University Counseling Center Research Articles

A qualitative assessment of mental health literacy and help-seeking behaviors among male college students

Although the number of students receiving care from college counseling centers has increased, engaging male college students to seek help presents a unique challenge. This qualitative study explored mental health literacy and help-seeking behaviors among undergraduate college men. Semi-structured interviews (n = 26) based on three vignettes (anxiety, depression, stress) were employed to assess mental health literacy. Analysis revealed three general themes and associated sub-themes: (a) knowledge of signs and symptoms (physiological, behavioral, and emotional); (b) recommended help-seeking behaviors (do nothing, self-care, seek help); and (c) barriers to help-seeking (social stigma, self-stigma, masculinity). Findings present a triadic interplay between the person, help-seeking behavior, and environment. Future research should explore this dynamic relationship to inform interventions aimed at improving college male mental health help-seeking behavior.

Many Hands Make Light Work: Group Therapy on College Campuses Is Efficient, Effective, Enticing, and Essential

ABSTRACT College and university counseling centers are facing increasing demand for services, increasing severity of psychopathology, and decreasing funding – thus college counseling is a strained system. Group psychotherapy is a flexible and impactful treatment format which addresses these challenges and suits the population well. We review literature on group counseling in higher education and present four studies examining its appropriateness. Study 1 is a mathematical proof showing group therapy is efficient. Studies 2 and 3 are archival survey data analyses of client feedback and student interest, showing group therapy is effective and enticing. Study 4 is an analysis of clinic staffing data showing group therapy is essential. Three recommendations are offered to counseling center staff and directors: design groups with a focus on ethics and appealing structure, promote groups both to prospective clients and within staff (i.e., “why not group?”), and apply affective process-dimension clinical skills in group delivery.

The Holistic Prevention & Intervention Model: A public health approach to college mental health and suicide prevention

The rate of college student mental health difficulties has been climbing, leading to overburdened college counseling centers. We propose the Holistic Prevention & Intervention Model (HPIM) as one solution in which campus and community resources work collaboratively to support students experiencing psychological distress and alleviate clinical demands. The HPIM moves from autonomous solutions to organizational-based strategies on a continuum of proactive to reactive interventions. We discuss how this model can be tailored and implemented for college campuses across the United States, including examining the resources available to the campus, the overall campus culture, and college demographics that affect risk and protective factors.

Cannabis use disorder uniquely predicts educational impairment in college students over and above other mental health disorders

Objective: The impact of cannabis use disorder (CUD) on education functioning and GPA was examined within the context of co-occurring alcohol use disorder (AUD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD). Participants: Undergraduates (N = 210) who reported using cannabis within the past six months were recruited. Methods: Hierarchical multiple regression analyses were used to determine whether CUD symptom severity and presence of probable CUD diagnosis predicted educational impairment and current GPA, over and above other mental health conditions. Results: CUD symptom severity, but not probable CUD, significantly predicted greater educational impairment, over and above probable PTSD and MDD, which were also significant predictors. CUD symptom severity, but not probable CUD, significantly predicted lower GPA. Conclusion: In addition to other common mental health conditions, CUD may be an important area of assessment and intervention for university counseling centers to foster student academic success.

대학상담사의 상담 외 업무에서의 어려움과 교육 및 지원 요구에 대한 조사연구

Objectives In this study, the difficulties experienced by university counselors while performing tasks aside from counseling and the contents of education and assistance that they need from the academic society were investigated.
 Methods 91 counselors who are currently working or had experience working at university counseling centers participated in the survey. The results were analyzed through qualitative content analysis.
 Results Results of the analysis are as follows: (1) University counselors were struggling in areas such as ‘administrative and university evaluation paperwork’, ‘working in additional positions’, ‘crisis management and referral’, ‘requests for non-counseling interventions’, and ‘violation of counseling ethics and expertise.’ (2) Their educational needs included ‘report preparation and research’, ‘program development and evaluation’, and ‘student counseling center management.’ (3) The assistance needs from academic associations were ‘preparing guidelines for the management of university counseling centers’, ‘protecting the role and rights of counselors’, and ‘counseling education for university members’.
 Conclusions With these results, suggestions for future tasks and roles that academic associations should meet were discussed.

Do as I say, not as I do: Therapist Evaluation of a Practice and Supervision Aid

Interactive software offers the potential to improve the quality of mental health care by promoting skill development, clinical insight, and shared reflection among mental health professionals. However, research on therapists' usage of interactive software has been primarily based in training and mock-clinical settings. In this paper, we present a qualitative study of clinicians' experience using CORE-MI, a collaborative recording and annotation software, in a real-world university counseling center. We describe how and why therapists, both trainees and licensed staff, used CORE-MI to support their practice and improve their skills. We also consider how usage varied with therapists' developmental level and how the software impacted relationships between supervisors and supervisees. Finally, we offer recommendations for future research and design of interactive systems in mental health settings.

