Nicholas Carleton

Permanent URI for this collection

https://hdl.handle.net/10294/14560

Dr. R. Nicholas Carleton, Ph.D., R.D. Psychology
Professor of Psychology,
Department of Psychology,
University of Regina

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Now showing 1 - 20 of 98

Open Access
Exploring item order in anxiety-related constructs: Practical impacts of serial position
(2012-04) Carleton, R. Nicholas; Thibodeau, Michel, A.; Osborn, Jason, A.; Asmundson, Gordon, J. G.
The present study was designed to test for item order effects by measuring four distinct constructs that contribute substantively to anxiety-related psychopathology (i.e., anxiety sensitivity, fear of negative evaluation, injury/illness sensitivity, and intolerance of uncertainty). Participants (n = 999; 71% women) were randomly assigned to complete measures for each construct presented in one of two modalities: (a) items presented cohesively as measures or (b) items presented randomly interspersed with one another. The results suggested that item order had a relatively small impact on item endorsement, response patterns, and reliabilities. The small impact was such that item order appears unlikely to influence clinical decisions related to these measures. These findings not only have implications for these and other similar measures, but further inform a long-standing debate about whether item grouping is a substantial concern in measurement.
Open Access
A controlled investigation of continuing pain education for long-term care staff
(Hindawi, 2013) Ghandehari, Omeed, O; Hadjistavropoulos, Thomas; Williams, Jaime; Thorpe, Lilian; Alfano, Dennis, P.; Dal Bello-Haas, Vanina; Malloy, David, C.; Martin, Ronald, R.; Rahaman, Omar; Zwakhale, Sandra, M.G.; Carleton, R. Nicholas; Hunter, Paulette, V.; Lix, Lisa, M.
The underassessment and undertreatment of pain in residents of long-term care (LTC) facilities has been well documented. Gaps in staff knowledge and inaccurate beliefs have been identified as contributors.OBJECTIVES: To investigate the effectiveness of an expert-based continuing education program in pain assessment/management for LTC staff.METHODS: Participants included 131 LTC staff members who were randomly assigned to either an interactive pain education (PE) program, which addressed gaps in knowledge such as medication management, or an interactive control program consisting of general dementia education without a specific clinical focus. Participants attended three sessions, each lasting 3 h, and completed measures of pain-related knowledge and attitudes/beliefs before, immediately after and two weeks following the program. Focus groups were conducted with a subset of participants to gauge perception of the training program and barriers to implementing pain-related strategies.RESULTS: Analysis using ANOVA revealed that PE participants demonstrated larger gains compared with control participants with regard to pain knowledge and pain beliefs. Barriers to implementing pain-related strategies certainly exist. Nonetheless, qualitative analyses demonstrated that PE participants reported that they overcame many of these barriers and used pain management strategies four times more frequently than control participants.CONCLUSIONS: Contrary to previous research, the present study found that the interactive PE program was effective in changing pain beliefs and improving knowledge. Continuing PE in LTC has the potential to address knowledge gaps among front-line LTC providers.
Open Access
The Center for Epidemiologic Studies Depression Scale: A Review with a Theoretical and Empirical Examination of Item Content and Factor Structure
(Public Library of Science, 2013-03-01) Carleton, R. Nicholas; Thibodeau, Michel, A.; Teale, Michelle, J. N.; Welch, Patrick, G.; Abrams, Murray, P.; Robinson, Thomas; Asmundson, Gordon, J. G.
The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) is a commonly used freely available self-report measure of depressive symptoms. Despite its popularity, several recent investigations have called into question the robustness and suitability of the commonly used 4-factor 20-item CES-D model. The goal of the current study was to address these concerns by confirming the factorial validity of the CES-D.
