Research Spotlights From Past Years
Does forgiving others affect your meaning in life?
Everyone looks for meaning in life. Psychological research on how people feel their life is meaningful is rather new, but it has revealed that people seek—and obtain—meaning from a variety of sources, especially through relationships. VCU social PhD graduate Daryl Van Tongeren (now a professor at Hope College), current social faculty Jody Davis and Jeffrey Green, and three other researchers investigated in two studies whether forgiveness creates meaning because it helps repair relationships.
One study of 491 people found that those who are naturally higher in forgivingness as well as those who reported more forgiveness after a specific offense by a close other also reported feeling that their life had more meaning. A second study looked at over 100 couples over a six month period. Participants reported every two weeks whether they had experienced offenses by their partner and to what extent they had forgiven their partner for those offenses. Participants who regularly forgave their partner subsequently reported increased meaning in life over time. In addition, forgiveness helped recover lost meaning for those reported more frequent offenses by their romantic partner.
Finding the ultimate meaning of life is beyond the scope of psychology, but psychology can reveal how and why people more or less meaning in their lives. Forgiving someone close to you can help you feel better about the future of the relationship, and thus feel that your life is more meaningful.
How can we track the psychosocial functioning of patients?
Taking note of the long-term clinical course characteristics of disorders has gained increasing importance in recent years. Evolving course descriptions in the DSMs published since 1980 reveal a growing emphasis on the long-term clinical course characteristics of disorders. Gaining a better understanding of a patient’s psychological profile over time can aid in diagnosis, assessment of patients’ functioning and guide treatment planning.
Dr. Jim McCullough and colleagues have developed a Psychosocial Functioning Scale (PFS) as a means to chart the effects symptom severity exerts on psychosocial functioning over time. The PFS uses a timeline graphing procedure where symptom interference over time is anchored on the y axis (vertical) and time is anchored on the x axis (horizontal). The scale uses a 1-10 rating scale anchored by a Severe Level rating (10) and descending in scaled value to a No Interference Level (0). The first step entails asking the patient two questions: (1) “I want you to think about how much all your symptoms interfere right now with your daily functioning in your work, in your family and in your social life? And secondly, (2) “How long have your symptoms remained at this level?” Once the current psychosocial interference level and its duration have been pinpointed by some dated time-point, the clinician asks two further questions: (1) “What happened to the interference level at this change/shift point? Did it increase or decrease and how would you rate the level here?” Secondly, (2) “How long did the symptom interference remain at this level?” Clinicians, by continuing to repeat the questioning procedure, determine the longitudinal symptom interference level variations for the duration of the patient’s disorder(s).
The PFS may be used repeatedly to chart the clinical course of psychosocial functioning levels from the onset of a disorder, throughout treatment process and outcome, and during follow-up periods. The scale is useable for both clinical psychotherapists and researchers wanting to plot the progress of psychosocial functioning of their patients in order to illustrate empirically the changes occurring as a function of treatment.
Day in, day out, how important are routines for our well-being?
We engage in numerous activities across a 24-hour period including eating meals, going outside, socializing, beginning work, and exercising, to name a few. The daily repetition of these activities can develop a rhythmic quality. The regularity of these rhythms exists along a continuum, with some individuals exhibiting remarkable consistency in the timing of their daily activities, while others display more chaotic, random timing of events. In the Chronopsychology Lab, we investigated whether greater regularity of these rhythms was associated with better well-being, specifically, better self-reported sleep outcomes. Also, we asked whether the duration of regularity (or irregularity) is important for sleep outcomes. For example, does disruption of routine for one day predict worse sleep outcomes for that night? Lastly, we examined whether age (being a younger versus older adult) affected this association.
This project is a collaboration among graduate students in Dr. Natalie Dautovich's lab (Janna Imel and Dana Schreiber at VCU and Kristy Shoji and Caitie Tighe at the University of Alabama) and Dr. Christina McCrae at the University of Missouri. We used a microlongitudinal study design involving 14 consecutive days of data collection with 50 younger (ages 18 – 30 years) and 50 older (65 – 95 years) community-dwelling adults. Participants completed a variety of self-report measures including daily measures of the regularity of their activities and their sleep. We used a multi-level modeling analytic approach, which allowed us to examine the associations between regularity of daily activities and sleep that occurred within individuals in addition to between-persons.
Overall, we found that younger adults were significantly more irregular in the timing of their daily activities compared to older adults. We also found that weekly, not daily, disruptions of activity rhythms predicted worse sleep outcomes. This effect was moderated by age, such that less regularity of rhythms predicted worse sleep for younger, not older adults. In particular, younger adults who had more irregular daily rhythms took longer to fall asleep and had less efficient sleep compared to those with more regular rhythms.
These results reinforce the idea that our bodies crave consistency. With regular daily activities, our various body systems are able to prepare for, and anticipate, events. However, consistency across a longer period of time (a week) was predictive of sleep while consistency over a shorter duration (a day) was not. Also, this association did not extend to older adults. In our future research, we continue to probe the role of age in predicting mental and physical well-being.
What affects parenting in high-risk communities?
We know that living in high-risk contexts, such as neighborhoods with high levels of violence, noise, and crowding, is stressful for parents and youth, but we don’t know how living in those communities affects how parents parent their adolescents. This question is important because parenting quality affects the extent to which youth use drugs, are aggressive, or engage in delinquent acts. We know that in high-risk neighborhoods parents adapt their parenting to better protect their children, although these strategies are not always successful. In this study we set out to understand how the stress parents experience, including their own exposure to violence, affects how they manage their adolescents. This study builds on work Dr. Wendy Kliewer and her colleagues have conducted on parent-adolescent relationships in high-risk contexts.
Over 300 families living in high-risk neighborhoods in and around Richmond, VA were followed over a two-year period and completed interviews in their home once a year. Parents’ life stress, exposure to violence, and mental health was measured at the start of the study. The analyses showed that parents’ life stress and their exposure to violence affected the extent to which they reported being depressed, anxious, or angry one year later. Parents who reported more stress and more exposure to violence also reported increases in mental health symptoms.
These feelings of depression, anxiety, and anger, in turn, were related to knowing less about their adolescents’ activities and the following year. These findings point to the importance of assisting parents in high-risk neighborhoods. Helping parents to reduce the stress in their life, resolve the trauma they have experienced, and cope more effectively can affect how they manage their adolescents.
