Clinical differences between outpatients with and without internet addiction and emotional disorders: a prospective naturalistic outcome study.

Background/Objective: as internet use becomes increasingly ingrained in contemporary society, internet addiction (IA) has emerged as a global public health concern. There is ongoing debate regarding whether IA represents a distinct psychological disorder or a secondary manifestation of other existing disorders. This study aimed to examine the pathological relationship between IA and emotional disorders (ED). Method: this study compared pre-treatment characteristics and treatment process of three groups of patients (N=1292) in a naturalistic treatment setting: IA only, ED only, and comorbidity of IA and ED. Results: the IA only group differed from the other groups by reporting the highest levels of life satisfaction, adaptive emotion regulation, as well as risk behavior urges at intake. In addition, the IA only group displayed the lowest level of depressive and anxiety symptoms throughout the treatment. Conclusion: our findings contribute to a better understanding of the discreteness of IA as a potential psychological disorder and inform more effective treatment strategies for IA and its comorbid conditions.

Negative religious coping versus spiritual struggles: Moderator or main effect?

OBJECTIVE: While previous research indicates that negative religious coping relates with distress, it is unclear if this represents generalized spiritual struggles or a specific vulnerability activated by negative events. Moreover, past research treats coping as a stable phenomenon, although it likely fluctuates. This research simultaneously tested both models longitudinally and examined the relationship between coping and distress. METHODS: The current study is a secondary analysis of longitudinal data collected online over 3 years from 397 participants. Life events, negative religious coping, and depressive symptoms were assessed on six occasions, and linear mixed-effect models were used to analyze data. RESULTS: Negative religious coping was largely stable with increases at times of stress. Participants with higher mean negative coping reported more depressive symptoms regardless of life circumstances (i.e., main effect), likely reflecting generalized spiritual struggles. In addition, those with higher mean coping or with particularly high levels at a given time reported even higher levels of symptoms when they experienced more negative life events (i.e., moderation effect). CONCLUSION: Results suggest that previous research merges two distinct phenomena-spiritual struggles and negative coping. This has important theoretical and research implications and suggests that integrating spirituality and religion into treatment can be warranted.

Response to anxiety treatment before, during, and after the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic yielded a substantial increase in worldwide prevalence and severity of anxiety, but less is known about effects on anxiety treatment. OBJECTIVE: We evaluated effects of the COVID-19 pandemic on responses to Cognitive Behavioral Therapy for anxiety, in a clinically heterogeneous sample of patients. METHODS: A sample of 764 outpatients were separated into four groups: (1) Pre-pandemic (start date on or prior to 12/31/2019), (2) Pandemic-Onset (start date from 01/01/2020 to 03/31/2020), (3) During-Pandemic (start date from 04/01/2020 through 12/31/2020), and (4) Post-Pandemic (start date on or after 01/01/2021). We subsequently compared treatment trajectories and effects within and between these groups over 5621 total time points (mean of 7.38 measurements per patient). RESULTS: Overall, patients presented with moderate levels of anxiety (M = 13.25, 95%CI: 12.87, 13.62), which rapidly decreased for 25 days (M = 9.46, 95%CI: 9.09, 9.83), and thereafter slowly declined into the mild symptom range over the remainder of the study period (M = 7.36, 95%CI: 6.81, 7.91), representing clinically as well as statistically significant change. A series of conditional multilevel regression models indicated that there were no substantive differences between groups, and no increase in anxiety during the acute pandemic phase. CONCLUSIONS: Our results suggest that responses to treatment for anxiety were equivalent before, during, and after the COVID-19 pandemic. Among patients who were in treatment prior to the pandemic, we failed to detect an increase in anxiety during the pandemic's acute phase (March 20th, 2020 through July 1st, 2020).

"G-d, in you I trusted, let me never be ashamed": Shame and sexual abuse among Orthodox Jews.

OBJECTIVE: Previous research suggests that generalized shame is an important consequence of sexual abuse, and that it maintains symptoms and hampers recovery. Orthodox Jews view sexuality as a powerful experience that is sacred within a loving marriage yet profane and damaging outside of that context. Sexual abuse may, therefore, be perceived as a shameful violation of modesty and spiritually degrading. Accordingly, we hypothesized that abuse would be more strongly related to shame among Orthodox Jews and that this would at least partially mediated resulting distress. METHOD: We assessed sexual abuse history, shame, and distress in a convenience sample of 628 adult patients completing an intake process for outpatient psychotherapy, of which 109 reported an Orthodox Jewish religious affiliation. RESULTS: Among Orthodox patients, 43% reported a history of sexual abuse and this group reported substantially higher levels of shame compared to both Orthodox patients without a history of sexual abuse and non-Orthodox patients with a history of abuse. Moreover, elevated shame fully mediated the relationship between abuse and depressive symptoms, life satisfaction, and spiritual struggles. CONCLUSIONS: Results suggest that treatment of Orthodox survivors of sexual abuse requires particular attention to shame and that further research is warranted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Spirituality/Religion and Self-Harm Among Patients With Alcohol/Substance Use Versus Other Disorders.

