Psychology Department Theses and Dissertations

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Trauma and racial discrimination: examining their association with marijuana behaviors among black young adults
(2022-08) Rowe, Alia T.; Zapolski, Tamika; Stewart, Jesse; Cyders, Melissa; Eliacin, Johanne
Marijuana use has been shown to increase and peak during young adulthood (i.e., ages 18-35). However, it appears that Black individuals do not decline in use at rates similar to other race groups. Marijuana use among Black adults has been linked to more problems such as increased arrests, greater mental health disorder diagnoses, and substance dependence. The biopsychosocial model of racism and race-based theoretical framework aims to understand how factors such as racial discrimination as a traumatic event could be associated with marijuana behaviors, particularly among Black adults. The present study aims to examine the association between racial discrimination and marijuana use and problem use above and beyond trauma exposure. Further, I aimed to explore whether gender or vocation (college, community, and military) moderated the relationships. 391 Black adults (57.5% female; mean age 24.9) completed measures on marijuana use and problems, trauma exposure, and racial discrimination distress. Hierarchical linear regression and Hayes PROCESS macro were used to evaluate the study aims. Racial discrimination distress was associated with marijuana use above and beyond trauma exposure (R2=.016, p=.004). However, racial discrimination distress did not add significant variance within the model for problem marijuana use (R2=.001, p=.419). Additionally, moderation by gender and vocation were not supported in either model. Taken together, the present results support that examining psychological and health outcomes among Black young adults should include an evaluation of racial discrimination distress. Further, future studies should continue to evaluate sociodemographic factors in larger more representative community-based studies to better understand potential variation in risk among Black young adults.
Trait Expectancies and Pain-Related Outcomes in Older Adults
(2022-08) Shanahan, Mackenzie; Rand, Kevin L.; Hirsh, Adam T.; Stewart, Jesse C.; Matthias, Marianne S.
Older adults with persistent pain experience reduced physical functioning, increased disability, and higher rates of depression. Previous research suggests that different types of positive and negative expectancies (e.g., optimism and hopelessness) may be associated with the severity of these pain-related outcomes. Moreover, different types of expectancies may interact with perceived control to predict these outcomes. However, it is unclear whether different types of expectancies are uniquely predictive of changes in pain-related outcomes over time in older adults and whether perceived control moderates these relationships. The primary aims of the current study were to 1) examine how the shared and unique aspects of optimism and hopelessness differentially predict changes in pain-related outcomes (i.e., pain severity, pain interference, disability, and depressive symptoms) in older adults experiencing persistent pain over a 10-year and 2-year timeframe and 2) examine whether perceptions of control over one’s health moderate these relationships. The present study sampled older adults with persistent pain who participated in a nationally representative, longitudinal study (i.e., The Health and Retirement Study) at three timepoints across a 10-year period. First, confirmatory factor analyses (CFA) were conducted to determine appropriate modeling of expectancy variables. Second, mixed latent and measured variable path analyses were created to examine the unique relationships between expectancy variables and changes in pain-related outcomes over both a 10- year and 2-year period. Finally, mixed latent and measured variable path analyses and PROCESS were used to test perceived control as moderator of the relationships between expectancy variables and changes in pain-related outcomes over time. CFA results suggested that measures of optimism and hopelessness were best understood in terms of their valence, as positive (i.e., optimism) or negative (i.e., pessimism and hopelessness) expectations. Results from path analyses suggested that only negative, not positive, expectancies were significantly associated with worsening pain severity, pain interference, disability, and depressive symptoms across both 10-year and 2-year periods. Moderation analyses demonstrated inconsistent results and difficulties with replication. However, post-hoc path analyses found that perceptions of control over one’s health independently predicted some changes in pain-related outcomes over time, even when controlling for expectancies. Altogether, the current findings expand our knowledge of the associations between expectancies and pain by suggesting that negative expectancies are predictive of changes in mental and physical pain-related outcomes across years of time. The current study also suggests that positive and negative expectancies may be related, but distinct factors in older adults with persistent pain and that health-related perceived control may be predictive of changes in pain over time. The current discussion reviews these extensions of our current knowledge in greater detail, discusses the potential mechanisms driving these relationships through a theoretical lens, and identifies the implications of this work.
