Assessing the need for pre-mental health competencies in undergraduate education: insights from graduate faculty surveys.

Introduction: Despite the value of clinical competencies for masters- and doctoral-level practitioners as well as the tremendous variability in preparedness for graduate school and at graduation from graduate school, there are no competency standards for students pursuing mental healthcare careers prior to graduate study. This study aimed to identify potential pre-mental health competency standards for undergraduates pursuing mental healthcare careers. Methods: Faculty at masters and doctoral programs in a range of mental healthcare fields were asked to rate their expectations of entry-level competence and the perceived entry-level competence of their first-year, bachelor-level graduate students on 42 sub-competencies derived from the APA's Competency Benchmarks in Professional Psychology. Results: Faculty of both masters (N = 320) and doctoral (N = 220) programs reported high expectations of first-year graduate students for 11 competency categories (professional values/attitudes; relationships; management-administration; interdisciplinary systems; individual/cultural diversity; advocacy; scientific knowledge and methods; reflective practice, self-assessment, and self-care; ethical standards and policy; supervision, and research/evaluation) and 25 sub-competencies. Faculty in masters programs rated students as not meeting their expectations in 28 sub-competencies, while faculty in doctoral programs rated students as not meeting their expectations in 17 sub-competencies. Faculty recommended internships as well as improvement in writing, counseling skills, professional behavior, diversity, equity, and inclusion, cultural competence and humility, research methods, reading research, connecting research to practice, and education about the different mental healthcare professions. Discussion: Our findings suggest that students would benefit from intentional training in multiple pre-mental health competency areas at the undergraduate level to facilitate graduate-level training in mental healthcare and to better prepare our future clinicians.

Resource Use After Unwanted Sexual Experiences in Undergraduates: A Comprehensive Evaluation of Factors Related to the Decision to Seek Help.

The risk for sexual victimization in college is high, and although there can be significant mental and physical consequences for the survivor, resource utilization for this issue is extremely low. The current study used the frameworks of both the ecological model and the theory of planned behavior to examine factors related to resource use in undergraduate survivors of unwanted sexual experiences. The sample consisted of 217 undergraduates who reported at least one unwanted sexual experience while in college (89% female, 76.5% Caucasian, M age 19.6). Data were collected in an online survey from a private liberal arts college, and were analyzed using decision tree modeling. Results suggested that resource use was less related to demographic or event characteristics, but rather related to victim response to the event as well as perceptions about control over potential resource use. In addition to key assault prevention efforts, it is thus important to also support survivor mental health and self-efficacy postassault.

Undergraduates' Disclosures of Unwanted Sexual Experiences: Who, Why, and When?

This study evaluated patterns of sexual assault disclosures as well as the response and impact of that response on assault survivors. The sample consisted of 217 undergraduates with a history of sexual assault (89.5% female, 76.5% Caucasian). Participants reported the order in which they disclosed and the nature and impact of the response they received. Results indicated that the majority of participants told close peers first and perceived the first response to be supportive. These findings are encouraging but also demonstrate the need for improving the response that an assault survivor receives.

Residual symptoms following empirically supported treatment for PTSD.

OBJECTIVE: Although there are several evidence-based treatments that are effective in mitigating the symptoms of posttraumatic stress disorder (PTSD), rates of nonresponse to treatment as well as treatment dropout remain high. In order to determine which symptoms remain most problematic at the end of treatment for PTSD, the present study examined residual symptoms in a treatment study that evaluated the effects of cognitive processing therapy (CPT) and prolonged exposure (PE). METHOD: The sample consisted of 108 female rape survivors who initially met criteria for PTSD and who were then randomized into and completed either CPT or PE. The sample was 71% White and 25% African American, with an average age of 32 years (SD = 9.98 years). RESULTS: Symptoms of PTSD, depression, guilt, and social adjustment were evaluated in the sample of treatment completers, and findings suggest that overall symptoms improved over the course of treatment. Results further suggested that distress related to trauma reminders, detachment, and insomnia were the most common residual PTSD symptoms at posttreatment, while self-blame, concerns about body image, and fatigue were the most common residual symptoms of depression. The most common residual symptom of guilt was lack of justification for actions that had to be taken during the index event. CONCLUSIONS: This pattern of findings is in line with past research suggesting that evidence-based practices are effective in the treatment of PTSD, but underscores the need to continue to evaluate residual symptoms to best assist clients in achieving full recovery. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Help-Seeking Behavior in Survivors of Intimate Partner Violence: Toward an Integrated Behavioral Model of Individual Factors.

