psychology

JAN/FEB 2024

monitor on GST# R127612802

12 EMERGING

FOR
WHAT ’S AHEAD FOR PSYCHOLOGISTS
IN THE COMING YEAR ?

FIGHTING MISINFORMATION 40 BACKLASH AGAINST RACIAL

EQUITY EFFORTS 56
THE UNSTOPPABLE MOMENTUM
OF GENERATIVE AI 44 INCREASING PATHWAYS TO CARE 60

HIGHER EDUCATION IS STRUGGLING 48 STABILITY AT WORK 64

TAKING AIM AT WOMEN TACKLING SUBSTANCE USE 68

AND LGBTQ INDIVIDUALS 52
MORE SCHOOL PSYCHOLOGISTS 72

MONETIZING MENTAL HEALTH

TECHNOLOGY 76

CLINICAL PRACTICE LOOKAHEAD 80

BRAIN HEALTH AND AGING 84

PLUS

A MESSAGE OF HOPE 88
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for story ideas or comments, contact Editor in Chief
Trent Spiner at tspiner@apa.org.

RESOURCES, OPPORTUNITIES, AND NEWS FOR PSYCHOLOGISTS FROM APA

PUBLIC HEALTH

APA Supports New

Federal Office on Gun
Violence Prevention
A
PA CEO Arthur Evans Jr., PhD, joined other invited
guests at the White House last fall as President Joe Biden
unveiled the first-ever federal Office of Gun Violence
Prevention. APA and APA Services applaud the new office, having
long advocated for a federal public health approach to gun violence
prevention and supported evidence-based programs and policies
that will reduce gun violence in the United States.
Meet APA’S
Find all of APA’s resources on gun violence prevention at www.apa.org/topics/
gun-violence-crime.

SKILL-BUILDING 2024 President:

Free Science Trainings for Researchers
APA has six new free science training sessions facilitated by subject Cynthia de las Fuentes, PhD
matter experts. Topics include an introduction to QuatCrit, an introduc-

I
tion to network models for multivariate data, introductions to mediation
n more ways than one, APA’s new president
and moderation, and more.
Find all the trainings at www.apa.org/science/programs/training-sessions. Cynthia de las Fuentes, PhD, is the clear, pas-
sionate voice that psychology and humanity
EQUITY AND DIVERSITY needs right now.
de las Fuentes, a bilingual counseling psy-
New Standards for Scientific Reporting on Race chologist who also studied voice performance
APA has launched a new set of Journal Article Reporting Standards for from childhood through her graduate school
Race, Ethnicity, and Culture. The standards spell out best practices on years—performing in her first opera at age 14—
how race and ethnicity are discussed in scientific manuscripts and aim to speaks about psychology’s potential in a way
promote equity, diversity, inclusion, and justice in psychological science. that would stir and resonate with anyone in
Learn more at https://apastyle.apa.org/blog/race-ethnicity-culture-reporting-standards.
need of more resolve, faith, and hope.
“Psychology touches every aspect of
SERVE PSYCHOLOGY humanity and the societies and cultures we
inhabit,” says de las Fuentes, who has an inde-
Interested in the APA Presidency?
pendent practice in Austin, Texas, and a long
Members who want to be nominated to be the next APA president-elect
DENNIS BURNETT

history of service to APA and pro bono work to

(to serve as president in 2026) are invited to submit a statement of 50
benefit the Latinx immigrant community. “We
words or fewer by Feb. 15.
For more information, contact APA’s Election Office at elections@apa.org. are needed in every room at every table: from

2 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
industry to international relations,
in the classroom and the therapy
room, from health care to govern-
ment settings, to research and the
entertainment industry. I can’t think of
a place where we aren’t needed, but
where we are most needed is in all
the areas that work to relieve human
suffering.” Learn more about her
background and perspectives, in her
own words:
■ Most treasured memory: Bring-
ing each of my adopted daughters
home. The oldest was 9 years old
at the time and then 4 years later,
[we brought home] her 10-month-old
sister. They are now 34 and 21 years
old and I couldn’t be prouder of the
women they have become.
Why she chose psychology:
■ said all the old people in my family.
Although he only had a third-grade
education, my maternal grandfather
was fond of the field and talked
about it frequently. Then I took an AP
Psychology class in high school, and
I was convinced it could satisfy both
my intellectual curiosity and desire
to be helpful.
■ What was expected of her grow-
ing up: Hah! How much space do
I have? As the oldest daughter in
a Mexican American family, I was
expected to always be dutiful and
helpful, never question the authority
of my elders or teachers, always
appear well groomed, excel as a
student, earn a minimum of a bach-
elor’s degree, and become a wife
and mother. Higher education and
motherhood, check!
WHAT’S AHEAD
MEMBERS CHOOSE 2024 PRESIDENT-ELECT
Debra Kawahara, PhD, will serve as the associ-
ation’s president-elect in 2024 and president in
2025. She is the first Asian American woman and
the first Japanese American elected to the posi-
tion. She is the associate dean of academic affairs
and a distinguished professor at the California
School of Professional Psychology at Alliant Inter-
national University.
■ Biggest obstacle she’s overcome:
Public speaking. While I don’t get
dizzy, lightheaded, and hyperven-
tilate anymore, I’m still working on
it. I have a feeling that this year will
provide me with many opportunities
for desensitization.
■ In her downtime: I spend time
with family and friends, and cooking,
and I average about three books per
month. A pandemic guilty pleasure
that has lasted is watching Korean
dramas. I recommend starting with
The Extraordinary Attorney Woo.
■ Best advice she’s gotten: “Focus on
your breath,” a voice instructor once
told me, and I have found that advice
works for many different circum-
stances. “Take care of your teeth,”
■ Leader she admires: Dr. Melba J.
T. Vasquez, the 2011 APA president.
She was our first Latina president,
my practicum supervisor, and my
dissertation cochair. She has left
her fingerprints indelibly all over my
career, and we’ve become cherished
friends.
■ What sparks hope: When we rec-
ognize suffering and wish to relieve
that suffering, we are experienc-
ing one of the superpowers of our
humanity: compassion. Practicing
compassion improves our lives, fuels
positive change in societies, and sup-
ports our most vulnerable. Our ability
to experience and act on compas-
sion in service of each other and our
planet gives me hope. n
M O N I TO R O N P S YC H O LO G Y
psychology
monitor on
A publication of the American Psychological Association
VOLUME 55 | NUMBER 1
PRESIDENT Cynthia de las Fuentes, PhD
CHIEF EXECUTIVE OFFICER Arthur C. Evans Jr., PhD
Alicia Aebersold
CHIEF COMMUNICATIONS OFFICER
EDITORIAL
EDITOR IN CHIEFTrent Spiner
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Brianna Garrison
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● JA N UA R Y / F E B R UA R Y 2 0 2 4 3
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Features JANUARY/FEBRUARY 2024

SPECIAL REPORT

12 EMERGING TRENDS FOR 2024

What’s ahead for psychologists and the field?
In 2024, psychology will play a major role in pointing the way toward a healthier, more just society. With rampant
misinformation and a presidential election on the line, we all have a basic duty to engage, using the tools of
psychological science to counter falsehoods. Psychologists are also working to guide the development of generative
artificial intelligence, but there is much to learn. And the outlook for higher education, women’s and LGBTQ
individuals’ rights, racial equity, access to mental health care, workplace satisfaction, addiction rates, and much
more will depend greatly on the work of psychologists. See page 38

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 7
Departments JANUARY/FEBRUARY 2024

Dr. Elizabeth
Kolmstetter
is creating a
healthy culture
as the first chief
people officer at
the Department
of Homeland
Security.
Page 27

2 @APA: THE HOT LIST

10 PRESIDENT’S COLUMN
12 UPDATE FROM THE CEO

RESEARCH
13 IN BRIEF
22 TOP 10 DOWNLOADED
JOURNAL ARTICLES
26 DATAPOINT
100 BY THE NUMBERS

NEWS
29 JUDICIAL NOTEBOOK

PEOPLE
27 4 QUESTIONS FOR ELIZABETH
KOLMSTETTER
91 PSYCHOLOGISTS IN THE NEWS
CE CORNER
CE CORNER
30 TREATING CHALLENGING COUPLES TREATING CHALLENGING COUPLES CASES
CASES
There is a shortage of well-trained providers in couples therapy. Evidence-
CAREER based modalities have proven to be highly effective in treating couples,
93 JOBS IN THE HEALTH TECH SECTOR but practitioners must also be prepared to assess and address each
EMPLOYMENTS ADS person individually in the cases of domestic violence, addiction, or severe
98 THE BEST JOBS IN PSYCHOLOGY psychopathology. See page 30

Dogs can
increase
their owners’
happiness.
Page 13

Top 10 journal articles. Page 22 Careers in health tech. Page 93

8 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
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From the President

POPULATION HEALTH
WILL BE CENTRAL IN 2024
Psychologists have an essential role to play in transforming our nation’s health
BY CYNTHIA DE LAS FUENTES, PhD

As APA’s 2024 president, I’m most looking for- addressing the root causes of adverse
ward to working closely with so many of you to circumstances that prevent us from living
our best lives.
further our association’s mission of promoting “the Leadership is not a position or a
advancement, communication, and application of role—it is a practice that we all have a
responsibility to undertake. To that end,
psychological science and knowledge to benefit
I ask you to join me in learning the skills
society and improve lives.” of structural competencies, structural
humility, and advocacy. They are neces-
I’m a governance wonk. I believe that to enhancing our collective impact on sary components of our psychological
when we embrace our association’s mis- promoting population health as a frame- population health practice.
sion, we must also advocate for our own work in the United States. We must This is an exciting time for APA,
transformation—making sure our work is use our psychological science to under- and I am grateful that together we are
aligned with the changes we want to see stand and advocate for population-level expanding psychology’s impact to benefit
in our society and the world. Throughout interventions, focusing our attention on everyone. n
the year I’ll focus on ensuring that our
governance structures, processes, cul-
tures, and organizing documents reflect
the best practices and framework of
how a modern membership association
can thrive. My top goal is the dynamic
advancement of our strategic plan–the
direction informed collaboratively by you,
our members.
Through my extensive involvement in
state and national psychology leadership,
I have seen the various ways psycholo-
gists can be effective change agents. We
can improve the structures, processes, and
people we care about by advancing and
leveraging our science, training, practice,
and advocacy. This year, I’m committed
KUBKOO/GETTY IMAGES

● Dr. de las Fuentes is the 2024 APA president

and works as a licensed psychologist in
independent practice in Austin, Texas.

10 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
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M O N I TO R O N P S YC H O LO G Y
● NOVEMBER/DECEMBER 2023 11
From the CEO

PSYCHOLOGY LEADING
THE WAY ON FIGHTING
MISINFORMATION
As experts in human behavior, it is incumbent on us to know the latest research and be part
of the solution
BY ARTHUR C. EVANS JR., PhD

The scourge of misinformation touches every aspect of

the field of psychology. Clinicians work with patients This work builds on the partnerships
who have been subsumed by harmful conspiracy we’ve built to empower other groups to
use our science. For example, we hosted
theories. Educators are dealing with disinforma-
a briefing for journalists with the
tion propagated by generative artificial intelligence. National Press Club on how to com-
Researchers are leading the effort to find science-based bat misinformation. We’ve joined the
tools to lessen its harmful effects. I’m sure most of you News Literacy Project to help explain
have seen the harm it is doing to our institutions and communities. As why people fall for lies and conspir-
you’ll read on page 40, the fight against misinformation is one of the top acies. And we’ve worked to share our
resources with more than 90 organiza-
trends facing the field in 2024, especially with U.S. elections this fall.
tions that are part of the Coalition for
I’m proud that the U.S. Centers for become literate in the science of stopping Trust in Health and Science.
Disease Control and Prevention asked misinformation, we can help people in the Please take a moment to read the
APA to lead an international effort to spheres we operate in—whether that’s in article on misinformation in this issue,
find consensus on the latest psychological our practices, our labs, our communities, including the eight key recommenda-
research about both the causes and solu- or our families. tions from this new report. I’m hopeful
tions to this ongoing problem. A team of APA is now working to share these that with this latest information, our
leading psychological scientists spent the recommendations widely. We are also ask- field will continue to make a positive
better part of 2023 delving through doz- ing social media companies to reduce the impact on the world.
ens of research studies on misinformation spread of misinformation and are pushing I hope you had a wonderful holiday
to produce a series of recommendations for new federal funding to find more ways season and wish you a healthy start to
for policymakers, social media companies, to counter it. the new year. Stay inspired. n
and mental health providers.
The researchers found it is import-
ant to avoid repeating misinformation,
the power of “debunking” inaccuracies
repeatedly, and the importance of lever-
aging trusted sources to share accurate
information. As this is a behavioral issue,
it is incumbent on each of us as psychol-
ALICJA NOWAKOWSKA/GETTY IMAGES

ogists to know what the research says so

we can be a part of the solution. If we can

● Arthur C. Evans Jr., PhD, is the chief

executive officer of APA. You can follow him
on LinkedIn.

12 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
 In Brief
Research COMPILED BY CHRIS PALMER

Spending time
with a pet dog IT’S OFFICIAL

A
can increase dog
owners’ happiness
and reduce their
ccording to a study in Emotion,
anxiety. spending time with a pet dog can
increase dog owners’ happiness
and reduce their anxiety. Researchers first
administered a stress test to 73 dog owners
in the United States, then assigned them
to one of three conditions: experimental
(interacting with their dogs), active control (a
­stress-reducing coloring activity), or inactive
control (waiting quietly). Participants who
spent time with their dogs after undergoing a
stressful task experienced increased mood and
reduced anxiety compared with the two con-
trol groups, regardless of the participants’ prior
experiences with dogs, attitudes toward dogs,
and the characteristics of their own dogs.
Specific behaviors during the interactions,
including physical touch, were not associated
with mood outcomes, but total time spent
actively engaging with the dog was.
DOI: 10.1037/emo0001256
ASIAVISION/GETTY IMAGES

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 13
In Brief

FAILING THE BOREDOM to their students’ lives and aim

TEST for an appropriate level of dif-
Students’ boredom during tests ficulty—one that is neither too
can negatively impact exam challenging nor too easy.
results, suggests a study in the DOI: 10.1037/edu0000807

Journal of Educational Psychology.

Across two studies, researchers
surveyed 1,820 German students
in Grades 5 through 10 about
the extent of their boredom
during math exams, the difficulty
of the questions, and the per-
sonal relevance of the material
on which they were being tested.
They found that more than 50%
of the students reported being
bored during tests. Boredom
during easy tasks had no effect
on achievement, likely because
students had sufficient cogni-
tive and motivational resources
to complete the tasks anyway.
However, when the questions
were hard, participants report-
ing more boredom performed
worse than those reporting being
more engaged. The researchers
offered two recommendations
to help overcome boredom and
bring out the best in students
during exams: Teachers should
prepare exam questions relevant
FAVORABLE IDEAS
GENERATED FASTER
According to research in Amer-
ican Psychologist, when tasked
with being creative, the more
people like their ideas, the faster
they provide them. Researchers
Boredom during tests invited 71 participants in France
can negatively impact to take a free association test,
results.
which consisted of matching
words in the most audacious
ways possible. They then asked
the participants to rate how
much they liked the associations
they came up with and whether
they seemed relevant and

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 original. The researchers found
that participants more quickly
formulated ideas they later rated
as liking more. They also noted
that participants’ preferences for
ideas were driven by a combina-
tion of relevance and originality.
In addition, the researchers built
a computational model that
predicted the speed and quality
of participants’ creative proposals
based on the qualities of their
valued ideas, which were mea-
sured in a separate task.
DOI: 10.1037/amp0001165
A WARNING ABOUT
CONTENT WARNINGS
Content warnings—notes that
warn readers or viewers that
they could find certain con-
tent distressing—don’t decrease
distress but instead could cause
it, suggests research in Clinical
Psychological Science. Research-
ers analyzed 12 studies that
SVITLANA HRUTS/GETTY IMAGES
explored the effectiveness of
content warnings. They found
that warnings made no mean-
ingful difference on participants’
affect or educational outcomes
in response to negative material.
Warnings did, however, increase
feelings of anxiety ahead of
viewing the content. Findings
on whether content warnings
increased avoidance were mixed,
for some warnings had no effect
on participants’ engagement with
negative material while other
warnings increased engagement
in certain cases.
DOI: 10.1177/21677026231186625
ALTERING BRAIN WAVE
FREQUENCY RELIEVES
DEPRESSION
Deep transcranial magnetic
stimulation (TMS) improves
depression by reducing excessive
slow-frequency waves in the pre-
frontal cortex, suggests a study in
Content warnings—
notes that warn
readers or viewers
that they could find
certain content
distressing—don’t
decrease distress
but instead could
cause it.
M O N I TO R O N P S YC H O LO G Y
the Journal of Affective Disor-
ders. Deep TMS is a procedure
involving use of a noninvasive
device that generates magnetic
fields to stimulate specific deep
brain regions. Over the course
of 9 weeks, researchers adminis-
tered 36 deep TMS sessions to
each of 44 participants diag-
nosed with major depressive
disorder in the United States.
In each session, participants
received two treatments target-
ing different regions of the brain.
Participants underwent quan-
titative electroencephalography
(QEEG) to measure brain waves
before the first and after the last
deep TMS session. Participants
reported significant reduction
in depressive symptoms after
the treatment compared with
pretreatment. The ­post-treatment
QEEG recordings showed
reduced slow-frequency brain
activity (delta and theta waves)
in the prefrontal cortex com-
pared with pretreatment
recordings.
DOI: 10.1016/j.jad.2023.05.066
BLOOD PROTEINS
FORESHADOW
ALZHEIMER’S
According to a study in Sci-
ence Translational Medicine,
abnormal levels of certain
proteins—many with functions
unrelated to the brain—could
be an early sign of Alzheimer’s
disease. Researchers examined
the relationship between the
abundance of 4,877 proteins in
the blood and dementia risk over
a 25-year follow-up period in
10,981 adults ages 45 to 65 in
the United States. About 1 in 5
participants developed Alzhei-
mer’s over the study period. The
● JA N UA R Y / F E B R UA R Y 2 0 2 4 15
In Brief
researchers’ analysis identified
32 ­dementia-associated plasma
proteins that were involved in
protein regulation, immunity,
synaptic function, and extracellu-
lar matrix organization. Eight of
these candidate protein markers
were abnormally expressed in
human postmortem brain tissue
from patients with Alzheimer’s.
Using network analyses, the
researchers found a protein sig-
nature for dementia risk that was
characterized by dysregulation of
specific immune and protein reg-
ulation pathways in adults about
20 years before dementia onset
as well as abnormal coagulation
about 10 years before onset.
DOI: 10.1126/scitranslmed.adf5681
SOCIAL ISOLATION AND
BRAIN AGE
According to a study in Psy-
chological Medicine, the brains
16 M O N I TO R O N P S YC H O LO G Y
of socially isolated adults age
faster than non-isolated adults.
Researchers used data from an
ongoing longitudinal investi-
gation of all individuals born in
New Zealand between April 1,
1972, and March 31, 1973. The
study included assessments at
multiple ages, from childhood
(ages 5 to 11) to adulthood (ages
26 to 38), tracking each individ-
ual’s social isolation status. The
researchers also estimated partici-
pants’ brain health at age 45 using
structural MRI data. They found
that individuals who experienced
social isolation only in adulthood
have an estimated brain age that
is 1.73 years older on average
than those who never experienced
isolation. By contrast, experienc-
ing social isolation exclusively
during childhood was not associ-
ated with faster brain aging.
DOI: 10.1017/S0033291723001964
● JA N UA R Y / F E B R UA R Y 2 0 2 4
LARGE INCREASE
IN MENTAL HEALTH
SPENDING
Individuals who Mental health spending exploded
experienced social during the COVID-19 pan-
isolation only in
adulthood cognitively demic, as telehealth options made
age faster than services more accessible, indicates
those who never a study in JAMA Health Forum.
experienced
isolation. By contrast, Researchers examined 1,554,895
experiencing social claims from about seven million
isolation exclusively commercially insured adults in
during childhood was
not associated with the United States from Jan-
faster brain aging. uary 2019 through August
2022. During the acute phase
of the pandemic (March 2020
to December 2020), in-person
mental health services declined
by 39.5% while telemental health
services increased roughly tenfold
(1,019.3%) compared with the
prior year. Overall, there was a
22.3% increase in use of mental
health services during the period.
During the post-acute period
(December 2020 to August
2022), telemental health service
use stabilized at roughly 10
times (1,068.3%) ­pre-pandemic
levels. By August 2022, in-person
mental services had returned to
79.9% of pre-pandemic levels.
Overall, mental health service use
in August 2022 was nearly 38.8%
higher than before the pandemic.
The average post-acute mental
health spending each month per
10,000 beneficiaries was more
than $3.5 million compared with
about $2.3 million during the
­pre-pandemic period (a 53.7%
increase).
DOI: 10.1001/jamahealthforum.2023.2645
THE PATH OF SOCIAL
ANXIETY
TOMMASO79/GETTY IMAGES
When choosing how to behave
in socially challenging situa-
tions, people who are anxious
use a different region of their
 prefrontal cortex than people who
are not anxious, according to a
study in Nature Communications.
Researchers presented 96 partic-
ipants in the Netherlands, about
half of whom experienced high
levels of anxiety, with the task
of using a joystick to approach
happy faces and avoid angry
ones. Then the task switched—
approach angry faces and avoid
happy ones—forcing participants
to control the automatic ten-
dency to avoid negative situations.
Anxious participants performed
just as well as non-anxious
participants in this simple task.
However, fMRI brain scans of
HALBERGMAN/GETTY IMAGES
and the motor cortex—a direct,
thus more efficient, neural path-
way. Anxious individuals relied on
indirect, less efficient neural paths
running through the dorsolateral
and medial prefrontal areas. A
different imaging protocol track-
ing the neurochemical GABA
indicated that this inefficiency
Higher rates of
cognitive impairment
were found among
people who reported
working night shifts.
SHIFT WORK LINKED TO
COGNITIVE IMPAIRMENT
Middle-age and older adult shift
workers are at an increased risk of
cognitive impairment, accord-
ing to a study in PLOS ONE.
Researchers analyzed data from
a longitudinal study of 47,811
Canadian adults ages 45 to 85.
Overall, 21% reported having
conducted some kind of shift
work—any work schedule that
occurs outside the traditional 9
a.m. to 5 p.m. working hours—
over their career. Higher rates of
cognitive impairment were found
among participants who reported
working night shifts for their

non-anxious participants, per- likely occurs because the more current job or during the job they
formed during the second task, suitable neural path becomes had held the longest compared
revealed signaling between the overstimulated in anxious people. with those who only reported
foremost prefrontal cortex region DOI: 10.1038/s41467-023-40666-3 working during daytime hours.

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M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 17
In Brief
Specifically, night shift work was associ-
ated with memory function impairment
and rotating shift work was associated
with impairment of executive function
when compared with daytime workers.
DOI: 10.1371/journal.pone.0289718
FEWER MEDICAL RESIDENTS
EXPERIENCE PTSD
First-year medical residents trained
during the first wave of the COVID-19
pandemic were less likely to experience
post-traumatic stress disorder (PTSD)
symptoms than residents trained before
the pandemic, according to a study in
JAMA Network Open. Researchers ana-
lyzed two waves of data (2018 to 2019
and 2019 to 2020) from a longitudinal
cohort study of first-year resident phy-
sicians in the United States (1,137 and
820 participants, respectively). Compared
18 M O N I TO R O N P S YC H O LO G Y
with residents trained pre-pandemic, res-
idents trained during the pandemic were
significantly less likely to screen posi-
tive for PTSD (7.1% versus 10.7%) and
workplace trauma exposure (50.9% versus
56.6%), researchers found. Residents
trained during the pandemic reported
3.1 fewer weekly duty hours, lower mean
reports of medical errors, and higher
workload satisfaction, suggesting those
factors as potential targets for future
interventions against PTSD.
DOI: 10.1001/jamanetworkopen.2023.30241
ADHD DX, RX SKYROCKETING
IN MEN
A study in BJPsych Open revealed a
20-fold increase in ADHD diagnoses
(DX) in U.K. men ages 18 to 29 from
2000 to 2018, with a nearly 50-fold
increase in prescriptions. Researchers
● JA N UA R Y / F E B R UA R Y 2 0 2 4
reviewed medical data from seven million
individuals ages 3 to 99 in a U.K. pri-
mary care database. Of these individuals,
35,877 had an ADHD diagnosis and
18,518 received prescriptions for ADHD
medication from their primary-care phy-
sician. Among boys ages 10 to 16, 1.4%
had an ADHD diagnosis and 0.6% had
been prescribed ADHD medication in
2000, rising to 3.5% and 2.4%, respec-
tively, in 2018. During that same period,
men between the ages of 18 and 29 saw
a 20-fold increase in ADHD diagno-
ses (from about 0.025% to 0.5%) and a
nearly 50-fold increase in ADHD pre-
scriptions (from about 0.01% to 0.56%).
There were no significant increases, how-
ever, in children under 5.
DOI: 10.1192/bjo.2023.512
BOSSES INFLUENCE
RECEPTIVITY TO FAKE NEWS
Research in Scientific Reports suggests
that individuals with authoritarian bosses
are more likely to agree with fake news.
Researchers asked 501 respondents in
the United Kingdom, United States,
Australia, and Canada to categorize
their immediate superior as autonomous,
paternalistic, or authoritarian. Partic-
ipants then assessed the accuracy of
four fake news headlines and imagined
that their boss had shared one of these
articles on social media. The researchers
found that participants with authoritar-
ian and paternalistic bosses were more
likely to agree with fake news compared
with those with autonomous supervi-
sors, though the effect was stronger with
authoritarian bosses. Those with author-
itarian bosses also tended to rate fake
news articles as more accurate compared
with participants with autonomous
leaders. The findings remained consistent
GORODENKOFF/GETTY IMAGES
even after controlling for various factors,
such as the perceived competence of
the leader, transformational leadership,
demographics, and political ideology.
DOI: 10.1038/s41598-023-39807-x

Children living in food-
insecure households had
a 55% higher frequency of
physician visits for mental
health reasons than those
with enough food at home.
EHR MESSAGE OVERLOAD
According to a study in JAMA Net-
work Open, the number of electronic
health record (EHR) messages patients
sent increased eightfold during the
­COVID-19 pandemic. Researchers
analyzed EHRs of 4,724 outpatients
receiving psychiatric treatment at a large
academic medical center in the United
States. They tallied all patient-initiated
messages pre-pandemic ( June 2, 2018,
to March 18, 2020) and mid-pandemic
(March 19, 2020, to January 3, 2022)
for patients with at least one sched-
uled appointment in either period. The
researchers found the total monthly
message volume increased from 4,661
in the pre-pandemic period to 44,929 in
the mid-pandemic period, an increase
of 861.5%. Message rates increased even
when COVID-19 infection rates went
down and patients could go to appoint-
ments in person. Patients identifying as
White were more likely to send messages
SDI PRODUCTIONS/GETTY IMAGES
before and during the pandemic. Men
were more likely than women to send
messages pre-pandemic, but that trend
reversed during the pandemic.
DOI: 10.1001/jamanetworkopen.2023.25202
MORE MENTAL HEALTH ISSUES
FOR FOOD-INSECURE CHILDREN
Children living in food-insecure house-
holds had a 55% higher frequency
of physician visits for mental health
reasons than those with enough food
at home, according to a study in the
Canadian Medical Association Journal.
Researchers used population health sur-
vey data to categorize household food
access for 32,321 Canadian children and
adolescents. Of the total, 5,216 (16.1%)
were living in food-insecure households.
The researchers found that children and
adolescents in food-insecure homes
had more past-year physician visits to
address mental health or substance use
disorders than those in food-secure
homes, corresponding to increases of
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M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 19
In Brief

55% for outpatient visits and 74% for

acute care visits. The most common
visits were for neurodevelopmental dis-
orders and mood and anxiety disorders.
DOI: 10.1503/cmaj.230332

PARENT DIAGNOSES TIED

TO PRETERM BIRTHS
A PLOS Medicine study indicates that
babies of mothers and fathers diagnosed
with psychiatric disorders are more
likely to be born prematurely. Research-
ers analyzed data on all 1,488,920
live births in Sweden between 1997
and 2016. They found that for parents
without a psychiatric diagnosis, 5.8%
of babies were born preterm. A pater-
nal diagnosis increased the risk to 6.3%
of births and a maternal diagnosis
increased the risk to 7.3% of births. The
risk of preterm birth was highest, 8.3%,
when both parents had a diagnosis.
The risk increased when either parent
was diagnosed with several coexisting
psychiatric disorders. Stress-related dis-
orders were associated with the highest
risks of preterm birth.
DOI: 10.1371/journal.pmed.1004256

Babies of mothers and

fathers diagnosed with
psychiatric disorders are
more likely to be born
prematurely.

