Psychology Department Theses and Dissertations

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Effect of Depression Treatment on Health Behaviors and Cardiovascular Risk Factors Among Primary Care Patients with Depression: Data from the eIMPACT Trial
(2023-12) Schuiling, Matthew D.; Stewart, Jesse; Hirsh, Adam; Wu, Wei
Background. Although depression is a risk factor for cardiovascular disease (CVD), few clinical trials in people without CVD have examined the effect of depression treatment on CVD-related outcomes. It’s unknown if successful depression treatment improves indicators of CVD risk, such as CVD-relevant health behaviors, traditional CVD risk factors, and CVD events. Methods. We examined data from eIMPACT trial, a phase II randomized controlled trial conducted from 2015-2020. Depressive symptoms, CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed. Incident CVD events over four years were identified using a statewide health information exchange. Results. The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). CVD-relevant health behaviors did not mediate any intervention effects on traditional CVD risk factors. Twenty-two participants (10%) experienced an incident CVD event. The likelihood of an CVD event did not differ between the intervention group (12.1%) and the usual care group (8.3%; HR = 1.45, 95% CI: 0.62-3.40, p = 0.39). Conclusions. Successful depression treatment alone improves self-reported sleep quality but is not sufficient to lower CVD risk of people with depression. Alternative approaches may be needed reduce CVD risk in depression. Trial Registration: ClinicalTrials.gov Identifier: NCT02458690
Evaluating Sex and Line Differences in Successive Negative Contrast and Ethanol Consumption Using Alcohol Preferring and High Alcohol Drinking Rats
(2023-12) Smith, Nicholle; Czachowski, Cristine; Grahame, Nicholas; Logrip, Marian
A loss of a job or relationship are a few examples of unexpected reward loss. Life events such as these can induce negative emotional reactions (e.g., anxiety and stress) which have been associated with increased drinking and in turn, an increased risk of developing an alcohol use disorder (AUD) (Keyes et al., 2011, Sinha, 2008). The present study used a consummatory successive negative contrast (SNC) procedure to demonstrate unexpected reward loss reactivity in two lines selectively bred to consume high amounts of ethanol, alcohol preferring (P) and high alcohol drinking (HAD) rats. Following this reward loss, animals were given free access to ethanol to determine if ethanol consumption would increase to negate any negative emotional reaction provoked by this loss. P rats demonstrated a longer contrast effect than HAD rats, indicated by a longer recovery time following the downshift in reward. Conversely, HAD males did not demonstrate a contrast effect following this downshift in reward. Surprisingly, P rats who experienced a loss of reward consumed significantly less ethanol than animals who did not. Lastly, an individual measure of contrast size, or shift ratio, was significantly associated with greater ethanol consumption in HAD males only, who did not display a contrast effect. These data indicate different reactivity to SNC between these two lines and sexes, suggesting different genetic and sex-related mechanisms underlying sensitivity to an unexpected loss of reward.
Role of the Prefrontal Cortex to Dorsomedial Striatum Projections in Compulsive Alcohol Drinking
(2023-12) Bauer, Meredith; Boehm, Stephen; Lapish, Christopher; Grahame, Nicholas; Gremel, Christina
Compulsive alcohol drinking is a defining feature of alcohol use disorder and is characterized as drinking alcohol despite knowledge of negative consequences. This behavior is hypothesized to be due to a disruption in the decision-making process. Decision making relies on a balance between goal-directedness and habit systems to efficiently execute behavior. An important distinction between compulsive and non-compulsive individuals is the ability to withhold drinking in the face of a negative consequence. The dorsomedial striatum (DMS) and dorsomedial prefrontal cortex (dmPFC) are brain regions necessary for goal directed behavior where the dmPFC is important for cognitive control and behavioral inhibition while the DMS is important for action selection. Importantly, the dmPFC sends a glutamatergic input to the DMS. We hypothesize this input is a behavioral control which is necessary to withhold action selection. Thus, in order to maintain non-compulsive alcohol use, the dmPFC and DMS need to work together to orchestrate inhibition of action selection in the face of negative consequences. Previous research shows a causal role for both the dmPFC and DMS in preventing compulsive alcohol drinking and a role for the projections from the dmPFC to DMS in behavioral inhibition. However, no research has demonstrated a role for this circuit’s activity in prevention of compulsive alcohol use. The current experiment tested the hypothesis that inhibiting the glutamatergic projection from the dmPFC to the DMS will cause non-compulsive Wistar rats to drink alcohol compulsively.