Open Access
Into the unknown: A review and synthesis of contemporary models involving uncertainty
(Elsevier, 2016-02-27) Carleton, R. Nicholas
The current review and synthesis serves to define and contextualize fear of the unknown relative to related constructs, such as intolerance of uncertainty, and contemporary models of emotion, attachment, and neuroticism. The contemporary models appear to share a common core in underscoring the impor- tance of responses to unknowns. A recent surge in published research has explored the transdiagnostic impact of not knowing on anxiety and related pathologies; as such, there appears to be mounting evidence for fear of the unknown as an important core transdiagnostic construct. The result is a robust foundation for transdiagnostic theoretical and empirical explorations into fearing the unknown and intolerance of uncertainty.
Open Access
Fear of the unknown: One fear to rule them all?
(Elsevier, 2016-03-29) Carleton, R. Nicholas
The current review and synthesis was designed to provocatively develop and evaluate the proposition that “fear of the unknown may be a, or possibly the, fundamental fear” (Carleton, 2016) underlying anxiety and therein neuroticism. Identifying fundamental transdiagnostic elements is a priority for clinical theory and practice. Historical criteria for identifying fundamental components of anxiety are described and revised criteria are offered. The revised criteria are based on logical rhetorical arguments using a constituent reductionist postpositivist approach supported by the available empirical data. The revised criteria are then used to assess several fears posited as fundamental, including fear of the unknown. The review and synthesis concludes with brief recommendations for future theoretical discourse as well as clinical and non-clinical research.
Open Access
Intolerance of Uncertainty: A Temporary Experimental Induction Procedure
(Public Library of Science, 2016-06-02) Mosca, Oriana; Lauriola, Marco; Carleton, R. Nicholas
Intolerance of uncertainty (IU) is a trans-diagnostic construct involved in anxiety and related disorders. Research focused on cross-sectional reporting, manipulating attitudes toward objective and impersonal events or on treatments designed to reduce IU in clinical populations. The current paper presents an experimental procedure for laboratory manipulations of IU and tests mediation hypotheses following the Intolerance of Uncertainty Model.
Open Access
Hierarchical factor structure of the Intolerance of Uncertainty Scale short form (IUS-12) in the Italian version
(Cises, Srl, 2016-09) Lauriola, Marco; Mosca, Oriana; Carleton, R. Nicholas
Despite widespread use, few translations are available for the Intolerance of Uncertainty Scale short form (IUS-12) as well as limited research on its psychometric properties in Italy. Moreover, recent evi- dence has suggested a multifaceted hierarchical structure for this scale. We compared the two-factor model to second-order and bi-factor models, in which a General IU factor was posited with two more nar- row factors: Prospective IU and Inhibitory IU. Models were tested on a pooled dataset of students (N = 609) taking the IUS-12 alone or with other IUS-27 items. The bi-factor model fitted the sample data better than alternative models. The general factor accounted for 80% of the item variance. Presentation mode did not impact scalar invariance. Convergent validity with neuroticism, need for closure, and the uncertainty response scale was high for the total score. As such, scoring the IUS-12 total score is recommended in clinical research and assessment.
Open Access
Mental Disorder Symptoms among Public Safety Personnel in Canada
(SAGE Publications, 2017-08-28) Carleton, R. Nicholas; Afifi, Tracie, O; Turner, Sarah; Taillieu, Tamara; Duranceau, Sophie; LeBouthillier, Daniel, M.; Sareen, Jitender; Ricciardelli, Rosemary; MacPhee, Renee; Groll, Dianne; Hozempa, Kadie; Brunet, Alain; Weekes, John, R.; Griffiths, Curt, T.; Abrams, Kelly, J.; Jones, Nicholas, A.; Beshai, Shadi; Cramm, Heidi, A.; Dobson, Keith, S.; Hatcher, Simon; Keane, Terence, M.; Stewart, Sherry, H.; Asmundson, Gordon
Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP.
Open Access
Chronic pain among public safety personnel in Canada
(Taylor and Francis Group, 2017-12-18) Carleton, R. Nicholas; Afifi, Tracie, O.; Turner, Sarah; Taillieu, Tamara; El-Gabalawy, Renée; Sareen, Jitender; Asmundson, Gordon, J. G.
