Psychology
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Item Embargo Relationships among Cumulative Life Stress, Interoception, and Psychiatric Presentations with Somatic Features(East Carolina University, July 2024) Simon, AliaInteroceptive processes involve awareness and insight into one's physiological state, as influenced by the integration of sensations detected and interpreted by the nervous system. Since interoception involves ongoing communication between the brain and the body, research is beginning to investigate if interoceptive processes are influenced by past experiences that may have disrupted mind-body communication. For the current study, we sought to investigate whether one's accumulation of severe stressors across the lifespan may interfere with one's ability to perceive the integration of internal bodily signals accurately and adaptively, contributing to interoceptive dysregulation and bodily distrust. We sought to explore whether this dysregulation would ultimately contribute to adverse mental health outcomes that feature somatization. Research examining relations between cumulative life stress, interoceptive processes, and psychiatric presentations remains in its infancy with limited investigation. The current study sought to bridge the current gap in the literature by investigating interoceptive accuracy and interoceptive awareness as a dual mediator, partially accounting for the assumed relationship between cumulative life stress and symptoms of psychological disorders with somatic features. Given that interoceptive processes are a multidimensional construct, we examined interoceptive awareness (attentional style when interpreting and attending to internal bodily signals) and interoceptive accuracy (appraisal of one’s perceived accuracy when interpreting bodily signals). Key variables of interest were explored within emerging adults, given that this is a salient developmental period marked by identity exploration with a greater propensity for the emergence of psychological presentations. A total of 575 undergraduate students at a large Southeastern university completed an online survey that examined cumulative life stressor severity, interoceptive processes (interoceptive awareness and interoceptive accuracy), and screeners assessing for symptoms of psychological disorders with somatic features (i.e., social anxiety disorder, panic disorder, depression, somatic symptom disorder, post-traumatic stress disorder, eating disorders). To our surprise, interoceptive accuracy did not demonstrate significant relationships with stress or symptoms, failing to account for the relationship between stress and symptoms. In contrast, interoceptive awareness demonstrated a significant inverse relationship with stress and symptoms while also acting as a protective mechanism, reducing the translation of stress to symptoms. Ultimately, our findings support the protective utility of one’s ability to attune to bodily senses with a mindful, non-judgmental mindset as captured by interoceptive awareness. Gaining insight into interoceptive patterns associated with common psychological disorders provides insight for tailoring transdiagnostic psychometric tools and interventions informed by the mind-body connection.Item Open Access Association Between the Behavioral Inhibition System/Behavioral Activation System, Big-5, and Sleep in a College Student Sample: The Moderating Role of Neuroticism(East Carolina University, July 2024) Falletta, GillianCollege students are a unique population due to the challenging transition into the independence of adulthood, as well as the increase in academic rigor and social expectations. As a result, health behaviors such as getting enough sleep can often fall to the wayside and, as such, sleep complaints are highly prevalent in college students. There are a variety of reasons for college students to experience sleep problems or choose to forgo sleep, and there is evidence to suggest that personality characteristics play a role. Jeffrey Gray’s Reinforcement Sensitivity Theory (RST) suggests that the Behavioral Inhibition System (BIS) responds to signals of punishment and non-reward, is responsible for individual differences in anxiety, and inhibits movement toward goals, while the Behavioral Activation System (BAS) responds to signals of reward and non-punishment and stimulates movement toward goals. The BAS scales can be further separated into three BAS factors – Drive, Reward, and Fun Seeking. While there are few studies available that explore the relationship between BIS/BAS and sleep, one study found that college students higher in BIS were more likely to forgo sleep to study while individuals higher in BAS were more likely to forgo sleep due to work, social life, and entertainment. In addition, higher BAS activation was positively correlated with the number of perceived benefits of cutting down on sleep and higher BIS activation was positively correlated with the number of perceived losses. Additionally, there is evidence linking the Five-Factor Model (FFM) of personality with sleep. Specifically, neuroticism is characterized by a tendency toward distress and negative affect and has largely been found to be associated with poor sleep quality. Extraversion is characterized by sociability and positive affect; the literature yields mixed results with some studies indicating that higher extraversion is associated with better sleep quality while other studies have found the opposite effect. Moreover, research suggests that neuroticism has a strong positive relationship with BIS and extraversion is positively related to all BAS scales. While there are many studies linking BIS and BAS to the Big Five personality traits, several studies focusing on the Big Five and sleep, and a few studies focusing on BIS and BAS and sleep, no studies were found that assess the relationship among all three factors. As a result, the present study expanded the literature by providing more insight into how BIS/BAS, the Big Five (i.e., neuroticism and extraversion), and sleep are interrelated in 657 college students. It was hypothesized that BIS would be significantly associated with higher neuroticism, and that BAS would be significantly associated with higher extraversion. It was also hypothesized that BIS and neuroticism would be significantly associated with worse sleep quality, higher levels of insomnia, increased daytime sleepiness, and higher levels of dysfunctional beliefs about sleep. All three BAS factors and extraversion were hypothesized to be significantly associated with sleep quality, levels of insomnia, daytime sleepiness, and dysfunctional beliefs about sleep; these hypotheses were