Ph.D. - Psychology

Permanent URI for this collectionhttps://hdl.handle.net/10125/2145

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Lay perceptions of contemporary American Jewish identity in the United States
(University of Hawai'i at Manoa, 2025) Pearson, Hannah I.; Sasaki, Joni Y.; Psychology
Jewish identity is uniquely made up of related but distinct components: religious identity, ethnic identity, and cultural identity. Religious Jewish identity refers to an individual’s religious practice and observance (e.g., Orthodox, Reform). Ethnic Jewish identity refers to an identity that includes both an ancestral and socialized component (e.g., Ashkenazi, Sephardi). Cultural Jewish identity, also sometimes referred to as secular Judaism, is used colloquially to describe holding some of the values and behaviors associated with Jewish identity but not practicing the religion. Depending on the individual, Jews living in the United States may identify as all three, a combination of two, or only one of these identity components. Being that religious and cultural identity are related to many psychological outcomes, including well-being and quality of life, differences in identification with each of these components of Jewish identity may lead to differences in psychological outcomes. Different components of Jewish identity likely impact the values that an individual holds and the behaviors they practice. Research on Jewish identity within the psychology of religion is limited, and Jewish identity is often examined without fine-grained distinction, lumping these components together into one broad ‘Jewish identity.’ While each specific form of Jewish identity is a valid way to identify as Jewish, some identities may be viewed more or less favorably by other Jewish individuals, at times resulting in “identity gatekeeping” or the act of denying someone else’s identity. The present project includes three studies to further understand contemporary Jewish identity in the U.S. by: 1) conducting qualitative interviews on participants’ lay perceptions of Jewish identity (N = 29), 2) examining how different forms of Jewish identity are related to psychological outcomes, values, and behaviors in a correlational survey (N = 216), and 3) experimentally testing whether situational threat can influence identity gatekeeping towards different Jewish targets among Jews (N = 251).
Understanding social anxiety among Asian Americans and European Americans: The role of appeasement
(University of Hawai'i at Manoa, 2025) Suh, Da Eun; Xu, Yiyuan; Psychology
Cross-cultural studies have consistently shown that there are ethnic group differences in social anxiety, with Asian-heritage individuals reporting higher scores on self-report measures compared to European-heritage individuals. Growing evidence indicates that appeasement, a process by which individuals pacify others to avoid conflict, may be an evolutionary factor that may be closely associated with social anxiety. Despite these theoretical implications, there is a lack of empirical studies that have integrated both cultural and evolutionary frameworks to investigate the ethnic differences in social anxiety. The present dissertation aimed to bridge this gap by exploring how appeasement may play a mediating role between ethnicity and social anxiety among Asian Americans, European Americans, and Korean nationals. However, Korean nationals were not included in the final analyses due to the incompatible sample properties. A total of 510 European Americans and 479 Asian American adults completed self-report measures assessing appeasement and social anxiety. Results of this study supported Keltner’s (1997) two-factor model of appeasement, indicating that anticipatory and reactive appeasement are distinct yet highly correlated constructs. Significant cultural group differences were found in both social anxiety and appeasement related constructs. A series of structural equation model found mediating roles of anticipatory and reactive appeasement in explaining the cultural group differences in social anxiety. These results suggest that cultural factors may shape the experiences and expressions of appeasement, which in turn influence the experience of social anxiety. Specifically, these findings underscore the importance of incorporating cultural framework when working with individuals with social anxiety, particularly for those from Asian-heritage backgrounds who may place a greater emphasis on appeasing others to maintain social harmony.
Prevalence and predictors of early onset eating disorders: A longitudinal investigation of the adolescent brain and cognitive development study
(University of Hawai'i at Manoa, 2025) Rozzell-Voss, Kaitlin Nicole; Latner, Janet D.; Psychology
The purpose of this dissertation is to address gaps in the eating disorder literature across three related studies. The planned studies will utilize data from the Adolescent Brain and Cognitive Development study, a large, multi-site, ten-year longitudinal study of 9–10-year-old children. This study is the largest long-term study of brain development and child health in the United States, and it includes data from clinical interviews, behavioral and neurocognitive tasks, and biospecimens of roughly 12,000 children. The first study plans to examine prevalence of early onset eating disorders over three timepoints, and demographic characteristics of the sample with eating disorders. The second and third studies aim to assess temporal risk factors of eating disorders; particularly, comorbid mental disorders and high risk behaviors. Past literature indicates high rates of psychiatric comorbidity among individuals with eating disorders, particularly mood, anxiety, and obsessive-compulsive disorders. While some literature indicates anxiety disorders and obsessive-compulsive disorder onset typically precedes the onset of eating disorders, associations between comorbid disorders and specific eating disorder subtypes remain unclear, and they have yet to be studied longitudinally prior to adolescence. Paper three is a longitudinal examination of the experiential avoidance model. Specifically, self-harm and suicidality are associated with a variety of disordered eating behaviors and may serve some of the same underlying functions. Previous longitudinal studies are relatively limited, and this is the first to examine these behaviors temporally among children. Taken together, these three studies aim to address the present lack of clarity in the literature on distinctive risk factors of various eating disorders among a large and diverse sample of children. Further, the present studies seek to clarify the nature of eating disorder psychopathology in youth, to improve the identification of individuals at risk for eating disorders, and to inform the development of improved prevention and treatment efforts.
