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Changes in narcissistic traits (e.g., entitlement) following the ceremonial use of ayahuasca were examined across three timepoints (baseline, postretreat, 3-month follow-up) in a sample of 314 adults using self- and informant-report (N = 110) measures. Following ceremonial use of ayahuasca, self-reported changes in narcissism were observed (i.e., decreases in Narcissistic Personality Inventory [NPI] Entitlement-Exploitativeness, increases in NPI Leadership Authority, decreases in a proxy measure of narcissistic personality disorder [NPD]). However, effect size changes were small, results were somewhat mixed across convergent measures, and no significant changes were observed by informants. The present study provides modest and qualified support for adaptive change in narcissistic antagonism up to 3 months following ceremony experiences, suggesting some potential for treatment efficacy. However, meaningful changes in narcissism were not observed. More research would be needed to adequately evaluate the relevance of psychedelic-assisted therapy for narcissistic traits, particularly studies examining individuals with higher antagonism and involving antagonism-focused therapeutic approaches.

Bayesian parameter estimation provides a systematic approach to compare heavy ion collision models with measurements, leading to constraints on the properties of nuclear matter with proper accounting of experimental and theoretical uncertainties. Aside from statistical and systematic model uncertainties, interpolation uncertainties can also play a role in Bayesian inference, if the model's predictions can only be calculated at a limited set of model parameters. This uncertainty originates from using an emulator to interpolate the model's prediction across a continuous space of parameters. In this work, we study the trade-offs between the emulator (interpolation) and statistical uncertainties. We perform the analysis using spatial eccentricities from the T$_\mathrm{R}$ENTo model of initial conditions for nuclear collisions. Given a fixed computational budget, we study the optimal compromise between the number of parameter samples and the number of collisions simulated per parameter sample. For the observables and parameters used in the present study, we find that the best constraints are achieved when the number of parameter samples is slightly smaller than the number of collisions simulated per parameter sample., 11 pages, 7 figures

Background: In a recent clinical trial examining the comparative efficacy of psilocybin therapy (PT) versus escitalopram treatment (ET) for major depressive disorder, 14 of 16 major efficacy outcome measures yielded results that favored PT, but the Quick Inventory of Depressive Symptomatology, Self-Report, 16 items (QIDS-SR16) did not. Aims: The present study aims to (1) rationally and psychometrically account for discrepant results between outcome measures and (2) to overcome psychometric problems particular to individual measures by re-examining between-condition differences in depressive response using all outcome measures at item-, facet-, and factor-levels of analysis. Method: Four depression measures were compared on the basis of their validity for examining differences in depressive response between PT and ET conditions. Results/Outcomes: Possible reasons for discrepant findings on the QIDS-SR16 include its higher variance, imprecision due to compound items and whole-scale and unidimensional sum-scoring, vagueness in the phrasing of scoring options for items, and its lack of focus on a core depression factor. Reanalyzing the trial data at item-, facet-, and factor-levels yielded results suggestive of PT’s superior efficacy in reducing depressed mood, anhedonia, and a core depression factor, along with specific symptoms such as sexual dysfunction. Conclusion/Interpretation: Our results raise concerns about the adequacy of the QIDS-SR16 for measuring depression, as well as the practice of relying on individual scales that tend not to capture the multidimensional structure or core of depression. Using an alternative approach that captures depression more granularly and comprehensively yielded specific insight into areas where PT therapy may be particularly useful to patients and clinicians.

STUDY DESIGN Retrospective single-institution study. OBJECTIVE The aim of this study was to determine the relationship between patients' insurance status and the likelihood for them to be recommended various spine interventions upon evaluation in our neurosurgical clinics. SUMMARY OF BACKGROUND DATA Socioeconomically disadvantaged populations have worse outcomes after spine surgery. No studies have looked at the differential rates of recommendation for surgery for patients presenting to spine surgeons based on socioeconomic status. METHODS We studied patients initially seeking spine care from spine-fellowship trained neurosurgeons at our institution from July 1, 2018 to June 30, 2019. Multivariable logistic regression was used to assess the association between insurance status and the recommended patient treatment. RESULTS Overall, 663 consecutive outpatients met inclusion criteria. Univariate analysis revealed a statistically significant association between insurance status and treatment recommendations for surgery (P

