Self-regulation processes and health: the importance of optimism and goal adjustment

Toward a Work Motivation Conceptualization of Grit in Organizations

Despite its widespread media acclaim and recognition as a strategic imperative, the role of grit in organizational research remains unclear. This ambiguity resulted from inconsistent empirical findings, thus triggering a pessimistic outlook for the construct across disciplines. To address these issues, we suggest that such confusion and lack of construct and predictive validity stem from not only methodological issues but also a lack of theoretical sophistication. In this article, we address methodological issues, focusing mainly on construct and criterion-related validity, by showing how traditional definitional components of grit are absent in existing measures. Next, we address theoretical issues impeding progress by developing a new work motivation conceptualization of the construct. To do so, we focus primarily on noncognitive ability, purpose-driven long-term goal setting, and task strategy (i.e., short-term goal) adaptation. Finally, we develop an organizing framework examining how, and under what conditions, work-related goal setting manifests, highlighting grit’s distinction from other historically related constructs. Coupled with the assumption that individuals hold higher order organizational goals toward which they are passionate, our organizing framework includes feedback mechanisms accounting for grit’s developmental properties over time. Finally, we acknowledge significant areas for future research and potential practical implications.

Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial

Young adults (18-39 year-olds) with hypertension have a higher lifetime risk for cardiovascular disease. However, less than 50% of young adults achieve hypertension control in the United States. Hypertension self-management programs are recommended to improve control, but have been targeted to middle-aged and older populations. Young adults need hypertension self-management programs (i.e., home blood pressure monitoring and lifestyle modifications) tailored to their unique needs to lower blood pressure and reduce the risks and medication burden they may face over a lifetime. To address the unmet need in hypertensive care for young adults, we developed MyHEART (My Hypertension Education And Reaching Target), a multi-component, theoretically-based intervention designed to achieve self-management among young adults with uncontrolled hypertension. MyHEART is a patient-centered program, based upon the Self-Determination Theory, that uses evidence-based health behavior approaches to lower blood pressure. Therefore, the objective of this study is to evaluate MyHEART's impact on changes in systolic and diastolic blood pressure compared to usual care after 6 and 12 months in 310 geographically and racially/ethnically diverse young adults with uncontrolled hypertension. Secondary outcomes include MyHEART's impact on behavioral outcomes at 6 and 12 months, compared to usual clinical care (increased physical activity, decreased sodium intake) and to examine whether MyHEART's effects on self-management behavior are mediated through variables of perceived competence, autonomy, motivation, and activation (mediation outcomes). MyHEART is one of the first multicenter, randomized controlled hypertension trials tailored to young adults with primary care. The design and methodology will maximize the generalizability of this study. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03158051.

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

OBJECTIVE

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

DESIGN

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

Agency and Motivation in Adulthood and Old Age

This review addresses conceptual and empirical research about how individual agency and motivation influences development during adulthood and old age. The major life-span approaches to individual agency and developmental regulation are discussed, with a focus on the motivational theory of life-span development. Developmental agency unfolds through action cycles of pursuing long-term goals for optimal development. Individuals differ in their capacity to regulate their goal engagements effectively within the age-graded structure of opportunities and constraints in their life courses. We discuss a set of research examples about specific developmental challenges, such as transition to adulthood, biological aging, illness, and societal transformation, and show how individuals, as agents in their own development, navigate change for better or worse. We conclude with suggestions for future research.

Starting university with high eating self-regulatory skills protects students against unhealthy dietary intake and substantial weight gain over 6 months

BACKGROUND

There is consistent evidence that suggests first year students are at risk of weight gain, but the reasons for this vulnerability are still unclear. This study aimed to explore whether the ability to regulate eating behaviours is a predictor of weight and dietary changes in first year undergraduate students.

METHODS

First year undergraduate students from universities situated in London were invited to complete a survey at the beginning of the academic year and at 6-month follow-up. Each survey included the Self-Regulation of Eating Behaviour Questionnaire, food frequency questions, socio-demographic questions and anthropometric questions. Linear and logistic regressions were performed to explore the associations between baseline eating self-regulatory skills and weight and dietary changes.

RESULTS

481 first year undergraduate students took part in the study. Students who entered university with higher eating self-regulatory skills were more likely to maintain or achieve a higher fruit and vegetable (OR = 1.8, p = 0.007) and a lower sweet and salty snack (OR = 1.9, p = 0.001) intake over the course of the first 6 months in university. Higher baseline eating self-regulatory skills were also related to lower weight changes (β = -0.15, p = 0.018) and lower likelihood of gaining 5% initial body weight (OR = 0.52, p = 0.006) at 6-month. Additionally, self-regulatory skills moderated the relationship between baseline BMI and weight changes (β = -0.25, p ≤0.001) and between baseline BMI and 5% weight gain (OR = 0.82, p = 0.008).

CONCLUSIONS

Starting university with higher eating self-regulatory skills may help students to maintain or achieve a healthy diet and protect them against substantial weight gain, especially among students with overweight.

Longitudinal associations between psychological well-being and the consumption of fruits and vegetables

BACKGROUND

Psychological well-being is associated with longevity and reduced risk of disease, but possible mechanisms are understudied. Health behaviors like eating fruits and vegetables may link psychological well-being with better health; however, most evidence is cross-sectional.

PURPOSE

This study investigated psychological well-being's longitudinal association with fruit and vegetable consumption across as many as 7 years.