more exploratory. Lastly, it was hypothesized that neuroticism would moderate the relationship between BIS and sleep quality, as well as the relationship between BIS and insomnia severity. The hypotheses were partially supported. The results suggested a significant relationship between BIS and neuroticism, and between all BAS factors and extraversion. Higher levels of BIS and neuroticism were both significantly correlated with worse self-reported sleep quality, increased insomnia severity, more daytime sleepiness, and increase dysfunctional beliefs and attitudes about sleep. Extraversion was not significantly related to the domains of sleep assessed in this study. However, participants higher in BAS- Reward Responsiveness and BAS-Drive reported significantly better sleep quality and individuals higher in BAS- Reward Responsiveness also reported significantly lower levels of insomnia severity. Unexpectedly, the results of this study suggest that neuroticism does not significantly moderate the relationship between BIS and sleep quality nor the relationship between BIS and insomnia severity. These results are discussed in light of post-hoc analyses, and clinical implications with regards to the association between personality characteristics and sleep in college students.Item Embargo Using A Sexual & Gender Minority Health Disparities Framework To Examine Multi-level Influences On Bisexual College Women’s Sexual Health Communication About HIV(East Carolina University, July 2024) Muscari, EmmaPrior studies have consistently revealed that bisexual+ women are at an increased risk for numerous mental and sexual health disparities compared to individuals with differing sexual orientations, in part due to bierasure and binegativity—yet less is known about bisexual+ women’s approaches to obtaining information about partner sexual health and HIV status. My dissertation employed a mixed-methods approach to investigate sexual health communication strategies (i.e., requesting partner sexual health history) as a means of HIV prevention, and the multi-level psychosocial factors that underlie sexual health communication related to HIV. Specifically, I assessed the individual, interpersonal, community, and societal factors—informed by the Sexual & Gender Minority (SGM) Health Disparities Research Framework and the Theory of Planned Behavior (TPB)—that guide sexual health communication in bisexual+ college women. A total of 258 bisexual+ college women completed an online survey that assessed for multi-level factors that affect HIV-related sexual health disparities and HIV prevention behaviors. Across levels of influence in the SGM ecological framework, community level influence in the form of LGBTQ community connectedness predicted bisexual women's individual level experience of sexual identity outness (i.e., more LGBTQ community connectedness predicted more sexual identity outness). Societal level influence in the form of bierasure predicted medical mistrust on the interpersonal level (i.e., less bierasure predicted less medical mistrust). When examining ecological influences on variables associated with the TPB, more LGBTQ community connectedness and less internalized heterosexism predicted more favorable attitudes around having a shared sexual conversation. More LGBTQ community connectedness also predicted more perceived social pressure around having a shared sexual conversation. Examining TPB variables more focally, the TPB intermediate variable of intention was not only influenced by upstream TPB variables (more attitudes, norms, and self-efficacy predicted greater intention) but also predictive of TPB outcome variables of sexual safety strategies and request for partner sexual health history. A qualitative analysis of HIV prevention behavior (request for partner sexual health history) yielded three themes across participants who reported requesting history: 1) Style, 2) Content, and 3) Timing, and one theme across participants who did not request history: 1) Barriers. The Barrier theme had seven subthemes: Discomfort, Unaware, Managing Partner Reactions, Perceived Minimal Risk, Partner Initiated, Social Norms, and Perceived Lack of Relevance. Qualitative responses provided context for upstream TPB variables and elucidated specific attitudes, norms, and efficacy factors that are involved in shared sexual health conversations. Future research should continue to take a multi-level approach in capturing the numerous factors that influence HIV-related sexual health outcomes for bisexual+ women. HIV prevention programs should consider how fostering positive attitudes, favorable social norms, and self-efficacy influences request for partner sexual health history.Item Embargo Use of Modular Therapy to Treat Anxiety for School Age Students with Autism(East Carolina University, July 2024) Glenn, Melissa RegineAutism spectrum disorder (ASD) is a neurological disorder characterized by challenges with social communication, interpersonal skills, sensory stimulation, and restricted and repetitive behaviors. Because of these challenges, the social demands of school can produce anxiety in some children with ASD. Although practitioners use several evidence-based interventions to treat autism, there are few evidence-based treatments to address the anxiety symptoms commonly associated with individuals with ASD. This study aims to determine the extent to which perceived anxiety levels decrease for school-age children with autism who also present with anxiety-related concerns, the extent to which children with ASD rate the usefulness of the intervention, and measure parent and teacher satisfaction with the intervention and perceived behavioral outcomes. The school psychology researcher will use a modified version of the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, and Conduct Disorders (MATCH-ADTC) to include more visuals, schedules, and social stories. In addition, the researcher intends to determine the effectiveness of the intervention by collecting data on the students’ engagement (determined by the practitioner) and feedback on the students’ experience (determined by the student).Item Embargo Feasibility and Acceptability of a Behavioral Intervention Program Among Patients with Atrial Fibrillation to Promote Engagement in Physical Activity(East Carolina University, July 2024) Anthony, Scarlett LeighContemporary AF management includes rate control, rhythm control, anticoagulation, and lifestyle management. Lifestyle management remains aspirational for most clinical settings around the world. Achieving regular physical activity (PA) is daunting for patients and programs such as cardiac rehabilitation are often not available, or not covered as in the USA, leaving few treatment options for patients. This study employed a behavioral PA intervention focused on psychoeducation, aerobic exercise, and problem solving to examine the feasibility and acceptability of a brief PA intervention among patients with AF in a rural-serving clinic. 