Advancing our understanding of evidence-based practice implementation in school mental health setting
(University of Hawai'i at Manoa, 2025) Maesaka, Tristan; Nakamura, Brad; Psychology
School mental health programs critically deliver substantial mental health services to youth and adolescents, positioning school-based mental health providers as valuable agents for supporting the delivery of high-quality, evidence-based treatment approaches. Toward the goal of improving school-based mental health student outcomes, some systems have focused on providing school-based providers with intensive training and ongoing support in implementing evidence-based practice (EBP). While a burgeoning body of EBP implementation research exists for public sector mental healthcare institutions, less has been done to understand the specific implementation processes and outcomes in school mental health settings. This series of research helps to address this gap in knowledge about EBP implementation in school mental health by evaluating different components of a local system-wide education sector EBP training initiative. Empirical questions across this three-study series are organized to roughly reflect Aaron and colleagues (2011) Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, a conceptual model for conducting and describing EBP implementation initiatives in public sector service systems. Study 1 sought to further our understanding of community care practices in school mental health settings during exploration and preparation phases of implementation. Descriptive examination of school-based providers’ reported characteristics, intentions to use different therapeutic techniques, and previous clinical training prior to implementation revealed diverse provider profiles characterized by breadth, rather than depth of previous training experiences and treatment intentions. Study 2 focused on evaluating initial provider training in EBP occurring at the outset of the implementation phase, and found that following training, providers were more selective in their treatment approaches and endorsed significantly less techniques with minimal support from the evidence-base. There was also a differential effect between problem areas, such that providers more accurately selected anxiety-, but not disruptive behavior-related treatment techniques post training. Study 2 additionally examined factors that may contribute to changes in providers’ intentions to use techniques with regard to the evidence-base. Results indicated that while organizational implementation characteristics did not predict changes in treatment intentions, factors such as climate and citizenship behavior were associated with treatment approaches with less evidence-based support. Study 3 lastly examined predictors of providers’ participation in ongoing consultation sessions, a strategy meant to promote long-term EBP fidelity in the sustainment phase of implementation. Organizational and individual adopter characteristics explored in this study did not predict consultation completion; however, more positive perceptions of EBP behavior among organizational staff and being in rural areas were associated with more training and consultation disengagement.
The examination of multidimensional psychological flexibility inventory: Application of factor analysis and item response theory
(University of Hawai'i at Manoa, 2025) Jo, Duckhyun; Masuda, Akihiko; Psychology
Background and Objective: The Multidimensional Psychological Flexibility Inventory (MPFI; Rolffs et al., 2018) is a recently developed self-report measure of psychological flexibility and psychological inflexibility. Using factor analyses and an item response theory (IRT) approach, my dissertation project aimed to examine and validate the MPFI with a racially and ethnically diverse sample of adults in Hawaiʻi, and to develop and validate a new shorter-version of MPFI (MPFI-S). Method: The present dissertation project consists of two phases (i.e., Study 1 and Study 2) with two convenience samples of racially diverse participants recruited from undergraduate psychology courses at the University of Hawaiʻi at Mānoa. The first phase (Study 1: n = 719) had five specific foci. First, the factor structure of the MPFI was examined through exploratory factor analysis (EFA) and confirmatory factory analysis (CFA). Second, following the framework of IRT, the functions of each item across purported trait levels were investigated. Third, the study assessed whether the original MPFI maintains measurement invariance at the structural level across gender and race/ethnicity groups. Fourth, preliminary validity evidence was gathered. Fifth and finally, a shorter version of the MPFI (i.e., MPFI-S) was preliminarily proposed by identifying three items for each dimension of psychological flexibility and psychological inflexibility, respectively. Following the completion of phase 1, Study 2 with another sample (n = 698) examined and psychometrically validated the short version of MPFI (MPFI-S). More specifically, the factor structure of MPFI-S was compared to that of MPFI derived from Study 1, and item functions were subsequently analyzed with the IRT application. Finally, the study preliminarily investigated the convergent validity as well as divergent validity of the specific domains of psychological flexibility and inflexibility measured by the MPFI-S. Results: The findings of Study 1 support the factor structure of MPFI that was confirmed by the original MPFI psychometric study (Rolffs et al., 2018). More specifically, the factor structure found in Study 1 consisted of two higher-order factors, each having six respective first-order factors. Additionally, measurement invariance was found for gender and race/ethnicity categories, and IRT analysis indicated that most items demonstrated optimal functioning at the item level. Furthermore, generally, correlational findings supported the construct validity of MPFI scores. Finally, based on these findings and a review of item contents, a 36-item MPFI-S was preliminarily developed. Study 2 results revealed that the MPFI-S is a theoretically and psychometrically sound measure, which is comparable to the original MPFI. More specifically, Study 2 confirmed the presence of two higher-order factors in the MPFI-S, each having six corresponding first-order factors. IRT analyses also indicated that all items in the MPFI-S and their categories functioned optimally. Finally, correlational findings preliminarily supported the construct validity of MPFI-S scores at the first-order factor levels. Discussion: With Hawaiʻi-based samples of racially diverse college students, my dissertation project offers preliminary evidence of the MPFI and MPFI-S as psychometrically sound self-report measures of psychological flexibility and inflexibility.
