Testing the Effectiveness of an Intervention to Improve Romanian Teachers' LGBT+-Related Attitudes, Cognitions, Behaviors, and Affect: Protocol for a Randomized Controlled Trial.

BACKGROUND: Repeated stigmatization due to group membership constitutes a recurrent stressor with negative impact on physical and mental health (minority stress model). Among European countries, Romania ranks low on LGBT+ (lesbian, gay, bisexual, and transgender people. The "+" represents individuals whose identities do not fit typical binary notions of male and female [nonbinary]) inclusion, with 45% of Romanian LGBT+ respondents reporting discrimination in at least 1 area of life in the year preceding the survey. Importantly, while all LGBT+ people might experience minority stress, younger sexual minority individuals are more prone to the detrimental impacts of stigma on their mental and physical health. As such, interventions are necessary to improve the inclusion climate within schools, where young people spend most of their time. Until now, most interventions addressing this topic have been conducted on undergraduate students in Western countries, with no studies conducted in countries that have widespread anti-LGBT+ attitudes. OBJECTIVE: This paper describes the research protocol for a randomized controlled trial investigating whether LGBT+ stigma and bias among Romanian school teachers can be reduced using an internet-based intervention focusing on education and contact as primary training elements. METHODS: A sample of 175 school teachers will be randomly assigned to either the control or experimental group. The experimental group participants will receive the intervention first and then complete the outcome measures, whereas the control group will complete the outcome measures first and then receive the intervention. The 1-hour multimedia intervention is developed for internet-based delivery under controlled conditions. It includes 2 interactive exercises, 2 recorded presentations, animations, and testimonies from LGBT+ individuals. Data for attitudinal, behavioral, cognitive, and affective measures will be collected during the same session (before or after the intervention, depending on the condition). We also plan to conduct a brief mixed methods follow-up study at 6 to 8 months post participation to investigate potential long-term effects of training. However, due to attrition and lack of experimental control (all participants will have completed the intervention, regardless of the condition), these data will be analyzed and reported separately using a mixed methods approach. RESULTS: This paper details the protocol for the teacher intervention study. Data collection began in December 2022 and was completed by February 2023. Data analysis will be performed upon protocol acceptance. Follow-up measures will be completed in 2024. Results are expected to be submitted for publication following analysis in the spring of 2024. CONCLUSIONS: The findings of this study will establish the effectiveness of an internet-based intervention intended to lessen anti-LGBT stigma and sentiment in a nation where these views have long been prevalent. If successful, the intervention could end up serving as a resource for Romanian teachers and guidance counselors in high schools. TRIAL REGISTRATION: ISRCTN 84290049; https://doi.org/10.1186/ISRCTN84290049. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54254.

The effectiveness of a rational-emotive intervention on teachers' unconditional self-acceptance, perfectionism, and pupil control ideology.

Introduction: The present research aimed to investigate the effectiveness of a Rational Emotive Behavior Therapy (REBT) intervention on in-service teachers. Methods: A quasi-experimental 2-group (intervention vs. control) × 3-time (pre, post-test, follow-up) design was applied to explore to what extent the REBT interventions help teachers increase their level of unconditional self-acceptance as the primary outcome and decrease their perfectionism tendencies and pupil control ideology as secondary outcomes. The sample consisted of 100 in-service teachers assigned to either the intervention group (n = 50) or the control group (n = 50). The experimental group received a 6-week intervention program. Every session was held weekly and lasted 90-120 min. The Unconditional Self-Acceptance Questionnaire (USAQ), Pupil Control Ideology Scale (PCI), and Perfectionism Inventory Scale (PI) were used to collect data. This study used a mixed model ANOVA 2 × 3 for data analysis. Results: The results indicated that in the experimental group, there was a statistically significant increase in unconditional self-acceptance level from pre-test to post-test, which remains significant at the 6-month follow-up. Likewise, there were no statistically significant differences in unconditional self-acceptance levels between the post-test and 6-month follow-up in the intervention group. Discussion: These findings prove that REBT interventions are effective in increasing teachers' unconditional self-acceptance.