Chronic pain is highly prevalent in the general population and may be even higheramong public safety personnel (PSP; e.g., correctional officers, dispatchers, firefighters, paramedics,police). Comprehensive data on chronic pain among diverse Canadian PSP are relatively sparse.Aims: The current study was designed to provide initial estimates of chronic pain frequencyand severity among Canadian PSP.
Open Access
Personal relative deprivation associated with functional disorders via stress: An examination of fibromyalgia and gastrointestinal symptoms
(Public Library of Science, 2017-12-27) Beshai, Shadi; Mishra, Sanju; Mishra, Sandeep; Carleton, R. Nicholas
Personal relative deprivation is a negative social comparison process typified by self-com- parison, negative appraisal, and resultant negative emotionality. Personal relative depriva- tion has been associated with poorer physical and mental health in several domains. It has been hypothesized that the deprivation-health link operates through a stress pathway. Stress has been specifically implicated in the onset and maintenance of functional disor- ders, including fibromyalgia and functional gastrointestinal disorders. Despite the theoretical links between personal deprivation, stress, and functional disorders, researchers have not assessed relationships between these variables.
Open Access
The Intolerance of Uncertainty Inventory: Validity and Comparison of Scoring Methods to Assess Individuals Screening Positive for Anxiety and Depression
(Frontiers Media, 2018-03-26) Lauriola, Marco; Mosca, Oriana; Trentini, Cristina; Foschi, Renato; Tambelli, Renata; Carleton, R. Nicholas
Intolerance of Uncertainty is a fundamental transdiagnostic personality construct hierarchically organized with a core general factor underlying diverse clinical manifestations. The current study evaluated the construct validity of the Intolerance of Uncertainty Inventory, a two-part scale separately assessing a unitary Intolerance of Uncertainty disposition to consider uncertainties to be unacceptable and threatening (Part A) and the consequences of such disposition, regarding experiential avoidance, chronic doubt, overestimation of threat, worrying, control of uncertain situations, and seeking reassurance (Part B). Community members (N = 1046; Mean age = 36.69 ± 12.31 years; 61% females) completed the Intolerance of Uncertainty Inventory with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory. Part A demonstrated a robust unidimensional structure and an excellent convergent validity with Part B. A bifactor model was the best fitting model for Part B. Based on these results, we compared the hierarchical factor scores with summated ratings clinical proxy groups reporting anxiety and depression symptoms. Summated rating scores were associated with both depression and anxiety and proportionally increased with the co-occurrence of depressive and anxious symptoms. By contrast, hierarchical scores were useful to detect which facets mostly separated between for depression and anxiety groups. In sum, Part A was a reliable and valid transdiagnostic measure of Intolerance of Uncertainty. The Part B was arguably more useful for assessing clinical manifestations of Intolerance of Uncertainty for specific disorders, provided that hierarchical scores are used. Overall, our study suggest that clinical assessments might need to shift toward hierarchical factor scores.
Open Access
Anxiety-related psychopathology and chronic pain comorbidity among public safety personnel
(Elsevier, 2018-03-28) Carleton, R. Nicholas; Afifi, Tracie, O; Taillieu, Tamara; Turner, Sarah; El-Gabalawy, Renee; Sareen, Jitender; Asmundson, Gordon
Canadian Public Safety Personnel (PSP; e.g., correctional service officers, dispatchers, firefighters, paramedics, police officers) regularly experience potentially traumatic, painful, and injurious events. Such exposures increase risk for developing mental disorders and chronic pain, which both involve substantial personal and social costs. The interrelationship between mental disorders and chronic pain is well-established, and both can be mutually maintaining; accordingly, understanding the relationship between mental health and chronic pain among PSP is important for improving health care. Unfortunately, the available research on such comorbidity for PSP is sparse. The current study was designed to provide initial estimates of comorbidities between mental disorders and chronic pain across diverse PSP. Participants included 5093 PSP (32% women) in six categories (i.e., Call Center Operators/Dispatchers, Correctional Workers, Firefighters, Municipal/Provincial Police, Paramedics, Royal Canadian Mounted Police) who participated in a large PSP mental health survey. The survey included established self-report measures for mental disorders and chronic pain. In the total sample, 23.1% of respondents self-reported clinically significant comorbid concerns with both mental disorders and chronic pain. The results indicated PSP who reported chronic pain were significantly more likely to screen positive for posttraumatic stress disorder (PTSD), major depressive disorder, generalized anxiety disorder, social anxiety disorder, and alcohol use disorder. There were differences between PSP categories; but, the most consistent indications of comorbidity were for chronic pain, PTSD, and major depressive disorder. Comorbidity between chronic pain and mental disorders among PSP is prevalent. Health care providers should regularly assess PSP for both symptom domains.