128 patients were approached in clinic and a total of 24 participated in the study. Accelerometer data revealed an average of 255 minutes of moderate and vigorous PA per week (36.4 min/day) at baseline and 298 minutes of moderate and vigorous PA per week (42.6 min/day) at the end of program. Accelerometer data showed an average of 18.24 hours per day of sedentary time at baseline compared to 17.18 hours per day at the end of the program. Despite increases in PA, overall symptom burden and quality of life scores remained consistent. The average rating of patient satisfaction of the program was 21.8 out of 25 indicating high satisfaction. High attendance rates and patient satisfaction ratings provide preliminary evidence of the feasibility and acceptability of a PA behavioral intervention for patients with AF. Findings suggest that programs have the potential to improve PA levels in rural-serving clinics.Item Embargo Evaluation of a Measure of Everyday Function in Older Adults; Use of a Rural-Serving, Outpatient Neurology Clinic Sample(East Carolina University, July 2024) Sorrell, Anne ElizabethBackground: Understanding a patient’s ability to complete instrumental activities of daily living (IADLs) provides valuable insight into the cognitive and functional decline associated with diseases of aging, such as neurocognitive disorders. Early and accurate evaluation of IADLs permits healthcare professionals to conceptualize level of impairment, track disease progression, and tailor interventions to support patients in preserving quality of life and, in some cases, slow decline for as long as possible. Revised in 2021, the Everyday Cognition scale (ECog-II; Farias et al., 2021) is a measure of IADLs, unique for its evaluation of everyday functioning relative to specific cognitive domains often examined in comprehensive neuropsychological evaluations and for its ability to be used both by patients and their informants. Purpose: The purpose of the present study was to evaluate the clinical utility of the ECog-II Patient- and Informant-Reports in an outpatient neurology clinic that primarily serves rural-living patients in the southeastern United States presenting with comorbid medical and mental health conditions. Methods: A total of 106 patients from an outpatient neurology clinic in Eastern North Carolina who were internally referred for neuropsychological testing were included in the present study. The sample included 52 patients with mild cognitive impairment (MCI), 48 patients with dementia, and six patients without any objective cognitive impairment. Patient reports and informant reports from the ECog-II were administered, which include a total Global factor score and six domain-specific factor scores: Everyday Language, Everyday Memory, Everyday Visual-spatial/perceptual abilities, Executive Functioning (EF): Everyday Planning, EF: Everyday Organization, and EF: Everyday Divided Attention. All patients also completed a neuropsychological test battery as standard of care, and age-normed standard scores were calculated for each measure. The study sought to examine differences between respondent types, evaluate construct and predictive validity, and develop cut-off scores for the global factor. Results: Evidence of convergent validity between ECog-II responses and gold standard neuropsychological measures of similar constructs was demonstrated. Observed trends are highlighted in the manuscript. Predictive validity between diagnostic severity, but not etiology, was established using informant reports. Global cutoff scores for ECog-II informant report data with adequate sensitivity and specificity were established. Data from patient self-reports were less significant overall, and predictive validity was no better than chance. As such, global cutoff scores were unable to be established based on patient-report data. Overall, results from the current study suggest that informant reports of patient IADLs and everyday cognitive functioning map on better to objective neuropsychological measures compared to patient reports. Discussion: Results suggest that when evaluating neurocognitive impairment in rural-living older adults with varying comorbid medical health conditions, objective neuropsychological assessment remains the gold standard as subjective reports are not as predictive of actual cognitive functioning. Patient reports of IADL functioning are encouraged for enhanced understanding of patient awareness and insight. Collateral reports are encouraged for use in clinical decision making to supplement, but not replace, neuropsychological test data. Future studies are encouraged to collect a larger, heterogeneous diagnostic sample to further understand cognitive and functional impairment in a predominantly rural-living, southeastern patient population.Item Embargo Validation of the Nine Item AvoidantRestrictive Food Intake Disorder (ARFID) Screen within a Pediatric Gastroenterology Clinical Setting(East Carolina University, July 2024) Al-Hammori, DeannaARFID is a relatively new psychiatric diagnosis having been introduced in the DSM-5 in 2013. As ARFID is a relatively new diagnosis, there is little research on the etiology, prevalence, outcomes, assessments, and treatments. Of the assessments available, the NIAS is currently the only free, easily accessible, and brief self-report measure of symptoms available. The validity of the NIAS has only been assessed in adult and special populations until recently when the only peer-reviewed validation of the NIAS with a pediatric population was published. This research aimed to validate the NIAS in a pediatric gastroenterology clinic using child self-report. Using a retrospective chart review, 41 participants between the ages of 8 and 17 years old were identified. Participants were split between two groups, those with ARFID and those without. A ROC curve analysis was conducted to assess the sensitivity and specificity of the NIAS. The results of the ROC curve analysis indicate that the NIAS correctly identified ARFID in the patient population beyond chance when they presented with the Picky eating subtype, but not overall.Item Open Access Improving Sleep in Young Children(East Carolina University, July 2024) Rodriguez, MarieABSTRACT Sleep disorders are a serious problem in the United States alone, affecting between 50 and 70 million individuals. Between 20% and 30% of toddlers, infants