Validity assessment in Eastern Europe: cross-validation of the Dot Counting Test and MODEMM against the TOMM-1 and Rey-15 in a Romanian mixed clinical sample.

OBJECTIVE: This study investigated performance validity in the understudied Romanian clinical population by exploring classification accuracies of the Dot Counting Test (DCT) and the first Romanian performance validity test (PVT) (Memory of Objects and Digits and Evaluation of Memory Malingering/MODEMM) in a heterogeneous clinical sample. METHODS: We evaluated 54 outpatients (26 females; MAge = 62.02; SDAge = 12.3; MEducation = 2.41, SDEducation = 2.82) with the Test of Memory Malingering 1 (TOMM-1), Rey Fifteen Items Test (Rey-15) (free recall and recognition trials), DCT, MODEMM, and MMSE/MoCA as part of their neuropsychological assessment. Accuracy parameters and base failure rates were computed for the DCT and MODEMM indicators against the TOMM-1 and Rey-15. Two patient groups were constructed according to psychometrically defined credible/noncredible performance (i.e., pass/fail both TOMM-1 and Rey-15). RESULTS: Similar to other cultures, a cutoff of ≥18 on the DCT E score produced the best combination between sensitivity (0.50-0.57) and specificity (≥0.90). MODEMM indicators based on recognition accuracy, inconsistencies, and inclusion false positives generated 0.75-0.86 sensitivities at ≥0.90 specificities. Multivariable models of MODEMM indicators reached perfect sensitivities at ≥0.90 specificities against two PVTs. Patients who failed the TOMM-1 and Rey-15 were significantly more likely to fail the DCT and MODEMM than patients who passed both PVTs. CONCLUSIONS: Our results offer proof of concept for the DCT's cross-cultural validity and the applicability of the MODEMM on Romanian clinical examinees, further recommending the use of heterogeneous validity indicators in clinical assessments.

Strategies of feigning mild head injuries related to validity indicators and types of coaching: Results of two experimental studies.

OBJECTIVE: In this paper, we analyzed differences between uncoached, symptom-coached, and test-coached simulators regarding strategies of feigning mild head injuries. METHOD: Healthy undergraduates (n = 67 in the first study; n = 48 in the second study), randomized into three simulator groups, were assessed with four experimental memory tests. In the first study, tests were administered face-to-face, while in the second study, the procedure was adapted for online testing. RESULTS: Online simulators showed a different approach to testing than face-to-face participants (U tests < 920, p < .05). Nevertheless, both samples favored strategies like memory loss, error making, concentration difficulties, and slow responding. Except for slow responding and concentration difficulties, the favorite strategies correlated with validity indicators. In the first study, test-coached simulators (m = 4.58-5.68, SD = 2.2-3) used strategies less than uncoached participants (m = 5.25-5.88, SD = 2.26-2.84). In the second study, test-coached participants (m = 3.8-5.6, SD = 1.51-2.2) employed strategies less than uncoached (m = 6.21-7.29, SD = 1.25-1.85) and symptom-coached participants (m = 6.14-6.79, SD = 1.69-2.76). DISCUSSION: Similarities and differences between online and face-to-face assessments are discussed. Recommendations to associate heterogeneous indicators for detecting feigning strategies are issued.

Standard CBT versus integrative and multimodal CBT assisted by virtual-reality for generalized anxiety disorder.

