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Mitnick DM, Lorber MF, Smith Slep AM, Heyman RE, Xu S, Bulling LJ, Nichols SR, Eddy JM. Self-report measures of coercive process in couple and parent-child dyads. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2021; 35:388-398. [PMID: 32658518 DOI: 10.1037/fam0000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
One of the most influential behavioral models of family conflict is G. R. Patterson's (1982) coercive family process theory. Self-reports for behaviors related to coercion (e.g., hostility toward a family member) abound; however, there are no self-report measures for coercive process itself, which is, by definition, a dyadic process. Operationalizations of coercive process are measured with behavioral observation, typically including sequential analyzed, microcoded behaviors. Despite its objectivity and rigor, coding of behavior observation is not always feasible in research and applied settings because of the high training, personnel, and time costs the observation requires. Because coercive process has been shown to predict a host of maladaptive outcomes (e.g., parent-child conflict, aggression, negative health outcomes) and given the complete absence of self-report measures of coercive process, we recently designed brief questionnaires to assess coercive process in couple (Couple Coercive Process Scale [CCPS]) and parent-child interactions (Parent-Child Coercive Process Scale [PCCPS]) and tested them via Qualtrics participant panels in samples recruited to mirror socioeconomic generalizability to U.S. Census data. The CCPS and PCCPS exhibited initial evidence of psychometric quality in measuring coercive process in couple and parent-child dyads: Both measures are unifactorial; have evidence of reliability, especially at higher levels of coercive process; and demonstrate concurrent validity with constructs in their nomological networks, with medium to large effect sizes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Heyman RE, Slep AMS, Mitnick DM, Nichols SR, Cracknell KM, Tiberio SS, Kim S, Perkins DF. Evaluation of Two Approaches for Responding to Allegations of Family Maltreatment in the U.S. Army: Coordinated Community Response Impacts and Costs. Mil Med 2021; 187:e987-e994. [PMID: 33772559 DOI: 10.1093/milmed/usab115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/15/2021] [Accepted: 03/18/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The U.S. Air Force (USAF) conducted a program of research to develop and disseminate reliable and valid criteria for partner and child maltreatment (comprising abuse [physical, emotional/psychological, and sexual] and neglect). These criteria are now used in all branches of the U.S. military. The U.S. Army was the first service outside the USAF to adopt the criteria sets and computerized decision support tool but maintained the original committee composition (the "Case Review Committee" [CRC]) instead of adopting the entire assessment, allegation determination, and treatment planning process (the "Field-tested Assessment, Intervention-planning, and Response" [FAIR] system). The Army commissioned this study to compare the CRC and FAIR processes by testing (1) intra-committee process (i.e., three facets of committee functioning-fidelity to regulations, cohesion and team process, outsized influence of unit representatives); (2) coordinated community response to maltreatment (i.e., perceptions of fairness to alleged offenders and victims, impact on unit representatives, and (3) collaboration between the Family Advocacy Program (FAP, the military's maltreatment response agency) and outside agencies; and (4) the time expended and cost. MATERIALS AND METHODS New York University's Institutional Review Board approved the study protocol, and the Army's Human Research Protection Office provided permission to collect data. The ten Army garrisons with the most annual maltreatment cases participated. Committee members, FAP social workers, unit commanders, and independent observers completed assessments of individual meetings and of their overall impression of the processes. A test of whether the means significantly differed between phases was then performed separately for each outcome, and 95% CIs of the unstandardized mean difference between phases were estimated. RESULTS Independent observers rated FAIR meetings as significantly more faithful to regulations. Unit representatives (i.e., commanders and/or first sergeants) perceived the committee to function better during FAIR (although other committee members and independent observers did not perceive differences). Unit representatives not only rated FAIR as significantly more fair to both alleged offenders and victims (ratings from other committee members did not differ), but also were more likely to attend FAIR meetings and, when they did, rated their ability to serve soldiers and families higher during FAIR. However, FAP social workers rated their relationships with units as being better during CRC, and outside agencies rated their relationship with FAP as significantly better during CRC. Costs to the Army were nearly identical in the two committee structures. CONCLUSION Results indicated that the CRC and FAIR processes cost almost identical amounts to run and that the FAIR system was superior in ways most likely to impact service members: (1) independent observers judged its meetings to be more faithful to Army and DoD Instructions; (2) unit representatives were more likely to attend and believed the FAIR system to be fairer (to both alleged offenders and victims) and better functioning. Care should be taken, however, in nurturing relationships between FAP and (1) unit representatives and (2) outside agencies, which may have weakened during FAIR.
