NYU OPUS Fall 2016 Vol. 7 Issue 2

OPUS

online publication of undergraduate studies Volume VII Issue II | Fall 2016

Department of Applied Psychology

The Online Publication of Undergraduate Studies was initiated in 2009 by undergraduate students in the Department of Applied Psychology at NYU Steinhardt. The ideas and opinions contained in this publication solely reflect those of the authors and not New York University. All work is licensed under the Creative Commons Attribution Noncommercial No Derivative Works License.

To view a copy of this license, visit http://creativecommons.org

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OPUS

online publication of undergraduate studies Volume VII Issue II | Fall 2016

EDITORS-IN-CHIEF

Julia Acker Ashlie Pankonin PROGRAMMING & COMMUNICATIONS DIRECTOR Julia Imperatore Layout & DESIGN Director Shirley Wu

CONTRIBUTING WRITERS Elise Conklin Caitlyn Corradino Julia Klein Bekah Myers Molly Nystrom Shirley Wu

Faculty Mentor Dr. Adina Schick SPECIAL THANKS NYU Steinhardt Department of Applied Psychology Dr. Gigliana Melzi Judson Simmons Rachel Hettleman

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Table of Contents LETTER FROM THE EDITORS

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Elise Conklin

Addressing Trauma in Substance Abuse Treatment

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Caitlyn Corradino

Mindfulness: An Avenue for Recovering Anorexics to Become Intuitive Eaters

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Julia Klein

The Mechanisms of Hypomanic Creativity in Bipolar II Disorder

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Rebekah Myers

The Effect of Attending a Military School on Military Personnel’s Perceptions of Mental Health

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Molly Nystrom

Elderly Help Seeking and Acceptance Behaviors in Relation to Living Circumstances

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Shirley Wu

The Impact of Mothers' Beliefs and Attitudes on Father Involvement with Children

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BIOGRAPHIES

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SUBMISSIONS

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Letter from the Editors New York University’s Applied Psychology Online Publication of Undergraduate Studies, also known as OPUS, was established in 2009. OPUS provides Applied Psychology undergraduate students with a forum for sharing their independent work. This publication is entirely written, edited, and designed

by Applied Psychology undergraduates, and is one of the only undergraduate psychology journals in the United States.

The themes of the Fall 2016 issue reflect the diverse clinical and research interests of our contributing writers. First, our writers review research about innovative mental health treatments: Elise Conklin investigates how addressing trauma in substance abuse treatment can support recovery, while Caitlyn Corradino explores how practicing mindfulness can help patients recovering from anorexia to become intuitive eaters. Julia Klein then examines the relation between hypomanic symptomatology and creative achievement in individuals with bipolar II disorder, noting that this mental illness may confer benefits to those afflicted.

Another set of articles in this issue examine the impact of various contexts on individuals’ mental health perceptions and related behaviors: Bekah Myers reviews literature on the influence of attending a military school on mental health stigma and help-seeking behaviors, while Molly Nystrom qualitatively explores how the living circumstances of elderly individuals are related to their acceptance of and uptake of formal support services. Shirley Wu investigates how maternal beliefs and attitudes can both facilitate and inhibit father involvement with children, depending on family structure and context.

We would like to thank our enthusiastic and talented writers for their scholarly contributions, as well as Julia Imperatore and Shirley Wu, the OPUS administrative staff, for their hard work and commitment to the journal. We are also grateful to Dr. Gigliana Melzi, the Director of Undergraduate Studies in Applied Psychology, and Judson Simmons, the OPUS advisor, for their continuous support of OPUS. Finally, we would like to thank Dr. Adina Schick, our faculty mentor, for her guidance and dedication to OPUS, without whom this issue would not be possible.

Best wishes and thank you for reading,

Julia Acker

Ashlie Pankonin 5

Submissions

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Online Publication of Undergraduate Studies 2016, Volume 7, Issue 2

Addressing Trauma and Substance Abuse

Addressing Trauma in Substance Abuse Treatment Elise Conklin Individuals seeking treatment for alcohol and substance abuse are likely to have a history of trauma (Wiechelt, 2014). In fact, there is a relation between increased trauma exposure and substance use (Shields, Delany, & Smith, 2015; Wolf, Nochajski & Farrell, 2015).

In addition, as the severity of the experienced trauma increases, there is also an increase in severity of substance abuse, as well as other negative life outcomes (Wolf et al., 2015). Despite this well-documented relation, substance abuse treatment programs tend to be separate from those addressing trauma, with a recent survey stating that only 19.7% of American outpatient substance abuse treatment programs consistently offer trauma services (Shields et al., 2015).

Traditionally, substance abuse treatment programs have held the belief that addressing trauma will trigger traumatic responses, which will overwhelm the client and cause them to relapse (Cadiz et al., 2005; Wolf et al., 2015). These programs consider substance abuse to be the primary concern and only address trauma once clients are in recovery, if at all (Shields et al., 2015).

However, the self-medication pathway hypothesis posits that trauma survivors use substances to manage their posttraumatic symptoms, which in turn increases their risk of developing substance use disorders (Haller & Chassin, 2014). From this perspective, recovery is unlikely to be stable and long-term without addressing the underlying trauma (Cadiz et al., 2005; Wiechelt, 2014). In fact, research suggests that improving posttraumatic symptoms may improve substance use symptoms as well (Hien et al., 2010). Trauma can be addressed directly in alcohol and substance abuse programs by integrating trauma treatment into the substance abuse treatment process, therefore addressing both simultaneously (Amaro et al., 2007). Organizations can also adopt trauma-informed care (TIC), wherein organizations intentionally shape their policies to accommodate the needs of trauma survivors and support their recovery (Hopper, Bassuk & Olivet, 2010).

This paper sought to explore the implications of the selfmedication pathway for substance abuse in clinical practice and social services, asking: How is recovery from substance abuse supported by addressing trauma in treatment?

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Defining Trauma Trauma is defined as a stressful event that emotionally overwhelms an individual’s ability to cope and creates a feeling of helplessness and horror (Smyth & Greyber, 2013; Wiechelt, 2014). Many stressful life events have the potential to be traumatic, but depending on an individual’s perception of and reaction to the event, some individuals may consider an event traumatic while others may not (Smyth & Gryber, 2013; Wiechelt, 2014). Such events may include unexpected catastrophes, such as warfare and natural disasters, but traumatization more commonly occurs through abuse, assault, neglect, or witnessing violence (Potthast & Cadani, 2012; Smyth & Greyber, 2013).

Individuals who experience trauma often experience posttraumatic symptoms, which, if left unresolved, may disrupt an individual’s life and relationships (Wiechelt, 2014). Posttraumatic symptoms are categorized as avoidant, including numbing and amnesia; intrusive, such as nightmares and flashbacks; negative mood changes, including irritability and rage; or hyperarousal, such as hypervigilance or startle response (Wiechelt, 2014). If an individual’s posttraumatic symptoms reach a certain threshold for intensity and frequency, they may be clinically diagnosed with post-traumatic stress disorder (PTSD), and this diagnosis is often used in the literature as an index to measure and study trauma (Cadiz et al., 2005).

However, not all individuals who have experienced trauma necessarily meet the diagnostic criteria for PTSD, despite living with the disruptive effects of trauma. Post-traumatic stress disorder represents a subcategory of individuals who have experienced trauma but does not include all individuals who live with posttraumatic symptoms (Herman, 1992). Regardless of PTSD diagnosis, posttraumatic symptoms may be significantly distressing for an individual and make it difficult for them to regain a sense of normalcy and safety for years following the trauma.

Prevalence of Trauma in Substance Abusing Population Substance abusing individuals tend to have significantly higher rates of traumatic experiences

Conklin, E. (2016). Online Publication of Undergraduate Studies, 7(2), 8-12. than their non-substance abusing counterparts.

Individuals with an alcohol addiction diagnosis, for instance, are six to 12 times more likely to have been physically abused and 18 to 20 times more likely to have been sexually abused than others (Potthast & Cadani, 2012). Additionally, chronicity of trauma correlates with increased number and severity of PTSD symptoms, as well as increased seriousness and frequency of substance use (Potthast & Cadani, 2012; Wiechelt, 2014).

Childhood sexual abuse, in particular, is linked to significantly more negative substance abuse outcomes than other types of childhood abuse, including more frequent and intense substance abuse (Wolf et al., 2015).

Individuals seeking treatment for substance abuse are highly likely to have experienced some form of trauma, and as the intensity of the experienced trauma increases, individuals are more likely to have more serious substance abuse problems.

Separating trauma and substance use treatment assumes that the two are distinct, unrelated issues and leads to an incomplete understanding of a client (Brown et al., 2013). Intentionally ignoring trauma in substance use treatment can also retraumatize clients by reinforcing the dynamic of secrecy that often surrounds trauma, thus causing substance abuse treatment to be less effective and potentially contributing to clients relapsing and dropping out of treatment (Cadiz et al., 2005; Potthast & Cadani, 2012).

In order to effectively treat substance users who have been exposed to trauma, many researchers have attempted to find a causal relation between traumatic experience and substance abuse (Haller & Chassin, 2014; Jester et al., 2015). Several hypotheses have been proposed to explain the connection, and some suggest that substance abuse is a risk factor for the development of PTSD, while others view substance abuse as a response to traumatic symptoms (Haller & Chassin, 2014). Recent longitudinal and prospective studies have provided strong evidence that trauma tends to precede substance abuse problems, which provides further support to the hypothesis that substances are frequently used to self-medicate in response to traumatic symptoms (Hien et al., 2010; Jester et al., 2015).

Additionally, improvements in PTSD symptoms directly relate with reductions in substance use, a finding that was sustained one year after treatment, whereas reduction in substance use does not significantly change PTSD symptoms (Hien et al., 2010; López-Castro, Hu, Papini, Ruglass, & Hien, 2015). Given the high rates of relapse among individuals with co-occurring PTSD and substance abuse diagnoses, this strongly indicates that PTSD symptoms exacerbate substance abuse (LópezCastro et al., 2015). These findings support the selfmedication hypothesis, which posits that substances are

often used by trauma survivors with the expectation that they will relieve stress and help with coping with their posttraumatic symptoms (Jester et al., 2015). Using the self-medication framework, the failure of substance abuse treatment programs to address trauma appears especially problematic because trauma is seen as the root cause of the problem facing the individual, while substance abuse is only a symptom. Trauma-informed care and integrated trauma services are two ways some organizations have responded to this need.

Trauma-Informed Care Trauma-informed care involves building organization-level policies and procedures that create a supportive environment for trauma survivors and respond appropriately to their traumatic responses (Wiechelt, 2014). Although exact definitions of TIC differ by organization and researcher, it is generally agreed that TIC involves reshaping policies to make trauma survivors feel more comfortable and help them build new skills and competencies (Brown, Harris & Fallot, 2013; Hopper et al., 2010). Trauma-informed care calls for trauma awareness, meaning that clinicians should treat all clients as if they have been exposed to trauma, regardless of whether or not they disclose it, and should incorporate screening for trauma into their intake procedures (Hopper et al., 2010; Wiechelt, 2014).

This also entails creating policies intended to avoid retraumatization, such as through the reenactment of the dynamics of trauma (Brown et al., 2013; Cadiz et al., 2005). For example, loss of control and agency are characteristics of traumatic events that the client has likely internalized, so if the client is not given agency in treatment, this can unintentionally reinforce their sense of powerlessness (Hopper et al., 2010). Therefore, TIC seeks to provide the client with opportunities to rebuild control and empowerment by giving the client the opportunity to make decisions and collaborate in the treatment process (Cadiz et al., 2005; Wiechelt, 2014). By taking an active role in their healing process, the client begins to recognize their abilities, allowing them to feel capable of taking control in other areas of their lives (Herman, 1992).

Avoiding retraumatization is also a part of TIC’s emphasis on safety, including the physical and emotional safety of the client and clinician (Amaro et al., 2007). Unsafe environments may recall the feelings of vulnerability clients experienced in their trauma, triggering feelings of victimization and fear (Herman, 1992). Trauma-informed care uses a strengths-based approach to create a safe emotional space, focusing on identifying clients’ strengths, building further skills, and reframing problems as potential strengths (Hopper et al., 2010). For example, conceptualizing substance abuse as

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Conklin, E. (2016). Online Publication of Undergraduate Studies, 7(2), 8-12. a way to cope with otherwise unbearable experiences shifts the perception from a personal weakness to an attempt to survive (Herman, 1992; Jester et al., 2015).

This reframing also draws attention to the need to build new coping skills rather than correct individual failings.

It is also important to note that trauma is expressed and perceived differently across cultures, and therefore clients may respond differently to treatments (Herman, 1992; Hopper et al., 2010). Trauma-informed care addresses these differences by striving for cultural sensitivity across ethnic and religious populations, socioeconomic classes, and genders. For example, women tend to consider experiences not traditionally viewed as traumatic, such as being separated from their children, to be very painful (McHugo et al., 2005).

Another example of culturally sensitive practice would be incorporating relevant spiritual beliefs, practices, or methods of healing into treatment, as in some Native American communities, where traditional spiritual practices such as healing lodges are used in conjunction with counseling to address trauma (Gone, 2009).

Acknowledging and responding to cultural differences and clients’ lived experience may help clients to feel understood and “seen” within treatment, which prevents early termination and avoids the trauma dynamic of feeling insignificant or invisible (Cadiz et al., 2005).

The most basic goal of TIC is to avoid causing harm and facilitate more positive and stable outcomes (Brown, Harris & Fallot, 2013). Because it is not a direct form of treatment, TIC can be implemented in the many systems with which substance users interact, which may not otherwise have the capacity to implement trauma treatment. For instance, drug courts, where individuals facing nonviolent drug charges are tried, could make use of TIC. Substance abusing populations have higher prevalence rates of trauma than non-substance abusing peers, with rates of sexual abuse as high as 54.5% for men and 83% for women (Potthast & Cadani, 2012).

