Recently Completed Projects
Interventions for Media Exposure to Racial Trauma
Recent research has shown that police violence toward unarmed Black individuals is associated with poorer mental health for Black people living in the same state as a killing, and with poorer health for Black Americans throughout the United States when an act of anti-Black violence receives national media attention. In Black men in particular, emotional responses to learning of a recent shooting can be consistent with post-traumatic stress symptoms, including anger, sadness, hypervigilance, avoidance, and dissociation, as well as a profound sense of injustice. This study examines both therapist and client beliefs regarding effective ways for psychotherapists and counselors to address the emotional impacts of vicarious (i.e., hearing about events in the media) experiences with violence against Black individuals, including police brutality.
Client Review of Therapy Sessions
Psychotherapy clients are rarely given the ability to review (i.e. watch, listen, or read transcripts) their own therapy sessions despite past research pointing to several potential benefits. However, several concerns exist as well. There is a paucity of literature on this topic, and client attitudes and concerns about the practice of reviewing sessions in this manner are largely unknown. This work has involved (a) a survey study of both clients and clinicians about the potential benefits of, concerns regarding, and preferences for accessing and reviewing treatment session recordings and/or transcripts; and (b) an experimental manipulation of assigning session review as homework.
Online and Text-Based Psychotherapies
Previous research points to barriers to receiving mental health care in the community, such as distance from a therapy office, time availability, privacy and stigma concerns, and financial concerns. Individuals may continue to struggle with psychological problems without the ability to access proper treatment. Telecommunication may be helpful in mitigating some of the barriers to and concerns regarding receiving psychotherapy. Recently, there has a been a surge of online therapy platforms that offer therapy via videochat, instant message, and/or email message. This work has involved (a) a study examining individuals' perceptions of acceptability and beliefs regarding online therapy platforms as an option for mental health treatment and a tool to overcoming some of the barriers to treatment; and (b) therapist facilitative interpersonal skills in culturally relevant text-based therapy scenarios.
Developing a Self-Report Fidelity Measure for Clinicians at an Eating Disorders Treatment Center
Treatment fidelity is a crucial component of implementing empirically supported treatments and evidence-based practice, yet maintaining high fidelity in a routine treatment setting with complex or severe populations can be challenging. Fidelity monitoring is needed to ensure adequate adherence and competence, but "gold standard" observer-rated methods are resource-intensive and can be perceived as intrusive, making them impractical long-term tools. To address this problem, we have developed and preliminarily tested a brief self-report fidelity measure that converges well enough with observer ratings to serve as a useful clinical tool for monitoring fidelity to a new treatment protocol at a residential eating disorders treatment center.
Careers and Practices of Black Therapists and Counselors
The limited availability of Black therapists and counselors in many settings and geographical areas is a barrier to ideal client care. We sought to understand the processes by which Black therapists choose particular graduate degree programs and clinical workplaces. Additionally, we examined professional goals, clinical practices, and predictors of career satisfaction among Black therapists. We hope the results from this study will help determine characteristics that help graduate training programs and workplaces to recruit, support, and retain Black mental healthcare providers.
Scharff, A., Roberson, K., Sutherland, M. E., & Boswell, J. F. (2021). Black therapists working with Black clients: Intervention use and caseload preferences. Practice Innovations, 6(2), 77–88. https://doi.org/10.1037/pri0000147
Diversity in Perceptions of Psychotherapy and Mental Health Care
Perceptions and expectations surrounding psychotherapy are an important determinant of treatment engagement and outcomes. Such expectations can be expected to vary based on individuals' backgrounds and identities, including factors such as race, gender, and ethnicity. These perceptions may also be influenced by experiences of discrimination, harassment, or bias that have taken place in healthcare settings, including in contact with therapists or counselors. As such, this study is a qualitative investigation of expectations, values, and goals related to psychotherapy and of discrimination or other forms of exclusion experienced in medical and mental healthcare settings. Questions related to these topics were explored via a mixed-methods investigation, including self-report measures and qualitative interviews.
