Positive and Negative Affect as Links Between Social Anxiety and Depression: Predicting Concurrent and Prospective Mood Symptoms in Unipolar and Bipolar Mood Disorders

Social Motivation Differentiates Social Anxiety and Depression: A Daily Diary Study

Because social anxiety and depression commonly co-occur, it can be challenging to disentangle the emotional and motivational features of these conditions in everyday life contexts. In this daily diary study, we sought to understand the interplay between daily social anxiety and depression symptoms and emotion and motivation, determining whether daily symptoms are independently linked with positive affect, negative affect, and social motivation (desire to approach or to withdraw from others). Community-dwelling adults (N = 269) with a wide range of social anxiety and depression symptoms completed daily assessments for 14 consecutive days (a total of 2,986 daily surveys). Within-person analyses found that increases in social anxiety and depression symptoms were uniquely associated with elevated negative affect; only increases in depression symptoms were associated with diminished positive affect. Increases in social anxiety symptoms were associated with an elevated desire to approach others but not a desire to withdraw from others. By contrast, increases in depression symptoms were associated with a diminished desire to approach others and an elevated desire to withdraw from others. Desire for social connection may distinguish social anxiety from depression. Examining patterns of daily social motivation may enhance clinicians' ability to differentiate the difficulties that arise from social anxiety from those that arise from depression.

The Impact of Mental Imagery Instructions on Patients' and Therapists' Positive Affect and Strength-Based Behaviours Within Psychotherapy Sessions: A Randomized Controlled Process Study

OBJECTIVE

Increased attention has recently been paid to the well-being and flourishing of patients in psychotherapy. This study investigated the occurrence of positive affect (PA) and strength-based behaviours within psychotherapy sessions contrasting positive versus neutral imagery instructions.

METHODS

This is a secondary analysis of a randomized controlled trial. Seventy-eight sessions of cognitive behavioural therapy involving 26 patients (69.23% female; Mage = 40.31) treated by 13 therapists were selected. PA and strength-based behaviours of patients and therapists were coded on a minute-by-minute basis with the Resource-Oriented Microprocess Analysis. Each session started with a brief mental imagery instruction. Data were analysed using multilevel modelling.

RESULTS

Mild levels of PA were very common, whereas stronger expressions were occasional, especially at the beginning and end of sessions. Strength-based behaviours were employed in one-fifth of the videos analysed. Therapists in the positive imagery instruction showed more strength-based behaviours in the beginning phase of sessions, p < 0.05. The two imagery instructions significantly differed in the session trajectories of PA, p < 0.05. A quadratic trend with higher initial values and a sharper decline in PA were found in the positive instruction, whereas the neutral instruction showed a flatter trend.

CONCLUSION

Patients and therapists experience PA and discuss strengths in psychotherapy sessions despite patients' distress. The positive imagery instructions potentially induced a positive focus at baseline for therapists but had a negligible effect on the subsequent session progression.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03767101 (registered December 6, 2018).

Remote work arrangement: a blessing in disguise for socially anxious individuals

This research examines the link between social anxiety disorder (SAD), psychological distance (PD), and burnout using survey data from 463 software development workers who are currently working remotely. According to the results of the study, SAD was associated with higher PD, but, in contrast to what had been shown in earlier studies, this higher PD had no effect on the participants' reported levels of burnout. Both psychological safety and workplace attachment orientation (WAO) were tested for their moderating effects in this study. According to the study's findings, the link between SAD and PD was moderated by WAO but not by psychological safety. The findings of this study underscore the importance of conducting additional research on the challenges faced by people with social anxiety in the workplace and the steps that can be taken by employers to better accommodate them.

Longitudinal associations of daily affective dynamics with depression, generalized anxiety, and social anxiety symptoms

BACKGROUND

Low average affect, measured using ecological momentary assessment (EMA), has been consistently linked with depression, generalized anxiety, and social anxiety, supporting trait-like negative affect as a shared underlying feature. However, while theoretical models of emotion regulation would also implicate greater variability in daily affect in these conditions, empirical evidence linking EMA of mood variability with affective disorders is mixed. We used multilevel modeling to test relationships of daily mood and mood variability with depression, generalized anxiety, and social anxiety symptoms.

METHODS

Participants (N = 1004; 72.31 % female; Mage = 40.85) responded to EMA of mood 2-3×/day and completed measures of depression (PHQ-8), generalized anxiety (GAD-7), and social anxiety (SPIN) every three weeks.

RESULTS

Lower mean affect predicted all symptoms at both the between-person (PHQ-8: β = -0.486, p < 0.001; GAD-7: β = -0.429, p < 0.001; SPIN: β = -0.284, p < 0.001) and within-person (PHQ-8: β = -0.219, p < 0.001; GAD-7: β = -0.196, p < 0.001; SPIN: β = -0.049, p < 0.001) levels. Similarly, at the between-person level, greater affective variability was linked with all three clinical symptoms (PHQ-8: β = 0.617, p < 0.001; GAD-7: β = 0.703, p < 0.001; SPIN: β = 0.449, p < 0.001). However, within-person, affective variability related to depression (β = 0.144, p < 0.001) and generalized anxiety (β = 0.150, p < 0.001), but not social anxiety (β = 0.006, p = 0.712).