20 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
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M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 21
News
THE TOP 10
JOURNAL ARTICLES
In 2023, APA’s 89 journals published more than 5,500 articles.
Here’s a quick look at the 10 most downloaded to date. BY CHRIS PALMER
1. Looking through a filtered lens:
Negative social comparison on social
media and suicidal ideation among
young adults.
Spitzer, E. G., et al.
Y oung adults who engage in com-
parisons to others on social media
and thus feel bad about themselves are
more likely to think about suicide, this
research in Psychology of Popular Media
22 M O N I TO R O N P S YC H O LO G Y
(Vol. 12, No. 1) suggests. Researchers
surveyed 456 college students about their
frequency of social media use and used
scales to assess participants’ tendency
to engage in negative social comparison
on Instagram and Facebook, suicidal
ideation, and thwarted belongingness
(i.e., feeling as if lacking connections or
meaningful relationships with others).
Results indicated that participants who
engaged in negative social comparisons
● JA N UA R Y / F E B R UA R Y 2 0 2 4
The most downloaded study
found that young adults who
engage in comparisons to others
on social media are more likely
to think about suicide.
were more likely to report suicidal
ideation than those who did not. Specifi-
cally, on Instagram, those who negatively
compared themselves to others the most
also showed the highest levels of associ-
ation between thwarted belongingness
and suicidal ideation. These findings
MINISERIES/GETTY IMAGES
suggest the need for limits on social
media use and education around its men-
tal health effects.
DOI: 10.1037/ppm0000380
 2. Self-compassion and women’s
experience of social media content
portraying body positivity and appear-
ance ideals.
Rutter, H., et al.
T he type of social media con-
tent women view can affect their
self-compassion—how kind to them-
selves and accepting of their flaws they
are—suggests this study in Psychology of
Popular Media (advance online publica-
tion). In two experiments, a total of 247
women viewed content consistent with
appearance ideals (fitspiration body
photos; faces with makeup), appear-
ance-neutral content (landscapes), or
body-positive content (body-positive
body photos, body-positive quotes, faces
without makeup). In both experiments,
women who viewed content consis-
tent with appearance ideals reported
a state of worse self-compassion and
worse thoughts about themselves than
those who viewed body-positive or
­appearance-neutral content. Women
who already had daily low self-com-
passion or high disordered-eating
symptoms were the most affected by
viewing content consistent with appear-
ance ideals. On the contrary, viewing
body-positive content increased the
state of self-compassion relative to
viewing appearance-neutral content.
DOI: 10.1037/ppm0000453
PEKIC/INVINCIBLE_BULLDOG/GETTY IMAGES
Reducing social media use can improve
body image.
■ PsycArticles is available by
subscription to institutions throughout
the world. These are the articles
published this year that were
downloaded most often between
January and September 2023. More at:
https://go.apa.org/psycarticles/
I n this review, published in Psychol-
3. Reducing social media use
improves appearance and weight
esteem in youth with emotional
distress.
Thai, H., et al.
R educing smartphone social media
use to 1 hour per day might
improve body image and weight esteem
in youth with emotional distress who
are heavy social media users, this study
in Psychology of Popular Media
(advance online publi-
cation) suggests. The
researchers randomly
assigned 220 partici-
pants (ages 17 to
25 who used social
media at least 2
hours per day) to
either a 4-week inter-
vention in which
they limited their
social media use to 1
hour per day or to a control
condition with unrestricted
access to social media. After
the 4-week intervention, the
group with restricted social
media use felt better about their
appearance and weight relative to
before the intervention, whereas the
other group showed no changes. Thus,
reducing smartphone social media use
appears to be a good method to improve
how youths feel about their appearance
and weight and could become a compo-
nent in the prevention and treatment of
body image–related disturbances.
DOI: 10.1037/ppm0000460
M O N I TO R O N P S YC H O LO G Y
4. Interventions to reduce the neg-
ative impact of online highly visual
social networking site use on mental
health outcomes: A scoping review.
Herriman, Z., et al.
ogy of Popular Media (advance online
publication), researchers identified 39
studies published between 2011 and
2022 that examined how interventions
designed to reduce the negative impact
of online highly visual social network-
ing site (e.g., Facebook, Instagram)
use impact mental health. Most of
the studies were conducted on West-
ern adults younger than age 35 and
varied widely in terms of the variables
assessed, making it difficult to highlight
overall conclusions.
Nevertheless, results
indicate that inter-
ventions focused on
reducing the exposure
to highly visual social
media platforms ben-
efited well-being but
may also reduce social
connectedness. Inter-
ventions focused on
social media literacy
programs may reduce
addiction and improve
body image. Other
interventions that
adopted varied psy-
chological approaches
did not appear to lead
to significant results. The researchers
also highlighted the gaps in research
that should be addressed to improve the
efficacy of such interventions, includ-
ing a need for interventions that are
more guided by psychological theories
and assessments of these interventions
that are rigorous and include diverse
populations.
DOI: 10.1037/ppm0000455
● JA N UA R Y / F E B R UA R Y 2 0 2 4 23
Top 10 Journal Articles

5. On the outside looking in: Social
media intensity, social connection,
and user well-being: The moderating
role of passive social media use.
Roberts, J. A., & David, M. E.
rated the internet (e.g., Wikipedia,
medical websites) as their most used
information source, followed by friends
and family, therapy, and social media.
Participants with an anxiety diagnosis or
severe symptoms sought information on

A ccording to this study in the

Canadian Journal of Behavioural
Science (Vol. 55, No. 3), heavy passive
social media use may be linked with a
weaker sense of social connection and
well-being. In two survey-based stud-
ies with 226 participants in the United
States, researchers found that passive
engagement with social media (viewing
social media but not regularly posting
or interacting through the platform)
was associated with less social con-
nection, lower well-being, and higher
stress. In a third, experimental study,
with 160 participants, the research-
ers asked participants to use social
media heavily (10 minutes) or lightly
(5 minutes) and engage with it actively
or passively. The results indicated that
heavy social media use had a negative
impact on feelings of social connec-
tion when used passively but a positive
effect when used actively.
DOI: 10.1037/cbs0000323
C ognitive behavioral therapy (CBT)
6. Social media usage is associated
with lower knowledge about anxiety
and indiscriminate use of anxiety
coping strategies.
Wolenski, R., & Pettit, J. W.
social media more frequently than the
other participants. Across all partici-
pants, those who sought information on
social media more frequently showed
a lower knowledge about anxiety and
were more likely to report using both
adaptive and maladaptive strategies to
reduce anxiety. On the contrary, using
the internet was associated with more
knowledge about anxiety. These findings
suggest the need to promote the dissem-
ination of accurate information about
anxiety on social media.
DOI: 10.1037/ppm0000456
7. An evaluation of cognitive behav-
ioral therapy for substance use
disorders: A systematic review and
application of the society of clinical diminish over time (i.e., CBT was most
psychology criteria for empirically sup- effective at early follow-up of 1 to 6
ported treatments. months posttreatment compared with
Boness C. L., et al. late follow-up of at least 8 months post-
treatment). The researchers recommend
is an empirically supported treat-
ment for substance use disorder (SUD),
CBT to be used as an evidence-based
approach to SUD but highlight the need
for more research to identify patient
is the conclusion of this review in Clin- characteristics that might moderate
ical Psychology: Science and Practice (Vol. response to CBT and the best deploy-
30, No. 2). The researchers reviewed five ment of CBT (e.g., as a standalone or an
meta-analyses of the effect of CBT on adjunct intervention).
SUD, but only one had sufficient quality

S
ocial media might not be the best
source to learn about anxiety and
how to reduce it, this study in Psychol-
ogy of Popular Media (advance online
publication) suggests. Young adults
(N=250) responded to an online survey
in which they reported their sources of
information about anxiety, the strate-
gies they use to cope with anxiety, and
their anxiety symptoms and severity.
The researchers also tested participants’
knowledge about anxiety. Participants
for inclusion to evaluate the size of the
effects of CBT. This ­meta-analysis found
that CBT produced small to moder-
ate effects on SUD when compared
with minimal treatment (e.g., waitlist,
brief psychoeducation) and nonspecific
treatment (e.g., treatment as usual, drug
counseling). These effects were smaller
in magnitude when compared with other
active treatments (e.g., motivational
interviewing, contingency management).
The effects of CBT on SUD tended to
DOI: 10.1037/cps0000131
8. A network approach to understand-
ing parenting: Linking coparenting,
parenting styles, and parental involve-
ment in rearing adolescents in
different age groups.
Liu, S., et al.
M others’ and fathers’ behaviors that
promote a sense of family integrity
(i.e., co-parenting integrity), warmth,
and emotional involvement are central

24 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4

In two-parent households, findings
suggest that maternal integrity,
warmth, and emotional involvement
remain important throughout
adolescence.
components of the parenting network
in two-parent families, according to
this study in Developmental Psychology
(Vol. 59, No. 4). Researchers used net-
work analysis to explore different facets
of maternal and paternal co-parenting
(e.g., integrity, conflict), parenting styles
(e.g., rejection, warmth), and parental
involvement (e.g., emotional support,
discipline) in two-parent families in
China with a total of 4,852 adoles-
cents at different stages of adolescence.
They found that maternal and paternal
co-parenting integrity, warm parenting
style, and emotional involvement were
key to the parenting network, as indi-
cated by the central spot they occupied
FG TRADE/SCHULTEPRODUCTIONS/GETTY IMAGES
in the network analysis. They also found
that the expected influence of these
characteristics varied for adolescents in
different developmental stages—mater-
nal integrity, warmth, and emotional
involvement were important through-
out adolescence, but paternal integrity,
warmth, and emotional involvement
were particularly important in early
adolescence. The results suggest that
supportive parenting might be a prime
target for enhancing parenting systems.
DOI: 10.1037/dev0001470
9. Seeking connection, auton-
omy, and emotional feedback:
A ­self-determination theory of
­self-regulation in attention-deficit
hyperactivity disorder.
Champ, R.E., et al.
In this article in Psychological Review
(Vol. 130, No. 3), the authors pro-
pose a new framework on the basis
of self-determination theory (SDT)
for understanding attention-deficit
hyperactivity disorder (ADHD) and
developing treatment approaches. The
researchers suggest that using SDT,
which proposes that humans have a
natural tendency toward growth and
self-actualization, supporting intrin-
sic motivation and self-organization,
can offer a new positive understand-
ing of ADHD and its symptoms. This
approach counters the negative charac-
terizations of ADHD; moves beyond
symptom reduction and the focus on
how ADHD presents motivation,
engagement, and self-regulation issues;
and instead focuses on potential posi-
tive aspects of ADHD and well-being.
In addition, the framework highlights
the need to help individuals with
ADHD better understand how they
function, tell the difference between
biological and individual needs,
and develop self-autonomy and
self-regulation skills. Accord-
ing to this SDT approach,
treatments that are auton-
omy supportive and increase
self-determination could
improve the functioning of
individuals with ADHD.
DOI: 10.1037/rev0000398
M O N I TO R O N P S YC H O LO G Y
10. The organizational psychology of
gig work: An integrative conceptual
review
Cropanzano, R., et al.
T
his review in Journal of Applied
Psychology (Vol. 108, No. 3) inves-
tigates how organizations engage with
gig workers and how these work-
ers adapt. Researchers reviewed 243
articles about gig work published in
management and psychology jour-
nals that provided a conceptually clear
definition of gig work. They found
that organizations break jobs into
standardized tasks, and gig workers
adapt by stringing tasks together to
craft their own jobs and work iden-
tities. Second, the temporary nature
of their jobs is reflected in the com-
mitment gig workers feel toward an
employer. Third, organizations use a
variety of nontraditional management
practices (e.g., decision-making algo-
rithms), and gig workers adjust their
behavior to balance perceived auton-
omy and dependence. Fourth, because
compensation for gig work is mostly
project based and lacking in benefits,
gig workers adopt a “ jack-of-all-trades”
mindset and learn to deal with pay
volatility. Fifth, employers offer little
training to gig workers, who adapt by
engaging in self-development. Sixth,
gig workers develop alternative social
relationships at work by finding their
place in blended teams and/or adapt to
social isolation.
DOI: 10.1037/apl0001029
● JA N UA R Y / F E B R UA R Y 2 0 2 4 25
Research

Datapoint
By Meron Assefa,
TiShawn Polk, Cory Page,
Wendy R. Williams, PhD,
and Karen Stamm, PhD

NEWS ON PSYCHOLOGISTS’ EDUCATION AND EMPLOYMENT FROM APA’S CENTER FOR WORKFORCE STUDIES

TRENDS IN GRE REQUIREMENTS AND APPLICATIONS

FOR GRADUATE PSYCHOLOGY PROGRAMS
From 2020 to 2023, GRE requirements continued to drop while applications increased
The percentage of psychology graduate programs requiring GRE scores decreased substantially between the 2020–21 and 2021–22 aca-
demic years and continued to decrease in the 2022–23 academic year.1 The percentage of doctoral programs requiring GRE Quantitative
and GRE Verbal scores decreased from 45% to 14%, and GRE Writing score requirements decreased from 40% to 13%. Psychology master’s
programs saw similar declining patterns in GRE requirements, with fewer master’s programs requiring GRE scores compared with previous
years. These trends suggest that graduate programs have reduced their emphasis on standardized test scores.

GRE Requirements for Psychology Doctoral and Master’s Degree Programs

■ 2020–21 ■ 2021–22 ■ 2022–23

50%
45% 45%
40% 40%
36% 37%

30%
28%
26% 26%
23%
20% 22%
21%

14% 15% 15% 14% 14%

10% 13%
9%

0% GRE Quantitative GRE Verbal GRE Writing GRE Quantitative GRE Verbal GRE Writing
MASTER’S DOCTORAL

Degree Level/GRE Requirements

At the same time, the number of applications for both master’s and doctoral programs has been increasing steadily. Doctoral psychology program
applications saw a continuous rise from an average of 95 applications in 2020–21 to 133 applications in 2022–23. Master’s psychology programs
also rose, though at a slower rate, from an average of 73 to 86 applications. It is possible that, among other factors, the lack of a GRE requirement
may have removed a perceived barrier to graduate education and may have led to more students applying to psychology graduate programs.

Trends in Average Number of Applications Received per Program

■ Master’s ■ Doctoral

140
133
120
116
100
95
80 86
84
60 73

40
20
0 2020–21 2021–22 2022–23
Academic Year

1 Data is from Graduate Study in Psychology, an annual survey conducted by APA’s Education Directorate. For the 2020–21 cycle, a total of 296 departments and schools in the United States and Canada provided responses on
912 graduate programs in psychology. For the 2021–22 cycle, a total of 297 departments and schools provided responses on 962 graduate programs in psychology. For the 2022–23 cycle, a total of 332 departments and schools
provided responses on 893 graduate programs in psychology.

Want more information? See CWS’s interactive data tools at www.apa.org/workforce/data-tools/index or contact cws@apa.org.

26 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
Conversation
4 QUESTIONS FOR ELIZABETH
KOLMSTETTER
The I/O psychologist is creating a healthy culture as the first chief people officer within the
Department of Homeland Security
A
BY KIRSTEN WEIR
fter working across
public agencies includ-
ing NASA, the CIA,
the FBI, and the
Transportation Secu-
rity Administration,
industrial and organizational (I/O) psy-
chologist Elizabeth Kolmstetter, PhD, is
no stranger to the challenges facing the
federal workforce. But work has changed
in the post-COVID-19 era, and employ-
ers are looking for new ways to balance
flexibility and productivity. So, in 2022,
when Kolmstetter was recruited as chief
people officer of the Cybersecurity and
Infrastructure Security Agency (CISA),
the newest agency of the Department of
Homeland Security (DHS), focused on
protecting the nation’s critical infrastruc-
ture from physical and digital threats, she
jumped at the chance to build a company
culture (almost) from scratch.
“Now that we’ve entered the hybrid
era, we have to design the workplace to
create meaningful connections while
allowing people as much flexibility as
possible in terms of where and when they
work,” she said. “It’s uncharted territory.”
Kolmstetter spoke with the Monitor
about the course she is mapping.
What does a chief people officer do?
I was recruited by CISA’s director,
Jen Easterly. Her goal was to create a
­people-first agency that cares for employ-
ees as people, not as workers here to get a
paycheck. There are chief people officers
in the private sector, but usually human
resources operations are included under-
neath that person. Director Easterly’s
vision was to make it a separate role. We
have a chief human capital officer focused
on things like hiring, pay, benefits, annual
appraisals, and retirement. They make sure
we have the right people with the right
tools. But what is the employee experience
at CISA? Are people at risk of burnout
or disengagement? I’ve been charged with
driving the people-first culture that sup-
ports well-being, engagement, and success.
That, in turn, ensures we have the organi-
zational capacity to achieve the agency’s
mission of preventing cyberattacks.
What are the challenges facing CISA’s
workforce?
CISA is growing rapidly. Our workforce
is about 3,100 civil servants, and a third
of them have been hired in just the past
2 years. It’s largely a STEM workforce,
a lot of engineers and analysts looking
at vulnerabilities in technology. Because
M O N I TO R O N P S YC H O LO G Y
technology touches everything, cyber-
security touches everything: hospitals,
education, the electric grid, water supply,
physical infrastructure, chemical security,
and more. The workload in cybersecurity
just keeps growing, and we need enough
people to do this complex work.
As a national security agency, we
have staff on alert in our control centers
24/7. The pace of hacks and cybersecu-
rity attacks is unforgiving, so I’m always
concerned about stress and burnout.
We need to create balance between
work and personal life so our people can
maintain physical and mental resilience.
Another challenge has to do with our
agency’s identity and culture. Although
the agency was created in 2018, CISA
existed as a smaller entity within DHS
headquarters almost 20 years before that.
So, there’s new infrastructure and new
ideas, but also legacy employees who are
steeped in doing things the way they’ve
been done for years. We have to create a
new culture that works for everyone.
What kinds of programs and policies are
you establishing?
We want to make sure that our people are
healthy and well, which means train-
ing our supervisors and managers to see
employees holistically and recognize that
our organizational culture is flexible about
meeting people’s needs. We built a CISA
KAREN BIAGAS-POWELL/CISA PHOTOGRAPHER
Cares program that provides ­wide-ranging
support services for mental and physical
health and well-being, including psychi-
atry and psychology services, as well as a
program affording 3 hours per week of
duty time for physical fitness. We have
a weekly town hall meeting that often
● JA N UA R Y / F E B R UA R Y 2 0 2 4 27
Conversation

features experts speaking about topics like burnout, resilience, UPCOMING 2024
CONTINUING
and suicide prevention. And we’ve rolled out psychological
safety training based on the work of Harvard Business School
researcher Amy Edmondson, PhD. We think a lot about how to

EDUCATION
create a safe space where people can be authentic and feel safe
raising ideas and concerns. That’s just for starters.

PROGRAMMING
Are there strategies you are developing that could be a model
for other workplaces?
We’re being very intentional about building a new culture, and
I do think it could serve as a model. We’ve created a culture
council that includes representatives from every division. Differ- APA… Advancing the skills of psychologists! Select
ent departments have very different missions, and this council from an outstanding lineup of APA CE programs
allows us to make sure we are thinking of everyone as we scale spanning a range of formats and topics.
best practices across the organization. We’re also doing a lot
with diversity and inclusion. CISA has worked hard to recruit
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a diverse workforce that reflects the makeup of the American
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We’re also thinking a lot about internal mobility. I/O psy- PROMO CODE: 2024NEWIS
chologist Edie Goldberg, PhD, has done a lot of research on this, (expires on January 31, 2024)
and I agree with her that we don’t think about it enough as a
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30 years, nor should they be. When people are ready to expand
their experience, they often think they have to get another job
somewhere else. I’m trying to build an internal mobility program LIVE WEBINAR SERIES
so that people have those workforce development opportunities • Artificial Intelligence Institute
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We have also designed a custom 360-degree feedback program • Interprofessional Continuing Education
that all supervisors, managers, and executives participate in, as • Psychological Assessment Institute
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and telework. Year after year, we can compare those metrics to LEARN MORE AT WWW.APA.CONTENT.ONLINE
ensure that we’re creating the healthy culture we’ve envisioned.
When people talk about measuring productivity, they’re The American Psychological Association is recognized by the New York
often still just counting outputs. For our national security mis- State Education Department’s (NYSED) State Board for Psychology as
sion, productivity includes collaboration, partnering, teamwork, an approved provider of continuing education for licensed psychologists
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information sharing, awareness, trust, and flexibility. That kind
of productivity doesn’t come from sitting alone at your desk at Disclaimer: Book-based programs are not currently in compliance with the
unique requirements imposed by the New York State Board of Education for
home building widgets. We need more psychological research New York licensed psychologists CE.
on the benefits of person-to-person connections as well as
“alone time” or “thinking time” so employers can determine the
right mix. Hybrid work is here to stay, and psychologists have to
weigh in on this if we’re going to balance the benefits of remote
work with the importance of human connection. n

28 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
 Judicial Notebook
IS THE RIGHT TO BEAR ARMS ABSOLUTE?
The U.S. Supreme Court is addressing whether those who have a domestic violence
restraining order against them can keep their guns
D
BY CYNTHIA CALKINS, PHD, CITY UNIVERSITY OF NEW YORK AND JOHN JAY COLLEGE OF CRIMINAL JUSTICE
uring an argument in December 2019, Zackey
Rahimi knocked his girlfriend to the ground,
dragged her to his car, and fired a shot into the
air. The incident led to the filing of a domes-
tic violence restraining order against Rahimi in
2020, which meant that he was no longer permitted to possess
a firearm, according to Section 922(g)(8) of the U.S. Code.
And yet, in the year that followed, Rahimi threatened another
woman with a gun and participated in a series of five shoot-
ings. The shootings led to a search warrant for Rahimi’s home,
where firearms were found. Rahimi was charged under U.S.C.
922(g)(8) for possessing a gun while subject to a domestic vio-
lence restraining order.
Though Rahimi argued that he had a Second
Amendment right to possess firearms, he was
convicted of unlawful firearm possession in federal
district court and sentenced to more than 6 years
in prison. The Fifth Circuit initially upheld U.S.C.
922(g)(8) but then withdrew its opinion after the AT ISSUE
U.S. Supreme Court ruling in New York State Rifle Should the
& Pistol Association, Inc. v. Bruen—the first major government
firearms case that the Supreme Court had ruled prohibit
dangerous people
upon in recent years—which found that the right
from having guns?
to bear arms in public is not a “second class right,”
or allowable only through discretionary evaluation
of need made by local authorities. The Fifth Circuit
later ruled that U.S.C. 922(g)(8) violated Rahimi’s
more broadly construed constitutional right to bear
arms. The U.S. Supreme Court started reviewing the
case in November 2023 and will address whether • injury. Should the Supreme Court rule in favor of
the government can limit the right to bear arms to
SILVIU OJOG/THE NOUN PROJECT
“Judicial
only those who are “law abiding, responsible citi- Notebook”
is a project of
zens” or whether individuals such as Rahimi can be APA Div. 9
prohibited from owning a firearm. (Society for the
Psychological
Among the many amicus briefs submitted in this Study of Social
case is that of the National Association of Federal Issues).
M O N I TO R O N P S YC H O LO G Y
Defenders, who, in support of Rahimi, argue
that Section 922(g)(8) is dissimilar to histori-
cal firearms restrictions, as it does not require an
individualized assessment of dangerousness but
rather aims to disarm an entire class of people
through a blanket ban on firearm possession. The
American Medical Association (AMA), who also
submitted an amicus brief, noted that preventing
individuals subject to domestic violence restraining
orders from owning guns will, quite simply, save
lives. In the brief, the AMA points to a “vast body
of evidence establishing the lethal nexus between
domestic violence and firearms,” citing research by
Jacquelyn C. Campbell, PhD, and colleagues, who,
in a large 11-city study of femicide, found that
access to firearms substantially increased the risk of
lethal domestic violence against women (American
Journal of Public Health, Vol. 93, No. 7, 2003). The
AMA also pointed out that homicide is the leading
cause of death during pregnancy and that guns are
the leading cause of death of children and teens,
with many of these childhood deaths by firearm
linked to domestic violence.
Psychological research on this topic must
continue to advance our understanding of how
economic disparities, education, and substance
use contribute to the already established connec-
tion between gun access and domestic violence.
Research might also address how strategies other
than gun laws, such as individualized safety
plans created by psychologists or medical profes-
sionals, can be used to reduce gun violence and
Rahimi, this may mean more access to firearms
by individuals with a history of domestic violence.
Psychologists who work with victims of intimate
partner violence should be prepared to assess access
to weapons and discuss with victims of domestic
violence the heightened risk that guns present. n
● JA N UA R Y / F E B R UA R Y 2 0 2 4 29
30 M O N I TO R O N P S YC H O LO G Y ● SEPTEMBER 2023
CE Corner

CE
Evidence-based modalities are
extremely effective in treating
couples, according to psychol-
ogists who specialize in such
treatment. In fact, 70% of couples
report positive effects of coun-
seling (Lebow, J. L., et al., Journal
of Marital and Family Therapy,
Vol. 38, No. 1, 2012), though those
rates vary depending on the type
of couples therapy provided, how
CONTINUING EDUCATION often research is conducted on
TREATING CHALLENGING the modality, and whether the
COUPLES CASES therapy is delivered by a special-
ist or a generalist, for example
BY TORI DEANGELIS
(Lebow, J., & Snyder, D. K., Family
Process, Vol. 61, No. 4, 2022).
But good outcomes depend
on good training, and there aren’t
enough well-trained providers to
go around, said Terence Patter-
son, EdD, ABPP, a couple and
family psychologist in San Fran-
cisco and coauthor of Real-World
Couple Counseling and Therapy:
An Introductory Guide (Cognella,
2020). At best, most psychology
graduate programs give only cur-
sory attention to family, couple,
for Couple & Family Psychology),
through relevant APA CE presen-
tations, and through institutions
that feature these trainings (see
Training Resources for more). The
most comprehensive credential
in the area is board certification
in couple and family psychology,
which offers both standard and
senior levels of certification; to
qualify, psychologists must meet
certain training and supervision
criteria and pass an exam, Patter-
son explained.
TREATMENT BASICS
Many couple psychologists use
a particular theoretical orienta-
tion in their couple work—say,
cognitive behavioral therapy
or existential therapy—but are
trained in various couple meth-
odologies and are flexible in their
approach. Good couple therapists
use approaches that best fit the
patient rather than the other way
around, Patterson said.
To this end, he and others
cite several universal strategies

F
and systems therapy, and even
orming and maintaining mutually satisfying marriage and family therapists
relationships is challenging, and divorce rates may not get adequately trained in
show that humans are not that great at it. couple work, he and others said.
However, psychological science is helping to iden- To become competent in
tify unreconcilable trouble spots as well as ways to the area, it is important to seek
heal relationship fractures. out specialized training for
evidence-based modalities such
as behavioral couples therapy,
cognitive behavioral couples
CE credits: 1
therapy, emotionally focused ther-
Learning objectives: After reading this article, CE candidates apy, and integrative behavioral
will be able to:
couples therapy (Doss, B. D., et
1. Describe the best evidence-based treatments for address-
al., Journal of Marital and Family
ing couple issues in therapy.
Therapy, Vol. 48, No. 1, 2022).
that can help with most couple
issues that you might find yourself
working with, including the most
challenging cases:
■ Assess first. Patterson always
begins with a comprehensive ini-
tial assessment, which takes place
in the first two to three sessions.
After asking about the couple’s
stated goals for treatment,
providers can use standardized
measures or interview the couple
to learn about the systemic
context and “ecology” of the
DEDRAW STUDIO/GETTY IMAGES

2. Identify common types of challenging couple cases and

ways of treating them.
3. Discuss optimal training levels in couples therapy, how to
receive such training, and gaps in the field.
For more information on earning CE credit for this article, go
to www.apa.org/ed/ce/resources/ce-corner.
Few or no programs currently
offer full, sequential training in
couples therapy, but psycholo-
gists can access relevant trainings
by contacting APA Div. 43 (Society
relationship—for example, how
partners solve problems together,
whether they communicate
clearly, whether they share joint
responsibilities, and the degree to

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 31
CE Corner

which they accept their partner as meaning to the couple, what

they are. The aim, Patterson said, helps them develop greater inti-
is to improve on these areas as macy, and how they can balance
treatment progresses. the tension between the need
It is also important at the for safety and security and the
beginning to develop a clear idea need for freedom, individuation,
of what you see as the main treat- and adventure. noted. “When we put people in
ment issues and how you plan categories, we fail to understand
to address them, said Corinne ■ Look beneath communica- them,” she said. “Their experience
Datchi, PhD, ABPP, a couple psy- tion problems. Communication of being gay, Black, or other may
chologist, professor of psychology is often considered the factor be very different from another
at William Paterson University in that couples need to work on person who may be part of the
Wayne, New Jersey, and coauthor the most. But poor communi- same category.
of Integrative Couple and Family cation often masks other major “The most important thing is to
Therapies: Treatment Models for issues such as unsolvable be curious, humble, and ask ques-
Complex Clinical Issues (APA, problems, unresolved resent- tions,” Datchi added. “Assume that
2019). “It’s really important to be ments, age-old baggage, money you don’t know anything about
clear about what principles and problems, competition, trauma, their unique experiences, for-
concepts inform your understand- or opposing values or views. mulate hypotheses that you can
ing of what is happening in a Therefore, besides helping share with the couple, and invite
couple relationship,” she said. couples develop better joint them to verify that these hypoth-
communication, it is important eses are good representations of
■ Use a relational lens. It may to probe what lies beneath their unique experiences.”
be self-evident, but couple murky communication patterns,
work is primarily about helping Shapiro said. For example, when ■ Learn the best intervention
couples effectively manage the people carry a long-standing techniques. There is a wide range
challenges of everyday life rather resentment of their partner, it of techniques that are useful
than addressing each person’s may actually be a way to avoid in couples therapy situations,
well-being—though that is often a becoming too intimate—a com- including tailored versions of tools
side benefit. mon issue for couples. psychologists use in individ-
“I look at each individual, but ual therapy. Among these are
also at the connection between ■ Be self-aware. Be honest psychoeducation—for example,
them,” said Jerrold Lee Shapiro, with yourself about your biases teaching partners about negative
PhD, a psychology professor and how they may impede communication styles and how
at Santa Clara University and good treatment, as well as to shift them when they arise;
­coauthor with Patterson of about areas where you need training in skills such as listening,
Real-World Couple Counseling better education, including in emotion regulation, and taking
and Therapy. “And I know that the cultural competence, these time outs to manage conflict;
best changes will occur if I can experts noted. At the same time, and therapeutic amazement—
work with the couple as a unit as remember that all people are expressing seemingly innocent
SDI PRODUCTIONS/GETTY IMAGES

opposed to the two individuals.” unique: Just because someone confusion over a partner’s
To this end, he helps couples think is lesbian, Native American, contradictory messages on a
and behave as a team; he is also cisgender, or other does not given topic. Let’s say one person
guided by an existential frame- mean that they fully represent claims to want to be closer to
work that focuses on what gives that particular group, Datchi their partner but is not taking

