[Design and validation of the scales for the assessment of the psychological impact of past life events: the role of ruminative thought and personal growth]

Emotion regulation processes as mediators of the impact of past life events on older adults' psychological distress

OBJECTIVE

Although it is known that certain emotion regulation processes produce a buffering effect on the relationship between life events and well-being, this issue has been poorly studied in the elderly population. Thus, the aim of the present study is to test and confirm a comprehensive model of the impact that past life events have on older adults' psychological distress, exploring the possible mediating roles of emotion regulation processes. These include rumination, experiential avoidance, and personal growth.

METHODS

In this cross-sectional study, 387 people over 60 years old residing in the community were assessed on life events, physical functioning, emotion regulation variables, psychological well-being, as well as symptoms of anxiety and depression.

RESULTS

The structural model tested achieved a satisfactory fit to the data, explaining 73% of the variance of older adults' psychological distress. In addition, the main results suggest possible mediation effects of both the physical functioning and the emotional variables: rumination, experiential avoidance, and personal growth in the face of hardship.

CONCLUSIONS

These findings confirm the importance of emotion regulation processes in the final stages of life. They reveal the various adaptive and maladaptive mechanisms that underlie the relationship between life events and psychological distress. The findings suggest - both in the explanatory models of psychological well-being and in psychotherapeutic interventions - the importance of emotion regulation in the elderly population's health.

Age differences in rumination and autobiographical retrieval

OBJECTIVES

Higher well-being in older adults compared to young adults is a well-known phenomenon. However, the variables associated with this effect are still uncertain. Negative repetitive thinking (rumination) is a transdiagnostic variable related to psychopathology. It is strongly associated with depression and a lack of specificity in autobiographical retrieval. This research explores age differences in the association of rumination with mood, autobiographical memories and working memory.

METHOD

Two groups of participants (older adults versus young adults), recruited through a public announcement, were compared in a cross-sectional study.

RESULTS

Older adults ruminated less than young participants. Rumination was positively associated with depression scores but not with working memory scores in both samples. More importantly, the interaction between brooding rumination and negative autobiographical memories was the only significant variable to explain the variance of mood scores in young participants. However, in older participants, the interaction between brooding and positive autobiographical memories significantly explained the variance of mood scores. Digit span forward and the interaction of brooding by negative autobiographical memories also significantly explained mood scores in older adults.

CONCLUSION

These results suggest that a different interaction between brooding rumination and the valence of autobiographical memories may be a relevant variable associated with mood differences by age.

[Rumination and cognitive fusion in dementia family caregivers]

INTRODUCTION

Rumination has been described as a dysfunctional coping strategy related to emotional distress. Recently, it has been highlighted from the Acceptance and Commitment Therapy therapeutic approach, the negative role that cognitive fusion (the extent to which we are psychologically tangled with and dominated by the form or content of our thoughts) has on the explanation of distress. The aim of this study is to simultaneously analyze the role of rumination and cognitive fusion in the caregiving stress process.

MATERIAL AND METHODS

The sample of 176 dementia caregivers was divided in four groups, taking into account their levels of rumination and cognitive fusion: HRHF=high rumination+high cognitive fusion; HRLF=high rumination+low cognitive fusion; LRHF= low rumination+high cognitive fusion; and LRLC=low rumination and low cognitive fusion. Caregiver stress factors, frequency of pleasant events, experiential avoidance, coherence and satisfaction with personal values, depression, anxiety and satisfaction with life, were measured.

RESULTS

The HRHF group showed higher levels of depression, anxiety, experiential avoidance and lower levels of satisfaction with life, frequency of pleasant events, coherence and satisfaction with personal values, than the other three groups.

CONCLUSIONS

Considering simultaneously rumination and cognitive fusion may contribute to a better understanding of caregiver coping and distress.

Insomnia among patients with advanced disease during admission in a Palliative Care Unit: a prospective observational study on its frequency and association with psychological, physical and environmental factors

BACKGROUND

THE AIMS OF THIS STUDY WERE

1) to assess the frequency of insomnia among patients during admission in a Palliative Care Unit (PCU); 2) to study the association between emotional distress and insomnia, taking physical, environmental and other psychological factors into account.

METHODS

Prospective observational study including patients consecutively admitted to a PCU during eight months, excluding those with severe cognitive problems or too low performance status. Insomnia was assessed by asking a single question and by using the Sleep Disturbance Scale (SDS), and emotional distress using the Hospital Anxiety and Depression Scale (HADS). Physical, environmental and other psychological factors potentially interfering with sleep quality were evaluated. Association between insomnia and the factors evaluated was studied using univariate and multivariate regression analyses.

RESULTS

61 patients were included (mean age 71.5 years; 95% with oncological disease); 38 (62%) answered "yes" to the insomnia single question and 29 (47%) showed moderate to severe insomnia according to the SDS. 65% showed clinically significant emotional distress and 79% had nocturnal rumination. The physical symptoms most often mentioned as interfering with sleep quality were pain (69%) and dyspnoea (36%). 77% reported at least one environmental disturbance. In the univariate analysis, answering "yes" to the insomnia single question was significantly associated with higher HADS score, anxiety, nocturnal rumination, clear knowledge of the diagnosis, higher performance status and dyspnoea; moderate to severe insomnia was significantly associated with nocturnal rumination, higher performance status, environmental disturbances and daytime sleepiness. In the multivariate regression analysis, answering "yes" to the single question was associated with dyspnoea (OR 7.2 [1.65-31.27]; p = 0.009), nocturnal rumination (OR 5.5 [1.05-28.49]; p = 0.04) and higher performance status (OR 14.3 [1.62-125.43]; p = 0.017), and moderate to severe insomnia with nocturnal rumination (OR 5.6 [1.1-29.1]; p = 0.041), and inversely associated with daytime sleepiness (OR 0.25 [0.07-0.9]; p = 0.043).

CONCLUSIONS

Insomnia was highly frequent. Several physical, psychological and environmental factors seemed to influence insomnia. Within the multimodal management of insomnia, the assessment of nocturnal rumination may be of particular interest, irrespective of emotional distress. Further studies with larger sample sizes could confirm this result.