A procedure for evaluating sensitivity to within-person change: can mood measures in diary studies detect change reliably?

Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects

BACKGROUND

Poor sleep quality among people with chronic low back pain appears to be related to worse pain, affect, poor physical function, and pain catastrophizing. The causal direction between poor sleep and pain remains an open question, however, as does whether sleep quality exerts effects on low back pain differently across the course of the day.

PURPOSE

This daily diary study examined lagged temporal associations between prior night sleep quality and subsequent day pain, affect, physical function and pain catastrophizing, the reverse lagged temporal associations between prior day pain-related factors and subsequent night sleep quality, and whether the time of day during which an assessment was made moderated these temporal associations.

METHODS

Chronic low back pain patients (n = 105) completed structured electronic diary assessments five times per day for 14 days. Items included patient ratings of their pain, affect, physical function, and pain catastrophizing.

RESULTS

Collapsed across all observations, poorer sleep quality was significantly related to higher pain ratings, higher negative affect, lower positive affect, poorer physical function, and higher pain catastrophizing. Lagged analyses averaged across the day revealed that poorer prior night sleep quality significantly predicted greater next day patient ratings of pain, and poorer physical function and higher pain catastrophizing. Prior poorer night sleep quality significantly predicted greater reports of pain, and poorer physical function, and higher pain catastrophizing, especially during the early part of the day. Sleep quality × time of day interactions showed that poor sleepers reported high pain, and negative mood and low function uniformly across the day, whereas good sleepers reported relatively good mornings, but showed pain, affect and function levels comparable to poor sleepers by the end of the day. Analyses of the reverse causal pathway were mostly nonsignificant.

CONCLUSIONS

Sleep quality appears related not only to pain intensity but also to a wide range of patient mood and function factors. A good night's sleep also appears to offer only temporary respite, suggesting that comprehensive interventions for chronic low back pain not only should include attention to sleep problems but also focus on problems with pain appraisals and coping.

Do mothers enjoy playing sensitively with their infants?

BACKGROUND

Early sensitive caregiver-infant interactions form an important foundation for infant development. Although mutual enjoyment is thought to motivate proximity and continued interactions, there is no empirical evidence that mothers enjoy interacting and behaving sensitively. Research to date has focused on the influence of stable/pathological maternal negative emotions on parenting, with parenting often assessed on one occasion only. Therefore, little is known about what accounts for the variability in sensitivity across interactions.

OBJECTIVES

The objective of the present study was to evaluate what makes sensitivity reinforcing to typical mothers and thus more likely to be repeated. We hypothesised that 15- to 28-week-old infants' positive and active engagement would mediate the relationship between their mothers' sensitivity and change in emotion state from pre- to post-interaction.

METHOD

Using a naturalistic, repeated-measures design, 390 unique interactions from 49 mothers (mean age: M = 29.90 years, SD = 5.41) and their infants (25 female; mean age: M = 22.53 weeks, SD = 3.77) were rated using the Global Rating Scales of Mother-Infant Interaction. Mothers completed measures of their own mood (Profile of Mood States - 15) before and after each interaction.

RESULTS

Mothers reported feeling slightly less negative and more vigorous after interacting with their infants. The more sensitively they behaved, the more engaged their infants were and the more vigorous the mothers felt thereafter. Infant engagement did not mediate the relationship between sensitivity and change in negative emotion or in vigour.

CONCLUSIONS

Results suggest that upon behaving sensitively, mothers feel more vigorous regardless of their infants' engagement.

Within-subject associations between inflammation and features of depression: Using the flu vaccine as a mild inflammatory stimulus

BACKGROUND

Inflammation plays a role in mood and behavior that may be relevant to identifying risk factors and treatment for depression and other stress-related illnesses. The purpose of this study was to examine whether fluctuations in inflammation following a mild immune stimulus were associated with changes in daily reported features of depression for up to a week in a healthy sample of young adults.

METHODS

Forty-one undergraduate students completed daily diaries of mood, feelings of social disconnection, sleep, and physical symptoms for one week before and after receiving the seasonal influenza vaccine. Circulating plasma interleukin-6 (IL-6) was measured via blood samples taken immediately before and one day after vaccination.

RESULTS

There was a significant increase in circulating IL-6 from pre- to post-intervention (p = .008), and there was significant variability in the magnitude of IL-6 change. Greater increases in IL-6 were associated with greater mood disturbance on post-vaccine days, specifically depressed mood and cognitive symptoms.

CONCLUSIONS

Minor increases in inflammation were associated with corresponding increases in features of depression, and these associations occurred in the absence of any physical symptoms. The influenza vaccine could be used to probe causal relationships with a high degree of ecological validity, even in high-risk and vulnerable populations, to better understand the role of inflammation in the pathogenesis of depression.

Prenatal maternal mood patterns predict child temperament and adolescent mental health

BACKGROUND

This study quantifies the dynamics of maternal mood focusing on unpredictability, and to assess if greater unpredictability of prenatal maternal mood predicts child temperament and internalizing symptoms through early adolescence.

METHODS

The association between prenatal mood predictability and child internalizing symptoms were assessed in two longitudinal cohorts (N's = 227 and 180). Maternal mood was assessed repeatedly during pregnancy as early as 15 weeks' gestation. Predictability of maternal mood was calculated by applying Shannon's entropy to the distribution of responses on mood questionnaires. Maternal reports of child negative affectivity (a predictor of later internalizing) were collected at 6, 12, 24 months and 7 years of age. Child self-reports of anxiety symptoms were collected at 10 years and reports of depression symptoms at 13 years.

RESULTS

Fetal exposure to more elevated maternal mood entropy predicted higher levels of child negative affectivity at 12 months (r = .36; p < 01), 24 months (r = .31; p < 01) and 7 years (r = .32; p < 01) of age. In addition, children exposed to higher prenatal maternal mood entropy, reported higher levels of anxiety symptoms at 10 years (r = .24; p < 01) and elevated depressive symptoms at 13 years (r = .29; p < .01). These associations persisted after adjusting for maternal pre and postnatal mood valence (e.g. depression levels) and for other relevant demographic characteristics.