32 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4

steps to do that. “The therapist
might say something like ‘I am
confused—help me understand.
Earlier you said you wanted more
intimate connection, and now you
say you prefer reading to sharing
a meal or a bedtime. Can you help
me put those together?’” Shapiro
explained.
Other techniques include
helping couples create firm but
flexible boundaries to protect the
relationship, avoiding triangulation
with third parties, such as in-laws,
by prioritizing communication
within the couple first and guiding
couples to understand each oth-
er’s vulnerabilities so they have
a better sense of what might set
their partner off.
“If someone pokes at their
partner’s vulnerability without
realizing it, it’s going to produce
some kind of negative reaction,”
said Jay L. Lebow, PhD, ABPP,
a clinical psychology professor
at Northwestern University and
coeditor of Clinical Handbook of
Couple Therapy, 6th edition (Guil-
ford, 2023). “Therapists can guide
couples to understand possible
triggers and then help partners
take a step back and notice when
they’ve engaged their partner’s
vulnerabilities.”
■ Consider follow-up sessions.
It is always the couple’s decision
whether to continue therapy,
and often therapists do not know
what happens once a couple
leaves their office. But if a couple
requests follow-up sessions, go for
it, said Shapiro. One couple that
managed to elude divorce now
checks in regularly with him “for
an oil and lube change,” as they
put it to Shapiro—something they
have been doing for 35 years.
COMPLEX CASES
All of these suggestions pertain to
any couple, but added interven-
tions are sometimes needed with
couples who have more special-
ized, complex, or serious issues.
Here are examples of such cases
and some ways of treating them:
■ High-problem pairings. Some
couples enter therapy with
extremely serious issues such as
domestic violence, addiction, or
severe psychopathology. In such
cases, Patterson takes time during
the initial assessment to get an
idea of how intractable the prob-
lem is, which may entail seeing
each partner individually for two
or three sessions.
If he determines that the issue
is serious enough—for example,
that a home is unsafe for one
of the partners or that a per-
son’s addiction or manipulative
KEY POINTS
1
Challenging couple
cases include those
with (a) partners
of diverse cultural,
ethnic, or religious
backgrounds; (b)
high-conflict couples;
(c) couples with an
abusing partner; and (d)
so-called mixed-agenda
couples, where one
couple is committed to
the relationship but the
other is ambivalent.
2 partners can take responsibility for
While couple cases are
as individual as couples
themselves, there are
common modalities
that can help most
couples improve or
make clearer decisions
about their relationship.
3
Helpful interventions
include behavioral
couples therapy,
cognitive behavioral
couples therapy,
emotionally focused
therapy, and integrative
behavioral couples
therapy.
M O N I TO R O N P S YC H O LO G Y
behavior prevents them from
being able to meaningfully com-
municate with their partner or with
him—he refers them to individual
treatment for those issues. He
also tells couples they are free
to return to him if the partner has
received enough treatment to
curb their tendency to abuse their
partner or has entered Alcohol-
ics Anonymous and undergone
rehab, for example.
The bottom line? “If the prob-
lem seems like it will prevent
successful couples therapy, it
doesn’t make sense for me to
take on those cases,” Patterson
explained. “The only way that cou-
ples therapy can work is if both
their own beliefs and behaviors
and offer their partner trust that
they will do their part.”
■ High-conflict couples. Other
challenging cases that sometimes
overlap with high-problem cases
are couples who are locked in
extremely negative relational pat-
terns, including those who argue
incessantly or who have entered
a long-term cold war.
Many of these couples fall into
communication patterns that Uni-
versity of Washington professor
emeritus and couple researcher
John Gottman, PhD, has found
predict divorce: defensiveness,
stonewalling, withdrawal, and
● JA N UA R Y / F E B R UA R Y 2 0 2 4 33
 CE Corner

criticism—what he calls “the four

horsemen [of the relationship
apocalypse].”
When Datchi sees couples
whose main communication style
is arguing, “I have to be very pres-
ent and very active so I don’t let
them reenact their usual patterns
in the room,” she said. When they
enter a fight, she acknowledges
their frustration, anger, and hurt,
then firmly puts a halt to the
problematic behaviors, saying
something such as, “You are put-
ting your gloves on as if you are
about to go into the boxing ring
and start punching each other.
Let’s try something different.”
Once they calm down, she works
with them on ways to communi-
cate their differences with greater
respect and attentiveness.
Another helpful tool is teaching
these couples de-escalation tech-
niques that can help them pause
in the middle of an argument and
become aware of their emotions
and bodily sensations before they
lose control. Psychoeducation,
too, can be extremely helpful in
helping people understand and
identify their negative communica-
tion patterns, Datchi said.
Again, if such patterns are
entrenched, it may be time to
refer each partner for individual
therapy in relevant areas such as
anger management or meditation
techniques, Patterson added.
He also underscored that
some of these couples may be
past the point of no return. “Char-
acterologically, some people have
never developed the ability to
CEMILE BINGOL/GETTY IMAGES

listen carefully to someone with-

out being defensive or arguing
or stonewalling,” he said. In such
cases, he acknowledges that
there is little that he can do to

34 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
 help and offers them assistance in
deciding whether to stay together
or to separate.

FURTHER ■ Couples with cultural, ethnic,

READING or religious differences. More
couples are entering therapy who
Call me maybe?
have significant cultural, religious,
In-person vs.
teletherapy outcomes ethnic, or racial differences or are
among married at varying levels of acculturation.
couples In Shapiro’s experience, such
Bradford, A. B., et al. couples often have opposing life
Psychotherapy ideals: The more acculturated
Research, 2023
person may be focused on indi-
A special section: viduation—on personal growth,
Recruiting independence, and external
and retaining success, for example—and the
couples from other on nurturing and maintain-
underrepresented
backgrounds in ing family harmony.
intervention research Shapiro uses his existential
Mitchell, E. A., & framework to help such couples
Gordon, K. C. achieve a better balance between
Family Process, 2023 security and adventure, family har-
The third shift: mony and individual growth. An
Addressing emotion example is a heterosexual couple
work in couple he treated: an East Indian man
therapy and a Jewish American woman.
Smoliak, O., et al. They were happily married except
Family Process, 2023
for one feature: When the man’s
A qualitative meta- parents visited from India, they
analysis exploring stayed for several months, which
client-reported drove the woman crazy.
outcomes of couple In therapy discussions, they
therapy
O’Malley, R., et al. emerged with a solution that
Psychotherapy, 2023 honored the man’s need for family
harmony and the woman’s need
Specialty for more space. On some week-
competencies in ends, the couple would leave for
couple and family
psychology a couples-only trip, and the grand-
Stanton, M., & parents stayed home to enjoy a
Welsh, R. weekend with their grandkids.
Oxford, 2011 “What’s needed sometimes is not
major life changes, but a push to
experiment with small, new free-
doms,” as Shapiro put it.
Religious differences can also
pose therapeutic challenges,
especially if the couple’s value
systems are at odds. Shapiro and

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 35
CE Corner

Patterson consulted together

in a case where both partners
belonged to the same funda- TRAINING RESOURCES
mentalist religious group, but the ■APA Div. 43 (Society for Couple & Family Psychology)
woman was questioning some www.apadivisions.org/division-43
of its tenets, including a strong
prohibition against sex before
■ APA CE programs on families and couples
marriage.
www.apa.org/education-career/ce/
The issue came to a head
topic?query=cetopic:Families+and+Couples
when the couple was sharing
intimate physical time, some of
■ American Academy of Couple and Family Psychology
which was tacitly allowed by
https://americanacademyofcoupleandfamilypsychology.org/
the group. As they grew physi-
cally closer, though, the woman
wanted to continue, but the man ■ Emotionally focused therapy
pulled back. https://iceeft.com/therapist-training/
In therapy, the woman said
the man’s actions made her feel ■ Integrative behavioral couples therapy
unattractive and rejected. While https://ibct.psych.ucla.edu
the man said he loved and was
attracted to her, he thought it ■ Cognitive-behavioral couples therapy
was more important to follow the 100-hour video training with Arthur Freeman, EdD
religion’s rules. Shapiro and Pat- www.apa.org/pubs/videos/4310765#:~:text=Description,Dr.
terson then used a technique that
helps people think more clearly ■Behavioral couples therapy
about big-picture issues by pro- www.recoveryanswers.org/resource/behavioral-couples-therapy/
jecting given scenarios into the
future. Asking how they would
feel about their children attending
a religious school, for example, emphasis in couples therapy Tom and Helen (real names
the man said it was mandatory, training, but they probably should withheld to protect privacy) are
and the woman said she would be: They are a common and often a case in point. The couple was
be open to a different approach. thorny source of couple prob- having difficulty moving from one
This querying helped the lems, couple practitioners noted. house to a new one: Their current
couple become clear that they Ashley Quamme, LMFT, a home was Tom’s from a previous
were on different paths, and they couple therapist and certified marriage, and Helen wanted a
decided to separate. While disap- financial therapist-practitioner in fresh start. But every time they
pointing, “it was probably exactly Evans, Georgia, has been trained neared action, Tom stalled, sug-
what they needed to do,” Patter- to understand the psychological gesting that he and Helen create
son said (Shapiro and Patterson patterns that underlie financial a new budget and timeline for the
discuss this case at greater length difficulties and conflicts. She house-seeking process. That did
in an APA webinar). uses her understanding to help not please Helen, who responded
couples address their money con- by criticizing Tom and withdrawing
■ Financially troubled couples. flicts and refer them for financial from him emotionally and sexually.
Financial issues are not a big guidance as needed. As Quamme talked with the

36 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
couple, it became clear that Tom’s
behavior stemmed from deep
financial insecurity, the result of
growing up with a single mom and
never having enough. In turn, Hel-
en’s reactions stemmed from an
earlier marriage to a man who had
been unfaithful and untrustworthy.
Quamme helped them identify
and discuss those patterns, which
eventually helped them catch
themselves in real time as those
cycles occurred. “They were able
to really learn and name those
positions and understand when
each of them would cue or trigger
the other,” she said.
The couple worked on these
issues for about a year, and on
Quamme’s suggestion, eventu-
ally visited a financial planner.
The planner helped to allay
Tom’s fears about their finances,
confirming that they could afford
the move and even benefit from
it financially. Meanwhile, the
therapy helped Helen to better
understand and empathize with
Tom, which helped improve their
relationship. The result was a new
home, though “there were a lot
of arguments around how big the
house should be,” said Quamme
with a chuckle.
■ “Mixed-agenda” couples. The
so-called mixed-agenda couple,
where one person is committed
to maintaining the relationship
and the other has one foot out
the door, is another challeng-
ing—and common—couple case.
Traditional couple counseling problems in the relationship,
does not seem to help these which helps them develop a
pairs, largely because the “lean- more nuanced, realistic, and
ing out” partner is ambivalent compassionate look at one
about staying in the relation- another, Doherty said.
ship and hence may sabotage At the end of the work,
counseling efforts, said William couples choose one of three
J. Doherty, PhD, a professor in directions: maintaining the status
the couple and family therapy quo (not getting divorced and
specialization at the University not continuing therapy), separat-
of Minnesota in St. Paul and ing or divorcing, or committing
author of Helping Couples on the to at least 6 months of couples
Brink of Divorce: Discernment therapy. If they choose therapy,
Counseling for Troubled Relation- they create a clear agenda of
ships (APA, 2017), cowritten with what they are going to work on
Steven M. Harris, PhD. in themselves. During that time,
Seeing these problems, they are asked to agree that
Doherty has developed a divorce is off the table, which
short-term mode of assessment helps to relieve the pressure of
called “discernment counseling” a decision, Doherty noted. The
designed to help these couples methodology has proven highly
make a clear decision on the effective and is now being taught
direction of their relationship. in workshops around the country.
The assessment lasts for a Patterson, who uses the dis-
maximum of five sessions, with cernment approach in his work,
couples deciding at the end of as well, added that good couples
each session whether to attend therapy is not about saving
the next one or stop. Each ses- couples per se but about help-
sion follows the same template: ing some couples to improve
The partners first meet together their relationship, and others to
with the therapist then break off clarify their need to separate or
to meet with the therapist individ- divorce. And if those who decide
ually while the other one waits. to part have children, it is also
At the end of the session, they about guiding them on how to
come together again to summa- successfully coparent for the rest
rize what they have discussed in of their lives, he said.
the individual meetings. Besides “Besides improving the couple
helping the “leaning out” person relationship, I’d say a main goal is
clarify negative feelings about to improve each person’s mental
the relationship, the work helps health, now and in the future—to
both partners examine how help them proceed in their lives
they may have contributed to with what they’ve learned.” n
M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 37
 12 EMERGING

2024 will be a pivotal year for psychology. The U.S. presidential

campaign, already infected with misinformation, needs psychological
science’s debunking and prebunking strategies. Generative artificial
intelligence—unleashed upon society with few guardrails—will
desperately require social science insights as it progresses along its
exciting and uncertain trajectory.

The ongoing crisis in mental health care access, the trauma

for women and LGBTQ+ individuals whose bodily autonomy is
threatened by ongoing legislation, and the backlash against racial
equity work present unprecedented challenges and opportunities
over the next year. There is hope though as mental health technology
enters a second wave of investment, clinicians continue to innovate to
reach more patients, new strategies to end addiction make promising
headway, and neuroscience helps us to discover ways to protect brain
health and treat brutal afflictions like Alzheimer’s.

Join us in exploring these 12 trends on the following pages.

Susan Straight
Managing Editor

38 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
 FOR

WHAT ’S AHEAD FOR PSYCHOLOGISTS IN THE COMING YEAR?

FIGHTING MISINFORMATION 40 STABILITY AT WORK 64

THE UNSTOPPABLE MOMENTUM TACKLING SUBSTANCE USE 68

OF GENERATIVE AI 44
MORE SCHOOL PSYCHOLOGISTS 72
HIGHER EDUCATION
MONETIZING MENTAL HEALTH
IS STRUGGLING 48
TECHNOLOGY 76
TAKING AIM AT WOMEN
CLINICAL PRACTICE LOOKAHEAD 80
AND LGBTQ INDIVIDUALS 52

BRAIN HEALTH AND AGING 84

BACKLASH AGAINST RACIAL
EQUITY EFFORTS 56 PLUS
A MESSAGE OF HOPE 88
INCREASING PATHWAYS TO CARE 60

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 39
2 0 2 4 TR EN DS R EP O RT

THIS ELECTION YEAR,

FIGHTING MISINFORMATION

IS MESSIER

AND MORE IMPORTANT THAN EVER

Psychologists are using science

communication to set the record
straight. But it’s ugly out there.

BY KIRSTEN WEIR

40 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4

D
uring the U.S. presidential election in 2016, “fake news” was the phrase on everyone’s lips. Two election
cycles later, the threat of misinformation has only become more insidious. “We haven’t seen anything
like this in our postwar modern political reality,” said Howard Lavine, PhD, a political psychologist at the
University of Minnesota who studies the psychology of mass political behavior. “Misinformation in politics is one
of the most difficult problems to crack.”
Despite the challenge, psychologists
are pushing back against the threat of
misinformation by studying its spread
and sharing psychological science with
the public. It’s not easy. Internet trolls,
online harassment, and the growing
threat of legal action make speaking
out against misinformation increasingly
fraught. But experts say standing up for
the truth can make an impact—and the
more psychologists who get involved, the
bigger that impact can be.
“As scientists our job is to fill the world
with more knowledge. To do that we
need to communicate to people and not
just to each other,” said Gordon Penny-
cook, PhD, a psychologist who studies
misinformation at Cornell University.
“Individually, we may all play a small role.
But we shouldn’t underestimate our col-
lective role in improving the information
ecosystem,” he added. “If we aren’t each
doing our best to get good information
out there, misinformation is going to win.”
PUSHING BACK AGAINST
MISINFORMATION
In many ways, communicating with the
public is easier than ever. Whether you
prefer YouTube, podcasts, TED Talks,
blogs, or social sites like TikTok or Blue
Sky, there’s no shortage of ways to put
your message out there. “With social
media, there has been a radical change in
how we share science even compared to
10 years ago,” says Jay Van Bavel, PhD, a
professor of psychology and neural sci-
ences at New York University. “We have
more of a voice than ever, and there is a
thirst for it from the public.”
While the rise of social media has
made communication easier, it has also
fueled the spread of false and misleading
information—about everything from
climate change to election integrity to
the very shape of the planet we stand on.
Social media typically lacks the over-
sight and safeguards of legacy media to
prevent and correct false claims. Its algo-
rithms and peer-to-peer sharing model
are a perfect setup for misinformation to
be shared widely, especially within the
echo chambers that form online.
The more people hear those falsehoods,
researchers have found, the more likely
they are to believe them—even if the
information contradicts their prior beliefs
(Fazio, L. K., et al., Journal of Experi-
mental Psychology: General, Vol. 144, No.
5, 2015). During the 2020 presidential
election, false claims about election fraud
were rampant. Three days after Joe Biden
was declared the winner, Pennycook and
MIT researcher David Rand, PhD, found
a majority of Trump voters falsely believed
that Trump was the rightful victor. Those
beliefs were more common among peo-
ple who followed election news closely
(Harvard Kennedy School Misinformation
Review, Vol. 2, No. 1, 2021). Such findings
suggest it’s important to nip misinforma-
tion in the bud before people have been
exposed to it multiple times.
Research also points toward some best
practices for setting the record straight.
Fact-checking, or debunking false claims,
can be effective. But there is a right way
to approach it, Van Bavel said. Debunking
is most effective when you can explain
why the information is false and provide
alternative information (van der Meer, T.
G. L. A., & Jin, Y., Health Communication,
M O N I TO R O N P S YC H O LO G Y
2 0 2 4 TRENDS REPO RT
With the presidential election coming up
in November, the stakes for combating
misinformation have never been greater.
Delivering effective messages and dealing
with online bullies is a challenge, but there
are tools to help.
Vol. 35, No. 5, 2020). Sharing misinfor-
mation to call it out could inadvertently
drive traffic to the person spreading the
false claim. A better way is to screenshot
the incorrect statement and share it with a
clear explanation of facts and a link to an
original expert source. “The way algo-
rithms work, fact-checking in the wrong
ways accidentally amplifies misinforma-
tion,” Van Bavel said.
BUILDING TRUST
Fostering trust with your audience is
another important facet of science com-
munication. In a study that spanned five
countries, including the United States
and the United Kingdom, Sander van
PERI PRIATNA/GETTY IMAGES
der Linden, PhD, a social psychologist
at Cambridge University, and colleagues
showed that higher trust in scientists
was correlated with reduced belief in
● JA N UA R Y / F E B R UA R Y 2 0 2 4 41
2 0 2 4 TR EN DS R EP O RT
M ISI N FO R M ATION
COVID-19 misinformation (Royal Soci-
ety Open Science, Vol. 7, No. 10, 2020).
Unfortunately, trust in politics is par-
ticularly lacking—and that’s no accident,
Lavine said. A common tactic of modern
politics is to demonize and dehuman-
ize the opponent, he explained. “In
that space, [false or misleading] state-
ments from partisan elites become more
credible. Once you’ve dehumanized the
other side, misinformation and conspir-
acy theories that would seem bizarre
now become believable.” And scientists
have become a frequent target for those
attacks. Yet all hope is not lost. One
way psychologists can engender trust is
by staying in their lane, van der Linden
said. As a misinformation researcher, he
publicly admits he’s not the expert on
virology or climatology, so he doesn’t
debate the fine points of false claims
about COVID-19 or climate change.
Instead, he focuses his attention on dis-
cussing the psychological processes that
make people fall prey to misinformation.
“People who believe one conspiracy
theory are more likely to believe oth-
ers. So it’s less important to get into the
nitty-gritty of whether a specific conspir-
acy is true or not and more effective to
promote the kind of thinking that will
help people recognize logical fallacies or
manipulation techniques,” van der Lin-
den said. Such techniques include using
language that stokes fear or outrage,
impersonating a trustworthy individual
or organization, exaggerating polariza-
tion by using “us vs. them” language, and
attacking a person’s character to take
attention away from their argument. “As
psychologists, we can help people cali-
brate their judgments and empower them
to make up their own minds,” he added.
One way psychologists are doing that
is through “prebunking,” interventions
designed to inoculate people against
misinformation they might encoun-
ter in the future. Just as vaccines use
weakened pathogens to stimulate the
42 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
IN AN ELECTION YEAR
PROTECT YOURSELF FROM TROLLS
“If you share online about sensitive topics, you risk getting criticized, trolled, and
threatened,” said New York University psychologist Jay Van Bavel, PhD. He learned
that lesson the hard way in 2021 when he helped fact-check a false claim about
COVID-19. In a coordinated online attack, he became the target of hundreds of angry
messages from an online mob of conspiracy theorists. Some of them even contacted
NYU to try to discredit Van Bavel with his superiors. (NYU’s provost responded by
sending Van Bavel messages of support.)
You can’t predict when a post might go viral and become a target for online
aggressors. But there are ways to protect yourself online.
● Consider the risks: Trolls are more likely to target members of nondominant
groups, such as women, people of color, and LGBTQ+ people (Vogels, E. A., “The
State of Online Harassment,” Pew Research Center, Jan. 13, 2021). And some
institutions may not be entirely supportive of their faculty. Speaking out isn’t for
everyone, so consider your situation before you engage.
● Protect privacy: Familiarize yourself with the privacy settings on your social media
sites of choice and avoid posting family pictures or personal information on public
accounts.
● Support colleagues: Not everyone who speaks out has tenure or support from
their institutions. If you are in a secure position, consider speaking up when
you see a colleague being harassed for fighting back against misinformation.
“Targeting someone online is harder if there are more people speaking up
collectively,” said Cornell University psychologist Gordon Pennycook, PhD. “If only
a few people are standing up, it’s easy to knock them down.”
● Use digital tools: Learn to use built-in tools to mute, block, and report trolls, online
abuse, and hate speech. If you get a flurry of attention on X, check to see if you’ve
been added to any lists and remove your name from any that seem suspicious.
Trolls often add people to lists for easy targeting by other online harassers.
● Let it pass: For Van Bavel, the flurry of interest died down after a few days. That’s
typical, Pennycook said. “If you go viral, there’s usually a flood of attention and
then it stops, and life moves on. You can hunker down for a week and go back to
normal.”
immune system to fight against viruses, misinformation techniques and also
prebunking exposes people to weak- increased their confidence in their own
ened versions of persuasive arguments judgments (Journal of Cognition, Vol. 3,
to build their resistance to manipulation No. 1, 2020).
and misinformation. Researchers have
designed infographics, videos, and even THE WILD WEST
games to help people learn to recognize Staying focused on psychological sci-
and resist the persuasion techniques ence—rather than engaging in political
used in misinformation. In one example, shouting matches online—also helps
van der Linden and colleagues showed protect communicators from becoming
that a prebunking game significantly targets of trolling and harassment. (See
improved participants’ ability to identify sidebar.) Unfortunately, online abuse
 2 0 2 4 TRENDS REPO RT

M I SI N FO R M AT ION IN AN ELECTION YEAR

lawsuits, it’s the Wild misinformation pool. Indeed, there are

Debunking is most effective when you
can explain why the information is false
and provide alternative information.
Here’s the best method: Screenshot the
incorrect statement and share it with a clear
explanation of facts and a link to an original
expert source.
is just one of the risks of speaking out
against misinformation. “In some ways,
trolls are the easier problem to deal with.
The bigger risk now, especially with politi-
cal misinformation, is that companies and
Congress are coming after disinformation
researchers,” Van Bavel said.
Over the past year, activists have set
their sights on researchers who study
misinformation. Ohio Congressman Jim
Jordan, chair of the Republican House
Judiciary Committee, has accused misin-
formation researchers of colluding with
the government to suppress conservative
speech, keeping them busy with a flurry
of public records requests and threats
of legal action. In May, the advocacy
group America First Legal filed a lawsuit
against researchers at the Stanford Inter-
net Observatory, a program at Stanford
University that focuses on misuse of
social media. A month later, X (formerly
Twitter) filed suit against the nonprofit
Center for Countering Digital Hate.
“We’re seeing a huge backlash against
PERI PRIATNA/GETTY IMAGES; ERE/GETTY IMAGES
West out there,” van
der Linden said. That
chilling effect extends
to the NIH, which this
year halted a planned
$150 million program
to improve commu-
nication of health
information, citing
legal threats as one fac-
tor in the decision. Many institutions are
pledging to keep fighting. Stanford Uni-
versity leaders, for example, have spoken
publicly in support of their researchers
and the work of the Stanford Internet
Observatory.
As this presidential election year
unfolds, psychologists are uniquely
poised to help push back against the
flurry of falsehoods, van der Linden
said. “Psychologists can help bridge the
partisan divide by fighting misinforma-
tion in ways that aren’t so polarizing,”
such as focusing on decision-making and
recognizing manipulation rather than
the content of an argument, he added.
“Giving people the tools that they need
to make better decisions is within our
expertise as psychologists.”
POSITIVE COMMUNICATION
Still, it’s possible to communicate sci-
entific findings to the public without
diving straight into the deep end of the
APA REPORT FIGHTS BACK AGAINST MISINFORMATION
What can be done to stop misinformation in its tracks? A task force of
psychological scientists tackled that question in a new APA consensus statement,
good reasons to put yourself out there.
“People might not appreciate the benefits
that come from speaking with the pub-
lic. When you discuss your work more
broadly, it can motivate the research and
help you learn things you wouldn’t other-
wise,” Pennycook said.
Communicating with the public isn’t
something that psychology training
programs tend to explicitly teach. But,
Van Bavel said, “public communication
is a skill. And anyone can work on it to
improve that skill.”
Meanwhile, the field of psychology
would benefit from more people studying
misinformation, Pennycook and van
der Linden said. Researchers studying
intergroup relations, persuasion, belief
formation, communication, health behav-
iors, and any number of other topics can
all contribute to the study of how misin-
formation spreads, why people believe it,
and how best to counter it.
“Misinformation poses huge risks to
democracy and public health, so if you
can find ways in which your research can
be applied to elucidate these important
questions, why not give it a go?” van der
Linden said. “From basic questions about
how the brain processes information
and why we believe things to interven-
tion research to counter misinformation,
psychologists are really well positioned to
come up with solutions.” n

the very concept of misinformation. So,
it’s more prudent than ever to find ways
to engage that speak to our strengths as
psychologists,” van der Linden said.
Speaking out is difficult but more
important than ever. “There’s been a huge
chilling effect on researchers speaking out
about misinformation. Between trolls and
Using Psychological Science to Understand and Fight Health Misinformation.
Developed with support from the U.S. Centers for Disease Control and Prevention,
the report describes the latest science and provides recommendations to help
scientists, policymakers, media, and the public address misinformation. It provides
a blueprint for clinicians engaging in delicate conversations with patients, and a
foundation for researchers working to identify the causes of, and solutions for, the
epidemic of misinformation.

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 43
2 0 2 4 TR EN DS R EP O RT

THE

UNSTOPPABLE
MOMENTUM
OF

GENERATIVE AI

AI is already part of
psychology, changing
work in the lab, clinic,
and classroom. How will
generative AI further evolve
in 2024 and what do
psychologists need to know?