Trauma drug court are also much more likely to have had prior arrests than drug court participants with no trauma background, suggesting that they are likely to return to drug use after completing drug court and to reenter the drug court system (Wolf et al., 2015). Given the consistent contact of clients with trauma histories with the drug court system, trauma-informed court policies could make courts more conducive to treating both trauma and substance abuse, which would therefore reduce recidivism (Wolf et al., 2015).

Homeless individuals are also at high risk for both trauma exposure and substance use disorders (Hopper et al., 2010). In one study, over 70% of the inpatient substance abuse participants had been homeless at some point in their lives, and another found that 40-50% were

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homeless at the time they began receiving substance abuse treatment services (Amaro et al., 2007; Cadiz et al., 2005). The experience of homelessness itself is traumatizing, and homelessness puts individuals at an increased risk for further trauma exposure (Hopper et al., 2010). A trauma-informed perspective would be beneficial in services for the homeless that do not have the capacity to provide direct trauma treatment due to lack of resources or time constraints, such as housing assistance and food providers (Hopper et al., 2010).

Integrated Trauma Treatment Trauma-informed care provides a strong foundation for working with traumatized individuals on which trauma treatment builds. By integrating trauma treatment into substance abuse programs, these programs can provide a space to process traumatic experiences and build coping skills (Amaro et al., 2007).

This, in turn, reduces clients’ need to self-medicate with substances (Jester et al., 2015). Integrated trauma treatment emphasizes the interrelatedness of substance use and trauma and implements evidence-based therapies, such as cognitive behavioral therapy (CBT), to address the specific experience of substance users with trauma exposure (Amaro et al., 2007; Cadiz et al., 2005; Hien et al., 2010; Hopper et al., 2010). Trauma-specific group therapy has been found to be significantly more effective than psychoeducation-focused therapy in improving PTSD and substance use symptoms in women who were heavy drug users, indicating that the focus on trauma has additional benefits beyond those of therapy in general (Hien et al., 2010).

Integrated trauma treatment can also be incorporated with individual counseling sessions to avoid the possibility of triggering group members through the sharing of traumatic experiences (Cadiz et al., 2005). Several studies have found higher retention rates for women in particular in residential treatment programs that integrate trauma services than residential programs that do not address trauma, and length of retention predicts more positive outcomes six months after the conclusion of treatment (Amaro et al., 2007).

Although there is a paucity of research including male participants, it is possible that similarly high retention rates occurs for men. Regardless of how trauma is treated in substance use treatment, organization-level policies and procedures should continually be reviewed to ensure that they are as supportive as possible of trauma survivors (Brown et al., 2013). Because the body of literature around integrated treatment is in its infancy, clinicians and social workers need to be responsive to the needs of their clients and prepared to modify treatment to best suit the communities they serve.

Conklin, E. (2016). Online Publication of Undergraduate Studies, 7(2), 8-12.

CONCLUSION Addressing the needs of substance abusing and traumatized populations together can better support treatment outcomes given the considerable overlap between the two (Lopez-Castro et al., 2015; Potthast & Catani, 2012). Trauma-informed care and integrated trauma services are two ways to accommodate their needs. Taking a trauma-informed perspective allows participants to feel safe and avoids retriggering their traumatic experiences by giving them agency and voice within their treatment process (Hopper et al., 2010).

Trauma-informed care also reduces rates of dropping out, optimizing the effectiveness of treatment (Brown et al., 2013). Because TIC consists primarily of changing policies and practices, organizations whose clients are likely to have experienced trauma can implement this type of care without the additional strain that incorporating trauma treatment can add in terms of resources like funding and space (Amaro et al., 2007; Brown et al., 2013; Cadiz et al, 2005). However, when implementation is feasible, integrating trauma treatment into substance abuse treatment programs is likely to make sobriety more stable and long term by addressing underlying trauma symptoms that are often selfmedicated by abusing substances (Jester et al., 2015; Shields et al., 2015). Integrated trauma treatment may mean making evidence-based individual or group therapy available in a substance abuse treatment program to provide space for clients to process traumatic experiences and develop more adaptive coping strategies (Brown et al., 2013; Cadiz et al, 2005).

Research indicates the benefits of taking a traumainformed approach in substance abuse treatment and of integrating trauma treatment into substance abuse treatment programs. However, there are also several major limitations in the current body of literature.

Studies tend to lack random assignment, making it difficult to draw causal conclusions about the effectiveness of TIC as compared to more traditional treatment paradigms (Cadiz et al., 2005; Hopper et al., 2010). Additionally, it is difficult to separate out the effects of specific elements of TIC from those of an intervention as a whole (Cadiz et al., 2005). Many of these interventions focus only on a specific population, such as women in inpatient centers (e.g., Amaro et al., 2007; Cadiz et al., 2005). While this may serve the purpose of addressing the specific needs of that subset of the substance abusing-population with traumatic history, some groups are largely ignored by the literature, including men and the elderly. The findings in the literature cannot be generalized to other genders, races, and geographical areas that are not represented in the

in the research. In addition, the current assessment tools for measuring the implementation of TIC fail to acknowledge fidelity, or the degree to which the principles are implemented. This means there may be a great deal of variability between the practices of two different organizations who both consider themselves to be “trauma-informed.”

Future research needs to address these gaps in the literature and continue developing innovative interventions for the overlap between substance abuse and trauma treatment. Additionally, more research should be conducted in outpatient and community settings, since much of the current research is based on inpatient or residential treatment models. Although it is likely that many individuals who seek inpatient treatment have been exposed to trauma, failing to include those who do not seek inpatient treatment excludes a large segment of the population and could cause a self-selection bias in research — there may be significant differences between those who seek residential treatment and those who do not. The intersections between trauma-informed care and harm reduction in treating substance abuse should also be explored, as this perspective has the potential to align well with TIC’s principle of client choice and empowerment.

Social service, public health, and healthcare settings could benefit universally from implementing TIC principles, surrounding clients in a trauma-informed network of services that would give them the greatest opportunity for healing and wellness.

REFERENCES Amaro, H., Chernoff, M., Brown, V., Arévalo, S., & Gatz, M. (2007). Does integrated trauma-informed substance abuse treatment increase treatment retention? Journal of Community Psychology, 35(7), 845-862.

Brown, V. B., Harris, M., & Fallot, R. (2013). Moving toward a trauma-informed practice in addiction treatment: A collaborative model of agency assessment.

Journal of Psychoactive Drugs, 45(5), 386-393.

Cadiz, S., Savage, A., Bonavota, D., Hollywood, J., Butters, E., Neary, M., & Quiros, L. (2005). The portal project. Alcoholism Treatment Quarterly, 22(3-4), 121-139.

Gone, J. (2009). A community-based treatment for Native American historical trauma: Prospects for evidence-based practice. Journal of Consulting and Clinical Psychology, 77(4), 751-762.

Haller, M., & Chassin, L. (2014). Risk pathways among traumatic stress, posttraumatic stress disorder symptoms, and alcohol and drug problems: A test of four hypotheses. Psychology of Addictive Behaviors,

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Conklin, E. (2016). Online Publication of Undergraduate Studies, 7(2), 8-12.

28(3), 841-851.

Herman, J. (1992). Trauma and recovery. New York, NY: Basic Books.

Hien, D., Jiang, H., Campbell, A., Hu, M., Miele, G., Cohen, L.,…Nunes, E. (2010). Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA’s clinical trials network.

American Journal of Psychiatry, 167(1), 95-101.

Hopper, E., Bassuk, E., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homeless services settings. The Open Health Services and Policy Journal, 3(1), 80-100.

Jester, J., Steinberg, D., Heitzeg, M., & Zucker, R. (2015). Coping expectancies, not enhancement expectancies, mediate trauma experience effects on problem alcohol use: A prospective study from early childhood to adolescence. Journal of Studies on Alcohol and Drugs, 76(5), 781-789.

López-Castro, T., Hu, M., Papini, S., Ruglass, L., & Hien, D., (2015). Pathways to change: Use trajectories following trauma-informed treatment of women with co-occurring post-traumatic stress disorder and substance use disorders. Drug and Alcohol Review, 34(1), 242-251.

McHugo, G., Caspi, Y., Kammerer, N., Mazelis, R., Jackson, E., Russell, L., & Kimerling, R. (2005). The assessment of trauma history in women with co occurring substance abuse and mental disorders and a history of interpersonal violence. Journal of Behavioral Health Services & Research, 32(2), 113-127.

Potthast, N., & Catani, C. (2012). Trauma and addiction: Implications for psychotherapy. Addiction, 58(4), 227-236.

Shields, J., Delany, P., & Smith, K. (2015). Factors related to the delivery of trauma services in outpatient treatment programs. Journal of Social Work Practice in the Addictions, 15(1), 114-129.

Smyth, N., & Greyber, L. (2013). Trauma-informed practice. In B. Thyer, C. Dulmus & K. Sowers (Eds.), Developing evidence-based generalist practice skills (1st ed., pp. 25-50). Hoboken, NJ: Wiley.

Wiechelt, S. (2014). Intersections between trauma and substance misuse: Implications for trauma-informed care. In S. Straussner (Ed.), Clinical work with substance-abusing clients (3rd ed., pp. 179-201). New York, NY: Guilford.

Wolf, M., Nochajski, T., & Farrell, M. (2015). The effects of childhood sexual abuse and other trauma on drug court participants. Journal of Social Work Practice in the Addictions, 15(1), 44-65.

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Mindfulness and Intuitive Eating

Online Publication of Undergraduate Studies 2016, Volume 7, Issue 2

Mindfulness: An Avenue for Recovering Anorexics to Become Intuitive Eaters Caitlyn Corradino

Research suggests that up to 40% of women recovering from the restrictive subtype of anorexia nervosa will experience episodes of binge eating (Strober, Freeman, & Morrell, 1997; Treasure & Alexander, 2013). These binges have been correlated with a psychological urge that occurs naturally after a prolonged period of self-imposed starvation or weight loss (Akkermann, Hiio, Villa, & Harro, 2011; Keys et. al 1950; Sumithran et al., 2011; Telch & Agras, 1996; Tuschl, 1990; Wardle, 1990). This phenomenon was first exhibited in the results of the Minnesota Starvation Study (Keys et al., 1950); when starved participants were given access to food again, they could not satisfy their intense desire for food and binged continuously. More recently, brain imaging has revealed that a lack of sensitivity to satiety develops with self-imposed food restriction (Tuschl, 1990), and leads to progressively larger meals when restriction is terminated (Wardle, 1990). In other words, even if the body does not demand ample quantities of food, the mind craves large amounts of the food that was actively banned for a substantial period of time.

Binge episodes induce metabolic and psychological stress that can lead to relapse or steps backward in the recovery process (Strober et al., 1997). Therefore, it is important for those recovering from anorexia to become aware of their propensity to binge before binge episodes become a barrier to recovery. During later stages of anorexia treatment, inpatient and outpatient programs should focus on strategies that may help patients resist their unique psychological inclination to overeat during recovery, so that those recovering from anorexia may become aware of their propensity to binge before binge episodes become a barrier to recovery. One of these strategies is developing a commitment to intuitive eating. Intuitive eating is defined as a “strong connection with, and eating in response to, internal physiological hunger and satiety cues” (Tribole & Resch, 2003, p. 19).

Research indicates that all humans hold a biological mechanism that, if undisturbed by disordered eating behaviors, will direct them to eat in a way that supports good nutrition and a healthy weight (Hawks, Madanat, Hawks, & Harris, 2005). Intuitive eating is

defined as a “strong connection with, and eating in response to, internal physiological hunger and satiety cues” (Tribole & Resch, 2003, p. 19).

Research indicates that all humans hold a biological mechanism that, if undisturbed by disordered eating behaviors, will direct them to eat in a way that supports good nutrition and a healthy weight (Hawks, Madanat, Hawks, & Harris, 2005). Intuitive eating is about reconnecting with this biological mechanism. A commitment to intuitive eating has been linked to a decline in eating disorder symptomatology, including body shaming, internalization of the thin ideal, ritualistic eating patterns, and obsession with calories and fat (Hawks et al., 2005). Moreover, intuitive eating has been positively correlated with several indicators of both physical and emotional wellbeing, including a healthy weight, optimism, and resilience (Tylka & Wilcox, 2006; Van Dyke & Drinkwater, 2014). Research also suggests that intuitive eating strategies and skills can be relearned, even when they have been blocked by restriction or overeating (Cole & Horacek, 2010; Denny, Loth, Eisenberg, & Neumark-Sztainer, 2013).

One of the most effective ways to regain this sense of control over food intake may be practicing mindfulness meditation (Albers, 2011; Berman, Boutelle, & Crow, 2009; Heffner, Sperry, Eifert, & Detweiler, 2002; Rawal, Enayati, Williams, & Park, 2009). During mindfulness meditation, an individual draws their attention to their present experience by simply noticing their breath, body, emotions, or thoughts without analyzing or judging them (Sahdra et al. 2011). The following review explores how practicing mindfulness meditation may support the relearning of intuitive eating and prevent binge eating among individuals recovering from anorexia. In this paper, “anorexia” refers to the restrictive subtype of anorexia, as outlined by the American Psychiatric Association (2013), rather than the binge-purge subtype of anorexia.

Mindfulness Meditation and Intuitive Eating Intuitive eating is indicated by following healthy standards about food and nutrition, even when experiencing contrary thoughts and feelings (Schoenefeld

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Corradino, C. (2016). Online Publication of Undergraduate Studies, 7(2), 13-16. & Webb, 2013). An intuitive eater is able to label their thoughts and feelings as such, and recognize what their body needs, despite what emotions or external factors might tell them they need. Mindfulness meditation may foster this ability, because the goal of the practice is to change one’s reaction to their thoughts, without changing the content of the thoughts (Ortner, Kilner, & Zelazo, 2007). For example, instead of thinking “I cannot eat this,” a meditator revises the thought to, “I am thinking I cannot eat this,” and does not necessarily act upon their thoughts. Therefore, meditation may help those recovering from anorexia to recognize their affective responses to food. Empirical evidence indicates that regularly practicing mindfulness meditation can reduce eating disorder symptoms in women with anorexia (Albers, 2011; Berman et al., 2009; Heffner et al., 2002; Rawal et al., 2009). This is likely because mindfulness supports three primary principles of intuitive eating: awareness of the internal body cues, eliminating food “rules,” and respect for one’s own body.