CONCLUSIONS

Our findings provide strong support for the notion that patterns of maternal mood influence the developing brain. More specifically, they suggest that prenatal maternal mood predictability may be a critical predictor of developmental mental health trajectories and should be considered when assessing early life influences on lifespan mental health.

Concurrent and lagged relations between momentary affect and sedentary behavior in middle-aged women

OBJECTIVE

The purpose of this study was to investigate the reciprocal relationship between sedentary behavior (SB) and momentary affect in the context of daily experiences.

METHODS

Community-dwelling midlife women (N = 121; age 40-60 y) were recruited for a 15-day daily diary study. The women rated their positive and negative affect when prompted on a personal digital assistant device four times per day and wore an accelerometer for objective assessment of SB. Multilevel models were estimated to test concurrent and lagged associations between momentary estimates of SB and affect.

RESULTS

In models that controlled for day of week, number of hot flashes, and total minutes of accelerometer wear time, greater concurrent positive affect was associated with fewer minutes spent being sedentary (β = -31, P < 0.01). Neither lagged positive nor negative affect predicted later SB; however, more sedentary minutes predicted lower positive affect at the next occasion (β = -0.04, P < 0.01).

CONCLUSIONS

These results suggest that SB has negative affective consequences from moment to moment. The implications of reduced positive affect after prolonged bouts of SB for subsequent motivational, behavioral, or well-being outcomes remain to be determined.

The critical role of internalized HIV-related stigma in the daily negative affective experiences of HIV-positive gay and bisexual men

BACKGROUND

Research suggests that HIV stigma exerts a detrimental impact on the mental health of HIV-positive gay and bisexual men (GBM). We sought to better understand these processes by examining two forms of HIV stigma (i.e., anticipated and internalized) at two levels (i.e., individual and situational) in association with daily negative affective experiences.

METHODS

We conducted a 21-day twice-daily ecological momentary assessment study of 51 HIV-positive GBM. Twice-daily stigma measures were disaggregated into individual-level averages and situational fluctuations, and we utilized multilevel models to examine both concurrent and time-lagged effects of HIV stigma on anxious affect, depressed affect, anger, fatigue, and emotion dysregulation.

RESULTS

Situational experiences of internalized HIV stigma were associated with increased levels of anxious and depressed affect, anger, and emotion dysregulation in both concurrent and time-lagged analyses. Situational experiences of anticipated HIV stigma were only associated with anger and only within concurrent analyses. Individual-level internalized HIV stigma was associated with anxious affect and emotion dysregulation in both concurrent and time-lagged models, and with depressed affect and fatigue in time-lagged models.

LIMITATIONS

The small and high-risk sample limits generalizability and results should be replicated in larger and more diverse samples.

CONCLUSIONS

These findings suggest that, independent of the effects of individual-level stigma, situational experiences of internalized HIV stigma are associated with increases in event-level negative affective experiences. A combination of individually-delivered and mobile interventions may be successful at reducing the impact of internalized HIV stigma on negative affect and emotion dysregulation.

Stress reactivity links childhood trauma exposure to an admixture of depressive, anxiety, and psychosis symptoms

Childhood trauma exposure has been associated with a clinically relevant mixed phenotype of psychopathology composed of depressive, anxiety, and psychosis symptoms, across healthy and clinical samples. Altered stress-reactivity after exposure to childhood trauma may be a plausible underlying mechanism explaining this association. In a general population sample of female twins (T0 = 564; T1 = 483), associations between childhood trauma exposure and symptom profile (no symptoms, isolated symptoms, or a mixed phenotype) on the one hand, and daily life stress reactivity on the other were investigated. Daily life stress reactivity was measured using the Experience Sampling Method (ESM), and was defined as negative affect reactivity to minor daily life stressors. Individuals exposed to childhood trauma who reported a mixed phenotype of psychopathology showed a significant increase in emotional reactivity to daily life stress (activity and social stress), compared with trauma-exposed individuals without a mixed phenotype. In the trauma-exposed mixed phenotype group, increased emotional reactivity to event-stress predicted more severe symptoms at ± 14 month follow-up. This study found evidence that may link heightened emotional reactivity to stress in individuals with a trauma history to the risk for later comorbid psychopathology.

Distinguishing transient versus stable aspects of depression in New Zealand Pacific Island children using Generalizability Theory

BACKGROUND

The distinction between temporary versus enduring or state/trait aspects of depression is important. More precise distinction would improve understanding of the aetiology of depression and those aspects most amenable to intervention thus identifying more homogeneous, dynamic targets for clinical trials. Generalizability Theory has been proposed as useful for disentangling state and trait components of psychopathology.

METHODS

We applied Generalizability Theory to determine the relative contributions of temporary and enduring aspects of depression in a widely used screening measure of depression the - 10-item Children's Depression Inventory (CDI-10; Kovacs, 1985). Participants were children of Pacific Island descent living in New Zealand (n = 668). Data were collected at ages - 9, 11, and 14 years.

RESULTS

The CDI-10 demonstrated acceptable generalizability across occasions (G = 0.79) with about one third of variance in total scores attributed to temporary and two thirds to more enduring aspects of depression. There were no other significant sources of error variance. Two items were identified as more sensitive than the remaining eight to more dynamic symptoms.

LIMITATIONS

Studies with briefer test-retest intervals are warranted. Use of this Pacific Island cohort limits generalizability of findings to other cultures and ethnicities. No data were collected on whether participants had received intervention for depression.

CONCLUSIONS

While the CDI-10 reliably measures both stable and transient aspects of depression in children, the scale does not permit clear distinction between them. We advocate application of Generalizability Theory for developing state/trait depression measures and determining which existing measures are most suitable for capturing modifiable features of depression.

