New Research From Clinical Psychological Science

The Role of Shame in the Sexual-Orientation Disparity in Mental Health: A Prospective Population-Based Study of Multimodal Emotional Reactions to Stigma
John E. Pachankis, Mark L. Hatzenbuehler, Daniel N. Klein, and Richard Bränström

Considering emotions such as shame as characteristic reactions to stigma might improve theories of stigma as well as the effectiveness of interventions to reduce the mental-health sequelae of stigma, this research suggests. Pachankis and colleagues assessed shame explicitly (via self-report) and implicitly (via a behavioral task) in a cohort of sexual-minority and heterosexual participants. Compared with heterosexuals, sexual minorities evidenced higher explicit and implicit shame, which explained sexual-orientation disparities in depression, social anxiety, and suicidal thoughts. Among sexual minorities, shame affected the association between interpersonal stigma (i.e., past-year family rejection and childhood bullying) and later experiences of adverse mental health.   

The Next Generation of Clinical-Psychological Science: Moving Toward Anti-Racism
Craig Rodriguez-Seijas et al.

Rodriguez-Seijas and colleagues examine how the clinical science model has neglected anti-racism (e.g., by overlooking systemic and contextual factors). By examining the idiosyncratic development of the clinical science model in clinical psychological science, the authors outline how its failure to contend with systemic racism in the field propagates a racist subdiscipline. They hope that by enacting difficult self-reflection, this article invites other stakeholders in the field to think more critically about how systemic racism and white supremacy pervade the field’s structures and institutions and to begin making concrete changes toward explicit anti-racism in clinical psychological science. 

Does Perceived Posttraumatic Growth Predict Observed Changes in Current-Standing and State Posttraumatic Growth?
Meghan Gangel, Rowan Kemmerly, Lindsey Wilson, Sydney Glickson, Patricia Frazier, Howard Tennen, and Eranda Jayawickreme

Research on posttraumatic growth (PTG) has been marred by the ubiquity of retrospective perceived growth assessments that lack construct validity. However, one justification for assessing perceived growth is that such perceptions may be a catalyst for subsequent change. We examined this question using a measurement burst design in a representative midlife sample who had experienced a major negative life event in the past year (Wave 1 N = 804). Participants completed three waves of retrospective measures of perceived growth (Posttraumatic Growth Inventory); current-standing measures of PTG domains; and experience sampling assessments of state manifestations of growth-relevant domains twice a day for three weeks (32,099 total assessments) over six months. In random intercept cross-lagged panel models, perceived growth did not predict subsequent observed change in current standing or aggregated state assessments of growth. Overall, perceived growth does not appear to serve as a catalyst for positive change in the short-term. 

Profiles of Risk, Allostatic Load, and Mental Health in Low-Income Children
Fanita Tyrell, Fred Rogosch, and Dante Cicchetti  

Most health disparities originate in childhood and extend across the lifespan. However, studies on health disparities have been predominately focused on adults. This study evaluated the biological and psychosocial consequences of exposure to chronic adversity among 491 low-income children aged 8 to 12 years old (52.1% male; Mage = 9.73, SD = 1.0; 68.2% Black/African American; 21.2% Latinx; 267 maltreated and 224 nonmaltreated). Latent profile analyses revealed six distinct profiles of cumulative socioeconomic risk, allostatic load, and mental health functioning. Childhood maltreatment, emotion regulation, affect, and personality characteristics were differentially associated with these latent profiles. Consistent with resilience theory, findings indicate differential effects of chronic adversity on adaptation. These findings also offer evidence that signs of physiological dysregulation emerge at earlier ages in development and suggest there may be a window of opportunity in childhood for interventions to reduce the detrimental effects of chronic adversity on health outcomes in children. 

Resilience Among Older Individuals in the Face of Adversity: How Demographic and Trait Factors Affect Mental-Health Constructs and Their Temporal Dynamics
Lotte Brinkhof, Monique Chambon, Richard Ridderinkhof, Frenk van Harreveld, Jaap Murre, Harm Krugers, and Sanne de Wit

Resilience can be conceptualized as a network of interacting mental health constructs characterized by weak autoconnections and/or interconnections. We investigated whether positive appraisal style (PAS), the ability to bounce back or recover from stress (BRS), age, education level, and urbanization grade can confer such desirable network properties within a network comprising depression, anxiety, loneliness, and mental well-being. Longitudinal data (five timepoints during the COVID-19 pandemic) were derived from a sample of older adults (N = 1270, 55+). Individuals who were aged 67 or older, highly educated, or scored high on PAS and BRS exhibited more resilient network dynamics, as well as generally better overall mental health outcomes. Findings pertaining to urbanization grade, as well as the (subgroup-dependent) dynamics among the mental-health constructs are also discussed. These findings may inform theorizing and interventions aimed at resilience during a challenging life phase. 