Narcissistic traits figure prominently in classical conceptualizations of psychopathy and bear substantial empirical overlap with components of psychopathy. Yet the degree to which various widely used self-report measures of psychopathy include relevant narcissistic content has not been evaluated, especially in relation to new, multidimensional models of narcissism. Using a large undergraduate sample ( N = 432) and self- and informant-ratings of narcissism, the present study examined narcissism’s instantiation in several commonly used self-report psychopathy measures. A modern conceptualization of narcissism at three levels of hierarchical organization (i.e., Trifurcated Model of Narcissism) was applied to comprehensively evaluate narcissism’s instantiation in these psychopathy measures. Although narcissistic traits related to self-centered antagonism were well-instantiated across psychopathy self-report measures, narcissistic traits related to agentic extraversion were represented more modestly by most (i.e., Triarchic Psychopathy Measure, Self-Report Psychopathy Scale: Version III, Levenson Self-Report Psychopathy Scale), but not all (i.e., Elemental Psychopathy Assessment [EPA]) psychopathy measures. Only the EPA contained substantial representation of all narcissism components. Given the theoretical and empirical overlap between psychopathy and narcissism, it behooves researchers to be aware of the degree to which psychopathy measures capture narcissistic content.

The Low-Income Housing Tax Credit (“LIHTC”) program remains the na- tion’s largest affordable housing production program. LIHTC units are under-represented in the neighborhoods that both promote movement to high- opportunity neighborhoods and affirmatively further fair housing. State and local officials should play an active role in guiding site selection decisions and ensuring that LIHTC developments are located in a manner that affirmatively furthers fair housing. Planners can use newly available data discussed herein to identify high-opportunity tracts.

Background: Evidence suggests that psychedelic-assisted therapy carries transdiagnostic efficacy in the treatment of mental health conditions characterized by low mood and the use of avoidance coping strategies. Aims: While preliminary evidence suggests that psychological flexibility and emotion regulation processes play an important role within psychedelic therapy, this prospective study addressed methodological gaps in the literature and examined the ability of ayahuasca to stimulate acute states of cognitive reappraisal and long-term changes in psychological flexibility and mood. The study also explored whether moderating factors predisposed participants to experience therapeutic changes. Methods: Participants ( N = 261) were recruited from three Shipibo ayahuasca retreat centers in Central and South America and completed assessments on mood, psychological flexibility, and acute ceremonial factors. Expectancy, demand characteristics, and invalid responding were controlled for with several validity scales. Results/Outcomes: Participants reported significant reductions in negative mood after three months, as well as increases in positive mood and psychological flexibility. Acute experiences of reappraisal during the ayahuasca ceremony exerted the strongest moderating effects on increases in positive mood and psychological flexibility. Increases in psychological flexibility statistically mediated the effects of acute psychological factors, including reappraisal, on changes in positive mood. Conclusions/Interpretation: These results highlight the role of acute psychological processes, such as reappraisal, and post-acute increases in psychological flexibility as putative mechanisms underlying positive outcomes associated with psychedelics. These results also provide support for the integration of third-wave and mindfulness-based therapy approaches with psychedelic-assisted interventions.

STUDY DESIGN Case series. OBJECTIVE To evaluate the impact of a multidisciplinary spine surgery indications conference (MSSIC) on surgical planning for elective spine surgeries. SUMMARY OF BACKGROUND DATA Identifying methods for pairing the proper patient with the optimal intervention is of the utmost importance for improving spine care and patient outcomes. Prior studies have evaluated the utility of multidisciplinary spine conferences for patient management, but none have evaluated the impact of a MSSIC on surgical planning and decision making. METHODS We implemented a mandatory weekly MSSIC with all spine surgeons at our institution. Each elective spine surgery in the upcoming week is presented. Subsequently, a group consensus decision is achieved regarding the best treatment option based on the expertise and opinions of the participating surgeons. We reviewed cases presented at the MSSIC from September 2019 to December 2019. We compared the surgeon's initial proposed surgery for a patient with the conference attendees' consensus decision on the best treatment and measured compliance rates with the group's recommended treatment. RESULTS The conference reviewed 100 patients scheduled for elective spine surgery at our indications conference during the study period. Surgical plans were recommended for alteration in 19 cases (19%) with the proportion statistically significant from zero indicated by a binomial test (P

Prior research has highlighted the possibility that current affect may be interchangeable with state assessments of other dimensions of subjective well-being. In the present study, we conducted a systematic replication and extension by examining the relationship between state assessments of affect and eudaimonic well-being (meaning, core self-evaluation, authenticity, and gratitude) in a 14-day diary assessment (N = 207 with 2,147 assessments). We utilized multi-level structural equation modeling (ML-SEM) with affect as a time-varying covariate and found that the impact of affect for these outcomes was less consequential than for assessments of state satisfaction, and that the impact of positive affect on these dimensions was stronger than that of negative affect.

