Bedtime procrastination mediates the relation between anxiety and sleep problems.

The prevalence of sleep problems is high in primary care patients and in anxious individuals. This study assessed whether total sleep time and bedtime procrastination mediated the association between anxiety and sleep problems. We predicted higher anxiety would be negatively associated with total sleep time and positively associated with bedtime procrastination and sleep problems, and these variables would statistically mediate the association between anxiety and sleep problems. Participants were 308 adult primary care patients, predominantly female (non-Hispanic White = 158, Latinx = 111, mean age = 33.30), who initiated behavioral health services at an integrated primary care clinic. Patients completed a questionnaire regarding psychological health and sleep behaviors. Using structural equation modeling, we found higher anxiety related to higher sleep problems, partially mediated by bedtime procrastination but not total sleep time. This study highlights related factors like anxiety and prebedtime behaviors that may be effective treatment targets for sleep challenges.

The effect of feedback and recollection rejection instructions on the development of memory monitoring and accuracy.

Recollection rejection (a form of memory monitoring) involves rejecting false details on the basis of remembering true details (recall to reject), thereby increasing memory accuracy. This study examined how recollection rejection instructions and feedback affect memory accuracy and false recognition in 5-year-olds, 6- and 7-year-olds, 8- and 9-year-olds, and adults. Participants (N = 336) completed three study-test phases. Instructions and item-level feedback were manipulated during the first two phases, with the third phase including a test containing no instructions or feedback to evaluate learning effects. As predicted, in the younger children, as compared with the older children and adults, we found reduced accuracy scores (hits to studied items minus false alarms to related lures), reduced recollection rejection to related lures, and increased false recognition scores. We also found that, in the third phase, prior feedback reduced false recognition scores, potentially by improving monitoring, and typical developmental differences in false recognition were eliminated. However, there were mixed findings of instructions and feedback, and in some conditions these interventions harmed memory. These findings provide initial evidence that combining instructions and feedback with repeated task practice may improve monitoring effectiveness, but additional work is needed on how these factors improve and sometimes harm performance in young children.

Measuring Productivity in Primary Care Behavioral Health: A Delphi Study.

High productivity by behavioral health consultants (BHC) is a defining aspect of the primary care behavioral health (PCBH) model to maximize access to care and is often measured by patient volume. Studies of productivity in health care settings suggest a single productivity target may not be optimal. We used a Delphi method to obtain expert consensus on an operational definition of high productivity by BHCs in the PCBH model. Clinicians, managers, and researchers in PCBH were recruited to participate in a multi-round survey using a modified Delphi technique and develop consensus on PCBH productivity metrics. Ten participants completed all three survey rounds and rated 28 metrics. After three rounds, two direct metrics (average number of billable BHC visits each day; number of patients seen per day) received at least 80% consensus as "Essential", two received at least 50%, and five received less than 50%. One influencer (level of integration at the practice) received at least 80% consensus as "Very Much" influential, 19 received at least 50%, and eight items received less than 50%. Several themes arose from participant comments. PCBH productivity can be interpreted as being high volume. Numerous practice factors influence how productive a BHC may be. Future studies should determine the feasibility of our metrics in clinical practice, establish productivity expectations based on patient needs and clinic resources, and identify patient-, clinician-, or practice-level moderators of productivity.

Implementing and Sustaining SHARE: An Exposure-Based Psychotherapy Group for Incarcerated Women Survivors of Sexual Violence.

