A randomized clinical trial of a gamified app for the treatment of perfectionism.

OBJECTIVES: Perfectionism is a common transdiagnostic problem that may lead to substantial distress and functional impairments. Cognitive behavioural therapy (CBT) is an effective treatment for perfectionism. However, the existing significant barriers to access and utilization of mental health services, including among college students, demand the development of low-intensity accessible interventions. The aim of the present study was to evaluate the effectiveness of a low-intensity CBT-based self-help gamified app developed specifically for perfectionism in a sample of college students. METHODS: Participants completed assessments of perfectionism, related symptoms, emotional burden and functional impairments at pretreatment, posttreatment and at one-month follow-up. RESULTS: Compared with the waitlist condition (n = 35), the app condition (n = 35) demonstrated a significant and greater reduction in perfectionism, obsessive-compulsive symptoms, functional impairments and subjective ratings of emotional burden. CONCLUSIONS: Results suggest that a brief, daily app-based game-like intervention targeting maladaptive perfectionistic beliefs may be a viable, low-cost alternative to traditional CBT treatments for vulnerable populations on college campuses.

Longitudinal Predictors of Informant-Rated Everyday Function in Mild Cognitive Impairment.

OBJECTIVE: To examine predictors of informant-reported everyday functioning in mild cognitive impairment (MCI) and relations between everyday function and conversion to dementia. METHODS: Informants of participants (n = 2614) with mild cognitive impairment (MCI) were administered the Functional Activities Questionnaire (FAQ). Changes in dimensions of functional ability as determined by an exploratory factor analysis (EFA) were examined over 3 years and participant predictors of change were examined using multilevel modeling (MLM). RESULTS: The FAQ consisted of 3 factors, multistep, finance, and memory/orientation daily tasks. Impairment in memory/orientation tasks was significantly higher than impairment in multistep tasks. Worse functioning was associated with greater depression, worse memory, worse speed/EF, higher years of education and identifying as White. There was variability in some of these associations with different FAQ factors. Impairments in financial and memory/orientation daily tasks predicted follow-up conversion to dementia. CONCLUSIONS: Depression, speed/EF, and memory are consistently associated with domains of everyday functioning. Race, education, and age may be more variability associated with everyday functioning. Specific attention should be paid to subtle declines in the financial and memory/orientation domains as they may uniquely predict future dementia development. Depression may be a modifiable risk factor associated with functional impairment over time.

Characterizing user needs for Beescape: A spatial decision support tool focused on pollinator health.

Interactive maps can serve as powerful environmental decision-support tools. However, designing an interactive map that meets the needs of diverse constituencies is a challenge. In this article, we evaluate and characterize user needs for an interactive map and spatial decision-support tool called Beescape. Beescape is designed to visualize resources and environmental risks to bees and other pollinators (such as availability of nutritional resources from flowering plants and exposure to pesticides) in order to help users make informed decisions about managing bee populations and associated landscapes. We conducted a needs assessment workshop with twenty stakeholders from four user groups including beekeepers, growers, conservationists, and pollinator scientists to elicit their knowledge to guide future Beescape development. The results of the workshop identify current analytical gaps with the existing Beescape prototype, including the need for predictive and historical tools, more actionable data layers, finer-grain spatial data, and better explanations on what data represent and how they were created. Our findings on user's analytical, informational, and interface needs can be utilized to guide the future development of spatial decision support tools like Beescape, and our methodological approach may apply to other environmental informatics tools where it is important to design for multiple constituent user groups.

A novel scale for the evaluation of physician drawn medical illustrations.

