The role of mindfulness in quality of life of persons with spinal cord injury: a cross-sectional study.

BACKGROUND: Quality of life is considered the most overarching psychosocial adaptation outcome following the rehabilitation of persons with spinal cord injury. Literature suggests that the quality of life of persons with spinal cord injury is determined by many personal and psychological factors, including mindfulness. This study aimed to identify the direct and indirect effect of mindfulness on the quality of life of persons living with spinal cord injury. METHODS: Participants consisted of 231 members of three spinal cord injury organizations in the United States: United Spinal Association, North American Spinal Cord Injury Consortium, and Paralyzed Veterans of America-Wisconsin Chapter. The participants completed a set of standardized self-report questionnaires in an online Qualtrics survey. A hierarchical regression analysis was performed to identify the contribution of mindfulness to quality of life, controlling for sociodemographic and injury-related factors. A serial mediation analysis was performed to examine the indirect effect of mindfulness on quality of life. RESULTS: In the hierarchical regression analysis, sociodemographic and injury-related factors (i.e., age, gender, race, marital status, education, employment, level and completeness of injury, comorbidities, frequency of hospitalization, pain intensity, and functional limitation) and mindfulness explained 59% variance on quality of life of the participants with spinal cord injury. Mindfulness uniquely contributed to the higher quality of life above and beyond sociodemographic and injury-related variables. In the serial mediation analysis, pain and functional limitation did not significantly mediate the relationship between mindfulness and quality of life. However, the indirect effects of mindfulness on functional limitation and quality of life through pain were significant. CONCLUSION: The findings underscore the vital role of mindfulness in improving the quality of life of persons with spinal cord injury. Implications of these findings for future research and clinical practice are discussed.

Evaluating psychotherapist competence: Testing the generalizability of clinical competence assessments of graduate trainees.

Health service psychology (HSP) graduate programs are shifting from knowledge- to competency-based assessments of trainees' psychotherapy skills. This study used Generalizability Theory to test the dependability of psychotherapy competence assessments based on video observation of trainees. A 10-item rating form was developed from a collection of forms used by graduate programs (n = 102) in counseling and clinical psychology, and a review of the common factors research literature. This form was then used by 11 licensed psychologists to rate eight graduate trainees while viewing 129, approximately 5-min video clips from their psychotherapy sessions with clients (n = 22) at a graduate program's training clinic. Generalizability analyses were used to forecast how the number of raters and clients, and length of observation time impact the dependability of ratings in various rating designs. Raters were the primary source of error variance in ratings, with rater main effects (leniency bias) and dyadic effects (rater-target interactions) contributing 24% and 7% of variance, respectively. Variance due to segments (video clips) was also substantial, suggesting that therapist performance varies within the same counseling session. Generalizability coefficients (G) were highest for crossed rating designs and reached maximum levels (G > .50) after four raters watched each therapist working with three clients and observed 15 min per dyad. These findings suggest that expert raters show consensus in ratings even without rater training and only limited direct observation. Future research should investigate the validity of competence ratings as predictors of outcome. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cultural context matters: Testing the minority stress model among Chinese sexual minority men.

Minority stress theory (e.g., Meyer, 2003b), a model for understanding mental health disparities affecting sexual minorities, has primarily been tested in Western samples yet has not been carefully applied to the experiences of sexual minorities in a global context, including in East Asian countries. Combining minority stress theory with considerations of Chinese culture, the current study tested the associations among norm conformity, distal minority stressor (enacted stigma), proximal minority stressors (sexual identity concerns and concealment), lesbian, gay, and bisexual (LGB) family support, and psychological distress among Chinese sexual minority men (n = 748). Structural equation modeling showed that sexual identity concerns mediated the associations of norm conformity, enacted stigma, and lower family support with concealment. Psychological distress was associated with enacted stigma and lower family support, but not with proximal stressors (sexual identity concerns and concealment). Alternative model testing found sexual identity acceptance concerns predicted psychological distress and mediated the associations of norm conformity and LGB family support with distress. Findings provide partial support for the minority stress model in a Chinese context and suggest the importance of incorporating cultural considerations into minority stress conceptualizations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sexual risk behaviors in the internet age: the case of Chinese men who have sex with men.