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Heyman RE, Baucom KJW, Xu S, Slep AMS, Snarr JD, Foran HM, Lorber MF, Wojda AK, Linkh DJ. High sensitivity and specificity screening for clinically significant intimate partner violence. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2021; 35:80-91. [PMID: 32673030 PMCID: PMC7906486 DOI: 10.1037/fam0000781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The U.S. Preventive Services Task Force has recommended that clinicians screen patients for intimate partner violence (IPV). This article aims to develop and test the first screeners for clinically significant physical and psychological IPV (i.e., acts meeting criteria in the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2019) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). The goal was to derive screeners that (1) are maximally brief, while still achieving high sensitivity and specificity; (2) assess perpetration and victimization when either men or women are reporting; and (3) use ICD-11/DSM-5 criteria as the reference standard. Random samples of active duty service members at 82 installations worldwide were obtained via e-mail invitation (2006: N = 54,543; 2008: N = 48,909); their response rates were excellent for long general population surveys with no payment (2006: 44.7%, 2008: 49.0%). The population of spouses at the participating installation was invited by mailed postcard (2006: N = 19,722; 2008: N = 12,127; response rates-2006: 12.3%, 2008: 10.8%). Clinically significant physical intimate partner violence can be effectively screened with as few as four items, with sensitivities > 90% and specificities > 95%; clinically significant psychological intimate partner violence can be screened with two items. Men and women can be screened with equivalent accuracy, as can those committing the violence and those victimized by it. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Heyman RE, Baucom KJW, Giresi J, Isaac LJ, Slep AMS. Patient Experience and Expression of Unpleasant Emotions During Health Care Encounters. J Patient Exp 2021; 7:969-972. [PMID: 33457530 PMCID: PMC7786783 DOI: 10.1177/2374373520978869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To examine the concordance between patients' experience and expression of unpleasant emotions in a health care context, 21 patients presenting to a university dental clinic were observed for expressed unpleasant emotions and patients provided the intensity of their experienced unpleasant emotions. We found low convergence between experience and expression. Most of the time that patients experience unpleasant emotions they do not express them, and 80% of the time patients express unpleasant emotions they are not experiencing them at the time. Providers need to frequently check in with patients regarding their emotional experience during appointments, as it is infrequently accessible to providers.
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Heyman RE, Baucom KJW, Slep AMS, Mitnick DM, Halford WK. An Uncontrolled Trial of Flexibly Delivered Relationship Education with Low-Income, Unmarried Perinatal Couples. FAMILY RELATIONS 2020; 69:849-864. [PMID: 33542587 PMCID: PMC7853666 DOI: 10.1111/fare.12431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To examine couple and parenting outcomes from an American version of Couple CARE for Parents (CCP) in low-income, unmarried couples. BACKGROUND We adapted an evidence-based, flexibly delivered program for use with low-income, unmarried couples, for whom the outcome literature is scarce. METHOD Couples (n = 443) were recruited from maternity units and began CCP. They completed measures before, during, and immediately after the intervention, and 6 months later. RESULTS Moderate psychological intimate partner violence (IPV) declined and perceived parenting efficacy increased over time; there was no change in severe psychological or physical IPV. Individuals with lower levels of relationship commitment than their partners showed improvement in relationship satisfaction, whereas those with similar or higher levels of commitment maintained their baseline levels despite being in a period of expected satisfaction decline. CONCLUSION CCP showed some signs of helping low-income couples during a stressful period and its flexible service delivery model allowed these couples to participate by reducing the impediments of transportation challenges, conflicting work schedules, and overall time poverty. IMPLICATIONS Practitioners interested in using CCP with low-income couples would likely maximize the impact by (a) focusing on pregnant, first-time parents; (b) integrating CCP within post-natal healthcare; and/or (c) assuming that a considerable minority of couples will avail themselves of only up to two sessions, and thus practitioners should front-load content, making other content optional or just-in-time. In addition, non-psychoeducational elements (e.g., gamification, easy computerized tasks to reduce angry responses, watching couple-themed movies) could enliven preventative offerings for perinatal couples.
