A Clinical Pharmacist-Led Transitions of Care Program for Veterans with Two Planned Care Transitions (Hospital to Skilled Care and Skilled Care to Home) amid the COVID-19 Pandemic.

Transitional care teams have been shown to improve patient safety. We describe a novel transitional care team with a clinical pharmacist as team leader initiated amid the COVID-19 pandemic. The program focused on Veterans with 2 planned transitions of care: hospital to skilled nursing facility (SNF) and from SNF to home. Ninety older Veterans were enrolled, and 79 medication errors and 80 appointment errors were identified. We conclude that a pharmacist-led program can improve safety in patients with 2 planned transitions of care.

Adults Without Advocates and the Unrepresented: A Narrative Review of Terminology and Settings.

Socially isolated adults, including those with and without the ability to make medical decisions, are encountered in clinical practice and are at risk for adverse health outcomes. Consensus is lacking on appropriate terminology to describe subpopulations of these patients. In addition, little is known about the settings in which they present. These gaps prevent clinicians and policymakers from identifying and understanding these populations and deploying appropriate resources to meet their complex needs. We conducted a narrative review of literature on socially isolated adults aged 50 and older to assess and integrate the available evidence regarding the terminology used to describe unrepresented patients and adults without advocates to inform consensus on terminology. We also identified the settings in which unrepresented patients and adults without advocates are described in the literature, including both within and outside health care settings. Our results indicate that there is heterogeneity and inconsistency in the terminology used to describe socially isolated adults, as well as heterogeneity in the settings in which they are identified in the literature. Our findings suggest that future work should include achieving consensus on terminology and integrating proactive interdisciplinary interventions across health systems and communities to prevent adults without advocates from becoming unrepresented.

Association between specific unmet functional needs and desire to institutionalize among caregivers of older veterans.

OBJECTIVES: To evaluate the associations between specific functional needs of older Veterans and the desire to institutionalize (DTI) among their caregivers. METHODS: Cross-sectional multivariable logistic regression analysis of 3579 Hero Care survey responses from caregivers of Veterans at five US sites from July to December 2021. Unmet needs were areas in which the caregiver reported the Veteran needed a little more or a lot more help. Caregiver DTI was defined as the caregiver reporting that they had discussed, considered, or taken steps toward a nursing home or assisted living placement for the Veteran or that they felt the Veteran would be better off in such a setting or they were likely to move the Veteran to another living arrangement. RESULTS: Caregivers were largely white, retired, females with an average age of 71 and with some college education who spent an average of 8-9 h per day 6 days a week caring for a Veteran spouse. There was evidence of associations between the following needs and a DTI: managing incontinence, using the telephone, transportation, and arranging services in the home such as visiting nurses, home care aides, or meals on wheels. Unmet functional needs in other selected domains were not associated with the DTI. CONCLUSION: Among caregivers of older Veterans, a need for more assistance managing incontinence, telephone use, transportation, and arranging in-home services were associated with the DTI. These may represent functional markers of important clinical determinants for institutionalization as well as potential targets for intervention to reduce caregiver DTI, such as programs that provide more caregiver or Veteran support in the home to meet these needs and reduce caregiver burden.

Hospital admission decisions for older Veterans with community-onset pneumonia: An analysis of 118 U.S. Veterans Affairs Medical Centers.

OBJECTIVES: Age is important for prognosis in community-onset pneumonia, but how it influences admission decisions in the emergency department (ED) is not well characterized. Using clinical data from the electronic health record in a national cohort, we examined pneumonia hospitalization patterns, variation, and relationships with mortality among older versus younger Veterans. METHODS: In a retrospective cohort of patients ≥ 18 years presenting to EDs with a diagnosis of pneumonia at 118 VA Medical Centers January 1, 2006, to December 31, 2016, we compared observed, predicted, and residual hospitalization risk for Veterans < 70, 70-79, and ≥ 80 years of age using generalized estimating equations and machine learning models with 71 patient factors. We examined facility variation in residual hospitalization across facilities and explored whether facility differences in hospitalization risk correlated with differences in 30-day mortality. RESULTS: Among 297,498 encounters, 165,003 (55%) were for Veterans < 70 years, 61,076 (21%) 70-80, and 71,419 (24%) ≥ 80. Hospitalization rates were 52%, 67%, and 76%, respectively. After other patient factors were adjusting for, age 70-79 had an odds ratio (OR) of 1.39 (95% confidence interval [CI] 1.34-1.44) and ≥ 80 had an OR of 2.1 (95% CI 2.0-2.2) compared to age < 70. There was substantial variation in hospitalization across facilities among Veterans < 70 (<35% hospitalization at the lowest decile of facilities vs. > 66% at the highest decile) that was similar but with higher risk for patients 70-79 years (54% vs. 82%) and ≥ 80 years (59% vs. 85%) and remained after accounting for patient factors, with no consistently positive or negative associations with facility-level 30-day mortality. CONCLUSIONS: Older Veterans with community-onset pneumonia experience high risk of hospitalization, with widespread facility variation that has no clear relationship to short-term mortality.

