Karen Fondacaro
University of Vermont, Psychology, Faculty Member
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Estimation de leurs propres mensurations par des femmes de poids normal atteintes de boulimie et un groupe controle; l'hypothese de depart etant que les boulimiques ont tendance a surestimer leurs dimensions corporelles (poitrine,... more
Estimation de leurs propres mensurations par des femmes de poids normal atteintes de boulimie et un groupe controle; l'hypothese de depart etant que les boulimiques ont tendance a surestimer leurs dimensions corporelles (poitrine, taille, hanches, ventre)
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Research Interests: Psychology, Clinical Psychology, Developmental Psychology, Coping Strategies, Consulting, and 14 moreAdolescent, Medicine, Emotions, Problem Solving, Humans, Child, High School, Female, Male, Perceived Control, Behavior Problems, Internal- External Locus of Control, Life Change Events, and Child behavior disorders
Research Interests: Mental Health, Traumatic Stress, Medicine, Distress, Anxiety, and 5 moreMhealth, Refugee, Psychosocial, ANXIETY, and stressor
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ABSTRACT This study contrasted the amount of food eaten in the absence of vomiting by normal-weight bulimia nervosa patients and matched normal controls. Subjects were instructed to eat as much food as they comfortably could without... more
ABSTRACT This study contrasted the amount of food eaten in the absence of vomiting by normal-weight bulimia nervosa patients and matched normal controls. Subjects were instructed to eat as much food as they comfortably could without vomiting afterwards in three standardized test meals: a complete dinner eaten in a laboratory situation, and spaghetti and candy eaten at home. Bulimia nervosa subjects ate a very small amount of food in each test meal when compared with control subjects. Bulimia nervosa subjects also reported greater anxiety and urge to vomit after eating. A content analysis of tape-recorded thoughts showed that bulimia nervosa subjects were more preoccupied with eating and expressed more negative food-related thoughts. The results support the hypothesis that women with bulimia nervosa are unable to eat normal amounts of “frightening” foods when they do not plan to vomit. This behavioral test of eating behavior appears to be useful for the assessment of bulimia nervosa.
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Refugees endure incredible adversity, including torture. Although many refugees report traumatic stress reactions, they also demonstrate considerable resilience. Among refugees, torture survivors have demonstrated greater symptom severity... more
Refugees endure incredible adversity, including torture. Although many refugees report traumatic stress reactions, they also demonstrate considerable resilience. Among refugees, torture survivors have demonstrated greater symptom severity as well as greater resilience than those who have not reported torture. The contrast of these results suggests potential mediators. Psychological inflexibility is one process predictive of posttraumatic stress symptoms. However, this process has rarely been studied among refugees or survivors of torture. Thus, we examined psychological inflexibility as a mediator between torture and traumatic stress symptoms among resettled refugees (n = 71; 55% female; mean age = 41.48; 63% reported torture). Psychological inflexibility fully mediated the relationship between torture status and traumatic stress symptoms in two simple mediation models. Results demonstrate the impact of psychological inflexibility on refugee mental health and have implications for clinical care.
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Refugees endure incredible adversity, including torture. Although many refugees report traumatic stress reactions, they also demonstrate considerable resilience. Among refugees, torture survivors have demonstrated greater symptom severity... more
Refugees endure incredible adversity, including torture. Although many refugees report traumatic stress reactions, they also demonstrate considerable resilience. Among refugees, torture survivors have demonstrated greater symptom severity as well as greater resilience than those who have not reported torture. The contrast of these results suggests potential mediators. Psychological inflexibility is one process predictive of posttraumatic stress symptoms. However, this process has rarely been studied among refugees or survivors of torture. Thus, we examined psychological inflexibility as a mediator between torture and traumatic stress symptoms among resettled refugees (n = 71; 55% female; mean age = 41.48; 63% reported torture). Psychological inflexibility fully mediated the relationship between torture status and traumatic stress symptoms in two simple mediation models. Results demonstrate the impact of psychological inflexibility on refugee mental health and have implications for c...