Do physicians’ racial biases affect clinical decision making?
Psychological research has demonstrated that individuals’ implicit, or automatic, racial bias can greatly impact decisions about others. For example, individuals who have a pro-White bias are more likely to interview job candidates and potential rental tenants with White sounding names compared to identical applications with Black-sounding names.
Dr. Joy-Gaba, in collaboration with researchers from the University of Virginia, examined whether racial bias can influence physicians’ decisions about patient care. Total knee replacement (TKR) is a cost-effective treatment option for severe osteoarthritis. While prevalence of osteoarthritis is higher among Blacks than Whites, TKR rates are lower among Blacks. Physicians’ implicit preferences might explain racial differences in TKR recommendation. To test, White physicians were given a scenario describing either a Black or White patient with severe osteoarthritis and asked to recommend medical treatment.
The results revealed that physicians displayed strong implicit preference for Whites over Blacks and implicitly believed that White patients were more medically cooperative than Black patients. Importantly, physicians were equally likely to recommend TKR for both the Black and White patients. Neither implicit nor self-reported racial biases predicted differential treatment recommendations by race. Interestingly, the results suggest that physicians’ belief in how medically cooperative a patient is, regardless of race, predicted whether a patient would be recommended for TKR, with the uncooperative receiving stronger recommendations for TKR.
How can we predict future rates of tobacco use?
The current tobacco marketplace is rapidly changing with the introduction of new products such as electronic cigarettes (e-cigarettes) and new regulations related to their use. Determining the impact of these events and those that may occur in the future on patterns of tobacco use is imperative for policymakers and the public health community to best protect the public’s health. Instead of waiting for years for data to accumulate, simulation modeling is one statistical approach that makes use of existing data to achieve this aim.
Dr. Caroline Cobb and colleagues from the Schroeder Institute of Tobacco Research and Policy Studies at Legacy developed a Markov model of tobacco use transitions to demonstrate the utility of this approach for projecting future patterns of tobacco use. As a proof of concept, prevalence estimates of e-cigarette and cigarette use from a cohort of young adults followed over 18 months (2011-2013) were used to populate the model. Tobacco use states included non-current, current, dual, and former use of cigarettes and e-cigarettes. Prevalence and the probability of transitioning between tobacco use states were estimated using available data and projected outwards for 10 years. Results indicated that the largest changes in prevalence occurred in the non-current, cigarette, and former use states with the dual and e-cigarette use states remaining at low prevalence in all years.
This model and accompanying demonstration using e-cigarette and cigarette use represents an important contribution to tobacco regulatory science by providing a means to quantify the extent to which current patterns in tobacco use and potential policies will impact future estimates of tobacco use prevalence. With results from several forthcoming national tobacco surveillance studies (e.g., FDA’s Population Survey of Tobacco and Health), the proposed model will be a valuable tool for researchers and regulators to inform their evaluation of whether the introduction (or removal) certain tobacco products or policies will be beneficial, have little impact on, or be harmful to the population as a whole.
Can coping skills help the bereaved bend but not break?
A striking 40% of college students have lost a loved one to death in the previous two years. During the college years, in the midst of so many developmental transitions, students may be particularly at risk for negative health and psychological outcomes following bereavement. What does the research tell us about how college students cope with bereavement and how can we enhance the coping skills of bereaved college students?
Dr. Sandra Gramling and her students in the Good Grief lab at Virginia Commonwealth University have been studying grief and coping processes among bereaved college undergraduates for several years. In a study with 739 students who suffered the loss of a loved one in the previous two years they found that 257 students had experienced the traumatic death of a loved one (suicide, homicide, accident) while the remaining 482 students had lost a loved one to illness. On measures of meaning making (e.g., being able to make sense of the loss; finding benefit/new strengths from the loss) there were no differences in the two groups of bereaved students. In a separate study looking at religious coping in bereaved students they found that the overlap between the positive and negative religious coping subscales when used with a bereaved undergraduate sample detracted from the predictive utility of the instrument. These results are different from those observed with bereaved mid to late adults. Thus, one focus of research in the Good Grief lab has been the development of psychometrically sound well-validated instruments assessing grief and coping processes specifically for bereaved undergraduates. In order to help undergraduates “bend but not break” following bereavement, the development of specific population based measures are paramount.
Why are VCU researchers dumpster diving?
Almost everyone agrees that children should eat more fruits and vegetables (F&Vs). Children who eat healthier diets perform better academically and report higher physical and emotional well-being than their peers with poorer nutritional status. Indeed, poor dietary habits increase risk for many chronic diseases, even among individuals who are not overweight, suggesting that improving children's eating behaviors is an extremely important target of public health efforts. Thus, numerous efforts are being made to improve children’s nutritional health, including revisions to the National School Lunch Program (NSLP).
The NSLP was recently changed to require students to pick fruits and vegetables in the lunch line. This change generated significant concerns from school districts about plate waste and very vocal complaints from students about the palatability of the foods offered. The NSLP policy uses a "serve" model to expose students to healthier nutritional options. However, this approach poses challenges, as research suggests that increasing (not forcing) dietary choices, is associated with greater fruit and vegetable consumption.
Dr. Suzanne Mazzeo and colleagues at VCU are partnering with Title I schools to assess the impact of the serve model on fruit and vegetable consumption during school breakfast and lunch in 1st-3rd grade students. Dr. Mazzeo’s research team will measure how much of the served fruits and vegetables are left on the plates at the end of the meal. They are also investigating methods to increase the “likability” and consumption of fruits and vegetables. This project is important given that many policies are mandated in the absence of data indicating whether they will have the desired effects, and if they might yield any unintended consequences. (Research spotlight summary provided by Dr. Rachel Gow.)
Can people have a "relationship" with the natural world?
The person-environment relationship is a burgeoning area of research in the field of conservation psychology. How will individuals respond to the day-to-day dilemmas that they face in their environmental behaviors: whether to do what is best for themselves or whether to do what is best for the environment? When confronted with day-to-day environmental dilemmas, willingness to sacrifice for the environment represents the extent to which individuals' decisions take into account the well-being of the environment, even at the expense of immediate self-interest, effort, or costs. For example, what leads individuals to be more likely to exhibit pro-environmental behaviors like recycling or conserving energy?