The Role of Objectification in College Women's Substance Misuse and Sexual Risk.

Sexism and objectification present major challenges for mental and physical health among women. Scholars have called for research to identify mechanisms that underlie these associations as well as to delineate factors to target in prevention and intervention efforts. This study aimed to build on central tenets of objectification theory through its examination of sexist experiences in relation to body surveillance, body shame, depressive symptoms, and the health risk behaviors of substance use (i.e., alcohol and drug misuse) and sexual risk (i.e., condom use and number of sexual partners) among a large sample of college student women. We also examined whether body surveillance, body shame, and depressive symptoms would mediate theorized pathways extended to substance use and sexual risk. A sample of 505 full-time college student women ages 18-26 completed an online survey that assessed their health and behaviors. We used structural equation modeling to test mediation hypotheses. Results largely supported hypotheses, extended objectification theory to sexual risk, and expanded upon past research on objectification in relation to substance use. Notably, results of this study provided a more nuanced knowledge of how objectification may lead to increases in sexual risk when assessed by number of sexual partners (but not condom use). Further research is warranted to understand potential explanatory pathways between sexism, objectification, and sexual risk. Findings can inform prevention and intervention efforts to target body surveillance, body shame, and depressive symptoms to attempt to reduce the burden of sexist experiences on women's health.

Psychotherapies for clients with physical health conditions: A scoping review of demographic reporting.

Recent research has highlighted the importance of investigating the efficacy of psychotherapeutic interventions for individuals with physical health conditions. To date, there is evidence that psychotherapeutic interventions are efficacious for a range of physical health conditions (e.g., cancer, obesity, and diabetes). However, less is known about for whom psychotherapeutic interventions for physical health conditions are effective. One reason for this might be pervasive underreporting of demographic data in research, despite the National Institute of Health's 2016 call to action to include such information. Specifically, studies that fail to report full demographic data of participants may reinforce inequities for historically and societally marginalized groups that are traditionally underrepresented in health research; function to restrict researchers from identifying nondiverse, unrepresentative samples; and limit the capacity for future research to address such limitations. To address this gap, we conducted a scoping review of reported demographic data in randomized clinical trials of psychotherapeutic interventions for cancer, obesity, and diabetes. We aimed to identify the frequency and type of demographic data in reported sample characteristics from 2016 to the present. Findings revealed that, on average, studies reported approximately 5 of the 8 demographic domains of interest (M = 5.1; SD = 1.24; range 3-7)-age, sex assigned at birth, race and ethnicity, sexual orientation, gender identity, marital status, education, mental health status-suggesting that researchers are not reporting demographic data regularly or consistently. The current article discusses the implications of underreporting demographic data for external validity and provides suggestions for future research directions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining the Dimensionality, Reliability, and Invariance of the Depression, Anxiety, and Stress Scale-21 (DASS-21) Across Eight Countries.

This study evaluated the dimensionality, invariance, and reliability of the Depression, Anxiety, and Stress Scale-21 (DASS-21) within and across Brazil, Canada, Hong Kong, Romania, Taiwan, Turkey, United Arab Emirates, and the United States (N = 2,580) in college student samples. We used confirmatory factor analyses to compare the fit of four different factor structures of the DASS-21: a unidimensional model, a three-correlated-factors model, a higher order model, and a bifactor model. The bifactor model, with three specific factors (depression, anxiety, and stress) and one general factor (general distress), presented the best fit within each country. We also calculated ancillary bifactor indices of model-based dimensionality of the DASS-21 and model-based reliability to further examine the validity of the composite total and subscale scores and the use of unidimensional modeling. Results suggested the DASS-21 can be used as a unidimensional scale. Finally, measurement invariance of the best fitting model was tested across countries indicating configural invariance. The traditional three-correlated-factors model presented scalar invariance across Canada, Hong Kong, Romania, Taiwan, and the United States. Overall, these analyses indicate that the DASS-21 would best be used as a general score of distress rather than three separate factors of depression, anxiety, and stress, in the countries studied.

