A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.     

Longitudinal idiographic analyses of appraisal and coping responses in sport

Objectives: To (a) identify perceived stressors encountered by high-performance female athletes and examine their attempts at coping with these specific stressors, and (b) to monitor athletes’ perceptions of their coping responses and assess how coping influenced on-going appraisal of the situation and subsequent coping.Method: Data were collected from four high-performance female soccer players (aged 21 to 28 years). Players maintained audio-diaries over a 6-week period during the season. They were also interviewed once at the start and again at the end of the data collection period.Results: Presented via idiographic profiles, results revealed certain recursive relationships between personal goals, stress appraisals, and coping responses. Stressors were reported when personal goals were threatened, and the coping responses that were employed appeared to influence subsequent stress reappraisals and coping.Conclusions: Appraisals and coping appear to occur in a recursive manner. Longitudinal idiographic approaches that include daily diaries may be useful in future research that considers other recursive relationships between goals, emotions, appraisal, and coping.     

Flow and Happiness in Later Life: An Investigation into the Role of Daily and Weekly Flow Experiences

Fifty-four older adults ranging in age from 70 to 86 years old (M = 77.54) reported daily levels of positive and negative affect, life satisfaction and daily activities for seven consecutive days. Hierarchical linear modeling (HLM) was used to investigate inter- and intra-individual effects of flow experiences on affect. Higher quality of flow was positively associated with high arousal positive affect (i.e., feeling peppy, enthusiastic, happy), negatively associated with low arousal negative affect (i.e., feeling sad and disappointed), and positively associated with life satisfaction. However, more frequent flow experiences throughout the week predicted lower average levels of positive affect and life satisfaction. Overall, the results demonstrate that flow is linked to the affective experiences of older adults, and that an individual’s overall propensity to experience flow may be influential beyond the immediate effects of a given flow experience.     

Affect Labeling to Facilitate Inhibitory Learning: Clinical Considerations

Exposure-based treatments known to be effective for a wide range of psychopathology are thought to work via inhibitory learning, where new learning acquired during exposure exercises inhibits previously learned fear and avoidance responses. One way in which this inhibitory learning may be enhanced is through affect labeling, during which clients verbalize their internal emotional experiences. Theoretically, affect labeling may be a subtle, implicit form of emotion regulation and may facilitate more explicit forms of extinction learning. Experimental research suggests that affect labeling may lead to attenuated fear responses to emotionally evocative stimuli in healthy samples and may be a helpful strategy in reducing physiological arousal experienced during exposure tasks, particularly for clients with inhibitory deficits. Research with clinical samples is limited and mixed, at best. Case examples illustrate how affective labeling may help get a client “unstuck” from unproductive processing loops, can contribute to shifts in perspective and meaning making, and may modulate distress and promote distress tolerance. We argue that routine use of affect labeling in clinical care is premature. When used, it should be employed strategically within a broader case conceptualization and may be of a limited benefit beyond what is already employed in quality exposure therapy.     

Affect and Affect Regulation Strategies Reciprocally Influence Each Other in Daily Life: The Case of Positive Reappraisal,Problem-Focused Coping,Appreciation and Rumination

Feelings of positive or negative affect are not restricted to temporary states. They can also determine future affective experiences, by influencing the building of an individual’s personal resources. The present study was designed to understand the daily fluctuations in positive and negative affect more fully. To this end, we examined the involvement of a variety of affect regulation strategies in these fluctuations. The affect regulation strategies we explored included positive reappraisal, problem-focused coping, appreciation and rumination. We adopted an experience sampling method, consisting of five daily assessments over a 2-week period. As expected, within a few hours of experiencing more positive affect, participants engaged in greater positive reappraisal, problem-focused coping and appreciation. In turn, greater use of each of these three strategies was followed by more intense experiences of positive affect. We observed analogous reciprocal influences between rumination and the experience of negative affect, within the same time interval. Changes in affective experience over several hours were also directly influenced by concurrent use of these strategies. More specifically, greater positive reappraisal, problem-focused coping and appreciation accelerated the rise in positive affect that follows low feelings of positive affect, and slowed the decline in positive affect that follows high feelings. Rumination had an analogous influence on change in negative affect. The clinical implications of these findings are discussed.     