Open Access
A longitudinal assessment of the road to mental readiness training among municipal police
(Taylor and Francis Group, 2018-06-18) Carleton, R. Nicholas; Korol, Stephanie; Mason, Julia, E.; Hozempa, Kadie; Anderson, Gregory, S.; Jones, Nicholas, A.; Dobson, Keith, S.; Szeto, Andrew; Bailey, Suzanne
Police agencies increasingly implement training programs to protect mental health. The Road to Mental Readiness (R2MR) program was designed by the Canadian military to increase mental health resilience. A version of R2MR was adapted for municipal police by the Mental Health Commission of Canada (MHCC). The current research was designed to assess the R2MR program, as adapted and delivered by the MHCC, in a municipal police sample. Participants were 147 Canadian police agency employees (57% women) who received a single R2MR training session. Participants completed pre- and post-training self-report questionnaires, and follow-ups at 6 and 12 months. The questionnaires assessed mental health symptoms, work engagement, resiliency, mental health knowledge, and stigma. Multilevel modeling analyses assessed for within-participant changes over time. The results were consistent with other single session interventions; specifically, there were no significant changes in mental health symptoms, resilience, or work engagement (p > .05). There were small, but significant (p < .05), reductions in stigma at post-training that may facilitate help-seeking among police; relatedly, in open-ended response fields, participants commonly described the training as helpful for changing attitudes and improving communication. More engagement with the material may produce larger, sustained gains, but more published research is critically needed.
Open Access
Experiences of trauma, depression, anxiety, and stress in western-Canadian HEMS personnel
(Community Safety Knowledge Alliance, 2018-10-17) Harenberg, Sebastian; McCarron, Michelle, C. E.; Carleton, R. Nicholas; O'Malley, Thomas; Ross, Terry
Mental health in first responders and other public safety personnel has received substantial research attention in the past decade. Emergency medical services (EMS) demonstrate a heightened prevalence of maladaptive mental health concerns compared to other first responders (e.g., police, fire fighters). Interestingly, there is an absence of research examining helicopter emergency medical services (HEMS) personnel, who respond to what are often life-threatening cases in challenging circumstances. Hence, the purpose of the present study was to assess the experiences of Posttraumatic Stress Disorder (PTSD) and associated mental health conditions (i.e., depression, anxiety, stress) in HEMS workers. HEMS workers from a single mid-western Canadian organization (n = 100) participated in the study. The participants completed the Posttraumatic Stress Disorder Checklist (PCL-5) and the Depression, Anxiety and Stress Scale (DASS-21) as part of an online survey. The results revealed that five per cent of HEMS personnel experienced heightened PTSD symptoms. Few participants exhibited signs of mild to severe depression, anxiety, and stress (< 17%). HEMS personnel experienced fewer mental health concerns than other first responder groups as reported in the literature; indeed, these figures are similar to levels observed within the general population. These findings may be explained by organizational or personality characteristics. Underreporting of mental health concerns may be an alternate explanation. Future qualitative and quantitative research is needed to explain and replicate the results of the present study.
