American Psychologist

To expose or not to expose: A comprehensive perspective on treatment for posttraumatic stress disorder.
Trauma-focused psychotherapies, in particular prolonged exposure (PE) therapy, have been recognized as the “gold standard” for the treatment of posttraumatic stress disorder (PTSD). But effectiveness and implementation data show that a large proportion of patients who undergo exposure therapy retain their PTSD diagnosis, and implementation studies have shown low engagement and high dropout rates. Meanwhile, non-trauma-focused therapies have shown promise in treating PTSD. In this review, we aim to answer the question of whether exposure is necessary to treat PTSD by integrating clinical and research literature from multiple perspectives. We review the roots of exposure therapy in both psychodynamic and behavioral paradigms and their proposed mechanisms. We then review non-trauma-focused treatments and their proposed mechanisms. We conclude that the specific form of exposure required by PE is not necessary for symptom remission. Finally, common psychotherapy factors may facilitate patient self-directed exposure outside of the therapy context. These findings should alter the direction of clinical research to identify the therapy processes that most effectively promote the processing of trauma memories. With respect to clinical practice, shared decision-making should allow for increased patient autonomy in choosing either trauma-focused or non-trauma-focused treatments. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Refreshing, necessary exposure to the problem with exposure therapies for trauma: Commentary on Rubenstein et al. (2024).
In this invited commentary, I address what I see as the major contributions Rubenstein et al. (2024) have made to challenging the hegemony of exposure therapies for trauma-exposed persons. These include a thorough review of the history of the rise of exposure therapies, the identification of posttrauma responses as forms of anxiety disorders, and an extensive discussion of the neurobiology of the trauma response. Additionally, Rubenstein et al. expose the very high dropout rates in studies of exposure therapies and ways in which many traumatized people have not found them helpful. This article brings the so-called “gold standard” back to its rightful position as one possible, occasionally helpful way of assisting some, but not all, traumatized people. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Beyond exposure: A healthy broadening of posttraumatic stress disorder treatment options: Commentary on Rubenstein et al. (2024).
This commentary on Rubenstein et al. (2024) applauds their sensitive historical exploration of exposure therapy for posttraumatic stress disorder (PTSD) and balanced review of the strengths and weaknesses of that approach. I offer five points to expand on their contribution. (a) Stringent exposure therapy workforce requirements limit scalability, thus restricting access for the large number of patients in need of PTSD treatment. (b) There are additional non-trauma-focused approaches that show efficacy for PTSD. (c) Results of exposure therapy trials should be interpreted in light of how much the study designs align with real-world conditions. (d) Some surprising results from the subfield of PTSD/substance use disorder could suggest new treatment options. (e) There is a need for stronger reporting of clinical worsening (iatrogenesis) outside of clinical trials. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Some closure on exposure—Realigning the perspective on trauma treatment and finding a pathway forward: Reply to Brown (2024) and Najavits (2024).
We respond to commentaries by Brown (2024) and Najavits (2024) on our original work titled “To Expose or Not to Expose: A Comprehensive Perspective on Treatment for Posttraumatic Stress Disorder” (Rubenstein et al., 2024). Their work serves to augment the original argument that exposure is an important change factor in the amelioration of traumatic stress but should be viewed more broadly than traditional treatment paradigms suggest. We are grateful for this opportunity and aim to promote additional dialogue in the field about ways to improve upon existing models of trauma and its treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Perspectives of researchers engaging in majority world research to promote diverse and global psychological science.