The Effects of Early-Life Lead Exposure on Adult Delta9-Tetrahydrocannabinol Sensitivity, Self-administration, and Tolerance
(2022-08) Garcy, Daniel; Boehm, Stephen; Lapish, Christopher; Logrip, Marian
Environmental exposure to lead (Pb) and cannabis use are two of the largest public health issues facing modern society in the United States and around the world. Exposure to Pb in early life has been unequivocally shown to have negative impacts on development, and recent research is mounting showing that it may also predispose individuals for risk of developing substance use disorders (SUD). At the same time, societal and legal attitudes towards cannabis (main psychoactive component delta-9-tetrahydrocannabinol) have been shifting, and many American states have legalized the recreational use of cannabis. It is also the 3rd most widely used drug of abuse in the US, and rates of cannabis use disorder are on the rise. This thesis sets out to establish whether there is a link between early life Pb exposure and later THC-related behavior in C57BL6/J mice, as has been demonstrated for other drugs of abuse. The first aim seeks to answer whether Pb exposure affects physiological THC sensitivity (as measured by the cannabinoid-induced tetrad). The second aim seeks to answer whether Pb exposure affects edible THC self-administration and the development of THC tolerance (also measured by the tetrad). It was hypothesized that Pb exposure would decrease THC sensitivity (Aim 1), would enhance THC self-administration (Aim 2), enhance the development of THC tolerance (Aim 2), and finally that sex-dependent effects of Pb-exposure and THC would be observed (Aims 1 & 2). These hypotheses ended up not being supported, but Aim 1 produced findings indicating that THC sensitivity was increased by Pb exposure, but only in female mice. Future research will hopefully be able to fully explore the implications of these findings.
Effect of Depression Treatment on Somatic Depressive Symptoms and Cardiometabolic Biomarkers among People without Diabetes
(2022-05) Shell, Aubrey Lynn; Stewart, Jesse; Hirsh, Adam; Cyders, Melissa; Considine, Robert
While depression is a risk factor for type 2 diabetes, little is known about the effect of depression treatment on diabetes risk markers. Using data from the recently completed eIMPACT trial (NCT02458690, supported by R01 HL122245), I examined if depression intervention improves diabetes risk markers and if improvements in somatic depressive symptoms mediate potential intervention effects. 216 participants (primary care patients ≥50 years with depression and elevated cardiovascular disease risk from a safety net healthcare system) were randomized to 12 months of the eIMPACT intervention (modernized collaborative care intervention involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants; n=107) or usual primary care for depression (primary care providers supported by embedded behavioral health clinicians and affiliated psychiatrists; n = 109). Given my focus on diabetes risk, I excluded participants who did not attend the post-treatment visit (n = 17) or who had a diabetes history at pre-treatment (n = 73), leaving a final sample of 126 (n=66 intervention, n=60 usual care; Mage = 58 years, 79% women, 50% Black, 47% with income <$10k/year). I computed depressive symptom severity variables from the Hopkins Symptom Checklist-20 (SCL-20) items: hyperphagia (“overeating” item), poor appetite (“poor appetite”), hypersomnia (“sleeping too much”), disturbed sleep (“sleep that is restless or disturbed”) and SCL-15 (mean of items not pertaining to appetite or sleep). I calculated insulin resistance from fasting plasma glucose and insulin using the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR)-2 calculator, body mass index (BMI) from measured height and weight, and plasma concentrations of high-sensitivity C-reactive protein (hsCRP), leptin, and ghrelin using ELISA kits. Parallel mediation analyses revealed that 12 months of modernized collaborative care for depression improved both directions of sleep symptoms but did not improve poor appetite or hyperphagia – the somatic symptom most consistently linked with increases in HOMA-IR, BMI, hsCRP, and leptin. Of the five cardiometabolic biomarkers examined, the eIMPACT intervention decreased only hsCRP and ghrelin. There were no intervention effects on HOMA-IR, BMI, or leptin. In addition, no somatic depressive symptoms mediated intervention effects on the cardiometabolic biomarkers, nor did race moderate any mediation effects. Further research is warranted to determine best practices for targeting hyperphagia and reducing cardiometabolic disease risk among people with depression.