STRENGTH-FOCUSED TREATMENT AND CLINICAL OUTCOMES FOR YOUTH IN PUBLIC MENTAL HEALTH CARE
(University of Hawai'i at Manoa, 2024) Turner, Emilee; Mueller, Charles W.; Psychology
Purpose. Research suggests focusing on strengths in therapy is associated with positive outcomes and might increase the efficacy of various evidence-based treatments. However, there is limited research on the use of strength-focused treatment in youth clinical populations. This program of research examined whether and to what extent therapeutic focus on strengths was associated with relevant treatment outcomes for youth receiving public mental health care (PMHC) services. Included herein is an introductory chapter, three studies in manuscript format, and an overall conclusion. Method. Hierarchical modeling was used to examine archival clinical data collected between 2006-2018 from two treatment formats in a state-wide youth PMHC system. Therapeutic focus on strengths was measured as a proportion of overall treatment targets endorsed by therapists that were strength-based (strength proportion [SP]). Results. Study 1 found greater SP was significantly associated with increased likelihood of successful treatment discharge in a sample of youth (N = 1,841) receiving standards-based intensive-in-home services. More broadly sampling the dataset available from Study 1, Study 2 (N = 2,362) found greater SP was significantly associated with better end of treatment functioning, and higher monthly treatment progress. Finally, results from Study 3 replicated findings from Study 1 and Study 2 in a sample of youth (N = 911) receiving Multisystemic Therapy, an implemented evidence-based intensive-in-home treatment. Study 3 found significant associations in the predicted directions between greater SP and all three previously studied outcomes. Conclusions. Findings from this program of research extended the strengths intervention literature to include youth with significant mental health challenges. If replicated and then extended into experimental designed studies, these results suggest that youth in PMHC might benefit when therapists incorporate strength-focused treatment strategies.
Gifts for the Dead: Maya Children's Developing Theory of Mind and Their Participation in Día de los Muertos
(University of Hawai'i at Manoa, 2024) Bowen, Kristy Elizabeth Jo; Maynard, Ashley; Psychology
This study sought to understand the ways in which participation in cultural activities with others may shape Maya children’s development of Theory of Mind (ToM). During Day of the Dead celebrations in Mexico, Maya children participate by helping adults to prepare food, drink, and other offerings that deceased relatives enjoyed during their lifetime. This requires understanding the desires and preferences of other minds including those only representational or symbolic in nature. This study hypothesized that children with greater ToM ability would be better able to engage in a simulated gift giving task where the object was to give a pretend spirit its preferred gifts. Interviews with pairs of Tzotzil Maya children and their mothers were conducted in Navenchauc, Mexico. Interviews with mothers assessed what they believed their children knew about the holiday and its traditions. Interviews with children assessed their knowledge of Day of the Dead traditions and their performance on ToM tasks. Analysis examined the relationship between children’s competency with a simulated Day of the Dead gift giving task and their ToM ability in addition to the relationship between ToM and other cultural variables. Children who performed better in a classic ToM task were found to be more likely to give the spirit its preferred gifts.
Social Anxiety, Implicit Theories, and Psychosocial Functioning in European Americans and Asian Americans
(University of Hawai'i at Manoa, 2024) Stacy, Taylor; Xu, Yiyuan; Psychology
Previous research has identified ethnic differences in self-reported social anxiety symptoms between Asian Americans and European Americans. The current study examined how these two groups may differ in implicit theories of social anxiety as well as their experiences of psychosocial correlates that are often associated with social anxiety. 976 Asian American and European American adults completed questionnaires about their social anxiety, implicit theories of social anxiety, loneliness, self-esteem, positive and negative affect, and well-being. Multi-group confirmatory factor analyses and latent group mean comparisons were used to examine measurement invariance and mean group differences in the variables of interest. Results of this study indicated that 1) many of the measures used in the study were non-invariant, suggesting important cultural differences in constructs of interest; and 2) European Americans and Asian Americans significantly differed in their levels of social interaction anxiety, social performance anxiety, and negative affect. These findings help explain ethnic differences in social anxiety, implicit theories, and psychosocial correlates.