Journal analyses have documented the historical neglect of research pertaining to the Majority World in psychological science, and the need for inclusivity is clearly articulated to ensure a science that is comprehensive and globally applicable. However, no systematic efforts have explored the perspectives of researchers working with Majority World communities regarding the challenges they experience in conducting and disseminating research and ways to address them. Our aim was to explore these challenges from the perspective of these researchers using an embedded mixed-methods design. Based on responses of 232 researchers who engage in psychological research with Majority World communities (68.1% from Africa, Asia, or Latin America, remaining from the Minority World), we identified challenges in three areas: (a) stemming from an inherent bias against Majority World research, (b) experienced by all researchers, which nonetheless are heightened for those engaging in research with Majority World populations, and (c) specific to researchers affiliated with Majority World institutions. Based on the findings, we recommend journal editorial teams and funding agencies: (a) acknowledge and address the bias inherent in the publication and funding process, (b) recruit editorial team members, program officers, and reviewers from the Majority World, (c) train editorial team members, program officers, and reviewers from the Minority World to thoughtfully evaluate Majority World research, and (d) provide resources for researchers affiliated with Majority World institutions. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Mental health and environmental factors in adults: A population-based network analysis.
Few studies have assessed the multifactorial nature of environmental influences on population mental health. In this large-scale, population-based study of adults, we applied network analysis to study the relationship between environmental factors and symptoms of depression, anxiety, and well-being. We estimated networks with overall mental health nodes and individual symptoms to assess both broad and fine-grained associations between environmental factors and mental health. Finally, we conducted an out-of-sample replication in an independent large-scale sample to assess the robustness of our results. Across 31,000 adults randomly sampled from the Norwegian population, we identified associations between numerous environmental characteristics and mental health. Recent discrimination and unsupportive social environments were strongly associated with lower population well-being and higher levels of mental illness symptoms, respectively. The most strongly connected variables in the networks were environmental factors, including perceived problems with crime, violence, or vandalism in the residential area, worrying about violence or threats when outside, and problems with noise or contamination at home. Substantial variation in population mental health was explained by environmental factors included in the networks. Replicability of the results was excellent and suggestive of strong robustness of the results across samples. Our findings are indicative of the importance of environmental factors, such as the social environment, housing satisfaction, and residential area characteristics, for multiple aspects of population mental health. We identify several environmental factors that represent potentially useful targets for future studies and public health efforts seeking to improve mental health in the general population. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
We built this culture (so we can change it): Seven principles for intentional culture change.
Calls for culture change abound. Headlines regularly feature calls to change the “broken” or “toxic” cultures of institutions and organizations, and people debate which norms and practices across society are now defunct. As people blame current societal problems on culture, the proposed fix is “culture change.” But what is culture change? How does it work? Can it be effective? This article presents a novel social psychological framework for intentional culture change—actively and deliberately modifying the mutually reinforcing features of a culture. Synthesizing insights from research and application, it proposes an integrated, evidence-based perspective centered around seven core principles for intentional culture change: Principle 1: People are culturally shaped shapers, so they can be culture changers; Principle 2: Identifying, mapping, and evaluating the key levels of culture helps locate where to target change; Principle 3: Culture change happens in both top-down and bottom-up ways and is more effective when the levels are in alignment; Principle 4: Culture change can be easier when it leverages existing core values and harder when it challenges deep-seated defaults and biases; Principle 5: Culture change typically involves power struggles and identity threats; Principle 6: Cultures interact with one another and change can cause backlash, resistance, and clashes; and Principle 7: Timing and readiness matter. While these principles may be broadly used, here they are applied to the issue of social inequality in the United States. Even though culture change feels particularly daunting in this problem area, it can also be empowering—especially when people leverage evidence-based insights and tools to reimagine and rebuild their cultures. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
How subjective idea valuation energizes and guides creative idea generation.
What drives us to search for creative ideas, and why does it feel good to find one? While previous studies demonstrated the positive influence of motivation on creative abilities, how reward and subjective values play a role in creativity remains unknown. This study proposes to characterize the role of individual preferences (how people value ideas) in creative ideation via behavioral experiments and computational modeling. Using the Free Generation of Associates Task coupled with rating tasks, we demonstrate the involvement of valuation processes during idea generation: Preferred ideas are provided faster. We found that valuation depends on the adequacy and originality of ideas and guides response selection and creativity. Finally, our computational model correctly predicts the speed and quality of human creative responses, as well as interindividual differences in creative abilities. Altogether, this model introduces the mechanistic role of valuation in creativity. It paves the way for a neurocomputational account of creativity mechanisms. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
A randomized wait-list controlled trial of Men in Mind: Enhancing mental health practitioners’ self-rated clinical competencies to work with men.
