Faculty Bibliography

OBJECTIVES/OBJECTIVE:We sought to identify subgroups of individuals based on patterns of psychological health problems (PH; e.g., depressive symptoms, hazardous drinking) and family maltreatment (FM; e.g., child and partner abuse). METHOD/METHODS:We analyzed data from very large surveys of United States Air Force active duty members with romantic partners and children. RESULTS:Latent class analyses indicated six replicable patterns of PH problems and FM. Five of these classes, representing ∼98% of survey participants, were arrayed ordinally, with increasing risk of multiple PH problems and FM. A sixth group defied this ordinal pattern, with pronounced rates of FM and externalizing PH problems, but without correspondingly high rates/levels of internalizing PH problems. CONCLUSIONS:Ramifications of these results for intervention are discussed.

Background/Objective: Intimate partner relationship problems and intimate partner abuse and neglect - referred to in this paper as "relational problems and maltreatment" - have substantial and well-documented impact on both physical and mental health. However, classification guidelines, such as those found in the International Classification of Diseases (ICD-10), are vague and unlikely to support consistent application. Revised guidelines proposed for ICD-11 are much more operationalized. We used standardized clinical vignette conditions with an international panel of clinicians to test if ICD-11 changes resulted in improved classification accuracy. Method: English-speaking mental health professionals (N = 738) from 65 nations applied ICD-10 or ICD-11 (proposed) guidelines with experimentally manipulated case presentations of presence or absence of (a) individual mental health diagnoses and (b) relational problems or maltreatment. Results: ICD-11, compared with ICD-10, guidelines resulted in significantly better classification accuracy, although only in the presence of co-morbid mental health problems. Clinician factors (e. g., gender, language, world region) largely did not impact classification performance. Conclusions: Despite being considerably more explicated, raters' performance with ICD-11 guidelines reveals training issues that should be addressed prior to the release of ICD-11 in 2018 (e. g., overriding the guidelines with pre-existing archetypes for relationship problems and physical and psychological abuse).

Dysfunctional conflict resolution behaviors in couples have been long recognized as markers of relationship maladjustment and are, consequently, frequent targets of couple therapy. The process of flooding may play a role. Flooding is the subjective sense of being overwhelmed by the partner's negative affect, which is perceived as unexpected and intense, and feeling as though one's information processing is impaired. It has been theorized that flooding is so aversive as to lead to maladaptive conflict behaviors (e.g., conflict escalation or withdrawal) as attempts to terminate the offending input (i.e., partner anger). Despite strong theory describing the construct, there has been a lack of valid measures to assess it. In the present study, we evaluated the psychometric properties of a 15-item measure in a sample of 453 couples. Reasonable unifactoriality, excellent internal consistency, and high test-retest reliability were demonstrated. Furthermore, using a dyadic latent variable model, the IPFS showed strong structural validity and concurrent validity with measures of relationship satisfaction, intimate partner violence, anger, depressive symptoms, and observed negative conflict behaviors. The IPFS appears to be a promising, economical instrument to assess flooding, a process relevant for understanding dysfunctional couple conflict behaviors.

Past research on the relation between hostility in intimate relationships and adiposity has yielded mixed findings. The present study investigated whether the association between relationship hostility and adiposity is moderated by people's biological reactions to couple conflict. Cohabiting adult couples (N = 117 couples) engaged in two conflict interactions, before and after which salivary cortisol levels were measured. Results revealed an association between relationship hostility and adiposity, but this association was concentrated among people with relatively low levels of cortisol reactivity to couple conflict. Results are interpreted in light of research demonstrating that cortisol reactivity can become blunted over time in response to repeated stressors. These results provide precision to etiological models of obesity by identifying cortisol reactivity as a factor that moderates the association between relationship hostility and adiposity. (PsycINFO Database Record

Relationship behaviors contribute to compromised health or resilience. Everyday communication between intimate partners represents the vast majority of their interactions. When intimate partners take on new roles as patients and caregivers, everyday communication takes on a new and important role in managing both the transition and the adaptation to the change in health status. However, everyday communication and its relation to health has been little studied, likely due to barriers in collecting and processing this kind of data. The goal of this paper is to describe deterrents to capturing naturalistic, day-in-the-life communication data and share how technological advances have helped surmount them. We provide examples from a current study and describe how we anticipate technology will further change research capabilities.