Effects OF Mestizaje Racial Ideologies ON Perceptions OF Discrimination In Latinx Populations
(University of Hawai'i at Manoa, 2024) Diaz, Salena; Pauker, Kristin; Psychology
Mestizaje Racial Ideologies (MRIs) suggest that most Latinxs share a mixed-race ancestry and are thus incapable of within-group discrimination. However, the potentially discriminatory effects of MRIs have not yet been experimentally tested. With this dissertation, I sought to unpack whether exposure to MRIs mask instances of discrimination in Latinx populations with heritage from the Caribbean and Atlantic coast regions of Latin America. To test this question, Latinx participants (S1a; N = 131) and non-Hispanic White participants (S1b; N = 133) interacted with a social media page endorsing MRIs, or an identity-relevant control social media page, before indicating whether they would support an Afro-Latino employee’s discrimination lawsuit against his White Latino employer. Study 2 (N = 126) examined the effects of MRIs compared to a control social media page that was not identity-relevant. Study 3 (N = 196) compared the discriminatory effects of MRIs to colorblindness. Results across studies indicated that exposure to MRI content increased Latinx participants’ perceptions of company fairness compared to neutral or colorblind content (S2, S3), particularly if they personally endorsed MRIs (S1a). The same patterns were demonstrated with non-Hispanic White participants, although they were not statistically significant (S1b). Perceptions of fairness tended to negatively predict perceptions of discrimination in the employee’s lawsuit. Overall, this work proposes MRIs as a racial ideology operating within Latinx populations, and demonstrates the first experimental evidence of their potentially negative consequences.
Investigation of affordance perception across different task types and presentation contexts
(University of Hawai'i at Manoa, 2024) Kim, I sak; Sinnett, Scott; Psychology
Growing evidence from behavioral and neurological studies of action perception indicates that the cognitive system partly supports action based on afforded features, even when the observer does not intend to act. This perception-action coupling system, known as affordance perception, is commonly explored using Stimulus-Response Compatibility (SRC) paradigms. This dissertation used the SRC paradigm to explore how affordance perception can be modulated in various experimental contexts. Specifically, this dissertation aimed to investigate three key aspects: (i) the effects of affordance perception on oculomotor behaviors, specifically its impact on search performance for categorically related objects, (ii) the interaction of affordance perception with the observer’s motor experience when discriminating faces of renowned athletes, and (iii) the modulation of affordance perception across different stimulus presentations, affording increasing levels of visual dimensions. The first study assessed the degree to which categorically related objects that do not include any explicit action are still afforded by semantic congruence, and how affordance might facilitate visual search when responding with the matching response effector. Findings indicated that affordance extends beyond simple object recognition, consistently influencing performance in a change blindness flicker paradigm based on the afforded response effector and the types of changes the target underwent. This demonstrates that affordance perception significantly impacts complex visual tasks, such as detecting changes beyond basic object recognition. The second study explored whether the presentation of well-known athlete (e.g., renowned soccer player) leads to an affordance effect when using a compatible (foot pedal) response. This idea rests on the concept that knowledge of another person’s highly practiced actions activates similar motor system actions in the observer. Both novice and elite (NCAA) athletes viewed renowned athletes in action or nonaction settings to determine how knowledge and athletic expertise influence affordance perception. Results showed that motor expertise significantly modulates affordance perception, as demonstrated by the reduced social contrast effect in elite athletes. This highlights the dynamic nature of affordance, shaped by individual differences in expertise and skill. The final study extended these findings by exploring how different visual presentations influence behavior and advancing methodological approaches in affordance perception research. Affordance perception was compared across two modes of stimulus presentation: computer-based 2D and virtual reality (VR). It was hypothesized that VR, with its higher ecological validity and immersive environment, would enhance cognitive performance. The findings showed that VR presentations led to faster reaction times and more pronounced affordance effects, likely due to the increased depth cues and realism of 3D stimuli. However, the higher error rates in VR also indicate greater task difficulty, suggesting the need for further investigation into the factors contributing to these effects. Together, this dissertation provides novel behavioral evidence that affordance can be modulated by categorical and contextual information and task demands, with the observer’s semantic knowledge, embodied experience, and modes of visual presentation influencing perception-action coupling.
HOʻOMANA I KA MAULI OLA: TRANSFORMATIVE APPROACHES TO DECOLONIAL AND INDIGENIZED WELLBEING FOR KĀNAKA ʻŌIWI
(University of Hawai'i at Manoa, 2024) Qinaʻau, Joanne; Papa, Anthony; Psychology
Background and Objectives: Wellbeing is a construct important across disciplines, vital in supporting psychological health. However, wellbeing for Kānaka ʻŌiwi (Native Hawaiians) with behavioral health concerns is not well understood, and current measures are not well suited for use with Indigenous groups that experience settler colonialism and value ecological pono in spiritual pilina with ʻāina and other kūpuna. As such, a decolonial (and therefore indigenizing) mixed-methods approach using the transformative paradigm was employed to understand wellbeing theory, measurement, and empowerment for Kānaka ʻŌiwi. Goal 1 was to identify an emergent theory of wellbeing for Kānaka ʻŌiwi with behavioral health challenges (i.e., with determinants, states, outcomes). Goal 2 was to design and gather preliminary data for a wellbeing measure for Kānaka ʻŌiwi. Goal 3 was to empower Kānaka ʻŌiwi to engage in wellbeing-supportive behaviors. In alignment with decolonial approaches, the present project takes a critical lens to psychology’s role in the wellbeing of Kānaka ʻŌiwi. Methods: To achieve these goals, Goal 1 used qualitative community-based participatory action research (N = 39), grounded theory, and a new intersectional method, ho‘omana i nā leo. For Goal 2, items were created from prior models of Kanaka ʻŌiwi mauli ola and the Goal 1 theory and validated using three methods: an expert panel review (N = 5), in-depth cognitive interviews (N = 5), and a mixed-methods online validation survey (N = 166). Inferential statistics were used to analyze validity of the measure. Finally, Goal 3 used participatory methods resulting in the creation of a mauli ola empowerment material for Kānaka ʻŌiwi. Results: An emergent theory of wellbeing for Kānaka ʻŌiwi with behavioral health challenges was identified (Ke Ao Nōweo 'Ula), along with implications for further interdisciplinary research and application. In support of Goal 2, a preliminary measure of decolonial wellbeing (Kukui Mālamalama) was developed and tested for multiple forms of validity. Results from validity testing suggest good face validity indicated by clarity scores, content validity indicated by relevance scores, and convergent and divergent validity indicated by correlations, t-tests, and one-way ANOVAs. A directory of wellbeing resources for Kānaka ʻŌiwi was created in response to participatory data and is publicly available (E Ho'omana me nā Kumu Waiwai: Empowering through Resources).
