A pilot test of Written Exposure Therapy for PTSD in residential substance use treatment.

BACKGROUND AND OBJECTIVES: Posttraumatic stress disorder (PTSD) is highly comorbid with substance use disorders (SUD) and can impede SUD recovery. Residential SUD treatment is a crucial opportunity to address PTSD. However, PTSD treatment is lacking in residential SUD care. METHODS: We conducted a nonrandomized feasibility study of Written Exposure Therapy (WET), a brief, evidence-based treatment for PTSD, with patients in residential SUD treatment. We assessed attitudes towards treatment (Credibility and Expectancy Questionnaire, Barriers to Treatment Participation Scale) and mental health indicators (PTSD Checklist for DSM-5, Trauma Coping Self-Efficacy, Difficulties in Emotion Regulation-Short Form, and Brief Assessment of Recovery Capital). RESULTS: Thirty of 49 eligible participants completed WET (61%) and 92% (n = 45) attended at least one WET session. Paired sample t-tests revealed significant posttreatment improvement across all mental health indicators, with medium to large effect sizes. DISCUSSION AND CONCLUSIONS: Attendance and completion rates compared favorably to prior exposure-based treatment for PTSD in SUD settings. Although causality cannot be inferred without a randomized controlled trial, mental health indicators, including PTSD, improved significantly following WET. SCIENTIFIC SIGNIFICANCE: These findings provide evidence that PTSD can be successfully treated in short-term residential care using brief exposure-based interventions, which is a crucial clinical need that has been minimally studied in the past.

Exaggerated meta-perceptions predict intergroup hostility between American political partisans.

People's actions toward a competitive outgroup can be motivated not only by their perceptions of the outgroup, but also by how they think the outgroup perceives the ingroup (i.e., meta-perceptions). Here, we examine the prevalence, accuracy, and consequences of meta-perceptions among American political partisans. Using a representative sample (n = 1,056) and a longitudinal convenience sample (n = 2,707), we find that Democrats and Republicans equally dislike and dehumanize each other but think that the levels of prejudice and dehumanization held by the outgroup party are approximately twice as strong as actually reported by a representative sample of Democrats and Republicans. Overestimations of negative meta-perceptions were consistent across samples over time and between demographic subgroups but were modulated by political ideology: More strongly liberal Democrats and more strongly conservative Republicans were particularly prone to exaggerate meta-perceptions. Finally, we show that meta-prejudice and meta-dehumanization are independently associated with the desire for social distance from members of the outgroup party and support for policies that harm the country and flout democratic norms to favor the ingroup political party. This research demonstrates that partisan meta-perceptions are subject to a strong negativity bias with Democrats and Republicans agreeing that the shadow of partisanship is much larger than it actually is, which fosters mutual intergroup hostility.

The stigmatization of nonsuicidal self-injury.

OBJECTIVE: Despite the high prevalence of nonsuicidal self-injury (NSSI), no research has systematically studied the occurrence and effects of stigmatization by others towards NSSI scarring. METHODS: The current study measured implicit and explicit attitudes among undergraduates towards NSSI scarring using the implicit association test and questionnaires to compare implicit and explicit biases towards NSSI with biases towards tattoos, a culturally sanctioned form of self-determined marking, as well as nonintentional disfigurement. RESULTS: Our study demonstrated strong negative implicit and explicit biases towards NSSI when comparing NSSI to tattoos and nonintentional disfigurement. CONCLUSIONS: Results extend previous research describing stigma towards mental illness and suggest a large negative bias towards NSSI. The importance of studying how stigma affects those who bear scarring from NSSI is discussed.

Selecting Patients for Intra-Arterial Therapy in the Context of a Clinical Trial for Neuroprotection.

