Sleep quality and treatment of social anxiety disorder

Background and Objectives: Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may affect treatment outcome. We examined whether: (1) individuals with SAD differed from healthy controls (HCs) in sleep quality, (2) baseline sleep quality moderated the effects of treatment (Cognitive–behavioral group therapy [CBGT] vs. mindfulness-based stress reduction [MBSR] vs. waitlist [WL]) on social anxiety, (3) sleep quality changed over treatment, and (4) changes in sleep quality predicted anxiety 12-months post-treatment.

Design: Participants were 108 adults with SAD from a randomized controlled trial of CBGT vs. MBSR vs. WL and 38 HCs.

Methods: SAD and sleep quality were assessed pre-treatment and post-treatment; SAD was assessed again 12-months post-treatment.

Results: Participants with SAD reported poorer sleep quality than HCs. The effect of treatment condition on post-treatment social anxiety did not differ as a function of baseline sleep quality. Sleep quality improved in MBSR, significantly more than WL, but not CBGT. Sleep quality change from pre- to post-treatment in CBGT or MBSR did not predict later social anxiety.

Conclusions: MBSR, and not CBGT, improved sleep quality among participants. Other results were inconsistent with prior research; possible explanations, limitations, and implications for future research are discussed. ClinicalTrials.gov identifier: NCT02036658.     

Cultural evidence for interpretation bias as a feature of social anxiety in Chinese adolescents

Background and Objectives: Interpretation bias (IB), defined as the tendency to interpret ambiguous social situations in a threatening manner, has increasingly been studied in children and adolescents. Compared to Western samples, the relation between IB and social anxiety in Chinese youth has received little attention. The present study was to mainly examine the relationship between IB and social anxiety among Chinese adolescents.

Design: Cross-sectional design was utilized.

Methods: IB, measured by the Adolescents’ Interpretation Bias Questionnaire (AIBQ), and social anxiety were surveyed among a group of high socially anxious Chinese adolescents (n?=?25) and a control group (n?=?29). Participants were asked to rate the likelihood of interpretations coming to mind in social/non-social situations and to choose the most believable interpretation.

Results: The high social anxiety group had more negative interpretations and beliefs in social situations, and the interpretation bias was particular to social anxiety versus depression. Additionally, the cognitive content-specificity hypothesis was supported; the high anxious group showed interpretation bias in social situations, but didn’t have more negative interpretations of non-social situations, after controlling for depression.

Conclusions: The present study yielded comparable findings as found in Western samples regarding the relation between IB and social anxiety.     

Confirmatory factor analysis of the post-event processing inventory in a community sample seeking self-help for social anxiety

Background: Post-event processing (PEP) refers to negative rumination following anxiety-inducing social situations. The Post-Event Processing Inventory (PEPI; Blackie & Kocovski, 2017, Development and validation of the trait and state versions of the post-event processing inventory. Anxiety, Stress, & Coping, 30, 202–218.) consists of both trait and state forms. Although the psychometric properties of the PEPI have been very good in past research, the factor structure of the scale was examined with student samples only.

Objectives: The primary purpose of the present study was to confirm the factor structure of the PEPI with a sample of individuals seeking self-help for social anxiety and shyness.

Design and Method: Individuals interested in receiving self-help (N?=?155) completed a battery of questionnaires, including the trait and state forms of the PEPI.

Results: On each version of the scale, we confirmed that a second-order factor (global PEP) could be inferred from three first-order factors (frequency, intensity, and self-judgment).

Conclusions: The hierarchical factor structure of the PEPI in the present study is consistent with previous research. The findings from the present study illustrate the utility of the PEPI amongst a community sample of individuals seeking self-help for social anxiety.     

A series of n-of-1 studies examining the interrelationships between social cognitive theory constructs and physical activity behaviour within individuals

Objectives: Research supports the ability of social cognitive theory (SCT) to explain physical activity (PA) behaviour, but most studies have examined this theory between individuals in large group studies. The aim of the present study was to examine the interrelationships between SCT constructs and PA within individuals of varying activity levels.

Design: Correlational n-of-1 studies.

Methods: Six adults aged 29–65 with varying levels of PA provided daily measures of PA, and completed probe measures over a four-week period of SCT constructs (e.g. barrier self-efficacy, goal setting, planning, social support, outcome expectations, perceived barriers, enjoyment). Data were analysed using cross-correlational time series analysis.