Effective communication is a crucial component of patient-centered care and individuals with low health literacy face significant challenges in managing their health, leading to longer hospital stays and worse outcomes. Visual aids, such as medical illustrations and pictograms, can enhance patient understanding and memory retention; however, there is a lack in the medical field of tools for evaluating and improving a physician's ability to draw clinical illustrations for their patient. This article explores an aesthetic scale created in collaboration between Boston University Medical School and the Boston University Fine-Arts department. The scale scores basic design elements that could reasonably be improved in a clinical setting. A pilot study demonstrated interrater reliability between trained artists scoring images of varying concepts and visual quality with a Cronbach's alpha of 0.95. This scale has potential use in medical visual education and clinical evaluation.

Beyond depression: examining the role of anxiety and anxiety sensitivity on subjective cognition and functioning in older adults.

OBJECTIVES: Subjective cognitive difficulties in the elderly may serve as potential risk-factors for future, objective decline and conversion to neurodegenerative disorders (e.g., mild cognitive impairment [MCI] and dementia). Though these subjective declines have been associated with depression, and to a lesser extent, anxiety, it is unknown if related constructs (e.g. anxiety sensitivity) and specific kinds of worries (e.g. worry about developing dementia, health anxiety) are related to subjective declines. The current study sought to examine if cognitive concerns related to anxiety sensitivity, dementia worry, and health anxiety added incremental validity beyond general symptoms of anxiety and depression in predicting subjective cognition and functioning in a sample of older adults. METHODS: Participants were 429 older adults who were at least 60 years old. Participants completed questionnaires on subjective cognition, subjective everyday function, anxiety, depression, anxiety sensitivity, dementia worry, and health anxiety via Qualtrics Panels. Hierarchical multiple regressions were conducted. RESULTS: Our variables of interest (anxiety sensitivity, dementia worry, and health anxiety) added significant variance in predicting subjective cognition and everyday function. Specifically, anxiety sensitivity was related to subjective cognition and functioning, while dementia worry and health anxiety were variably associated. CONCLUSION: Our results suggest that constructs related to anxiety and worry have a significant relationship with subjective cognition and function in older adults beyond general symptoms of depression and anxiety. Future work should examine if interventions and education may help to decrease anxiety sensitivity and worry about dementia respectively in older adults, which may in tern protect against future subjective declines.

Psychometric properties of the interpersonal needs questionnaire (INQ-15) in Army soldiers: Implications and future directions.

The Interpersonal Theory of Suicide posits that two unmet interpersonal needs, thwarted belongingness and perceived burdensomeness, interact to predict suicide desire. These two constructs are frequently assessed using the 15-item Interpersonal Needs Questionnaire (INQ-15); however, this measure has never been validated in military service members. The current study analyzed the psychometric properties of the INQ-15 in a sample of (N = 1096) military personnel stationed overseas. Results indicated that the two-factor model of the INQ-15 had a poor model fit in this population; however, a bifactor model with two specific factors representing TB and PB demonstrated good fit. As seen in previous research, perceived burdensomeness was more strongly related to suicidal ideation severity than thwarted belongingness. Implications and future directions for research are discussed.

Language dominance predicts cognate effects and metalinguistic awareness in preschool bilinguals.

The current work investigates whether language dominance predicts transfer of skills across cognitive-linguistic levels from the native language (Spanish) to the second language (English) in bilingual preschoolers. Sensitivity to cognates (elephant/elefante in English/Spanish) and metalinguistic awareness (MLA) have both been shown to transfer from the dominant to the nondominant language. Examining these types of transfer together using a continuous measure of language dominance may allow us to better understand the effect of the home language in children learning a majority language in preschool. Forty-six preschool-aged, Spanish-English bilinguals completed English receptive vocabulary and metalinguistic tasks indexing cognate effects and MLA. Language dominance was found to predict crosslinguistic (cognate) facilitation from Spanish to English. In addition, MLA skills also transferred from Spanish to English for children with lower English proficiency, and no transfer of MLA was evident for children with higher English proficiency. Altogether, findings suggest that transfer from a dominant first language to a nondominant second language happens at linguistic and cognitive-linguistic levels in preschoolers, although possibly influenced by second language proficiency. The current study has implications for supporting the home language for holistic cognitive-linguistic development.