ABSTRACT: Spirituality/religion (S/R) is clinically relevant to recovery from alcohol use disorders (AUDs)/substance use disorders (SUDs) and also associated with less self-injury; however, the interplay of these factors has not been adequately evaluated. Participants ( n = 1443) were culled from a larger study among psychiatric patients. We assessed for S/R using self-report measures, and medical records were reviewed for demographics, clinical diagnoses, psychiatric medications, and self-harm engagement. Self-harm engagement was significantly higher among patients without AUD/SUD. S/R distress was higher among participants with AUD/SUD, but S/R community activity and importance of religion were lower. Interest in discussing S/R in treatment did not significantly differ across patients. Religious affiliation, importance of religion, and belief in God were associated with less self-harm, but effects were not moderated by presence of AUD/SUD. S/R factors are associated with lower self-harm, irrespective of the presence or absence of AUD/SUD. In contrast with clinical lore, S/R may be equally salient to psychiatric patients with AUD/SUD versus other disorders.

Internet Addiction and the Treatment of Depression? A Prospective Naturalistic Outcome Study.

The increasing prevalence of Internet addiction (IA) has been linked with a wide range of psychological disorders, including depression. We explored how IA was prospectively associated with effectiveness of treatment for adult patients with depressive symptoms (n = 241) in the context of a New York-based outpatient clinic. Although IA was not correlated with symptoms at intake, patients with higher IA attended fewer total sessions on average. Multilevel regression modeling also revealed that patients with higher IA scores terminated treatment with higher depression scores compared with those with lower IA scores. In addition, those with higher levels of IA were more likely to exhibit rising levels of depressive symptoms toward the end of the treatment, whereas patients with lower levels of IA maintained reduced depressive symptoms through termination. These results suggest that presence of IA may predict a less successful treatment outcome for adults with depression, as IA may slow down the process of symptom reduction and correlate with relapse.

Religious Beliefs, Trust In Public Figures, And Adherence to COVID-19 Health Guidelines among American Orthodox and Non-Orthodox Jews.

The COVID-19 pandemic and resultant health crisis highlighted the lack of scholarly understanding of the effects of sociocultural factors and religious beliefs on compliance with public health guidelines. Orthodox Jews in particular were suspected of mistrusting medical experts and were singled out for alleged non-compliance with COVID-19 health guidelines. We surveyed American Jews (N = 1,141) during the early stages of the pandemic about their religious beliefs connected with the pandemic, trust in relevant public figures, and compliance with health guidelines to examine whether and how these factors are related. Generally, participants expressed high levels of trust in scientists, medical professionals, and religious leaders and a high degree of adherence to health guidelines. We examined how trust varies as a function of sociodemographic features, religious affiliation, and health-related religious beliefs (i.e., spiritual health locus of control). Overall, our research underscores the relevance of religious beliefs and trust in public figures to adherence to health guidelines and public health messaging.

Religious affiliation protects against alcohol/substance use initiation: A prospective study among healthy adolescents.

BACKGROUND: A substantial volume of the literature suggests that religious factors buffer against alcohol/substance use among adults, but research among adolescents is sparse. Further, few studies in this area have been prospective, and therefore it is unclear how religion may impact less alcohol/substance use among adolescents. METHOD: We prospectively evaluated effects of religious affiliation on initiation of alcohol/substance use in a sample of 81 psychiatrically healthy 13-14-year-olds from New England, over a 3-year period (from November 2015 to January 2019). Known risk factors were also evaluated including anxiety, depression, and impulsivity; family history of mental illness and alcohol/substance misuse; and volume of brain regions implicated in adolescent alcohol/substance misuse (assessed by Magnetic Resonance Imaging). RESULTS: Religiously affiliated adolescents were significantly less likely to initiate use of alcohol/substances (hazard ratio [HR] = 0.38). The addition of family history of alcohol/substance misuse to the model increased the predictive value of religious affiliation (HR = 0.34). Other risk factors did not diminish nor increase observed effects. CONCLUSIONS: These findings support and extend the current research by suggesting that religious affiliation protects against initiation of alcohol/substance use during early adolescence, particularly in individuals with elevated risk.

