Characteristics of sleep disturbance across two waves of the COVID-19 pandemic among nursing staffs

Objectives

COVID-19 has impacted human lifestyles, including sleep quality. For nursing staff, sleep disorders not only impact their health and daily lives but also have implications for patient safety. The objective of this study is to explore the impact of the COVID-19 pandemic on the psychological and social aspects of nursing staff and the factors influencing their sleep quality through a two-wave survey.

Methods

Nursing staff from a psychiatric hospital in southern Taiwan were recruited in two waves during the COVID-19 epidemic. The level of sleep disturbance and related variables, such as Lo's Healthy and Happy Lifestyle Scale (LHHLS) and Societal Influences Survey Questionnaire (SISQ), were collected through self-report questionnaires. Factors related to the level of sleep disturbance were examined using univariate linear regression and multilevel linear regression.

Results

508 nursing staff members were included in the study, with 254 members in each wave. A significant difference was found between the two waves in the positive thinking of LHHLS and all subscales of SISQ. During the second wave, sleep disturbances were mainly related to self-efficacy, positive thinking, social anxiety, and social desirability. At the fourth wave, sleep disturbances were mainly related to self-efficacy, positive thinking, and social anxiety. However, these effects change when the trend of the epidemic shifts, and other factors are taken into account.

Conclusions

This study analyzed the factors related to the sleep quality of nursing staff during the COVID-19 pandemic. We preliminarily explored the impact of the COVID-19 pandemic on the sleep quality of nursing staff. However, determining whether the end of the epidemic has reduced the impact on nursing staff requires further research.

Social participation, positive affect, and negative affect in postoperative patients with hip fractures: A cross-sectional study

This study investigated the social participation, positive affect (PA), and negative affect (NA) of patients with hip fractures after surgery and determined their possible predictive factors. We used a cross-sectional study design to recruit 154 participants with hip fractures post-surgery. Assessment tools included the Barthel Index, the Automatic Thoughts Questionnaire, the Assessment of Life Habits, and the Positive and Negative Affect Schedule. Patients with better functioning in daily living activities experienced more social participation, higher PA, and lower NA. Patients with more positive automatic thoughts experienced more social participation and higher PA. Patients with more negative automatic thoughts experienced more social participation, lower PA, and higher NA. Early rehabilitation and psychosocial interventions should be provided for postoperative hip fracture patients to improve their activities of daily living and emotional well-being.

The ABC of happiness: Validation of the tridimensional model of subjective well-being (affect, cognition, and behavior) using Bifactor Polytomous Multidimensional Item Response Theory

Background

Happiness is often conceptualized as subjective well-being, which comprises people's evaluations of emotional experiences (i.e., the affective dimension: positive and negative feelings and emotions) and judgements of a self-imposed ideal (i.e., the cognitive dimension: life satisfaction). Recent research has established these two dimensions as primary parts of a higher order factor. However, theoretical, conceptual, and empirical work suggest that people's evaluations of harmony in their life (i.e., the sense of balance and capacity to behave and adapt with both acceptance and flexibility to inter- and intrapersonal circumstances) constitutes a third dimension (i.e., the behavioral dimension). This tridemensional conceptualization of subjective well-being has recently been verified using Unidimensional Item Response Theory (UIRT) and Classical Test Theory (CTT). Here, we use a recently developed and more robust approach that combines these two methods (i.e., Multidimensional Item Response Theory, MIRT) to simultaneously address the complex interactions and multidimensionality behind how people feel, think, and behave in relation to happiness in their life.

Method

A total of 435 participants (197 males and 238 females) with an age mean of 44.84 (sd = 13.36) responded to the Positive Affect Negative Affect Schedule (10 positive affect items, 10 negative affect items), the Satisfaction with Life Scale (five items), and the Harmony in life Scale (five items). We used Bifactor-Graded Response MIRT for the main analyses.

Result

At the general level, each of the 30 items had a strong capacity to discriminate between respondents across all three dimensions of subjective well-being. The investigation of different parameters (e.g., marginal slopes, ECV, IECV) strongly reflected the multidimensionality of subjective well-being at the item, the scale, and the model level. Indeed, subjective well-being could explain 64 % of the common variance in the whole model. Moreover, most of the items measuring positive affect (8/10) and life satisfaction (4/5) and all the items measuring harmony in life (5/5) accounted for a larger amount of variance of subjective well-being compared to that of their respective individual dimensions. The negative affect items, however, measured its own individual concept to a lager extent rather than subjective well-being. Thus, suggesting that the experience of negative affect is a more independent dimension within the whole subjective well-being model. We also found that specific items (e.g., "Alert", "Distressed", "Irritable", "I am satisfied with my life") were the recurrent exceptions in our results. Last but not the least, experiencing high levels in one dimension seems to compensate for low levels in the others and vice versa.

