Disclosure of traumas and immune function: Health implications for psychotherapy

Psychiatric symptoms and emotion regulation strategies among the unemployed people in Korea: A latent profile analysis

This study aimed to explore the profiles of emotion regulation strategies among unemployed people, and to examine the association of latent profiles with demographics and psychiatric symptoms. The study included 136 men (42.8%) and 182 women (57.2%). The average age of the participants was 35.84 years (SD = 26.83). Latent profile analysis was used to determine emotion regulation strategy profiles. Associated factors of profile membership were identified with multinomial logistic regression. The four-profile model (low adaptive emotion regulation class, low negative emotion regulation/moderate positive regulation class, high negative emotion regulation/support-seeking class, adaptive emotion regulation class) was selected as the best solution. As a result of examining the probability of being classified into each class according to emotional difficulties, the lower the level of anxiety and somatization, the higher the probability of belonging to the class 2 adaptive emotion regulation class (n = 56, 18%). The higher the depression, the higher the probability of being classified into class 4 (n = 65, 20%) using a lot of negative emotion regulation strategies. The results of this study indicate that unemployed people can be classified into various subgroups according to their emotion regulation strategies. Also, the probability of being classified into each subgroup was different based on the types of emotional difficulties such as depression, anxiety, and somatization. Through the results of this study, it is possible to understand the relationship between the psychiatric symptoms of unemployed people and emotion regulation strategies and to suggest methods for promoting effective emotion regulation strategies among this population group.

Secretive and close? How sharing secrets may impact perceptions of distance

Having secrets is incredibly common. However, secrecy has only recently started to receive more attention in research. What has largely been neglected so far are the consequences of secret-sharing for the relationship between sharer and receiver. In this project, we aim to fill this gap. Previous research has shown that closeness can make secret-sharing more likely. Building on research from the self-disclosure and relationship literature, we experimentally investigate whether secret-sharing might in turn increase perceptions of closeness. In addition, we test the valence of the secrets shared as potential driver of the hypothesized effect, as negative secrets might signal a high level of trust, but might also present a burden to the receiver. To provide a holistic picture, we build on a variety of methods to investigate three perspectives: Study 1 focuses on the receiver and tests whether another person sharing secrets (vs. nonconfidential information) decreases distance in the eyes of the receiver. Study 2 investigates lay theories and tests how an observer perceives the relationship between two people who share secrets (vs. nonconfidential information). Study 3 tests whether these lay theories about sharing secrets are predictive of behavior, and how a sharer might choose secrets of negative or positive valence to decrease perceived distance on the receiver’s side. Our results will contribute to the understanding of how sharing secrets affects the way individuals think about each other, how close they feel to each other, and how they interact with each other.

Memory of Others' Disclosures Is Consolidated during Rest and Associated with Providing Support: Neural and Linguistic Evidence

Social scientists have documented the power of being heard: Disclosing emotional experiences to others promotes mental and physical health. Yet, far less is known about how listeners digest the sensitive information people share with them. We combined brain imaging and text analysis methods with a naturalistic emotional disclosure paradigm to assess how listeners form memories of others' disclosures. Neural and linguistic evidence support the hypothesis that listeners consolidate memories for others' disclosures during rest after listening and that their ability to do so facilitates subsequently providing the speakers with support. In Study 1, brain imaging methods showed that functional connectivity between the dorsomedial subsystem of the default network and frontoparietal control network increased during rest after listening to others' disclosures and predicted subsequent memory for their experiences. Moreover, graph analytic methods demonstrated that the left anterior temporal lobe may function as a connector hub between these two networks when consolidating memory for disclosures. In Study 2, linguistic analyses revealed other-focused thought increased during rest after listening to others' disclosures and predicted not only memory for the information disclosed but also whether listeners supported the speakers the next day. Collectively, these findings point to the important role of memory consolidation during rest in helping listeners respond supportively to others' disclosures. In our increasingly busy lives, pausing to briefly rest may not only help us care for ourselves but also help us care for others.

Cancer-Related Self-Disclosure in the Workplace/School by Adolescent and Young Adult Cancer Survivors

Purpose: Little is known about how survivors of adolescent and young adult (AYA) cancers navigate the process of communicating their cancer history to those at work/school. The purpose of this study was to evaluate the factors impacting workplace/school disclosure decisions among AYA survivors and strategies used for self-disclosure. Two hypotheses were tested: (1) survivors would be significantly less likely to disclose their cancer history and more likely to avoid cancer-related topics at work/school versus with friends/acquaintances; (2) survivors' satisfaction with previous cancer-related self-disclosures at work/school would mediate the relationship between the reactions of others to those disclosures and the likelihood of future work/school disclosures. Methods: Online survey data, including a measure of self-disclosure adapted from the Nebraska Outness Scale, were collected from 120 survivors (age = 15 to 39 years at diagnosis, 19 to 45 years when surveyed). Data were analyzed descriptively and study hypotheses were evaluated using paired t-tests (Hypothesis 1) and multiple regression with bootstrapping (Hypothesis 2). Results: Both hypotheses were supported: participants were less likely to self-disclose at work/school than to friends/acquaintances (p < 0.001) and satisfaction with previous self-disclosure at work/school mediated the relationship between reactions to previous disclosures and likelihood of future disclosures (95% confidence interval = 0.39-0.81). Descriptive analyses indicated that participants were guided by a variety of factors when making disclosure decisions (e.g., anticipated reactions) and used a range of strategies for disclosures (e.g., humor). Conclusions: AYA survivors are cautious in their approach to workplace/school disclosure. Employers and school administrators should create supportive and inclusive environments that facilitate self-disclosure for survivors who wish to self-disclose.

Depressive costs: medical expenditures on depression and depressive symptoms among rural elderly in China

OBJECTIVES

To provide an evaluation of medical expenditures induced by depression and depressive symptoms among rural elderly in China.