Following the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), section III alternative model of personality disorder, much of the empirical attention has been directed toward testing the performance of Criterion B (i.e., pathological traits). Much more recently, with the development of assessment tools related to Criterion A (i.e., personality impairment), a burgeoning literature base is forming for it as well. A closer look at the Criterion A component, however, reveals disagreements around its structure, discriminant validity, ability to distinguish between personality-based and nonpersonality-based forms of psychopathology, overlap between the two criteria, and incremental validity. The goal of the current study (N = 365 undergraduates) was to test Criterion A in relation to both pathological personality traits, as specified in the DSM-5, and general personality traits, as some scholars suggested that might be more appropriate. The results suggest that impairment domains overlap substantially with pathological and general traits, and these traits account for considerable variance in impairment domains. Most importantly, the findings suggest that general and pathological traits functioned in nearly identical ways, as evidenced by the similar relations that they evinced with traditional DSM-5 personality disorder constructs. In line with previous work, the present findings demonstrate limited discriminant validity among impairment domains and an inability to distinguish between Axis I and II symptoms. Further research on the alternative model of personality disorder is needed to test the necessity and sufficiency of its constituent components. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Scholars of perfectionism have proposed significant modifications to DSM-5's alternative model of personality disorders (AMPD), such that (1) perfectionism be expanded beyond the inclusion of a singular trait—rigid perfectionism—and (2) perfectionistic traits be specified as trait descriptors of personality disorders (PDs) other than obsessive-compulsive PD. In this study, we evaluate these proposals by examining the degree to which (a) perfectionistic traits are already instantiated in Section II and Section III models of personality pathology; and (b) perfectionistic traits meaningfully augment the construct validity of AMPD PDs. We conducted these approaches in a large sample (N =3D 435) from an Iranian undergraduate population that is atypically found in the literature. Results showed that perfectionistic traits are already fairly well instantiated in Section III Criterion B. Perfectionistic traits minimally improved the construct validity of OCPD, but did not meaningfully do so for other PDs. Future investigation into the clinical utility of perfectionistic traits is needed.

There is substantial and ongoing debate regarding the centrality of Fearless Dominance/Boldness (FD/B) to psychopathic personality due, in part, to its generally weak relations with externalizing behaviors. In response to these findings, proponents of FD/B have offered two hypotheses. First, FD/B may have nonlinear associations with externalizing outcomes such that FD/B may lead to resilience at moderate levels, but an overabundance of FD/B will yield maladaptive behavioral outcomes. Second, FD/B may be related to antisocial outcomes when paired with high scores on other psychopathic traits such as self-centered impulsivity, meanness, or disinhibition. The current study tests these two possibilities using two large samples (Study 1: 787 undergraduates; Study 2: 596 Amazon’s Mechanical Turk participants). An item response theory scoring approach particularly sensitive to curvilinearity was used to maximize our ability to find a true curvilinear effect, if present. No evidence in favor of the curvilinearity hypothesis was found. Only a single significant interaction predicting substance use was observed between boldness and meanness. These findings contribute to a growing literature raising concerns regarding the relevance of FD/B to psychopathy.

The present study examines prospective changes in personality traits relevant to social functioning as well as perceived social connectedness in relation to the naturalistic use of psychedelic compounds in an online volunteer sample. The study also examined the degree to which demographic characteristics, social setting, baseline personality, and acute subjective factors (e.g., emotional breakthrough experiences) influenced trajectories of personality and perceived social connectedness. Participants recruited online completed self-report measures of personality and social connectedness at three timepoints (baseline, 2weeks post-experience, 4weeks post-experience). Linear mixed models were used to examine changes in outcomes and the moderation of these outcomes by covariates. The most substantive changes were reductions in the personality domains Neuroticism, and increases in Agreeableness and social connectedness. Notably, reductions in Neuroticism and increases in Agreeableness covaried over time, which may be suggestive of common processes involving emotion regulation. Preliminary evidence was found for a specific effect on a component of Agreeableness involving a critical and quarrelsome interpersonal style. Although moderation by demographic characteristics, social setting, baseline personality, and acute factors generally found limited support, baseline standing on Neuroticism, perspective taking, and social connectedness showed tentative signs of amplifying adaptive effects on each trait, respectively. Our findings hold implications for the potential use of psychedelics for treating interpersonal elements of personality pathology as well as loneliness.

