Social support and psychotherapy outcomes for international students in university/college counseling centers

Objective: To explore the relationship between international students' social support at intake and international student distress at end of treatment. Participants: Data was collected from participants (n = 40,085) from 90 United States universities using the Center for Collegiate Mental Health (CCMH) database. Methods: Participants completed measures of psychological distress and perceived social support. Using multilevel modeling, we predicted participants' distress at end of treatment by international student status, social support, race, and length of therapy. Results: We found that international students who reported lower social support at intake ended treatment with higher levels of psychological distress when distress at intake was controlled compared to United States peers. Conclusions: Understanding the significance of social support for international students can help to inform mental healthcare professionals' approach to psychotherapy.

Psychotherapy outcomes with Latinx clients attending Hispanic-serving institutions and predominantly White institutions

In the present study, we used a large, national data set to examine psychotherapy outcomes from 9,515 Latinx clients seeking treatment in 71 college or university counseling centers in the United States, 13 of which were in Hispanic-serving institutions (HSIs) and 58 in predominantly White institutions (PWIs). We examined the hypothesis that Latinx clients in HSIs, compared to Latinx clients in PWIs, would experience greater relief in symptoms of depression, generalized anxiety, and academic distress over the course of psychotherapy. Results of multilevel modeling offered partial support for our hypothesis. Compared to their counterparts in PWIs, Latinx clients in HSIs were found to experience significantly greater relief in academic distress over the course of psychotherapy, but there were no significant differences between Latinx clients in HSIs and PWIs in terms of changes in depression or generalized anxiety over time. We offer recommendations for future research and discuss the practical implications of these findings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Measurement invariance and psychometric properties of the CCAPS-62 and -34 for international student clients

OBJECTIVES

International students attending universities in the United States may encounter psychological distress related to their adjustment and experiences studying in a new context and seek services from university counseling centers. Many centers use the Counseling Center Assessment of Psychological Symptoms (CCAPS) to measure psychological distress in college counseling centers. However, this scale has not been tested for measurement invariance with international students. Our purpose was to explore the measurement invariance of the CCAPS-62 and -34 for international students.

METHODS

We tested measurement invariance for both versions of the scale using data from over 107,000 university students in psychotherapy at university counseling centers. We also examined construct validity and internal consistency.

RESULTS

Invariance testing indicated the measurement models of the CCAPS-62 and -34 are equivalent between both groups.

CONCLUSION

These findings are discussed in light of utilizing this widely-used scale in United States university/college counseling centers with international student clients.

Center effects, therapist effects, and international student clients' drop out from psychotherapy

In 2019-2020, 1,075,496 international students pursued higher education in the United States. Many of these students endure unique experiences of psychological distress that accompanies their shared experience of studying abroad in the United States. Researchers have explored clinical experiences within this diverse group, with some suggesting that international students are at greater risk than students from the United States for dropping out of psychotherapy. This issue is underexplored in the extant psychotherapy literature. Therefore, we used a large, national data set and multilevel analyses to test if international students are more likely than students from the United States to drop out of psychotherapy, defined in this study as failure to attend one's last scheduled session. Data from 65,293 clients (n = 3,970 international students), 2,735 therapists, and 131 university/college counseling centers were included in the analysis. Results revealed that (a) international students are no more likely to drop out than United States domestic students, (b) on average, centers (ICC = 0.045) and therapists (ICC = 0.071) are differentially effective at preventing drop out, and (c) therapist effects on drop out differ for international students. We discuss these findings with respect to therapist and center roles in international students' drop out from treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Therapist and counseling center effects on international students' counseling outcome: A mixed methods study

We employed a convergent mixed methods design to examine therapist and counseling center effects on international student clients' (ISCs) counseling outcomes. Using the Center for Collegiate Mental Health (CCMH) data set (2015-2017), we conducted a three-level hierarchical linear model with clients (N = 85,110) nested in therapists (N = 1,267), and therapists nested in counseling centers (N = 111), with clients' international status predicting distress (DI) in their last sessions while controlling for initial DI. Compared to domestic students, the average last session DI was significantly higher among ISCs. Random effects were significant, suggesting that some therapists and centers were more effective in their work with ISCs than others. When the proportion of ISCs seen was accounted into the model, we found a cross-level interaction in which the last session DI differences between ISCs and domestic students were significant for centers seeing a small percentage of ISCs but not for centers with large percentages of ISCs in the caseload. Grounded theory analysis of qualitative data from 11 therapists with international backgrounds revealed therapist and center factors that converged with our quantitative findings. Participants reported adhering to general clinical frameworks when working with ISCs given the lack of training on international competence (which may help explain the effectiveness gap), but also noted nuanced culturally-informed components that likely contribute to more effectively working with ISCs. Findings around center effects were complemented by qualitative results emphasizing systemic representation and engagement with diversity, creative outreach efforts, and administrative/leadership support. Implications for practice and research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Therapists' cultural comfort and clients' distress: An initial exploration

The extent to which therapists are comfortable discussing clients' cultural identities in psychotherapy has been considered a valuable component of how therapists integrate clients' cultures into treatment. Cultural comfort specifically reflects a therapist's way of being at ease, relaxed, and open when discussing clients' cultural identities in treatment. Some initial research has demonstrated the relationships between cultural comfort and clinical outcomes, yet this work has relied largely on cross-sectional designs. The purpose of this preliminary study was to use longitudinal psychotherapy data to explore the relationships between clients' perceptions of their therapists' cultural comfort and clients' distress over the course of psychotherapy. Data were collected from 48 clients who attended 476 sessions in a doctoral training clinic. Multilevel modeling was used to account for the nested nature of the data. Results showed that, when session number was held constant, within-client increases in their perceptions of their therapists' cultural comfort were predictive of decreases in psychological distress. We discuss these findings in light of the multicultural orientation literature and with respect to the implications for therapists striving to be comfortable with culture in sessions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Pretreatment counseling experiences, stressors, and support differences between transgender and cisgender university students seeking mental healthcare

OBJECTIVES

Our aim was to explore rates of prior counseling experiences as well as pretreatment stressors and supports among transgender university students seeking psychotherapy services in university counseling centers.

