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).

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.

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).

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).

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.

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.

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.

Does Group Size Matter? Group Size and Symptom Reduction Among Incarcerated Women Receiving Psychotherapy Following Sexual Violence Victimization.

Survivors Healing from Abuse: Recovery through Exposure (SHARE) is an eight-week therapy group for incarcerated women who have experienced sexual violence victimization. SHARE requires each member to complete an imaginal exposure and to listen when others share their experiences of victimization. While trauma-focused group interventions including SHARE are associated with reductions in internalizing symptoms, little work has examined how group characteristics predict symptom decreases. The purpose of this study was to examine whether group size was associated with symptom changes pre- to post-treatment. Participants (n=140 across 29 groups) completed self-report measures of posttraumatic stress symptoms before and after completing SHARE. Multilevel modeling revealed the majority of the variance in post-treatment symptoms was attributed to individual factors rather than group factors. Symptom change was comparable for groups of two to eight women; declines in symptom improvement were observed at a group size of ten participants.

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.

Barriers to integrated primary care and specialty mental health services: Perspectives from Latinx and non-Latinx White primary care patients.

Significant disparities in access to mental health care exist in the current mental health system; integrated primary care (IPC) offers an alternative model of service delivery with initial evidence for reducing disparities. Little is known about whether, and how, IPC reduces barriers to mental health services. Here we report on a set of three studies using mixed methodology to explore the perceptions of potential recipients of care regarding barriers to accessing mental health treatment by setting (IPC or specialty mental health [SMH]) and ethnicity (Latinx or non-Latinx White). In Study 1, a main effect of setting indicated IPC patients perceived fewer barriers to accessing IPC than SMH. A setting by ethnicity interaction revealed Latinx patients perceived greater barriers to SMH than non-Latinx White patients. In Study 2, data from qualitative interviews suggested IPC patients found behavioral health treatment in IPC to be accessible and satisfactory. In Study 3, a non-treatment-seeking sample did not endorse a difference in barriers by setting or ethnicity. Overall, it appears IPC patients perceive behavioral health treatment delivered in primary care to be satisfactory, beneficial, and successful in reaching individuals with mental health need who otherwise may not receive care. Non-treatment-seeking individuals with lower psychiatric distress did not identify a difference in barriers between IPC and SMH settings. Findings are consistent with the potential of the IPC setting for reducing barriers to care, although key elements of IPC may need to be addressed to increase acceptability across all population subgroups. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

Decreases in psychiatric symptoms persist following exposure-based group therapy for sexual violence victimization among incarcerated women.

Survivors Healing from Abuse: Recovery through Exposure (SHARE) is a brief, exposure-based group treatment for incarcerated female survivors of sexual violence. Preliminary evaluations of SHARE showed declines in depression and posttraumatic stress disorder (PTSD) symptoms from pre- to posttreatment. However, prior investigations have not included a longitudinal follow-up period and thus knowledge of whether therapeutic benefits persist following the termination of the group is lacking. Here, we examined data from 57 incarcerated women who completed SHARE and provided follow-up data while still incarcerated (M = 95 days posttreatment). Results from a one-way repeated-measures ANOVA showed significant reductions in PTSD and depression symptoms from pre- to posttreatment (large effect sizes), with symptoms further reduced during the follow-up period. In addition, McNemar tests showed a significant reduction in the proportion of participants at or above the clinical cut-off for probable PTSD and depression from pre- to posttreatment as well as from posttreatment to the follow-up assessment. Together, results suggest that the therapeutic benefits of SHARE persist after treatment is completed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Primary care behavioral health patients' stage of change: Correlates and relation to follow-up session attendance.

INTRODUCTION: In this study, we examined patients' readiness to change behavior (their stage of change) in a primary care behavioral health (PCBH) setting. We examined sociodemographic and health correlates of patients' stage of change and whether stage of change related to follow-up visit attendance. METHOD: One-hundred eleven adult primary care patients completed self-report measures of psychiatric symptoms, hope, and stage of change at their initial behavioral health session. Demographic, health information, and follow-up visit attendance were gathered from patient electronic health records. RESULTS: Results suggest most patients referred to PCBH providers were in preparation and action stages of change. At the bivariate level, older age and non-Latinx ethnicity were associated with greater readiness to change. At the multivariate level, older age and higher levels of hope were associated with later stages of change. Patients in preparation, but not action, stages of change were significantly more likely to attend a follow-up behavioral health appointment than were patients in precontemplation/contemplation. DISCUSSION: Findings suggest most PCBH patients are prepared to take action or have already taken action to improve their behavioral health. Further, a single item assessing patients' stage of change is associated with continued retention in behavioral health treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Bystander Intoxication and Appraisal of Sexual Assault Risk: A Field Study of Emerging Adult Bargoers.