Conclusion

As expected, the three subjective well-being dimensions do not work separately. Interestingly, the order and magnitude of the effect by each dimension on subjective well-being mirror how people define happiness in their life: first as harmony, second as satisfaction, third as positive emotions, and fourth, albeit to a much lesser degree, as negative emotions. Ergo, we argue that subjective well-being functions as a complex biopsychosocial adaptive system mirroring our attitude towards life in these three dimensions (A: affective dimension; B: behavioral dimension; C: cognitive dimension). Ergo, researchers and practitioners need to take in to account all three to fully understand, measure, and promote people's experience of the happy life. Moreover, our results also suggest that negative affect, especially regarding high activation unpleasant emotions, need considerable changes and further analyses if it is going to be included as a construct within the affective dimension of a general subjective well-being factor.

Well-Being Therapy for Depression

Well-being therapy (WBT) is a short-term psychotherapeutic strategy, based on the technique of self-observation via the use of a structured diary and the guide of a therapist, with the goal of increasing psychological well-being, thus reaching euthymia and a balance among psychic forces. WBT showed to be suitable for application in residual symptoms of unipolar and bipolar depression, since the sequential combination with cognitive-behavioural therapy (CBT) led to a decrease in the relapse rate of recurrent depression. WBT also showed clinical utility in the treatment of cyclothymia, which represents one of the stages of bipolar disorder. Further, WBT seems to have efficacy in treatment-resistant depression and in case of withdrawal syndromes (in particular the so-called persistent post-withdrawal disorder) following antidepressant decrease, switch or discontinuation. In brief, WBT is a rather new but promising therapeutic strategy in the management of unipolar and bipolar depression. This chapter offers an overview of WBT possible applications.

Effectiveness of an app-based intervention to improve well-being through cultivating positive thinking and positive emotions in an adult sample: study protocol for a randomized controlled trial

Introduction

Interventions to promote health and well-being based on the construction of psychological resources can positively impact the daily life of users and foster human flourishing. Nowadays, mobile health represents a safe way to support health research and implement evidence-based psychological interventions. The present study aims to evaluate the effectiveness of a mobile app-based intervention program (OneUS) designed to cultivate positive emotions and positive thinking to improve overall well-being.

Methods

The study is designed as a randomized controlled trial. Two hundred participants will be randomly assigned to either a mobile health intervention condition (OneUS App) or an active control condition. The intervention consists of a program to cultivate positive emotions and positive thoughts. The active control intervention will comprise a set of mental imagery exercises and daily routine recording. The primary outcome comprises optimal well-being assessed using the multidimensional PERMA-Profiler scale. The sample will include adult people from the general population, who will be assessed at 8 time points: baseline (t1), intervention (t2, t3, t4, t5, t6) post-intervention (t7) and 3-month follow-up (t8).

Discussion

Mobile apps seem to be promising tools to promote health and well-being. This study will evaluate the effectiveness of a mobile app (OneUS) aiming to cultivate positive emotions and positive thinking to improve well-being. The main strength of this study is the development of an evidence-based mobile health app, based on intentional mental training, to promote well-being. The limitations of this study relate to potential participant drop-out and the non-generalizability of the results to clinical populations.

Clinical trial registration

https://ensaiosclinicos.gov.br/rg/RBR-43hpwqk, Identifier RBR-43hpwqk.

What factors are associated with posttraumatic growth among mothers of children with developmental disabilities in South Korea?

BACKGROUND

The identification of PTG and its correlates in the aftermath of a traumatic event would assist professionals in recognizing and amplifying individual's potential strengths. However, there are few studies on PTG and its correlates in mothers who have birthed or raised children with developmental disabilities in South Korea.

AIM

This study examined the predictive role of caregiving strain and social support on the subdimensions of PTG among South Korean mothers of children with developmental disabilities.

METHODS AND PROCEDURES

The participants were 344 mothers of children with intellectual disabilities or autism. PTG was divided into four sub-dimensions (change in self-perception, increase in interpersonal depth, finding new possibilities, and increase in spiritual interest), and the predictive roles of caregiving strain and social support on each sub-dimension were identified using hierarchical multiple regression.

OUTCOMES AND RESULTS

Subjective caregiving strain; family support services; and support from family, friends, or significant others were significantly related to the subdimensions of PTG. Interestingly, support from significant others was positively associated with PTG.

CONCLUSIONS AND IMPLICATIONS

Social support was more likely to influence all subdimensions of PTG, except for changes in self-perception while only subject caregiving strain was associated with PTG. Thus, policymakers and practitioners should prioritize expanding family support services and strengthening various informal supportive resources for mothers with higher PTG.

Enhancing future-directed thinking in people with first-episode psychosis using a guided imagery intervention

BACKGROUND AND OBJECTIVES

Future-directed thinking (FDT) is associated with goal directed behaviour and may differ in people with psychosis compared to non-clinical controls. This study investigated whether guided imagery could enhance positive FDT in people with psychosis.

METHOD

Participants were 44 people experiencing a first episode of psychosis. They were assessed for negative and positive symptoms, FDT on the Future Thinking Task (FTT), depression, anxiety, autobiographical memory, verbal fluency and spontaneous use of imagery. They were randomised to either a positive or neutral imagery condition, before being retested on the FTT. Outcomes on the FTT were number of events generated, anticipated likelihood, anticipated affect and a composite score.