METHODS

We used regression models to explore relationships between gender identity and prior mental health experiences, risk-related experiences, traumatic experiences, and support among clients (cisgender: n = 162,305; transgender: n = 545) seeking treatment at 136 university counseling centers.

RESULTS

Results demonstrate more previous mental health service utilization and greater frequency of some prior stressors transgender clients. Findings indicate the odds of transgender clients reporting drug and alcohol concerns are lower than the reference group. Additionally, transgender clients report less familial support but more social support than cisgender clients.

CONCLUSION

We discuss the importance of these findings through a more holistic lens that recognizes both stressors as well as positive factors that may more accurately characterize the experiences of transgender clients.

Mixed methods in psychotherapy research: A review of method(ology) integration in psychotherapy science

OBJECTIVE

Mixed methods can foster depth and breadth in psychological research. However, its use remains in development in psychotherapy research. Our purpose was to review the use of mixed methods in psychotherapy research.

METHOD

Thirty-one studies were identified via the PRISMA systematic review method. Using Creswell & Plano Clark's typologies to identify design characteristics, we assessed each study for rigor and how each used mixed methods.

RESULTS

Key features of mixed methods designs and these common patterns were identified: (a) integration of clients' perceptions via mixing; (b) understanding group psychotherapy; (c) integrating methods with cases and small samples; (d) analyzing clinical data as qualitative data; and (e) exploring cultural identities in psychotherapy through mixed methods.

CONCLUSION

The review is discussed with respect to the value of integrating multiple data in single studies to enhance psychotherapy research.

Treatment-seeking college students with disabilities: Presenting concerns, protective factors, and academic distress

Students with disabilities are a growing population on college campuses and have unique challenges that put them at risk for early departure, creating complexity in efforts to address their personal and academic needs.

PURPOSE

The purpose was to explore academic and other sources of distress among college students with disabilities to identify possible areas where enhanced supports might benefit this population. Research Method and Design: Researchers analyzed cross-sectional data from the Center for Collegiate Mental Health to compare subsamples of students with (n = 1,774) and without disabilities (n = 1,774) on presenting concerns, and to determine significant predictors of academic distress among students with disabilities.

RESULTS

Results indicated that students with disabilities have many similar treatment concerns with their peers, but showed greater concerns in depression and self-harm; academic performance; anxiety and obsessions/compulsions; and fewer concerns in relationship problems. Significant predictors of academic distress for students with disabilities included attention deficit-hyperactivity disorder (ADHD), depression and self-harm, trauma or victimization, stress and academic performance, and social support from family and peers.

CONCLUSIONS/IMPLICATIONS

These results suggest the importance of several factors in understanding the presenting concerns of treatment-seeking students with disabilities and mitigating academic distress for this population. Additional areas for research are presented. (PsycINFO Database Record

The context and consequences of sexual assault among undergraduate women at Historically Black Colleges and Universities (HBCUs)

To examine the context of sexual assault and postassault actions and consequences among women attending historically Black colleges or universities (HBCUs), web-based surveys were administered in November 2008 to 3,951 undergraduate women attending four HBCUs. Data on the context in which assaults occurred were generated for women who had been sexually assaulted since entering college (n = 358). Multivariate models were run on the full sample to examine the association between sexual assault and symptoms of depression and posttraumatic stress disorder (PTSD). Results indicated that most survivors were assaulted by assailants well known to them and when the survivor and perpetrator were drinking alcohol. Very few survivors disclosed their experiences to formal sources of support. Survivors had significantly more symptoms of depression and were more likely to screen positive for PTSD than nonvictims. Further research on disclosure and its moderating role on the mental health consequences of sexual assault is needed.

Airway cooling and mucosal injury during cold weather exercise

In human subjects that exercise strenuously in cold weather, there is evidence that hyperventilation with cold air leads to peripheral airway cooling, desiccation and mucosal injury. Our hypothesis was that hyperventilation with cold air can result in penetration of unconditioned air (air that is not completely warmed and humidified) into the peripheral airways of exercising horses, resulting in peripheral airway mucosal injury. To test this hypothesis, a thermister-tipped catheter was inserted through the midcervical trachea and advanced into a sublobar bronchus in three horses that cantered on a treadmill at 6.6 m/s while breathing cold (5 degrees C) air. The mean (+/- s.e.) intra-airway temperature during cantering was 33.3 +/- 0.4 degrees C, a value comparable to the bronchial lumen temperatures measured in man during maximal exercise while breathing subfreezing dry air. In a second experiment, 6 fit Thoroughbred racehorses with satisfactory performance were used to determine whether strenuous exercise in cold conditions can produce airway injury. Horses were assigned to Exercise (E) or Control (C) groups in a random crossover design. Samples of bronchoalveolar lavage fluid (BALF) in the E treatment were recovered within 30 min of galloping exercise in 4 degrees C, 100% relative humidity (E), while in C BALF samples were obtained when the horses had not performed any exercise for at least 48 h prior. Ciliated epithelial cells in BALF were higher in E than in the C treatment. Similar results have been found in human athletes and laboratory animal models of cold weather exercise. These results support the hypothesis that, similar to man, horses that exercise in cold weather experience peripheral airway mucosal injury due to the penetration of unconditioned air. Furthermore, these results suggest that airway cooling and desiccation may be a factor in airway inflammation commonly found in equine athletes.