Social factors that predict cognitive decline in older African American adults.

OBJECTIVES: Projections from the United States Census Bureau suggest that the African American population may be the fastest growing race over the next 30 years and that they may be at the highest risk for developing dementia later in life. Various social factors have been shown to be associated with cognitive function and health outcomes. The present study aims to evaluate the relationship between social engagement and cognitive decline in a cohort of older African American adults. METHODS: We utilized multilevel modeling to examine the association between cognitive decline and social engagement in a sample of 617 older African American adults. RESULTS: Social activity was associated with global cognition, perceptual speed, perceptual orientation, and episodic memory over time. Loneliness was associated with better semantic memory performance over time. Perceived discrimination was associated with better semantic memory performance over time. Larger social network was associated with worse perceptual speed scores over time. CONCLUSIONS: Although our findings on loneliness and perceived discrimination over time were inconsistent with prior research, our findings on social activity and social network size over time were consistent with past literature and are thought to be due to positive social interactions providing a catalyst for cognitively stimulating activities. These results suggest that interventions designed to preserve cognition in African American older adults should incorporate adequate social activity. Furthermore, to maximize effectiveness, interventions should not necessarily focus on just expanding one's social network.

The role of user context in the design of mobile map applications.

Mobile map applications are typically used by a broad range of users. Users can be diverse in their context attributes (e.g. map use experience, activities during map use), and several previous user experience (UX) studies have focused on understanding how some contextual factors influence the UX for designing maps that satisfy users' needs. A need for research remains to evaluate the relationship between user context, UX, and variants of mobile map element design. In this article, we present our research investigating the interplay of these factors through an empirical user study with citizens in Austria. We created an online survey and generated 84 map variations, combining seven map-related tasks, three base map styles, two map detail densities, and two time-pressure variants. We tested these map variations with 107 survey participants and related their UX to user context. Map-related tasks emerged as a dominant factor modifying the map design UX. Further results showed that interactivity loaded map-related tasks were aided when paired with low detail-dense base maps, contrasting overlay features. We recommend future research to analyze an extended set of context attributes with additional participant data, to evaluate dynamic variations in context, and to find ways to dynamically monitor mobile map design UX.

Frequency and predictors of virtual hope box use in individuals experiencing suicidal ideation: An ecological momentary assessment investigation.

INTRODUCTION: The Virtual Hope Box (VHB) is a smartphone application designed to support emotion regulation when one is distressed, in a crisis, or experiencing suicidal ideation (SI). Initial proof of concept studies indicate that individuals are more likely to use the VHB than traditional hope boxes, and find it both easy to setup and helpful. To our knowledge, no studies have harnessed ambulatory assessment methodology to assess VHB use as it relates to incidence of suicidal thinking. METHODS: As such, we recruited N = 50 undergraduates who endorsed SI either the past year or past 2 weeks to complete a 10-day investigation. At baseline, participants were oriented to the VHB and instructed on how to use the application. Over the next 10 days, participants responded to prompts five times per day on their personal smartphones regarding their current experiences of SI and stress as well as VHB usage. RESULTS: Results found that most participants used the VHB at least once, rated its usefulness as high, and rated their perceived likelihood of future use as high. In addition, increases in state SI severity were related to subsequent VHB use. CONCLUSION: The VHB may be a useful tool for managing crises in undergraduates experiencing suicidal thoughts.

Factor Structure and Measurement Invariance of the Suicide Status Form-IV.