Improved engagement of men in psychotherapy is an essential element in improving male health outcomes. This trial examined whether the Men in Mind intervention improved practitioners’ self-rated clinical competencies to engage and respond to male clients in therapy. A parallel, single-blind, wait-list randomized controlled trial was conducted with Australian-based mental health practitioners, currently administering psychotherapy to males, fluent in English, and not currently completing their undergraduate degree. Participants were randomly assigned 1:1, through variable-sized blocks stratified by gender, to either the intervention (Men in Mind) or wait-list control. Men in Mind was offered as a self-led 6-week, five-module online program to upskill practitioners to engage and respond to male clients. The primary outcome was self-reported competency in engaging men in psychotherapy, measured by the Engaging Men in Therapy Scale (EMITS) at 6 weeks. All analyses were by intention-to-treat. Between January 16 and March 17, 2022, 587 participants were randomly assigned to the intervention (n = 300) or wait-list control (n = 287). In total, 492 (84%) participants completed the primary endpoint assessment at 6 weeks. Men in Mind demonstrated a large effect of improved EMITS scores compared to the control group (d = 2.63, 95% CI [2.39, 2.87], p <.001). Men in Mind was effective at increasing mental health practitioners’ self-reported efficacy to work with men, which is potentially a key change mechanism in their ability to improve health outcomes for male clients. A limitation of the trial was the use of a bespoke, self-reported primary outcome, while a strength was the gender-responsive intervention design. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Increased functional connectivity between the midbrain and frontal cortex following bright light therapy in subthreshold depression: A randomized clinical trial.
The underlying mechanisms of bright light therapy (BLT) in the prevention of individuals with subthreshold depression symptoms are yet to be elucidated. The goal of the study was to assess the correlation between midbrain monoamine-producing nuclei treatment-related functional connectivity (FC) changes and depressive symptom improvements in subthreshold depression. This double-blind, randomized, placebo-controlled clinical trial was conducted between March 2020 and June 2022. A total of 74 young adults with subthreshold depression were randomly assigned to receive 8-week BLT (N = 38) or placebo (N = 36). Depression severity was measured using the Hamilton Depression Rating Scale (HDRS). The participants underwent resting-state functional magnetic resonance imaging at baseline and after treatment. The dorsal raphe nucleus (DRN), ventral tegmental area (VTA), and habenula seed-based whole-brain FC were analyzed. A multivariate regression model examined whether baseline brain FC was associated with changes in scores on HDRS during BLT treatment. BLT group displayed significantly decreased HDRS scores from pre- to posttreatment compared to the placebo group. BLT increased the FC between the DRN and medial prefrontal cortex (mPFC) and between the left VTA and right superior frontal gyrus (SFG). Altered VTA–SFG connectivity was associated with HDRS changes in the BLT group. Moreover, the baseline FC between DRN and mPFC could predict HDRS changes in BLT. These results suggested that BLT improves depressive symptoms and increases midbrain monoamine-producing nuclei and frontal cortex connectivity in subthreshold depression, which raises the possibility that pretreatment FC of DRN–mPFC could be used as a biomarker for improved BLT treatment in depression. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Replicating and extending Sengupta et al. (2023): Contact predicts no within-person longitudinal outgroup-bias change.
