Faculty Bibliography

Sexual minorities face greater exposure to discrimination and rejection than heterosexuals. Given these threats, sexual minorities may engage in sexual orientation concealment in order to avoid danger. This social stigma and minority stress places sexual minorities at risk for anxiety and related disorders. Given that three fourths of anxiety disorder onset occurs before the age of 24, the current study investigated the symptoms of generalized anxiety disorder, social phobia, panic disorder, posttraumatic stress disorder, and depression in sexual minority young adults relative to their heterosexual peers. Secondarily, the study investigated sexual orientation concealment as a predictor of anxiety and related disorders. A sample of 157 sexual minority and 157 heterosexual young adults matched on age and gender completed self-report measures of the aforementioned disorders, and indicated their level of sexual orientation concealment. Results revealed that sexual minority young adults reported greater symptoms relative to heterosexuals across all outcome measures. There were no interactions between sexual minority status and gender, however, women had higher symptoms across all disorders. Sexual minority young women appeared to be at the most risk for clinical levels of anxiety and related disorders. In addition, concealment of sexual orientation significantly predicted symptoms of social phobia. Implications are offered for the cognitive and behavioral treatment of anxiety and related disorders in this population.

This pilot project implemented a mental health program, STAIR, targeting basic skills in mood management training and social functioning for women veterans with military-related trauma who live in rural areas. We report on outreach and implementation procedures, the women veterans' reactions to the program, and lessons learned.

This study examined posttraumatic stress disorder (PTSD) and related symptoms among sexual minority (SM) and heterosexual women and the influence of social support on the relationship between SM status and symptoms. We hypothesized that SM women would endorse higher symptoms of PTSD and related difficulties and that social support would moderate the relationship between SM status and symptoms. The sample, women seeking treatment for PTSD related to interpersonal violence (n = 477; mean age = 36.07 years; 22.9% SM) completed clinician-administered measures of PTSD and self-report measures of trauma-related difficulties and social support. The rate of PTSD diagnosis was higher for SM women. Social support and SM status were significantly associated with suicidality, self-perceptions, depression, somatic complaints, and functional impairment. The interaction between social support and SM status was significant for both functional impairment (beta = -.26) and somatic complaints (beta = -.39). High social support had an equal, positive effect among SM and nonminority women, whereas low social support had a greater negative impact among SM women. Results suggested the particular salience of social support on functioning and symptom severity among SM women and the potential importance of including interventions addressing social support into PTSD treatments for SM women.

BACKGROUND: There has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD) is distinct from Borderline Personality Disorder (BPD) when the latter is comorbid with PTSD. OBJECTIVE: To determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD. METHOD: A latent class analysis (LCA) was conducted on an archival dataset of 280 women with histories of childhood abuse assessed for enrollment in a clinical trial for PTSD. RESULTS: THE LCA REVEALED FOUR DISTINCT CLASSES OF INDIVIDUALS: a Low Symptom class characterized by low endorsements on all symptoms; a PTSD class characterized by elevated symptoms of PTSD but low endorsement of symptoms that define the Complex PTSD and BPD diagnoses; a Complex PTSD class characterized by elevated symptoms of PTSD and self-organization symptoms that defined the Complex PTSD diagnosis but low on the symptoms of BPD; and a BPD class characterized by symptoms of BPD. Four BPD symptoms were found to greatly increase the odds of being in the BPD compared to the Complex PTSD class: frantic efforts to avoid abandonment, unstable sense of self, unstable and intense interpersonal relationships, and impulsiveness. CONCLUSIONS: Findings supported the construct validity of Complex PTSD as distinguishable from BPD. Key symptoms that distinguished between the disorders were identified, which may aid in differential diagnosis and treatment planning.