This cross-sectional study examined a sample of sexually active Chinese MSM recruited online (N = 403) to determine the associations of MSM social life (both online and in-person) and sexual identity stigma with three types of sexual risk behaviors in the past 12 months, including condom use %, number of anal intercourse partners, and number of partners engaged in condomless anal intercourse (CAI). Hierarchical regression analyses were conducted. More frequent use of social media was associated with higher numbers of anal intercourse partners as well as more condom use in past 12 months, but not number of CAI partners. More active in-person MSM social life was associated with higher numbers of partners in anal intercourse as well as CAI. Both perceived and enacted sexual identity stigma associated with higher numbers of CAI partners; perceived stigma was also linked to less condom use. In conclusion, social life and minority stress are relevant factors of sexual risk among MSM in China in the uptrend of internet use. The internet may be an important and promising platform for HIV prevention, and intervention efforts should consider online-based designs to promote safe sex and reduce sexual minority stigma.

Effect size calculation in meta-analyses of psychotherapy outcome research.

Meta-analysis of psychotherapy intervention research normally examines differences between treatment groups and some form of comparison group (e.g., wait list control; alternative treatment group). The effect of treatment is normally quantified as a standardized mean difference (SMD). We describe procedures for computing unbiased estimates of the population SMD from sample data (e.g., group Ms and SDs), and provide guidance about a number of complications that may arise related to effect size computation. These complications include (a) incomplete data in research reports; (b) use of baseline data in computing SMDs and estimating the population standard deviation (σ); (c) combining effect size data from studies using different research designs; and (d) appropriate techniques for analysis of data from studies providing multiple estimates of the effect of interest (i.e., dependent effect sizes). Clinical or Methodological Significance of this article: Meta-analysis is a set of techniques for producing valid summaries of existing research. The initial computational step for meta-analyses of research on intervention outcomes involves computing an effect size quantifying the change attributable to the intervention. We discuss common issues in the computation of effect sizes and provide recommended procedures to address them.

Unpacking the therapist effect: Impact of treatment length differs for high- and low-performing therapists.

OBJECTIVE: Differences between therapists in their average outcomes (i.e., therapist effects) have become a topic of increasing interest in psychotherapy research in the past decade. Relatively little work, however, has moved beyond identifying the presence of significant between-therapist variability in patient outcomes. The current study sought to examine the ways in which therapist effects emerge over the course of time in psychotherapy. METHOD: We used a large psychotherapy data set (n = 5828 patients seen by n = 158 therapists for 50,048 sessions of psychotherapy) and examined whether outcomes diverge for high-performing (HP) and low-performing (LP) therapists as treatment duration increases. RESULTS: Therapists accounted for a small but significant proportion of variance in patient outcomes that was not explained by differences between therapists' caseload characteristics. The discrepancy in outcomes between HP and LP therapists increased as treatment duration increased (interaction coefficient = 0.071, p < .001). In addition, patients' trajectories of change were a function of their therapist's average outcome as well as the patient's duration of treatment (interaction coefficient = 0.060, p = .040). CONCLUSIONS: Indeed, patterns of change previously described ignoring between-therapist differences (e.g., dose-effect, good-enough level model) may vary systematically when disaggregated by therapist effect.

Unique effects and moderators of effects of sources on self-efficacy: A model-based meta-analysis.

Self-efficacy beliefs are strong predictors of academic pursuits, performance, and persistence, and in theory are developed and maintained by 4 classes of experiences Bandura (1986) referred to as sources: performance accomplishments (PA), vicarious learning (VL), social persuasion (SP), and affective arousal (AA). The effects of sources on self-efficacy vary by performance domain and individual difference factors. In this meta-analysis (k = 61 studies of academic self-efficacy; N = 8,965), we employed B. J. Becker's (2009) model-based approach to examine cumulative effects of the sources as a set and unique effects of each source, controlling for the others. Following Becker's recommendations, we used available data to create a correlation matrix for the 4 sources and self-efficacy, then used these meta-analytically derived correlations to test our path model. We further examined moderation of these associations by subject area (STEM vs. non-STEM), grade, sex, and ethnicity. PA showed by far the strongest unique association with self-efficacy beliefs. Subject area was a significant moderator, with sources collectively predicting self-efficacy more strongly in non-STEM (k = 14) compared with STEM (k = 47) subjects (R2 = .37 and .22, respectively). Within studies of STEM subjects, grade level was a significant moderator of the coefficients in our path model, as were 2 continuous study characteristics (percent non-White and percent female). Practical implications of the findings and future research directions are discussed. (PsycINFO Database Record

Eating disorder severity and functional impairment: moderating effects of illness duration in a clinical sample.