Although incarcerated women are a highly victimized population, therapy for sexual violence victimization (SVV) sequela is not routinely offered in prison. SHARE is a group therapy for SVV survivors that was successfully implemented and sustained in a women's correction center. Here, we aimed to identify implementation factors and strategies that led to SHARE's success and describe incarcerated women's perspectives on the program. We conducted a retrospective process evaluation using interviews structured according to EPIS, a well-established implementation science framework. Participants (N = 22) were incarcerated women, members of the SHARE treatment team, and members of the correction center's leadership, therapeutic team, and volunteer program. Factors that facilitated SHARE implementation varied by EPIS phase and organization. Positive inter-organizational and interpersonal relationships were key across phases, as were the synergies between both the strengths and needs of each organization involved in implementation. Incarcerated women reported a strong need for SHARE and did not report any concerns about receiving trauma therapy in a carceral setting. Therapy for SVV sequelae, including exposure-based therapy, is possible to implement and sustain in carceral settings. Community-academic partnerships may be a particularly feasible way to expand access to SVV therapy for incarcerated women.

Alcohol's Effects on Bystander Intervention Strategies to Prevent Sexual Assault.

Alcohol's effects on bystander responses to potential sexual assault situations are understudied. In this mixed-methods study, we examined quality of bystander responses in intoxicated versus sober people. Participants were 121 young adults (ages 21-29, 50% female) randomly assigned to consume alcoholic beverages or soda water. After drinking, participants listened to a sexual assault vignette and completed a semistructured interview assessing how they would respond if they had witnessed the situation. Nearly all participants reported they would directly intervene if faced with the situation. Intoxicated participants and men were significantly less likely to use high-quality bystander intervention strategies than were sober participants and women. Results suggest that alcohol intoxication may negatively impact the likelihood that bystander intervention efforts will be helpful.

Interpersonal vs. Non-Interpersonal Cumulative Traumas and Psychiatric Symptoms in Treatment-Seeking Incarcerated Women.

Incarcerated women are at elevated risk of lifetime trauma exposure. Prevalence rates of trauma exposure and how these events relate to specific domains of psychiatric symptomology among this group are lacking. This study hypothesized a greater range of diverse cumulative trauma experiences (CTEs) would be positively associated with psychiatric symptoms in general (depression, PTSD, distress tolerance), but that interpersonal CTEs in particular would be uniquely associated with greater symptoms of guilt and shame. A total of 112 women (87% White, Mage = 34 years) seeking treatment for a history of sexual violence victimization participated in the study. Women incarcerated for nonviolent offenses at two minimum-security prisons completed self-report measures of exposure to diverse traumatic events and internalizing symptoms. On average, participants reported a history of experiencing 5.46 traumatic event types. Total CTEs was significantly associated with all psychiatric variables in the expected direction. While both interpersonal and non-interpersonal CTEs were positively associated with levels of PTSD, depression, and distress intolerance, only interpersonal CTEs were significantly associated with guilt and shame. Traumatic experiences that are interpersonal in nature may confer specific risk for psychiatric symptoms in victims.

I (Dis)Like it Like That: Gender, Pornography, and Liking Sex.

Rates of pornography consumption in the U.S. are high and increasing. With exploratory aims, this study addresses the questions: What is the association between pornography consumption and liking of sexual behaviors commonly depicted in pornography, and is enjoyment moderated by gender? Sexual scripts theory suggests that increased pornography consumption is associated with increased engagement in pornographic sex acts, but it does not speak to enjoyment of the acts when engaged. The current study seeks to fill that gap. Based on data collected from a larger sample of 1,883 heterosexual men and women (predominantly, 86.6%, college or university students) in the U.S., and comparing correlations between pornography consumption (frequency of use) and reported enjoyment of a range of sexual behaviors by gender using Fisher's z transformations (α value set at <.0025), analysis revealed that pornography consumption, overall, was not significantly correlated with increased enjoyment of the sexual acts that comprise the pornographic sexual script. However, gender was a significant moderating factor in the enjoyment, specifically, of degrading and/or uncommon acts. Male respondents were significantly more likely to report enjoying these acts than their female counterparts. These findings have possible implications for consumers, educators, and mental health professionals.

A Retrospective Examination of Symptom Improvements in Primary Care Patients Receiving Behavior Therapy With and Without Concurrent Pharmacotherapy.

