Students

Graduate Student Travel Awards: Previous recipients

Each award winner is listed, followed by the abstract for their presentation at the APA Convention, and a description of how attending the APA conference was beneficial to the recipient.

2010

Gia M. DiNicola, M.A. Doctoral candidate in Clinical psychology Alliant International University, San Francisco

Anxiety in COPD: Role of Social Support and Disease Severity
Problem
Chronic Obstructive Pulmonary Disease (COPD) comprises several serious breathing disorders including chronic bronchitis and emphysema. It is characterized by coughing, dyspnea (breathlessness), the production of sputum, and irreversible impairment in lung functioning (Burgess, Kunik & Stanley, 2005). COPD currently affects somewhere between 10 and 15 million people in the United States (Wilt et al., 2005), and by 2020 is expected to become the third leading cause of death, surpassing even stroke (Jemal et al., 2005). Anxiety disorders occur much more often in COPD patients than in the general public (Brenes, 2003), and individuals with COPD who have comorbid depression and anxiety have particularly poor health outcomes and higher impairment (Aydin & Ulusahin, 2001). To date, little research has addressed the role of social and psychological factors (e.g., social support, depression) in contributing to the high comorbidity of anxiety and COPD (Rose et al., 2002; Aydin & Ulusahin, 2001).
Research evidence suggests that social support can be helpful with disease management. Several studies have found that social support reduces the progression of chronic degenerative diseases (Chrousos & Gold, 1992; McEwen & Stellar, 1993). Additionally, several prospective epidemiological studies have demonstrated that greater mortality is associated with low levels of social support (Berkman & Syme, 1979; Blazer, 1982; House, Robbins, & Metzner, 1982). Not much is known in the research literature on COPD, however, about the contribution of social support to anxiety. Moore & Zebb (1998) have identified a “need for the consideration of mental health concerns in patients with chronic pulmonary disease” (p. 83). Research, therefore, should address the impact of social support on anxiety in COPD patients and should control for patient demographics and depression to further understand factors affecting anxiety in COPD outcomes.
The goal of the present study is to examine the relationship to anxiety of COPD patient’s perceived social support and the severity of their illness, controlling for demographic variables, smoking status and depression. Thus, the research questions are: RQ1) Controlling for patient age, sex, education, smoking status, and depression, will perceived social support predict patient anxiety?; RQ2) Controlling for patient age, sex, education, smoking status, depression and perceived social support, will COPD severity predict patient anxiety?
     The present research study employs cross-sectional data collected from a multi- wave longitudinal population-based cohort interview study of U.S. adults with COPD (n = 452). Subject demographics are as follows: 277 females (61.3%), 242 participants age 66 and over (53.5%), 132 with bachelors degree or higher (29.2%), and 235 with an annual household income of $40,000 or less (54.8%).  Structured telephone interviews were conducted using computer-assisted telephone interviewing software. Subjects were asked about demographic characteristics, utilization of health care, medication use, respiratory symptoms, use of supplemental oxygen, symptoms and experience of anxiety, and availability and quality of social interactions. Anxiety was measured using the Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS), with higher scores indicating greater anxiety. The Geriatric Depression Scale (GDS) was utilized to assess depression. Illness severity was measured with the COPD Severity Scale (which is based on respiratory symptoms, systemic corticosteroid use, other COPD medication use, previous hospitalization or intubation, and home oxygen use). Social support was measured with 5 subscales of the Positive (P) and Negative (N) Social Exchanges (PANSE): Instrumental Support (P), Emotional Support (P), Companionship (P), Failure to Provide Help (N), and Unsympathetic/Insensitive Behavior (N).
    Preliminary, zero-order intercorrelations among target variables were examined. A single hierarchical multiple regression was run with the following steps in order to answer both research questions: 1) patient age, education, income, and smoking status (never, former, current); 2) depression; 3) all 5 social support subscales; 4) COPD severity score. RQ1 was answered with Step 3 of the hierarchical regression, while RQ2 was answered with Step 4.
   The results of RQ1 indicate that while controlling for patient age, education, income, smoking status and depression, three types of social support are significant predictors of higher anxiety: higher instrumental support (β=.18, p<.001), unsympathetic/insensitive behavior (β= .17, p<.05), and failure to provide help (β=.14, p<.05). While patient smoking status (β=.01, p>.05), companionship (β=-.08, p>.05) and emotional support (β=-.03, p>.05) were not significant predictors of anxiety at the final step of the model, the overall model remains significant [F(10, 418)=33.4, p<.001, R2adj=.44 ]. RQ2 results reveal that disease severity (β= .01, p>.05) does not predict patient anxiety after controlling for age, education, income, smoking status, depression, and all five forms of perceived social support. Although disease severity did not add to the prediction of variance in patient anxiety, the overall model remains significant [F(11, 418)=30.3, p<.001, R2adj=.44].
    The present analysis suggests that social support can be a significant factor contributing to the experience of anxiety in COPD patients, even when controlling for comorbid depression. Further, after controlling for social and psychological variables, the measure of disease severity does not make a significant contribution to patients’ anxiety. If social support can affect patient anxiety, therapy interventions to improve social support may be helpful to COPD patient's overall health. It is critical to design and utilize research on the interplay of anxiety, social support and morbidity in COPD in the design of future interventions to improve functional status, emotional health, and health status in those with COPD. Future research should address the role of patients’ experience of illness and their functional status in contributing to their emotional health and COPD disease adjustment.