Connections of Wellness with Power and Privilege in the Contexts of Lived Experiences and Employee Well-being
(University of Hawai'i at Manoa, 2024) Combs, Sarah; Baker, Charlene; Psychology
Wellness is a multidimensional construct that includes different dimensions that provide additive value to one’s life. Wellness is more than the absence of illness and wellness within a workplace can decrease stress and mitigate burnout. Whether or not someone is able to or would like to prioritize wellness is influenced by identities and life experiences. Considering the various levels of the ecological model and the influence of power and privilege on identity and experiences, this phenomenological study sought to understand the connections between power, privilege, and wellness within the context of a single organization in Honolulu, Hawaiʻi. Three frameworks were used to understand this complex topic: the Substance Abuse and Mental Health Administration’s Model of Wellness, which utilizes eight dimensions of wellness; Hays’ ADDRESSING Model, which incorporates ten identity constructs; and McLeroy’s Ecological Model which incorporates five levels of influence. This phenomenological study examined connections between power and privilege broadly, how intersecting identities influence wellness perceptions, how people’s lived experiences impact their occupational wellness, and how organizations can support the specific wellness needs of those with lived experiences that mirror the community they serve. Overarching results suggested strong connections between time, money, and the impact of less money/less time as important in wellness. Results also suggested a need for an intersectional approach to program development that considers how identities and experiences conflict or compound with one another to help or hinder the prioritization of wellness. Overall, study participants’ lived experiences positively affected occupational wellness through a sense of living their purpose, connecting with others, and sharing unique insights that can only be learned experientially. A few challenges working in communities with similar lived experiences as the employee also arose, especially concerning creating boundaries and a work-life balance, coping with the mental toll of the work, and dealing with trauma. These negative effects were generally mitigated by a strong organizational culture that prioritizes wellness and supportive supervisors who proactively support staff wellness. Utilizing a trauma informed approach to understanding wellness needs supports an organizational culture where people feel safe, they are supported by managers and the organization, and they can bring their full authentic lives that integrate previously marginalized identities. Two recommendations arose from this research. The first is for the organization to dispose of predetermined definitions of what constitutes wellness and let staff self-identify what wellness means to them. This will help create empowering and trusting atmospheres where people can utilize their tools to promote wellness that make sense on an individualized basis. The second recommendation is for the organization to provide supportive training for supervisors to intentionally integrate principles of trauma-informed care into their leadership as they support wellness in their departments. The sample of this study was skewed toward individuals who believed in the importance of wellness and, therefore, is not representative of all barriers organizations will face in terms of supporting staff wellness. Future research could include assessing experiences of people who do not believe in the importance of wellness or examining specific intersectional experiences of how certain communities experience wellness.
An Examination of Parental Behavioral Intentions to Use Youth Evidence-Based Services
(University of Hawai'i at Manoa, 2023) Choy, Spencer; Nakamura, Brad J.; Psychology
Research on parental consumers of youth mental health evidence-based services (EBS) is developing quickly. A focus on treatment attitudes and structural barriers has dominated such scholarship; however, such research is not necessarily fully informed by relevant theoretical frameworks that have the potential promise for powerful application(s). Ajzen’s (1991) theory of planned behavior (TPB) is a widely-examined theoretical framework to understand and predict behavior through behavioral intentions that are influenced by attitudes, subjective norms, and perceived behavioral control. Although the TPB has generally been used to predict physical health behaviors, some researchers have applied it to adults to understand their intentions and behavior to seek mental health services. Furthermore, over the past several years, these types of studies have even expanded to parental intentions for seeking general and evidence-based youth mental health services. Thus, this study aimed to understand parental intentions to seek and utilize evidence-based services through structural equation modeling (SEM). With a diverse community sample of 351 parents, results indicated that none of the three models, including the original TPB model (model one), fit the data well. Across the models, there was no significant positive effect for parental help-seeking attitudes about youth mental health services on their intentions to seek EBS. However, findings consistently showed significant and positive direct effects of subjective norms and perceived behavioral control on evidence-informed action. In the expanded models (models two and three), there was no significant and negative direct effect of parental perceptions of treatment barriers on intentions, but there was a significantly negative indirect effect on intentions through perceived behavioral control. Additionally, caregivers’ perceived knowledge about youth services had a significant and positive direct effect on their intentions. Regarding parental empowerment about service system navigation, there was a counterintuitive negative direct effect on evidence-informed action in model two, and an expected positive indirect effect on intentions through perceived behavioral control in model three. Although none of the measurement models fit the data well, the original TPB model fit the data the best. These findings provide considerations for further refinement of frameworks in regards to understanding parental intentions to seek and utilize EBS for their children’s mental health challenges.