STUDY DESIGN

The panel dataset used for this study is taken from the China Family Panel Studies (CFPS) data for the years 2012 and 2016. We examined the case of rural elderly who were 60 years old or older at the time of the 2012 survey and 64 years old or older at the time of the 2016 survey and then created a panel dataset that includes 2938 rural elderly for both years to estimate the influence of depressive symptoms/depression on medical cost.

METHODS

Both two part model and four part model were used to estimate the influence of depressive symptoms and depression on medical expenditure. Then a counter-factual method was used to calculate the cost of depressive symptoms and depression among rural elderly in China.

RESULTS

Mental health status has significant effects on individual medical expenses, and they aggregately contribute to 47.26% of total personal expected medical expenditures. Specifically, the rural group, the female group, the widowed group, and the poorly educated group have higher medical expenditures because of depressive status than the other groups.

CONCLUSIONS

Mental health status significantly increased both the chance of undergoing medical care and the degree of medical expenditure among rural elderly in China. This situation is more serious in some vulnerable groups. Therefore, the Chinese government needs to reform its mental health of rural elderly and insurance institutions to eliminate the policy-caused barriers to mental health resources, especially for vulnerable groups.

Online writing about positive life experiences reduces depression and perceived stress reactivity in socially inhibited individuals

Therapeutic writing can enhance psychological and physical health. Recent studies have suggested that these kinds of interventions can be effective when delivered online. The present study investigated whether positive emotional writing online can influence psychological and physical health in individuals reporting high levels of negative affectivity, who are most likely to benefit from psychological intervention (N = 72, M_age = 28.5, SD_age = 8.7), and further, to investigate the potential moderating role of social inhibition. Participants completed self-report measures of physical symptoms, perceived stress, perceived stress reactivity, depression and generalised anxiety, before completing either i) positive emotional writing, or ii) a non-emotive control writing task on an online portal, for 20 min per day over three consecutive days. State anxiety was measured immediately after each writing session, and self-report questionnaires were again administered four weeks post-writing. Socially inhibited individuals exhibited significant reductions in depression and perceived stress reactivity four weeks following positive emotional writing, relative to writing about a neutral topic. The present study supports the efficacy of online therapeutic writing in individuals who, due to their socially inhibited nature, are most likely to benefit from online interventions which avoid interaction with a therapist or other clients.

Effects of Expressive Writing on Neural Processing During Learning

Expressive writing about past negative events has been shown to lead to a slew of positive outcomes. However, little is known about why writing about something negative would have positive effects. While some have posited that telling a narrative of a past negative event or current anxiety "frees up" cognitive resources, allowing individuals to focus more on the task at hand, there is little neural evidence suggesting that expressive writing has an effect on cognitive load. Moreover, little is known about how individual differences in the content of expressive writing could affect neural processing and the cognitive benefits writing confers. In our experiment, we compared brain activity in a group that had engaged in expressive writing vs. a control group, during performance on a feedback-based paired-associate word-learning task. We found that across groups, differential activation in the dorsal striatum in response to positive vs. negative feedback significantly predicted better later memory. Moreover, writing about a past failure resulted in more activation relative to the control group during the learning task in the mid-cingulate cortex (MCC), an area of the brain crucial to processing negative emotion. While our results do not provide support for the assertion that expressive writing alters attentional processing, our findings suggest that choosing to write about particularly intense past negative experiences like a difficult past failure may have resulted in changes in neural activation during task processing.

The relative impacts of disclosure and secrecy: the role of (perceived) target response

This review examines the current trends in understanding the impact of individuals' decisions to either disclose information or continue to conceal it. As a whole, the evidence points to a relative benefit of disclosure over secret-keeping, but with clear cases, in which disclosure may be harmful. Advances in knowledge about factors that shape that impact, new research on the role verbal rumination with a partner following disclosure, and attention to the role of communal coping as an outcome of traumatic disclosures are addressed. In addition, recent re-conceptualization of secret-keeping, and investigations into the burden experienced by confidants are reviewed. Finally, a call for greater attention to the culture-specific impacts of disclosure decisions is made.

Pilot Randomized Controlled Trial of a Syndemics Intervention with HIV-Positive, Cocaine-Using Women

This pilot randomized controlled trial examined the feasibility and acceptability of a Syndemics intervention targeting the intersection of stimulant use, trauma, and difficulties with HIV disease management in cocaine-using women. All participants received contingency management (CM) for 3 months with financial incentives for stimulant abstinence during thrice-weekly urine screening and refilling antiretroviral medications monthly. Sixteen participants were randomized to complete four expressive writing (n = 9) or four neutral writing (n = 7) sessions delivered during the CM intervention period. Completion rates for writing sessions were high (15 of 16 women completed all four sessions) and engagement in CM urine screening was moderate with women randomized to expressive writing providing a median of 11 non-reactive urine samples for stimulants. There were non-significant trends for those randomized to expressive writing to provide more CM urine samples that were non-reactive for stimulants, report greater decreases in severity of cocaine use, and display reductions in log10 HIV viral load at 6 months. Although the Syndemics intervention was feasible and acceptable to many women, qualitative interviews with eligible participants who were not randomized identified structural and psychological barriers to engagement. Further clinical research is needed to test the efficacy of Syndemics interventions with HIV-positive, cocaine-using women.

Effectiveness of Stress-Reducing Interventions on the Response to Challenges to the Immune System: A Meta-Analytic Review

BACKGROUND

There is consistent evidence showing an interplay between psychological processes and immune function in health and disease processes.

OBJECTIVES

The present systematic review and meta-analysis aims to provide a concise overview of the effectiveness of stress-reducing psychological interventions on the activation of immune responses in both healthy subjects and patients.