Introduction: Generalized Anxiety Disorder (GAD) is a prevalent emotional disorder associated with increased dysfunctionality, which has a lasting impact on the individual's quality of life. Besides medication, Cognitive-Behavioral Therapy (CBT) represents the golden standard psychotherapeutic approach for GAD, integrating multilevel techniques and various delivery formats that enable the development of tailored treatment protocols. The objective of this study was to compare the efficiency of a standard CBT protocol targeting worries, dysfunctional beliefs, and intolerance of uncertainty with an integrative and multimodal CBT intervention augmented with Virtual Reality (VR). Materials and methods: This study included 66 participants (M age = 22.53 years; SD = 2.21) with moderate GAD symptoms that were randomized to the standard CBT group (CBTs; N = 32) and the Integrative and Multimodal CBT augmented with VR (IM-VRCBT; N = 34) group. The interventions comprised 10 weekly sessions conducted by trained CBT therapists, including cognitive restructuring, problem-solving, behavioral exposure, and relaxation techniques. Baseline and post-assessments were conducted with both groups. Primary outcome measures included the Hamilton Anxiety Rating Scale (HARS) and Penn-State Worry Questionnaire (PSWQ) to evaluate the severity of GAD symptoms and worries, respectively. Secondary outcomes involved the administration of Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS) and Unconditional Self-Acceptance Questionnaire (USAQ). Results: Both interventions determined statistically significant effects on both primary and secondary outcomes (ps < 0.001) in the expected direction. However, CBTs was associated with higher effect sizes for anxiety (Cohen's d = 2.76) and worries (Cohen's d = 1.85), in contrast to IM-VRCBT. Also, secondary analyses revealed positive correlations between changes in anxiety and worries level and the reduction of dysfunctional cognitive processes. Conclusion: This research emphasized the effectiveness of CBT interventions for treating adults with moderate GAD symptomatology. Specifically, both interventions were efficient for reducing anxiety symptomatology present at individuals with GAD. However, regarding cognitive dysfunctions like worries, the standard CBT protocol performed better, as compared to the IM-VRCBT. In addition, we conclude that VR could be integrated within CBT interventions in a single protocol for GAD treatment.

Evaluation of Various Detection Strategies in the Assessment of Noncredible Memory Performance: Results of Two Experimental Studies.

OBJECTIVE: This article investigates the accuracy of individual and combined indicators based on different strategies for detecting noncredible performance as part of a new test for the continuous assessment of short-term memory. METHOD: In two independent studies, we assessed three groups of simulators, cognitively impaired patients, and nonimpaired community members with four tasks separated by a distractor. RESULTS: Pairwise comparisons between receiver operating characteristic (ROC) curves revealed significant differences between two clusters of indicators: mean recognition, inconsistent responses in recognition, and false positives (area under the ROC curves > .800) proved more accurate than delayed recall and false negatives (area under the ROC curves < .800) in discriminating simulators from patients. Likewise, both studies revealed that adding the false positives indicator based on cued recall to mean recognition incrementally improved classification accuracy (including sensitivity, positive predictive value, and negative predictive value ) compared with the recognition indicator alone. CONCLUSIONS: Our results support the association of two distinct indicators for the assessment of noncredible performance, of which one should be a forced-choice indicator.

Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial.

