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ImportanceMounting evidence supports the role of spiritual, existential, religious, and theological components in mediating psychedelic-assisted therapy, yet integration of these elements into the clinical setting is laggingObservationsAlthough psychedelic-assisted therapy commonly produces spiritually, existentially, religiously, or theologically relevant experiences for patients, these have not been systematically integrated into the psychotherapies that accompany therapeutic uses of psychedelics. As a key feature and potential mediator of therapeutic effects, evidence-based psychedelic-assisted therapies should include these topics in the treatment model. Research across multiple diagnostic targets and treatment contexts suggests that spiritually integrated psychotherapies are effective, feasible, and produce add-on benefits in spiritually, existentially, religiously, and theologically relevant outcomes, which are particularly germane to psychedelics. Established standards in spiritually integrated psychotherapy may be fruitfully applied to psychedelic-assisted therapy. Objectives for spiritually, existentially, religiously, and theologically integrated psychedelic-assisted therapy based on these standards and informed by considerations specific to psychedelics are recommended.Conclusions and RelevanceSpiritual, existential, religious, and theological topics’ integration in psychedelic-assisted therapy is needed to ensure culturally competent, evidence-based treatment aligned with the highest standards of clinical care. Neglecting to address these topics can detract from cultural competence, contribute to risks for patients, and potentially undermine treatment success.

Individuals’ daily behaviors and social interactions play a central role in the diagnosis and treatment of psychological disorders. Despite this, observational ambulatory assessment methods—research methods that allow for direct and passive assessment of individuals’ momentary activities and interactions—have a remarkably scant history in the clinical science field. Prior discussions of ambulatory assessment methods in clinical science have focused on subjective methods (e.g., ecological momentary assessment) and physiological methods (e.g., wearable heart rate monitoring). Comparatively less attention has been dedicated to ambulatory assessment methods that collect objective, relational data about individuals’ social behaviors and their interactions with their momentary environmental contexts. Drawing on extant social-ecological measurement frameworks, this article first provides a conceptual and psychometric rationale for the integration of daily relational data into clinical science research. Next, the nascent research applying such methods to clinical science is reviewed, and priorities for further research organized by the NIH Stage Model for Clinical Science Research are recommended. These data can provide unique information about the social contexts of diverse patient populations; identify social-ecological targets for transdiagnostic, precision, and culturally responsive interventions; and contribute novel data about the effectiveness of established interventions at creating behavioral and relational change.

Objective: Latent class modeling (LCM) offers a promising approach for examining correlates of heart rate (HR) patterns over multiple exercise sessions. This research examined biological and psychological variables associated with different patterns of HR response to physical activity (PA). Methods: In a three-arm RCT (exercise video games vs. standard exercise vs. non-exercise control), HR was recorded during PA sessions over a 12-week period. LCM identified three patterns of HR during PA across 189 participants in active arms: 1) high HR across sessions with low variability within sessions, 2) linear increase in HR across sessions with low variability within sessions, and 3) high variability in HR across all sessions. Associations with biological (resting heart rate, blood pressure, BMI, age, cholesterol, triglycerides, HbA1c) and psychological (depression, motivations for PA, PA-induced feelings) predictors of latent class membership were iteratively tested. Results: Psychological variables played as important a role in the final model as biological variables for predicting latent class membership. Few differences were found between LC1 and LC2, but LC3 differed from the other two groups in that participants were likelier to report that feel revitalized after PA (vs. LC1 and LC2), to be less motivated for PA (vs. LC1), reported greater depression (vs. LC1 and LC2), and were younger (vs. LC1). Conclusions: These findings demonstrate the potential of LCM to identify biological and psychological factors associated with chronotropic responses to PA, and advance understanding of the role of psychological factors in chronotropic PA outcomes.