Treatment Focus Diffusion And Client Outcomes In Public Mental Health Care For Youth
(University of Hawaii at Manoa, 2023) Holmes, Kalyn; Mueller, Charles W.; Psychology
Research conducted in public mental health care (PMHC) suggests that therapists often divide treatment focus across several co-occurring issues (both diagnostic and non-diagnostic) over the course of treatment. This spreading of treatment focus across multiple concerns is referred to as treatment focus diffusion (TFD). There is emerging evidence that maintaining a central focus in treatment is an important element of effective services and that higher levels of TFD are associated with poorer client outcomes. Additional research is needed in order to determine the robustness and generalizability of TFD as a predictor of clinical and system outcomes. The program of research described in this dissertation aims to investigate the extent of TFD as it occurs in different service formats in PMHC settings (e.g., standards-based in- and out-of-home services and implemented evidence-based therapies) and its association with relevant outcomes. Data collected as part of routine quality assurance initiatives in a local state-wide child and adolescent mental health care system were examined using multi-level linear and logistic regression analyses including statistical controls for potential covariates.The following dissertation includes an introductory chapter to orient the reader to the theoretical and empirical background relevant to all four subsequent studies. Chapters two through five include four separate studies in manuscript submission format. The first study showed that in implemented Multisystemic Therapy (MST), an evidence-based treatment package, therapists reported a significantly lower average TFD level than those in a standards-based intensive in-home (SB-IIH) service format when accounting for other indicators of case complexity. The first, second, and third studies found that higher TFD was related to poorer outcomes in these two service formats, whether measured by therapist reported progress ratings, change in functional impairment, or longer-term subjective indicators of return to services and cost to the system. Across all three of these studies, the relationship between higher TFD and poorer outcomes tended to be stronger in the implemented MST service format than in the SB-IIH format. In the final study (Chapter 5) we examined TFD’s relationship to all previously identified outcomes in an out-of-home, community-based residential (CBR) service and in Functional Family Therapy (FFT), another implemented evidence-based treatment. This study found that CBR therapists reported relatively high levels of TFD while FFT therapists reported relatively low TFD. Second, more TFD was significantly related to poorer immediate outcomes (monthly average progress ratings and functional improvement over the course of the study episode) in the CBR service format. In FFT, higher TFD was significantly related to higher odds of returning to services. Across all four service formats, all but one of the TFD/outcomes relationships were in the expected direction. These results suggest that TFD might be a useful early indicator of later treatment success in PMHC. These services generally have a high rate of use and are often utilized by historically underserved clientele. Thus, it is important to deepen our understanding of treatment elements related to clinical outcomes in PMHC that might be amenable to improvement such as TFD.
Parents’ Marital Context And Adjustment In Children With Intellectual Disabilities
(University of Hawaii at Manoa, 2023) Conover, Olivia; Floyd, Frank J.; Psychology
Parents’ marital context, or the quality of their marital relationships and marital transitions across time, appears to affect emotional adjustment for typically developing children. However, little research has examined the impact of both marital quality and marital transitions on children’s development of adaptive skills, especially for children with intellectual disabilities. The current study examined how parents’ marital quality, status, and transitions over a 14-year period were related to behavior problems and adaptive behavior in children (n = 153, age 6 to 18 at the first wave of measurement) with mild or moderate intellectual disability, using parent reports at four time points. Parent’s marital quality, status, and experience of divorce or remarriage were considered at the start and the end of the study period. It was predicted that being happily married, as opposed to being unhappily married or single, would predict children’s concurrent and future lower levels of behavior problems and greater adaptive behavior. The experience of marital transitions was hypothesized to predict greater behavior problems and lower adaptive behavior skills at the final wave of measurement. Being unhappily married, single, or experiencing a marital transition was also hypothesized to predict greater growth in behavior problems and less growth in adaptive behavior over the course of the study. Multiple linear regression and multi-level modeling analyses were used. Being in a happily married family predicted children’s concurrent and future lower levels of behavior problems and greater adaptive behavior skills. Marital satisfaction was inconsistently related to rate of change in outcomes, but children in happily married families generally showed better adjustment across all time points. Marital transitions were not associated with behavior problems, but were associated with some aspects of adaptive behavior. These results provide evidence for the likely importance of parents’ marital context for the long-term adjustment of children with intellectual disabilities.