COVID-19 and Turkish University Students With Visual Impairments: An In-Depth Inquiry

Introduction: The purpose of this study was to investigate the effect of COVID-19 on the academic life, psychological well-being, social relations, and physical health of university students with visual impairments via their personal judgments. Methods: A qualitative research design was utilized with 19 participants studying at 10 Turkish universities located across seven cities. Personal online semi-structured interviews were held in January 2021. The audio-taped qualitative data were analyzed deductively in light of four predetermined themes: academic life, physical health, psychological well-being, and social relations. Results: Findings revealed the negative effects of the lockdown on daily and, specifically, campus life. Most participants claimed their preference for traditional over online education due to certain academic, psychological, and social difficulties, stating also that campus life had many academic and social advantages compared to online education. Physical health issues including access to medical treatments and lack of activity/mobility were also stressed. Discussion: It was interesting to observe that despite the interviews' focus on daily life, students provided views on the benefits of traditional education and how and why their individual needs should be met by universities, much more than expected. Implications for Practitioners: It may be concluded that several developmental domains of students with visual impairments are affected by attendance at a university and that offices of disability services of higher education institutions and university counseling centers should take thoughtful actions to meet the specific needs of this student population tailored to both online and traditional education.

Yes, It's that Common and Yes, It's that Bad: An Estimation of the Prevalence and Psychological Correlates of Rape and Sexual Assault in College Women.

Rape myths play a role in rape denialism, in which individuals deny the prevalence and severity of sexual assault. This project aimed to address two common rape myths: that rape is uncommon and its effects are exaggerated. To test these claims, we explored two archival samples consisting of undergraduate women. Study 1, a 5-year chart review of university counseling center intake forms (n = 883), demonstrated that 30.2% of clients had experienced "sexual violence," "sexual contact without consent," or both. Study 2, a re-analysis of an emerging adulthood resilience survey dataset (n = 359), demonstrated that 20.6% of subjects had a history of sexual assault, and that those women reported lower life satisfaction and more severe psychological symptoms than those who did not. These findings are in line with previous literature debunking harmful rape myths that contribute to the perpetuation of rape culture. Our data help validate these rape notions as mythical; rape is indeed common and devastating.

The relationship of alliance, cohesion, and climate with outcome among college counseling populations.

It is not yet fully understood how alliance, cohesion, and climate differentially correlate with client outcome in group therapy, especially when assessed simultaneously. This study aims to elucidate these relationships through an archival analysis of continuous Group Questionnaire (GQ) and Outcome Questionnaire-45 (OQ-45) data from 412 group therapy clients at college counseling centers, which were originally collected by Burlingame, Whitcomb, et al. (2018). We predicted that alliance, cohesion, and climate would each correlate with improvements in outcome and, further, that they would have similar relationships with change in outcome. Results indicate that greater alliance, cohesion, and climate are individually associated with lower distress. This relationship was significant regarding session-to-session fluctuations on individual client scores (p < .01), as well as regarding differences between clients in their personal averages across sessions (p < .01). However, when linear growth trajectories were considered, only alliance was significantly associated with improvement (p < .05). In other words, alliance, climate, and cohesion all correlate with outcome when time is ignored; however, alliance alone significantly correlates with outcome when change over time is taken into account. This study highlights the importance of the client-therapist relationship, emphasizing how alliance is significantly related to change in group therapy. Thus, therapists should prioritize a strong bond with clients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Threat alert: The effect of outliers on the alliance-outcome correlation.

Meta-analyses have established the alliance as the most robust predictor of outcome in psychotherapy. A growing number of studies have evaluated potential threats to the conclusion that alliance is a causal factor in psychotherapy. One potential threat that has not been systematically examined is the possibility that the alliance-outcome association is driven by low alliance outliers. We examined the influence of removing low alliance outliers on the alliance-outcome association using data drawn from two large-scale, naturalistic psychotherapy data sets (Ns = 1,052; 11,029). These data sets differed in setting (university counseling center, community mental health center), country (United States and Canada), alliance measure (four-item Working Alliance Inventory Short Form Revised, 10-item Session Rating Scale), and outcome measure (Counseling Center Assessment of Psychological Symptoms-34, Outcome Questionnaire-45). We examined the impact of treating outliers in five different ways: retaining them, removing values three or two standard deviations from the mean, and winsorizing values three or two standard deviations from the mean. We also examined the effect of outliers after disaggregating alliance ratings into within-therapist and between-therapist components. The alliance-outcome correlation and the proportion of variance in posttest outcomes explained by alliance when controlling for pretest outcomes were similar regardless of how low alliance outliers were treated (change in r ≤ .04, change in R² ≤ 1%). Results from the disaggregation were similar. Thus, it appears that the alliance-outcome association is not an artifact of the influence of low alliance outliers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Engaging stakeholders for change: A learning community methodology for implementing evidence-based, trauma-focused care on college campuses.