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Introduction: There are 1.3 million refugee survivors of torture currently living in the United States today. While a substantial body of research has been growing on refugee mental health, few studies have focused on refugee resilience.... more
Introduction: There are 1.3 million refugee survivors of torture currently living in the United States today. While a substantial body of research has been growing on refugee mental health, few studies have focused on refugee resilience. Objective: The current study focuses on a clinical sample of refugee survivors of torture to examine resilience-promoting factors, including community engagement, employment, English fluency, and psychological flexibility. Specifically, our study conducted moderation and mediation analyses to better understand how these resilience-promoting factors impact the torture-mental health relationship. Results: Findings showed that torture severity was significantly and positively associated with all mental health symptoms, and psychological flexibility was significantly and negatively associated with all mental health symptoms, including PTSD, depression, and anxiety. Psychological flexibility also emerged as a significant mediator of the torture-mental he...
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Suicidal behavior and death by suicide are significant and pressing problems in the Bhutanese refugee community. Currently, Bhutanese refugees are dying by suicide at a rate nearly two times that of the general U.S. population. Proper... more
Suicidal behavior and death by suicide are significant and pressing problems in the Bhutanese refugee community. Currently, Bhutanese refugees are dying by suicide at a rate nearly two times that of the general U.S. population. Proper identification of risk factors for suicide saves lives; however, if risk is underestimated due to culturally inflexible risk assessments, preventable deaths may continue to occur. In this review, we examine specific cultural factors related to psychopathology and suicide among Bhutanese refugees. To contextualize the current suicide crisis among Bhutanese refugees, we propose an integration of the interpersonal psychological theory of suicide (Joiner, 2005) and the cultural model of suicide (Chu, Goldblum, Floyd, & Bongar, 2010). We provide recommendations for preventing suicide from a systems framework and discuss practical lessons from a preliminary study designed to test a culturally-responsive model of suicide in Bhutanese refugees.
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Numerous evidence based interventions have been developed to address trauma and psychological distress and wellbeing. A number of individuals are unable to benefit from these due to failing to attend and engage in treatment. Clients may... more
Numerous evidence based interventions have been developed to address trauma and psychological distress and wellbeing. A number of individuals are unable to benefit from these due to failing to attend and engage in treatment. Clients may fail to attend therapy sessions for a number of reasons, ranging from severe psychological distress to tangible economic barriers. These challenges may be particularly salient among a refugee population. The current study examines predictors of treatment attendance and unplanned drop out in a diverse sample of refugees from a broad array of countries (e.g. Somali-Bantu, Nepali-Bhutanese, Congolese, etc.). Symptoms of depression, anxiety, and PTSD, as well as income, family size, gender, and feeling connected with community supports will be examined to determine predictors of treatment engagement difficulties. Intervention delivered uses a functional contextual framework based on the ACT approach, along with skills drawn from other evidence based prac...
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An increasing number of refugees and survivors of torture resettled in the United States are presenting to clinics for treatment related to trauma and postmigration difficulties. Although clinicians experienced in treating trauma with... more
An increasing number of refugees and survivors of torture resettled in the United States are presenting to clinics for treatment related to trauma and postmigration difficulties. Although clinicians experienced in treating trauma with diverse populations may recognize the limitations of a PTSD diagnosis, one of the primary diagnoses received by refugees and survivors of torture remains post-traumatic stress disorder (PTSD). A variety of interventions exist (e.g., supportive, trauma specific, interdisciplinary including physical, social and psychological) for survivors of torture and trauma that move beyond this diagnosis, however, a unifying conceptual model is needed to guide treatment and further the empirical investigation and evidence base in this growing field. In this paper, we propose a broader biopsychosocial framework of the impact of traumatic war events including the measurement of stress related to post migration living difficulties, and daily hassles while highlighting ...
