For example, discrimination produced greater outgroup identification by elevating negative affect, but only when the outgroup was transgender people. Results for transgender and Black targets converged for outcomes requiring participants to consider societal injustice toward the outgroup. We observed only one effect for affirmation: It reduced LGB people's empathic anger for both transgender and Black people. Results may inform efforts of coalition building. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Assessing Perceived Barriers to Meditation: the Determinants of Meditation Practice Inventory-Revised (DMPI-R).

OBJECTIVES: Engaging in meditation on a regular basis has been shown to enhance well-being. However, barriers to adopting it as a health behavior are poorly understood. The Determinants of Meditation Practice Inventory (DMPI) is an existing scale designed to measure perceived barriers to meditation. However, it was developed without factor analyses; thus, the dimensionality and construct validity of overall scale and/or subscale scores are unknown. Using factor analyses and tests of convergent validity, the present study explored the psychometric properties of the DMPI and presents a revised, psychometrically valid scale (The Determinants of Meditation Practice Inventory-Revised; DMPI-R). METHODS: Adult participants living in the USA (n = 621) provided data through an online survey platform. Extensive exploratory factor analyses were conducted (n = 311) and followed by confirmatory factor analysis (n = 310) on the best-fitting model. Convergent validity was estimated using the full sample data. RESULTS: Five items were removed because they demonstrated high residual variances and cross loaded onto multiple factors. Relationships among the remaining items were best explained by a four-factor structure with the following subscales: low perceived benefit, perceived inadequate knowledge, perceived pragmatic barriers, and perceived sociocultural conflict. Convergent validity was evidenced by associations between subscale scores and experiential avoidance, distress tolerance, and curiosity. CONCLUSIONS: The multifactor structure of the DMPI-R indicates that there are multiple classes of perceived barriers on which people can vary. Validity analyses suggest that the DMPI-R is a promising measure of perceived barriers to meditation among North American adults.

Intersectional experiences, stigma-related stress, and psychological health among Black LGBQ individuals.

OBJECTIVES: We used microlongitudinal methods to examine the prevalence and day-to-day correlates of intersectional experiences (IEs) in a U.S. sample of 131 Black sexual minorities. METHOD: Participants were 97 gay/lesbian people (74.0%) and 34 bisexuals (26.0%); nearly a third of the sample also identified as queer (32.1%). Most participants identified solely as Black; however, 23 participants (17.6%) indicated at least 1 secondary racial/ethnic identification. Every evening for 1 week, participants reported both negative and positive IEs from the last 24 hr and completed measures of identity conflict, rumination, and affect. Multilevel path analysis was used to test daily relations between IEs and mood-as well as the mediating roles of identity conflict and rumination-at the within- and between-person levels, controlling for nonintersectional experiences (e.g., related only to race, related only to sexual orientation, unrelated to identity). RESULTS: Negative IEs (n = 97, 11.4% of total days) were related with identity conflict and negative affect at both levels of analysis and with negative rumination at the within-person level only. Positive IEs (n = 263, 31.0% of total days) predicted positive rumination and positive affect (but not identity conflict) both within and between persons. Many hypothesized indirect paths were supported-for example, identity conflict and rumination mediated the relation between negative IEs and negative affect at the within-person level. CONCLUSION: Building upon accumulating research linking stigma and health, this study demonstrates that multiple axes of oppression can jointly shape daily events and predict fluctuations in psychological health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).