Awareness of internal body cues. The first element of intuitive eating that can be cultivated through mindfulness meditation is an awareness and trust of hunger and satiety cues. Those diagnosed with anorexia have shown to be extremely driven to predict and control their food intake, which leads to a failure to integrate internal body cues into their dietary decisions (Fassino, Pierò, Gramaglia, & Abbate-Daga, 2004). A reliance on body signals is replaced by restrictive dieting, which makes patients less likely to recognize when they have a bodily need, and more likely to respond to any distress with disordered eating behavior (Ricca et al., 2012). In favor of deliberate and rigid eating habits, patients with anorexia ignore their intuitive body cues until they eventually lose awareness of them. This detachment from body signals may largely support the tendency to binge during recovery. Even when individuals recovering from anorexia restore their weight and reduce their dietary restrictions, they still may not be able to listen to their bodies over their brains, which can lead them to succumb to the psychological urge for over-consumption that follows periods of restriction (Akkermann, Hiio, Villa, & Harro, 2011; Sumithran et al., 2011; Tuschl, 1990; Wardle, 1990; ).

Mindfulness meditation, however, may prevent this overconsumption.

A key component of mindfulness meditation is approaching all present experiences with openness, acceptance, and awareness (Sahdra et al., 2011). Thus, over time, practicing mindfulness meditation generates an enhanced connection with present experiences, including ongoing body cues and ongoing thoughts (Kabat‐Zinn, 2003). This may help individuals with anorexia to recognize that disordered eating behaviors

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lead their bodies to feel imbalanced. As demonstrated by multiple case studies (e.g., Albers, 2011; Hayes, Strosahl, & Wilson, 1999; Safer, Telch, & Agras, 2001), mindfulness meditation can guide individuals towards eating for physical rather than mental or emotional reasons. This applies specifically to patients with anorexia; mindfulness has shown to reduce the negative thoughts and emotions that these patients often attach to feelings of satiety (Albers, 2011). The “acceptance” component of mindfulness meditation may help individuals with anorexia to acknowledge and accurately register their present internal sensations, accepting them as useful cues. They can then base their decision of whether or not to eat on these signals, rather than on what their distorted psychology may drive them to do.

Overall, mindfulness builds a body awareness that can support the ability to eat intuitively, and may allow recovering anorexics to use conscious awareness to resist the subconscious urge to binge.

Eliminating food "rules". Another principle of intuitive eating that may be sustained by practicing mindfulness is eliminating “rules” around food.

Recovering anorexics often believe that hyperconscious control of diet is necessary for proper nutrition (Polivy & Herman, 1999), and that not having any specific boundaries regarding meals will have irreversible consequences (Tribole & Resch, 2003). Yet, research implies that those who “ban” foods that they would otherwise enjoy eating end up binging more often than those who allow themselves total freedom to eat their preferred foods (Polivy & Herman, 1999). Giving oneself unrestricted permission to eat any food in any amount is an aspect of intuitive eating that is instrumental to anorexia recovery. When recovering patient learns to eliminate “food rules,” the decision to eat may become less of an analytical decision and more of an intuitive decision. This means that if a recovering individual begins to binge, they may recognize that the binge is not intuitively what their body craves, and stop before it becomes harmful to the body or to the recovery process.

Because mindfulness cultivates non-judgmental awareness (Ortner et al., 2007), it may be an effective way to eliminate the uncompromising ideas that many anorexia patients have about food. A significant barrier to developing unconditional permission to eat is the tendency among patients with anorexia to make food choices based on whether the food is “good” or “bad” (Hermans, Pieters, & Eelen, 1998)—a determination that is originally made by nutritional content, but eventually influenced by the patient’s cognitive inflexibility (Tchanturia, Davies, & Campbell, 2007). When one practices meditation, they practice actively eradicating judgment from their thoughts. As previously mentioned, a meditator would revise their

Corradino, C. (2016). Online Publication of Undergraduate Studies, 7(2), 13-16. idea from “This food is bad,” to “I am thinking that this food is bad.” Such a shift may transform eating into an activity that is natural, rather than one that is forced and deemed as “good” or “bad” (Tribole & Resch, 2003). By eliminating food rules and judgments, a recovering anorexic may find the clarity to listen to their instinctual body signals. Also, when the psychological desire to binge arises during recovery, they may be able to separate this inclination from their body’s true needs.

Respect for the body. The final principle of intuitive eating that can be cultivated by practicing mindfulness is respect for the body, which is defined as an individual’s feeling that their body is ultimately serving them and deserves to be nourished and honored, rather than starved and criticized (Tribole & Resch, 2003). Individuals with anorexia are often motivated to restrict by a distorted body image and aspiration to achieve the “thin ideal” (Thomsen, McCoy, & Williams, 2001). They experience ruminative thoughts that are centered on control of eating, weight, and body shape (Startup et al., 2013). While this rumination has been shown to produce and maintain the destructive behaviors of eating disorders (Deyo, Wilson, Ong, & Koopman, 2009), mindfulness meditation may prevent or terminate these behaviors. Actively practicing mindfulness is the cognitive opposite of passive rumination; therefore, it prompts significant reductions in rumination (Deyo et. al, 2009; Jain et. al, 2007; Lee et. al, 2007). Additionally, research indicates that mindfulness-based treatments are successful in motivating patients to directly challenge self-criticism with self-acceptance, especially in regards to body image (Ingvarsson, Nordén, & Norlander, 2014). For example, participants in a mindfulness-based eating disorder intervention reported learning to distinguish appetite regulation cues from emotions, thoughts, and behavioral urges (Wolever & Best, 2009). In other words, the nonjudgment element of mindfulness replaced self-criticism with self-perception, and allowed patients to distinguish when their hunger (or lack thereof) was triggered by natural biology from when it was triggered by disordered eating psychology.

Enhancing self-perception through meditationbased treatments can also cultivate a sense of self-respect that is crucial to curing disordered eating behaviors. In a controlled study of patients with anorexia, participating in mindfulness meditation groups resulted in greater acceptance of the body and self and reduced feelings of fatness compared to a control group (Rawal et al, 2009).

Another study showed that through exercises such as “the thought parade” (Heffner & Eifert, 2004), in which patients with anorexia are asked to observe their flow of self-deprecating thoughts without giving further attention to any of them, patients become more likely to

Mindfulness-Based Eating Awareness Training There are a variety of methods that have incorporated mindfulness meditation into anorexia treatment, including Acceptance and Commitment Therapy (Hayes et al., 1999), Dialectical Behavior Therapy (Linehan & Chen, 2005), and Mindfulness-Based Stress Reduction (Kristeller, & Wolever, 2006). However, the method that may most directly support the three components of intuitive eating (internal body awareness, eliminating food rules, and respect for the body) has yet to be applied to anorexia treatment. This method is called Mindfulness-Based Eating Awareness Training (MBEAT; Kristeller & Hallett, 1999), and it incorporates mindfulness meditation into food-related activities.

Participants are asked to direct their “acceptance” to not just their general present experience, but to the thoughts, emotions, and senses that surround eating. The first meditation in the treatment is done while eating simple, low-calorie foods. As the treatment continues, participants progress to eating more dense foods, and are eventually asked to make their own food choices, first between two foods and then with various food options.

Treatment also includes cultivating mindful acceptance of the physical body through body scans, self-soothing touch, and mindful walking (Kristeller & Hallett, 1999).

MB-EAT is traditionally applied to patients with binge eating disorder (Kristeller & Wolever 2010).

Controlled studies of these patients have shown that using MB-EAT predicts greater self-regulation during eating, with mindfulness and increased awareness of hunger and satiety cues as the most significant mediating variables (Kristeller & Hallett, 1999; Kristeller, & Wolever, 2010; Kristeller, Wolever, & Sheets, 2014). Although this empirical support for MB-EAT has focused on those diagnosed with binge eating disorder, MB-EAT is likely to help patients recovering from anorexia as well. Once weight is restored, recovering individuals may benefit from strategies to help navigate the psychological tendency to binge, such as MB-EAT. MB-EAT encourages individuals to become aware of their body cues, eat without contemplation, to eat consciously without over-analyzing or following strict rules, and to accept what they are feeling with full intent. Thus, it may be a viable way to cultivate the intuitive eating mindset and therefore prevent binge eating from inhibiting anorexia recovery.

CONCLUSION The human mind has a unique ability to imagine beyond what is presently occurring, leading some to become too burdened by their psychological cues to be attentive to their physiological cues; such is often the case for individuals recovering from anorexia. After a long

Mindfulness and Intuitive Eating | 15

Corradino, C. (2016). Online Publication of Undergraduate Studies, 7(2), 13-16. period of conscious restriction, these individuals are susceptible to a psychological urge to binge eat. Because they have become so insensitive to their body cues, these individuals may easily give into this urge. Yet, practicing mindfulness meditation may help them to recognize their thoughts or psychological urges as mere mental events that do not need to dictate their action. This may lead them to honor their body’s natural desire to maintain internal balance, eat without rigid rules, and respect their body enough to give it proper nutrition. In other words, they may cultivate a habit of intuitive eating, which will likely prevent them from binge eating.

Future research should investigate the effects of mindfulness-based interventions on binges specifically during anorexia recovery. Yet, it should be noted that supporting intuitive eating through mindfulness might only be useful for the later stages of anorexia treatment.

It is most likely beneficial for populations that are weight-restored and learning to manage the end of an intense restrictive period. The starvation associated with the incipient diagnosis of anorexia is often so severe that an attempt to rely on intuitive signals might only motivate the individual to maintain their famished state (Tribole & Resch, 2003). Thus, it is doubtful that any patient in the early stages of anorexia treatment will successfully adopt the principles of intuitive eating.

Research suggests that the beginning of anorexia treatment should focus exclusively on feeding patients in a deliberate fashion to avoid stressing the body (Gentile, Pastorelli, Ciceri, Manna, & Collimedaglia, 2010). This research may also not apply to individuals recovering from the binge-purge subtype of anorexia, or perhaps need modifications to address the different aspects of recovery from this subtype of anorexia. It should also be noted that mindfulness meditation’s effect on eating behaviors has not been widely tested on men, even though research shows that cases of anorexia among men are rising (Allen, Byrne, Oddy, & Crosby, 2013).

Finally, mindfulness, intuitive eating behaviors, and binge eating are constructs that are measured with a variety of instruments. Future research should involve more controlled studies with standardized measures for these constructs, as standardizing measurements would render more reliable support for the connection between them. Bearing these limitations in mind, researchers can continue to more deeply explore how mindfulness meditation can be incorporated into the treatment process. Shifting recovering patients’ focus from ruminative thoughts to present bodily sensations may support the skills of intuitive eating for each of the various populations that lose intuitive, healthful eating behaviors to restrictive, harmful habits. Eating disorder treatment programs often begin with physiological

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remedies, so ending the programs with psychological remedies like mindfulness meditation may lead patients towards the sense of balance they are seeking in their body and mind. This balance may be what ultimately helps recovering anorexics cope with the tendency to binge post recovery.

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Berman, M. I., Boutelle, K. N., & Crow, S. J. (2009). A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosa.

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Cole, R. E., & Horacek, T. (2010). Effectiveness of the My Body Knows When intuitive-eating pilot program. American Journal of Health Behavior, 34(3), 286-297.

Denny, K. N., Loth, K., Eisenberg, M. E., & Neumark-Sztainer, D. (2013). Intuitive eating in young adults. Who is doing it, and how is it related to disordered eating behaviors? Appetite, 60, 13-19.

Deyo, M., Wilson, K. A., Ong, J., & Koopman, C. (2009). Mindfulness and rumination: does mindfulness training lead to reductions in the ruminative thinking associated with depression EXPLORE: The Journal of Science and Healing, 5(5), 265-271.

Fassino, S., Pierò, A., Gramaglia, C., & Abbate-Daga, G. (2004). Clinical, psychopathological and personality correlates of interoceptive awareness in anorexia nervosa, bulimia nervosa and obesity.

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Gentile, M. G., Pastorelli, P., Ciceri, R., Manna, G. M., & Collimedaglia, S. (2010). Specialized

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Hawks, S., Madanat, H., Hawks, J., & Harris, A (2005). The relationship between intuitive eating and health indicators among college women.

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Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.

Heffner, M., & Eifert, G. H. (2004). The anorexia workbook: How to accept yourself, heal your suffering, and reclaim your life. Oakland, CA: New Harbinger Publications.

Heffner, M., Sperry, J., Eifert, G. H., & Detweiler, M. (2002). Acceptance and commitment therapy in the treatment of an adolescent female with anorexia nervosa: A case example. Cognitive and Behavioral Practice, 9(3), 232-236.

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Kristeller, J. L., & Hallett, C. B. (1999). An exploratory study of a meditation-based intervention for binge eating disorder. Journal of Health Psychology, 4(3), 357-363.

Kristeller, J. L., & Wolever, R. Q. (2010).

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Linehan, M. M., & Chen, E. Y. (2005). Dialectical

behavior therapy for eating disorders. In S. Felgoise, A. M. Nezu, C. M. Nezu, & M. A. Reinecke (Eds.), Encyclopedia of cognitive behavior therapy (pp. 168-171). New York: Springer.

Ortner, C. N., Kilner, S. J., & Zelazo, P. D. (2007).

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Polivy, J., & Herman, C. P. (1999). Distress and eating: why do dieters overeat?. International Journal of Eating Disorders, 26(2), 153-164.

Rawal, A., Enayati, J., Williams, J. M. G., & Park, R. J. (2009). A mindful approach to eating disorders. Healthcare Counselling and Psychotherapy Journal, 9(4), 16-20.