and preschoolers around the world suffer from problems with falling asleep or staying asleep throughout the night. One of the most common sleep problems in young children is delayed sleep onset (DSO). This occurs when the child has difficulty going to bed within 20 minutes. Night waking episodes, when the child wakes up at least once per night and does not reinitiate sleep independently, are another common problem. DSO and night waking episodes in children can negatively impact caregiver sleep as well. Because these children lack the ability to self-soothe, their caregiver(s) have to wake up and help them fall back to sleep. One evidence-based intervention for DSO is letting the child “cry it out”, also called “extinction”. However, some caregivers are not comfortable with this method. Other interventions include moving the child’s bedtime back by small increments until the child’s desired bedtime is reached, called fading. Fading interventions have been effective when paired with response cost, but this has only been studied in the case of one typically developing child. This pilot study tested a novel fading intervention for typically developing children between the ages of two and six. During the intervention, caregivers moved the child’s bedtime back by 15 minutes every night and woke them at the same time every morning. Sleep was monitored using ActiGraphs to objectively examine frequency of night waking episodes and how well the intervention worked over 3.5 to 6.5 weeks. By implementing this pilot study of sleep, I aimed to determine the feasibility, acceptability, and preliminary effectiveness of a sleep intervention in promoting independent sleep onset (ISO) and less frequent night waking episodes in typically developing preschool aged children with DSO. While the two caregivers who completed this intervention demonstrated that it was feasible for some, it was not feasible for the 12 caregivers who declined to participate in either part or all parts of the study. The two caregivers who completed this intervention found it to be acceptable. The intervention was also effective at reducing night waking episodes in both participants. For one participant, diaries revealed night waking episodes were reduced from five episodes during baseline (an average of one episode per night) to zero at intervention and post-intervention. For the other participant, the sleep diary revealed eight night waking episodes during baseline, three episodes during the intervention, and the caregiver reported qualitatively that night waking episodes had ceased altogether post-intervention (the caregiver did not fill out diaries during post-intervention). The intervention was also effective at promoting ISO, which was found to continue past the post-intervention phase based on a follow up email survey for both participants. Both caregivers reported a decrease in the length of time it took their child to fall asleep independently from 30 minutes at baseline to 15 minutes at post-intervention. Limitations of this study included a small sample size, homogeneity of participants, unforeseen barriers to approval of the study, including difficulties with recruitment due to the COVID-19 pandemic, and multiple barriers to participants completing the study as written in the protocol. Future studies of sleep should include larger, more diverse samples, seek to reduce caregiver barriers to participation, and increase feasibility of sleep interventions for night waking and delayed sleep onset.Item Open Access A FOOD BOX INTERVENTION FOR FAMILIES EXPERIENCING FOOD INSECURITY AND TYPE 2 DIABETES: A PILOT PROJECT(East Carolina University, July 2024) Donelan, JenniferThe negative impacts of type 2 diabetes (T2D) can be exacerbated by food insecurity (FIS), contributing towards overall familial stress, poor health outcomes, and difficulties with diabetes management. Food box interventions may reduce some barriers to healthy eating, including access to fresh produce, transportation, and food cost. The current pilot project was designed to examine the feasibility, acceptability, and satisfaction of a produce food box intervention for families impacted by T2D and FIS, as well as any changes in eating habits and perceived stress. The pilot project was shown to be acceptable to families and participants indicated that they were satisfied with the intervention. Study feasibility was negatively impacted by participant recruitment and retention. Participant eating habits did not change; however, perceived stress was shown to decrease mid-intervention before rebounding post-intervention. Barriers identified throughout the pilot study, as well as via participant response are highlighted.Item Embargo An Evaluation of the Psychometric Properties of the Coping Flexibility Scale-Revised(East Carolina University, July 2024) Vanacore, Sarah MarieCoping flexibility is the ability to alter coping strategies based on situational demands. While it has been conceptualized in multiple ways, the dual-process theory defines coping flexibility as the ability to discontinue ineffective strategies and devise and implement alternative strategies (Kato 2012; 2020). In order to measure the dual-process theory, Kato (2020) developed the Coping Flexibility Scale-Revised (CFS-R), which has been validated only in Japan. As some researchers (e.g., Cheng et al., 2014; Kato, 2012) have suggested that individuals in Western countries do not cope as flexibly as individuals in Eastern countries, it is unclear whether the dual-process theory as measured by the CFS-R is appropriate for a Western population. Therefore, the purpose of this study was to start to examine the factor structure, reliability, and validity of the CFS-R in a sample of U.S. college students. This dissertation took a two-study approach. Study 1 (N = 1246) was a cross-sectional study that took place during the 2021-22 academic year. Study 2 (N = 441) was longitudinal study that took place during three time points during Spring 2023. In both studies, participants were recruited from Introductory Psychology courses, other psychology courses, a sample obtained from the university survey research and oversight committee, student groups, and academic advisors. Study 1 examined the CFS-R’s factor structure and associations with measures of depression, anxiety, and stress. Study 2 assessed the CFS-R’s longitudinal invariance, internal consistency, test-retest reliability, and convergent, discriminant, ecological, and predictive validity. In addition, to evaluate whether individualism/collectivism impacted scores, the CFS-R’s relationship with self-construal was also investigated. Overall, there were mixed findings. Study 1 