BACKGROUND AND PURPOSE: The advent of intra-arterial neurothrombectomy (IAT) for acute ischemic stroke opens a potentially transformative opportunity to improve neuroprotection studies. Combining a putative neuroprotectant with recanalization could produce more powerful trials but could introduce heterogeneity and adverse event possibilities. We sought to demonstrate feasibility of IAT in neuroprotectant trials by defining IAT selection criteria for an ongoing neuroprotectant clinical trial. METHODS: The study drug, 3K3A-APC, is a pleiotropic cytoprotectant and may reduce thrombolysis-associated hemorrhage. The NeuroNEXT trial NN104 (RHAPSODY) is designed to establish a maximally tolerated dose of 3K3A-APC. Each trial site provided their IAT selection criteria. An expert panel reviewed site criteria and published evidence. Finally, the trial leadership designed IAT selection criteria. RESULTS: Derived selection criteria reflected consistency among the sites and comparability to published IAT trials. A protocol amendment allowing IAT (and relaxed age, National Institutes of Health Stroke Scale, and time limits) in the RHAPSODY trial was implemented on June 15, 2015. Recruitment before and after the amendment improved from 8 enrolled patients (601 screened, 1.3%) to 51 patients (821 screened, 6.2%; odds ratio [95% confidence limit] of 4.9 [2.3-10.4]; P<0.001). Gross recruitment was 0.11 patients per site month versus 0.43 patients per site per month, respectively, before and after the amendment. CONCLUSIONS: It is feasible to include IAT in a neuroprotectant trial for acute ischemic stroke. Criteria are presented for including such patients in a manner that is consistent with published evidence for IAT while still preserving the ability to test the role of the putative neuroprotectant. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02222714.

Improving intergroup relations with meta-perception correction interventions.

We explore meta-perceptions (i.e., what we think others think about reality), their impact on intergroup conflict, and the interventions correcting these often-erroneous perceptions. We introduce a two (direct or indirect) by two (with or without framing) framework classifying these interventions, and we critically assess the benefits and constraints of these approaches.

Stress Exposure and PTSD in a Cross-Sectional Residential Substance Use Treatment Sample.

BACKGROUND: Aim 1 of this cross-sectional, observational study with people in residential treatment for substance use disorders (SUDs) was to document stress exposure. Aim 2 was to assess potential sociodemographic and health differences based on probable posttraumatic stress disorder (PTSD) status. Aim 3 was to assess relative contributions of Diagnostic and Statistical Manual (DSM)-congruent versus DSM-incongruent stressors (Criterion A vs non-Criterion A) to mental and physical health. We hypothesized that both types of stressors would significantly contribute to impairment across indicators and that DSM-congruent stressor exposure would be more strongly associated with impairment than DSM-incongruent exposure. METHODS: We assessed exposure to DSM-congruent traumatic stressors and DSM-incongruent life stressors, PTSD and depressive symptoms, emotion regulation difficulties, substance use recovery capital, and physical/mental health-related quality of life among 136 people in residential SUD treatment who were 64% men, 36% women; 49% white, 41% Black, 11% multiracial/another race; 18% lesbian, gay, or bisexual (LGB+); mean age = 39.82 (standard deviation = 12.24) years. RESULTS: Participants reported experiencing a mean of 9.76 (SD = 6.11) DSM-congruent events. Those with probable PTSD were younger and more likely to be LGB+ than those without probable PTSD (P < .05). Experiencing higher numbers of DSM-congruent events was associated with more severe PTSD and depressive symptoms, emotion regulation difficulties, and lower physical health-related quality of life (P < .05). DSM-incongruent stressor exposure was not independently associated with any indicators. Recovery capital was not associated with either type of stress exposure. CONCLUSIONS: Stressful event exposure among people in residential SUD treatment is very high. Those who are younger or LGB+ in residential SUD treatment may be at greater risk of developing PTSD. DSM-congruent stressors are more consistently associated with mental health indicators than are DSM-incongruent stressors. Prioritizing treatment targets and identifying implementable treatment strategies can be challenging with this complex population.

The Effect of Social Anxiety on the Risk of Sexual Victimization via Assertiveness in an Ethnically Diverse Sample.

Preliminary evidence suggests social anxiety may increase the risk of sexual victimization via decreased sexual assertiveness. A sample of 2,043 undergraduate students completed an online survey. Analyses of moderated indirect effects examined whether gender or ethnicity moderated the indirect effect of social anxiety on sexual victimization via sexual assertiveness. No moderation effects were found, but the indirect effect of social anxiety on sexual victimization via sexual assertiveness was significant for all five types of sexual victimization. Clinically, the findings suggest that sexual assault risk reduction programs may be improved by including assertive resistance strategies and behavioral rehearsals.