Primary care providers are the biggest prescribers of psychopharmacological medications. In this non-randomized retrospective examination, we asked whether primary care patients receiving behavioral health interventions with and without concurrent pharmacological treatments showed differential symptom improvement. Participants (79.4% women, 61.5% Hispanic, M age = 41.68, SD = 13.50) were 431 primary care patients referred to behavioral health with a primary concern of depression at one of three federally qualified health centers. Thirty-three percent of patients initiated or had an increase in pharmacotherapy concurrently with behavioral therapy; 26.9% had no change in medication during the episode of care, and 39.7% had no concurrent psychotropic medication prescribed during the episode of care. One-way analyses of variance revealed patients in the no medication group had higher global functioning, as measured by Global Assessment of Functioning (GAF) scores, than patients who were taking medication, or who initated or had an increase in medication. There was a significant main effect of time, where patients had significantly higher GAF scores during their last session in comparison to the first session. All three patient groups experienced comparable improvements in GAF scores, but patients in the initiated/increased medication group were significantly more likely to terminate behavioral health treatment prematurely. Results suggest primary care patients experience improvements in functioning across an episode of behavioral health care, even without concurrent psychotropic medication use.

Personal Pornography Viewing and Sexual Satisfaction: A Quadratic Analysis.

Personal pornography viewing has been associated with lower sexual satisfaction in both experimental and observational research. The language used to hypothesize this relationship typically suggests that it is frequent viewing, rather than infrequent or only occasional viewing, that is responsible for any adverse effects. When the nature of the relationship between a predictor and a criterion depends on the levels of the predictor, a curvilinear relationship is indicated. Nevertheless, studies have assumed linearity in their analytical approach. Curvilinear relationships will go undetected unless they are specifically tested. This article presents results from a survey of approximately 1,500 U.S. adults. Quadratic analyses indicated a curvilinear relationship between personal pornography viewing and sexual satisfaction in the form of a predominately negative, concave downward curve. The nature of the curvilinearity did not differ as a function of participants' gender, relationship status, or religiosity. But the negative acceleration was slightly more pronounced for men than for women, for people not in a relationship than for people in a relationship, and for religious people than for nonreligious people. For all groups, negative simple slopes were present when viewing reached once a month or more. These results are correlational only. However, if an effects perspective were adopted, it would suggest that consuming pornography less than once a month has little or no impact on satisfaction, that reductions in satisfaction tend to initiate once viewing reaches once a month, and that additional increases in the frequency of viewing lead to disproportionately larger decrements in satisfaction.

Children's Use of Memory Editing Strategies to Reject Source Misinformation.

This is the first reported study of children's use of two metacognitive strategies, recollection rejection and diagnostic monitoring, to reject misinformation. Recollection rejection involves the retrieval of details that disqualify an event, whereas diagnostic monitoring involves the failure to retrieve expected details. First (n = 56, age 7 years) and third graders (n = 52, age 9 years) witnessed a staged classroom interaction involving common and bizarre accidents, were presented with misinformation about the source of these events, and took a memory test. Both age groups used recollection rejection, but third graders were more effective. There was little evidence that diagnostic monitoring influenced responses for bizarre events, potentially because these events were not sufficiently bizarre in the context of the stereotype induction.

Effects of feedback and test practice on recollection and retrieval monitoring: comparing first graders, third graders, and adults.

We tested the effects of repeated testing and feedback on recollection accuracy in first graders, third graders, and adults. All participants studied a list of words and pictures, and then took three recollection tests, with each test probing different words and pictures from the earlier study phase. On the first and third tests no feedback was given, whereas on the second test, some subjects received item-level feedback throughout the recollection test. Recollection confusion scores declined across successive tests in all age groups. However, explicit feedback did not improve recollection accuracy or reduce recollection confusions in any age group. We also found that all age groups were able to use picture recollections in a disqualifying monitoring strategy without task experience or feedback. As a whole, these findings suggest that children and adults can use some aspects of retrieval monitoring without feedback or practice, whereas other aspects of retrieval monitoring can benefit from test practice in children and adults. We discuss the potential roles of metacognitive learning and unintended social feedback on these test practice effects.