Dr. Jody Davis and colleagues have examined the connection between individuals' relationships with the natural environment and their environmental behaviors with a focus on commitment to the environment, defined as psychological attachment and long-term orientation to the natural world. Commitment to the environment theoretically emerges from individuals' reliance on the natural world to gratify important needs. A series of studies has identified three key antecedents to commitment to the environment: satisfaction with the environment (e.g., benefits from the environment), investments in the environment (e.g., effort put into the environment), and subjective norms (e.g., beliefs about others' approval).
To the extent that individuals feel satisfaction with the environment, invest in the environment, and believe that those close to them care about the environment, they are more likely to feel psychological attachment and long-term orientation toward the natural world that leads them to be willing to sacrifice by engaging in pro-environmental behaviors. The structure of the commitment model has been supported in undergraduate and community samples, and for general commitment to the environment as well as for commitment to specific conservation behaviors (recycling, alternative transportation, "green" campus initiatives). In addition, individuals who experienced an experimental manipulation designed to increase their dependence on the natural world were more likely to volunteer (or learn about volunteer opportunities) for a local river clean-up. Commitment to the environment is a powerful predictor of pro-environmental behavior.
What can increase emergency department visits in children with asthma?
Asthma disparities research suggests that racial and ethnic minority children are more likely to visit the emergency department (ED) for asthma care. As pediatric asthma is managed within the family context, parents and caregivers are responsible for daily decisions related to child asthma including symptom control, trigger reduction, and even when a child needs to visit the ED. Mechanisms to explain differences in ED rates likely stem from factors within families, such as caregiver quality of life (QOL; caregiver adaption to child asthma) or culturally-based beliefs about asthma that families might share. In fact, research has found that Latino caregivers may experience lower levels of QOL than non-Latino White caregivers in caring for a child with asthma, and that QOL is associated with child asthma morbidity.
Dr. Robin Everhart and colleagues at Rhode Island Hospital have continued to investigate pathways between cultural factors, family factors, and caregiver QOL in pediatric asthma. Recently, Dr. Everhart and her colleagues presented data from an NIH-funded study, Project PAAC (Pediatric Asthma Across Cultures). Project PAAC participants included 102 caregivers and their child with asthma (6-15 years) from non-Latino White, Latino, and African American backgrounds in the Providence area. The results of this study suggest that family beliefs related to asthma medications (e.g., concerns about usage, beliefs about necessity) and beliefs related to fear of child dying from asthma may negatively impact caregiver QOL. Caregivers with poor QOL were also more likely to have a child that had visited the ED in the last year. Moreover, caregiver QOL mediated the association between beliefs related to medication necessity and child ED use. Findings suggest that family beliefs related to medication necessity may be modifiable intervention targets to improve caregiver QOL and reduce child ED use.
Dr. Everhart's research highlights the importance of continuing to understand family and culturally-based processes that may reduce adverse child health outcomes, especially among racial and ethnic minority children living in urban areas. In collaboration with researchers at Penn State, Dr. Everhart and her research team at VCU will begin collecting data for the CARE study (Childhood Asthma in Richmond Families) this fall that uses ecological momentary assessment (EMA) to further understand factors that contribute to pediatric asthma management in urban families. Dr. Everhart's research has also highlighted the importance of understanding caregiver health within the context of pediatric asthma. Working with a community-based health center in the Richmond area, Dr. Everhart is planning a study focused on examining processes related to optimal caregiver and child asthma outcomes in ethnic minority families. Together, Dr. Everhart's research endeavors are focused on understanding processes that will ultimately lead to the development of family-based, tailored interventions to improve both caregiver and child health in urban families.
Can we train students' brains to work more effectively?
Many students are struggling to achieve good academic outcomes in school. The typical approach to helping them is to provide content-based remediation or tutoring. Studies show that this type of intervention does not produce a meaningful impact on academic achievement, particularly among minority students. A different approach that is gaining popularity is to directly train cognitive skills independently from academic material. Neuroscientists and educational researchers have been testing a variety of approaches for specifically improving "executive functions"—a term that refers to our ability to plan ahead, switch between tasks, sustain attention, reason, and problem solve. Executive functions are critical for learning and success at all levels of schooling, and there is growing evidence that these skills are trainable.
With funding from the National Science Foundation, Dr. Zewelanji Serpell and collaborators from Virginia State University are studying whether cognitive training improves executive functions in African American students. Preliminary findings suggest that a relatively low dose of training (1 hour/5 days a week for 15 weeks), provided in a school context, improves students' cognitive skills. We have also learned that training one-on-one with a person works better than training with a computer-based program. One-on-one methods are not practical for widespread use in public schools that frequently lack the human resources to provide individualized instruction. As such, developing more effective computer-based programs is an important goal. We are trying to achieve this goal by studying the strategies human trainers use when they are working with students.
We hypothesized that trainers may be using their perceptions of students' emotional states to modulate (i.e. change the difficulty level, provide strategies or use motivational prompting) the training task. We tested this hypothesis in a small pilot study with 66 African American college students who were randomly assigned to receive training on a cognitive task with a human trainer in a traditional face-to-face context, with a remote trainer who could not see the student but could monitor task performance, or with a trainer that could monitor task performance and view a real-time video of the student's face during the task. Results suggest that access to the video influenced trainer decisions and, that the information available in the video may help them to improve students' training gains. We are currently working with collaborators at University of California San Diego to understand what specific aspects of facial expression and non-verbal behavior human trainers use, and to see if we can replicate them in an automated system they have developed.
Can you strengthen your character in six hours?
Positive psychology helps people build character strengths or virtues. Traditional virtue theory suggests that people glimpse the goal they seek, practice virtue until it becomes second nature, meet self-imposed tests or tests that life throws at us, and thereby build a stronger character.
