Neither Amphetamine nor Sub-Anesthetic Ketamine Treatment during Adolescence Impairs Devaluation in Rats Tested during Adulthood.

BACKGROUND: Much of the existing animal literature on the devaluation task suggests that prior repeated exposure to drugs of abuse during adulthood can impair goal-directed action, but the literature on human drug users is mixed. Also, the initiation of drug use often occurs during adolescence, but examinations of the effects of drug exposure during adolescence on behavior in the devaluation task are lacking. METHODS: We examined whether repeated exposure during adolescence to amphetamine (3 mg/kg injections every-other day from post-natal day 27-45) or ketamine (twice daily 30 mg/kg injections from post-natal day 35-44) would impair behavior in a devaluation test when tested drug-free in adulthood. Rats were trained to press a left lever with a steady cue-light above it for one reinforcer and a right lever with a flashing cue-light above it for a different reinforcer. We tested whether any impairments in goal-directed action could be overcome by compensation between strategies by giving rats information based on lever-location and cue-lights during the test that was either congruent (allowing compensation) or incongruent (preventing compensation between strategies) with the configurations during training. RESULTS: Our results provided no evidence for impairment of goal-directed action during adulthood after adolescent amphetamine or ketamine exposure. CONCLUSIONS: We discuss possible reasons for this discrepancy with the prior literature, including (1) the age of exposure and (2) the pattern in the previous literature that most previous demonstrations of drug exposure impairing devaluation in laboratory animals may be attributed to either drug-associated cues present in the testing environment and/or accelerated habit learning in tasks that predispose laboratory animals towards habit formation with extended training (with training procedures that should resist the formation of habits in the current experiment). However, additional research is needed to examine the effects of these factors, as well a potential role for the particular doses and washout periods to determine the cause of our finding of no devaluation impairment after drug exposure.

Compassion Meditation for Distressed Older Veterans: A Feasibility Study.

OBJECTIVES: Older Veterans are at elevated risk for psychological distress and may encounter barriers to accessing mental health services. Compassion Meditation (CM) promotes positive emotions and outcomes among distressed individuals; thus, we conducted a preliminary feasibility study of CM among distressed older Veterans. METHODS: Participants included 25 Veterans aged 55+ (M = 69.0, SD = 10.6) with anxiety and/or depressive symptoms, recruited from primary care, mostly male (76.0%), and White (60.0%). CM consisted of 10 groups, which were transitioned from in-person to telehealth due to COVID-19. Feasibility indices included rates of intervention initiation and completion, and attendance. Participants completed measures of symptom severity and well-being pre- and post-intervention. RESULTS: Of 25 enrolled participants, 88.0% (n = 22) attended at least one session, and 52% (n = 13) completed the intervention (attended six or more sessions). Among intervention completers, the average number of sessions attended was 9.46. Seven Veterans withdrew from intervention due to difficulties engaging via telehealth. CONCLUSIONS: These findings support the feasibility of CM training in older Veterans with psychological distress, though dropouts highlighted potential need for additional strategies to facilitate telehealth participation. CLINICAL IMPLICATIONS: Older Veterans appear amenable to meditation-based practices, provided they are easy to access.

Feasibility and initial impact of single-session internet-delivered acceptance vs change skills for emotions for stress- and trauma-related problems: a randomized controlled trial.

