Doctor of Psychology (Psy.D.), Xavier University, 2017, Psychology

Obesity in children and adolescents has risen precipitously over the past several decades, especially among underserved populations, due largely to unhealthy diet and insufficient physical activity. Theory and research suggest a link between health beliefs and health behaviors across populations, and current research aims to identify factors that influence and account for this link. The present study explored whether psychological flexibility/inflexibility mediates associations between eating attitudes and both food and physical activity habits in a sample of urban underserved youth. Results indicate that psychological flexibility/inflexibility did not mediate either of the proposed models for the full sample or when sex or age groups were examined separately. Associations were found between eating attitudes and both food habits and physical activity, as well as between psychological flexibility/inflexibility and eating attitudes, food habits, and physical activity, although findings were mixed across the full sample and subsamples examined. It is recommended that future research examine links between psychological flexibility/inflexibility and health beliefs and behaviors more broadly, and that differences by sex and age be more thoroughly studied.

Committee: Abbie Beacham Ph.D. (Committee Chair); Jennifer Gibson Ph.D. (Committee Member); Janet Schultz Ph.D. (Committee Member) Subjects: Psychology; Public Health

Doctor of Philosophy, University of Akron, 2023, Counselor Education and Supervision

The purpose of this study was to investigate the contribution of mindfulness experience and psychological flexibility on burnout among counselor educators from CACREP-accredited institutions. Data were collected from May through August of 2022. One-hundred and forty-four counselor educators from four regions across the United States completed a web-based survey including three instruments: the Five Facet Mindfulness Questionnaire-15 (FFMQ-15), the Acceptance and Action Questionnaire – II (AAQ-II), the Maslach Burnout Inventory–Educators Survey (MBI-ES), and a demographic questionnaire. Canonical correlation was used to investigate the research hypotheses. Results showed that mindfulness experience and psychological flexibility were statistically significantly related to degree of burnout among counselor educators. Specifically, higher levels of Observing, Describing, Acting with Awareness, Nonjudging of Inner Experience, Nonreactivity to Inner Experience, and Psychological Flexibility were associated with lower Emotional Exhaustion, lower Depersonalization, and higher Personal Accomplishment. However, contrary to expectations, the univariate regression analysis showed that only Psychological Flexibility and Acting with Awareness (the only mindfulness experience factor) were statistically significantly related to the three areas of burnout (Emotional Exhaustion, Depersonalization, and Personal Accomplishment). Results suggested that mindfulness experience and psychological flexibility can be important psychological resources to understanding and mitigating burnout among counselor educators. Limitations and recommendations for future research on mindfulness experience, psychological flexibility, and burnout among counselor educators were discussed.

Committee: Robert Schwartz (Committee Chair); Varunee Faii Sangganjanavanich (Committee Member); Ronald Otterstetter (Committee Member); Yue Dang (Committee Member); Delila Owens (Committee Member) Subjects: Counseling Education

Doctor of Psychology (Psy.D.), Xavier University, 2023, Psychology

While nurses generally report high levels of burnout (The Joint Commission, 2020), often due to the post-traumatic stress associated with nursing, the International Council of Nurses (2021) noted an increase in the number of nurses reporting burnout during COVID-19. Acceptance and Commitment Therapy (ACT) has been suggested as an intervention strategy for burnout as psychological flexibility, a key outcome of ACT, is correlated with lower burnout among nurses. The goal of this study was to examine whether psychological flexibility moderated the relationship between COVID-19-specific post-traumatic stress and burnout. Fifty-three nurses from the United States completed a survey that measured their levels of burnout, secondary-traumatic stress, COVID-19-specific post-traumatic stress, and psychological flexibility, as well as a variety of demographic and COVID-19 related factors. Results of a moderation analysis indicated that, while there was a significant, positive correlation between COVID-19-specific post-traumatic stress and burnout, psychological flexibility did not significantly moderate that relationship. These results are vital for clinicians and organizations dedicated to helping nurses, indicating that a commonly-used method for reducing and preventing burnout would likely not be time or cost-effective for nurses during a global health crisis such as COVID-19. It is possible that this study's small sample size contributed to the non-significant findings and brings into question the generalizability of this study to larger groups of nurses. Future research ought to focus on whether there is enough nuance between the questionnaires used to measure the general post-traumatic stress associated with nursing and event-specific post-traumatic stress, such as that associated with COVID-19.