LIMITATIONS

The COVID-19 pandemic lockdown period occurred midway through the study.

CONCLUSION

Findings point to common and specific emotion dynamics that characterize affective symptoms severity, with implications for affective monitoring in a clinical context.

The impacts of intra-individual daily sleep variability on daytime functioning and sleep architecture in healthy young adults: An experimental study

Sleep variability is commonly seen in the young populations. This study aimed to examine the impacts of experimentally induced sleep variability on sleepiness, mood, cognitive performance and sleep architectures among young adults. Thirty-six healthy individuals (aged 18-22 years) were randomly assigned to either variable sleep schedule (n = 20) or control (n = 16) groups. The protocol involved 1 week of regular sleep (time in bed = 7.5 hr) in the home setting, followed by one adaptation night (time in bed = 7.5 hr), one baseline night (time in bed = 7.5 hr), and 6 nights of sleep manipulation in the laboratory monitored by polysomnography (three cycles of variable sleep schedule by changing daily time in bed alternating between 6 hr and 9 hr for variable sleep schedule group versus fixed sleep schedule with daily time in bed for 7.5 hr for control group). Sleepiness, mood, sustained attention, processing speed, response inhibition and working memory were measured every morning and evening. The variable sleep schedule group reported a higher level of sleepiness, especially in the mornings, and increased negative mood in the evenings. There were no significant differences in positive mood, cognitive performance and sleep macro- and micro-structures. Our results showed the negative effects of sleep variability on daytime functioning especially sleepiness and negative mood, suggesting the need to address variable sleep schedules through sleep intervention.

Exploring the relationship across autonomous motivation, affects, and anxiety among gym practitioners during the second COVID-19 lockdown

The present study explores the association of autonomous motivation and the relationship of positive and negative affect on anxiety levels among individuals engaged in gym practitioners during the second COVID-19 lockdown. A total of 196 exercisers (29.17 ± 10.77) were enrolled in the present study, of which 112 (57.1%) were women and 84 (42.9%) were men. The survey included sociodemographic data, as well as validated instruments measuring autonomous motivation, positive and negative affect, and anxiety states related to the COVID-19 pandemic. The results revealed a positive association between autonomous motivation and positive affect (β = 0.36, CI 0.12, 0.37; p < 0.001), and a negative association between autonomous motivation and negative affect (β = - 0.17, CI - 0.31, - 0.01; p = 0.03). Moreover positive, and negative affect are negatively (β = - 0.33, CI - 0.43, - 0.24; p < 0.001) and positively (β = 0.72, CI 0.57, 0.82; p < 0.001) associated to anxiety, respectively. Thus, this study appears to emphasize the association of autonomous motivation on affect as a potential buffer against anxiety levels, particularly in a context where practitioners found themselves restricted in their usual gym practices.

Negative affect variability differs between anxiety and depression on social media

OBJECTIVE

Negative affect variability is associated with increased symptoms of internalizing psychopathology (i.e., depression, anxiety). The Contrast Avoidance Model (CAM) suggests that individuals with anxiety avoid negative emotional shifts by maintaining pathological worry. Recent evidence also suggests that the CAM can be applied to major depression and social phobia, both characterized by negative affect changes. Here, we compare negative affect variability between individuals with a variety of anxiety and depression diagnoses by measuring the levels and degree of change in the sentiment of their online communications.

METHOD

Participants were 1,853 individuals on Twitter who reported that they had been clinically diagnosed with an anxiety disorder (A cohort, n = 896) or a depressive disorder (D cohort, n = 957). Mean negative affect (NA) and negative affect variability were calculated using the Valence Aware Dictionary for Sentiment Reasoning (VADER), an accurate sentiment analysis tool that scores text in terms of its negative affect content.

RESULTS

Findings showed differences in negative affect variability between the D and A cohort, with higher levels of NA variability in the D cohort than the A cohort, U = 367210, p < .001, r = 0.14, d = 0.25. Furthermore, we found that A and D cohorts had different average NA, with the D cohort showing higher NA overall, U = 377368, p < .001, r = 0.12, d = 0.21.

LIMITATIONS

Our sample is limited to individuals who disclosed their diagnoses online, which may involve bias due to self-selection and stigma. Our sentiment analysis of online text may not completely capture all nuances of individual affect.

CONCLUSIONS

Individuals with depression diagnoses showed a higher degree of negative affect variability compared to individuals with anxiety disorders. Our findings support the idea that negative affect variability can be measured using computational approaches on large-scale social media data and that social media data can be used to study naturally occurring mental health effects at scale.

Evaluation of chronic idiopathic tinnitus and its psychosocial triggers

BACKGROUND

The tinnitus susceptibility patterns in relation to different psychological and life stressors are unknown in different cultures.

AIM

To determine the comorbid psychosocial factors and behaviors associated with tinnitus and the predictors for the increase in its severity.

METHODS

Participants were 230 adults (males = 70; females = 160; mean age = 38.6 ± 3.3). They underwent audiograms, speech discrimination and masking testing, and neuropsychiatric evaluation. Measures used for assessment included tinnitus handicap inventory, depression anxiety stress scale 21 (DASS-21), perceived stress scale (PSS), and insomnia severity index (ISI).