Leveraging Whole Brain Imaging to Identify Brain Regions Involved in Alcohol Frontloading
(2023-12) Ardinger, Cherish; Lapish, Christopher; Grahame, Nicholas; Czachowski, Cristine; Kimbrough, Adam
Frontloading is an alcohol drinking pattern where intake is skewed toward the onset of access. The goal of the current study was to identify brain regions involved in frontloading using whole brain imaging. 63 C57Bl/6J (32 female and 31 male) mice underwent 8 days of binge drinking using drinking-in-the-dark (DID). Three hours into the dark cycle, mice received 20% (v/v) alcohol or water for two hours on days 1-7. Intake was measured in 1-minute bins using volumetric sippers, which facilitated analyses of drinking patterns. Mice were perfused 80 minutes into the day 8 DID session and brains were extracted and processed for iDISCO clearing and c-fos immunohistochemistry. For brain network analyses, day 8 drinking patterns were used to characterize mice as frontloaders or non-frontloaders using a change-point analysis described in our recent ACER publication (Ardinger et al., 2022). Groups were female frontloaders (n = 20), female non-frontloaders (n = 2), male frontloaders (n = 13) and male non-frontloaders (n = 8). There were no differences in total alcohol intake as a function of frontloading status. Water drinkers had an n of 10 for each sex. As only two female mice were characterized as non-frontloaders, it was not possible to construct a functional correlation network for this group. Following light sheet imaging, ClearMap2.1 was used to register brains to the Allen Brain Atlas and detect fos+ cells. Functional correlation matrices were calculated for each group from log10 c-fos values. Euclidean distances were calculated from these R values and hierarchical clustering was used to determine modules (highly connected groups of brain regions) at a tree-cut height of 50%. In males, alcohol access decreased modularity (3 modules in both frontloaders and non-frontloaders) as compared to water drinkers (7 modules). In females, an opposite effect was observed. Alcohol access (9 modules) increased modularity as compared to water drinkers (5 modules). These results suggest sex differences in how alcohol consumption reorganizes the functional architecture of networks. Next, key brain regions in each network were identified. Connector hubs, which primarily facilitate communication between modules, and provincial hubs, which facilitate communication within modules, were of specific interest for their important and differing roles. In males, 4 connector hubs and 17 provincial hubs were uniquely identified in frontloaders (i.e., were brain regions that did not have this status in male non-frontloaders or water drinkers). These represented a group of hindbrain regions (e.g., locus coeruleus and the pontine gray) connected to striatal/cortical regions (e.g., cortical amygdalar area) by the paraventricular nucleus of the thalamus. In females, 16 connector and 17 provincial hubs were uniquely identified which were distributed across 8 of the 9 modules in the female alcohol drinker network. Only one brain region (the nucleus raphe pontis) was a connector hub in both sexes, suggesting that frontloading in males and females may be driven by different brain regions. In conclusion, alcohol consumption led to fewer, but more densely connected, groups of brain regions in males but not females, and recruited different hub brain regions between the sexes. These results suggest target brain regions for future studies to try to manipulate frontloading behavior and more broadly contribute to the literature on alcohol’s effect on neural networks.
Health vs Success: Examining Whether Exposure to Negative Stereotypes Motivates Engagement in Unhealthy Behaviors among Low-SES College Students
(2023-11) Gonzalez , Daniela; Derricks, Veronica; Johnson, India R.; Hirsh, Adam T.
Individuals from low socioeconomic (SES) backgrounds experience worse health outcomes than high-SES individuals. Those disparities may be explained, at least in part, by low-SES individuals' routine exposure to stigma that can activate concerns about belonging in several settings, including academics. The current study tested whether activation of negative stereotypes (e.g., low academic ability) among low-SES students affects their motivation to engage in unhealthy behaviors (e.g., pulling an "all-nighter") in an effort to maximize academic success and disconfirm negative stereotypes about their group. Moreover, we assessed the role of key moderators (e.g., contingencies of self-worth in academic settings and stereotype threat concerns about one’s ingroup) and mediators (e.g., motivation to disconfirm negative ingroup stereotypes and stereotype threat concerns) on these outcomes. In an online experiment, college students recruited on Prolific Academic read a hypothetical news article indicating that low-SES students underperform academically relative to high-SES students (stereotype activation condition) or that low-SES students perform just as well as high-SES students (control condition). Although the findings indicated that our manipulation was effective, our results did not reach significance across the hypothesized outcomes. Implications for coping behaviors and academic outcomes for students from low-SES backgrounds are discussed.
