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Background Racial bias in medical care is a significant public health issue, with increased focus on microaggressions and the quality of patient-provider interactions. Innovations in training interventions are needed to decrease microaggressions and improve provider communication and rapport with patients of color during medical encounters. Methods This paper presents a pilot randomized trial of an innovative clinical workshop that employed a theoretical model from social and contextual behavioral sciences. The intervention specifically aimed to decrease providers’ likelihood of expressing biases and negative stereotypes when interacting with patients of color in racially charged moments, such as when patients discuss past incidents of discrimination. Workshop exercises were informed by research on the importance of mindfulness and interracial contact involving reciprocal exchanges of vulnerability and responsiveness. Twenty-five medical student and recent graduate participants were randomized to a workshop intervention or no intervention. Outcomes were measured via provider self-report and observed changes in targeted provider behaviors. Specifically, two independent, blind teams of coders assessed provider emotional rapport and responsiveness during simulated interracial patient encounters with standardized Black patients who presented specific racial challenges to participants. Results Greater improvements in observed emotional rapport and responsiveness (indexing fewer microaggressions), improved self-reported explicit attitudes toward minoritized groups, and improved self-reported working alliance and closeness with the Black standardized patients were observed and reported by intervention participants. Conclusions Medical providers may be more likely to exhibit bias with patients of color in specific racially charged moments during medical encounters. This small-sample pilot study suggests that interventions that directly intervene to help providers improve responding in these moments by incorporating mindfulness and interracial contact may be beneficial in reducing racial health disparities.

Acceptance and commitment therapy (ACT) is a contextual–behavioral approach to psychotherapy and other behavioral health concerns that has progressively attracted attention from both researchers and clinicians. ACT’s psychological flexibility model relies on middle-level terms that, despite being less precise than behavioral principles, are seen as being valuable for teaching and practicing ACT. One such term is cognitive defusion, which refers to the reduction of stimulus function transformation that occurs through verbal relations. In other words, defusion aims to minimize the influence of verbal relations, such as thoughts, on behavior, when doing so leads to adaptive behavior and valued living. Recently, some authors have stressed the importance of functionally defining middle-level terms, establishing clear links between the concept and basic behavioral processes. This article begins this endeavor by analyzing these links with respect to cognitive defusion. First, we briefly contextualize ACT’s theoretical roots. Second, we present cognitive defusion as a therapeutic intervention, reviewing its objectives, procedures, outcomes, and hypothesized processes as stated in the relevant literature. Third, the outlined process of change is critically examined, leading to a new conceptualization of cognitive defusion. Finally, the conceptual, clinical, and research implications of this new conceptualization are considered.

Background Pierce’s (The Black seventies: an extending horizon book, 1970) conception of “subtle and stunning” daily racial offenses, or microaggressions, remains salient even 50 years after it was introduced. Microaggressions were defined further by Sue and colleagues (Am Psychol 62:271, 2007), and this construct has found growing utility as the deleterious effects of microaggressions on the health of people of color continues to mount. Microaggressions are common on campuses and contribute to negative social, academic, and mental health outcomes. Method This paper explores how Black college students’ experiences correspond to or differ from the microaggression types originally proposed by Sue et al. (Am Psychol 62:271, 2007). Themes were identified from focus group data of students of color ( N  = 36) from predominately White institutions (PWIs) of higher learning ( N  = 3) using interpretative phenomenological analysis. Results We identified 15 categories of racial microaggressions, largely consistent with the original taxonomy of Sue et al. but expanded in several notable ways. New categories in our data and observed by other researchers, included categories termed Connecting via Stereotypes, Exoticization and Eroticization, and Avoidance and Distancing. Lesser studied categories identified included Sue et al.’s Denial of Individual Racism, and new categories termed Reverse Racism Hostility, Connecting via Stereotypes, and Environmental Attacks. Discussion While previous literature has either embraced the taxonomy developed by Sue and colleagues or proposed a novel taxonomy, this study synthesized the Sue framework in concert with our own focus group findings and the contributions of other researchers. Improving our understanding of microaggressions as they impact people of color may better allow for improved understanding and measurement of this important construct.

In Behavioral Activation (BA) for depression (Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001)), which has recently received empirical support in a large randomized trial, therapists pay close attention to the function of behavior and the role of aversive controlling stimuli and escape and avoidance behavior in depression. A key variable to measure in studies of BA is when and how clients become more activated over the course of treatment. This study sought to develop an initial set of items for the Behavioral Activation for Depression Scale (BADS), submit these items to an exploratory factor analysis in an initial administration (Study 1, N = 391), and submit the resulting scale to a confirmatory factor analysis in a second administration (Study 2, N = 319). Results indicated four factors (Activation, Avoidance/Rumination, Work/School Impairment, and Social Impairment) with good factor structure, internal consistency, and test-retest reliability. Evidence for construct and predictive validity is presented.[PUBLICATION ABSTRACT]

Previous efforts to understand microaggressions have surveyed stigmatized group members’ experiences of receiving microaggressions. This report presents the first attempt to measure self-reported likelihood of delivering microaggressions rather than receiving microaggressions and to explore the association between the likelihood of delivering microaggressions and racial prejudice. We conducted a cross-sectional survey of 33 black and 118 non-Hispanic white undergraduate students at a large public Southern/Midwest university. Black students reported the degree to which a series of statements would be experienced as microaggressive. White students reported their likelihood of delivering those statements and completed measures of racial prejudice. White students’ self-reported likelihood of engaging in microaggressive acts was significantly related to all measures of racial prejudice. The single item “A lot of minorities are too sensitive” was the strongest predictor of negative feelings toward black people. Results offer preliminary support that the delivery of microaggressions by white students is not simply innocuous behavior and may be indicative of broad, complex, and negative racial attitudes and explicit underlying hostility and negative feelings toward black students.