METHOD

Participants were 6,565 older adults from the English Longitudinal Study of Ageing, which includes men and women aged 50 years or older. Psychological well-being was assessed with 17 items from the Control, Autonomy, Satisfaction, Pleasure Scale. Fruit and vegetable consumption was initially assessed during 2006-2007 and then approximately every 2 years through 2012-2013. Covariates included sociodemographic factors, health status, and other health behaviors.

RESULTS

Mixed linear models showed that higher baseline levels of psychological well-being were associated with more fruit and vegetable consumption at baseline (β = 0.05, 95% confidence interval [CI] [0.02, 0.08]) and that fruit and vegetable consumption declined across time (β = -0.01, 95% CI [-0.02, -0.004]). Psychological well-being interacted significantly with time such that individuals with higher baseline psychological well-being had slower declines in fruit and vegetable consumption (β = 0.01, 95% CI [0.01, 0.02]). Among individuals who initially met recommendations to consume 5 or more servings of fruits and vegetables (N = 1,719), higher baseline psychological well-being was associated with 11% reduced risk of falling below recommended levels during follow-up (hazard ratio = 0.89, 95% CI [0.83, 0.95]).

CONCLUSIONS

Findings suggest that psychological well-being may be a precursor to healthy behaviors such as eating a diet rich in fruits and vegetables. (PsycINFO Database Record

A model to facilitate implementation of the International Classification of Functioning, Disability and Health into prosthetics and orthotics

BACKGROUND

The International Classification of Functioning, Disability and Health is a classification of human functioning and disability and is based on a biopsychosocial model of health. As such, International Classification of Functioning, Disability and Health seems suitable as a basis for constructing models defining the clinical P&O process. The aim was to use International Classification of Functioning, Disability and Health to facilitate development of such a model. Proposed model: A model, the Prosthetic and Orthotic Process (POP) model, is proposed. The Prosthetic and Orthotic Process model is based on the concepts of the International Classification of Functioning, Disability and Health and comprises four steps in a cycle: (1) Assessment, including the medical history and physical examination of the patient. (2) Goals, specified on four levels including those related to participation, activity, body functions and structures and technical requirements of the device. (3) Intervention, in which the appropriate course of action is determined based on the specified goal and evidence-based practice. (4) Evaluation of outcomes, where the outcomes are assessed and compared to the corresponding goals. After the evaluation of goal fulfilment, the first cycle in the process is complete, and a broad evaluation is now made including overriding questions about the patient's satisfaction with the outcomes and the process. This evaluation will determine if the process should be ended or if another cycle in the process should be initiated.

CONCLUSION

The Prosthetic and Orthotic Process model can provide a common understanding of the P&O process. Concepts of International Classification of Functioning, Disability and Health have been incorporated into the model to facilitate communication with other rehabilitation professionals and encourage a holistic and patient-centred approach in clinical practice. Clinical relevance The Prosthetic and Orthotic Process model can support the implementation of International Classification of Functioning, Disability and Health in P&O practice, thereby providing a common understanding of the P&O process and a common language to facilitate communication with other rehabilitation professionals.

Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series

Facets of positive psychological well-being, such as optimism, have been identified as positive health assets because they are prospectively associated with the 7 metrics of cardiovascular health (CVH) and improved outcomes related to cardiovascular disease. Connections between psychological well-being and cardiovascular conditions may be mediated through biological, behavioral, and psychosocial pathways. Individual-level interventions, such as mindfulness-based programs and positive psychological interventions, have shown promise for modifying psychological well-being. Further, workplaces are using well-being-focused interventions to promote employee CVH, and these interventions represent a potential model for expanding psychological well-being programs to communities and societies. Given the relevance of psychological well-being to promoting CVH, this review outlines clinical recommendations to assess and promote well-being in encounters with patients. Finally, a research agenda is proposed. Additional prospective observational studies are needed to understand mechanisms underlying the connection between psychological well-being and cardiovascular outcomes. Moreover, rigorous intervention trials are needed to assess whether psychological well-being-promoting programs can improve cardiovascular outcomes.

An Alternative Relationship to Unemployment: Conceptualizing Unemployment Normalization

Unemployment is widely described as a situation that engenders stress, malaise, and a loss of identity for those affected by it. Whereas the deleterious effects of unemployment are clear, people may also develop an alternative relationship to unemployment and hold other perceptions of this transition period. Some studies have indeed pointed toward a shift in the social work norm, whereas others have questioned the negative impact of unemployment on some individuals. Yet to date, few studies have directly focused on the process through which these other, less negative perceptions of unemployment may arise. The present article thus explores one possible experience that we have termed unemployment normalization. We conceptualize unemployment normalization as an emotional regulation process based on cognitive reappraisal. This article suggests some variables that may influence it and presents a roadmap for future research.

Positive organizational behavior: Longitudinal effects on subjective well-being

Increasing individual subjective well-being has various positive outcomes, knowledge about its antecedents and the mediators of this relationship can therefore help to increase subjective well-being and the accompanying positive effects. The more future oriented facets of psychological capital, i.e. optimism, hope and self-efficacy have been shown in several studies to be positively related to subjective well-being and negatively to ill-being. Furthermore, recent studies suggest coping strategies as mediators for these relationships. In our study, we examined the longitudinal relation of optimism, hope and self-efficacy with subjective well-being and ill-being in a German panel dataset and tested the mediating effect of flexible goal adjustment in a path model. Our results show a statistically significant positive effect of self-efficacy and optimism on subjective well-being as well as a statistically significant negative effect of optimism on depression over three years. All three predictors show a statistically significant relation with flexible goal adjustment, but flexible goal adjustment did not mediate the effect on subjective well-being or depression.