Within the Counseling Psychology program, researchers in the Positive Psychology Research Group (PPRG) at VCU—Professor Everett Worthington (www.EvWorthington-forgiveness.com), graduate students Caroline Lavelock, Brandon Griffin, Yin Lin, Chelsea Reid (Social Psychology), and Chelsea Greer, and undergraduate honors student Quandrea Harper—have conducted grant-funded research by the John Templeton Foundation and the Fetzer Institute on psychoeducational groups to promote forgiveness, including a study to see whether secular college-based groups would be as well received by foreign students as Virginia-born-and-raised students. In the last two years, the PPRG researchers have expanded the grant-funded research to include self-administered 6-hour workbooks to promote forgiveness (three studies), humility, patience, self-control, and self-forgiveness. Initial results show that workbooks are producing even more character strengths than the evidence-based psychoeducational groups. After using feedback provided by the participants in the first round of studies, the PPRG researchers have developed beta-versions of the workbooks. Studies are underway in humility and patience.
After these workbooks have been vetted through referred publication, they will be made available to the public in the same way that the REACH Forgiveness psychoeducational group materials are. Visit Everett Worthington’s web site for access to the free materials.
How Can We Reduce HIV?
African American young adults are at higher risk for HIV than any other racial/ethnic group with the highest disparity occurring in the 13-24 year old group. Unless this epidemic is reversed, at some point in their lifetimes, an estimated 1 in 16 Black men and 1 in 32 Black women in the United States will be diagnosed with HIV infection. At VCU we are working hard to reduce these disparities.
The Raise 5 project was funded by the Center for Substance Abuse Prevention to reduce HIV risk and substance abuse among African American students attending VCU. Raise 5 uses five major strategies to achieve this goal. The first strategy involves the participation of students in peer-led evidenced-based HIV and substance abuse prevention curriculums. Sisters Informing Sisters about the Topic of AIDS (SISTA) is the curriculum for women and NIA is the HIV prevention curriculum for males. Safe in the City is used for both men and women. A substance abuse education component that emphasizes the role of alcohol and other drug use on sexual risk behaviors is integrated into all curriculums. The second strategy is a social marketing environmental strategy that consists of "stall seat" journal posters specifically targeting African Americans. These "stall" journals are strategically placed on VCU's campus at different time periods. The third strategy is substance abuse and HIV education and awareness "edutainment" sessions, labeled "the Black Perspective." These forums are open to all in the VCU community and held in partnership with Black student organizations. The final strategy is HIV testing. The goal is to encourage routine testing among VCU students.
The project is funded for five years and is beginning its third year. Over a thousand students have attended the education and awareness forums; over one hundred students have participated in our evidenced-based programs; and over 800 students have been tested. The project is carried out under the leadership of Dr. Faye Belgrave, Principal Investigator and Project Director, Deborah Butler, Project Coordinator, and Raymond Tademy, post-doc and evaluator. Graduate students Jasmine Abrams, Joshua Brevard, Sarah Javier, and Morgan Maxwell are also involved in carrying out all five strategies. Learn more at the Center for Cultural Experiences in Prevention web site. Raise 5 partners include Susan Tellier from the Fan Free Clinic, Dr. Linda Hancock and other staff from VCU's Wellness Center, and a host of other student organizations at VCU.
Preliminary evaluation of the program indicates increases in testing among African American college students, high levels of engagement in Raise 5 education and awareness activities, and reduction in risky sexual and drug attitudes and behaviors.
Does racial bias affect patient-physician interactions?
Only about 6% of physicians and surgeons are self-identified as Blacks. Thus, Blacks are more likely to see non-Black physicians when they seek medical help. In fact, approximately 75% of Black patients see non-Black physicians, even though many prefer seeing Black physicians to non-Black physicians.
Dr. Hagiwara and her colleagues have investigated how Black patients behave when they interact with non-Black physicians and what determines those patients' behaviors. They also examined non-Black physicians' behavior during such racially discordant medical interactions. To address these questions, Dr. Hagiwara's research team drew upon prior research in social psychology which provides strong evidence that racial attitudes negatively influence communication during interracial interactions. The results of the study suggested that both Black patients and non-Black physicians tried to exert more control over the interactions by talking more when they harbored more negative racial attitudes. Their findings highlight the importance of racial attitudes and biases in the dynamics of racially discordant medical interactions.
As demonstrated in the above study, Dr. Hagiwara bridges basic social psychology research of intergroup biases and applied health disparities research. Her basic social psychology research investigates the underlying mechanisms involved in stereotyping, prejudice, and discrimination, and her applied health research focuses on how these factors contribute to inequality in health status and health care among socially disadvantaged groups. She is currently conducting a NIH-funded study examining the effects of Black patients' and non-Black physicians' racial biases and attitudes on their affective expression during racially discordant medical interactions.
Is teasing a slippery path to bullying?
Every child, every adolescent, and every adult is teased, for better or for worse; it may feel like fun or it may be painful. Three components of teasing—aggression, humor, and ambiguity—are at the heart of what makes teasing both dangerous and attractive. Unlike teasing, which may be playful, bullying always has an aggressive intent. Bullying can cause deep problems for both the perpetrator and the victim. We know that both bullies and victims show deficits in emotion regulation, the ability to manage the experience and the expression of emotion. We proposed that how children perceive and respond to teasing is related to their capacity to regulate their emotions. Led by faculty member Dr. Barbara Myers, she and her former grad students (now all Ph.D.’s) Virginia Mackintosh, Maria Kuznetsova, Geri Lotze, and Neeraja Ravindran, along with Dr. Al Best from Dentistry, explored these questions with a vulnerable group of children, those whose mothers were incarcerated.
Sixty-one children of currently or previously incarcerated mothers who were attending a summer camp answered questions on the teasing they observed, experienced, and practiced, at home and at school. Children self-reported that they were more likely to practice hurtful teasing if they experienced it at school and more likely to practice playful teasing if they observed it at school and experienced it at home. Adult camp mentors rated the children’s teasing, bullying, peer behavior, and emotion regulation. From their reports, high bullying was predicted by a child being a hurtful teaser, being aggressive with peers, and having low prosocial behavior, high lability/negativity, and low emotion regulation. Emotion regulation was a strong predictor of being a bully. The children whose moods flew up and down, showing more Lability/negativity, were at greatly increased probability of being a bully. Each point increase on the scale raised the odds almost 20 times. This held real and concrete meaning in our camp context. Children who are labile and negative are difficult to supervise and cause trouble with the other children in a crowded cabin; they are no doubt just as hard to live with at home and in the classroom. They show wide mood swings, frustration, and impulsivity, and they are prone to disruptive outbursts and tantrums. Emotion regulation has potential importance as a mechanism for understanding resilience and long-term outcomes for children of incarcerated parents. Supporting their emotion regulation is a worthy goal, though one that is challenged by the difficult life histories and family situations of children whose parents are in prison or jails.
