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.     

Is avoidance of illness uncertainty associated with distress during oncology treatment? A daily diary study

Objective: The aim of this study was to explore the daily relationship between illness uncertainty, avoidance of uncertainty, well-being and treatment-related distress among patients with cancer receiving treatment with curative intent. It was hypothesised that daily illness uncertainty, daily avoidance of uncertainty and daily treatment-related distress would be negatively associated with daily well-being. It was also hypothesised that daily illness uncertainty and daily avoidance of uncertainty would be positively associated with daily treatment-related distress.

Design: Thirty-one patients receiving oncology treatment with curative intent completed a daily diary for seven consecutive days. Data were analysed using multilevel modelling.

Main outcome measures: Daily illness uncertainty, avoidance of illness uncertainty, treatment-related distress and well-being.

Results: As hypothesised, on days when patients with cancer reported heightened treatment-related distress they experienced diminished well-being. And on days when patients reported more experiential avoidance of illness uncertainty, they also experienced heightened levels of treatment-related distress. No other daily associations were significant.

Conclusion: These findings indicate that patients with cancer experience day-to-day fluctuations in distress and well-being throughout oncology treatment. Avoidance of illness uncertainty-related thoughts and/or emotions are associated with daily distress, but not daily well-being.     

Patient-provider care goal concordance: implications for palliative care decisions

Objective: Goal-concordant care is an important feature of high quality medical treatment. Patients’ care goals may focus on curative and/or palliative outcomes. Patients rarely communicate their care goals, and providers’ predictions of patient goals are often inaccurate, corresponding most closely to their own treatment goals. This projection of own goals onto patients introduces the potential for bias, leading to goal-discordant care.

Design and Main Outcomes: We examined goal discordance using data from a U.S. sample of healthcare providers (N?=?492) recruited online in 2017 using GfK Knowledge Panel. Providers reported their perceptions of their patients’ care goals (curative relative to palliative), their own care goals if they were to become ill, and their willingness to deliver palliative care.

Results: For 28% of providers, their own care goals differed from their patients’. Providers were more likely to prioritise palliative care (relative to curative) in their own goals than in their predictions about patients’ goals. Providers were more willing to deliver palliative care when their own goals prioritised more palliative relative to curative care, but their perceptions of patient goals were unassociated with willingness to provide it.

Conclusions: Efforts to improve goal communication and reduce projection biases among providers may facilitate goal-concordant care.     

An improved method for counting stressful life events (SLEs) when predicting mental health and wellness

Objective: Checklists for registering stressful life events (SLEs) generally correlate negatively, but weakly, with mental health outcome measures. Thus, the present study examined various methodological approaches for improving these relationships.

Design: A total of 1679 participants (women?=?943, men?=?736, M age-39.8) were randomly drawn from the general Norwegian population (response rate 34%). This prospective cohort study included two follow-ups at 10 (n?=?1181) and 23 months (n?=?942).

Main outcome measures: Satisfaction with life and absence of psychological distress (i.e. anxiety and depression) represented a joint measure for indexing ‘mental wellness’ (MW).

Results: A simple count of SLEs weakly predicted MW, as expected, whereas the addition of a moderator (i.e. manageability of the event) substantially improved predictive power. Four additional moderators were examined: duration, impact, help-seeking and time since onset, but these were non-significant after inserting manageability into the model. This SLE counting method also retained its predictive power after including multiple criterion-related variables that substantially adjusted the longitudinal statistical model.

Conclusion: This new SLE counting method exhibited a considerable improvement to predicting mental health and well-being. It is well suited for use in epidemiological research requiring a short SLE checklist format with high predictive power.     

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.     

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.     

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.     

Experiences of HIV-related discrimination and consequences for internalised stigma,depression and alcohol use

Objective: HIV stigma undermines health and well-being of people living with HIV (PLWH). Conceptual work on stigma mechanisms suggests that experiences of stigma or discrimination increase internalised stigma. However, not all PLWH may internalise the HIV discrimination they experience. We aimed to investigate the role of stress associated with events of HIV-related discrimination on internalised HIV stigma, as well as the downstream effects on depressive symptoms and alcohol use severity.

Design: 199 participants were recruited from an HIV clinic in the southeastern United States.

Main study measures: HIV-related discrimination was assessed using items adapted from measures of enacted HIV stigma and discrimination. Participants rated perceived stress associated with each discrimination item. Internalised HIV stigma was assessed using the internalised stigma subscale of the HIV Stigma Mechanisms Scale. Depressive symptoms were assessed with the Centre for Epidemiological Studies-Depression Index. Alcohol use severity was assessed with the Alcohol Use Disorders Identification Test.

Results: In serial mediation models, HIV-related discrimination was indirectly associated with both depressive symptoms and alcohol use severity through its associations with stress and internalised HIV stigma.

Conclusions: Understanding the mechanisms through which PLWH internalise HIV stigma and lead to poor health outcomes can yield clinical foci for intervention.     

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.     

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.     

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.     

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.     

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.     

Optimising daily diary questionnaires about fatigue,psychological flexibility and well-being: perspectives of people with rheumatic disease

Objectives: The aim of this study was to understand the perspectives of people with rheumatic disease have about completing a pilot daily diary questionnaire on fatigue and well-being, with the objective of incorporating these perspectives into future daily studies.

Methods: Twenty-two participants with experience of rheumatic disease-related fatigue attended a focus group and/or an individual interview. Before the focus group or interview, participants completed a one-off quantitative diary about their fatigue and well-being that day. In the focus groups and interviews, participants were asked about their experience completing the questionnaire. Data were analysed using inductive thematic analysis.

Results: Three themes were identified. ‘Concerns about Misinterpretation and Ambiguity’ addressed the elements of the diary questionnaire that were confusing or unclear to participants. ‘Desire to Provide Useful and Accurate Information’ outlined participants’ uncertainty about how to report complex daily experiences. ‘Gaining Personal Insight through Diaries’ revealed the personal benefits participants gained, particularly the development of insight into their fatigue.

Conclusions: People with rheumatic disease are willing to complete a daily diary questionnaire, but emphasise it is important for diary questionnaires to have clear instructions, questionnaire items and response scales. Addressing these concerns will ensure the reliability and validity of quantitative diary data.     

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.     

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.     

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.     

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.     

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.