Sexuality and gender invariance of the PHQ-9 and GAD-7: Implications for 16 identity groups.

BACKGROUND: The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) are two commonly used screening tools for depression and anxiety, respectively. Despite the widespread use of these instruments, researchers have yet to examine whether scores may differ as a function of gender identity or sexuality orientation. METHOD: Using data from the 2018 and 2019 National Healthy minds study (N = 46,672), the present study tested each instrument for measurement invariance across 16 gender and sexual minority groups. RESULTS: Multigroup structural equation modeling revealed that several sexual minority groups evidenced questionable fit indices for both measures. Gay men, questioning women, and queer men had unacceptable fit indices for the PHQ-9. Only cisgender heterosexual men and women evidenced residual invariance on the PHQ-9. All gender minority groups evidenced significantly higher factor loadings for item 9 (the self-harm indicator) for the PHQ-9. Most identity groups evidenced scalar or partial scalar invariance for the GAD-7; however, no groups evidenced residual invariance on the GAD-7. LIMITATIONS: Findings may not generalize to non-college student populations. CONCLUSIONS: Researchers should weight means when conducting between group comparisons for groups that failed scalar invariance. Gender and sexual minorities may have inflated scores using the PHQ-9 and GAD-7 cut-offs.

Using Item Response Theory to Develop Revised (SSOSH-7) and Ultra-Brief (SSOSH-3) Self-Stigma of Seeking Help Scales.

The current research developed ultra-brief (SSOSH-3) and revised (SSOSH-7) versions of the Self-Stigma of Seeking Help scale. Item response theory was used to examine the amount of information each item provided across the latent variable scale and test whether items functioned differently across women and men. In a sample of 857 community adults, results supported removal of three reverse-scored items to create the SSOSH-7. The three most informative items were retained to create the SSOSH-3. Differential item functioning testing supported the use of both versions across women and men. Results replicated in an undergraduate student sample (n = 661). In both samples, the SSOSH-3 (αs = .82-.87) and SSOSH-7 (αs = .87-.89) demonstrated evidence of internal consistency. The SSOSH-3 (rs ≥ .89) and SSOSH-7 (rs ≥ .97) were highly correlated with the original SSOSH across samples and demonstrated significant correlations with help-seeking constructs and in similar magnitude to the original SSOSH.

"And it snowballed from there": The development of orthorexia nervosa from the perspective of people who self-diagnose.

This study aims to include the perspective of those who share content about Orthorexia Nervosa (ON) on Instagram and self-diagnose with ON (SD-ON) to trace their development of ON, gain insights into risk factors, symptoms and recovery, and explore differences with those who do not SD-ON. This research used mixed methods, with a sequential explanatory design. The quantitative component (n = 185) aimed to identify biological, psychological, interpersonal, and contextual factors that play a role in each phase of ON development. The qualitative component (n = 10) aimed to probe how and why individuals who SD-ON feel that certain experiences have shaped their development of ON. Respondents defined ON an obsession with healthy eating and clean or pure foods, with unhealthy effects on physical, mental or social wellbeing. A minority of participants did not view ON as problematic, but as a "salvation" from chronic diseases. Three phases characterizing the development of ON were identified: onset, progression and help seeking. Regarding the onset, two routes were identified, both characterized by a snowball effect of interacting factors. Regarding the progression of ON, several symptoms were identified, with obsession with healthy eating being the most frequent one. The majority of participants were trying to lose weight during ON, but their rationale was health rather than appearance. Regarding the help-seeking phase, reasons for problem realization were identified. ON was not noticed by loved ones until major health problems occurred, this being a barrier for recovery. While most believed that recovery is possible, respondents agreed that ON is a condition that will always linger in the back of the mind. This study contributes to addressing the shortage of qualitative studies investigating ON from insiders' perspective.