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Objective: After resettlement, an overwhelming number of refugees struggle with Chronic Traumatic Stress (CTS), the persistence of traumatic events (e.g., re-experiencing past trauma; news of on-going war) coupled with daily... more
Objective: After resettlement, an overwhelming number of refugees struggle with Chronic Traumatic Stress (CTS), the persistence of traumatic events (e.g., re-experiencing past trauma; news of on-going war) coupled with daily post-migration stressors (e.g., poverty, lack of transportation). CTS significantly increases the burden of mental health challenges experienced by refugees. Evidence-based mental health treatments often rely on worksheets, mobile applications, websites, or telephone calls to facilitate the management of distress outside of treatment sessions. Language barriers prevent these strategies from being incorporated into mental health treatment for refugees, which results in a significant disparity in care. Treatments delivered via mobile devices can address this barrier through the use of intuitive images that eliminate the need for text or language-based instruction.Methods: A six-week pilot study assessing the effectiveness of group intervention utilizing a language free, culturally relevant mobile health (mHealth) application was conducted in a sample of Somali-Bantu and Nepali-Bhutanese adult refugee men and women (N=18). Paired-samples t-tests were conducted to compare pre- and post-intervention levels of psychosocial distress, anxiety, depression, and traumatic stress, on the Refugee Health Screener (RHS-15) and an investigator generated coping measure.Results: Results indicated significant reduction (p<.001) in symptoms related to traumatic stress, anxiety, depression and somatic complaints in addition to a significant increase (p<.001) in the use of coping skills.Conclusions: The use of a mobile mental health app, in combination with in-person therapy, was effective in reducing mental health symptomology and in increasing the use of coping skills in Somali-Bantu and Nepali-Bhutanese refugees.
This manuscript introduces the Chronic Traumatic Stress-Treatment for refugees and survivors of torture (CTS-Treatment; Mazzulla & Fondacaro, 2018). CTS-Treatment aligns with the Chronic Traumatic Stress model (CTS; Fondacaro & Mazulla,... more
This manuscript introduces the Chronic Traumatic Stress-Treatment for refugees and survivors of torture (CTS-Treatment; Mazzulla & Fondacaro, 2018). CTS-Treatment aligns with the Chronic Traumatic Stress model (CTS; Fondacaro & Mazulla, 2018), a biopsychosocial-spiritual and culturally responsive theoretical framework designed to guide empirical investigation and intervention for refugees and survivors of torture. CTS-Treatment is designed for use by mental health clinicians working within an individual or group format. The ten modules of CTS-Treatment are in sequence; however, flexibility in implementation is strongly encouraged. The ten intervention modules include: 1) Mental Health Discussion, 2) Safety, 3) Values, 4) Behavioral Activation, 5) Coping Skills, 6) Sleep Hygiene, 7) Working with Thoughts, 8) Acceptance and Tolerance of Emotions, 9) Life-Path Exercise and Narrative Exposure, and 10) Celebration of Life. Empirical principles underlying the treatment, along with support...
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OBJECTIVE Numerous psychological constructs exist to describe different facets of emotional responding, but they have rarely been examined together. We empirically modeled the associations between four psychological constructs... more
OBJECTIVE Numerous psychological constructs exist to describe different facets of emotional responding, but they have rarely been examined together. We empirically modeled the associations between four psychological constructs (mindfulness, emotional nonacceptance, experiential avoidance, and anxiety sensitivity) of individuals' responses to their affective experience, hypothesizing that a bifactor model would fit the data best. METHOD We used exploratory structural equation modeling, a novel latent variable modeling framework, to compare five measurement models of emotional responding in an online community sample (N = 307). RESULTS A bifactor model including a general emotional responding factor had substantial factor loadings from nearly all items, with mixed results for specific factors. Exploratory analyses supported the significant association of avoidant emotional responding and psychopathology/well-being. CONCLUSION The general avoidant emotional responding factor appears to overlap most directly with experiential avoidance and may be a transtheoretical construct relevant to mental health.
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An increasing number of refugees and survivors of torture resettled in the United States are presenting to clinics for treatment related to trauma and postmigration difficulties. Although clinicians experienced in treating trauma with... more
An increasing number of refugees and survivors of torture resettled in the United States are presenting to clinics for treatment related to trauma and postmigration difficulties. Although clinicians experienced in treating trauma with diverse populations may recognize the limitations of a PTSD diagnosis, one of the primary diagnoses received by refugees and survivors of torture remains post-traumatic stress disorder (PTSD). A variety of interventions exist (e.g., supportive, trauma specific, interdisciplinary including physical, social and psychological) for survivors of torture and trauma that move beyond this diagnosis, however, a unifying conceptual model is needed to guide treatment and further the empirical investigation and evidence base in this growing field. In this paper, we propose a broader biopsychosocial framework of the impact of traumatic war events including the measurement of stress related to post migration living difficulties, and daily hassles while highlighting ...