Undifferentiated Gender Role Orientation, Drinking Motives, and Increased Alcohol Use in Men and Women.

BACKGROUND: Alcohol misuse has historically affected men more than women. However, the differences in drinking behaviors across sex have steadily decreased over time and accumulating research suggests that gender role orientation, or culturally scripted gender-specific characteristics, and negative reinforcement drinking motives may better explain risk for alcohol use and related problems than sex. OBJECTIVES: The current study tested a mediational model of the undifferentiated orientation (low masculinity and low femininity), an oft neglected orientation despite evidence that it could carry much weight in drinking behaviors, versus the other three gender role orientations, coping and conformity drinking motives, and hazardous alcohol use. METHOD: Participants were 426 current drinkers over age 21 (41% men; 77.8% Caucasian; Mage = 34.5, range = 21-73) residing across the United States who completed an online survey. RESULTS: Structural equation modeling analyses suggested that individuals with an undifferentiated orientation (n = 99), compared to masculine (high masculinity, low femininity; n = 102), feminine (high femininity, low masculinity; n = 113), or androgynous (high masculinity, high femininity; n = 112) orientations, reported higher coping drinking motives, which were positively associated with levels of hazardous alcohol use. Although analyses suggested that undifferentiated individuals reported drinking for conformity motives more often than masculine and androgynous individuals, conformity motives were not associated with increased use. Conclusions/Importance: An undifferentiated gender role orientation may contribute a unique risk for alcohol use and related problems by increasing frequency of drinking to cope, a motive specifically associated with hazardous use trajectories.

Sexual violence therapy group in a women's correctional facility: a preliminary evaluation.

This pilot study was an evaluation of an 8-week exposure-based therapy group targeting sexual trauma in incarcerated women, an underserved population with high rates of trauma exposure. Preliminary findings from 14 female prisoners showed significant decreases in depressive and anxiety symptoms from pre- to posttreatment. Of the women who were above the screening cutoff for possible posttraumatic stress disorder (PTSD; n = 13), depression (n = 12), and generalized anxiety disorder (GAD; n = 12) at pretreatment, approximately 60% had recovered, meaning they had symptom reductions that placed them below the cutoff at posttreatment (n = 8 for PTSD; n = 8 for depression, and n = 9 for GAD). In addition, 85% of participants reported a clinically significant reduction in depressive symptoms and 50% in GAD symptoms. The findings show promise for successful group treatment of sexual violence sequelae in incarcerated women.

The manifestation of health equity tourism in psychological science and research.

Health equity tourism (HET) represents yet another example of how structural racism may manifest in our discipline. While not a new phenomenon, HET was coined recently in the context of medicine and is defined as investigators without the requisite experience or commitment to health equity work "parachuting into the field in response to timely and often temporary increases in public interest and resources" (Lett et al., 2022, p. 2). To determine how HET manifests in psychological science, we interviewed 18 health equity experts. Data were analyzed using reflexive thematic analysis. Results revealed that HET manifests as a passing interest in health equity research, minimal engagement with communities under study or with health equity experts, and a failure to appreciate health equity scholarship as a specialty area of psychological science. Consequences of HET include poor quality research, harm to communities under study, funneling of resources away from health equity experts, frustration with and disengagement from the field and academia (leading to slow career advancements and attrition), and a maintenance of structural racism in psychological science. We provide recommendations for preventing the further manifestation of HET in psychology and for reducing the associated harms. These recommendations include education and training regarding the construct of HET, engagement in reflective practice, and a reconsideration of how research with minoritized populations is approached and evaluated. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Telebehavioral health at a federally qualified health center pre- and peri-COVID-19.

