- Psychology, Social Psychology, Clinical Psychology, Social Support, Clinical Neuropsychology, Mass Violence, and 22 moreSchool violence, School Shootings, Military Psychology, Combat-Related Post-Traumatic Stress Disorder, Traumatic Brain Injury, Posttraumatic Stress Disorder (PTSD), Veterans, Elder Caregiving, Childhood traumatic grief and adult psychopathology, Children and Grief, Persistent Complex Bereavement Related Disorder, Combat Veterans, Developmental Psychology, Child and adolescent mental health, Trauma Studies, Bereavement, Grief (Psychology), Group Therapy, Grief, Grief and Loss, Group Cohesion, and Complicated Griefedit
- PhD in clinical psychology. Current Instructor (tenure-track faculty) in the Department of Psychiatry at the Universi... morePhD in clinical psychology. Current Instructor (tenure-track faculty) in the Department of Psychiatry at the University of Utah and Staff Psychologist in Primary Care Mental Health Integration at the VA Salt Lake City HCS. Founder and director of the Occupational Trauma Program in the Department of Psychiatry, University of Utah School of Medicine (est. October 2018).
I am an interdisciplinary clinical scientist working in the area of stress, health, and resilience, with an interest in integrated care and population health management. Over the past several years, my primary focus has been to integrate tools/analyses to understand the confluence of environments, self-regulation, and neural circuitry as it relates to resilience after trauma. My current and prospective research focuses on identifying mechanisms of change/motivation for the purposes of intervention development to enhance individuals' engagement in social networks. Increasing social connectivity among chronically stressed populations will have downstream effects for mental health, physical health, meaning and purpose, engagement in specialty EBTs, and reduced healthcare system burden.
Clinically, I work from an interdisciplinary/integrative healthcare model. I utilize a diversity of clinical technologies, evidence based treatments, and tools to attend to the 'whole health' of the individual, involving integration of traditional cognitive behavioral therapy, third-wave CBT (e.g., acceptance and commitment therapy; dialectical behavioral therapy), motivational interviewing, neuropsychology, and neuroscience.edit
Research Interests:
This study tested social cognitive theory of posttraumatic adaptation in the context of mass violence, hypothesizing that pre-event protective factors (general self-efficacy and perceived social support) would reduce posttraumatic stress... more
This study tested social cognitive theory of posttraumatic adaptation in the context of mass violence, hypothesizing that pre-event protective factors (general self-efficacy and perceived social support) would reduce posttraumatic stress symptoms (PTSS) and depression severity through boosting post-event coping self-efficacy appraisals (mediator). We qualified hypotheses by predicting that post-event social support barriers would disrupt (moderate) the health-promoting indirect effects of pre-event protective factors. With a prospective longitudinal sample, we employed path models with bootstrapping resampling to test hypotheses. Participants included 70 university students (71.4% female; 40.0% White; 34.3% Asian; 14.3% Hispanic) enrolled during a mass violence event who completed surveys one year pre-event and 5–6 months post-event. Results revealed significant large effects in predicting coping self-efficacy (mastery model, R 2 = .34; enabling model, R 2 = .36), PTSS (mastery model, R 2 = .35; enabling model, R 2 = .41), and depression severity (mastery model, R 2 = .43; enabling model, R 2 = .46). Overall findings supported study hypotheses, showing that at low levels of post-event social support barriers, pre-event protective factors reduced distress severity through boosting coping self-efficacy. However, as post-event social support barriers increased, the indirect, distress-reducing effects of pre-event protective factors were reduced to nonsignificance. Study implications focus on preventative and responsive intervention.