As a student of clinical psychology, I am striving to be a scientist-practitioner. I hope to have a multi-faceted career which combines research, teaching, and clinical practice. Attendance at APA's annual conventions offers me numerous opportunities to update my knowledge in all three realms: effective teaching methods, research findings and methods, and effective clinical methods and interventions. At the 2011 APA Convention I had many opportunities to listen to exciting new research on issues of development, health, stress, and trauma. I learned much about the methodologies necessary to examine these complex issues, and I had opportunities to learn from a number of leaders in research and clinical practice. As I begin my predoctoral psychology internship this coming year at UCSF's Child Trauma Research Program, I hope to continue learning from the many valuable professional resources offered by APA.

Keiko Kurita, B.S. Department of Psychology University of Southern California

Cancer Predicts Long-Term Cognitive Impairment in Older-Adult Twins
Keiko Kurita, B.S., Beth E. Meyerowitz, Ph.D., Margaret Gatz, Ph.D.

Over recent decades, an increasing number of people are living as survivors of cancer. Unfortunately, the challenges of cancer survivorship do not end after diagnosis and treatment. While cancer survivorship can be demanding emotionally and physically for anyone, for older adults it may be especially stressful as challenges may be superimposed on physical changes and on the onset of other diseases that accompany aging. One phenomenon associated with aging is a decrement in cognitive functioning. Studies have found that generally, cancer patients who undergo treatment have a greater risk for a decrease in cognitive performance. However, most of these studies have focused on cognitive performance of cancer patients and survivors under the age of 65. Less studied is the extent to which cognitive impairment may be a late effect for older adults who had cancer earlier in life. In other words, cancer may be a risk factor for greater cognitive impairment once survivors reach ages that place them at an increased risk for cognitive dysfunction.

In our previous research examining the association of cognitive impairment among cancer survivors and their cancer history-free co-twins older than 65 years of age (Heflin et al., 2005), we found that cancer survivors overall and those who had survived cancer for at least five years were more likely to have cognitive dysfunction compared to their co-twins who did not have a history of cancer. To explore this finding further, it is worthwhile to examine the possible contribution of psychological and physical factors that are associated with both cancer and cognitive functioning. Depression has been found to be prevalent in cancer patients and associated with poorer cognitive processing in areas such as attention, learning, and memory. Similarly, sleep disturbance is found among cancer survivors and associated with poorer cognitive functioning such as attention and memory. Chronic pain can also be common among cancer survivors and can interfere with cognitive test performance. In addition, a weak but significant correlation had been found between a general self-rated health and cognitive performance. Thus, these factors are important to consider as possible confounds in the association between cancer survivorship and cognitive impairment.

We examined the risk of cancer on cognitive impairment and the extent to which psychological and physical factors contribute to this relation. In this retrospective, nested study, 427 monozygotic and same-sex and opposite-sex dizygotic twin pairs discordant for cancer were identified from the Swedish Twin Registry’s Screening Across the Lifespan of Twins (SALT) study. Cancer diagnosis was obtained using the Swedish Cancer Registry. Twin pairs included in this study were those 65 years and older who were given a cognitive screening at least three years after the cancer diagnosis of the survivor twins. All survivor twins whose cancer diagnosis was confirmed by histological findings and who had a diagnosis other than skin or brain cancer were included. Demographic and cognitive screening information were drawn from SALT’s telephone interview, which was conducted between 1998 and 2001. Questions were asked directly to the twin participant, and in some cases, an informant. Variables to measure depressive symptoms, sleep disturbance, pain, and general health were also available in SALT. To determine the degree to which criterion variables including cancer diagnosis are associated with cognitive impairment, conditional logistic regression (proportional hazards regression) was used, stratifying the data with matched pairs. Model fits were compared using differences of -2 Log Likelihood values.