RESULTS

Participants in the positive imagery condition generated significantly more positive events on the FTT compared with those in the neutral (F (1, 42) = 19.916, p < .001, η_p² = 0.322). In both imagery conditions, likelihood ratings of positive events increased post-intervention. Positive and negative events were both perceived as less likely to occur the further into the future they were, and positive events were anticipated to be more positive and negative events more negative, the further into the future they were.

LIMITATIONS

The participants in this study experienced relatively low levels of symptoms, and therefore caution should be used when applying these results to people with greater symptomatology.

CONCLUSIONS

Positive guided imagery shows promise for enhancing positive FDT in people with first-episode psychosis. This intervention may offer a simple and effective method of enhancing engagement with the future, with potential implications for goal-directed behaviour.

Internal conversations, self-reliance and social support in emerging adults transitioning from out-of-home care: An interpretative phenomenological study

Young people transitioning from out-of-home care frequently have a history of maltreatment and multiple psychosocial challenges. 'Survivalist self-reliance' - thought to involve social disconnection from others, and reluctance to seek support - provides one coping strategy. However, little is known about the self-reliant young person's own reflexive interpretations of social relationships and support during transition. This qualitative study addresses the question: In the context of transitioning from out-of-home care, what reflexive meanings do 'avowedly' self-reliant individuals attribute to current social support and social relationships? Participants were four avowedly self-reliant young adults in transition from care, each with a history of maltreatment and multiple adversities. In this secondary analysis, data were from semi-structured interviews utilizing Margaret Archer's internal conversations interview framework. Data were analyzed using Interpretative Phenomenological Analysis (IPA). Three thematic contexts were identified in which social support was salient: (a) current thoughts and active memories of both the birth family and foster families; (b) the importance of socializing; and (c) perceptions of formal services. There was evidence of cognitive reappraisal (a known amenable resilience factor) and selective engagement with social support, despite the strong overall stance of self-reliance. The findings suggest a more nuanced approach to our understanding of 'survivalist self-reliance'.

A mindfulness-based, stress and coping model of craving in methamphetamine users

There is increasing interest in the role of mindfulness and mindfulness-based interventions to optimize recovery from a substance use disorder (SUD). However, relatively little is known about the theory-based psychological and social pathways whereby mindfulness could have beneficial effects for managing a chronic, relapsing SUD. Informed by Revised Stress and Coping Theory, the present cross-sectional study examined affective, cognitive, and social pathways whereby mindfulness is associated with lower methamphetamine craving. A total of 161 HIV-positive, methamphetamine-using sexual minority men completed a screening visit for a randomized controlled trial. Using a hybrid structural equation model, we examined pathways whereby mindfulness is associated with lower methamphetamine craving. We found that greater mindfulness was directly associated with lower negative affect and higher positive affect as well as indirectly associated with less methamphetamine craving. Interestingly, the indirect association between mindfulness and methamphetamine craving appeared to be uniquely attributable to positive affect. Only positive affect was indirectly associated with lower methamphetamine craving via higher positive re-appraisal coping and greater self-efficacy for managing triggers for methamphetamine use. Methamphetamine craving was supported by moderate associations with greater substance use severity and more frequent methamphetamine use. These findings support the role of mindfulness in cultivating positive affect, which could be crucial to build the capacity of individuals to manage methamphetamine craving as a chronic stressor that threatens recovery from SUD.

Thoughts about health and patient-reported outcomes among people with diabetes mellitus: results from the DiaDec-study

Background

There is considerable evidence that repetitive negative thoughts are often associated with adverse health outcomes. The study aims are (i) to identify the frequency and valence of thoughts about health in people with diabetes mellitus using questions based on the day reconstruction method (DRM) and (ii) to analyse associations between thoughts about health and health-related quality of life (HRQoL), diabetes-related distress and depressive symptoms.

Methods

Cross-sectional study of a random sample of a German statutory health insurance population with diabetes aged between 18 and 80 linking questionnaire and claims data. Associations between frequency and valence of thoughts about health on a previous day and HRQoL assessed by a 12-Item Short-Form Health Survey, diabetes-related distress assessed using the Problem Areas in Diabetes scale and depressive symptoms assessed by Patient Health Questionnaire-9 were analysed using linear and logistic regression analysis, adjusting for sociodemographic and clinical characteristics.

Results

Thoughts about health were analysed in 726 participants (86% type 2 diabetes, 62% male, mean age 67.6 ± 9.7 years). A total of 46% had not thought about their health the day before, 17.1% reported low frequency and negative thoughts, 21.4% low frequency and positive thoughts, 12.1% high frequency and negative thoughts and 3.4% high frequency and positive thoughts. The presence of thoughts about health irrespective of their frequency and valence is associated with a lower physical and mental component summary score of the 12-Item Short-Form Health Survey. Negative thoughts are associated with high diabetes-related distress. Frequent or negative thoughts are associated with depressive symptoms.

Conclusions

Thoughts about health are a part of everyday life for a substantial number of people with diabetes. Surprisingly, even positive thoughts are associated with poorer HRQoL in our study. Further research within the DRM paradigm is needed to understand how thoughts about health may affect people’s (assessment of) state of health. Thoughts about health should be considered in diabetes education and patient counselling with a view to preventing and treating emotional disorders. More attention should be paid to the outcomes of interventions that may themselves lead to an increase in the frequency of thoughts about health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10231-y.