Behavioral Assessment in DBT

Dialectical behavior therapy is a widely popular treatment that has been demonstrated to be efficacious with individuals with severe emotion dysregulation problems. DBT is a highly flexible treatment that relies heavily on assessment throughout all phases of treatment to generate idiographic interventions that closely match each client’s varied needs. This series describes a set of principles for utilizing assessment to enhance both one’s adherence to the DBT manual and one’s treatment outcomes. The four articles and commentary illustrate how assessment can facilitate the development of a case formulation; improve skills acquisition, strengthening, and generalization; reduce suicide risk; and make interventions with couples, parents, and other family members more effective. They discuss what pitfalls may occur if providers drift from careful, ongoing assessment, and how best to utilize assessment to work well within DBT’s flexible structure.     

Affective processing in overwhelmed individuals: Strategic and task considerations

Previous research suggests that emotionally overwhelmed individuals (high affect intensity, intermediate attention to emotions, low clarity of emotions) attempt to counteract the influence of affective information. In five studies (ns=129, 177, 119, 339, 261), the current research found that task performance in overwhelmed individuals varied by current arousal and by whether affective influence occurred on evaluative versus non-evaluative tasks. Overwhelmed high current arousal participants exhibited decreased affective influence on evaluative tasks but increased affective influence on non-evaluative tasks. These results are consistent with the effects of active suppression of affective information, including ironic effects of monitoring for affective information. In contrast, overwhelmed low current arousal participants exhibited increased affective influence on evaluative tasks but decreased affective influence on non-evaluative tasks. These results are consistent with attentional avoidance of affective information. Overall, these results further suggest that overwhelmed individuals attempt to counteract the influence of affective information. Whether they are successful depends on their current arousal and how affect can influence performance.     

Preparing for racial microaggressions: The role of cognition and emotion in the proactive coping process of African American college students

Traditionally, conceptual models of racial stressors (including racial microaggressions) have characterized the reactive experiences of African Americans, particularly identifying how African Americans cognitively, emotionally, and behaviorally respond to racial stress. The current study extends beyond the reactive coping experience and identifies nuances in the anticipatory and preparatory coping processes associated with racial microaggressions. Methods: 58 African American college students participated in a stress induction condition that exposed them to racial microinsults and prompted anticipatory concerns of further exposure to racial stress while completing a task with a racially insensitive peer. Following exposure to the stress induction condition, participants completed self-report questionnaires about their anticipatory thoughts, current affect, and proactive coping behaviors. Results: Threat-oriented thinking and negative affect were experienced in anticipation of racial discrimination; however, the endorsement of challenge-oriented thinking and positive affect were better predictors of how the current sample planned to use proactive coping behaviors to manage the anticipated racial stress. Implications: The current findings expand the racial stress coping narrative by capturing how the expression of optimism, perceived control, self-confidence, goal attainability, and positive emotion in anticipation of racial stress increases one's intention to implement coping strategies to minimize the impact of racial stress on task completion. Such findings provide cognitive and emotional targets for assessment when attempting to understand how African Americans are preparing themselves to manage anticipated racial stressors.     

Dispositional optimism as a buffer against emotional reactivity to daily stressors: A daily diary approach

The current research examined if dispositional optimism buffers against the negative influences of daily stressors on affective experiences, using a daily diary study of two large and nationally-drawn samples of American adults (N = 2,349). Optimism, exposure to daily stressors, and daily positive and negative affect were assessed over eight days. Multilevel modelling revealed that optimism significantly attenuated the associations between daily stressor exposure and negative affect reactivity even after controlling for demographic factors, subjective physical health, and socioeconomic status. However, in a similar analysis, the inclusion of socioeconomic variables fully accounted for the moderating effect of optimism on stress and positive affect reactivity. The findings suggest distinct processes that are involved in how optimism reduces daily stress reactivity.     

The influence of between and within-person hope among emergency responders on daily affect in a stress and coping model

This study reports on daily hope, coping, stress, and affect among 84 fire service members who completed a 21-day diary. Multilevel modeling showed that between-person hope was related to higher positive affect. Three-way interactions were found for within-person hope, stress, and daily coping in the prediction of daily affect. When under high stress and if low in hope, more emotion–expression coping predicted higher next day positive affect whereas if high in hope, more problem-focused coping predicted more positive affect. Within-person hope, stress, and emotion–expression coping interacted to predict negative affect. Findings for the prediction of negative affect necessitate further research to determine if the nature of coping under low hope and low stress is qualitatively distinct from high hope states.     

