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.     

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.     

Increasing self-efficacy reduces visual intrusions to a trauma-film paradigm

Background and Objectives: It has been proposed that self-efficacy plays a critical role in the onset and maintenance of Posttraumatic Stress Disorder (PTSD). This study aimed to test if increasing perceptions of self-efficacy using a false feedback technique about coping abilities prior to a trauma-film paradigm lead to a reduction of visual intrusions over the course of 6 days.

Design and Methods: Healthy participants recruited from the community were randomized to a high self-efficacy (HSE, N?=?18), low self-efficacy (LSE, N?=?21), or neutral self-efficacy (NSE, N?=?23) conditions.

Results: Participants in the HSE condition reported higher levels of self-efficacy. In addition, individuals in the HSE conditions reported significantly fewer intrusions over 6 days. Unexpectedly, individuals in the LSE condition reported fewer intrusions on the final day of the study compared to those in the NSE condition. The LSE group was also the only group showing a significant linear decline in intrusion across the 6 days.

Discussion: These findings provide further support that perceptions of self-efficacy are modifiable and may contribute to clinically-relevant processes underlying PTSD. Future prospective research with individuals exposed to trauma will help to shed light on the potential role of self-efficacy to buffer the negative impacts of traumatic stress.     

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.     

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.     

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.     

Appraisals of dependent stressor controllability and severity are associated with depression and anxiety symptoms in youth

Background and objectives: Stress is well established as a strong risk factor for internalizing psychopathology. Learned helplessness research demonstrates that perceived controllability of stressors affects internalizing symptoms. Furthermore, subjective perceived stress is associated with psychopathology. However, most recent research has focused on measuring the frequency and expert-rated severity of stressful life events despite evidence for the importance of stress perceptions. The present study brings together past and current literatures to investigate the importance of perceived severity and controllability of recent life events in the association between stressors and internalizing symptoms.

Design and methods: We used a revised version of the Adolescent Life Events Questionnaire (ALEQ) that asked participants (ages 13–22, N?=?328) to rate the frequency of 65 stressful events typical to youth, as well as the perceived stressfulness and control they felt over each event. Events were categorized prior to analysis as dependent (self-generated), independent (fateful) or neither.

Results: Controllability and severity appraisals were associated with depression and anxiety symptoms, controlling for stressor frequency (which also predicted symptoms), for dependent but not independent stressors.

Conclusions: These results highlight the importance of controllability and severity appraisals as potential risk factors for internalizing disorders, exposing a potential target for therapy.     

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.     

Attentional disengagement from negative natural sounds for high-anxious individuals

Background and objectives: Previous studies have not consistently concluded whether high-anxious persons exhibit attentional bias towards negative natural auditory stimuli. The present study explores whether auditory negative stimuli could induce attentional bias to negative sounds in real life and investigates the exact nature of these biases using an emotional spatial cueing task.

Design: Experimental study with a mixed factorial design.

Method: We created two groups according to the state-trait anxiety scale, namely high and low trait anxiety. Participants (N?=?68 undergraduate students) were required to respond to an auditory target after receiving a negative (aversive sounds from natural life) or neutral auditory stimuli.

Results: A 2 (Validity: valid/invalid)?×?2 (Cue Valence: negative/neutral)?×?2 (Anxiety Group: LA/HA) repeated-measures ANOVA on reaction times revealed that participants with high trait anxiety exhibited slower reaction times in invalid trials following negative cues than following neutral cues. Higher levels of trait anxiety were associated with more difficult attentional disengagement from negative auditory information.

Conclusions: The results demonstrate that impaired attentional disengagement was one of the mechanisms by which high-anxious participants exhibited auditory attentional bias to natural negative information.     

The surgical anxiety questionnaire (SAQ): development and validation

Objective: Preoperative anxiety is often assessed using general anxiety measures; existing specific measures might lack content coverage and/or are not psychometrically validated. This study aimed to develop a new self-report measure of surgery-specific anxiety and test its psychometric properties.

Design: The surgical anxiety questionnaire (SAQ) was developed from themes identified in qualitative research and reviewed by an interdisciplinary expert team. It was administered preoperatively to 135 patients (56% female, mean age 51) on the day of surgery alongside additional measures of preoperative anxiety, state anxiety, perceived stress, depression and social desirability. Follow-up assessment was conducted immediately post-surgery and two weeks post-surgery (n?=?114) to examine recovery and predictive validity of the scale.

Results: Factor analysis revealed a three component structure, including: concerns about health (six items), concerns about recovery (four items) and concerns about procedures (four items). Three additional items of relatively high concern were retained in the total score (17 items). The SAQ displayed good reliability, validity (content, construct and predictive) and adequate overall psychometric properties.

Conclusions: Preliminary results suggest that the SAQ is a promising tool for measuring preoperative anxiety and predicting recovery. Recommendations for future research include employing a confirmatory factor analysis and examining test-retest reliability.     

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.     

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.     