Preadolescents' Daily Peer Victimization and Perceived Social Competence: Moderating Effects of Classroom Aggression

Few studies have assessed children's daily peer experiences, and even fewer have considered their daily self-perceptions. This daily diary study examined relations between preadolescents' daily reports of peer victimization and perceived social competence, along with moderating effects of classroom aggression. A racially diverse sample of 182 children in 5th grade (105 boys; M age = 10.64 years; 35% White, 31% Black, 17% Hispanic, 17% other or not reported) completed daily measures of peer victimization and perceived social competence, with most children completing measures on 8 school days. Teachers completed measures of aggression for each participating pupil. Four types of peer victimization (verbal victimization, social manipulation, social rebuff, and property attacks) predicted decreased daily perceived social competence. Daily social rebuff predicted decreased daily perceived social competence beyond the effects of the other types of victimization. Classroom aggression moderated the relation of verbal victimization with perceived social competence, such that this relation was significant in classrooms with lower aggression and nonsignificant in classrooms with higher aggression. Results indicate that preadolescents' daily self-perceptions fluctuate with daily victimization by peers, particularly with social rebuff. Findings also suggest that the impact of verbal victimization on children's self-views could be exacerbated in classrooms that better manage peer-to-peer aggression. Accordingly, targeted interventions appear critical for children who continue to experience peer victimization in schools with highly effective aggression prevention programs.

Coordination of Self- and Parental-Regulation Surrounding Type I Diabetes Management in Late Adolescence

Background

Type 1 diabetes management involves self- and social-regulation, with past research examining components through individual differences unable to capture daily processes.

Purpose

Dynamical systems modeling was used to examine the coordinative structure of self- and social-regulation (operationalized as parental-regulation) related to daily diabetes management during late adolescence.

Methods

Two hundred and thirty-six late adolescents with type 1 diabetes (M age = 17.77 years, SD = .39) completed a 14-day diary reporting aspects of self- (e.g., adherence behaviors, cognitive self-regulation failures, and positive and negative affect) and parental-regulation (disclosure to parents, knowledge parents have, and help parents provide).

Results

Self-regulation functioned as one coordinative structure that was separate from parental-regulation, where mothers and fathers were coordinated separately from each other. Mothers' perceived helpfulness served as a driver of returning adolescents back to homeostasis.

Conclusions

The results illustrate a dynamic process whereby numerous facets of self- and social-regulation are coordinated in order to return diabetes management to a stable state.

Initial elevation bias in subjective reports

People's reports of their thoughts, feelings, and behaviors are used in many fields of biomedical and social science. When these states have been studied over time, researchers have often observed an unpredicted and puzzling decrease with repeated assessment. When noted, this pattern has been called an "attenuation effect," suggesting that the effect is due to bias in later reports. However, the pattern could also be consistent with an initial elevation bias. We present systematic, experimental investigations of this effect in four field studies (study 1: n = 870; study 2: n = 246; study 3: n = 870; study 4: n = 141). Findings show clear support for an initial elevation bias rather than a later decline. This bias is larger for reports of internal states than for behaviors and for negative mental states and physical symptoms than for positive states. We encourage increased awareness and investigation of this initial elevation bias in all research using subjective reports.

For everything a season? A month-by-month analysis of social network resources in later life

It is widely acknowledged that informal social ties provide older persons with many resources that serve to protect and improve their levels of health and well-being. Most studies on this topic, however, ignore the month or season of the year during which data was accumulated. This study proposes two hypotheses to explain seniors' social network resources over the calendar year: the "fluctuation hypothesis", which proposes that seasonal variation, in the form of weather fluctuations, institutional calendars, and holidays, might influence the social lives and resources of older persons, and the "network stability" perspective, which, informed by tenets of convoy theory and socioemotional selectivity theory, emphasizes the increasing importance of close network ties as individuals age and the stability of these ties. Using two waves (2005-2006 and 2010-2011) of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of community-dwelling older adults aged 57-85 in the United States, we examine a diverse set of nine social connectedness outcomes. Results, overall, support the network stability perspective, as the only social connectedness outcome found to significantly vary by month of year was average closeness with network members. We conclude by suggesting some methodological considerations for survey research and by noting how these findings complement the growing literature on inter-year fluctuation in social networks and social support. Changes in older adults' networks, while frequently observable over the course of years, do not seem to be seasonally patterned.

Reliability and Validity of Ambulatory Cognitive Assessments

Mobile technologies are increasingly used to measure cognitive function outside of traditional clinic and laboratory settings. Although ambulatory assessments of cognitive function conducted in people's natural environments offer potential advantages over traditional assessment approaches, the psychometrics of cognitive assessment procedures have been understudied. We evaluated the reliability and construct validity of ambulatory assessments of working memory and perceptual speed administered via smartphones as part of an ecological momentary assessment protocol in a diverse adult sample ( N = 219). Results indicated excellent between-person reliability (≥0.97) for average scores, and evidence of reliable within-person variability across measurement occasions (0.41-0.53). The ambulatory tasks also exhibited construct validity, as evidence by their loadings on working memory and perceptual speed factors defined by the in-lab assessments. Our findings demonstrate that averaging across brief cognitive assessments made in uncontrolled naturalistic settings provide measurements that are comparable in reliability to assessments made in controlled laboratory environments.

Prolonged Non-metabolic Heart Rate Variability Reduction as a Physiological Marker of Psychological Stress in Daily Life

Background

Prolonged cardiac activity that exceeds metabolic needs can be detrimental for somatic health. Psychological stress could result in such “additional cardiac activity.”

Purpose

In this study, we examined whether prolonged additional reductions in heart rate variability (AddHRVr) can be measured in daily life with an algorithm that filters out changes in HRV that are purely due to metabolic demand, as indexed by movement, using a brief calibration procedure. We tested whether these AddHRVr periods were related to worry, stress, and negative emotions.