The Suicide Status Form-IV (SSF-IV) is the measure used in the Collaborative Assessment and Management of Suicidality (CAMS). The SSF-IV Core Assessment measures various domains of suicide risk. Previous studies established a two-factor solution in small, homogeneous samples; no investigations have assessed measurement invariance. The current investigation sought to replicate previous factor analyses and used measurement invariance to identify differences in the Core Assessment by race and gender. Adults (N = 731) were referred for a CAMS consultation after exhibiting risk for suicide. Confirmatory factor analyses indicated good fit for both one- and two-factor solutions while the two-factor solution is potentially redundant. Configural, metric, and scalar invariance held across race and gender. Ordinal logistic regression models indicated that neither race nor gender significantly moderated the relationship between the Core Assessment total score and clinical outcomes. Findings support a measurement invariant, one-factor solution for the SSF-IV Core Assessment.

Perfectionism and Suicidal Ideation.

Background: The integrated motivational-volitional (IMV) model of suicidal behavior posits that defeat leads to suicidal ideation through increased vulnerability for feelings of entrapment. One potentially important vulnerability factor for the development of feelings of defeat is socially prescribed perfectionism. Aims: The current study investigated these relationships in a sample of 313 US adults. Method: Mediation and parallel mediation analyses were conducted to determine the relationships between defeat, entrapment, social prescribed perfectionism, negative social comparison, and rejection sensitivity. Results: Findings indicated that socially prescribed perfectionism was significantly related to defeat through both negative social comparison and rejection sensitivity even when controlling for depression symptoms. Negative social comparison and rejection sensitivity were related to entrapment through feelings of defeat. This relationship was strongest when analyzing externalized (vs. internalized) entrapment. Limitations: The findings were limited by the cross-sectional study design as well as the relatively homogeneous sample. Implications and future directions are discussed.

Perceived stress and suicidal ideation: The role of dispositional mindfulness.

OBJECTIVES: Extant literature suggests that dispositional mindfulness may reduce the impact perceived stress has on the severity of suicidal ideation (SI). Only one study has analyzed this question but did so with a cross-sectional design in a sample of undergraduate women. METHODS: This study analyzed the potential moderating role of dispositional mindfulness on the relation between perceived stress and SI cross-sectionally and at one-week follow-up in a sample of US adults (N = 598) with a history of SI. RESULTS: Results indicated that dispositional mindfulness and its facets were inversely related to perceived stress, SI severity at baseline, and SI severity one week later. At baseline, regression results indicated that only the nonreacting component of dispositional mindfulness interacted with perceived stress to concurrently predict SI severity. This relation was not significant when SI severity was measured one week later. LIMITATIONS: Study results are limited by the high attrition rate from baseline to follow-up and the relatively homogeneous sample. CONCLUSION: Study results indicate that dispositional mindfulness, particularly components related to nonreacting, is inversely related to SI severity concurrently but not prospectively. Interventions focused on mindfulness skills, particularly skills around nonreaction to inner experience, may be beneficial for those considering suicide.

Settling the Score: Can CPT-3 Embedded Validity Indicators Distinguish Between Credible and Non-Credible Responders Referred for ADHD and/or SLD?

OBJECTIVE: The purpose of the present study was to further investigate the clinical utility of individual and composite indicators within the CPT-3 as embedded validity indicators (EVIs) given the discrepant findings of previous investigations. METHODS: A total of 201 adults undergoing psychoeducational evaluation for ADHD and/or Specific Learning Disorder (SLD) were divided into credible (n = 159) and non-credible (n = 42) groups based on five criterion measures. RESULTS: Receiver operating characteristic curves (ROC) revealed that 5/9 individual indicators and 2/4 composite indicators met minimally acceptable classification accuracy of ≥0.70 (AUC = 0.43-0.78). Individual (0.16-0.45) and composite indicators (0.23-0.35) demonstrated low sensitivity when using cutoffs that maintained specificity ≥90%. CONCLUSION: Given the lack of stability across studies, further research is needed before recommending any specific cutoff be used in clinical practice with individuals seeking psychoeducational assessment.

Toward a More Perfect Conceptualization of Perfectionism: An Exploratory Factor Analysis in Undergraduate College Students.