Emerging adults are especially vulnerable to experiencing alcohol-related sexual assault. While bystanders play a critical role in preventing sexual assault, little is known about how bystander alcohol intoxication affects the intervention process-particularly in naturalistic settings. We recruited 315 emerging adult bargoers ages 21-29 (46% women; 28% non-college attending; 81% White) from a high-density bar area to provide responses to a sexual assault vignette and complete a breath alcohol concentration test. In this field-based study, we found a negative direct association between intoxication and appraisal of risk in the hypothetical sexual assault situation. We also found a negative indirect relation of intoxication on perceptions of personal responsibility to intervene and confidence in the ability to intervene, statistically mediated through reduced risk appraisal. Findings add to the limited literature in laboratory-based settings suggesting that bystander intoxication interferes with sexual assault intervention and help inform effective bystander intervention programming for emerging adults.

"I'm not alone, my story matters": Incarcerated women's perspectives on the impact and acceptability of group psychotherapy involving imaginal exposure to sexual assault memories.

BACKGROUND: Although it is clear that incarcerated women need access to effective therapies for trauma sequelae, some have argued that one of the most effective treatments - exposure therapy - should not be provided in carceral settings due to the presumed lack of safety and stability making such an intervention inappropriate. Group therapy, the typical mode of intervention in prisons, has also been presumed to be unacceptable for exposure-based processing due to assumptions that hearing others' trauma narratives would be traumatizing and unhelpful to listeners. However, there is a lack of data to support either of the aforementioned assumptions. This study examined the acceptability of an exposure-based group therapy for women survivors of sexual violence who were currently incarcerated (N = 61) by asking women themselves about their experiences completing an exposure-based group therapy protocol (SHARE; Survivors Healing from Abuse: Recovery through Exposure) while incarcerated. We assessed women's reasons for enrolling in the group, satisfaction with various therapy components (e.g., exposure, skill-building) and the treatment overall, and experiences of both sharing and listening to trauma narratives using a feedback survey that included a mix of multiple-choice and open-ended questions. Treatment dropout was examined as an additional index of acceptability. RESULTS: Treatment completion was very high (88.8%). Nearly all women who completed the group reported that they would recommend it to other incarcerated women (96.7%, with the remaining 3.3% reporting "it depends"). Qualitative results revealed overwhelmingly positive feedback about the effect of the group and indicated that sharing and listening to trauma narratives in a group setting serve discrete but dually important functions. Specifically, women almost universally experienced listening to others' trauma narratives (i.e., exposures) in the SHARE group context as helpful-making them feel less alone and normalizing their experiences. Sharing one's own story primarily provided an emotional release and/or transformation (i.e., an intrapersonal rather than interpersonal function). CONCLUSIONS: Our findings challenge common concerns about the appropriateness of 1) prison as a context for trauma-focused treatments, including exposure and 2) sharing trauma narratives in a group setting. Unless empirical evidence demonstrating harm is uncovered, best practices for PTSD and other trauma-related sequelae-those recommended in reputable treatment guidelines and interventions like SHARE that incorporate components shown to be effective (e.g., cognitive challenging, exposure)-should be offered to incarcerated women as part of standard of care.

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.

Assessing the Within-Person Variability of Internal and External Sexual Consent.

Sexual consent is often conceptualized as an internal willingness to engage in sexual activity, which can be communicated externally to a sexual partner. Internal sexual consent comprises feelings of physical response, safety/comfort, arousal, agreement/want, and readiness; external sexual consent includes communication cues that may be explicit or implicit and verbal or nonverbal. Most previous research on sexual consent has focused on between-person differences; little attention has been devoted to examining the within-person variation of sexual consent across time. We conducted a 28-day experience sampling methodology (ESM) study with a sample of adults (N = 113) to assess fluctuations in internal and external sexual consent across a given person's sexual events. We found that more than 50% and up to 80% of the variance in sexual consent scores could be accounted for by within-person variability. The type of sexual behavior participants engaged in during a sexual event predicted their internal and external consent. Further, internal consent feelings predicted external consent communication. Overall, our findings provided initial evidence regarding the extent that situational contexts are relevant for sexual consent. ESM study designs may be used to further investigate the potential contextual, intrapersonal, and interpersonal factors associated with internal and external sexual consent.

Developing Valid and Feasible Measures of Sexual Consent for Experience Sampling Methodology.

Preliminary evidence indicates that people's sexual consent (i.e., their willingness to engage in sexual activity and communication of that willingness) varies across time and context. Study designs that assess sexual consent at multiple time points (e.g., experience sampling methodology [ESM]) are needed to better understand the within-person variability of sexual consent. However, extant validated measures of sexual consent are not appropriate for ESM studies, which require shorter assessments due to the increased burden this methodology has on participants. As such, the goal of the present study was to develop ESM measures of sexual consent based on items that have previously been validated for use in cross-sectional surveys. We selected items that balanced face validity as evidenced by cognitive interviews (n = 10) and content validity as evidenced by experts' ratings (n = 6). To assess the construct validity and feasibility of these items, we administered the selected ESM measures of sexual consent in a seven-day pilot study (n = 12). The results suggested that the ESM measures developed in the present study were a valid and feasible assessment of people's experience-specific internal consent feelings and external consent communication. We conclude with recommendations for sex researchers interested in ESM.

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.

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.