Journal of Consulting and Clinical Psychology

Sayer, Nina A.; Wiltsey Stirman, Shannon; Rosen, Craig S.; Kehle-Forbes, Shannon; Spoont, Michele R.; Eftekhari, Afsoon; Chard, Kathleen M.; Kaplan, Adam; Nelson, David B.

2023 Journal of Consulting and Clinical Psychology

doi: 10.1037/ccp0000832pmid: 37668578

Objective: This study estimated the size of therapist effects (TEs) for dropout and clinical effectiveness of two trauma-focused psychotherapies (TFPs) and evaluated whether therapy delivery and clinic organizational factors explained observed TEs. Method: Participants were 180 therapists (54.4% psychologists, 42.2% social workers) from 137 Veterans Health Administration facilities and 1,735 patients (24.7% women; 27.2% people of color) who completed at least two TFP sessions. Outcomes were dropout (< 8 TFP sessions) and for a subsample (n = 1,273), clinically meaningful improvement and recovery based on posttraumatic stress disorder checklist for DSM-5 (PCL-5) scores. Therapist-level predictors were ascertained through survey, manual chart review, and administrative data. Multilevel models estimated TEs. Results: Over half (51.2%) of patients dropped out and those who dropped out were less likely to meet criteria for clinically meaningful improvement or recovery (ps < .001). Adjusting for case-mix and TFP type, therapists accounted for 5.812% (p < .001) of the unexplained variance in dropout. The average dropout rate for the 45 therapists in the top performing quartile was 27.0%, while the average dropout rate for the 45 therapists in the bottom performing quartile was 78.8%. Variation between therapists was reduced to 2.031% (p = .140) when therapists’ mean of days between sessions, adherence, implementation climate, and caseload were added to multilevel models. TEs were nonsignificant for clinically meaningful improvement and recovery. Conclusions: Interventions targeting therapy delivery and clinic organization have the potential to reduce variation between therapists in TFP dropout, so that more patients stay engaged long enough to experience clinical benefit.

Sowers, Alexandria F.; Clapp, Joshua D.; Freng, Scott A.; Stanton, Kasey

2023 Psychological Assessment

doi: 10.1037/pas0001274pmid: 37707476

Whereas existing data verify the importance of support networks in facilitating resilience following trauma, the sociocultural perceptions of posttrauma difficulties that provide context for these interactions remain largely unexplored. Folk psychiatry models propose that lay explanations of mental illness can be quantified along distinct moralizing, medicalizing, and psychologizing dimensions. The current project aimed to develop a trauma-specific measure capturing lay explanations of posttraumatic stress disorder (PTSD) based on this framework. Data were collected from three samples of Mechanical Turk respondents (N1 = 367; N2 = 365; N3 = 401) as well as an independent sample of university students (N4 = 311). Factor analysis of the final, 13-item Folk Psychiatry Measure–PTSD (FPM-P) indicated close fit of a correlated three-factor model in MTurk and student respondents. Across samples, moralizing beliefs about PTSD (e.g., people with PTSD lack a moral compass) evidenced moderate-to-strong correlations with general attitudes toward those with mental illness, including positive associations with authoritarianism, social restrictiveness, blame, anger, and perceived dangerousness. Negative associations with benevolence and support for community-based care were also noted. Medicalizing beliefs (e.g., PTSD is caused by a chemical imbalance) demonstrated more modest associations with negative attitudes, as noted through weak correlations with increased authoritarianism, anger, and lower benevolence toward those experiencing psychological difficulties. Finally, psychologizing explanations (e.g., people with poor relationships and low social support are at greater risk of developing PTSD) evidenced weak but positive associations with benevolence and pity for those with mental health concerns. Implications and cultural-based nuances of the scale are discussed.

Walters, Glenn D.

