A Qualitative Analysis of Stakeholder Attitudes Regarding Personalized Provider Selection and Patient-Therapist Matching.

This study explored mental health care patients and therapists' perspectives on using therapists' measurement-based and problem-specific effectiveness data to inform case assignments - a type of treatment personalization that has been shown to outperform non-measurement-based case assignment as usual (Constantino et al., 2021). We conducted semi-structured qualitative interviews with 8 patients (75% women; M age = 33.75 years) and 8 therapists (75% women; M age = 47.50 years). The interview protocols were unique to stakeholder group. Recorded responses were transcribed and qualitatively analyzed by four judges using a blend of consensual qualitative research and grounded theory methods. Derived patient domains included preferred characteristics of a provider, and experiences and suggestions regarding provider selection. Within the domains, most patients expressed an interest in accessing more specific provider information online. Additionally, most patients indicated that both provider outcome track records and personal preference information (e.g., therapist characteristics) should be considered in the therapist selection process. All patients endorsed being comfortable with having the ability to select a provider based on a list of empirically well-matched recommendations. Derived therapist domains included using routine outcomes monitoring for patient-provider matching, referral source and direct patient use of preferred provider lists, and improvements to the provider selection process. Within the domains, all therapists remarked that outcome data would be useful for matching patients to providers; however, most also indicated that outcome data should not be the only factor used in provider selection. All therapists expressed a willingness to be included in preferred provider lists that incorporate track record data. Overall, both patients and therapists held generally positive views toward using therapist effectiveness data to help personalize mental health care. Yet, both stakeholder groups acknowledged that other personalization factors should be considered alongside these data. Based on these results, our team is in the process of implementing patient-therapist match strategies in larger and more diverse mental health care contexts.

A Bridge Between DSM-5 Section II Personality Disorder Criteria and ICD-11 Personality Disorder Trait Domains.

The organization of personality pathology into trait domains (vs. specific disorders) in ICD-11 represents an important shift in personality disorder (PD) nosology. However, to facilitate clinical implementation, a bridge is needed between this system and the DSM-5 Section II system familiar to many researchers and clinicians. In this study, individual DSM-5 PD criteria were assigned to ICD-11 trait domains based on the published Clinical Descriptions and Diagnostic Requirements. This scoring scheme was examined empirically alongside DSM-5 PD dimensions (using SIDP ratings from the MIDAS project; N = 2,147 outpatients) in terms of descriptive properties and relations with psychosocial morbidity and functioning. Most PD criteria could be matched to at least one ICD-11 trait domain, indicating considerable cross-system continuity. However, points of incongruity are noteworthy for research and clinical applications. Results provide key information for bridging categorical and dimensional frameworks, indicating that the shift toward trait-based PD models need not be as disruptive as feared.

Latent classes of symptom trajectories during partial hospitalization for major depressive disorder and generalized anxiety disorder.

BACKGROUND: A variety of treatments have been empirically validated in the treatment of major depressive disorder and generalized anxiety disorder. Researchers commonly evaluate symptom change during treatment using single model curves, however, modeling multiple curves simultaneously allows for the identification of subgroups of patients that progress through treatment on distinct paths. METHODS: Latent growth mixture modeling was used to identify and characterize distinct classes of symptom trajectories among two samples of patients with either MDD or GAD receiving treatment in a daily partial hospital program. RESULTS: Four depression symptom trajectories were identified in the MDD sample, and three anxiety symptom trajectories were identified in the GAD sample. Both samples shared symptom trajectory classes of responders, rapid responders, and minimal responders, while the MDD sample demonstrated an additional class of early rapid responders. In both samples, low symptom severity at baseline was associated with membership in the responder class, though few other patterns emerged in baseline characteristics predicting trajectory class membership. At treatment discharge, those in the minimal responder class reported poorer outcomes on every clinical measure. Patients within each class reported similar scores at discharge as compared to each other class, indicating that class membership affects clinical measures beyond symptom severity. LIMITATIONS: Patient demographic characteristics were relatively homogeneous. Group-based trajectory modeling inherently involves some degree of uncertainty regarding the number and shape of trajectories. CONCLUSIONS: Identifying symptom trajectories can provide information regarding how patients are likely to progress through treatment, and thus inform clinicians when a patient deviates from expected progress.