Among cancer-free twins, 60.7% were female, and among cancer-history twins, 65.8%. Average age was 73.3 years. Among male twins with a cancer history, the most common sites were prostate (37%) and bladder (11%). Among female twins with a cancer history, the most common sites were breast (40.2%) and corpus uteri (13.5%). There were no significant differences in the means and frequencies of the demographic or psychological attributes between the cancer history-free and survivor twins.

Matched odds ratio showed that survivors of cancer were 1.7 times (95% confidence limits = 1.01, 2.84) as likely to exhibit cognitive impairment at least three years post cancer diagnosis as their twin partner not diagnosed with cancer. The model that included both cancer diagnosis and general health as predictors was no better than the model with cancer diagnosis alone in predicting cognitive impairment. However, the adjusted models of the remaining three variables were significantly better in predicting cognitive impairment than the model with cancer diagnosis alone. Cancer diagnosis continued to be a significant predictor of cognitive impairment when depressive symptoms (n =716, odds ratio = 2.36, confidence limits = 1.01, 5.51) and sleep quality (n = 716, odds ratio = 2.34, confidence limits = 1.04, 5.27) were added to the model. In addition, cancer diagnosis trended towards significance as a predictor of cognitive impairment when general pain was added (n = 722, odds ratio = 2.19, confidence limits = .99, 4.85). Thus, it appears that depressive symptoms and sleep, and marginally general pain, contribute independently to predicting cognitive impairment when considered together with cancer diagnosis. In other words, these variables do not appear to be confounders, as the parameter estimates for cancer diagnosis do not change greatly when these variables are included.

These findings suggest that other cancer-related factors should be explored as determinants that underlie the association between cancer diagnosis and cognitive impairment. One future study is to consider treatment biomarkers such as hormonal functioning that may mediate this relation.

I believe that studying the biopsychosocial factors that are associated with physical and mental well-being requires both collaboration with other professionals in health and illness as well as keeping current with the research and practice among other areas of psychology. Attending the 118th American Psychological Association Annual Convention was a valuable way for me to learn about the latest research findings in other areas of psychology. This stimulated my thinking about other approaches and questions that may contribute to our knowledge of the areas I’m interested in. The convention was also an opportunity for me to meet people at different points in their careers, from undergraduate students to mentors who have dedicated their careers to health psychology. This inspired me to think more broadly about my career and personal goals. I am grateful for Division 38 of APA for their support!

Veronica J. Sanchez, M.S. Department of Psychology University of California, Riverside

Patient Socioeconomic Status and Physician-Patient Communication: A Meta-Analysis

Background: In research on the delivery of health care, disparities between various social groups in diagnosis, treatment, and health outcomes have been demonstrated (Phelan & Link, 2005). In particular, patients with low income, low education levels and generally low socioeconomic status are disadvantaged, and in many cases they receive less than optimal medical treatment (Adler et al., 1994). It is plausible that the source of the problem goes beyond limited financial resources; health disparities might be explained partly by differences in the style and quality of interactions that patients of low socioeconomic status (SES) have with their physicians. Research has suggested that low SES patients are treated by physicians with less respect, receive less warmth and empathy, and receive less information about necessary medical procedures compared with higher SES patients (Kenney, 2007; Ommen, 2008; Devoe, 2009). The purpose of the present study was to use meta-analytic techniques to assess the nature and strength of the relationships between a number of aspects of physician-patient communication and patients’ income, education level, and overall SES, and to examine moderators of those relationships. A quantitative meta-analytic approach is ideal for the question at hand; meta-analysis offers a method to search for and quantify the results of all existing research on patient SES and physician-patient communication.

