Doctor of Philosophy in Psychology (PhD)
Predicting Posttraumatic Stress Symptomology in Emergency Medical Personnel
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Coping with chronic illness; family and marital stress; social support; social relationships and health; life stress
Spinal cord injury (SCI) and the subsequent events resulting from such a life-altering event can present a host of impairments, stressors and challenges in many aspects of one’s life. Of the stressors and medical complications found in SCI, pain has been reported to be the most frequent and disabling condition that affects activities of daily living and social life for those living with SCI. Using an intensive longitudinal design, the current line of research examined the ways in which mood regulation, social support, and catastrophizing affect the experience of pain in a sample of 87 individuals with SCI. Following an initial interview, participants completed brief telephone interviews twice daily across five days. Hypotheses were tested using multilevel modeling, with daily measures nested within individuals. Study 1 examined the ways in which mood regulation impacted pain intensity both within and across days. Regulation of positive mood was found to prospectively predict decreases in pain intensity. In addition, an examination of gender differences revealed that some mood regulation processes significantly predicted changes in pain for women but not for men. Study 2 examined the moderating role of social support in the relationship between catastrophizing and pain. Perceptions of global support availability were found to buffer the deleterious effects of catastrophizing on pain. Specifically, catastrophizing was not significantly associated with subsequent changes in pain intensity for individuals perceiving high levels of support availability. For those with average or low levels of perceived support, catastrophizing prospectively predicted increases in pain. In addition, perceptions of critical responses from the support provider were also found to moderate the association between catastrophizing and pain. When perceptions of criticism were high, catastrophizing was found to prospectively predict increases in pain. In contrast, when perceptions of criticism were at average or below-average levels, catastrophizing was not significantly associated with pain. Taken together, findings from these studies may aid in designing effective interventions for managing pain in individuals with SCI, by tailoring programs to individual needs based on their particular strengths in mood regulation and including close others in determining the most appropriate ways in which to provide support.
Due to the unique demands of their job, paramedics have been identified as high risk for post-traumatic stress disorder and trauma-related symptoms (Regehr, Goldberg, & Hughes, 2002). There is additional qualitative evidence that stress experienced by paramedics at work transmits to the home setting and has a negative impact on spouses (Regehr, 2005). Using intensive longitudinal methods, the current line of research examined the daily interplay between home and work environments in a sample of 87 paramedics and their cohabitating spouses. Repeated measures were collected across home and work settings for a period of four consecutive work days. It was generally expected that stress and burnout experienced by paramedics in the work setting would predict subsequent outcomes in the home setting for both paramedics and their spouses. Hypotheses were tested using hierarchical linear modeling (HLM; Bryk & Raudenbush, 1992), with daily measures nested within couples over time. Study 1 first identifies paramedics as experiencing high levels of post-traumatic stress and depressive symptoms. Daily stress transmission to the home setting was also supported, whereby work stress, negative affect, and burnout predicted subsequent outcomes at home for both partners. Study 2 examined the additional impact on dyadic functioning (as moderated by neuroticism), demonstrating significant predictive value of paramedics' burnout in subsequent marital tension. Lastly, Study 3 provides evidence for an impact of work stress and burnout on coping responses in the home setting. Higher levels of extramarital stress predicted increased engagement in rumination and withdrawal, which in turn contributed to greater marital tension. Together, these findings help to explain the intricacies of stress transmission and contagion in couples dealing with high levels of stress. Implications for paramedics specifically and married couples more generally are discussed.
Although the divorce rate in first-marriages has stabilized after years of increase in North America, the divorce rate of remarriages continues to increase. It has been suggested that increased divorce rates in remarriages may be attributableto higher levels of conflict in stepfamilies (e.g., Hobart, 1991). Drawing from familysystems theory and contextual models of divorce, this study tested the hypotheses that tension levels in stepfamily dyads will predict divorce above and beyond the effects of marital quality alone and that increasing emotional and marital distress will be mechanisms through which the stepfamily system affects marital stability. Datawere collected from 112 couples who were followed for 20 years. Logistic regression analyses tested main and interaction effects of marital quality and (step)parent-child tension levels on divorce probability. Depression and marital quality were also tested as mediators and moderators of the effects of stepfamily relationship quality ondivorce. Results confirmed that marital quality is an important predictor of divorce in stepfamilies, as it is in first-marriages. However, results also revealed that stepparent-child tension moderates the effect of marital quality on divorce. Depression mediated the effects of marital quality on divorce for wives, but not husbands. The importance of using a contextual approach for stepfamily research and clinical interventions is discussed.