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Baucom KJ, Giresi J, Heyman RE, Slep AMS. Associations between self-rated physical Health and relationship satisfaction in couples with children. Health Psychol Open 2020; 7:2055102920959527. [PMID: 33014407 PMCID: PMC7518011 DOI: 10.1177/2055102920959527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The degree to which individual self-rated physical health and concordance of self-rated physical health between partners are associated with relationship satisfaction was examined in a community sample of 399 couples with children. Couples completed self-report assessments of physical health (general health and physical functioning) and relationship satisfaction. Results suggest unique associations between partners’ general health and their own relationship satisfaction. Further, higher between-partner concordance in physical functioning was uniquely associated with higher relationship satisfaction in women. Understanding associations between health and relationship processes is crucial and has implications for future research on couple-based interventions to promote physical health.
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Mitnick D, Dills A, Smith Slep AM, Heyman RE, Giresi J. Family Influences on Caries in Grenada. Dent J (Basel) 2020; 8:E105. [PMID: 32916915 PMCID: PMC7559639 DOI: 10.3390/dj8030105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022] Open
Abstract
If high-conflict family environments are cariogenic across cultures, and can be studied in cultures where both these environments and cariogenic dental practices are particularly prevalent, this would afford the opportunity to examine how these two pathways of risk might interact, laying the stage for culturally competent, integrated prevention efforts. The first investigation involved qualitative data about perceptions of oral health and family stressors in Grenadian families with school-aged children. The second study used a questionnaire and observational data to assess relations among oral health behaviors, relationship satisfaction, parenting, and child behavior; it also included a pilot study of Motivational Interviewing. Most of the themes discussed in focus groups suggested overlap between U.S. and Grenadian parents; possible culture-specific issues were high prevalence of single-parent homes, normativity of physical discipline, less preventive dental care, and more fatalistic view of oral health outcomes. Significant associations were found between parent and child oral health behaviors, between child externalizing and internalizing behaviors, and between family variables (e.g., relationship satisfaction, child behavior) and oral health behaviors (e.g., parent flossing, child brush time). The results strongly support the need for research on the relations between family functioning and oral health to be embedded within culture.
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Malik J, Heyman RE, Smith Slep AM. Emotional flooding in response to negative affect in couple conflicts: Individual differences and correlates. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2020; 34:145-154. [PMID: 31393141 PMCID: PMC7007326 DOI: 10.1037/fam0000584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study explored whether individual differences in self-reported emotional flooding were associated with observational behaviors and experienced and displayed anger during a 10-min problem solving discussion. A sample of 233 married or cohabiting couples, comprising 4 groups (distressed with intimate partner violence [IPV], distressed/nonIPV, satisfied/IPV, and satisfied/nonIPV) was recruited via random digit dialing. Consistent with predictions, both men's and women's flooding were positively associated with partners' negative affect variables, including partners' experienced and displayed anger, as well as positively associated with their own anger. A multinomial logistic regression revealed significant differences between flooding in prediction of couples' group status; specifically that higher levels of emotional flooding were reported by distressed and IPV couples compared with other types of couples. Finally, couples that included at least 1 member high on self-reported emotional flooding were less effective in solving problems during the conflict discussion. Implications and future directions are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Heyman RE, Snarr JD, Slep AMS, Baucom KJW, Linkh DJ. Self-reporting DSM-5/ICD-11 clinically significant intimate partner violence and child abuse: Convergent and response process validity. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2020; 34:101-111. [PMID: 31328945 PMCID: PMC6980226 DOI: 10.1037/fam0000560] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) and International Classification of Diseases-11th Revision (ICD-11; proposed) now include criteria for clinically significant (a) intimate partner violence (IPV) and neglect and (b) child abuse and neglect. However, existing measures of IPV and child abuse do not allow for assessment of established criteria. The current study examines the convergent and response process validity of the Family Maltreatment (FM) measure of clinically significant physical and psychological IPV and child abuse. Participants (N = 126) completed the FM via computer and measures of IPV (Revised Conflict Tactics Scale; Straus, Hamby, Boney-McCoy, & Sugarman, 1996) and child abuse (Parent-Child Conflict Tactics Scale; Straus, Hamby, Finkelhor, Moore, & Runyan, 1998) via paper-and-pencil. Participants who endorsed acts of aggression on the FM completed an audio-recorded computerized interview recounting the 2 most severe incidents. Verbalized incidents (n = 138) were coded for clinically significant family maltreatment. Results largely supported the convergent validity of the FM. Agreement