ACTing Spiritually: Integrating Spiritual Care and Mental Health Care within a US Department of Veterans Affairs Inpatient Psychiatric Unit.

As a part of the VA's interprofessional fellowship in psychosocial rehabilitation, the authors developed an 8-week spirituality group manual, ACTing Spiritually, which incorporates principles of acceptance and commitment therapy (ACT) into a spirituality group protocol. The group, administered weekly as possible for 28 weeks on an inpatient psychiatric unit at a veterans affairs (VA) medical center in West Haven, CT, aimed to incorporate veterans' spirituality into their mental health treatment through concepts of acceptance, values, mindfulness, and committed action. ACTing Spiritually ran in tandem with a basic ACT group and the two groups had comparable average group sizes, suggesting interest in ACTing Spiritually similarly compares to interest in a basic ACT group in this context. In addition, development of the group yielded several qualitative findings, including a discussion of the similarities and differences between ACT and spiritual care, clinical gains for chaplains conducting the group, and clinical tensions that arose through the process of integration. The study provided preliminary evidence of the potential feasibility and acceptability of ACTing Spiritually. Next steps should include a formal evaluation of its potential efficacy.

Neither a problem nor my problem: Risk factors for underage drinking disengagement among college students.

OBJECTIVE: Underage drinking disengagement (UDD; cognitive restructuring/minimizing agency) measures attitudes about the acceptability and responsibility of drinking. We examined demographic correlates of UDD, as well as the moderating effects of legal drinking status on the association between UDD and drinking. PARTICIPANTS: College student drinkers (n = 893; Mage = 19.48, range = 18-25; White = 74.1%; female = 68.1%) from a multi-site study. METHODS: An online confidential survey included the UDD Scale for College Students and the AUDIT-C. RESULTS: White and multiracial, underage students, or those living with others endorsed greater cognitive restructuring disengagement than Hispanic students, legal-age students, or those living alone or with parents, respectively. Greek membership and greater "party school" perceptions were related to more cognitive restructuring and minimizing agency. The associations between UDD and alcohol use were not moderated by legal drinking age status. CONCLUSION: Identifying and educating students at risk for UDD on the ramifications associated with underage drinking could combat drinking.

The Effects of Alcohol Intoxication on Perceptions of Consent and Refusal Indicators in a Fictional Alcohol-Involved Sexual Encounter.

Alcohol intoxication may influence how bystanders interpret other people's consent and refusal cues. We examined the effects of alcohol intoxication on participants' perceptions of characters' consent and refusal indicators in a fictional vignette depicting an alcohol-involved sexual encounter. Young adults (n = 119, 52% women) participated in an alcohol administration experiment examining the influence of acute intoxication on bystander perceptions during a vignette depicting a character who is intoxicated and declines a sexual advance from another character, who ignores her refusal and continues to pursue sexual activity. Participants were randomly assigned to an alcohol or non-alcohol condition and then guided through a semi-structured interview in which we asked about the characters' consent and refusal cues. Interviews were analyzed using both inductive and deductive coding. Most participants eventually indicated the encounter was nonconsensual, but approximately 9% of participants described the encounter as entirely consensual and another 42% of participants described the interaction as initially consensual and then nonconsensual. Participants discussed nuanced accounts of consent and refusal cues, including indicators related to alcohol consumption. Disregarding intoxication and gender, participants eventually recognized the situation as nonconsensual and thus potentially risky. However, some participants recognized this risk earlier in the encounter than others. Consequently, bystanders who recognize risk later in a situation may have fewer opportunities to intervene before a situation escalates. We recommend sexual assault prevention educators take a more nuanced approach when discussing consent and refusal indicators, emphasizing contextual factors that may indicate risk.

Victim Centered, Aggressor Focused, and Bystander Friendly: A Qualitative Analysis of Bystander Intervention Strategies and Outcomes for Sexual Harassment or Assault.

