Research Spotlights

Is Religious Counseling Effective?

When many people come to counseling, they want religiously consistent counseling. Is it helpful to match a religiously accommodated treatment to the client's religious beliefs? Turns out, the answer is yes. It can be helpful, but religious people can also benefit from purely secular treatments. They improve in mental health symptoms just as much with either treatment, but sometimes the religious treatments can produce more positive spiritual benefits.

Dr. Everett Worthington, Jr., who just finished up a three-year commitment as President (President-elect, President, and Immediate Past-President, for the three years, respectively) of the Society for the Psychology of Religion and Spirituality (Division 36 of the American Psychological Association, APA), has worked with two former student colleagues now at the University of North Texas (Dr. Joshua Hook) and Georgia State University (Dr. Don E. Davis), and a VCU faculty colleague in another Department (Dr. Michael McDaniel) to analyze the accumulated literature. Their meta-analysis was considered by an APA joint task force (Divisions of Clinical Psychology and Psychotherapy) on relationship factors in psychotherapy. That task force evaluated the evidence Worthington and his colleagues presented as providing the highest level of support for considering the religious beliefs and values of the client in considering treatment options.

Dr. Worthington is a member of the Counseling Psychology program and also affiliated with Social, Developmental, and Health Psychology programs. He typically studies forgiveness and other aspects of positive psychology, religious and spiritual issues, and couple enrichment.

Can We Help Children with ADHD Succeed in School?

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed childhood disorders. Children with ADHD frequently experience problems at school, and these problems often get worse during adolescence. Compared to their peers, adolescents with ADHD earn significantly lower school grades, score significantly lower on standardized achievement tests and experience higher rates of special education placements, grade retention and school dropout.

Dr. Joshua Langberg, a clinical psychologist at VCU, partnered with investigators from multiple universities to develop a better understanding of the school performance of adolescents with ADHD (Langberg, Molina et al., 2011). The investigators examined data collected as part of the Multimodal Treatment Study for Children with ADHD (MTA study), a large dataset including over 500 children with ADHD followed from elementary school through high school. Dr. Langberg and colleagues wanted to determine if school problems in high school age adolescents with ADHD could be predicted by behaviors present when the students were in elementary school. If behaviors in elementary school can be used to predict later school problems, interventions can be developed to target these issues, with the goal of preventing these problems from occurring.

The results of the study showed that in elementary school, students' ability to organize and manage homework materials as rated by parents and students' reading and writing abilities as rated by teachers were strong predictors of grades and achievement scores in high school. In fact, these behaviors were stronger predictors of school performance than the severity of their ADHD symptoms in elementary school and were more important predictors than the treatments they received, including medication and/or school services.

These data suggest that it is very important to develop school-based interventions that seek to improve students' materials organization and reading and writing skills. Dr. Langberg has been working to develop an intervention that targets the organizational skills of students with ADHD, the Homework, Organization, and Planning Skills (HOPS) intervention (Langberg, 2011). Results from the initial tests of the HOPS intervention demonstrate that it has significant potential to improve the school functioning of students with ADHD (Langberg et al., 2008; 2011).

Dr. Langberg's research focuses on improving the school performance of children and adolescents with ADHD. He conducts research to identify why students with ADHD struggle in the school and develops interventions to improve academic and behavioral performance. Dr. Langberg has focused much of his research on the school performance of young adolescents with ADHD, especially surrounding the transition to middle school. This tends to be a very difficult period for students with ADHD and interventions targeting school performance are frequently needed during this time. Dr. Langberg focuses on developing interventions that are feasible for delivery in the school setting as providing interventions in schools allows many more children to have access to these much needed supports and interventions.

Why have African American Youth Traded Cigarettes for Cigars?

As a child growing up in the rural South during the 1980s, cigarette smoking seemed to him a necessary rite of passage into manhood; so seamlessly intertwined with developmental as well as cultural aspects of African American life. From the vantage point of a ten year-old, smoking was an ostensible attribute of family eldership status, independence, and coolness. He became so enamored with smoking that on several occasions he would venture off behind a workshed to light a cigarette and emulate the smoking behaviors of family members (as well as fictive kin) – all the time, hoping that it would instill within him the same bravado he had witnessed among older men in his family. However, as he grew older, the unfortunate and untimely demise of family elders because of tobacco-related diseases led to a more sobering assessment of the impact of tobacco in his family and within African American communities, in general.