Optimism, Symptom Distress, Illness Appraisal, and Coping in Patients With Advanced-Stage Cancer Diagnoses Undergoing Chemotherapy Treatment

PURPOSE/OBJECTIVES

To explore the relationships between optimism, self-efficacy, symptom distress, treatment complexity, illness appraisal, coping, and mood disturbance in patients with advanced-stage cancer.
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DESIGN

Cross-sectional study.
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SETTING

Smilow Cancer Hospital at Yale New Haven in Connecticut, an outpatient comprehensive cancer center.
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SAMPLE

A convenience sample of 121 adult patients with stages III-IV cancer undergoing active chemotherapy.
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METHODS

Participants completed common self-report questionnaires to measure variables. Treatment hours and visits were calculated from data retrieved from medical record review. Mediation and path analysis were conducted to identify direct and indirect pathways from the significant antecedent variables to mood disturbance.
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MAIN RESEARCH VARIABLES

Dispositional optimism, self-efficacy, social support, treatment complexity, symptom distress, illness appraisal, coping, and mood disturbance.
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FINDINGS

Greater optimism and self-efficacy were associated with less negative illness appraisal, less avoidant coping, and decreased mood disturbance. Conversely, greater symptom distress was associated with greater negative illness appraisal, greater avoidant coping, and greater mood disturbance. In the final model, optimism and symptom distress had direct and indirect effects on mood disturbance. Indirect effects were partially mediated by illness appraisal.
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CONCLUSIONS

Mood disturbance resulted from an interaction of disease stressors, personal resources, and cognitive appraisal of illness. Avoidant coping was associated with greater disturbed mood, but neither avoidant nor active coping had a significant effect on mood in the multivariate model. 
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IMPLICATIONS FOR NURSING

Illness appraisal, coping style, and symptom distress are important targets for intervention. Optimism is a beneficial trait and should be included, along with coping style, in comprehensive nursing assessments of patients with cancer.

Psychological interventions for behavioral adjustments in diabetes care - a value-based approach to disease control

Psychological aspects of a person, such as the personal value and belief systems, cognition and emotion, form the basis of human health behaviors, which, in turn, influence self-management, self-efficacy, quality of life, disease control and clinical outcomes in people with chronic diseases such as diabetes mellitus. However, psychological, psychosocial and behavioral interventions aimed at these groups of patients have yielded inconsistent effects in terms of clinical outcomes in clinical trials. This might have been due to differing conceptualization of health behavioral theories and models in the interventions. Assimilating different theories of human behavior, this narrative review attempts to demonstrate the potential modulatory effects of intrinsic values on cognitive and affective health-directed interventions. Interventions that utilize modification of cognition alone via education or that focuses on both cognitive and emotional levels are hardly adequate to initiate health-seeking behavior and much less to sustain them. People who are aware of their own personal values and purpose in life would be more motivated to practice good health-related behavior and persevere in them.

Predicting symptoms of anxiety and depression in patients living with advanced cancer: the differential roles of hope and optimism

PURPOSE

Psychological distress is related to poorer functioning and reduced quality of life in patients with advanced cancer and may have untoward influences on treatment decisions. Current research on factors associated with this distress is limited, making targeted interventions to reduce it suboptimal. We examined the relationships between two goal-related expectancies and two of the most common symptoms of psychological distress in patients living with advanced cancer: anxiety and depressive symptoms.

METHODS

Patients with advanced gastrointestinal cancer, colorectal cancer, lung cancer, or melanoma (N = 84) completed measures of anxiety, depressive symptoms, optimism, hope, and prediction for 12-month survival. Oncologists provided prediction for patient 12-month survival and patient performance status.

RESULTS

Hope, but not optimism, was associated with less severe depressive symptoms (β = - 0.42). Conversely, optimism, but not hope, was associated with less severe anxiety symptoms (β = - 0.36).

CONCLUSIONS

Hope and optimism appear to be associated with different aspects of psychological distress in patients living with advanced cancer. This may be explained by different appraisals of the uncertainty and distress that are associated with living with advanced-stage cancer. Hope- or optimism-focused interventions can be tailored to help alleviate specific aspects of psychological distress among these patients.

Linguistic Evidence for the Failure Mindset as a Predictor of Life Span Longevity

BACKGROUND

When people think that their efforts will fail to achieve positive outcomes, they sometimes give up their efforts after control, which can have negative health consequences.

PURPOSE

Problematic orientations of this type, such as pessimism, helplessness, or fatalism, seem likely to be associated with a cognitive mindset marked by higher levels of accessibility for failure words or concepts. Thus, the purpose of the present research was to determine whether there are individual differences in the frequency with which people think about failure, which in turn are likely to impact health across large spans of time.

METHODS

Following self-regulatory theories of health and the learned helplessness tradition, two archival studies (total n = 197) scored texts (books or speeches) for their use of failure words, a category within the Harvard IV dictionary of the General Inquirer.

RESULTS

People who used failure words more frequently exhibited shorter subsequent life spans, and this relationship remained significant when controlling for birth year. Furthermore, study 2 implicated behavioral factors. For example, the failure/longevity relationship was numerically stronger among people whose causes of death appeared to be preventable rather than non-preventable.

CONCLUSIONS

These results significantly extend our knowledge of the personality/longevity relationship while highlighting the value of individual differences in word usage as predictors of health and mortality.

Optimism, Positive and Negative Affect, and Goal Adjustment Strategies: Their Relationship to Activity Patterns in Patients with Chronic Musculoskeletal Pain

Objective

Activity patterns are the product of pain and of the self-regulation of current goals in the context of pain. The aim of this study was to investigate the association between goal management strategies and activity patterns while taking into account the role of optimism/pessimism and positive/negative affect.