We cannot empathize with what we do not recognize: Perceptions of structural versus interpersonal racism in South Africa.

Recent research suggests holding a structural, rather than interpersonal, understanding of racism is associated with greater impetus to address racial disparities. We believe greater acknowledgment of structural racism also functions to mitigate against empathic failures in response to structural injustices. Given South Africa's situatedness as a country characterized by historical racialized oppression and continuing unjust legacies, it is appropriate to examine these ideas there. Across three studies, we tested the hypotheses that members of advantaged groups' perspective taking and empathic concern may be compromised in response to people challenging the unequal status quo, and that a priori perceptions about the impact of structural (vs interpersonal) racism may mitigate or exacerbate such empathic failures. In Study 1, a national sample of White South Africans (n = 195) endorsed perceptions of interpersonal racism more readily than perceptions of structural racism, and expressed high levels of competitive victimhood for perceived anti-White structural racism. Studies 2 (n = 138) and 3 (n = 85) showed that White participants at a historically White university responded with impaired perspective taking and intergroup empathy bias in response to people challenging structural disparities. Finally, reduced recognition of continuing structural racism predicted greater intergroup empathy bias, which, in turn, was associated with reduced willingness to engage in intergroup discussions about past harm (Study 3). We propose that greater acknowledgment of structural racism is necessary not only to surmount intergroup empathic failures, but also to transcend the socioeconomically unequal legacies of apartheid and beyond.

Intervention Tournaments: An Overview of Concept, Design, and Implementation.

A large portion of research in the social sciences is devoted to using interventions to combat societal and social problems, such as prejudice, discrimination, and intergroup conflict. However, these interventions are often developed using the theories and/or intuitions of the individuals who developed them and evaluated in isolation without comparing their efficacy with other interventions. Here, we make the case for an experimental design that addresses such issues: an intervention tournament-that is, a study that compares several different interventions against a single control and uses the same standardized outcome measures during assessment and participants drawn from the same population. We begin by highlighting the utility of intervention tournaments as an approach that complements other, more commonly used approaches to addressing societal issues. We then describe various approaches to intervention tournaments, which include crowdsourced, curated, and in-house-developed intervention tournaments, and their unique characteristics. Finally, we discuss practical recommendations and key design insights for conducting such research, given the existing literature. These include considerations of intervention-tournament deployment, characteristics of included interventions, statistical analysis and reporting, study design, longitudinal and underlying psychological mechanism assessment, and theoretical ramifications.

Misperceptions about out-partisans' democratic values may erode democracy.

Two studies (one preregistered) of Americans (N = 2200) drawn from a nationally representative panel show that both Democrats and Republicans personally value core democratic characteristics, such as free and fair elections, but severely underestimate opposing party members' support for those same characteristics. Democrats estimate that the average Democrat values democratic characteristics 56% (in Study 1) and 77% (in Study 2) more than the average Republican. In a mirror image, Republicans estimate that the average Republican values democratic characteristics 82% (in Study 1) and 88% (in Study 2) more than the average Democrat. In turn, the tendency to believe that political ingroup members value democratic characteristics more than political outgroup members is associated with support for anti-democratic practices, especially among Republicans. Results suggest biased and inaccurate intergroup perceptions may contribute to democratic erosion in the United States.

Using first-person narratives about healthcare workers and people who are incarcerated to motivate helping behaviors during the COVID-19 pandemic.