Committee: Kathleen Hart Ph.D., ABPP (Committee Chair); Heather McCarren Ph.D. (Committee Member); Jennifer Phillips Ph.D. (Committee Member) Subjects: Clinical Psychology; Health Care; Psychology

Doctor of Education (Ed.D.) in Leadership Studies, Xavier University, 2022, Leadership Studies and Human Resource Development

To address the lack of literature on burnout among leaders, this study extended the research of Baranick and Eby (2015) by studying burnout in behavior scientist practitioners by assessing psychological flexibility and the possible mediating effect of work engagement on burnout and possible moderating effect of work-life balance on work engagement. Participants completed four, self-report surveys to assess the psychological flexibility, work-life balance, work engagement, and burnout of behavior scientist. The study confirmed the previously identified negative relationships between burnout and both psychological flexibility and work engagement exists among behavior scientists. The proposed mediation of work engagement between psychological flexibility and burnout was found to be statistically significant, but the mediation model explained less variance than considering engagement alone as a predictor of burnout. The proposed moderation of work-life balance on engagement was not significant. The results of this study could spur investigations to better understand what has been called a crisis of burnout in the field. Since the correlations among psychological flexibility, work engagement and burnout were found to be independently significant, there is justification for conducting further study to determine whether efforts to increase psychological flexibility and work engagement separately could decrease burnout among behavior scientists.

Committee: Gail F. Latta Ph.D. (Committee Chair); Katrina Wyche Ed.D. (Committee Member) Subjects: Behavioral Psychology; Behavioral Sciences

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2022, Health Programs

The overarching objective of this study was to investigate the impact of individual psychological flexibility (PF) based on three fundamental constructs: secondary trauma, compassion fatigue, and burnout experienced by healthcare workers during the COVID-19 pandemic. Data were gathered from healthcare workers in the United States in ambulatory community health centers. Participants were drawn from public databases of demographic information, professional and social platforms such as LinkedIn, licensing and professional listservs, and healthcare organization associations. Data sources included online self-report questionnaires using the AAQ-II and ProQOL. An analysis was conducted to determine if a relationship exists between PF and compassion fatigue (CF), secondary traumatic stress (STS), and burnout. Furthermore, data were reviewed and compiled for healthcare leaders, consultants, policymakers, and other relevant stakeholders to analyze the benefit of developing psychological flexibility as a tool to promote emotional and psychological wellness and resiliency in their staff and organizations.

Committee: Cheryl Chance (Committee Chair); Jesse Florang (Committee Member); Gail Frankle (Committee Member) Subjects: Health Care; Health Care Management; Public Health

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2020, Psychology/Clinical

The prevalence of overweight and obesity has continued to rise among adults. While biological factors contribute to overweight (Frayling et al., 2007), body weight regulation is influenced by behavior (Fuglestad, Jeffery, & Sherwood, 2012). Behavioral weight loss interventions often demonstrate only modest reductions in weight, possibly because the psychological factors that modulate obesity-related behaviors are rarely targeted in treatment. Thus, psychological flexibility may be of particular importance, given it describes the ability to perform goal-consistent behavior in the presence of contrary urges or environmental demands. To characterize the dynamic factors involved in psychological flexibility (Kashdan & Rottenberg, 2010), the present study examined between-group (overweight/obese: n=33, normal weight: n=47) differences in executive function, cognitive traits of awareness and acceptance, and heart rate variability (HRV). Individuals with overweight/obesity demonstrated poorer attention-shifting (Wisconsin Card Sorting Task, p = .009) and lower attention and awareness (Mindful Attention Awareness Scale, p = .01 and Difficulties in Emotion Regulation subscale emotional clarity, p = .006). Participants with overweight/obesity also demonstrated greater vagally-mediated HRV compared to normal weight with marginal significance (p = .07) and a medium effect size (partial eta squared = .042) across all HRV conditions (rest, stress, and recovery). No other significant differences were found regarding executive function (i.e., inhibition and working memory), cognitive features of acceptance and awareness (i.e. subscales of the Difficulties in Emotion Regulation scale), or HRV reactivity and recovery. Findings suggest some factors essential to psychological flexibility may be altered in individuals with overweight/obesity compared to normal-weight.

