Aging and Engaging: A Pilot Randomized Controlled Trial of an Online Conversational Skills Coach for Older Adults.

OBJECTIVE: Communication difficulties negatively impact relationship quality and are associated with social isolation and loneliness in later life. There is a need for accessible communication interventions offered outside specialty mental health settings. DESIGN: Pilot randomized controlled trial. SETTING: Assessments in the laboratory and intervention completed in-home. PARTICIPANTS: Twenty adults age 60 and older from the community and a geriatric psychiatry clinic. INTERVENTION: A web-based communication coach that provides automated feedback on eye contact, facial expressivity, speaking volume, and negative content (Aging and Engaging Program, AEP), delivered with minimal assistance in the home (eight brief sessions over 4-6 weeks) or control (education and videos on communication). MEASUREMENTS: System Usability Scale and Social Skills Performance Assessment, an observer-rated assessment of social communication elicited through standardized role-plays. RESULTS: Ninety percent of participants completed all AEP sessions and the System Usability Scale score of 68 was above the cut-off for acceptable usability. Participants randomized to AEP demonstrated statistically and clinically significant improvement in eye contact and facial expressivity. CONCLUSION: The AEP is acceptable and feasible for older adults with communication difficulties to complete at home and may improve eye contact and facial expressivity, warranting a larger RCT to confirm efficacy and explore potential applications to other populations, including individuals with autism and social anxiety.

Home-based primary care providers' perspectives on the unique challenges of working with late life posttraumatic stress disorder within their population of Veterans.

Posttraumatic stress disorder (PTSD) is more prevalent in medically ill older Veterans in Home-Based Primary Care (HBPC) settings than in the general population, raising unique considerations. The aim of this qualitative project was to explore HBPC mental health providers' perceptions of the presentation and treatment of PTSD and trauma-related symptoms in this population of older Veterans, many of whom face additional barriers to treatment due to living in rural settings. Five focus groups and one one-on-one interview were conducted with 23 HBPC mental health providers serving rural or rural/urban mixed communities across the United States. We applied qualitative content analysis to the data. Three themes were found: (1) Presentation of Trauma-Related Symptoms and PTSD in HBPC Population; (2) Treatment Challenges in HBPC; and (3) PTSD Treatment Strategies. Each theme had multiple subthemes which illustrate unique issues in this population. Results of this project contribute to key insights surrounding the unique presentation of PTSD and trauma-related processes and treatment considerations in a medically, cognitively, and psychosocially complex group of veterans. Efforts to improve access to care should consider the specific needs of veterans who are homebound, live in rural settings and identify with rural cultural norms, and have difficulty engaging in specialized PTSD treatment due to the convergence of these factors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Enhancing social functioning in older veterans with PTSD: Rationale and design of an intervention and initial RCT.

BACKGROUND: Older Veterans with Posttraumatic Stress Disorder (PTSD) are often socially isolated and have complex comorbid physical health problems. Aging-related stressors can exacerbate PTSD symptoms. These factors contribute to greater impairment in social functioning and decreased quality of life (QoL). Evidence-based psychotherapies for PTSD often address these issues, but not all older Veterans with PTSD seek help for these challenges, some don't want to engage in trauma-focused treatment, some drop out prematurely, and some still have residual symptoms upon completion. Thus, additional interventions that directly target social functioning among older Veterans with PTSD are needed. METHODS: In this paper we describe the development of and feasibility evaluation plan for, "Enhancing Social Functioning for older Veterans with PTSD (ESVP)," a social functioning group intervention for older (>60 years) Veterans with PTSD. This project involved four phases of work: 1) Intervention development, 2) Review of intervention and potential modifications using focus groups, 3) Intervention pilot testing and modification, and 4) A randomized feasibility trial comparing the intervention with a support group control. Intervention modules address interpersonal relationships, effective communication, anger management, social skills, social support/activities, and behavioral activation. CONCLUSION: This project details the iterative process used to develop the ESVP intervention designed to enhance social functioning in older Veterans with PTSD, and to evaluate feasibility. Analyses are underway to examine feasibility of conducting ESVP with a sample of older Veterans with PTSD. Findings from the final project phase, the randomized feasibly trial, will inform the design and implementation of a future trial. CLINICALTRIALS: gov Identifier: NCT02803125.