2023 Psychological Assessment

doi: 10.1037/pas0001277pmid: 37707475

This study sought to assess whether two scales from a criminal thinking inventory displayed bipolar properties such that high scores on these scales reflect a risk effect and low scores a promotive effect. To test this hypothesis, the proactive criminal thinking (PCT) and reactive criminal thinking (RCT) scales from the Psychological Inventory of Criminal Thinking Styles (PICTS) were organized into three categories—top 25% of scores (high group), the middle 50% of scores (intermediate group), and bottom 25% of scores (low group)—and crossed with preincarceration (prior convictions and age at first conviction), peri-incarceration (total and aggressive institutional infractions), and postincarceration (revocation and rearrest) outcome indicators. Participants for this study were 3,039 male inmates who completed the PICTS while confined in a medium-security federal prison. Results showed that the PCT and RCT each achieved a mixed (risk and promotive) effect for four out of six outcomes. Of the four unipolar effects, PCT achieved a promotive effect but not a risk effect for the two preincarceration outcomes, whereas RCT produced a risk but not promotive effect for the two postincarceration outcomes. These results provide support for the notion that PCT and RCT are primarily bipolar dimensional constructs in which high scores are associated with negative criminal justice outcomes and low scores with positive criminal justice outcomes, although there may be unipolar aspects to each scale as well.

Veilleux, Jennifer C.; Higuera, Danielle E.; Warner, Elise A.; Schreiber, Regina E.; Brott, Katherine Hyde; Clift, Jeremy B.

2023 Psychological Assessment

doi: 10.1037/pas0001275pmid: 37707474

Desire intolerance is conceptualized as a motivational counterpoint to the transdiagnostic risk factor of distress intolerance and is defined as the inability or unwillingness to “sit with” the motivation to approach a rewarding object or task. The current work describes the development and validation of a novel measure of desire intolerance. After initial item development and exploratory factor analysis (Study 1) and confirmatory factor analysis (Study 2), the 10-item unidimensional Desire Intolerance Questionnaire (DIQ) was created. Desire intolerance was conceptually related to low self-control (Studies 1–4) and both approach and avoidance motivation (Studies 2, 4, 5) and was distinct from delay of gratification (Study 3). Greater desire intolerance was also associated with higher distress intolerance (Studies 4 and 5). In Study 4, we used qualitative coding to explore what people were thinking about when they considered their “desires.” Findings revealed that higher desire intolerance was associated with thinking about desired long-term outcomes more than proximal short-term hedonic pleasures. Finally, Study 4 focused on unique and independent associations between desire and distress intolerance with psychopathology, and we found that both distress intolerance were associated with heightened psychological distress and borderline personality symptoms. Only distress intolerance was uniquely associated with uncontrolled eating and self-criticism, whereas only desire intolerance was uniquely associated with aggressive behavior and dichotomous thinking. The current research supports the DIQ as a psychometrically sound indicator of difficulties withstanding desires and allows for a better understanding of intolerance as a transdiagnostic clinical phenomena.

McClure, Kenneth; Bell, Kerri-Anne; Jacobucci, Ross; Ammerman, Brooke A.

2023 Psychological Assessment

doi: 10.1037/pas0001268pmid: 37668583

The present study aimed to expand the literature on single-item assessments for suicidal thoughts and behaviors (STBs) by examining measurement invariance of commonly used single-item assessments of suicidal ideation (SI), planning (SP), and attempts (SA) with respect to race and ethnicity. Predictive invariance with respect to depression, and multi-item measures of passive and active SI were also explored. Measurement invariance was examined across (a) Black and White respondents and (b) Hispanic/Latinx and non-Hispanic/-Latinx respondents. Participants (N = 1,624; 51.66% male) were recruited from Mechanical Turk and Prime Panels. Participants were administered four distinct single-item measures each for SI, SP, and SA across three timeframes (past month, past year, lifetime). Items were drawn from well-known large-scale studies (e.g., National Comorbidity Survey) and common suicide risk assessments. Multiple group confirmatory factor analysis was used to examine measurement invariance; regression with group by measure interactions were used to evaluate predictive invariance. Measurement invariance was observed for both Black (N = 534) and White (N = 1,089) respondents as well as Hispanic/Latinx (N = 335) and non-Hispanic/-Latinx (N = 1,288) respondents across single-item outcomes. Thus, SI, SP, and SA rates can be defensibly compared between Black and White and Hispanic/Latinx and non-Hispanic/-Latinx respondents within studies; however, comparison of SI and SP rates across studies with differing assessment prompts should be met with caution. Multiple single-item STB measures demonstrated predictive bias across race and ethnicity suggesting potential differential screening capabilities. Elevated SI, SP, and SA rates for Hispanic/Latinx individuals were also observed. Findings reiterate the importance of minor language differences in single-item STB assessments.