Limited qualitative research has been conducted to understand the experiences of victims of sexual harassment or assault (SHA) when a bystander intervenes. Even less research has focused on the consequences of bystander actions from the victim's perspective, particularly regarding the aggressor's subsequent behavior toward the victim and occurrence of verbal or physical harm to those involved. This qualitative study aimed to address these limitations with the following research questions: (a) what strategies did victims of SHA identify bystanders use when intervening? (b) what strategies were present when the aggressor's behavior was stopped, paused, or continued toward the victim? and (c) what strategies were present when verbal or physical harm occurred to someone involved? Adult women between the ages of 18 to 30 (N = 25, college student = 80%) were interviewed about one situation of bystander intervention during SHA since the age of 16 years. Findings suggest that victims identified direct, distance, distract, delegate, and proximity strategies by bystanders. Most participants reported that the aggressor's behavior stopped or paused following bystander action, and in these cases, at least one distance or direct strategy was reportedly used most frequently. Approximately, 24% and 8% of participants reported verbal or physical harm, respectively, to at least one party. Direct and distance strategies were most frequently mentioned in experiences of SHA that involved harm. When the aggressor's behavior continued (i.e., was not altered during the event) despite bystander actions, strategies most frequently reported included distract, delegate, and proximity. Together, results suggest that bystander intervention training programs and future research may be needed to understand under what contexts certain strategies successfully prevent or thwart SHA while maintaining emotional and physical safety for those involved.

Masculine Drinking Norms and Alcohol Use in a National Sample of NCAA Male Student-Athletes.

Objectives: Participation in sports can increase young adults' risk for heavy alcohol use and related consequences. Among student-athletes, more men report heavy drinking than women. These gender differences may reflect men's expression of masculinity which can encompass excessive consumption. While a growing body of research indicates that general masculine norms are positively associated with alcohol use and consequences among men, the extent to which alcohol-specific masculine norms can increase student-athletes' risk for elevated drinking and related outcomes is not yet known. Thus, we examined how masculine drinking norms are associated with alcohol use and related consequences while accounting for demographics and multiple dimensions of general masculine norms. Methods: 1,825 NCAA student-athletes (White=79%, Mage=20.1/SDage=1.3; 50 colleges/universities) completed a confidential online survey which included questions regarding masculine drinking norms of excess and control and conformity to general masculine norms. Results: We created latent constructs and tested a path model in SEM. Results indicated that, after accounting for demographics and multiple dimensions of general masculine norms, the masculine drinking norm of excess was positively associated with alcohol use and consequences. Conversely, control was negatively related to alcohol use but unrelated to consequences. Compared to control and other dimensions of general masculine norms, excess was most strongly related to alcohol use and consequences. Conclusions: A move from assessing general masculine norms toward alcohol-specific masculine norms can further researchers' and practitioners' knowledge of masculine norms and their link to drinking behaviors, and enhance the application of masculine norms in alcohol intervention and prevention programs.

Shame and guilt for alcohol-related transgressions and hazardous drinking among male and female college students.

Objective: Shame and guilt are often present prior to and consequent to alcohol use among college students. Little is known about the propensity to experience these emotions in the context of transgressions that occur while drinking alcohol. We examined the association between shame and guilt propensity for alcohol-related transgressions with hazardous drinking, and the role of gender in these relationships. Participants: College student drinkers (N = 130; Mage=19.39; 68% females; 86% White) from a Mid-south college. Methods: An online confidential survey included measures of hazardous drinking, guilt and shame propensity, and guilt and shame propensity specific to alcohol-related transgressions. Results: Our preliminary findings suggest that experiencing guilt (but not shame) after alcohol-related transgressions was related to less hazardous drinking when controlling for general guilt and shame propensity for male and female students. Conclusions: Targeting components of guilt (e.g., reparative behaviors) after alcohol-related transgressions may help to reduce problematic drinking among college students.

Examining the Drinking Motives Questionnaire-Revised Short Form among university students in Australia, New Zealand and Argentina.