Federally Qualified Health Centers (FQHCs) are a safety net for low-income individuals needing mental and/or physical health care. The COVID-19 pandemic required FQHCs (and other health organizations) to pivot rapidly to telehealth. In theory, telehealth services can expand access to needed care. The COVID-19 pandemic provides a natural opportunity to "test" this assumption. We compared sociodemographic differences in patients accessing behavioral health services pre- and peri-COVID-19 at an FQHC. We also investigated potential patient sociodemographic disparities in telebehavioral health service use during the first year of the COVID-19 pandemic. Data were collected from a single FQHC (13 sites, 4 integrated primary care medical clinics) in the southern United States. Participants included 5,190 patients (69.2% female, 59.7% persons of color) attending a total of 16,474 behavioral health sessions across 2 years (one pre- and one peri-COVID-19). Before the COVID-19 pandemic, 100% of behavioral health visits were conducted in person. During the pandemic, nearly half of behavioral health visits were conducted via telehealth. Telehealth visits were most frequently attended by adults, non-Latinx Whites, women, and people making ≤ 200% of the federal poverty level. A combination of in-person and telehealth service delivery models should be used by FQHCs to maximize access to care for different demographic groups. FQHCs should consider key factors (e.g., access, ableism, technology facility, and language) to increase patients' ability to take advantage of telehealth services where available. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Acculturation and Depression Help-Seeking Intentions in a Majority Mexican American College Student Sample.

Work has not examined if acculturation or enculturation may predict endorsed benefits, barriers, and intentions to seek mental health services for depression, specifically among Latino students enrolled in a rural and majority Latino immigrant institution of higher education. An improved understanding of factors informing mental health help-seeking is needed to identify possible intervention points to address gaps in accessing depression treatment. Participants (N = 406) read a vignette depicting a person with depressive symptoms. Participants were asked if they would seek help for depression if in the situation described in the vignette. Participants provided text responses about their preferences for managing depression symptoms and their mental health help-seeking history. Additionally, participants completed a self-report depression symptom screener, demographic surveys, acculturation assessment, and questionnaires on perceived benefits and barriers to seeking mental health services. Path analysis was used to test the link between acculturation status and intent to seek services for depression, with benefits and barriers as mediators. The results revealed that higher perceived benefits and lower barriers were directly associated with greater intentions to seek help. Furthermore, an indirect effect of acculturation on help-seeking intentions via higher perceived benefits of seeking care was observed. These findings persisted after controlling for age, gender, depression, and history of seeking care for depression. Future work should test the replicability of this finding with diverse college students living in predominantly immigrant communities. Universities might consider tailoring outreach initiatives to provide information on the range and accessibility of mental health services, the location of mental health service centers, and the procedures for accessing such services.

Victim Centered, Aggressor Focused, and Bystander Friendly: A Qualitative Analysis of Bystander Intervention Strategies and Outcomes for Sexual Harassment or Assault.

Limited qualitative research has been conducted to understand the experiences of victims of sexual harassment or assault (SHA) when a bystander intervenes. Even less research has focused on the consequences of bystander actions from the victim's perspective, particularly regarding the aggressor's subsequent behavior toward the victim and occurrence of verbal or physical harm to those involved. This qualitative study aimed to address these limitations with the following research questions: (a) what strategies did victims of SHA identify bystanders use when intervening? (b) what strategies were present when the aggressor's behavior was stopped, paused, or continued toward the victim? and (c) what strategies were present when verbal or physical harm occurred to someone involved? Adult women between the ages of 18 to 30 (N = 25, college student = 80%) were interviewed about one situation of bystander intervention during SHA since the age of 16 years. Findings suggest that victims identified direct, distance, distract, delegate, and proximity strategies by bystanders. Most participants reported that the aggressor's behavior stopped or paused following bystander action, and in these cases, at least one distance or direct strategy was reportedly used most frequently. Approximately, 24% and 8% of participants reported verbal or physical harm, respectively, to at least one party. Direct and distance strategies were most frequently mentioned in experiences of SHA that involved harm. When the aggressor's behavior continued (i.e., was not altered during the event) despite bystander actions, strategies most frequently reported included distract, delegate, and proximity. Together, results suggest that bystander intervention training programs and future research may be needed to understand under what contexts certain strategies successfully prevent or thwart SHA while maintaining emotional and physical safety for those involved.