Spinal metastasis is usually associated with debilitating pain and results in deteriorating life quality. The role of percutaneous management of spinal metastasis has evolved from a diagnostic role to a significant part of therapeutic options in conjunction with conventional management techniques, including radiotherapy and open surgical options. Percutaneous vertebral augmentation (PVA) showed substantial pain reduction, vertebral stabilization, and improvement of quality of life. Minimally invasive local ablative procedures (MILAPs) demonstrated significant pain reduction, local tumor burden control, and improvement of quality of life. Though combined PVA and MILAP's synergistic role in pain reduction may need additional investigation, considering different actions on spine metastasis patients, combining both techniques might beneficial to selected patients. The role of percutaneous management will likely expand since its role in improving patient's quality of life with very minimal procedure-related risk and in conjunction with future technological advancement.

The present study examines the association between the ceremonial use of ayahuasca—a decoction combining the Banistereopsis caapi vine and N,N-Dimethyltryptamine-containing plants—and changes in personality traits as conceived by the Five-Factor model (FFM). We also examine the degree to which demographic characteristics, baseline personality, and acute post-ayahuasca experiences affect personality change. Participants recruited from three ayahuasca healing and spiritual centers in South and Central America (N = 256) completed self-report measures of personality at three timepoints (Baseline, Post, 3-month Follow-up). Informant-report measures of the FFM were also obtained (N = 110). Linear mixed models were used to examine changes in personality and the moderation of those changes by covariates. The most pronounced change was a reduction in Neuroticism dzself-reportT1–T2 = − 1.00; dzself-reportT1–T3 = − .85; dzinformant-reportT1–T3 = − .62), reflected in self- and informant-report data. Moderation of personality change by baseline personality, acute experiences, and purgative experiences was also observed.

The present study examines the association between the ceremonial use of ayahuasca – a decoction combining the Banistereopsis caapi vine and N,N Dimethyltryptamine-containing plants – and changes in personality traits as conceived by the Five-Factor model (FFM); as well as the degree to which demographic characteristics, baseline personality, and acute post-ayahuasca experiences affect personality change. Method: Participants recruited from three ayahuasca healing and spiritual centers in South and Central America (N=256) completed self-report measures of personality at three timepoints (Baseline, Post, 3-Month Follow-up). Informant-report measures of the FFM were also obtained (N=110). Results: Linear mixed models were used to examine changes in personality and the moderation of those changes by covariates. The most pronounced change was a reduction in Neuroticism dself-reportT1-T2=1.00; dself-reportT1-T3=.85; dinformant-reportT1-T3=.62), reflected in self- and informant-report data. Moderation of personality change by baseline personality, acute experiences, and purgative experiences was also observed.

Quantitative models of psychopathology (i.e., HiTOP) propose that personality and psychopathology are intertwined, such that the various processes that characterize personality traits may be useful in describing and predicting manifestations of psychopathology. In the current study, we used data from the Human Connectome Project (N = 1050) to investigate neural activation following receipt of a reward during an fMRI task as one shared mechanism that may be related to the personality trait Extraversion (specifically its sub-component Agentic Extraversion) and internalizing psychopathology. We also conducted exploratory analyses on the links between neural activation following reward receipt and the other Five-Factor Model personality traits, as well as separate analyses by gender. No significant relations (p < .005) were observed between any personality trait or index of psychopathology and neural activation following reward receipt, and most effect sizes were null to very small in nature (i.e., r < |.05|). We conclude by discussing the appropriate interpretation of these null findings, and provide suggestions for future research that spans psychological and neurobiological levels of analysis.

Rates of anxiety disorders are significantly elevated among sexual and gender minorities. In this chapter, the minority stress model is discussed as a framework for conceptualizing anxiety among sexual and gender minorities, and the authors review the literature on the relationships between specific minority stressors and symptoms. The authors examine prevalence rates of anxiety disorders among sexual minorities and gender minorities, separately and in comparison to heterosexual and cisgender individuals. Also reviewed is the literature on anxiety disorders among sexual and gender minorities with a racial or ethnic minority status. Current assessment and treatment approaches are identified and reviewed. Finally, limitations to the current literature base are discussed and recommendations are provided for future studies.

There is substantial and ongoing debate regarding the centrality of Fearless Dominance/Boldness (FD/B) to psychopathic personality due, in part, to its generally weak relations with externalizing behaviors. In response to these findings, proponents of FD/B have offered two hypotheses. First, FD/B may have non-linear associations with externalizing outcomes such that FD/B may lead to resilience at moderate levels, but an overabundance of FD/B will yield maladaptive behavioral outcomes. Second, FD/B may be related to antisocial outcomes when paired with high scores on other psychopathic traits such as self-centered impulsivity (SCI), meanness, or disinhibition. The current study tests these two possibilities using two large samples (Study 1: 787 undergraduates; Study 2: 596 MTurk participants). An Item-Response Theory (IRT) scoring approach particularly sensitive to curvilinearity was used to maximize our ability to find a true curvilinear effect, if present. No evidence in favor of the curvilinearity hypothesis was found. Only a single significant interaction predicting substance use was observed between boldness and meanness. These findings contribute to a growing literature raising concerns regarding the relevance of FD/B to psychopathy.