Metta-based group meditation and individual cognitive behavioral therapy (MeCBT) for chronic depression: study protocol for a randomized controlled trial

BACKGROUND

Depression is a widespread disorder with severe impacts for individuals and society, especially in its chronic form. Current treatment approaches for persistent depression have focused primarily on reducing negative affect and have paid little attention to promoting positive affect. Previous studies have shown that metta meditation increases positive affect in chronically depressed patients. Results from previous trials provide evidence for the efficacy of a stand-alone metta meditation group treatment in combination with mindfulness-based approaches. Further research is needed to better understand the implementation of meditation practice into everyday life. Therefore, mindfulness and metta meditation in a group setting are combined with individual cognitive behavioral therapy (CBT) into a new, low-intensity, cost-effective treatment ("MeCBT") for chronic depression.

METHODS/DESIGN

In this single-center, randomized, observer-blinded, parallel-group clinical trial we will test the efficacy of MeCBT in reducing depression compared to a wait-list control condition. Forty-eight participants in a balanced design will be allocated randomly to a treatment group or a wait-list control group. Metta-based group meditation will be offered in eight weekly sessions and one additional half-day retreat. Subsequent individual CBT will be conducted in eight fortnightly sessions. Outcome measures will be assessed at four time points: before intervention (T0); after group meditation (T1); after individual CBT (T2); and, in the treated group only, at 6-month follow-up (T3). Changes in depressive symptoms (clinician rating), assessed with the Quick Inventory of Depressive Symptoms (QIDS-C) are the primary outcome. We expect a significant decline of depressive symptoms at T2 compared to the wait-list control group. Secondary outcome measures include self-rated depression, mindfulness, benevolence, rumination, emotion regulation, social connectedness, social functioning, as well as behavioral and cognitive avoidance. We will explore changes at T1 and T2 in all these secondary outcome variables.

DISCUSSION

To our knowledge this is the first study to combine a group program focusing on Metta meditation with state-of-the art individual CBT specifically tailored to chronic depression. Implications for further refinement and examination of the treatment program are discussed.

TRIAL REGISTRATION

ISRCTN, ISRCTN97264476. Registered 29 March 2018 (applied on 14 December 2017)-retrospectively registered.

An Empirical Test of the Three-Step Theory of Suicide in U.K. University Students

The purpose of this study was to further our understanding of how individuals move down the pathway from first thinking about suicide to ultimately attempting to take their own lives by empirically testing the Three-Step Theory (3ST) in a sample of university students (n = 665). Results largely support the theory's central propositions. First, an interactive model of pain and hopelessness accounted for substantial variance in suicidal desire. This result replicated in both men and women, and across age groups (i.e., below 35 and at or above 35). Also, as predicted, connectedness was protective against ideation in those high on both pain and hopelessness. However, contrary to our prediction, connectedness was similarly protective among everyone else. Finally, suicide capacity predicted suicide attempt history over and above current and lifetime suicide ideation. These findings provide further support to the 3ST.

The vividness of imagining emotional feelings in positive situations is attenuated in non-clinical dysphoria and predicts the experience of positive emotional feelings

OBJECTIVE

The vividness of imagining emotional feelings in positive situations (EFP) in non-clinically dysphoric and non-dysphoric individuals and its relation to dysphoric and positive feelings was examined.

METHOD

Participants were university students in Study 1 (N = 106, 84 women; 18-45 years), in Study 2 (N = 43, 39 women; 20-47 years), in Study 3 (N = 109, 92 women; 18-50 years) who filled out a set of questionnaires assessing depressive symptoms, cognition measures, and then completed an affective imagery task, using a cross-sectional design.

RESULTS

Non-clinically dysphoric participants imagined less vividly EFP than non-dysphoric participants. The vividness of imagining EFP accounted for group differences in positive feelings beyond positive and negative cognition and negative mood.

CONCLUSIONS

In addition to deficits in the general imagery of positive events, the attenuation of vividness of EFP in non-clinical dysphoric individuals warrants attention as a separate pathway by which non-clinically dysphoric individuals develop deficiencies of conscious positive feelings.

Role of Religiosity in Psychological Well-Being Among Medical and Non-medical Students

Religion has been generally considered as a protective factor for the psychological health of the people. As many studies have publicized a high prevalence of psychological morbidities among the medical students during their academic stages of medical schools, it is significant to investigate whether religiosity functions as a protective factor, to explore religiosity as a predictor of psychological well-being in a sample of medical students, and to compare the results of medical students as well as non-medical students with respect to religiosity and psychological well-being. The study is carried out in Federal Medical and Dental College and International Islamic University, Islamabad. The present study examined a sample of 120 medical students from Federal Medical and Dental College and 120 non-medical students from International Islamic University, Islamabad. Purposive sampling was used. The respondents completed religious orientation scale and scale of psychological well-being scale along with a demographic data sheet. In order to measure the study variables, linear regression and t test were used. The findings revealed that religiosity is a strong predictor of psychological well-being. Extrinsic and intrinsic religiosity predicts psychological well-being among the students. The results indicated a significant difference in psychological well-being between medical and non-medical students. No significant difference was found in religiosity of medical and non-medical students. The gender differences in religiosity and psychological well-being were found to be insignificant. The results emphasize that psychological well-being is prophesied by religiosity. The present research suggests further investigations and also endows with trends for psychological evaluation, development of religious beliefs, and interventions for augmenting psychological well-being among the medical students.