Open Access
Mental Health Training, Attitudes Towards Support, and Screening Positive for Mental Disorders
(Taylor and Francis Group, 2019-02-22) Carleton, R. Nicholas; Afifi, Tracie, O.; Turner, Sarah; Taillie, Tamara; Vaughan, Adam, V.; Anderson, Gregory, S.; Ricciardelli, Rosemary; MacPhee, Renée, S.; Cramm, Heidi; Czarnuch, Stephen; Hozempa, Kadie; Camp, Ronald, D.
Public Safety Personnel (PSP; e.g. correctional workers, dispatchers, firefighters, paramedics, police) are frequently exposed to potentially traumatic events (PTEs). Several mental health training program categories (e.g. critical incident stress management (CISM), debriefing, peer support, psychoeducation, mental health first aid, Road to Mental Readiness [R2MR]) exist as efforts to minimize the impact of exposures, often using cognitive behavioral therapy model content, but with limited effectiveness research. The current study assessed PSP perceptions of access to professional (i.e. physicians, psychologists, psychiatrists, employee assistance programs, chaplains) and non-professional (i.e. spouse, friends, colleagues, leadership) support, and associations between training and mental health. Participants included 4,020 currently serving PSP participants. Data were analyzed using cross-tabulations and logistic regressions. Most PSP reported access to professional and non-professional support; nevertheless, most would first access a spouse (74%) and many would never, or only as a last resort, access professional support (43–60%) or PSP leaders (67%). Participation in any mental health training category was associated with lower (p < .01) rates for some, but not all, mental disorders, with no robust differences across categories. Revisions to training programs may improve willingness to access professional support; in the interim, training and support for PSP spouses and leaders may also be beneficial.
Open Access
A Correlational Analysis of the Relationships among Intolerance of Uncertainty, Anxiety Sensitivity, Subjective Sleep Quality, and Insomnia Symptoms
(Multidisciplinary Digital Publishing Institute, 2019-09-05) Lauriola, Marco; Carleton, R. Nicholas; Tempesta, Daniela; Calanna, Pierpaolo; Socci, Valentina; Mosca, Oriana; Salfi, Federico; De Gennaro, Luigi; Ferrara, Michele
In this study, we used structural equation modeling to investigate the interplay among Intolerance of Uncertainty (IU), Anxiety Sensitivity (AS), and sleep problems. Three hundred undergraduate students completed the Intolerance of Uncertainty Scale, the Intolerance of Uncertainty Inventory, the Anxiety Sensitivity Index, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. 68% and 40% of the students reported poor sleep quality or sub-threshold insomnia problems, respectively. Depression and anxiety levels were above the cut-off for about one-fourth of the participants. Structural equation modeling revealed that IU was strongly associated with AS, in turn influencing both insomnia severity and sleep quality via depression and anxiety. Significant indirect effects revealed that an anxious pathway was more strongly associated with insomnia severity, while a depression pathway was more relevant for worsening the quality of sleep. We discussed the results in the frameworks of cognitive models of insomnia. Viewing AS and IU as antecedents of sleep problems and assigning to AS a pivotal role, our study suggested indications for clinical interventions on a population at risk for sleep disorders.
Open Access
Fit for public safety: Informing attitudes and practices tied to the hiring of public safety personnel
(Taylor and Francis Group, 2019-09-25) Ricciardelli, Rosemary; Andres, Elizabeth; Kaur, Navjotpal; Czarnuch, Stephen; Carleton, R. Nicholas
Recent recognition that public safety personnel (PSP) have a high prevalence of mental disorders has initiated a discussion around PSP mental readiness for their work. The discussions have raised new interest in potential protective factors or characteristics of PSP that may be identifiable at recruitment and used to mitigate mental disorders among high-exposure occupations. We draw on a pan-Canada study of mental disorder prevalence to understand the personal characteristics and factors that a sample of active PSP believe will impact the occupational success of recruits. We situate our work within the broader discussion of the expression of a shared responsibility between PSP recruits and PSP organizations, exploring how PSP perceive and describe hiring practices across public safety occupations. Our results indicate that accountability is currently placed on individual PSP to fully understand, in advance, the complexities and pressures inherent to their occupation. Accordingly, participants expressed a need for more scrupulous screening processes designed to recruit candidates who are ‘fit’ for the job, along with a belief that some recruits could be considered ‘unfit’ for employment, such as persons without an innate mental capability for PSP work. Cautions around unpacking the consequences versus ‘perceived’ need to properly screen individuals for their suitability as a PSP are discussed as well as the expressed co-responsibility of potential PSP and PSP organizations during hiring to learn about the job as a means to improve the mental health and wellbeing of the future PSP workforce.
