Rehabilitation Psychology最新文献

One common gait issue associated with advanced Parkinson's disease (PD) is freezing of gait (FoG). FoG impacts approximately half of people with PD and negatively impacts quality of life. Studies have suggested that anxiety may contribute to FoG. Individuals with FoG exhibit higher rates of anxiety, but it is unclear if anxiety contributes to FoG development. No known studies have assessed the impact of treating anxiety to improve FoG symptoms.

Objective: This pilot study evaluated the efficacy of cognitive behavioral therapy (CBT) training in reducing anxiety and improving gait in persons with PD following standard physical therapy (PT) treatment.

Method: Ten participants who had completed PT treatment for FoG were evaluated for psychological distress and gait parameters at baseline. They were then seen for four weekly virtual individual CBT sessions. Outcome measures were subsequently obtained 1 week after the CBT intervention and 5 weeks after the CBT intervention.

Results: Comparisons of baseline and postintervention Depression Anxiety Stress Scale-21 scores 1 week after the intervention were not statistically significant; however, improvements were both statistically and clinically significant a few weeks after the intervention, likely reflecting ongoing positive impact of CBT treatment. Gait parameters were noted to be clinically but not statistically significant after CBT treatment.

Conclusion: This study suggests that a brief course of CBT may help to reduce emotional distress and to improve aspects of gait in a cohort of PD patients with FoG. Future research using a larger cohort and providing concurrent CBT/PT interventions is needed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Purpose/objective: The purpose of the present study was to identify perceived effects of spinal cord injury (SCI) on identity development and processes of reestablishing an integrated identity after SCI in a veteran sample.

Research method/design: Semistructured interviews with N = 21 veterans explored perceived effects of SCI on identity, including future orientation, meaning and purpose in life, engagement in key life roles including family, friendships, and work and engagement with other individuals with disabilities. Participants also completed survey measures of depressive symptoms and self-concept clarity. Mental health history data were extracted from electronic health records. Qualitative data were analyzed using thematic analysis.

Results: Participants frequently discussed identity-relevant changes in career roles, disrupted social roles, and changes in their sense of independence. However, most participants also emphasized aspects of their identity that remained continuous despite their injury. Among the most frequently discussed strategies for reestablishing an integrated identity after SCI were "adapting activities" and "establishing an active life," themes that highlight the relevance of identity exploration in adulthood. Military identity and culture afforded both benefits in adjusting to SCI (e.g., perseverance in recovery processes) as well as vulnerabilities (e.g., threats to self-sufficiency and physical fitness).

Conclusions/implications: The findings reinforce the importance of disability identity development as well as overall identity integration and reveal potential strategies that individuals may use to adapt their identities following SCI. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Lower mental health was observed in individuals with lower socioeconomic position (SES) in the general population. Similarly, social inequalities in mental health have also been observed in individuals with spinal cord injury (SCI), however, there is limited knowledge of the nonbiological mechanisms contributing to this uneven distribution. Previous research has demonstrated that psychosocial resources are linked to improved mental health. The aims of the present study were (a) to investigate the direct effects between SES and mental health load and (b) the mediating role of psychosocial resources in the SES mental health load associations in individuals living with SCI.

Research method: Cross-sectional self-report data from N = 1,294 persons living with SCI from the Swiss Spinal Cord Injury Cohort study were analyzed using structural equation modeling. SES was operationalized by education, household income, perceived financial hardship, and subjective social status. Psychosocial resources were operationalized by self-esteem, self-efficacy, hope, optimism and energy, feeling of belonging, purpose in life, social support, and relationship satisfaction. Mental health load was operationalized by emotional state, depressive symptoms, psychological distress, and affective components of well-being.

Results: Higher SES was significantly associated with lower mental health load. Self-esteem, self-efficacy, optimism and energy, feeling of belonging, purpose in life, and relationship satisfaction were found to mediate the association between SES and mental health load.

Conclusion: The study underscores potential interventions to address socioeconomic inequalities in mental health load among individuals living with SCI. Strengthening psychosocial resources could offer promising interventions, particularly for those from low SES backgrounds facing mental health challenges. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Purpose/objective: Prior research highlights the complex interplay among disability, education, employment, and poverty, underscoring the importance of investigating how positive academic experiences among disabled individuals may predict employment status and poverty levels, potentially many years later. To address this gap, this study examined how educational factors including academic satisfaction, college degree attainment, and unmet academic accommodation needs predict employment and poverty among adults with disabilities or chronic health conditions.