Effects of Engaging in Repeated Mental Imagery of Future Positive Events on Behavioural Activation in Individuals with Major Depressive Disorder

Depression is associated with decreased engagement in behavioural activities. A wide range of activities can be promoted by simulating them via mental imagery. Mental imagery of positive events could thus provide a route to increasing adaptive behaviour in depression. The current study tested whether repeated engagement in positive mental imagery led to increases in behavioural activation in participants with depression, using data from a randomized controlled trial (Blackwell et al. in Clin Psychol Sci 3(1):91–111, 2015. doi:10.1177/2167702614560746). Participants (N = 150) were randomized to a 4-week positive imagery intervention or an active non-imagery control condition, completed via the internet. Behavioural activation was assessed five times up to 6 months follow-up using the Behavioural Activation for Depression Scale (BADS). While BADS scores increased over time in both groups, there was an initial greater increase in the imagery condition. Investigating mental imagery simulation of positive activities as a means to promote behavioural activation in depression could provide a fruitful line of enquiry for future research.

Self-management and quality of life in chronic obstructive pulmonary disease (COPD): The mediating effects of positive affect

OBJECTIVE

This study aimed to increase our understanding of general self-management (SM) abilities in COPD by determining if SM can predict disease specific quality of life (QoL), by investigating whether specific SM domains are significant in COPD and by exploring the mediating effect of the positive/negative affect in the association between SM and QoL.

METHODS

Cross-sectional study based on 292 patients with COPD. Measures included demographics, lung function, gait speed, health care utilization, positive/negative affect, SM abilities, breathlessness and disease specific QoL. We performed, correlation, multiple regression models and mediation analysis (positive/negative affect being mediator between SM and QoL association).

RESULTS

After controlling for breathlessness, living alone, marital status, hospitalization history, age and lung function, SM related to QoL (p<0.0001). Investment in behaviors (hobbies and social relationships) and self-efficacy are SM domains independently related to QoL in COPD. Positivity measured by the positive/negative affect ratio completely mediates the relationship of SM with QoL.

CONCLUSION

SM is independently associated with disease specific QoL in COPD after adjustment significant covariates but positive/negative affect ratio completely mediates the relationship of SM with QoL.

PRACTICE IMPLICATIONS

Measuring positive/negative affect and addressing investment behavior and self-efficacy are important in implementing COPD-SM programs.

Mental Imagery in Depression: Phenomenology, Potential Mechanisms, and Treatment Implications

Mental imagery is an experience like perception in the absence of a percept. It is a ubiquitous feature of human cognition, yet it has been relatively neglected in the etiology, maintenance, and treatment of depression. Imagery abnormalities in depression include an excess of intrusive negative mental imagery; impoverished positive imagery; bias for observer perspective imagery; and overgeneral memory, in which specific imagery is lacking. We consider the contribution of imagery dysfunctions to depressive psychopathology and implications for cognitive behavioral interventions. Treatment advances capitalizing on the representational format of imagery (as opposed to its content) are reviewed, including imagery rescripting, positive imagery generation, and memory specificity training. Consideration of mental imagery can contribute to clinical assessment and imagery-focused psychological therapeutic techniques and promote investigation of underlying mechanisms for treatment innovation. Research into mental imagery in depression is at an early stage. Work that bridges clinical psychology and neuroscience in the investigation of imagery-related mechanisms is recommended.

Empowering families to help a loved one with Hoarding Disorder: pilot study of Family-As-Motivators training

Individuals with Hoarding Disorder (HD)-a dangerous problem and public health concern-are often ambivalent about treatment. Furthermore, family members of those with HD report high levels of distress and often attempt to intervene unsuccessfully. The current study reports outcome data from a pilot study of a new training package-designed exclusively for empowering family members to address a loved one's treatment ambivalence-called Family-As-Motivators (FAM) training. Nine family members of a loved one with HD initiated 14 sessions of FAM Training and were measured at pre-, mid-, and post-training on a comprehensive outcome battery. Results over the course of training suggested that family members improved in the use of certain coping strategies and in the application of motivational interviewing techniques. They also exhibited increased hopefulness, reported a reduced negative impact of HD on the family, rated a reduction in family accommodation of HD behaviors, and displayed boosts in HD and motivational interviewing knowledge. According to participants who completed the program, FAM Training was rated as highly acceptable. Although only preliminary, the current pilot study suggests that FAM Training is palatable for participants and shows promise for improving the lives of family members of those with HD.

Optimism and mental imagery: a possible cognitive marker to promote well-being?

