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.     

Application of a worry reduction intervention in a medically unexplained symptoms-analogue student-sample

Objective: Worry is an important perpetuating factor of Medically Unexplained Symptoms (MUS). Former research has shown that a worry postponement instruction is effective in reducing Subjective Health Complaints (SHC) in non-clinical samples. This study aimed to (1) replicate these findings in a MUS-analogue student-sample and (2) assess alexithymia as a moderator.

Design: The current study had an experimental design with two waves of data collection: pre- and post-intervention.

Main outcome measures: A MUS-analogue student-sample consisting of 114 undergraduate students with high self-reported health worry and a minimum of two doctor visits in the previous year with no current diagnosis for a (chronic or acute) disease were instructed to register their worry frequency and duration eight times per day via an experience sampling-application on their smartphones. The intervention group additionally postponed their worries to a 30-minute period in the evening. SHC were assessed pre- and post-intervention.

Results: The intervention did not have an effect on worry or SHC. Alexithymia did not moderate this effect (p’s > .05).

Conclusion: Our study did not find evidence for the effectiveness of the worry reduction intervention on SHC in a MUS-analogue student-sample. This finding contributes to several previous studies that have found mixed evidence for the effectiveness of the worry reduction intervention on SHC and suggests that the worry intervention may not be effective in all cases.     

A one-year prospective investigation of Type D personality and self-reported physical health

Objective: Type D personality is characterised by negative affectivity (NA) and social inhibition (SI), and is often associated with poorer physical and psychological health. However, the underlying mechanisms are unclear and the literature lacks longitudinal assessment. Therefore, the aim was to prospectively examine the relationships between Type D and physical symptoms, in addition to aspects of retrospective health.

Design: An online questionnaire-based study (N?=?535) with a one-year follow-up (N?=?160) was conducted with healthy individuals (18–65 years). Type D was assessed as both a categorical and dimensional construct.

Main outcome measures: Participants completed the Type D scale-14 (DS14), Hospital Anxiety and Depression Scale (HADS), Cohen–Hoberman Inventory of Physical Symptoms (CHIPS) and Perceived Stress Scale (PSS) at both phases. Retrospective health questions and the Social Readjustment Rating Scale (SRRS) were also completed at follow-up.

Results: Type D was independently related to cardiac/sympathetic, metabolic, vasovagal, muscular and headache symptoms at baseline. At follow-up stressful events and anxiety mediated the relationships between Type D and particular symptoms. Type Ds were more likely to report poorer health, increased minor illnesses, work absences, and medical information seeking.

Conclusions: Type D is associated with symptoms often linked to stress. Although the relationships appear to be primarily driven by NA, these findings support the theory of a stress-related mechanism potentially underpinning the Type D-health relationship. These findings contribute to the literature continuing to highlight Type D personality as a risk factor for negative health outcomes.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

The detrimental effect of academic procrastination on subsequent grades: the mediating role of coping over and above past achievement and working memory capacity

Background: Academic procrastination is common among university students and its effect on their achievement is worrisome. Although procrastination is often depicted as self-regulation failure, research still needs to examine the self-regulatory mechanisms involved in the relationship between procrastination and achievement.

Objectives: In this prospective study, we sought to (a) unravel the unique effect of academic procrastination on university grades, (b) examine the mediating role of task-oriented and disengagement-oriented coping as a self-regulatory pathway toward achievement, (c) control for the potential confounding influence of past achievement and working memory capacity.

Methods: A sample of 258 university students completed self-report measures of academic procrastination and coping, and performed tests of working memory. Their semester grade point average was collected at the end of the semester.

Results: Results of structural equation modeling showed that academic procrastination negatively predicted subsequent academic achievement, even after controlling for high school achievement and working memory capacity. Furthermore, indirect effects revealed that task- and disengagement-oriented coping explained 70% of the total effect.

Conclusion: These findings outline that the effect of academic procrastination cannot be reduced to a history of academic difficulties or limited cognitive ability and that coping plays an important role in the procrastination – achievement relationship.     

How resilience is strengthened by exposure to stressors: the systematic self-reflection model of resilience strengthening

Background: Exposure to demands is normally considered to drain resources and threaten wellbeing. However, studies have indicated a resilience-strengthening role for stressors.

Objectives: This paper introduces a unifying model, including five testable hypotheses regarding how resilience can be strengthened progressively via exposure to life-stressors.

Methods: We review and synthesize relevant scholarship that underpins the Systematic Self-Reflection model of resilience-strengthening.

Results: The model highlights the importance of a specific meta-cognitive skill (self-reflection on one’s initial stressor response) as a mechanism for strengthening resilience. The Systematic Self-Reflection model uniquely proposes five self-reflective practices critical in the on-going adaptation of three resilient capacities: (1) coping resources, (2) usage of coping and emotional regulatory repertoire, and (3) resilient beliefs. The self-reflective process is proposed to strengthen a person’s resilience by developing insight into their already-present capacities, the limitations of these capacities, and by stimulating the search for person-driven alternative approaches.

Conclusion: This model extends the existing scholarship by proposing how the experience of stressors and adversity may have resilience-strengthening opportunities. The implication of this model is that engaging with stressors can have positive consequences for longer-term healthy emotional development if scaffolded in adaptive reflective practices.     

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.     

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.     

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.     

The roles of autonomous motivation and self-control lapses in concurrent adherence to a gluten-free diet and a self-chosen weight loss plan in adults with coeliac disease

Objective: Examine the correspondence between autonomous motivation, self-control lapses, and adherence, to a gluten-free diet (GFD) and weight loss plan in adults with coeliac disease; and assess the impact of the interaction of motivation style and self-control lapses on adherence to both diets.

Design: Cross-sectional survey in 519 adults with coeliac disease, 238 of whom were also attempting weight loss.

Main outcome measures: Adherence, motivation style, frequency of temptation and self-control lapses (e.g. when tired, stressed, happy) for GFD and weight loss plan.

Results: Autonomous motivation was higher, and amotivation lower, for the GFD than weight loss; adherence to the two diets was unrelated. Similar circumstances led to temptation and self-control lapses across diets; both were less frequent for the GFD than weight loss. Motivation and self-control lapses explained 21% and 35% of the variance in adherence, respectively; the interaction between motivation and lapse frequency did not explain additional variance for either diet.

Conclusions: There are clear benefits to developing autonomous motivations and strategies to resist temptation for both the GFD and weight loss. Understanding how these processes differ and interact across diets may lead to the design of interventions to improve adherence and weight outcomes in coeliac disease.     

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.