Our group is interested in children of incarcerated parents because they are a large and growing group who are at high risk for many problems in their lives as children and then when they grow up. For more than a decade, VCU undergraduate students have taken the summer field study class PSYC 493, Mentoring Children at Risk, and gone to work with these children at a summer camp. It is a challenging, exhausting, sweaty, exhilarating, and deeply meaningful experience for the students—as well as a great week of camp for the kids.
How can we treat insomnia?
Graduate students in the Clinical and Counseling Psychology doctoral programs have completed a series of studies under the mentorship of Dr. Bruce Rybarczyk that will contribute to advancing the treatment of insomnia in individuals with co-morbid psychiatric conditions. Cognitive-behavioral therapy (CBT) has several treatment components, including an initial reduction in sleep to increase sleep drive and retrain normal sleep as well as methods for eliminating time spent in bed while awake to weaken the association between being in bed and having anxiety about not falling asleep. The treatment also includes education in the science of sleep, in order to provide the patient with an “owner’s manual” for their sleep system.
Dr. Nile Wagley's dissertation included patients undergoing outpatient psychiatric treatment for an average of 3.6 years who continued to have insomnia symptoms in spite of their psychiatric care. Two sessions of CBT for insomnia (one conducted via telephone) were effective in improving sleep and reducing depressive symptoms. A second dissertation study at the same clinic employing a large group of patients and a longer format of treatment is currently being conducted by graduate student Hannah Lund. Another study targeting recent veterans with Post-Traumatic Stress Disorder (PTSD) was conducted by Dr. Skye Margolies. This dissertation study tested four sessions of CBT and an optional supplementary treatment for nightmares (imagery rehearsal therapy) with 40 combat veterans who served in Afghanistan and/or Iraq. The treatment led to significant improvements in self-report and objectively measured sleep, a reduction in PTSD symptom severity and PTSD-related nighttime symptoms, and a reduction in depression and distressed mood compared to the waitlist control group. This study is also being replicated by Laurin Mack. Her study provides a classroom CBT intervention to veterans who have recently completed a psycho-educational course on coping with PTSD.
These studies contribute to growing evidence that CBT for insomnia is a treatment that should be offered to all mental health patients as a supplement other treatments they are receiving that are targeting the primary mental health diagnosis. Not only is sleep substantially improved as a result of these interventions, but other mental health symptoms are alleviated as a consequence of improved sleep. Additionally, there are no side effects, treatment is brief, the benefits are sustained over time and the cost is limited, especially when employing self-help materials. The challenge that lies ahead is training more clinicians to deliver this brief treatment and getting the word out to health professionals and the public that this should be a first line treatment for persistent insomnia. To address the science-practice gap, future research by Dr. Rybarczyk and colleagues will test a “stepped care” approach to delivering CBT in primary care, using varied levels of treatment intensity and different methods of delivery, including the internet. This concept was detailed in a 2011 publication by Laurin Mack and Dr. Rybarczyk.
Is religious counseling effective?
When many people come to counseling, they want religiously consistent counseling. Is it helpful to match a religiously accommodated treatment to the client's religious beliefs? Turns out, the answer is yes. It can be helpful, but religious people can also benefit from purely secular treatments. They improve in mental health symptoms just as much with either treatment, but sometimes the religious treatments can produce more positive spiritual benefits.
Dr. Everett Worthington, Jr., who just finished up a three-year commitment as President (President-elect, President, and Immediate Past-President, for the three years, respectively) of the Society for the Psychology of Religion and Spirituality (Division 36 of the American Psychological Association, APA), has worked with two former student colleagues now at the University of North Texas (Dr. Joshua Hook) and Georgia State University (Dr. Don E. Davis), and a VCU faculty colleague in another Department (Dr. Michael McDaniel) to analyze the accumulated literature. Their meta-analysis was considered by an APA joint task force (Divisions of Clinical Psychology and Psychotherapy) on relationship factors in psychotherapy. That task force evaluated the evidence Worthington and his colleagues presented as providing the highest level of support for considering the religious beliefs and values of the client in considering treatment options.
Dr. Worthington is a member of the Counseling Psychology program and also affiliated with Social, Developmental, and Health Psychology programs. He typically studies forgiveness and other aspects of positive psychology, religious and spiritual issues, and couple enrichment.
Can we help children with ADHD succeed in school?
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed childhood disorders. Children with ADHD frequently experience problems at school, and these problems often get worse during adolescence. Compared to their peers, adolescents with ADHD earn significantly lower school grades, score significantly lower on standardized achievement tests and experience higher rates of special education placements, grade retention and school dropout.
Dr. Joshua Langberg, a clinical psychologist at VCU, partnered with investigators from multiple universities to develop a better understanding of the school performance of adolescents with ADHD (Langberg, Molina et al., 2011). The investigators examined data collected as part of the Multimodal Treatment Study for Children with ADHD (MTA study), a large dataset including over 500 children with ADHD followed from elementary school through high school. Dr. Langberg and colleagues wanted to determine if school problems in high school age adolescents with ADHD could be predicted by behaviors present when the students were in elementary school. If behaviors in elementary school can be used to predict later school problems, interventions can be developed to target these issues, with the goal of preventing these problems from occurring.
The results of the study showed that in elementary school, students' ability to organize and manage homework materials as rated by parents and students' reading and writing abilities as rated by teachers were strong predictors of grades and achievement scores in high school. In fact, these behaviors were stronger predictors of school performance than the severity of their ADHD symptoms in elementary school and were more important predictors than the treatments they received, including medication and/or school services.
These data suggest that it is very important to develop school-based interventions that seek to improve students' materials organization and reading and writing skills. Dr. Langberg has been working to develop an intervention that targets the organizational skills of students with ADHD, the Homework, Organization, and Planning Skills (HOPS) intervention (Langberg, 2011). Results from the initial tests of the HOPS intervention demonstrate that it has significant potential to improve the school functioning of students with ADHD (Langberg et al., 2008; 2011).