When Arousal Influences Ad Evaluation and Valence Does Not (and Vice Versa)

This research examines, across 2 studies, the interplay between the valence and arousal components of affective states and the affective tone of a target ad. In the first study, music was used to induce a pleasant or unpleasant mood, while controlling for arousal. Participants were subsequently exposed to an ad that either had a positive‐affective tone or was ambiguous in its affective tone. As predicted, the valence of the affective state colored the evaluation of the ad in a mood‐congruent direction, but this coloring effect occurred only when the ad had an ambiguous‐affective tone. In the second study, the target ad had a clear positive or negative affective tone, and the valence and arousal dimensions of the mood state were manipulated independently. As predicted, the arousal dimension, but not the valence dimension, influenced ad evaluation. Ad evaluations were more polarized in the direction of the ad's affective tone under high arousal than under low arousal. This effect was more pronounced for self‐referent evaluations (e.g., “I like the ad”) than for object‐referent evaluations (e.g., “The ad is good”), favoring an attributional explanation—the excitation transfer hypothesis—over an attention‐narrowing explanation—the dynamic complexity hypothesis. Taken together, the results of the 2 studies stress the important contingency of the affective tone of the ad, when examining the effects of the valence and arousal dimensions of a person's affective state on ad evaluation. The results also provide additional insights into how and when affect serves as information in judgment processes.     

Individual differences in the relationship between pleasure and arousal

The two fundamental dimensions assumed to underlie emotional experience—pleasure and arousal—are considered to be independent across individuals. We present evidence from an experience sampling study demonstrating that this independence does not necessarily hold when considering the affective experiences of a single individual. Participants (N = 80) reported how they were feeling in terms of pleasure and arousal nine times a day for seven days. The data showed that, although on average pleasure and arousal were independent, within-person pleasure–arousal associations substantially varied and ranged from strongly positive to strongly negative. This finding demonstrates that pleasant/unpleasant feelings usually co-occur with high arousal for some (reflecting joy/stress), but with low arousal for others (reflecting relaxation/sadness) and that persons differ in whether arousal is usually pleasant or unpleasant. These differences were found to be related to dispositional reward responsiveness, with high reward responsive individuals being characterized by a positive relation between pleasure and arousal and vice versa.     

Spirituality moderates the effect of stress on emotional and physical adjustment

This study examined the relationship of spirituality with emotional and physical adjustment to daily stress. One hundred and thirteen college students completed questionnaire measures of spirituality, daily stress, affect, and physical symptoms at two times one month apart. The results showed that spirituality buffered the adverse effect of stress on adjustment, controlling for the use of various coping strategies. The findings have implications for developing prevention programs to improve people's coping skills by incorporating greater emphasis on spirituality.     

Longitudinal Assessment of Pain, Coping, and Daily Functioning in Children with Sickle Cell Disease Receiving Pain Management Skills Training

Objective. To conduct intensive pain management skills training (IST) in children with sickle cell disease (SCD) and their parents and to comprehensively evaluate pain, coping, and daily functioning in children pre, immediately post, and 3 months following treatment. Methods. Three children who received IST in nonpharmacological and pharmacological pain management strategies completed a Coping Strategies Questionnaire (CSQ) at pre, post, and follow-up assessments, and daily pain and activity diaries for 18 weeks, spanning from 1 week pretreatment to 11 weeks posttreatment. Results. From pre- to posttreatment, 1 child receiving IST indicated increased report of active coping attempts and all 3 children indicated decreased report of negative thinking on the CSQ. Participants in IST used coping skills on 90% of days with pain and reported the skills to be moderately helpful on the daily diaries. For daily activities such as eating dinner, playing with friends, and hours slept, children participated similarly on days with pain and days without pain during the posttreatment period. Given the small number of participants in this study, individual cases are discussed to highlight similarities and differences in how participants responded to the treatment and during the 3-month follow-up period. Conclusions. In this pilot study, each participant showed improvement in coping and daily functioning after completing the IST program. Individual differences in response to treatment indicate the need for more targeted intervention programs that incorporate pharmacological and nonpharmacological components. The results of this study highlight both the promise and the complications of conducting comprehensive pain intervention and functional outcome studies in children with SCD.     