Telehealth treatment of patients with major depressive disorder during the COVID-19 pandemic: Comparative safety, patient satisfaction, and effectiveness to prepandemic in-person treatment.

BACKGROUND: The COVID-19 pandemic impelled a transition from in-person to telehealth psychiatric treatment. There are no studies of partial hospital telehealth treatment for major depressive disorder (MDD). In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the effectiveness of partial hospital care of patients with MDD treated virtually versus in-person. METHODS: Outcome was compared in 294 patients who were treated virtually from May 2020 to December 2021 to 542 patients who were treated in the in-person partial program in the 2 years prior to the pandemic. Patients completed self-administered measures of patient satisfaction, symptoms, coping ability, functioning, and general well-being. RESULTS: In both the in-person and telehealth groups, patients with MDD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups also reported a significant improvement in positive mental health, general well-being, coping ability, and functioning. A large effect size of treatment was found in both treatment groups. Contrary to our hypothesis, the small differences in outcome favored the telehealth-treated patients. The length of stay and the likelihood of staying in treatment until completion were significantly greater in the virtually treated patients. LIMITATIONS: The treatment groups were ascertained sequentially, and telehealth treatment was initiated after the COVID-19 pandemic began. Outcome assessment was limited to a self-administered questionnaire. CONCLUSIONS: In an intensive acute care setting, delivering treatment to patients with MDD using a virtual, telehealth platform was as effective as treating patients in-person.

Trait boldness and emotion regulation: An event-related potential investigation.

The present study sought to extend knowledge of the role of boldness, a transdiagnostic bipolar trait dimension involving low sensitivity to threat, in emotional reactivity and regulation using physiological and report-based measures. One prior study found that boldness was associated with reduced late positive potential (LPP) while passively viewing aversive images, but not during emotion regulation; a disconnect between LPP and self-reported reactivity was also observed. Here, participants (N = 63) completed an emotion regulation task in which they either passively viewed or effortfully up- or downregulated their emotional reactivity to pleasant, unpleasant, and neutral pictures while EEG activity was recorded; they later retrospectively rated the success of their regulation efforts. ANOVAs examining the interactive effects of regulation instruction and boldness on LPP amplitude revealed that lower boldness (higher trait fearfulness) was associated with paradoxical increases in LPP to threat photos during instructed downregulation, relative to passive viewing, along with lower reported regulation success on these trials. Unexpectedly, similar LPP effects were observed for affective images overall, and especially nurturance photos. Although subject to certain limitations, these results suggest that individual differences in boldness play a role not only in general reactivity to aversive stimuli, as evidenced by prior work, but in the ability to effortfully downregulate emotional response.

Is there no "I" in team? Potential bias in key informant interviews when asking individuals to represent a collective perspective.

This paper sought to understand the extent to which, and how individuals use personal or collective language when asked to articulate sense of place from a collective perspective. Understanding a collective sense of place could illuminate place-based connections in natural resource industries, where it is as groups or as institutions that organizations interact with the environment rather than as individuals. While there are well known methods for collecting information about sense of place at the individual level, there is a gap in understanding the best method to collect information at a collective level. We examined the use of key-informant interviews as a method to understand collective sense of place. In Bocas del Toro, Panama, ecotourism and environmentally based organizations are becoming more prolific due to abundant natural resources, making it an interesting case study for understanding sense of place from an organizational perspective. The use of personal and collective language is examined though in-depth semi-structured interviews from 15 environmentally-oriented organizations with a total of 17 interviews. This study specifically examined whether and how key informants, when prompted to speak for their organization, spoke collectively, reflecting a collective perspective versus their own. Methods included both quantitative analysis of personal versus collective language use frequency, and qualitative examinations of how individuals used personal versus collective language. Our results indicated no difference in the frequency with which individuals use personal versus collective language. We found that how individuals situated their perspectives into an organization reflects a complex personal and collective point of view reflecting five themes of personal versus collective language use: 1) sole personal perspective, 2) sole collective perspective, 3) distinction between collective and personal perspective; 4) organization perspective with insertion of "I think"; and 5) personal and collective perspective about organization and greater community. Our research identifies a previously undiscussed potential bias of key informant interviews. These findings have implications for how researchers approach collecting information beyond the individual level.

Structural Intersectionality as a New Direction for Health Disparities Research.

