Broad and Adaptive Integrated Health Psychology Services: Engaging BIPOC Veterans in VA Healthcare.

Clinical health psychologists provide adaptive, evidenced-based interventions that incorporate behavioral medicine and behavioral health strategies, with the potential to integrate broadly across the medical system. Veterans Affairs (VA) healthcare strives to meet the needs of an increasingly diverse patient population with complex behavioral health needs. This conceptual paper describes an example of health psychology at one VA healthcare system, with a focus on adaptive and culturally responsive services reaching Black, Indigenous and People of Color/Veterans of Color (BIPOC). The clinical health psychology services and cases described aim to reach Veterans who may not participate in, or benefit as fully from, traditional disease self-management or mental health services. The authors offer recommendations, to secure the value and sustainability of these integrated health psychology services, and hopefully contribute to addressing healthcare inequities.

Concreteness of thoughts and images during suppression and expression of worry.

The avoidance theory of worry (Borkovec, Alcaine, & Behar, 2004) posits that the verbal-linguistic (versus imagery-based) nature of worry elicits abstract (versus concrete) processing, which inhibits affective responding and generates a host of negative consequences. Although suppression of worrisome thinking is maladaptive (Purdon, 1999), expression of worry using vivid imagery may increase concreteness of worrisome thinking and facilitate more adaptive emotional responding. The present study examined whether the valence, content, and expression of mentation impacts concreteness of thought. Participants (N = 62) were randomly assigned to verbalize their thoughts while engaging in either verbal-linguistic- or imagery-based mentation about both worrisome and neutral topics. Participants were also randomly assigned to engage in a 5-min period of suppressing or expressing the target stimuli before engaging in 5-min of freely expressing the targets. Verbalizations of mental content were coded for level of abstractness/concreteness. For neutral stimuli, imagery-based mentation led to greater concreteness than did verbal-linguistic mentation; however, for worrisome stimuli, imagery-based mentation did not enhance concreteness. In addition, for neutral (but not worrisome) stimuli, an initial period of suppression was associated with increased concreteness during subsequent expression. Imagery-based mentation about worrisome stimuli may not enhance concreteness; moreover, unlike suppression of neutral stimuli, suppression of worrisome stimuli may maintain, rather than ameliorate, abstractness of thought.

Enhancing the Efficacy of Cognitive Bias Modification for Social Anxiety.

Cognitive bias modification for interpretation (CBM-I) is a promising treatment modality for social anxiety disorder, but effect sizes are relatively small across investigations (Hallion & Ruscio, 2011). Additionally, the extent to which CBM-I impacts other cognitive, emotional, and behavioral outcomes is unclear. This study investigated whether two empirically supported treatment components for anxiety disorders, imaginal exposure (IE) and relaxation, augment the effects of CBM-I and increase the extent to which the effects of CBM-I generalize to behavioral and affective outcomes. We randomly assigned 111 undergraduate students with social anxiety to undergo IE, relaxation, or neutral thinking prior to CBM-I, then measured their interpretation biases, as well as their speaking time, anxiety, and subjective evaluations of performance during a speech task. Results indicated that individuals who received IE prior to CBM-I evidenced more adaptive interpretation biases and less behavioral avoidance during the speech task than did individuals who engaged in relaxation or neutral thinking. However, they did not report differential anxiety, habituation, or evaluations of their performance on the speech task. These findings suggest that the combination of CBM-I with adjunct components that target behavioral, rather than cognitive, mechanisms can facilitate transfer of the effects of CBM-I to reducing behavioral avoidance.

The Effects of Worry and Relaxation on Flexibility During Cognitive Restructuring.