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Schoenefeld, S. J., & Webb, J. B. (2013). Self compassion and intuitive eating in college women: Examining the contributions of distress tolerance and body image acceptance and action.

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Tchanturia, K., Davies, H., & Campbell, I. C. (2007).

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Thomsen, S. R., McCoy, J. K., & Williams, M. (2001). Internalizing the impossible: Anorexic outpatients' experiences with women's beauty and fashion magazines. Eating Disorders, 9(1), 49-64.

Treasure, J., & Alexander, J. (2013) Anorexia nervosa: A recovery guide for sufferers, families and friends. London, England: Routledge.

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Online Publication of Undergraduate Studies 2016, Volume 7, Issue 2

Hypomanic Creativity in Bipolar II Disorder

The Mechanisms of Hypomanic Creativity in Bipolar II Disorder Julia Klein There is a popular notion of the artist as a ‘mad genius’, who uses her deviant thought process and emotional fluidity to innovate and create (Taylor, Fletcher, & Lobban, 2015). The widespread acceptance of this character construct has spurred attempts by researchers to substantiate the link between creative minds and the cognitive and affective elements of bipolar disorder (e.g., Johnson, Tharp & Holmes, 2015; Kaufman, 2014; Soeiro-de-Souza, Dias, Bio, Post & Moreno, 2011). Bipolarity is categorized by at least one clinically significant manic episode, or period of significantly elevated mood, and is almost always accompanied by a lifetime presence of depressive episodes, or periods of persistent feelings of worthlessness and sadness (American Psychiatric Association, 2013). Bipolar II disorder (BPD II) is often thought of as the less severe iteration of bipolar disorder, but it can still greatly affect functioning (Johnson et al., 2012). Diagnosed individuals experience similar, albeit shorter, depressive episodes as their bipolar I disorder (BPD I) counterparts. The manic facet of BPD II, known as hypomania, also only requires a four-day period of expansive or elevated mood, as opposed to the seven-day period necessary to be considered clinically significant mania in BPD I (American Psychiatric Association, 2013). Although there is a noticeable change in functioning, the DSM-5 specifies that hypomania, by definition, does not markedly impair functioning (McCraw, Parker, Fletcher & Friend, 2013; Soeiro-deSouza, 2011). At least three of the seven hypomanic symptoms (i.e., grandiosity, decreased need for sleep, talkative, racing thoughts, distractibility, increase in goal direction or psychomotor agitation, excessive risk taking) must be present during a period of mood alteration in order to meet clinical diagnosis of BPD II, and they are often measured by the Hypomanic Personality Scale (HPS) (Fulford, Feldman, Tabak, McGillicuddy, & Johnson, 2013; Malhi, Chengappa, Gershon, & Goldberg, 2010).

Although creativity has been explored in both the context of BPD I and BPD II, it is important to substantiate the link between BPD II hypomania and creativity in its own right. Hypomania has repeatedly

been related to elevated levels of creativity (Drapeau & DeBrule, 2013; Fulford et al., 2013; Furnham, Batey, Anand, Manfield, 2008), and many have posited that hypomania may be more conducive to heightened creativity than mania (Johnson et al., 2012; McCraw et al., 2013; Taylor et al., 2015).

Creativity as a construct has been defined by affective and cognitive abilities and is frequently measured by aesthetic preferences, occupation, and problem solving methods (Johnson et al., 2015; Soeiro-deSouza et al., 2011). Nevertheless, while a link has been substantiated by research, the specific ways in which creativity and hypomania interact have only recently begun to be explored. Existing literature has focussed on understanding and explaining this relation and the mechanisms through which it works (Johnson et al., 2012; Johnson, Tharp & Holmes, 2015; Kaufman, 2014; Taylor et al., 2015).

Therefore, this paper examined the following research question: How does hypomania relate to heightened creativity in individuals with clinical bipolar II disorder?

Hypomanic Traits Associated with Creativity Many key traits that are thought to drive creativity are related to hypomanic symptomatology (Drapeau & DeBrule, 2013). For example, divergent thought processing, or the ability to derive unique cognitive solutions, and disinhibited cognition, or unhindered thinking, are commonly shared traits of self-identified creative and clinically diagnosed bipolar II individuals (Fulford et al., 2013).

Alternatively, positive affect, goal directedness, and creative achievement have all been hypothesized as moderators of the relation between hypomania and elevated levels of creativity (Fulford et al., 2013).

These positive characteristics emphasize the dimensional nature of the disorder, and potential benefits of BPD II that may arise, such as enhanced creative accomplishment (Galvez, Thommi & Ghaemi, 2011).

Creative Achievement Retrospective biographical reviews, in which

Hypomanic Creativity in Bipolar II Disorder | 19

Klein, J. (2016). Online Publication of Undergraduate Studies, 7(2), 19-21. researchers delve into historical records, have found that successful historical artists, meaning those who achieved great creative accomplishments, were most likely to experience severity and persistence of symptoms consistent with hypomania (Johnson et al., 2015).

Patients with more severe forms of bipolarity, like BPD I, have more variability in thought processes and solution formulation, as well as increased artistic drive and ingenuity. However, these individuals also undergo more profound instances of depression (Johnson et al., 2012; Johnson et al., 2015). As a result, research has emphasized the importance of clinicians dispelling the myth that creative minds must sacrifice emotional stability for their work, and instead posits that hypomanic productivity exists without the debilitation of full blown mania (Galvez, Thommi & Ghaemi, 2011). Moreover, in qualitative explorations of the links between the disorder and elevated creativity, participants with bipolar II disorder felt that hypomania fed their creativity, and that completing successful projects elevated their moods (Taylor et al., 2015). In this manner, a cyclical system is established in which hypomanic traits such as positive affect and feelings of euphoria increase creative production and achievement, which in turn enhances positive emotional states.

Positive Affect Positive affect refers to the extent that an individual experiences joyful, lively and otherwise engaged moods (Fulford et al., 2013). Better moods have been increasingly linked to elevated levels of creative expression (Fulford et al., 2013; Taylor et al., 2015). Studies have provided evidence backing a meaningful interaction between induced positive mood and severity of hypomanic symptoms on cognitive flexibility scores (Fulford et al., 2013). High mood levels also lead to expanding the mind and a broader attentional scope, concepts that begin to enter into the territory of disinhibited cognition and divergent thought (Taylor et al., 2015). Similarly, positive affect has been linked to faster development of novel solutions to problems posed to individuals with BPD II (Taylor et al., 2015). The significance of these findings reveal the nuanced and complex relation between hypomanic symptoms themselves; for example, positive affect appears to work through divergent thought processes to achieve creative outcomes (Fulford et al., 2013; Furnham et al., 2008).

Divergent Thought Processing and Disinhibited Cognition Divergent thinking involves inventing novel

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and unique ideas when presented with stimuli (Taylor et al., 2015). Divergent thought and disinhibited cognition, two major facets of hypomania, are common metrics used to understand creativity, as an extensive scale that encapsulates and quantifies the creative construct, or Creativity Quotient, has yet to be established (Furnham et al., 2008). As a result, unusual thought and unique cognitive approaches, both aspects of divergent thought and disinhibited cognition, are most frequently used to represent creative abilities in research studies (Rybakowski, & Klonowska, 2011; Taylor et al., 2015). Additionally, individuals with BPD II have a preference for novel aesthetic shapes compared to healthy control participants, which may suggest an inclination towards new stimuli that challenges conventional thought (Johnson et al., 2015).

Executive functioning is another essential facilitator of both divergent thought and creativity, although intelligence may play an active role in the relation (Benedek, Jauk, Sommer, Arendasy, & Neubauer, 2014).

Executive function provides capabilities like shaping, inhibiting, and updating ideas, which are necessary and highly conducive to divergent patterns of thought and disinhibited cognition (Benedek et al., 2014). In fact, inhibiting and updating ideas is directly related to aspects of creativity, specifically the generation of useful and novel thoughts (Benedek et al., 2014). In addition, divergent thinking and creative achievements have also been positively correlated with suicidal ideation, which provides a possible new direction for scientific inquiry regarding creativity (Drapeau & DeBrule, 2013).

CONCLUSION The underlying cognitions and hypomanic traits essential to understanding creativity often play off one another. As they interact, these assets, such as positive affect and divergent thought all enhance expression and facilitate creative achievement. Hypomania inherently elevates the mood of the diagnosed individual, in most cases resulting in what appears to be positive affect (Fulford et al., 2013). This positive affect correlates with higher cognitive flexibility scores, mind expansion, and broader attentional scope, capabilities which could be viewed as facets of divergent thought (Fulford et al., 2013; Taylor et al., 2015). In turn, divergent thought and disinhibited cognition elicit multiple novel pathways leading to unique responses and solutions (Furnham et al., 2008; Rybakowski, & Klonowska, 2011). In this way, the two components of hypomania work together to promote creative achievement in individuals diagnosed with BPD II (Taylor et al., 2015).

Future studies should examine the inconsistency in

Klein, J. (2016). Online Publication of Undergraduate Studies, 7(2), 19-21. previous research between self-reported creativity in people with bipolar disorder and the sometimes inconsistent results seen through creative testing (Rybakowski, & Klonowska, 2011). In addition, researchers should attempt to control for individual differences that may play roles in creative ability and accomplishment (Johnson et al., 2015). Furthermore, explorations into the cross-section of bipolar disorder and creativity often produce results of a qualitative nature. While informative, these methods are often susceptible to investigator bias, and future research should investigate the relation in more quantitative ways (Johnson et al., 2015).

REFERENCES American Psychiatric Association. (2013).

Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.

Benedek, M., Jauk, E., Sommer, M., Arendasy, M., & Neubauer, A. C. (2014). Intelligence, creativity, and cognitive control: The common and differential involvement of executive functions in intelligence and creativity. Intelligence, 46, 73–83.

Drapeau, C. W. & DeBrule, D. S. (2013). The relationship of hypomania, creativity, and suicidal ideation in undergraduates. Creativity Research Journal, 25(1), 75-79.

Fulford, D., Feldman, G., Tabak, B. A., McGillicuddy, M., & Johnson, S. L. (2013). Positive affect enhances the association of hypomanic personality and cognitive flexibility. International Journal of Cognitive Therapy, 6(1), 1-16.

Furnham, A., Batey, M., Anand, K., & Manfield, J. (2008). Personality, hypomania, intelligence and creativity. Personality and Individual Differences, 44(5), 1060-1069.

Galvez, J. F., Thommi, S. & Ghaemi, S.N. (2011).

Positive aspects of mental illness: A review in bipolar disorder. Journal of Affective Disorder, 128(3), 185-90.

Johnson, S. L., Moezpoor, M., Murray, G., Hole, R., Barnes, S. J. & Michalak, E. E. (2015). Creativity and bipolar disorder: Igniting a dialogue.

Qualitative Health Research, 26(1), 32-40.

Johnson, S. L., Murray, G., Fredrickson, B., Youngstrom, E. A., Hinshaw, S., Bass, J. M.,...

Salloum, I. (2012). Creativity and bipolar disorder: Touched by fire or burning with questions? Clinical Psychology Review, 32(1), 1-12.

Kaufman, J. C. (2014). Creativity and mental illness.

New York, NY: Cambridge University Press.

Malhi, G. S., Chengappa, K. N. R., Gershon, S., &

Goldberg, J. F. (2010). Hypomania: Hype or mania bipolar disorders, 12(8), 758-763.

McCraw, S., Parker, G., Fletcher, K., & Friend, P. (2013). Self-reported creativity in bipolar disorder: Prevalence, types and associated outcomes in mania versus hypomania. Journal of Affective Disorders, 151(3), 831-836.

Rybakowski, J. K. & Klonowska, P. (2011). Bipolar mood disorder, creativity and schizotypy: An experimental study. Psychopathology, 44(5), 296-302.

Soeiro-de-Souza, M. G., Dias, V. V., Bio, D. S., Post, R. M., & Moreno, R. A. (2011). Creativity and executive function across manic, mixed and depressive episodes in Bipolar I Disorder. Journal of Affective Disorders, 135(1-3), 292-297.

Taylor, K., Fletcher, I., & Lobban, F. (2015).

Exploring the links between the phenomenology of creativity and bipolar disorder. Journal of Affective Disorders, 174, 658-664.

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Effect of Military Schools on Mental Health

Online Publication of Undergraduate Studies 2016, Volume 7, Issue 2

The Effect of Attending a Military School on Military Personnel’s Perceptions of Mental Health Rebekah Myers “Duty, Honor, Country” is the motto that thousands of United States Army men and women live by. Taught to follow a strength narrative of high leadership and character in both military and civilian activities, military personnel are considered to be one of the strongest subsets of the population (Bartone, Snook, & Tremble, 2002; Kelly, Matthews, & Bartone, 2014).

They are able to handle high stress situations, behave under a rigid discipline, and maintain a group mentality (Driskell & Salas, 1991; Kelly et al., 2014; Matthews, Eid, Kelly, Bailey, & Peterson, 2006). These characteristics allow military men and women to lead soldiers through dangerous conditions and maintain face during difficult circumstances. However, upon return to the lesssurveilled civilian life, these same qualities can pose emotional adjustment difficulties and can increase the likelihood of developing a mental illness (Wintre & BenKnaz, 2000; Verey & Smith, 2012).

In 2003 alone, nearly 30% of military personnel presented symptoms of major depression, generalized anxiety, and PTSD upon returning from deployment in Iraq and Afghanistan, yet most of these men and women failed to seek mental health care (Hoge et al., 2004).

Military members tend to forgo seeking help for mental illness because they have learned to stigmatize mental illness as a weakness, which is a contradiction to the strength narrative they were taught to uphold (GreeneShortridge, Britt, & Castro, 2007; Hoge et al., 2004).

Whereas most researchers claim that a negative mental health stigma exists within the whole military (Hoge et al., 2004), little research examines the effect stigma may have on help-seeking behaviors at specific levels of position, such as among officers, compared to enlistees.