This article advances the field by integrating insights from intersectionality perspectives with the emerging literatures on structural racism and structural sexism-which point to promising new ways to measure systems of inequality at a macro level-to introduce a structural intersectionality approach to population health. We demonstrate an application of structural intersectionality using administrative data representing macrolevel structural racism, structural sexism, and income inequality in U.S. states linked to individual data from the Behavioral Risk Factor Surveillance System to estimate multilevel models (N = 420,644 individuals nested in 76 state-years) investigating how intersecting dimensions of structural oppression shape health. Analyses show that these structural inequalities: (1) vary considerably across U.S. states, (2) intersect in numerous ways but do not strongly or positively covary, (3) individually and jointly shape health, and (4) are most consistently associated with poor health for black women. We conclude by outlining an agenda for future research on structural intersectionality and health.

Therapist and client attitudes toward client independent review of psychotherapy sessions.

OBJECTIVES: Little consideration has been given to the possibility that clients may find therapeutic value in reviewing (i.e., watching, listening, or reading transcripts of) their own therapy sessions independently. This study aimed to evaluate prevalence, interest, and preferences in this practice, beliefs regarding potential benefits and concerns, and overall attitudes. METHODS: A diverse sample of clients (N = 275) as well as trainee (N = 85) and Master's/doctoral-level (N = 89) therapists of different therapeutic approaches completed forms online. Descriptive statistics, frequency counts, and one-way analysis of variance tests were used to analyze the data. RESULTS: Relatively few clients and therapists have engaged in this practice, but clients report interest in doing so. All participant groups identified several advantages and concerns. Clients rated overall helpfulness and harm significantly higher than therapists. CONCLUSION: Client independent review of sessions may be a promising transdiagnostic and transtheoretical treatment intervention. Future research is needed to evaluate its impact on treatment.

Loneliness Following Widowhood: The Role of the Military and Social Support.

OBJECTIVES: Increased loneliness is a common consequence of widowhood in later life. However, individuals with high levels of perceived social support from friends tend to cope more effectively following major social losses like widowhood. Military service is associated with cultivation of strong social support structures. This effect may not only influence those who serve, but also their spouses. Roughly half of older women today are married to veterans, which could shape how they cope with widowhood. We tested two hypotheses: (a) widows of veterans will be less lonely following widowhood compared to their nonveteran counterparts, and (b) this effect will be explained by perceived social support from friends. METHODS: We used the Health and Retirement Study (HRS) to examine changes in loneliness following widowhood among wives of veterans and nonveterans. We used Ordinary Least Squares regression and mediation tests to address our hypotheses. RESULTS: Net of baseline differences, widows of veterans reported statistically lower levels of loneliness (p < .05) following widowhood compared to widows of nonveterans. Widows of veterans retained the same level of perceived social support from friends pre- and postwidowhood, whereas nonveteran wives experienced a loss. Perceived social support from friends mediated the association between veteran status of the deceased spouse and loneliness. DISCUSSION: Our findings suggest wives of veterans may have more resilient social support structures than nonveteran spouses, helping them cope at widowhood. Future research should explore whether these effects persist in association with other major stressful events in later life.

Feasibility and acceptability of a novel tool for the study of interpersonal processes in psychotherapy.

Psychotherapy process research methods often require extensive time and resources. Technology innovations, such as wearable sensors, have the potential to increase the efficiency of process data collection and processing. One such tool is the Sociometric Badge (SB), which is a portable, palm-sized device that can simultaneously record raw audio and data on social signals (e.g., speech patterns, body movement) in real-time and in varied contexts. In addition to describing the nature and implications of wearable sensing devices for psychotherapy research, this article reports results from a pilot study that examined the feasibility and acceptance of these assessment devices in comparison with traditional audio recording equipment. Undergraduate students (N = 306; Mage = 19.16 years, SD = 1.44; 50.3% female) were randomly placed into 153 dyads to mimic a psychotherapy dyad. Each dyad was randomly assigned to either a SB condition (n = 75 dyads) or a standard recording device condition (n = 78 dyads), and engaged in a conversation task. Participants completed self-report items assessing perceived relationship quality and experience with the respective recording device. Between-condition tests showed that perceived relationship quality did not differ between conditions. Participants in the audio recorder (vs. SB) condition reported more awareness of the device in the room. These findings reveal comparable acceptability and feasibility of SBs to traditional audio recorders in a simulated dyad, suggesting that wearable sensing devices may be suitable for research and practice in routine psychotherapy contexts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Use of common and unique techniques in the early treatment phase for cognitive-behavioral, interpersonal/emotional, and supportive listening interventions for generalized anxiety disorder.