BACKGROUND: Current psychological trauma-focused interventions have left a gap for individuals who may not be ready for trauma-focused treatment and/or who present with other forms of clinically significant distress, such as subthreshold post-traumatic stress disorder (PTSD). Emotion regulation is a possible transdiagnostic mechanism of change that may promote and maintain some of the varied mental health problems related to trauma exposure. AIMS: This study examines the feasibility and initial impact of two brief emotion regulation skill trainings targeting different processes hypothesized to reduce trauma-related problems, compared with an active control. METHOD: Subjects (n = 156) were randomized to receive one of three brief internet-based trainings: (1) skill training on accepting emotions, (2) skill training on changing emotions, or (3) stress psychoeducation (control). Participants completed measures of emotion regulation, mindfulness, and affect intensity 24 hours pre- and immediately post-training. RESULTS: Results suggested that a brief internet-based skills training programme was feasible and acceptable, with 91.9% completing the training programme to which they were randomized. Results showed that participants in all conditions demonstrated significant decreases in emotion regulation problems over time; yet these improvements did not vary by condition. Participants in the Change condition with higher PTSD symptoms were significantly more likely to have greater increases in positive affect compared with those with lower PTSD symptoms. CONCLUSIONS: Although the three conditions did not show different outcomes, all three brief internet-delivered trainings were feasible. Results provide direction for future studies to evaluate the delivery of emotion regulation skills in individuals with trauma-related distress.

Mental Health Beliefs, Access, and Engagement with Military Sexual Trauma-Related Mental Health Care.

BACKGROUND: Military sexual trauma (MST) is associated with negative mental health outcomes. Mental health beliefs, such as stigma or secondary victimization, have been identified as possible barriers to care; however, it is unclear whether such beliefs impact receiving care. OBJECTIVE: To assess if mental health beliefs impact MST-related mental health care access and engagement. DESIGN: Veterans completed a survey following detection of MST. Survey data were linked to Veteran's Health Administration administrative data in order to examine associations with outpatient MST-related care in the year following MST detection. PARTICIPANTS: A national sample of women and men Veterans (N = 1,185) with newly detected MST who reported a perceived need for MST-related mental health treatment. MAIN MEASURES: Building on prior work that identified four latent classes of mental health beliefs (Hahn et al., J Trauma Stress 34:394-404, 2020; low barrier, stigma-related beliefs, negative perceptions of care, high barrier), we examined associations with outpatient mental health care indicated by a provider as related to MST. Care was examined in total, as well as the specific categories of medication management, individual psychotherapy, and group psychotherapy. KEY RESULTS: Access to care following MST detection was high: most (71.6%) Veterans had an MST-related mental health visit within 30 days, and nearly all (83.6%) within 180 days, with the median number of days to receiving care being 2. Negative perceptions of care predicted a lower likelihood of treatment engagement (3+ encounters) with MST-related individual psychotherapy (OR = 0.65, 95% CI (0.43-0.96)), whereas the stigma-related beliefs and high barrier classes did not. CONCLUSIONS: There appears to be excellent access to mental health care among Veterans with a perceived need for MST-related mental health treatment. However, treatment beliefs that represented negative perceptions of care may serve as barriers to engagement. Interventions targeting negative perceptions of care during early encounters could help promote subsequent engagement.

Recommendations to disclose sexual assault are motivated by retribution among women who endorse honor values.

Rape arrests are higher in US states wherein residents more typically endorse honor values. Because honor values reflect an association between reputation and self-worth, which is based on one's ability to uphold traditional gender norms, one should expect that women who endorse honor values are motivated to conceal a sexual assault. However, honor values also engender the expectation that women defend their reputations if threatened. Thus, women from honor cultures should be more likely to seek retribution by disclosing a sexual assault to others. The current research investigates the impact of honor values on the recommendation to disclose a sexual assault when women believe the victim is motivated to protect her reputation. We evaluated the role of common post-rape emotions (shame, anger, and fear) on motivations to either conceal a "victim" status or to punish the transgression. In two studies, US women (total n = 842) responded to vignettes of sexual assault that varied the relationship of the perpetrator (acquaintance or husband). Using path modeling to test the two competing hypotheses, we found that women who endorsed honor values more strongly perceived that the victim of a sexual assault experienced more anger and fear, was more likely to seek retribution, and, in turn, were more likely to recommend that she disclose to confidants (similar across the acquaintance and husband scenarios). These findings may help increase researchers' and practitioners' cultural understanding of the help-seeking behavior of survivors of sexual assault across different communities.

A Public Health Framework for Preventing Mental Disorders in the Context of Pandemics.