METHODS

Included are 3 types of challenges: in vivo, in vitro, and psychophysiological. Such challenges are designed to mimic naturally occurring immune-related threats.

RESULTS

A systematic literature search was conducted using PubMed, EMBASE, and PsychInfo, resulting in 75 eligible studies. The risk of bias was assessed with the Cochrane risk-of-bias tool. Across all studies, a small-to-medium effect size was found for the effects of psychological interventions on optimization of the immune function (g = 0.33; 95% CI 0.22-0.43). While the largest effects were found for in vivo immune-related challenges (g = 0.61; 95% CI 0.34-0.88; especially on studies that incorporated skin tests and wound healing), studies incorporating psychophysiological challenges and in vitro immune-related stimulations similarly suggest more optimal immune responses among those receiving stress-reducing interventions (g = 0.28; 95% CI 0.15-0.42).

CONCLUSION

These findings showed substantial heterogeneity depending on the type of challenge, the study populations, and the intervention types. These data demonstrate support for the effectiveness of stress-reducing psychological interventions in improving immunity in studies that tested immune function by means of incorporating an in vivo,in vitro, or psychophysiological challenge. Future research should more consistently incorporate challenges into the study design to gather more insights in the mechanisms underlying the optimized immune function following a psychological intervention. This is also relevant for clinical practice, as psychological interventions can possibly supplement, or at least partially replace, current drug treatments in various somatic conditions to reduce side effects.

Self-Disclosure and Perceived Responsiveness Among Youth With Asthma: Links to Affect and Anti-Inflammatory Gene Expression

Self-disclosure and perceived responsiveness are important building blocks of social relationships that have long-lasting consequences for health and well-being. However, the conditions under which self-disclosure and responsiveness are likely to benefit health, and how early in life these benefits arise, remain unclear. Among 141 youth (aged 10-17) with asthma, we investigated how average daily levels of self-disclosure and responsiveness are linked to positive and negative affect and the expression of the glucocorticoid receptor gene NR3C1, a marker of improved regulation of stress physiology and immune functioning. Higher levels of self-disclosure were associated with higher NR3C1 expression and positive affect only when perceptions of responsiveness were high. Furthermore, perceived responsiveness was linked to NR3C1 expression for females but not males. These results suggest that the potential benefits of self-disclosure depend on the extent to which interaction partners are perceived as responsive and that these benefits emerge prior to adulthood.

Outsiders’ Thoughts on Generating Self-Regulatory-Depletion (Fatigue) Effects in Limited-Resource Experiments

We offer thoughts pertaining to purported conceptual and replication crises that have been discussed in relation to the limited-resource model (LRM) of self-control, functioning as crisis outsiders who have been conducting related research concerned with determinants and cardiovascular correlates of effort. Guiding analyses in our laboratory convey important lessons about experimental generation of the now-classic LRM self-regulatory-fatigue effect on control. They do so by drawing attention to conditions that must be met in fatigue-induction and fatigue-influence phases of relevant experiments. One fundamental lesson is that even highly standardized fatigue-induction protocols cannot be expected to consistently allow definitive tests of this effect. Another is that the effect might emerge consistently only in a behavioral-restraint “sweet spot” of sorts—a multidimensional motivational space wherein rested study participants view restraint as possible and worthwhile and fatigued participants do not. Implications are identified and discussed.

Self-Disclosure Here and Now: Combining Retrospective Perceived Assessment With Dynamic Behavioral Measures

Most previous research on self-disclosure (SD) focused on its perceived retrospective aspects using self-report questionnaires. Few studies investigated actual SD as reflected in interpersonal interaction. We propose a comprehensive approach that combines new objective and dynamic measures of SD that evaluate situated SD with the traditional measures that evaluate stable SD properties. As SD is essentially verbal, we build on linguistic parameters for assessing actual SD, including acoustic features such as intonation and fluency, and verbal features such as the particular choice of words. Critically, the new measures highlight SD here and now and may reveal transient situational factors that affect it, such as the dynamics of interpersonal interaction. Based on these measures, we propose a three-dimensional evaluation that can portray different profiles of SD and offer a better prediction of SD behavior in different situations. The theoretical and clinical implications of the proposed approach are discussed.

Why Women Are Not Talking About It: Reasons for Nondisclosure of Sexual Victimization and Associated Symptoms of Posttraumatic Stress Disorder and Depression

Disclosure of traumatic experiences is typically encouraged and associated with positive outcomes. However, there is limited research on nondisclosure of sexual trauma and consequent symptomology. This online study of undergraduate females examines reasons for nondisclosure and associated symptoms of posttraumatic stress disorder (PTSD) and depression. Of 221 participants who reported sexual victimization, 25% had not previously disclosed it. Four reasons for nondisclosure were identified: shame, minimization of experience, fear of consequences, and privacy. Nondisclosers who minimized the experience and nondisclosers low on shame reported fewer PTSD symptoms than disclosers. These findings suggest that reasons for nondisclosure are associated with symptomology.

Recent Canadian efforts to develop population-level pregnancy intervention studies to mitigate effects of natural disasters and other tragedies

The preconception, pregnancy and immediate postpartum and newborn periods are times for mothers and their offspring when they are especially vulnerable to major stressors - those that are sudden and unexpected and those that are chronic. Their adverse effects can transcend generations. Stressors can include natural disasters or political stressors such as conflict and/or migration. Considerable evidence has accumulated demonstrating the adverse effects of natural disasters on pregnancy outcomes and developmental trajectories. However, beyond tracking outcomes, the time has arrived for gathering more information related to identifying mechanisms, predicting risk and developing stress-reducing and resilience-building interventions to improve outcomes. Further, we need to learn how to encapsulate both the quantitative and qualitative information available and share it with communities and authorities to mitigate the adverse developmental effects of future disasters, conflicts and migrations. This article briefly reviews prenatal maternal stress and identifies three contemporary situations (wildfire in Fort McMurray, Alberta, Canada; hurricane Harvey in Houston, USA and transgenerational and migrant stress in Pforzheim, Germany) where current studies are being established by Canadian investigators to test an intervention. The experiences from these efforts are related along with attempts to involve communities in the studies and share the new knowledge to plan for future disasters or tragedies.