Evidence for Bidirectional, Cross-Lagged Associations Between Alliance and Psychological Distress in an Unguided Mobile-Health Intervention
Simon Goldberg, Zishan Jiwani, Daniel Bolt, Kevin Riordan, Richard Davidson, and Matthew Hirshberg

Bidirectional associations between changes in symptoms and alliance (i.e., a cooperative working relationship between client and therapist) are established for in-person psychotherapy. Alliance may play an important role in promoting engagement and effectiveness within unguided mobile health (mHealth) interventions. Using models disaggregating alliance and psychological distress into within- and between-person components (random intercept cross-lagged panel model), we report bidirectional associations between alliance and distress over the course of a 4-week smartphone-based meditation intervention (n=302, 80.0% elevated depression/anxiety). Associations were stable across time with effect sizes similar to those observed for psychotherapy (betas=-.13 to -.14 and -.09 to -.10, for distress to alliance and alliance to distress, respectively). Alliance may be worth measuring to improve the acceptability and effectiveness of mHealth tools. Further empirical and theoretical work characterizing the role and meaning of alliance in unguided mHealth is warranted. 

Associations of DNA-Methylation Measures of Biological Aging With Social Disparities in Child and Adolescent Mental Health
Laurel Raffington, Peter Tanksley, Liza Vinnik, Aditi Sabhlok, Megan Patterson, Travis Mallard, Margherita Malanchini, Ziada Ayorech, Elliot Tucker-Drob, and K. Harden 

Children who experience environmental adversities are at increased risk of both internalizing and externalizing disorders. Epigenetic mechanisms may regulate the influence of environmental adversities on mental health. We examined the hypothesis that salivary DNA-methylation patterns of pace of biological aging (DunedinPoAm) and inflammation (DNAm-CRP) are socially stratified and associated with mental health in 1,183 children (609 female, age M=13.6y) from the Texas Twin Project. Analyses were preregistered. Participants’ DNA-methylation algorithms and psychiatric symptoms differed by socioeconomic contexts and race/ethnicity. Children with more parent-reported internalizing symptoms had higher DunedinPoAm and DNAm-CRP scores, and children with more aggression problems had higher DNAm-CRP. DunedinPoAm partially mediated advantage of White racial identity on internalizing. Similarly, DNAm-CRP partially mediated advantage of higher family socioeconomic contexts and, in a separate model, White racial identity on reduced internalizing symptoms. Children’s epigenetic measures of pace of biological aging and inflammation are associated with social inequalities and mental health. 

A Meta-Analysis of the Efficacy of Trigger Warnings, Content Warnings, and Content Notes
Victoria M. E. Bridgland, Payton J. Jones, and Benjamin W. Bellet

Trigger warnings, content warnings, or content notes are alerts about upcoming content that may contain themes related to past negative experiences. Advocates claim that warnings help people to emotionally prepare for or completely avoid distressing material. Critics argue that warnings both contribute to a culture of avoidance at odds with evidence-based treatment practices and instill fear about upcoming content. Recently, a body of psychological research has begun to investigate these claims empirically. We present the results of a meta-analysis of all empirical studies on the effects of these warnings. Overall, we found that warnings have no effect on affective responses to negative material nor on educational outcomes. However, warnings reliably increase anticipatory affect. Findings on avoidance were mixed, suggesting either that warnings have no effect on engagement with material, or that they increase engagement with negative material under specific circumstances. Limitations and implications for policy and therapeutic practice are discussed. 