The predominant model of burnout posits three dimensions: emotional exhustion (EE), depersonalization (D), and (a lack of) personal accomplishment (PA). To date, contextual behavioral approaches have explored the role of psychological flexibility within this model of burnout but has not focused on the role of interpersonal variables, such as suggested by the Awareness, Courage, and Love (ACL) model of Functional Analytic Psychotherapy. In this study, 269 Spanish mental health workers completed a questionnaire study exploring the unique contribution of ACL, over and above psychological flexibility, to understanding burnout. Results indicated that psychological flexibility predicted all three dimensions of burnout. Regarding ACL, love was the strongest predictor of D over and above psychological flexibility and all three ACL dimensions contributed to PA prediction. We briefly present a contextual-behavioral model that integrates these findings with implications for improving interventions to reduce burnout in mental health practitioners.

Purpose Humans are fundamentally social beings, and the relationships we form with others are crucial for our well-being. Research across a variety of domains has established the association between a variety of interpersonal factors and health outcomes, including quality-of-life. However, there is a need for a more integrative, holistic analysis of these variables and how they relate to one another. Methods Undergraduate students ( n  = 1456) from four universities across the United States completed self-report measures of their quality-of-life and a variety of interpersonal factors identified as important predictors across the literature. We examined zero-order correlations between these measures and quality-of-life, estimated a path model to look at unique variance accounted for by each, and finally used network analysis to examine the network of direct and indirect associations among these variables and quality-of-life. Results Loneliness had the strongest association with quality-of-life across all analyses. When examining the unique association between quality-of-life and each interpersonal variable, six remained statistically significant: loneliness, social support, social connectedness, emotional intelligence, intimacy with one’s romantic partner, and empathic concern. These results were supported by the network model, which found direct associations between quality-of-life and these six variables as well as indirect associations with all other interpersonal variables in the model. Conclusions Results from this research suggest that interpersonal factors in general, and loneliness in particular, are strongly associated with quality-of-life. Future research is needed to establish the direction of these effects and examine for whom these findings are generalizable.

This study examined the extent to which self-stigmatizing attitudes mediated the relationship between depression severity and avoidance. Participants were 167 community members with elevated depressive symptoms who completed a questionnaire packet that included measures of depression severity, self-stigma, treatment stigma, previous stigmatizing experiences, and behavioral avoidance. Self-stigma, treatment stigma, and stigmatizing experiences were found to partially mediate the relationship between depression severity and avoidance. Findings from the current study support a model in which an individual experiences depressive symptoms, which leads to stigmatizing experiences and an increase in the salience of stigmatizing attitudes about depression, which in turn leads to avoidance. Depression self-stigma plays an important role in exacerbating avoidance behaviors within the context of depressive symptoms. Future research would benefit from examining depression self-stigma as a mediator between depression severity and treatment seeking. [PUBLICATION ABSTRACT]

Prior research has demonstrated a clear relationship between experiences of racial microaggressions and various indicators of psychological unwellness. One concern with these findings is that the role of negative affectivity, considered a marker of neuroticism, has not been considered. Negative affectivity has previously been correlated to experiences of racial discrimination and psychological unwellness and has been suggested as a cause of the observed relationship between microaggressions and psychopathology. We examined the relationships between self-reported frequency of experiences of microaggressions and several mental health outcomes (i.e., anxiety [Beck Anxiety Inventory], stress [General Ethnic and Discrimination Scale], and trauma symptoms [Trauma Symptoms of Discrimination Scale]) in 177 African American and European American college students, controlling for negative affectivity (the Positive and Negative Affect Schedule) and gender. Results indicated that African Americans experience more racial discrimination than European Americans. Negative affectivity in African Americans appears to be significantly related to some but not all perceptions of the experience of discrimination. A strong relationship between racial mistreatment and symptoms of psychopathology was evident, even after controlling for negative affectivity. In summary, African Americans experience clinically measurable anxiety, stress, and trauma symptoms as a result of racial mistreatment, which cannot be wholly explained by individual differences in negative affectivity. Future work should examine additional factors in these relationships, and targeted interventions should be developed to help those suffering as a result of racial mistreatment and to reduce microaggressions.

In The Lancet, David Richards and colleagues 1 present the Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA) trial--one of the largest randomised controlled trials so far of psychotherapy for depression--comparing junior, low-cost mental health workers delivering a simple treatment (behavioural activation [BA]) to experienced psychological therapists delivering the gold-standard treatment (cognitive behavioural therapy [CBT]).