Methods

Two hundred and thirty-seven patients with chronic musculoskeletal pain filled out questionnaires on optimism, positive and negative affect, pain intensity, and the activity patterns they employed in dealing with their pain. Questionnaires were also administered to assess their general goal management strategies: goal persistence, flexible goal adjustment, and disengagement and reengagement with goals.

Results

Structural equation modelling showed that higher levels of optimism were related to persistence, flexible goal management, and commitment to new goals. These strategies were associated with higher positive affect, persistence in finishing tasks despite pain, and infrequent avoidance behaviour in the presence or anticipation of pain.

Conclusions

The strategies used by the patients with chronic musculoskeletal pain to manage their life goals are related to their activity patterns.

Life for patients with myelofibrosis: the physical, emotional and financial impact, collected using narrative medicine-Results from the Italian 'Back to Life' project

PURPOSE

Myelofibrosis (MF) is a chronic myeloproliferative neoplasm characterised by an aggressive clinical course, with disabling symptoms and reduced survival. Patients experience a severely impaired quality of life and their families face the upheaval of daily routines and high disease-related financial costs. The aim of this study was to investigate the perceptions of Italian patients and their caregivers about living with MF and the burden of illness associated with MF.

METHODS

A quali-quantitative questionnaire and a prompted written narrative survey were administered to patients affected by primary or post-essential thrombocythemia/post-polycythaemia vera MF and their primary caregiver in 35 Italian haematological centres.

RESULTS

In total, 287 questionnaires were returned by patients and 98 by caregivers, with 215 and 62, respectively, including the narrative. At the time of diagnosis, the most commonly expressed emotional states of patients were fear, distress and anger, confirming the difficulty of this phase. A high level of emotional distress was also reported by caregivers. Along the pathway of care, the ability to cope with the disease differed according to the quality of care received. The mean cost to each patient attributable to MF was estimated as €12,466 per year, with an estimated average annual cost of loss of income of €7774 per patient and €4692 per caregiver.

CONCLUSIONS

Better understanding of the personal life of MF patients and their families could improve the relationships between health workers and patients, resulting in better focused healthcare pathways and more effective financial support to maintain patients in their social roles.

Life satisfaction is a protective factor against the onset of Type 2 diabetes in men but not in women: findings from the MONICA/KORA cohort study

AIMS

To investigate the association of high life satisfaction with incident Type 2 diabetes separately in men and women.

METHODS

A longitudinal analysis was conducted among the 7107 participants (3664 men, 51.5%; 3443 women, 48.5%) aged 25-74 years (mean ± sd age 47.8 ±13.7 years) of two population-based MONICA/KORA surveys conducted in 1989-1995 and followed up until 2009. Life satisfaction was assessed using a one-item instrument with a six-order response level, which was dichotomized into high vs medium or low. Sex-specific hazard ratios were estimated using Cox proportional hazards models.

RESULTS

Crude incidence rates for Type 2 diabetes per 10 000 person-years were lower in participants with high than in those with medium or low life satisfaction (men: 57 vs 73; women: 37 vs 48). In men with high life satisfaction, there was a 27% risk reduction in incident Type 2 diabetes (hazard ratio 0.73, 95% CI 0.56-0.94; P=0.02) in a model adjusted for sociodemographic, behavioural and clinical risk factors. The association lost statistical significance after further adjusting for depressed mood (hazard ratio 0.79, 95% CI 0.61-1.03). Life satisfaction was not significantly associated with incident Type 2 diabetes in women.

CONCLUSION

Life satisfaction may be a valuable asset in assessing risk of Type 2 diabetes, especially in men, and in the development of more effective prevention strategies to deter onset of diabetes. More research is needed to investigate the underlying potential causal pathways that may link life satisfaction to the development of Type 2 diabetes.

Goal Navigation, Approach-Oriented Coping, and Adjustment in Young Men with Testicular Cancer

BACKGROUND

Cancer can challenge important life goals for young adult survivors. Poor goal navigation skills might disrupt self-regulation and interfere with coping efforts, particularly approach-oriented attempts. Two studies are presented that investigated relationships among goal navigation processes, approach-oriented coping, and adjustment (i.e., social, emotional, and functional well-being) in separate samples of young adults with testicular cancer.

METHODS

In study 1, in-depth interviews (N = 21) were analyzed using thematic analysis to understand experiences of goal pursuit following cancer. In study 2, 171 men completed measures of goal navigation, coping, and adjustment to cancer.

RESULTS

In study 1, three prominent themes emerged: goal clarification, goal engagement and disengagement, and responses to disrupted goals. Regression analyses in study 2 revealed that goal navigation skills were positively associated with emotional (B = .35, p < .001), social (B = .24, p < .01), and functional (B = .28, p < .001) well-being, as was approach-oriented coping (B = .22, p < .01; B = .32, p < .001; B = .26, p < .001, respectively). Goal navigation moderated associations between approach-oriented coping and well-being, such that those with low goal navigation ability and low approach-oriented coping reported lower well-being.

CONCLUSIONS

Goal navigation skills and approach-oriented coping have unique and interactive relationships with adjustment to testicular cancer. They likely represent important independent targets for intervention, and goal navigation skills might also buffer the negative consequences of low use of approach-oriented coping.