BY ZARA ABRAMS

44 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4

Generative artificial intelligence (AI), which can rapidly produce original
text, images, audio, and more, is here to stay. Psychologists are exploring how the new
technology can simplify or amplify their efforts—and are increasingly leading efforts to
bring behavioral insights into the creation and deployment of generative AI tools.
Within the field, ChatGPT and
other AI models are changing the way
psychologists teach, conduct research,
and diagnose and treat patients. While
concern about the ongoing development
of generative AI is legitimate, espe-
cially given the moratorium proposed by
technology developers themselves last
year, psychologists should accept AI as a
reality and work with rather than against
it, said Jessica Jackson, PhD, a licensed
psychologist and clinical strategy man-
ager for a mental health startup.
While there are plenty of reasons to
be cautious about therapeutic algorithms,
for example, they also offer an oppor-
tunity to dramatically expand access to
mental health care, psychologists say.
“If people can’t afford therapy, we
can’t stop them from logging on to a
computer and talking to a chatbot,” said
Jackson, who is chair of APA’s Mental
Health Technology Advisory Commit-
tee. “We can’t control this, so how can we
form strategic partnerships that help us
embrace and optimize it?”
Psychologists bring a behavioral
perspective to the development and
rollout of new technologies, producing
research insights about how people view
AI’s competence, credibility, morality,
and more.
“Most of the work in the
human-technology interaction field is
very heavy on technology and very thin
on humans,” said Kai Chi (Sam) Yam,
PhD, a professor of psychology and head
of the Department of Management and
Organization at the National University
of Singapore. “Psychologists are now
working to fill the gap on the human side
of that equation.”
Ultimately, the field can offer a
nuanced exploration of new technologies
that helps developers, users, and regula-
tors grasp their inherent complexity.
“There are complex trade-offs in
AI’s potential. It won’t be all good or all
bad,” said Adam Miner, PsyD, a clini-
cal assistant professor of psychiatry and
behavioral sciences at Stanford Uni-
versity who studies AI in health care.
“Fortunately, psychologists are accus-
tomed to weighing complex trade-offs in
their research and clinical work, so we are
ready to meet this challenge.”
AI IN HIGHER EDUCATION
One way to quantify the impact of AI
on a profession—both how it can help
and who it threatens to replace—is to
break down work into a set of tasks and
skills, said Johannes Eichstaedt, PhD,
a computational psychologist and an
assistant professor at Stanford University.
For researchers, many of those tasks can
increasingly be automated.
“The truth, whether we want to admit
it or not, is that a lot of what we do in
the scientific process is quite formulaic,”
Eichstaedt said.
Specialized generative AI tools,
such as Genei, can help with literature
searches, literature summarization, and
academic writing. ChatGPT can gen-
erate items for scales, detect themes in
M O N I TO R O N P S YC H O LO G Y
2 0 2 4 TRENDS REPO RT
qualitative textual data, and write Python
and R code for statistical analyses.
“The key is to figure out how to make
GPT function either like a research
assistant or like a participant,” said Kurt
Gray, PhD, a professor of psychology and
neuroscience at the University of North
Carolina at Chapel Hill who studies
how people make sense of emerging
technology.
Gray’s research shows that the latter—
using GPT to replace participants in
certain types of experiments—is not only
possible, but it could also save experiment-
ers valuable time and resources (Trends in
Cognitive Sciences, Vol. 27, No. 7, 2023).
For example, he and his colleagues tested
GPT on 500 moral judgment scenar-
ios and found that its answers correlated
nearly perfectly (.95) with human answers.
They suggest that AI could be used in
pilot studies to refine measures or as an
extra layer of evidence to augment results
from humans.
“We’re not arguing that you never
need to ask people anymore, but what
are the times when it might make more
sense to ask AI?” Gray said.
For teaching psychology, generative AI
can simplify a range of time-consuming
tasks, from drafting slides, outlines, and
exam questions to mentoring trainees on
PREVIOUS PAGE: BLACKDOVFX/GETTY IMAGES
therapeutic techniques. But the tech-
nology is also fundamentally changing
the learning environment, leaving many
educators worried about how to detect
cheating and ensure that students are
actually learning.
● JA N UA R Y / F E B R UA R Y 2 0 2 4 45

One relatively safe way psychologists can begin using AI tools for therapy is to maintain
clinical supervision of patients. For example, patients can use an app to practice cognitive
behavioral therapy or dialectical behavior therapy skills between sessions.
“That’s a legitimate concern, but we’re
living in a world where these tools are at
our fingertips, so what we teach will ulti-
mately have to change,” Eichstaedt said.
For example, students may be able
to focus more on higher-level cognitive
functions—such as finding a punchy
example or deciding how to frame an
argument—instead of worrying about
the order of sentences in a paragraph,
he said.
Because of generative AI’s ubiquity,
most higher education institutions are
trying to embrace it rather than ban
it. But research in progress suggests
that approach may have unintended
consequences. Yam and his colleagues
randomly assigned college students to
write an essay about a topic they recently
learned about or to use ChatGPT
to write the essay. Those who used
ChatGPT later reported less interest in
the topic and less intrinsic motivation to
study it further.
“Once college students used
ChatGPT to write an essay for a given
topic, they found that topic to be less
exciting,” Yam said. “We find that quite
worrying, because allowing the use of
ChatGPT may actually be undermining
the intrinsic motivation to learn.”
CHATBOTS IN THERAPY
In the clinical sphere, psychologists are
also proceeding with caution. Generative
46 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
AI clearly holds potential for automating
administrative tasks such as docu-
mentation and note-taking. Tools like
ChatGPT can also help trainees practice
delivering psychological interventions
to a simulated patient. And natural
language processing tools can provide
insights to help licensed clinicians up
their game, said Miner.
“Clinicians probably don’t want AI
telling them what to do, but it might
help us find gaps in our training or areas
for improvement,” he said.
For example, a clinician might
respond differently to a patient who
mentions self-harm in the last 5 minutes
of a session than they would to a patient
who mentions self-harm during the first
5 minutes. Based on large data sets of
therapist-client interactions, what are
positive examples of how to respond?
(npj Mental Health Research, Vol. 1, 2022)
The biggest open question is whether
and how generative AI can help address
the shortage of mental health service pro-
viders (see page 80), both in the United
States and worldwide. Can chatbots safely
and effectively deliver therapy?
“The prevalence of mental health
issues in America is reaching a critical
point,” said Scott Wallace, PhD, a clin-
ical psychologist and director of clinical
innovation at Remble, a mental health
technology company that offers chat-
bot support and other tools. “With the
devastating crisis we’re facing, we can’t
afford to write off promising innovations
before fully exploring how they might
expand access and improve care.”
Chatbots can provide support on
day-to-day challenges, such as conflict
with a spouse, trouble sleeping, and
stress related to work or school. Wallace
said using AI to deliver research-backed
advice can help reduce the burden on
human therapists of providing services.
Mental health chatbots may be useful
for more serious concerns, but harm is
also possible. Companies have delivered
AI therapy without informed consent
and perpetuated bias with their algo-
rithms (Obermeyer, Z., et al., Science, Vol.
366, No. 6464, 2019).
“If you leave psychologists out of the
development process, it’s going to be
harmful,” Jackson said. “Currently, there’s
no true bridge between technology and
psychology, so the people who are build-
ing these tools aren’t always aware of the
ethical issues at play.”
One relatively safe way to begin using
AI tools for therapy is to maintain clini-
cal supervision of patients. For example,
patients can use an app to practice cog-
nitive behavioral therapy or dialectical
behavior therapy skills between sessions.
“By thoughtfully integrating AI to
augment professionals, but not replace
them, we can build on human strengths
while benefiting from data-based
insights,” Wallace said.
See more about the nuance of current
AI use in practice on page 78.
AGENTS OF REPLACEMENT
As generative AI continues to perme-
ate society, knowledge of how it impacts
WIPHOP SATHAWIRAWONG/GETTY IMAGES
individuals, relationships, and societies is
suddenly in high demand.
“Soon, we’ll have AIs that are super
intelligent—in the technical sense,
they’re better at most things than most
people,” Eichstaedt said. “They will
tutor our children, but they were never

“I believe together we can shape AI into a driving force for much needed progress
and healing. But we have to be willing to take those first steps.”
SCOTT WALLACE, PHD, CLINICAL PSYCHOLOGIST AND DIRECTOR OF CLINICAL INNOVATION AT REMBLE
Buddy, a TED-i robot designed to bridge social interactions with children who are isolated,
instructs a student at the Paul Chevalier school near Lyon, France.
designed to be encouraging, understand-
ing, or wise.”
Theoretically, those qualities can be
fine-tuned, but that requires significant
attention to the social, developmental,
and identity contexts in which they will
be applied, he said.
In religious settings, Yam and psy-
chologist Joshua Jackson, PhD, of the
University of Chicago, have shown that
people find robots to be equally compe-
tent—but less credible—than humans
(Journal of Experimental Psychology:
General, online first publication, 2023).
OLIVIER CHASSIGNOLE/GETTY IMAGES
Yam, Gray, and their colleagues have also
found that in the workplace, the fear of
being replaced by AI is associated with
burnout and incivility (Journal of Applied
Psychology, Vol. 108, No. 5, 2023). Nearly
4 in 10 U.S. workers worry that AI will
G E NERATIVE AI
eventually replace all or most of their job
duties, according to APA’s 2023 Work in
America survey.
“The big issue around AI is that these
are agents of replacement,” Gray said.
“We design artificial agents to replace
human labor, but when we are confronted
with that, we’re not always sure about
how to act.”
What’s on the horizon? Eichstaedt
points to new multimodal generative
AI tools, such as Google’s Gemini, that
can seamlessly shift between images,
text, and other types of data. To keep
up with the rapid pace of development
and generate research insights that
can be quickly applied, Yam said field
research—as well as better incentives for
cross-disciplinary collaboration—will
be key. Engineers often disseminate
M O N I TO R O N P S YC H O LO G Y
2 0 2 4 TRENDS REPO RT
findings through conference proceed-
ings, for example, while psychologists
aim to publish journal articles.
We may even see new subfields geared
toward understanding the reasons, ratio-
nales, and capacities of AI systems, said
Peter Hancock, PhD, DSc, a professor of
psychology at the University of Central
Florida who has studied human-machine
interaction in a variety of contexts.
“Machine psychology” could apply the
methods, simulations, and analyses long
used to scrutinize the human mind to
glean insights about how generative AI
processes information.
Despite its risks, some psychologists
are proceeding with cautious optimism
about the potential for AI to improve
mental health care and beyond.
“Are there open challenges? Abso-
lutely. But sticking to the status quo
isn’t working,” Wallace said. “I believe
together we can shape AI into a driv-
ing force for much needed progress and
healing. But we have to be willing to take
those first steps.” n
FURTHER READING
The psychology of social robots and
artificial intelligence
Gray, K., et al.
The Handbook of Social Psychology,
6th ed., In press
How to use ChatGPT as a learning
tool
Abramson, A.
Monitor on Psychology, June 2023
Advancing psychology in national
artificial intelligence strategy
APA, 2023
● JA N UA R Y / F E B R UA R Y 2 0 2 4 47
2 0 2 4 TR EN DS R EP O RT

HIGHER

EDUCATION

IS

ST RUG G L I N G
Many of the dramatic changes in society are fueling faculty
burnout, high turnover, and even fear among educators

BY ZARA ABRAMS

48 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
 2 0 2 4 TRENDS REPO RT

T
he COVID-19 pandemic upended the economy and exacerbated concerns about financial
stability in higher education. More recently, falling tuition dollars and the looming enrollment
cliff are forcing cuts or closures at many institutions, precisely when students need more
support than ever. Those entering college today have faced years of erratic schooling and a widespread
mental health crisis.

But students are not the only ones
struggling. The majority of faculty
report feeling burned out because of
work: They face their own set of stress-
ors, such as adapting to ChatGPT in
the classroom and, for faculty of color,
providing extra support for students of
color (Exploring Faculty Burnout through
the 2022–23 HMS Faculty/Staff Survey,
APA). Meanwhile, employee turnover at
colleges and universities continues to rise
(The CUPA-HR 2023 Higher Education
Employee Retention Survey).
“Workers in higher ed feel like they’re
being nickeled and dimed, they’re being
overworked, and they’re not being rec-
ognized. What better recipe is there to
drive people toward other jobs?” said
cognitive psychologist Jacqueline Bichsel,
PhD, director of research at the College
and University Professional Association
for Human Resources (CUPA-HR).
In a growing number of states, insti-
tutions also face the added pressures
of political attacks on academic free-
dom, tenure, and university governance
systems. Faculty are being silenced on
subjects ranging from gender identity to
reproductive health, while administrators
are seeing their decision-making powers
seized by politicians.
Academic Freedom and Florida. universities for centuries. New laws
On top of it all, higher education may passed in Florida, Idaho, Iowa, Missis-
mean something fundamentally different sippi, North Dakota, Oklahoma, South
today. With growing questions about the Dakota, Tennessee, and other states limit
value of education, some potential stu- or prohibit instruction on various sub-
dents question whether they should even jects, including race, sex, and American
go to college. At the same time, coming history, and even seek to broadly restrict
of age amid a pandemic, climate change, discussing “current, controversial topics”
and fierce political clashes has left many (PEN America Index of Educational
of today’s students uncertain about what Gag Orders, 2023).
lies ahead, said psychologist Kisha Jones, “Where I’m located, these laws cre-
PhD, an assistant professor of global ate a lot of fear among faculty. Often,
leadership and management at Florida it’s easier to just drop material and
International University.
“What is it like to be
motivated, to be excited about
your career and excited about
the future, when things look
so bleak?” she said.
A DARK PLACE
Political battles across the
nation have created an
increasingly hostile world
for academics. Those who
speak in support of topics
such as vaccination and racial
equity have faced harassment
and death threats; many are
leaving X, formerly known
as Twitter, in search of safer
IMAGE SOURCE/GETTY IMAGES; HILL STREET STUDIOS/GETTY IMAGES

“What kind of an environment are forums or taking extra steps

we creating at these institutions, which
have long been based on the idea of
free inquiry and academic freedom? It’s
frightening to think about where we’re
headed,” said Afshan Jafar, PhD, chair
and professor of sociology at Con-
necticut College and cochair of the
American Association of University Pro-
fessors (AAUP) Special Committee on
to protect themselves, both
online and off.
Alongside the routine
threats and harassment, aca-
demics are also navigating
deliberate, state-sponsored attempts to
control higher education and disman-
tle academic systems and structures
that have governed U.S. colleges and
Most faculty report feeling burned out
by work stressors, including adapting
to ChatGPT in the classroom and heavy
course loads. Many faculty of color expe-
rience additional burnout from providing
extra support for students of color.

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 49
2 0 2 4 TR EN DS R EP O RT
avoid a controversial topic,” said David
Strohmetz, PhD, chair and professor of
psychology at the University of West
Florida, who recently chose to exclude a
section on sexuality and gender identity
from one of his psychology courses due
to concerns about the political climate.
A new Florida law seeks to under-
mine tenure by reviewing tenured
professors’ research and teaching at least
every 5 years, while other legislation in
the state weakens teachers’ unions and
strengthens the role of politicians in
higher-ed decision-making. (Several
other states, including Texas, Louisiana,
and Iowa, have also proposed legislation
that aims to limit or end tenure.) These
actions amount to a coordinated attack
that could ultimately lead to authori-
tarian control of the state’s education
system, said Jafar.
Some faculty have observed that students from the so-called pandemic generation lack basic
skills such as time management that are essential for success in college and may have a
shakier academic foundation than students who had a typical high school experience.
50 M O N I TO R O N P S YC H O LO G Y
BLEAK ACADEM IA
“When you’re attacking governance
at the same time that you’re attacking
the ideals of academic freedom and free
inquiry, you’re heading to a really dark
place in academia, where people now
have no means to fight the changes that
are coming their way,” she said.
The laws are already triggering “brain
drain” in the state, with more than
one-third of the faculty at New College
of Florida departing since Governor
Ron DeSantis began his overhaul of the
school. And nearly one-third of faculty
in Florida, Texas, Georgia, and North
Carolina said they are actively looking
for jobs in other states, according to an
August 2023 AAUP survey of 4,250
faculty members (AAUP national release,
Sept. 2023).
“Those who are left behind are now
forced to figure out how to survive in this
● JA N UA R Y / F E B R UA R Y 2 0 2 4
environment,” which is likely to further
diminish the quality of teaching and
research in those states, Jafar said.
THE ACADEMIC GAP
The instability of recent years has also
left students struggling—and that affects
everyone on campus. Some faculty have
observed that students from the so-called
pandemic generation lack basic skills such
as time management that are essential for
success in college and may have a shakier
academic foundation than students who
had a typical high school experience.
“There’s concern about the impact
of the academic gap after losing those 3
years. Is this a blip, or has education at
the secondary level been fundamentally
changed?” Strohmetz said.
Student mental health also remains
in crisis. Data from the Healthy Minds
Study, which surveys tens of thousands
of students across the nation each year
about mental health, shows a slight
positive change during the 2022–23
academic year. But 14% of students still
reported considering suicide, and more
than 40% screened positive for clini-
cally significant symptoms of depression.
Some populations, including LGBTQ+
students, report even higher rates of
mental health problems (The Healthy
Minds Study: 2022–2023 Data Report).
Those concerning figures are impact-
ing academic institutions more broadly,
said Sarah Lipson, PhD, an associate
professor in Boston University’s School
of Public Health and principal investiga-
tor of the Healthy Minds Study. Faculty
are changing the way courses are taught
and working to connect students to
services before they are in crisis. Admin-
istrators are rolling out public health
campaigns, counseling services, and new
support systems. Those changes are wel-
FOTODUETS/GETTY IMAGES
come, Lipson said, but can be taxing on
institutions already strained for resources.
“The urgency around student mental
health has infiltrated so many different
 aspects of higher education,” she said.
Meanwhile, schools are scram-
bling to adapt to a new challenge: how
to handle artificial intelligence tools,
such as ChatGPT, in the classroom. In
some cases, that requires reimagining
coursework to preclude cheating and to
help students learn to use ChatGPT to
enhance—rather than replace—their
own critical thinking.
“We have to take on the challenge as
educators to find a way to weave that into
assignments, so we’re preparing students
for a workplace where there will be a
shift in the skills needed to succeed,” said
Jones, of Florida International University.
Those shifting sands put pressure
on the glue that holds higher education
together: its workforce. In a 2022–23
Healthy Minds survey of faculty and
instructors, 64% of those questioned
said they felt burned out because of
work (Exploring Faculty Burnout through
the 2022–23 HMS Faculty/Staff Survey,
APA). Faculty who are women, gender
minorities, or people of color tend to
report even higher rates of burnout. A
2023 APA report found that faculty of
color are expected to do extra “invisible
labor,” such as mentoring students of
color and educating their White col-
leagues about diversity (APA Task Force
Report on Tenure and Promotion for Fac-
ulty of Color, 2023).
For staff, higher education is steadily
becoming an undesirable place to work.
Turnover during the 2022–23 school
year was the highest it has been since
CUPA-HR began tracking it 7 years ago
(The CUPA-HR 2023 Higher Education
Employee Retention Survey). Only about
half of employees reported being recog-
nized regularly for their work, and few
received raises on par with inflation. The
XAVIERARNAU/GETTY IMAGES
majority want flexible or hybrid work
arrangements, but only about one-third
receive them.
“When retention efforts are nonexis-
tent, turnover is going to remain high,”
As colleges and universities navigate the stormy seas of financial uncertainty, workforce
instability, and technological change, it’s important for faculty and administrators to stay
focused on the group at the center of it all: students.
said Bichsel. “Higher education institu-
tions need to start positioning themselves
as employers of choice, or they’ll be left
only with candidates and employees who
cannot find something better—those who
have fewer qualifications, less experience,
or cannot relocate for other reasons.”
FOCUS ON STUDENTS
Since the pandemic began, the financial
model of higher education has been put
to the test. Demand has dropped, but
schools have struggled to cut costs with-
out compromising quality.
That puts higher-ed institutions in
a tight spot as they fight to survive and
adapt. Some have moved toward a corpo-
rate culture in senior leadership, but Jafar
warned that such a shift can also put col-
leges and universities at risk. Traditional
academic governance systems—which
move more slowly and typically include
additional checks and balances—have an
important function: protecting academic
institutions from outside influence,
including political attacks on academic
freedom.
As colleges and universities navigate
the stormy seas of financial uncertainty,
workforce instability, and technological
change, Jones highlights the importance
of staying focused on the group at the
center of it all: students.
M O N I TO R O N P S YC H O LO G Y
“Younger generations have com-
pletely different concerns than we do.
Do they have a chance to contribute to
society? Will there even be a society for
them to contribute to?” she said. “It’s
important to recognize the impact that
will have on everything in academia,
from enrollment to engagement to what
people choose to study.” n
FURTHER READING
Academic independence under fire
Abrams, Z.
Monitor on Psychology, 2023
How to use ChatGPT as a learning
tool
Abramson, A.
Monitor on Psychology, 2023
Hopeful despite headwinds: A survey
of presidents
Lederman, D.
Inside Higher Ed, 2023
Higher ed’s ruinous resistance to
change
Rosenberg, B.
The Chronicle of Higher Education,
2023
Is it time for tenure to evolve?
Dance, A.
Nature, 2023
● JA N UA R Y / F E B R UA R Y 2 0 2 4 51
2 0 2 4 TR EN DS R EP O RT
POLICYMAKERS
ARE TAKING AIM AT
WOMEN
INDIVIDUALS
A barrage of new policies
is targeting the most
intimate parts of the
lives of those living in the United
States—their reproductive
choices, sexual orientations,
and gender identities. And these
policy developments are having
a severe impact on the mental
health of those targeted, say
psychology researchers and
practitioners.
52 M O N I TO R O N P S YC H O LO G Y
AND LGBTQ+
Alarming policy trends are affecting people’s mental
health, but psychologists are fighting back
BY REBECCA A. CLAY
Individuals who are unable to obtain
an abortion are more likely to experi-
ence worse mental and physical health,
increased poverty, and prolonged contact
with abusers, for example. LGBTQ+
youth are facing greater stigma, increased
mental health problems, and less access
to medical care.
The U.S. Supreme Court’s 2022
decision to overturn the constitutional
right to abortion was a high-profile
event. And since then, 21 states have
put in place additional restrictions on
abortion or outlawed the procedure
almost altogether, and five more have
enacted restrictions or bans that are
still in legal limbo. Now some lawmak-
ers have set their sights on outlawing
gender-affirming care for transgender
youth; more than 35% of transgender
young people now live in states that have
passed bans, according to the Human
Rights Campaign. Following Florida’s
lead, some states are also trying to enact
“Don’t Say Gay”–style policies that
outlaw even the mention of LGBTQ+
people—such as books showing different
types of families—in schools.
● JA N UA R Y / F E B R UA R Y 2 0 2 4
What all these policies share: the issue
of bodily autonomy and individuals’ right
to make their own decisions.
The mental health repercussions of
these policies not only affect those tar-
geted directly but also ripple outward.
Parents are worried about their children.
Physicians and other health care provid-
ers are no longer able to provide the care
patients need. Some survey data even
suggest that people are deciding not to
have children for fear of being denied
emergency care during pregnancy. And
relatives, friends, and acquaintances are
concerned about those they love.
The individuals affected by these
THE WASHINGTON POST/GETTY IMAGES; PROBAL RASHID/GETTY IMAGES
policies may find it increasingly difficult
to get the mental health care they need,
too. As the legal environment becomes
more fraught, psychologists may become
wary of discussing health care services
like abortion or gender-affirming care
with their patients. But psychologists
are already fighting back, both within
the therapy office and beyond: They are
empowering patients to advocate for
themselves and fighting misinformation
with science-based evidence.
 Restrictions or bans on abortion and bans on gender-affirming care for transgender youth
have severely altered bodily autonomy and the right to make decisions for American
women and LGBTQ individuals.

TARGETING THE
MOST VULNERABLE Restrictions or Bans on Abortion
Many of these new policies claim to
protect individuals’ mental and physical n Full ban
health but have the opposite impact. Take n Restrictions
abortion. “The anti-abortion rhetoric
continues to claim that having an abortion
harms pregnant people,” said Antonia
Biggs, PhD, an associate professor of
obstetrics/gynecology and reproductive
sciences at the University of California,
San Francisco. “But we know that abor-
tion restrictions can force people to carry
unwanted pregnancies to term, which
harms people’s mental and physical health,
increases their chances of living in poverty,
and lowers their aspirations for the future.”
Biggs points to the landmark Tur-
naway Study, which for 5 years tracked
women who were denied abortions. The
researchers found that having an abortion
did not harm women’s well-being, said
Biggs, who led the study’s mental health
analysis. But being denied an abortion was
harmful to both women and their families,
the study found. Compared with those Bans on Gender-Affirming Care Impacting Youth
who got the abortions they wanted, those
denied faced increased poverty, continued
contact with abusive partners, and serious n Law or policy banning gender-affirming
health problems. Some women even died care (up to age 18) has passed
in childbirth. The next generation suffered,
too, with existing children suffering worse
developmental outcomes and children
of unwanted pregnancies experiencing
poorer maternal bonding.
Forced childbirth will hit people
of color especially hard. Black women,
for example, have a maternal mortality
rate nearly triple that of White women,
according to the U.S. Centers for Disease
Control and Prevention.
That differential policy impact is by
design, said Sara McClelland, PhD, an
associate professor of psychology and
SOPA IMAGES/GETTY IMAGES

women’s and gender studies at the Uni-

versity of Michigan, who studies abortion
policy’s racist and sexist underpinnings.
It’s not for nothing that policies in states
like Texas echo slavery-era policies about

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 53

bodily autonomy and travel restrictions,
she said. The bounty hunter provision
in Texas’s SB8 law, which allows citi-
zens to sue people who help patients get
abortions, parallels the practice in the
antebellum South of empowering armed
private citizens to police the movement of
enslaved people and recapture those who
escaped, for instance. “Everyone becomes
an agent of the state,” said McClelland.
Research by McClelland and col-
leagues has confirmed that racist, sexist
attitudes rooted in stereotypes about
Black women’s sexuality and motherhood
predict opposition to abortion (Sex Roles,
Vol. 87, 2022). In another study, McClel-
land and colleagues found that even
before the Dobbs decision, participants
described abortion as violating the law,
gender norms, and religious doctrine and
deserving of such punishments as fines, jail
time, and forced sterilization (Psychology of
Women Quarterly, Vol. 47, No. 1, 2022).
Anti-LGBTQ+ policies are having a
similarly dire impact on well-being in the
LGBTQ+ community, especially among
youth. In Florida, for example, the state’s
Board of Education declared that the
material on sexual orientation and gender
identity within the Advanced Placement
(AP) Psychology course violated state law
(See “Education under siege,” Monitor on
Psychology, November/December 2023).
Although an outcry from APA and other
advocates resulted in the state reversing its
decision, some schools canceled the class
anyway and other states are looking for
ways to ban teaching or even discussion of
such topics in classrooms.
These efforts to censor school curricula
aren’t the only policies affecting LGBTQ+
youth. According to The Trevor Project,
an unprecedented 633 anti-LGBTQ+
bills were active as of September, with
53 already enacted into law. These
54 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
policies—which purport to protect chil-
dren—are instead taking a toll on young
people’s mental health. In The Trevor
Project’s 2023 National Survey on the
Mental Health of LGBTQ Young People,
nearly 1 in 3 LGBTQ 13- to 24-year-olds
said their mental health was poor most
or all the time because of such policies,
regardless of whether they lived in a state
where these policies are being debated or
implemented.
Almost two-thirds of respondents
said that just hearing about potential
laws banning discussion of LGBTQ
people at school worsened their mental
health considerably. “Sometimes the bills
don’t get passed, but that doesn’t mean
there’s not an impact on young people,”
said Myeshia Price, PhD, who was the
principal investigator of the survey and is
now an associate professor of counseling
and educational psychology at Indiana
University. “Their very existence is being
debated on a huge platform.”
School-related policies, such as not
allowing youth to choose their pronouns,
participate in sports, or use the bath-
rooms or locker rooms they want, can be
especially harmful given how much time
kids spend at school, added Price, noting
that fewer than 40% of respondents to
the Trevor Project survey described their
homes as LGBTQ-affirming. “It could be
that school is the only place where their
identity is being affirmed,” Price said.
Policymakers are now singling out
transgender and gender-diverse youth for
particular attention. For Roberto Abreu,
PhD, an assistant professor of psychology
at the University of Florida, such policies
are part of a backlash against marriage
equality and other progress the LGBTQ+
community has made in recent years.
“Their larger goal is to erase LGBTQ
people, and they are predominantly
Just hearing about potential laws
banning discussion of LGBTQ+
people at school considerably
worsened students’ mental health.
targeting trans youth and their fam-
ilies,” said Abreu, adding that some
policymakers are even trying to define
gender-affirming care for young people as
child abuse. “They want us to be in con-
stant fear, wondering ‘What next?’”
Policies banning young people’s access
to gender-affirming care are particularly
harmful, said Abreu. In one study he and
colleagues conducted, parental figures of
transgender and gender-diverse youth
reported that such policies had increased
children’s depression, suicidality, and
gender dysphoria; increased stigma; and
decreased safety and access to medical care
(Journal of Family Psychology, Vol. 36, No.
5, 2022). In another study, Abreu and his
colleagues found that these policies left
parental figures feeling fearful, anxious,
and angry about the violation of their
rights (Psychology of Sexual Orientation
and Gender Diversity, Vol. 9, No. 4, 2022).
Some spoke of relocating to new states so
their children would be safe.
As Abreu’s findings suggest, the impact
of all these policies goes beyond the spe-
cific groups targeted.
Abortion bans, for instance, may be
making many rethink parenthood. A
recent poll by the nonprofit organization
All In Together found that more than a
third of women ages 18 to 39 said they or
someone they knew had decided not to
get pregnant because of concerns about
being unable to manage pregnancy-related
medical complications, even in states
where abortion remains legal. In addition
to worrying about dying if a pregnancy
MEDIANEWS GROUP/LONG BEACH PRESS-TELEGRAM/GETTY IMAGES
goes wrong and abortion is denied,
would-be parents are worried about the
growing trend toward criminalizing mis-
carriages, said Julie Bindeman, PsyD, who
codirects Integrative Therapy of Greater
Washington and specializes in reproduc-
tive psychology. “In certain states, being
pregnant is like Russian roulette,” she said.
The mental health of obstetrician/
gynecologists, emergency room physi-
cians, and other health care providers is

also suffering, Bindeman said. “If they are
dealing with miscarriages or pregnancy
complications, they can’t do what they are
trained to do and know is the right thing
to do,” she said, adding that the result in
states like Idaho has been a mass exodus
of physicians and medical trainees. “It’s a
moral injury.”
While there are signs of hope—with
some states making themselves into
safe havens for people seeking abor-
tions or gender-affirming care—the
sociopolitical context around reproduc-
tive and LGBTQ+ rights may get even
worse, psychologists warn. Advocates
worry that access to birth control and
gender-affirming care for adults may be
under threat, for instance. In 2022, for
example, 195 policymakers voted against
the Right to Contraception Act, which
would guarantee access to birth control.
On the LGBTQ front, Missouri has
already put in place major restrictions on
gender-affirming care for adults as well as
young people, with other states making
moves to erode access for adults.
As all these policies are damaging
mental health, it may be increasingly
difficult to find good mental health care,
warned Shirley Higuchi, JD, associate
chief of professional practice for jus-
tice, legal, and state advocacy at APA. In
addition to the shortage of mental health
practitioners in some areas, the chilling
effect of such policies could affect psychol-
ogists’ willingness to discuss topics like
abortion or gender-affirming care because
of uncertainty about risks.
While psychologists have not yet been
targeted the way medical providers of
abortion or gender-affirming care have,
Higuchi said, that day may come in a few
states. Psychologists could face insurers
unwilling to cover mental health services
related to reproductive or LGBTQ+
JON CHERRY/GETTY IMAGES
issues. Others might fear the risk of being
accused of aiding and abetting patients
seeking services that have been banned.
“Everything is in flux right now,” said
Higuchi, adding that APA Services has
developed resources to help psychologists
practice safely with patients affected by
abortion laws (see Further Reading) and
is developing similar resources around
gender-affirming care laws. “There’s just
a fear that psychologists could become
collateral damage.”
ADVOCATING FOR BETTER
POLICIES
Psychologists are fighting back to protect
their patients and themselves. In 2022,
APA’s Council of Representatives reaf-
firmed APA’s denunciation of abortion
restrictions and its commitment to repro-
ductive justice. In 2020, the council issued
updated resolutions opposing discrim-
inatory LGBTQ+ policies. Having the
backing of APA and other organizations
makes it easier to share evidence-based
messages and makes it less scary to speak
out, said Laura Kuper, PhD, ABPP, a
pediatric psychologist who works on a
multidisciplinary team that has histor-
ically provided medical treatment for
transgender youth.
Individual psychologists can help by
empowering patients to speak out, said
Antoine L. Crosby, PhD, vice president
for professional affairs at the D.C. Psy-
chological Association and founder of
Affirmative Spaces Psychological Services,
a practice that primarily serves LGBTQ+
people of color. Crosby helps his patients
find ways to counter an ever-increasing
sense of what they describe as “impend-
ing doom,” in whatever way works best
for them. “Some are out protesting. Some
write letters. For some, the call for advo-
cacy is too much of an ask because of all
the traumas they’re dealing with. Some
are tired of fighting to simply exist as
human beings,” said Crosby. “It’s about
being attuned to yourself and what you
can handle.”
Psychologists are also taking action
beyond the therapy office.
For example, Megan Mooney, PhD,
M O N I TO R O N P S YC H O LO G Y
Psychologists are fighting back to protect
their patients and themselves, citing APA
Council of Representatives resolutions,
supporting patients in speaking out, and
engaging in advocacy and legislation
themselves.
a child and adolescent psychologist, is
currently a co-plaintiff in a lawsuit in Texas
challenging the restrictions there. Mooney
provides therapeutic services treating a
wide range of concerns, including affirming
care for LGBTQ+ youth and their families.
Kuper and her colleagues have devel-
oped a menu of advocacy ideas that
includes collaborating with psychological
associations, promoting evidence-based
information via traditional and social
media, and getting involved in politi-
cal advocacy at all levels, from school
board meetings to state legislatures and
Congress (Clinical Practice in Pediatric
Psychology, Vol. 10, No. 3, 2022). “Mental
health providers can play an important
role … since our licenses are not directly
at stake,” said Kuper. “It can be harder for
physicians in some contexts, so we can
step in and help share messages and be
advocates,” said Kuper.
“Just knowing that progress isn’t linear
gives me hope,” said Kuper. “Big picture,
I try to stay optimistic knowing that, in
general, society’s views are changing and
becoming more supportive.” n
FURTHER READING
Resources for grassroots and state-
level advocacy on LGBTQ+ issues
APA and Div. 44 (Society for the
Psychology of Sexual Orientation and
Gender Diversity), 2023
Frequently asked questions about
abortion laws and psychology practice
APA Services, 2022
Subverting the mandates of our
methods: Tensions and considerations
for incorporating reproductive justice
frameworks into psychological science
Avery, L. R., & Stanton, A. G.
Journal of Social Issues, 2020
When the political is professional: Civil
disobedience in psychology
Flynn, A. W. P., et al.
American Psychologist, 2021
● JA N UA R Y / F E B R UA R Y 2 0 2 4 55
2 0 2 4 TR EN DS R EP O RT

DESPITE A GROWING
BACKLASH
AGAINST RACIAL
EQUITY EFFORTS,

PSYCHOLOGISTS
PERSEVERE

56 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
 D
uring the past year, many private industry and public institutions have cut equity, diversity, and inclusion (EDI, also referred
to as DEI) funds and positions, leaving psychologists who filled many of these roles—and especially the racial equity
work they have done—in limbo. In addition to these challenges, there have also been legislative battles, both at state and
national levels, to undermine racial equity efforts. Recent developments such as the Students for Fair Admissions v. Harvard
decision by the Supreme Court of the United States (SCOTUS), which eliminated the use of race-based affirmative action in
college admissions decisions, and efforts by state legislatures to pass anti-EDI laws have created a number of legal, financial,
and social roadblocks for those who are doing the work to create a more just and equitable society.