This study examined individual behavioral predictors of help-seeking using the frameworks of the Andersen model and the theory of planned behavior in a sample of help-seeking female survivors of intimate partner violence (IPV). In-person interviews were conducted with 372 women (Mage = 34.41 years, 66% African American). Results indicated that variables suggested by the Andersen model, including age, depression, psychological aggression, and posttraumatic stress-related arousal symptoms, were significant predictors of help-seeking. Variables suggested by the theory of planned behavior, including perceived helpfulness of resource and perceived controllability of the violence, were also significantly related to help-seeking. However, a combined model including variables from both theoretical approaches accounted for the most variance in help-seeking behavior. Overall, results suggest that these models are useful conceptualizations of help-seeking in an IPV population and that it is important to consider personal characteristics, need-based variables, and cognitive factors in outreach efforts.

Do as I Say, Not as I Do? An Examination of the Relationship Between Partner Behaviors and Help Seeking for Alcohol Related Issues.

BACKGROUND: Although there are a number of risks associated with problematic alcohol use, the proportion of people who seek help for alcohol-related issues is alarmingly low. OBJECTIVE: This study investigated the potential social influences that are associated with alcohol-related help seeking, including perceived partner support, descriptive and injunctive subjective norms, and marital satisfaction. METHODS: Participants included 133 individuals (50% female, 48% male, and 2% did not report) recruited nationwide through both print and electronic methods. Data were collected in an online survey in 2013. Respondents were 77% Caucasian, 16% African-American, 2% Asian, 2% American Indian, and 1% Hawaiian/Pacific Islander, with a mean age of 38 years (SD = 11.93). Data were analyzed using hierarchical multiple regression. RESULTS: Results suggested that when considered independently, perceived partner support, injunctive social norms, and closest friend's level of drinking were significantly associated with help seeking behavior, while marital satisfaction was not. Results further indicated that examining support and norms together accounted for increased variance in help seeking over examining the variables separately. Significant interactions were found between gender and acceptance of drinking behavior, which suggested that acceptance of drinking behavior was important for men's help seeking but not for women's, and between positive support and acceptance, which indicated that the role of support varied by level of acceptance for both genders. CONCLUSION: Overall, this study suggests that social influences play an important role in a person's decision to seek help for alcohol related issues.

Motivating Action and Maintaining Change: The Time-Varying Role of Homework Following a Brief Couples' Intervention.

Studies regarding the effectiveness of homework assignments in cognitive-behavioral treatments have demonstrated mixed results. This study investigated predictors of compliance with homework recommendations and the time-varying relationship of recommendation completion with treatment response in a brief couples' intervention (N = 108). More satisfied couples and couples with more motivation to change completed more recommendations, whereas couples with children completed fewer. The association between recommendation completion and treatment response varied with the passage of time, with the strongest effect observed 6 months after the intervention, but no discernible differences at 1 year postintervention. Couples that completed more recommendations experienced more rapid treatment gains, but even those couples doing substantially fewer recommendations ultimately realized equivalent treatment effects, although they progressed more slowly. Implications are discussed.

Predicting three types of dissociation in female survivors of intimate partner violence.

Previous research suggests that studying the effect of dissociation is particularly important in survivors of intimate partner violence because of the risk of revictimization. The current study investigated demographic variables, child and current abuse characteristics, coping style, and cognitive distortions as predictors of peritraumatic, trait, and posttraumatic stress disorder (PTSD)-related dissociation in a sample of female intimate partner violence survivors. The sample consisted of 372 women, the majority African American, with an average age of 34.41 years (SD = 8.09). Peritraumatic dissociation was significantly predicted by child physical abuse, current abuse injury, cognitive distortions about safety, and problem disengagement coping. Trait dissociation was significantly predicted by minority race, personal income, and cognitive distortions about safety and self-worth. PTSD-related dissociation was significantly predicted by cognitive distortions about self-worth, problem and emotion disengagement coping, and peritraumatic dissociation. In the models predicting both trait and PTSD-related dissociation, abuse characteristics significantly predicted dissociation until the entry of cognitive variables into the model. The analysis indicated a significant indirect effect of cognitive distortions on the relationship between current sexual aggression and trait dissociation. Results also suggested that there were indirect effects of both cognitive distortions and peritraumatic dissociation on the relationships between current psychological abuse/injury and PTSD-related dissociation. Findings point to the importance of cognitions in the development and maintenance of dissociation and suggest that treatments designed to help clients accept and process traumatic events may help reduce dissociation and in turn prevent future revictimization.