Nutrition Enhancement in Early Psychosis (Neep): A Feasibility Trial of Enhanced Nutrition with Text Messaging and a Dietary Tracking Mobile Application
(2022-08) Fischer, Melanie W.; Salyers, Michelle; Minor, Kyle; Stewart, Jesse; Rivera, Rebecca; Leonhardt, Bethany
Background. People with psychotic disorders tend to die earlier than the general population, primarily due to preventable cardiovascular disease. Behavioral risk factors, such as poor diet, have been identified as major contributors. Given the importance of prevention, the early stages of psychosis have been described as a “critical” time to intervene on health behaviors. As such, a mobile-based intervention, Nutrition Enhancement in Early Psychosis (NEEP) was created to improve diet quality in persons with early psychosis. This study has three aims: (1) assess the feasibility of the intervention, (2) examine preliminary outcomes, and (3) investigate mechanisms associated with dietary change. Methods. NEEP incorporates a combination of nutrition education, goal setting, and mobile technology (i.e., a mobile application for dietary tracking, as well both automated and personalized text-messages). Given the pilot nature of the study, all participants (N=15) received the intervention. Feasibility was assessed through different metrics related to recruitment and adherence to the dietary tracking application, as well as self-report responses regarding acceptability. Preliminary outcomes (i.e., two measures of diet quality) and potential mechanisms of change (i.e., self-efficacy and motivation) were also evaluated using paired sample t-tests. Qualitative interviews were conducted following study participation. Given the emphasis on feasibility with a small sample, all significance tests were set at p <.10, and Hedges g was used to examine effects over time. Results. 15 participants were enrolled in the study and 12 participants completed follow-up assessments. Evaluative measures of feasibility suggest that the majority of those who were screened enrolled in this intervention and regularly engaged with the mobile tracking device to record their dietary consumption. In addition, participants enjoyed the intervention and found it to be useful in improving their diet. Preliminary evidence also suggests this intervention may improve diet quality. As such, one indicator of improvement in diet quality was considered significant (Rapid Eating Assessment for Participants- Shortened; p=.084), and both measures of diet quality suggested improvement in diet at the end of the 28-day intervention with small to medium effect sizes (REAP-S g=.44; Heathy Eating Index-2015 g=.69). Contrary to hypotheses, self-efficacy significantly decreased after the intervention (p=.028) and motivation remained relatively stable. Conclusion. Results suggest that NEEP is feasible as a low-cost, low-resource mobile intervention that is well-tolerated and may improve diet quality in people with early psychosis; however, mechanisms of change require further exploration.
