Professional Psychology: Research and Practice

Association of health literacy with chronic pain and pain-related distress.
Research suggests health literacy should be considered when treating chronic pain. The purpose of this secondary analysis was to examine the relationship of health literacy with pain and psychological functioning and to determine whether health literacy status was associated with outcomes after a brief psychological intervention for chronic pain. Participants with chronic musculoskeletal pain (N = 60) were randomized to a five-session psychological intervention or control group between September 2018 and February 2020. Participants completed a baseline and postassessment, which included measures of health literacy status (i.e., adequate vs. lower level), pain severity, pain interference, pain catastrophizing, depression, anxiety, and pain acceptance. Participants were mostly female (78.3%) and Black (88.3%) with a mean age of 62.2 years. At baseline, lower levels of health literacy were associated with greater pain severity (p = .003), pain catastrophizing (p = .03), and depressive symptoms (p = .02). Among those randomized to the intervention group, health literacy status was not related to engagement in the intervention. However, those with adequate levels of health literacy were more likely to have lower depressive symptoms (p = .045) and higher acceptance of pain (p = .01) at postintervention compared to those with lower levels. Among individuals with chronic pain, those with lower levels of health literacy may have worse pain and psychological functioning. Those with lower levels may also not benefit as much from standardized psychological interventions for pain management. Clinicians delivering psychological interventions for chronic pain may want to consider screening for health literacy status and adapt the intervention to ensure understanding. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Exploration of an immigrant paradox in Muslims living in the United States (MLUS).
The immigrant paradox refers to findings that first-generation and less acculturated immigrants generally have better adaptation and health compared with second/third-generation and more acculturated immigrants. Some work supports an immigrant paradox among European Muslims. Further, Pew’s telephone interviews of Muslims living in the United States (MLUS)—about half of whom are foreign-born—consistently reveal that United States-born and English-speaking MLUS perceive and experience more discrimination than foreign-born Muslims. We explored the immigrant paradox in a representative sample of 350 MLUS (33% immigrants) as a function of (a) immigrant status, (b) acculturation levels, and (c) age of arrival in the United States (among immigrants). We conducted analyses of covariance and hierarchical regressions after administering standardized measures of discrimination, perceived Islamophobia in America, religiousness, acculturation, depression, anxiety, and stress (and controlling for covariates). United States-born participants reported greater experiences of discrimination and perceptions of Islamophobia. Both United States-born and more acculturated participants reported greater psychological distress, maladaptive religious coping, and religious struggles. Our findings support the presence of an immigrant paradox among MLUS, highlighting a need to extend accessible services to United States-born and more acculturated Muslims. Potential explanations for the paradox are discussed and have implications for future research in this area. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Adult attachment, emotional intelligence, affect regulation, and self-reported distress in first-year college students at a predominantly White university.
The transition to college presents developmental challenges for young adults similar to those presented by Ainsworth et al. (1978) laboratory “strange situation” for young children. For both, adaptation to an unfamiliar environment is facilitated by managing anxiety that otherwise interferes with exploration. According to the Mikulincer and Shaver (2018) model of attachment dynamics, when coping with threats, adults who cannot recruit support from a secure attachment figure engage in one of two secondary strategies: hyperactivation or deactivation. Each strategy is associated with unique patterns of affect regulation deficits that lead to psychological distress (Nielsen et al., 2017). In our study, undergraduates (N = 122; 83% White) 2 months after starting college at a predominantly White university completed survey measures of adult attachment, emotional intelligence, emotion regulation, and psychological distress. More than 25% reported symptoms above a clinical cutoff for significant distress. Cross-sectional correlation findings supported a model with associations between adult attachment insecurity and psychological distress, mediated by emotional intelligence and affect regulation deficits. Consistent with the Mikulincer and Shaver (2018) attachment hyperactivation and deactivation model, attachment anxiety, but not avoidance, was associated with problems in impulse control and repairing negative moods. Avoidance, but not anxiety, was associated with devaluing attending to feelings. Two variables appear to be especially important mediators: lack of clarity about feelings and lack of strategies for emotion regulation. Counseling interventions that address these skills deficits may assist new students with insecure attachment to persist and flourish in college. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Pilot randomized, crossover trial of prolonged exposure with and without the PE Coach mobile application: A mixed-methods study of patient-centered outcomes among veterans with PTSD.
Prolonged exposure (PE) Coach is a mobile application designed to support the tasks of PE psychotherapy for posttraumatic stress disorder (PTSD). However, little is known about patient treatment preferences for the application nor its impact on clinically salient outcomes. Veterans with PTSD (N = 20) were randomly assigned to use PE Coach during three-session blocks of treatment (either Sessions 1–3 or 4–6). After Session 6, veterans were asked to choose whether they wanted to continue treatment with or without the app. Homework was monitored, and veterans were surveyed on their treatment experience following each three-session block. Qualitative interviews explored reasons for treatment preference. Thirteen of 14 veterans (92.8%) chose to finish treatment with PE Coach. Veterans reported improved clinical experiences during PE Coach use, including increased convenience completing homework tasks (Hedge’s g = 1.37) and higher treatment satisfaction (Hedge’s g = 0.63). PE Coach usability was highly rated. Adequate homework thresholds for maximizing clinical outcomes were achieved more frequently during use of PE Coach than without the app (69% vs. 50% for imaginal exposure; 88% vs. 65% for in vivo homework). Qualitative interviews highlighted ease of use and improved accessibility, privacy, and homework accountability. This pilot study suggests PE Coach may be some veterans’ preferred way to participate in PE and is a promising tool to enhance acceptability, accountability, and engagement in PTSD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Key issues and recommendations for ethical and effective endings in psychotherapy.