Professional versus personal resource utilization in survivors of intimate partner violence.

Although many women are affected by intimate partner violence (IPV) across the life span, rates of help seeking for IPV-related concerns are low. The current project examined predictors of personal and professional resource use in a sample of female IPV survivors, with the purpose of identifying engagement strategies for IPV services and resources. The study is notable for is concurrent examination of demographic variables, abuse characteristics, beliefs about cause of violence, beliefs about helpfulness of resources, coping style, and PTSD symptoms as predictors of resource use. Interviews and self-report measures were completed by 372 women recruited from community agencies. The average age was 34.41 years (SD = 8.09), and 66% of the sample was African American, followed by 28% Caucasian, 1.4% Latino, and 1.4% Native American. Results indicated that professional help seeking was significantly related to psychological aggression, age, controllability of cause of violence, engaged coping, helpfulness of resource, and PTSD severity (p < .001), and that personal resource use was related to relationship length, stability of cause of violence, disengaged coping, and helpfulness of resource (p < .001). These findings point to the importance of cognitions and coping style in the decision to seek help for IPV. In particular, beliefs about the helpfulness of potential resources as well as beliefs about the controllability and stability of the violence appear to be important targets for increasing engagement of IPV survivors in available services. (PsycINFO Database Record

Research on PTSD prevalence in OEF/OIF Veterans: expanding investigation of demographic variables.

BACKGROUND: A series of recent articles has reported on well-designed studies examining base rates of posttraumatic stress disorder (PTSD) screenings within the Operation Enduring Freedom (Afghanistan conflict)/Operation Iraqi Freedom (Iraq conflict) (OEF/OIF) military population. Although these studies have a number of strengths, this line of research points out several key areas in need of further examination. OBJECTIVE: Many OEF/OIF Veterans do not use available Veterans Affairs (VA) services, especially mental health care. This highlights the need to understand the differences between those who use and do not use the VA, especially as research with pre-OEF/OIF Veterans suggests that these two groups differ in significant ways. The high rates of PTSD-related concerns in non-VA users also points to a need to understand whether-and where-Veterans are seeking care outside the VA and the accessibility of evidence-based, trauma-focused treatments in the community and private sectors. Careful examination of relationship status is also paramount as little research has examined relationship status or other relationship context issues. Social support, especially from a spouse, can buffer the development of PTSD; however, relationship discord has the potential to greatly exacerbate PTSD symptomatology. Furthermore, given the additional risk factors for sexual minority Veterans to be exposed to trauma, the 2011 repeal of the US Military "Don't Ask, Don't Tell" policy, and the emergence of the VA as likely the largest health care provider for sexual minority Veterans, it will be critically important to study the trauma and mental health experiences of this group. CONCLUSIONS: Studies that examine prevalence rates of PTSD in the returning cohort contribute significantly to our understanding of the US OEF/OIF military population. Further study of PTSD in relation to demographic variables such as VA and non-VA use, relationship status, and sexual orientation will provide rich data that will enhance our ability to develop policy and practice to provide the best care to this population.

The Marriage Checkup: a randomized controlled trial of annual relationship health checkups.

OBJECTIVE: This study assessed the efficacy of the Marriage Checkup (MC) for improving relationship health and intimacy. METHOD: Cohabiting married couples (N = 215, Mage women = 44.5 years, men = 47 years, 93.1% Caucasian) recruited from a northeastern U.S. metropolitan area through print and electronic media were randomly assigned to MC treatment or wait-list control. Treatment but not control couples participated in assessment and feedback visits, at the beginning of the study and again 1 year later. All couples completed 9 sets of questionnaires over 2 years. Outcome measures included the Quality of Marriage Index, the Global Distress subscale of the Marital Satisfaction Inventory-Revised, the Intimate Safety Questionnaire, and the Relational Acceptance Questionnaire. RESULTS: A latent growth curve model indicated significant between-group differences in intimacy at every measurement point after baseline (d ranged from .20 to .55, Md = .37), significant between-group differences in women's felt acceptance for every measurement point after baseline (d ranged from .17 to .47, Md = .34), significant between-group differences in men's felt acceptance through the 1-year 2-week follow-up (d across follow-up ranged from .11 to .40, Md = .25), and significant between-group differences in relationship distress through 1-year 6-month follow-up (d across follow-up ranged from .11 to .39, Md = .23). CONCLUSIONS: Longitudinal analysis of the MC supports the hypothesis that the MC significantly improves intimacy, acceptance, and satisfaction. Implications for dissemination are discussed.