Results: Cross-correlation analysis showed that at least one SCT construct was associated with PA in five participants, although no individual had the same pattern of associations across the study. On some occasions, SCT constructs predicted subsequent PA, but at other times, PA engagement caused a subsequent change in the SCT construct. There were also examples of PA and SCT constructs being concurrently associated.

Conclusions: SCT factors are associated with variations in PA behaviour, but the cause and effect of these relationships within individuals is complex.     

The mediating role of mood in the relationship between perseverative cognition,sleep and subjective health complaints in music students

Objective: Subjective health complaints (SHC) are frequent in musicians. These complaints may be particularly distressing in this population because they are performance relevant. This paper aims at testing a model positing that (a) perseverative cognition (PC) predicts sleep duration/quality, (b) sleep duration/quality predicts SHC and (c) mood is a mediator of these associations.

Design: Participants were 72 music students (mean age (SD): 22.7 (3.0) years), and the assessment period consisted of seven consecutive days, with a solo performance on the fifth day.

Main outcome measures: Self-reported total sleep time (TST) and sleep quality were assessed 30?min after wake-up, and objective TST/sleep quality were assessed with an actigraphy watch. PC and mood were measured five times a day. Daily SHC were assessed at 9 p.m.

Results: PC did not significantly predict sleep duration/quality. Self-reported and objective TST and sleep quality were all significantly associated with SHC. Mood played a mediating role in each of these relationships with the exception of objective sleep quality.

Conclusion: The tested model on the association among PC, sleep and SHC and the mediating role of mood received partial support, highlighting the importance of sleep and mood in the emergence of SHC among university music students.     

Development and initial validation of the job loss grief scale

Background: Research on complicated grief (CG) symptoms following job loss is surprisingly rare. Involuntary job loss can turn someone’s world upside down and can result in loss of identity, social contacts, and self-worth. In this study, we drew on the literature on major life events in conceptualizing involuntary job loss as a significant and potentially devastating life event.

Objectives: The aim of this study was to develop and evaluate an instrument that measures job loss-related CG symptoms, the Job Loss Grief Scale (JLGS). The purpose of the JLGS is to foster systematic research on CG symptoms following job loss.

Design: A cross-sectional study

Methods: We recruited Dutch workers who had lost their job, 130 men and 158 women with an average age of 49.6 years. To examine the psychometric properties of the JLGS and its associations with other concepts we conducted correlational and confirmatory factor analyses.

Results: CFA revealed that the JLGS was a one-dimensional instrument, and that CG symptoms were distinguishable from depression and anxiety symptoms.

Conclusion: The JLGS is a reliable and valid instrument to measure job loss-related CG symptoms. The availability of the JLGS could stimulate systematic research on the antecedents and consequences of involuntary job loss.     

Social interactions and physical symptoms in daily life: quality matters for older adults,quantity matters for younger adults

Objective: The present study examined how the different attributes of daily social interactions (quality and quantity) were associated with physical health, and how these associations vary with age.

Method: Using an ecological momentary assessment approach, participants from an adulthood lifespan sample (n = 172; aged 20–79 years) reported their social interactions five times daily, and physical symptoms and symptom severity at the end of each day, for one week.

Main outcome measures: Number of physical symptoms and physical symptom severity.

Results: There was a within-person main effect of the quality (positivity), but not the quantity (frequency), of social interactions on the number of reported physical symptoms and their severity. Moderation analyses further revealed that the quality of daily social interactions predicted fewer physical symptoms for older adults, but not for younger adults; in contrast, the frequency of social interactions predicted less severe physical symptoms for younger adults, but not for older adults. Finally, the reported severity of physical symptoms predicted less frequent but more positive social interactions the next day.

Conclusions: Our findings point to the bidirectional associations between social interactions and health and highlight the importance of considering individuals' developmental context in future research and interventions.     