Committee: Abby Braden Ph.D. (Advisor); Amilcar Challu Ph.D. (Other); Dara Musher-Eizenman Ph.D. (Committee Member); William O'Brien Ph.D. (Committee Member) Subjects: Psychology

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2019, Psychology/Clinical

In the work place, people who identify as sexual minorities experience elevated levels of incivility, discrimination, and a general lack of protection from unfair workplace practices. These difficulties can then lead to physical, psychological, social, and intrapersonal deficits. Acceptance and Commitment Therapy (ACT) is a contextual-behavioral therapy that is associated with improving psychological and health outcomes across a myriad of difficulties. Further, ACT has been used with people who identify as sexual minorities, and as a treatment for work stress. However, it has never been used to address work stress for sexual minorities. The current study is a two-part study. Study 1 was a cross-sectional assessment of variables related to the sexual minority experience: work stress, well-being, psychological flexibility, and internalized homonegativity. I hypothesized that greater work stress would be related to lower well-being, lower psychological flexibility, and higher internalized homonegativity. All correlations were observed in the hypothesized directions. Regarding the mediational analysis, psychological flexibility was found to be a significant mediator between work stress and wellbeing, but internalized homonegativity was not. This relation suggests that psychological flexibility could be used by sexual minorities to cope in difficult workplace situations and helped inform the Study 2 was a feasibility and acceptability study of an ACT intervention for sexual minorities experiencing work stress. All measures of feasibility and acceptability indicated that participants found the intervention to be helpful, effective, and insightful. Further, outcome measures that were considered targets of the ACT intervention were administered to assess if change happened at a statistically significant level. One-tailed paired-samples t-tests, reliable change index scores, and sign tests were used to assess meaningful change on outcome variables. Signi (open full item for complete abstract)

Committee: William O'Brien Ph.D. (Advisor); Kristina LaVenia Ph.D. (Other); Clare Barratt Ph.D. (Committee Member); Abby Braden Ph.D. (Committee Member) Subjects: Clinical Psychology

Doctor of Philosophy (Ph.D.), Bowling Green State University, 0, Psychology/Clinical

Test anxiety is a major concern among today's college students. Test anxious students demonstrate consistently diminished performance compared to their less anxious peers. Although the adverse impact of test anxiety on academic performance is well documented, there is active debate about the way that anxiety affects performance. Cognitive interference theory (CIT) may help explain this relationship. CIT suggests that test anxiety leads to increased levels of off-task thoughts, which are processed by the working memory, which leaves fewer resources to manage the task at hand. Traditional test anxiety interventions such as cognitive therapy focus on reducing anxiety by increasing positive or neutral self-talk which may place additional demands on cognitive resources. This may explain the modest improvements in cognitive performance and at times adverse effects associated with these traditional test anxiety interventions. Alternatively, acceptance based interventions, which promote nonjudgmental acceptance of anxious thoughts and feelings, may allow students to conserve cognitive resources that can be used to focus on the task at hand and maximize performance. To explore these possibilities, a sample of 88 university students were randomly assigned to receive one 2-hour acceptance based behavior therapy intervention (ABBT), cognitive therapy intervention (CT), or healthy living intervention (HL). Following the intervention, participants received anxiety inducing instructions and were administered three computerized working memory tasks. Finally, participants completed self report questionnaires. The results of this study demonstrated that participants in the ABBT group had significantly better performance on the digit span forward and Stroop tasks compared to participants in the CT or HL groups. Furthermore, the ABBT group demonstrated the lowest levels of cognitive interference, while demonstrating the highest levels of psychological flexibility and mindfulness comp (open full item for complete abstract)

Committee: William O'Brien Ph.D (Advisor); Marilyn Motz Ph.D (Other); Clare Barratt Ph.D (Committee Member); Abby Braden Ph.D (Committee Member) Subjects: Clinical Psychology

Master of Arts, The Ohio State University, 2017, Psychology

Evidence to date suggests that a higher level of positive emotion is generally associated with improved psychological health (e.g., Tugade, Fredrickson, & Barrett, 2004). However, the specific features characterizing the ways in which upregulation of positive emotion is associated with good psychological functioning are less understood. I investigated how three factors may link regulation of positive emotions to greater psychological health: 1) the presence of both a large repertoire and persistent use of regulation strategies; 2) a “match” between the features of a situation and the strategy used; and 3) the use of specific categories of regulatory strategies, such as expression (capitalization), and less use of suppression. One-hundred and thirty-four undergraduates (mean age = 19.22; 73% female; 78% Caucasian) indicated the strategies they would use to maintain or improve their mood in response to eleven hypothetical positive situations. After their initial response, participants were prompted four more times to report how they would respond if their initial strategy was not working. Participants then completed a battery of self-report measures assessing psychological health variables, including measures of positive emotion and psychopathology. Coders rated the quality (effectiveness) of each strategy and assigned them to categories. Coders also rated each situation for its degree of ambiguity (how ambivalent the situation was), and whether it represented a more hedonic (i.e., short-term pleasure) or eudaimonic (i.e., long-term meaning) form of well-being. Data were analyzed with a series of correlations and regression models using the three factors above as predictors and the psychological health (PH) measures as criterion variables. Repertoire was associated with several indices of positive emotion, but was unrelated to measures of psychopathology. In contrast, persistence was unrelated to PH, except for an inverse association with intensity of positive emotion (open full item for complete abstract)