Past, present or future? Word tense and affect in autobiographical narratives of women with HIV in relation to health indicators

This study examined how the expression of positive and negative affect words and word tense in autobiographical narratives of 98 HIV+ women, predominantly African American, predicted undetectable HIV viral load (UDVL), CD4+ cells/mm3 counts and antiretroviral therapy medication (ART) adherence assessed concurrently (T1) and at 3 to 9-month follow-up (T2). Logistic regressions revealed that higher past tense words predicted worse odds of UDVL, CD4+ cells/mm3 above 350 at T1, and worse odds of 95% ART adherence at T2. However, using both high past tense words and high positive affect words predicted better odds of CD4+ cells/mm3 > 350 at T2. Higher future tense words predicted better odds of CD4+ cells/mm3 > 350 at T1. Additionally, using both high present tense words and negative affect words predicted better odds of UDVL at T1. These findings provide preliminary evidence that the quality of affect expression significantly interacts with temporal context to relate to the health of women with HIV.

Self-disclosure to peers by young adult cancer survivors

OBJECTIVE

Given the potential benefits of self-disclosure, the goal of this study was to learn more about how young adult cancer survivors navigate the process of disclosing their cancer history to peers.

METHODS

A sample of 122 young adult cancer survivors completed a brief, online survey. Data were collected to assess how and why survivors self-disclose to peers and how peers react.

RESULTS

Participants endorsed a number of reasons for disclosing their cancer history to peers (eg, felt it was important for them to know) or choosing not to disclose (eg, to avoid upsetting/burdening them). Participants used a variety of strategies during the disclosure with the most frequently endorsed being humor and providing reassurance. Mediational analyses supported the study hypothesis: The relationship between peer reactions to self-disclosure and the likelihood of future disclosure was mediated by survivors' satisfaction with the self-disclosure experience. Exploratory analyses provided some insight into which disclosure strategies were met with a more positive reaction from peers.

CONCLUSIONS

The actual and anticipated reactions from peers play a crucial role in shaping young adult cancer survivors' experience of self-disclosure. Clinicians may use these findings to help young survivors optimize their self-disclosure experiences.

The effects of interpersonal emotional expression, partner responsiveness, and emotional approach coping on stress responses

[Correction Notice: An Erratum for this article was reported online in Emotion on Sep 5 2019 (see record 2019-52812-001). In the article, two text call outs for figures are incorrect. At the end of the "Negative emotional responses" section under the "Psychological Stress Responses" heading, "(see Figure 7)" should have been deleted. Under the "Negative task-related ruminative thoughts" heading in that same section, "(see Figure 5)" in the first paragraph should be "(see Figure 7)."] Expressing emotions is a common strategy for coping with stress. Yet, little is known about the effects of using this strategy in close relationships, or when and for whom emotional expression is effective. This study examined romantic partner responsiveness and the dispositional tendency to use emotional approach coping (EAC; the processing and expression of emotions) as moderators of the effects of experimentally manipulated emotional expression on stress responses to a laboratory stressor. We brought couples (N = 145) to the lab and randomly assigned 1 partner (the participant) to perform a stressful task. We manipulated whether participants expressed their feelings about the task to their partner (expression vs. no-expression), and whether participants received supportive messages from their partners (as an indicator of partner responsiveness; support vs. no-support). We examined physiological stress responses (cortisol and salivary alpha-amylase [sAA]), negative emotional stress responses (anxiety and self-conscious emotions), and post-task ruminative thoughts. Participants high in EAC showed larger sAA and cortisol responses and reported more negative post-task ruminative thoughts after emotionally expressing to their partners, but partner support mitigated the effect on cortisol. Participants low in EAC showed smaller cortisol responses and reported less negative emotional responses and fewer negative post-task ruminative thoughts after emotionally expressing to their partners. Receiving partner support reduced negative emotional responses for people high in EAC, but increased negative emotional responses for those low in EAC. These results may help explain when and for whom emotional expression is an effective means of coping in the immediate context of a stressor. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Say cheese? The connections between positive facial expressions in student identification photographs and health care seeking behavior

This study examined whether positive facial expressions in student identification photographs were connected with a health-relevant behavior: visits to a health care center in the last year for preventive and non-preventive (e.g. illness, injury) purposes. Identification photographs were coded for degree of smile. Smiling participants were more likely to have sought preventive care versus those not smiling in their photographs, but there was no difference in non-preventive (i.e. ill health) visits. This study shows for the first time that smiling in photographs may be related to healthy behavior and complements past work connecting smiling to positive psychosocial and health outcomes.

The physical and psychological health benefits of positive emotional writing: Investigating the moderating role of Type D (distressed) personality

OBJECTIVES

Type D personality is associated with psychological and physical ill-health. However, there has been limited investigation of the role of Type D personality in interventions designed to enhance well-being. This study investigated associations between Type D personality and the efficacy of positive emotional writing for reducing stress, anxiety, and physical symptoms.

DESIGN

A between-subjects longitudinal design was employed.

METHOD

Participants (N = 71, M_age  = 28.2, SD_age  = 12.4) completed self-report measures of Type D personality, physical symptoms, perceived stress, and trait anxiety, before completing either (1) positive emotional writing or (2) a non-emotive control writing task, for 20 min per day over three consecutive days. State anxiety was measured immediately before and after each writing session, and self-report questionnaires were again administered 4 weeks post-writing.