Objectives Although hospital chaplains play a critical role in delivering emotional and spiritual care to a broad range of both religious and non-religious patients, there is remarkably little research on the best practices or “active ingredients” of chaplain spiritual consults. Here, we examined how chaplains’ compassion capacity was associated with their linguistic behavior with hospitalized inpatients, and how their language in turn related to patient outcomes. Methods Hospital chaplains (n = 16) completed self-report measures that together were operationalized as self-reported “compassion capacity.” Next, chaplains conducted consultations with inpatients (n = 101) in five hospitals. Consultations were audio-recorded, transcribed, and analyzed using Linguistic Inquiry Word Count (LIWC). We used exploratory structural equation modeling to identify associations between chaplain-reported compassion capacity, chaplain linguistic behavior, and patient depression after the consultation. Results We found that compassion capacity was significantly associated with chaplains’ LIWC clout scores, a variable that reflects a confident leadership, inclusive, and other-oriented linguistic style. Clout scores, in turn, were negatively associated with patient depression levels controlling for pre-consult distress, indicating that patients seen by chaplains displaying high levels of clout had lower levels of depression after the consultation. Compassion capacity exerted a statistically significant indirect effect on patient depression via increased clout language. Conclusions These findings inform our understanding of the linguistic patterns underlying compassionate and effective chaplain-patient consultations and contribute to a deeper understanding of the skillful means by which compassion may be manifest to reduce suffering and enhance well-being in individuals at their most vulnerable.

Objective: Extensive research suggests that short-term meditation interventions may hold therapeutic promise for a wide range of psychosocial outcomes. In response to calls to subject these interventions to more methodologically rigorous tests, a randomized controlled trial tested the effectiveness of a mindfulness meditation intervention and a compassion meditation intervention against an active control in a sample of demographically diverse, medically and psychiatrically healthy adults. Methods: Two hundred and four participants completed a battery of questionnaires to assess psychological experience, participated in a laboratory stress test to measure their biological stress reactivity, and wore the Electronically Activated Recorder (EAR) to assess daily behaviors before and after an eight-week intervention (mindfulness meditation intervention, compassion meditation intervention, or health education discussion group). Results: Neither meditation intervention reliably impacted participants’ subjective experience, biological stress reactivity, or objectively assessed daily behaviors. Further, post-hoc moderation analyses found that neither baseline distress nor intervention engagement significantly moderated the effects. Conclusion: Results from this trial – which was methodologically rigorous and powered to detect all but small effects – were essentially null. These results are an important data point for the body of research about meditation interventions. Implications of these non-significant effects are discussed in the context of prior studies, and future directions for contemplative intervention research are recommended.

The challenges observed in health service psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic, but became more visible during the global health crisis. In a position paper written by 23 trainees across different sites and training specializations, the authors use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe longstanding dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. The authors make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.

Over the last decade, numerous interventions and techniques that aim to engender, strengthen, and expand compassion have been created, proliferating an evidence base for the benefits of compassion meditation training. However, to date, little research has been conducted to examine individual variation in the learning, beliefs, practices, and subjective experiences of compassion meditation. This mixed-method study examines changes in novice meditators’ knowledge and contemplative experiences before, during, and after taking an intensive course in CBCT® (Cognitively-Based Compassion Training), a contemplative intervention that is increasingly used for both inter- and intrapersonal flourishing. The participants in this study (n = 40) were Christian healthcare chaplains completing a 1-year residency in Clinical Pastoral Education (CPE) who learned CBCT as part of their professional chaplaincy training curriculum. Prior to and upon completion of training, we surveyed participants to assess their beliefs about the malleability of compassion, types of engagement in compassion meditation, and perceptions of the impact of taking CBCT. We also conducted in-depth interviews with a subset of participants to gain a qualitative understanding of their subjective experiences of learning and practicing compassion meditation, a key component of CBCT. We found that participants reported increases in the extent to which they believed compassion to be malleable after studying CBCT. We also found high levels of variability of individual ways of practicing and considered the implications of this for the study of contemplative learning processes. This multi-methodological approach yielded novel insights into how compassion practice and compassion-related outcomes interrelate, insights that can inform the basic scientific understanding of the experience of learning and enacting compassion meditation as a means of strengthening compassion itself.

Since its introduction in 2001, the Electronically Activated Recorder (EAR) method has become an established and broadly used tool for the naturalistic observation of daily social behavior in clinical, health, personality, and social science research. Previous treatments of the method have focused primarily on its measurement approach (relative to other ecological assessment methods), research design considerations (e.g., sampling schemes, privacy considerations), and the properties of its data (i.e., reliability, validity, and added measurement value). However, the evolved procedures and practices related to arguably one of the most critical parts of EAR research-the coding process that converts the sampled raw ambient sounds into quantitative behavioral data for statistical analysis-so far have largely been communicated informally between EAR researchers. This article documents "best practices" for processing EAR data, which have been tested and refined in our research over the years. Our aim is to provide practical information on important topics such as the development of a coding system, the training and supervision of EAR coders, EAR data preparation and database optimization, the troubleshooting of common coding challenges, and coding considerations specific to diverse populations.