The COVID-19 pandemic has universally threatened the building blocks of mental health, well-being, and quality of life, namely, expectations of safety, connectedness, hope, and individual and societal efficacy. Consequently, unprecedently large numbers of individuals are significantly stressed and many are at risk for relapse of mental health problems, exacerbations of existing mental and behavioral health problems, and new onset clinical problems. Because of the scope of the problem, a population-based public health perspective is needed, which in the context of disasters has well-established theories and prevention approaches. Public health approaches to disasters and pandemics focus on preventing subclinical problems from becoming clinical disorders, in comparison to clinical care approaches that focus on treating established disorders. Fortunately, specialty care clinicians who typically think about assessing and treating established disorders have the training and clinical competencies to deliver prevention-focused interventions. This paper is designed to help specialty care clinicians who use cognitive-behavioral strategies to understand the biopsychosocial impacts and resource deficits associated with COVID-19-related stressors and the public health perspective to address them. We also provide ways clinicians can help people who are suffering from significant stress and resource deficits bounce back and regain functioning. We describe psychological first aid, stress management, repeated ecological assessment, writing about stressors, problem-solving, and behavioral activation approaches to assist individuals at risk for enduring stress-linked problems.

To honor and obey: Perceptions and disclosure of sexual assault among honor ideology women.

The overwhelming majority of rapes goes unreported. To better understand the sociocultural mechanisms behind why underreporting may occur, three studies (total n = 1,481) examine how women's endorsement of honor values influence the perceptions of rape. Using vignettes that varied the closeness of the perpetrator of a sexual assault (i.e., stranger, acquaintance, or husband), we found that women who endorse honor values of womanhood were less likely to label a forced sexual act as "rape" and to suggest that the victim discloses the rape to others, including to the police. This was especially true the closer the victim was to the perpetrator (e.g., husband vs. stranger). Our findings highlight the effects of honor values on perceived sexual assault and the consequences of disclosure, and may aid in understanding barriers to rape reporting and areas for intervention.

A dialectical behavior therapy skills intervention for women with suicidal behaviors in rural Nepal: A single-case experimental design series.

BACKGROUND: Suicide in low- and middle-income countries (LMICs) accounts for 75% of the world's burden of suicide mortality and is the leading single cause of death among Nepali reproductive age women. To advance treatment for suicidal behaviors in LMICs, a single-case experimental design (SCED) was conducted of a culturally adapted Dialectical Behavior Therapy skills intervention for Nepali populations (DBT-N). METHOD: Ten Nepali women with histories of suicidality participated in the 10-session intervention. Outcomes of emotion regulation, suicidal ideation, depression, anxiety, resilience, and coping skills use were measured at multiple time points pre-intervention, during, and at follow-up. Qualitative interviewing assessed DBT-N's feasibility and acceptability. RESULTS: Participants showed improvements in emotion regulation over the course of treatment, which were associated with increased skills use. Rapid, sustained reductions in suicidal ideation and improvements in resilience were observed after DBT-N initiation. CONCLUSION: This SCED supports conducting further evaluation of DBT-N through controlled trials with emotion regulation as a target mechanism of action for reducing suicidal behaviors in LMICs.

Self-Compassion and Psychological Flexibility in a Treatment-Seeking Sample of Women Survivors of Interpersonal Violence.

Interpersonal violence is pervasive and is related to numerous negative psychological outcomes. This study examines self-compassion and psychological flexibility as potential protective factors for the range of diverse problems associated with interpersonal trauma. A community sample of 27 women (mean age = 37.74, SD = 16.16) participated in a larger pilot intervention study for psychological distress related to interpersonal violence. In this treatment-seeking sample, self-compassion was positively associated with psychological flexibility and negatively linked to higher levels of trauma-related distress, including posttraumatic stress disorder (PTSD) symptoms as well as problems related to the self and relations with others. The results suggest that self-compassion and psychological flexibility may function as protective factors in the development of problems in survivors of interpersonal violence.

