Assertiveness predicts threat and challenge reactions to potential stress among women

Personality antecedents of challenge and threat appraisal

It has been suggested in personality and emotion theories that traits can influence emotional states and behaviour through interpretive processes such as cognitive appraisals. The present study investigated the relationships between Big Five personality dimensions and the cognitive appraisal processes associated with challenge and threat states in a large sample of municipal firefighters. The study assessed the Big Five traits and cognitive appraisal tendencies using a new measure of challenge-threat appraisal that measured appraisals directly and aggregated both across stressful situations and within six specific stressor domains. The results indicated that the Big Five traits related to overall challenge-threat appraisal and their accompanying primary and secondary components in unique and compelling ways, with some traits related more strongly to primary appraisals of situational demands and others related more to secondary appraisals of coping abilities. Overall, the results provide insights into how personality traits are associated with stress-related emotional experiences.

Video Games and Stress: How Stress Appraisals and Game Content Affect Cardiovascular and Emotion Outcomes

Although previous studies have found that video games induce stress, studies have not typically measured all salient indicators of stress responses including stress appraisals, cardiovascular indicators, and emotion outcomes. The current study used the Biopsychosocial Model of Challenge and Threat (Blascovich and Tomaka, 1996) to determine if video games induce a cardiovascular stress response by comparing the effects of threat and challenge appraisals across two types of video games that have shown different cardiovascular outcomes. Participants received challenge or threat appraisal instructions, and played a fighting game (Mortal Kombat) or a puzzle game (Tetris). Study outcomes were heart rate variability, systolic and diastolic blood pressure, and positive and negative emotion ratings measured before, during and after gameplay. Results indicated that threat appraisal instructions increased negative emotion ratings and decreased heart rate variability, but not blood pressure, which is an essential marker for cardiovascular stress responses. Increased blood pressure and decreased heart rate variability was associated with fighting game players when compared with the puzzle game players, indicating a cardiovascular stress response; however, fighting game players also reported higher positive emotion ratings. Based on the study findings, video games do not induce stress responses like mental stressors used in previous research, demonstrating that the interactive player experience in video gaming may have more complex effects on stress outcomes. Future research should comprehensively measure biopsychosocial stress indicators and multiple emotional states over time to fully examine the relationship between video games and stress.

Access to primary care for socio-economically disadvantaged older people in rural areas: exploring realist theory using structural equation modelling in a linked dataset

Background

Realist approaches seek to answer questions such as ‘how?’, ‘why?’, ‘for whom?’, ‘in what circumstances?’ and ‘to what extent?’ interventions ‘work’ using context-mechanism-outcome (CMO) configurations. Quantitative methods are not well-established in realist approaches, but structural equation modelling (SEM) may be useful to explore CMO configurations. Our aim was to assess the feasibility and appropriateness of SEM to explore CMO configurations and, if appropriate, make recommendations based on our access to primary care research. Our specific objectives were to map variables from two large population datasets to CMO configurations from our realist review looking at access to primary care, generate latent variables where needed, and use SEM to quantitatively test the CMO configurations.

Methods

A linked dataset was created by merging individual patient data from the English Longitudinal Study of Ageing and practice data from the GP Patient Survey. Patients registered in rural practices and who were in the highest deprivation tertile were included. Three latent variables were defined using confirmatory factor analysis. SEM was used to explore the nine full CMOs. All models were estimated using robust maximum likelihoods and accounted for clustering at practice level. Ordinal variables were treated as continuous to ensure convergence.

Results

We successfully explored our CMO configurations, but analysis was limited because of data availability. Two hundred seventy-six participants were included. We found a statistically significant direct (context to outcome) or indirect effect (context to outcome via mechanism) for two of nine CMOs. The strongest association was between ‘ease of getting through to the surgery’ and ‘being able to get an appointment’ with an indirect mediated effect through convenience (proportion of the indirect effect of the total was 21%). Healthcare experience was not directly associated with getting an appointment, but there was a statistically significant indirect effect through convenience (53% mediated effect). Model fit indices showed adequate fit.

Conclusions

SEM allowed quantification of CMO configurations and could complement other qualitative and quantitative techniques in realist evaluations to support inferences about strengths of relationships. Future research exploring CMO configurations with SEM should aim to collect, preferably continuous, primary data.

Electronic supplementary material

The online version of this article (10.1186/s12874-018-0514-x) contains supplementary material, which is available to authorized users.

Gender roles and traits in stress and health

Women have a life-expectancy advantage over men, but a marked disadvantage with regards to morbidity. This is known as the female–male health-survival paradox in disciplines such as medicine, medical sociology, and epidemiology. Individual differences in physical and mental health are further notably explained by the degree of stress individuals endure, with women being more affected by stressors than men. Here, we briefly examine the literature on women’s disadvantage in health and stress. Beyond biological considerations, we follow with socio-cognitive explanations of gender differences in health and stress. We show that gender roles and traits (masculinity in particular) explain part of the gender differences in stress, notably cognitive appraisal and coping. Stress in turn degrades health. Implications are discussed. In conclusion, traditional socialization is advantageous for men in terms of health.