found a similar factor structure to Kato’s (2020), and Study 2 found configural, weak, and strong invariance of the CFS-R. Good internal consistency (McDonald’s omegas > .70) was also found; however, adequate test-retest reliability was found between Times 1 and 2, but not between Times 1 and 3 or 2 and 3. The CFS-R subscales demonstrated acceptable convergent validity with Goal Re-engagement (Goal Disengagement and Re-engagement Scale [GDRS]), Knowledge of Cognition (Metacognitive Awareness Inventory-19; [MAI-19]), and Regulation of Cognition (MAI-19; rs ranging from .18 to .51); however, CFS-R scores were negatively correlated with Goal Disengagement (GDRS; rs ranging from -.19 to -.01). The CFS-R also demonstrated mixed discriminant validity, with trivial-to-small positive correlations with the Ten-Item Personality Inventory (TIPI; rs ranging from .06 to .26) and small-to-moderate correlations with the Balanced Inventory of Desirable Responding-16 (BIDR-16; rs ranging from .25 to .42). Regarding predictive validity, CFS-R scores at Time 1 did not predict perceived stress or symptoms of anxiety or depression at Times 2 or 3; however, there were negative correlations with symptoms and stress within each time point (rs ranging from -.22 to -.54). In addition, Abandonment and Re-coping scores did not predict the likelihood of engaging in abandonment or re-coping behaviors, but Meta-coping scores did predict the likelihood of engaging in meta-coping. Finally, regarding self-construal, the longitudinal CFA did not demonstrate weak invariance, so only Time 1 data was used to examine the relationship between self-construal and coping flexibility. Higher Independent Self-construal significantly predicted greater coping flexibility, but Interdependent Self-construal did not significantly predict coping flexibility. These studies built upon Kato’s (2012, 2020) research, in which they suggested that coping flexibility may not be an applicable construct to Western populations. These findings indicate that the CFS-R has similar factor structure to Kato’s (2020), good internal consistency, but test-retest reliability and predictive validity could not be established. There were also mixed findings regarding convergent validity, and discriminant validity results suggested that responses may be impacted by socially desirable responding. In addition, ecological validity was not established, and contrary to the hypothesis, higher independent self-construal was related to coping flexibility in Time 1; however, these were exploratory aims. Additional research is needed to continue to establish the test-retest reliability and validity of the CFS-R in Western populations. Such research could aid clinicians in college counseling centers and other professionals in higher education settings in understanding how their students cope flexibly with stress across the semester.Item Open Access A Third-Wave Intervention for Internalized Weight Bias Combined with a Weight Loss Program Using Video Conference Software(East Carolina University, December 2024) Force, CarolineBackground. Obesity is highly prevalent and associated with a plethora of adverse outcomes on health (e.g., heart disease, type II diabetes, certain forms of cancer), suggesting a clear need for effective weight loss strategies. Behavioral weight loss programs (BWLP) can produce weight loss for mild to moderate obesity, with a 5-10% weight loss on average by modifying lifestyle factors. However, complex biological, psychological, social, and environmental factors also contribute to an individual’s weight. Specifically, individuals who are overweight or obese are often frequently subjected to discrimination, prejudice, or stigmatization in a variety of settings. It is possible for individuals to internalize stereotypes about weight, such as the belief that individuals who are obese or overweight are lazy. This internalization, known as internalized weight bias (IWB), has been shown to impact mental (e.g., depression and anxiety) and physical health (e.g., cardiometabolic functioning), as well as weight loss and weight loss associated behaviors (e.g., interference with exercise and healthy eating). These associated behaviors especially pose a risk for weight regain and disruption of healthy weight loss. Therefore, given the association between IWB and weight loss associated behaviors, as well as the psychological and health risks associated with IWB, IWB interventions are also needed independently and in conjunction with BWLPs. Interventions using third-wave strategies (such as acceptance commitment therapy; ACT) have begun to show promise in reducing IWB, but have not yet been conducted in conjunction with a BWLP. Finally, there has also been a growing need for telehealth-based programs and interventions. The COVID19 pandemic demonstrated a clear need for efficacious telehealth programs, and a further benefit is that these programs may reach populations with limited access to resources (i.e., rural populations). Thus, the current study aims to pilot a novel ACT-based IWB intervention paired with a standard BWLP delivered through video conferencing software. Methods. The baseline sample included 54 men, women, and individual identifying as nonbinary, with 28 participants completing some form of post data. The mean age was 45.4 years (SD = 12.2) and the average weight was the average weight was 227.4 lbs (SD = 42.8) and 38.5 for BMI (SD = 6.6), Racial and ethnic breakdown was as follows: Black (N = 13, 24.1%), Hispanic or Latino/a (N = 3, 5.6%), Native American/Native Alaskan (N = 2, 3.7%) or White (N = 34, 63%). Ten 90-minute weekly sessions were offered over video conferencing software, with 60 minutes of weight loss programming and 30 minutes of IWB intervention. The BWLP used was adapted from the Diabetes Prevention Program, while the IWB intervention used ACT-based principles, self-compassion, and the dialectical behavioral therapy skill DEAR MAN. Results. Participants demonstrated a significant reduction in IWB (p = .002), as well as externalized weight bias (p <.001). In addition, participant weight loss was significant, as participants lost an average of 2.16% of their body weight (SD = 2.34%; p = < .001). Participants also demonstrated a decrease in emotional eating (p =.001) and saturated fat intake (p =.016), and an increase in moderate physical activity (p =.005). Participants reported several other benefits including a reduction in depressive symptoms (p =.026), self-judgement (p =.023), and psychological inflexibility (p =.004), and an increase in self-esteem (p =.007), mindfulness (p =.013), and self-compassion (p <.001). Participants reported high treatment