Dr. Langberg's research focuses on improving the school performance of children and adolescents with ADHD. He conducts research to identify why students with ADHD struggle in the school and develops interventions to improve academic and behavioral performance. Dr. Langberg has focused much of his research on the school performance of young adolescents with ADHD, especially surrounding the transition to middle school. This tends to be a very difficult period for students with ADHD and interventions targeting school performance are frequently needed during this time. Dr. Langberg focuses on developing interventions that are feasible for delivery in the school setting as providing interventions in schools allows many more children to have access to these much needed supports and interventions.
Why have African American youth traded cigarettes for cigars?
As a child growing up in the rural South during the 1980s, cigarette smoking seemed to him a necessary rite of passage into manhood; so seamlessly intertwined with developmental as well as cultural aspects of African American life. From the vantage point of a ten year-old, smoking was an ostensible attribute of family eldership status, independence, and coolness. He became so enamored with smoking that on several occasions he would venture off behind a workshed to light a cigarette and emulate the smoking behaviors of family members (as well as fictive kin) – all the time, hoping that it would instill within him the same bravado he had witnessed among older men in his family. However, as he grew older, the unfortunate and untimely demise of family elders because of tobacco-related diseases led to a more sobering assessment of the impact of tobacco in his family and within African American communities, in general.
Since then, Dr. Aashir Nasim has endeavored to understand the link between cigarette smoking and the social and cultural experiences of African Americans (Nasim et al. 2011a; Nasim et al., 2009; Nasim et al., 2007; Nasim et al., 2003). Although there are many known risks for smoking, his research has identified cultural and religious / spiritual factors that protect against risks for smoking among African American adolescents (e.g., neighborhood stressors; see Belgrave et al., 2010) and young adults (e.g., race-related stress; see Fernander et al., 2008). Promotive and protective factors identified in his research include a strong ethnic identity (Clark et al., 2008), family cohesion and interdependency (Nasim et al., 2007) and endorsement of religious coping strategies (Nasim, et al., 2006). Perhaps more importantly, Dr. Nasim's research on protective factors for cigarette smoking has led to the development of theoretical frameworks (Nasim et al., 2011b) and models of praxis for broader efforts in substance use prevention (Belgrave et al., 2007; Belgrave et al., 2008).
More recently, Dr. Nasim's research has followed the shifting landscape of adolescent tobacco use. For instance, in Virginia, cigars (specifically, little cigars) have now supplanted cigarettes as the most prevalent form of tobacco use among youth ages 12 to 17. What is more, his recent study on cigar misreporting revealed that statewide tobacco surveillance systems have significantly underestimated rates of cigar use among African Americans and other health disparities populations (Nasim et al., in press). Many African American youth have chosen cigars over cigarettes because cigars are generally less expensive than cigarettes; smell and taste better (e.g., strawberry, cherry, and chocolate flavorings); pose fewer perceived health risks; and, are considered more socially acceptable and attractive. This is particularly concerning because his research, in collaboration with Drs. Melissa Blank and Thomas Eissenberg (Director of VCU's Clinical Behavioral Pharmacology Laboratory), shows that little cigar smoke contains many of the same lethal toxicants and effects as cigarette smoke (Blank et al., 2011). These misperceptions are compounded by adolescents' beliefs that modifying (hyping or freaking) the little cigar by removing the "chemical / cancer paper" renders the tobacco product "cancer-free." His ongoing qualitative research funded by the Virginia Foundation for Healthy Youth (VFHY) – a multi-study project involving content analytic methods – reveals that many of attitudes and beliefs about little cigar smoking are socially (e.g., social and urban cachet) and culturally-rooted (e.g., traditional health beliefs).
Dr. Nasim is currently awaiting review of his revised grant application to the National Cancer Institute (NCI) to investigate the effects of little cigar modification (i.e., hyping) on smoke toxicant and user toxicant exposure. In addition, he is preparing a research study to determine if risks and protective factors for little cigar smoking and other alternative tobacco uses (e.g., hookah) are consistent with previous findings for cigarette smoking.
Are cultural issues important in rehabilitation medicine?
Each year, 700,000 Americans suffer a new or recurrent stroke, and currently 5.6 million Americans are living with the effects of stroke, positioning it as the leading cause of disability in the United States. The effects of stroke are especially pronounced in Black and Latino individuals, who experience more strokes and recover more slowly from stroke than White individuals do. For example, Black individuals who sustain a stroke are twice as likely as White individuals to sustain a second stroke, whereas Latinos are 2.6 times as likely. Further, these differences are even more pronounced in the Southeastern United States, where there has long been a 50% greater mortality rate from stroke across the "Stroke Belt."
Dr. Paul Perrin and his colleagues have hypothesized that one of the contributors to racial/ethnic disparities in stroke rehabilitation could be the nature of informal care that individuals with stroke receive. Individuals with stroke from differing racial/ethnic backgrounds can often have very different caregiving experiences because of family structure, cultural norms, and living arrangements.
In order to investigate the connections between caregiving and racial/ethnic disparities in stroke, Dr. Perrin's research team collected data on caregiver mental health and functioning of individuals with stroke from 124 White, Black, and Latino/Puerto-Rican caregiving dyads at 1, 6, and 12 months post-hospital discharge. Out of the three racial/ethnic groups, Latino/Puerto-Rican individuals with stroke showed the lowest functioning, and their caregivers showed the poorest mental health.
Based in part on the findings from this study, Dr. Perrin's research team developed and implemented a pilot study of a culturally sensitive Transition Assistance Program (TAP), primarily for Latino stroke caregivers. The program was implemented completely through videophone devices while caregivers were at their own homes. The intervention was comprised of (1) skill development, (2) education, and (3) supportive problem solving. Sixty-one dyads participated: thirty-nine from Puerto Rico and twenty-two from Texas. Participants were randomly assigned to the TAP treatment or a control group. The TAP effectively reduced caregiver strain at the 3-month follow-up, and when controlling for baseline differences, the treatment group had lower depression than the control group at follow-up. Among individuals with stroke who had low functioning at the beginning of the study, those whose caregivers had received the TAP improved in functioning more so than did those whose caregivers had been in the control group.