PURPOSE: The aim was to examine duration of illness and body mass index as possible moderators of the relationship between eating disorder severity and functional impairment, as well as psychological distress as a possible mediator of this relationship. METHODS: The study included 159 patients diagnosed with bulimia nervosa, binge eating disorder or eating disorder not otherwise specified. Regression analysis was applied to assess the effect of the hypothesized moderators and mediators. Eating disorder severity was measured with the Eating Disorder Examination Questionnaire, functional impairment was measured with the Sheehan Disability Scale, and psychological distress was measured with the Symptom Check List-90-R. Duration of illness and body mass index were assessed clinically. RESULTS: Duration of illness significantly moderated the relationship between eating disorder severity and functional impairment; the relationship was strongest for patients with a shorter duration of illness. Psychological distress partly mediated the relationship between eating disorder severity and functional impairment. Duration of illness significantly moderated the relationship between psychological distress and functional impairment; the strongest relationship was seen for patients with a shorter duration of illness. Body mass index was not a significant moderator of the relationship between ED severity and functional impairment. CONCLUSIONS: Overall, this study established a link between ED severity, psychological distress and functional impairment indicating that both eating disorder severity and psychological distress are more strongly related to impaired role functioning for patients with more recent onset of an eating disorder. More research in the complex relationship between ED severity and functional impairment is needed.

Acculturation and enculturation as predictors of psychological help-seeking attitudes (HSAs) among racial and ethnic minorities: A meta-analytic investigation.

Psychological services are culturally encapsulated for dominant cultural groups, and racial minorities underutilize treatment even though they suffer from more severe psychological distress. Sociocultural factors such as acculturation (one's adaptation into mainstream group) and enculturation (one's adherence to culture of heritage) are hypothesized to affect minorities' attitudes toward seeking psychological services. This meta-analysis examined 3 methods to assess acculturation/enculturation-unidimensional acculturation, bidimensional acculturation, and bidimensional enculturation as predictors of help-seeking attitudes (HSAs)-both positive and negative attitudes-among racial and ethnic minorities in 207 samples drawn from 111 research reports. The omnibus correlations between acculturation/enculturation variables and HSAs were quite small, but in the predicted direction. Moderator analyses suggested a more nuanced understanding of the association between bidimensional enculturation and positive HSAs: This association was significant (r = -.14 95% CI[-.18, -.09]) for Asians and Asian Americans, but very close to zero and nonsignificant for other racial minority groups (African Americans, Latino Americans, and others). In addition, the domain of acculturation/enculturation assessed was predictive of effect size, with enculturation measures containing a higher proportion of cognitive items (e.g., items that assess cultural values and beliefs) showing stronger (more negative) associations with positive HSAs. Post hoc analyses indicated that certain Asian cultural values, including emotional self-control, conformity to social norms, and collectivism, showed especially high negative associations with positive HSAs. (PsycINFO Database Record

Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting.

OBJECTIVE: Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time. METHOD: The present study examined changes in psychotherapists' outcomes over time using a large, longitudinal, naturalistic psychotherapy data set. The sample included 6,591 patients seen in individual psychotherapy by 170 therapists who had on average 4.73 years of data in the data set (range = 0.44 to 17.93 years). Patient-level outcomes were examined using the Outcome Questionnaire-45 and a standardized metric of change (prepost d). Two-level multilevel models (patients nested within therapist) were used to examine the relationship between therapist experience and patient prepost d and early termination. Experience was examined both as chronological time and cumulative patients seen. RESULTS: Therapists achieved outcomes comparable with benchmarks from clinical trials. However, a very small but statistically significant change in outcome was detected indicating that on the whole, therapists' patient prepost d tended to diminish as experience (time or cases) increases. This small reduction remained when controlling for several patient-level, caseload-level, and therapist-level characteristics, as well as when excluding several types of outliers. Further, therapists were shown to vary significantly across time, with some therapists showing improvement despite the overall tendency for outcomes to decline. In contrast, therapists showed lower rates of early termination as experience increased. CONCLUSIONS: Implications of these findings for the development of expertise in psychotherapy are explored. (PsycINFO Database Record

Are therapists uniformly effective across patient outcome domains? A study on therapist effectiveness in two different treatment contexts.