of acts endorsed on the FM with those endorsed on convergent measures was excellent for IPV and physical child abuse, yet poor for psychological child abuse. Further, in support of the response process validity of the FM, comparison with observer ratings of interviews indicated few "false positives" and no "false negatives" on the FM across the examined types of clinically significant IPV and child abuse. In summary, the FM is a promising measure for the assessment of clinically significant physical and psychological abuse as defined in the DSM-5 and ICD-11 (proposed). (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Bulling LJ, Baucom KJW, Heyman RE, Smith Slep AM, Mitnick DM, Lorber MF. Predicting Program Retention in a Flexibly-Delivered Relationship Education Program for Low-Income, Unmarried Parents. JOURNAL OF FAMILY SOCIAL WORK 2019; 23:234-256. [PMID: 33536725 PMCID: PMC7853667 DOI: 10.1080/10522158.2019.1681337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 09/04/2019] [Accepted: 09/22/2019] [Indexed: 06/12/2023]
Abstract
Participation rates in couple relationship education (CRE) programs for low-income couples are typically low. We examined predictors of session attendance and early dropout (i.e., dropout after 1 session) among a sample of low-income, unmarried parents of a newborn (N = 467 couples) enrolled in an evidence-based CRE program. Predictors included demographics and socioeconomic status, as well as baseline indicators of relationship commitment, family and individual functioning, infant health, preventive health care utilization, and CRE coach perceptions of participant engagement and alliance in the first session of the program. Couples attended an average of 4.4 (SD = 2.5) of the 7 sessions, with nearly a quarter of couples dropping out after the first session. Attendance at fewer sessions was predicted by younger age. Early dropout was predicted by lower ratings of females' engagement and both partners' therapeutic alliance and, unexpectedly, by commitment. We discuss considerations for engaging low-income couples in CRE.
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Langhinrichsen-Rohling J, Snarr JD, Slep AMS, Heyman RE. Risk for suicide attempts among United States Air Force active duty members with suicide ideation: An ecological perspective. J Consult Clin Psychol 2019; 87:1124-1136. [PMID: 31556654 DOI: 10.1037/ccp0000435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Differentiating suicide attempters from suicide ideators has been named a critical suicidology frontier (Klonsky & May, 2013). Per Bronfenbrenner's (1977, 1994) ecological systems theory, risk/protective factors from four ecological levels (individual, family, workplace, and community) were used to predict last year suicide attempt status among active duty service members expressing suicide ideation. METHOD Active duty U.S. Air Force members (N = 52,780, 79.3% male, 79.2% non-Hispanic White, M age = 31.8 years) anonymously completed an online community assessment administered biennially at 82 bases worldwide. Last year suicide ideation and attempts were concurrently measured, as were an array of co-occurring risk and protective factors. RESULTS Among the 1,927 (approximately 4%) service members self-reporting suicidal ideation, 152 also reported a last year suicide attempt (7.9% of the ideators, 8.7% of men vs. 6.1% of women). However, in multivariate models, military member sex was not a significant moderator. In bivariate models, numerous individual, family/spouse/parent, and community factors were associated with suicide attempt status. In the final multivariate model for the whole sample, risk for a last year attempt was associated with years in the military, social support, and alcohol use problems, but not depression. Among active duty military in relationships, attempt status risk was associated with years in the military, social support, and intimate partner violence victimization. However, the effect sizes for these models were small. CONCLUSIONS Beyond a focus on depression, addressing alcohol misuse, facilitating resilient and nonviolent couple/family relationships, and increasing social support may enhance suicide attempt prevention efforts among military members. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Heyman RE, Baucom KJW, Slep AMS, Mitnick DM, Lorber MF. A Research Program Testing the Effectiveness of a Preventive Intervention for Couples with a Newborn. FAMILY PROCESS 2019; 58:669-684. [PMID: 30811594 PMCID: PMC7183237 DOI: 10.1111/famp.12428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Noxious family environments are associated with a wide range of adverse child outcomes. In order to prevent couple and parent-child relationship problems, a number of programs have been developed for couples with newborns. The current paper describes a program of research evaluating the American version of couple CARE for parents of newborns. This version of CCP was administered to low-income, unmarried couples with a new baby in an uncontrolled demonstration project (Study 1), compared with a waitlist control condition in a randomized controlled trial (Study 2), and evaluated with low-income parents recruited from urban hospitals in two major metropolitan areas of the United States (Study 3 and Study 4). Despite participant satisfaction with CCP, preventive effects of the program were limited and there was one potential iatrogenic effect. Results were likely impacted by major challenges with recruiting participants and maintaining their engagement in CCP for the duration of the program. We discuss methodological differences between this series of studies and previous trials of prevention programs and make recommendations for improving service delivery to at-risk new parents. These results have implications for public policies that aim to benefit children and families.