RESULTS

Patients had mean duration of tinnitus of 11.5 ± 2.5 mo. They had intact hearing perception at 250-8000 Hz and 95 (41.3%) had aggravation of tinnitus loudness by masking noise. Decompensated tinnitus was reported in 77% (n = 177). The majority had clinically significant insomnia (81.3%), somatic symptoms (75%) other than tinnitus and perceived moderate (46.1%) and high (44.3%) stress to tinnitus. The severe/extremely severe symptoms of depression, anxiety and stress were reported in 17.4%, 35.7% and 44.3%, respectively. Patients with decom-pensated type had significantly higher scores for ISI (P = 0.001) and DASS-21 (depression = 0.02, anxiety = 0.01, stress = 0.001) compared to those with compensated tinnitus. Psychiatric interviewing showed that 35.7% had non-specific anxiety disorder, 17.4% had major depression, and 19.6% fulfilled the criteria of somatization disorder. Multivariate analysis showed that the only independent predictors for tinnitus severity were the duration of tinnitus [odd ratios (OR) = 0.832, 95%CI: 0.640-1.158; P = 0.001] and PSS (OR = 0.835, 95%CI: 0.540-1.125; P = 0.001) scores.

CONCLUSION

To the best of our knowledge, this is the first study in our culture to evaluate the causal relationship between psychological factors and tinnitus onset, severity and persistence. Tinnitus could be the earliest and dominant somatic symptom induced by life stressors and psychological vulnerabilities. Therefore, multidisciplinary consultation (psychologists, psychiatrists, and neurologists) is important to acknowledge among the audiologists and otolaryngologists who primarily consult patients.

The longitudinal trajectory of emotional cognition in subgroups of recently diagnosed patients with bipolar disorder

Although cross-sectional studies show heterogeneity in emotional cognition in bipolar disorder (BD), the temporal course within subgroups is unclear. In this prospective, longitudinal study we assessed the trajectories of emotional cognition subgroups within a 16-month follow-up period in recently diagnosed BD patients compared to healthy controls (HC). Recently diagnosed BD patients and HC underwent comprehensive emotional and non-emotional testing at baseline and again at follow-up. We employed hierarchical cluster analysis at baseline to identify homogenous emotional cognition subgroups of patients, and changes across the subgroups of BD and HC were assessed with linear mixed-model analyses. We found two emotional cognition subgroups: subgroup 1 (65%, n = 179), showing heightened negative emotional reactivity in neutral and negative social scenarios and faster recognition of emotional facial expressions than HC (ps<0.001, n = 190), and subgroup 2 (35%, n = 96) showing blunted reactivity in positive social scenarios, impaired emotion regulation, poorer recognition of positive and slower recognition of all facial expressions than HC (ps≤.03). Subgroup 1 exhibited normalization of the initial emotional cognition abnormalities in follow-up. In contrast, subgroup 2 showed a lack of improvement in reactivity positively-valenced emotional information. Patients in subgroup 2 presented more and longer mixed episodes during the follow-up time and were more often prescribed lithium. One third of patients display blunted emotional reactivity, impaired emotion regulation abilities and facial expression recognition difficulties also show persistent impairments and poorer course of illness. This subgroup may indicate a need for earlier and more targeted therapeutic interventions.

The mediating role of anxiety between negative feelings and depression among students with congenital physical disabilities

Congenital physical disability is associated with various psychological challenges, including negative feelings, anxiety, and stress. These challenges will, in turn, predict significant negative emotional well-being among students with congenital physical disabilities, but the mechanisms of these effects are not well known. This study examined whether Negative Emotional Wellbeing Anxiety (NEWA) would mediate the effect of Negative Feelings (NF) and Negative Emotional Wellbeing Depression (NEWD) among students with congenital physical disabilities. Forty-six students with congenital physical disabilities (mean age: 20 years, SD = 2.05; 45.65% females) completed self-rating measures that included sociodemographic variables (age and sex), emotional state for Children to assess negative feelings, and an emotional distress protocol to assess NEWA and NEWD. Results show that NF was positively correlated with NEWA (r = .69, p < .001) and NEWD (r = .69, p < .001), and NEWA was positively correlated with NEWD (r = .86, p < .001). Findings further reported that NEWA significantly mediated the positive relationship between NF and NEWD (a*b = .37, Bootstrap CI95 = .23 and .52) [Sobel test statistic of 4.82 (p < .001)] among students with congenital physical disabilities. The results highlight the importance of screening students with congenital physical disabilities for common psychological challenges and providing suitable interventions.