The ending of the psychotherapy relationship is an important clinical, legal, and ethical matter. While some guidance and requirements are found in the American Psychological Association Ethical Principles of Psychologists and Code of Conduct, psychologists may at times experience challenges regarding when and how to most appropriately end the treatment relationship and even question what their obligations are to former patients after treatment ends. The lead article provides guidance to assist psychologists in proactively addressing treatment endings so that they are planned for and carried out with each patient’s best interests in mind. Recommendations are made for how to conceptualize this final phase of treatment as a period of consolidation of gains made in treatment and for preparing the patient to successfully move forward after treatment. Specific recommendations are made for avoiding abandonment of patients and how to engage in appropriate risk management strategies that best serve the interests of patients and psychologists alike. The expert commentaries that follow this lead article offer guidance on how to utilize principle-based ethics to assist psychologists in applying their professional judgment when making decisions about ending treatment, how to avoid nonrational processes in one’s thinking and decision making (known as tripping points) to support more effective decision making, and how to apply relevant legal rulings and the role of licensing laws to better understand one’s obligations to patients relevant to the ending of the treatment relationship. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Simulating the impact of psychologist prescribing authority policies on mental health prescriber shortages.
This study simulated the impact of granting prescriptive authority to licensed psychologists on shortages of mental health providers with prescriptive authority. We used national and state-level secondary data to construct a policy simulation. Mental health prescribing need and the number of mental health prescribers were estimated at the national and state levels, and the provider shortage was calculated as the difference between these two values. The simulated policy intervention added 10% of psychologists to the prescriber group to estimate the associated reduction in prescriber shortages. Probabilistic uncertainty and sensitivity analyses were conducted using 10,000 Markov trials in which all model parameters varied randomly based on their associated uncertainty. The simulated policy value was allowed to vary between 5% and 15%. The prescriber shortage was predicted to fall by 4.34% (95% CI [0.75%, 16.58%]) nationally, though this varied widely by state, ranging from 1.10% [0.20%, 3.82%] in North Dakota to 26.44% [2.89%, 570.29%] in Washington, DC. Uncertainty and sensitivity analyses demonstrated that variability in the provider shortage reduction was primarily driven by the percentage of psychologists becoming licensed to prescribe. Our results suggest that granting prescriptive authority to licensed psychologists would reduce the shortage of mental health professionals with prescriptive authority. Further work is needed to examine the potential implications for other mental health providers. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Identification and referral of at-risk older adults: A clinical training perspective.
As the percentage of older adults aged 65 and over continues to rise dramatically in the United States and globally, psychology must develop ways to meet the behavioral health needs of this age group. The psychology workforce devoted to working with older adults is insufficient, and one consequence of this deficit is the underidentification of behavioral health symptoms in this age group, often closing the door for further intervention. Older adults with mild–moderate symptoms and who reside in rural and/or underresourced areas are least likely to seek help for behavioral health concerns, and, when they do, it is most often requested from their primary care provider who may not recognize symptoms as indicative of a behavioral health concern. Psychologists in training participated in a clinical experience to improve their competence in providing services to older adults. This training and community engagement experience focused on the identification of mild–moderate behavioral health symptoms within a rural, community-dwelling older adult population over a 6-year span. Students provided behavioral health screenings, psychoeducation, feedback, and referral to assessment/treatment services for older adults during regional health and wellness events. Screening results revealed high rates of anxiety, mild neurocognitive disorder, and depressive symptomology in our sample (n = 658) of older adults, providing evidence for routine and systematic screening and early detection of behavioral health symptoms in the older adult age group. Impacts on readiness to work with older adults by those who completed this clinical training experience are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Should patients be evaluated for ADHD while using ADHD medication?
Psychologists often perform evaluations on patients who are already being prescribed stimulant medication for attention-deficit/hyperactivity disorder. The evaluation may be sought to confirm the diagnosis or to determine specific treatment or accommodation needs. In these cases, psychologists are often asked whether the patient should take their medication as prescribed on the day of the evaluation. There does not appear to be any existing authoritative guidance on this question, and different clinics and clinicians have different policies. In the present article, relevant research on stimulant effects and attention-deficit/hyperactivity disorder assessment tools is reviewed, to develop empirically informed guidance for determining when patients should take their medication on evaluation day and when they should not. The article concludes with several proposed guidelines for practice, synthesizing findings from the available research with consideration of psychologists’ ethical responsibilities. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Development and evaluation of psychometric properties of the Humanized Care Behaviors in Health Personnel Scale.
Interventions to reduce the stigma of health care personnel toward people with mental disorders have been generally evaluated fundamentally by improving attitudes and reducing the desire for a social distance toward this population. However, decreasing stigma should be accompanied by an increase in good treatment behaviors toward those affected. Humanization of care, which is understood as a friendly, respectful, and supportive relationship, could be an excellent way to evaluate the effectiveness of antistigma interventions. This requires reliable and valid instruments. This study aimed to examine the psychometric properties of the humanized care behavior scale used in health care personnel. The study was quantitative and cross-sectional. The participants were a nonrandom sample of 217 health providers from 12 family health centers in Gran Concepción, Chile. An exploratory factorial analysis was applied to study the factorial structure, and Cronbach’s alpha and McDonald’s total omega coefficients were used to evaluate the internal consistency. The concurrent validity was assessed through a correlational analysis with three other scales. Regarding the results, the final scale comprised 16 items in two factors. There was an acceptable correlation between the two dimensions. The reliability indices for the total scale were high. Correlations between the total scale and its factors with the other scales used were in the expected direction. Consequently, the instrument developed is valid and reliable. It can be used to evaluate antistigma interventions and improve health personnel’s humanization of care toward consultants with mental disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

Professional Psychology: Research and Practice - Vol 55, Iss 2