A Mixed-Methods Investigation of the Implications of Substance Use Disorder Stigma for Justice-Involved Youth
(2023-08) Johnson-Kwochka, Annalee V.; Salyers, Michelle; Cyders, Melissa; Zapolski, Tamika; Aalsma, Mathew
Objectives: Compared to youth without justice-involvement, justice-involved youth are more likely to experience substance use disorders. Yet, few justice-involved youth receive appropriate, evidence-based treatment for substance use disorders. Although there are numerous barriers to the accessibility of appropriate treatment, research also suggests that it is difficult to engage justice-involved youth in treatment even when it is available and accessible. It is possible that substance use disorder stigma, or negative attitudes towards youth with substance use disorders, may contribute to low treatment accessibility, and make it more difficult for justice-involved youth to engage with available treatment. Few researchers have examined substance use disorder stigma among this population. The purpose of this study was to 1) explore the nature of substance use disorder stigma among justice-involved youth, at multiple ecological levels and 2) examine the role of substance use disorder stigma in limiting the accessibility of and engagement in treatment and justice-involved youth’s engagement in treatment. Methods: Participants (n = 44 youth-guardian dyads) were referred to the study by juvenile probation departments in two Indiana counties. In addition, 66 system personnel participants who work with justice-involved youth with substance use disorders were recruited from community mental health centers and juvenile probation departments in rural and suburban Indiana counties. All participants completed survey measures of substance use disorder stigma and familiarity with substance use; youth-guardian dyads also provided information about the youth’s substance use history and treatment utilization. A subset of participants (n = 9 youth, 11 guardians, 12 system personnel) completed qualitative interviews, providing perspectives on substance use disorder stigma and the role of stigma in discouraging treatment. Using analysis of covariance, multiple regression analyses, and qualitative grounded theory analysis, I explored the nature of stigma toward justice-involved youth with substance use disorders and examined the impact of stigma on treatment accessibility and engagement. Results: For aim 1, as hypothesized, public stigma (assessed by survey data) varied significantly according to participant role and specific substance, with guardians endorsing greater stigma than system personnel. All participants expressed greater negative emotions towards youth with opioid use disorder compared to marijuana use disorder. Interview data revealed particularly nuanced attitudes about marijuana use. Contrary to expectations, youth reported little self-stigma. Both youth and guardians described limited knowledge of problematic substance use. For aim 2, interview data suggests that youth and guardians may identify more stigma associated with seeking treatment for problematic substance use than with using substances. All participants reported that perceived stigma has improved in recent years, and that youth feel more comfortable discussing their substance use. However, guardians identified family attitudes about behavioral health treatment as negatively impacting engagement among youth. In addition, system personnel reported that stigma continues to limit the accessibility of youth SUD treatment. Discussion: Youth endorsed lower than expected levels of self-stigma with no difference by primary substance type; this may have been affected by youth’s limited understanding of problematic substance use and lower than expected heterogeneity in substance use type among participants. Consistent with prior research, self-stigma was directly related to the severity of mental health symptoms. The high prevalence of public stigma among guardians of JIY with SUDs suggests that parents and guardians would benefit from interventions to better support their caregiving experiences. All participants identified complex attitudes about marijuana use, suggesting that the increasing public acceptability and endorsement of marijuana as a helpful substance may complicate treatment seeking when use becomes problematic. Although youth did not conceptualize self-stigma as a barrier to treatment, given that the primary substance used in this study was marijuana, these results may be complicated by changing societal attitudes about marijuana in particular. Qualitative perspectives from guardians and system personnel suggest that substance use disorder stigma may limit both the accessibility of treatment and youth’s likelihood to engage with treatment; this may depend on type of substance used. Particularly for the participants in this study, extremely limited treatment accessibility posed the largest barrier to evidence-based substance use disorder treatment for adolescents, making it difficult to accurately assess the role of stigma in actual treatment use. Finally, findings suggest that measuring substance use disorder stigma may be dependent on participants’ ability to accurately identify problematic substance use. It may also be important to refine both qualitative and quantitative measurement of stigma specifically with adolescents. Limitations and suggestions for future research are discussed.
Social Anhedonia in the Daily Lives of People with Schizophrenia: Examination of Anticipated and Consummatory Pleasure
(2024-05) Abel, Danielle B.; Minor, Kyle S.; Salyers, Michelle P.; Wu, Wei; Vohs, Jenifer L.