Effects of religion on the course of suicidality among geriatric patients with mood disorders.

BACKGROUND: A growing volume of research suggests that religion protects against late-life suicide, but it remains unclear whether effects are relevant to clinical samples, which facets of religion are most relevant, and variations over the course of mood disorders (e.g. during periods of euthymia, depression, and/or heightened suicidality). METHOD: Eighty adults aged 55-85 years with mood disorders completed assessments of religion (affiliation, service attendance, importance of religion, belief and faith in God), depression, and suicidality over time (M = 7.31 measurements over M = 727 days). We computed metrics to identify mean and maximum levels of depression and suicidality, and the number of episodes of significant depression and suicidality experienced by each participant. RESULTS: Religious affiliation and importance of religion, but not service attendance, belief, or faith in God, were associated with lower mean and maximum depression. Conversely, all facets of religion predicted significantly lower mean and maximum levels of suicidality (rs ranging from -0.24 to -0.39), and substantially less likelihood of experiencing significant suicidality during the study (ORs ranging from 0.19 to 0.33). Service attendance, belief, and faith in God predicted less suicidality even among individuals who did not affiliate with a religious group. CONCLUSIONS: Religious factors, particularly faith in God, are associated with substantially less suicidality over time among older adults with mood disorders, irrespective of religious affiliation.

Dual-Task Effects on Concurrent Speech Production in School-Age Children With and Without Stuttering Disorders.

PURPOSE: Contemporary motor theories indicate that well-practiced movements are best performed automatically, without conscious attention or monitoring. We applied this perspective to speech production in school-age children and examined how dual-task conditions that engaged sustained attention affected speech fluency, speech rate, and language productivity in children with and without stuttering disorders. METHOD: Participants included 47 children (19 children who stutter, 28 children who do not stutter) from 7 to 12 years of age. Children produced speech in two baseline conditions with no concurrent task and under a dual-task condition requiring sustained attention to on-screen stimuli. Measures of speech fluency, speech rate, and language productivity were obtained for each trial and compared across conditions and groups. RESULTS: Dual-task conditions resulted in a reduction in stutter-like disfluencies relative to the initial baseline speaking condition. Effects were similar for both groups of children and could not be attributed to decreases in language productivity or a simple order effect. CONCLUSIONS: Findings suggest that diverting attention during the process of speech production enhances speech fluency in children, possibly by increasing the automaticity of motor speech sequences. Further research is needed to clarify neurophysiological mechanisms underlying these changes and to evaluate potential clinical applications of such effects. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19945838.

Managerialism: A workforce health hazard in human service settings.

BACKGROUND: This study assesses the relationship between managerialism and health among human service workers. METHODS: A total of 2154 New York City human service workers participated in an electronic survey that included validated measures of a system of work organization (the Organizational Commitment to Managerialism scale [OCTM]) and a work stressor (the Effort Reward Imbalance scale [ERI]), and single items about physical, mental, and behavioral health. Controlling for demographic variables, logistic regression models were used to predict health outcomes assess the potential role of ERI as a mediator. RESULTS: Managerialism was associated with increased risk of high blood pressure, neck and back pain, gastrointestinal difficulties, sleeping disorders, anxiety, and depression. Mediation analyses suggested that the effects of managerialism on health were partially explained by ERI. CONCLUSIONS: Managerialism in human service agencies significantly increased the risk of adverse physical and mental health. Increased levels of a work stressor helped to explain part of this association.

A comparative study of mental health diagnoses, symptoms, treatment, and medication use among Orthodox Jews.

Historical clinical reports and media narratives suggest that Orthodox Jews are reticent to seek treatment for mental illness, present only with serious concerns, and hesitate to comply with treatment in general and psychopharmacology in particular. On the other hand, recent developments, and some limited research, suggest that Orthodox Jews may be likely to seek and comply with treatment. The current study compared the diagnostic, symptomatic, and treatment characteristics of 191 Orthodox Jews and 154 control patients all presenting to a large private mental health clinic with offices throughout greater New York. Results indicated that the groups were largely demographically similar, and that their diagnoses did not significantly differ. Orthodox Jews initially presented with lower levels of symptoms, terminated with similar symptom levels, attended a similar number of sessions, and were equally likely to use psychopharmacological interventions of similar types, compared to controls. This was equally true of ultra-Orthodox and modern Orthodox Jews. Clinicians providing mental health services to Orthodox Jews should be aware of these findings, which contrast with existing clinical and popular stereotypes. Further, excessive efforts to protect Orthodox Jewish patients against stigma may be unnecessary and counterproductive.