Cognitive-Behavioral Treatment of Depression, Part X: Reducing the Risk of Relapse

Cognitive-behavioral therapy has been found effective for the treatment of depression. Nonetheless, many clients who respond to treatment are still vulnerable to relapse during the months following remission. It is important for therapists to be aware of the temporal patterns often seen in patients following recovery from depression so they can use strategies designed to reduce the risk of relapse or recurrence. Relapse prevention strategies focus on helping clients: 1) identify high risk situations, 2) develop specific coping strategies to deal with emotional distress, 3) deliberately seek and confront difficult situations, 4) cope with feeling overwhelmed, 5) expand and refine their coping skills, 6) enhance their feelings of self-confidence, and 7) anticipate and prepare for a lapse. These strategies provide much help in maintaining the gains that had been obtained through the earlier treatment efforts.     

Cognitive-Behavioral Treatment of Social Phobia

Social phobia can be a chronic disorder, capable of restricting a client's social and occupational functioning. Cognitive-behavioral therapy can help many clients learn to overcome their social inhibitions, and make lasting changes in their interpersonal style. Cognitive-behavioral therapy for social phobia includes four general components for helping clients learn to manage their social anxiety. First, therapy begins with the establishment of a sound therapeutic alliance, a focus on assessment, diagnostic interviewing, and education regarding anxiety symptoms and their treatment. Second, the therapist helps clients to develop competence in social skills, relaxation training, and cognitive restructuring. Third, therapy uses exposure to social situations in order to help clients confront their fears and refine their coping skills. Fourth, relapse prevention strategies are used to help clients learn to tolerate feelings of discomfort and confront challenging social interactions. This treatment framework can be adapted to the specific needs of different clients.     

Never ready: Addictions counselors dealing with client death

This study explored the experiences of addictions counselors who have undergone client death and the immediate and long-lasting impacts of client death on addictions counselors through the consensual qualitative research (CQR) method. We conducted semistructured interviews with 10 participants exploring their lived, in-depth, experiences in working with clients with addictive disorders with focus given to the death of clients and how they responded to the experience. Results from a data analysis process using the CQR method indicate eight domains: (a) professional ethics, (b) coping skills, (c) client care, (d) preparation for profession, (e) experience of addiction, (f) agency impact, (g) exploring the death experience, (h) recommendations, and 28 categories embedded in each of these domains. Implications for counselor education, training, and practice are discussed.     

Experiencing Range in an Electric Vehicle: Understanding Psychological Barriers

Range of electric vehicles (EVs) has long been considered a major barrier in acceptance of electric mobility. We examined the nature of how range is experienced in an EV and whether variables from other adaptation contexts, notably stress, have explanatory power for inter‐individual differences in what we term comfortable range. Forty EVs were leased to a sample of users for a 6‐month field study. Qualitative and quantitative analyses of range experiences were performed, including regression analyses to examine the role of stress‐buffering personality traits and coping skills in comfortable range. Users appraised range as a resource to which they could successfully adapt and that satisfied most of their daily mobility needs. However, indicators were found that suggested suboptimal range utilisation. Stress‐buffering personality traits (control beliefs, ambiguity tolerance) and coping skills (subjective range competence, daily range practice) were found to play a substantial role in comfortable range. Hence, it may be possible to overcome perceived range barriers with the assistance of psychological interventions such as information, training, and interface design. Providing drivers with a reliable usable range may be more important than enhancing maximal range in an electric mobility system.     

Effects of Rumination and Worry on Sleep

Recent research suggests that the stress-sleep relationship is mediated by pre-sleep arousal (PSA) and that cognitive arousal has a stronger mediating effect than somatic arousal; however, this has not been directly tested. Using multilevel moderated mediation, we compared the effects of cognitive arousal and somatic arousal within the stress-sleep relationship. We also assessed whether two forms of repetitive negative thought—rumination and worry—are similarly involved in the stress-sleep relationship. Data was collected from 178 participants across the United States via an online platform. Participants completed baseline self-report surveys examining rumination tendencies and worry tendencies. Over the course of 2 weeks, participants completed daily questionnaires assessing daily stress, PSA, and sleep quality. Results indicated that indirect effects from stress to sleep quality via PSA were statistically significant at low and high levels of rumination and worry, and people at high levels of rumination and worry had stronger relationships between stress and PSA. Across all models, cognitive arousal consistently accounted for more of the variance in the stress-sleep relationship as compared to somatic arousal. Implications for the cognitive behavioral treatment of insomnia are discussed.