Previous work has demonstrated mostly null to small associations between boldness and externalizing behaviors associated with psychopathy. The present study replicated this finding and examined an alternate manner in which boldness may be relevant to the construct of psychopathy, namely by enhancing psychopathic individuals’ capacity for interpersonal manipulation. Using data collected from a Mechanical Turk sample, we measured persuasiveness using ratings of video-recorded product pitches and examined the relations between psychopathic and general traits and persuasiveness across weaker (improvised) and stronger (scripted) conditions. Boldness exhibited a small, positive relation with perceived persuasiveness in the improvised condition only; conversely, psychopathic traits related to antagonism/meanness and disinhibition exhibited small negative associations with persuasiveness and trust in the scripted condition. The results suggest that boldness may help individuals persuade others so as to achieve desired outcomes, although the effect was quite small in nature, whereas psychopathic individuals who are not high on boldness may need to use other tactics (e.g., intimidation, coercion) to manipulate others.

This pilot study assessed the feasibility, acceptability, and initial efficacy of a skills-focused treatment delivered via video teleconferencing (VTC) to women veterans living in rural areas who had experienced military sexual trauma (MST). The Skills Training in Affective and Interpersonal Regulation (STAIR) program focuses on teaching emotion management and interpersonal skills in 8 to 10 sessions. The STAIR program may be a good fit for individuals in rural areas for whom social isolation and low social support are particularly problematic. Clinic-to-clinic VTC was used to connect a STAIR therapist with veterans for weekly individual therapy sessions. The participants (n = 10) reported high satisfaction with the intervention and would recommend the program to others. There were significant pretreatment to posttreatment improvements in social functioning, Hedge's g = 1.41, as well as in posttraumatic stress disorder symptoms, Hedge's g = 2.35; depression, Hedge's g = 1.81; and emotion regulation, Hedge's g = 2.32. This is the first report of the successful application of a skills-focused treatment via VTC for women veterans.

Recently developed quantitative models of psychopathology (i.e., Hierarchical Taxonomy of Psychopathology) identify an Antagonistic Externalizing spectrum that captures the psychological disposition toward criminal and antisocial behavior. The purpose of the present study was to examine relations between Antagonistic psychopathology (and associated Five-Factor model Antagonism/Agreeableness) and neural functioning related to social-cognitive Theory of Mind using a large sample (N = 973) collected as part of the Human Connectome Project (Van Essen et al., 2013a). No meaningful relations between Antagonism/Antagonistic Externalizing and Theory of Mind-related neural activity or synchrony were observed (p < .005). We conclude by outlining methodological considerations (e.g., validity of social cognition task and low test–retest reliability of functional biomarkers) that may account for these null results, and present recommendations for future research.

Objective: Clinicians’ perceptions of CBT-I Coach, a patient-facing mobile app for cognitive-behavioral therapy for insomnia (CBT-I), are critical to its adoption and integration into practice. Diffusion of innovations theory emphasizes the influence of perceptions, including the relative advantage to current practice, the compatibility to clinicians’ needs, the complexity, the innovation’s trialability, and observability. This study intended to evaluate the use and perceptions of CBT-I Coach among Veterans Affairs (VA)-trained CBT-I clinicians. Participants and Methods: Clinicians (N = 108) were surveyed about their use, feedback, and perceptions of CBT-I Coach a year after the app became available. Results: Overall perceptions of CBT-I Coach were favorable. Fifty percent of clinicians reported using CBT-I Coach, with 98% intending to continue use. The app was perceived to increase sleep diary completion and homework compliance. Clinicians viewed the app as providing accessibility to helpful tool...

The Five-Factor Narcissism Inventory (FFNI) has exhibited strong construct validity and is the only measure that captures the three factors associated with recent models of narcissism. Unfortunately, the FFNI and its short form (FFNI-SF) may be too long to use in certain research protocols. To make the FFNI-SF even briefer while maintaining its structure and breadth, the FFNI-SF was administered to 2 samples of undergraduate students (N = 1009, N = 432) and 2 samples of adults recruited from Amazon's Mechanical Turk platform (N = 494, N = 591) along with commonly used measures of narcissism, antisocial behavior, and other related constructs. Fifteen items (one per FFNI subscale) were selected to constitute the FFNI “super-short” form (FFNI-SSF). Exploratory factor analyses of the items supported a three-factor (antagonism, agentic extraversion, and neuroticism) solution consistent with its longer parent instrument. Total, presentation (grandiose and vulnerable), and factor (antagonism, agentic extraversion, and neuroticism) scores showed strong associations with other narcissism measures and external criteria related to narcissism, and all of these relations were virtually identical for the SSF compared to the SF. The FFNI-SSF shows promise as a very brief but multifaceted measure of narcissism grounded in an empirically validated model of personality.