Rather, most studies employ samples comprised solely of enlistees but generalize their findings to every rank of the military. Differing from enlistees who join the military right after high school, officers are required to receive a college education at a military academy before starting active duty. Gradually exposing the officers to the gritty military environment for four extra years, this education may have an impact on officers’ beliefs about utilizing mental health resources. Thus, this review explored this gap in the literature by examining the

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following research question: To what extent does attending a military institution affect mental health stigma and help-seeking behaviors for military officers?

The Effects of Stigma on Help-Seeking Behaviors Current research supports a negative relation between mental health stigma and help-seeking behaviors in a variety of samples, including civilian adults, college students, and military personnel (Britt et al., 2008; Greene-Shortridge et al., 2007). An individual’s mental health stigma, or negative judgment toward people with mental illness, derives from societal attitudes that mentally ill individuals are weak, undependable, unsafe, and responsible for developing their illness (Ben-Zeev, Corrigan, Britt, & Langford, 2012; Corrigan & Penn, 1999; Corrigan & Watson, 2002). When individuals suffering from mental health problems perceive these negative attitudes about mental illness, they develop a lower sense of self-esteem and self-efficacy, and fear being mistreated by peers, losing their jobs, and not receiving adequate treatment (BenZeev et al., 2012; Britt et al., 2008; Greene-Shortridge et al., 2007; Mengeling, Booth, Torner, & Sadler, 2014).

Ultimately then, these fears hinder individuals from wanting to seek help for their illness (Verey & Smith, 2012).

The fear of appearing weak is a common reason for low help-seeking among military personnel (VanSickle et al., 2016; Verey & Smith, 2012). Immersed in an environment of grit (Kelly et al., 2014), aggressive masculinity (Verey & Smith, 2012), and conformity (U’ren, Conrad, & Patterson, 1973), military personnel are expected to maintain high levels of strength at all times. Not only do military schools initially accept these men and women based on their high physical performance and emotional stability, but they also expect them to maintain this status throughout their time in the military (Bartone et al., 2002; Matthews et al., 2006). Showing any sign of physical or emotional weakness, or deviating from the “healthy” norm, guarantees that a student will be ranked lower amongst his peers or encouraged to drop out (Gold & Friedman, 2000; Lerew, Schmidt, & Jackson, 1999). Indeed, Lerew

Myers, R. (2016). Online Publication of Undergraduate Studies, 7(2), 22-26. et al. (1999) found that physical and psychological conditions characterized those who were asked to leave the Air Force Academy during basic training. Thus, many military personnel fear that exposing mental illness will put them at risk of being judged as incompetent and losing their rank (VanSickle et al., 2016; Verey & Smith, 2012).

Because military personnel constantly fear portraying any sign of mental weakness due to its status as being emotionally unhealthy according to the military’s standards, they tend to negatively stigmatize mental illness and subsequently forgo treatment for any symptoms they may experience (Ben-Zeev et al., 2012; Greene-Shortridge et al., 2007; Verey & Smith, 2012).

Regardless of the intensity of the psychological pain, such as the pain following a sexual assault experience, the fear of being mistreated by peers and superiors hinders most military men and women from seeking help (Mengeling et al., 2014). In fact, only when they see extreme differences in their relationships or changes in their behavior do they eventually seek out mental health care (Snell & Tusaie, 2008). However, failing to get help until the extreme occurs ultimately causes many suffering men and women to further exacerbate their symptoms through social isolation (Greene-Shortridge et al., 2007) and using substances to cope (Ben-Zeev et al., 2012), which consequently contribute to the high suicide rate (18.7%) amongst military members (Smolenski et al., 2013). Thus, because mental health stigma has drastic effects on the livelihoods of military men and women, it is important to determine potential protective and/or risk factors for developing mental health stigma at various levels of rank.

Protective Factors of Military Schools on Stigma and Help-Seeking Behaviors Commissioned officers, who attended military colleges before beginning active duty, may struggle less with mental health stigma simply because they might develop mental illness less often. Most importantly, these men and women have been found to have certain protective personality factors in dealing with stressful situations (Bartone et al., 2002; Herrmann, Post, Wittmaier, & Elsasser, 1977; Kelly et al., 2014).

Successful cadets have been found to be more conscientious, agreeable, and to have fewer neurotic tendencies. These characteristics help cadets be successful, as they are effective for learning to manage a group and adapting to sudden changes (Bartone et al., 2002). While these personality characteristics subsequently make individuals more inclined to seek out the military environment, military institutions also have a selection bias to only accept individuals whose personalities align with military values and who appear

to have high levels of grit and hardiness (Atwater, Dionne, Avolio, Camobreco & Lau, 1999; Bartone et al., 2002; Kelly et al., 2014). This bias helps the military ensure that their students will be successful and remain at the schools through graduation. Accepting only those applicants who demonstrate high levels of hardiness, military schools may protect officers from developing a mental illness because they offer a structured curriculum that strengthens officers’ resilient qualities while indoctrinating them into the stressful military life (Bartone et al., 2002; Herrmann et al., 1977; Kelly et al., 2014; Matthews et al., 2006).

Compared to enlisted soldiers who are placed immediately into basic training and then combat, commissioned officers may also experience less mental illness because attending a military school provides officers with four additional years to adapt to the stress of military life and further develop their hardiness (Atwater et al., 1999; Gold & Friedman, 2000). For example, students are expected to participate in basic training every summer with different roles and responsibilities, such as acting as commanding leaders of their companies, in order to slowly introduce them to higher levels of leadership and authority (Gold & Friedman, 2000). Purposely exposing the officers to situations that challenge their resilience, military institutions provide students more opportunity to develop persistence and effective coping strategies that could ultimately protect them against developing mental illness symptoms and needing to seek help (Kelly et al., 2014).

However, even if officers were to develop mental illness, military schools foster high levels of camaraderie and social support that may act as a buffer against mental illness’ effects (Gibson & Myers, 2006; Myers & Bechtel, 2004). Research has found that being in a highly cohesive unit diminishes the stigma of getting mental health help (Wright, Cabrera, Bliese, & Adler, 2009).

This may be due to the fact that relying on each other, which contributes to the functioning of the team, helps individuals feel as though they are not alone in their decision to seek professional help. Furthermore, knowing that they are all suffering together (Gold & Friedman, 2000), students are able to help each other by giving specific, empathetic advice to get through stressful situations (Verey & Smith, 2012). Overall, military schools have the potential to be a protective factor in officers’ stigmatizations of mental health and help-seeking behaviors with their specific clientele, curriculum, and brotherly environment, as they ultimately protect them from developing mental illness in general.

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Myers, R. (2016). Online Publication of Undergraduate Studies, 7(2), 22-26.

Risk Factors of Military Schools on Stigma and HelpSeeking Behaviors While military academies may protect officers from developing a mental health stigma by protecting them from developing a mental illness and giving them a support system if they do struggle, they also hold significant risk factors for promoting mental health stigma. Because the schools expose military officers to the strength narrative at an intense level in order to prepare them for their upcoming positions of authority, officers may be more indoctrinated to think that mental illness is the highest form of weakness. Held to higher standards of face and strength as the leaders of their companies (VanSickle et al., 2016), officers admit to struggling to seek help for their own mental illness, because they have the weight of taking care of the other soldiers in their companies (Verey & Smith, 2012). Having more responsibilities for the group and subsequently feeling pressured to appear stronger, officers may feel more of a need to put aside their own problems for the safety of the group (Gold & Friedman, 2000; Verey & Smith, 2012).

Despite beginning school with high levels of selfcare, officers’ health has been found to decline throughout their four years as their leadership responsibilities for their units increase (Gibson & Myers, 2006; Gold & Friedman, 2000; Myers & Bechtel, 2004).

For example, many upperclassmen students claim that the weight of such responsibilities cause many to suffer from sleep deprivation in order to focus on the group’s functioning (Gold & Friedman, 2000). In fact, the lack of self-care that arises out of the group mindset results in many older students isolating themselves from others, losing their social support systems, and failing to seek help (Gold & Friedman, 2000; Greene-Shortridge et al., 2007). Consequently, because officers are constantly aware that they have more to lose with their high ranking and that they must always exhibit individual strength for the better of the group (Gold & Friedman, 2000; Verey & Smith, 2012), they may be at a higher risk of stigmatizing mental illness as a weakness.

Most importantly, there are currently no programs in place that teach students how to emotionally adjust to military life and that further enrich their hardiness levels (Atwater et al., 1999; Ben-Zeev et al., 2012; Gold & Friedman, 2000).

Despite the fact that hardiness is a learned quality that needs to be further developed, officers leave the academies with hardiness levels similar to those at the start of their schooling (Atwater et al., 1999; Maddi, 2007). These schools accept men and women who they believe already have high levels of hardiness and simply put their efforts toward reorienting students’ hardiness to the needs of the 24 | SUBMISSIONS

military (Atwater et al., 1999; Kelly et al., 2014). Without implementing official hardiness trainings and continuously trying to develop these qualities, military schools leave students to figure out how to cope with high levels of stress on their own (Maddi, 2007). In fact, when comparing military students’ physical, emotional, and academic stress to that of civilian college students, it is evident that military students’ self-care is inadequate with their stress management skills mirroring those of their less stressed peers (Gibson & Myers, 2006; Myers & Bechtel, 2004). Therefore, military schools negatively affect the physical health, performance, and mental health of their students by having little focus on their emotional development.

Although military students have access to counseling services, many have observed breaches of confidentiality in which other students’ superiors found out about their visit (Mengeling et al., 2014). These breaches ultimately dissuade students from seeking help in order to avoid any negative ramifications that they may experience with their own superiors. Without being taught how to appropriately cope with stressors and being given a safe space to discuss how they feel, officers are subsequently faced with high stress levels and a lack of knowledge about how to cope. Rather than initiating the conversation about mental health, creating preventative measures for when they do show signs of mental illness, and assuring students that mental illness is nothing to be ashamed of in this line of work, military schools create a deeper sense of mental illness as taboo. In conjunction with the weakness stigma, this lack of mental health education perpetuates a negative mental health stigma and inhibits officers from learning how to cope in a healthy manner.

CONCLUSION Military schools have the means to be protective against mental illness and stigma. In their current state, however, they function as a risk factor by failing to properly educate officers on appropriate self-care in the military. Despite accepting students who already demonstrate high levels of grit and hardiness, military academies fail to implement specific trainings that deepen these strengths and instead push these students into experiences of high stress as a way to build resilience (Kelly et al., 2014; Maddi, 2007). This unstructured strategy leaves students to develop their own, typically unhealthy coping mechanisms for stress management, like isolating themselves from the group to avoid appearing incompetent or weak (Atwater et al., 1999; Ben-Zeev et al., 2012; Gold & Friedman, 2000). The lack of structure also eliminates the schools’ protective nature of creating social support systems, perpetuates the military’s stigma of mental illness as a sign of weakness, and forces students to

Myers, R. (2016). Online Publication of Undergraduate Studies, 7(2), 22-26. develop stigmatized beliefs that inhibit them from seeking help (Gibson & Myers, 2006; GreeneShortRidge et al., 2007; Myers & Bechtel, 2004; VanSickle et al., 2016).

Officers’ stigmatizations and lack of help-seeking behaviors have important implications since officers are expected to run military units of enlisted soldiers and foster in them a similar belief system (Wright et al., 2009). As this is one of the first explorations of specifically officers’ help-seeking behaviors, future research is needed to explore more in-depth the various factors associated with a lack of help seeking within this particular ranking. Most importantly, government and school policies should incorporate mandatory resilience, stress management, and mental illness trainings as a part of the curriculum in order to save the many military lives taken by suicide every year.

REFERENCES Atwater, L. E., Dionne, S. D., Avolio, B., Camobreco, J. F., & Lau, A. W. (1999). A longitudinal study of the leadership development process: Individual differences predicting leader effectiveness. Human Relations, 52(12), 1543-1562.

Bartone, P. T., Snook, S. A., & Tremble, T. R. (2002). Cognitive and personality predictors of leader performance in West Point cadets.

Military Psychology, 14(4), 321-338.

Ben-Zeev, D., Corrigan, P. W., Britt, T. W., & Langford, L. (2012). Stigma of mental illness and service use in the military. Journal of Mental Britt, T. W., Greene–Shortridge, T. M., Brink, S., Health, 21(3), 264-273.

Nguyen, Q. B., Rath, J., Cox, A. L., . . . & Castro, C. A. (2008). Perceived stigma and barriers to care for psychological treatment: Implications for reactions to stressors in different contexts. Journal of Social and Clinical Psychology, 27(4), 317-335.

Corrigan, P. W., & Penn, D. L. (1999). Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54(9), 765-776.

Corrigan, P. W., & Watson, A. C. (2002). The paradox of self-stigma and mental illness.

Clinical Psychology: Science and Practice, 9(1), 35-53.

Driskell, J. E., & Salas, E. (1991). Group decision making under stress. Journal of Applied Psychology, 76(3), 473-478.

Gibson, D. M., & Myers, J. E (2006). Perceived stress, wellness, and mattering: A profile of first-year Citadel cadets. Journal of

College Student Development, 47(6), 647-660.

Gold, M. A., & Friedman, S. B. (2000). Cadet basic training: An ethnographic study of stress and coping. Military Medicine, 165(2), 147-152.

Greene-Shortridge, T. M., Britt, T. W., & Castro, C. A. (2007). The stigma of mental health problems in the military. Military Medicine, 172(2), 157-161.

Herrmann, D. J., Post, A. L., Wittmaier, B. C., & Elsasser, T. C. (1977). Relationship between personality factors and adaptation to stress in a military institution. Psychological Reports, 40(3), 831-834.

Hoge, C. W., Castro, C. A., Messer, S. C., Mcgurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13-22.

Kelly, D. R., Matthews, M. D., & Bartone, P. T. (2014). Grit and hardiness as predictors of performance among West Point cadets. Military Psychology, 26(4), 327-342.

Lerew, D. R., Schmidt, N. B., & Jackson, R. J. (1999).