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.     

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.     

Should we suppress or reappraise our stress?: the moderating role of reappraisal on cortisol reactivity and recovery in healthy adults

Background: People differ in their ability to regulate their physiological stress response. Individual differences in emotion regulation strategies such as suppression and reappraisal may explain this differential response to stress.

Objective: The aim of the current study was to assess whether daily use of suppression and reappraisal as well as their interaction predicted physiological stress reactivity and/or recovery, as assessed by variations in cortisol levels.

Method: Thirty-eight healthy young adults (13 men) completed the Emotion Regulation Questionnaire and were exposed to a psychosocial stressor, throughout which salivary cortisol was measured.

Results: Linear regressions showed main effects of reappraisal and suppression on cortisol reactivity and a main effect of suppression on cortisol recovery, where both strategies were positively associated with stress phases. Moreover, results showed a significant interaction of suppression by reappraisal in predicting both cortisol reactivity and recovery. Simple slope tests revealed that reappraisal moderated the association between suppression and both phases of cortisol responsivity.

Conclusion: Our results suggest that reappraisal represents a protective factor against the deleterious effects of suppression on stress responsivity. This study underlines the importance of investigating emotion regulation strategies as a means to understand individual differences in vulnerability to stress-related psychopathologies such as anxiety and depression.     

Distraction and reappraisal efficiency on immediate negative emotional responses: role of trait anxiety

Background and Objectives: Emotion regulation involves attempts to influence emotion unfolding and may target experiential, expressive and physiological responses. Several strategies can be used, such as reappraisal (re-evaluating the emotional situation to reduce its emotional meaning) or distraction (turning the attention toward non-emotional aspects of the situation). Previous research on these regulation strategies produced contrasting results regarding their efficiency and we hypothesize that this could be due to individual differences such as trait anxiety.

Design and Methods: Participants (N?=?77) were confronted with negative pictures and we examined the differential emotional reactivity according to trait anxiety, followed by a comparison of the efficiency of reappraisal and distraction in reducing emotional responses.

Results: Results show that trait anxiety has no impact on reactivity at the experiential and expressive levels, but has an impact at the physiological level, where high anxiety individuals show increased cardiac orienting effect, as well as higher skin conductance and respiratory rate. Regarding regulation, reappraisal and distraction successfully reduce emotional experience and expressivity, but not physiological arousal.

Conclusions: Such contrasting results involve that high trait anxiety individuals might benefit from the use of other kinds of strategies than reappraisal and distraction, some that may successfully target physiological responses.     

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.     

Autonomy deficits as vulnerability for anxiety: evidence from two laboratory-based studies

Background: Autonomous individuals are characterized by self-governance; awareness of and capacity to realize one’s wishes and needs, while being connected with and sensitive towards others. In line with earlier research showing consistent associations between autonomy-connectedness deficits and anxiety, we tested in two studies whether autonomy deficits predict anxious responses to acute stressors.

Methods: In Study 1, participants (N?=?177) viewed an anxiety-inducing film fragment and reported anxiety before and after viewing the clip. In experimental Study 2, participants (N?=?100) were randomly allocated to one of two conditions: giving a short presentation to an audience (impromptu speech task) or watching another person’s presentation (control condition). Anxiety was measured at baseline, after a preparation period and directly after the presentation.

Results: In Study 1, individuals’ anxiety in reaction to watching the movie was positively associated with the autonomy-connectedness component sensitivity to others. In Study 2, individuals’ anxiety in reaction to preparing the presentation was negatively associated with the autonomy-connectedness component self-awareness.

Conclusions: Specific autonomy components may be related to experiencing anxiety in differing situations (i.e., related to others’ distress or presenting one’s personal views). Collectively these results indicate that autonomy-connectedness deficits may form a vulnerability factor for experiencing anxiety.     

Illness representations,pain and physical function in patients with rheumatic disorders: between- and within-person associations

Objectives: Rehabilitation for patients with rheumatic diseases improves both illness representations (IR) and clinical outcomes such as pain and physical functioning (PF). However, it is unclear whether IR may affect and, in turn, are affected by pain and PF. In this study, we examined both between-person associations and within-person associations between IR and pain/PF over time on three measurement occasions. Furthermore, cross-lagged relationships were examined.

Design and main outcome measures: This secondary analysis is based on data from N?=?186 patients with rheumatic diseases. Data on pain, PF and IR were assessed using self-report questionnaires at the beginning, the end and three months after a 3-week inpatient rehabilitation.

Methods: To separate between- and within-person level, data were analysed using random-intercept cross-lagged panel models.

Results: On both the between-person level (r?=?|0.21|???|0.44|) and the within-person level (r?=?|0.15|???|0.46|), pain and PF were related to cognitive and emotional IR. In addition, we found within-person bidirectional cross-lagged effects between emotional IR and PF.

Conclusion: IR show complex relationships with pain and PF. Improving PF might improve subsequent illness-related emotional distress and vice versa.