This randomized controlled trial assessed the efficacy of a five-session version of Skills Training in Affective and Interpersonal Regulation (STAIR) among veterans obtaining treatment in primary care. Veterans who screened positive for either posttraumatic stress disorder (PTSD) or depression (N = 26) were enrolled and randomized into either five-session STAIR or treatment as usual (TAU). Assessments of PTSD symptoms (PTSD Checklist for DSM-5; PCL-5), depression (Beck Depression Inventory-II; BDI-II), emotion regulation (Difficulties in Emotion Regulation Scale; DERS), and social engagement difficulties (World Health Organization Disability Assessment 2.0; WHODAS-2) were assessed at pretreatment, posttreatment, and 3-month follow-up assessments. Participants assigned to the five-session STAIR condition reported significant improvements on all measures, whereas those assigned to TAU showed no change. Group × Treatment interactions were significant for all outcomes, and effect sizes for the interactions ranged from moderate to large, Hedge's gs = 0.81 for the PCL-5, 1.15 for the BDI-II, 0.75 for the DERS, and 0.81 for the WHODAS-2. The results indicate that five-session STAIR, a brief, skills-focused treatment, may be effective in reducing a range of symptoms and in improving social functioning among veterans treated in primary care settings.

This chapter reviews the current state of the narcissism and NPD literature highlighting areas of progress, points of continued debate, and areas for future research. After a brief review of narcissism’s origins, current conceptualizations of the construct are discussed beginning first with NPD and continuing with narcissism’s grandiose and vulnerable dimensions. Grandiose narcissism represents the prototypical manifestation of the construct, while vulnerable narcissism is more commonly observed in clinical settings. A review of grandiose and vulnerable narcissisms’ nomological networks makes it clear that both manifestations can yield significant impairment, albeit of different forms. Converging evidence for a three-dimensional (i.e., “trifurcated”) model of narcissism, which allows for an integrated understanding of its grandiose and vulnerable dimensions is presented. We argue that general application of the trifurcated model is necessary to provide further clarity to the narcissism literature. The “oscillation hypothesis” (i.e., that narcissistic individuals fluctuate between grandiose and vulnerable presentations) is highlighted as an area of continued debate and emerging measures capable of investigating narcissistic fluctuation are identified. The chapter concludes with a review of self-report measures of narcissism and recommendations using the trifurcated model to guide scale selection decisions.

Fearless dominance (FD) generally manifests null to small relations with externalizing problems, leading some researchers to propose alternative paths by which FD features may relate to these problems. The current study provides a test of two possibilities, namely that FD (a) interacts statistically with self-centered impulsivity (SCI) such that FD is associated with externalizing problems only at high levels of SCI and (b) demonstrates curvilinear relations with externalizing problems such that FD is more strongly associated with these problems at high levels. We used a large correctional sample and item-response theory-related statistics to precisely estimate individuals' scores at the extremes of each major psychopathic trait. FD was not significantly associated with externalizing problems in interaction with SCI or at higher levels of FD, suggesting that psychopathic traits linked to boldness are not especially relevant to generalized externalizing behavior. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychopathy is characterized by a constellation of traits including callousness, superficial charm, grandiosity, exploitativeness, irresponsibility, and impulsivity (e.g., Cleckley, 1941; Hare, 2003). Despite longstanding interest, the nature and scope of the construct as well as the centrality and sufficiency of its components remain debated (i.e., Fearless Dominance/Boldness; Miller & Lynam, 2012; Lilienfeld et al., 2012). Recently, the Triarchic Model of Psychopathy (TriPM; Patrick, Fowles, & Krueger, 2009) has garnered considerable interest, positing that psychopathy can be characterized by three partially overlapping, phenotypic domains: Boldness, Meanness, and Disinhibition. The present meta-analysis sought to examine the relations between these domains and other well-validated psychopathy measures and theoretically relevant outcomes in its nomological network. Across outcomes, Meanness and Disinhibition demonstrated robust convergent and criterion validity with other models of psychopathy as well as with pathological traits and externalizing outcomes; however, they manifested limited discriminant validity in relation to one another. In addition, empirical evidence for Boldness in relation to maladaptive outcomes was much weaker. Specifically, Boldness evinced the most robust relations with markers of adaptive functioning and only small relations with central criterion variables (e.g., externalizing behavior).