COVID-related stressors and their impact on parental sleep, parenting behaviors, and child functioning.

This longitudinal study examined the impact on families of multiple stressors that emerged due to the COVID-19 pandemic. Accordingly, we modeled the indirect effects of three stressors (i.e., the stress of new childcare and work demands, financial stress, and health-related stress assessed within the first month of the pandemic in the United States) on children's functioning over the next 8 weeks via the mediating pathways of parental sleep quality and two forms of parenting (i.e., angry/hostile, constructive). The longitudinal sample of 701 parents (81.5% female; Mage = 41.7, SD = 8.2) reported an average of 1.8 children (SD = 1.0) living in the home (Mage = 9.8 years old, SD = 5.8 years). Multilevel results suggested that, at the within-families level (Level 1), drops in parental sleep on a specific week predicted corresponding increases in angry/hostile parenting, which predicted increases in children's distress during that same week. At the between-families level (Level 2), baseline levels of stress from new demands were predictive of stably higher levels of angry/hostile parenting, which predicted stably higher levels of children's distress across the 8 weeks of the study. Furthermore, baseline health-related stress and financial stress predicted lower stable levels of parental sleep quality, which predicted higher stable levels of children's distress. Finally, health-related stress predicted lower levels of parental sleep quality, which predicted higher levels of angry/hostile parenting, which predicted higher levels of children's distress. Findings highlight the important role that parents' sleep plays in both parenting and children's functioning during periods of high stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The impact of psychological flexibility on family dynamics amidst the COVID-19 pandemic: A longitudinal perspective.

Background: Health risks associated with contracting COVID-19, stay-at-home orders, and pandemic-related economic and social hardships created unique challenges for individuals throughout the pandemic, and in particular for families whose daily routines were disrupted at the start of the pandemic. This study applied a contextual behavioral science lens to Family Systems Theory to examine the impact of COVID-19 stressors on family and individual functioning. Methods: A sample of 742 coparents (86% married/engaged; 84% Caucasian; 71% female; M = 40.7 years old, SD = 8.1; M income = $82,435, SD income = $27,604) of school-aged children (5-18 years old) completed a baseline survey from late March to late April 2020. Of the initial sample, 556 coparents completed weekly diaries for 8 weeks. Results: Mediation models were tested within a multilevel path modeling framework to evaluate both the stable, between-family differences (i.e., at level 2) and the within-family changes from week to week (i.e., at level 1). Across both levels of the model, parent psychological inflexibility was robustly linked to poorer functioning across all levels of the family system, showing direct links to a majority of the processes assessed. The results further supported a top-down spillover cascade in which parent inflexibility was proximally linked to greater COVID-19 related stress and parent depressive symptoms, which were proximally linked to poorer romantic functioning (greater negative conflict, lower satisfaction), which were proximally linked to poorer family functioning (greater coparent discord and family chaos), which were proximally linked to poorer parenting (greater angry/reactive parenting), which was proximally linked to greater child distress. Multi-group models suggested that the results were largely stable across (1) parent race (white vs non-white), (2) family size (1 child vs 2 or more), (3) child age (less than 10 years old vs 10 or older), (4) parent age (under 40 vs. 40 or older), (5) perceived COVID-19 risk, (6) parent gender (mothers vs fathers), (7) household income groups (less than $100k vs $100k or more), and (8) perceived economic stress/uncertainty (low vs high). However, a handful of moderated effects emerged from those multi-group models suggesting that fathers might be slightly more prone to negative spillover effects across the family systems and that wealthier families might have experienced the stress of new demands (e.g., homeschooling, remote working) as more disruptive. Conclusions: Results highlight the crucial role parental psychological flexibility and inflexibility play in families managing the stress of COVID-19, as well as key mechanisms for how those stressors may either reverberate or become dampened throughout the family system.