Since then, Dr. Aashir Nasim has endeavored to understand the link between cigarette smoking and the social and cultural experiences of African Americans (Nasim et al. 2011a; Nasim et al., 2009; Nasim et al., 2007; Nasim et al., 2003). Although there are many known risks for smoking, his research has identified cultural and religious / spiritual factors that protect against risks for smoking among African American adolescents (e.g., neighborhood stressors; see Belgrave et al., 2010) and young adults (e.g., race-related stress; see Fernander et al., 2008). Promotive and protective factors identified in his research include a strong ethnic identity (Clark et al., 2008), family cohesion and interdependency (Nasim et al., 2007) and endorsement of religious coping strategies (Nasim, et al., 2006). Perhaps more importantly, Dr. Nasim's research on protective factors for cigarette smoking has led to the development of theoretical frameworks (Nasim et al., 2011b) and models of praxis for broader efforts in substance use prevention (Belgrave et al., 2007; Belgrave et al., 2008).

More recently, Dr. Nasim's research has followed the shifting landscape of adolescent tobacco use. For instance, in Virginia, cigars (specifically, little cigars) have now supplanted cigarettes as the most prevalent form of tobacco use among youth ages 12 to 17. What is more, his recent study on cigar misreporting revealed that statewide tobacco surveillance systems have significantly underestimated rates of cigar use among African Americans and other health disparities populations (Nasim et al., in press). Many African American youth have chosen cigars over cigarettes because cigars are generally less expensive than cigarettes; smell and taste better (e.g., strawberry, cherry, and chocolate flavorings); pose fewer perceived health risks; and, are considered more socially acceptable and attractive. This is particularly concerning because his research, in collaboration with Drs. Melissa Blank and Thomas Eissenberg (Director of VCU's Clinical Behavioral Pharmacology Laboratory), shows that little cigar smoke contains many of the same lethal toxicants and effects as cigarette smoke (Blank et al., 2011). These misperceptions are compounded by adolescents' beliefs that modifying (hyping or freaking) the little cigar by removing the "chemical / cancer paper" renders the tobacco product "cancer-free." His ongoing qualitative research funded by the Virginia Foundation for Healthy Youth (VFHY) – a multi-study project involving content analytic methods – reveals that many of attitudes and beliefs about little cigar smoking are socially (e.g., social and urban cachet) and culturally-rooted (e.g., traditional health beliefs).

Dr. Nasim is currently awaiting review of his revised grant application to the National Cancer Institute (NCI) to investigate the effects of little cigar modification (i.e., hyping) on smoke toxicant and user toxicant exposure. In addition, he is preparing a research study to determine if risks and protective factors for little cigar smoking and other alternative tobacco uses (e.g., hookah) are consistent with previous findings for cigarette smoking.

Are Cultural Issues Important in Rehabilitation Medicine?

Each year, 700,000 Americans suffer a new or recurrent stroke, and currently 5.6 million Americans are living with the effects of stroke, positioning it as the leading cause of disability in the United States. The effects of stroke are especially pronounced in Black and Latino individuals, who experience more strokes and recover more slowly from stroke than White individuals do. For example, Black individuals who sustain a stroke are twice as likely as White individuals to sustain a second stroke, whereas Latinos are 2.6 times as likely. Further, these differences are even more pronounced in the Southeastern United States, where there has long been a 50% greater mortality rate from stroke across the "Stroke Belt."

Dr. Paul Perrin and his colleagues have hypothesized that one of the contributors to racial/ethnic disparities in stroke rehabilitation could be the nature of informal care that individuals with stroke receive. Individuals with stroke from differing racial/ethnic backgrounds can often have very different caregiving experiences because of family structure, cultural norms, and living arrangements.

In order to investigate the connections between caregiving and racial/ethnic disparities in stroke, Dr. Perrin's research team collected data on caregiver mental health and functioning of individuals with stroke from 124 White, Black, and Latino/Puerto-Rican caregiving dyads at 1, 6, and 12 months post-hospital discharge. Out of the three racial/ethnic groups, Latino/Puerto-Rican individuals with stroke showed the lowest functioning, and their caregivers showed the poorest mental health.