“This has never been easy work, but this discussed on the news, in your classroom, places, companies are buckling down
is a particularly hard climate right now or in your home, that can be enough to and saying, ‘It’s a part of our values, so
to be fighting this fight,” said Brooke lead to a feeling of isolation, alienation, we’re here for the long haul.’” As Shelby
Vick, PhD, a social psychologist and and stress.” notes, a lot of chief diversity officers and
the chief diversity officer and associ- More than 3 years after summer EDI employees are losing their jobs after
ate provost for equity and inclusion 2020, when many companies and public funding cuts or are quitting because of
at Muhlenberg College in Allentown, institutions made pledges to increase burnout. For example, Hollywood recently
Pennsylvania. “It’s particularly hard to racial diversity in the wake of the murder saw an exodus of six EDI leaders, from
do this work against forces that feel big of George Floyd, the story on the ground companies such as Netflix, Disney, and
and out of your control.” is far less optimistic than what many had Warner Bros. Discovery, owing to a
hoped for. “There’s two different sides,” mixture of company restructuring and
ANTI-EDI LEGISLATION said Courtney Bryant Shelby, PhD, an voluntary resignations.
Within the last year, EDI programs have organizational psychologist and founder For those who are still in EDI roles,
faced a significant number of legislative of Simply You Solutions, LLC. “DEI has the current backdrop of anti-EDI legisla-
efforts aimed at either undermining or fallen off in some places, and in other tion is making these jobs much harder, as
eliminating their endeavors. At the state
level, more than 24 bills in 15 states,
including Texas, Florida, Iowa, Missouri, ANTI-EDI Legislation
and South Carolina, have either canceled
or proposed canceling EDI programs. n Introduced or Approved
This includes Florida Governor Ron n Signed Into Law
DeSantis announcing he would block
EDI programs at state colleges and Texas
Governor Greg Abbott signing a bill ban-
ning EDI offices and initiatives at higher
education institutions.
Some of these bills have passed into
law, while others are still being debated.
However, even if these bills never become
law, the damage may already have been
done. “There are still open questions about
whether the law even needs to be passed,”
said Skyler Jackson, PhD, an assistant
professor of social and behavioral sciences
CHIP SOMODEVILLA/GETTY IMAGES

at Yale School of Public Health, where his

work focuses on the ways social identities Within the past year, EDI efforts have faced
such as race, gender, and sexual orientation signficant opposition: At the state level,
more than 24 bills in 15 states, including
influence mental health and well-being. Texas, Florida, Iowa, Missouri, and South
“Your identity or social group becoming Carolina, have either canceled or proposed
a high-profile controversial topic that is canceling these programs.

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 57
2 0 2 4 TR EN DS R EP O RT
many find themselves having to navigate a
very fine line—one that ensures compli-
ance with the law while also finding ways
of achieving their goals—with far fewer
resources than needed. “It is having a
chilling effect on the implementation of
new ideas,” Vick said. “A lot more time
and resources are being spent in a way
that is not advancing our goals.”
Even within this context, there is still
cause for hope, as these laws do not affect
equity initiatives by private companies,
nor do they explicitly outlaw certain types
of efforts, such as strategies to increase
the racial diversity of an applicant pool.
However, “it’s making people nervous that
there’s a group that will come for [their
EDI efforts] next,” Shelby said.
SCOTUS DECISION
Although the full impact of the
SCOTUS decision banning race-based
affirmative action in college admissions
will only be realized years down the
road, similar state measures foreshadow
the results. One example is Proposition
209, passed in California in 1996, which
made it illegal to use race, ethnicity, or
sex as a criterion for admissions to state
schools. As a result, the percentage of
underrepresented minorities dropped at
many University of California cam-
puses, including UC Berkeley and
UCLA (Bleemer, Z., Affirmative Action,
Mismatch, and Economic Mobility after
California’s Proposition 209, 2020).
“Based on what happened in Cali-
fornia after Prop. 209, we can expect to
see, across the board, less diversity at our
higher education institutions,” said Cyn-
thia Pickett, PhD, a social psychologist
and the chief diversity officer at Cal Poly
Pomona. “I’m expecting that there will be
a backslide.”
In the absence of affirmative action
since the passing of Proposition 209,
schools in California have devised other
strategies for increasing diversity; how-
ever, these efforts tend to be less targeted
58 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
EMBATTLED EDI
and less effective. For example, although
universities cannot make admissions
decisions based on race, they can try to
diversify the applicant pool, and they can
factor major life experiences, such as expe-
riencing adversities because of race, into
application decisions. Such efforts can
help increase the diversity of a campus,
but are not quite as effective as the use of
affirmative action.
If the proposed anti-EDI legislation
does pass, research suggests that it can
affect the physical and mental health of
the people it targets. “When laws are
introduced that attack or undermine the
dignity of a population, it sends a message
to them that they don’t matter, that their
rights might be taken away,” Jackson said.
“That can elevate stress, and that, over
time, if chronic and not adequately coped
with, can undermine their mental health.”
THE ONGOING ROLE
OF PSYCHOLOGISTS
In this particular area, psychologists are
uniquely situated to continue making
progress, especially through clinical
expertise and research.
Whether it is finding ways to support
individuals who are facing the mental
and physical toll of being stigmatized,
coming up with effective strategies for
increasing access to historically under-
represented groups, carrying out research
to understand the factors leading to
polarization, or working with legislators
to create more equitable laws, psychol-
ogists possess essential skills that can
further EDI efforts.
One major skill includes applying
clinical expertise to the practice of racial
equity work, which is often emotion-
ally fraught. “Psychologists are experts at
thinking about what it takes to create a
safe place for people to explore and talk
about things that are difficult, that are
emotional, and that they aren’t encouraged
by society to talk about, and these are the
precise skills that are sorely needed to do
effective DEI work,” Jackson said. “This is
an area where psychology thrives.”
Another major skill is the broader
practice of researching effective strate-
gies for creating a more racially equitable
societal framework. “One critical role
that psychologists can play, in the long
term, to secure the role of diversity and
inclusion work in the fabric of our society,
is to improve the science and the scien-
tific rigor that shows DEI work is safe,
[is] effective, and leads to a better society
for all of us,” Jackson said. “Science is not
going to save us alone. However, I do
believe that the lack of good science is an
additional vulnerability, and it is a place
where psychologists are uniquely posi-
tioned to contribute.”
Some examples of researchers who
are doing this crucial work are Kimberly
Rios, PhD, at the University of Illinois
Urbana-Champaign, who studies how
people respond to threats to their social
and personal identities, with a particular
focus on majority versus minority identity,
and Mark Hatzenbuehler, PhD, at Har-
vard University, who studies the effects of
structural stigma, such as racist policies.
Rios, who runs the Conformity,
Attitudes, Threat, and Stereotypes
(CATS) Lab, is studying the backlash
against EDI initiatives. “A lot of my own
research looks at why members of domi-
nant groups feel threatened by diversity,”
said Rios. “These different sources of
threat that dominant group members
might feel are good predictors of even-
tual backlash” (Personality and Social
Psychology Review, Vol. 26, No. 4, 2022).
These threats can include practical
concerns about losing resources, such as
jobs, promotions, or educational oppor-
tunities. They can also be intangible, such
as feeling left out of the conversation or
failing to become invested in EDI efforts
because of a lack of connection. “Domi-
nant group members often perceive that
discussions of diversity are not about them
at all,” Rios said. “That, in and of itself, can
 2 0 2 4 TRENDS REPO RT

EMBATTLED EDI

feel threatening.” Researching the ways in

which members of the dominant groups
feel threatened by EDI initiatives can help
lend insight into why the backlash is hap-
pening, while also suggesting strategies for
lessening the perceived threats.
Despite the backlash against racial
equity funding and initiatives, psychology
as a field and psychologists as individuals
continue to persevere in creating a more
diverse and inclusive society. “When I
moved into DEI leadership, I knew I was
not leaving psychology behind,” Vick
said. “Psychology is at the heart of how I
do my job.” n

FURTHER READING

State-level immigration and immigrant-

focused policies as drivers of Latino
“When I moved health disparities in the United States
Philbin, M. M., et al.
into DEI leadership, Social Science & Medicine, 2018
I knew I was not Structural racism and myocardial
leaving psychology infarction in the United States
behind. Psychology Lukachko, A., et al.
Social Science & Medicine, 2014
is at the heart of how
I do my job.” Stigma as an unrecognized determinant
of population health: Research and
policy implications
Link, B., & Hatzenbuehler, M. L.
Journal of Health Politics, Policy
and Law, 2016

Taking a “multiple forms” approach

implications, and legal recommendations
BROOKE VICK, PHD,
SOCIAL PSYCHOLOGIST
AND CHIEF DIVERSITY
OFFICER AND ASSOCIATE
PROVOST FOR EQUITY
AND INCLUSION AT
MUHLENBERG COLLEGE
EVA ALMQVIST/GETTY IMAGES
to diversity: An introduction, policy
Rios, K., & Cohen, A. B.
Social Issues and Policy Review, 2023
Multiculturalism and colorblindness
as threats to the self: A framework for
understanding dominant and non-
dominant group members’ responses to

interethnic ideologies
Rios, K.
Personality and Social
Psychology Review, 2022

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 59
2 0 2 4 TR EN DS R EP O RT

Increasing Pathways to
Access Mental Health Care

Psychologists are leveraging approaches

that rely on technology and peer support
to meet the high demand for services

BY HEATHER STRINGER

60 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4

N
inety percent of the public
think there is a mental
health crisis in the United
States today, with half of young
adults and one-third of all adults
reporting that they have felt anxious
either always or often in the past
year, according to a 2022 survey
conducted by the Kaiser Family
Foundation and CNN. One-third
of respondents could not get the
mental health services they needed.
When asked about the specific
barriers to accessing care, 80%
cited cost and more than 60% cited
shame and stigma as the main
obstacles. The shortage of mental
health providers is also prohibitive,
with 60% of psychologists reporting
no openings for new patients,
according to APA’s 2022 COVID-19
Practitioner Impact Survey.
Mental health providers throughout the
country share a sense of urgency to find
new ways to meet the high demand for
services, and innovators are exploring
interventions that diverge from tra-
ditional therapy models. The creative
approaches include forms of support that
require less time commitment from indi-
viduals, can be offered through digital
devices, or both. Clinicians and research-
ers are seeing the benefits of these
strategies in settings such as commu-
nity clinics and college campuses, where
psychologists experience a duty to serve
and patients are open to exploring new
SVETLOZAR HRISTOV/GETTY IMAGES
options to access help.
“The lack of access to mental health
care is an equity issue,” said Martyn
Whittingham, PhD, a licensed psycholo-
gist in Ohio who developed a brief group
therapy intervention. “Too often people
MENTAL HEALTH CRISIS
Ninety percent of the public think there is a mental
health crisis in the United States today
90%
One-third of all adults report that they have felt anxious
either always or often in the past year
33%
One-third of respondents could not get the mental health
services they needed
33%
from marginalized communities struggle
to access quality psychotherapy, and these
innovative strategies can provide support
to many more people.”
DIGITAL INTERVENTIONS
The use of mental health apps continues
to skyrocket. Certain apps, such as digital
therapeutics, can cost between $300
and $1,500 per year and are typically
not covered by insurance. Psychologists
are advocating at the state and federal
level for health insurance organizations
to cover the fees. Even though digital
therapeutics have significant potential,
psychologists are also “still figuring out
how to use these tools in the context
of clinical workflows,” said Stephen
Schueller, PhD, an associate profes-
sor of psychology at the University of
California, Irvine. “Evidence suggests
that people benefit most from digital
therapeutics when the apps are used in
conjunction with some form of human
support.” People may need coaching
to troubleshoot technical problems
and check-ins to see if symptoms are
improving, he said. (See more about the
use of digital therapeutics within clinical
M O N I TO R O N P S YC H O LO G Y
2 0 2 4 TRENDS REPO RT
practice on page 80.)
Digital therapeutics could play an
important role in providing support
for underserved communities—spe-
cifically, people who speak languages
other than English. But most mental
health apps are only available in English.
The Latinx community represents the
largest non-White community in the
United States, yet only 14.5% of mental
health apps studied in a recent literature
review had Spanish-language operability
(Muñoz, A. O., et al., Frontiers in Digital
Health, Vol. 3, 2021).
Schueller recently launched a study
using a digital therapeutic called Silver-
Cloud that offers cognitive behavioral
therapy skills and practice exercises to
help people address anxiety, depression,
insomnia, and other issues. His team is
using the Spanish-language version and
training Spanish-speaking laypeople
from the community to coach monolin-
gual Spanish-speaking patients to use the
app effectively. Schueller’s team is explor-
ing how the addition of human support
to the SilverCloud intervention impacts
clinical outcomes and engagement with
the app and how to best integrate this
● JA N UA R Y / F E B R UA R Y 2 0 2 4 61
2 0 2 4 TR EN DS R EP O RT
digital therapeutic into care delivery.
Jessica Schleider, PhD, an associate
professor of medical social sciences at
Northwestern University in Chicago,
has been studying interactive digi-
tal tools that allow social media users
to access single-session interventions
that could be completed in one sitting.
She was interested in creating a form
of support beyond the automated crisis
hotline messages users often receive
when algorithms for social media plat-
forms detect high-risk searches, such as
“suicide” or “kill self.” Data revealed that
few people were using these resources
because the messages felt impersonal and
invalidating, said Schleider. “These new
interventions are not designed to solve
problems in one session, but helping peo-
ple make one good choice can shift the
trajectory of their lives,” she said.
SHARING THROUGH
OPEN ACCESS
Open science has been a trend among
researchers for many years, but psychol-
ogists are now also uniting to share the
most reliable clinical assessment tools
available with the public on one website.
The idea to build this type of resource
originated from Mian-Li Ong, PhD, a
former graduate student working with
Eric Youngstrom, PhD, a professor of psy-
chology and psychiatry at the University
of North Carolina at Chapel Hill. Eager
to break down walls between psychology
and the public, Youngstrom and several
students formed Helping Give Away Psy-
chological Science (HGAPS), a nonprofit
organization working to share psychology
to promote well-being.
Youngstrom and colleagues reviewed
and statistically analyzed dozens of
free assessment instruments for several
conditions—including depression, anx-
iety, post-traumatic stress disorder, and
attention-deficit/hyperactivity disorder—
and made the most reliable measures
available on the HGAPS website. People
62 M O N I TO R O N P S YC H O LO G Y
MEETING THE NEED
can take the tests online and then receive
assessment scores, which they can share
with providers. “Many therapists provide
treatment without using a rating scale or
screener,” said Youngstrom. “We tend to
ask clients why they want therapy and
focus treatment based on the response,
but assessments can identify important
issues that clients may not be aware of.”
He hopes the assessments will prompt
more people to seek therapy and benefit as
much as possible from treatment.
HGAPS has also started building
pages on Wikiversity that share the most
reliable assessment tools in multiple lan-
guages for 16 mental health conditions,
including autism spectrum disorder, bipo-
lar disorder in youth, and substance use
disorder. Some Wiki pages are also related
to popular shows, such as Squid Game,
offering mental health resources related to
topics covered in the show, such as food
insecurity and sexual violence. According
to the HGAPS dashboard, there have
been more than 400 million views of the
organization’s resources on the web.
THE POWER OF ONE
APPOINTMENT
The importance of designing inter-
ventions that can reach more people is
gaining momentum not only in the digi-
tal arena but also in individual and group
therapy contexts. Data show that most
patients do not return after their first
therapy appointment, even when provid-
ers recommend ongoing treatment (Hoyt,
M. F., et al. [Eds.], Single-Session Therapy
by Walk-In or Appointment, Routledge,
2018). Aware of this reality, psychologist
Windy Dryden, PhD, professor emeritus
of psychotherapeutic studies at Gold-
smiths University of London, started
offering a form of therapy that could
effectively help patients in one session. He
has trained counselors at more than 20
universities in the United Kingdom to use
the model, and the majority of patients
he sees through an employee assistance
● JA N UA R Y / F E B R UA R Y 2 0 2 4
program opt for one session even though
eight sessions are covered by insurance
(Australian & New Zealand Journal of
Family Therapy, Vol. 41, No. 3, 2020).
In the last year, demand for Dryden’s
single-session therapy training has
increased because managers at health care
agencies are motivated to reduce waiting
lists. “I’m happy to provide training for
this purpose, but this is not the primary
purpose of single-session therapy,” Dryden
said. “The goal is to help people walk
away from a session with the help they are
looking for.”
Patients complete a questionnaire
before the session and share what they
want from the meeting, how they have
sought help in the past, what helped
and what didn’t, and other information.
Many patients struggle to accurately
assess threats and their ability to cope in
the face of threats, so Dryden helps them
talk through scenarios to improve their
accuracy. “This intervention is designed
for populations that are poorly served,”
he said. “People get what they want and
waiting lists come down.”
Evidence suggests that the
single-session approach is helping
patients. In a systematic review of studies
involving single-session therapy to treat
anxiety disorders in youth and adults,
researchers found that this intervention
was superior to no treatment and similar
to multi-treatment sessions in reducing
anxiety symptoms (Bertuzzi et al., Fron-
tiers in Psychology, Vol. 12, 2021).
LEARNING BY DOING
Focused brief group therapy (FBGT) is
another strategy that increases access by
empowering participants to practice skills
in a safe environment. The model, which
involves 8 to 12 sessions of group therapy,
was developed by Whittingham when
he was an associate professor of clinical
psychology at Wright State University.
The counseling center’s providers had
long waitlists and a desperate need for

Focused brief group therapy empowers participants to practice skills in a safe environment
over eight to 12 sessions. Although FBGT originated in the university setting, an increasing
number of health care organizations are looking to implement the model.
an intervention that would fit within the
school calendar system. “I knew students
were developmentally concerned about
relationships, and I wanted to use the
power of the group to help people,” Whit-
tingham said.
Participants take a pre-assessment
called the interpersonal circumplex to
understand their specific type of relation-
ship distress. The tool assesses traits like
assertiveness, dominance, agreeableness,
and warmth, and members collabora-
tively establish goals with the therapist
to improve relationships. During the
meetings, participants restate their goals
and practice new behaviors. If someone
shares difficulties with a relationship, a
group member who is striving to be less
conflictual could practice being supportive
by asking follow-up questions and affirm-
ing the individual. “This is not role play,”
Whittingham said. “By interacting in real
time, people experience deep physical
and emotional responses because they are
often afraid of rejection.” When they take
risks by trying new behaviors and expe-
rience acceptance, participants are more
willing to try the new behaviors in their
SVETLOZAR HRISTOV/GETTY IMAGES; SIMPLEHAPPYART/GETTY IMAGES
lives, he said.
Although FBGT originated in the
university setting, an increasing num-
ber of health care organizations have
started contacting Whittingham to learn
how to implement the model. Psychi-
atrist Meenakshi Denduluri, MD, was
drawn to FBGT because the groups
were here-and-now focused rather than
centered on skills-based psychoeduca-
tion. Denduluri, who recently led FBGT
2 0 2 4 TRENDS REPO RT
the other person. Survey results from
more than 500 students showed that
most participants felt less stress, anxiety,
and overwhelm after the peer listening
interactions. “It was remarkable how
many students feel that they don’t have
a forum in which they can speak about
what is going on without interruption,”
­Ragouzeos said.
Peer support programs range from psy-
in the Stanford University Department choeducation, in which trained students
of Psychiatry and Behavioral Sciences in provide information on mental health
California, had also noticed that patients topics, to support groups, where students
in individual therapy often struggled gather in formalized settings to share their
with interpersonal patterns that inhib- experiences and feelings. Ragouzeos has
ited their ability to progress in treatment. seen robust interest among students to
“The psychological safety in the therapy learn how to help peers who are strug-
groups allowed people to take interper- gling and have conversations that boost
sonal risks that they could not take in well-being. “We can’t meet the needs
their personal lives,” she said. without them because too few people
College campuses are also increasingly come through the formal channels of
leveraging the healing power of social counseling services,” said Ragouzeos. “It is
connections to boost support for students our responsibility to find ways to engage
struggling with mental health issues. students in helping each other and ensure
Although peer support programs are not they have the right resources to support
new, they are proliferating on campuses one another safely.” n
nationwide amid a current mental health
crisis and a renewed understanding that
supporting students is the responsibility of
the whole campus community—including FURTHER READING
peers, said Zoe Ragouzeos, PhD, LCSW,
Randomized evaluation of an
executive director of Counseling and
online single-session intervention
Wellness Services at New York University. for minority stress in LGBTQ+
These peer programs can reduce stigma, adolescents
reach more people, and increase diversity Shen, J., et al.
in the support options, she explained. Internet Interventions, 2023
Mental health providers at New York
Peer programs in college student
University were eager to incorporate peers
mental health: An essential approach
into the school’s student support offer- to student well-being in need of
ings in 2023, which prompted Ragouzeos structure and support
to launch a peer listening program in Humphrey, D., et al.
Mary Christie Institute and Ruderman
which participants divided into pairs and
Family Foundation, 2022
responded to a prompt, such as “What
is on your heart right now?” The partic- How Kaiser Permanente created a
ipants took turns listening and sharing mental health and wellness digital
with responses of either “Is there more?” ecosystem
Mordecai, D., et al.
or “Thank you for sharing.” Partners
NEJM Catalyst, 2021
ended the conversation by expressing in a
positive way how it felt getting to know
M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 63
2 0 2 4 TR EN DS R EP O RT

People Want
Meaning
and Stability
in Their Work
Widespread volatility is
strengthening employee
resolve to advocate for
security, purpose, and
well-being on the job.
Here’s how psychologists
can continue to advance
that momentum.

BY ANNA MEDARIS

64 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4

W hen it comes to employment, Americans in all sorts of occupations—from auto workers to Hollywood
actors, from startup founders to restaurant servers—are feeling unsteady thanks to artificial
intelligence (AI), reverberations of the pandemic, job design, and other factors, psychologists say.
“Instability of work is something that
has been part of humanity, and it feels
like it’s getting worse in some ways
because it is getting worse,” said David
Blustein, PhD, a professor in Boston
College’s Department of Counsel-
ing, Developmental, and Educational
Psychology.
“The number one thing people are
craving right now is stability—espe-
cially in their workplaces,” said Ella F.
Washington, PhD, an organizational
psychologist and professor of practice at
Georgetown University’s McDonough
School of Business.
But the future of work isn’t all bleak:
An unstable ground is strengthening
workers’ resolve to advocate for meaning,
well-being, and work-life balance on the
job, and psychologists are poised to help.
“We know how to improve jobs
and to improve motivation, to increase
people’s satisfaction, and also to make
it so that they add value,” said Susan
J. Lambert, PhD, co-director of the
Employment Instability, Family
Well-Being, and Social Policy Scholars
Network at the University of Chicago.
In other words, working toward
greater stability, she added, “is good for
business and it’s good for people, and I
think it’s really good for society.”
MORSA IMAGES/GETTY IMAGES; HENRIK SORENSEN/GETTY IMAGES; KLAUS VEDFELT/GETTY IMAGES
ORIGINS OF INSTABILITY
Instability at work doesn’t just mean the
threat, or reality, of layoffs. Researchers
define it as “a state in which the con-
sequences of a mismatch between an
individual’s functional and/or cognitive
abilities and demands of their job can
threaten continuing employment if not
resolved” (Brain Injury, Vol. 20, No. 8,
2006).
Maybe someone’s not paid enough to
maintain their lifestyle, maybe they can’t
keep up with the pace, maybe they lack a
sense of belonging, maybe their environ-
ment is straight-up toxic.
PERCENTAGE OF WORKERS REPORTING NEGATIVE ATTITUDES ABOUT WORK
BY WORRY ABOUT AI MAKING SOME/ALL JOB DUTIES OBSOLETE
n Not worried about AI n Worried about AI
Believe they do not matter
to their co-workers
17%
37%
Believe they do not matter
to their employer
23%
41%
Believe they are not valued at work
20%
24%
However workers experience it, the
pandemic is perhaps the most blatant
driver of instability at work—continu-
ing to shake up the literal ground many
employees stand on as employers exper-
iment with hybrid schedules. While
research suggests more flexibility largely
benefits workers’ mental health and pro-
ductivity, quickly-shifting mandates on
who should work where and when can
be disorienting, as can an office environ-
ment that’s just not the same.
Employees are “not necessarily in the
same location when they are ‘on loca-
tion.’ They’re not necessarily, or rarely,
with the same configurations of people
and activities that they were before,” said
Amy Wrzesniewski, PhD, a profes-
sor of management at Wharton at the
University of Pennsylvania who studies
meaning at work. “So maybe people are
in the office a few days a week, but the
M O N I TO R O N P S YC H O LO G Y
2 0 2 4 TRENDS REPO RT
Feel micromanaged at work
33%
56%
Worried new forms of tech will take over
some/all work duties in next 10 years
23%
75%
Employees in all sorts of occupations
are feeling unsteady because of the rise
of artificial intelligence, reverberations
of the pandemic, and job design, among
other factors.
office isn’t the office anymore.”
Job design is contributing to instabil-
ity too, said Lambert, a professor at the
University of Chicago Crown School of
Social Work who studies work schedul-
ing practices among low-wage workers.
“A lot of jobs have just been so frag-
mented that people can’t complete a
whole job from beginning to end, and
they can’t take pride in it,” she said.
It’s easier for a salesperson who sees a
purchase all the way through to reap
satisfaction, for example, than someone
whose single duty is to price items.
Put another way: When jobs are
designed so that people can be replace-
able, they’ll feel replaceable.
Relatedly, an increasing reliance on
contract workers over salaried employees
is driving instability, Blustein said. This
played out in the auto workers’ strike
of fall 2023, he said, where the workers
● JA N UA R Y / F E B R UA R Y 2 0 2 4 65
2 0 2 4 TR EN DS R EP O RT
Many organizations have eased up on their commitment to EDI—sometimes unintentionally,
and often quietly, such as leaving an EDI director role unfilled. Employees from
underrepresented populations can feel it and start to psychologically retreat.
demanded automakers stop hiring so
many temporary workers to do their tasks.
Wavering equity, diversity, and inclu-
sion (EDI) efforts (see page 52) can
also contribute to instability at work,
particularly among employees from
marginalized groups, said Washington,
a EDI expert who serves as founder and
CEO of Ellavate Solutions in Washing-
ton, D.C.
Washington said she’s witnessed
many organizations ease up on their
commitment to EDI—sometimes
unintentionally, and often quietly, such
as having a page on their website about
inclusion go dark or an EDI director role
go unfilled.
“To me that’s the more scary part of
the change because—unlike the change
in 2020—you can’t see it until it’s too
late,” she said.
But employees from underrepre-
sented populations can feel it and, as a
result, start to psychologically retreat.
That has implications for both them and
their employers, Washington said.
“Research shows that when employ-
ees can be their authentic selves and they
can work and play toward their strengths,
66 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
they’re not only happier and feel more of
a sense of psychological safety, but they
also do better work,” she said.
Finally, how artificial intelligence
(see page 44) is and will affect people’s
livelihoods is contributing to both prac-
tical and emotional instability among
workers.
In a follow-up to APA’s 2023 Work
in America survey specifically about AI,
38% of respondents reported worrying
that AI might make some or all of their
job duties obsolete, and 64% of those
who were worried said they typically feel
tense or stressed during the workday.
In one recent study, Wrzesniewski
explored how 94 former or unemployed
newspaper journalists have navigated not
just job loss but also the decline of their
whole industry, and often along with it,
a sense of identity and purpose. She and
collaborator Winnie Jiang, PhD, found
that whether people had a “fixed” or
“flexible” meaning in their work pre-
dicted whether they held out hope that
their field would be restored—or they
reinvented their careers.
Those with a more flexible mindset
tended to recover more quickly from the
sadness of their loss, and even found a
sense of freedom along the way. Pro-
fessionals of all stripes who may be
impacted by AI should take note.
“There’s some pretty good evidence
that AI is going to affect people in
jobs that are more precarious to begin
with, or jobs that are easily replaced by
automation,” Blustein said. “So that’s a
huge issue, and that’s going to add to the
precariousness of work.”
FINDING MEANING
AMID UNCERTAINTY
Despite a social media trend of younger
workers saying they want mindless work
that allows them to clock in and out and
live their lives, research suggests people
of all ages largely crave a deeper purpose
on the job.
In APA’s survey, 93% reported believ-
ing it’s very or somewhat important to
have a job where they feel the work has
meaning. Fortunately, most workers felt
their jobs met the mark. Indeed, “matter-
ing at work,” which is defined to include
meaning and dignity, has been listed by
the U.S. Surgeon General as one of the
“five essentials” for mental health and
well-being in the workplace.
If you’re not seeking value from your
work outside of a paycheck, Wrz-
esniewski asked, “then where is that
THE GOOD BRIGADE/GETTY IMAGES; LUIS ALVAREZ/GETTY IMAGES; COLORBLIND/GETTY IMAGES
sense of meaning or that sense of accom-
plishment or that sense of development
and learning and pride coming from?”
“If there’s not an available other
domain in life in which that’s happen-
ing,” she said, “then I think it becomes
a pretty closed and unfulfilling loop
ultimately.”
The search for meaning shouldn’t be a
privilege limited to white-collar workers,
Lambert said. “Everybody wants to have
a job that uses their skills, that allows
them to take pride in their work,” she
said. “Think of the electrician, think of
the plumber, think of the craftsmen who
used to be able to make something and
 2 0 2 4 TRENDS REPO RT

WHAT ’S T HE FUTUR E OF WOR K?