Previous investigations on the factor structure of perfectionism have largely focused on the Frost Multidimensional Perfectionism Scale and the Multidimensional Perfectionism Scale. The current study aimed to identify the underlying factor structure of perfectionism, based on several widely used measures, and to examine how these factors related to psychopathology and personality broadly. College students (N = 598) completed several measures of perfectionism and broadband measures of psychopathology and personality. Exploratory structural equation modeling (ESEM) was conducted to examine the hierarchical structure of perfectionism followed by exploratory factor analysis. The hierarchical structure examined provides a framework for understanding the relationship between models of perfectionism at different levels of the hierarchy. The exploratory factor analysis revealed five dimensions of perfectionism: Achievement Striving, Evaluative Concerns, Expectations From Others, Narcissistic Perfectionism, and Organization. These dimensions were associated with psychopathology to differing degrees and were differentially related to personality. These results support using a multidimensional perspective to understand perfectionism.

Affective Congruence in Visualization Design: Influences on Reading Categorical Maps.

Recent work in data visualization has demonstrated that small, perceptually-distinct color palettes-such as those used in categorical mapping-can connote significant affective qualities. Data that are mapped or otherwise visualized are also often emotive in nature, either inherently (e.g., climate change, disease mortality rates), or by design, such as can be found in visual storytelling. However, little is known about how the affective qualities of color interact with those of data context in visualization design. This article describes the results of a crowdsourced study on the influence of affectively congruent versus incongruent color schemes on categorical map-reading response. We report both objective (pattern detection; area comparison) and subjective (affective quality; appropriateness; preference) measures of map-reader response. Our results suggest that affectively congruent colors amplify perceptions of the affective qualities of maps with emotive topics, affective incongruence may cause confusion, and that affective congruence is particularly influential in maps of positive-leaning data topics. Finally, we offer preliminary design recommendations for balancing color congruence with other design factors, and for synthesizing color and affective context in thematic map design.

Perfectionistic Self-Presentation, Socially Prescribed Perfectionism, Self-Oriented Perfectionism, Interpersonal Hopelessness, and Suicidal Ideation in U.S. Adults: Reexamining the Social Disconnection Model.

OBJECTIVE: Research has linked perfectionism to increased suicidal ideation (SI), although less is known regarding the mechanisms that explain this relation. The Perfectionism Social Disconnection Model (PSDM) posits that interpersonal aspects of perfectionism cause interpersonal problems (e.g., hostility, loneliness) which in turn increase a person's risk for experiencing SI. The present study aimed to replicate and extend previous findings related to the PSDM and SI using measures of interpersonal hopeless and general hopelessness. METHOD: Tenets of the PSDM were tested in a sample of 313 U.S. adults with a history of SI, by determining whether experiences of general hopelessness and interpersonal hopelessness explained the relation between three types of perfectionism: perfectionistic self-presentation (PSP), socially prescribed perfectionism (SPP), and self-oriented perfectionism (SOP). RESULTS: Results indicated that PSP, SPP, and SOP were positively associated with SI, general hopelessness, and interpersonal hopelessness.The relation between aspects of perfectionism and SI demonstrated an indirect effect through interpersonal hopelessness only. CONCLUSIONS: These results lend support to the PSDM's assertion that interpersonal problems aid in explaining the relation between perfectionism and SI. The current study was limited by the cross-sectional nature of the study as well as the homogenous sample. Implications for research and clinical work are discussed.HIGHLIGHTSAspects of perfectionism are related to suicidal ideationAspects of perfectionism are related to interpersonal hopelessnessInterpersonal hopelessness explains why perfectionism and suicidal ideation are related.

Trainee perceptions of multicultural climate and supervision in neuropsychology.