We are well into the third decade of HIV disease, and unprotected anal intercourse remains the primary mode of transmission in men who have sex with men (MSM). Since 2000, evidence suggests decreased precautionary sex behaviors and increased incidences of HIV in MSM. Traditional models of risky behaviors have focused primarily on cognitive factors related to intention to use condoms. Yet, there is an often-observed gap between intentions and behaviors. This ‘gap’ has fueled calls in the literature to move beyond cognitions and explore other psychological and contextual factors that may predict condom use. In the present study, I examined a functional model of condom use in MSM not in committed, long-term relationships, given their increased risk of HIV transmission vulnerability. Sex motives were examined as predictors of condom use in single MSM as a function of partner type and HIV serostatus. Sex motives examined were having sex to enhance intimacy, gain pleasure, escape a negative affective state, enhance self-esteem, and avoid partner disapproval. For a period of two months, MSM reported condom use for anal intercourse, sex motives, and partner type on a daily basis. Hierarchical logistic regression analyses revealed that consistent with hypotheses, on occasions when participants reported higher levels, as compared to lower levels, of having sex to enhance intimacy, and to cope with a negative affective state, the likelihood of using a condom for anal intercourse was decreased. Further, consistent with hypotheses, when participants reported higher levels, compared to lower levels, of having sex to enhance sexual pleasure, to attain partner approval, and to confirm to oneself a sense of sexual esteem, the more likely they were to use a condom for anal intercourse. Results also indicated that, in general, the relationships between motives and condom use were stronger when having sex with someone considered a regular partner as compared to casual. Finally, relationships were also stronger when participants self-reported HIV seropositive status as compared to seronegative or serostatus unknown. Implications for intervention approaches, at both the individual and community levels, are discussed.
Paramedics are frequently exposed to traumatic events on the job, and although they have higher levels of posttraumatic stress symptomology (PTSS) than the general population (Berger et al., 2012), not all paramedics experience high PTSS. Identifying factors that impact PTSS among individuals who are frequently exposed to traumatic stress is important for the development of evidence-based interventions. Using a longitudinal design, we examined relationships among rumination, perceived stress, and PTSS in 87 shift-working paramedics. Perceived stress and rumination were examined daily across a one-week period, while measurements of PTSS were assessed at baseline and at a two-year follow-up. Regression analyses indicated that perceived stress significantly predicted rumination. Rumination significantly predicted PTSS at the two-year follow-up, even after controlling for baseline PTSS, depression, and occupational stressors. Perceived stress did not directly predict PTSS at follow-up. Rather, rumination mediated the relationship between perceived stress and PTSS. Specifically, higher levels of perceived stress were associated with higher rumination, and higher rumination was associated with higher levels of PTSS at follow-up. These findings suggest the importance of targeting both perceived stress and rumination in clinical interventions for individuals who are frequently exposed to traumatic stressors.
Shift workers are a population at risk for experiencing poor sleep. Given the evidence linking health with shift work and sleep disturbance, it is important to identify factors that can exacerbate or mitigate sleep problems in this vulnerable population. We followed eighty-seven shift-working paramedics morning and evening over one week using an intensive longitudinal design. Multilevel modeling was used to examine whether the detrimental effects of daily occupational stress on sleep quality were buffered by perceived social support availability. Paramedics who reported more social support tended to report better quality sleep over the week. Additionally, social support buffered sleep from day-to-day fluctuations in occupational stress as well as from high average occupational stress over the week. Findings indicated that those with low levels of social support displayed poor sleep quality on days with high occupational stress; those high in support did not show significant effects of occupational stress on sleep. Those with low levels of social support tended to also display poor sleep on average across the week when they also tended to report high occupational stress on average across the week. Theoretical and practical implications are discussed.
Objective. To examine the effects of depressive symptoms and empathic responding on patient disability and marital quality over time. To identify factors that contribute to patient perceptions of spouses as responding empathically to their rheumatoid arthritis. Methods. Patients diagnosed with rheumatoid arthritis and their spouses (n = 133 couples) independently completed mailed questionnaires at baseline and one year later. Patients completed measures of functional impairment, marital quality, depressive symptoms, and perceived empathic responding from their spouse. Spouses reported their own depressive symptoms and empathic responding behavior. Results. Perceived empathic responding was found to interact with spouse depressive symptoms contributing significantly to the prediction of patient functional impairment reports at follow-up. Only when spouse empathic responding was low was spouse depression associated with greater patient functional impairment at 1-year follow-up. Similarly, in the model predicting patient marital quality at follow-up, there were significant 2-way interactions between perceived empathic responding and both spouse depressive symptoms and patient depressive symptoms. Only when spouse empathic responding was low did patient or spouse depression significantly predict poorer marital quality at follow-up. Patient perceptions of spouse empathic responding were found to depend on spouse reports of their own empathic responding, patient marital satisfaction, and the interaction of patient depressive symptoms and marital satisfaction. Conclusion. Empathic responding from the spouse was found to buffer against the negative effects of spouse depression on functional and marital outcomes for patients with RA. In developing couple-oriented RA treatments, increasing perceived empathic responding could serve as a useful target for intervention.