As established in several studies, therapists differ in effectiveness. A vital research task now is to understand what characterizes more or less effective therapists, and investigate whether this differential effectiveness systematically depends on client factors, such as the type of mental health problem. The purpose of the current study was to examine whether therapists are universally effective across patient outcome domains reflecting different areas of mental health functioning. Data were obtained from 2 sites: the Research Consortium of Counseling and Psychological Services in Higher Education (N = 5,828) in the United States and from primary and secondary care units (N = 616) in Sweden. Outcome domains were assessed via the Outcome Questionnaire-45 (Lambert et al., 2004) and the CORE-OM (Evans et al., 2002). Multilevel models with observations nested within patients were used to derive a reliable estimate for each patient's change (which we call a multilevel growth d) based on all reported assessment points. Next, 2 multilevel confirmatory factor analytic models were fit in which these effect sizes (multilevel ds) for the 3 subscales of the OQ-45 (Study 1) and 6 subscales of CORE-OM (Study 2) were indicators of 1 common latent factor at the therapist level. In both data sets, such a model, reflecting a global therapist effectiveness factor, yielded large factor loadings and excellent model fit. Results suggest that therapists effective (or ineffective) within one outcome domain are also effective within another outcome domain. Tentatively, therapist effectiveness can thus be conceived of as a global construct. (PsycINFO Database Record

The influence of multicultural counseling competence and anti-Black prejudice on therapists' outcome expectancies.

The broad goal of this study was to examine multiple potential predictors of anti-Black bias among counselors. Specifically, in an online survey of 173 trainees and professionals in mental health, this study used 3 measures related to cultural sensitivity as predictors of therapists' expectancies for bond and prognosis with African American clients compared with White clients. The Multicultural Counseling Inventory (MCI; Sodowsky, Taffe, Gutkin, & Wise, 1994) was used to measure global multicultural competence. The Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) served as a measure of automatic prejudice toward Blacks. Additionally, a new self-report measure of anti-Black clinical prejudice was created specifically for this study. The Balanced Inventory of Desirable Responding (Paulhus, 1984) was included to control for socially desirable responding. Each predictor of cultural sensitivity uniquely explained variance in anti-Black bias in bond ratings, with the IAT accounting for more variance than the 2 self-reports. Our novel measure of clinical prejudice accounted for anti-Black bias in prognosis ratings, but the MCI and the IAT did not. Researchers studying cultural competence are encouraged to consider the roles of automatic and deliberate prejudice in determining disparities in clinical expectancies and cross-racial therapeutic alliances. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

The secret ingredient in mindfulness interventions? A case for practice quality over quantity.

As mindfulness-based interventions become increasingly widespread, interest has grown in better understanding which features of these treatments produce beneficial effects. The present study examined the relative contribution of mindfulness practice time and practice quality in predicting psychological functioning (negative affect, emotion regulation, quality of life, mindfulness). Data were drawn from a randomized clinical trial of mindfulness training for smokers and assessed outcomes at posttreatment (n = 43) and 5-month follow-up (n = 38). The intervention included instruction in mindfulness techniques targeted to smoking cessation and relapse prevention and was composed of 10 group meetings over 8 weeks. Data from 8 treatment groups were used. Mindfulness practice quality was measured weekly over the course of treatment, and multilevel modeling was used to estimate trajectories of change in practice quality. The measure of practice quality was shown to be valid and reliable, with change in practice quality predicting change in psychological functioning at both posttreatment (ß = .31, 95% CI = [0.04, 0.56], p = .022) and follow-up (ß = .45 [0.16, 0.73], p = .002), even when controlling for practice time. Practice time predicted outcomes at posttreatment (ß = .31 [0.05, 0.57], p = .019) but not at follow-up (ß = .16 [-0.14, 0.47], p = .293). Neither practice time nor change in practice quality predicted smoking abstinence at 1 month or 6 months postquit. Results support the importance of practice quality as a relevant aspect of mindfulness interventions.

The role of therapeutic alliance in mindfulness interventions: therapeutic alliance in mindfulness training for smokers.

OBJECTIVE: Mindfulness-based interventions have enjoyed a marked increase in support within biomedical and psychological research and practice in the past two decades. Despite the widespread application of these treatments for a range of psychological and medical conditions, there remains a lack of consensus regarding mechanisms through which these interventions effect change. One plausible yet underexplored mechanism is the therapeutic alliance between participants and mindfulness instructors. METHODS: In this report, data are presented on therapeutic alliance from the mindfulness arm (n = 37) of a randomized controlled trial of a mindfulness-based smoking cessation treatment. RESULTS: Results suggest that client-reported therapeutic alliance measured midtreatment did not significantly predict primary smoking outcomes. Alliance did predict improvement in posttreatment scores on several outcome variables linked to mindfulness practice, including emotion regulation (ß = -.24, p = .042), mindfulness (ß = .33, p = .007), negative affect (ß = -.33, p = .040), as well as treatment compliance (ß = .39, p = .011). CONCLUSION: Implications of these relationships and the possible role of therapeutic alliance in mindfulness treatments are explored.