Over 1 in 5 dental patients report moderate to severe dental fear. Although the efficacy of cognitive-behavioral treatment (CBT) for dental fear has been examined in over 20 randomized controlled trials-with 2 meta-analyses finding strong average effect sizes ( d > 1)-CBT has received almost no dissemination beyond the specialty clinics that tested it. The challenge, then, is not how to treat dental fear but how to disseminate and implement such an evidence-based treatment in a way that recognizes the rewards and barriers in the US health care system. This mixed-method study investigated the potential of disseminating CBT through care from a mental health provider from within the dental home, a practice known as evidence-based collaborative care (EBCC). Two preadoption studies were conducted with practicing dentists drawn from a self-organized Practice-Based Research Network in the New York City metropolitan area. The first comprised 3 focus groups ( N = 17), and the second involved the administration of a survey ( N = 46). Focus group participants agreed that CBT for dental fear is worthy of consideration but identified several concerns regarding its appeal, feasibility, and application in community dental practices. Survey participants indicated endorsement of factors promoting the use of EBCC as a mechanism for CBT dissemination, with no factors receiving less than 50% support. Taken together, these findings indicate that EBCC may be a useful framework through which an evidence-based treatment for dental fear treatment can be delivered.

This phase of the NIH Science of Behavior Change program emphasizes an "experimental medicine approach to behavior change," that seeks to identify targets related to stress reactivity, self-regulation, and social processes for maximal effects on multiple health outcomes. Within this framework, our project focuses on interpersonal processes associated with health: coercive couple and parent-child conflict. Diabetes and poor oral health portend pain, distress, expense, loss of productivity, and even mortality. They share overlapping medical regimens, are driven by overlapping proximal health behaviors, and affect a wide developmental span, from early childhood to late adulthood. Coercive couple and parent-child conflict constitute potent and destructive influences on a wide range of adult and child health outcomes. Such interaction patterns give rise to disturbed environmental stress reactivity (e.g., disrupted sympathetic nervous and parasympathetic nervous systems) and a wide range of adverse health outcomes in children and adults, including dental caries, obesity, and diabetes-related metabolic markers. In this work, we seek to identify/develop/validate assays assessing coercion, identify/develop and test brief interventions to reduce coercion, and test whether changes in coercion trigger changes in health behaviors.

The longitudinal course of the psychological health (PH) of United States Air Force (USAF) base communities in relation to risk and demographic factors was studied over a 5-year period. PH (clinically significant hazardous drinking, prescription drug misuse, depressive symptoms, suicidal thoughts and behaviors, intimate partner violence [IPV] and child abuse) and risk (personal and family adjustment, workplace adjustment, broader community adjustment) and demographic factors (age and gender distribution) were operationalized at the aggregate level for bases (N = 77) as measured in three large scale surveys of USAF active duty members. Bases whose members collectively exhibited greater levels of risk collectively experienced greater initial problems with alcohol and drug use, depression, suicidality, and physical IPV. Hazardous drinking more quickly increased at bases whose members were younger and more male, and at those with poorer initial aggregate personal adjustment and workplace adjustment. The challenges of studying the community-level course of PH are highlighted.

This study explored the use of dynamical systems modeling techniques to evaluate self- and co-regulation of affect in couples' interactions before and after the transition to parenthood, and the impact of the Family Foundations program on these processes. Thirty-four heterosexual couples, randomized to intervention and control conditions, participated in videotaped dyadic interaction tasks at pretest (during pregnancy) and posttest (1 year after birth). Husbands' and wives' positivity and negativity were micro-coded throughout interactions. Individual negativity set-points, self-regulation, and partner co-regulatory processes during interactions were examined using a coupled oscillators model. Regarding self-regulatory processes, men exhibited amplification of negativity at the prenatal assessment that did not change at the postnatal assessment; women demonstrated no significant damping or amplification at pretest and a marginally significant change towards greater amplification at the postnatal assessment. In terms of partner-influenced regulatory dynamics, men's positive behaviors changed from damping to amplifying women's negative behaviors in the control group following the transition to parenthood, but exerted an even stronger damping effect on women's negative behaviors in the intervention group. The study highlights the advantages of dynamic modeling approaches in testing specific hypotheses in the study of self- and co-regulatory couple dynamics and demonstrates the potential of studying dynamic processes to further understanding of developmental and intervention-related change mechanisms.

OBJECTIVE: Investigate (1) the association of child adiposity with parent-to-child and parent-to-parent hostility, (2) the mediation of these associations by dietary behaviours and (3) moderation by gender. DESIGN: One hundred thirty-five couples with 6- to 14-year-old children completed measures of emotional and physical aggression, overreactive discipline and child diet. Parent-to-parent hostility was also coded from laboratory observations. MAIN OUTCOME MEASURE: Child adiposity was a combination of body mass index and waist-to-hip ratio. RESULTS: Mother-to-child hostility was associated with child adiposity. This association was concentrated in boys and was not significantly explained by child dietary factors. Mother-to-father hostility was not significantly associated with boys' or girls' adiposity. Girls' adiposity was not significantly associated with family hostility. Fathers' hostility was not linked to child adiposity. CONCLUSION: This is the first study to take a family-level approach to understanding the relation of hostility to child adiposity by examining relations among adiposity and both mothers' and fathers' hostility directed toward one another and toward their children. Our findings highlight the potential role played by mothers' emotional hostility in boys' adiposity and suggest that, if this role is further substantiated, mother-son emotional hostility may be a promising target for the prevention of child obesity.