Childhood Sexual Abuse, Spirituality/Religion, Anxiety and Depression in a Jewish Community Sample: the Mediating Role of Religious Coping.

Childhood sexual abuse (CSA) is a pervasive problem impacting a broad range of mental health outcomes. Previous research has shown that spiritual and religious (S/R) factors both positively and negatively relate to mental health issues among survivors of CSA, but mediating mechanisms of effect are unclear. The present study examined CSA, anxiety, depression, and positive/negative religious coping among 372 Jewish community members with and without CSA histories. Individuals who experienced CSA endorsed significantly higher anxiety and depression as well as negative religious coping than those without CSA. Negative religious coping mediated the relationship between CSA and anxiety and depression. We discuss clinical and social implications of these findings, including the need to address S/R factors in treatment of CSA, especially within religious communities. Further research examining abuser identity, survivors' disclosure experience, and other S/R mediators of effect is warranted.

Why is Spiritual Psychotherapy for Inpatient, Residential, and Inpatient Treatment (SPIRIT) more effective when provided by nonreligious clinicians?

Previous research suggests that patients receiving spiritual psychotherapy may have better outcomes when treatment is provided by nonreligious clinicians, compared to religious clinicians. We examined these effects within a large and clinically heterogeneous sample of patients (N = 1,443) receiving Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT; Rosmarin et al., 2019) by a diverse sample of clinicians (n = 22). In addition to demographics, patients completed a brief measure of their experience in SPIRIT; clinicians completed measures of previous mental health training, previous training in spiritual psychotherapy, and attitudes toward spiritual psychotherapy, and also provided details regarding modalities, clinical interventions, and spiritual interventions utilized at each SPIRIT session. Perceived benefit of SPIRIT was greater when treatment was delivered by non-religious clinicians. Mediating factors on these effects were evaluated using correlations and multiple regression analyses. Of 26 potential explanatory factors, only 4 were significant, all of which related to the therapeutic process. Nonreligious clinicians were more likely to utilize dialectical behavior therapy (DBT), facilitate coping, encourage spiritual coping, and explore the relevance of spirituality to mental health, all of which also predicted better perceived benefit from SPIRIT. All four variables jointly, but not severally, mediated relationships between clinician religion and perceived benefit of SPIRIT. These findings suggest that DBT may be the most effective modality for delivering spiritual psychotherapy to acute patients, particularly in a group setting. Future research should further examine preferences for clinical modalities and techniques among religious and nonreligious clinicians, and effects of such preferences on perceived benefit, in a variety of settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cognitive Flexibility and Effortful Control in School-Age Children With and Without Stuttering Disorders.

Purpose This study compared attention control and flexibility in school-age children who stutter (CWS) and children who do not stutter (CWNS) based on their performance on a behavioral task and parent report. We used a classic attention-shifting paradigm that included manipulations of task goals and timing to test effects of varying demands for flexibility on switching accuracy and speed. We also examined associations between task performance, group, and relevant aspects of temperament. Method Participants included 33 children (15 CWS, 18 CWNS) between 8 and 11 years of age. Children sorted stimuli that differed on two dimensions (color and shape) based on sorting rules that varied from block to block or trial to trial. Timing manipulations included intervals of 200-, 600-, or 1,200-ms durations for critical trial components. Temperament data were obtained via the Children's Behavior Questionnaire. Results All children showed expected performance costs in response to block and trial manipulations; however, CWS were more affected by task conditions that increased demands for cognitive flexibility. Effects of interval durations also differed by group. Factor scores on the Children's Behavior Questionnaire indicated differences in effortful control between groups; however, this aspect of temperament did not mediate between-groups differences in switching performance. Conclusions Findings suggest that stuttering continues to be associated with differences in attention control and flexibility beyond the preschool years. Further research is needed to clarify how these cognitive processes shape the development of stuttering throughout childhood.

COVID-19, Religious Coping, and Weight Change in the Orthodox Jewish Community.