Research Interests:
Although the linkage between PTSD symptoms and aggression has been demonstrated among victims of in-terpersonal traumas, this relationship is rarely examined among child survivors of other traumas. This study was conducted to examine the... more
Although the linkage between PTSD symptoms and aggression has been demonstrated among victims of in-terpersonal traumas, this relationship is rarely examined among child survivors of other traumas. This study was conducted to examine the association between posttraumatic stress symptoms and aggression among 135 children who survived a residential fire. Data analyses, conducted via hierarchical linear modeling (using HLM and R software packages), support the hypothesis that re-experiencing symptom severity predicts higher levels of aggression. Clinically, results from this study suggest that when children with PTSD present with aggressive symptomology, more attention should be given to the re-experiencing cluster in children. Future studies should consider investigating the impact of the re-experiencing cluster on other externalizing and internalizing PTSD symptoms.
Objective: Network analysis is a useful tool for understanding how symptoms interact with one another to influence psychopathology. However, this analytic strategy has not been fully utilized in the PTSD field. The current study utilized... more
Objective: Network analysis is a useful tool for understanding how symptoms interact with one another to influence psychopathology. However, this analytic strategy has not been fully utilized in the PTSD field. The current study utilized network analysis to examine connectedness and strength among PTSD symptoms (employing both partial correlation and regression network analyses) among a community sample of students exposed to the 2007 Virginia Tech shootings. Method: Respondents (N 4,639) completed online surveys 3–4 months postshootings, with PTSD symptom severity measured via the Trauma Symptom Questionnaire. Results: Data were analyzed via adaptive least absolute shrinkage and selection operator (LASSO) and relative importance networks, as well as Dijkstra’s algorithm to identify the shortest path from each symptom to all other symptoms. Relative importance network analysis revealed that intrusive thoughts had the strongest influence on other symptoms (i.e., had many strong connections [highest outdegree]) while computing Dijkstra’s algorithm indicated that anger produced the shortest path to all other symptoms (i.e., the strongest connections to all other symptoms). Conclusion: Findings suggest that anger or intrusion likely play a crucial role in the development and maintenance of PTSD (i.e., are more influential within the network than are other symptoms).
Keywords: network analysis, PTSD, mass violence, shooting
Keywords: network analysis, PTSD, mass violence, shooting
BACKGROUND: The current case study presents a 43 year old African American woman admitted to a Tertiary Care Rehabilitation unit at a major medical center for concerns over left-sided anesthesia and weakness. Head scans indicate a right... more
BACKGROUND: The current case study presents a 43 year old African American woman admitted to a Tertiary Care
Rehabilitation unit at a major medical center for concerns over left-sided anesthesia and weakness. Head scans indicate a
right middle cerebral arterial distribution infarct altering blood flow in temporal, parietal, and occipital regions in the right
cerebral hemisphere.
OBJECTIVE:Physician and therapist reports (i.e., speech and occupational therapists) referred the patient for a neuropsychological
evaluation for concerns over the patient’s capacity to recognize the severity of her deficits and self-care, with potential
rule-outs indicated by the extant literature on right CVA for anosognosia, anosodiaphoria, and left hemibody/hemispace
neglect.
METHODS: The current case integrates interdisciplinary physician notation, magnetic resonance imaging and magnetic
resonance angiogram, observations and reports from speech and occupational therapy, and neuropsychological assessment
via standardized tests and neurobehavioral syndrome analysis.
RESULTS: Evidence was found for co-occurring syndromes of moderate anosognosia, anosodiaphoria, and left hemibody/
hemispatial neglect derived from shared functional cerebral space with overlapping temporal, parietal, and occipital
damage.
CONCLUSIONS: Clinical implications are discussed, including recommendations for therapy approaches based on functional
cerebral space theory that may indicate the use of known techniques (e.g., for left hemibody neglect) that may also
have therapeutic implications for treating other, more mercurial co-occurring syndromes of anosognosia and anosodiaphoria.
Rehabilitation unit at a major medical center for concerns over left-sided anesthesia and weakness. Head scans indicate a
right middle cerebral arterial distribution infarct altering blood flow in temporal, parietal, and occipital regions in the right
cerebral hemisphere.