Research method/design: A sample of 409 adults with disabilities or chronic health conditions while they had attended school in the United States completed an online survey of these constructs. Random forest models and their built-in measures of feature (or predictor) importance were used to predict the binary outcomes of employment status and poverty status using academic satisfaction, college degree attainment, and unmet academic accommodation needs as well as several common sociodemographic characteristics, including age, disability level, gender, rurality, and minority racial/ethnic identity. Across measures of feature importance, the academic factors showed comparable or greater predictive importance than all other sociodemographic predictors, and correlational analyses revealed that these academic factors were associated with higher levels of employment and lower levels of poverty.

Conclusion/implication: These findings suggest that positive educational experiences and accommodations are important predictors of both employment and poverty outcomes for individuals with disabilities. Future research should further explore how specific educational experiences impact employment outcomes for individuals with disabilities and examine supports and interventions that can create positive academic experiences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Purpose/objective: Text-to-image (TTI) systems are artificial intelligence (AI) models that incorporate large amounts of data to produce high-resolution images. Although research has documented racial/ethnic and gender bias in TTI, little has examined disability bias. This study compared generated images of disabled people with no prompted setting to images of disabled individuals in health care settings.

Research method/design: OpenAI's DALL-E-3 TTI generated 50 images for each of the following prompts: (a) "person with a disability," (b) "patient with a disability," (c) "doctor with a disability," and (d) "doctor with a disability and a patient without a disability." We calculated DALL-E's success in generating prompted images and coded disability type and demographics.

Results: When prompted to create a "person with a disability," DALL-E-3 was 100% successful, with a wide diversity of disabilities. When prompted to create a "patient with a disability," DALL-E-3 was similarly 100% successful, although 70% of images portrayed an individual with a stereotypical physical disability. When prompted to create a "doctor with a disability," DALL-E-3 did with 92% accuracy: 94% had a physical disability and 6% a sensory disability; no other disability types were portrayed. When prompted to create a "doctor with a disability and a patient without a disability," in 64% of cases, DALL-E-3 generated images of doctors without disabilities, and 70% portrayed a disabled patient instead.

Conclusions/implications: Disability diversity decreases dramatically when AI-generated images place disabled people in a medical environment. As TTI generation grows more ubiquitous, further work by model developers to mitigate representational harms is vital. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Purpose/objective: To evaluate the Caring Connections intervention compared to an attention control condition on loneliness, perceived burdensomeness (PB), and thwarted belongingness (TB).

Research method/design: In a two-arm parallel randomized controlled trial (RCT), 58 individuals with spinal cord injuries and disorders were randomized 1:1 to the intervention or the attention control condition. Block randomization with random block sizes of 2, 4, or 6 and allocation concealment were used to assign individuals to arms.

Results: Both groups showed within-group improvements in loneliness from baseline to post-RCT, but no statistically significant differences in change scores between the conditions over time. The treatment group showed within-group improvement in PB from baseline to post (p = .0008), but not in TB. The control group showed within-group improvement in TB from baseline to post (p = .04), but not in PB. No significant differences over time were found for either PB or TB between conditions. A greater proportion of the treatment versus control group found the program to be beneficial (76% vs. 45%, p = .02) and satisfactory (79% vs. 52%, p = .03).

Conclusions/implications: We did not demonstrate that the Caring Connections intervention reduced feelings of loneliness compared to the control condition. We found significant within-group improvements in loneliness from baseline to post-RCT for both groups. Within-group improvements in PB were seen in the treatment group and TB in the control group, but no significant differences in change scores over time between conditions. Communication over a 6-month period (from personalized peer letters or informational material on quality of life) had some impact on loneliness, PB, and TB. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: This study (a) used OpenAI's GPT-4 large language model to generate an initial item pool for a potential scale measuring internalized ableism, (b) involved disabled community stakeholders in refining the items and prompting additional artificial intelligence-generated items, and (c) psychometrically validated the scale in a large sample of disabled individuals.

Method: Following a series of GPT-4 prompts and iterative community-based participatory research feedback, a tentative item pool of 90 statements was developed. A sample of 409 adults with diverse disabilities completed a survey containing the initial item pool, potentially related scales, and demographic questions.

Results: An exploratory factor analysis helped identify the final 51 items and subscale structure, and a confirmatory factor analysis then provided evidence of excellent factor structure fit. The scale contained eight subscales with Cronbach's αs that ranged from .85 to .97, with an overall total score α of .98. The total score and subscales showed consistent convergent validity with other measures of internalized stigma for chronic illness and anger and frustration with disability.