Given links between stress and obesity, it is likely that individuals gained weight during the COVID-19 lockdown. Research suggests that religiosity facilitates coping, which may have lessened the relationship between stress and weight gain during the COVID-19 lockdown. We examined this relationship among Orthodox Jews (n = 731). Results indicated that stress was marginally associated with weight gain, and that this was moderated by intrinsic religiosity (IR). For those with low IR, stress correlated with weight gain, while for those with mean or higher IR, stress and weight change were unrelated. Results suggest that for some, religiosity may moderate links between stress and weight gain during times of crisis.

Implicit/Explicit Beliefs About God, Uncertainty, and Anxiety.

ABSTRACT: Intolerance of uncertainty (IU) refers to the incapacity to cope with a perceived lack of information sustained by negative perceptions about uncertainty and its implications. Previous research regarding the role of religion and spirituality (R/S) in coping with uncertainty is unclear. The current research assessed if implicit and explicit beliefs about God are related to these discrepancies. Participants completed an explicit task, an implicit association task, the Intolerance of Uncertainty Scale, and the Hospital Anxiety and Depression Scale. Results indicated that explicit and implicit beliefs independently correlated with IU and anxiety. Regression analyses suggested that these correlations were primarily due to the relationship between negative beliefs of God and IU and that IU partially mediated the relationship between R/S and anxiety. The current findings add to the growing literature on IU and suggest the need to address R/S as a possible correlate of IU.

COVID-19, Mental Health, and Religious Coping Among American Orthodox Jews.

The COVID-19 pandemic presents potential mental health challenges, and the American Orthodox Jewish population has been particularly affected by the virus. The current study assessed the impact of the pandemic and explored the relationships between exposure, religiosity, and distress in a sample of n = 419 American Orthodox Jews. Results indicated high levels of exposure, concern, and compliance with medical guidelines; however stress was generally low and we found evidence for positive impact. Direct exposure correlated with higher religiosity. Positive religious coping, intrinsic religiosity and trust in God strongly correlated with less stress and more positive impact, while negative religious coping and mistrust in God correlated with the inverse. While the study is limited by its design, findings highlight that for some, faith may promote resilience especially during crisis.

Do religious patients need religious psychotherapists? A naturalistic treatment matching study among orthodox Jews.

Religion is professed by the majority of the general population, but a minority of mental health practitioners. We evaluated whether religious patients benefited more from treatment with religious psychotherapists in a naturalistic study among adult Orthodox Jewish (n = 117) and control patients (n = 91) receiving psychotherapy from Orthodox Jewish (n = 15) and other (n = 7) psychotherapists at a New York based outpatient clinic. Groups did not differ with respect to diagnoses (χ2(200) = 7.5, p = .76), likelihood of having an Orthodox Jewish therapist (χ2(200) = .06, p = .81), or number of therapy sessions (t(206) = .73, p =  .47). Multilevel regression modeling revealed that Orthodox patients reported lower initial anxiety (t(198) = 3.71, p < .001, d = .54) and depression (t(198) = 3.71, p < .001, d = .54, d = .50), but were equivalent to controls at termination (Anxiety t(189) = .36, p =  .72; Depression t(182) = 1.00, p =  .32). Interactions between patient and therapist religious affiliations were not significant. These results suggest that religious (and non-religious) patients may benefit equally from treatment delivered by religious and non-religious therapists.

Effects of different attention tasks on concurrent speech in adults who stutter and fluent controls.

PURPOSE: Motor theories indicate that focusing attention on well-practiced movements interferes with skilled performance; however, specific forms of attention (alerting vs. orienting vs. executive control) associated with this effect are not well understood. The present study explored this question in relation to stuttering, and examined whether dual task conditions that engaged sustained attention or working memory (WM) affected speech fluency in different ways. We also considered whether fluency changes were associated with changes in speech rate and language. METHODS: Nineteen adults who stutter (AWS) and 20 controls produced spontaneous speech under a baseline condition and two dual task conditions: one involving a sustained attention task, the other involving WM demands. RESULTS: Both groups produced fewer stutter-like disfluencies under dual task relative to baseline conditions and this reduction did not differ between the two dual tasks (attention vs. WM). Speech rate and language variables, which were potentially influenced by attention conditions, were not affected by dual tasks in the same way as disfluencies, and appeared to be unassociated with fluency results. CONCLUSIONS: Findings indicate that atypical disfluencies decrease when attention is divided, even when secondary task demands are minimal, as they were in the sustained attention task. For simple secondary tasks, fluency changes do not appear to be a byproduct of slowed rate and are not accompanied by observable changes in language. These results demonstrate that simple manipulations of attention can induce measurable effects on aspects of speech production, and may be a useful tool for facilitating fluency in clinical intervention.