Social withdrawal is a disabling feature of schizophrenia. To understand its development, researchers have focused on social anhedonia— diminished pleasure from social interactions. Discrepancies in anticipated versus consummatory pleasure for non-social stimuli are well-documented in schizophrenia. Thus, a similar emotional paradox may underlie social anhedonia. If so, our understanding of social anhedonia—including how to treat it in schizophrenia—could be enhanced. This project used a 5-day experience sampling method (ESM) to measure discrepancies between anticipated and consummatory pleasure for real-world social activities in people with schizophrenia and healthy controls (n=30/group). Results suggest people with schizophrenia exhibited similar levels of anticipated and consummatory social pleasure as controls, and both groups were accurate in their short-term predictions of pleasure. Yet, healthy control participants were somewhat more precise in their short-term pleasure predictions, and clinical interviews revealed those with schizophrenia showed moderate deficits in long-term social pleasure prediction. Negative symptoms and cognitive impairment in schizophrenia were related to anticipated, but not consummatory, social pleasure, suggesting anhedonia is driven by deficits in thinking about pleasure, rather than inability to experience pleasure. Clinical implications include focusing on building upon short-term ability to predict pleasure in therapy in order to increase social motivation in schizophrenia. Moreover, exploratory analyses revealed differences in qualitative aspects of social activities such as level of engagement may lead to social anhedonia in schizophrenia and are a promising treatment target for addressing social dysfunction.
Daily Experiences of Racial Microaggressions and Health Outcomes Among Black Adolescents: A Daily Diary Study
(2023-08) Clifton, Richelle Lee; Zapolski, Tamika C. B.; Stewart, Jesse C.; Johnson, India R.; Aalsma, Matthew C.
Racial microaggressions are associated with multiple negative health outcomes, including increased distress, anxiety (Blume et al., 2012; Schoulte et al., 2011), and substance use (Su et al., 2019). The negative effects of racial microaggressions have been observed through daily assessments (Burrow & Ong, 2010; Ong et al., 2009; Swim et al., 2003). However, these studies have been conducted almost exclusively among Black adults. Thus, the first aim of the current study is to examine the impact of daily experiences of racial microaggressions on health outcomes among Black adolescents. Further, it is also important to examine factors that might influence the relationship between racial microaggressions and health outcomes. One factor that has received a considerable amount of attention is racial identity, with more recent studies examining the impact of racial identity profiles. Thus, the second aim of the current study was to explore variability in these risk pathways based on racial identity profiles. Participants were Black adolescents (N = 48; 79.2% girls; Mage=17.13). Respondents completed measures of racial identity at baseline and daily diary measures of racial microaggressions, depression, anxiety, aggression, and substance use for 14 days. Participants reported an average of 5.56 experiences of racial microaggressions per day. Neither concurrent or lagged-day associations between racial microaggressions and symptoms of depression or symptoms of anxiety were significant. Concurrent analyses indicated that the between-person effect of racial microaggressions on aggression was significant (estimate=0.345, SE=0.138, t=2.495, p=0.016), and that effect was still evident one day later (estimate=0.107, SE=0.040, t=2.686, p=0.007). The concurrent, within-person effect of racial microaggressions on cannabis use was also significant (OR=1.524, 95%CI[0.103, 0.740], p=0.010). Four racial identity profiles were identified (labeled race- focused, undifferentiated, integrationist, and multiculturalist) and a number of effects were significant within profiles. This study further highlighted that Black youth are experiencing an overwhelming number of racial microaggressions on a daily basis. Additionally, this project represents a crucial step in advancing our understanding of how racial microaggressions operate to influence health outcomes among Black adolescents on the daily level and highlights several areas for needed study and intervention.
The Role of Trait and Specific Expectations in the Dysmenorrhea Experience
(2024-08-13) Rogers, Sarah K.; Rand, Kevin L.; Mosher, Catherine E.; Stewart, Jesse C.; Chen, Chen X.
Dysmenorrhea is the most common pain condition in reproductive-aged women and is characterized by pain during menstruation. Dysmenorrhea has far-reaching effects, such as increased psychological distress, increased relationship problems, reduced physical activity, and decreased sleep efficiency. It is the leading cause of absenteeism in this population. Though dysmenorrhea impacts many women and has such far-reaching effects, it has not been studied as extensively as other pain conditions, specifically regarding trait expectations and specific expectations. In other pain conditions, hope and optimism, the two most studied trait expectations, are protective factors for pain severity, interference, and the psychological effects of pain. Trait expectations additionally predict specific expectations, with hope predicting specific expectations related to the self, and optimism predicting specific expectations related to experiences. Both self- and experience-expectations predict outcomes, such as pain severity and pain tolerance. The current study sought to 1) examine the factor structure of specific expectations for dysmenorrhea; 2) examine the roles of trait and specific expectations in predicting dysmenorrhea; and 3) examine the roles of trait expectations and dysmenorrhea in predicting psychological adjustment. A longitudinal study of 389 menstruating women, over the age of 18, who could read and write English was conducted through CloudResearch. Confirmatory factor analysis and mixed latent- and measured-variable path analysis were used. Results indicated two distinct factors of specific expectations, pain-expectation and self- expectation. Hope predicted self-expectation, which predicted dysmenorrhea interference. Pain- expectation predicted dysmenorrhea severity and interference. Additionally, both hope and optimism predicted psychological adjustment. Dysmenorrhea interference predicted psychological distress. However, trait expectations did not predict dysmenorrhea. This study is the first to examine the associations among trait expectations, specific expectations, and dysmenorrhea and expands on the differences between dysmenorrhea and other pain conditions.