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Heyman RE, Slep AMS, Lorber MF, Mitnick DM, Xu S, Baucom KJW, Halford WK, Niolon PH. A Randomized, Controlled Trial of the Impact of the Couple CARE for Parents of Newborns Program on the Prevention of Intimate Partner Violence and Relationship Problems. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 20:620-631. [PMID: 30535623 DOI: 10.1007/s11121-018-0961-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Effective, accessible prevention programs are needed for adults at heightened risk for intimate partner violence (IPV). This parallel group randomized controlled trial examines whether such couples receiving the American version of Couple CARE for Parents of Newborns (CCP; Halford et al. 2009) following the birth of a child, compared with controls, report fewer first occurrences of clinically significant IPV, less frequent physical and psychological IPV, and improved relationship functioning. Further, we test whether intervention effects are moderated by level of risk for IPV. Couples at elevated risk for IPV (N = 368) recruited from maternity units were randomized to CCP (n = 188) or a 24-month waitlist (n = 180) and completed measures of IPV and relationship functioning at baseline, post-program (when child was 8 months old), and two follow-ups (at 15 and 24 months). Intervention effects were tested using intent to treat (ITT) as well as complier average causal effect (CACE; Jo and Muthén 2001) structural equation models. CCP did not significantly prevent clinically significant IPV nor were there significant main effects of CCP on clinically significant IPV, frequency of IPV, or most relationship outcomes in the CACE or ITT analyses. Risk moderated the effect of CCP on male-to-female physical IPV at post-program, with couples with a planned pregnancy declining, but those with unplanned pregnancies increasing. This study adds to previous findings that prevention programs for at-risk couples are not often effective and may even be iatrogenic for some couples.
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Heyman RE, Kogan CS, Foran HM, Burns SC, Slep AMS, Wojda AK, Keeley JW, Rebello TJ, Reed GM. A case-controlled field study evaluating ICD-11 proposals for relational problems and intimate partner violence. Int J Clin Health Psychol 2018; 18:113-123. [PMID: 30487916 PMCID: PMC6225040 DOI: 10.1016/j.ijchp.2018.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/08/2018] [Indexed: 11/29/2022] Open
Abstract
Background/Objective: Intimate partner relationship problems and intimate partner abuse and neglect - referred to in this paper as "relational problems and maltreatment" - have substantial and well-documented impact on both physical and mental health. However, classification guidelines, such as those found in the International Classification of Diseases (ICD-10), are vague and unlikely to support consistent application. Revised guidelines proposed for ICD-11 are much more operationalized. We used standardized clinical vignette conditions with an international panel of clinicians to test if ICD-11 changes resulted in improved classification accuracy. Method: English-speaking mental health professionals (N = 738) from 65 nations applied ICD-10 or ICD-11 (proposed) guidelines with experimentally manipulated case presentations of presence or absence of (a) individual mental health diagnoses and (b) relational problems or maltreatment. Results: ICD-11, compared with ICD-10, guidelines resulted in significantly better classification accuracy, although only in the presence of co-morbid mental health problems. Clinician factors (e. g., gender, language, world region) largely did not impact classification performance. Conclusions: Despite being considerably more explicated, raters' performance with ICD-11 guidelines reveals training issues that should be addressed prior to the release of ICD-11 in 2018 (e. g., overriding the guidelines with pre-existing archetypes for relationship problems and physical and psychological abuse).