The Protective Role of Positive Well-Being in Cardiovascular Disease: Review of Current Evidence, Mechanisms, and Clinical Implications

Positive psychological aspects of well-being-including positive emotions, optimism, and life satisfaction-are increasingly considered to have protective roles for cardiovascular disease (CVD) and longevity. A rapidly-growing body of literature has linked positive well-being with better cardiovascular health, lower incidence of CVD in healthy populations, and reduced risk of adverse outcomes in patients with existing CVD. This review first examines evidence on the associations of positive well-being with CVD and mortality, focusing on recent epidemiological research as well as inconsistent findings. Next, an overview is provided of putative biological, behavioral, and stress-buffering mechanisms that may underlie the relationship between positive well-being and cardiovascular health. Key areas for future inquiry are discussed, in addition to emerging developments that capitalize on technological and methodological advancements. Promising initial results from randomized controlled trials suggest that efforts to target positive well-being may serve as valuable components of broader CVD management programs.

Optimism as a Candidate Health Asset: Exploring Its Links With Adolescent Quality of Life in Sweden

This study aims to understand the role that optimism could play in the context of a health asset approach to promote adolescent health-related quality of life (HRQOL). Adolescents (n = 948), between 11 and 16 years old from a medium-sized rural town in Sweden, answered questionnaires measuring optimism, pessimism, and HRQOL. The findings indicate a significant decrease in optimism and a significant increase in pessimism between early and midadolescence. The study has allowed us to present associational evidence of the links between optimism and HRQOL. This infers the potential of an optimistic orientation about the future to function as a health asset during adolescence and by implication may provide additional intervention tool in the planning of health promotion strategies.

Internal resources among informal caregivers: trajectories and associations with well-being

PURPOSE

The experiences, skills, and internal resources that informal caregivers bring into their role may play a critical part in their mental health and well-being. This study examined how caregiver internal resources changed over a 10 year period, and how this was related to caregivers' well-being.

METHODS

Data are from the Midlife in the United States (MIDUS) study, a national sample of adults, at two time points: 1995-1996 (T1) and 2004-2006 (T2). We identified subjects who reported being a caregiver at T2 and starting care after T1 (mean age = 56; 65% female). We examined internal resources: sense of control (personal mastery); primary and secondary control strategies (persistence in goal striving, positive reappraisal, and lowering expectations); and social support seeking, and psychological and subjective well-being. We evaluated how internal resources changed over time, and how these trajectories were associated with well-being at T2 using multivariable linear regressions.

RESULTS

Most caregivers had stable levels of internal resources (between 4 and 13% showed an increase or decrease). Caregivers with increasing or high-stable levels of personal mastery had significantly better well-being scores on 6 out of 8 subscales compared with low-stable levels [effect sizes (ES) between 0.39 and 0.79]. Increasing persistence was associated with better personal growth and environmental mastery (ES = 0.96 and 0.91), and increasing and high-stable positive reappraisals were associated with better affect (ES = 0.63 and 0.48) compared with low-stable levels. Lowering aspirations and support seeking were not associated with well-being outcomes.

CONCLUSIONS

Practices or interventions that support or improve internal resources could potentially improve caregiver well-being.

Enhanced Medical Rehabilitation: Effectiveness of a clinical training model

BACKGROUND

Patient engagement in medical rehabilitation can be greatly influenced by their provider during therapy sessions. We developed Enhanced Medical Rehabilitation (EMR), a set of provider skills grounded in theories of behavior change. EMR utilizes 18 motivational techniques focused on providing frequent feedback to patients on their effort and progress and linking these to patient goals.

OBJECTIVE

To examine the effectiveness of a clinical training protocol for clinicians to do EMR, as measured by clinician adherence.

METHODS

A physical therapist, physical therapist assistant, occupational therapist, and certified occupational therapist assistant were trained in EMR. Training consisted of five formal training sessions and individual and group coaching. Adherence to EMR techniques was measured during two phases: Pre-Training and Maintenance, with an a priori target of 90% adherence by clinicians to each EMR technique.

RESULTS

With training and coaching, clinician adherence per therapeutic activity significantly improved in 13 out of 18 items (p < 0.05). The target of 90% adherence was not achieved for many items.

CONCLUSIONS

Our training and coaching program successfully trained clinicians to promote patient engagement during therapeutic service delivery, although not typically to 90% or greater adherence. Ongoing coaching efforts were necessary to increase adherence.

How Positive Is Their Future? Assessing the Role of Optimism and Social Support in Understanding Mental Health Symptomatology among Homeless Adults

Optimism has been noted as a primary protective factor in understanding mental health symptomatology in clinical and non-clinical settings. Any exploration of optimism has been absent in understanding mental health outcomes among homeless people. This study, using intensive interviews with 168 homeless adults in Northwest Arkansas, examines the role that social support and optimism play in lessening the negative impact of homeless circumstances/experiences on mental health symptomatology. Using OLS, findings support a mediating/protective role that social support and optimism play in lowering the negative effects of childhood life experiences on depressive symptoms among homeless persons. Despite the overwhelming conditions of homelessness, persons with higher levels of optimism and social support report lower depression and anxiety symptoms. The findings are discussed paying particular attention to the importance of developing and maintaining the perception of support and resiliency in preserving a positive outlook for the future among homeless persons facing often-debilitating circumstances. Copyright © 2016 John Wiley & Sons, Ltd.

A randomized controlled trial of expressive writing in breast cancer survivors with lymphedema

OBJECTIVE

Breast cancer survivors who develop lymphedema report poorer quality of life (QoL) than those without lymphedema. Expressive writing is a potential intervention to address QoL.

DESIGN

Adult women (N = 107) with breast cancer and chronic Stage II lymphedema were randomised to writing about thoughts and feelings specific to lymphedema and its treatment (intervention) or about daily activities (control) for four, 20-min sessions.