Peer Support and Outcome for Veterans with Posttraumatic Stress Disorder (PTSD) in a Residential Rehabilitation Program.

This observational study aims to determine the characteristics of peer support that change attitudes toward recovery and PTSD symptom severity. The study respondents were a sample of 55 VA patients who were residents at a residential rehabilitation program for PTSD where they were the recipients of peer support. Veterans perceived greater support from other veterans (mean = 4.04 on 1-5 scale, SD = 0.78) than from any other source. Greater perceived support from the peer support provider, other veterans and mental health staff was associated with improvements from intake to discharge in recovery attitudes. Greater perceived support from other veterans and mental health staff was associated with an improvement in PTSD symptoms. Results from this study suggest that positive perceptions of peer support favorably influences attitudes toward recovery, from PTSD, in veterans who are the recipients of such support.

Acceptance and commitment therapy as a nonpathologizing intervention approach for survivors of trauma.

Acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 2012) is proposed as a nonpathologizing approach to trauma-related problems. ACT has at its core a functional approach to understanding the human condition such that problems are maintained by functional processes, such as avoidance. Treatment focuses on these processes to institute change, stepping away from directly pursuing symptoms as an evaluative outcome. A collaborative, client-centered approach is used in defining valued life directions and committing to action based on those values. ACT presents a method of approaching trauma-related problems that is structured to support a client in finding a life beyond trauma that has value.

Resources Utilized by Otolaryngology Fellowship Directors When Determining Reputations of Residency Programs.

OBJECTIVE: Residency program reputation is consistently reported as an important factor by fellowship directors when considering applicants. This study sets out to determine resources fellowship directors rely on when determining residency program reputation. STUDY DESIGN: Cross-sectional study. SETTING: Using an anonymous online survey of all 2022 Otolaryngology (OHNS) fellowship program directors. METHODS: The 13-question survey sought to assess fellowship director's perspectives and resource utilization when determining residency program reputation. RESULTS: Representing all OHNS fellowship program directors and co-directors (N = 287), 103 responded to our survey, response rate 35.9%. Most participants reported that residency reputation was important for fellowship candidacy. On a Likert scale of 1 to 5, 1 being most important and 5 being not important, personal knowledge of the residency program (2.03 out of 5) and program faculty/mentor reputation (2.09 out of 5) were the most important factors cited. 63% were unfamiliar with the survey methodology of Doximity Residency Navigator (DRN), while 53% contributed to DRN by filling out surveys. Nearly all fellowship directors (N = 100, 97%) reported their rank list was not influenced by DRN. Most fellowship directors reported that US News and World Report (USNWR) and DRN were neither consistent nor inconsistent with their perceptions of residency reputations (38% and 56%, respectively), suggesting ambivalence toward these resources. CONCLUSION: Residency reputation is important for fellowship directors when evaluating fellowship candidates. Directors do not rely on USNWR, National Institute of Health (NIH) ranking, or DRN when gauging residency reputation, but rather personal knowledge of the applicant's residency program or reputation of the otolaryngology faculty.

Predicting Adherence to Topical Medications in Chronic Rhinologic Disease: A Systematic Review.

OBJECTIVE: To determine risk factors of medical adherence and describe strategies to increase adherence in patients with chronic rhinologic disease. DATA SOURCES: PubMED, SCOPUS, CINAHL, and Cochrane. REVIEW METHODS: Systematic review of 4 databases (PubMED, SCOPUS, CINAHL, Cochrane) from inception of databases to September 1, 2022 to identify studies that evaluated factors related to and affected by medical adherence in patients with chronic rhinologic disease. RESULTS: Of 1491 studies screened, 25 studies met inclusion criteria. Of these, 7 studies described how sensory attributes of intranasal sprays affect adherence, including odor, taste, aftertaste, and side effects. Five studies described record keeping diaries/notification systems to improve adherence, with demonstration of web-based platforms to send reminders as well as keep record of medication usage to improve adherence. Eight studies described patient-specific risk factors to nonadherence, with demonstration of increased age and conscientious personalities correlating with medical adherence. Five studies looked at pediatric patients specifically, with adherence rates in children parallelling that of adults. Additionally, nonadherence in children may have greater implications for school performance. CONCLUSION: Overall, adherence to topical medical therapy in patients with chronic rhinologic disease is affected by patient-related and medication-specific factors which should be considered when counseling patients. Web-based diary or notification systems may help increase adherence. Additionally, children are equally adherent to topical medical therapy as adults and nonadherence may have negative implications for school performance.