RESULTS

Participants in the positive emotional writing condition showed significantly greater reductions in (1) state anxiety and (2) both trait anxiety and perceived stress over the 4-week follow-up period, compared to the control group. While these effects were not moderated by Type D personality, a decrease in trait anxiety was particularly evident in participants who reported both high levels of social inhibition and low negative affectivity. Linguistic analysis of the writing diaries showed that Type D personality was positively associated with swear word use, but not any other linguistic categories.

CONCLUSION

These findings support the efficacy of positive emotional writing for alleviating stress and anxiety, but not perceived physical symptoms. Swearing may be a coping strategy employed by high Type D individuals. Statement of contribution What is already known on this subject? Type D (distressed) personality is characterized by high levels of both negative affectivity and social inhibition, and has been associated with adverse physical and psychological health. Positive emotional writing is known to reduce subjectively reported physical symptoms and increase positive affect. What does this study add? Positive emotional writing was shown to attenuate (1) state anxiety immediately post-writing, and (2) trait anxiety and perceived stress 4 weeks post-writing. The findings demonstrate that positive writing might be a useful intervention for attenuating the adverse psychological effects of Type D personality in the general population. Type D personality was associated with more frequent use of swear words, which may be a coping mechanism used by high Type D individuals.

Behavioral Adjustment Moderates the Link Between Neuroticism and Biological Health Risk: A U.S.-Japan Comparison Study

Neuroticism, a broad personality trait linked to negative emotions, is consistently linked to ill health when self-report is used to assess health. However, when health risk is assessed with biomarkers, the evidence is inconsistent. Here, we tested the hypothesis that the association between neuroticism and biological health risk is moderated by behavioral adjustment, a propensity to flexibly adjust behaviors to environmental contingencies. Using a U.S.-Japan cross-cultural survey, we found that neuroticism was linked to lower biological health risk for those who are high, but not low, in behavioral adjustment. Importantly, Japanese were higher in behavioral adjustment than European Americans, and as predicted by this cultural difference, neuroticism was linked to lower biological health risk for Japanese but not for European Americans. Finally, consistent with prior evidence, neuroticism was associated with worse self-reported health regardless of behavioral adjustment or culture. Discussion focused on the significance of identifying sociocultural correlates of biological health.

Can an experimental self-efficacy induction through autobiographical recall modulate analogue posttraumatic intrusions?

BACKGROUND AND OBJECTIVES

Research has shown a link between self-efficacy appraisals and PTSD symptoms. Less is known about the relation between perceived self-efficacy and specific PTSD symptoms such as intrusions. These two experiments tested the causal relationship between perceived self-efficacy and intrusions from a trauma film.

METHODS

In Experiment I, healthy student participants received a self-efficacy manipulation consisting of the recall of autobiographical memories of success (high self-efficacy condition), failure (low self-efficacy condition) or 'important' memories (control condition). Afterwards, they viewed a trauma film and recorded their intrusions of the film in the following week. In Experiment II the self-efficacy manipulation was given after the film.

RESULTS

In contrast to expectations, the high self-efficacy condition reported a higher number of intrusions relative to the low self-efficacy condition in both experiments.

LIMITATIONS

The trauma film provides experimental control but precludes generalization to real-life trauma. The effect of the experimental manipulation was small. The control condition also affected mood and confidence.

CONCLUSIONS

The results suggest that the relation between self-efficacy and intrusions development is causal, but not straightforward. Recalling personal memories of success before or after a traumatic event may increase the risk of developing intrusions, at least under some circumstances. Conversely, recalling past failure experiences may be protective, perhaps by preparing the individual for adversity, or prompting them to search for coping strategies that have been successful in the past. Overall, autobiographical recall involves complex processes related to the self that could be useful but need to be more fully understood.

Expressive writing intervention and self-reported physical health out-comes - Results from a nationwide randomized controlled trial with breast cancer patients

The objective was to examine the effect of Expressive Writing Intervention (EWI) on self-reported physical symptoms and healthcare utilization in a nationwide randomized controlled trial with Danish women treated for primary breast cancer, and to explore participant characteristics related to emotion regulation as possible moderators of the effect. Women who had recently completed treatment for primary breast cancer (n = 507) were randomly assigned to three 20 min. home-based writing exercises, one week apart, focusing on emotional disclosure (EWI) of a distressing experience (their cancer or a non-cancer topic) or a non-disclosing topic (control). Outcomes were self-reported physical symptoms and healthcare utilization (visits and telephone contacts with GP) 3 and 9 months post-intervention. Potential moderators were repressive coping, alexithymia, rumination, social constraints, and writing topic. Results revealed no group by time interaction effects for any outcomes. Moderation analyses showed that 1) low alexithymic women in the EWI group showed larger decreases in GP telephone calls over time than both high alexithymic women and controls and 2) women in the EWI group writing about their own cancer, but not women writing about other topics, showed a larger decrease than controls. The results from this large randomized trial are concordant with previous findings showing that EWI is unlikely to be a generally applicable intervention to improve health-related outcomes in cancer patients and cancer survivors. However, written disclosure might have a beneficial impact for individuals who write about their own cancer, as well as for those low in alexithymia.

Emotional and physical health benefits of expressive writing

Writing about traumatic, stressful or emotional events has been found to result in improvements in both physical and psychological health, in non-clinical and clinical populations. In the expressive writing paradigm, participants are asked to write about such events for 15–20 minutes on 3–5 occasions. Those who do so generally have significantly better physical and psychological outcomes compared with those who write about neutral topics. Here we present an overview of the expressive writing paradigm, outline populations for which it has been found to be beneficial and discuss possible mechanisms underlying the observed health benefits. In addition, we suggest how expressive writing can be used as a therapeutic tool for survivors of trauma and in psychiatric settings.