“Research shows that when employees can be their authentic selves and they
can work and play toward their strengths, they’re not only happier and feel
more of a sense of psychological safety, but they also do better work.”
ELLA WASHINGTON, PHD, GEORGETOWN UNIVERSITY

put their name on it. Those are incredibly
rewarding jobs.”
But meaning is self-defined: For
some, earning a paycheck is richly mean-
ingful alone, Blustein said.
Meaningful work can also coexist
with firm work-life demarcation, some-
thing employees increasingly say they
want, but that the pandemic further
blurred, according to Tammy Allen,
PhD, a distinguished university profes-
sor in the University of South Florida’s
Department of Psychology who studies
work-life balance. Indeed, APA’s Work
in America survey found only 40% said
their time off is respected.
That’s problematic for all parties
since, Allen said, “some detachment from
work makes people be able to be better
workers and to be able to bring their best
selves to work, as opposed to being per-
petually on and overworked, which can
result in burnout.”
She’s found that simple so-called
temporal boundary management tactics
can help people set boundaries between
work and home. Shutting down the
computer at the end of the day and tak-
ing breaks during the day, for instance,
can make a big difference in improving
employee mental health.
Wrzesniewski’s research on “job
crafting,” meanwhile, demonstrates how
employees can weave their own values
and interests into their work to keep
them more engaged. For example, an
accountant may implement a new way
to file taxes to make the job less repet-
itive or a teacher who moonlights as a
musician may reframe their lectures as
a performance. People who successfully
job craft, other work has found, are more
likely to have their needs for autonomy,
competence, and relatedness at work met,
and they also report better subjective and
psychological well-being (Journal of Hap-
piness Studies, Vol. 15, 2014).
“Try to start to build up and out
from where you are to run these small
experiments and make these small moves
that may become bigger moves that get
sustained and cemented into changes in
your role over time,” she said.
Still, much of the onus is on employ-
ers to design roles, cultivate work
environments, and support relationships
that help staff find purpose, belonging,
and ultimately, more security. Policy-
makers, governments, and health care
providers also have a responsibility to
support workers’ mental health through
population-wide, not just individual,
interventions a recent article in The Lan-
cet argues (Rugulies, R., et al., Vol. 402,
No. 10410, 2023).
The good news, psychologists say,
is that employers are waking up to this
reality, which also supports their bottom

MOMO PRODUCTIONS/GETTY IMAGES; KLAUS VEDFELT/GETTY IMAGES; MASKOT/GETTY IMAGES

line.
“Organizations are realizing they
need to adapt to the needs of their work-
ers,” Blustein said, “and that would be a
very positive trajectory for the future.” n

Many employees have trouble setting

boundaries between work and home.
Shutting down the computer at the end
of the day and taking breaks throughout
the day are among the strategies that can
make a big difference.

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 67
 2 0 2 4 TR EN DS R EP O RT

Psychologists Are
Innovating to Tackle
Substance Use New interventions are improving
chances of recovery from addictions

BY HEATHER STRINGER

People who lost relatives to a drug overdose sit

among imitation graves near the U.S. Capitol.
The graves were set up by Trail of Truth, an
organization that works to memorialize those lost
to substance use and to demand change.

68 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
 2 0 2 4 TRENDS REPO RT

T he latest trends in the United States for both illicit and legalized substances are sounding alarm bells
for experts who track the harmful consequences of addiction. In 2022, more than 109,000 people in the
nation died of drug overdoses—an estimated 54% jump from 2019, according to provisional data from
the Centers for Disease Control and Prevention (CDC) (National Center for Health Statistics, 2023). Roughly
two-thirds of these deaths involved illicitly manufactured fentanyl, a synthetic opioid that is 50 to 100 times more
potent than heroin (Morbidity and Mortality Weekly Report, CDC, Vol. 72, No. 26, 2023).

Illicit drug makers are also increasingly
mixing other substances with fentanyl,
such as cocaine, methamphetamine, or
xylazine, a sedative used in veterinary
medicine. These combinations are creating
a perfect storm of responses in the body
that increases the risk of death, said Nora
Volkow, MD, director of the National
Institute on Drug Abuse (NIDA).
“The recreational drugs today are
much more dangerous than what was
available on the market 10 years ago, and
we are seeing a dramatic increase in mor-
tality,” Volkow said. “As we come out of
the pandemic, there is also still a signifi-
cant amount of distress in the population,
and this increases the risk of substance
use disorders.”
She is also concerned about the
surge in regular cannabis consumption,
especially as the availability of products
with high levels of tetrahydrocannab-
inol (THC)—the main psychoactive
compound in cannabis—continues to
increase. Daily use in 2022 reached
the highest level ever reported for
young adults in NIDA’s Monitoring the
Future survey. Eleven percent of the
respondents ages 19–30 reported using
cannabis daily, and regular consumption
of higher-content THC products can
increase the risk of developing psycho-
sis, cannabis hyperemesis syndrome
(repeated and severe bouts of vomiting),
STEFANI REYNOLDS/AFP/GETTY IMAGES
will successfully recover from substance
use disorders. The strategies range from
including probation officers in treatment
efforts to advocating for programs that
reward positive behavior.
The researchers pioneering this work
are optimistic the innovations will help
to slow or reverse worrisome trends, but
societal biases have impeded progress.
“There is remarkable stigma associated
with substance use disorders in regu-
latory agencies, law enforcement, and
health care, and psychologists need to
use their position to develop and advo-
cate for the programs that can assist
patients,” said Rosemarie Martin, PhD,
an experimental psychologist at Brown
University and a principal investigator
in the National Institutes of Health’s
(NIH) Helping to End Addiction
Long-term (HEAL) Initiative. “Increas-
ing access to care for people struggling
with substance use issues is a matter
of social justice,” she said. NIH has
invested $2.5 billion in more than 1,000
HEAL projects nationwide.
BUILDING NEW ALLIANCES
As an investigator for HEAL’s Justice
Community Opioid Innovation Net-
work, Martin is leading a program that
equips probation officers to collaborate
with community treatment providers.
“Historically, treatment providers have
probation staff and community health
providers in Rhode Island to collaborate
to identify gaps in care. They recognized
that courts often do not mandate sub-
stance use treatment to reduce the number
of restrictive conditions for probation.
As a result, individuals misusing opioids
were not accessing the care they needed.
Now, probation workers in Rhode Island
are screening individuals for opioid use
at the outset of parole or probation. The
community treatment providers are also
communicating openly with probation
officers when patients are struggling
with opioid misuse. “If someone is going
through a rough time, the probation
officer can meet with the individual more
often to provide referrals or other forms of
support,” Martin said. She helped launch
similar collaboration programs in Phila-
delphia and North Carolina.
Family members are another invalu-
able, often overlooked, resource in efforts
to combat the opioid epidemic, said
Marc Fishman, MD, medical director of
Maryland Treatment Centers and a psy-
chiatrist at the Johns Hopkins University
School of Medicine. “When we think
about any other subspeciality in health
care, it is natural to involve family mem-
bers if someone is ill,” he said. “With
substance use disorders, loved ones are
unsure what to do and there is a sense
of shame and stigma.” He developed the

suicidal ideation, and other conditions.
Although the statistics are alarming,
psychologists are forging new path-
ways not only to offer support to more
people who are misusing substances but
also to improve the chances that they
not shared information with probation
staff,” Martin said. “They are concerned
about violating the patient’s privacy and
that probation workers are looking for
reasons to send people back to jail.”
Martin’s team recently invited
Youth Opioid Recovery Support (YORS)
intervention, in which one or more family
members learn how to become allies who
ensure youth in the program receive their
monthly injections of medication for opi-
oid use disorder—such as buprenorphine

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 69
2 0 2 4 TR EN DS R EP O RT
N EW
Psychologists are forging new pathways to help more people successfully recover from
substance use disorders.
or naltrexone—to reduce cravings and
block the effects of opioids. Family
members also learn how to maintain the
patient’s confidentiality and when to call
the treatment team with concerns.
The program also uses an “assertive
outreach” approach, which involves fre-
quent communication with patients and
family members about reminders, progress
check-ins, and scheduling. “We are not
passively waiting for the patient because
motivation can fluctuate,” said Fishman.
The medication is also delivered directly
to the patient’s house. In the pilot study,
nearly 50% of YORS patients did not
relapse after 6 months, compared with
5% for the controls. The controls received
treatment as usual, which included one
dose of medication and an appointment to
return to the clinic for subsequent doses
(Journal of Substance Abuse Treatment, Vol.
125, 2021).
NOVEL MEDICATIONS
FOR WITHDRAWAL
New pharmacological treatments are
also showing promise as a strategy to
help people reduce drug use. For years,
scientists have struggled to develop med-
ications to treat cannabis use disorder,
70 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
ST RAT EGIES TO END ADDICTION
which occurs in about 1 in 5 cannabis
consumers. One approach was blocking
the specific cannabinoid receptors that
are associated with the “high” caused by
THC. But this method inhibits naturally
occuring endogenous cannabinoids in the
body, which leads to harmful side effects
such as depression and suicidal ideation
as well as withdrawal in individuals with
cannabis use disorder. Recently, research-
ers discovered a drug currently called
AEF0117 that inhibits only a subset of
intracellular activity resulting from THC
activation of the receptor. This medication
does not produce negative side effects or
withdrawal symptoms.
In a recent study, Margaret Haney,
PhD, a professor of neurobiology at
Columbia University Medical Center
and director of the school’s Cannabis
Research Laboratory, found that people
who received the medication consumed
less cannabis over a period of 4 days than
those who did not receive the medication
(Nature Medicine, Vol. 29, No. 6, 2023).
For Haney, one of the major advantages
of this new pharmacological treatment is
that it could help people who are inter-
ested in either abstaining or reducing
their cannabis intake. “Many people are
not open to quitting and want to control
their use,” she said. “This is the first time
we have found a medication that will help
people use less by decreasing the high
without side effects.”
Psychologists have also recently seen
the benefits of a new pharmacological
treatment that reduces a common with-
drawal symptom: insomnia. People in
treatment for opioid use disorder (OUD)
often report that insomnia continues
long after other withdrawal symptoms
subside, but sedative medications typically
used to treat insomnia are not recom-
mended for people with OUD because
these drugs can create a “high” sensation.
Andrew Huhn, PhD, an associate profes-
sor in behavioral pharmacology at Johns
Hopkins University School of Medicine,
recently found that a drug called suv-
orexant—which inhibits wakefulness
rather than promoting sedation—reduced
insomnia in participants with OUD. The
medication also helped to reduce other
withdrawal symptoms such as vomiting
and cravings (Science Translational Medi-
cine, Vol. 14, No. 650, 2022).
MONETARY INCENTIVES
FOR SOBRIETY
There are also signs that contingency
management—or rewarding people for
positive behavior—may be available to
more patients soon. With this method,
patients receive financial incentives such
as gift cards as a reward for negative drug
urine tests or other outcome measures,
and there is overwhelming evidence that
this strategy is highly effective in helping
people recover from stimulant use disor-
ders. But contingency management has
not been used widely because the Cen-
ters for Medicare & Medicaid Services
(CMS) has been unwilling to fund these
FG TRADE LATIN/GETTY IMAGES
programs, said Stephen Higgins, PhD, a
behavioral pharmacology professor at the
University of Vermont and founder of
voucher-based contingency management
for substance use disorders. “Regulators
 2 0 2 4 TRENDS REPO RT

N EW ST RAT EGIES TO END ADDICTION

NEW BOOK HELPS CHILDREN PROCESS A LOSS TO DRUG OVERDOSE

In May, APA’s children’s book imprint Magination Press will publish All the Pieces: When a Loved
One Dies from Substance Use, a picture book to help children understand the loss of a loved one
to drug overdose. The book is geared toward children 4 to 8 years old and can guide parents,
educators, and mental health professionals on how to address the stigma associated with a death
from a drug overdose and the common grief responses children have, such as assuming the death
was their fault rather than a symptom of a disease. Learn more at www.apa.org/pubs/magination/
all-pieces.

are concerned about fraud, such as
providers who use the vouchers to draw
people to a clinic who do not need treat-
ment,” Higgins said. “But these programs
can be designed to include safeguards
that prevent this.”
In 2021, California became the first
state to receive a waiver from CMS
allowing regulatory approval to use a
contingency management program for
recovery from stimulants. In 2023, Wash-
ington state received a similar waiver.
Michael McDonell, PhD, a profes-
sor in the Department of Community
and Behavioral Health at Washington
State University, has advocated for these
programs, and he is encouraged by the
increased openness to this evidence-based
approach to treating addiction. “States
are responding to the struggles that their
citizens are having, and psychologists are
leading the way to advocate for this strat-
egy,” McDonell said.
RESOURCES FOR
HEALTHY COPING
Researchers are also working to address
the underlying psychological and social
conditions that perpetuate problem-
atic drug use. Katie Witkiewitz, PhD,
director of the University of New Mex-
ico Center on Alcohol, Substance Use,
and Addictions, believes it is critical to
depathologize substance use behaviors.
“If we recognize that people experience
something positive when using these
products, we can help them see the
negative consequences and find different
ways of getting their needs met,” she said.
Witkiewitz has been studying
mindfulness-based treatment programs
for people with alcohol use disorders. In
2022, rates of binge drinking in adults
35–50 reached an all-time high of 29%,
according to the Monitoring the Future
survey. For all age groups, the gaps are
narrowing between males and females in
consumption and related harms, such as
emergency department visits and deaths.
Witkiewitz recently launched an
online mindfulness group therapy pro-
gram, known as THRIVE, that helps
people with alcohol use disorder learn
general life skills to cope with stress. In
60-minute virtual group meetings, par-
ticipants explore how to feel stress and
discomfort without trying to alter these
emotions with alcohol, how to be mind-
ful when things are going well, and how
to savor moments. She plans to follow
the participants for 3 years to track alco-
hol use and well-being.
Although new interventions like this
hold promise, people who could bene-
fit from them are missing opportunities
for help because many clinicians do not
screen patients for substance use, said
Witkiewitz. “Most psychologists lack
training in addiction medicine, and as
a result, too many patients are treated
solely for mental health conditions with-
out receiving support for substance use
disorders,” she said.
Volkow believes consistent screening
will not only increase the chances of
identifying people who are suffering from
addictions but also help more individuals
avoid substance use disorders altogether.
“By screening more people, psychologists
are in a unique position to do an inter-
vention that can prevent patients from
escalating to more frequent use,” she said.
“It starts with telling patients how dan-
gerous certain substances can be.” n
FURTHER READING
Contingency management for
patients receiving medication for
opioid use disorder: A systematic
review and meta-analysis
Bolívar, H. A., et al.
JAMA Psychiatry, 2021
Gender differences in the
epidemiology of alcohol use and
related harms in the United States
White, A. M.
Alcohol Research: Current Reviews,
2020
Post-incareration outcomes
of a comprehensive statewide
correctional MUD program: A
retropective cohort study
Martin, R. A., et al.
The Lancet Regional Health—
Americas, 2022

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THERE’S A STRONG PUSH FOR MORE

SCHOOL
PSYCHOLOGISTS
A combination of pre-existing shortages and a rise in school stressors
has led to a major effort to train and hire more school psychologists

BY EMILY SOHN

Among high school students, rates of

chronic absenteeism (defined as missing
10% or more of school days) has nearly
doubled from about 15% to 30% since the
pandemic.

72 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
 2 0 2 4 TRENDS REPO RT

When school psychologists oversee too

many students, their schedule is often filled
with discussing children’s individualized
education plans. While that is an important
part of the job, it leaves little or no time left
to do behavior interventions, help teachers,
offer counseling, or other tasks.

W
ith a growing mental health crisis among young people—a trend both exacerbated and illuminated
by COVID—the need for school psychologists is multiplying. School psychologists in the United
States offer counseling, assess students for intervention needs, respond to crises, launch school-
wide initiatives to reduce bullying—and more. Trained in psychology, child development, and education, these
experts play a crucial role in identifying mental health needs in young people, especially in cases where families
don’t speak English or don’t have resources to pursue evaluations on their own.

But school psychologists are in short
supply in the U.S. During the 2021–22
school year, there was, on average, just
one psychologist for every 1,127 students
in kindergarten through 12th grade
across the United States (State Shortages
Data Dashboard, National Association
of School Psychologists (NASP), January
2023). That’s far fewer than the goal of
one for every 500 students set by NASP.
There is a particular need for bilingual
school psychologists to work in a cultur-
ally sensitive and inclusive way with an
increasingly diverse student body. The
shortage is notably extreme in rural areas
and certain parts of the country, espe-
children with mental health disorders,”
said Andrea Clyne, PhD, president of
NASP in Bethesda, Maryland. “Schools
are woefully underresourced when
it comes to the provision of needed
services for a population with diverse
backgrounds and needs.”
To address the gap between sup-
ply and demand, a variety of efforts are
underway to boost the numbers of men-
tal health professionals in schools. Many
of those efforts are buoyed by an influx
of support from the U.S. Department of
Education. In 2023, the department gave
$141 million to 103 states and school
districts. Grantees are working to raise TREVOR WILLIAMS/GETTY IMAGES; MEDIANEWS GROUP/READING EAGLE/GETTY IMAGES

cially southern states. the profile of school psychology as a pro-

In Mississippi, according to the best
available data, there is 1 school psychol-
ogist for every 9,292 students. In New
Mexico, the ratio is 19,811 to one. In
rural Colorado, it’s 2,128 to one, com-
pared with 942 to one in the state overall.
Only a few states and territories meet or
come close to the recommended ratio,
including Utah and Puerto Rico.
“Our nation is seeing increasing
numbers of students experiencing pov-
erty and trauma and growing numbers of
fession and recruit more candidates by
eliminating the barriers to entry. It is the
biggest level of commitment counseling
psychologist Dorothy Espelage, PhD, has
seen in her 30 years in the field, and it is
fueling long-overdue momentum.
“It took a crisis in the schools,”
said Espelage, who is also a
bullying-prevention expert at the Uni-
versity of North Carolina, Chapel Hill.
“We’ve had the shortage, but somehow—
because of the suicide rates, because of

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MO RE
school shootings and other crises—we’ve
had an administration that said, ‘We’re
going to pay attention to mental health.’”
GROWING DEMANDS
Although a shortage of school psycholo-
gists has been a problem for decades, the
COVID-19 pandemic made the situation
worse, experts say, in part by exacerbat-
ing a growing mental health crisis among
young people. Growing awareness also
put a lens on the issue, in turn identifying
more kids in need of support.
In 2021, 42% of high school stu-
dents and 57% of teen girls said they felt
persistently sad or hopeless, according to
a U.S. Centers for Disease Control and
Prevention report—the highest rate in 10
years (Youth Risk Behavior Survey Data
Summary & Trends Report, 2023). Some
20% of adolescents had major depressive
disorder that year, according to a 2023
study, which found that fewer than half of
those who needed treatment were getting
it (Flores, M. W., et al., JAMA Pediatrics,
online first publication).
Suicide is also a rising concern. In
2021, according to the CDC report, 10%
of high school students attempted suicide,
and 22% seriously considered it. Certain
groups of kids are particularly vulnerable
to mental health and suicide risks. Among
LGBTQ+ students, 69% felt persistently
sad or hopeless, and 45% seriously con-
sidered attempting suicide. “These are
dramatic and staggering numbers of chil-
dren and youth who are struggling with
their mental health,” Clyne said.
For younger kids, educators report
seeing more aggressive behavior, dysregu-
lation, bullying, and disruption—a lack of
emotional regulation that appears linked
to isolation during the pandemic. Kinder-
gartners are running out of the classroom
and away from school, and that behav-
ior extends to older students, too, said
Stephanie Corcoran, PhD, president of
the Alabama Association for School Psy-
chologists and program director for school
74 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
SCHOOL PSYCHOLOGISTS
psychology at the University of Alabama
at Birmingham (UAB). Among high
school students, rates of chronic absen-
teeism (defined as missing 10% or more
of school days) has nearly doubled from
about 15% to 30% since the pandemic,
according to an analysis of national data.
Parents tell Espelage that their kids don’t
seem to be hitting developmental mile-
stones, and their kids say they don’t want
to go to school. “I’m in schools every day,
and sometimes I’ll turn to the teacher and
say, ‘This is an eighth-grade classroom,
right?’” Espelage said. “Why do I feel like
I’m in a sixth-grade classroom?”
The growing demand has put a heavy
strain on already-overworked school psy-
chologists, who may be overseeing 10,000
or more students. The job can quickly
become overwhelming. A psychologist
needs to be present for every meeting to
discuss any child’s individualized educa-
tion plan, Espelage said, and each of those
meetings can take a half a day. With such
high student caseloads, that leaves little
or no time left to do behavior interven-
tions, help teachers, offer counseling, or
other tasks. “What you end up doing is
spending all of your time doing special
education evaluations,” Corcoran said.
“You’re just trying to keep your head
above water.”
BARRIERS TO ENTRY
With escalating behavior problems that
sometimes include violence alongside
COVID-19-related academic losses,
schools can be high-stress environments,
and burnout rates are high for educa-
tion professionals of all kinds. Around
the country, there are shortages of school
nurses, social workers, and counselors.
New teachers leave the profession at a rate
of 44% in the first 5 years, according to a
2018 study (Seven Trends: The Transforma-
tion of the Teaching Force, Consortium for
Policy Research in Education). In a 2022
survey of members of the American Fed-
eration of Teachers, 74% of teachers said
they were dissatisfied with their jobs, and
40% said they thought they would leave
the profession in the next 2 years (Under
Siege: The Outlook of AFT Members, Hart
Research, 2022).
School psychologists are vulnerable
to the stresses of working in schools, too.
Up to 90% of school psychologists report
feeling burnt out sometimes, according
studies conducted before the pandemic
(Schilling, E. J., & Randolph, M., Con-
temporary School Psychology, Vol. 25, No.
4, 2021). In a 2018 survey in the south-
eastern United States, where shortages are
most extreme, about 22% reported think-
ing about leaving their current position
(Schilling, E. J., et al. Contemporary School
Psychology, Vol. 22, No. 3, 2018). “There
are a lot of issues in schools,” Corcoran
said. “Kids have significant needs, and
there’s just not enough personnel to cover
all the needs, so they can start to feel
overwhelmed.”
Then there’s politics. In Florida,
Governor Ron DeSantis recently banned
social-emotional learning, directly con-
trasting the efforts of school psychologists.
It is illegal there, Espelage said, to teach
topics related to social justice, intersec-
tionality, and other concepts integral to
psychologists’ work. Similar bills have
been proposed in at least eight states.
Even for people who might be a good
fit for the profession, school psychology
has a visibility problem, Corcoran said.
She was working as a special education
teacher when she learned about the career,
and many of her colleagues have simi-
lar stories. “You don’t hear about a lot of
little girls and boys saying they want to be
school psychologists,” she said. “We joke
in the field that you kind of fall into it by
accident.”
There is also a strain on the pipeline.
Many university PhD programs, which
take 6 or more years to complete, graduate
just a handful of school psychologists
a year, Espelage said. Boosting num-
bers more quickly, she said, will require

Part-time, hybrid, and
online programs for school
psychologists expand access
to people in rural areas, people
who have families, and people
who can’t or don’t want to
leave their full-time jobs to
complete the training.
increasing the number of programs that
offer master’s-level EdS degrees, which
generally require 2 years of coursework
and a yearlong internship. “We don’t have
time to wait for somebody for 5 to 6 years
and then only put five [graduates] out, and
then only three of them might actually
be in schools,” she said. “It’s going to take
decades to address this gap.”
WIDENING THE PIPELINE
With help from federal funding as part
of the U.S. Department of Education’s
School-Based Mental Health Services
Grant Program, more school psycholo-
gists may soon be filling in some of the
holes. This past fall, for example, UAB
launched a 2-year program to retrain
cohorts of 12 educators as school psy-
chologists, earning them an EdS. Instead
of the traditional full-time, in-person
classroom model, the UAB program
offers part-time, hybrid, and online
options, Corcoran said. That flexibility
expands access to people in rural areas,
people who have families, and people
who can’t or don’t want to leave their
full-time jobs to complete the train-
ing. The program also collaborates with
ANDRESR/GETTY IMAGES
school districts to match program partic-
ipants with fieldwork and internships.
UAB doesn’t require graduates to stay
in the school system, Corcoran said, but
because people who enter the program
have already been working in schools,
they are passionate about their work.
“One of my students was just saying that
they’re having such issues with severe
behavior and elopement and that kind
of thing, and no one knows how to han-
dle that; they weren’t trained for that,”
Corcoran said. “They want to help these
kids. The kids are struggling, and the
teachers are struggling because they don’t
know what to do.”
Other grantees include the University
of Wisconsin, Lacrosse; the University
of North Carolina, Greensboro; Indi-
ana University; and the University of
Denver’s Morgridge College of Edu-
cation, which is using $3.82 million in
federal grant money to recruit and train
32 school psychologists over the next
5 years, with a focus on placing peo-
ple in Colorado’s rural communities,
where ratios of school psychologists
are significantly lower than the state
average. SUNY Oswego is using its new
5-year grant from the U.S. Department
of Education to offer free tuition, a paid
internship, and guaranteed placement
after graduation in the Syracuse City
School District.
One of the most promising strategies
for boosting the ranks of school psychol-
ogists in the places where they are most
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2 0 2 4 TRENDS REPO RT
needed may be with “grow your own”
programs, which recruit people where
they already live and work, said Stepha-
nie Schmitz, PhD, a school psychologist
at the University of Northern Iowa in
Cedar Falls. She and colleagues have
used federal funding to recruit people
with master’s degrees working in educa-
tion around the state to re-specialize as
school psychologists.
The university’s EdS program is now
working with its third cohort of five stu-
dents and has made adjustments based on
experience. Students in the grow-your-
own program take classes part time and
primarily online over 2 and a half years,
instead of 2 as the program was originally
designed, followed by a yearlong intern-
ship. They make a 3-year commitment to
work in schools in their current geograph-
ical area after they graduate.
Few studies have examined the best
way to retain school psychologists,
Schmitz and colleagues wrote in a 2021
study, but grow-your-own programs offer
opportunities to address many of the
obstacles. “Within our state I feel like
the momentum is definitely building for
this,” she said. “There’s a lot of interest.”
In addition to recruitment efforts like
these, NASP is working to increase job
satisfaction through a focus on initiatives
that improve working conditions and
professional growth, Clyne said. They are
advocating for more federal investments,
as well as paid internships for graduate
students, stipends and other financial
incentives for school psychologists who
earn and maintain their credentials. The
organization also offers guidance to school
districts on how to create working con-
ditions that help school psychologists do
their jobs. And they are working to estab-
lish credentialing reciprocity so school
psychologists can work across state lines.
When more school psychologists join
the profession and stay there, Clyne said,
the job gets more enjoyable for every-
one—and more students can thrive. n
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Monetizing Mental Health