MAIN OUTCOME MEASURES

Outcome measures were several indicators of QoL assessed at baseline, one, three, and six months post-intervention (total scores and subscales of Upper Limb Lymphedema 27 and Functional Assessment of Cancer Therapy-Breast). Hypothesised moderators of change in QoL were dispositional optimism, avoidant behaviours, and time since lymphedema diagnosis.

RESULTS

There was no statistically significant intent-to-treat main effects of expressive writing on QoL. Statistically significant moderating effects on change in different indicators of QoL were observed for all three moderators. Expressive writing was more effective for improving QoL in women who were higher on optimism, lower on avoidance and had less time since a lymphedema diagnosis.

CONCLUSION

These results provide further evidence that there are subsets of individuals for whom expressive writing is more effective. Future research may investigate targeting expressive writing based on identified moderators.

Let it go: Depression facilitates disengagement from unattainable goals

BACKGROUND AND OBJECTIVES

Previous studies have demonstrated that clinging to unattainable goals is linked to the onset of depression. The present study investigated whether symptoms of a clinical depression are adaptive in that they facilitate disengagement from unattainable goals.

METHODS

A group of depressive inpatients (n = 40) was compared to a non-depressive control group (n = 38) in regard to how much time they spent on unsolvable anagrams, while controlling for group differences in the time spent on solvable anagrams.

RESULTS

In line with our hypothesis, depressive inpatients spent less time on unsolvable anagrams. There was no group difference in the time needed to solve the solvable anagrams.

LIMITATIONS

Our study tested disengagement from anagram tasks in the lab in a sample of depressive inpatients and thus may not be representative for contexts of disengagement from personal goals outside the lab or for people with milder or briefer forms of depression. Follow-up questions thus concern the development of goal disengagement processes in everyday life during the course of a major depressive episode.

CONCLUSIONS

Our findings provide evidence for the view that clinical depression, although pathological, might also serve an adaptive function. We discuss possible implications of our findings for psychotherapy.

Activity Pattern Profiles: Relationship With Affect, Daily Functioning, Impairment, and Variables Related to Life Goals

The aim of this cross-sectional study was to identify subgroups of patients on the basis of their activity patterns and to investigate their relationship with life goals, optimism, affect, and functioning. The sample was comprised of 276 patients with chronic musculoskeletal pain. Hierarchical cluster analysis was performed on the activity pattern variables and the resulting clusters were compared using 1-way analysis of variance. The 4-cluster was the optimal solution. The 4 clusters comprised: 1) avoiders: patients with high levels of avoidance and low levels of persistence, who use pacing to reduce pain, 2) doers: patients with high levels of persistence and low levels of pacing and avoidance, 3) extreme cyclers: patients with high levels of avoidance and persistence and low levels of pacing, and 4) medium cyclers: patients with moderately high levels of avoidance and persistence and high levels of pacing. Comparison of the clusters showed that doers had the most adaptive profile, whereas avoiders, followed by extreme cyclers, had unhealthy profiles. Doers showed a high level of optimism and a good balance between goal value, expectancy, and conflict.

PERSPECTIVE

It is useful to distinguish profiles on the basis of various activity patterns. In contrast to profiles characterized by avoidance, profiles characterized by high persistence and low avoidance were associated with adaptive results. Patients with this profile also showed a high level of optimism and a good balance between goal value, expectancy, and conflict.

Adjusting to Chronic Health Conditions

Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.

A Person-Centered Analysis of Risk Factors that Compromise Wellbeing in Emerging Adulthood

The transition to adulthood is a major life course transition that can pose risk to wellbeing. Research is needed to identify patterns of risk for compromised wellbeing, in order to best identify supports for individuals during this potentially vulnerable transition. The purpose of this study was to identify profiles of risk in an emerging adulthood sample, and to relate these profiles to mental health and subjective and academic wellbeing. Undergraduate emerging adults (N = 903, 82 % female), aged 18-25 years (M = 21.14, SD = 1.75), completed a series of questionnaires about risk factors, mental health, and academic variables. Results from a latent profile analysis identified four distinct risk profiles: Low Risk (76 %), Low Social Support Risk (4 %), Financial Risk (11 %), and Multiple Risk (8 %). The risk profiles were subsequently related to mental health and subjective and academic wellbeing outcomes, using a pseudo-class draws approach. Analyses indicated that the risk-pattern profiles differed in several ways across outcomes. Implications for targeted interventions are discussed.

The impact of mild cognitive impairment on the self-regulation process: A comparison study of persons with mild cognitive impairment and cognitively healthy older adults

This study examined whether mild cognitive impairment affects the associations between personal expectations (i.e. optimism and self-efficacy), illness-related coping, and quality of life. In total, two groups of older adults participated: 127 persons diagnosed with mild cognitive impairment and 225 cognitively healthy older persons (cognitively non-impaired group). Several significant relationships observed in the cognitively non-impaired group did not reach significance among mild cognitive impairment patients, with the opposite trend noted for others (e.g. between palliative coping and physical health). These findings indicate that mild cognitive impairment may lead to problems in the self-regulation process and highlight the significance of the interplay between neurocognitive and psychosocial aspects of self-regulation.