Seeking help despite the stigma: Experiential avoidance as a moderated mediator.

The help-seeking literature identifies a model wherein public stigma of seeking help is internalized as self-stigma of seeking help, which, in turn, decreases help-seeking outcomes. The current study considered whether experiential avoidance, or a tendency to avoid painful thoughts or emotions, moderates how strongly these stigmata relate to help-seeking intentions among university students. Specifically, this study tested whether experiential avoidance moderates (a) the direct relationship between self-stigma of seeking psychological help and help-seeking intentions and (b) the indirect relationship between public stigma and help-seeking intentions. Conditional process modeling in a university student sample (N = 235) supported these hypotheses. The direct relationship between self-stigma and help-seeking intentions was nonsignificant and weaker for those who reported low experiential avoidance than for those who reported high experiential avoidance. Results also demonstrated a moderated indirect effect wherein the relationship between self-stigma and intentions was nonsignificant among those reporting low levels of experiential avoidance. This suggests that self-stigma may predict help-seeking intentions when avoidance of therapy functions as a means for avoiding unpleasant emotions. These findings suggest that interventions designed to decrease experiential avoidance by increasing openness to unpleasant emotions may offer a novel avenue to attenuate the impact of self-stigma on help-seeking intentions without requiring the difficult task of reducing stigma altogether. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Longitudinal associations between marianismo beliefs and acculturative stress among Latina immigrants during initial years in the United States.

Acculturative stress is commonly experienced among Latinx immigrants in the United States who may feel pressured to maintain their heritage cultural norms and beliefs and/or adopt norms and beliefs of the dominant culture. The present study examined longitudinal relations between acculturative stress and endorsement of traditional Latina gender role beliefs (i.e., marianismo). We determined strength of the relations and temporal precedence of acculturative stress and endorsement of marianismo across 3 time points during participants' initial 3 years in the United States using a random intercept cross-lagged panel model. Participants were 530 Latina young adult women (ages 18-23) recruited from Miami-Dade County, Florida. Results suggested that acculturative stress levels at Time 1 positively predicted endorsement of the Family Pillar belief at Time 2, but acculturative stress levels at Time 2 negatively predicted the Virtuous and Chaste and Subordinate to Others beliefs at Time 3. In terms of marianismo beliefs predicting acculturative stress levels over time, the Virtuous and Chaste belief at Time 1 positively predicted acculturative stress at Time 2, and the Silencing Self to Maintain Harmony belief at Time 2 positively predicted acculturative stress at Time 3. Findings suggest that the Family Pillar belief, or feeling responsibility for the family's unity, may be protective against acculturative stress over time. Endorsing certain gender role beliefs (i.e., Virtuous and Chaste, Subordinate to Others) may lead to greater acculturative stress, and Latina young adult women experiencing acculturative stress may alter their endorsement of marianismo beliefs in an attempt to resolve culturally conflicting stress experienced after immigration. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Disentangling Gratitude: A Theoretical and Psychometric Examination of the Gratitude Resentment and Appreciation Test-Revised Short (GRAT-RS).

This study extended our theoretical and applied understanding of gratitude through a psychometric examination of the most popular multidimensional measure of gratitude, the Gratitude, Resentment, and Appreciation Test-Revised Short form (GRAT-RS). Namely, the dimensionality of the GRAT-RS, the model-based reliability of the GRAT-RS total score and 3 subscale scores, and the incremental evidence of validity for its latent factors were assessed. Dimensionality measures (e.g., explained common variance) and confirmatory factor analysis results with 426 community adults indicated that the GRAT-RS conformed to a multidimensional (bifactor) structure. Model-based reliability measures (e.g., omega hierarchical) provided support for the future use of the Lack of a Sense of Deprivation raw subscale score, but not for the raw GRAT-RS total score, Simple Appreciation subscale score, or Appreciation of Others subscale score. Structural equation modeling results indicated that only the general gratitude factor and the lack of a sense of deprivation specific factor accounted for significant variance in life satisfaction, positive affect, and distress. These findings support the 3 pillars of gratitude conceptualization of gratitude over competing conceptualizations, the position that the specific forms of gratitude are theoretically distinct, and the argument that appreciation is distinct from the superordinate construct of gratitude.

Does sleep partially mediate the effect of everyday discrimination on future mental and physical health?