Use of Common and Unique Techniques in the Early Treatment Phase for GAD
Psychotherapy research often compares model-based treatments to control conditions to establish efficacy of a specified treatment. Research typically evaluates common factor elements in treatments only after the first or second session, largely as a manipulation check, and under the assumption that such factors are static. This study observed therapist common factor and model-specific interventions in three treatment approaches from an RCT for generalized anxiety disorder (GAD), across the entire early phase of treatment (i.e. first five sessions).The parent RCT compared two treatment conditions, using an additive design where patients were randomized to receive either interpersonal/emotional processing (I/EP) interventions or supportive listening (SL) after receiving a session of cognitive-behavioral therapy (CBT). The first five video recorded sessions were observationally coded with a multidimensional intervention measure with subscales reflecting diverse theoretical orientations and common factors. Multilevel modeling was used to examine intervention use, and to investigate differences between treatment conditions and segments. Among the results, common factor interventions were rated as significantly more typical in CBT compared to SL. The pattern of intervention use of other subscales was generally consistent with the orientation of the respective protocols. In the early phase of treatment, supportive listening conditions do not appear to function as common factor controls in the manner that many might assume. Common factors are potentially enhanced in bona fide treatments that include a more detailed, specific rationale, and clear and cohesive techniques and goals.
King, B., Schwartzman, C., Boswell, J.F., Lehrbach, K., Newman, M.G., & Castonguay, L.G. (2020). Use of common and unique techniques in the early treatment phase for cognitive-behavioral, interpersonal/emotional, and supportive listening interventions for generalized anxiety disorder. Psychotherapy. doi: 10.1037/pst0000277
Also see:
King, B., & Boswell, J.F. (2019). Therapeutic strategies and techniques in early cognitive-behavioral therapy. Psychotherapy, 56, 35-40. http://dx.doi.org/10.1037/pst0000202
- Most downloaded article in the journal in 2019; Second most downloaded article in all APA journals in 2019
Qualitative Analysis of Clinician Experiences Implementing a Transdiagnostic, Evidence-Based Treatment Program for EDs
The success of attempts to get clinicians to adopt and keep using evidence-based practices (EBPs) is often related to clinician attitudes and anxieties about the programs, as well as the ways in which the programs are implemented (i.e., how clinicians are trained and supported in their use of the treatment). We have partnered with an eating disorder treatment network to train staff to implement EBPs for eating disorders. In order to gain knowledge and insight on staff experiences throughout the training and implementation process, we conducted semi-structured interviews with volunteering staff who have completed training and started to implement the new EBPs used qualitative analyses to gather more in-depth information and feedback about the training and implementation process, as well as factors that staff experienced as either barriers or facilitators to implementation.
Oswald, J.M., Boswell, J.F., Smith, M., Thompson-Brenner, H., & Brooks, G. (2019). Practice-research integration in the residential treatment of patients with severe eating and comorbid disorders. Psychotherapy, 56, 134-148. http://dx.doi.org/10.1037/pst0000180
Interoceptive Intervention Research Study
This study investigated the role of constructs associated with eating disorder psychopathology: interoceptive awareness and interoceptive sensitivity. Both constructs relate to the perception of (and reaction to) internal sensations. Individuals with disordered eating attitudes and behaviors often report deficits in sensing and reacting properly to internal cues such as hunger, satiety, and anxiety. Research in the anxiety literature indicates that interoceptive exposure leads to extinction of maladaptive associations (i.e., elevated heart rate triggers a panic attack and belief that one is seriously ill), while learning new associations that are more adaptive (i.e., sensations are not dangerous or indicative of a serious negative outcome). Participants were asked to complete a short series of self-report questionnaires related to interoceptive awareness and related emotion awareness and emotional experiences. Some participants were randomized to an interoceptive exposure treatment condition to address maladaptive associations between interoceptive awareness, sensitivity, and eating disorder symptoms with the goal of reducing eating disorder-related and anxiety symptoms.