Examining the Effects of Contextually-Imposed Cognitive Load on Providers' Chronic Pain Treatment Decisions for Racially and Socioeconomically Diverse Patients
(2022-08) Anastas, Tracy; Hirsh, Adam; Salyers, Michelle; Stewart, Jesse; Kroenke, Kurt
Compared to people who are White and have high socioeconomic status (SES), those who are Black and have low SES are more likely to receive suboptimal pain care. One potential contributor to these disparities is biased provider decision-making—there is compelling evidence that providers are influenced by patient race and SES when making pain treatment decisions. According to the dual process model, people are more likely to be influenced by demographic stereotypes, including implicit beliefs, when they are under high cognitive load (i.e., mental workload). One stereotype belief relevant to pain care is that Black and low SES people are more pain tolerant. Aligned with the dual process model, providers who are under high cognitive load and have strong implicit beliefs that Black and low SES people are more pain tolerant may be particularly likely to recommend fewer pain treatments to them. To test this hypothesis, I recruited physician residents and fellows (n=120) to make pain treatment decisions for 12 computer-simulated patients with back pain that varied by race (Black/White) and SES (low/high). Half of the providers were randomized to the high cognitive load group in which they were interrupted during the decision task to make conversions involving hypertension medications for another patient. Remaining providers completed the task without being interrupted. Providers’ implicit beliefs about race and SES differences in pain tolerance were measured with two separate Implicit Association Tests (IATs). Multilevel modeling indicated that providers recommended stronger medications to low than high SES patients (OR=.68, p=.03). There was also a significant interaction between patient SES and cognitive load (OR=-.56, p=.05) and a trending interaction between patient race and cognitive load (OR=1.7, p=.07). Under low cognitive load, providers recommended more pain treatments to high SES (vs. low SES) and Black (vs. White) patients, but under high cognitive load, providers recommended more pain treatments to low SES (vs. high SES) patients and equivalent treatment to Black and White patients. There were no three-way interactions between patient demographics (race or SES), cognitive load, and providers’ implicit beliefs (race-pain or SES-pain IAT scores). However, there was a trending interaction between patient race and race-pain IAT scores (OR=2.56, p=.09). Providers with stronger implicit beliefs that White people are pain sensitive and Black people are pain tolerant recommended more pain treatments to White patients and fewer pain treatments to Black patients. Lastly, there was a trending effect that providers with stronger implicit beliefs that high SES people are pain sensitive and low SES people are pain tolerant recommended stronger medications in general (OR=13.03, p=.07). Results support that provider cognitive load is clinically relevant and impacts clinical decision-making for chronic pain for racially and socioeconomically diverse patients. Future studies are needed to further understand the impact of cognitive load on providers’ pain care decisions, which may inform evidence-based interventions to improve pain care and reduce disparities.
Posttraumatic Stress and Depressive Symptoms and Symptom Clusters in US Military Personnel: The Longitudinal Effects of General Self-Efficacy and Meaning in Life
(2022-08) Fischer, Ian C.; Rand, Kevin L; Davis, Louanne W; Cyders, Melissa A; Salyers, Michelle P
US military personnel often experience ongoing distress after being exposed to traumatic events, and many develop posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Both general theories of stress and coping and cognitive theories of PTSD suggest that traumatic events give rise to distress by negatively influencing important beliefs and goals related to the self, other people, and the world. According to these theories, more positive belief- and goal-systems are associated with less severe symptoms of distress. Two constructs that tap into these systems are general self-efficacy and subjective meaning in life. The overall goal of the current study was to examine the ways general self-efficacy and subjective meaning in life relate to posttraumatic stress and depressive symptoms and symptom clusters in US military personnel, both cross-sectionally and longitudinally. Data from a VA-funded intervention study (n = 191) were examined. Results demonstrated that meaning in life is consistently associated with posttraumatic stress and depressive symptoms and symptom clusters cross-sectionally, whereas general self-efficacy is only associated with some aspects of depressive symptoms. Longitudinal analyses further revealed that meaning in life is associated with the Cluster D symptoms of PTSD and the cognitive-affective symptoms of depression. Interpretations, possible explanations, implications, and future directions are provided. Continued research in this area may identify important targets for treatment that enhance ongoing efforts to facilitate recovery from trauma.