OBJECTIVE: The current study examined whether sleep mediates the effect of discrimination experiences on mental and physical health over time. Prior research suggests a partially mediated relation; however, these studies used cross-sectional designs which provide insufficient causal evidence. METHOD: The study used longitudinal data available from the Midlife in the United States Study (MIDUS II, Biomarker project, and MIDUS III) applying structural equation modeling to evaluate whether self-reported sleep (N = 866) mediated the impact of discrimination on mental and physical health outcomes. RESULTS: Self-reported sleep quality partially mediated the effect of discrimination on mental and physical health. Analyses also indicated self-reported daytime dysfunction (i.e., difficulties maintaining alertness and motivation during the day) as a key component of sleep that mediates the discrimination and mental and physical health relations. Interestingly, having multiple marginalized identities did not amplify the impact of discrimination on sleep and health. CONCLUSIONS: These findings build upon previous cross-sectional research by better supporting the causal assertion that experiences of discrimination undermine sleep, which in turn worsens both mental and physical health. Altogether, results underscore the harmful impact of discrimination on health indirectly through sleep and offer insight into directions for future research.

Self-affirming values to increase student veterans' intentions to seek counseling.

Student veterans experiencing mental health concerns could benefit from seeking counseling (Rudd, Goulding, & Bryan, 2011), though they often avoid these services. Self-affirmation interventions have been developed to increase openness to health-related behaviors (Sherman & Cohen, 2006), and may also help promote psychological help-seeking intentions. This study explored whether a self-affirmation intervention increased intentions to seek counseling in a sample of 74 student veterans who had not previously sought counseling services. Participants completed pretest (Time 1) measures of distress and help seeking (i.e., self-stigma, attitudes, and intentions to seek counseling). A week later (Time 2), participants completed one of two conditions: (1) a self-affirmation intervention before viewing a psychoeducational video and brochure or (2) only the psychoeducational video and brochure before completing the same help-seeking measures as Time 1. A week after the intervention (Time 3), participants again completed the help-seeking measures. A focused longitudinal mediation model was conducted, examining the effect of the self-affirmation experimental condition on help-seeking intentions. Compared with those in the psychoeducation-only group, student veterans who completed the self-affirmation intervention reported increased intentions to seek counseling both immediately postintervention (Time 2) and a week later (Time 3). (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Do self-compassion and self-coldness distinctly relate to distress and well-being? A theoretical model of self-relating.

The current research tested a theoretical model of self-relating that examined the unique relationships of self-compassion and self-coldness with distress and well-being. Self-coldness has recently been identified as theoretically distinct from self-compassion, rather than part of a unitary self-compassion construct. As such, the incremental value of self-compassion and self-coldness on clinically relevant outcomes is unclear. Therefore, the current research tested a theoretical model of the unique relationships of self-compassion and self-coldness and both distress and well-being among university students (N = 457) and community adults (N = 794), as well as interactions between these 2 constructs. Structural equation modeling results in both samples revealed that self-compassion was uniquely related to well-being (ßs = .36-.43), whereas self-coldness was uniquely related to distress (ßs = -.34) and well-being (ßs = .65-.66). Consistent with the Theory of Social Mentalities, across samples self-compassion more strongly related to well-being, whereas self-coldness more strongly related to distress. Self-compassion did not demonstrate a unique direct relationship with distress, but it did buffer the relationship between self-coldness and distress in both samples and the relationship between self-coldness and well-being in the community sample. Overall, results suggest that clinicians would benefit from tailoring the use of self-compassion and self-coldness interventions. Implications for future research and practice are discussed. (PsycINFO Database Record

Two is more valid than one: Examining the factor structure of the Self-Compassion Scale (SCS).