Patterns of adverse childhood experiences and cardiovascular risk factors in U.S. adults.

Adverse Childhood Experiences (ACEs) are associated with poor health yet, we know little about how distinct patterns of ACE types are associated with cardiovascular (cardiovascular (CVD)) risk factors. The current study 1) examined associations of latent ACE classes with modifiable CVD risk factors including high cholesterol, smoking, diabetes, hypertension, high triglycerides, physical inactivity, overweight/obesity, and lifetime depression; and 2) examined the impact of socioeconomic status-related (SES) factors on these relationships. Using a cross-sectional analysis of the National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36,309) data, four latent classes of ACEs were previously identified: 1) low adversity, 2) primarily household dysfunction, 3) primarily maltreatment, and 4) multiple adversity types. We examined the association of these classes with CVD risk factors in adulthood and subsequently, the same model accounting for SES-related factors. Tobacco smoking, overweight/obesity, and lifetime depression were each associated with higher odds of being in classes 2, 3, and 4 than class 1, respectively. These relationships held after adjusting for SES-related factors. Class 4 was associated with the most CVD risk factors, including high triglycerides and high cholesterol after controlling for SES-related factors. The consistent associations between tobacco smoking, overweight/obesity, and lifetime depression with each adverse ACE profile, even after controlling for SES, suggest behavioural CVD prevention programs should target these CVD risk factors simultaneously.

Relationships among race, ethnicity, and gender and whole health among U.S. veterans.

Racial, ethnic, and gender health care disparities in the United States are well-documented and stretch across the lifespan. Even in large integrated health care systems such as Veteran Health Administration, which are designed to provide equality in care, social and economic disparities persist, and limit patients' achievement of health goals across multiple domains. We explore Veterans' Whole Health priorities among Veteran demographic groups. Participants who were enrolling in Veteran Health Administration provided demographics and Whole Health priorities using eScreening, a web-based self-assessment tool. Veterans had similar health care goals regardless of demographic characteristics but differences were noted in current health appraisals. Non-White and women Veterans reported worse health-relevant functioning. Black Veterans were more likely to endorse a low rating for their personal development/relationships. Multiracial Veterans were more likely to endorse a low rating of their surroundings. Asian Veterans were less likely to provide a high rating of their surroundings. Women Veterans reported lower appraisals for body and personal development but higher appraisals of professional care. Results indicated that demographic factors such as race and gender, and to a lesser extent ethnicity, were associated with health disparities. The Whole Health model provides a holistic framework for addressing these disparities. These findings may inform more culturally sensitive care and enhance Veteran Health Administration equal access initiatives. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mitigating the health effects of systemic racism: Evaluation of the Race-Based Stress and Trauma Empowerment intervention.