Based in part on the findings from this study, Dr. Perrin's research team developed and implemented a pilot study of a culturally sensitive Transition Assistance Program (TAP), primarily for Latino stroke caregivers. The program was implemented completely through videophone devices while caregivers were at their own homes. The intervention was comprised of (1) skill development, (2) education, and (3) supportive problem solving. Sixty-one dyads participated: thirty-nine from Puerto Rico and twenty-two from Texas. Participants were randomly assigned to the TAP treatment or a control group. The TAP effectively reduced caregiver strain at the 3-month follow-up, and when controlling for baseline differences, the treatment group had lower depression than the control group at follow-up. Among individuals with stroke who had low functioning at the beginning of the study, those whose caregivers had received the TAP improved in functioning more so than did those whose caregivers had been in the control group.

Dr. Perrin's studies have shown that critical knowledge may be lost regarding the connections between caregiver mental health and the functioning of individuals with stroke when researchers and clinicians look only across race/ethnicity as opposed to also within. A culture-free approach to mental-health interventions for stroke rehabilitation is likely limited, and race/ethnicity may affect how caregiver mental health and functioning of individuals with stroke reciprocally influence each other, contributing to some of the disparities in rehabilitation seen all too often.

Are Mindful People Better at Regulating Their Emotions?

Our emotions are an integral part of who are, coloring our relationships, impacting our decisions, and playing an important role in determining our mental and even physical health. We are “hard-wired” to be emotional. But our emotions do not always serve our best interests, as anyone knows who has ever fought with a loved one, made an impulse purchase, or gotten sick from too much stress. Emotions, particularly of the difficult kind – fear, sadness, anger, jealousy, and so on – often need to be “regulated” for us to behave in healthy, adaptive ways. How can people better regulate their emotions when provoked or stressed? To date, much research devoted to understanding emotion regulation has either focused on maladaptive ways to manage emotions, like rumination and suppression, or has focused on strategies that are brought to bear after some judgment about an event or situation has already been made. Less research has focused on ways to intervene in the early stages of a challenging encounter – ways that may help to inhibit the arising of difficult emotions before they have a chance to impact us and, potentially, the people around us.

Dr. Kirk Warren Brown studies a beneficial quality of mind that we all have the potential to exercise, called mindfulness, that may be a game-changer in otherwise stressful situations. Mindfulness, simply put, is presence of mind, the capacity to be receptively attentive to what we encounter moment to moment. Instead of approaching people or situations through the filter of our memories of them from past encounters, or reacting on the basis of our prior experiences or our expectations, a mindful response encounters what is happening with openness and freshness. Dr. Brown’s research, and that of numerous others, has shown that mindfulness, and training to enhance it, can positively impact a host of life domains, from mood states to decision-making to romantic relationship quality. Given the key role of emotion regulation in these and other important domains, Dr. Brown and graduate student Robert Goodman, both of the Social and Affective Neuroscience Laboratory at VCU, along with colleague Michael Inzlicht of the University of Toronto, recently set out to explore how mindfulness might play a role in healthy emotion regulation.

Emotions often arise very quickly after we encounter a provocative stimulus – over a matter of seconds, even milliseconds, so it was important to capture this process as close as possible to the source of emotion generation – by investigating what happens in key regions of the brain in the immediate aftermath of an encounter with evocative stimuli. After completing a battery of psychological measures, including two assessing dispositional mindfulness, college student participants in the study viewed a series of photographs that varied in valence – some pleasant (e.g., a baby), some unpleasant (e.g., a pointed gun), some mildly evocative, and some very provocative. During the viewing of 150 such images, neural responses to them that unfolded over milliseconds – called “event-related potentials” – were recorded through highly sensitive sensors placed at multiple sites on the scalp.

The results, described in a new article in the journal Social Cognitive and Affective Neuroscience, were, well, provocative. More mindful participants showed attenuated neural responses to highly arousing images of both pleasant and unpleasant kinds. Their brains simply did not react as strongly to the kinds of provocation that typically lead to challenging emotions (that then often require psychological work to manage them). The study findings lent support to the claim that mindfulness may alter the time course of emotion very early in the game – within fractions of a second after being confronted with emotionally potent stimuli. The findings suggest that being present, or attending openly and receptively to what we encounter on a day-to-day basis, may be important to enhancing our moment-to-moment experience and our quality of life more generally. Finally, the findings of this study also support the value of now widely available mindfulness training to promote healthy emotional lives.

How Do We React to Criticism?