Optimism is associated with a range of benefits not only for general well-being, but also for mental and physical health. The development of psychological interventions to boost optimism derived from cognitive science would have the potential to provide significant public health benefits, yet cognitive markers of optimism are little understood. The current study aimed to take a first step in this direction by identifying a cognitive marker for optimism that could provide a modifiable target for innovative interventions. In particular we predicted that the ability to generate vivid positive mental imagery of the future would be associated with dispositional optimism. A community sample of 237 participants completed a survey comprising measures of mental imagery and optimism, and socio-demographic information. Vividness of positive future imagery was significantly associated with optimism, even when adjusting for socio-demographic factors and everyday imagery use. The ability to generate vivid mental imagery of positive future events may provide a modifiable cognitive marker of optimism. Boosting positive future imagery could provide a cognitive target for treatment innovations to promote optimism, with implications for mental health and even physical well-being.

Well-being, positivity and mental health: an introduction to the special issue

Enhancing well-being, as opposed to reducing distress, has traditionally not been a focus for clinical practice. There are differences in views about the nature of well-being, but enhancing well-being in clinical settings is a straightforward goal whatever concept of well-being is adopted. Reasons for adopting a well-being enhancing, as well as a distress-reducing, focus include the fact that many psychological problems do not fit the simple acute treatment model of disorder, that positive experience inhibits negative experience, and that people can benefit from therapists seeing them as more than the sum of their problems. In recent years, well-being has been of increasing interest to researchers and clinicians, and enhancing well-being is emerging as a potentially valuable element of effective clinical practice.

Involuntary memories after a positive film are dampened by a visuospatial task: unhelpful in depression but helpful in mania?

Spontaneous negative mental images have been extensively researched due to the crucial role they play in conditions such as post-traumatic stress disorder. However, people can also experience spontaneous positive mental images, and these are little understood. Positive images may play a role in promoting healthy positive mood and may be lacking in conditions such as depression. However, they may also occur in problematic states of elevated mood, such as in bipolar disorder. Can we apply an understanding of spontaneous imagery gained by the study of spontaneous negative images to spontaneous positive images? In an analogue of the trauma film studies, 69 volunteers viewed an explicitly positive (rather than traumatic) film. Participants were randomly allocated post-film either to perform a visuospatial task (the computer game 'Tetris') or to a no-task control condition. Viewing the film enhanced positive mood and immediately post-film increased goal setting on a questionnaire measure. The film was successful in generating involuntary memories of specific scenes over the following week. As predicted, compared with the control condition, participants in the visuospatial task condition reported significantly fewer involuntary memories from the film in a diary over the subsequent week. Furthermore, scores on a recognition memory test at 1 week indicated an impairment in voluntary recall of the film in the visuospatial task condition. Clinical implications regarding the modulation of positive imagery after a positive emotional experience are discussed. Generally, boosting positive imagery may be a useful strategy for the recovery of depressed mood.

Autobiographical memory characteristics in depression vulnerability: formerly depressed individuals recall less vivid positive memories

The differential activation hypothesis (DAH; Teasdale, 1988) proposes that individuals who are vulnerable to depression can be distinguished from non-vulnerable individuals by the degree to which negative thoughts and maladaptive cognitive processes are activated during sad mood. While retrieval of negative autobiographical memories is noted as one such process, the model does not articulate a role for deficits in recalling positive memories. Two studies were conducted to compare the autobiographical memory characteristics of never-depressed and formerly depressed individuals following a sad mood induction. In Study 1, features of negative memories of never-depressed and formerly depressed individuals did not differ, either in neutral or sad mood. For positive memories, groups did not differ in neutral mood, but following a sad mood induction, formerly depressed individuals rated their positive memories as less vivid than their never-depressed counterparts. Study 2 examined positive autobiographical memory features more comprehensively and replicated the finding that in a sad mood formerly depressed individuals recalled less vivid positive memories than never-depressed controls. These findings suggest that the phenomenological features of positive memories could represent an important factor in depressive vulnerability, and, more broadly, that depression may be associated with a deficit in the processing of positive material.

Relationship of Mental Health and Illness in Substance Abuse Patients

This study examined the latent structure of a number of measures of mental health (MH) and mental illness (MI) in substance use disorder outpatients to determine whether they represent two independent dimensions, as Keyes (2005) found in a community sample. Seven aspects of MI assessed were assessed - optimism, personal meaning, spirituality/religiosity, social support, positive mood, hope, and vitality. MI was assessed with two measures of negative psychological moods/states, a measure of antisociality, and the Addiction Severity Index's recent psychiatric and family-social problem scores. Correlational and exploratory factor analyses revealed that MH and MI appear to reflect two independent, but correlated, constructs. However, optimism and social support had relatively high loadings on both factors. Antisociality and the family-social problem score failed to load significantly on the MI factor. Confirmatory factor analysis supported the existence of two obliquely related, negatively correlated dimensions. Study findings, although generally supporting the independence of MH and MI, suggest that the specific answers to this question may be influenced by the constructs and assessments used to measure them.