Advances in implementation science have encouraged novel methods for disseminating and implementing evidence-based treatments. Mental health services offered to trauma-exposed students on college campuses are characterized by unique contextual, developmental, and cultural factors that must be considered to effectively disseminate and implement trauma-focused, evidence-based treatments (TF-EBTs). Informed by novel implementation designs, this project utilized a strategic stakeholder engagement method of creating a learning community to identify and adapt a TF-EBT for use in university counseling centers (UCCs). Project leads convened campus and community stakeholders included UCC clinicians, administrators, student life professionals, and students, to join researchers in a reciprocal collaboration to work toward dissemination and implementation. These stakeholders participated in a learning community that reviewed, selected, and adapted a TF-EBT and other tools for dissemination and implementation to UCCs and other campus professionals. There were a number of benefits and challenges of using the learning community as a method of dissemination and implementation. Benefits included context-specific knowledge sharing, clarification of the scope of trauma among college students, creation of helpful tools, emphasis on cultural competence in TF-EBTs, and facilitating connections between professionals. Challenges included balancing flexibility with progress toward project goals and recruitment and retention of stakeholders. Stakeholder engagement is an integral component of dissemination and implementation efforts. The learning community method allowed for stakeholders to take an active part in adapting a TF-EBT for UCCs and can be utilized in other settings to aid in adoption and utilization of evidence-based treatments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The relationship between clients' expectation of therapist support and challenge and treatment outcome: A response surface analysis.

Clients' expectations of treatment have long been posited as an important therapeutic factor in treatment success. Decades of research and meta-analytic findings have supported the notion that client expectations about what will happen over the course of therapy and how beneficial therapy will be are directly related to treatment factors, such as the working alliance and treatment outcome. Client expectations can be categorized into two broad categories, outcome expectations (i.e., how beneficial treatment will be) and treatment expectations (i.e., what will happen in treatment). This study sought to examine clients' treatment expectations, specifically, their role expectations, which represent their beliefs of how their therapists will act in session. Data for this study included 1,233 clients participating in individual counseling with 49 therapists at a university counseling center. Multilevel polynomial regression and response surface analysis were used to test congruent and discrepant effects of clients' pretreatment support and challenge expectancy on reductions in their psychological distress over the course of treatment. Results indicated that reductions in clients' psychological distress were the greatest when their support and challenge expectancy scores were congruent and high. In other words, clients who expected both high challenge and high support from their therapist, prior to the start of counseling, reported the greatest improvement in counseling. Clients similarly reported reductions in their psychological distress when their support and challenge expectations were congruent and low, although this effect was smaller than when they expected high levels of both support and challenge. Together, these findings suggest that when clients' expectations of support and challenge are similar, they fare better in treatment, as opposed to when they expect a greater amount of support than challenge or vice versa. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

University Mental Health Counselors Perceptions Of Exercise Is Medicine Prescription And Referral

Studies show a rise in college students’ mental health needs as prevalence of diagnosed anxiety and depression has increased on college campuses. Consequently, yearly visits of students to college counseling centers have increased. Physical activity shows to have positive benefits for mental health, but many counselors lack confidence to be able to prescribe physical activity. PURPOSE: To explore university mental health counselors’ perceptions on prescribing physical activity to patients and referring patients to a physical activity specialist. METHODS: Using a qualitative descriptive design, 14 certified counselors (13 females and 1 male, ages: 26-67), across 7 southern universities, participated in semi-structured virtual interviews. Questions, aligned with Social Cognitive Theory (SCT) constructs, including individual, environmental, and behavioral factors related to prescribing physical activity to patients and counselors referring patients to a physical activity specialist. Thematic analysis was used to develop overarching themes and subthemes from the data. RESULTS: Counselors are open to prescribing physical activity and referring patients to a physical activity specialist. Though, prescribing physical activity would take more formal training for counselors to do so. Question topics, themes, subthemes, and number of participants who reported the most prevalent subthemes are found in Table 1. CONCLUSION: Counselors iterated the convenience of referring to a trained physical activity specialist is currently more feasible than prescribing physical activity. Future studies should quantitatively investigate how effective referring patients to a physical activity specialist would be for improving patients’ physical activity and mental health.