Are you more likely to recall the compliment your boss gave you, or the criticism? Dr. Jeffrey Green and colleagues have examined how people process and remember feedback. In a series of experiments, they have had people take an alleged personality test via computer that provides feedback in the form of positive and negative behaviors that they are likely to do, such as keeping a secret, or forgetting to pick up a friend. Then they have given them a surprise memory task. They have found that people do indeed recall poorly negative, threatening information about themselves, but they remember flattering or affirming information well. However, people tend to be strategically flexible. They do not neglect all negative information about themselves, but only the most threatening information: feedback that relates to their most central or cherished aspects of themselves.

However, there probably are some downsides to wholesale forgetting of threatening negative feedback, most notably not learning from our mistakes. Are there other conditions that might limit this general selective forgetting tendency? Green and colleagues reasoned that if the feedback came from someone close, like a romantic partner or best friend, then it should be remembered better. Such feedback might be seen as more trustworthy or helpful for the relationship. In a twist on their previous experiments, close friends or romantic partners were separated and thought that the other sent them feedback about themselves. Others received the very same information from a stranger. The usual forgetting of negative, threatening feedback occurred when it supposedly came from a stranger, but it was remembered better when it came from a close friend or romantic partner.

We also may be more open to threatening feedback when we are motivated to improve. We may accept the short-term drop in self-esteem in order to better ourselves in the long run. Green and colleagues subliminally activated in people a desire to self-improve by having them read sentences that included improvement-related words. Others in a control condition read words unrelated to improvement. The results were similar to the close other study: people in the control condition exhibited the usual forgetting of threatening information, but those who had self-improvement activated in their minds recalled more of the threatening information. Thus, while we are generally motivated to protect the self by engaging in selective forgetting, we can turn off this tendency when the feedback comes from those who are close to us or when we are focusing on self-improvement.

Dr. Jeffrey Green has investigated the cognitive processes by which individuals are able to forget threatening information as well as various factors that can increase or reduce this forgetting. He and his colleagues have published nine articles and chapters on this topic.

Does Your Family Work Together Successfully?

In an ideal world, a family would work together like a well-oiled machine, but in reality, things don't always go so smoothly. Coordinating school, friends, meals, and extracurricular activities is challenging enough during adolescence. Families who also deal with the diagnosis and management of a chronic medical condition stretch available resources and resilience even thinner. Type 1 diabetes requires constant monitoring of blood sugar levels and multiple insulin injections every day. Individuals must also be aware of how daily activities, such as exercise, type/amount of food, and stress will affect blood sugar levels and insulin dose calculations. No matter how mature a teen may be, management of type 1 diabetes is a complex process, and the help of a concerned parent is crucial. In fact, parental involvement in disease care is the single best social predictor of better health outcomes in youth with diabetes. Greater personal health demands and parental monitoring come at a time when teens desire independence from parents and may result in family conflict, making successful family teamwork even more challenging. Since parental involvement and teamwork are key elements of successful diabetes management, Dr. Holmes' NIH-funded research seeks to provide families with a set of fundamental coping skills. These techniques allow families to continue working together toward good diabetes management while minimizing parent-teen conflict. Trained interventionists help parents and teens practice productive ways to communicate, avoid arguments, problem solve as well as change attitudes and behaviors.

Managing diabetes at school can present another layer of challenges. High and low blood sugar levels can have immediate and long term effects on school performance. Some symptoms of high/low blood sugar levels include feeling lightheaded, dizzy, nauseous, trouble with concentration, and feelings of fatigue. People who have skipped a meal can experience some of these symptoms. However, individuals with diabetes often have blood sugar levels outside the normal range and experience these symptoms more frequently and to a greater degree. Best cognitive performance occurs when blood sugar levels are optimal; it is easy to imagine how a student with diabetes may have trouble doing their best on an assignment or exam while experiencing high or low symptoms. Therefore, disease management and performance at school is optimized when family teamwork involves teachers and school nurses.

The research of Dr. Clarissa Holmes explores the effects of type 1 diabetes on aspects of psychosocial and cognitive functioning in children and adolescents with diabetes. She is currently conducting a prevention program for families of youth with type 1 diabetes to maintain parental involvement in daily disease care through family teamwork. Dr. Holmes also is interested in the cognitive side effects of extreme blood sugar levels. An exploratory study is underway to evaluate the effects of blood sugar changes on memory and learning performance and to help youth manage diabetes challenges at school.

How Important is Dating in Adolescence?