Social network subtypes among socially disconnected older adults at risk for suicide: A latent class analysis.

OBJECTIVES: We sought to characterize the social networks of older adults who report feeling lonely or like a burden on others, psychological states that are associated with risk for suicide according to the Interpersonal Theory of Suicide. METHODS: We used a latent class analysis to identify distinct groups of older adults based on social network characteristics and perceptions of their networks within a sample of older adults endorsing loneliness and/or feeling like a burden. We examined associations between class membership and mental health outcomes. RESULTS: Four network types were identified: small, cohabitating networks with daily contact; moderate-sized family-oriented networks with multiple contacts weekly; moderate-sized friend-oriented networks with weekly contact; and average-sized mixed networks with weekly contact. The friend-oriented class reported the greatest loneliness, perceived burden, and lifetime prevalence of suicidal ideation and attempts. CONCLUSIONS: Social network composition may be more explanatory of loneliness and perceived burden than number of members alone. Profile differences in outcomes suggest utilizing tailored social connectedness interventions. Individuals with small-to-moderate networks may benefit most from interventions designed to build friendships. Individuals with many close confidants may benefit most from psychotherapy. Individuals reporting moderately frequent contact with moderately-sized networks may benefit from both intervention types.

Shocks to the system: The influence of COVID-19-related stressors on coparental and family functioning.

In addition to the fears associated with contracting COVID-19, the pandemic has forced families across the United States to quickly transition to new patterns of living. These transitions present new stressors, including health-related concerns, new demands placed on families by lockdowns and stay-at-home orders, and the possibility of losing a job or inability to pay bills. Such stressors have the potential to disrupt collaboration between coparents in addition to basic family functioning. Drawing upon a family systems perspective, the current study thus sought to examine links between COVID-19-related stressors and family cohesion through coparental functioning. A total of 1,003 parent/caregivers (97% from the United States; 82% Caucasian, 74% female; M = 40.9 years old, SD = 8.5; Mincome = $83,631, SDincome = $36,320) of school-age children completed an initial online survey from the end of March to the end of April of 2020. Of the initial sample, a total of 685 parents/caregivers completed weekly diaries for a month. Based on multilevel modeling, results suggested that, at the between-family level, coparental conflict mediated the impact of the stress of parenting/work demands and financial stress on family cohesion. At the within-family level, weekly spikes in health-related stress were associated with corresponding spikes in coparental conflict, which, in turn, were associated with drops in family cohesion. Results from the current study suggest that beyond the fears associated with contracting the COVID-19 virus, other key stressors associated with the emerging pandemic played a role in increasing coparental conflict, ultimately exacerbating family functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Modeling suicide risk among parents during the COVID-19 pandemic: Psychological inflexibility exacerbates the impact of COVID-19 stressors on interpersonal risk factors for suicide.

Public health researchers have raised the concern that both the 2019 coronavirus disease (COVID-19) pandemic and the ensuing public health response will increase interpersonal stressors associated with suicide risk. The Acceptance and Commitment Therapy (ACT) framework conceptualizes psychological flexibility as an important way to reduce the impact of painful and even catastrophic events on psychological suffering. The current study examines psychological flexibility as a potential moderator of the prevailing interpersonal model of suicide risk. METHODS: A sample of 1003 parents (73% female, 82% Caucasian 86% in romantic relationships) were recruited as part of a larger study on the COVID-19 pandemic and family functioning from Mach 27th to the end of April 2020, the height of the United States' "first wave." Participants completed measures of psychological flexibility (the Multidimensional Psychological Flexibility inventory; MPFI), interpersonal constructs (perceived burdensomeness and thwarted belongingness), desire for death, COVID-19 related stressors (resource strain and loss due to COVID-19). RESULTS: Moderated-mediation path models highlighted a significant indirect association between COVID-19 stressors and desire for death mediated by perceived burdensomeness to others. This indirect pathway was moderated by psychological inflexibility such that links were strongest at high levels of inflexibility and weak or non-significant at low levels of inflexibility. Results were generally consistent across five of the six facets of inflexibility. DISCUSSION: The findings highlight the value of targeting psychological inflexibility as an important strategy to reduce suicide risk during the COVID-19 pandemic. Implications of patterns of results across different facets for treatment approach are discussed.