INTRODUCTION: The Drinking Motives Questionnaire-Revised Short Form (DMQ-R-SF) is widely used among alcohol researchers studying adolescents and young adults. The psychometric properties of the DMQ-R-SF have been examined among university students in many countries, but to our knowledge, not in Australia, New Zealand or Argentina. We sought to examine the reliability and endorsement of the items on the DMQ-R-SF, and test the associations between the DMQ-R-SF subscales and alcohol use, and negative alcohol consequences between university students from Australia, New Zealand and Argentina. METHOD: University students (N = 820) in Australia (n = 315), New Zealand (n = 265) and Argentina (n = 240) completed a confidential online alcohol survey which included the DMQ-R-SF, the Daily Drinking Questionnaire and the Brief Young Adult Alcohol Consequences Questionnaire. RESULTS: Using the alignment method, support for the four-factor model on the DMQ-R-SF emerged and the factor loadings for 11 of the 12 items were invariant across sites. Most items (8 out of 12) on the DMQ-R-SF were fully invariant across all sites, but some small differences in item reliability for one item, and endorsement for three items emerged between the sites. Across the three countries, coping motives were positively correlated with negative alcohol consequences. Enhancement motives were positively associated with both alcohol use and negative alcohol consequences among students from Australia and New Zealand. DISCUSSION AND CONCLUSIONS: Most items on the DMQ-R-SF were comparably reliable among the university students sampled from Australia, New Zealand and Argentina. Our preliminary findings suggest that the DMQ-R-SF can be reliably used with university students from these countries.

Exploratory Examination of Knee Self-Efficacy in Individuals With a History of ACL Reconstruction and Sport-Related Concussion.

CONTEXT: Knee self-efficacy and injury-related fear are associated with poor self-reported knee function and decreased physical activity (PA) after ACL reconstruction (ACLR). Limited research has explored contextual factors that may influence psychological responses in this population, such as history of sport-related concussion (SRC). After SRC, individuals may experience increased negative emotions, such as sadness and nervousness. However, it is unknown how SRC history may influence knee-self efficacy and injury-related fear in individuals with ACLR. The purpose of this study was to compare knee self-efficacy and injury-related fear in individuals after ACLR who present with and without history of SRC. DESIGN: Cross-sectional study. METHODS: Forty participants ≥1 year postunilateral ACLR were separated by history of SRC (no SRC = 29, SRC = 11). The Knee Self-Efficacy Scale (KSES) and subscales measured certainty regarding performance of daily activities (KSES-ADL), sports/leisure activities (KSES-Sport), physical activities (KSES-PA), and future knee function (KSES-Future). The Tampa Scale of Kinesiophobia-11 measured injury-related fear. Mann-Whitney U tests were used to examine between-group differences. Hedges g effect sizes and 95% confidence interval were used to examine clinically meaningful group differences. RESULTS: Individuals with a history of ACLR and SRC demonstrated worse KSES-PA (7.5 [5.3]) compared with those without a history of SRC (8.1 [6.1], P = .03). No other statistically significant differences were observed. A medium effect size was present for the KSES-PA (0.62), KSES-ADL (0.42), KSES-Present (ADL + PA + Sport) (0.48), KSES-Total (0.53), and Tampa Scale of Kinesiophobia-11 (0.61) but must be interpreted with caution as 95% confidence interval crossed 0. CONCLUSIONS: This exploratory study indicated that individuals with a history of ACLR and SRC had worse knee self-efficacy for PA compared with those without history of SRC. Rehabilitation specialists should monitor knee self-efficacy deficits in the post-ACLR population and recognize the potential influence of cumulative injury history on rehabilitative outcomes.

What pandemic? A multisite study of drinking motives and drinking games participation among college students during a pandemic (COVID-19) academic year.