The Self-Compassion Scale (SCS; Neff, 2003a) is the most widely used measure of self-compassion. Self-compassion, as measured by the SCS, is robustly linked to psychological health (Macbeth & Gumley, 2012; Zessin, Dickhaüser, & Garbade, 2015). The SCS is currently understood as exhibiting a higher-order structure comprised of 6 first-order factors and 1 second-order general self-compassion factor. Recently, some researchers have questioned the internal validity of this 1-factor conceptualization, and posit that the SCS may instead be comprised of 2 general factors-self-compassion and self-coldness. The current paper provides an in-depth examination of the internal structure of the SCS using oblique, higher-order, and bifactor structural models in a sample of 1,115 college students. The bifactor model comprised of 2 general factors-self-compassion and self-coldness-and 6 specific factors demonstrated the best fit to the data. Results also indicated the Self-Coldness factor accounted for unique variance in depression, anxiety, and stress, whereas the Self-Compassion factor only accounted for unique variance in its association with depression, providing further evidence for the presence of 2 distinct factors. Results did not provide support for the 1-factor composition of self-compassion currently used in research. Implications for using, scoring, and interpreting the SCS are discussed. (PsycINFO Database Record

Masculinity and barriers to seeking counseling: The buffering role of self-compassion.

Less than 1/3 of college men seek psychological help per year when experiencing mental health concerns. Many believe this is because socialized masculine norms are incongruent with help-seeking decisions. In line with this, adherence to masculine norms, like emotional control and self-reliance, is consistently linked to factors associated with lower use of counseling. Identifying constructs that buffer, or reduce, the relationship between masculine norm adherence and common barriers to seeking help, like help-seeking self-stigma and resistance to self-disclosing, could shed light on mechanisms through which effective interventions could be developed. As such, this study examined whether self-compassion, or the ability to show oneself kindness and understanding in the face of challenges, moderated the relationship between masculine norm adherence and both help-seeking self-stigma and the risks associated with self-disclosing to a counselor in a sample of 284 undergraduate men (Mage = 19.68, range = 18-30). Results indicate that self-compassion is associated with lower levels of help-seeking self-stigma and disclosure risks. Additionally, and perhaps more importantly, self-compassion buffered the relationship between overall masculine norm adherence and each of these barriers. Furthermore, when specific masculine norms were examined, self-compassion buffered the relationship between emotional control and disclosure risks. These results support the need for future research focused on the development and assessment of self-compassion based interventions aimed at decreasing the barriers undergraduate men experience toward seeking psychological help. (PsycINFO Database Record

Does self-stigma reduce the probability of seeking mental health information?

An important first step in seeking counseling may involve obtaining information about mental health concerns and treatment options. Researchers have suggested that some people may avoid such information because it is too threatening due to self-stigma and negative attitudes, but the link to actual help-seeking decisions has not been tested. Therefore, the purpose of the present study was to examine whether self-stigma and attitudes negatively impact decisions to seek information about mental health concerns and counseling. Probit regression models with 370 undergraduates showed that self-stigma negatively predicted decisions to seek both mental health and counseling information, with attitudes toward counseling mediating self-stigma's influence on these decisions. Among individuals experiencing higher levels of distress, the predicted probabilities of seeking mental health information (8.5%) and counseling information (8.4%) for those with high self-stigma were nearly half of those with low self-stigma (17.1% and 15.0%, respectively). This suggests that self-stigma may hinder initial decisions to seek mental health and counseling information, and implies the need for the development of early interventions designed to reduce help-seeking barriers.

Measuring thought content valence after a breakup: Development of the Positive and Negative Ex-Relationship Thoughts (PANERT) scale.

The end of a romantic relationship is a common and serious presenting concern among clients at university counseling centers. Researchers have highlighted the need to understand the nature of thoughts about an ex-relationship, because they may lead to unique clinical interventions. One aspect of thought that may be clinically relevant is content valence, or the positive or negative emotions associated with the content of the thought. Unfortunately, content valence has not been addressed in the romantic relationship dissolution literature. To address this omission, we developed the 12-item Positive and Negative Ex-Relationship Thoughts (PANERT) scale across 4 samples. In Sample 1 (n = 475), exploratory factor analyses demonstrated a multidimensional scale with 2 factors: positive content valence and negative content valence. Sample 2 (n = 509) and Sample 3 (n = 291) confirmed the factor structure in college and community samples. Internal consistencies ranged from .88-.94 for positive content valence and from .87-.94 for negative content valence. In Sample 4 (n = 133), construct validity was supported, with the PANERT factors uniquely predicting breakup distress, relationship preoccupation, depression, loss of self-concept, rediscovery of self-concept, negative emotional adjustment, and positive emotional adjustment. Further, the direction of these relationships suggest that positive thought content valence may be consistently maladaptive to recovery from an ex-relationship, and negative thought content valence may have maladaptive and adaptive features. Implications for future research and practice are discussed.