Committee: Jennifer Cheavens (Advisor); Daniel Strunk (Committee Member); Baldwin Way (Committee Member) Subjects: Clinical Psychology; Psychology

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2017, Psychology/Clinical

I designed this study to assess the acceptability of 12 harm reduction interventions by American addiction treatment professionals, the availability of each intervention, and the association between professionals' reported acceptance and their stigmatizing attitudes (i.e., authoritarianism and benevolence), psychological flexibility, and burnout (i.e., emotional exhaustion, depersonalization, and personal accomplishment). I recruited a sample of 257 members of NAADAC, the Association for Addiction Professionals, to complete web-based questionnaires. Depending on the intervention and the severity of the client's substance use disorder diagnosis (mild-moderate or severe using DSM-5 criteria), 63% to 90% of participants rated five behavioral and three pharmaceutical interventions as acceptable. Smaller proportions (27% to 52%) rated limited or moderate use of cannabis, opioids, cocaine/crack cocaine, and amphetamines as acceptable. Whatever their acceptability, interventions were not available from most providers or their agencies. Exploratory factor analyses suggested two subscales of harm reduction interventions: 1) behavioral and pharmaceutical interventions and 2) limited or moderate use goals. Regression analyses revealed that higher benevolence and lower depersonalization significantly predicted greater acceptance of behavioral and pharmaceutical interventions for individuals diagnosed with a mild-moderate substance use disorder. Higher benevolence, higher emotional exhaustion, and lower depersonalization significantly predicted greater acceptance of behavioral and pharmaceutical interventions for individuals with a severe substance use disorder. Subsequent exploratory regression analyses revealed that these characteristics were associated with acceptance of the behavioral interventions but not of the pharmaceutical interventions. There was no association between participants' psychological characteristics and their acceptance of limited or moderate use goals. Ac (open full item for complete abstract)

Committee: Harold Rosenberg Ph.D. (Advisor); William O'Brien Ph.D. (Committee Member); Steve Jex Ph.D. (Committee Member); Marc Simon Ph.D. (Committee Member) Subjects: Clinical Psychology

Doctor of Psychology (Psy.D.), Xavier University, 2017, Psychology

Dementia caregiving has the potential to adversely affect the caregiver's emotional and physical well-being. Based on the stress process model (Hilgemann et al., 2009; Pearlin, Mullan, Semple, & Skaff, 1990), dementia symptoms, or objective stressors, have the potential to result in emotional distress, or subjective stressors. Coping variables are influential in predicting subjective stressors, and research suggests coping abilities may moderate the relationship between objective and subjective stressors (Dunkin & Anderson-Hanley, 1998; Pearlin et al., 1990). Research suggests that Acceptance and Commitment Therapy (ACT) is a potentially useful framework for conceptualizing and addressing caregiver burden. This study examined measures of psychological flexibility as moderators of the relationship between objective and subjective stressors. Dementia caregivers were recruited from both online and in-person support groups, with a resulting sample of 121 participants. Objective and subjective stressors were found to be significantly correlated, r (119) = .41, p < .001. Additionally, multiple aspects of psychological flexibility were correlated with both primary objective stressors and subjective stressors. The four measures of aspects of psychological flexibility were individually evaluated as potential moderators of the relationship between objective stressors and subjective burden. No moderating effect was found for any of the four measures of psychological flexibility. Future studies should focus on recruiting a more diverse and representative sample, and conducting a randomized controlled trial to evaluate the efficacy of ACT for dementia caregiver burden.

