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.     

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.     

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.     

Does integral affect influence intentions to use artificial intelligence for skin cancer screening? A test of the affect heuristic

Objective: This study investigated how affect influences people’s processing of messages about risks and benefits of using autonomous artificial intelligence (AI) technology to screen for skin cancer. We examined integral affect (emotion derived during decision making) separately from incidental affect (extraneous mood states).

Design: Using the affect heuristic framework, we randomly assigned 273 participants to conditions featuring risk (high, low, uncertain) or benefit (high, low, uncertain) messages about AI. Following ‘affect-as-spotlight’, we also explored whether people’s integral affect towards skin cancer moderated the relationship between risk/benefit messages and AI screening intentions.

Outcomes: Perceived risk, perceived benefit, positive and negative affect toward AI, intention to use AI screening.

Results: After controlling for incidental affect and risk perceptions, we found that compared to low risk messages, uncertain risk messages increased participants’ negative affect toward AI, decreased positive affect toward AI, increased AI risk evaluations and reduced AI benefit evaluations. Perceptual variables significantly mediated participants’ intentions to use AI for risk messages but not benefit messages. No moderation effects were found.

Conclusions: Results suggest extending the affect heuristic framework to include uncertain risk conditions. Integral AI affect influenced people’s interpretation of messages, which then impacted likelihood to use AI technology for health.     

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.     

Living with painful diabetic neuropathy: insights from focus groups into fears and coping strategies

Objective: Painful diabetic neuropathy (PDN) is known to negatively affect quality of life. Being physically active is a crucial part of successful diabetes self-management, but regimen adherence is often low. Coping strategies and fears have shown to be related to less physical activity (PA). The aim of the present study was to obtain more in-depth information on psychological risk factors leading to less PA in persons with PDN.

Design: Three semi-structured focus group interviews were conducted with a representative sample of persons with PDN (N?=?12). Data were transcribed verbatim and analysed using a hybrid method of thematic analyses and a grounded theory approach.

Main Outcome Measures: Fears and coping strategies related to PA in persons with PDN.

Results: Several specific fears were identified; fear of hypoglycaemia, fear of pain increase, fear of total exhaustion, fear of physical injury, fear of falling, fear of loss of identity, and fear of negative evaluation by others. To cope with these fears, avoidance, remaining active, cognitive distraction, and acceptance strategies were described.

Conclusion: In persons with PDN, diabetes-related fears and pain-related fears play a role in less engagement in PA, indicating the need for new methods for improving self-management in persons with PDN.     

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.     

Cumulative trauma,emotion reactivity and salivary cytokine levels following acute stress in healthy women

Background and Objectives: To better understand how trauma leads to poor health, this study examined whether cumulative trauma and emotion reactivity contribute to pro- (IL-1β) and anti-inflammatory (IL-10) salivary cytokine levels after stress.

Design: Seventy-three women, screened to be physically and mentally healthy, completed an acute stress paradigm and measures of lifetime trauma exposure.

Method: Saliva was collected 10?min before (i.e., baseline) and 35?min after the onset of a 10-min stressor. State negative and positive emotion were measured at baseline and post-stress.

Results: Most participants reported exposure to at least one trauma, with a mean of five. Cumulative trauma was associated with higher post-stress IL-1β and IL-1β/IL-10, but not with IL-10 or changes in emotion. Declines in positive emotion correlated with greater post-stress IL-1β.

Conclusions: These findings suggest that both cumulative trauma exposure and positive emotion have implications for salivary cytokine responses to acute stress. The inclusion of healthy women strengthens internal validity, and increases confidence that observed associations between trauma and salivary cytokine responses can be attributed to trauma, rather than to confounding health problems. This study adds to the growing literature examining how trauma may connect to cytokines, and ultimately, poor health.     

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.     

The relation between goal adjustment,goal disturbance,and mental well-being among persons with multiple sclerosis

Objective: This study investigated the role of goal adjustment, i.e. disengaging from blocked goals and reengaging into alternative goals, in mental well-being and goal disturbance in persons with multiple sclerosis (MS).

Design: A cross-sectional design was used with self-report data from questionnaires and Personal Project Analysis (PPA).

Main outcome measures: Dependent variables were mental well-being, indicated by depression/anxiety (HADS; Hospital Anxiety and Depression Scale) and mental functioning (SF-36; Short Form Health Survey), and goal disturbance, indicated by goal manageability and goal interference (PPA). Independent variables were patient-reported physical impairment (SF-36) and goal disengagement and reengagement (GAS; Goal Adjustment Scale).

Results: Higher goal reengagement was associated with better mental well-being, but unrelated to goal disturbance. Goal disengagement only showed a negative association with anxiety. High disengagement was associated with lower goal interference but only for those also scoring high on reengagement. Goal adjustment did not buffer the effects of physical impairment on mental well-being and goal disturbance. Contrary to expectations, higher goal reengagement increased the association between physical impairment and goal interference.

Conclusion: Although goal reengagement is associated with better mental well-being in persons with MS, it might also strengthen the perceived effect of physical impairment on goal interference.     

Perfectionism and beliefs about emotions in adolescents with chronic fatigue syndrome and their parents: a preliminary investigation in a case control study nested within a cohort

Objectives: To investigate perfectionism and beliefs about emotions in adolescents with chronic fatigue syndrome (CFS) and their parents.

Design: Case-control comparing adolescents (age 11–18) with CFS (N?=?121), asthma (N?=?27) and healthy controls (N?=?78) with a 3-month follow up for CFS participants.