RATIONAL: Overcoming the COVID-19 pandemic requires large-scale cooperation and behavior change on an unprecedented scale. Individuals can help reduce the burden of the pandemic by participating in behaviors that benefit people whose life circumstances make them especially vulnerable. OBJECTIVE: We tested the effect of reading narrative (i.e., story-like) as opposed to expository (i.e., factual recounting) messages on beliefs about protecting others in groups vulnerable during the pandemic through increased message transportation (i.e. immersing the reader into the story). Additionally, we examined if reading narratives, as opposed to expository messages, increased intentions to engage in prosocial behaviors that benefit these groups through increased transportation. METHODS: The study used a between-subjects design where participants either read narrative or expository messages about the experiences of people who were at greater exposure to SARS-CoV-2 due to social and political factors, namely people who were incarcerated or working in healthcare during the onset of the COVID-19 pandemic. RESULTS: In line with pre-registered hypotheses, participants in the narrative (vs. expository) condition reported greater transportation into the message. We also observed indirect effects of narrative (vs. expository) messages, through increased message transportation, on: (1) beliefs that by physical distancing, one can protect vulnerable people (2) beliefs that members of the target groups (i.e., healthcare workers and people who are incarcerated), were vulnerable during the pandemic, (3) intentions to engage in prosocial behaviors that help family and friends, and (4) intentions to engage in prosocial behaviors that help members of vulnerable groups. CONCLUSION: Together these results suggest that narratives can be used to motivate prosocial action during the COVID-19 pandemic to the extent that the narratives elicit transportation.

Higher Social Anxiety Severity Predicts Better Cognitive Empathy Performance in Women but Not Men.

Findings regarding relationships between social anxiety and subtypes of empathy have been mixed, and one study suggested that this may be due to moderation by biological sex. The present study examined whether accounting for general anxiety and biological sex clarifies these relationships. Undergraduates (N = 701, 76% female) completed online self-report measures of cognitive and affective empathy, social and general anxiety severity, and a behavioral measure of cognitive empathy (Reading the Mind in the Eyes Task; MIE). Path analysis examined relationships among social and general anxiety severity and affective and cognitive empathy. Model modification indices showed a significant influence of sex on the path from social anxiety severity to MIE accuracy. When the model was re-estimated with this path freed, more socially anxious women, but not men, showed greater MIE accuracy. Across both sexes, general anxiety severity related negatively to self-reported and behavioral (MIE) cognitive empathy. Affective empathy did not relate to either type of anxiety. The use of path analysis to simultaneously account for overlapping variance among measures of anxiety and empathy helps clarify earlier mixed findings on relationships between social anxiety and empathy subtypes.

Intergroup Contact Reduces Dehumanization and Meta-Dehumanization: Cross-Sectional, Longitudinal, and Quasi-Experimental Evidence From 16 Samples in Five Countries.

In 16 independent samples from five countries involving ~7,700 participants, we employ a mixture of cross-sectional, longitudinal, and quasi-experimental methods to examine the effect of intergroup contact on (a) the blatant dehumanization of outgroups, and (b) the perception that outgroup members dehumanize the ingroup (meta-dehumanization). First, we conduct a meta-analysis across 12 survey samples collected from five countries regarding eight different target groups (total N = 5,388) and find a consistent effect of contact quality on dehumanization and meta-dehumanization. Second, we use a large longitudinal sample of American participants (N = 1,103) to show that quality of contact with Muslims at Time 1 predicts dehumanization of Muslims and meta-dehumanization 6 months later. Finally, we show that sustained semester-long "virtual contact" between American and Muslim college students is associated with reduced American students' (N = 487) dehumanization of, and perceived dehumanization by, Muslims.

Self-Stigma Toward Nonsuicidal Self-Injury: An Examination of Implicit and Explicit Attitudes.

OBJECTIVE: Evidence suggests that individuals without a history of nonsuicidal self-injury (NSSI) are likely to view NSSI as a stigmatized behavior. However, there is limited evidence evaluating the presence of self-stigma among individuals who have engaged in NSSI. METHODS: We recruited a university sample (n = 351) and employed implicit and explicit measures to examine the degree of stigmatization toward those with NSSI scarring, as compared to nonintentional disfigurement (i.e., accidental scarring) and to tattoos (i.e., a culturally sanctioned form of intentional tissue alteration). We examined the extent to which bias is related to indicators of NSSI severity among those with a history of NSSI. RESULTS: We provide evidence that negative biases toward NSSI may represent the effects of self-stigma. However, findings suggest that biases were generally attenuated among participants with a history of NSSI as compared to those without. Participants who had lower levels of NSSI explicit bias were more likely to have a history of more severe engagement in NSSI; however, no significant relationships were found between implicit bias and NSSI severity indicators. CONCLUSIONS: We present a theoretical rationale for attenuated biases among individuals with a history of NSSI and discuss implications of this research for NSSI recovery.