Dating is a common experience among adolescents. It gives them the chance to learn about interacting and communicating with romantic partners and influences patterns of behavior in intimate partner relationships in adulthood. Although dating offers opportunities for positive growth, adolescents may also have to face problematic dating situations including those that place them at-risk for dating violence. Terri N. Sullivan and colleagues are conducting a series of qualitative studies to better understand the dynamics of problem situations that happen in dating contexts. The first step was interviewing adolescents and asking them to describe situations in dating contexts they perceived as problematic. We then conducted follow-up interviews to determine adolescents' perceptions of the best response in these situations and supports and barriers that would help or hinder them in engaging in those responses. We believe this information will benefit prevention effort focused on helping adolescents develop and maintain healthy dating relationships.

Dr. Terri Sullivan works more generally on the development, implementation, and evaluation of school-based prevention efforts to promote behavioral, social, and emotional competence among middle school students.

Prescription Medications Can't be Dangerous, Right?

Most people receive prescription drugs at some point—you break your wrist, your doctor gives you a week's worth of Vicodin, but it stops hurting after three days and you put the leftover pills in your medicine cabinet. Most of the time they stay there. Sometimes they are later shared with other people.

Over the past decade, the number of people who use prescription drugs without a doctor's prescription has increased dramatically. In a recent study with young adults, Eric Benotsch and colleagues found that 36% of those surveyed reported using a prescription medication without a doctor's consent. The most commonly used type of medication was pain medication (e.g., Vicodin), followed by anxiolytics (e.g., Xanax), stimulants (e.g., Adderall), and sedatives (e.g., Ambien). Friends and family were the main sources of prescription medications—those leftover pills in the medicine cabinet were used, but not for the purpose the doctor intended.

Common motivations for using prescription medications included some legitimate medical uses such as pain relief but also included recreational use-- to "get high" or to "try something new." In general, young people who used prescription medications without a prescription were also more likely to use traditional recreational drugs, especially marijuana (50%), ecstasy (18%), and cocaine (10%). Overall, prescription drugs taken without a doctor's prescription were more frequently used than all other recreational drugs except alcohol and marijuana.

Among individuals who reported the non-medical use of prescription drugs, 43% indicated that they had combined this use with the use of alcohol and 21% indicated that they had used a prescription medication in combination with an illicit drug. Although the majority of participants believed that the use of prescription medications posed little or no risk for injury or illness, overdose of opioid analgesics is now the primary cause of drug-related poisoning in the United States, and these drugs are particularly dangerous when combined with alcohol. Additional research aimed at understanding the recreational use of prescription drugs is needed. Dr. Eric Benotsch and colleagues have two papers on the non-medical use of prescription drugs accepted for publication.

How Can We Reduce Childhood Obesity?

In the past 30 years, the number of obese children has more than tripled! This statistic is concerning because obesity is associated with a number of physical and mental health concerns, including diabetes, cardiovascular problems, and poor quality of life. As a result, many programs have been developed to prevent and reduce pediatric obesity, however, they have had limited success.

Dr. Suzanne Mazzeo and her colleagues, including VCU's Dr. Marilyn Stern, believe that targeting the parents of overweight children might be the best approach to fighting childhood obesity, largely because parents serve as powerful models of eating and exercise behaviors. In fact, the best predictor of children's exercise and eating behaviors are their parents' eating and exercise behaviors. For example, parents who eat more fruits and veggies are more likely to have children that do the same. Also, other researchers have found that when parents are involved in the treatment of pediatric obesity, children's outcomes improve. Further, because most overweight children have overweight parents, targeting parents can help the entire family improve its health. Finally, parent-only interventions are more cost-effective than family-based approaches, as they require fewer staff and other resources.

To test their hypothesis, Drs. Mazzeo and Stern and their colleagues recruited families with overweight children from all over the Richmond area to participate in a study. Half of the parents were assigned to the NOURISH (Nourishing Our Understanding of Role Modeling to Improve Support and Health) program in which parents were taught how to be healthy role models for their children. The other half of the parents were assigned to a control group which received publicly-available information in a one-session meeting and through the mail over the course of the intervention period. Results showed that children in the control group gained more weight than children in the NOURISH program. Children in the NOURISH group also reported higher quality of life and less dissatisfaction with their body. These findings suggest that NOURISH may be an effective way to prevent overweight children from becoming overweight adults, while also enhancing the way children feel about themselves and their body. The next step for Dr. Mazzeo and her colleagues is to evaluate the impact of the NOURISH program on childhood obesity with a much larger sample. It is Dr. Mazzeo's hope that this study will lead to the dissemination of a program capable of combating today's obesity epidemic.