Methods

Movement and the root of the mean square of successive differences (RMSSD) in heart rate were measured during a calibration phase and the subsequent 24 h in 32 participants. Worry, stress, explicit and implicit emotions were assessed hourly using smartphones. The Levels of Emotional Awareness Scale and resting HRV were used to account for individual differences. During calibration, person-specific relations between movement and RMSSD were determined. The 24-h data were used to detect prolonged periods (i.e., 7.5 min) of AddHRVr.

Results

AddHRVr periods were associated with worrying, with decreased explicit positive affect, and with increased tension, but not with the frequency of stressful events or implicit emotions. Only in people high in emotional awareness and high in resting HRV did changes in AddHRVr covary with changes in explicit emotions.

Conclusions

The algorithm can be used to capture prolonged reductions in HRV that are not due to metabolic needs. This enables the real-time assessment of episodes of potentially detrimental cardiac activity and its psychological determinants in daily life.

The association between self-compassion and treatment outcomes: Session-level and treatment-level effects

OBJECTIVE

Self-compassion (SC) has been consistently linked to less psychopathology; however, the link between changes in client's SC levels and psychotherapy outcomes has yet to be explored.

METHOD

Clients at a university-based community clinic completed SC and outcome measures session by session (N = 112) as well as pre- to posttreatment (N = 70).

RESULTS

Increases in clients' SC levels across the entire therapeutic process were associated with improvement in all posttreatment outcomes. Additionally, session-to-session increases in SC levels predicted improved symptoms and functioning at the session level; these effects were significant above and beyond the effects of the therapeutic alliance.

CONCLUSION

The results of the current study highlight SC as a possible process variable in psychotherapy.

Multiplicity and mutuality in the transition of patient and therapist's self-states: Comparison of good vs. poor outcome groups

Objective: According to the Assimilation Model, the self is consisted of multiple internal voices which are sometimes conflicted, or even dissociated, from one another. Thus, a key therapeutic goal is to create awareness and dialogue between a patient's various internal voices, in order to facilitate positive change. A recent development of this theoretical line suggests that clinically addressing both the patients' and therapists' internal voices, and their mutual influences, contributes significantly to the treatment outcome. Current study aims to examine: (a) Patients' progression throughout treatment in their quality of movement of self-states, from lower levels of dissociation to higher ones of dialectics, and whether this pattern is associated with positive outcomes; (b) temporal congruence in patient-therapist quality of movement of self-states and its association with session outcome. Method: Nine good and nine poor-outcome cases of psychodynamic treatment were analyzed (N = 18) for both the patient and the therapist using the TPA, an expansion of the assimilation of problematic experiences scale (APES). Patients completed the Outcome Rating Scale (i.e., ORS), a session-by-session measure that assesses overall functioning, and symptomatic pre-and-post treatment measures (BDI). Results: A quadratic pattern of change was observed on the TPA of patients from the good-outcome cases: Patients showed more conflict in the beginning, avoidance between self-states in the middle phase, and dialectics towards the end. Additionally, the patient-therapist TPA temporal congruence was significantly related to session outcome of the good-outcome group. Conclusion: These findings emphasize the importance of combining an intra-psychic and inter-psychic set of lenses when inquiring therapeutic processes.

Growth curves of clients' emotional experience and their association with emotion regulation and symptoms

OBJECTIVE

Emotional experience during psychotherapy is considered a core mechanism of change. Yet the sheer experience itself may not necessarily be beneficial; instead, the trajectories of emotional experience need to be explored as possible predictors of treatment outcomes. This study investigated whether clients' pre-treatment levels of emotion regulation and symptoms predicted patterns of session-to-session change in emotional experience. We also explored which patterns better predict clients' improvement in emotion regulation and symptoms from pre- to post treatment.

METHOD

One-hundred and seven clients undergoing psychodynamic psychotherapy completed questionnaires on their symptoms and emotion regulation at pre- and post- treatment. They also reported their level of emotional experience at the end of each session.

RESULTS

Pre-treatment symptoms and difficulties in emotion regulation predicted greater instability in emotional experience. Higher mean levels of emotional experience during treatment were associated with an improvement in emotion regulation, and greater stability during treatment was associated with improvement in emotion regulation and symptoms.

CONCLUSIONS

These findings lend weight to the idea that experiencing emotion in the therapeutic environment has significant implications for clients' ability to manage their emotions outside the session. However, emotions experienced in an unstable manner within therapy are associated with poorer outcomes. Clinical and methodological significance of this article: Therapists can benefit from observing the patterns and not only the level of their clients' emotional experiences. The identification of clients' difficulties early in treatment may help therapists guide clients through the delicate process of carefully attending to their emotions.

Threat in the Company of Men: Ensemble Perception and Threat Evaluations of Groups Varying in Sex Ratio

Everyday, we visually perceive people not only in isolation but also in groups. Yet, visual person perception research typically focuses on inferences made about isolated individuals. By integrating social vision and visual ensemble coding, we present novel evidence that (a) perceivers rapidly (500 ms) extract a group’s ratio of men to women and (b) both explicit judgments of threat and indirect evaluative priming of threat increase as the ratio of men to women in a group increases. Furthermore, participants’ estimates of the number of men, and not perceived men’s coalition, mediate the relationship between the ratio of men to women and threat judgments. These findings demonstrate the remarkable efficiency of perceiving a group’s sex ratio and downstream evaluative inferences made from these percepts. Overall, this work advances person perception research into the novel domain of people perception, revealing how the visually perceived sex ratio of groups impacts social judgments.

The promise of digital mood tracking technologies: are we heading on the right track?