Evaluation of psychological risk factors: Prospective prediction of psychopathology during basic training. Military Medicine, 164(7), 509-513.

Maddi, S. R. (2007). Relevance of hardiness assessment and training to the military context.

Military Psychology, 19(1), 61-70.

Matthews, M. D., Eid, J., Kelly, D., Bailey, J. K., & Peterson, C. (2006). Character strengths and virtues of developing military leaders: An international comparison. Military Psychology, 18(Suppl), S57 S68.

Mengeling, M. A., Booth, B. M., Torner, J. C., & Sadler, A. G. (2014). Reporting sexual assault in the military: Who reports and why most servicewomen don't. American Journal of Preventive Medicine, 47(1), 17-25.

Myers, J. E., & Bechtel, A. (2004). Stress, wellness, and mattering among cadets at West Point: Factors affecting a fit and healthy force. Military Medicine, 169(6), 475-482.

Snell, F., & Tusaie, K. R. (2008). Veterans reported reasons for seeking mental health treatment.

Archives of Psychiatric Nursing, 22(5), 313-314.

Smolenski, D.J., Reger, M. A., Alexander, C. L., Skopp, N. A., Bush, N. E., Luxton, D. D., & Gahm, G. A. (2013). Department of Defense suicide report (DoDSER) calendar year 2012 annual report.

Tacoma, WA: National Center for Telehealth and Technology.

U’ren, R. C., Conrad, F. E., & Patterson, P. H. (1973). A year’s experience in student mental health at West Point. American Journal of Psychiatry, 130(6), 643-647.

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Myers, R. (2016). Online Publication of Undergraduate Studies, 7(2), 13-26.

Vansickle, M., Werbel, A., Perera, K., Pak, K., Deyoung, K., & Ghahramanlou-Holloway, M. (2016). Perceived barriers to seeking mental health care among United States Marine Corps noncommissioned officers serving as gatekeepers for suicide prevention. Psychological Assessment, 28(8), 1020-1025.

Verey, A., & Smith, P. K. (2012). Post�combat adjustment: Understanding transition. Journal of Aggression, Conflict and Peace Research, 4(4), 226-236.

Wintre, M. G., & Ben-Knaz, R. (2000). It's not academic, you're in the army now: Adjustment to the army as a comparative context for adjustment to university. Journal of Adolescent Research, 15(1), 145-172.

Wright, K. M., Cabrera, O. A., Bliese, P. D., & Adler, A. B. (2009). Stigma and barriers to care in soldiers postcombat. Psychological Services, 6(2), 108-116.

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Elderly Help Acceptance and Living Circumstances

Online Publication of Undergraduate Studies 2016, Volume 7, Issue 2

Elderly Help Seeking and Acceptance Behaviors in Relation to Living Circumstances Molly Nystrom

According to the U.S. Administration on Aging (2010), projected U.S. population growth of those aged 65 years or older is expected to rise by as much as 20% by the year 2050. Due to a lack of manpower, specifically in the subfield of geropsychology, medical and mental health professionals are unprepared to manage the quantity of older people expected to need assistance in years to come (American Geriatrics Society, 2013; American Psychological Association, 2013). Completing everyday tasks becomes increasingly difficult with age, and many seniors need help with household chores on a regular basis (Abma, Bruijn, Kardol, Schols, & Widdershoven, 2012; Dunér &Nordström, 2005; Stoller & Earl, 1983). However, research indicates that elderly are resistant to both seeking and accepting help from formal support services (Husaini, Moore, & Cain, 1994; Singh, Mazi-Kotwal, & Thalitaya, 2015; Sorkin, Murphy, Nguyen, & Biegler, 2016). This study aimed to address the living circumstances of elderly in relation to use and acceptance of formal support services.

Physical and Mental Health As seniors continue to age, they begin to experience a reduction in their physical abilities and many resist or deny the reality that they may need considerable help when performing daily tasks (Covinsky et al., 2003; Moen et al., 2009). While individual health factors should be taken into account, the overarching trend as seniors age is a decline in overall health (Logan & Spitze, 1994; Nakashima, Chapin, Macmillan, & Zimmerman, 2005; Wu & Pollard, 1998). Physically, seniors experience loss of vision, mobility impairments due to diminishing bone and muscle structure, hearing loss, vitamin deficiencies, and decreased immune response (Berkman et al., 1986; Nakashima et al., 2005; Sharkey et al., 2002). In addition to physical health, most seniors will struggle with some form of mental impairment or deterioration (Greiner, Snowdon, & Schmitt, 1996; Smith, Braunack-Mayer, Wittert, & Warin, 2007). Notably, depression is a prevalent problem in elderly populations (Midlöv, Andersson, Östgern, & Mölstad, 2014). Changes in socializing, stressful decisions, reduced income, independence loss,

or any combination of the aforementioned circumstances can contribute to feelings of depression, creating a cyclical pattern that both feeds and cultivates depression (Gollub & Weddle, 2004; Logan & Spitze, 1994). Unfortunately, depression is commonly dismissed as a natural part of the aging process (Midlöv et al., 2014). Because the symptoms are often mistakenly attributed to old age, recognizing the severity of depressive symptoms is difficult for healthcare professionals, and depression remains a widespread problem among elderly populations (Drageset, Eide, & Ranhoff, 2012).

Loss of independence directly correlates with depression in the elderly (Gollub & Weddle, 2004; Greiner et al., 1996; Smith et al., 2007). Seniors emphasize that independence is the key factor to maintaining a high quality of life (Smith et al., 2007). In comparison to those who cannot, seniors able to perform all of their daily activities and care for themselves report a higher level of defined self-identity and positive attitudes towards themselves or the aging process in general (Greiner et al., 1996).

Another important factor that has received attention in recent studies is socialization, or the lack thereof, in elderly populations (Kerse et al., 2010). The quality and frequency of senior socialization are significant components of their overall mental health and life satisfaction (Butler & Ciarrochi, 2007; Gollub & Weddle, 2004; Haight, 1988; Nakashima et al., 2005).

Many seniors struggle with loneliness, depression, and isolation due to their inability to attend regular social gatherings (Gollub & Weddle, 2004; Sharkey et al., 2002). As seniors begin to struggle with self-sufficiency, decreases in mobility hinder their access social support (Logan & Spitze, 1994; Smith et al., 2007).

After considering the effects of aging, adjustments in day-to-day living may be necessary. Very few are prepared for all of the living adjustments that will have to be made during old age. The elderly must make difficult choices about their living circumstances that will affect how they function on a daily basis (Wu & Pollard, 1998). Physical and cognitive changes often force seniors to seek help from either a formal support service or their own informal support network (Logan &

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Nystrom, M. (2016). Online Publication of Undergraduate Studies, 7(2), 27-33.

Spitze, 1994; Nakashima et al., 2005; Wu & Pollard, 1998).

Help Seeking and Accepting The elderly feel an increased vulnerability with age and are more likely to resort to informal support (Logan & Spitze, 1994; Mascarenhas et al., 2006; Moen et al., 2009 Nakashima et al., 2005). Informal care networks consist of family members and friends caring for the elderly individual in informal settings, such as their home, and are still used more than formal support (Logan & Spitze, 1994; Nakashima et al., 2005). Seniors will call upon neighbors to help with small tasks, but immediate family members usually step in to provide most of the comprehensive and hands-on support (Wu & Pollard, 1998). A senior’s spouse is usually their first source of support. If a spouse is unavailable or unable to perform necessary caretaking duties, then the responsibilities fall on children, siblings, or other relatives (Logan & Spitze, 1994; Wu & Pollard, 1998).

However, even in a home setting with relatives acting as primary caretakers, conflicts are quite common.

Research indicates that both family members and medical professionals often assume that an elderly person is unfit to make their own decisions (Brown, McAvay, Raue, Moses, & Bruce, 2003; Nakashima et al., 2005). In some cases, family members will make decisions on behalf of an older person with little to no consultation or discussion (Nakashima et al., 2005).

Research also indicates seniors have difficulty accessing or even finding appropriate services, contributing to the disconnect between the formal services available for the elderly and their target demographic (Logan & Spitze, 1994; Nakashima et al., 2005; Van Deursen, 2012). This can be problematic for seniors or family members seeking formal help services.

In recent years, great efforts have been made in trying to find new ways of advertising available services to the former group (McQuerry, 2016). Resources available to seniors include, but are not limited to, social work organizations, nursing facilities, home delivery meal programs, shopping and escort assistance, friendly visiting, professional counseling, and other tasks completed by local volunteers (Cepeda-Benito & Short, 1998; Edelman & Hughes, 1990; Gollub & Weddle, 2004; Poulin & Walter, 1992). For many of these organizations, most of the difficulty in circulating information to seniors is due to low funding or lack of venues (Jackson & Hafemeister, 2013).

However, there remains resistance to using formal services from both the elderly population and familial caretakers (Edelman & Hughes, 1990; Nakashima et al., 2005; Smith et al., 2007). Of the seniors who know that services exist, many still choose not to take advantage of

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of the services available to them; they report not feeling entitled to services and, therefore, choose not to search for or accept any (Logan & Spitze, 1994). Although finding services can be challenging, a senior’s unwillingness to admit they need help acts as one of the greatest barriers to formal support services (Moen, 1978). Whether it is due to pride or denial, seniors do not necessarily feel the immediate need to reach out for help, considering it either superfluous or optional (Smith et al., 2007). Furthermore, mistrusting formal care services and the medical field in general is quite common in elderly populations. More often than not, the elderly feel that their doctors do not understand them or their problems (Mascarenhas et al., 2006).

Seniors worry that doctors have a greater interest in pushing the agendas of pharmaceutical companies over the wellbeing of the individual (Mascarenhas et al., 2006; Moen et al., 2009). Negative societal stigma around aging and how the elderly are treated also tend to contribute to a senior’s reluctance in seeking and accepting help (Logan & Spitze, 1994; Nakashima et al., 2005).

Current Study Due to the limited professionals and resources available, the field of geropsychology struggles with keeping literature up to date. As reported by the American Psychological Association (2013), only 4.2% of practicing psychologists work exclusively with the elderly. The retiring baby boomers, who currently make up 23% of the population, have forced healthcare professionals to realize that they are hopelessly overwhelmed and cannot meet the growing needs of a population that will desperately need help (Fry, 2016).

Currently, part of the problem stems from how doctors diagnose their older patients. More often than not, medical professionals only address or focus on physical problems and ailments. Their thought process revolves exclusively around physical functioning. Nurses and doctors are not usually able to identify symptoms of mental and emotional stress in elderly patients (Brown et al., 2003). Treating physical and mental health as though they are separate, especially in reference to the elderly, has created compartmentalization in research.

Medical research, psychology research, and social work research all tend to look towards and build off of the research that exists within their own area of study. The lack of communication between professionals in each field, when applied to practice, can be detrimental to the elderly.

For the current study, observations were made during an internship at a social-work based organization that provides a variety of services to support seniors’ independent living. Living accommodations, which

Nystrom, M. (2016). Online Publication of Undergraduate Studies, 7(2), 27-33. include factors such as dwelling, familial involvement, and adjustments made for individual health factors, all play a role in determining how a senior will respond to formal support service assistance (Cohen-Mansfield, Hazan, Lerman, & Shalom, 2016; Logan & Spitze, 1994; Wu & Pollard, 1998). Modern trends are showing that many elderly rely on a combination of both formal and informal support, but formal support networks still have to overcome the hurdle of seniors seeking help and accepting it (Cohen, Miller, & Weinrobe, 2001; Smith et al., 2007; Sole-Auro & Crimmins, 2014). Therefore, the following research question was explored: How do the living circumstances of seniors affect their help acceptance behaviors relative to formal support services?

METHOD Participants The participants consisted of 21 seniors ranging between the ages of 65 to 98, nineteen of whom were between 75 and 98. All seniors in the study were registered in programs at a social work based organization. The organization served as a formal support service for seniors. In order to participate in the homebound meal delivery program or many other programs, all seniors had to complete an initial social work assessment and continue to update their information annually. To complete a reassessment, seniors provided interviewers with information on their finances, medical history, personal background, family information, daily routine, social and leisure activities, living accommodations, and any information about future program involvement. The sample included both seniors who are homebound and those who are not. In the sample, 43% of the seniors lived alone. Of the 57% of seniors that did not live alone, 25% lived with spouses, 58% lived with an aide or nurse, and 25% lived with a family member or a roommate. One participant lived with both an aide and a family member. Of the seniors living with a nurse or aide, 75% did so with full time assistance while only 25% had part time assistance.

Socio-economic statuses varied.

Procedure Supervisors scheduled reassessment visits for interns. Normally, interns had two reassessments per shift, for a total of four each week. Each reassessment took approximately an hour and a half to two hours. All reassessments were completed in the home of the older person (OP), and answering all questions was required.

Detailed notes about intern interactions were taken for program records and allowed the intern to add comments about cleanliness standards, possible health hazards, the coherence and responsiveness of OP, or any

other important notes. An edited version of the intern’s notes were submitted as observational field notes.

Participants were aware of any notes made pertaining to the questions asked, but they may or may not have been aware of the notes taken about their interaction with the interviewer.

For the purpose of this study, the operational definition of living accommodations was broken into components which were used to address several questions taken from the social work reassessments. The first question asked was whether or not OP lived alone. If they did, then follow-up questions were asked regarding their daily routine: (1) “Do you have any issues completing day-to-day tasks (such as cooking, cleaning, walking, bathing, grocery shopping, and preparing meals)?”, (2) “If so, what issues are you experiencing?”, (3) “Have you considered options on how to address the issue?” If, however, the OP did not live alone, they received the following questions instead: (1) “If not, who do you live with?”, (2) “Would you be able to function daily without the assistance of the person you are residing with?”, (3) “Is the person living with you a family member, a friend, or a live-in aide?” To be considered independent, individuals were not allowed to rely solely on their spouse. Those who were unable to perform daily activities by themselves included seniors that are homebound, bedbound, those that lived with a spouse and were dependent on the spouse, or those that lived with a 24/7 aide. Two OPs were unable to answer questions themselves, in which case a nurse or aide responded on behalf of the OP. Coding Thematic analysis was used to code all field notes.