Dermatoscopic features of extrafacial lentigo maligna.

The dermatoscopic features of classic lentigo maligna (LM) are well described; however, there is little literature available on extrafacial LM, which is a less frequently reported condition. The skin architecture is especially rich in adnexae on sun-exposed areas such as the face, relative to other parts of the body, thus it is possible that the dermatoscopic findings of extrafacial LM will differ from the usual findings of LM. We carried out a dermatoscopic study on three patients with extrafacial LM. The dermatoscopic patterns reflected the underlying histological features of the disease, with increased melanocytes seen along the rete ridges and around follicular ostia, which result in a unique pigment network architecture.

Predicting Relationship Help Seeking Prior to a Marriage Checkup.

Although the barriers to couples' help seeking can be daunting, to date there is only a small body of literature addressing the factors that motivate couples to seek help. This study examined the association between attitudes towards relationship help seeking and relationship help seeking behaviors, as well as the association between marital quality and help seeking. This study was completed in the context of the Marriage Checkup, a brief intervention designed to reduce the barriers to help seeking. Results indicated that help seeking attitudes and behaviors were not related in couples, and that wives' marital quality was negatively associated with both wives' and husbands' help seeking. Husbands' marital quality was not associated with husbands' help seeking. Overall, this suggests that the process of couples' help seeking is distinct from that of individuals, and seems to be driven primarily by the female partner. Further implications for theory and treatment are discussed.

Current trends and controversies in cutaneous melanoma.

Cutaneous melanoma is an emerging and complex health problem. Management may require the expertise of multiple specialties. Although the outlook for advanced disease remains very poor, there are major advances in the understanding of melanoma. The heterogeneous nature of melanoma is more apparent and as such it is becoming evident that in the future we will probably utilise multiple approaches to treat disease and treatments may be tailored to individual needs. We can anticipate that as technology improves and information continues to accrue, our increased understanding of melanoma will lead to improved treatment of advanced disease.

A pilot study of treatment of lentigo maligna with 5% imiquimod cream.

BACKGROUND: Lentigo maligna (LM) is an in situ form of malignant melanoma, and surgical excision is often unsatisfactory. Imiquimod cream is an immune response modifier and induces a predominantly T-helper 1 type response. OBJECTIVES: Assessment of histological and clinical response of surgically resectable LM after treatment with 5% imiquimod cream. METHODS: Six patients with LM were treated with 5% imiquimod cream daily for 6 weeks. The whole site of the original lesion was then excised. Clinical and histological and appearances were measured using clinical response and histological grading scores. RESULTS: Complete or almost complete clearance of pigmentation with minimal residual histological evidence of LM was observed in four patients, one patient showed no clinical or histological improvement, and the remaining patient had almost no residual pigmentation clinically after treatment yet histopathological changes remained as severe as before treatment. CONCLUSIONS: Topical imiquimod cream merits further investigation as a new therapy for LM.

Cosmetic camouflage advice improves quality of life.

BACKGROUND: The subjective benefit of attendance at cosmetic clinics has not previously been reported. OBJECTIVES: To assess the effect on perceived quality of life (QoL) of cosmetic camouflage advice. METHODS: In a three-centre study, 135 individuals were invited to complete a dermatology-specific QoL measure, the Dermatology Life Quality Index (DLQI), before and 1 month after their first visit to a cosmetic camouflage clinic. RESULTS: Eighty-two completed DLQI questionnaires were returned before the camouflage clinic appointment, and 56 corresponding questionnaires were returned 1 month after. The mean age of responders was 50 years, and the mean duration of their skin conditions was 15 years. The main conditions seen were pigmentary disorders (29%), scars (22%) and vascular disorders (13%). There was a significant difference in mean DLQI scores before and after the clinic visit (9.1 vs. 5.8, P = 0.0001). CONCLUSIONS: When assessed at 1 month, attendance at a cosmetic camouflage clinic appears to improve QoL significantly.