Positive Interpretation Bias Predicts Longitudinal Decreases in Social Anxiety

Theoretical models of social anxiety suggest that distorted interpretation processes contribute to its development and maintenance, although the pathways through which this occurs are not well understood. Therefore, the present longitudinal study sought to determine whether negative interpretation bias, positive interpretation bias, and interpretation inflexibility (the degree to which participants correctly revise initial interpretations) predict changes in social anxiety over time. In an important advance over prior studies, individual differences in working memory capacity (WMC) were accounted for, as WMC is thought to play a crucial role in the generation and maintenance of interpretation biases. Following a baseline assessment of social anxiety, interpretation biases, and WMC, participants completed follow-up assessments of social anxiety both 2 weeks (n = 106) and 4 weeks (n = 96) later. After controlling for baseline social anxiety and WMC, greater positive interpretation bias was found to predict lower social anxiety at both follow-ups. Neither negative interpretation bias nor interpretation inflexibility was significantly associated with follow-up social anxiety. These results provide support for greater positive interpretation bias as a facilitator of decreases in social anxiety and a potential target for clinical intervention.

Examining the Latent Dimensions of Social Anxiety Disorder

While the body of literature has investigated the latent dimensions of Social Anxiety Disorder (SAD), only few have directly anchored in the DSM-5 SAD symptoms. Similarly, a continuing issue on measuring mental health disorders pertains to whether a symptom's frequency, intensity, or both, are appropriate and sufficient indicators of severity. To address this gap, the present study developed and validated a DSM-5-based measurement tool, the Social Anxiety Symptom Severity Inventory (SASSI), which assesses both the intensity (intensity of disturbance) and frequency (frequency of occurrence) of SAD symptoms. In study 1 (n = 6458, college students), the results revealed a two-factor structure using exploratory structural equation modeling. In study 2 (n = 425, left-behind emerging adults), confirmatory factor analysis, measurement invariance testing, and latent class analysis were used. Findings demonstrated the importance of using both frequency and intensity of symptoms in assessing SAD severity. Moreover, a five-class solution best fitted the sample. Studies 1 and 2 demonstrated the good psychometric properties of SASSI and filled an important gap among available measures in assessing SAD severity through symptom frequency and intensity.

Anxiety in bipolar disorder: A review of publication trends

BACKGROUND

Although anxiety is highly prevalent in people with bipolar disorders and has deleterious impact on the course of the illness, past reviews have shown that many aspects of the topic remain under-researched. This scoping review aims to provide a comprehensive overview of the literature addressing anxiety in bipolar disorder (A-BD) between 2011 and 2020, assess if the interest in the topic has increased over the period and map the publication trends.

METHODS

Three databases were systematically searched, and all articles were screened at the title/abstract and full text level based on inclusion and exclusion criteria. Of these, 1099 articles were included in the study. The annual number of articles on A-BD published between 2011 and 2020 was calculated and articles addressing it as a primary topic (n = 310) were classified into 4 categories and 11 subcategories to identify gaps in the knowledge.

RESULTS

The results show no clear increase in the number of annual publications during the period and much of the available literature is of a descriptive nature. Less is known about the processes underlying the comorbidity and about treatment approaches.

LIMITATIONS

Given the large scope of the research question, no quality assessment of the evidence was made. Only articles in English or French were considered.

CONCLUSIONS

These results highlight the need to change the focus of research efforts to better understand and address this unique set of conditions in clinical settings.

Motivation and anxiety during the second COVID-19 lockdown in gym exercisers: The mediating role of affects and satisfaction with life

The present study aimed to analyze the association between motivation (self-determined and non-self-determined motivation), positive and negative affect, life satisfaction and state-anxiety in a sample of gym exercisers, during the 2nd COVID-19 lockdown in Portugal. Also, we aimed to analyze the possible mediating role of positive and negative affect and life satisfaction in the relationship between motivation and levels of state-anxiety. A total of 201 gym participants (30.42 ± 11.22) were enrolled in the present study, of which 116 (57.7%) were women and 85 (42.3%) were men. The survey included sociodemographic data as well as the subsequently validated instruments: the State-Trait Anxiety Inventory, the Positive and Negative Affect Schedule, and the Satisfaction with Life Scale. The results revealed a positive association between state-anxiety and negative affect (r = .69), controlled motivation (r = .33), and autonomous motivation (r = .25). Still, state-anxiety was negatively associated with positive affect (r = -.40) and with satisfaction with life (r = -.43),. In addition, the results of mediation analysis, revealed inconsistent mediation of positive affect and life satisfaction in the relationship between autonomous motivation and state-anxiety. However, a total mediation was observed through negative affect and life satisfaction in the relationship between controlled motivation and anxiety since the indirect effect (β = .27) is higher than the direct effect (β = .06). Overall, the results reinforce that positive affect and satisfaction with life could act as a possible buffer against state-anxiety in gym exercisers and, thus, should be considered in future interventions and studies.

Paranormal belief, cognitive-perceptual factors, and well-being: A network analysis

By assessing interrelationships among variables within a specified theoretical framework, network analysis (NA) provides nuanced insights into how associations between psychological constructs are related to outcome measures. Noting this, the authors used NA to examine connections between Paranormal Belief, cognitive-perceptual factors (Schizotypy, Transliminality, and Manic-Depressive Experience), and well-being (Life Satisfaction, Meaning in Life, Somatic Complaints, Perceived Stress, Depressive Symptoms). Data derived from a sample of 3,090 participants (mean age = 50.30, standard deviation = 15.20; 46.5% male, 53.1% female) who completed standardised self-report measures capturing the study constructs online. Transliminality, Unusual Experiences (positive schizotypy), and Depressive Experience demonstrated high expected influence centrality. This indicated that these factors were the most strongly connected and influential in the network. Moreover, Transliminality was a connecting variable between Paranormal Belief, positive schizotypy, and psychopathology. Depressive Experience bridged the relationship between Transliminality and well-being. The conceptual implications of these outcomes are discussed with regards to better understanding relationships between Paranormal Belief, cognitive-perceptual factors, and well-being.