The growing understanding that mood disorders are dynamic in nature and fluctuate over variable epochs of time has compelled researchers to develop innovative methods of monitoring mood. Technological advancement now allows for the detection of minute-to-minute changes while also capturing a longitudinal perspective of an individual's illness. Traditionally, assessments of mood have been conducted by means of clinical interviews and paper surveys. However, these methods are often inaccurate due to recall bias and compliance issues, and are limited in their capacity to collect and process data over long periods of time. The increased capability, availability and affordability of digital technologies in recent decades has offered a novel, non-invasive alternative to monitoring mood and emotion in daily life. This paper reviews the emerging literature addressing the use of digital mood tracking technologies, primarily focusing on the strengths and inherent limitations of using these new methods including electronic self-report, behavioural data collection and wearable physiological biosensors. This developing field holds great promise in generating novel insights into the mechanistic processes of mood disorders and improving personalised clinical care. However, further research is needed to validate many of these novel approaches to ensure that these devices are indeed achieving their purpose of capturing changes in mood.

Emotion Regulation in Borderline Personality Disorder: An Experimental Investigation of the Effects of Instructed Acceptance and Suppression

Difficulties with emotion regulation are central to borderline personality disorder (BPD). Recent research suggests that avoidance of emotions in general, and emotion suppression specifically, may be commonly used among those who meet criteria for the disorder. Contemporary behavioral interventions for BPD incorporate cognitive and behavioral skills to increase emotional experiencing and acceptance while decreasing behaviors that function to escape or avoid from emotions. Few studies, however, have experimentally examined the effects of instructed emotion suppression and acceptance in BPD. The present study examined the effects of instructed use of different emotion regulation strategies on emotions, psychophysiology, and behavior in BPD. Participants with BPD, major depressive disorder (MDD), and nonpsychiatric controls (N = 193) were randomly assigned to either suppress or accept emotions during an audio recording of a social rejection scenario, and completed a behavioral measure of distress tolerance. BPD participants exhibited greater heart rate variability in the acceptance (vs. suppression) condition; this pattern was not evident within the other groups. These results suggest that deliberate use of acceptance-based emotion regulation strategies may have unique physiological effects among individuals with BPD.

Longitudinal validity and reliability of the Myeloma Patient Outcome Scale (MyPOS) was established using traditional, generalizability and Rasch psychometric methods

PURPOSE

The Myeloma Patient Outcome Scale (MyPOS) was developed to measure quality of life in routine clinical care. The aim of this study was to determine its longitudinal validity, reliability, responsiveness to change and its acceptability.

METHODS

This 14-centre study recruited patients with multiple myeloma. At baseline and then every two months for 5 assessments, patients completed the MyPOS. Psychometric properties evaluated were as follows: (a) confirmatory factor analysis and scaling assumptions (b) reliability: Generalizability theory and Rasch analysis, (c) responsiveness and minimally important difference (MID) relating changes in scores between baseline and subsequent assessments to an external criterion, (d) determining the acceptability of self-monitoring.

RESULTS

238 patients with multiple myeloma were recruited. Confirmatory factor analysis found three subscales; criteria for scaling assumptions were satisfied except for gastrointestinal items and the Healthcare support scale. Rasch analysis identified limitations of suboptimal scale-to-sample targeting, resulting in floor effects. Test-retest reliability indices were good (R = > 0.97). Responsiveness analysis yielded an MID of +2.5 for improvement and -4.5 for deterioration.

CONCLUSIONS

The MyPOS demonstrated good longitudinal measurement properties, with potential areas for revision being the Healthcare Support subscale and the rating scale. The new psychometric approaches should be used for testing validity of monitoring in clinical settings.

Children's diurnal cortisol responses to negative events at school and home

This study examined the within-and between-person associations between daily negative events - peer problems, academic problems and interparental conflict - and diurnal cortisol in school-age children. Salivary cortisol levels were assessed four times per day (at wakeup, 30min later, just before dinner and at bedtime) on eight days in 47 youths ages 8-13 years old (60% female; M age=11.28, SD=1.50). The relative contributions of within- and between-person variances in each stressor were estimated in models predicting same-day diurnal cortisol slope, same-day bedtime cortisol, and next morning wakeup cortisol. Children who reported more peer problems on average showed flatter slopes of cortisol decline from wakeup to bedtime. However, children secreted more cortisol at wakeup following days when they had reported more peer or academic problems than usual. Interparental conflict was not significantly associated with diurnal cortisol. Findings from this study extend our understanding of short-term cortisol responses to naturally occurring problems in daily life, and help to differentiate these daily processes from the cumulative effects of chronic stress.

Daily antecedents and consequences of nightly sleep

Sleep can serve as both cause and consequence of individuals' everyday experiences. We built upon prior studies of the correlates of sleep, which have relied primarily on cross-sectional data, to examine the antecedents and consequences of sleep using a daily diary design. Specifically, we assessed the temporal sequence between nightly sleep and daily psychosocial stressors. Parents employed in a US information technology company (n = 102) completed eight consecutive daily diaries at both baseline and 1 year later. In telephone interviews each evening, participants reported on the previous night's sleep hours, sleep quality and sleep latency. They also reported daily work-to-family conflict and time inadequacy (i.e. perceptions of not having enough time) for their child and for themselves to engage in exercise. Multi-level models testing lagged and non-lagged effects simultaneously revealed that sleep hours and sleep quality were associated with next-day consequences of work-to-family conflict and time inadequacy, whereas psychosocial stressors as antecedents did not predict sleep hours or quality that night. For sleep latency, the opposite temporal order emerged: on days with more work-to-family conflict or time inadequacy for child and self than usual, participants reported longer sleep latencies than usual. An exception to this otherwise consistent pattern was that time inadequacy for child also preceded shorter sleep hours and poorer sleep quality that night. The results highlight the utility of a daily diary design for capturing the temporal sequences linking sleep and psychosocial stressors.