A number of self-report measures of social anxiety contain language that appears to assume heterosexuality. It is unclear how such items should be answered by individuals who are not exclusively heterosexual, which may lead to inaccurate measurement of symptoms, perpetuation of stigma, and alienation of respondents. More specific wording could improve measurement accuracy for sexual minorities as well as heterosexual respondents. Gender-neutral wording was developed for items containing the phrase "opposite sex" in commonly used self-report measures of social anxiety (Interaction Anxiousness Scale [Leary, 1983], Social Avoidance and Distress Scale [Watson & Friend, 1969], Social Interaction Anxiety Scale [Mattick & Clarke, 1998], and Social Phobia and Anxiety Inventory [Turner, Beidel, Dancu, & Stanley, 1989]). Undergraduate college students (N=405; mean age=19.88, SD=2.05) completed measures containing original and revised items. Overall, results indicated that the alternate-worded items demonstrated equivalent or slightly stronger psychometric properties compared to original items. Select alternate-worded items are recommended for clinical and research use, and directions for future research are recommended.

The Pittsburgh Sleep Quality Index (PSQI) is a widely used, comprehensive self-report measure of sleep quality and impairment, which has demonstrated good psychometric properties within various populations, including older adults. However, the psychometric properties of the PSQI and its component scores have not been evaluated for older adults with generalized anxiety disorder (GAD). Additionally, changes in PSQI global or component scores have not been reported following cognitive-behavioral treatment (CBT) of late-life GAD. This study examined (1) the psychometric properties of the PSQI within a sample of 216 elderly primary care patients age 60 or older with GAD who were referred for treatment of worry and/or anxiety; as well as (2) response to CBT, relative to usual care, for 134 patients with principal or coprincipal GAD. The PSQI demonstrated good internal consistency reliability and adequate evidence of construct validity. Those receiving CBT experienced greater reductions in PSQI global scores at post-treatment, relative to those receiving usual care. Further, PSQI global and component scores pertaining to sleep quality and difficulties falling asleep (i.e., sleep latency and sleep disturbances) demonstrated response to treatment over a 12-month follow-up period. Overall, results highlight the usefulness of the PSQI global and component scores for use in older adults with GAD.

Cognitive-behavioral therapy (CBT) for the treatment of Social Anxiety Disorder (SAD) has demonstrated efficacy in numerous randomized trials. However, few studies specifically examine the applicability of such treatment for ethnic minority clients. Thus, the purpose of this article is to present two case studies examining the utility of individualized CBT for SAD with two clients who immigrated to the United States, one from Central America and one from China, for whom English was not their primary language. Both clients demonstrated improvement on a semi-structured interview and self-report measures. Necessary adaptations were modest, suggesting that therapy could be conducted in a culturally sensitive manner without much deviation from the treatment protocol. Results are discussed in terms of adapting treatment to enhance acceptability for and better fitting the needs of ethnic minority clients and non-native speakers of English. Implications for treating ethnic minority clients, as well as the practice of culturally sensitive treatment, are discussed.

This preliminary study examined the nature of worry content of lesbians, gay men, and bisexual individuals and the relationship between worry related to sexual orientation and mental health. A community sample of 54 individuals identifying as sexual minorities was recruited from two cities in the Great Plains to complete a packet of questionnaires, including a modified Worry Domains Questionnaire (WDQ; Tallis, Eysenck, & Mathews, 1992) with additional items constructed to assess worry over discrimination related to sexual orientation, and participate in a worry induction and verbalization task. The content of self-reported worries was consistent with those reported in prior investigations of worry content, and worry related to sexual orientation was not found to be elevated compared to other topics. However, degree of worry related to sexual orientation was significantly associated with increased negative affect, depressive symptoms, and internalized homophobia and decreased quality of life and positive affect. Implications of these findings, limitations, and future research issues are discussed.

Many studies support the effectiveness of paraprofessionals in administering psychotherapy. However, no review has compared the utility/efficacy of paraprofessionals versus professionals in administering cognitive-behavioral therapies (CBT). This article systematically reviews published trials comparing outcomes of paraprofessional to professional therapists using CBT to treat anxiety and depressive symptoms. Four studies met inclusion criteria and are critiqued using evidence-based quality parameters. The authors conclude that paraprofessionals can be effective in delivering CBT to these patients, with outcomes comparable to those of professionals.