Personality and occupational correlates of anxiety and depression in nurses: the contribution of role conflict, core self-evaluations, negative affect and bullying

Background

The work environment and the fatiguing nature of nursing are risk factors that cause psychological disorders. This study was conducted with the aim of investigating the relationship between role conflict, core self-evaluations, negative affect, and bullying with anxiety and depression in nurses.

Methods

This cross-sectional study was conducted on the nurses working in hospitals of Bandar Abbas, Iran over 4 months (August 2019–November 2019). Data were collected using the Positive and Negative Affect Schedule scale, Role Conflict Questionnaire, Core Self-Evaluations Scale, Negative Acts Questionnaire-Revised, Beck Depression Inventory-Second Edition (BDI-II) and Beck Anxiety Inventory. Data were analyzed using t-test, one-way analysis of variance, Pearson correlation coefficient and multiple regression analysis using SPSS version 22 software and the significance level was considered 0.05.

Results

The findings revealed that there was a significant positive relationship between role conflict (r = 0.422, p < 0.01), negative affect (r = 0.715, p < 0.01), and bullying (r = 0.443, p < 0.01) with anxiety. Moreover, there was a significant negative relationship between core self-evaluations with anxiety (r = − 0.482, p < 0.01). Also, the findings indicated that there was a significant positive relationship between role conflict (r = 0.382, p < 0.01), negative affect (r = 0.672, p < 0.01), and bullying (r = 0.433, p < 0.01) with depression. There was a significant negative relationship between core self-evaluations and depression (r = − 0.603, p < 0.01). Moreover, regression analysis results revealed that negative affect, role conflict, and core self-evaluations predicted 54.3% of anxiety variance significantly. And lastly, negative affect and core self-evaluations predicted 53.3% of depression variance significantly.

Conclusions

Findings indicated that having high negative affect, low core self-evaluations, high role conflict, and exposure to bullying at work enhances the rate of depression and anxiety in nurses. Hence, it is essential to improve the mental health of nurses and thus the quality of care provided by them through recognizing suitable supportive strategies and interventions.

Can a Brief Interaction With Online, Digital Art Improve Wellbeing? A Comparative Study of the Impact of Online Art and Culture Presentations on Mood, State-Anxiety, Subjective Wellbeing, and Loneliness

When experienced in-person, engagement with art has been associated—in a growing body of evidence—with positive outcomes in wellbeing and mental health. This represents an exciting new field for psychology, curation, and health interventions, suggesting a widely-accessible, cost-effective, and non-pharmaceutical means of regulating factors such as mood or anxiety. However, can similar impacts be found with online presentations? If so, this would open up positive outcomes to an even-wider population—a trend accelerating due to the current COVID-19 pandemic. Despite its promise, this question, and the underlying mechanisms of art interventions and impacts, has largely not been explored. Participants (N = 84) were asked to engage with one of two online exhibitions from Google Arts and Culture (a Monet painting or a similarly-formatted display of Japanese culinary traditions). With just 1–2 min exposure, both improved negative mood, state-anxiety, loneliness, and wellbeing. Stepdown analysis suggested the changes can be explained primarily via negative mood, while improvements in mood correlated with aesthetic appraisals and cognitive-emotional experience of the exhibition. However, no difference was found between exhibitions. We discuss the findings in terms of applications and targets for future research.

A mental imagery micro-intervention to increase positive affect in outpatient CBT sessions (PACIfIC): Study protocol of a randomized controlled implementation trial

Background

Recent findings indicated that mental disorders are associated with both an up-regulation of negative affect and a down-regulation of positive affect (PA) as distinct processes. Established treatment approaches focus on the modification of problems and negative affect only. Experimental paradigms in healthy samples and research on strengths-based approaches showed that fostering PA may improve psychotherapy process and outcome. Specific and easily implementable interventions targeting PA in treatment sessions are scarce. Mental imagery was shown to be a promising strategy for boosting positive emotional experiences.

Method

The PACIfIC-study is planned as a longitudinal randomized-controlled trial in the context of cognitive behavioral therapy, implemented at a German outpatient training and research center. In the process analysis, trajectories of PA over the first twelve treatment sessions will be examined with weekly questionnaires. In the intervention analysis, a six-minute positive mental imagery intervention to enhance PA will be developed and tested. The intervention is implemented with loudspeakers at the beginning of each session for a standardized induction of PA. The experimental group will be compared to an active control group (neutral mental imagery) and treatment as usual. Procedures in all treatment arms are parallelized. Main outcomes after twelve sessions of psychotherapy will be psychosocial resources, resilience and self-esteem (theory-driven), as well as psychopathology and working alliance (secondary outcome). Multilevel modeling will be conducted to address the nested data structure.