BACKGROUND: Disparities in physical and mental health among Black, Indigenous, and People of Color (BIPOC) are well-documented and mirrored in the Veteran population. Chronic stress due to racism and discrimination is one possible mechanism driving these negative health outcomes. The Race-Based Stress and Trauma Empowerment (RBSTE) group is a novel, manualized, health promotion intervention designed to address the direct and indirect impacts of racism among Veterans of Color. This paper describes the protocol of the first pilot randomized controlled trial (RCT) of RBSTE. This study will examine the feasibility, acceptability, and appropriateness of RBSTE compared to an active control (an adaptation of Present-Centered Therapy; PCT) in a Veterans Affairs (VA) healthcare setting. A secondary aim is to identify and optimize strategies for holistic evaluation. METHODS: Veterans of Color (N = 48) endorsing perceived discrimination and stress will be randomized to RBSTE or PCT; both groups will be delivered in 8 weekly, 90-min virtual group sessions. Outcomes will include measures of psychological distress, discrimination and ethnoracial identity, holistic wellness, and allostatic load. Measures will be administered at baseline and post-intervention. CONCLUSION: This study will inform future interventions targeting identity-based stressors and represents an important step in advancing equity for BIPOC in medicine and research. CLINICAL TRIAL REGISTRATION NUMBER: NCT05422638.

It Happened Matters More Than What Happened: Associations Between Intimate Partner Violence Abuse Type, Emotion Regulation, and Post-Traumatic Stress Symptoms.

Intimate partner violence (IPV) has varied consequences including post-traumatic stress (PTS). One proposed risk factor for PTS is escalating types of violence; however, data are mixed. Because emotion dysregulation acts as a causal mechanism across numerous problems co-occurring in survivors of IPV, this study examined its association with PTS severity versus abuse type. Regression using data from women (n = 89) seeking treatment for IPV-related distress found the following: Type of abuse was not related to emotion dysregulation and emotion dysregulation was more strongly associated with PTS than type of abuse. This suggests emotion dysregulation may be more predictive of PTS than abuse type.

Social support coping styles and psychological distress during the COVID-19 pandemic: The moderating role of sex.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic led to the onset and exacerbation of mental health problems, such as stress, anxiety, and depression; yet stay-at-home-orders affected individuals' ability to make use of social support as a coping skill in managing distress. We aimed to evaluate how social support (emotional and instrumental) and biological sex were associated with stress, anxiety, and depression early in the COVID-19 pandemic. METHODS: Participants (n = 7256) had an average age of 50.13 years (SD = 16.75) and 51.6% were male. Using a cross-sequential design, seven cohorts of individuals completed baseline (T1) and one-month follow-up (T2) questionnaires online from March to July of 2020. We used a series of hierarchical regressions to identify types of social support (Brief-COPE, T1) associated with stress (Perceived Stress Scale-10, T1 and T2), anxiety and depression (Patient Health Questionnaire-4, T2). RESULTS: Greater emotional support was associated with less perceived stress, anxiety and depression (all ps < 0.001), whereas greater instrumental support predicted increased distress (all ps < 0.036) on all four outcomes. Moderation analyses revealed that greater emotional social support was associated with lower perceived stress at T1 for both women and men, with a stronger association for women relative to men. For women, greater emotional social support predicted lower anxiety. LIMITATIONS: Self-selection may have introduced bias and participant self-report on brief measures may not have fully captured coping and distress. CONCLUSIONS: Interventions enhancing emotional social support strategies, which appear especially important for women, might help manage enduring stressors such as the COVID-19 pandemic.

The feasibility of a brief, Internet-based mantram repetition program for undergraduate students.

OBJECTIVE: To assess the feasibility of a brief, self-guided, Internet-based version of the mantram repetition program (MRP) for undergraduate students, a population with mental health challenges and high reliance on Internet-based resources. PARTICIPANTS: Undergraduate students (n = 60) receiving course credit had a mean age of 20.66 years and primarily identified as female (84.5%) and Asian (55.9%). METHODS: MRP was taught through four video modules. Participants completed module 1 at timepoint 1 (T1), modules 2-4 one week later (T2), and questions about their practice one week following (T3). RESULTS: Most (88.3%) participants completed all four video modules and 76.7% completed T3 questions. At T3, 80.4% of participants endorsed using mantram repetition, practicing 4.46 days/week and 3.26 times/day on average. CONCLUSIONS: A self-guided, Internet-delivered MRP is feasible for undergraduate students. Further research is needed to establish its utility for managing psychological challenges in college students.