Mediators of the association between COVID-19-related stressors and parents' psychological flexibility and inflexibility: The roles of perceived sleep quality and energy.

BACKGROUND: The COVID-19 pandemic has forced parents across the United States to quickly transition to a new way of living. These transitions present new stressors, including the stress associated with physical health, with the demands of social distancing placed on families, and with the possibility of losing a job or not being able to pay bills. Such stressors have the potential to disrupt basic functioning, such as sleep and daily energy levels. Furthermore, the impact of stress might have repercussions on parents' capacities to be psychologically flexible, thus putting their psychological functioning at risk. Drawing upon a contextual behavioral science perspective, the current study sought to examine links between COVID-19-related stressors and psychological flexibility/inflexibility through such basic processes as parents' perceived sleep quality and daily energy level. METHODS: A total of 1003 parents (97% from the US; 74% female; M = 40.9 years old, SD = 8.5) of children (ages 5-18) completed an online survey from the end of March to the end of April of 2020. RESULTS: Path analyses suggested that, after controlling health-related stress and the stress of work and parenting demands due to the pandemic directly predicting greater inflexibility and lower inflexibility, two mediation paths emerged. Specifically, higher levels of health-related stress were associated with lower levels of energy, which, in turn predicted lower levels of psychological flexibility. In addition, higher levels of health-related stress were associated with lower perceived sleep quality, which, in turn, was associated with higher levels of psychological inflexibility. In secondary analyses on the specific dimensions of flexibility and inflexibility, results suggested that lower energy levels indirectly linked health-related stress to lower levels of all 6 dimensions of flexibility and poorer sleep quality indirectly linked health-related stress to higher levels of self-as-content, fusion, and inaction. CONCLUSIONS: The stressors associated with COVID-19 pandemic have the potential to disrupt parents' perceived sleep quality and daily energy levels, reducing their abilities to respond to difficult or challenging experiences in a flexible manner and instead promoting more reactive and inflexible responses.

Psychological flexibility and inflexibility as sources of resiliency and risk during a pandemic: Modeling the cascade of COVID-19 stress on family systems with a contextual behavioral science lens.

BACKGROUND: The coronavirus disease (COVID-19) pandemic and the historic economic shutdown and stay-at-home efforts to slow its spread have radically impacted the lives of families across the world, completely disrupting routines and challenging them to adjust to new health risks as well as to new work and family demands. The current study applied a contextual behavioral science lens to the spillover hypothesis of Family Systems Theory to develop a multi-stage mechanistic model for how COVID-19 stress could impact family and child functioning and how parents' psychological flexibility could shape those processes. METHODS: A total of 742 coparents (71% female; 84% Caucasian, 85% married, M = 41 years old) of children (ages 5-18, M = 9.4 years old, 50% male) completed an online survey from March 27th to the end of April 2020. RESULTS: Path analyses highlighted robust links from parent inflexibility to all components of the model, predicting: greater COVID-19 stress, greater coparenting discord and family discord, greater caustic parenting, and greater parent and child distress. Parent flexibility was associated with greater family cohesion, lower family discord and greater use of constructive parenting strategies (inductive, democratic/autonomy supportive, positive). Results further suggested that COVID-19 stressors predicted greater family and coparent discord, which in turn predicted greater use of caustic parenting (reactive, inconsistent, aggressive), which in turn predicted greater child and parent distress. CONCLUSIONS: The current results highlight parental flexibility and inflexibility as key points of intervention for helping families navigate the current global health crisis, highlighting the crucial role they play in the lives of families.