Conclusion

Study results may have implications on the consideration of positive constructs in mental disorders and the implementation of strengths-based interventions in psychotherapy.

Changes in emotions and perceived stress following time spent in an artistically designed multisensory environment

Self-management strategies that enhance positive emotions are considered most effective to cope with stress and maintain good mental health and well-being. An artistically designed multisensory environment, The Sensory-Art Space (SAS), was installed in a university in NSW Australia as a new self-management intervention. The design of the SAS was informed by evidence regarding the benefits of viewing art, experiencing nature and accessing sensory rooms.A pilot pre-post intervention study measured changes in affect and perceived stress in 224 participants who spent time in the SAS. Descriptive statistics were completed on the individual affective states, and paired sample t-tests were used to determine changes in Positive and Negative Affect (PANAS-X) and perceived stress (Visual Analogue Scale).The Wilcoxon signed-rank test showed that negative affect reduced, z=-10.23 (p<0.001), and positiveaffect increased, z=-2.57 (p=0.01), following spending time in the SAS. In addition, stress levels reduced after time spent in the SAS, z=-11.29 (p<0.0001).Self-management benefits were found following time in the SAS and future implications for public health and well-being are discussed.

Affect mediates the influence of the "Three Good Things" intervention on depression and well-being

The "Three Good Things" is a self-administered positive psychological intervention that is effective in reducing depressive symptoms and improving well-being; however, there is still little known about its possible underlying mechanisms. I examined the efficacy of the Three Good Things intervention and investigated the mediating role of positive and negative affect in the intervention's effect on depressive symptoms and subjective well-being. Participants were undergraduate students randomly assigned to either the intervention group ( n = 128), who participated in a 16-week trial of the intervention and completed assessment measures, or to the control group (n = 121), who completed assessment measures but not the intervention. The three time points for assessment were Week 1 (baseline), Week 8 (Time 1), and Week 16 (Time 2). The results show that levels of depression and negative affect were lower in the intervention group than in the control group at Time 2, whereas positive affect and subjective well-being were higher. Thus, the intervention can reduce depression and promote well-being by reducing negative affect and improving positive affect.

Integrative psycho-biophysiological markers in predicting psychological resilience

The hypothalamic-pituitary-adrenal (HPA) and parasympathetic nervous systems have been reported to play important roles in emotion regulation and stress coping. Yet, their direct relationship with psychological resilience remains unclear. These biophysiological features should be considered together with the traditional psychometric properties in studying resilience more comprehensively. The current study aimed to examine the role of these systems during a laboratory stress task and to determine the prediction power of resilience by combining psychological and biophysiological features. One hundred and seven (52 females) university students without psychiatric disorders underwent the Trier Social Stress Task (TSST). Psychometric properties of resilience were measured at rest; vagal heart rate variability (HRV), salivary cortisol, and dehydroepiandrosterone (DHEA) levels were captured at baseline, during, and after TSST. Multivariate linear regression as well as support vector regression machine-learning analyses were performed to investigate significant predictors and the prediction power of resilience. Results showed that positive and negative affects, HRV during the anticipatory phase of stress, and the ratio of cortisol/DHEA at the first recovery time point were significant predictors of resilience. The addition of biophysiological features increased the prediction power of resilience by 1.2-fold compared to psychological features alone. Results from machine learning analyses further demonstrated that the increased prediction power of resilience by adding the ratio of cortisol/DHEA was significant in "cortisol responders"; whereas a trend level was observed in "cortisol non-responders". Our findings extend the knowledge from the literature that high vagal activity during the anticipating phase of stress and the ability to restore the balance between cortisol and DHEA after a stress event could be an important feature in predicting resilience. Our findings also further support the need of combining psychological and biophysiological features in studying/predicting resilience.

Social Anxiety and Empathy: A Systematic Review and Meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to clarify the association between social anxiety and affective (AE) and cognitive empathy (CE).

METHODS

1442 studies from PsycINFO, Medline, and EMBASE (inception-January 2020) were systematically reviewed. Included studies (N = 48) either predicted variance in empathy using social anxiety scores or compared empathy scores between socially anxious individuals and a control group.

RESULTS

Social anxiety and AE were statistically significantly positively associated, k = 14, r = .103 (95%CI [.003, .203]), z = 2.03, p = .043. Sex (Q_M (2) = 18.79, p <  .0001), and type of measures (Q_M (1 = 7.34, p = .007) moderated the association. Correlations were significant for male samples (r_male = .316, (95%CI [.200, .432])) and studies using self-report measures (r_self-report = .162 (95%CI [.070, .254])). Overall, social anxiety and CE were not significantly associated, k = 52, r =-.021 (95%CI [-.075, .034]), z= -0.74, p = .459. Sample type moderated the association (Q_M (1) = 5.03, p < .0001). For clinical samples the association was negative (r_clinical= -.112, (95%CI [-.201, -.017]).

CONCLUSION

There was evidence for a positive association between social anxiety and AE, but future studies are needed to verify the moderating roles of sex and type of measure. Besides, low CE might only hold for patients with SAD.