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Abstract
Dysfunctional conflict resolution behaviors in couples have been long recognized as markers of relationship maladjustment and are, consequently, frequent targets of couple therapy. The process of flooding may play a role. Flooding is the subjective sense of being overwhelmed by the partner's negative affect, which is perceived as unexpected and intense, and feeling as though one's information processing is impaired. It has been theorized that flooding is so aversive as to lead to maladaptive conflict behaviors (e.g., conflict escalation or withdrawal) as attempts to terminate the offending input (i.e., partner anger). Despite strong theory describing the construct, there has been a lack of valid measures to assess it. In the present study, we evaluated the psychometric properties of a 15-item measure in a sample of 453 couples. Reasonable unifactoriality, excellent internal consistency, and high test-retest reliability were demonstrated. Furthermore, using a dyadic latent variable model, the IPFS showed strong structural validity and concurrent validity with measures of relationship satisfaction, intimate partner violence, anger, depressive symptoms, and observed negative conflict behaviors. The IPFS appears to be a promising, economical instrument to assess flooding, a process relevant for understanding dysfunctional couple conflict behaviors.
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Lorber MF, Del Vecchio T, Slep AMS. The development of individual physically aggressive behaviors from infancy to toddlerhood. Dev Psychol 2018; 54:601-612. [DOI: 10.1037/dev0000450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lorber MF, Xu S, Heyman RE, Slep AMS, Beauchaine TP. Patterns of psychological health problems and family maltreatment among United States Air Force members. J Clin Psychol 2018. [PMID: 29528487 DOI: 10.1002/jclp.22594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We sought to identify subgroups of individuals based on patterns of psychological health problems (PH; e.g., depressive symptoms, hazardous drinking) and family maltreatment (FM; e.g., child and partner abuse). METHOD We analyzed data from very large surveys of United States Air Force active duty members with romantic partners and children. RESULTS Latent class analyses indicated six replicable patterns of PH problems and FM. Five of these classes, representing ∼98% of survey participants, were arrayed ordinally, with increasing risk of multiple PH problems and FM. A sixth group defied this ordinal pattern, with pronounced rates of FM and externalizing PH problems, but without correspondingly high rates/levels of internalizing PH problems. CONCLUSIONS Ramifications of these results for intervention are discussed.
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Thorson KR, Lorber MF, Slep AMS, Heyman RE. Adult adiposity linked to relationship hostility for low-cortisol reactors. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2018; 32:197-205. [PMID: 29658757 PMCID: PMC5905724 DOI: 10.1037/fam0000397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Past research on the relation between hostility in intimate relationships and adiposity has yielded mixed findings. The present study investigated whether the association between relationship hostility and adiposity is moderated by people's biological reactions to couple conflict. Cohabiting adult couples (N = 117 couples) engaged in two conflict interactions, before and after which salivary cortisol levels were measured. Results revealed an association between relationship hostility and adiposity, but this association was concentrated among people with relatively low levels of cortisol reactivity to couple conflict. Results are interpreted in light of research demonstrating that cortisol reactivity can become blunted over time in response to repeated stressors. These results provide precision to etiological models of obesity by identifying cortisol reactivity as a factor that moderates the association between relationship hostility and adiposity. (PsycINFO Database Record
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Lorber MF, Slep AMS. The reliability paradox of the Parent-Child Conflict Tactics Corporal Punishment Subscale. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2018; 32:145-150. [PMID: 28594198 DOI: 10.1037/fam0000307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In the present investigation we consider and explain an apparent paradox in the measurement of corporal punishment with the Parent-Child Conflict Tactics Scale (CTS-PC): How can it have poor internal consistency and still be reliable? The CTS-PC was administered to a community sample of 453 opposite sex couples who were parents of 3- to 7-year-old children. Internal consistency was marginal, yet item response theory analyses revealed that reliability rose sharply with increasing corporal punishment, exceeding .80 in the upper ranges of the construct. The results suggest that the CTS-PC Corporal Punishment subscale reliably discriminates among parents who report average to high corporal punishment (64% of mothers and 56% of fathers in the present sample), despite low overall internal consistency. These results have straightforward implications for the use and reporting of the scale. (PsycINFO Database Record
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Smith Slep AM, Heyman RE, Mitnick DM, Lorber MF, Beauchaine TP. Targeting couple and parent-child coercion to improve health behaviors. Behav Res Ther 2017; 101:82-91. [PMID: 29108651 DOI: 10.1016/j.brat.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/29/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023]
Abstract
This phase of the NIH Science of Behavior Change program emphasizes an "experimental medicine approach to behavior change," that seeks to identify targets related to stress reactivity, self-regulation, and social processes for maximal effects on multiple health outcomes. Within this framework, our project focuses on interpersonal processes associated with health: coercive couple and parent-child conflict. Diabetes and poor oral health portend pain, distress, expense, loss of productivity, and even mortality. They share overlapping medical regimens, are driven by overlapping proximal health behaviors, and affect a wide developmental span, from early childhood to late adulthood. Coercive couple and parent-child conflict constitute potent and destructive influences on a wide range of adult and child health outcomes. Such interaction patterns give rise to disturbed environmental stress reactivity (e.g., disrupted sympathetic nervous and parasympathetic nervous systems) and a wide range of adverse health outcomes in children and adults, including dental caries, obesity, and diabetes-related metabolic markers. In this work, we seek to identify/develop/validate assays assessing coercion, identify/develop and test brief interventions to reduce coercion, and test whether changes in coercion trigger changes in health behaviors.