Predicting Treatment Outcomes With Caregiver-youth Discrepancy Reporting Patterns In A Multiethnic Public Mental Health Sample
(University of Hawaii at Manoa, 2023) Laba, Tommie Mitsuko; Nakamura, Brad J.; Psychology
Multi-informant reporting has long been recommended as one of several best practices for assessing youth psychopathology. In children’s mental health, this approach includes gathering information from the youth as well as others in their ecology. Gathering information from multiple perspectives yields benefits through broadening available data and examining cross-informant reporting patterns that might affect assessment findings and treatment recommendations. However, for many decades it has been acknowledged that in both clinical and research settings, informants often provide diverging perspectives when reporting about youth emotional and behavioral concerns. These diverging perspectives have been studied extensively and are commonly referred to in the literature as “informant discrepancies” (or low cross-informant rater agreement). More recently, researchers have found that such discrepancies at treatment intake have been linked to poor youth outcomes and responses to intervention. In line with this area of work, the current study examined the relation between caregiver-youth informant discrepancies at treatment intake and youth functional impairment at discharge using a multiethnic public mental health sample of 366 caregiver-youth dyads. Prior to investigating the current study’s major aim, preliminary confirmatory factor analyses involving the Ohio Scales Problem Severity domain was conducted to inform subsequent analytic strategies. These confirmatory factor analysis results suggested utilizing both the Total Scale and Subscale (i.e., Externalizing, Delinquency, Anxiety, and Depression) scores of the Problem Severity domain for my major aim, which was to examine the extent to which caregiver-youth discrepancy scores at intake into a mental health system predicted youth functional impairment at treatment discharge. Overall, while there were slightly mixed findings across Total Scale and Subscale scores, results generally supported an association between increased levels of youth functional impairment at treatment discharge with both (a) high levels of caregiver-youth agreement (i.e., high caregiver and high youth Problem Severity domain scores) and (b) higher caregiver-reports of problem severity compared to their respective youth at intake. The present findings contribute to the current literature by utilizing the latest statistical approach recommendations for research in this area, incorporating measurement schemes that include identical item content across reporter versions, and including an ethnically-diverse public mental health sample of youths and their caregivers. Implications and suggestions for future research are discussed.
Examination of the feasibility, acceptability, and effectiveness of a group program for internalized weight bias among undergraduate women
(University of Hawaii at Manoa, 2023) Marshall, Rachel; Latner, Janet D.; Psychology
Objective: Internalized weight bias is experienced by young women across the weight spectrum and contributes to the development of eating disorders. Interventions have demonstrated preliminary success in reducing weight self-stigma and disordered eating, but findings have only applied to individuals with overweight and obesity and little is known about the mechanisms of change. A mediation model was developed to show how interventions for internalized weight bias indirectly improve eating behaviors by reducing drive for thinness and body image avoidance. Support for the model was obtained in a cross-sectional pilot study. Informed by the mediation model, a three-session cognitive-behavioral group program was developed to increase the potency of treatment for internalized weight bias. The following three studies examined the mediation model and group program among racially and ethnically diverse undergraduate women with wide-ranging body sizes. Method: Study 1 (N = 179) was a cross-sectional study designed to replicate the pilot study and provide additional support for the theoretical model underlying the group program. Study 2 (N = 5) was a pilot intervention to examine the feasibility and acceptability of the treatment in a single group of undergraduate women. Study 3 (N = 55) was a randomized controlled trial (active vs. waitlist control) that evaluated the feasibility, acceptability, and effectiveness of the program in improving internalized weight bias, disordered eating, drive for thinness, body image avoidance, body dissatisfaction, body acceptance, thin ideal internalization, and general distress. Participants completed measures at baseline, post-treatment, and six-week follow-up. Results: Study 1 confirmed mediation of the relationship between internalized weight bias and disordered eating by drive for thinness and body image avoidance. Treatment adherence and group leader competence were high in Study 2 and Study 3. The program was well-received, as evidenced by high rates of attendance and retention. Feedback from participants indicated that the program was informative, acceptable, and impactful. Participants in the active condition reported improvement on all outcomes relative to the waitlist control condition. Within the combined sample, there was clinically meaningful improvement on internalized weight bias, disordered eating, drive for thinness, body image avoidance, body dissatisfaction, body acceptance, thin ideal internalization, and general distress from baseline to post-treatment. Despite some rebound in body image avoidance, significant improvement remained in all outcomes at follow-up. Discussion: The current research revealed how interventions for internalized weight bias may indirectly improve eating disturbances. Results also showed that a brief cognitive-behavioral group program was feasible, acceptable, and effective in improving internalized weight bias, eating disturbances, and other psychological outcomes among undergraduate women. Findings demonstrated that women with diverse cultural backgrounds and body sizes ranging from healthy to obese benefitted from a weight self-stigma reduction intervention. If the observed improvements were sustained over time, additional benefits could emerge, such as the reduced incidence of eating disorders.