Positive and Negative Affect Changes during Gender-Affirming Hormonal Treatment: Results from the European Network for the Investigation of Gender Incongruence (ENIGI)

Improving transgender people's quality of life (QoL) is the most important goal of gender-affirming care. Prospective changes in affect can influence QoL. We aim to assess the impact of initiating gender-affirming hormonal treatment (HT) on affect. In the European Network for the Investigation of Gender Incongruence (ENIGI) study, we prospectively collected data of 873 participants (451 transwomen (TW) and 422 transmen (TM)). At baseline, psychological questionnaires including the Positive and Negative Affect Schedule (PANAS) were administered. The PANAS, levels of sex steroids and physical changes were registered at each follow-up visit during a 3-year follow-up period, starting at the initiation of hormonal therapy. Data were analyzed cross-sectionally and prospectively. Over the first three months, we observed a decline in positive affect (PA) in both TM and TW. Thereafter, PA reached a steady state in TW, whereas in TM there was also a second decline at 18 months. In both TM and TW there was no persisting difference comparing baseline to the 36-months results. Concerning negative affect (NA), we observed a decline during the first year in TM, which sustained during the second year and was not different anymore at 36 months compared to baseline. In TW though, we did not find any change of NA during the entire follow-up. Even if some of these results show significant differences, they should be considered with caution, since there was no control group and the absolute differences are small. No association between affect and the level of sex steroids was observed. Baseline QoL and psychological burden are related to affect independently from gender but are not necessarily good predictors of the evolution of one's affect during the gender-affirming process. Further research is necessary to investigate these preliminary results.

Cognitive reactivity to low positive and high negative affect

Cognitive Reactivity (CR), an established diathesis for depression, has been defined as the within-person strength of association between sad affect and dysfunctional attitudes. Watson and Tellegen (1985) proposed that sad affect is a combination of high negative affect (NA) and low positive affect (PA). The current study integrated the CR and the affect literatures by examining the differential and conjoint roles of cognitive reactivity to high negative affect (CR-highNA) and cognitive reactivity to low positive affect (CR-lowPA). In the current study, college student participants completed daily diary measures of CR-highNA, CR-lowPA, and CR to sadness (CR-Sad). Results showed that naturally occurring NA and PA accounted for the relation of sadness to dysfunctional cognitions. Further, the relation of depressive symptoms to CR-Sad was explained by high levels of CR-highNA and CR-lowPA. Born out of the integration of research on CR and affective structures, the current results have implications for both theory and treatment of depression.

Patient anxiety of verticalization on day 0 after a Cesarean section

Purpose

The ERAS protocol recommends fast mobilization of a patient along with providing psychological comfort; however, early verticalization can generate mental discomfort. In the post-operative period after Caesarean section (CC), a patient may experience pain, anxiety and negative affect. The main aim of the study was to investigate levels of patient anxiety concerning verticalization on day 0 after CC using. Also, the dependence between anxiety of verticalization and the following: pain, anxiety as a permanent disposition, resistance to pain, negative and positive emotions, and positive orientation was described.

Methods

The study included 150 women on day 0 after their CC. The measurement of anxiety concerning verticalization, pain, and also negative and positive emotions was conducted twice. During the first measurement, variables such as anxiety levels as a constant disposition, level of pain resistance and positive orientation were also monitored.

Results

Patients upon arrival at the post-operative room declared a higher level of anxiety of verticalization (p < 0.05) (Median = 4; IQR = 5) when compared to 6 h after surgery (Median = 3; IQR = 4). A weak correlation of anxiety and pain was noted (r = 0.264; p < 0.01) in the second measurement. In both measurements, negative emotions and pain resistance proved to be the strongest variables explaining anxiety concerning verticalization.

Conclusions

Low levels of pain experienced by a patient after CC do not explain the variance in anxiety of verticalization. The use of the Numerical Rating Scale (NRS) of anxiety allows care givers to gain patients' psychological perspective in different moments after CC.

Spanish Adaptation of the Inventory of Depression and Anxiety Symptoms (IDAS-II) and a study of its psychometric properties

BACKGROUND

The Inventory of Depression and Anxiety Symptoms (IDAS-II) is composed of 99 items organized into 18 specific scales that provides dimensional assessment of depression, anxiety and bipolar symptoms. To date, IDAS-II is only available in the English and Turkish population. The main purpose of this study is to adapt the IDAS-II to the Spanish population and to assess the psychometric properties.

METHODS

Participants included community adults (n = 620) and college students (n = 378). All participants completed the Beck Depression Inventory-II, Beck Anxiety Inventory, Hypomania Check List-32, Post-traumatic Stress Disorder Checklist-Civilian Version and Obsessive-Compulsive Inventory-Revised, in addition to the Spanish version of the IDAS-II.

RESULTS

The results indicate good internal consistency and high temporal stability of the Spanish version of the IDAS-II. Confirmatory factor analyses show for the first time that the three-factor structure of the IDAS-II (Distress, Obsessions/Fear, and Positive Mood) loads on a second order factor, labeled "Internalizing" according to the Hierarchical Taxonomy Of Psychopathology (HiTOP).