No pain,no gain: cross-lagged analyses of posttraumatic growth and anxiety,depression, posttraumatic stress and prolonged grief symptoms after loss

Background and objectives: Major negative life-events including bereavement can precipitate perceived positive life-changes, termed posttraumatic growth (PTG). While traditionally considered an adaptive phenomenon, it has been suggested that PTG represents a maladaptive coping response similar to cognitive avoidance. To clarify the function of PTG, it is crucial to establish concurrent and longitudinal associations of PTG with post-event mental health problems. Yet, longitudinal studies on this topic are scarce. The present study fills this gap in knowledge.

Design: A two-wave longitudinal survey was conducted.

Methods: Four-hundred and twelve bereaved adults (87.6% women) filled out scales assessing PTG and symptoms of depression, anxiety, prolonged grief, and posttraumatic stress at baseline and 6 months later.

Results: The baseline concurrent relationships between all symptom levels and PTG were curvilinear (inverted U-shape). Cross-lagged analyses demonstrated that symptom levels did not predict levels of PTG 6 months later, or vice versa.

Conclusions: Findings suggest PTG after loss has no substantive negative or positive effects on mental health. Development of specific treatments to increase PTG after bereavement therefore appears premature.     

Perceiving college peers’ alcohol consumption: temporal patterns and individual differences in overestimation

Objective: This study examines temporal patterns and individual differences of overestimation in alcohol norm perception within a social network.

Design: Hundred psychology freshmen indicated biweekly during their first semester the drinks they consumed, the perceived average of their peers’ consumption, and with whom they were acquainted. At baseline, trait self-control was assessed.

Main outcome: The moderation of alcohol consumption overestimation by time and individual characteristics was explored.

Results: Results show that students overestimated alcohol consumption of their acquainted peers by 1.22 drinks (p?<?.001). For time periods at which peers reported high consumption, overestimation decreased. Additionally, individuals reporting high alcohol consumption (b?=??0.25, p?<?.001) and low self-control (b?=?0.27, p?=?.010) showed higher overestimation.

Conclusions: Students overestimate the alcohol consumption of peers not fully accounting for changes in peer-reports. Furthermore, individual differences suggest informational and motivational processes underlying overestimation.     

Emotion dysregulation and posttraumatic stress disorder: a test of the incremental role of difficulties regulating positive emotions

Background and Objectives: Literature provides support for the role of emotion dysregulation in the development and course of posttraumatic stress disorder (PTSD) among women victims of intimate partner violence (IPV). However, a dearth of studies have examined the contribution of emotion dysregulation stemming from positive emotions to PTSD. Extending research, the current study examined (1) the bivariate association of difficulties regulating positive emotions to PTSD symptom severity, and (2) the incremental role of difficulties regulating positive emotions in PTSD symptom severity beyond difficulties regulating negative emotions.

Design: Participants were 210 women victims of IPV involved in the criminal justice system because of their partners’ arrest (M age?=?36.14, 48.6% African American).

Methods: Participants completed empirically-supported self-report measures assessing difficulties regulating positive and negative emotions and PTSD symptom severity.

Results: Difficulties regulating positive and negative emotions (overall and across each of the specific dimensions) were significantly positively associated with PTSD symptom severity. Moreover, difficulties regulating positive emotions demonstrated an incremental relation to PTSD symptom severity beyond the variance accounted for by difficulties regulating negative emotions.

Conclusions: Our findings suggest the potential utility of targeting difficulties regulating positive emotions in interventions for PTSD among women victims of IPV.     

“R U Mad?”: Computerized text analysis of affect in social media relates to stress and substance use among ethnic minority emerging adult males

Objective: This study examined the interactive role of affectivity and stress in substance use severity among ethnic minority, emerging adult males, using linguistic indicators of affect obtained through social media.

Method: Participants were 119 emerging adult, ethnic minority males (ages 18–25) who provided access to their mobile phone text messaging and Facebook activity for 6-months. Computerized text analysis (LIWC2015) was used to obtain linguistic indices of positive and negative affect from texts and Facebook posts. The Perceived Stress Scale was used to measure stress, and items from the Drug Abuse Screening Test were used to measure substance use severity.

Results: Generalized estimating equations showed that higher negative affect in texts was associated with greater substance use severity. Stress moderated the relationship between positive affect expressed in Facebook posts and substance use such that higher positive affect in Facebook posts was associated with less substance use at higher stress and greater substance use at lower stress.

Conclusions: Findings highlight the complexities of interactions between stress and affectivity. Findings could inform development of substance use interventions for young males that employ social technologies.     