Pornography Use and Sexual Objectification of Others.

Researchers have demonstrated associations between use of pornography and sexual objectification of women. We examine whether self-reported preference for degrading pornography moderated the relation between use frequency and sexual objectification of others. Participants were 1,342 heterosexual women and men residing in the United States. In women and men, pornography use frequency was associated with the sexual objectification of others, even after controlling for interest in generally explicit content. In men, interest in degrading pornography content significantly predicted sexual objectification of women. Our results suggest greater pornography use is associated with greater sexual objectification of others, across a variety of content categories.

To SHARE or not to SHARE: Exploring incarcerated women's decisions about enrolling in exposure-based group therapy.

Exposure therapies effectively treat traumatic stress sequelae, including that which follows sexual violence victimization (SVV). Carceral facilities house women with significantly higher rates of SVV than community samples, yet they rarely implement this form of treatment. In this study, women with histories of SVV (n = 63) completed semistructured qualitative interviews about their decision to enroll or not enroll in an exposure-based group therapy called Survivors Healing from Abuse: Recovery through Exposure while incarcerated. All study participants were previously incarcerated in a prison, where they were offered the opportunity to enroll in Survivors Healing from Abuse: Recovery through Exposure. We used the theory of planned behavior to analyze factors that affected enrollment decisions. Results revealed that enrollment decisions among incarcerated women can be categorized within the theory of planned behavior framework. Interview responses indicated that recognizing current problems as related to experiences of SVV, holding positive attitudes about mental health treatment, observing peers engaging in help-seeking behaviors, and perceiving treatment as accessible were linked with enrollment. Negative perceptions of treatment, fear of judgment, and negative peer influence (e.g., distrust of peers) were linked to decisions not to enroll. While certain beliefs were influenced by contextual features of incarceration (e.g., peer interactions outside of group therapy), many overlapped with factors found to influence help-seeking among nonincarcerated populations. Findings have implications for how to engage members of underserved populations in resource-deprived contexts who have a great need for treatment of traumatic symptoms secondary to sexual violence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Peritraumatic dissociation and peritraumatic emotional predictors of PTSD in Latino youth: results from the Hispanic family study.

This is the 1st study to examine peritraumatic dissociation and peritraumatic emotions as they predict symptoms and diagnosis of posttraumatic stress disorder (PTSD) in Latino youth. Our aim was to test the hypothesis that the degree of peritraumatic dissociation would predict the number of PTSD symptoms and PTSD clinical diagnosis when the influences of other salient factors were statistically controlled. We also explored the possible contributions of peritraumatic emotional responses to PTSD symptomatology and PTSD diagnosis. We expected that peritraumatic dissociation would emerge as a significant predictor of PTSD. A total of 204 Latino youth (mean age = 12.37 years) completed semistructured individual clinical interviews with bilingual research assistants. These interviews assessed trauma exposure, peritraumatic responses, and current psychopathology. A linear regression analysis demonstrated significant relationships between lifetime number of traumatic events, peritraumatic dissociation, shame, and number of PTSD symptoms endorsed. Significant inverse (protective) relationships were demonstrated between anger and guilt and current PTSD symptomatology. Logistic regression analysis demonstrated significant relationships between peritraumatic dissociation, shame, lifetime number of traumatic events experienced, and PTSD diagnosis. The analyses examined both the number of PTSD symptoms as well as diagnosis of PTSD while simultaneously controlling for age, lifetime exposure to traumatic events, time residing in the United States, and gender. These results support an increasingly robust body of empirical literature suggesting that the peritraumatic dissociative and emotional responses to trauma are important predictors of future PTSD diagnosis. Possible cultural factors contributing to the dissociative responses in Latino youth and clinical implications are discussed.