Worry is associated with inflexibility in cognitive, emotional, and physiological functioning. In addition, worry's negative valence and abstract level of construal are rigid characteristics that contribute to its nonadaptive consequences. Relaxation and cognitive therapy aim to increase flexibility in chronic worriers, and may have greater efficacy when administered in combination. We examined the extent to which relaxation enhances and/or worry inhibits cognitive flexibility during a cognitive restructuring exercise in which participants generated alternative predictions for their worries. Participants ( n = 189) were randomly assigned to engage in relaxation, worry, or neutral thinking prior to cognitive restructuring. We measured the number and perceived likelihood of alternative predictions generated by participants, and coded those alternative predictions for their degree of positive valence, negative valence, and level of construal (abstractness to concreteness). Worry and relaxation did not lead to different numbers or perceived likelihood of alternative predictions. However, compared with participants with minimal symptoms of generalized anxiety disorder (GAD), those with elevated symptoms of GAD who engaged in prior worry generated alternative predictions characterized by greater negative valence and more abstractness (i.e., less concreteness). We also found that greater negative valence of alternative predictions was associated with more abstractness, whereas greater positive valence of alternative predictions was associated with more concreteness. These findings suggest that after engaging in worry, individuals with GAD may be less able to flexibly shift from the use of nonadaptive characteristics (negative valence, abstractness) associated with feared outcomes to the use of more adaptive characteristics (positive valence, concreteness) when considering alternative predictions.

Neural markers of positive reappraisal and their associations with trait reappraisal and worry.

Positively reinterpreting negative experiences is important for psychological well-being and represents a key mechanism of cognitive-behavioral therapies for emotional problems. Yet, little is known about the neural mechanisms that underlie this process and how they relate to clinically relevant individual differences. Here we demonstrate using event-related potentials (ERPs) that positively reappraising distress-inducing images is associated with early increases in frontal control activity and later decreases in parietal arousal-related activity. Moreover, we show that people's chronic tendencies to reappraise versus worry modulate neural activity in opposing directions--trait reappraisal predicts decreases in parietal arousal-related activity during positive reappraisal implementation whereas worry predicts increases in the same waveform. These findings provide novel insights into the neural time course of positive reappraisal. They also speak to the potential clinical utility of neurophysiological measures as relatively inexpensive, noninvasive biomarkers that could serve as risk indicators and treatment mediators.

The psychometric properties of the late positive potential during emotion processing and regulation.

The late positive potential (LPP) is a commonly used event-related potential (ERP) in the study of emotion and emotion regulation. The LPP has also been evaluated as a neural marker of affective psychopathology. The psychometric properties of this component have not been examined, however. The current study was conducted with the aim of addressing two questions: how internally consistent is the LPP, and how many trials are necessary to obtain a stable LPP? Fifty-eight participants completed an emotion regulation task. First, split-half reliabilities were computed for the LPP and for difference waves revealing emotion effects (negative minus neutral) and regulation effects (reappraise minus negative). Second, averages including progressively more trials were evaluated and compared to overall participant averages. These data indicated good-to-excellent reliability for neutral, negative and reappraise trials, as well as difference waves. Furthermore, the LPP varies little after 8 trials are added to the average and the difference waves vary little after 12 trials are included. Together, the findings of the current study suggest that the LPP demonstrates good internal consistency and can be adequately quantified with relatively few trials.

Parsing relationships between dimensions of anxiety and action monitoring brain potentials in female undergraduates.

Anxiety is associated with enhanced action monitoring. Research to date, however, has employed extreme group designs that fail to address the full spectrum of anxiety, and in which overlapping and co-occurring symptoms obscure the exact nature of the relationships between anxiety and action monitoring. To address these limitations, relationships between distinct dimensions of anxiety and neural indicators of action monitoring were examined in a sample of female undergraduates. Results revealed that higher anxious apprehension (i.e., worry) was associated with enhanced early action monitoring activity, as indexed by the error-related negativity/correct-response negativity. Anxious arousal (i.e., somatic tension) on the other hand, was unrelated to measures of action monitoring. These findings suggest that the anxiety-action monitoring link holds along the continuum of severity and is specific to the worry component of anxiety.