Sighing is a common nonverbal everyday behavior thought to signal the experiencing of negative emotions. Prior research from a small-scale study suggests that observed daily expressions of sighing is associated with subclinical depression (Robbins, Mehl, Holleran, & Kasle, 2011). This paper replicates and extends these findings, hypothesizing that individual differences in negative emotionality are associated with frequency of spontaneous sighing. Study 1 (N = 320) documents a strong lay assumption that frequent sighing signals dispositional negative emotionality. Study 2 estimates the actual association between daily sighing, assessed naturalistically using the Electronically Activated Recorder (EAR), and negative emotionality in a large, diverse, pooled sample (N = 469). Bayesian tests across six measures (neuroticism, depression, anxiety, stress, fatigue, loneliness) strongly support the null model. Together, results suggest the common intuition that people who sigh frequently experience more negative emotionality is inaccurate. Assessing whether an individual sighs more (or less) than others cannot be used to infer that they experience more negative emotions.

Mindfulness-based interventions are increasingly recognized for their efficacy in clinical settings. Because of the historical and social associations of mindfulness-based interventions with spirituality and religion, individual differences in religiosity are likely to play a role in how people perceive these interventions, and may ultimately impact the acceptability and implementation of mindfulness-based techniques. Mindfulness-based interventions’ religious associations are often left unspecified, but when they are stated, they are typically represented as either 1) secular and neutral to religious concerns, or as 2) religiously influenced. Dichotomously presenting MBIs as either religious or secular can undermine the delivery of these interventions, as can failing to address religion or spirituality altogether. We present theory and research that explicates the likely ways in which religion influences the acceptability of mindfulness-based interventions, and provide recommendations for researchers and interventionists that enable them to respond to religious concerns about mindfulness-based interventions.

Since its introduction in 2001, the Electronically Activated Recorder (EAR) method has become an established and broadly used tool for the naturalistic observation of daily social behavior in clinical, health, personality, and social science research. Previous treatments of the method have focused primarily on its measurement approach (relative to other ecological assessment methods), research design considerations (e.g., sampling schemes, privacy considerations), and the properties of its data (i.e. reliability, validity, added measurement value). However, the evolved procedures and practices around arguably one of the most critical parts of EAR research – the coding process that converts the sampled raw ambient sounds into quantitative behavioral data for statistical analysis – have so far been largely communicated informally between EAR researchers. This article documents the “best practices” for processing EAR data that have been tested and refined in our research over the years. Our aim is to provide practical information on important topics such as the development of a coding system, the training and supervision of EAR coders, EAR data preparation and database optimization, the troubleshooting of common coding challenges, and coding considerations specific to diverse populations.

Recent research suggests that school-based kindness education programs may benefit the learning and social-emotional development of youth and may improve school climate and school safety outcomes. However, how and to what extent kindness education programming influences positive outcomes in schools is poorly understood, and such programs are difficult to evaluate in the absence of a conceptual model for studying their effectiveness. In partnership with Kind Campus, a widely adopted school-based kindness education program that uses a bottom-up program framework, a methodology called concept mapping was used to develop a conceptual model for evaluating school-based kindness education programs from the input of 123 middle school students and approximately 150 educators, school professionals, and academic scholars. From the basis of this model, recommendations for processes and outcomes that would be useful to assess in evaluations of kindness education programs are made, and areas where additional instrument development may be necessary are highlighted. The utility of the concept mapping method as an initial step in evaluating other grassroots or non-traditional educational programming is also discussed.

OBJECTIVE Maladaptive repetitive thought (RT), the frequent and repetitive revisiting of thoughts or internal experiences, is associated with a range of psychopathological processes and disorders. We present a synthesis of prior research on maladaptive RT and develop a framework for elucidating and distinguishing between five forms of maladaptive RT. METHOD In addition to the previously studied maladaptive RT (worry, rumination, and obsession), this framework is used to identify two additional forms of maladaptive RT (yearning and interoceptive RT). We then present a review of extant psychotherapy intervention research targeting maladaptive RT, focusing both on specific empirically based treatment strategies, and also constructs within treatments that impact maladaptive RT. CONCLUSION The paper concludes with recommendations for future basic and intervention research on maladaptive RT and related psychopathologies.