Background: Internet-delivered psychotherapy represents an impactful large-scale solution for addressing psychological disorders. In spite of its flexibility and scalability, the fact that the ones in need have to initiate and sustain the curse of the treatment by themselves comes with considerable downsides in terms of treatment adherence. One solution could be to increase the ease of use and attractivity of the strategies and assignments from such programs. The present study aims to address this issue by incorporating a series of self-oriented strategies to the validated internet-delivered short version of the Unified Protocol (UP). By this mean we intend to complement the symptom-focused assignments, which may be more suitable in a therapist assisted context, with ones designed for self-enhancement, which may be easier approached as self-initiated. Based on a randomized controlled non-inferiority trial we compared the modified version of the UP with the standard short version. Method: The trial design was factorial, with two parallel arms and three measurement moments (baseline, post-intervention and 6-months follow-up). A total of 284 participants were randomly assigned to the intervention or the active control groups. The intervention group (baseline n = 142) received the self-enhanced nine modules of the UP (Self-enhanced 9UP) while the active control (baseline n = 142) received the standard nine modules (9UP). The newly added techniques were inspired by the acceptance and commitment therapy and were specific for self-concepts such as self-compassion or unconditional self-acceptance. Both programs lasted for 9 weeks. The non-inferiority of the Self-enhanced 9UP was tested against a margin of d = -0.35, on the following primary outcome measures: Patient Health Questionnaire 9 (PHQ9) - operationalization for depression; Generalized Anxiety Disorder 7 (GAD7) - operationalization for generalized anxiety or worry; Social Phobia Inventory (SPIN) - operationalization for social phobia; and Panic Disorder Severity Scale-Self Report (PDSS-SR) - that showed participants' level of panic. Treatment adherence was assessed through the drop-out analyses and the engagement in completing the homework assignments. Secondary outcome measures included several self-concept measures: Self-Compassion Scale (SCS); Rosenberg Self-Esteem Scale (RSES); Unconditional Self-Acceptance Questionnaire (USAQ); New General Self-Efficacy Scale (NGSE); and Self-Concept Clarity Scale (SCCS). On the secondary outcomes we explored the potential boost of effectiveness produced by the newly added self-enhancement components. Results: The dropout rates were similar in both groups (approximately 45%) and high overall. Adherence to treatment assignments was also modest and similar between groups (on average participants completed approximately half of the tasks), without a statistically significant bias toward the self-enhancement ones. Overall, both the intention-to-treat and completers analyses yielded no significant group by time interactions for any of the post-intervention and follow-up measurements, but a few non-inferiority analyses suggested that the Self-enhanced 9UP had a significantly weaker effectiveness than the standard 9UP. Within-group analyses showed significant alleviations on all the primary and secondary outcomes for both groups. The effect size estimates were mainly medium and high, and their magnitude tended to be kept also at 6-months follow-up. Discussion: We failed to increase treatment adherence, but we found support with some exceptions, for the non-inferiority hypothesis. Hence, the alterations performed to the 9UP protocol, although they did not boost the treatment attractiveness, they also did not decrease the treatment effectiveness as suggested by most non-inferiority analyses. Likewise, the gain on self-concepts was produced by both groups. Hence, the short version of the UP seems to have the potential of effectively alleviating a larger palette of psychological variables associated with mental health symptoms than previously known. Even though our main objective was only partially achieved, these secondary results are insightful and could open new avenues of research. Clinical Trial Registration: This trial has been registered at ClinicalTrials.Gov (NCT03917550; 17 April 2019; https://clinicaltrials.gov/ct2/show/NCT03917550).

Performing Multilingual Analysis With Linguistic Inquiry and Word Count 2015 (LIWC2015). An Equivalence Study of Four Languages.

Today, there is a range of computer-aided techniques to convert text into data. However, they convey not only strengths but also vulnerabilities compared to traditional content analysis. One of the challenges that have gained increasing attention is performing automatic language analysis to make sound inferences in a multilingual assessment setting. The current study is the first to test the equivalence of multiple versions of one of the most appealing and widely used lexicon-based tools worldwide, Linguistic Inquiry and Word Count 2015 (LIWC2015). For this purpose, we employed supervised learning in a classification problem and computed Pearson's correlations and intraclass correlation coefficients on a large corpus of parallel texts in English, Dutch, Brazilian Portuguese, and Romanian. Our findings suggested that LIWC2015 is a valuable tool for multilingual analysis, but within-language standardization is needed when the aim is to analyze texts sourced from different languages.

Cognitive-behavioral correlates of pupil control ideology.

Teacher's pupil control ideology is a central feature for the quality of the teacher-student relationship, which, in turn, impacts the teacher's level of well-being. The pupil control ideology refers to a teacher's belief system along a continuum from humanistic to custodial views. Teachers with humanistic orientation view students as responsible and, therefore, they exert a lower degree of control to manage students' classroom behaviors. Teachers with a custodial orientation view students as untrustworthy and, therefore, they exert a higher degree of control to manage students' classroom behaviors. The relationship between pupil control ideology and dysfunctional beliefs originated from the cognitive-behavioral therapy framework has not been investigated, despite existing evidence suggesting that the pupil control ideology is linked to stress and burnout. One hundred fifty-five teachers completed a set of self-report questionnaires measuring: (i) teacher's pupil-control ideology; (ii) perfectionistic and hostile automatic thoughts; (iii) irrational beliefs; (iv) unconditional self-acceptance; (v) early maladaptive schemas; and (vi) dimensions of perfectionism. The result suggests that teachers who adopt a custodial view on pupil control ideology endorse more dysfunctional beliefs than teachers who adopt a humanistic view. They tend to present a higher level of perfectionism, unrelenting standards, and problematic relational beliefs, including schemas of mistrust and entitlement. They also present more often other-directed demands and derogation of other thoughts. Such results picture a dysfunctional view on pupils who misbehave, as adversaries who threaten their rigid and/or perfectionistic expectations.