Dr. Perrin's studies have shown that critical knowledge may be lost regarding the connections between caregiver mental health and the functioning of individuals with stroke when researchers and clinicians look only across race/ethnicity as opposed to also within. A culture-free approach to mental-health interventions for stroke rehabilitation is likely limited, and race/ethnicity may affect how caregiver mental health and functioning of individuals with stroke reciprocally influence each other, contributing to some of the disparities in rehabilitation seen all too often.
Are mindful people better at regulating their emotions?
Our emotions are an integral part of who are, coloring our relationships, impacting our decisions, and playing an important role in determining our mental and even physical health. We are “hard-wired” to be emotional. But our emotions do not always serve our best interests, as anyone knows who has ever fought with a loved one, made an impulse purchase, or gotten sick from too much stress. Emotions, particularly of the difficult kind – fear, sadness, anger, jealousy, and so on – often need to be “regulated” for us to behave in healthy, adaptive ways. How can people better regulate their emotions when provoked or stressed? To date, much research devoted to understanding emotion regulation has either focused on maladaptive ways to manage emotions, like rumination and suppression, or has focused on strategies that are brought to bear after some judgment about an event or situation has already been made. Less research has focused on ways to intervene in the early stages of a challenging encounter – ways that may help to inhibit the arising of difficult emotions before they have a chance to impact us and, potentially, the people around us.
Dr. Kirk Warren Brown studies a beneficial quality of mind that we all have the potential to exercise, called mindfulness, that may be a game-changer in otherwise stressful situations. Mindfulness, simply put, is presence of mind, the capacity to be receptively attentive to what we encounter moment to moment. Instead of approaching people or situations through the filter of our memories of them from past encounters, or reacting on the basis of our prior experiences or our expectations, a mindful response encounters what is happening with openness and freshness. Dr. Brown’s research, and that of numerous others, has shown that mindfulness, and training to enhance it, can positively impact a host of life domains, from mood states to decision-making to romantic relationship quality. Given the key role of emotion regulation in these and other important domains, Dr. Brown and graduate student Robert Goodman, both of the Social and Affective Neuroscience Laboratory at VCU, along with colleague Michael Inzlicht of the University of Toronto, recently set out to explore how mindfulness might play a role in healthy emotion regulation.
Emotions often arise very quickly after we encounter a provocative stimulus – over a matter of seconds, even milliseconds, so it was important to capture this process as close as possible to the source of emotion generation – by investigating what happens in key regions of the brain in the immediate aftermath of an encounter with evocative stimuli. After completing a battery of psychological measures, including two assessing dispositional mindfulness, college student participants in the study viewed a series of photographs that varied in valence – some pleasant (e.g., a baby), some unpleasant (e.g., a pointed gun), some mildly evocative, and some very provocative. During the viewing of 150 such images, neural responses to them that unfolded over milliseconds – called “event-related potentials” – were recorded through highly sensitive sensors placed at multiple sites on the scalp.
The results, described in a new article in the journal Social Cognitive and Affective Neuroscience, were, well, provocative. More mindful participants showed attenuated neural responses to highly arousing images of both pleasant and unpleasant kinds. Their brains simply did not react as strongly to the kinds of provocation that typically lead to challenging emotions (that then often require psychological work to manage them). The study findings lent support to the claim that mindfulness may alter the time course of emotion very early in the game – within fractions of a second after being confronted with emotionally potent stimuli. The findings suggest that being present, or attending openly and receptively to what we encounter on a day-to-day basis, may be important to enhancing our moment-to-moment experience and our quality of life more generally. Finally, the findings of this study also support the value of now widely available mindfulness training to promote healthy emotional lives.
How do we react to criticism?
Are you more likely to recall the compliment your boss gave you, or the criticism? Dr. Jeffrey Green and colleagues have examined how people process and remember feedback. In a series of experiments, they have had people take an alleged personality test via computer that provides feedback in the form of positive and negative behaviors that they are likely to do, such as keeping a secret, or forgetting to pick up a friend. Then they have given them a surprise memory task. They have found that people do indeed recall poorly negative, threatening information about themselves, but they remember flattering or affirming information well. However, people tend to be strategically flexible. They do not neglect all negative information about themselves, but only the most threatening information: feedback that relates to their most central or cherished aspects of themselves.
However, there probably are some downsides to wholesale forgetting of threatening negative feedback, most notably not learning from our mistakes. Are there other conditions that might limit this general selective forgetting tendency? Green and colleagues reasoned that if the feedback came from someone close, like a romantic partner or best friend, then it should be remembered better. Such feedback might be seen as more trustworthy or helpful for the relationship. In a twist on their previous experiments, close friends or romantic partners were separated and thought that the other sent them feedback about themselves. Others received the very same information from a stranger. The usual forgetting of negative, threatening feedback occurred when it supposedly came from a stranger, but it was remembered better when it came from a close friend or romantic partner.
We also may be more open to threatening feedback when we are motivated to improve. We may accept the short-term drop in self-esteem in order to better ourselves in the long run. Green and colleagues subliminally activated in people a desire to self-improve by having them read sentences that included improvement-related words. Others in a control condition read words unrelated to improvement. The results were similar to the close other study: people in the control condition exhibited the usual forgetting of threatening information, but those who had self-improvement activated in their minds recalled more of the threatening information. Thus, while we are generally motivated to protect the self by engaging in selective forgetting, we can turn off this tendency when the feedback comes from those who are close to us or when we are focusing on self-improvement.
Dr. Jeffrey Green has investigated the cognitive processes by which individuals are able to forget threatening information as well as various factors that can increase or reduce this forgetting. He and his colleagues have published nine articles and chapters on this topic.
Does your family work together successfully?
In an ideal world, a family would work together like a well-oiled machine, but in reality, things don't always go so smoothly. Coordinating school, friends, meals, and extracurricular activities is challenging enough during adolescence. Families who also deal with the diagnosis and management of a chronic medical condition stretch available resources and resilience even thinner. Type 1 diabetes requires constant monitoring of blood sugar levels and multiple insulin injections every day. Individuals must also be aware of how daily activities, such as exercise, type/amount of food, and stress will affect blood sugar levels and insulin dose calculations. No matter how mature a teen may be, management of type 1 diabetes is a complex process, and the help of a concerned parent is crucial. In fact, parental involvement in disease care is the single best social predictor of better health outcomes in youth with diabetes. Greater personal health demands and parental monitoring come at a time when teens desire independence from parents and may result in family conflict, making successful family teamwork even more challenging. Since parental involvement and teamwork are key elements of successful diabetes management, Dr. Holmes' NIH-funded research seeks to provide families with a set of fundamental coping skills. These techniques allow families to continue working together toward good diabetes management while minimizing parent-teen conflict. Trained interventionists help parents and teens practice productive ways to communicate, avoid arguments, problem solve as well as change attitudes and behaviors.