Employee and Supervisor (Mis)Matching IPT and Performance Management Consequences
(2022-05) Findley, Mya; Williams, Jane; Stockdale, Margaret; Derricks, Veronica
Although performance management (PM) is a common, vital system used in most organizations, both supervisors and employees have been routinely disappointed with PM experiences, despite extensive research. Recent studies have identified certain individual differences that impact PM effectiveness. Specifically, the inclination to believe that one’s core traits are either malleable (an incremental mindset; high IPT) or fixed (an entity mindset; low IPT), a concept called "implicit person theory" (IPT), predicts many important supervisor behaviors that subsequently influence employee’s behaviors and attitudes. Furthermore, there is substantial support indicating that employee IPT also predicts their own performance, behaviors, and attitudes. This research shows the many benefits of having a high IPT over a low IPT. In this study, I examined the matching or mismatching IPT between employees and their respective supervisors and whether this differentially predicts employee attitudes that relate to PM. Responses were gathered from 211 participants. In an initial survey, participants were asked to report their IPT and their perceptions of their supervisor’s IPT. Two days later, participants reported their perceptions of procedural justice, satisfaction with PM, and motivation to improve performance. Employee perceptions of procedural justice and satisfaction were combined into a single measure measuring general affective reactions to PM, after an exploratory factor analysis revealed the two outcomes loaded onto a single factor. PROCESS Model 1 was used to examine the central hypothesis. I found significant interactions of employee and supervisor IPT on motivation and affective reactions to PM. The relationship between employee IPT and motivation was positive and strongest when supervisors had a high IPT, and was positive but weaker when supervisors had a low IPT. Interestingly, the relationship between employee IPT and affective reactions was negative when supervisors had a low IPT, such that low IPT employees reported better affective reactions to PM when they perceived their supervisors to have a low IPT rather than a high IPT. This research contributes to the literature by demonstrating the nuances of how IPT predicts employee outcomes. Organizations can benefit from this research by increasing awareness of one’s IPT and implementing cultural changes alongside interventions to increase favorable outcomes.
Working Memory in Posttraumatic Stress Disorder: Trauma Cue Reactivity
(2022-05) McGonigle, Colleen E.; Logrip, Marian; Lapish, Christopher; Czachowski, Cristine
Posttraumatic stress disorder involves a constellation of neural and behavioral alterations in response to trauma exposure. Aside from symptoms involved in posttraumatic stress disorder diagnosis, patients frequently present with working memory impairments. Working memory training has been established as an effective intervention to reduce posttraumatic stress symptoms. Working memory is associated with posttraumatic stress disorder in that it is commonly impaired in patients and that training can reduce the severity of posttraumatic stress symptoms. Taken together, these points suggest the possibility of a shared mechanism between working memory and posttraumatic stress disorder but working memory has not been studied thoroughly in rodent models of posttraumatic stress disorder. The present study utilizes footshock trauma to induce a posttraumatic stress state in rats and evaluates the effect of trauma and trauma-paired cues on working memory performance. Results demonstrate the emergence of chronic deficits in working memory among traumatized animals three weeks post-trauma. Presentation of trauma-paired cues caused further decrement in working memory performance. Regression analysis indicates that the degree of working memory impairment in response to a trauma-paired cue can be significantly predicted by behavioral phenotypes typic of diagnostic symptoms for posttraumatic stress disorder. This study enhances existing animal models by replicating the clinical observations of working memory deficits associated with posttraumatic stress disorder. This will pave the way for future work to probe underlying mechanistic dysregulation of working memory following trauma exposure and for future development of novel treatment strategies.
Examining the Relationship Between Callings and Employee Well-being
(2022-05) Lukjan, Kristyn; Andel, Stephanie; Stockdale, Peggy; Porter, Christopher
Although the occupational callings literature has largely focused on positive outcomes of living a calling, there are some emerging findings that suggest that callings may have a “negative” side as well. Drawing upon past studies within the callings literature, as well as upon theoretical perspectives such as self-regulation theory, identity theory, and the Effort-Recovery model, I tested a theoretical model to examine psychological detachment as a mechanism that accounts for the relationship between living a calling (also referred to as one’s calling intensity) and two well-being outcomes: sleep quality and burnout. Further, I built on previous work in the callings literature by examining the moderating impact of two individual differences (trait mindfulness, perfectionism) on the relationship between calling intensity and psychological detachment. Study hypotheses were tested using a two-wave study design with 358 emergency medical professionals. Results revealed that for called emergency medical professionals, trait mindfulness strengthened the negative relationship between calling intensity and psychological detachment, which had downstream negative effects on sleep quality. In addition, one facet of perfectionism, namely perfectionistic strivings, exacerbated the negative indirect effect of calling intensity on sleep quality via psychological detachment. Ultimately, this study contributed to the occupational callings literature by examining the impact of differential levels of trait mindfulness and perfectionism on employee well-being. Implications for enhancing employee well-being are discussed.

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