Big Five personality traits and allostatic load in midlife

Objective: To examine the cross-sectional associations of Big Five personality traits with midlife allostatic load, including the role of sex, socio-demographic factors and health-related behaviours.

Design: Cross-sectional analyses of 5512 members of the Copenhagen Aging and Midlife Biobank, aged 49–63 years, 69% men.

Main outcome measure: Allostatic load (AL) based on 14 biomarkers representing the inflammatory, cardiovascular and metabolic system.

Results: Due to significant sex?×?trait interactions, analyses were stratified by sex. Openness and Conscientiousness were inversely associated with AL in both sexes, and Extraversion was positively associated with AL in men. Adjusting for socio-demographic factors significantly attenuated the association of Openness in both sexes and of Extraversion in men, for whom the inverse association of Agreeableness with AL was strengthened. Further adjusting for health-related behaviours, the Conscientiousness-AL association was attenuated but remained significant, and Agreeableness remained significantly associated with AL in men.

Conclusion: Results imply that higher levels of Agreeableness (in men) and Conscientiousness are associated with lower levels of AL above and beyond socio-demographic factors and health-related behaviours. The study further contributes by demonstrating the relevance of sex?×?trait and trait?×?trait interactions in the personality-health literature.     

Social influences on cognitive processing in enacted social support: effects on receivers’ cognitive appraisals,emotion, and affiliation

Background and objectives. Social support is linked with psychological health, but its mechanisms are unclear. We examined supporters’ influence on recipients’ cognitive processing as a mechanism of effects of support on outcomes associated with depression.

Design/methods. 2?×?2 between-subjects experiment. 147 participants (1) experienced a negative event (false feedback); (2) received social support modeling one of two contrasting cognitive processing modes (abstract/evaluative or concrete/experiential); (3) generated explanations for the event, later coded for processing mode and internal/external causal attribution; and (4) reported on emotion, perceptions of self and future, and social affiliation. To examine relational effects, half of participants were led to perceive the supporter as similar to themselves via a shared birthday manipulation.

Results. Support condition influenced participants’ processing mode and causal attributions as predicted. Abstract/evaluative support led to more positive emotion and self-perceptions, and less pessimistic expectancies for the future than concrete/experiential support. Perceived similarity moderated effects on beliefs about an upcoming social interaction, magnifying positive affiliation outcomes of abstract/evaluative versus concrete/experiential support.

Conclusions. Processing modes that are generally maladaptive at the intrapersonal level may be adaptive (and vice versa) when they are interpersonally influenced, and perceived similarity may facilitate interpersonal effects of processing mode on affiliation.     

Increased chronic stress predicts greater emotional negativity bias and poorer social skills but not cognitive functioning in healthy adults

Background and Objectives: Chronically stressed individuals report deficits spanning cognitive and emotional functioning. However, limitations to clinical populations and measures of stress have impeded the generalisability and scope of results. This study investigated whether chronic stress predicted cognitive and emotional functioning, and whether these relationships differed between males and females, in a large representative sample of healthy participants.

Design: Cross-sectional study.

Method: 1883 healthy adults sampled from the Brain Resource International Database reported stress using the 21-item Depression Anxiety Stress Scales. Participants then completed a cognitive and emotional assessment battery (IntegNeuro), as well as questionnaires related to sleep, emotional functioning, and self-regulation.

Results: In contrast to previously reported results, chronic stress did not predict cognitive functioning. However, higher stress predicted a greater negativity bias and poorer social skills, confirming previous research identifying these links.

Conclusions: Cognitive deficits related to stress are absent in healthy participants when stress is measured using the 21-items Depression Anxiety Stress Scales. Identifying how chronic stress is associated with aspects of emotional functioning can lead to personalized interventions for individuals to better manage the negative outcomes resulting from stress.     

Doctors as patients: How psychological therapists experience the opposing ideologies

Research suggests that doctors experience higher levels of stress and mental health problems than the general population. Doctors frequently experience difficulty seeking help, and also challenges during psychological treatment, due to role reversal and competing ideologies.

Focusing specifically on the under-researched area of doctors as patients in a psychological context, this paper explores the processes underlying role transition as well as the therapeutic relationship that follows.