Managing diabetes at school can present another layer of challenges. High and low blood sugar levels can have immediate and long term effects on school performance. Some symptoms of high/low blood sugar levels include feeling lightheaded, dizzy, nauseous, trouble with concentration, and feelings of fatigue. People who have skipped a meal can experience some of these symptoms. However, individuals with diabetes often have blood sugar levels outside the normal range and experience these symptoms more frequently and to a greater degree. Best cognitive performance occurs when blood sugar levels are optimal; it is easy to imagine how a student with diabetes may have trouble doing their best on an assignment or exam while experiencing high or low symptoms. Therefore, disease management and performance at school is optimized when family teamwork involves teachers and school nurses.
The research of Dr. Clarissa Holmes explores the effects of type 1 diabetes on aspects of psychosocial and cognitive functioning in children and adolescents with diabetes. She is currently conducting a prevention program for families of youth with type 1 diabetes to maintain parental involvement in daily disease care through family teamwork. Dr. Holmes also is interested in the cognitive side effects of extreme blood sugar levels. An exploratory study is underway to evaluate the effects of blood sugar changes on memory and learning performance and to help youth manage diabetes challenges at school.
How important is dating in adolescence?
Dating is a common experience among adolescents. It gives them the chance to learn about interacting and communicating with romantic partners and influences patterns of behavior in intimate partner relationships in adulthood. Although dating offers opportunities for positive growth, adolescents may also have to face problematic dating situations including those that place them at-risk for dating violence. Terri N. Sullivan and colleagues are conducting a series of qualitative studies to better understand the dynamics of problem situations that happen in dating contexts. The first step was interviewing adolescents and asking them to describe situations in dating contexts they perceived as problematic. We then conducted follow-up interviews to determine adolescents' perceptions of the best response in these situations and supports and barriers that would help or hinder them in engaging in those responses. We believe this information will benefit prevention effort focused on helping adolescents develop and maintain healthy dating relationships.
Dr. Terri Sullivan works more generally on the development, implementation, and evaluation of school-based prevention efforts to promote behavioral, social, and emotional competence among middle school students.
Prescription medications can't be dangerous, right?
Most people receive prescription drugs at some point—you break your wrist, your doctor gives you a week's worth of Vicodin, but it stops hurting after three days and you put the leftover pills in your medicine cabinet. Most of the time they stay there. Sometimes they are later shared with other people.
Over the past decade, the number of people who use prescription drugs without a doctor's prescription has increased dramatically. In a recent study with young adults, Eric Benotsch and colleagues found that 36% of those surveyed reported using a prescription medication without a doctor's consent. The most commonly used type of medication was pain medication (e.g., Vicodin), followed by anxiolytics (e.g., Xanax), stimulants (e.g., Adderall), and sedatives (e.g., Ambien). Friends and family were the main sources of prescription medications—those leftover pills in the medicine cabinet were used, but not for the purpose the doctor intended.
Common motivations for using prescription medications included some legitimate medical uses such as pain relief but also included recreational use-- to "get high" or to "try something new." In general, young people who used prescription medications without a prescription were also more likely to use traditional recreational drugs, especially marijuana (50%), ecstasy (18%), and cocaine (10%). Overall, prescription drugs taken without a doctor's prescription were more frequently used than all other recreational drugs except alcohol and marijuana.
Among individuals who reported the non-medical use of prescription drugs, 43% indicated that they had combined this use with the use of alcohol and 21% indicated that they had used a prescription medication in combination with an illicit drug. Although the majority of participants believed that the use of prescription medications posed little or no risk for injury or illness, overdose of opioid analgesics is now the primary cause of drug-related poisoning in the United States, and these drugs are particularly dangerous when combined with alcohol. Additional research aimed at understanding the recreational use of prescription drugs is needed. Dr. Eric Benotsch and colleagues have published several articles on the non-medical use of prescription drugs.
How can we reduce childhood obesity?
In the past 30 years, the number of obese children has more than tripled! This statistic is concerning because obesity is associated with a number of physical and mental health concerns, including diabetes, cardiovascular problems, and poor quality of life. As a result, many programs have been developed to prevent and reduce pediatric obesity, however, they have had limited success.
Dr. Suzanne Mazzeo and her colleagues, including Dr. Marilyn Stern, believe that targeting the parents of overweight children might be the best approach to fighting childhood obesity, largely because parents serve as powerful models of eating and exercise behaviors. In fact, the best predictor of children's exercise and eating behaviors are their parents' eating and exercise behaviors. For example, parents who eat more fruits and veggies are more likely to have children that do the same. Also, other researchers have found that when parents are involved in the treatment of pediatric obesity, children's outcomes improve. Further, because most overweight children have overweight parents, targeting parents can help the entire family improve its health. Finally, parent-only interventions are more cost-effective than family-based approaches, as they require fewer staff and other resources.
To test their hypothesis, Drs. Mazzeo and Stern and their colleagues recruited families with overweight children from all over the Richmond area to participate in a study. Half of the parents were assigned to the NOURISH (Nourishing Our Understanding of Role Modeling to Improve Support and Health) program in which parents were taught how to be healthy role models for their children. The other half of the parents were assigned to a control group which received publicly-available information in a one-session meeting and through the mail over the course of the intervention period. Results showed that children in the control group gained more weight than children in the NOURISH program. Children in the NOURISH group also reported higher quality of life and less dissatisfaction with their body. These findings suggest that NOURISH may be an effective way to prevent overweight children from becoming overweight adults, while also enhancing the way children feel about themselves and their body. The next step for Dr. Mazzeo and her colleagues is to evaluate the impact of the NOURISH program on childhood obesity with a much larger sample. It is Dr. Mazzeo's hope that this study will lead to the dissemination of a program capable of combating today's obesity epidemic.