Method: The PubMed and PsychInfo databases were searched to identify relevant studies conducted from 1948 to 2009. Studies were included in the meta-analysis if they involved face to face medical interactions in a non-psychiatric setting, did not involve institutionalized patients, or those treated for substance use, reported an assessment of patients’ SES (i.e., income, education), and measured some aspect of physician-patient communication (e.g., instrumental communication such as information giving, socioemotional communication such as empathy, or both). To be included, the study also had to include the sample size and an r correlation between patient SES and physician-patient communication (or any statistics that could be used to calculate an effect size r). Forty-two published empirical studies relating patient income, education, occupational status, and/or socioeconomic status to any form of physician-patient communication (e.g., verbal, non-verbal, task-oriented, psychosocial, etc.) met the inclusion criteria.
For each study, the correlation r between patient SES and the quality of physician-patient communication was recorded, with a positive r indicating that communication was better for higher SES patients, and a negative r indicating that communication was better for lower SES patients. The significance of the average effect size was systematically calculated for the 42 studies combined, using both fixed and random effects models.
Results: A total of 42 articles were included for the SES and communication analysis and subsets of those articles were used to assess the relationship between SES and communication. The effect size for the overall relationship between SES and physician-patient communication was found to be positive and significant (r=0.044, p=0.001), indicating that communication between patients and physicians was better for wealthier patients and worse for poorer patients. The results were moderated by physician practice setting (University medical center or other), experience (practicing physician or other), type (primary care or specialist), communication skill (psychosocial or task-oriented), and average patient age.

Implications: Essential elements of the delivery of medical care are affected by patients’ income, education, and overall socioeconomic status. The present meta-analytic research shows significant differences in the quality of communication when physicians are caring for high versus low SES patients; income disparities in effective communication in the physician-patient encounter can contribute to limitations in patient commitment to treatment, patients’ nonadherence to physicians’ recommendations, and ultimately to poorer health care outcomes. Implications for clinical practice are several. Providers should be trained to recognize and eliminate subtle disparities in their communication with low SES patients so that they can provide patients with high quality medical attention. Future research should determine practical and effective ways for improving the quality of the communication that takes place between disadvantaged patients and their physicians. Emphasis needs to be placed on the problematic psychosocial and behavioral aspects of the physician-patient interaction in order to target areas where improvement is needed. It may be essential to address the perceptions and stereotypes that physicians have of low SES patients, as well as subtle discrepancies in how physicians behave toward low versus high SES patients to determine what behaviors are linked to negative health outcomes for low SES patients. Disparities in physician-patient communication may perpetuate existing negative health care outcomes, but improved communication can enhance important elements of health care delivery, including patients’ satisfaction with medical care, adherence to treatment regimens, and lower rates of morbidity and mortality.

Attending the APA convention in San Diego, CA, in August 2010, was a productive experience for me. I was able to share my research findings with fellow colleagues and obtain useful comments and feedback regarding my current research and ideas for subsequent projects. I also enjoyed attending poster presentations and talks given by other graduate student

2009

Megan J. Murphy, M.S. Doctoral candidate in Clinical psychology Ohio University

Title: A Holistic Approach to Health: The Benefits of Mindfulness
Authors: Murphy, M. J., Mermelstein, L. C., Edwards, K. M., Hranica, D. L. & Gidycz, C. A.

Abstract: Mindfulness is shown to be associated with a wide range of health benefits and is part of a larger movement toward a holistic understanding of health and the goal of enhancing optimal well-being through an understanding of the mutual relationship between mind and body. The purpose of this study was to investigate the relationship between dispositional mindfulness and traditional health behaviors (i.e. diet, sleep and exercise). Among a sample of 202 college women, those with higher levels of dispositional mindfulness had healthier eating practices, better quality of sleep, and better physical health.
Dispositional mindfulness contributed to better physical health even after controlling for traditional health behaviors and also mediated the relationship between healthy eating and physical health. Additionally, a bidirectional partial mediation relationship was found between sleep quality and mindfulness.

Attending the APA conference allowed me the opportunity to share and discuss research findings with colleagues from around the country, which is beneficial in disseminating research findings, discussing clinical implications of research findings, and generating ideas for future research. At the convention, I also had the opportunity to network with students, researchers, and professional psychologists from around the country.

2008

Jessica Lohnberg, B.A. Department of Psychological and Quantitative Foundations University of Iowa

s and by renowned psychologists. The APA convention was the ideal place for networking with past professors and future mentors and colleagues. I am looking forward to attending another APA convention soon!