Monitoring mindfulness practice quality: an important consideration in mindfulness practice.

Mindfulness-Based Stress Reduction (MBSR) is an experientially based group intervention empirically supported to reduce psychological symptomology. Although MBSR has shown to be an effective intervention, little is known about which facets of the intervention are important in producing positive outcomes. This study tested several aspects of mindfulness practice (total practice duration, practice frequency and practice quality) with the primary focus being on validating (i.e., predictive and convergent validity) a new measure of mindfulness practice quality (PQ-M). The PQ-M fit a two-factor solution via a Maximum Likelihood Exploratory Factor Analysis (n=99). Using longitudinal multilevel modeling on a smaller subsample (n=19), preliminary support was found for changes in practice quality over the course of the MBSR intervention. Further, change in practice quality was associated with improvements in psychological symptoms. While this study was exploratory, these findings suggest that practice quality is a relevant factor to promote positive outcomes and may guide mindfulness instructors in providing highly tailored interventions.

The psychological impact of wrongful convictions: Exploring retrospective trajectories of distress in exonerees.

OBJECTIVE: Although an emerging body of research has examined the legal causes of wrongful convictions, there is little research that examines the psychological impact of wrongful convictions. This study aims to understand the psychological experiences of exonerees, with a focus on the role of meaning-making in individuals' reactions to trauma. The study also aims to examine exonerees' self-reported trajectories of distress throughout their experience of being wrongfully convicted and subsequently exonerated. METHOD: A total of 46 exonerees completed an online survey. Measures included: Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, PTSD Checklist for DSM-5, Posttraumatic Growth Inventory, World Assumptions Questionnaire, Meaning in Life Questionnaire, Satisfaction with Life Scale, and a self-reported retrospective trajectory measure. RESULTS: Cluster analysis suggested a four-factor solution: Chronic Distress, Relief and Readjustment, Recovery, and Intense Distress with Minimal Recovery. The Recovery cluster (n = 17; 37.0%) had significantly lower levels of PTSD and anxiety symptoms than the other three groups. The Recovery cluster had higher levels of positive world assumptions and lower levels of searching for meaning than the other three clusters, but there were no differences among clusters in level of meaning made, presence of meaning, depression symptoms, and satisfaction with life. CONCLUSIONS: The results revealed that exonerees with more positive world beliefs (conceptualized as an outcome of meaning-making) have lower rates of PTSD and anxiety. Consistent with the literature, results also suggest that the search for meaning may be indicative of increased distress and less recovery. Clinical and policy implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Longitudinal effects of psychotherapy with transgender and nonbinary clients: A randomized controlled pilot trial.

Minority stress has been determined to contribute to some mental health concerns for transgender, nonbinary, and gender nonconforming individuals, yet little is known regarding interventions to decrease the effects of minority stress. The purpose of this pilot study was to assess the feasibility and relative effectiveness of two interventions developed for work with transgender clients. Transgender individuals (N = 20) were recruited to participate in a randomized controlled trial comparing two psychotherapy interventions for transgender adults seeking psychotherapy for a variety of concerns: (a) transgender affirmative psychotherapy (TA) and (b) Building Awareness of Minority Stressors + Transgender Affirmative psychotherapy. Gender-related stress and resilience were assessed before, immediately after, and 6 months following the intervention; psychological distress and working alliance were assessed at these three time points as well as weekly during the intervention. Feasibility and acceptability of the study and psychotherapy interventions were supported. Exploratory analyses indicate improvement in both groups based on general outcome measures; targeted outcome measures indicate a trend of improvement for internalized stigma and nonaffirmation experiences. Results from this study support further evaluation of both treatment arms in a larger randomized controlled trial. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Applications of generalizability theory to clinical child and adolescent psychology research.

Using generalizability theory to evaluate the reliability of child and adolescent measures enables researchers to enhance precision of measurement and consequently increase confidence in research findings. With an observer-rated measure of child self-regulation, we illustrate how multiple sources of error variance (e.g., raters, items) affect the dependability (replicability) of scores and demonstrate methods for enhancing dependability of observer ratings. Using ratings of 181 children, we illustrate the use of two-facet (i.e., raters and items as sources of error) and three-facet (i.e., raters, items and occasions) analyses to optimize design features of future studies using this measure. In addition, we show how generalizability theory provides a useful conceptual framework for thinking about determinants of scores on acquaintance (e.g., teacher or parent) ratings, as well as observer ratings, and sheds light on the strengths and limitations of both types of data for child and adolescent clinical research.