Psychotherapy research often compares specific treatments to control conditions to establish efficacy of the specified treatment. Research has typically evaluated common factor elements (e.g., credibility, expectancy) in treatments only after the first or second session, largely as a manipulation check and under the assumption that such factors are static. This study observed therapist common factor and model-specific interventions in three treatment approaches from a randomized control trial for generalized anxiety disorder across the entire early phase of treatment (i.e., first five sessions). The parent randomized control trial compared two treatment conditions, using an additive design where patients were randomized to receive either interpersonal/emotional processing interventions or supportive listening after receiving a session of cognitive-behavioral therapy. The first five video-recorded sessions of N = 40 randomly sampled participants were observationally coded with a multidimensional intervention measure, with subscales reflecting diverse theoretical orientations and common factors. Multilevel modeling was used to examine intervention use and investigate differences between treatment conditions and segments. Among the results, common factor interventions were rated as significantly more typical in cognitive-behavioral therapy compared with supportive listening. The pattern of intervention use of other subscales was generally consistent with the orientation of the respective protocols. In the early phase of treatment, supportive listening conditions do not appear to function as common factor controls in the manner that many might assume. Common factors are potentially enhanced in bona fide treatments that include a more detailed, specific rationale and clear and cohesive techniques and goals. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Women's Recovery Group for Individuals with Co-occurring Substance Use and Eating Disorders: Feasibility and Satisfaction in a Residential Eating Disorders Program.

Despite the high rate of co-occurring eating disorders (EDs) and substance use disorders (SUDs) in women, there is a lack of integrated treatment. This study implemented the Women's Recovery Group (WRG), a gender-specific group therapy for women with SUDs, in an ED residential treatment program to assess the feasibility and satisfaction of the WRG for women with co-occurring SUDs and EDs. Women (N = 24) were enrolled in the study if they were aged 18 years or older and engaged in the WRG as part of their treatment. Patient and therapist satisfaction with the WRG were assessed post-treatment, and craving to use substances was measured at enrollment and post-treatment. Participants reported moderate satisfaction with the WRG, and therapists reported above average satisfaction with the WRG. Craving to use substances in the environment in which one previously used significantly decreased from enrollment to post-treatment. In its current form, the WRG was feasible to implement in ED residential treatment. Participants indicated that they would have liked more information on co-occurring EDs, self-image/self-esteem, shame and guilt, and maintaining sobriety at college. These results support the need for modifications to the WRG to better integrate treatment for women with co-occurring EDs and SUDs.

Food Type and Lentil Variety Affect Satiety Responses but Not Food Intake in Healthy Adults When Lentils Are Substituted for Commonly Consumed Carbohydrates.

BACKGROUND: Lentils have potential to increase satiety and may contribute to a body weight management strategy; however, the effects on satiety of replacing common food ingredients with lentils within food products remain largely unknown. OBJECTIVE: The aim of this study was to determine the effects of replacing wheat and rice with 2 lentil varieties within muffins and chilies on satiety, test-meal food intake, and 24-h energy intake. METHODS: Healthy adults consumed muffins or chilies in which wheat or rice was substituted with green (61.8 g) or red (54 g) lentils in 2 randomized crossover studies (muffin study: n = 24, mean ± SE age: 25.4 ± 0.9 y, BMI (in kg/m2): 23.2 ± 0.5; chili study: n = 24, age: 25.7 ± 1.0 y, BMI: 23.2 ± 0.5), with ≥1-wk washout periods between study visits and studies. Subjective appetite sensations measured over 180 min were summarized with total area under the curve (AUC), food intake was measured at an ad libitum test meal, and 24-h energy intake was measured using weighed food records. Treatment effects were compared within each study using repeated-measures ANCOVA (subjective appetite sensations) and ANOVA (food intake, 24-h energy intake). RESULTS: Green, but not red, lentil chili significantly increased fullness AUC (17.5%, P = 0.02) and decreased desire to eat AUC (20.1%, P = 0.02) and prospective food consumption AUC (16.7%, P = 0.04) compared with rice chili, with no significant differences between chili treatments for test-meal food intake or 24-h energy intake. Muffin treatments did not significantly differ for any outcomes. CONCLUSIONS: Replacing rice with green, but not red lentils within chili increases satiety but does not decrease food intake, whereas replacing wheat with lentils within muffins does not increase satiety or decrease food intake in healthy adults. Further study of the role of lentil replacement in food products in body weight management is warranted. This trial was registered at clinicaltrials.gov as NCT03128684.

