Antagonism Graduate Student Training Survey
Creators: name: Sleep, Chelsea
name: Lynam, Donald
name: Phillips, Nathaniel
name: Hyatt, Courtland
name: Miller, Josh
Publisher: name: OSF Registries
Year: 2023
Subjects: subject: Social and Behavioral Sciences

description: Antagonism Graduate Student Training Survey Project – Pre-Registration

Background:
Antagonism is a core dimension of psychopathology that forms part of the basis of the externalizing spectrum of psychiatric disorders. Patients who are highly antagonistic may exhibit qualities including: combativeness, manipulativeness, deceitfulness, grandiosity, and/or hostility. Primary diagnoses that clinicians may consider for antagonistic adult patients include antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder, and intermittent explosive disorder. Primary diagnoses that clinicians may consider for antagonistic child/adolescent patients include conduct disorder, oppositional defiant disorder, and attention-deficit/hyperactivity disorder. 

Negative Affectivity is a core dimension of psychopathology that forms part of the basis for the internalizing spectrum of psychiatric disorders. Patients who are high in negative affect may exhibit qualities including: depressiveness, self-consciousness, anxiousness, vulnerability, and/or emotional lability. Primary diagnoses that clinicians may consider for adult patients who are high in negative affect include major depressive disorder, generalized anxiety disorder, persistent depressive disorder, and/or panic disorder. Primary diagnoses that clinicians may consider for child/adolescent patients who are high in negative affect include major depressive disorder, generalized anxiety disorder, persistent depressive disorder, separation anxiety disorder, and/or panic disorder.

In this project, we are surveying current clinical psychology doctoral students on their clinical training and experiences with psychological treatments for patients with antagonistic traits or antagonism-based disorders (hereafter ANT-patients), and how these experiences compare to clinical training and experiences with patient who are high in negative affect (hereafter NA-patients). We are also interested in how these experiences may differ for students who work primarily with adults vs. students who work primarily with children/adolescents.

We gathered email addresses for N = 1973 graduate students in clinical psychology doctoral programs (found on graduate program websites) and are recruiting these students to complete a brief survey. In this survey, after completing demographic questions, participants are asked if they primarily do clinical work with children/adolescents or adults. Next, participants are asked about the extent of the clinical training and experiences they have had with antagonistic patients (i.e., either antagonistic adults or antagonistic children/adolescents, based on participant response to the previous question), as well as the extent of the clinical training and experiences they have had with NA-patients. 

Then, participants are asked if they have worked with an ANT-patient (i.e., either adult or child) and an NA-patient. If participants report that they have worked with either type of patient, they are asked a series of questions about their experiences working with that patient. If participants report that they have not worked with that type of patient, they do not complete the series of questions about that type of patient. The full surveys used in this study can be found on this OSF page.

Analyses:
Given the exploratory nature of this work, we plan to present descriptive statistics (i.e., means, standard deviations) for all responses we receive. Additionally, for participants who report that they have seen both an ANT-patient and NA-patient, we plan to compare the clinical training and experiences that students report for ANT-patients vs. NA-patients. We will calculate Cohen’s d values as a metric of effect size for all of these comparisons. If our sample reaches a pre-determined threshold in terms of size (see below), we will also conduct inferential tests to determine statistical significance of these comparisons. We are interested in four primary sets of comparisons: 

1) Comparing the clinical training and experiences that adult-focused students have had with ANT-patients vs. the clinical training and experiences adult-focused students have had with NA-patients.

2) Comparing the clinical training and experiences that child/adolescent-focused students have had with ANT-patients vs. the clinical training and experiences child/adolescent-focused students have had with NA-patients.

3) Comparing the clinical training and experiences that adult-focused students have had with ANT-patients vs. the clinical training and experiences that child/adolescent-focused students have had with ANT-patients.

4) Comparing the clinical training and experiences adult-focused students have had with NA-patients vs. the clinical training and experiences child/adolescent-focused students have had with NA-patients.

Previous work (Hyatt et al., 2023) suggests that the effect sizes that characterize certain aspects of mental health providers’ experiences with antagonistic patients vs. patients high in negative affect (e.g., differences in rapport, length of treatment) are very large, ranging from |d| = .60 to &gt; 3.0. As such, we elected to conservatively estimate that we expect to observe effect sizes of |d| = .40 (consistent with a “medium” effect size as defined by Funder &amp; Ozer, 2019).
 
Dependent sample t-tests are appropriate for comparisons #1 and 2 above, as we are comparing responses about ANT-patients vs. NA-patients as reported by the same participants (i.e., within-person analyses). We conducted power analyses using the pwr package in R (Champely et al., 2018), with parameters of d = .40, alpha = .01, and power = 80% for a two-tailed test. To achieve 80% power to find this effect size using dependent sample t-tests, we need N = 77 participants. Thus, we will set N= 77 as a minimum threshold for the number of adult-focused or child/adolescent-focused participants who report on their clinical experiences with both ANT-patients and NA-patients. If we attain a final sample size at or above this threshold for adult-focused students and/or child/adolescent-focused students, we will conduct 15 t-tests, reflecting the 15 pairs of questions that participants were asked about their clinical training and experiences with ANT-patients and NA-patients (i.e., maximum number of t-tests = 30). We will use p &lt;.01 as the significance threshold for all of these comparisons. If we do not attain this sample size for either adult-focused or child/adolescent-focused students, we will still compute Cohen’s d values, but we will not conduct inferential tests for that group. 

Independent-sample t-tests are appropriate for comparisons #3 and 4, as we are comparing responses about ANT-patients or NA-patients as reported by two independent groups (i.e., adult-focused students vs. child/adolescent-focused students). We conducted power analyses using the pwr package in R (Champely et al., 2018), with parameters of d = .40, alpha = .01, and power = 80% for a two-tailed test. To achieve 80% power to find this effect size using independent sample t-tests, we need N = 148 participants per group. Thus, we will set N = 148 as the minimum threshold of number of individuals who need to be in each group. If we attain a final sample size at or above this threshold for both of the two groups (e.g., adult-focused students who have seen an ANT-patient and child/adolescent-focused students who have seen an ANT-patient), we will conduct 15 t-tests, reflecting the 15 pairs of questions that participants were asked about their clinical training and experiences with ANT-patients or NA-patients (i.e., maximum number of t-tests = 30). We will use p &lt;.01 as the significance threshold for all of these comparisons. If we do not attain this sample size for either adult-focused or child/adolescent-focused students, we will still compute Cohen’s d values, but we will not conduct inferential tests for that type of patient. 

Exclusion Criteria:
Participants will be excluded if they meet any of the following criteria:
-Reporting they are not currently a graduate student in a clinical psychology doctoral program.
-Answering 0 questions past the demographic section of the survey.
-Completing the survey in under 1 minute (i.e., less than ~1.5 second to complete each item).

References: 

Champely, S., Ekstrom, C., Dalgaard, P., Gill, J., Weibelzahl, S., Anandkumar, A., ... &amp; De Rosario, M. H. (2018). Package ‘pwr’. R package version, 1(2).

Funder, D. C., &amp; Ozer, D. J. (2019). Evaluating effect size in psychological research: Sense and nonsense. Advances in Methods and Practices in Psychological Science, 2(2), 156-168.

Hyatt, C. S., Sleep, C. E., Hemmy Asamsama, O., &amp; Reger, M. A. (2023). Surveying veterans affairs mental health care providers on experiences working with veteran patients with antagonistic clinical presentations. Psychological Services.