Temporary sharing prompts unrestrained disclosures that leave lasting negative impressions

Relative to traditional, offline forms of communication, there is an enhanced permanence to digital sharing. Digital disclosures can come back to haunt, making it challenging for people to manage the impressions they make upon others. Nine studies show that, paradoxically, these challenges can be exacerbated by temporary-sharing technologies. Temporary sharing reduces privacy concerns, in turn increasing disclosure of potentially compromising information (in the form of uninhibited selfies). Recipients attribute these indiscretions to sharers’ bad judgment, failing to appreciate the situational influence—the temporariness of the sharing platform—on sharers’ disclosures. Sharers do not anticipate this consequence, mistakenly believing that recipients will attribute their disclosure decisions to the (temporary) platform on which they chose to send the photographs.

With the advent of social media, the impressions people make on others are based increasingly on their digital disclosures. However, digital disclosures can come back to haunt, making it challenging for people to manage the impressions they make. In field and online experiments in which participants take, share, and evaluate self-photographs (“selfies”), we show that, paradoxically, these challenges can be exacerbated by temporary-sharing media—technologies that prevent content from being stored permanently. Relative to permanent sharing, temporary sharing affects both whether and what people reveal. Specifically, temporary sharing increases compliance with the request to take a selfie (study 1) and induces greater disclosure risks (i.e., people exhibit greater disinhibition in their selfies, studies 1 and 2). This increased disclosure is driven by reduced privacy concerns (study 2). However, observers’ impressions of sharers are insensitive to permanence (i.e., whether the selfie was shared temporarily versus permanently) and are instead driven by the disinhibition exhibited in the selfie (studies 4–7). As a result, induced by the promise of temporary sharing, sharers of uninhibited selfies come across as having worse judgment than those who share relatively discreet selfies (studies 1, 2, and 4–7)—an attributional pattern that is unanticipated by sharers (study 3), that persists days after the selfie has disappeared (study 5), is robust to personal experience with temporary sharing (studies 6A and 6B), and holds even among friends (studies 7A and 7B). Temporary sharing may bring back forgetting, but not without introducing new (self-presentational) challenges.

The Effects of Expressive Writing Interventions for Patients With Cancer: A Meta-Analysis

PURPOSE/OBJECTIVES

To evaluate the effects of expressive writing (EW) interventions in patients with cancer.
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DATA SOURCES

Electronic databases searched included both international and Korean databases through January 2015.
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DATA SYNTHESIS

Of the 20 trials that met the eligibility criteria of this review, a meta-analysis was conducted of 14 articles involving 13 randomized and 1 nonrandomized trials with 1,718 patients with cancer. EW interventions were compared with a neutral writing intervention or usual care (no writing). A significant small effect was noted on relieving cancer symptoms; however, the effects on psychological and cognitive outcomes were not significant. When subgroup analysis by control condition was performed, a significant effect on health-related quality of life was found between the EW intervention group and the usual care group. 
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CONCLUSIONS

EW had significant small effects only on cancer symptoms. The findings suggest that the traditional EW intervention protocol may need to be intensified to confirm its effect on patients with cancer.
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IMPLICATIONS FOR NURSING

Current evidence for EW as a nursing intervention for improving physical, psychological, and cognitive outcomes among patients with cancer is promising, but not conclusive.

Expressive Writing in Psychological Science

The 1997 Psychological Science paper "Writing About Emotional Experiences as a Therapeutic Process" summarized the results of several expressive writing studies. Since the publication of the first expressive writing study in 1986, a number of discoveries had emerged that had both theoretical and clinical implications. The scientific and personal backstories of the research are discussed. Finally, several possible reasons are advanced to explain why this particular paper has been cited as much as it has.

The effect of expressive writing on the error-related negativity among individuals with chronic worry

The error-related negativity (ERN), an ERP elicited immediately after errors, is enlarged among individuals with anxiety. The relationship between anxiety and enlarged ERN has spurred interest in understanding potential therapeutic benefits of decreasing its amplitude within anxious individuals. The current study used a tailored intervention-expressive writing-in an attempt to reduce the ERN among a sample of individuals with chronic worry. Consistent with hypotheses, the ERN was reduced in the expressive writing group compared to an unrelated writing control group. Findings provide experimental support that the ERN can be reduced among anxious individuals with tailored interventions. Expressive writing may serve to "offload" worries from working memory, therefore relieving the distracting effects of worry on cognition as reflected in a decreased ERN.

Emotion and biological health: the socio-cultural moderation

Prior evidence shows that positive and negative emotions are associated with better and worse health, respectively. However, the emotion-health relationship may be conflated since this evidence is based nearly exclusively on subjective measures of health. Here, we reviewed more recent evidence focusing on biological health and showed that the emotion-health link is more complex. First, whereas negative emotional states such as negative affect and anger expression are inversely linked to biological health among Americans, this relationship is either not present (negative affect) or even reversed (anger expression) for Japanese. Second, whereas a meaningfulness aspect of happiness (eudaimonia) is linked consistently to better biological health, the relationship between its pleasantness aspect (hedonia) and biological health is uncertain. Moreover, a contextualized sense of meaningfulness in a work setting is strongly associated with better biological health among Japanese. Altogether, the initial evidence reviewed here underscores a need to conceptualize the biological dynamics of health and wellbeing as inherently intertwined with socio-cultural processes.