In the present chapter, we answer two questions concerning Antagonism in the context of narcissism: (a) Is Antagonism the core trait of narcissism? and (b) Is the Antagonism of Grandiose narcissism the same as the Antagonism of Vulnerable narcissism? To quantify the role that Antagonism plays in narcissism, we compare its empirical correlates to those generated by factors across narcissism's three levels of organization (i.e., single factor; Grandiose and Vulnerable; Agentic Extraversion, Antagonism, and Neuroticism) using intraclass correlations (ICCs) that assess absolute similarity between correlate profiles. To assess divergences in the content of Antagonism across Grandiose and Vulnerable narcissism, we examine how levels of specific antagonistic traits vary across narcissism constructs at different levels of organization (i.e., NPD, Grandiose narcissism, Vulnerable narcissism, trifurcated factors).

Psychopathy is characterized by a constellation of traits including callousness, superficial charm, grandiosity, exploitativeness, irresponsibility, and impulsivity (e.g., Cleckley, 1941/1955; Hare, 2003). Despite longstanding interest, the nature and scope of the construct as well as the centrality and sufficiency of its components remain debated (i.e., Fearless Dominance/Boldness; Miller & Lynam, 2012; Lilienfeld et al., 2012). Recently, the Triarchic Model of Psychopathy (TriPM; Patrick, Fowles, & Krueger, 2009) has garnered considerable interest, positing that psychopathy can be characterized by three partially overlapping, phenotypic domains: Boldness, Meanness, and Disinhibition. The present meta-analysis sought to examine the relations between these domains and other well-validated psychopathy measures and theoretically relevant outcomes in its nomological network. Across outcomes, Meanness and Disinhibition demonstrated robust convergent and criterion validity with other models of psychopathy as well as with pathological traits and externalizing outcomes; however, they manifested limited discriminant validity in relation to one another. In addition, empirical evidence for Boldness in relation to maladaptive outcomes was much weaker. Specifically, Boldness evinced the most robust relations with markers of adaptive functioning and only small relations with central criterion variables (e.g., externalizing behavior).

Purpose: The objective of this article is to describe the implementation of the Skills Training in Affective and Interpersonal Regulation (STAIR), a manualized, evidence-based cognitive behavioral group treatment for childhood trauma at Cedar Centre, a community-based trauma treatment center, and describe the preliminary evaluation of the effectiveness of the treatment. Method: Pre- and postmeasurements of emotion regulation, interpersonal problems, and traumatic stress symptoms using psychometrically validated instruments were collected. Outcomes were assessed for 85 individuals who experienced childhood sexual abuse and participated in the first cycles of intervention at the center. Results: Results indicated significant reductions in difficulties in emotion regulation, interpersonal problems, and trauma symptoms among participants from pretreatment to posttreatment. Discussion: Overall, there was a positive response to the adoption and integration of the STAIR intervention into the program. Qualitative assessment identified the benefits perceived by both facilitators and group participants.

This paper describes CBT-I Coach, a patient-facing smartphone app designed to enhance cognitive behavioral therapy for insomnia (CBT-I). It presents findings of two surveys of U.S. Department of Veterans Affairs (VA) CBT-I trained clinicians regarding their perceptions of CBT-I Coach before it was released (n = 138) and use of it two years after it was released (n = 176).VA-trained CBT-I clinicians completed web-based surveys before and two years after CBT-I Coach was publicly released.Prior to CBT-I Coach release, clinicians reported that it was moderately to very likely that the app could improve care and a majority (87.0%) intended to use it if it were available. Intention to use the app was predicted by smartphone ownership (β = 0.116, p0.05) and perceptions of relative advantage to existing CBT-I practices (β = 0.286, p0.01), compatibility with their own needs and values (β = 0.307, p0.01), and expectations about the complexity of the app (β = 0.245, p0.05). Two years after CBT-I Coach became available, 59.9% of participants reported using it with patients and had favorable impressions of its impact on homework adherence and outcomes.Findings suggest that before release, CBT-I Coach was perceived to have potential to enhance CBT-I and address common adherence issues and clinicians would use it. These results are reinforced by findings two years after it was released suggesting robust uptake and favorable perceptions of its value.

This pilot project implemented a mental health program, STAIR, targeting basic skills in mood management training and social functioning for women veterans with military-related trauma who live in rural areas. We report on outreach and implementation procedures, the women veterans' reactions to the program, and lessons learned.