Conclusion: This study generated for the first time in the known research literature a nuanced, comprehensive, and psychometrically sound scale based on the integration of both artificial intelligence and community-based participatory research methodology: the Internalized Ableism Inventory. The demonstrated methodology generating it has the potential to modernize psychological scale development approaches. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Despite daily challenges, persons with spinal cord injury (PwSCI) successfully mobilize individual and relational resources and attain good mental health. Psychosocial resources were investigated as components of resilience, defined as satisfactory adaptation to adversity. While the association between resilience and positive mental health, conceptualized as psychological, emotional, and social well-being, was widely observed in individuals, it remains unexplored within dyads. This study was thus aimed to investigate this association at both individual and relational levels among PwSCI and their informal caregivers, defined as family members providing regular and unpaid assistance.

Method: Through a cross-sectional dyadic design, 162 PwSCI and their 162 caregivers completed the Resilience Scale for Adults and the Mental Health Continuum-Short Form. Actor and partner effects were analyzed using the actor-partner interdependence model.

Results: Significant actor effects emerged for self-perception (b = .60, p < .001), planned future (b = .62, p < .001), social competence (b = .26, p < .01), and social resources (b = .28, p < .01), resilience components positively associated with individuals' own positive mental health. A significant partner effect emerged for self-perception (b = .33, p < .05), suggesting interpersonal influence within the dyad. Caregivers reported higher positive mental health than PwSCI, but no role-based interactions emerged.

Conclusions: Resilience, particularly through self-perception, supports both personal and relational well-being, suggesting the potential usefulness of dyadic-focused interventions in chronic disease. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Purpose/objective: Caregivers of children with physical disabilities face unique stressors and experience high levels of anxiety, depression, and burnout. In general, self-compassion-based skills are associated with decreased psychological distress and increased well-being. However, the nuances of why or how self-compassion may promote the psychological well-being in caregivers of children with physical disabilities are unknown. Using qualitative data, this study explores the relevance of self-compassion in supporting caregivers' psychological well-being from multiple perspectives.

Method: We conducted 13 semistructured interviews with community service providers, a group feedback session with seven caregiver advisors, and a feedback session with eight caregivers who had recently completed a self-compassion-based resilience course. Transcripts were analyzed by two coders using reflexive thematic analysis.

Results: We developed three themes regarding how self-compassion skills may promote caregivers' psychological well-being within the context of caregiving: (a) balancing "gritting through" with increased awareness and expression of emotions and needs, (b) balancing isolation with increased connection, and (c) balancing self-judgment with increased grace and self-advocacy.

Conclusion: Self-compassion skills may benefit caregivers in specific ways in the context of caring for a child with a physical disability. Self-compassion-based interventions that target and measure these unique factors are promising for alleviating psychological distress for this community. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Purpose/objective: Individuals with spinal cord injuries and disorders (SCI/D) may exhibit cues that tell a story about their loneliness. Health care providers must recognize loneliness cues in order to take action. This study identified and described loneliness cues exhibited by persons with SCI/D from health provider perspectives.

Research method/design: Descriptive qualitative design using in-depth interviews with health providers and analyzed using thematic analysis.

Results: Multidisciplinary SCI/D health providers from 10 nationwide Veterans Health Administration facilities. Ten themes described loneliness cues exhibited by persons with SCI/D: (a) direct or indirect verbal expression; (b) physical health symptoms/conditions; (c) mental health indicators; (d) withdrawal/lack of engagement; (e) "severe" voluntary seclusion, for example, not leaving house, not getting out of bed, sitting in the dark; (f) poor lifestyle behaviors, for example, substance use, poor nutrition; (g) neglecting personal self-care, for example, poor hygiene; (h) neglecting ones' internal environment, for example, dirty home, hoarding; (i) avoiding health care and health care management needs, for example, missing medical appointments, neglecting bowel care; and (j) fixating on health care to meet social health needs.

Conclusions/implications: Health care providers identified several loneliness cues commonly exhibited by individuals with SCI/D. These cues, whether verbal or nonverbal, may represent a signal that alerts the provider of a concern around loneliness. The value of such cues depends on the health provider's ability to identify them in order to decide on next steps, which may involve formal screening or validated measurement followed by collaborative patient engagement to identify potential sources contributing to loneliness and areas patients wish to address. (PsycInfo Database Record (c) 2025 APA, all rights reserved).