Committee: John Barrett Ph.D. (Committee Chair) Subjects: Aging; Gerontology; Psychology; Psychotherapy

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2017, Psychology/Clinical

Physical inactivity and sedentary behaviors independently contribute to the rise in preventable chronic illnesses and a decrease in overall wellbeing and workplace productivity. As a result, efforts to intervene and reverse the negative health, wellbeing, and occupational impact through movement promotion and physical activity interventions are imperative. This pilot randomized control trial compared an Acceptance and Commitment Therapy (ACT) approach to a traditional Education approach. All participants (ACT: N = 17; Education: N = 19) completed a four hour workshop with a three month follow-up. The current study found that both workshops positively and significantly impacted self-reported physical activity (minutes per week and days per week), satisfaction with life, feelings of depression, anxiety, and stress, job burnout, work role overload, ratings of their coworkers and opportunities for promotion, as well as psychological flexibility and mindfulness. While there were few differences between the ACT and Education approaches, the ACT workshop participants increased their satisfaction with their job relative to Education workshop participants. Additionally, analyses approaching significance suggest that both workshops demonstrated increases in minutes of exercise per day. An interaction effect that approached significance revealed that ACT participants increased their pedometer steps per day from baseline to follow-up while Education participants decreased their steps per day. While more research is needed, these preliminary findings support an Acceptance and Commitment Therapy approach for physical inactivity and sedentary behavior intervention as a promising alternative to traditional educational activity programs.

Committee: Robert Carels (Advisor); William O'Brien (Committee Member); Dara Musher-Eizenman (Committee Member); Tim Brackenbury (Other) Subjects: Psychology

Doctor of Philosophy, University of Akron, 2012, Counselor Education and Supervision

The purpose of this study was to add to the empirical literature in the growing area of psychological flexibility. Specifically, this study investigated the Buddhist practices of nonattachment, self-compassion, and meditation as they related to the Acceptance and Commitment Therapy (ACT) construct of psychological flexibility among Buddhists. In addition, it was examined whether differences existed in levels of psychological flexibility among Buddhists and other religious and spiritually oriented individuals. Buddhist participants (N = 299) completed the Acceptance and Action Questionnaire – II (AAQ-II), Nonattachment Scale (NAS), Self-Compassion Scale – Short Form (SCS-SF), and a demographic questionnaire. Non-Buddhist participants (N=303) completed the AAQ-II and demographic questionnaire. Although findings indicated significant differences in degrees of psychological flexibility between Buddhists and non-Buddhists, the actual difference in mean scores was very small. Number of years of regular meditation practice, nonattachment, and self-compassion contributed to a significant degree of variance in degree of psychological flexibility among Buddhists, while the overall model was significant, accounting for (R2) 42.2% of the variance in psychological flexibility. Implications of results for clinical practice and counselor education, along with recommendations for future research are discussed.

Committee: Cynthia A. Reynolds Dr. (Advisor); Ingrid Weigold Dr. (Committee Member); Sandra Perosa Dr. (Committee Member); Robert Schwartz Dr. (Committee Member); Sean Cai Dr. (Committee Member) Subjects: Counseling Education; Mental Health; Psychology; Psychotherapy; Religion; Therapy

Doctor of Philosophy, University of Akron, 2013, Counselor Education and Supervision

The purpose of this study was to investigate predictors of functional outcomes (physical and psychosocial daily functioning) and self-efficacy among persons with chronic pain. Specifically, the present study investigated whether mindfulness (observing, describing, acting with awareness, and accepting without judgment), psychological flexibility, and emotional intelligence predicted better overall daily functioning and greater self-efficacy in chronic pain patients. The sample (N= 148) consisted of individuals 18 years of age or older who have struggled with a chronic pain condition for more than three months and who were seeking treatment in a pain management treatment center in a Midwestern state. Participants completed the following measures: Demographic Questionnaire, Kentucky Inventory of Mindfulness Scale, Acceptance and Action Questionnaire, Brief Emotional Intelligence Scale, Pain Disability Index, and Pain Self-Efficacy Questionnaire. Two multiple regression analyses were utilized, each controlling for demographic factors found to correlate with overall daily functioning or self-efficacy. Results indicated that psychological flexibility significantly predicted both daily functioning level and self-efficacy among chronic pain patients. Emotional intelligence significantly predicted self-efficacy (but not daily functioning level) among chronic pain patients. Mindfulness was not found to significantly correlate with either daily functioning level or self-efficacy. Implications for clinical practice, as well as counselor education and supervision were reviewed. Recommendations for future research were also provided.

Committee: Robert Schwartz Dr. (Advisor); Sandra Perosa Dr. (Committee Member); Varunee Sangganjanavanich Dr. (Committee Member); Kuldhir Bhati Dr. (Committee Member); Alan Kornspan Dr. (Committee Member) Subjects: Counseling Education