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Balderrama-Durbin C, Stanton K, Snyder DK, Cigrang JA, Talcott GW, Smith Slep AM, Heyman RE, Cassidy DG. The risk for marital infidelity across a year-long deployment. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2017; 31:629-634. [PMID: 28054799 DOI: 10.1037/fam0000281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Military deployment can create significant relationship strain. Although most couples navigate the challenges of deployment successfully, this period may render some couples more vulnerable to adverse relationship outcomes such as infidelity due to a convergence of factors including geographic separation and reduced emotional and physical intimacy. Despite anecdotal reports of increased rates of infidelity during deployment, empirical findings are lacking. This study used a prospective design to examine the prevalence and risk factors of infidelity across the deployment cycle including a year-long deployment to Iraq. A total of 63 married male Airmen were assessed both pre- and 6-9 months postdeployment. The rate of sexual infidelity prior to deployment (21%) was commensurate with the lifetime rate of sexual involvement outside the marriage in representative community samples of men. Across the deployment period, the prevalence of sexual infidelity was strikingly high (22.6%) compared with annual community estimates (1.5-4%; Allen et al., 2005). Findings demonstrated that service members with a prior history of separation, steps toward divorce, and relationship distress prior to deployment had elevated risk for infidelity over the deployment cycle. Moreover, roughly 75% of Airmen who experienced infidelity over the deployment cycle divorced by 6-9 months postdeployment whereas only 5% of service members without infidelity divorced during this same time period. Considering well-documented adverse impacts of infidelity and divorce, the current findings may assist in identifying military couples at risk for infidelity and informing targeted prevention or early intervention strategies for these couples prior to or immediately following deployment. (PsycINFO Database Record
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Heyman RE, Slep AMS, White-Ajmani M, Bulling L, Zickgraf HF, Franklin ME, Wolff MS. Dental Fear and Avoidance in Treatment Seekers at a Large, Urban Dental Clinic. ORAL HEALTH & PREVENTIVE DENTISTRY 2016; 14:315-20. [PMID: 27351733 DOI: 10.3290/j.ohpd.a36468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE The prevalence and correlates of dental fear have been studied in representative population studies, but not in patients presenting for dental treatment. We hypothesized that dental fear among patients presenting at a large, urban college of dentistry would be similar to that of the population (e.g. 11% high dental fear, 17% to 35% moderate or higher fear) and that fear would be associated with avoidance of routine dental care, increased use of urgent dental care and poor oral health. MATERIALS AND METHODS Participants were 1070 consecutive patients at a large, urban dental care center. All patients completed a clinical interview, including demographics, medical history, dental history and presenting concerns, and behavioral health history. Patients were also asked to rate their dental anxiety/fear on a 1 (none) to 10 (high) scale. RESULTS Over 20% of patients reported elevated anxiety/fear, of which 12.30% reported moderate and 8.75% high fear. Severity of dental anxiety/fear was strongly related to the likelihood of avoiding dental services in the past and related to myriad presenting problems. CONCLUSIONS As hypothesized, the prevalence of moderate or higher fear in dental patients was considerable and closely matched that found in general population surveys. Thus, the 'dental home' is an ideal location to treat clinically significant dental anxiety/fear.