Is Harder Than It Looks
After several years of rapid growth of mental health technology companies, a slew of high-profile
layoffs and ethical breaches are spurring better clinical and business practices

BY ZARA ABRAMS

76 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4

In 2020, interest rates were
low and concerns about mental
health were high. Funding for
digital mental health poured in.
But times have changed.
Companies such as Better Therapeutics
and Akili Interactive have laid off at least
30 percent of their workforces, and clini-
cians have often been among those let go.
Even popular products are struggling to
stay afloat: Headspace Health let go 33
therapists, and weight loss startup Noom
made three rounds of job cuts in under
a year. After going public in 2021, Pear
Therapeutics filed for bankruptcy and
sold its assets in April.
And the problems are not just on the
business side; some of the layoffs and
business practices have caused therapeu-
tic harm to patients. Headspace laid off
therapists abruptly, providing little warn-
ing or explanation to patients. Cerebral
faced scrutiny for alleged unethical pre-
scribing practices, problematic ads tying
attention-deficit/hyperactivity disorder to
overeating, and sharing personal health
data with social media platforms.
“The intent was probably good. We
have a mental health crisis, particularly
as a result of the pandemic,” said C. Vaile
Wright, PhD, senior director for health
care innovation in APA’s Practice Direc-
torate. “But mental health is not a ‘get
rich quick’ scheme, and funders need to
have appropriate expectations.”
Abruptly firing clinicians is not only
antithetical to the goal of providing
effective mental health care, but also bad
for business. In many cases, companies
hit troubled waters because they failed to
VISUAL GENERATION INC/GETTY IMAGES
integrate clinical expertise from the start.
“How are you building mental health
tools or mental health care without
mental health clinicians? You don’t see
companies building a pacemaker without
cardiologists,” said Jessica L. Jackson,
There are reasons to be optimistic as we
enter what some are calling a “second wave”
of mental health technology
PhD, a licensed psychologist and chair of
APA’s Mental Health Technology Advi-
sory Committee (MHTAC).
But there are also reasons to be opti-
mistic as we enter what some are calling
a “second wave” of mental health tech-
nology. One aspect of this second wave
is a shift in investors’ approach. Instead
of backing technology experts looking to
capitalize on the upswing in demand for
mental health care, investors are increas-
ingly looking to fund mental health care
experts who are building technologies
and digital products that serve those
seeking help.
“I’m still optimistic, because com-
panies are starting to adjust from what
they learned in the first phase of digital
mental health,” said Matt Scult, PhD,
a digital mental health consultant and
part of the leadership team for Thera-
pists in Tech, a nonprofit organization
that supports mental health profession-
als working with technology companies.
“People still have trouble accessing and
paying for mental health care, so there’s
still a need for innovation to increase
access to care.”
M O N I TO R O N P S YC H O LO G Y
2 0 2 4 TRENDS REPO RT
WHAT WENT WRONG
Around the start of the COVID-19
pandemic, the mental health technol-
ogy industry was booming. A favorable
economic climate (low interest rates and
lots of venture capital funding) coincided
with a strong need for affordable and
accessible mental health care—what digi-
tal mental health expert David Cooper,
PsyD, calls “easy money and people with
really good intentions.”
In startup culture, funding companies
with potential rather than a proven track
record is common. Most startups do not
need to be profitable right off the bat.
But when the economy took a downturn,
digital mental health companies with-
out clinical know-how or a clear path to
profitability started to struggle.
“That changed the timeframe for
which the economics needed to be
figured out and gave a real jolt to the
industry that people weren’t necessarily
expecting,” Scult said.
When the money started to run out,
mental health technology companies
had a few options, said Cooper, who is
a member of the MHTAC. Companies
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2 0 2 4 TR EN DS R EP O RT
MO N ET IZI N G
could take a “down round” and raise
funds at a lower valuation—which can
send the message that a company is
struggling. They could find a way to
increase revenue—which is tough in a
crowded market—or “extend the run-
way,” meaning try to keep the lights on
as long as possible with remaining funds.
One way to do that is through layoffs.
In many cases, psychologists are among
the first to go because they are seen as
service providers who can be rehired later
if funds allow.
“Health tech and startups tend to
focus on this hyper-growth model, and
with that often comes over-hiring,” said
Kay Nikiforova, head of clinical and
research at health equity startup Violet
and a member of the MHTAC. “Clini-
cians who provide direct care are viewed
as a dispensable resource, rather than as
part of the organization.”
Perhaps surprisingly, psychologists
working in other roles—including clinical
strategy, clinical research, product devel-
opment, and marketing—are also some of
the first to go. While those layoffs might
temporarily extend the runway, Cooper
said they are likely to harm a company’s
long-term viability when it comes time to
demonstrate the quality of their services in
an increasingly saturated market.
“Who can assess your product’s qual-
ity, advocate for it with credibility, and
help you improve quality compared to
your competitors? All of the psycholo-
gists you just laid off,” he said.
Cutting clinicians is bad for business,
and it can also cause real harm. Patients
may feel abandoned, and even those who
stay engaged with technology products
may be less likely to seek out mental
or behavioral health care in the future,
Wright said.
“These apps could be a gatekeeper, in
a good way, where they allow people a
less stigmatizing or more cost-effective
way to approach their emotional
well-being,” she said. “But if someone has
78 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
M ENTAL H E A LT H TECHNOLOGY
a bad experience, how does that impact
them in the long run?”
For patients who have never had an
experience with mental health care and
who cannot access or afford traditional
private practitioners, an app could be the
next best thing. An abrupt termination of
their burgeoning therapeutic relationship
or other ethical breach could sour their
views on therapy.
“Technology can be a path toward a
more inclusive field of psychology, but the
people building these apps aren’t always
thinking about ethics,” Jackson said.
Another concern is that the rocky early
days of digital mental health care might
bias psychologists against the industry,
which could limit its growth potential.
For people with no experience with mental health care or who cannot access or afford
traditional private practitioners, an app could be the next best thing.
“If these challenges cause us to see
technology as a threat, rather than as a
tool, that could have negative implica-
tions for the profession,” Wright said.
A SECOND WAVE
Despite the recent struggles—and to some
extent, because of them—digital mental
health experts are optimistic about the
industry’s prospects. As a second wave of
mental health technology begins, compa-
nies are seeing that success requires some
changes to the business model.
For one, outlining a clear path to
profitability is particularly important for
technology companies in the health care
space, Cooper said, where factors such as
insurance and licensing rules can limit
potential profits. One way to plan effec-
tively is to integrate clinical founders,
leaders, researchers, and strategists from
the outset.
“Companies who did not have clinical
leaders or founders have really had to
backtrack over the years, so the ones that
are just getting started are learning from
that,” Nikiforova said.
Mental health startups without
clinical leadership have struggled on
the business side, and some have even
made legal and ethical missteps. In 2023,
mental health chat service Koko sent its
VISUAL GENERATION INC/GETTY IMAGES
users responses written by GPT-3 with-
out getting their informed consent, then
defended the decision to do so. Other
companies repurpose online resources
intended for individual therapists in a
way that could be seen as plagiarism,

MO N ET IZI N G
Jackson said. And many do not under-
stand the complexities of mental health
licensing restrictions and interjurisdic-
tional practice.
“A lot of people in the tech space
think they’re disrupting health care, but
[true mental health innovation] is much
larger than creating a new app,” Jackson
said. “It’s not the simple fix that people
think it is.”
Mental health technology compa-
nies are increasingly being founded by
clinicians or adding clinical leadership
in their first few hires (see page 93 for
more information on psychologists
pursuing career opportunities in health
tech), Nikiforova said. Examples include
Nema Health, Appa Health, and Instride
Health. Rather than starting a tech-
nology company that addresses mental
health, new startups are launched as
mental health companies that leverage
technology to reach more people.
Investors are also more cautious,
seeking proof of how a new product
will benefit patients, save money, or
address an unmet need. That’s leading
startups to place a focus on research
that demonstrates clinical efficacy from
the beginning, which presents another
opportunity for psychologists.
“Most mental health tech companies
honestly don’t know what’s under their
hood,” Nikiforova said, and could benefit
from guidance on what data to collect
and how best to utilize it. “There’s a lot
of data they aren’t using, and some aren’t
measuring the right things.”
Even with these encouraging signs,
Scult concedes that layoffs may be a
reality of startup culture that cannot be
entirely avoided. Rather than cutting
clinicians entirely, though, he suggests
VISUAL GENERATION INC/GETTY IMAGES
that companies consider ways to shift
them into other roles—for instance, into
marketing or operations.
“That way, even if a company can’t
afford a robust clinical team, they won’t
lose all of their clinical expertise,” he said.
ME NTAL H E A LT H TECHNOLOGY
More startups are focusing on clinical efficacy, which presents opportunities for psychologists.
RAMPING UP TRAINING
For psychologists looking for work in
digital mental health, job prospects may
remain slim for a while.
“We have this perfect storm of more
people than ever wanting to get in, more
people being laid off and entering the
job market—and frankly, we need fewer
companies,” Cooper said.
But the layoffs could present an
opportunity to ramp up training oppor-
tunities if psychologists with expertise
in mental health can loop back into aca-
demia, he said, then inject their expertise
into academic literature and psychology
courses. Most graduate programs provide
little training on skills needed to work
in tech, such as navigating electronic
medical records, or guidance on what to
expect from the industry.
“Individuals are transitioning and
starting careers without having a clear
career path. That can be very exciting, but
also very daunting,” Nikiforova said.
Therapists in Tech is working to
change that, with career development,
mentorship, and advocacy efforts, as well
as an extensive database of company
reviews, which includes details about
compensation, company culture, and how
M O N I TO R O N P S YC H O LO G Y
2 0 2 4 TRENDS REPO RT
legal and ethical issues are handled. In
addition to clinical and research roles,
psychologists are working in opera-
tions, product management and design,
software development, customer success,
and content development, which hints
at other possible paths into the industry.
Meanwhile, the MHTAC is exploring
how APA can shape the field of mental
health technology and better support
psychologists who hold or seek roles in
digital mental health.
“Despite the rough sailing ahead, I
still believe in the ability for technol-
ogy to enhance how we address mental
health concerns,” Cooper said. “This cri-
sis isn’t something we can train our way
out of, so we’re going to have to expand
our reach. Technology remains one of the
best ways to do that.” n
FURTHER READING
The big blunder happening right now in
digital mental health
Scult, M.
Medium, August 2023
Digital therapeutics and mHealth
APA, 2023
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2 0 2 4 TR EN DS R EP O RT

WHAT’S AHEAD FOR

CLINICAL
PRACTICE

Many key issues in the practice

of psychology center around
technology and telehealth

BY STEPHANIE PAPPAS

NICKYLLOYD/GETTY IMAGES; RENATA ANGERAMI/GETTY IMAGES;

LUIS ALVAREZ/GETTY IMAGES; JOVAN GEBER/GETTY IMAGES

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Telehealth is settling into a new normal, but new policies around reimbursement and data
privacy are still being hammered out. Practice across state lines is continuing to expand.
TELEHEALTH ENTERS
A NEW NORMAL
The COVID-19 pandemic threw tele-
psychology into overdrive overnight.
Now, nearly 4 years later, the practice of
psychology at a distance is settling into
a new normal, but new policies around
reimbursement and data privacy are still
being hammered out.
The federal Public Health Emer-
gency (PHE) enacted at the onset of the
coronavirus pandemic expired in May
2023. Prior to the PHE, Medicare and
Medicaid reimbursed for telehealth at a
lower rate than in-person therapy, said
Stephen Gillaspy, PhD, senior director
of the Office of Health and Health Care
Financing. Under the PHE, these rates
were made equitable. Now that the PHE
has expired, the Centers for Medi-
care & Medicaid Services (CMS) has
announced that the agency will continue
to pay for telehealth and audio-only
mental health services at the same rate as
in-person.
“That’s very positive,” Gillaspy said.
But questions remain about psycho-
logical and neuropsychological testing via
telehealth. These were included in reim-
bursement under the PHE, and CMS has
extended waivers to continue to reimburse
SU ARSLANOGLU/GETTY IMAGES
for them via telehealth for the time being.
Whether that policy will persist long
term, however, is not clear, Gillaspy said.
On the state and private insurance
levels, the policies are mixed, but there
seems to be an acceptance of the fact
that many practitioners are moving to a
hybrid model: seeing patients in-person
at times and virtually at others, Gillaspy
said. A survey this year by the New York
State Psychological Association found
that 96% of respondents reported deliv-
ering at least some services via telehealth.
The respondents were not a represen-
tative sample of all psychologists—or
even all New York psychologists—said
Barbara Meehan Reyes, PhD, a clin-
ical psychologist and the chair of the
Psychology Interjurisdictional Compact
(PSYPACT®) Subcommittee for the
association, but the overwhelming num-
ber hints at how common telepractice
has become.
There has been some concern that
if payers saw practitioners moving en
masse to virtual-only practice, they
might slash reimbursement rates, because
those practitioners would no longer be
maintaining a physical office and have
reduced practice expense, Gillaspy said.
So far, however, that does not seem to be
the most common arrangement. “When
I talk to insurance companies and regula-
tors, I talk about how the vast majority of
people are going to continue to provide
the full array of services,” he said. “Most
people think about services in which the
default is in-person, but with telehealth
as an option.”
Closing a physical office can also be
a challenge, because using one’s home
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address as a business address enters it
into the public record, which can be
undesirable for many mental health
practitioners. Several insurance com-
panies and Medicare require the use of
physical addresses for providers and will
not accept a P.O. box or a UPS-center
address, said Marnie Shanbhag, PhD,
senior director of the Office of Inde-
pendent Practice at APA. “You’re going
to have to think about how comfortable
you are with your home address being on
your billing,” she said.
Another perennial concern for tele-
health is privacy. Earlier this year, Zoom
rolled out a plan to leverage user data for
artificial intelligence (AI) training, which
they had to walk back after user outcry,
said Deborah Baker, JD, director of legal
and regulatory policy at APA. Instances
such as that raise questions about how to
govern the use of big data. “Our mem-
bers are becoming more sensitive to the
use of data, and what the limits are in
terms of technology in practice,” she said.
The U. S. Department of Health
and Human Services has issued several
invites for public comment on these data
and security issues in telehealth in the
last year, Baker said, while several states
have enacted consumer data privacy laws
that are stronger than what HIPAA
alone would mandate. As a result, many
telehealth platforms now issue additional
protections for residents of those states.
Patients, too, are becoming savvier about
the policies of the tech tools they engage
with, Baker said.
“Now users are starting to be more
thoughtful and read the fine print about
how data is being used a little more
closely,” she said.
PSYPACT WIDENS PRACTICE
ACROSS STATE LINES
PSYPACT now encompasses 39 states,
enabling participating psychologists to
see patients across state lines without
having to get separate licensure in each
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C L I N I CAL PRACTICE LOOKAHEAD

state. A 40th state, Vermont, has enacted PSYPACT Participating States

PSYPACT legislation and will become
active this year. n PSYPACT participating state
The compact has been adding roughly
n Enacted PSYPACT legislation
six members a year in recent years, said
Janet Orwig, executive director of the (practice under PSYPACT not yet permitted)
PSYPACT Commission, the compact’s n PSYPACT legislation introduced
governing body. This rate will likely slow,
given the relatively few states and territo-
ries left outside of PSYPACT, Orwig said,
but there is still interest in these areas.
“Folks are providing an increasing
amount of mobile services to an increas-
ingly mobile population,” said Reyes.
New York has not yet enacted
PSYPACT but was one of two states,
along with Massachusetts, with active
PSYPACT legislation in 2023. In New
York, Reyes said, the association is cur-
rently seeking a majority lead sponsor
in both legislative houses for the bill,
which is necessary for moving legisla-
tion through the New York state system.
Other states, including Mississippi and
Hawai’i, had bills in committee in 2023,
but time ran out in the legislative session
before they could come up for a vote. rapport with, or at least have a cushion the individual practitioners who hold
Hopefully, Orwig said, those bills will be before transferring to a psychologist in PSYPACT authorization. One theme, she
reintroduced in 2024. In all, 12 states saw their new state. said, is that PSYPACT allows psychol-
PSYPACT bills in 2023, and 6 enacted “What we have heard most from our ogists in specialty areas to expand their
them. members is that their client base was reach, bringing their services to patients
The New York State Psychological increasingly more mobile, and they are who would not otherwise have options
Association began pursuing membership finding it difficult to provide ongoing ser- in their regions. As a result, PSYPACT is
after a “groundswell of interest” from vice and continuity of care,” Reyes said. helping address the psychologist shortage,
members, Reyes said. “It really is far less Many of the challenges to adding said Shanbhag.
cost-prohibitive and far less logistically additional states to the compact are a “Maybe the pediatric psychologists in
challenging to practice with PSYPACT matter of education and outreach for local our state are booked out several months,
than it is to pursue licensure in multiple legislators, Orwig said. Especially in states but you can get one in the neighboring
states,” she said. that don’t have compacts for other profes- state in 3 weeks,” she said. “It helps you
New York psychologists have a patient sional licensures, PSYPACT can be new get care much more quickly, and you can
base prone to cross state lines, Reyes said. territory. New York is one of those states, get much wider access for specialty care.”
Patients may live in Connecticut, work in Reyes said, which means that policymak- There are still implementation ques-
New York, and have a second house in a ers have to consider the possible impacts tions around PSYPACT and billing,
third state, Reyes said, or they may com- on other professions and on the regulatory said Baker. It can be tricky to navigate
mute as far away as Washington, D.C. framework surrounding licensing before payment when a provider is in-network
PSYPACT is also helpful when a patient they set final rules. for a national insurance company but
moves out of state permanently, Reyes PSYPACT is currently working not in-network in any of that company’s
said; they can continue receiving care on developing its first strategic plan, plans in the state that they are practicing
from the provider they’ve already built Orwig said, beginning with surveys of in remotely. APA has begun educational

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C L I N I CAL
outreach to payers in order to understand
their level of awareness of any provider
policies around PSYPACT.
“My hope is that interjurisdictional
practice is becoming more streamlined
under PSYPACT, and more resources are
made available to psychologists practicing
under PSYPACT, so providing care across
jurisdictional lines is easier,” Baker said.
Ultimately, Orwig said, it’s unlikely
that every single state and territory
will join PSYPACT; it’s rare for any
cross-state compact to achieve universal
reach. And she expects to continue add-
ing new PSYPACT members at a slower
rate going forward.
“If we can add one or two per year
going forward,” she said, “that will be
really excellent.”
AI’S GRADUAL INTEGRATION
INTO PRACTICE
As machine learning grows more pow-
erful, researchers and health systems
are starting to explore bringing AI into
practice. However, while some tools are
already being used by larger organiza-
tions to help streamline administrative
tasks, it’s still uncommon to see AI
digital therapeutics used in direct patient
care. (See more on AI applications on
page 44.)
“We don’t have a lot of saturation of
these products in the hands of clinicians
because there’s just not a reimbursement
pathway yet,” said C. Vaile Wright,
PhD, senior director of the APA Office
of Health Care Innovation. “The prod-
ucts exist, but how much they’re being
used is unclear.”
Unlike health and wellness apps that
are prohibited from making medical
claims about their outcomes, digital ther-
apeutics are under the purview of the U.S.
Food and Drug Administration, Wright
said. But the health care regulatory and
reimbursement systems are not designed
for innovative products or for the idea of
software as a medical treatment, she said.
PRACTICE LOOKAHEAD
That has led to slow implementation even
as companies and academic researchers
develop algorithms for everything from
matching patients with potential providers
to monitoring of passive suicide ideation.
Expanding the use of AI as a tool in
practice will likely require careful testing, a
rethinking of regulatory categories around
innovative technologies, and the culti-
vation of trust in technology from both
clinicians and patients.
“I don’t think we’re quite ready for
AI or similar approaches to be used in
direct care without human oversight,
but there are a lot of exciting opportuni-
ties for AI in supporting the care that is
being provided by trained professionals,”
said Victoria Bangieva, PhD, a clinical
psychologist who advises technology com-
panies developing mental health tools, as
well as a member of APA’s Mental Health
Technology Advisory Committee. “That’s
what we’re seeing happen.”
For instance, HIPAA-compliant
services such as Mentalyc or Eleos
will transcribe session transcripts into
insurance-ready progress notes, reduc-
ing the time therapists must spend on
non-patient-facing activities. Some
larger systems are also using algorithms
to match patients to the provider most
likely to suit their needs, Bangieva said.
Some services are also used to coach
clinicians, giving them suggestions of
which treatment paths to pursue. In the
United Kingdom, the National Health
Service is using Ieso, a service founded
by two psychologists for providing online
typed therapy. The company is working
to use AI to analyze what human thera-
pists write in these sessions and tie it to
outcomes, in the hopes that AI can help
therapists understand which concepts
and phrasings are most effective.
“There is a lot of excitement around
AI, but we’re still quite early on, and
there needs to be a bit more validation
of the models and the different tools
that are being built,” Bangieva said,
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particularly in a real-world environment.
AI always carries a risk of perpetuating
preexisting biases, Wright said—if bad
data go in, bad data come out.
“Algorithms are written by people,” she
said, “and if you’ve got people with biases
using data that’s biased, what are the
unintended consequences in perpetuating
what is already an inequitable system?”
Nevertheless, these tools are import-
ant to pursue, she said, because there are
simply not enough providers to handle
the mental health need without addi-
tional help. There are efforts underway
to create a framework around both data
management and reimbursement for the
use of these tools. Earlier in 2023, CMS
solicited a request for information about
digital therapeutics from stakeholders.
A response to those comments outlin-
ing next steps from the federal payer
is expected at the end of 2023, Wright
said.
A final hurdle for the development of
AI in mental health right now involves
training, said Ross Jacobucci, PhD, an
assistant professor of psychology at the
University of Notre Dame, who is work-
ing on a project using machine learning
to monitor suicide risk using screenshots
of people’s cell phone activity. There are
relatively few people who are trained
in both big data and psychology, Jaco-
bucci said, and most psychology graduate
programs lack the in-house statistics
classes needed to work in machine learn-
ing. Students who want to work on the
tool-development side should look to out-
side workshops on artificial intelligence
and machine learning, he said. Fortunately,
more and more graduate programs are
providing funding for students to get that
expertise from third parties, he added.
“It’s really difficult for a clinical person
to speak to somebody in computer science
if neither of them has worked with the
others’ type of data,” Jacobucci said. “I do
think there are a lot of people with the
skill set that want to work with both.” n
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Psychology
Is Improving

Brain Health
FG TRADE/GETTY IMAGES, YOUNG777/GETTY IMAGES, GABRIJELAGAL/GETTY IMAGES, VALERIA BLANC/GETTY IMAGES,
and Aging MAREEN FISCHINGER/GETTY IMAGES, LAUREN MULLIGAN/GETTY IMAGES, GRANDRIVER/GETTY IMAGES

Researchers are developing new interventions

that can help prevent, identify, and manage
cognitive decline

BY ASHLEY ABRAMSON

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W ith an increasing percentage of Americans aging into the over-65 category, there is a
growing need for science-based therapies to help slow, prevent, and treat the cognitive
changes that can affect people’s aging brains. At the same time, geropsychologists, who
specialize in treating older adults, are in short supply: APA estimates that the United States will
need nearly 6,000 more of these specialists by 2030.

To support the expanding need to
maintain and improve brain health,
researchers are developing interventions
that can help prevent, recognize, and
treat mild cognitive impairment, demen-
tia, and Alzheimer’s disease.
Here are four recent developments in
the field of brain health that carry the
potential to dramatically improve our
quality of life as we age.
SLOW-PACED BREATHING
INTERVENTIONS
Sympathetic nervous system activity,
associated with the stress response, tends
to be higher in older adults—and it’s
linked with an increased risk of demen-
tia. Researchers are studying how to help
adults flip the nervous system’s switch
from stress to relaxation.
Biofeedback exercises involving
slow-paced breathing are one way to
modulate heart rate and potentially
prevent the sympathetic system from
negatively impacting the brain, accord-
ing to Mara Mather, PhD, a professor of
gerontology, psychology, and biomedical
engineering at the University of South-
ern California.
In a clinical trial, Mather and her
collaborators studied breathing interven-
tions in adults between 65 and 80 years
old with the goal of increasing heart rate
variability, a measure of parasympathetic
activity. Those who practiced slow-paced
breathing to a metronome until they
achieved deep relaxation had lower rates
of anxiety and depression than the steady
breathing group. In their blood, they also
had lower levels of amyloid-beta, a small
peptide that can accumulate in the brain
to form the amyloid plaque that is one
defining feature of Alzheimer’s disease
(Scientific Reports, Vol. 13, 2023).
While manipulating heart rate
variability clearly impacts Alzhei-
mer’s biomarkers outside of the brain,
researchers do not yet know how it
affects the brain itself. Mather’s lab
is working on a second clinical trial
exploring how manipulating heart rate
variability can impact the brain itself
through examining MRIs.
In the same study, older adults who
participated in the slow breathing inter-
vention also showed increased volume in
subregions of the hippocampus, a part
of the brain that is critical for memory
processes and shows declines early in
the Alzheimer’s disease process (Neuro-
biology of Aging, 2023). Mather’s work
suggests that focusing on reducing stress
through breathing could be an inter-
vention to prevent or slow Alzheimer’s
progression—and it’s something anyone
can do.
“Slow-paced breathing may be able
to slow the early stages of Alzheimer’s
disease in adults who are still cognitively
healthy,” said Mather. “If so, this simple
relaxing technique could be a low-cost
and low-risk way to reduce risk of the
disease.”
SMARTPHONE TOOLS
AND TRAINING
As technology advances, so does evi-
dence that effectively using it can help
people cope with the impact of cogni-
tive decline—and even help prevent it.
Michael K. Scullin, PhD, associate pro-
fessor of psychology and neuroscience
at Baylor University in Waco, Texas,
helped develop a behavioral randomized
controlled trial to train people between
55 to 92 years old with mild dementia to
use smartphones.
The researchers focused on helping
participants set recurring appointment
reminders as a way to improve quality
of life. “People affected by dementia
often have a challenge with prospective
memory, or the ability to remember to
do things in the future,” Scullin said.
In his study, care partners—such as the
participant’s spouse, adult child, younger
relative, or hired nurse—reported that
participants with cognitive decline had
improved independent functioning
across a month timespan (Journal of
the American Geriatrics Society, Vol. 70,
2022).
Scullin’s team recently received fund-
ing for a Phase 2 trial of 200 participants
over 6 months. Half of the participants
are from digitally disadvantaged back-
grounds, such as rural areas without
internet access or homes without com-
puters. “We want to know how to use
these devices in a way that’s most effec-
tive at preserving daily functioning and
overall health in individuals living with
diseases,” said Scullin.
While Scullin’s work focuses on
improving quality of life in those with
impaired cognition, he theorizes using
digital devices can also be a protective
factor in cognitive health, contributing
to a cognitive reserve in aging people—
the more mentally active someone is,
the more likely their cognitive abili-
ties will be preserved (Wolff, J. L, et
al., Journal of the American Geriatrics

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AG I NG BRAIN H E A LT H

“Alzheimer’s pathology accumulates in a person’s brain for many decades,

so it’s important to slow that down as much as possible. Interventions that healthy people
can do in their 50s or even earlier could be really beneficial and exciting.”
MARA MATHER, PHD, PROFESSOR OF GERONTOLOGY, PSYCHOLOGY, AND BIOMEDICAL
ENGINEERING AT THE UNIVERSITY OF SOUTHERN CALIFORNIA

Society, Vol. 69, No. 7, 2021). Technol-
ogy also encourages social connection,
which can promote better cognition, and
provides ways to better cope with daily
difficulties, such as forgetting about
appointments or medication.
Andrew Kiselica, PhD, assistant
professor of health psychology at the
University of Missouri, also studies
smartphone use among aging people
with cognitive impairment. He received
a career development award from the
National Institute on Aging to develop
an intervention that helps patients
and their caregivers access affordable
technology and implement individu-
alized technology-based solutions to
reach care goals. To do so, the inter-
vention includes occupational therapy
strategies to help people choose, set up,
and troubleshoot their technologies.
In this way, caretakers can choose the
technologies that best work for them.
For example, caretakers might use a
shared calendar with their loved ones to
remind them of appointments, light-
ening their own caregiving load. The
intervention can be delivered by any
master’s-level behavioral or occupa-
tional health provider.
Kiselica is seeking funding for a
feasibility trial to take place through the
broader University of Missouri health
system. He’s also working on a pilot
study with collaborators from the Uni-
versity of Missouri Extension’s health
and wellness program for older adults
involving a tech-focused interven-
tion that helps people glean cognitive
benefits from smart technologies before
they develop symptoms of cognitive
impairment.
VIRTUAL BRAIN GAMES
Adam Gazzaley, MD, PhD, founder of
Neuroscape, a translational neurosci-
ence center for technology creation and
scientific research, sees technology as a
form of medicine for cognitive decline.
“We don’t have perfect drugs; some
people don’t respond and they have
side effects. My goal is to come up with
[effective technologies] and validate
them,” he said.
Gazzaley, a professor in neurol-
ogy, physiology, and psychiatry at the
University of California, San Francisco,
focuses on creating and studying ther-
apeutic tablet-based and virtual reality
games that improve attention ability.
Some studies focus on older adults,
homing in on the evidence that games
can improve cognitive function that
often declines with age (Nature Aging,
Vol. 2, 2022). The video games Neuro­
HALFPOINT IMAGES/GETTY IMAGES

scape creates are adaptive, closed-loop

games, which means the challenges and
rewards adjust in real time based on
ability according to user data, unlike
As the percentage of older adults increases, there is a growing need for science-based
therapies to slow, prevent, and treat cognitive changes in older adults, particularly related most consumer games. If someone
to mild cognitive impairment, dementia, and Alzheimer’s disease. answers questions slowly, the games