Furthermore, therapeutic reactions and adaptions of practice to this dynamic is also explored. A qualitative approach was employed and seven psychological therapists who had worked extensively with doctors as their patients were interviewed.

Subsequent interview data were thematically analyzed.

Six themes were generated: fear and pressure; status and control; variation of ideologies; change in practice; temporal changes; and help seeking and support.

The main barrier to recovery for doctors is difficulty in accessing services owing to the high-levels of stigma and shame that may be experienced. This research identifies some of the adaptions made by psychological therapists within their practice when working with doctors as patients.     

Trajectories of public psycho-behavioural responses relating to influenza A(H7N9) over the winter of 2014-15 in Hong Kong

Objective: To explore trajectories of public psycho-behavioural responses over one influenza A(H7N9) epidemic wave, and examine the interplays among social norm influence, disease worry and protective behaviours.

Methods: Participants were 464 adults who completed the baseline and at least two follow-up assessments on their H7N9-related Perceived Susceptibility, Perceived Severity, Perceived Efficacy, Worry, Social Norms influence and Protective Behaviours in a five-phase longitudinal survey over one H7N9 epidemic wave. Latent growth modelling (LGM) identified trajectories of these psycho-behavioural responses while multi-process LGM examined the inter-relationships among trajectories of Social Norms influence, Worry and Protective Behaviours.

Results: Trajectories of Perceived Susceptibility, Worry, Social Norms and Protective Behaviours increased initially but declined as the epidemic decayed, while Perceived Severity increased linearly and Perceived Efficacy remained stable across the epidemic. Change in Social Norms influence was significantly associated with change in Worry (β?=?0.65) which was significantly associated with change in Protective Behaviours (β?=?0.62).

Conclusion: The public’s threat appraisal but not efficacy appraisal may have been well-informed by epidemic-related information. Social Norms may be important contributors of public emotional response to an epidemic. Communication via social networks during an epidemic could be important for regulating public emotional response and guiding their behavioural change.     

A meta-analysis of the association between forgiveness of others and physical health

Objective: This meta-analysis tested the relation between forgiveness of others and physical health (PH) with age, gender, race, education level, employment status, sample type, research design, type of PH variables, and publication status as the potential moderators.

Design: Eligible studies had participants with or without physical or mental health problems and had quantitative data on forgiveness of others and PH. The random-effects model was used to aggregate Fisher’s z effect sizes, which were converted back to correlation coefficients.

Main Outcome Measures: State forgiveness (forgiving an offense or offender) measures, trait forgiveness (a disposition to forgive) measures and physical health measures were included in the meta-analysis.

Results: A hundred and twenty-eight studies (N?=?58,531) were retrieved, in which the mean effect sizes showed a significant positive relationship between forgiveness of others and PH (r?=?0.14, p?<?0.001, 95% CI [0.11, 0.17]). Further, no moderators showed a significant relation between forgiveness of others and PH.

Conclusions: The positive relation between forgiveness of others and PH was not affected by potential moderators. Because the results are correlational, more forgiveness interventions may be needed to examine the causal effect of the relation between forgiveness of others and PH.     

Tortoise or hare? Supporting the chronotope preference of employees with fluctuating chronic illness symptoms

Objective: Our aim is to understand how to facilitate the job retention of employees with chronic illness. We focus on multiple sclerosis (MS) as a criterion chronic illness.

Design: An opportunity sample of 20 individuals of working age (13 female; 7 male) were recruited who had been in paid employment for over 28 months with a concurrent diagnosis of MS. Participants took part in one of three focus groups with a topic guide comprising keywords: work, coping, performance, support, future, expectations, sharing and symptoms. Data were analysed using dialogical analysis.

Main outcome measures: As a qualitative study, no outcome measure was used. However, the specific focus of interest was to search for differential patterns of ‘timespace’ – chronotope – that people with chronic illness utilise to manage their condition in the workplace.

Results: Participants oriented to two distinct chronotope types: unsustainable epic (characterised by condensed time) and temporary idyll (characterized by condensed space). Perceived managerial discretion was identified as possibly influencing participants’ chronotope preference.

Conclusion: Identifying chronotope preference has practical implications for health psychologists and related professionals who provide and advise on support to facilitate people with chronic illness to thrive in the workplace.