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Despite substantially higher rates of posttraumatic stress disorder (PTSD) among male inmates than among men in the general population, there is a dearth of research on PTSD among incarcerated men. The current study addresses traumatic... more
Despite substantially higher rates of posttraumatic stress disorder (PTSD) among male inmates than among men in the general population, there is a dearth of research on PTSD among incarcerated men. The current study addresses traumatic events that precede PTSD and psychiatric disorders that are comorbid with PTSD in an inmate sample. Seeing someone seriously injured or killed, being sexually abused, and being physically assaulted were the three most commonly reported antecedent traumas to PTSD. Lifetime and current rates of mood disorders, anxiety disorders, and antisocial personality disorder were elevated among inmates with a diagnosis of PTSD. Two hundred and thirteen inmates participated in the study. Sixty-nine participants (33%) met lifetime DSM–III–R criteria for PTSD, and 45 (21%) met current criteria. The findings are compared with general population samples, and implications of the findings are discussed.
Research Interests: Psychology, Violence, Sexual Abuse, Traumatic Stress, Comorbidity, and 18 moreAntisocial Personality Disorder, Humans, Posttraumatic stress disorder, Male, Men, Mental Disorders, Risk factors, Prisoners, Questionnaires, Adult, New England, Risk Factors, Anxiety Disorder, Traumatic, Mood Disorder, Life Change Events, General Population, and Case Control Studies
A limited number of recent empirical studies suggest that inmates suffer from high rates of serious mental illness. Different explanations are offered depending on the type of institution: jail or prison. The literature is based largely... more
A limited number of recent empirical studies suggest that inmates suffer from high rates of serious mental illness. Different explanations are offered depending on the type of institution: jail or prison. The literature is based largely on urban samples and does not offer comparisons of rates across types of institution within a single study. The present study examined a random sample of 213 jail and prison inmates in a rural state using the Diagnostic Interview Schedule (III-R). Among jail inmates there was little evidence of high rates of serious mental illness, suggesting the criminalization of mental illness may not be as evident in rural settings as urban areas. Among prison inmates, however, high rates of mental disorders were found, supporting previous findings in urban and rural jurisdictions. Implications of the findings are discussed in the context of a consolidated correctional system.
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ABSTRACT This study contrasted the amount of food eaten in the absence of vomiting by normal-weight bulimia nervosa patients and matched normal controls. Subjects were instructed to eat as much food as they comfortably could without... more
ABSTRACT This study contrasted the amount of food eaten in the absence of vomiting by normal-weight bulimia nervosa patients and matched normal controls. Subjects were instructed to eat as much food as they comfortably could without vomiting afterwards in three standardized test meals: a complete dinner eaten in a laboratory situation, and spaghetti and candy eaten at home. Bulimia nervosa subjects ate a very small amount of food in each test meal when compared with control subjects. Bulimia nervosa subjects also reported greater anxiety and urge to vomit after eating. A content analysis of tape-recorded thoughts showed that bulimia nervosa subjects were more preoccupied with eating and expressed more negative food-related thoughts. The results support the hypothesis that women with bulimia nervosa are unable to eat normal amounts of “frightening” foods when they do not plan to vomit. This behavioral test of eating behavior appears to be useful for the assessment of bulimia nervosa.
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Both the capacity to generate alternative solutions to cope with stressful events and the strategies actually used to cope with interpersonal and academic stressors were examined in a sample of junior high school age youngsters. Subjects... more
Both the capacity to generate alternative solutions to cope with stressful events and the strategies actually used to cope with interpersonal and academic stressors were examined in a sample of junior high school age youngsters. Subjects were moderately consistent in the ...