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Del Vecchio T, Lorber MF, Slep AMS, Malik J, Heyman RE, Foran HM. Parental Flooding During Conflict: A Psychometric Evaluation of a New Scale. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 44:1587-1597. [PMID: 26909682 PMCID: PMC4996766 DOI: 10.1007/s10802-016-0137-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Parents who are overwhelmed by the intensity and aversive nature of child negative affect - those who are experiencing flooding - may be less likely to react effectively and instead may focus on escaping the aversive situation, disciplining either overly permissively or punitively to escape quickly from child negative affect. However, there are no validated self-report measures of the degree to which parents experience flooding, impeding the exploration of these relations. Thus, we created and evaluated the Parent Flooding scale (PFS), assessing the extent to which parents believe their children's negative affect during parent-child conflicts is unexpected, overwhelming and distressing. We studied its factorial validity, reliability, and concurrent validity in a community sample of 453 couples with 3- to 7-year-old children (51.9 % girls) recruited via random digit dialing. Confirmatory factor analyses indicated a one-factor solution with excellent internal consistency. Test-retest stability over an average of 5.6 months was high. Concurrent validity was suggested by the associations of flooding with parents' aggression toward their children, overreactive and lax discipline, parenting satisfaction, and parents' anger, as well as with child externalizing behavior and negative affect. Incrementally concurrent validity analyses indicated that flooding was a unique predictor of mothers' and fathers' overreactive discipline and fathers' parent-child aggression and lax discipline, over and above the contributions of parents' anger and children's negative affect. The present results support the psychometric validity of the PFS.
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Lorber MF, Mitnick DM, Slep AMS. Parents' experience of flooding in discipline encounters: Associations with discipline and interplay with related factors. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2016; 30:470-479. [PMID: 26690330 DOI: 10.1037/fam0000176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In family psychology, the term flooding refers to the feeling of being overwhelmed by a family member's behavior in a manner that undermines an organized response. In the present investigation we first aimed to clarify the role of flooding in overreactive and lax discipline. The second study aim was to more fully establish the position of parental flooding in its nomological network given the relative paucity of research on parental flooding. Maternal discipline and physiological responses, as well as child behavior, were observed in laboratory discipline encounters with 97 mother-toddler dyads. Mothers then rated the extent to which they experienced flooding in response to their children's behavior and emotion displays during the immediately preceding discipline encounters. Mothers' experience of negative emotion was assessed via video-mediated recall. Flooding was positively associated with both overreactive and lax discipline; this association did not reflect confounding by mothers' experience of negative emotion. Flooding was further associated with mothers' experienced negative emotion and heart rate reactivity, as well as child misbehavior and negative emotion displays. The flooding-overreactive discipline association was concentrated in those mothers who exhibited greater increases in heart rate and greater vagal withdrawal, and whose children misbehaved more during the discipline encounter. The present results suggest the incremental validity of flooding in predicting discipline practices, as well as the strong fit of flooding in its nomological network. Parents' self-recognition of flooding may ultimately prove useful in parenting interventions as a signal to trigger compensatory techniques. (PsycINFO Database Record
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Snyder DK, Balderrama-Durbin C, Cigrang JA, Talcott GW, Slep AMS, Heyman RE. Help-seeking among airmen in distressed relationships: Promoting relationship well-being. Psychotherapy (Chic) 2016; 53:1-12. [PMID: 26928135 DOI: 10.1037/pst0000045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although a substantial proportion of service members returning from a combat deployment report individual emotional and behavioral disorders as well as intimate relationship difficulties, previous studies indicate that only a minority actually seek mental health services. Little is known about factors that predict help-seeking in this population. We first review key findings from the literature on help-seeking in military and veteran populations, including mixed findings regarding the role of perceived stigma and attitudes toward mental health treatment. We then present data from a longitudinal study of United States Air Force Security Forces following a year-long high-risk deployment to Iraq-including findings regarding who seeks help, for what problems, and from which providers. We also examine whether these findings differ for Airmen in a married or committed relationship versus nonpartnered Airmen and, for the former group, whether findings differ for those in a distressed versus nondistressed relationship. Finally, we discuss implications of these findings for extending couple-based interventions to service members and veterans, and describe a multitiered "stepped" approach for promoting relationship resiliency.
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