Borderline Personality Disorder and the Effects of Instructed Emotional Avoidance or Acceptance in Daily Life

This study examined the effects of avoidance- versus acceptance-oriented emotion regulation instructions among individuals with borderline personality disorder (BPD; n = 48), major depressive disorder (MDD; n = 54), and non-psychiatric controls (NPC; n = 50) using ecological momentary assessment. Participants were randomly assigned to either accept or avoid negative emotions, and monitored their moods, urges, and distress tolerance several times per day over 6 days. Avoidance instructions resulted in reduced negative affect and urges for maladaptive behaviors uniquely among BPD participants. Together with past research, and consistent with treatment approaches emphasizing the short-term use of skills to avoid or distract from emotions (e.g., DBT; Linehan, 1993b, 2015), these findings suggest that avoidance of negative emotions may have temporary benefits for individuals with BPD. Acceptance-oriented strategies may take longer or may require more extensive training to be beneficial for emotional functioning in everyday life in BPD.

The Role of Patient Characteristics in the Concordance of Daily and Retrospective Reports of PTSD

Research has documented discrepancies between daily and retrospective reports of psychological symptoms in a variety of conditions. A limited number of studies have assessed these discrepancies in samples of individuals with posttraumatic stress disorder (PTSD), with even less research addressing potential covariates that may influence such discrepancies. In the current study, 65 individuals with co-occurring PTSD and alcohol use disorder (AUD) completed daily assessments of their PTSD symptoms for 1 month, followed by a standard retrospective report of PTSD over the same month. Initial analyses explored the mean levels of daily and retrospective PTSD symptoms, while multilevel models assessed the level of agreement between daily and retrospective reports and the role of demographic variables and comorbid psychopathology (e.g., depression) or substance use (e.g., alcohol use) in moderating the association of daily and retrospective reports. Results showed that retrospective reports of arousal and avoidance symptoms were weakly related to daily reports of these symptoms, while reports of reexperiencing and numbing symptoms showed better agreement. Intra-individual alcohol consumption also moderated associations of reexperiencing and avoidance symptoms, such that on days individuals drank more, their daily reports resembled their retrospective reports less well. Future research should explore the degree to which these results generalize to nondually diagnosed samples, as well as the role such reporting discrepancies may play in PTSD treatment.

The Influence of Daily Coping on Anxiety Under Examination Stress: A Model of Interindividual Differences in Intraindividual Change

Although much is known about people’s attempts to cope with stressors, unmeasured heterogeneity in these stressors has made it difficult to assess the effectiveness of coping attempts. We remedied this problem by focusing on coping effectiveness in people preparing for a major, planned, uniform stressor, the Bar Examination. Within-person analyses of longitudinal data on anxiety in 321 persons over 35 days provided evidence on (a) coping effectiveness for the typical person, (b) how effectiveness changed across time, and (c) the extent to which individuals differed in their effectiveness. For the typical person, active coping and positive reinterpretation on one day were associated with reduced anxiety the next morning, whereas practical support seeking, venting, and mental disengagement were associated with increased anxiety. The effectiveness of planning, acceptance, and disengagement varied as a function of time to the stressful event. Finally, there were large individual differences in coping effectiveness across the sample.

Goal Disengagement, Well-Being, and Goal Achievement in Romantic Couples Pursuing Health Behavior Change: Evidence from Two Daily Diary Studies

BACKGROUND

Withdrawing effort and commitment from important goals (i.e. goal disengagement) has been discussed as an effective aspect of goal adaption. However, studies have focused especially on between-person differences. The present studies aimed to investigate within-person differences in goal disengagement within a dyadic context of romantic couples. Across two different health behaviors, we specifically tested whether goal disengagement would be associated with better well-being, but lower goal achievement in everyday life.

METHODS

In two dyadic daily diary studies (Study 1: 61 overweight couples aiming to become physically active; Study 2: 83 dual-smoker couples aiming to quit smoking), both partners independently reported on goal disengagement, positive and negative affect. Behavioral goal achievement was measured via accelerometer (Study 1) and self-report (Study 2).

RESULTS

Analyses based on the Actor-Partner Interdependence Model revealed that across both studies, one's own goal disengagement was related to lower well-being and a lower likelihood for goal achievement on a daily level (actor effects). Only in Study 1 were partner effects on negative affect and goal achievement found.

CONCLUSIONS

In daily life, goal disengagement may not be as adaptive for well-being and goal achievement in health behavior change. Dyadic associations were not consistent, and might be more context-sensitive.

Zooming into daily life: within-person associations between physical activity and affect in young adults

OBJECTIVE

Negative affect in daily life is linked to poorer mental and physical health. Activity could serve as an effective, low-cost intervention to improve affect. However, few prior studies have assessed physical activity and affect in everyday life, limiting the ecological validity of prior findings. This study investigates whether daily activity is associated with negative and positive evening affect in young adults.

DESIGN

Young adults (N = 189, Mdn = 23.00) participated in an intensive longitudinal study over 10 consecutive days.

MAIN OUTCOME MEASURES

Participants wore accelerometers to objectively assess moderate-to-vigorous physical activity continuously throughout the day and reported their affect in time-stamped online evening diaries before going to sleep.

RESULTS

On days when participants engaged in more activity than usual, they reported not only less depressed and angry evening affect but also more vigour and serenity in the evening.

CONCLUSION

Young adults showed both less negative and more positive affect on days with more activity. Physical activity is a promising health promotion strategy for physical and mental well-being.

Attenuation of Frontostriatal Connectivity During Reward Processing Predicts Response to Psychotherapy in Major Depressive Disorder

There are few reliable predictors of response to antidepressant treatments. In the present investigation, we examined pretreatment functional brain connectivity during reward processing as a potential predictor of response to Behavioral Activation Treatment for Depression (BATD), a validated psychotherapy that promotes engagement with rewarding stimuli and reduces avoidance behaviors. Thirty-three outpatients with major depressive disorder (MDD) and 20 matched controls completed two runs of the monetary incentive delay task during functional magnetic resonance imaging after which participants with MDD received up to 15 sessions of BATD. Seed-based generalized psychophysiological interaction analyses focused on task-based connectivity across task runs, as well as the attenuation of connectivity from the first to the second run of the task. The average change in Beck Depression Inventory-II scores due to treatment was 10.54 points, a clinically meaningful response. Groups differed in seed-based functional connectivity among multiple frontostriatal regions. Hierarchical linear modeling revealed that improved treatment response to BATD was predicted by greater connectivity between the left putamen and paracingulate gyrus during reward anticipation. In addition, MDD participants with greater attenuation of connectivity between several frontostriatal seeds, and midline subcallosal cortex and left paracingulate gyrus demonstrated improved response to BATD. These findings indicate that pretreatment frontostriatal functional connectivity during reward processing is predictive of response to a psychotherapy modality that promotes improving approach-related behaviors in MDD. Furthermore, connectivity attenuation among reward-processing regions may be a particularly powerful endophenotypic predictor of response to BATD in MDD.