Emotional word usage in groups at risk for schizophrenia-spectrum disorders: An objective investigation of attention to emotion

Both extreme levels of social anhedonia (SocAnh) and extreme levels of perceptual aberration/magical ideation (PerMag) indicate increased risk for schizophrenia-spectrum disorders and are associated with emotional deficits. For SocAnh, there is evidence of self-reported decreased trait positive affect and abnormalities in emotional attention. For PerMag, there is evidence of increased trait negative affect and increased attention to negative emotion. Yet, the nature of more objective emotional abnormalities in these groups is unclear. The goal of this study was to assess attention to emotions more objectively in a SocAnh, PerMag, and control group by using a positive (vs. neutral) mood induction procedure followed by a free writing period. Linguistic analyses revealed that the SocAnh group used fewer positive emotion words than the control group, with the PerMag group falling in between the others. In addition, both at-risk groups used more negative emotion words than the control group. Also, for the control group only, those in the positive mood induction used more positive emotion words, suggesting their emotions influenced their linguistic expression. Overall, SocAnh is associated with decreased positive emotional expression and at-risk groups are associated with increased negative emotional expression and a decreased influence of emotions on linguistic expression.

Verbal Emotional Disclosure of Traumatic Experiences in Adolescents: The Role of Social Risk Factors

It is well-known that traumatic events and adverse life situations are very important in both physical and psychological health. Prevalence studies suggested that adolescents experience at least one potentially traumatic event before reaching age 18. The paradigm of research centered on expressive writing has evidenced the beneficial effects that the emotional disclosure of previous traumas produces on physical health and psychological adjustment. The aims of the study are threefold: determining the prevalence of adverse or traumatic events; examining the extent to which psychopathological symptoms developed in those exposed to traumatic events; and exploring an verbal emotional disclosure (VED) paradigm in which variations on time spent talking about traumatic experiences to others resulted in a reduction of the psychological impact of trauma in a sample of Spanish adolescents. 422 volunteer adolescents participated, 226 boys and 192 girls, from 10 to 19 years old, all of them living in Tenerife. The mean age was 14.8 years (SD = 1.83). All of them completed the instruments used to assess the psychological impact of traumatic experiences and VED. The main results indicated that 77% of the participants had suffered a traumatic situation. The participants who have been exposed to traumatic events scored significantly higher in measures of post-traumatic stress, disorder, intrusive thoughts, avoidance behaviors, anxiety and depression, compared to those without trauma. Furthermore, results show a decrease in symptomatology scores as a function of time spent disclosing emotional experiences to others, particularly when disclosure occurred several times. In conclusion, stressful events or traumatic experiences and their concomitant emotional effects are highly prevalent in adolescents, and repeated VED to others appears to ameliorate their impact. VED shows greater therapeutic benefits when adolescents narrate the experience on several occasions and in an extensive way.

Impact of Narrative Expressive Writing on Heart Rate, Heart Rate Variability, and Blood Pressure After Marital Separation

OBJECTIVE

Divorce is a common stressor that is associated with increased risk for poor long-term physical and mental health. Using an experimental design, the current study examined the impact of expressive writing (EW) on average heart rate (HR), HR variability (HRV), and blood pressure (BP) 7.5 months later.

METHODS

Participants from a community sample of recently separated adults (N = 109) were assigned to one of three conditions: traditional EW, narrative EW, or a control writing condition, and were assessed three times for an average of 7.5 months. Each study visit included 27 minutes of physiological assessment; the primary outcomes at each assessment were mean-level HR, HRV, BP scores averaged across six different tasks.

RESULTS

Participants in the traditional EW condition did not significantly differ from control participants in their later HR, HRV, or BP. However, relative to control participants, those in the narrative EW condition had significantly lower HR (B = -3.41, 95% confidence interval = -5.76 to -1.06, p = .004) and higher HRV 7.5 months later (B = 0.41, 95% confidence interval = 0.16 to 0.74, p = .001). When comparing narrative EW participants to those in the traditional EW and control writing as a single group, these effects remained and were moderately sized, Cohen d values of -0.61 and 0.60, respectively, and durable across all task conditions when analyzed in independent models. The writing condition groups did not differ in their later BP.

CONCLUSIONS

Narrative EW decreased HR and increased HRV after marital separation but did not affect BP. We discuss the possible disconnect between psychology and physiology in response to EW, as well as possible future clinical applications after marital separation.

A Disclosure Decision Model: Determining How and When Individuals Will Self-Disclose

Different lines of research have explored many aspects of self-disclosure, yet there are few broad, connecting principles that can be used to describe this behavior. A Disclosure Decision model is introduced that specifies a cognitive process resulting in decisions that affect the content, depth, breadth, and duration of self-disclosure. One of 5 possible disclosure goals must be made accessible. Disclosure must be selected as a strategy for reaching that goal, and a disclosure target must be selected. Potential disclosers then evaluate the subjective utility and the subjective risk of disclosing. The subjective utility of disclosing is hypothesized to decrease breadth and increase duration of disclosure. Subjective risk is hypothesized to decrease depth of disclosure. The Disclosure Decision model is designed to provide a framework for studying and predicting self-disclosure across situations.

Self-Disclosure and Occupational Stress in Chinese Professionals

The relationship of self-disclosure with occupational stress and symptoms of stress was examined among 243 Hong Kong Chinese adult professionals. Self-disclosure was negatively correlated with both occupational stress and psychological symptoms of stress for disclosures of personal feelings and social relationships when disclosing to a Best Friend, indicating a stress-buffering effect. There was a positive correlation between occupational stress and psychological symptoms of stress for disclosure of personal feelings and information about social relationships when disclosing to Mother. While both sexes reported similar occupational stress, the total self-disclosure of women was higher than for men, and this was especially true for intimate topics. The implications of the results were discussed.

The Effects of Mood on Expository Writing

Past research has shown that analytical writing and problem solving may be influenced by mood and that experiencing intense mood states may be a catalyst for creativity. This experiment sought to test the hypothesis that good and bad moods have differential effects on expository writing. Sixty-two participants were asked to write a fictional story, a non-fictional story, or story of their choosing when they were in either a good or a bad mood. They then completed a questionnaire that assessed their mood again. The results of this study showed that good moods were associated with the stories that expressed positive emotions, used a narrative style, and conveyed concrete concepts, but bad moods were associated with the stories that expressed negative emotions, used a diary style, and discussed abstract concepts.