Positive everyday experiences interact with social support to predict depression in multiple sclerosis

Both social support and stress predict depression in multiple sclerosis (MS) patients. Little work has been done on the relationship between positive life experiences and depression in this group. Ninety MS patients completed the Social Support Questionnaire (SSQ), the Hassles and Uplifts Scale (HUS), the Chicago Multiscale Depression Inventory (CMDI), and the Affective Reading Span Task (ARST). The Expanded Disability Status Scale (EDSS) was also used. Separate regression analyses were conducted with the EDSS entered at step 1, ARST memory bias score at step 2, SSQ at step 3, either Hassles or Uplifts at step 4, and the interaction term at step 5 to predict depression. Uplifts interacted significantly with social support to predict depression, but hassles did not. After considering disability level, memory bias, and social support and uplifts main effects, the interaction of uplifts and social support accounted for nearly 5% independent variance in depression (p < .05). These results suggest that the absence of uplifts, combined with low levels of social support, is related to depression in MS patients. More generally, these data indicate that it is important to study the absence of positive experiences along with stress and negative experiences in this population.

Differential effects of well-being promoting and anxiety-management strategies in a non-clinical school setting

The aim of the present study was to examine the differential effects of strategies for promotion of psychological well-being (Well-Being Therapy, WBT) and removal of distress (Anxiety Management, AM) in a non-clinical school setting.162 students attending middle schools in Northern Italy were randomly assigned to: (a) a protocol derived from WBT; (b) an anxiety-management protocol (AM). The students were assessed immediately before and after the interventions, and after 6 months using: Psychological Well-Being Scales (PWB), Symptom Questionnaire (SQ) and the Revised Children's Manifest Anxiety Scale (RCMAS). In school children, well-being and symptom focused interventions produced slightly different effects on psychological dimensions. WBT, by facilitating progression toward positive and optimal functioning, may integrate symptom-centered strategies.

School intervention for promoting psychological well-being in adolescence

OBJECTIVE

to test the efficacy of a new school program for the promotion of psychological well-being. In this study a school program for promoting psychological well-being has been compared to an attention-placebo intervention in a high school setting.

METHODS

Nine classes (227 students) were randomly assigned to: a) Well-Being intervention (5 classes); b)attention-placebo (4 classes). Assessment was performed at pre and post-intervention, and after six months using: 1) Symptom Questionnaire (SQ); 2) Psychological Well-Being Scales (PWB); 3) Revised Children's Manifest Anxiety Scale (RCMAS).

RESULTS

A significant effect of WB school intervention in improving Personal Growth (PWB), and in decreasing distress (Somatization (SQ), Physical Well-being (SQ), Anxiety (SQ), and RCMAS Physiological Anxiety) emerged.

CONCLUSIONS

A school intervention based on promoting positive emotions and well-being was effective not only in increasing psychological well-being among adolescents, but also in decreasing distress, in particular anxiety and somatization.

Active multimodal psychotherapy in children and adolescents with suicidality: description, evaluation and clinical profile

The aim of this study was to describe and evaluate the clinical pattern of 14 youths with presenting suicidality, to describe an integrative treatment approach, and to estimate therapy effectiveness. Fourteen patients aged 10 to 18 years from a child and adolescent outpatient clinic in Stockholm were followed in a case series. The patients were treated with active multimodal psychotherapy. This consisted of mood charting by mood-maps, psycho-education, wellbeing practice and trauma resolution. Active techniques were psychodrama and body-mind focused techniques including eye movement desensitization and reprocessing. The patients were assessed before treatment, immediately after treatment and at 22 months post treatment with the Global Assessment of Functioning Scale. The clinical pattern of the group was observed. After treatment there was a significant change towards normality in the Global Assessment of Functioning scale both immediately post-treatment and at 22 months. A clinical pattern, post trauma suicidal reaction, was observed with a combination of suicidality, insomnia, bodily symptoms and disturbed mood regulation. We conclude that in the post trauma reaction suicidality might be a presenting symptom in young people. Despite the shortcomings of a case series the results of this study suggest that a mood-map-based multimodal treatment approach with active techniques might be of value in the treatment of children and youth with suicidality.

Facilitating a benign interpretation bias in a high socially anxious population

Previous research has shown that high socially anxious individuals lack the benign interpretation bias present in people without social anxiety. The tendency of high socially anxious people to generate more negative interpretations may lead to anticipated anxiety about future social situations. If so, developing a more benign interpretation bias could lead to a reduction in this anxiety. The current study showed that a benign interpretation bias could be facilitated (or 'trained') in a high socially anxious population. Participants in the benign training groups had repeated practice in accessing benign (positive or non-negative) interpretations of potentially threatening social scenarios. Participants in the control condition were presented with the same social scenarios but without their outcomes being specified. In a later recognition task, participants who received benign interpretation training generated more benign, and less negative, interpretations of new ambiguous social situations compared to the control group. Participants who received benign training also predicted that they would be significantly less anxious in a future social situation than those in the control group. Possible implications of the findings for therapeutic interventions in social phobia are discussed.

Future-directed thinking and depression in relapsing-remitting multiple sclerosis

BACKGROUND

Research has shown that depression is associated with a view of the future characterized by reduced anticipation of future positive experiences, but not necessarily increased anticipation of future negative experiences. The aim of the present study was to investigate how participants with relapsing-remitting multiple sclerosis (MS) anticipated their future in terms of positive and negative events.