Individual Differences in Expectancies for Change in Depression: Associations with Goal Pursuit and Daily Experiences

More optimistic expectations for change in patients entering treatment often predict more favorable outcomes. However, our understanding of the nature and function of those expectancies is limited. The current study tested the proposal that optimistic expectancies among patients seeking outpatient psychotherapy for major depressive disorder may be explained in part by having a more adaptive self-regulatory style. A sample of 56 adults (78.6% female; mean age 36.5) completed measures of expectancies, depressive symptoms, and aspects of self-regulation. Participants also completed a week of experience sampling using a cell phone system that signaled them 8 random times per day for 7 days. Results were largely consistent with hypotheses. Depressed participants with more optimistic expectancies had a stronger promotion goal orientation, higher goal re-engagement, and reported greater progress on their most important personal goals; daily positive affect and positive situational appraisals were also higher. Findings may suggest a possible self-regulatory mechanism underlying optimistic expectancies for change.

Affectivity as mediator of the relation between optimism and quality of life in men who have sex with men with HIV

Background/Objective: Increased life expectancy has made quality of life the primary objective in the care of chronic patients and people living with HIV. It found evidence of the link between optimism, quality of life and well-being. This article aimed to determine whether affectivity in its two dimensions (positive and negative) played a mediating role in the association between optimism and quality of life in men living with HIV. Method: 116 men living with HIV (the average age was 36.8 years (SD=9.06), and the average time from the diagnosis was 8.2 years) responded to three instruments: Life Orientation Test revised version (LOT-R), the Positive and Negative Affect Schedule (PANAS) and the World Health Organization Quality of Life-Bref (WHOQoL-Bref). Results: The results showed that positive affect had no mediating effect, whereas negative affect mediated the relation of optimism with two quality-of-life dimensions (overall quality of life and environment). Conclusion: In conclusion, negative affect was found to participate only partially, acting as a mediating variable.

The effects of experimental pain and induced optimism on working memory task performance

Background/aims

Pain can interrupt and deteriorate executive task performance. We have previously shown that experimentally induced optimism can diminish the deteriorating effect of cold pressor pain on a subsequent working memory task (i.e., operation span task). In two successive experiments we sought further evidence for the protective role of optimism on pain-induced working memory impairments. We used another working memory task (i.e., 2-back task) that was performed either after or during pain induction.

Methods

Study 1 employed a 2 (optimism vs. no-optimism) × 2 (pain vs. no-pain) × 2 (pre-score vs. postscore) mixed factorial design. In half of the participants optimism was induced by the Best Possible Self (BPS) manipulation, which required them to write and visualize about a life in the future where everything turned out for the best. In the control condition, participants wrote and visualized a typical day in their life (TD). Next, participants completed either the cold pressor task (CPT) or a warm water control task (WWCT). Before (baseline) and after the CPT or WWCT participants working memory performance was measured with the 2-back task. The 2-back task measures the ability to monitor and update working memory representation by asking participants to indicate whether the current stimulus corresponds to the stimulus that was presented 2 stimuli ago. Study 2 had a 2 (optimism vs. no-optimism) × 2 (pain vs. no-pain) mixed factorial design. After receiving the BPS or control manipulation, participants completed the 2-back task twice: once with painful heat stimulation, and once without any stimulation (counterbalanced order). Continuous heat stimulation was used with temperatures oscillating around 1 °C above and 1 °C below the individual pain threshold.

Results

In study 1, the results did not show an effect of cold pressor pain on subsequent 2-back task performance. Results of study 2 indicated that heat pain impaired concurrent 2-back task performance. However, no evidence was found that optimism protected against this pain-induced performance deterioration.

Conclusions

Experimentally induced pain impairs concurrent but not subsequent working memory task performance. Manipulated optimism did not counteract pain-induced deterioration of 2-back performance.

Implications

It is important to explore factors that may diminish the negative impact of pain on the ability to function in daily life, as pain itself often cannot be remediated. We are planning to conduct future studies that should shed further light on the conditions, contexts and executive operations for which optimism can act as a protective factor.

Why We Don't "Just Do It": Understanding the Intention-Behavior Gap in Lifestyle Medicine

Intention can be a poor predictor of actual health behavior change-now termed the intention-behavior gap. In other words, although patients intend to change and maintain their behavior, the data suggest that many will not follow through with their intention. This review introduces 5 factors that could help the practitioner understand the patient intention-behavior gap: (1) the motivation, (2) the trigger, (3) the response, (4) the capacity, and (4) the process. These key factors allow the lifestyle medicine practitioner to (1) understand the difficulties in changing patient behavior and (2) apply strategies to encourage successful change and maintenance of healthy lifestyle behavior in their patients.

Patient and partner dispositional optimism as a long-term predictor of illness representations in autoimmune diseases

We examined whether the dispositional optimism of patients suffering from an autoimmune disease as well as of their partners can predict, at a dyadic level, their representations of illness consequences, and personal and treatment control, assessed 1 year later. Patient optimism predicted several patient and partner illness representations. Partner optimism was unrelated to own or patient illness representations. Results highlight the strong long-term predictive power of patient optimism and underline the importance of the interpersonal function of personality traits. At the same time, study findings indicate that the dyadic effects of optimism are complex and probably conditional on several factors.