acceptability and that the program was helpful. Discussion. While the current study does note limitations (e.g., small sample size, no control group), this is the first intervention combing treatment for IWB using third-wave skills (including ACT, self-compassion, and DEARMAN skill of DBT) in conjunction with a BWLP. In addition, this is the first IWB intervention that has utilized a virtual format. The intervention was successful in reducing IWB (and weight) among a sample of weight loss seeking participants.Item Open Access IMPACT OF A MEDICAL TEAM PROGRAM ON PATIENT EXPERIENCE IN CARDIOLOGY- FEASIBILITY STUDY(East Carolina University, December 2024) Force, ZacharyBackground. Patient-centered care (PCC) is a proposed style of healthcare that succinctly explores aspects of the biopsychosocial model by allowing the opportunity for patients to actively engage in their medical visit, forming a patient-provider relationship (PPR). Research confirmed the importance of the PPR but has not identified consistent means of improving this relationship. Provider self-disclosure (PSD) has varied efficacy on the PPR, depending on clinic setting with patients expressing greater benefit from PSD in the specialty setting of surgery as compared to a primary care setting. Harnessing provider biographies to convey information that patients want to know may be a strategy to standardize and elucidate effective practices of PPR in pursuit of the goals and benefits of PCC. It also remains to be seen whether biographies can provide a quick and simple way to heed the call of directives issued by the American College of Cardiology (2012) and improve PPR and PCC. Purpose. The purpose of the study was to examine the effect of provider biographical information on the perceptions of patient-centered care and the patient-provider relationship in a cardiology practice setting. Methods. The sample included 200 patients who attended their regularly scheduled medical appointment at a cardiology practice. Participants were randomized to receive either a biography about their provider (intervention) or about the medical institution (control). The mean age was 62.74 (SD = 14.04) and the mean Charlson Comorbidity Index was 3.87 (SD = 2.33). Demographics for the sample included individuals who identified as Black (N = 95, 47.5%), White (N = 89, 44.9%), Hispanic or Latino/a (N = 5, 2.5%), Asian (N = 1, 0.5%), middle Eastern (N = 2, 1%), and multiple racial (N = 3, 1.5%). Results. Acceptability of reading a one-page biography was high, with patients from both groups having read the biography. Patients who read biographical information about their providers perceived their providers as engaging in higher levels of patient-centered care behavior (M = 74.54, SD = 11.34; t(195) = 23.05, p = .003) as compared to the control (M = 69.83, SD = 15.28), having higher levels of relationship depth with their providers (M = 26.72, SD = 6.57; t(196) = 2.461, p = .015.) as compared to the control (M = 23.75, SD = 15.28), and were more likely to ask a question during their consult (X2 (1, N = 198) = 6.58, p = 0.01). Qualitative information was collected on what patients would like to know about their providers. Conclusion. Presenting patients with provider biographical information significantly improved perceptions of their provider’s patient-centered care behavior, perceptions of the provider-patient relationship, and were more engaged in their medical visit. This study offers a viable and low-cost method of improving patient-centered care with minimal provider burden that can be implemented at any clinic.Item Embargo THE IMPACT OF IDENTITY ON BMI AND CONTRIBUTING FACTORS: A Comparison of Identity, Sociocultural Attitudes, Maladaptive Eating, Physical Activity, Weight Stigma, and BMI among Bisexual, Lesbian, and Heterosexual Women(East Carolina University, July 2024) Shonrock, Abigail ThorndykeWith the rising rates of obesity and its association with chronic health conditions, there has been an increasing focus on the contributing factors. Also concerning are the numerous disparities observed in the prevalence of obesity within certain marginalized groups. In particular, sexual minority women have higher rates of obesity (as defined by BMI) than heterosexual women. This disparity is concerning due to the correlation between obesity and chronic health conditions, and LGBTQ+ populations have significant health disparities compared to their cisgender and heterosexual counterparts. While research has turned towards examining maladaptive eating, physical activity, internalized and experienced weight stigma, and sociocultural attitudes among LGBTQ+ populations, there is still much work to be done in exploring the connections between these variables. For sexual minority women in particular, research has demonstrated that this population reports higher maladaptive eating than heterosexual women despite comparable levels of experienced weight stigma and internalized weight bias. Some research attempting to examine barriers to physical activity for lesbian and bisexual women has hypothesized that the unique identity of an LGBTQ+ individual may play a significant role in health behavior engagement. Therefore, this dissertation explored the impact of sexual identity on predictors (maladaptive eating, physical activity, internalized and experienced weight stigma, and sociocultural attitudes) of obesity among bisexual and lesbian women, as compared to heterosexual women. Furthermore, the dissertation explored the potential predictive value of identity acceptance, heterosexist experiences, and community connection on BMI outcomes among bisexual and lesbian women. While sexual orientation appeared to moderate the relationship between several predictive variables and BMI, the relationship between these variables and bisexual and lesbian women was not clearly explained by the current models of obesity. Additionally, identity acceptance, community connection, and heterosexist experiences were not predictive of BMI, suggesting they may play more of a distal role in BMI outcomes. Future research should continue to explore the mechanism of obesity for bisexual and lesbian women.Item Embargo THE HEART OF THE PROBLEM: ASSESSING THE RELATIONSHIP BETWEEN WORKAHOLISM AND HEALTH-RELATED OUTCOMES.