Main outcome measures: Adolescents: Chalder Fatigue Questionnaire, physical functioning, Beliefs about Emotions scale (BES), Child and Adolescent Perfectionism Scale, Frost Multidimensional Perfectionism Scale (FMPS). Parents: BES, FMPS, Self—sacrificing scale, Affective styles questionnaire.

Results: Adolescents with CFS did not consistently report higher levels of perfectionism and unhelpful beliefs about emotions than adolescents with asthma or healthy adolescents. Mothers’ and adolescents’ beliefs about emotions and unhelpful perfectionism were significantly associated (p = .007). Linear regression found that neither adolescent perfectionism nor beliefs about emotions accounted for variance in subsequent fatigue or physical functioning.

Conclusion: Parental perfectionism and emotion regulation style may contribute to perfectionism in adolescents with CFS. Parental representations could contribute to fatigue maintenance.     

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.     

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.     

Justified indulgence: self-licensing effects on caloric consumption

Objective: Research on self-licensing, i.e. employing justifications to give into temptation, largely consists of studies examining dichotomous food choices (healthy vs. unhealthy), while evidence for its effects on how much (unhealthy) food is consumed remains scarce. The present studies aimed to demonstrate self-licensing effects on caloric consumption in both lab (Study 1 & 2) and field setting (Study 3).

Design: In all studies, female student samples were recruited. They either received a justification cue (license condition) or not (control condition), after which they could eat freely from unhealthy snacks (Study 1, N?=?85 and Study 2, N?=?95) or choose a snack for direct consumption at a take-out lunch place (Study 3, N?=?110).

Main outcome measures: Caloric value of consumed snacks (Study 1 and 2) and chosen snack (Study 3).

Results: In all studies, caloric consumption was higher in the license condition compared to the control condition: Participants ate more of the provided unhealthy snacks (Study 1 and 2) and chose a snack of higher caloric value (Study 3).

Conclusions: The present research corroborates self-licensing as an important factor in the consumption of unhealthy foods by employing more ecologically valid outcomes.     

Sources of stress and worry in the development of stress-related mental health problems: A longitudinal investigation from early- to mid-adolescence

Background and Objectives: Stress and stress-related mental health complaints are common and increasing among adolescents, especially girls. Identifying typical sources of stress as well as central intervention targets is an important effort in the development of effective prevention and treatment protocols. This study investigated worry as potential mediator in the development of mental health problems in response to common stressors in adolescence. We also examined to what sources adolescents ascribe their stress over the years from the 7th through the 9th grade.

Design: Prospective cohort study.

Methods: Self-reported subjective stressor load, worry, anxiety and depressive symptoms were assessed in a sample of Swedish 7th graders (N?=?1137; 46% girls, mean age 13.2) with follow-up assessments one and two years later.

Results: School was the most common source of stress across all time-points, with girls reporting considerable more stress than boys. Worry mediated the relationship between overall stressor load and depressive symptoms and anxiety over time and was not moderated by gender.

Conclusions: Worry may be an important target in stress prevention and efforts to prevent stress-related problems would benefit from focusing on early adolescence as especially school stress is already relatively common in grade 7.     

Manifestations of anxiety and coping strategies in patients with metastatic lung cancer and their family caregivers: a qualitative study

Objective: Advanced non-small cell lung cancer (NSCLC) is common, deadly, and associated with impairing anxiety for patients and caregivers who often co-experience similar symptoms that can vary together over time. We aimed to discover themes as to how NSCLC patients and caregivers express and cope with anxiety.

Design: Semi-structured interviews of patient-caregiver dyads (N?=?21), coded using NVivo Software.

Main Outcome Measures: Open-ended questions on anxiety mutuality, giving or receiving care, communication, and the most difficult aspects of having or caring for someone with Stage IV NSCLC.

Results: Analyses revealed that patients and caregivers were linked psychologically, co-experiencing symptoms of distress or coping, rising and falling together. Shared patient and caregiver themes emerged of cognitive, behavioural and physiological manifestations of anxiety and coping mechanisms.

Conclusions: Patient and caregiver expressions of anxiety and coping methods mapped onto the cognitive-behavioural model, implying potential use of cognitive behavioural therapy (CBT) to address these issues. This expands understanding of symptoms and coping strategies in NSCLC, explores patient-caregiver interaction, and confirms the need for future clinical intervention. Future research should focus on development and dissemination of CBT-based dyadic interventions addressing anxiety in NSCLC patients and caregivers.     

Reducing alcohol consumption during pre-drinking sessions: testing an integrated behaviour-change model

Objective: Pre-drinking, the practice of consuming alcohol prior to attending a subsequent event, increases the risk of alcohol-related harm, and is common in undergraduate student populations. The current study tested an integrated behaviour change model to identify the motivational, social-cognitive, and implicit predictors of pre-drinking.

Design: University students (N?=?289) completed an online questionnaire comprising measures of motivational and social-cognitive constructs related to reducing pre-drinking alcohol consumption and past behaviour, and an implicit association test for drinking identity. Participants reported their pre-drinking alcohol consumption at follow-up, 4 weeks from baseline.

Main Outcome Measures: Self-reported pre-drinking alcohol consumption.

Results: A variance-based structural equation model revealed that few model hypotheses were supported. Although the effects of past behaviour, perceived behavioural control, and implicit drinking identity, on follow-up pre-drinking alcohol consumption were statistically significant, the effect of intention was not.

Conclusions: Current findings indicate pre-drinking alcohol consumption is associated with past behaviour, perceived behavioural control and implicit drinking identity, and no intentions to reduce pre-drinking alcohol consumption. The finding raise questions over the validity of applying the integrated model in this context. Interventions should consider these factors and attempt to facilitate the formation of intentions that lead to subsequent behaviour.     

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.