Open Access
The Relationship Between Uncertainty and Affect
(Frontiers Media, 2019-11-12) Anderson, Eric, C.; Carleton, R. Nicholas; Diefenbach, Michael; Han, Paul, K.J.
Uncertainty and affect are fundamental and interrelated aspects of the human condition. Uncertainty is often associated with negative affect, but in some circumstances, it is associated with positive affect. In this article, we review different explanations for the varying relationship between uncertainty and affect. We identify “mental simulation” as a key process that links uncertainty to affective states. We suggest that people have a propensity to simulate negative outcomes, which result in a propensity toward negative affective responses to uncertainty. We also propose the existence of several important moderators of this process, including context and individual differences such as uncertainty tolerance, as well as emotion regulation strategies. Finally, we highlight important knowledge gaps and promising areas for future research, both empirical and conceptual, to further elucidate the relationship between uncertainty and affect.
Open Access
Intolerance of Uncertainty Fuels Depressive Symptoms through Rumination: Cross-Sectional and Longitudinal Studies
(Public Library of Science, 2019-11-19) Huang, Vivian; Yu, Mabel; Carleton, R. Nicholas; Beshai, Shadi
The current study replicated and extended previous studies by examining the mediating and moderating role of rumination in the relationship between intolerance of uncertainty (IU) and depression in a community sample using both cross-sectional (n = 494; 56.9% female) and a two-months longitudinal (n = 321; 48.4% female) designs. Participants in each study were recruited through online crowdsourcing websites and completed study questionnaires. Results from Study 1 suggested that, while rumination did not appear to moderate the relationship between IU and depression, rumination appeared to partially mediates such relationship. Results from Study 2 supported rumination as fully mediating the relationship between IU and depression over two months. The brooding and reflection rumination subtypes exerted a significant indirect, but not moderating, effect on the relationship between IU and depression. Brooding exhibited a stronger mediation effect than did reflection. Overall, current results suggest that high levels of IU fuel the development of depression symptoms over time through engagement in heightened rumination. The IU-depression association appeared fully explained through rumination as it is a passive and contextually-dependent coping response that may enhance individuals’ emotion and facilitate the development of depressive symptoms.
Open Access
Demographic and cognitive risk factors for police mental disorder symptoms
(SAGE Publications, 2019-12-17) Korol, Stephanie; Vig, Kelsey, D.; Teale Sapach, Michelle, J. N.; Asmundson, Gordon, J. G.; Carleton, R. Nicholas
The current study was designed to assess whether cognitive risk factors (i.e. anxiety sensitivity (AS), intolerance of uncertainty (IU)) explained variance in mental disorder symptoms in Canadian police officers beyond variance explained by demographic variables (i.e. sex, marital status, education, years of service). Police participants (708 men; 271 women) completed measures assessing posttraumatic stress disorder, panic disorder, social anxiety disorder, major depressive disorder, generalized anxiety disorder, IU and AS. Multivariate analysis of variance demonstrated that only main effects of sex were significant for all symptom variables, except SAD. Hierarchical multiple regressions demonstrated that AS and IU accounted for greater variance than sex on all mental disorder symptom measures, which suggests that cognitive risk factors explain more variance in mental disorder symptoms than sex. Efforts to reduce AS and IU may be beneficial for improving police mental health.