A drinking game (DG) is a widely practiced social activity that tends to encourage rapid alcohol consumption. While social restrictions during the pandemic (COVID-19) academic year were implemented as a health measure across many colleges/universities, the extent to which college student drinkers continued to play DGs in-person is not well understood. Because theory and research suggest that drinking motives are proximal correlates of drinking behaviors, we examined which drinking motives increased the likelihood of playing DGs in-person, and playing DGs in-person in a group of 10 + people during the 2020-21 pandemic academic year. College students (past-year drinkers) from 12 universities completed an online survey (N = 900; Mage = 19.42, Range = 18-25; SDage = 1.45, White = 73.1%, 69.2% female). Of the students surveyed, 590 students played DGs, with 460 students only playing DGs in-person. Of the students who played DGs in-person, 274 students reported that the maximum number of people they played DGs with in-person exceeded the CDC's recommended guidelines (10 + people). Accounting for demographics, general alcohol use, and perceived COVID-19 threat, social drinking motives were positively associated with an increased likelihood of playing DGs in-person; the inverse was found for coping motives. Drinking motives were not associated with the likelihood of playing DGs with 10 + people but greater alcohol use and lower perceived threat of COVID-19 were. Given that the pandemic did not deter many student drinkers from playing DGs in-person, further investment in targeted intervention and public health initiatives aimed at substance-free alternatives promoting engagement and enhancement of social activities may be needed.

The Body, the Mind, and the Spirit: Including the Spiritual Domain in Mental Health Care.

This article supports the expansion of Engel's (Science (AAAS) 196(4286):129-136, 1977) biopsychosocial model into a biopsychosocial-spiritual model, as Sulmasy (The Gerontologist 42(5):24-33, 2002) and others have suggested. It utilizes case studies to describe five areas of clinical work within mental health (religious grandiosity, depression and grief, demoralization and suicidality, moral injury, and opioid use disorder) with emerging evidence for the inclusion of the spiritual domain in addition to the biological, psychological, and social. For each clinical area, an underutilization of the spiritual domain is compared with a more developed and integrated use. An argument is made for continuing to develop, understand, and utilize a biopsychosocial-spiritual model in mental health.

Playing Drinking Games as a Typical Form of Prepartying among Young Adults.

Prepartying, or drinking prior to going out, and playing drinking games (DG) can increase young adults' risk of heavy alcohol consumption. In the present study, we examined whether playing DG as a typical form of prepartying can increase alcohol consumption risk when compared with prepartying alone or with friends, and whether the type of DG played while prepartying can increase this risk. Participants consisted of young adults from Amazon's Mechanical Turk (N = 482, Mage=22.56, 44.2% women, 74.3% White, 62.7% were current college students) who played a DG within the past month and completed an anonymous online survey about their prepartying and DG behaviors. Results indicated that team games (e.g. beer pong) are the most commonly played type of DG while prepartying. Controlling for alcohol use on drinking occasions when DGs were not played, gender, and college status, those who played DG as a form of prepartying (n = 163) consumed more alcohol while prepartying than those who prepartied alone or with friends. Finally, those who played card games (e.g. Kings) while prepartying also consumed more preparty drinks than those who do not typically play card games. Implications for prevention and intervention as well as future research directions are briefly discussed.

The Brief Young Adult Alcohol Consequences Questionnaire: A cross-country examination among university students in Australia, New Zealand, Canada, Argentina, and the United States.

BACKGROUND: The Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ) was designed to measure alcohol consequences and identify at-risk students. It was developed and originally validated among university students in the United States (U.S.), yet it is widely used in both the U.S. and abroad. Using the alignment method, we tested whether the B-YAACQ measures alcohol consequences similarly across university students in several countries where heavy alcohol use and related outcomes are prevalent. METHODS: The sample consisted of 1473 university students (ages 18-30) from five university sites: Australia (n = 315), New Zealand (n = 270), Canada (n = 276), Argentina (n = 232), and the U.S. (n = 380). Participants completed a confidential, online alcohol use survey which included the B-YAACQ. RESULTS: Overall, 12 of the 24 B-YAACQ items had invariant factor loading and threshold parameters, suggesting that these items exhibited similar reliability and difficulty among university students across the five countries. Of the 24 B-YAACQ items, 21 exhibited comparable reliability across the five countries; the remaining 3 items were slightly less reliable indicators of alcohol consequences among U.S. students. Thus, several items on the B-YAACQ may be particularly informative for identifying students who are experiencing high levels of drinking harm across multiple countries. CONCLUSIONS: The present study is an important step toward (a) validating the B-YAACQ among university students in New Zealand and Canada, and (b) furthering our understanding of the psychometric properties of the B-YAACQ among university students in Australia, Argentina, and the U.S.