Intergroup contact has long been touted as a premier means to reduce prejudice and forge positive bonds with outgroups. Given its origins in psychological research, it is perhaps of little surprise that contact is expected to induce change within people over time. Yet using random-intercepts crossed-lagged modeling that parses within-person from between-person effects, Sengupta et al. (2023) recently found no evidence of within-person change, only unexplained between-person effects, regarding contact’s effects on outgroup solidarity in New Zealand. We conceptually replicated their study, focusing on modern racism and an affect thermometer as the outcomes, in a three-wave study of White British participants (NT1 = 946, NT2 = 667, NT3 = 591) and their attitudes toward foreigners. We replicated the general pattern described by Sengupta and colleagues, confirming between-person effects without within-person effects, suggestive of third-variable explanations. As a novel finding, we discover that differences in social dominance orientation (SDO) and right-wing authoritarianism (RWA) can account for the observed between-person effects. Problematically for contact theory, contact effects, at least those relying on self-reported accounts, increasingly appear to reflect differences between people (person factors) rather than being context-driven (situation factors)—such that those lower (vs. higher) in SDO and RWA are more favorable toward outgroups, rather than intergroup contact bringing about positive outcomes itself. Implications for theory development and intervention are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Preserving privacy in the era of openness: Commentary on open science requirements for identifiable data in psychological science journals.
Psychological science journals are increasingly adopting open science (OS) policies (e.g., Transparency and Openness Promotion) requiring researchers to make all data and materials publicly available in an effort to drive research toward greater transparency and accessibility. These policies certainly have many benefits to the scientific community and public in helping ensure the quality of published research. However, the Center for Open Science has not offered any explicit guidelines regarding when exceptions to OS policies should be made, with only vague guidelines offered such as “when ethical or legal constraints prevent it.” We argue that these ambiguous policies may create bias in decisions made by journal editors as to whom and what type of research is granted exceptions. When journals are too rigid in their exception policies, this may unintentionally contradict OS’s goals to create a more valid and ethical science. We argue that journals should never mandate identifiable data to be posted publicly as a publication prerequisite. Maintaining participant anonymity should always come before OS policies to (a) align with psychologists’ primary obligation of maintaining participant confidentiality, (b) encourage participation from the broader population and more specifically from marginalized communities, and (c) maintain unbiased, representative, and valid data. From empirical and ethical insights, we offer several solutions to ease the tensions between OS and participant privacy during the data collection and publication process. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Robert Alan LeVine (1932–2023).
Article memorializes Robert Alan LeVine (1932–2023). Robert Alan LeVine was a leading psychological anthropologist, who was instrumental in the rise of cultural psychology. LeVine taught at Northwestern University (1958–1960), the University of Chicago (1960–1976), and Harvard University (1976–1998), where he was Emeritus Professor of Education and Human Development. He wrote 15 books and published over 125 peer-reviewed articles and book chapters. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
William R. Safarjan (1943–2023).
This article memorializes William R. Safarjan (1943–2023). Dr. Safarjan spent much of his career working as a clinical psychologist for the California Department of State Hospitals at Atascadero State Hospital, 1984–2009. During his professional career, Dr. Safarjan served in many roles with the California Psychological Association, including president in 1998, liaison to the California Psychological Association, and membership chair and chair of the research political action committee. He served as vice chair of the American Psychological Association (APA) membership committee, chair of the APA committee of state leaders, council of representatives from California. In addition to his work in psychology, Dr. Safarjan served in several professional organizations including Rotary International where he was recognized as an outstanding club president (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Charles Silverstein (1935–2023).
Memorializes Charles Silverstein (1935-2023). One of Charles’s most important contributions to the field of psychology and lesbian, gay, bisexual, and transgender rights in particular was his testimony in 1973 opposing the classification of homosexuality as a mental illness. His testimony, along with that of several others, led to the removal of homosexuality in the Diagnostic and Statistical Manual of Mental Disorders. He was also the founding editor of the Journal of Homosexuality, which began publication in 1976. Charles maintained a private practice in Manhattan for many years and was an advocate against conversion therapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

American Psychologist - Vol 79, Iss 3