The Effects of Guided Imagery (GI) on Allergic Subjects' Responses to Ragweed-Pollen Nasal Challenge: An Exploratory Investigation

This study investigated the effects of guided imagery (GI) on allergic subjects' responses to ragweed-pollen nasal challenge. Complete data was obtained for fourteen subjects ranging from twenty-one to sixty-two years of age. Nasal challenges were performed before and after GI. Dependent variables consisted of two biochemical mediators obtained from nasal secretions and two subject-reported measures of symptoms, respectively: TAME (tosylarginine methyl ester)-esterase; histamine; severity of symptoms (e.g., nasal congestion); and numbers of sneezes. An experimental group ( n = 7) participated in a three-week program of GI designed to promote relaxation, psychosynthesis, and modulation of immunological activity at the cellular level. A posttreatment, between-groups analysis of the experimental group and a no-contact control group ( n = 7) determined that treatment significantly suppressed TAME-esterase release ( p < .03). Thereafter, the control group participated in the treatment program, and a posttreatment, within-group analysis also indicated significantly suppressed TAME-esterase release ( p < .05). A two-week, follow-up nasal challenge administered to the experimental group indicated maintenance of suppressed TAME-esterase release ( p < .03) and reduced severity of symptoms ( p < .05).

Sex-Related Differences in Health and Illness

Mortality and morbidity statistics which reflect the major health disorders in the nation have changed dramatically in this century. Infectious diseases have been largely controlled, and this country's citizens are now burdened with the chronic and disabling disorders of an aging population that are increasingly linked to environmental and behavioral factors. This article documents gender and sex differences among the major life-threatening disorders and chronic health problems and suggests implications for psychology as a health science and profession.

Improving Maternal Mental Health Following Preterm Birth Using an Expressive Writing Intervention: A Randomized Controlled Trial

Evaluations of evidence-based, easily accessible, psychological interventions to improve maternal mental health following very preterm birth are scarce. This study investigated the efficacy and acceptability of the expressive writing paradigm for mothers of very preterm infants. The level of maternal posttraumatic stress and depressive symptoms was the primary outcome. Participants were 67 mothers of very preterm babies who were randomly allocated into the intervention (expressive writing; n = 33) or control group (treatment-as-usual; n = 32) when their infant was aged 3 months (corrected age, CA). Measurements were taken at 3 months (pre-intervention), 4 months (post-intervention), and 6 months CA (follow-up). Results showed reduced maternal posttraumatic stress (d = 0.42), depressive symptoms (d = 0.67), and an improved mental health status (d = 1.20) in the intervention group, which were maintained at follow-up. Expressive writing is a brief, cost-effective, and acceptable therapeutic approach that could be offered as part of the NICU care.

Thriving after Trauma: The Experience of Parents of Murdered Children

Psychological literature on trauma usually focuses on pathology that results from trauma and pays little attention to positive out-comes. This article presents a phenomenological inquiry into the experiences of a profoundly traumatized group of people—parents whose son or daughter has been murdered—to assess if they were able to experience a positive outcome resulting from their trauma and to identify associated processes and resources. Of 65 parents who volunteered, 16 were selected to complete a questionnaire and were given in-depth, semistructured interviews. The interview data, analyzed qualitatively, affirm positive outcomes for these parents. Four processes—acceptance, finding meaning, personal decision making, and reaching out to others in compassion—and six resources—personal qualities, spirituality, continuing bond with the victim, social support, previous coping experience, and self-care—facilitate a positive outcome.

Self-reference in psychosis and depression: a language marker of illness

BACKGROUND

Language use is of increasing interest in the study of mental illness. Analytical approaches range from phenomenological and qualitative to formal computational quantitative methods. Practically, the approach may have utility in predicting clinical outcomes. We harnessed a real-world sample (blog entries) from groups with psychosis, strong beliefs, odd beliefs, illness, mental illness and/or social isolation to validate and extend laboratory findings about lexical differences between psychosis and control subjects.

METHOD

We describe the results of two experiments using Linguistic Inquiry and Word Count software to assess word category frequencies. In experiment 1, we compared word use in psychosis and control subjects in the laboratory (23 per group), and related results to subject symptoms. In experiment 2, we examined lexical patterns in blog entries written by people with psychosis and eight comparison groups. In addition to between-group comparisons, we used factor analysis followed by clustering to discern the contributions of strong belief, odd belief and illness identity to lexical patterns.

RESULTS

Consistent with others' work, we found that first-person pronouns, biological process words and negative emotion words were more frequent in psychosis language. We tested lexical differences between bloggers with psychosis and multiple relevant comparison groups. Clustering analysis revealed that word use frequencies did not group individuals with strong or odd beliefs, but instead grouped individuals with any illness (mental or physical).

CONCLUSIONS

Pairing of laboratory and real-world samples reveals that lexical markers previously identified as specific language changes in depression and psychosis are probably markers of illness in general.

A Functional Theory of Psychogenic Illness

The functional theory of psychogenic illness proposes that the human capacity for psychological states to cause physical illness evolved during the Paleolithic as an adaptive mechanism for ensuring mutually interdependent behaviour under conditions when mutual interdependence was essential for survival. This integrative theory is consistent with existing data from several disciplines, including archaeology, anthropology, ecology and health psychology, and leads to two sorts of empirical consequence for health psychology. First, the theory acts as a heuristic for suggesting the most predictive psychological units for use in health psychology: the current weak or inconsistent results may be the consequence of using an inappropriate psychological unit, namely behavioural aggregation. Secondly, the theory provides predictions about how psychological variables should interact with type of disease, age and sex.