Optimism's Explicative Role for Chronic Diseases

The increasing interest about dispositional optimism's role in health status and its positive modulating effect on health outcomes has led to a remarkable scientific production in the last decade. To date lot is known for which diseases optimism is relevant, instead much less is known about how optimism interacts with other factors, both biological and psychological, in determining health status. The aim of this mini review is to explore the literature derived from clinical and experimental research assessing the associations between dispositional optimism and health status. Dispositional optimism can be considered as facet of personality that is cognitive in nature which holds the global expectation that the future will be plenty of good events. Optimists view desired goals as obtainable, so they often confront adversities in active manners resulting in perseverance and increased goal attainment. Only studies that explicitly included optimism and health outcomes, as measurable variables, and that reported a clear association between them have been reviewed. Cancer, cardiovascular disease, respiratory failure, and aging with multimorbidity were considered. Among the possible explicative hypotheses, two seem to best describe results: optimism may have a direct effect on the neuroendocrine system and on immune responses, and it may have an indirect effect on health outcomes by promoting protective health behaviors, adaptive coping strategies and enhancing positive mood. The research on optimism and health status has already shed light on important mechanisms regarding chronic diseases' management, however, further studies are needed to deepen the knowledge.

Happier People Show Greater Neural Connectivity during Negative Self-Referential Processing

Life satisfaction is an essential component of subjective well-being and provides a fundamental resource for optimal everyday functioning. The goal of the present study was to examine how life satisfaction influences self-referential processing of emotionally valenced stimuli. Nineteen individuals with high life satisfaction (HLS) and 21 individuals with low life satisfaction (LLS) were scanned using functional MRI while performing a face-word relevance rating task, which consisted of 3 types of face stimuli (self, public other, and unfamiliar other) and 3 types of word stimuli (positive, negative, and neutral). We found a significant group x word valence interaction effect, most strikingly in the dorsal medial prefrontal cortex. In the positive word condition dorsal medial prefrontal cortex activity was significantly higher in the LLS group, whereas in the negative word condition it was significantly higher in the HLS group. The two groups showed distinct functional connectivity of the dorsal medial prefrontal cortex with emotional processing-related regions. The findings suggest that, in response to emotional stimuli, individuals with HLS may successfully recruit emotion regulation-related regions in contrast to individuals with LLS. The difference in functional connectivity during self-referential processing may lead to an influence of life satisfaction on responses to emotion-eliciting stimuli.

Illness perception and quality of life of HIV-positive persons: mediation effects of tenacious and flexible goal pursuit

Medical advances contribute to raise life expectancy of people living with HIV/AIDS (PLHIV). However, they still face challenges related to the disease, thus, quality of life (QOL) became a priority on the field. The self-regulatory model (SRM) guided this study. Illness perceptions (IP) are the beliefs, cognitions, representations of a disease, impacting PLHIV coping strategies and QOL. Tenacious goal pursuit (TGP) is the pursuit of goals with determination, flexible goal adjustment (FGA) is doing it with flexibility, disengaging if necessary, they can both be considered as coping strategies. This study aims to measure the impact of HIV Perception in the QOL of PLHIV mediated by the TGP and FGA. Data was collected from 196 PLHIV with the WHOQOL-HIV Bref, the Brief-IPQ and the FGA and TGP scales. Structural equation model provided a good fit consistent with the theoretical SRM. IP, TGP and FGA had direct effects on the QOL of PLHIV. IP had also an indirect effect (partially mediated by TGP/FGA), suggesting that TGP/FGA reduce the impact of a threatening IP in the QOL. Goal oriented interventions should focus in the HIV perception of PLHIV to ameliorate their QOL.

Development and Psychometric Properties of the Yoga Self-Efficacy Scale (YSES)

BACKGROUND

Yoga is a behavioral practice that uses physical movement, breathing, and meditation to improve health and promote personal transformation. Ancient yoga philosophy proposed that an individual's confidence about yoga, a concept similar to self-efficacy, will affect the likelihood of improved health from yoga practice. The purpose of this study was to develop and examine the psychometric properties of a self-efficacy measure for yoga practice (the Yoga Self-Efficacy Scale; YSES).

METHODS

Yoga practitioners were recruited to evaluate the psychometric properties of YSES via a secure online survey. We collected data on additional measures to further examine construct validity. After two weeks, participants were invited to complete YSES items again to assess test-retest reliability.

RESULTS

A majority of participants (N = 309) were White (85%), female (82%), and yoga instructors (56%). The 12-item YSES is unidimensional with a Cronbach's alpha of 0.93. Test-retest reliability is r = 0.79 (n = 170). YSES scores are positively correlated with health competence, health-related quality of life, and years practicing yoga, supporting construct validity. Also, yoga teachers scored significantly higher on the YSES than non-teachers (p < 0.001). Non-significant relationships with education, income and sex supported discriminant validity. YSES maintained internal consistency and construct validity for all yoga styles surveyed.

CONCLUSION

YSES is a reliable and valid measure of self-efficacy for yoga practice that may provide insight into barriers to adopting and maintaining yoga as a health behavior.

Factors promoting diabetes self-care among low-income, minority pregnant women

OBJECTIVE

To prospectively identify factors promoting healthy self-management of gestational and type 2 diabetes mellitus among underserved pregnant women.

STUDY DESIGN

Twenty-nine in-depth, semi-structured interviews were performed over the course of pregnancy for 10 women with diabetes. Interviews on factors promoting diabetes self-management used cognitive load theory to frame questions. Qualitative analysis of longitudinal interview data applied grounded theory techniques to generate themes.

RESULT

Half this cohort of minority, low-income, public aid-supported women had type 2 diabetes. Four themes, comprised of both internal self-driven motivators and external sources of support, were identified. These themes were: (1) disease familiarity and diabetes self-efficacy; (2) external motivation (for health of fetus and responsibilities to older children); (3) supportive social and physical environment; and (4) self-regulatory behavior, including goal responsiveness and long-term goal-setting.

CONCLUSION

Low-income women used multiple internal and external resources to promote health during a pregnancy complicated by diabetes. Successful behavior modification and achievement of diabetes care goals require leveraging these resources.