Implementation of empowerment self-defense programming in a university counseling center: An effective sexual violence prevention delivery model

Objective: Empowerment Self-Defense (ESD) is a sexual violence prevention approach backed by rigorous empirical research, yet its availability on college campuses is limited. This manuscript evaluates the feasibility and efficacy of an ESD program embedded within a university counseling center. Methods: Participants completed an 8-session ESD intervention and group counseling program. Results: Feasibility and acceptability of this program were demonstrated by excellent participant retention and supported by institutional buy-in and counselor involvement. Pre-post assessments demonstrated that participants reported significant reductions in posttraumatic stress symptoms, F (1, 56) = 22.46, p < .001 and improvements in both interpersonal self-efficacy, F (1, 56) = 88.81, p < .001, and self-defense self-efficacy, F (1, 56) = 100.20, p < .001. Conclusion: The findings support the use of ESD programming as part of college campus sexual violence efforts and provide a blueprint for administrators and college mental-health centers who wish to offer this effective program to the college students they serve.

Development and validation study of the suicide screening questionnaire-observer rating (SSQ-OR).

BackgroundObserver rating scales are necessary to evaluate the risk of suicide because individuals at risk for suicide are often unwilling to seek help on their own. Reliability and validity were evaluated for the newly developed Suicide Screening Questionnaire-Observer Rating (SSQ-OR).MethodsPreliminary items were assessed by 251 experts online and 25 questions were selected. 328 individuals at high-risk and 661 controls from 12 Crisis Response Centers and 5 university counseling centers were recruited to complete SSQ-OR, Beck Scale for Suicide Ideation (BSSI) and Patient Health Questionnaire-9 (PHQ-9). In a 6 months follow-up, we reached out to 176 participants to ask whether they had experienced a suicidal thought, plan, or attempt since the baseline assessment. Cronbach's α, Mann-Whitney U test, Spearman's correlation, factor analyses, Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to verify the SSQ-OR.ResultsStructural validity was supported by a two-factor solution using exploratory and confirmatory factor analyses. Excellent model fit indices for the two-factor structure using exploratory factor analysis were confirmed (RMSEA = 0.033, TLI = 0.980, CFI = 0.983). The SSQ-OR demonstrated strong internal consistency. The concurrent validity based on the correlations with other self-reported indicators of suicidal potential–BSSI and PHQ-9– revealed substantial relationships. The high-risk group was effectively characterized by a cut-off point of 4, with a sensitivity of 0.73 and a specificity of 0.79. The SSQ-OR scores were significant predictors of suicidal thoughts and behaviors within 6 months.ConclusionsThe SSQ-OR exhibits sound psychometric properties, and could be used as a complement to a self-report or clinical-administered scale to screen suicide risk comprehensively.

Adapting stepped care: Changes to service delivery format in the context of high demand.

Given the ongoing dilemma for college counseling centers to meet steady increases in demand for services, this study outlines the implementation of an adapted stepped care model in a university counseling center. Our adapted model focused, as do other stepped care models, on treatment planning and lower-intensity interventions, with the addition of the intensive therapy option being provided on a weekly basis. We adopted our stepped care model across a large center and hypothesized that after implementation we would be able to serve a similar number of clients as our previous model and that treatment outcomes for these clients would improve. Descriptive data and regression analyses demonstrated support for our hypotheses, including an increased likelihood of clinically significant improvement for clients postimplementation. Implications for adapting service delivery models using practice-based evidence are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining the Mental Health Needs of Post-secondary Students with Child-maltreatment Histories Seeking Campus Counseling Services

ABSTRACT Our study sought to provide a more nuanced understanding of the significant issues experienced by young adult survivors of child-maltreatment (CM) prior to seeking counseling services. More specifically, we examined differences between survivors of CM and participants with no CM histories related to non-suicidal self-injury (NSSI), suicidal ideation, and suicide attempt, and scores on the Counseling Center Assessment of Psychological Symptoms (CCAPS). In our sample of N = 2604 post-secondary students seeking counseling services, CM histories were significantly associated with higher frequencies of NSSI, suicidal ideation, and suicide attempt. Further, results indicated that survivors of CM reported significantly higher mean scores on all CCAPS subscales and were more likely to report scores that were considered “elevated” when compared to peers with no reported CM history. Implications for college counseling centers and college mental health providers are discussed.

Psychotherapy session frequency: A naturalistic examination in a university counseling center.