LIMITATIONS

Study was conducted exclusively on student and community samples and some of the measures used as gold-standard have presented limitations CONCLUSIONS: According to previous studies, the results supported the convergent and discriminant validity of the majority of IDAS-II scales. IDAS-II is useful in assessing the severity of depression, anxiety and bipolar symptoms in research contexts in a Spanish population according to the HiTOP model. However, more evidence is required to prove the adequate functioning of the IDAS-II in clinical samples.

Do depressive symptoms affect the outcome of treatments for SAD? A meta analysis of randomized controlled trials

Individuals with social anxiety disorder (SAD) typically have elevated depressive symptoms. In the present meta-analysis, we reviewed the treatment outcome literature in SAD and examined whether depressive symptoms predict treatment outcome. We focused on randomized controlled trials of cognitive behavior therapy (individual face-to-face, group format, and internet-delivered format) and randomized controlled trials of pharmacotherapy. After implementing exclusion criteria, 108 studies with 133 treatment conditions (n = 12,913 participants) were included in the meta-analysis. Our findings indicated that treatments for SAD were efficacious and significantly reduced social anxiety symptoms across all treatment modalities. Exclusion of individuals with MDD or high levels of depression did not affect outcome at post-treatment or at follow-up. However, we found that elevated depressive symptoms were associated with greater reductions in social anxiety symptoms from pre-treatment to post-treatment. Importantly, this effect was above and beyond pre-treatment levels of social anxiety. Finally, analyzing treatment modalities separately, we found that depressive symptoms were associated with better post-treatment outcomes in individual face-to-face CBT but not in other modalities. Clinical and research implications of these findings are discussed.

Positive Affect and Well-Being in Huntington's Disease Moderates the Association Between Functional Impairment and HRQOL Outcomes

BACKGROUND

Positive affect is associated with resiliency and beneficial health outcomes, but little is known about associations between positive affect and health-related quality of life (HRQOL) in Huntington's disease (HD).

OBJECTIVE

This longitudinal study determined the association between positive affect and several HRQOL outcomes in persons with HD. Functional status was examined as a moderator of the association between positive affect and HRQOL.

METHODS

Participants, with premanifest (i.e., genetically at risk but no clinical diagnosis, n = 50) and manifest HD (early-stage n = 171; late-stage n = 101), completed a measure of positive affect and well-being and several HRQOL measures at baseline, 12-, and 24-month follow-ups. UHDRS Functional Assessment scale indicated functional status.

RESULTS

Positive affect was associated with better HRQOL for persons with premanifest and manifest HD over the 24-month time frame. These associations were moderated by functional status. For persons with higher functional status, positive affect was associated with better HRQOL, including less depression, lower anxiety, less anger, better social role satisfaction, better executive functions, greater upper extremity function, less dyscontrol, and less concern with death and dying. For persons with lower functional status, positive affect was not associated with HRQOL.

CONCLUSIONS

Positive affect predicted better self-reported HRQOL over a 24-month period in persons with premanifest and manifest HD, particularly when participnats had better functional status. Interventions to enhance positive affect in HD may have beneficial effects on HRQOL.

Immigrant Children's Proficiency in the Host Country Language is More Important than Individual, Family and Peer Characteristics in Predicting Their Psychological Well-Being

Immigrant children are exposed to high levels of psychological distress, leading to an increased risk of mental and physical health problems. In the present study we investigated the impact of first and second generation immigrant children's proficiency in the host country language on their psychological well-being one year later. The effects of gender, family SES, and classmates' characteristics were also examined. A structural equation model was tested on 2334 immigrant children in a representative sample of 561 Italian primary schools taking measurement errors into account. Children's language proficiency significantly predicted their psychological well-being one year later, both in first and second immigrant generations (B = .23; p < .001). None of the other variables had a significant impact. Improving the language skills of immigrant children could promote their mental health, regardless of their backgrounds and whether they were born in the host country or not.

Psychopathological Consequences Related to Problematic Instagram Use Among Adolescents: The Mediating Role of Body Image Dissatisfaction and Moderating Role of Gender

In a minority of cases, problematic use of technology can negatively impact on adolescents and impair some aspects of their social, emotional, and psychological development. The purpose of the present study was to examine the direct and indirect effects of problematic Instagram use (PIU) on different psychopathological outcomes including loneliness, depression, anxiety, and social anxiety via body image dissatisfaction (BID). Additionally, moderating role of gender on the relationships among variables was investigated. A total of 491 adolescents (Mage = 15.92 years, SDage = 1.07; range = 14 to 19 years) were recruited for the study to complete a questionnaire that included the relevant assessment tools for the aforementioned variables. Mediation and moderation analyses showed that among male adolescents, PIU was directly associated with loneliness, depression, general anxiety, and social anxiety and BID partially mediated these associations. Among females, PIU was directly associated with depression and indirectly with general anxiety and social anxiety via BID. Gender significantly moderated the direct relationships of PIU with loneliness, general anxiety, and social anxiety. PIU was directly associated with loneliness, general anxiety, and social anxiety among males only, whereas among females, PIU was indirectly associated with general and social anxiety via BID but was not related to loneliness. Results of this study indicate that PIU has different negative psychological effects on male and female adolescents and that BID appears to be one explanatory factor for these impairments especially among females.