Boswell, J.F., Anderson, L.M., Oswald, J.M., Reilly, E.E., Gorrell, S., & Anderson, D.A. (2019). A preliminary naturalistic clinical case series study of the feasibility and impact of interoceptive exposure for eating disorders. Behaviour Research and Therapy, 117, 54-64. https://doi.org/10.1016/j.brat.2019.02.004
A Novel Tool for Understanding Social Interactions
Advances in technology and statistical modeling have led to the development of a new area of social science research labeled "social physics" or "people analytics." Essentially, wallet-sized sensing devices can record large amounts of interpersonal/behavioral data in real time. If each person in a dyad is wearing one of these devices, information can be gathered related to the individual and inter-dependent (i.e., dyadic) unfolding communication patterns. For example, is the interaction equitable, or is one person dominating the discussion? Is the vocal tone of the participants complementary or asynchronous? These "social signals" are known to be indicators of important processes, such as empathy, emotion regulation, and cognitive functioning. The purpose of this study is to pilot the use of social sensing devices ("Sociometric Badges") to study interpersonal behaviors in a laboratory setting.
Schwartzman, C., King, B., Newheiser, A., Oswald, J., Bugatti, M., Cedeno, E., & Boswell, J.F. (2020). Feasibility and acceptability of a novel tool for the study of interpersonal processes in psychotherapy. Journal of Counseling Psychology, 67, 462–474. https://doi.org/10.1037/cou0000385
Mental Health Care Consumer Values and Preferences Regarding the Use of Provider Performance Data
Research demonstrates differences in treatment outcomes among mental health care (MHC) providers, yet consumers rarely have access to these performance data, and consumer perspectives on the value of performance information is lacking. Consumer views are vital given growing emphasis on performance assessment in developing new service delivery and payment models. Using a combination of survey, semi-structured interview, and focus group data, this study examines diverse MHC consumers' attitudes and preferences regarding the use of provider outcome/performance information, and the relative values placed on providers' performance track record compared to other potentially important provider/treatment factors.
Boswell, J.F., Constantino, M.J., Oswald, J.N., Bugatti, M., Coyne, A., Goodwin, B., & Morrison, N. (in press). A multi-method study of mental health care patients’ attitudes toward clinician-level performance information. Psychiatric Services.
Boswell, J.F., Constantino, M.J., Oswald, J.M., Bugatti, M., Goodwin, B., & Yucel, R. (2018). Mental health care consumers’ relative valuing of clinician performance information. Journal of Consulting and Clinical Psychology, 86, 301-308. http://dx.doi.org/10.1037/ccp0000264
Approaches to Public Speaking Exposure
This study compares two commonly used approaches for conducting public speaking practice exposures. The differences between approaches imply slightly different theoretical understandings of what is most important in such practice, and potential differences could have important practical implications for conducting public speaking practice exposures. The impact of these procedural differences may be subtle to detect yet ultimately important. This study will utilize the data gathered by pocket-size "Sociometric Badges" in order to identify potential differences in "social signals" (i.e. speech pattern, body movement rate, vocal frequencies) that are produced by participants engaging in either one of two commonly utilized public speaking practice procedures for fear of public speaking.
Bugatti, M., & Boswell, J.F. (2018, June). Levels and patterns of anxious arousal in two exposure approaches for fear of public speaking. Paper presented at the annual meeting of the Society for Psychotherapy Research (SPR), Amsterdam, Netherlands.
Patients' Perceptions of Routine Psychotherapy and Counseling
It is widely recognized in the field of psychotherapy that psychotherapy delivered in routine, everyday treatment settings can differ from the psychotherapy being delivered in research protocols. In addition, new research findings often point to psychotherapy problems and strategies that are not adequately addressed in existing manualized treatments. For example, multiple areas of research point to low levels of positive emotion in social anxiety disorder, yet few existing manualized therapies for social anxiety explicitly identify positive emotion as a target of intervention. Previous research has surveyed community psychotherapists regarding their typical practices; however, we are unaware of research that has directly surveyed psychotherapy and counseling client's perceptions of what happened (e.g., what topics were covered) during their treatment. In order to examine what is and is not happening in routine psychotherapy from the client's perspective, this study will examine current and former therapy participants' recollections of what took place during their therapy.
Chen, Y., Boswell, J.F., Schwartzman, C., & Iles, B. (2017). Psychotherapy clients’ recalled treatment experiences: A survey of perceived evidence-based practice elements. Journal of Clinical Psychology, 73, 1534-1542. doi: 10.1002/jclp.22526