A Psychometric Investigation Of The Family Empowerment Scale
(University of Hawaii at Manoa, 2023) Vincent, Amanda M.; Nakamura, Brad J.; Psychology
Since the advent of the consumer movement roughly 30 years ago, professionals across helping disciplines have lauded empowerment as a critical piece to effective consumer-centered services. Within youth mental health in particular, quality improvement initiatives and flagship service models have been effortfully built with empowerment as a core tenet. Notably, these clinical efforts largely outpaced any consensus on how to clearly define or measure empowerment, and consequently, empirical investigation of empowerment’s relationships to service engagement, processes, and outcomes is relatively underdeveloped. Koren and colleagues’ Family Empowerment Scale (FES; 1992) is the first general empowerment measure ever created and remains the primary instrument for assessing caregivers’ empowerment in the context of their seeking supports for children with emotional disabilities; however, questions about its structure, scoring, and performance, particularly with ethnic minority caregivers, remain unresolved even decades after its conception. The current study therefore examined the FES’ factor structure, reliability, and validity as applied to a community sample of 354 ethnically diverse caregivers from Hawaiʻi. Although the competing four-factor, three-factor, and three-factor bifactor models were all identified to provide an acceptable fit to this sample’s data, the three-factor bifactor model yielded the best fit indices. Furthermore, omega hierarchical estimates indicated the majority of FES response variance was attributable to participants’ differences on a general empowerment factor (as opposed to empowerment within the family, service system, or community/political subdomains). The identified FES General scale and three subscales’ reliabilities all fell in the excellent range. Regarding convergent validity, all FES scales showed promising associations with purported determinants of treatment-seeking behavior, including Help-Seeking Intentions, Knowledge, and Perceived Behavioral Control; however, more unexpected patterns emerged between the FES Community/Political scale and scales measuring Help-Seeking Attitudes and Perceived Treatment Barriers. Overall results contribute to the FES psychometric literature by furthering evidence of its potential bifactor structure, highlighting its applicability to Asian and Pacific Islander caregivers, and replicating observed relationships with other variables associated with mental health service uptake.
Acceptance and commitment therapy as a transdiagnostic, process-based approach to treatment for mental health concerns: A mechanism of change analysis using a multiple baseline design across participants
(University of Hawaii at Manoa, 2023) Spencer, Samuel David; Masuda, Akihiko; Psychology
Although much research exists concerning outcomes of evidence-based psychosocial interventions, relatively less is known about the processes, or mechanisms, of change underlying these interventions. One evidence-based intervention that is commensurate with a process-based, transdiagnostic approach to treatment development is acceptance and commitment therapy (ACT). ACT targets the functionally and contextually defined, systematically manipulable behavioral processes of change that underlie topographically diverse symptomology, and it does so to promote a client’s adaptive behavioral functioning in important life domains. Key exemplars of such processes are engaged living (EL) and experiential avoidance (EA). Using a multiple baseline design across participants, the current study investigated the effects of individually delivered ACT in adults with varied mental health concerns, while simultaneously examining EL and EA as potential processes of change on an ongoing basis throughout the course of ACT. Three university students who endorsed mental health concerns associated with elevated levels of EA participated in the present study and received the proposed 10-week ACT intervention. Results of daily measured primary outcomes (i.e., clinically relevant behavioral excesses and deficits) and process of change variables (i.e., EL and EA), along with weekly and pre-, mid-, post-treatment, and 3-month follow-up self-report measures, provided equivocal support for the efficacy of the ACT intervention. Similarly, cross-lagged correlation analyses did not reveal evidence of temporal precedence of change in process over outcome variables (or vice versa), although these findings are still consistent with an ACT theory of behavior change. Further research should continue to examine the processes of change (and their temporal sequencing) within ACT for transdiagnostic mental health concerns, as well as the relationship between process of change variables and behavioral outcomes more generally.
Do Ethnic And Intersectional Identities Help Lgbtq+ Bipoc People Cope With Discrimination?
(University of Hawaii at Manoa, 2023) Brightly-Brown, Shari Antoinette; Floyd, Frank J.; Barile, John P.; Psychology
This study applied a risk and resilience framework to assess the effects of overall, racial/ethnic, sexual orientation, and gender discrimination, for LGBTQ+ BIPOC in the U.S. Strong positive connections to one’s ethnic and intersectional LGBTQ+ BIPOC identities were assessed as potential protective factors. Data were collected via online surveys from people living in the U.S. who self-identified as both LGBTQ+ and BIPOC. Responses were analyzed using linear regression analyses. In line with hypothesis 1, greater frequencies of discrimination were associated with more symptoms of depression. However, contrary to hypothesis 2, in most contexts, ethnic identity was not associated with protection against the impact of discrimination on depression symptoms. In support of hypothesis 3, intersectional identity was found to be associated with protection against the impact of discrimination that was attributed to multiple identities (multiple attribution discrimination), whereas ethnic identity was not found to moderate the impact of multiple attribution discrimination in any context. Post hoc analyses revealed that intersectional identity was also associated with buffering the impact of racial/ethnic discrimination on depression symptoms. Additionally, post hoc analyses found that the combined impact of ethnic and intersectional identity was associated with unique buffering effects of the impacts of overall, racial/ethnic, and sexual orientation discrimination on depression symptoms. Limitations and future directions are discussed.

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