Pressure From Within: Gay-Community Stress and Body Dissatisfaction Among Sexual-Minority Men
Zachary Soulliard, Micah Lattanner, and John Pachankis  

Although intraminority gay-community stress has been theorized to affect sexual-minority men’s body dissatisfaction, this association has not been evaluated quantitatively. Using two samples of sexual-minority men—one sample recruited from a population-based study of U.S. adults (N = 424; age: M = 54.29 years) and the other a sample meeting diagnostic criteria for depressive, anxiety, or trauma-/stressor-related disorders (N = 251; age: M = 26.52 years)—in this study, we investigated associations between gay-community stress and body dissatisfaction. In both samples, gay-community stress was significantly associated with sexual-minority men’s greater body dissatisfaction in models that controlled for demographic and minority-stress variables. In terms of specific domains of gay-community stress, perceptions of the gay community’s focus on sex, social status, and social competition were significant correlates of greater body dissatisfaction. Future research can determine the impact of routinely addressing gay-community stress in body image and eating-disorder treatments for this population.

Integrating “Lumpers” Versus “Splitters” Perspectives: Toward a Hierarchical Dimensional Taxonomy of Eating Disorders From Clinician Ratings 

Kelsie Forbush, Yiyang Chen, Po-Yi Chen, Brittany Bohrer, Kelsey Hagan, Danielle Chapa, Kara Christensen, Victoria Perko, Brianne Richson, Sarah Johnson, Marianna Thomeczek, Sarah Nelson, Kylie Christian, Trevor Swanson, and Jennifer  Wildes  

Clinical Psychological Science  

In this study, we describe a hierarchical dimensional model of eating-disorder (ED) classification based on the Hierarchical Taxonomy of Psychopathology. Participants were community-recruited adults with an ED (N = 252; 81.9% female). We used a modified version of Goldberg’s method, which involved sequentially extracting latent factors using exploratory structural equation modeling, resulting in a 10-factor hierarchical-dimensional model. Dimensions predicted 92.4% and 58.7% of the variance in recovery outcomes at 6 months and 1 year, respectively. Compared with other illness indicators (e.g., Diagnostic and Statistical Manual of Mental Disorders [DSM] diagnoses, dimensional ED impairment scores, weight/shape overvaluation, and DSM ED-severity specifiers), hierarchical dimensions predicted 0.88 to 334 times more variance in ED behaviors at baseline and 1.95 to 80.8 times more variance in psychiatric impairment at 1-year follow-up. Results suggest that reducing within-disorder heterogeneity for EDs within the broader context of internalizing symptoms provides a powerful framework from which to predict outcomes and understand symptoms experienced by people with EDs. 

Self-Referential Processing and Depression: A Systematic Review and Meta-Analysis
Amanda Collins and Sam Winer

Reward devaluation theory posits that depressed individuals avoid and devalue positivity, suggesting that they may hold fewer positive self-schemas. Previous meta-analytic reviews have supported this theoretical framework regarding positivity but have not assessed for self-referential stimuli. Self-referential encoding and recall tasks assess for self-schemas and thus provide further insight into how depressed individuals process self-referential positivity. The aim of this systematic review and meta-analysis was to examine the extent to which depressed individuals differ in processing self-referential positivity and negativity and whether this processing differs when depressed individuals think of others (i.e., other-referential). Results indicate that depressed individuals recall and endorse fewer self-referential positive words than negative words and fewer self-referential positive words than other-referential positive words than nondepressed individuals. These findings support reward devaluation theory and suggest that conceptualizing self-referential processing in depression as merely based on negativity biases can overlook crucial information about how depressed individuals devalue self-referential positive information. 

Trajectories and Personality Predictors of Eating-Pathology Development in Girls From Preadolescence to Adulthood
Emilie Lacroix, Sylia Wilson, Matthew McGue, William Iacono, and Kristin von Ranson 

Understanding eating-pathology development may enable meaningful prescriptions for its prevention. Here, we identified common trajectories of eating-pathology development and the personality factors associated with these trajectories. Participants were 760 female twins from the Minnesota Twin Family Study who reported on eating pathology at approximate ages 11, 14, 18, 20, 24, and 29. Parents reported on twins’ personality characteristics at age 11, and twins completed self-report personality questionnaires at ages 14 and 18. Latent class growth analysis identified two distinct trajectories for total eating pathology, binge eating, and weight preoccupation and three distinct trajectories for body dissatisfaction. Girls with more pathological trajectories already showed elevated eating pathology at age 11. These subgroups of high-risk girls self-reported greater proneness to anxiety, stress, and alienation, and less sociable personality styles. Prevention efforts may be enhanced by using self-reported personality traits to identify girls at high risk for eating pathology. 

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