Ecological Momentary Assessment (EMA) Goes to Jail

Abstract. Ecological Momentary Assessment (EMA) involves the repeated collection of data in everyday life. This method has helped uncover underlying mechanisms in several mental disorders. EMA studies are still scarce in adolescent patients and particularly incarcerated juvenile offenders (IJO), possibly due to their frequent rule-breaking and high impulsivity. This study evaluated the feasibility and reliability of EMA in IJO. One hundred three antisocial adolescents (mean age 14.8, 78% boys, including 52 IJO and 51 institutionalized antisocial adolescents, IAA) answered four times a day during 8 days questions about their antisocial behavior, negative affect, impulsivity, and fear of punishment, on a handheld computer. Staff members also regularly reported on each participant’s antisocial behavior. This first application of EMA in IJO overall supported its feasibility, with an excellent participation rate (95%) and a good compliance in completers (84%). About one-third of IJO participants dropped out, with no evidence of sampling bias across a wide range of indicators, while 96% of IAA completed EMA. No reactivity or lack of objectivity was observed. One- to two-thirds of the variance was within-person and reliability was acceptable to good. EMA can thus be reliably used in IJO to study the dynamics of daily antisocial behavior as it naturally unfolds in its context.

The relationship between positive affect and negative affect during treatment for major depressive disorder

OBJECTIVE

The present study examined the relationship between positive affect (PA) and negative affect (NA) along the course of combined cognitive behavior therapy and pharmacological treatment for major depressive disorder (MDD).

METHOD

Participants were 165 individuals who sought treatment for MDD in a partial hospital setting. Participants' PA, NA, and depressive symptoms were measured at pre- and post-treatment and PA and NA were measured at up to 10 additional measurements along the course of treatment.

RESULTS

Results indicated that PA at pre-treatment predicted depressive symptoms at post-treatment above and beyond NA and the PA*NA interaction. However, an analysis of patterns of change during treatment using lower level mediational modeling in a multilevel framework indicated that NA predicted subsequent PA to a greater extent than vice versa.

CONCLUSION

Though many treatments for MDD predominantly focus on reducing NA, our findings suggest that PA may be an important predictor of outcome in treatment for MDD, and that the inclusion of interventions to increase the experience of PA may help improve the efficacy of treatment.

Measuring medication adherence in asthma: Development of a novel self-report tool

OBJECTIVE

This study presents the development and validation of MIS-A (Medication Intake Survey-Asthma), a new self-report instrument measuring key adherence properties during long-term asthma treatment.

DESIGN

Within a longitudinal asthma cohort study in France and the United Kingdom, adult patients and caregivers of children responded to computer-assisted telephone interviews.

MAIN OUTCOME MEASURES

Scores for distinct adherence properties (taking adherence, correct dosing, therapeutic coverage, drug holidays, overuse) and composite measures were computed for several time intervals. We examined distributions, longitudinal variation, associations between adherence scores and concordance with adherence calculated from medication prescribing or dispensing records.

RESULTS

Nine hundred and two participants reported on adherence to 4481 medications on 4140 occasions. About 59.47 and 70.36% revealed < 100% taking adherence in the last week and month; 42.76% had a drug holiday of > 1 week in the last 4 months. Adherence varied within patients during the follow-up (intra-class correlation = . 41-.71). Correlations between adherence scores were moderate to strong (ρ = .51-.85, p ≤ .001), except medication overuse (ρ = .04-.19, p ≤.05). Four-month taking adherence was associated with dispensing adherence, but not with prescribing adherence (ρ = .33, p < .001; and .12, p = .26).

CONCLUSION

MIS-A is a promising, easy-to-use self-report tool that can capture accurately different adherence properties over a long time period.

Stressors, Appraisal of Stressors, Experienced Stress and Cardiac Response: A Real-Time, Real-Life Investigation of Work Stress in Nurses

BACKGROUND

Stress in health care professionals may reflect both the work and appraisal of work and impacts on the individuals, their patients, colleagues and managers.

PURPOSE

The purpose of the present study is to examine physiological and psychological effects of stressors (tasks) and theory-based perceptions of work stressors within and between nurses in real time.

METHODS

During two work shifts, 100 nurses rated experienced stress, affect, fatigue, theory-based measures of work stress and nursing tasks on electronic diaries every 90 min, whereas heart rate and activity were measured continuously.

RESULTS

Heart rate was associated with both demand and effort. Experienced stress was related to demand, control, effort and reward. Effort and reward interacted as predicted (but only within people). Results were unchanged when allowance was made for work tasks.

CONCLUSIONS

Real-time appraisals were more important than actual tasks in predicting both psychological and physiological correlates of stress. At times when effort was high, perceived reward reduced stress.

Daily links between school problems and youth perceptions of interactions with parents: A diary study of school-to-home spillover

This study examined how academic and peer problems at school are linked to family interactions at home on the same day, using eight consecutive weeks of daily diary data collected from early adolescents (60% female; M age = 11.28, SD = 1.50), mothers and fathers in 47 families. On days when children reported more academic problems at school, they, but not their parents, reported less warmth and more conflict with mothers, and more conflict and less time spent around fathers. These effects were partially explained by same-day child reports of higher negative mood. Peer problems were less consistently associated with parent-child interactions over and above the effects of academic problems that day. A one-time measure of parent-child relationship quality moderated several daily associations, such that the same-day link between school problems and child-report of family interactions was stronger among children who were closer to their parents.