OBJECTIVE:Physician and therapist reports (i.e., speech and occupational therapists) referred the patient for a neuropsychological
evaluation for concerns over the patient’s capacity to recognize the severity of her deficits and self-care, with potential
rule-outs indicated by the extant literature on right CVA for anosognosia, anosodiaphoria, and left hemibody/hemispace
neglect.
METHODS: The current case integrates interdisciplinary physician notation, magnetic resonance imaging and magnetic
resonance angiogram, observations and reports from speech and occupational therapy, and neuropsychological assessment
via standardized tests and neurobehavioral syndrome analysis.
RESULTS: Evidence was found for co-occurring syndromes of moderate anosognosia, anosodiaphoria, and left hemibody/
hemispatial neglect derived from shared functional cerebral space with overlapping temporal, parietal, and occipital
damage.
CONCLUSIONS: Clinical implications are discussed, including recommendations for therapy approaches based on functional
cerebral space theory that may indicate the use of known techniques (e.g., for left hemibody neglect) that may also
have therapeutic implications for treating other, more mercurial co-occurring syndromes of anosognosia and anosodiaphoria.
Research Interests:
Theory highlights forgiveness as a dynamic process that unfolds over time, as well as a potential target for posttrauma therapy. Longitudinal research, however, is nonexistent in the trauma literature. Further, the adaptation of... more
Theory highlights forgiveness as a dynamic process that unfolds over time,
as well as a potential target for posttrauma therapy. Longitudinal research,
however, is nonexistent in the trauma literature. Further, the adaptation of
forgiveness for understanding mass violent events has yet to be tested. The
current study examined a theory-based hypothesis posing forgiveness as a
mediator between posttraumatic stress (PTS) symptoms and posttraumatic
growth (PTG) in the context of a mass university campus shooting. Results
showed that forgiveness was a significant mediator of the indirect, positive
relationship between Time 1 PTS and Time 1 and Time 2 PTG.
Implications include considering mechanisms (e.g., forgiveness) that link
PTS and PTG for application in future research and practice.
as well as a potential target for posttrauma therapy. Longitudinal research,
however, is nonexistent in the trauma literature. Further, the adaptation of
forgiveness for understanding mass violent events has yet to be tested. The
current study examined a theory-based hypothesis posing forgiveness as a
mediator between posttraumatic stress (PTS) symptoms and posttraumatic
growth (PTG) in the context of a mass university campus shooting. Results
showed that forgiveness was a significant mediator of the indirect, positive
relationship between Time 1 PTS and Time 1 and Time 2 PTG.
Implications include considering mechanisms (e.g., forgiveness) that link
PTS and PTG for application in future research and practice.
Research Interests:
The future viability of some coastal communities has been severely challenged by the recent major disasters, as well as other episodic and chronic coastal hazards. These events also instigated a dialogue on their long-term resilience,... more
The future viability of some coastal communities has been severely challenged by the recent major
disasters, as well as other episodic and chronic coastal hazards. These events also instigated a dialogue on
their long-term resilience, adaptation options, and the possibility of permanent relocation from high risk
areas. Little is known how exposure to disaster, in combination with other contemporary coastal challenges,
affects willingness to consider relocation on a household level in the highly-developed urban
settlements. The main objective of this paper is to provide a bottom-up perspective on this dilemma via
identification of demographic determinants and other disaster-related concerns that may influence
support for relocation. More specifically, this study takes an interdisciplinary approach to examine the
effects of pre-disaster socio-economic household characteristics, level of preparedness, disaster exposure,
experience with recovery, community embeddedness, and resource loss on relocation decisionmaking.