First, basic demographic information was taken from their reassessment in order to group them for analysis.

This included the following information: whether or not the OP lived alone (and, if not, who they lived with), how they initially heard about the organization, and their ability to function daily with or without assistance.

Specific keywords and phrases were coded regarding the OP’s feelings or opinions towards the organization’s program(s) or any other program in which they participated that was tailored to an elderly demographic. Four key themes emerged from both open ended and closed ended questions with the reassessment interview process: thankfulness, compliments, complaints, and questions. Thankfulness referred to any time the OP thanked the interviewer directly or thanked the organization in general for services. Compliments included any positive remarks made about the organization or other programs. Complaints included any unhappy or critical remarks made about the organization’s programs or services. Questions were in

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Nystrom, M. (2016). Online Publication of Undergraduate Studies, 7(2), 27-33. reference to any expressed interest in other available services.

These themes were chosen because the quotes and words used were all in reference to either a service they were receiving from the organization or one of the organization’s workers or volunteers. These specific themes allowed the researcher to narrow down participants’ thoughts and feelings towards the organization, a formal source of support, as opposed to their circumstances in general.

RESULTS AND DISCUSSION The coding themes emerged from reviewing field notes, and keywords and phrases were then determined based on these reviews. The total number of positive comments made were 27, 20 being thankfulness, and 7 being compliments. There were 25 complaints and 8 questions. Although there were more positive comments highlighted within the reassessment quotes overall, once the keywords and phrases were divided into themes, the theme with the highest number of coded information was complaints. Complaints were also spread out amongst the population. Ten OPs out of the 21 had some form of criticism or complaint.

Demographic information pulled from reassessments was then used to examine each OP’s living circumstances and connect that information to their coded interview quotes. An interesting trend emerged in comparing seniors who lived alone versus seniors who did not. Seniors who lived alone had a larger number of complaints (e.g. “Last week, I ordered the chicken and I wanted the chicken breast, but they gave me a leg; I didn’t want the chicken leg.”; “Their programs are dull. I keep suggesting better things, but no one seems to want to listen to me.”; “The outreach is so infrequent; I really hate that.”). However, they also had a higher number of thankfulness in comparison to those that lived with a nurse, aid, spouse or roommate (e.g. “Thank you for your help.”; “Thank you for coming by.”; “My daughter is so thankful for the organization’s consistent communication with her during my recovery.”; “I really liked the going with an escort to the baseball game last year.”; “They work so hard over there, and they’re doing such a great job.”). Out of the eight participants who could not function on their own, a majority lived with a family member and were more thankful in comparison to the OPs that lived with an aide or nurse, a majority of whom had complaints.

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Looking at the circuumstances of the seniors in the sample, their responses supported current literature regarding loneliness and desire for social interaction. Past research indicated depression remains prevalent in elderly populations, which can influence how they behave and interact with others (Fiske, Wetherell, & Gatz, 2009).

While those living alone voiced the highest number of complaints, they also held the largest number of thankful remarks, which was not expected. Previous studies have shown that the elderly long for social interaction and appreciate any type of communication or visit (Portet, Vacher, Golanski, Roux, & Meillon, 2013). While causation should not be inferred, loneliness may have been a prevalent factor in this population’s OPs living alone. The findings in this study indicated the complaints made by those living alone might possibly have been linked to loneliness. Researchers have noted unfriendly behaviors, agitation, and complaints result from loneliness and a need for social interaction, and loneliness has been highly correlated with depression (Donovan, Rentz, Sperling, Marshall, & Glymour, 2016; Gerstein & Tesser, 1987). Despite vocalizing complaints, participants still chose to use programs offered by this social work organization. Complaints made by OPs may have had less to do with participant dissatisfaction and, instead, might have related more to an OP’s eagerness to use what interactions they have as a platform for expression. By conveying both thankfulness and complaints together, their behavior might have indicated an underlying desire for more interaction and attention.

However, there seemed to be another added layer of distance between the seniors and actively seeking formal support services. Only three participants sought out the organization on their own. The rest reported hearing about the organization from a family member or after a friend recommended it to them. Seven participants asked questions about other services (e.g. “Oh, I didn’t know they had a holiday meal delivery.”; “Do you know if they have volunteers to escort me to a museum on a Saturday?”). The yes-or-no phrasing of this particular question on the reassessment indicated that the other 14 participants were not interested in any other programs.

Within that 14, there were two participants that used very strong language to refuse any further information (“I do not need any extra help, no matter what my wife says; we’re enrolled in the meal program for her, but I don’t need anything.”; “Are you trying to imply you think I need extra assistance? Because I don’t. I’m managing just fine.”). The responses, or lack thereof, in this study

Nystrom, M. (2016). Online Publication of Undergraduate Studies, 7(2), 27-33. supported literature regarding independence as a factor to higher quality living. Most OPs did not wish to use any more programs or services beyond the ones in which they were already enrolled. Any additional services were dismissed as unnecessary and were usually not even considered. In alignment with past literature, it was revealed that independence and motor functioning are valued traits that indicate a higher quality of life (Crewdson, 2016). Maintaining the ability to function independently at home was directly correlated with lower levels of physical health issues, loneliness, depression, and other psychological problems (Searle, Mahon, IsoAhola, Sdrolias, & van Dyck, 1995). One possible explanation was that acceptance of more programs would have been in direct opposition to their perceived independence, a trait greatly valued by elderly due to its slow, continual loss.

CONCLUSION This study found support for existing literature regarding behaviors towards formal support services in the elderly. It also highlighted a possible connection between seniors living alone and their complaints as an indicator of depression or a need for further social interaction. This study did have several limitations. First, the sample size was very small. Future studies should consider using larger populations. However, while most studies focus on one particular factor (e.g., OPs that live with aides or OPs that are homebound), this study was able to take advantage of the fact that each OP had different living circumstance and this allowed for a comparison across several different demographic factors.

Second, not all of the reassessments were taken by the researcher. Several were filled out by others and the researcher only reported interaction information after a friendly visit. Also, because the reassessment was preapproved and used pre-written phrasing, participants that asked about other programs only did so in response to the question within the reassessment. Future research should consider developing a more organic method for bringing up this topic. Another limitation identified when reviewing for keywords and phrases was that two participants had no specific positive or negative phrases or words in their reassessment interview. They were still included, however, because they answered the question specific to their interest in other organization programs.

Despite the limitations of this study, as a psychology study based on social work data, it could prove valuable to both fields and lead to possible future collaborations.

Both fields, and possibly the medical field as well, would benefit from further study as this could prove to educate professionals on recognizing the identifiers of elderly depression. Also, due to the psychology field’s continuous problem with maintaining current literature, this study could serve as the base for future studies used to update existing research. The experiences in a social work program proved to be meaningful in connecting the three areas of psychology: theory, research, and practice.

Working in the field with an elderly demographic, researching the population as a student, and bringing forth information and ideas to supervisors to inform future projects showed a practical example of the connection between the three areas.

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Nystrom, M. (2016). Online Publication of Undergraduate Studies, 7(2), 27-30.

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Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., Counsell, S. R., Stewart, A. L., Kresevic, D., … & Landefeld, C. S. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. Journal of the American Geriatrics Society, 51(4), 451-458.

Crewdson, J. A. (2016). The effect of loneliness in the elderly population: A review. Healthy Aging & Clinical Care in the Elderly, 8, 1-8.

Donovan, N. J., Wu, Q., Rentz, D. M., Sperling, R. A., Marshall, G. A., & Glymour, M. M. (2016).

Loneliness, depression and cognitive function in older US adults. International Journal of Geriatric Psychiatry. Retrieved from http:/ onlinelibrary.wiley.com/doi/10.1002/gps.4495/ epdf.

Drageset, J., Eide, G. E., & Ranhoff, A. H. (2013).

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Online Publication of Undergraduate Studies 2016, Volume 7, Issue 2

Mothers' Beliefs and Attitudes on Father Involvement

The Impact of Mothers' Beliefs and Attitudes on Father Involvement with Children Shirley Wu

While studies about parental involvement in the United States have historically emphasized the maternal role in child care, research today has become increasingly focused on the effects of father involvement on child development (Schoppe-Sullivan, Brown, Cannon, Mangelsdorf, & Sokolowski, 2008; Zvara, Schoppe-Sullivan, & Dush, 2013). Emerging evidence suggests that fathers are slowly beginning to spend more time caring for their children (McBride, Brown, Shin, Vaughn, & Korth, 2005). Defined as father’s accessibility (presence and availability), engagement (direct contact, like play), and responsibility (decision-making on child care, health visits, etc.), father involvement significantly affects child outcomes in a number of ways (Flouri & Buchanan, 2004; Pleck & Masciadrelli, 2004; SchoppeSullivan, McBride, & Ho, 2005). Several findings have shown that children with less engaged fathers are at greater risk of adverse outcomes, such as increased rates of suspension from school, more frequent delinquent behavior, and higher reports of depression, whereas other studies have highlighted benefits for children of highly involved fathers, such as better academic performance, higher levels of self-esteem, and fewer behavioral problems (Flouri & Buchanan, 2004; Schoppe-Sullivan et al., 2005).

Nearly 92% of Americans believe that fathers make a unique contribution to their children’s lives, whether that may be providing a safe environment for the child to grow up in or being involved in their child’s education (National Center for Fathering, 2009). Yet, 46% of fathers report that they do not spend an adequate amount of time with their children (Parker & Wang, 2013). Although fathers’ time with children has nearly tripled from 1965 to 2011 (Parker & Wang, 2013), they are still devoting significantly less time caregiving compared to the child’s mother (Pleck & Masciadrelli, 2004). This discrepancy may be related to maternal gatekeeping, or mothers’ beliefs and behaviors that restrict fathers’ opportunities for caregiving, such as maternal criticism towards fathers’ parenting abilities (Allen & Hawkins, 1999; Fagan & Barnett, 2003).

However, research suggests that maternal beliefs and attitudes may also encourage fathering behaviors by

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valuing, supporting, and praising paternal engagement, indicating that mothers’ perceptions about their spouses’ roles can both restrict and facilitate father involvement (Allen & Hawkins, 1999; Arendell, 1996). Therefore, this paper addressed the following research question: How do maternal beliefs and attitudes influence father involvement with children?

Maternal Beliefs and Attitudes as a Restricting Factor in Father Involvement The traditional family structure in the United States depicts mothers as primary caregivers who hold a more dominant role in parenting, and fathers as “breadwinners,” or the main source of financial support (McBride et al., 2005; Ngai, Chan, & Ip, 2010). This idea about mothers’ greater claim to the domestic sphere has contributed to maternal gatekeeping, or maternal ideologies that restrict father involvement (Arendell, 1996; De Luccie, 1995). Mothers who hold these beliefs may perceive father participation in caretaking as an infringement upon their role in the family and subsequently resist paternal involvement (Ngai et al., 2010). One way of asserting such resistance is through maternal criticism, which occurs when mothers express disapproval towards fathers’ parenting behaviors by rolling their eyes or taking over a task and completing it their own way (Van Egeren, 2000). Frequent maternal criticism has been shown to hinder father participation in caretaking activities, like making babysitting or medical checkup arrangements (Schoppe-Sullivan et al., 2008). In fact, highly critical mothers are more likely to assume control of their husbands’ childrearing involvement if they believe their partners’division of household responsibilities (e.g., housework, financial contributions) is set too low or is unsatisfactory (Beitel & Parke, 1998).

Findings also suggest that maternal gatekeeping can manifest itself as mothers’ negative beliefs and attitudes towards fathers’ competency in caregiving (Fagan & Barnett, 2003; Hawkins, Marshall, & Meiners, 1995; Schoppe-Sullivan et al., 2008). Mothers often perceive themselves as having greater competence than fathers in parenting skills like discipline and guidance,

Wu, S. (2016). Online Publication of Undergraduate Studies, 7(2), 34-37. academic support, and praise and affection (Fagan & Barnett, 2003). This negative perception towards fathers’ parenting abilities has shown to restrict paternal access to children (Hawkins et al., 1995). Specifically, mothers who perceive their spouse as having lower childrearing abilities (e.g., teaching responsibility, providing homework support, encouraging talents) also share less responsibilities in child care activities with the father (e.g., attending parent teacher conferences, picking up the child from school; Hawkins et al., 1995; SchoppeSullivan et al., 2008). This suggests that maternal gatekeeping behaviors can be explained in part by mothers’ negative ideas about paternal competence and attitudes about the father role.

Maternal Beliefs and Attitudes as a Facilitating Factor in Father Involvement Although maternal beliefs and attitudes may inhibit father involvement with children, studies suggest that they may also encourage and support it (Arendell, 1996; De Luccie, 1995). Research has found that the quantity and quality of father-child engagement is strongest when mothers value the fathering role, such as believing fathers’ interactions and playtime with their child is important in meeting their child’s psychological needs (Arendell, 1996; Finley, Mira, & Schwartz, 2008).

Father involvement may even be unlikely without mothers’ encouragement (McBride et al., 2005). For example, fathers are more likely to be engaged with their children if their wives take into account the fathers’ views about child care matters or note that his presence or actions make their child happy (Finley et al., 2008; McBride et al., 2005). Allen and Hawkins (1999) note that when couples perceive higher levels of maternal encouragement for fathers, both parents tend to report higher levels of father involvement in child care activities compared to mothers. This demonstrates that mothers’ positive affirmation and appraisal of paternal parenting are associated with an increase in father involvement (McBride et al., 2005). Consistent with these findings, fathers with partners who promote their efforts in paternal caregiving believe their own fathering role is more important, and thus participate in more caretaking activities compared to fathers without the same degree of maternal support (Allen & Hawkins, 1999; Finley et al., 2008). Therefore, maternal encouragement may directly affect fathers’ own perceptions of their involvement with children, because fathers who feel more supported by their spouses are more inclined to share parenting responsibilities and interact with their children (Allen & Hawkins, 1999; Pleck & Pleck, 1997).