Influential Factors for Anticipating Posttraumatic Growth in Cancer Patients

Cancer, a potentially terminal disease, can be considered a traumatic and stressful experience affecting an individual’s quality of life. In their research on trauma and growth, Tedeschi and Calhoun (1995) described a “traumatic” event as a sudden, unexpected, and uncontrollable event that produces ongoing and,
sometimes, life-long effects. Similar to other life-threatening illnesses, a diagnosis of cancer highlights one’s mortality as foreseeable and uncontrollable. Individuals with cancer often exhibit psychological distress including depression, anxiety, and symptoms of post-traumatic stress disorder. Recent research in psychology has focused on examining the “positive” rather than the “pathological” side of human functioning. Posttraumatic growth (PTG; Tedeschi & Calhoun, 1995) has been defined as experiencing positive growth following traumatic life events. In fact, numerous studies have explored PTG in individuals diagnosed with cancer (for a review, see Stanton, Bower, and Low, 2006). Despite growing literature in the area of posttraumatic growth, little, if any, research has examined whether individuals who are faced with a potentially traumatic event anticipate finding benefit from their experience. This study aims to better understand what influences the anticipation of experiencing benefit from a negative life event. Specifically, recently diagnosed cancer patients were asked if they knew a close friend or relative who had experienced positive life changes as a result of cancer, and whether this relationship affects the cancer patient’s anticipation of finding benefit from his or her own experience.

For the purposes of this study, we used a diverse sample of cancer types including lymphoma, leukemia, colorectal, and cancers requiring a bone marrow transplant. The cancer patients identified a collateral (a close friend or relative who will be influential in their cancer treatment) to participate in the study. Anticipation of benefit finding was measured using a modified version of the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996). The PTGI is a 21-item self-report scale where respondents are asked to indicate to what degree they have experienced various changes in their lives as a result of the indicated traumatic event (e.g., cancer) according to a Likert-style scale ranging from “1” (“I did not experience this change as a result of my crisis”) to “6” (“I experienced this change to a very great degree as a result of my crisis”). Therefore, higher scores on the modified PTGI indicate greater perceived PTG. In this study, patients were asked to anticipate how much change they expect as a result of their cancer diagnosis and subsequent treatment. In addition, collaterals were asked the same questions for both themselves (whether they anticipate experiencing any changes as a result of their friend/relative’s cancer) and for the patient (whether they anticipate the patient will change as a result of the patient’s cancer experience). Both patients and collaterals were also asked if they knew anyone who had cancer in the past and whether that person experienced any benefit as a result of their cancer. Data are currently being collected for patients (N=28; anticipated N=100) and collaterals (N=17; anticipated N=100).

Preliminary analyses indicate that both patients and collaterals anticipate high levels of benefits from patients’ cancer experience. Mean differences for patients and collaterals for anticipated benefits were examined by independent samples t-test. Overall, patients reported anticipating more benefits compared to collaterals, although mean differences were not significant. Mean differences for collaterals anticipating benefits for themselves and anticipating benefits for patients were examined by dependent samples t-tests. Overall, collaterals reported anticipating higher levels of benefits for patients over themselves; that is, they anticipate the patient will experience greater benefit. Collaterals reported significantly higher levels of benefits for patients on the “Relating to Others” (t = -2.166, p= .046) and “Appreciation of Life” subscale (t= -3.08, p=.007). We also examined mean differences of anticipating benefits for participants who knew someone who had cancer. Given the current small sample size, patient and collateral information were pooled. Participants who have known someone with cancer reported anticipating less benefits compared to participants who have not known someone with cancer. Again, mean differences between groups were not significant. Of the participants who knew someone with cancer, those who knew someone who experienced benefits were compared to those who knew someone who did not experience benefits. Though mean differences were not significant, those participants who knew someone who had cancer and experienced benefit had higher mean scores on the modified PTGI.

Given the current small sample size, results should be interpreted with caution. We hypothesize the trends of our current results to strengthen as we reach our projected sample size. Specifically, we expect that participants who have known someone to find benefit after cancer will endorse higher levels of anticipated benefits themselves, as has been shown by our current results. This finding would prove clinically useful to the field of psychology by highlighting the importance of introducing immediately post-diagnosis information about the possible benefits of the cancer experience. Implications for psychologists will be discussed including how these results and any other findings translate to practice to improve the quality of life among cancer patients.

Attending APA to present this research provided several opportunities as a graduate student. First, it allowed me to showcase this research to individuals interested in the topic and, consequently, I was able to learn about similar research being conducted across the country and how that research could potentially influence my own research within this field. Second, as somebody who conducts health psychology research within counseling psychology, I was very excited to engage with individuals with analogous research interests within Division 38 and to talk with experts in the health psychology field. Attending APA was extremely beneficial in fostering my own professional development by allowing me these opportunities to expand my knowledge base about the research and activities conducted within APA.

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