The findings hereby reveal that the willingness to consider relocation is primarily influenced by
the age of respondents, disaster exposure, level of experienced stress related to recovery, personal financial recovery concerns, future cost of living in high-risk area, concerns with increase in crime andfuture flooding, and disasterinduced resource loss
disasters, as well as other episodic and chronic coastal hazards. These events also instigated a dialogue on
their long-term resilience, adaptation options, and the possibility of permanent relocation from high risk
areas. Little is known how exposure to disaster, in combination with other contemporary coastal challenges,
affects willingness to consider relocation on a household level in the highly-developed urban
settlements. The main objective of this paper is to provide a bottom-up perspective on this dilemma via
identification of demographic determinants and other disaster-related concerns that may influence
support for relocation. More specifically, this study takes an interdisciplinary approach to examine the
effects of pre-disaster socio-economic household characteristics, level of preparedness, disaster exposure,
experience with recovery, community embeddedness, and resource loss on relocation decisionmaking.
The findings hereby reveal that the willingness to consider relocation is primarily influenced by
the age of respondents, disaster exposure, level of experienced stress related to recovery, personal financial recovery concerns, future cost of living in high-risk area, concerns with increase in crime andfuture flooding, and disasterinduced resource loss
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
BACKGROUND: The current case study presents a 43 year old African American woman admitted to a Tertiary Care Rehabilitation unit at a major medical center for concerns over left-sided anesthesia and weakness. Head scans indicate a right... more
BACKGROUND: The current case study presents a 43 year old African American woman admitted to a Tertiary Care Rehabilitation unit at a major medical center for concerns over left-sided anesthesia and weakness. Head scans indicate a right middle cerebral arterial distribution infarct altering blood flow in temporal, parietal, and occipital regions in the right cerebral hemisphere. OBJECTIVE: Physician and therapist reports (i.e., speech and occupational therapists) referred the patient for a neuropsycho-logical evaluation for concerns over the patient's capacity to recognize the severity of her deficits and self-care, with potential rule-outs indicated by the extant literature on right CVA for anosognosia, anosodiaphoria, and left hemibody/hemispace neglect. METHODS: The current case integrates interdisciplinary physician notation, magnetic resonance imaging and magnetic resonance angiogram, observations and reports from speech and occupational therapy, and neuropsychological assessment via standardized tests and neurobehavioral syndrome analysis. RESULTS: Evidence was found for co-occurring syndromes of moderate anosognosia, anosodiaphoria, and left hemi-body/hemispatial neglect derived from shared functional cerebral space with overlapping temporal, parietal, and occipital damage. CONCLUSIONS: Clinical implications are discussed, including recommendations for therapy approaches based on functional cerebral space theory that may indicate the use of known techniques (e.g., for left hemibody neglect) that may also have therapeutic implications for treating other, more mercurial co-occurring syndromes of anosognosia and anosodiaphoria.
Research Interests:
Abstract: Millions of children and adolescents each year are exposed to potentially traumatic events (PTEs), placing them at risk for posttraumatic stress (PTS) disorder symptoms. Medical providers play an important role in the... more
Abstract: Millions of children and adolescents each year are exposed to potentially traumatic events (PTEs), placing them at risk for posttraumatic stress (PTS) disorder symptoms. Medical providers play an important role in the identification and treatment of PTS, as they are typically the initial point of contact for families in the wake of a PTE or during a PTE if it is medically related (eg, injury/illness). This paper offers a review of the literature focused on clinical characteristics of PTS, the assessment and diagnosis of PTS, and current effective treatments for PTS in school-age children and adolescents. The clinical presentation of PTS is often complex as symptoms may closely resemble other internalizing and externalizing disorders. A number of screening and evaluation tools are available for medical providers to assist them in the accurate diagnosis of PTS. Treatment options are available for youth at minimal risk of PTS as well as for those with more intensive needs. Additional training regarding trauma-informed medical care may benefit medical providers. By taking a trauma-informed approach, rooted in a solid understanding of the clinical presentation of PTS in children and adolescents, medical providers can ensure PTS does not go undetected, minimize the traumatic aspects of medical care, and better promote health and well-being.
Keywords: posttraumatic stress, medical traumatic stress, children, primary care, assessment, treatment
Keywords: posttraumatic stress, medical traumatic stress, children, primary care, assessment, treatment