With increasing demand for psychotherapy services, clinicians are carrying increasingly large caseloads (Bailey et al., 2020). As the number of new intakes exceeds the number of clinical hours available each week in some settings, psychotherapy is delivered on an attenuated schedule for returning clients (rather than the traditional weekly frequency); there is, however, little support for the efficacy of this practice. The present study explored the effect of session frequency on psychotherapy outcomes using a quasi-randomized controlled design. In a working university counseling center, we assigned therapists to either a treatment-as-usual (TAU) group (attenuated session frequency) or an experimental group (weekly session frequency). Clients were randomly assigned to a therapist in either condition. Using hierarchical linear modeling and survival analyses, we examined psychotherapy outcomes (measured by session-by-session Outcome Questionnaire 45 scores) for 1,322 clients (3,919 individual sessions). We found no differences between groups when examining the full sample, but also found limited fidelity in the experimental group. When identifying individuals who were seen weekly in at least the first three sessions after intake (sensitivity analysis), we found the following: (a) weekly therapy resulted in faster trajectories of change over time, (b) weekly therapy resulted in a greater likelihood of achieving recovery, and (c) weekly therapy resulted in a greater likelihood of achieving recovery sooner. We discuss the importance of including session frequency when considering the dose of therapy, as well as the implication that prioritizing weekly therapy may increase therapy efficacy and efficiency in routine practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mental Health Status Among Iranian Medical University Students: A Cross-sectional Study

Background: Mental health status of university students is a critical issue due to its essential role in students’ academic performance. Therefore, this study aimed to evaluate the mental health status of first-year students at Hamadan University of Medical Sciences in 2020. Methods: All first-year students of Hamadan University of Medical Sciences entered this cross-sectional study through census sampling. Two Questionnaires, the Goldberg’s General Health Questionnaire-12 (GHQ-12) as a screening instrument, and a researcher-made questionnaire were used to collect demographic information. After data collection, the chi-square test and logistic regression coefficient were applied to analyze the data at a significance level of 0.05. Results: The results showed that out of 875 students, 170 cases (19.4%) suffered from mental disorders, including depressed mood (93.5%) and anxiety attack (22%) as the most and least common disorders, respectively. Fitting the logistic regression model revealed that the highest educational degree (P&lt;0.001, medical residency), admission quotas other than the free quota (P=0.03), high (P=0.04) and low (P=0.01) financial status, and fathers’ unemployment (P=0.04) increased the chance of mental health disorders. Conclusion: Due to the high rate and negative consequences of mental health problems in university students, it is recommended that university counseling centers provide services for students with a focus on coping with more frequent mental disorders. Finally, it is suggested they have yearly follow-up surveys to recognize the effects of the university environment and different conducted programs on the students’ mental status.

The Effectiveness of a Brief Telehealth and Smartphone Intervention for College Students Receiving Traditional Therapy: Longitudinal Study Using Ecological Momentary Assessment Data.

BackgroundBrief interventions such as mental health apps and single-session interventions are increasingly popular, efficacious, and accessible delivery formats that may be beneficial for college students whose mental health needs may not be adequately met by college counseling centers. However, no studies so far have examined the effectiveness of these modes of treatment for college students who are already receiving traditional therapy, despite it being common among this population.ObjectiveThe aim of this study was to compare the differences in self-reported momentary negative affect between college students in therapy and not in therapy who received a brief single-session intervention delivered by counseling center staff and a supplemental mobile app.MethodsData for this study were drawn from E-Manage, a brief mobile health intervention geared toward college students. Participants in the study were 173 college students who indicated whether they had received therapy. We conducted a multilevel model to determine whether there were differences between those in therapy versus not in therapy in negative affect reported throughout the study. Following this, we conducted multilevel models with therapy status as the predictor and negative affect as the outcome.ResultsResults of the multilevel model testing showed that the cross-level interaction between the time point (ie, pre- vs postexercise) and therapy status was significant (P=.008), with the reduction in negative affect from pre- to postexercise greater for those in therapy (b=–0.65, 95% CI –0.91 to –0.40; P<.001) than it was for those not in therapy (b=–0.31, 95% CI –0.43 to –0.19; P<.001). Therapy status was unassociated with both the pre-exercise (b=–1.69, 95% CI –3.51 to 0.13; P=.07) and postexercise (b=–1.37, 95% CI –3.17 to 0.43; P=.14) ratings of negative affect.ConclusionsThese findings suggest that app-based and single-session interventions are also appropriate to use among college students who are receiving traditional therapy. A randomized controlled trial comparing students receiving therapy to students receiving therapy and E-Manage will be necessary to determine to what extent E-Manage contributed to the reductions in negative affect that therapy-attending college students experienced.