Sexual minorities face greater exposure to discrimination and rejection than heterosexuals. Given these threats, sexual minorities may engage in sexual orientation concealment in order to avoid danger. This social stigma and minority stress places sexual minorities at risk for anxiety and related disorders. Given that three fourths of anxiety disorder onset occurs before the age of 24, the current study investigated the symptoms of generalized anxiety disorder, social phobia, panic disorder, posttraumatic stress disorder, and depression in sexual minority young adults relative to their heterosexual peers. Secondarily, the study investigated sexual orientation concealment as a predictor of anxiety and related disorders. A sample of 157 sexual minority and 157 heterosexual young adults matched on age and gender completed self-report measures of the aforementioned disorders, and indicated their level of sexual orientation concealment. Results revealed that sexual minority young adults reported greater symptoms relative to heterosexuals across all outcome measures. There were no interactions between sexual minority status and gender, however, women had higher symptoms across all disorders. Sexual minority young women appeared to be at the most risk for clinical levels of anxiety and related disorders. In addition, concealment of sexual orientation significantly predicted symptoms of social phobia. Implications are offered for the cognitive and behavioral treatment of anxiety and related disorders in this population.

BACKGROUND CONTEXT Spinal disorders are a leading cause of disability and lost productivity. Streamlining the route to the appropriate spine specialist can mitigate healthcare costs and improve patient outcomes and satisfaction. We instituted a multidisciplinary spine clinic (MSC) including physicians from neurosurgery, orthopedics, interventional pain medicine, and physiatry, where patients are simultaneously seen by providers from all of these specialties, as appropriate. We studied the rates of different treatment recommendations and compared them between an MSC and a traditional unidisciplinary neurosurgery spine clinic (USC). PURPOSE To study the effect of a MSC on rates of different treatment recommendations - cleared without treatment, physical therapy, injection, surgery, or lost to follow-up. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 853 consecutive outpatients from our institution who initially visited a neuosurgeon for spine care at either the USC or MSC from July 1, 2018 to June 30, 2019. OUTCOME MEASURES Rates of different treatment recommendations - cleared without treatment, physical therapy, injection, surgery, or lost to follow-up. METHODS A retrospective study was conducted of all patients who initially visited a neurosurgeon for spine care at either the USC or MSC from July 1, 2018 to June 30, 2019, inclusive. Patient demographics, comorbidities, diagnosed spine pathology, and final treatment recommendations - including surgery, injections, and physical therapy (PT) - were recorded. Univariable analysis and multivariable logistic regression was used to assess if the rates for these treatment recommendations differed between the two groups. RESULTS Records from 853 consecutive outpatients meeting inclusion criteria were abstracted with 397 patients initially seen at the USC and 456 at the MSC. There were 22.7% of patients seen at the UC who were recommended for surgery, compared to 11.4% at the MSC (p≤;0.001). Conversely, only 13.4% of patients seen at the USC were recommended PT, compared to 23.3% at the MSC (p≤;0.001). Similarly, 11.6% of patients seen at the USC were referred for injection, compared to 17.3% at the MSC (p=0.02). Patients were medically cleared without treatment and lost to follow-up at similar rates at both clinics (p=0.18 and p=0.84, respectively). A multivariable logistic regression model controlling for potential confounders including the patient's diagnosis, identified initially seeing a provider at the USC as increasing the rates of surgeons recommending surgery for patients (OR 2.12, 95% CI 1.40-3.21, p≤0.001) compared to MSC. CONCLUSIONS Multidisciplinary clinic visits reduce recommendations for surgical intervention by 50% compared to standard unidisciplinary clinics. By centralizing providers in an MSC, they are more likely to initially recommend injections and physical therapy than surgery. It is clear that multidisciplinary decision making can significantly alter treatment plans for patients with spinal disorders. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Fearless Dominance (FD) generally manifests null to small relations with externalizing problems, leading some researchers to propose alternative paths by which FD may relate to these problems. The current study provides a test of two possibilities, namely that FD (a) demonstrates curvilinear relations with externalizing problems such that it is associated with these problems only at high levels; and (b) interacts statistically with other features of psychopathy such that FD is associated with externalizing problems at high levels of other psychopathic traits. We used a large correctional sample and item-response theory-related statistics to precisely estimate individuals’ scores at the extremes of each major psychopathic trait. FD traits were not significantly associated with externalizing problems at higher levels of FD traits or in interaction with other psychopathic traits. In those few cases in which FD traits displayed curvilinear relations, they were negatively associated with externalizing problems at higher levels.