86 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4

start out easier and progressively get
more difficult. If someone needs more of
a challenge, the game follows suit.
One game developed and studied at
Neuroscape is Neuroracer, a video game
that was shown to improve attention in
older adults (Nature, Vol. 501, 2013). It
is the first and only FDA-authorized
treatment delivered through a video
game experience. Some of Neuroscape’s
games are in the research phase, but
Gazzaley hopes to eventually scale them
so medical providers can either prescribe
them or patients can use them over the
counter in tandem with psychological
treatment. “We’ll have a whole set of
technological tools that will complement
standard approaches, like pharmaceuti-
cals and behavioral therapy,” he said.
DIGITAL COGNITIVE
ASSESSMENTS
Games can be useful to help preserve
cognition, but some people may benefit
more from non-gamified cognition
tasks. “For some people, games can pro-
vide motivational structure,” said Aaron
Seitz, PhD, professor of psychology at
Northeastern University in Boston and
director of the Brain Game Center for
Mental Fitness and Well-Being at the
University of California, Riverside. “But
for others, it may be overwhelming or
distracting to see all these things hap-
pening on a screen, and then the game
isn’t as helpful,” he added.
Seitz’s work focuses on creating
digital apps that measure individual
differences in cognition—for example,
how well someone can accomplish tasks
that involve distractions—and suggest-
ing potentially beneficial interventions,
games or otherwise. His goal is to better
understand how factors like cognition,
lifestyle, cultural experiences, and overall
health affect how people interact with
BSIP/GETTY IMAGES
different interventions. That way, he and
his team can better predict the most
useful individual treatments.
2 0 2 4 TRENDS REPO RT
AG I NG BRAIN H E A LT H
Seitz’s lab has created several games
designed to address individual needs.
One memory app he is currently study-
ing is called Recollect, available for free
in the Apple and Android app stores.
Recollect requires users to employ their
working memory to recall a series of
colors presented on the screen. Another
version of Recollect has the same prem-
ise, but it uses an astronaut collecting
colored gems in space.
The lab has also created digital
assessments that could be useful to psy-
chologists and other clinicians, such as
an app called PART (portable adaptive
rapid testing) that evaluates focused
attention and working memory. Rather A brain scan shows how the cortical gray
than going to a clinic or hospital, people matter is affected in late-onset Alzheimer’s
disease. Research suggests that reducing
will be able to participate in cognitive stress may help prevent cognitive decline.
testing at home on their devices. Cur-
rently, the app is available for free to
researchers studying cognition, but Seitz FURTHER READING
hopes to share it publicly in the future.
Digital methods for performing
This type of testing also allows cli-
daily tasks among older adults: An
nicians to gain a deeper understanding initial report of frequency of use and
of a person’s cognition because it tracks perceived utility
how long it takes for someone to answer Benge, J. F., et al.
a question and whether they change Experimental Aging Research, 2023
their response. “Digitizing assessments
Does ‘brain training’ actually work?
doesn’t just get rid of paper but also Jaeggi, S. M., et al.
helps the clinician collect more useful Scientific American, 2020
data to help the person on an individual
level,” said Seitz. Integrated cognitive and physical
fitness training enhances attention
Given all the progress in research
abilities in older adults
about cognition and the aging brain, Anguera, J. A., et al.
there is reason to be hopeful about the NPJ Aging, 2022
future. These and other brain researchers
are looking forward to fine tuning and Leisure-time sedentary behaviors
are differentially associated with
scaling up their interventions so that
all-cause dementia regardless of
more people can access resources that engagement in physical activity
benefit their brain function before they Raichlen, D. A., et al.
develop cognitive impairment. PNAS Psychological and Cognitive
“Alzheimer’s pathology accumulates Sciences, 2022
in a person’s brain for many decades,
The integrity of dopaminergic and
so it’s important to slow that down as noradrenergic brain regions is associ-
much as possible,” said Mather. “Inter- ated with different aspects of late-life
ventions that healthy people can do in memory performance
their 50s or even earlier could be really Dahl, M. J., et al.
Nature Aging, 2023
beneficial and exciting.” n
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 HOPE AS THE
ANTIDOTE
Why it’s important to have hope
in today’s chaotic world and
how people can cultivate hope
in their lives and communities
BY ASHLEY ABRAMSON
“Hope isn’t a denial of what
is, but a belief that the current
It’s easy to feel discouraged about situation is not all that can be,”
said Thema Bryant, PhD, APA’s
the persistent onslaught of difficulties
immediate past-president. “You
in the world today, whether these be can recognize something’s wrong,
personal circumstances or social issues. but also that it’s not the end of
Psychologists, some of whom have a the story.”
close-up view of the suffering these
THE SCIENCE OF HOPE
difficulties inflict, may find it especially Beginning in the 1980s, the work
difficult to stay positive about the future. of the late psychologist C. Rick
Yet a growing body of research suggests Snyder, PhD, set the stage for
much of today’s research about
that if you want to cultivate positive
hope. Snyder defined hope as
change—in yourself, others, or society— “the perceived capability to
restoring hope is a vital first step. derive pathways to desired goals,
and motivate oneself via agency
thinking to use those pathways”
(Psychological Inquiry, Vol. 13, No.
Start by understanding what hope 4, 2002). Snyder also published
is—and what it isn’t. Hope is work on positive psychology,
sometimes equated with bury- or the study of how people and
ing your head in the sand and communities can thrive.
ignoring reality or sitting idly by Unlike optimism, which is
waiting for things to get better. In simply the expectation of a better
reality, hope is a more nuanced, future, hope is action-oriented
cognitive process that involves and a skill that can be learned.
well-known psychological con- “We often use the word ‘hope’ in
cepts, such as goal-setting, agency, place of wishing, like you hope it
and cognitive restructuring. rains today or you hope someone’s
88 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
well,” said Chan Hellman, PhD,
a professor of psychology and
founding director of the Hope
Research Center at the Univer-
sity of Oklahoma. “But wishing is
passive toward a goal, and hope is
about taking action toward it.”
At the crux of this action is
identifying the steps to achieve a
goal and working toward them.
In one study of a hope-based
therapy intervention, research-
ers had participants write down
goals they hoped to meet,
followed by several possible
pathways toward that goal
(Social Indicators Research, Vol.
77, 2006). “You identify where
you are currently, and then you
generate multiple ways to get
there,” said Jennifer Cheavens,
PhD, a professor of psychology
at The Ohio State University
in Columbus who developed
this hope-focused interven-
tion. After 8 weeks, participants
reported more life meaning and
self-esteem and fewer symptoms
of depression and anxiety.
More recently, Cheavens and
a former doctoral student, Jane
 Heiy, PhD, had primary-care
patients with elevated symptoms
of depression create goals to
improve their symptoms. After
10 weeks, patients who defined
pathways to improve their men-
tal health were more likely to
seek treatment and report less
severe depression symptoms than
those who participated in an
enhanced referral system (doc-
toral dissertation, The Ohio State
University, 2014).
Along with improving
mental health and increasing
self-esteem, studies suggest
increasing hope can improve
symptoms and daily function-
ing in those with chronic illness
(Steffen, L. E., et al., Supportive
Care in Cancer, Vol. 28, 2020).
Other work has found hope to
be a protective factor against
post-traumatic stress disorder
(Gallagher, M. W., et al., Journal
of Clinical Psychology, Vol. 76, No.
3, 2020). Hellman sees hope as a
mindset that promotes resilience
in the face of difficulty. “If I have
the perspective that something
better is possible in the future,
then I can better endure my
struggles today,” he said.
Reaping the benefits of hope
involves doing the work of
reframing thoughts and forming
new habits. But with a shift
to your mindset and habits,
you can begin to see and work
toward the possibility of a better
future—and equip others to
do the same. Here’s what hope
experts recommend:
• Break goals into
DRAFTER123/GETTY IMAGES
smaller chunks
If you’re taking your first steps
toward hope, big goals might
overwhelm you—and zap your
ability to envision success. On
the other hand, smaller goals
allow more frequent achieve-
ments, which can highlight the
possibility of progress and ener-
gize you toward a goal.
It’s important to keep path-
ways small and manageable. For
people with depression and anxi-
ety specifically, successfully taking
small steps can in turn cultivate
more hope and boost motivation
to continue taking action. “As you
realize it feels good to do some-
thing, you’re more likely to do it
again,” said Shara Sand, PsyD, a
clinical psychologist in New York
City. “Engagement increases, and
so does your sense of hope about
the future.”
Matthew W. Gallagher,
PhD, a professor of clinical
and quantitative psychology at
the University of Houston and
editor of the Oxford Handbook of
Hope, also recommends mak-
ing goals specific and concrete.
Hope is about embracing possi-
bility, and it’s easier to maintain
hope when you feel that your
goals are achievable rather than
lofty and distant.
• Stay in community
Hope can occur in isolation, but
it grows when you’re connected
to a supportive and inspiring
collective. A community of
hopeful people can inspire you
by encouraging you in your goals,
helping you pivot when you
encounter obstacles, or by simply
reminding you that overcoming
difficulty is possible.
“One benefit of being in a
community when you’re trying
to maintain hope is there are
people who are living examples
of what hope looks like when
it’s achieved,” said Jacqueline
Mattis, PhD, dean of faculty
and a professor of psychology
at Rutgers University–Newark.
“When you’re falling, they’ll be
there to reimagine with you what
it means to stand.”
In her research of low-income
youth, Mary Beth Medvide,
PhD, an assistant professor of
psychology at Suffolk University
in Boston, found seeing other
people succeed can be motivat-
ing—especially in the absence of
other support, such as an encour-
aging family. For example, some
adolescents reported feeling
they could earn a college degree
because their high schools hung
banners listing where graduates
were attending college.
If you feel powerless about
systemic issues, such as racism
or climate change, joining forces
with a group of people who
share your desire for change can
increase your hope—and increase
the likelihood of change. Collec-
tive hope, according to Hellman,
involves combining energies to
cast a shared vision of the future
and identifying strategies to
achieve goals. “Big societal issues
can feel overwhelming because
alone, we can’t move the nee-
dle,” he said. “But when we find
others who share our story or
experience, we collectively form
a powerful voice and energy that
can influence change.”
• Prepare to pivot
When a designated pathway
does not lead directly to a goal,
you may feel discouraged, which
can drain your motivation.
Being primed to pivot can help
maintain hope. “Try to see set-
backs as new information about
M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 89
A Message of Hope
which strategies work and don’t
work, and then modify your
approach and goal so you main-
tain momentum toward what
you’re trying to accomplish,”
said Gallagher.
Reframing the outcome
can help promote flexibility.
For example, imagine that you
applied for a specific research
grant but didn’t get it. Instead
of abandoning hope, try a new
pathway toward the goal or
redefine the end point according
to the ultimate goal or the value
behind it. Perhaps the grant
was more of a pathway toward
your goal than a goal itself, and
there are other pathways that
will work.
With that mindset, you could
begin to focus on getting any
grant that enables you to con-
duct your research and help more
people. “Don’t be so wedded to
specificity of outcome that you
lose the big picture and can’t
pivot,” said Mattis.
Along with the ability to
reframe, this process requires
creativity—another learnable
skill. “Those who are willing
to be open to possibilities can
maintain their hope,” said Bry-
ant. “Instead of ‘there is no path,’
you think, ‘I haven’t [yet] found
the path that’s going to work.’”
• Reflect on the past
Hope, by nature, is future focused.
But reflecting on the past can also
encourage hope down the road,
especially if you feel your hope-
fulness wavering. “I’ll ask people
to be their own ‘hope models’
by reflecting back on a time
they achieved something really
difficult in their lives, when they
chose to take action and it made
90 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
all the difference,” said Hellman.
This type of reflection can
be especially helpful for those
with depression, who may have
a skewed perspective about their
own growth. Kathryn Gordon,
PhD, a clinical psychologist and
author of The Suicidal Thoughts
Workbook: CBT Skills to Reduce
Emotional Pain, Increase Hope,
and Prevent Suicide, developed
a framework to restore hope
in patients with suicidal ide-
ation. Perspective is an essential
ingredient. “I have them gather
evidence that they’ve been able to
get through difficult things in the
past, which helps them identify
tools they can use in their current
situation,” she said.
If your past feels like a
barrier, as is the case for many
who have experienced trauma,
reflection can help you maintain
hope. Benjamin Hardy, PhD, an
organizational psychologist and
author of several books related
to goal-setting and personal
growth, recommends identifying
ways you’ve changed over time—
even from week to week—to
promote a growth mindset.
“How you frame your past can
dictate what you expect for your
future,” he said.
• Celebrate wins
Counting successes along your
journey toward a goal can help
energize you to move forward.
“When we achieve something,
we often take it for granted
because our minds go to the next
thing we don’t have or haven’t
done,” said Bryant. Take time to
acknowledge—and celebrate—
what you’ve accomplished in the
present to support your hopeful
mindset for the future.
Even honoring your tiny steps
forward through a mindful grat-
itude practice makes a difference.
Imagine your goal is to work at
a particular university. You may
not have that position today, but
you may be doing similar work
as you would in that job, whether
mentoring students or conduct-
ing research. “Your wins may not
be in the same context you’re
hoping for, but it’s important
to recognize that you’re already
achieving some aspect of the
goal that’s important to you,”
said Mattis.
Tracking emotional inten-
sity and noticing how feelings
fluctuate can also promote hope,
said Gordon, whether person-
ally or for struggling patients or
mentees. Even if a difficult emo-
tion, such as sadness or anxiety,
does not completely dissipate,
tracking it is a reminder that it
will not last forever, which can
increase hope.
• Recognize that you’re
already practicing hope
Whether you recognize it or not,
hope is inherent to a psycholo-
gist’s work because it is rooted
in the belief that you can be
part of positive change, whether
your work focuses on therapy,
research, teaching, or myriad
other applications. For oth-
ers, even simply showing up to
therapy or a psychology course—
whether as a psychologist,
patient, or student—is a hopeful
act, hinging on the belief that
growth and change are possible.
“Psychology is not only the study
of what is, but the study and
enactment of transformation and
healing in both individuals and
communities,” said Bryant. n
People
Joiner Taylor
PSYCHOLOGISTS IN THE NEWS
Thomas Joiner, PhD, is the 2023 recipi-
ent of the International Association for
Suicide Prevention Lifetime Achieve-
ment Award, which is presented every
two years to one outstanding researcher
in the field. Joiner’s work focuses on the
psychology, neurobiology, and treat-
ment of suicidal behavior and related
conditions.
Shelley E. Taylor, PhD, a Distinguished
Professor Emerita of Psychology at the
University of California, Los Ange-
les, was awarded the National Medal
of Science by President Joe Biden at a
White House ceremony held in Octo-
ber. An expert on adversity and how
social relationships can protect people
against stress, Taylor was honored for
helping to launch the fields of social
cognition, health psychology, and social
neuroscience.
Kenya Key, PsyD, CCHP-MH, has
joined the National Commission on
Correctional Health Care’s multidis-
ciplinary Board of Representatives as
APA’s liaison. As deputy director of
health services for the Washington, D.C.,
Department of Youth Rehabilitation
Services, Key oversees behavioral health
and restorative justice programs. Previ-
ously, she served as chief psychologist
Key Arigo
for Cermak Health Services at Cook
County Jail in Chicago.
The National Institutes of Health
(NIH) has awarded the Director’s New
Innovator Award to Dani Arigo, PhD,
an associate professor of psychology in
Rowan’s College of Science & Math-
ematics. Arigo’s work centers on social
comparisons. Argo will use the 5-year,
$1.5 million grant to further explore the
myriad ways people are influenced by
social comparisons.
Faye Belgrave, PhD, has been named
vice president and chief diversity officer
at Virginia Commonwealth University
(VCU). Belgrave currently serves as
associate dean for equity and commu-
nity partnerships in VCU’s College of
Humanities and Sciences, a position she
has held since 2020. She joined VCU
in 1997 as a professor of psychology
and her work centers on health dispari-
ties, community-engaged and culturally
informed research, and gender-specific
research.
The National Commission on Cor-
rectional Health Care (NCCHC) has
honored Thomas Fagan, PhD, CCHP-MH,
with the 2023 Bernard P. Harrison
Award of Merit. Fagan served as APA’s
M O N I TO R O N P S YC H O LO G Y
Belgrave
liaison to the NCCHC board for 25
years. He is professor emeritus in the
College of Psychology at Nova South-
eastern University in Florida and has
published extensively on topics related to
mental health care in corrections.
Debra Baeder, PhD, was appointed to
the independent commission that will
be investigating the facts surrounding
the mass shooting in Lewiston, Maine,
on Oct. 25. Baeder is the former Chief
Forensic Psychologist for the state of
Maine. The independent commission is
looking carefully at all the facts sur-
rounding the event, including official
response in the months preceding and
during the shootings.
Colorado State University (CSU) has
chosen Marion Underwood, PhD, as the
next provost and executive vice president,
effective Jan. 1. She serves as CSU’s chief
academic officer and as the second in
command within the university admin-
istration. Since 2018, Underwood has
served as dean for the College of Health
and Human Sciences at Purdue Uni-
versity in Indiana. Prior to her work at
Purdue, Underwood was a faculty mem-
ber at Reed College in Portland, Oregon,
then a professor and administrator at the
University of Texas at Dallas. ■
● JA N UA R Y / F E B R UA R Y 2 0 2 4 91
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Career
News You Can Use

NEW IDEAS FOR PSYCHOLOGISTS WHO WANT TO ENHANCE THEIR SKILLS AND ADVANCE THEIR CAREERS

Dr. Jessica Jackson left

her faculty role at Baylor
College of Medicine in
Houston to become a
clinical strategy manager
at Modern Health, a health
tech startup. While she
still sees patients part-time
virtually, she finds her role
at the company allows her
to reach more people than
had she stayed in a more
traditional role.

IS A JOB IN THE BOOMING HEALTH TECH

SECTOR RIGHT FOR YOU?
Psychologists who value variety and cross-disciplinary teamwork can make an outsize impact
in industry and at startups. But the digital health field has its downsides, too. BY ANNA MEDARIS

I
t was the height of the COVID-19 pandemic in 2020, and Harris Health System, which surrounds Houston. People of
RHEA WHITNEY PHOTOGRAPHY

Jessica Jackson, PhD, was in high demand.
She was a young faculty member at Baylor College of
Medicine, teaching and delivering inpatient and outpatient
care. Not only was the hospital overwhelmed with patients,
but Jackson was the sole Black psychologist working for the
color—who were disproportionately affected by the health
crisis and at the center of a national racial reckoning—clam-
ored for her care.
“It got to a point where I was like, This is not sustainable,”
Jackson said. So when she noticed a psychologist friend was

M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 93
Career
doing some consulting work in
the health tech space, she, for the
first time, questioned whether
that was a potential career path
for her.
“It had just never occurred to
me that this is a job I could do,”
Jackson said.
Now Jackson is a clinical
strategy manager at Modern
Health, a health tech startup.
While she still sees patients
part-time virtually, she finds her
role at the company allows her to
reach more people than had she
stayed in a more traditional role.
“The impact I can have is
[much] larger than I could have
guessed in grad school,” she said.
Other psychologists are also
finding unanticipated rewards in
the health tech sector.
Sure, it can be more lucrative
than clinical or academic work,
but it also can appeal to profes-
sionals who enjoy faster-paced
environments, lots of variety,
and working in teams and across
disciplines.
And, as Kay Nikiforova, MA,
head of clinical and research at
the health equity platform Violet,
emphasizes, “companies need
psychologists.” Indeed, inves-
tors poured a record-breaking
$1.5 billion into mental health
startups in 2020 alone, according
to Forbes.
“Companies need psychol-
ogists working at every single
level of the company—not just in
clinical care but also working on
product, in marketing, and on the
data team,” said Nikiforova, who
serves on APA’s Mental Health
Technology Advisory Commit-
tee. “Psychologists have the skill
sets and the knowledge to be able
to guide these companies in a
94 M O N I TO R O N P S YC H O LO G Y
direction that will lead to more
efficacious and more ethical care.”
Here’s what Nikiforova and
others say psychologists should
know before pivoting toward a
career in health tech.
BREAKING IN
David Cooper, PsyD, a psy-
chologist who’s been working
in digital health for more than
a decade, says roles for mental
health professionals in the field
tend to fall into four categories.
First, there’s research. “Every
company’s got to know whether
or not their product works,”
said Cooper, who also serves on
APA’s Mental Health Technol-
ogy Advisory Committee. There’s
also content (how to word ques-
tionnaires to screen for suicidal
ideation, for example), telehealth
(providing direct services to
patients or supervising those
who do), and product develop-
ment (helping design or improve
the tool itself ).
While that work can
sound intimidating to tech- When Arevalo was con-
nology-averse mental health sidering a transition from
professionals, Nikiforova said various group practice settings
their roles rarely require in-the- to a digital health role where
weeds tasks like coding. “People he hoped he could make more
tend to have this viewpoint of of a systemic impact, he sent
technology with a capital T,” cold requests for chats to psy-
they said. “But that’s not the chologists via LinkedIn. After
totality of health tech companies. pointing out some common
And in fact, most psychologists, ground, like a mutual friend or
whether they’re clinicians or similar alma mater, in his initial
researchers, will never touch that. messages, he found “a lot of peo-
They just have to pick up a little ple were very accommodating.”
bit of the language.” Arevalo’s connections led
One way to figure out which him to a Slack community called
area may be a good fit is through Therapists in Tech as well as to
KENDALL BROBST SCHIFF
informational interviews, said consulting gigs with early-stage
Mike Arevalo, PsyD, now the startups while maintaining his
clinical development lead at Big clinical work. But it wasn’t until
Health. he took a Google certification
● JA N UA R Y / F E B R UA R Y 2 0 2 4

course in project management
that he began to learn the lan-
guage that helped him land a
full-time job in the field.
“I found it a little difficult
when I was doing my infor-
mational interviews that a lot
of people broke into tech by
knowing someone person-
ally or knowing someone who
knew someone. And I thought,
‘Why is it so easy for everyone?
I’ve had dozens and dozens of
interviews, but I can’t seem to
get it right,” said Arevalo. “And
I’ve learned that’s OK. There’s
no straight path for everyone.
Everyone’s different.”
That’s true once you’ve
broken into the field, too, said
Nikiforova, who’s pursuing a
PhD in psychology in addition
to their role at Violet.
“No trajectory exists at this
current moment, which can
be difficult because it’s hard to
know how to follow,” they said.
“But for me, that’s also very
exciting. That means we can craft
our own paths and work with
companies in the way that feels
authentic or do the type of work
that really speaks to us.”
Arevalo recommends asking
potential employers how the
clinical side of the business
works with the rest of the team.
“Clinical might serve as a con-
sultant that’s brought in at the
end—or be embedded through-
Dr. Emily Anhalt is
cofounder and chief
clinical officer of
COA, a digital mental
health “gym” that
hosts therapist-led
emotional fitness
classes and therapist
matchmaking
services in some
states.
M O N I TO R O N P S YC H O LO G Y
out the product development
process,” he said. You can also
ask if there are opportunities
for collaboration on strategy,
Arevalo added.
SPEAKING THE
LANGUAGE
There are practical differences,
too, between getting a job in
academia and industry. For one,
you’ll need a resumé, not a CV,
Jackson learned. And accolades
that matter in higher education
hiring, like publishing articles
in top-tier journals and having
lab experience, don’t carry much
weight at a startup.
Rather, tech companies care
that you speak their language—
and ditch medical jargon like
“DX” for diagnosis—and col-
laborate well with nonmedical
professionals like designers,
engineers, salespeople, and
marketing professionals, said
Jackson, who chairs APA’s Men-
tal Health Technology Advisory
Committee.
Psychologists’ value isn’t
always well understood in
business settings, she added.
Applicants must prove it during
the application and hiring pro-
cess, and sometimes beyond. The
interview process could include
a homework assignment like
describing what you think the
market is missing—without giv-
ing away too much intellectual
property.
“It’s a different way to think
about applied psychology,”
Jackson said. “How do we use
our expertise to communicate
to people who don’t have a
background in mental health to
develop products and services?”
Emily Anhalt, PsyD, said
● JA N UA R Y / F E B R UA R Y 2 0 2 4 95
Career

making her value as a psychol-

ogist visible through writing
helped land her where she is
today: cofounder and chief
clinical officer of COA, a digital
mental health “gym” that hosts
therapist-led emotional fitness
classes and therapist matchmak-
ing services in some states.
Anhalt’s posts on social
media, which largely helped
people navigate working
relationships based on her
knowledge of personal relation-
ships, caught the eye of a product
and marketing executive, who’s
now COA’s other cofounder.
“I learned early on that when
you know a lot about psychology,
you know a little about every-
thing,” said Anhalt, who’s also a
private practitioner, soon-to-be
book author, and speaker. “Every
psychologist can take what they
know about the human condi-
tion and apply it to anything
that’s interesting to them.”

A FASTER PACE
For psychologists who work
in health tech, no day looks
the same. Anhalt, for example,
may start her workday in the meet with customers, then with Jackson joked that in a university
late morning with one-on-one the education team, then with role, she needed approval from
meetings with COA colleagues, the CEO to discuss high-level 10 people to do something as
followed by seeing a handful of strategies for integrating Vio- Jackson says tech minor as move her desk. Now,
patients virtually, then putting let’s services into health plans companies want if she wants a title change, for
psychologists who
the final touches on a talk to be across the country. Nikiforova can speak their example, she can write up a pitch
delivered in Europe on the traits also might also pick up the language and and make it happen.
of an emotionally fit leader. occasional task like reading collaborate well “People who want to be inno-
with nonmedical
“One of the benefits of through a blog post to ensure professionals like vative and are able to be flexible
having my own schedule is the it’s credible. “I so enjoy this designers, engineers, are best cut out for this work,”
ability to do so many things,” she work because it really keeps me salespeople, Jackson said. It also requires
and marketing
said, because she can do them at answering hard questions over professionals. some relinquishment of con-
RHEA WHITNEY PHOTOGRAPHY

the times of day that work best and over, and challenges me to trol as a project moves from one
for her. In other words, not early come up with creative solu- phase and one group of experts
mornings. tions,” they said. to the next.
For Nikiforova, days can be There are perks to working in Arevalo appreciates how
meetings heavy. They might a fast-paced environment, too. the field’s variety and pace have

96 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
pushed him to become more
adaptable. On any one day,
he may talk to the leadership
team about the product, then a
designer about more inclusive
wording, and then the market-
ing team about a release strategy.
“Previously it was hard for me
to change, but now I like to say
that my superpower is context
switching,” he said.
NOT FOR THE RISK-
AVERSE
For all their allures, health
tech careers aren’t suited for all
psychologists.
For one, you must be com-
fortable thinking and talking
about money. “In the health tech
space, if a company can’t sell a planning and decisions that we
product, they’re not bringing in need to make. You’re just flexing
revenue and that puts our jobs at a different muscle,” he said.
risk,” Jackson said. Perhaps the most notable
But when you do get paid, it’s downside of the health tech
typically more than you’d make industry is its instability. “In men-
in an academic setting—and tal health in general, you really
that shouldn’t be taboo, Anhalt have to mess up to lose your job,”
said. “It’s OK to want to make Jackson said. “In the tech space,
money,” she said. And you can there are massive layoffs.”
do it, she added, without “selling Although you can’t get
your soul.” a guarantee of security, it’s
Psychologists who are inter- important to do your due dili-
ested in health tech should also gence before taking an offer.
be prepared for hard work, just But if you find a company
a different type of hard work you believe in, you’ll reap the
from running a clinical practice, rewards. “I’m in awe some-
Arevalo said. “There are plenty times,” Jackson said, “of the
of days where I get tired from a way the work we do can touch
lot of the higher-level strategic millions of people.” ■

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M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 97
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TUFTS UNIVERSITY DEPARTMENT OF
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98 M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4
PsycCareers
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M O N I TO R O N P S YC H O LO G Y ● JA N UA R Y / F E B R UA R Y 2 0 2 4 99
By the Numbers BY TORI DEANGELIS

SOLDIERS WITH TRAUMATIC BRAIN

INJURY ARE AT HIGH RISK FOR SERIOUS
MENTAL HEALTH PROBLEMS
Service members
100 % Percentage of increase in substance use disorders in active-duty soldiers
following a TBI diagnosed while they were in the military, compared with
who sustained a a 14.5% increase in those without a military TBI diagnosis*. The sample included
military-related 860,892 soldiers who returned from a deployment in Afghanistan or Iraq between
fiscal years 2008 and 2014.
traumatic brain injury

67.7
(TBI) are much more
likely than soldiers
% Percentage of increase in mood disorders in soldiers following a TBI, compared
with a 37.5% increase in soldiers without a TBI. For example, 25.6% of soldiers
with a TBI had new-onset anxiety disorders, compared with 9.8% of soldiers
without a military without a TBI.
history of TBI to

31.9%
Percentage of increase in alcohol use disorders in soldiers following a TBI, com-
develop a mental pared with a 10.3% increase in soldiers without TBI history. Most diagnoses
health or substance happened for the first time following a TBI—twice the rate of new-onset disorders
use problem. They experienced by soldiers without a TBI.

21.3
are also at an
increased risk of % Rate of increase in time to suicide for soldiers with a TBI, compared with those
without a history of TBI.
suicide.
SHIRONOSOV/GETTY IMAGES

*For all study data, soldiers without a history of TBI were assigned a match date that aligned with the injury date for those with a TBI, based on available data and year of return from deployment.

Source: Brenner, L. A., et al. (2023). Associations of military-related traumatic brain injury with new-onset mental health conditions and suicide risk. JAMA Network Open, 6(7). Available
at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807787.

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