Therapeutic strategies and techniques in early cognitive-behavioral therapy.

Examination of the early phase of therapy is of growing importance. Early improvement in client symptoms and functioning is associated with positive posttreatment outcomes and reduced premature termination, including in cognitive-behavioral-oriented treatments. This article focuses on 3 strategies salient in the early phase of cognitive-behavioral therapy, including the provision of a rationale and goal-oriented framework, cultivating an attitude of collaborative empiricism, and initiating objective client self-monitoring. A description and rationale, relevant supporting research, and case examples are presented for each component. Finally, practical recommendations are offered for therapists and trainees to implement these strategies in their own practice. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Depressive Symptoms and the Buffering Effect of Resilience on Widowhood by Gender.

BACKGROUND AND OBJECTIVES: Spousal loss is a stressful life event that often results in significant depressive symptoms, with men often experiencing more significant depressive symptoms than women. Recent research suggests that psychological resilience may play a role in shaping how well people recover from the loss of a spouse. This study examined the moderating effect of resilience on widowhood in relation to changes in depressive symptoms for men and women. RESEARCH DESIGN AND METHODS: This study used data from the Health and Retirement Study to examine a change in depressive symptoms for men and women who experience spousal loss compared to those who remain continuously married (N = 5,626). We used the Simplified Resilience Score, which is based on measures drawn from the psychosocial and lifestyle questionnaire. Ordinary least squares regression was used to assess depression following reported spousal loss for widows relative to their continuously married counterparts. RESULTS: Results show resilience moderated depressive symptoms following spousal loss, but these effects varied by gender. Resilience was significantly and negatively associated with depressive symptoms for married but not for widowed women. However, for widowed men, resilience was significantly and negatively associated with depressive symptoms, and a high resilience score buffered the effect of widowhood. DISCUSSION AND IMPLICATIONS: Our study suggests that having high levels of resilience prior to spousal loss may help offset persistent depressive symptoms, especially for men. Implications for future research and clinical practice are discussed.

Aerobic bacteria from mucous membranes, ear canals, and skin wounds of feral cats in Grenada, and the antimicrobial drug susceptibility of major isolates.

In a 2-year period 54 feral cats were captured in Grenada, West Indies, and a total of 383 samples consisting of swabs from rectum, vagina, ears, eyes, mouth, nose and wounds/abscesses, were cultured for aerobic bacteria and campylobacters. A total of 251 bacterial isolates were obtained, of which 205 were identified to species level and 46 to genus level. A commercial bacterial identification system (API/Biomerieux), was used for this purpose. The most common species was Escherichia coli (N=60), followed by Staphylococcus felis/simulans (40), S. hominis (16), S. haemolyticus (12), Streptococcus canis (9), Proteus mirabilis (8), Pasteurella multocida (7), Streptococcus mitis (7), Staphylococcus xylosus (7), S. capitis (6), S. chromogenes (4), S. sciuri (3), S. auricularis (2), S. lentus (2), S. hyicus (2), Streptococcus suis (2) and Pseudomonas argentinensis (2). Sixteen other isolates were identified to species level. A molecular method using 16S rRNA sequencing was used to confirm/identify 22 isolates. Salmonella or campylobacters were not isolated from rectal swabs. E. coli and S. felis/simulans together constituted 50% of isolates from vagina. S. felis/simulans was the most common species from culture positive ear and eye samples. P. multocida was isolated from 15% of mouth samples. Coagulase-negative staphylococci were the most common isolates from nose and wound swabs. Staphylococcus aureus, or S. intemedius/S. pseudintermedius were not isolated from any sample. Antimicrobial drug resistance was minimal, most isolates being susceptible to all drugs tested against, including tetracycline.