Daily Goals and Psychological Well-Being in Midlife and Older Women: Physical Pain Interacts with Goal Conflict

Physical pain is more prevalent with older age and female gender, and pain can interfere with goal pursuit and its psychological benefit. In particular, insofar as pain is associated with fatigue, it may limit resources for goal pursuit and increase goal resource conflict: the competition between goals for time and energy. Therefore, the pursuit of goals with high value and low resource conflict should provide the most psychological benefit, particularly for women who experience physical pain. Women in middle and older age (N = 200) completed up to 7 daily diaries (n = 1,380), in which they reported and rated their daily goals and assessed their daily pain, distress, fatigue, and cognitive function. Raters also assessed goal conflict. Multilevel models tested the within- and between-person relationships of goal value and goal conflict with daily distress, fatigue, and cognitive function, as well as moderation by pain. Higher goal value was associated with less distress and fatigue and better cognitive function within and between women. Depending on whether or not a woman had physical pain, goal conflict had different relationships with fatigue and cognitive function: for women with no pain, there was a modest positive relationship between goal conflict and both cognitive difficulties and subjective fatigue; for women with pain, there was a negative relationship between goal conflict and both cognitive difficulties and subjective fatigue. Results suggest women without pain may be taxed by their goal conflict, whereas women with pain may regulate their goal conflict in response to their available resources.

Heritability of Intraindividual Mean and Variability of Positive and Negative Affect

Positive affect (e.g., attentiveness) and negative affect (e.g., upset) fluctuate over time. We examined genetic influences on interindividual differences in the day-to-day variability of affect (i.e., ups and downs) and in average affect over the duration of a month. Once a day, 17-year-old twins in the United Kingdom (N = 447) rated their positive and negative affect online. The mean and standard deviation of each individual’s daily ratings across the month were used as the measures of that individual’s average affect and variability of affect. Analyses revealed that the average of negative affect was significantly heritable (.53), but the average of positive affect was not; instead, the latter showed significant shared environmental influences (.42). Fluctuations across the month were significantly heritable for both negative affect (.54) and positive affect (.34). The findings support the two-factor theory of affect, which posits that positive affect is more situational and negative affect is more dispositional.

Sexually dimorphic and interactive effects of prenatal maternal cortisol and psychological distress on infant cortisol reactivity

In utero exposure to maternal psychological distress is a risk factor for developmental psychopathology, and these effects are believed to partially occur via dysregulation of the maternal and fetal hypothalamus-adrenal-pituitary axes. Nevertheless, only a few human studies have directly assessed the effects of prenatal cortisol exposure on infant cortisol reactivity, and none have investigated sex differences or potential interactions between prenatal cortisol and psychological distress. Here we report on a prospective longitudinal investigation (N = 236) of in utero exposure to maternal cortisol and distress in a relatively high socioeconomic status and low-risk population to determine whether these exposures interact in their effects on infant (M age = 3.0 months, range = 2.3-5.0 months, 51.9% male) cortisol reactivity and whether there are sex differences in these effects. Results revealed both sexually dimorphic and interactive effects of prenatal cortisol and distress, even after controlling for postnatal distress. In general, blunted reactivity in females was associated with exposure to high maternal distress and flattened patterns of diurnal maternal cortisol, whereas blunted reactivity in males was associated with exposure to steeper morning increases and daytime decreases in maternal cortisol. The findings suggest that sex differences in the effects of prenatal cortisol and distress on infant cortisol reactivity are a plausible mechanism by which maternal experiences during pregnancy contribute to sex differences in the development of psychopathology.

Applying generalizability theory methods to assess continuity and change on the Adolescent Quality of Life-Mental Health Scale (AQOL-MHS)

PURPOSE

The Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) is designed to measure quality of life in clinical samples of Latino adolescents aged 12-18 years. Initial findings support its reliability, validity and conceptual model for use of its three domains (emotional regulation, self-concept and social context). Our current study tests the usefulness of the AQOL-MHS for tracking changes in HRQOL during the course of service use.

METHODS

Three waves of data were collected from 59 participants who were recruited from mental health clinics, where waves were spaced 4 months apart. Participants were receiving services at baseline assessment and were tracked for follow-up appointments regardless of treatment status. We analyze conventional reliability statistics for individual differences (e.g., Cronbach's alpha and test-retest correlations), and to estimate the reliability of change, we carried out a variance decomposition analysis.

RESULTS

The psychometric analyses from Chavez et al. (Qual Life Res 23(4):1327-1335, 2014) were replicated with comparable results. A generalizability theory (GT) analysis revealed that the AQOL-MHS domains can measure change reliably. The reliability estimates varied from .65 to .78. Although there was reliable change at the individual level, on the average the AQOL-MHS means improved only slightly over time.

CONCLUSIONS

The reliability of change for all three scales in the AQOL-MHS was acceptable, but consistently lower than the Cronbach's alpha values for each wave. Future work will use this approach to adapt our current measure to provide a better reliability of within-person change and thus broaden its applicability for prospective use.

Experiences With Parents and Youth Physical Health Symptoms and Cortisol: A Daily Diary Investigation

Using daily diary data, this study examined the associations between positive and negative parent-youth experiences and youth cortisol and physical health symptoms among a sample of adolescents (N=132, Mean Age = 13.39). On days when girls reported more negative experiences than usual, they exhibited more physical health symptoms and flatter evening cortisol slopes than usual. Negative experiences with mothers were associated with higher dinner and bedtime youth cortisol levels (between-person). Daily positive experiences with fathers were linked with lower dinner cortisol levels. Youth with high levels of negative experiences, on average, were less sensitive to daily variation in negative experiences than youth who experienced lower parental negativity. We discuss the benefits of a daily diary approach.