(East Carolina University, May 2024) Tresidder, AdamWhile prior research has examined workaholism in relation to physiological outcomes and physical health, less is known about how employees perceive these negative health-related consequences of workaholism. To address this concern, we examined whether employees are anxious about the health-related consequences of prolonged workaholic tendencies. Drawing on effort-recovery theory, we examined workaholism in relation to heart anxiety (H1), psychological well-being (H2), work-life balance (H3), and recovery (H4). Additionally, we investigated the moderating relationships of recovery (H5, H6) and work-life balance (H7, H8) to further investigate workaholism in relation to heart-anxiety and psychological well-being. By doing so, we aimed to further examine the recovery paradox within the context of workaholism. Our final sample consisted of 368 full-time faculty and staff at a southeastern university. Additionally, we found partial support for the recovery paradox. Furthermore, we found significant main effects between workaholism and psychological well-being (H2), work-life balance (H3), and recovery (H4). Given our results, we cannot determine whether workaholics are anxious about health-related consequences of workaholism. Future research, organizational implications, and study limitations are addressed.Item Embargo Exploring the Moderating Role of Health Promoting Leadership on Burnout and Willingness to Take Leave(East Carolina University, May 2024) Kurtz, AshlynEmployees and organizations are consistently being studied for the wellness of employees. There have been gaps in viewing workers as individuals and in catering to their specific needs. In more recent years, researchers have seen emerging impacts of organizational and employee wellness as employees desire more benefits within work. As an increasing issue, employee wellness poses challenges to both employees and their employers. This has led to topics such as burnout, willingness to take leave (WTTL) and health promoting leadership (HPL) to be explored. Burnout is a psychological and physical state of chronic emotional and physical exhaustion, often accompanied by a sense of reduced personal accomplishment and a feeling of cynicism or detachment from work. Willingness to take leave is an employee's readiness or eagerness to request and use time off from work. Additionally, health promoting leadership is defined as an approach to leadership within organizations that prioritizes the physical, mental, and emotional well-being of employees.Item Embargo Digital Buffer: The Moderating Role of Social Media Use on the Relationship between Job Boredom, Loneliness, and Burnout(East Carolina University, May 2024) Vitti, ThomasBurnout is described by feelings of exhaustion, cynicism, and decreased professional efficacy. It has been associated with several physical, psychological, and organizational consequences, driving companies to find strategies to mitigate its causes. This study examined the relationship between job boredom, loneliness, and social media use on burnout. It also investigated the possible buffering role of social media use as a moderator of burnout from job boredom and loneliness. A final sample of 263 workers were recruited to participate in a questionnaire. Correlational and hierarchical regression results indicated that job boredom and loneliness were associated with all three subcomponents of burnout. Additionally, social media use was positively associated with exhaustion; however, there was no relationship between cynicism and professional efficacy. No moderation effects of social media use were detected, indicating that social media use, as measured, did not buffer the effects of burnout. Limitations, practical implications, and future research are discussed.Item Embargo Fear of Recurrence in Atrial Fibrillation Patients: Development of the ECU Fear of Recurrence Scale(East Carolina University, 2023-05-04) Harrell, RebeccaAtrial fibrillation (AF) is characterized by a rapid and irregular heartbeat that results from abnormal impulse generation from the upper chambers of the heart, the atria. A disorganized heartbeat obstructs the ability of the heart to adequately pump blood through the heart and to other vital organs. Because of this, individuals with AF are at increased risk of adverse health effects including stroke, premature death, and heart failure. Advances in medicine have allowed for treatment developments that target arrhythmic substrate dysfunction and decrease the risk of adverse events. While some AF patients respond effectively to anti-arrhythmic medications, others may require additional interventions to decrease the burden of AF. Given the increased burden among patients who present with sustained AF recurrence rate following intervention, it is plausible that many patients experience significant fear or anxiety related to AF recurrence. The phenomenon of fear of recurrence (FOR) is well-researched in cancer survivors and is often associated with significant psychological and behavioral consequences. The role of FOR among AF patients, however, has not yet been studied despite notable psychological concerns in this population. The present study aimed to determine the overall prevalence and impact of FOR among AF patients through the development of a valid, reliable measure to assess this construct. At the East Carolina Heart Institute (ECHI), 51 patients were recruited to complete the ECU Fear of Recurrence Scale, the Cardiac Anxiety Questionnaire, the ECU Behavioral and Lifestyle Assessment for Atrial Fibrillation, the Fear about Exercise Questionnaire, and the Generalized Anxiety Disorder and Patient Health Questionnaire screeners. Descriptive analyses revealed that the mean age of the sample was 69.71 (SD = 10.12) with 49% identifying as women and the majority identifying their racial/ethnic background as non-Hispanic White (80.4%). Medical and psychological co-morbid conditions were common across the study sample, and health care utilization was high. Major findings of the present study included a) an acceptable degree of reliability ([alpha] = .92) and construct validity for the new measure b) notable prevalence of recurrence fears across the sample c) moderate-high relationships between FOR, cardiac-specific anxiety, and fears about experience and d) evidence of a predictive relationship between AF-specific fears and exercise-related fears. The findings in the present study provide promising evidence for conceptualization and existence of FOR among AF populations and offer a foundation for continuing to address nuance in the patient experience. This measure can likely help to continue to identify patients struggling with adjustment to this condition and aid in future development of targeted interventions to address AF-specific fears.Item Embargo The Impact of Illness Perception in Cardiopulmonary Rehabilitation Patients: An Exploratory Study in Rural Eastern North Carolina(East Carolina University, 2023-04-28) McNinch, Ashlan PBackground: Cardiovascular and pulmonary rehabilitation (CVPR) is an underutilized resource that can aid in recovery from cardiovascular events and improve health related quality of life in pulmonary patients. Illness perception, which refers to how a patient views and understands their disease state, appears to have a role in the attendance and completion of CVPR. The current study investigated the relationship between illness perception and attendance and completion of CVPR, 6-minute walk test (6MWT) performance, and experience of depression and/or anxiety. Methods: The present study used a longitudinal design that followed CVPR patients who were taking part in an intervention study which aimed to increase engagement in values-based health behavior change over 5-weeks. Participants completed baseline and follow-up measures of illness perception, depression, and anxiety, along with ecological momentary assessment (EMA) of illness perception on days which they were scheduled to attend CVPR. Demographic data and 6MWT scores were derived from the CVPR registry database. Results: Results suggested that illness perception was not a significant predictor of CVPR absence (p=0.532) or completion (p=0.502) in this sample. Illness perception was associated with baseline 6MWT performance (p=0.004) and baseline 6MWT performance was associated (p=0.006) with more threatening follow-up illness perception for participants that completed the study. The relationship between baseline illness perception and discharge 6MWT was also evaluated for participants that completed CVPR, however, the relationship was not statistically significant (p=0.141). Finally, illness perception was significantly positively associated with baseline experience of both depressive (p[less-than]0.001) and anxious symptoms (p[less-than]0.001). Conclusion: Results from this study suggested that there is a significant association between illness perception and both 6MWT and affective state, but not between illness perception and attendance and completion of the CVPR program. The study was novel in that it was conducted in a rural southeastern United States sample and in that it included a sample with heterogeneous disease states. Further research is needed to evaluate possible interventions addressing illness perception and to further investigate the relationship between illness perception and 6MWT performance.Item Embargo Factors Predicting Changes in Sleep in North Carolina Children During the Coronavirus Pandemic(East Carolina University, 2023-05-17) Long, Kelli RAs the COVID-19 virus evolved into a global pandemic, a myriad of changes occurred for children and families worldwide. Bronfenbrenner's socio-ecological model argues that there is a complex interaction of factors impacting child development, ranging from child specific factors (i.e., personal characteristics, genetic factors) to factors close to the child like family, school or childcare, and neighborhood (i.e., the microsystem) to factors more distal such as media, social services, and government agencies (i.e., the exosystem and beyond). The purpose of the present study was to describe some of the changes resulting from the COVID-19 pandemic and to consider how systemic factors may have impacted those changes during the pandemic, which may in turn affect the child's development. Specifically, the study aimed to describe changes in media use and sleep patterns in young children and to investigate the relationship between child sex, household income, and media use on sleep changes that occurred over the course of the study. Participants in the present study were 88 children ages 4 to 7 whose caregiver completed one survey prior to the pandemic, and one survey in the early months of the pandemic. Survey results indicate there was a significant decrease in average daily sleep duration and a significant increase in average daily media use over the course of the study. While sleep duration decreased, children in the present sample continued to obtain recommended amounts of sleep both before and during the early weeks of the pandemic. Neither household income, sex, nor media use were related to the observed changes in sleep in the present sample. Instead, only pre-pandemic sleep duration explained a significant amount of variance in sleep changes. These findings suggest that in some ways families transitioned to a "summer vacation" schedule, rather than establishing completely new routines for a global pandemic. Families may be cautiously optimistic that changes like increased media use did not significantly impact sleep in the present sample. Given that hypothesized factors like household income and sex were also not responsible for the observed decrease in sleep, additional research is needed to determine what factors explain additional variance in children's sleep during the pandemic.Item Open Access The Role of Weight Stigma in Healthcare Avoidance and Mistrust Among Pregnant Women(East Carolina University, 2023-04-13) Byrd, RhondaPast research has indicated a multitude of negative outcomes related to experiencing and internalizing weight stigma (Alberga et al., 2016; Hayward et al., 2018; Latner et al., 2014). Weight stigma is sometimes experienced in healthcare contexts, thus negatively impacting relationships between patients and providers (Mensinger et al., 2018). In recent years, the number of pregnant women with overweight and obesity has steadily increased (CDC, National Center for Health Statistics, 2020), and the potential impact of weight stigma in healthcare settings is understudied in this population (Incollingo Rodriguez et al., 2021). The current thesis project aimed to examine the relationship between pre-pregnancy BMI, trust in one's healthcare provider, and healthcare avoidance. This project examined experienced stigma in healthcare and internalized weight bias as potential mediators of the relationship between pre-pregnancy BMI, trust in healthcare provider, and healthcare avoidance. In the current study, there was no relationship between a woman's pre-pregnancy BMI and her frequency of experiencing stigmatizing situations. Women with a higher pre-pregnancy BMI did report greater levels of internalized weight bias. Further, for women reporting higher levels of both experienced and internalized stigma, trust in provider was lower, and healthcare avoidance was greater. There was no evidence of mediation, except for evidence of partial mediation in the model of avoidance related to body exam discomfort. Of note, it was observed that IWB acted as a suppressor variable rather than a mediator in all other models. This thesis adds to the current literature on pregnant women and weight stigma as it relates to healthcare experiences.