DESIGN

A mixed design compared three groups of participants on a measure of future thinking using an adapted verbal fluency paradigm.

METHODS

Depressed MS participants (N=14), non-depressed MS participants (N=28) and healthy control participants (N=26) were assessed on their ability to generate future positive and negative experiences. A content analysis was also conducted on the responses generated by the MS depressed and MS non-depressed groups according to whether or not they were related to MS.

RESULTS

The MS depressed group anticipated significantly fewer future positive events than the healthy control group and the MS non-depressed group. The three groups did not differ in the total numbers of anticipated future negative events, though the MS depressed group did anticipate a significantly higher proportion of MS-related negative events.

CONCLUSIONS

Like depressed but physically healthy individuals, the MS depressed group was characterized by a lack of positive thoughts about the future, rather than an increased number of negative thoughts. The clinical implications of these findings are discussed along with recommendations for future research.

Alternatives to debriefing and modifications to cognitive behavior therapy for posttraumatic stress disorder

BACKGROUND

Psychological debriefing uses brief unsystematic exposure, and is ineffective for posttraumatic stress symptoms and disorder. Systematic exposure alone and cognitive restructuring alone are each effective. Other approaches too may be useful.

METHODS

The treatment of 3 posttraumatic stress disorder (PTSD) patients is detailed in which there was no exposure to the main traumatic event. There was exposure to related cues in case 1, exposure to related and other cues followed by well-being therapy (WBT) in case 2 and WBT in case 3.

RESULTS

The 3 patients improved enduringly, confirming earlier findings that exposure to the main trauma is not essential for PTSD to improve.

CONCLUSIONS

A study is needed of therapeutic mechanisms in PTSD and of the value of WBT in a randomized controlled trial.

Zur aktuellen Stimmung von Patienten: Wie relevant ist sie im Therapiegeschehen?

Zusammenfassung. Theoretischer Hintergrund: Das Stimmungsmediationsmodell von Robinson schreibt der aktuellen Stimmung von Personen sowohl eine retrospektive als auch eine prospektive Funktion bei der Verarbeitung aktueller Lebensereignisse zu. Die Implikationen des Modells für die Psychotherapie werden untersucht. Fragestellung: Inwieweit kommt der aktuellen Stimmung von Patienten eine Mediatorfunktion im Therapiegeschehen zu? Methode: Im Rahmen einer randomisierten kontrollierten Studie zur Psychotherapie sozialer Phobie (N = 74 Patienten) wurde die zum Ende jeder Therapiesitzung erhobene Stimmung in Beziehung zu Therapieprozess und Sitzungsergebnis gesetzt. Die Zusammenhänge zur Eingangssymptomatik wurden analysiert. Ergebnisse: Es ergeben sich für fast alle Therapiephasen positive Zusammenhänge zwischen Stimmung und Therapieprozess sowie Sitzungsergebnis. Je höher die Symptombelastung vor Therapiebeginn, desto negativer ist die aktuelle Stimmung in der ersten Therapiephase. Schlussfolgerungen: Die Ergebnisse belegen auf die Relevanz der aktuellen Stimmung von Patienten für die Regulation des Therapieprozesses und die Verbesserung des Sitzungsergebnisses.

The role of catastrophic misinterpretation of bodily sensations and panic self-efficacy in predicting panic severity

This study investigated the role of both negative and positive cognitions in predicting panic severity in an international sample of patients diagnosed with panic disorder (with and without agoraphobia). One hundred and fifty-nine patients were administered the Brief Bodily Sensations Interpretation Questionnaire (BBSIQ), the Self-efficacy to Control Panic Attacks Questionnaire, and the Panic and Agoraphobia Scale (PAS) prior to receiving treatment. Regression analyses indicated that both catastrophic misinterpretation of bodily sensations and panic self-efficacy independently predicted panic severity. The influence of panic self-efficacy upon panic severity remained significant even after controlling for the presence or absence of agoraphobia. There was no evidence to suggest a moderating relationship between the two cognitive factors. Results are discussed in terms of the need to consider both negative and positive cognitions in cognitive accounts of panic disorder.

An integrated cognitive model of panic disorder: The role of positive and negative cognitions

One reason for the neglect of the role of positive factors in cognitive-behavioural therapy (CBT) may relate to a failure to develop cognitive models that integrate positive and negative cognitions. Bandura [Psychol. Rev. 84 (1977) 191; Anxiety Res. 1 (1988) 77] proposed that self-efficacy beliefs mediate a range of emotional and behavioural outcomes. However, in panic disorder, cognitively based research to date has largely focused on catastrophic misinterpretation of bodily sensations. Although a number of studies support each of the predictions associated with the account of panic disorder that is based on the role of negative cognitions, a review of the literature indicated that a cognitively based explanation of the disorder may be considerably strengthened by inclusion of positive cognitions that emphasize control or coping. Evidence to support an Integrated Cognitive Model (ICM) of panic disorder was examined and the theoretical implications of this model were discussed in terms of both schema change and compensatory skills accounts of change processes in CBT.