A Web-Based Transdiagnostic Intervention for Affective and Mood Disorders: Randomized Controlled Trial.

BACKGROUND: Research increasingly supports a transdiagnostic conceptualization of emotional disorders (ie applying the same underlying treatment principles across mental disorders, without tailoring the protocol to specific diagnoses), and many international researchers are currently investigating this issue. OBJECTIVE: The aim of this study was to evaluate the efficacy and acceptability of a Web-based transdiagnostic program using a sample of Romanian adults diagnosed with anxiety and/or depression. METHODS: Volunteer participants registered for the study and completed a series of online self-report measures. Participants who fulfilled basic inclusion criteria on these measures were contacted for a telephone diagnostic interview using the Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders (SCID-I). Enrolled participants were randomized to either the active treatment group (N=69) or the wait-list control group (N=36) using a 2:1 ratio. The transdiagnostic treatment was based on the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al, 2011) that addresses common underlying mechanisms of anxiety and depression. Participants randomized to the active treatment condition received 10 weeks of Web-based treatment based on the UP. Throughout treatment, graduate students in clinical psychology provided guidance that consisted of asynchronous written communication on a secure Web platform. After the intervention, participants in both study conditions were invited to complete a set of self-report measures and a postintervention SCID-I interview conducted by a different team of graduate students blinded to participants' group and diagnostic status. Six months later, participants in the active treatment group were invited to complete an online follow-up assessment. RESULTS: During the intervention, active treatment participants completed on average 19 homework assignments (SD 12.10), and we collected data from 79.0% (83/105) at postintervention and 51% (35/69) at follow-up for self-report measures. Postintervention SCID-I interviews were collected from 77.1% (81/105) participants. Relative to the wait-list control group, the transdiagnostic intervention yielded overall medium to large effect sizes for the primary outcome measures (within-group Hedges g=0.52-1.34 and between-group g=0.39-0.86), and also for anxiety sensitivity (g=0.80), symptom interference (g=0.48), and quality of life (g=0.38). Significant within-groups effects only were reported for the active treatment group on Panic Disorder Severity Scale-Self Report (PDSS-SR, g=0.58-0.65) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS, g=0.52-0.58). CONCLUSIONS: Insignificant between-group differences for the Y-BOCS and PDSS-SR could be explained by the small number of participants with the associated primary diagnostic (eg, only 3 participants with obsessive compulsive disorder) by the choice of outcome measure (PDSS-SR was not rated among the evidence-based measures) and by the fact that these disorders may be more difficult to treat. However, the overall results suggest that the transdiagnostic intervention tested in this study represents an effective treatment option that may prove easier to disseminate through the use of Web-based delivery systems. TRIAL REGISTRATION: ClinicalTrials.gov CT02739607; https://clinicaltrials.gov/ct2/show/study/NCT02739607 (Archived by WebCite at http://www.webcitation.org/6yY1VeYIZ).

Virtual reality measures in neuropsychological assessment: a meta-analytic review.

OBJECTIVE: Virtual reality-based assessment is a new paradigm for neuropsychological evaluation, that might provide an ecological assessment, compared to paper-and-pencil or computerized neuropsychological assessment. Previous research has focused on the use of virtual reality in neuropsychological assessment, but no meta-analysis focused on the sensitivity of virtual reality-based measures of cognitive processes in measuring cognitive processes in various populations. METHOD: We found eighteen studies that compared the cognitive performance between clinical and healthy controls on virtual reality measures. RESULTS: Based on a random effects model, the results indicated a large effect size in favor of healthy controls (g = .95). For executive functions, memory and visuospatial analysis, subgroup analysis revealed moderate to large effect sizes, with superior performance in the case of healthy controls. Participants' mean age, type of clinical condition, type of exploration within virtual reality environments, and the presence of distractors were significant moderators. CONCLUSIONS: Our findings support the sensitivity of virtual reality-based measures in detecting cognitive impairment. They highlight the possibility of using virtual reality measures for neuropsychological assessment in research applications, as well as in clinical practice.