De-Mixing Decision Representations in Rodent dmPFC to Investigate Strategy Change During Delay Discounting
(2023-05) White, Shelby M.; Lapish, Christopher; Czachowski, Cristine; Oberlin, Brandon; Seamans, Jeremy
Several pathological disorders are characterized by maladaptive decision-making (Dalley & Robbins, 2017). Decision-making tasks, such as Delay Discounting (DD), are used to assess the behavioral manifestations of maladaptive decision-making in both clinical and preclinical settings (de Wit, Flory, Acheson, Mccloskey, & Manuck, 2007). DD measures cognitive impulsivity and broadly refers to the inability to delay gratification (Hamilton et al., 2015). How decisions are made in tasks that measure DD can be understood by assessing patterns of behavior that are observable in the sequences of choices or the statistics that accompany each choice (e.g. response latency). These measures have led to insights that suggest strategies that are used by the agent to facilitate the decision (Linsenbardt, Smoker, Janetsian-Fritz, & Lapish, 2016). The current set of analyses aims to use individual trial data to identify the neural underpinnings associated with strategy transition during DD. A greater understanding of how strategy change occurs at a neural level will be useful for developing cognitive and behavioral strategies aimed at reducing impulsive choice. The rat dorso-medial prefrontal cortex (dmPFC) has been implicated as an important brain region for recognizing the need to change strategy during DD (Powell & Redish, 2016). Using advanced statistical techniques, such as demixed principal component analysis (dPCA), we can then begin to understand how decision representations evolve over the decision- making process to impact behaviors such as strategy change. This study was the first known attempt at using dPCA applied to individual sessions to accurately model how decision representations evolve across individual trials. Evidence exists that representations follow a breakdown and remapping at the individual trial level (Karlsson, Tervo, & Karpova, 2012; Powell & Redish, 2016). Furthermore, these representational changes across individual trials have previously been proposed to act as a signal to change strategies (Powell & Redish, 2016). This study aimed to test the hypothesis that a ‘breakdown’ followed by a ‘remapping’ of the decision representation would act as a signal to change strategy that is observable in the behavior of the animal. To investigate the relationship between trials surrounding the breakdown and/or subsequent remapping of the decision representation and trials surrounding strategy changes, sequences of trials surrounding the breakdown and/or remapping were compared to sequences of 9 trials surrounding the strategy-change trial. Strategy types consisted of either exploiting the immediate lever (IM-Exploit), delay lever (DEL-Exploit), or exploring between the two lever options (Explore). Contrary to the hypothesis, an overall relationship between breakdown and remapping trial sequences were not associated with change-trial sequences. In partial support of the hypothesis however, at the 4-sec delay when the subjective value of the immediate reward was high, a relationship between breakdown sequence and strategy change sequence was detected for when the animal was exploiting the delay lever (e.g. DEL-Exploit strategy). This result suggests that a breakdown in decision representation may act as a signal to prompt strategy change under certain contexts. One notable finding of this study was that the decision representation was much more robust at the 4-sec delay compared to the 8-sec delay, suggesting that decisions at the 4-sec delay contain more context that differentiate the two choice options (immediate or delay). In other words, the encoding of the two choice options was more dissociable at the 4-sec delay compared to the 8-sec delay, which was quantified by measuring the average distance between the two representations (immediate and delay) on a given trial. Given that Wistar rats are equally likely to choose between the immediate and delay choice alternatives at the 8-sec delay (Linsenbardt et al., 2016), this finding provides further support for current prevalent theories of how animals use a cognitive search process to mentally imagine choice alternatives during deliberation. If context which differentiates choice options at the 8-sec delay is less dissociable, it is likely that the cognitive search process would be equally likely to find either choice option. If the choice options are equally likely to be found, it would be assumed that the choice alternatives would also be equally likely to be chosen, which is what has been observed in Wistar rats at the 8-sec delay.

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