INTRODUCTION: Mentor relationships are important in developing and supporting professional self-efficacy among psychology trainees. Additionally, the rapid diversification of the United States calls for the preparation of clinical neuropsychology trainees to work within a multicultural context. The present study aimed to assess neuropsychology trainees' perceptions of multicultural climate and supervision and if these perceptions differ based on trainee demographics. We also sought to identify aversive experiences of trainees, program strengths or weaknesses, and how programs support trainees. METHOD: Participants were 310 neuropsychology trainees (Mean age = 30.27, SD = 5.67) from clinical psychology graduate (n = 136), pre-doctoral internship (n = 38), and post-doctoral (n = 71) programs across the United States and Canada who completed a survey assessing perceptions to multicultural climate and supervision. 64.5% self-identified as women, 60.3% as heterosexual, and 46.1% as non-Hispanic White. 34.5% of trainees reported at least one American Disabilities Act (ADA) recognized disability. RESULTS: Though satisfied with general supervision, trainees reported overall dissatisfaction with multicultural supervision. Satisfaction with multicultural supervision did not differ by demographics. Trainees also reported various aversive experiences with supervisors, clients, and research participants that negatively impacted their training. These experiences were at times due to an aspect of the trainee's multicultural identity, with Black and Hispanic trainees being more likely to report an aversive experience. Trainees reported ways in which they felt unsupported by their programs. CONCLUSIONS: Important areas of growth for programs are discussed. Issues raised by neuropsychology trainees overlap to some degree with the experiences of trainees in other fields. Recommendations of approaches that have been successfully adopted in other fields to improve trainee satisfaction are provided. Early identification of needs that go above and beyond clinical training will allow programs to respond promptly, improve trainee satisfaction, and potentially improve the retention of trainees from diverse backgrounds.

Examining patterns of executive functioning across dimensions of psychopathology.

BACKGROUND AND OBJECTIVES: The current study examined relationships between psychopathology and individual domains of executive functioning (EF) amongst adults. While previous studies have examined these relationships using diagnostic groups, we compared factor structures of both dimensional psychopathology and EF and used an approach to better isolate EF-specific task variance within each domain. METHODS: This study analyzed the data of 722 individuals between the ages of 18-59 years, who took part in the Nathan Kline Institute (NKI)-Rockland project. Confirmatory factor analyses were used to derive a three-factor model of EF (i.e., inhibition, shifting, and fluency) proposed by Karr et al. (2019) with scores primarily from the Delis-Kaplan Executive Function System (D-KEFS), as well as a three-factor model of psychopathology (i.e., internalizing, externalizing, and thought disorder symptoms) from the Adult Self-Report (ASR) and Peter's et al. Delusions Inventory (PDI). These models were compared using structural equation modeling. RESULTS: Results demonstrated an adequate fit for both model structures and indicated that internalizing and externalizing psychopathology had positive and negative relationships with different factors of EF, while thought disorder traits were not related to EF. LIMITATIONS: This study examines pathological traits within a non-clinical sample that excluded individuals with severe mental illness. Additionally, analyses were limited by the availability of certain variables, and potential shared method variance within factors. CONCLUSIONS: Patterns of associations with EF were unique to all three aspects of dimensional psychopathology. When examined together, different dimensions of psychopathology were related to both better and worse EF performance.

Factor structure of the anxiety sensitivity index-3 in a sample of older adults.

Anxiety sensitivity is a transdiagnostic risk factor for internalizing psychopathology in children and adults. Several factor analytic studies have examined the factor structure of anxiety sensitivity in children, adolescents, and adults. However, to date, no studies have specifically examined the factor structure of the Anxiety Sensitivity Index-3 in older adults. The purpose of the current study was to compare the fit of a correlated three-factor, higher-order, and bifactor model of the Anxiety Sensitivity Index-3 (ASI-3) in a sample of older adults. Participants were 856 older adults aged 60-94 recruited through Qualtrics Panels. Confirmatory factor analyses demonstrated good model fit for the bifactor model and the higher-order model and adequate fit for the correlated three-factor model. These results suggests that the ASI-3 is a valid tool assessing anxiety sensitivity in older adults. Limitations and future directions are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00736-9.