Fathers’ positive perceptions of their involvement

with children are also associated with positive partner relationships, indicating that paternal child engagement may be facilitated by the quality of the relationship they have with their spouse (Finley et al., 2008; Holes & Huston, 2010). In other words, fathers who believe that their relationship with their partners are more cohesive and compatible (e.g., being responsive to each other’s needs, equally sharing decision-making responsibilities) are more likely to receive less maternal criticism (Schoppe-Sullivan et al., 2008), spend more time with their children (McBride et al., 2005), and have greater quality of caregiving compared to fathers who perceive having less positive relationships (Allen & Hawkins, 1999). Therefore, maternal attitudes and beliefs that support father involvement may lead to a more cohesive parenting partnership, and subsequently facilitate positive father-child engagement (Allen & Hawkins, 1999; Finley et al., 2008).

CONCLUSION As the literature has shown, mothers’ attitudes and beliefs influence how fathers approach parenting.

Specifically, maternal ideologies about the role of the father may inhibit or encourage father involvement with children (Allen & Hawkins, 1999; Arendell, 1996). Yet, these findings cannot be viewed as conclusive. Because this paper relies heavily on correlational data, these results should not be used to infer causal relationships.

Conducting longer-term longitudinal research would help further elucidate the relations between mothers’ attitudes and beliefs on father involvement.

Additionally, much of the data collected stem from convenience sampling methods. Thus, findings cannot be used to make generalizations about the larger population. Many of the families are also middle-class and White, which weakens how representative the findings are to various family structures and contexts.

Using larger and more diverse samples would help resolve this issue.

Furthermore, future research should examine the various contexts and pathways in which mothers transmit their maternal beliefs and attitudes towards fathers. For example, mothers who believe in the importance of the father role may decrease their own time with their children (McBride et al., 2005). This demonstrates that mothers who value father involvement may actively offer or create opportunities for fathers to participate in child care activities (McBride et al., 2005) such as sharing responsibilities more equally or depending more on them to assist in childrearing (Arendell, 1996). In a similar vein, working mothers may be less available, have less traditional and gendered

Mothers' Beliefs and Attitudes on Father Involvement | 35

Wu, S. (2016). Online Publication of Undergraduate Studies, 7(2), 28-32. views about the mother’s claim to the domestic sphere, and therefore prefer more engaged fathers (McBride et al., 2005; Schoppe-Sullivan et al., 2008). Thus, future research should consider investigating the effects of working and non-working mothers’ perspectives on father involvement.

This paper represents an important step in understanding the need to support parent education programs so fathers can become more confident in their parenting abilities, and can interact more effectively and more regularly with their children (De Luccie, 1995; Gaertner, 2007). Practitioners and programs working with expectant and first-time parents should look into developing interventions and strategies that can help increase paternal engagement with children since relatively few have investigated the significant influence of maternal beliefs and attitudes (Gaertner, 2007; McBride et al., 2005). Current efforts working to increase father involvement include school programs that invite fathers to attend or volunteer at their child’s school and parent workshops that strengthen coparenting and marital relationships (National Center for Fathering, 2009). These types of initiatives have increased fathers’ positive perceptions of their childrearing abilities, and have also significantly improved their relationships with their children (Gaertner, 2007; Magill-Evans, Rempel, Harrison, & Slater, 2006). Such strategies have also increased children’s cognitive development (Magill-Evans et al., 2006) and decreased their problem behaviors (Lundahl, Tollefson, Risser, & Lovejoy, 2007) while strengthening parenting relations among mothers and fathers (Gaertner, 2007). Taken together, this research can help set positive expectations about the father’s caregiving role to best support positive child outcomes.

REFERENCES Allen, S. M., & Hawkins, A. J. (1999). Maternal gatekeeping: Mothers’ beliefs and behaviors that inhibit greater father involvement in family work. Journal of Marriage and the Family, 61(1), 199-212.

Arendell, T. (1996). Co-parenting: A review of the literature. Philadelphia, PA: National Center on Fathers and Families.

Beitel, A. H., & Parke, R. D. (1998). Paternal involvement in infancy: The role of maternal and paternal attitudes. Journal of Family Psychology, 12(1), 268-288.

De Luccie, M. F. (1995). Mothers as gatekeepers: A model of maternal mediators of father involvement. The Journal of Genetic Psychology, 156(1), 115–131.

Fagan, J., & Barnett, M. (2003). The relationship

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between maternal gatekeeping, paternal competence, mothers’ attitudes about the father role, and father involvement. Journal of Family Issues, 24(1), 1020-1043.

Finley, G. E., Mira, S. D., & Schwartz, S. J. (2008).

Perceived paternal and maternal involvement: Factor structures, mean differences, and parental roles. Fathering, 6(1), 62-82.

Flouri, E., & Buchanan, A. (2004). Early father's and mother's involvement and child's later educational outcomes. British Journal of Educational Psychology, 74(2), 141-153.

Gaertner, B. M. (2007). Parental childrearing attitudes as correlates of father involvement during infancy. Journal of Marriage and the Family, 69(4), 962-976.

Hawkins, A. J., Marshall, C. M., & Meiners, K.M. (1995). Exploring wives' sense of fairness about family work: An initial test of the distributive justice framework. Journal of Family Issues, 16(1), 693-721.

Lundahl, B. W., Tollefson, D., Risser, H., & Lovejoy, M. C. (2007). A meta-analysis of father involvement in parent training. Research on Social Work Practice, 42(1), 462-476.

Magill-Evans, J., Harrison, M. J., Rempel, G., & Slater, L. (2006). Interventions with fathers of young children: Systematic literature review.

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McBride, B. A., Brown, G. L., Bost, K. K., Shin, N., Vaughn, B., & Korth, B. (2005). Paternal identity, maternal gatekeeping, and father involvement. Family Relations, 54(1), 360-372.

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Ngai, F. W., Chan, S. W. C., & Ip, W. Y. (2010).

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Parker, K., & Wang, W. (2013). Modern parenthood: Roles of moms and dads converge as they balance work and family (pp. 27-32).

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Pleck, E. H., & Pleck, J. H. (1997). Fatherhood ideals in the United States: Historical dimensions. In M. E. Lamb (Ed.), The role of the father in child development (pp. 33-48). Hoboken, NJ: Wiley.

Pleck, J. H., & Masciadrelli, B. P. (2004). Paternal involvement by U.S. residential fathers: Levels, sources, and consequences. In M. E. Lamb (Ed.), The role of the father in child development (pp. 222-271). Hoboken, NJ: Wiley.

Schoppe-Sullivan, S. J., Brown, G. L., Cannon, E. A.,

Wu, S. (2016). Online Publication of Undergraduate Studies, 7(2), 28-32.

Mangelsdorf, S. C., & Sokolowski, M. S. (2008).

Maternal gatekeeping, coparenting quality, and fathering behavior in families with infants.

Journal of Family Psychology, 22(3), 389-398.

Schoppe-Sullivan, S. J., McBride, B. A., & Ho, M. H. R. (2004). Unidimensional versus multidimensional perspectives on father involvement. Fathering, 2(2), 147-163.

Van Egeren, L. A. (2000). Parental gatekeeping inventory. Unpublished manuscript, Michigan State University, East Lansing, MI. Zvara, B. J., Schoppe�Sullivan, S. J., & Dush, C. K. (2013). Fathers' involvement in child health care: Associations with parental involvement, parents' beliefs, and maternal gatekeeping.

Family Relations, 62(4), 649-661.

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38

Biographies

39

40

JULIA ACKER

ASHLIE PANKONIN

Editor-in-Chief

Editor-in-Chief

ackerj@nyu.edu

ashlie.pankonin@nyu.edu

Julia Acker is a senior in the Applied Psychology program with a combined major in Global Public Health and a minor in Sociology. She is a member of the Latino Family Engagement and Language Development (L-FELD NYU) research team led by Dr. Gigliana Melzi and Dr. Adina Schick. Under the mentorship of Dr. Schick, Julia is completing an honors thesis on how school and classroom context predicts teacher self-efficacy for teachers of lowincome dual language learners. For this project, she won the 2016 Steinhardt Student Challenge Grant for Undergraduate Research and will be presenting her work at the 2017 SRCD Biennial Conference. She also conducts research on social inequalities in health under the mentorship of Dr. Sean Clouston at Stony Brook University. In the future, she hopes to pursue a career in health and education research, specifically addressing social inequality and cultural difference.

Ashlie Pankonin is a senior in the Applied Psychology program with a minor in Linguistics. She is a research assistant for the Latino Family Engagement and Language Development (L-FELD NYU) team led by Drs. Gigliana Melzi and Adina Schick. Her passion to conduct research has led her to pursue the Honors Program in the department and she is currently completing her honors thesis investigating perspective-taking in children’s narratives and how this changes across the preschool years under the mentorship of Dr. Melzi and will be presenting her work at NYU's 2017 Undergraduate Research Conference. Ashlie is also the two-year captain of the NYU diving team. In the future, she hopes to pursue a career that allows her to explore the roles language plays in psychological processes, that not only has a real-world impact, but also gives back to the community.

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JULIA IMPERATORE | Programming & Communications Director jmi268@nyu.edu Julia Imperatore is a senior in the Applied Psychology program. She currently is a research assistant with MDRC for the project ExCEL P-3 coding footage of public elementary school classrooms with the aim of identifying critical factors in low-income children's classroom experiences. She previously worked as a Constituent Services Intern for City Council Member Ben Kallos of District 5, and before that working under Dr. Shabnam Javdani with the ROSES team researching an alternative to detention for young girls involved in the juvenile justice system of New York City. Julia hopes to apply her interests of research, public policy and social justice in both future studies and work.

SHIRLEY WU | Layout & Design Director | Contributing Writer shirleywu@nyu.edu Shirley Wu is a senior in the Applied Psychology and Global Public Health program. She is currently a research assistant for Drs. Melzi and Schick’s L-FELD team, a Product Management intern at Healthfirst, and a resident assistant at NYU. In the past, Shirley has worked on the Corporate Partnerships team at UNICEF and the Development and Fundraising team at The National Eating Disorders Association. She hopes to leverage her strengths in research, data analytics, and strategic marketing to address critical issues in today’s rapidly evolving healthcare industry. After graduating from NYU, Shirley will pursue a career in health policy and healthcare management, and continue exploring her interests in health promotion and disease prevention.

ELISE CONKLIN | Contributing Writer erc365@nyu.edu Elise Conklin is a senior in the Applied Psychology program. She is currently an intern at The Door, where she conducts intake interviews with young people, and an advocate in ROSES, working with girls involved in the juvenile justice system. In the past she interned at EPRA, a vocational rehabilitation organization for people in recovery from substance abuse. She is interested in studying trauma and strengths-based interventions. In the future she plans to pursue an MSW.

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CAITLYN CORRADINO | Contributing Writer cc3852@nyu.edu Caitlyn Corradino is a senior in the Applied Psychology program, minoring in Nutrition. She is highly interested is the mental health benefits of physically healthy practices like meditation, healthy eating, and exercise. She is particularly intent on exploring how these practices can benefit at-risk populations. She is currently serving as an intake counselor at The Door Center, and launching a non-profit organization that aims to make exercise and other wellness opportunities more accessible to underprivileged populations. In the past, she has been a research assistant for Dr. Javdani’s R.I.S.E. lab, Dr. Aronson’s Mindfulness Education Lab, and at the Brain and Mind Institute of Sydney, Australia. She has also served at The National Eating Disorders Association.

Although she is graduating this semester, Caitlyn will be staying at NYU Steinhardt for the graduate program in Clinical Nutrition. Caitlyn hopes to use her knowledge from her undergraduate degree in psychology in conjunction with a graduate degree in nutrition to give marginalized populations more opportunities to foster their mental and physical wellbeing.

JULIA KLEIN | Contributing Writer jmk723@nyu.edu Julia Klein is a senior in the Applied Psychology program, minoring in Studio Art. She currently works on the Care Coordination Team at the Bellevue/NYU Program for Survivors of Torture and is the Greenhouse Intern at the Horticultural Society of New York, where she aids in implementing horticultural therapy with detained young men on Rikers Island. In the past, Julia has been a Neuroscience and Education Lab research assistant for Dr. Clancy Blair's meta-analysis examining the effects of self-regulation on anxiety and depression, and has also served as a social work intern at the Bay Area based foster family agency, A Better Way, Inc. She is interested in the study of childhood trauma, and expanding knowledge on Complex PTSD and theories of resilience. After graduating from NYU, Julia plans to pursue a PhD in Clinical Psychology.

REBEKAH MYERS | Contributing Writer rem464@nyu.edu Rebekah Myers is a senior in the Applied Psychology program. She is a member of the Latino Family Engagement and Language Development (L-FELD NYU) research team led by Dr. Gigliana Melzi and Dr. Adina Schick. Rebekah is currently conducting an honors thesis regarding the influences of teachers’ perceptions on preschoolers’ beliefs about their competence under the mentorship of Dr. Schick. After graduating from NYU, Rebekah plans on pursuing a Master’s of Social Work with a specialization of working with military members (past and current) and their families in order to serve those who serve for us.

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MOLLY NYSTROM | Contributing Writer molly.nystrom@nyu.edu Molly Nystrom is a senior in the Applied Psychology program with a minor in German. She is currently working full time as the Administrative Coordinator for Public Services and Library Information Technology and Media Services at NYU Elmer Holmes Bobst Library. In the past, Molly completed internships for the Defense Equal Opportunity Management Institute and DOROT, a nonprofit organization for older adults. She has also worked as a research assistant for the NYU Neuroscience and Education Lab and organized data for the Opportunities for Equitable Access to Quality Basic Education (OPEQ) in the Democratic Republic of Congo study. After graduating from the Applied Psychology program, Molly plans to pursue a Master's Degree in Statistics and work towards a career in geropsychology.

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