Predictors of prevention failure in college students participating in two indicated depression prevention programs

The purpose of this study was to identify subgroups of university students with the highest likelihood of remaining at elevated levels of depressive symptoms six months following the receipt of a depressive prevention intervention on the basis of known risk factors and participation in one of two depression prevention programs. Data from a randomized controlled trial evaluating depression prevention among 133 college students with elevated depressive symptoms were analyzed. Participants were randomized to a cognitive-behavioral or relaxation training group preventive intervention. Classification tree analysis showed that older age was the strongest risk factor for persistently elevated depression. Additional risk factors were: (1) for younger students, fewer daily pleasant activities; (2) for those with higher level of pleasant activities, higher level of stressful events; and (3) for those with higher level of stressful events, lower assertiveness. Results offer directions for prevention foci, identify specific subgroups of college students to target for depression prevention efforts, and suggest that research aim to help older, non-traditional students or graduating students manage the transition from college to the work force.

Timing is everything: anticipatory stress dynamics among cortisol and blood pressure reactivity and recovery in healthy adults

Psychological states of anticipation modulate biological stress responsivity. While researchers generally investigate how subjective distress corresponds to the magnitude of stress reactivity, physiological recovery after acute stressors must also be considered when investigating disease vulnerabilities. This study assessed whether anticipatory stress would correspond to stress reactivity and recovery of salivary cortisol and blood pressure levels in response to a well-validated psychosocial stressor. Thirty participants (63% female; mean ± SEM age 45.4 ± 2.12 years) were exposed to the Trier Social Stress Test (TSST) consisting of a public speech and mental arithmetic. Ten salivary cortisol samples and systolic and diastolic blood pressure recordings were collected at time points spanning 50 min before and up to 50 min after stress exposure. These data were transformed into parameters representing stress reactivity (area under the curve) and stress recovery (percent change). The Primary Appraisal Secondary Appraisal scale assessed anticipatory stress before exposure to the TSST. Our results revealed that increased anticipatory stress predicted increased stress reactivity for cortisol (p = 0.009) but not blood pressure. For stress recovery, increased anticipatory stress predicted greater decrements of cortisol concentration (p = 0.015) and blood pressure (p = 0.039), even when controlling for total systemic "output" by incorporating baseline activity. This efficient shutdown of stress responses would have otherwise been ignored by solely investigating reactive increases. These findings underscore the importance of measuring multiple dynamic parameters such as recovery when investigating physiological stress response patterns as a function of psychosocial factors.

The influence of neuroticism, extraversion and openness on stress responses

The present research moved beyond focusing on negative dispositions to investigate the influence of positive aspects of personality, namely extraversion and openness, on stress responses including appraisals, affect and task performance. Challenge appraisals occur when stressor demands are deemed commensurate with coping resources, whereas threat appraisals occur when demands are believed to outweigh coping resources. We examined the unique influence of personality on stress responses and the mediating role of appraisals. Personality was assessed, and then participants (N = 152) were exposed to a validated math stressor. We found unique effects on stress responses for neuroticism (high threat and negative affect and low positive affect), extraversion (high positive and low negative affect) and openness (high positive and low negative effect and better performance). Mediation analyses revealed that neuroticism indirectly worsened performance, through threat appraisals, and that openness indirectly increased positive affect through lower threat. These findings highlight the importance of investigating multiple aspects of personality on stress responses and provide an avenue through which stress responses can be changed-appraisals. Only by more broad investigations can interventions be tailored appropriately for different individuals to foster stress resilience.

Effects of Stimuli on Cardiovascular Reactivity Occurring at Regular Intervals During Mental Stress

Studies examining the direct effects of stimuli needed to perform mental stress tasks such as instructor commands at regular intervals during the mental task are limited to date. Because of the comprehensive effects of different stimuli, we studied the effect of short instructor commands occurring at regular intervals on the behavior of the cardiovascular system during two different types of tasks. Continuous beat-to-beat heart rate and blood pressure, respiration, thoracic impedance, skin conductance, and peripheral temperature were measured in 20 healthy females during a cancellation test of attention (stimuli interval of 20 s) and during mental arithmetic tasks (stimuli interval of 120 s). The transient effects of the stimuli on measures in the time domain as well as the effects of stimulus intervals on measures in the frequency domain (using spectral analysis) were examined. Instructor commands caused increases in several cardiovascular variables and in skin conductance. SBP (systolic blood pressure) and DBP (diastolic blood pressure) showed a significant stimulus response only during the mental arithmetic tasks. An effect of instructor commands at regular intervals was seen in the spectral analysis at 0.05 Hz (cancellation test of attention) and 1/120 Hz (mental arithmetic), according to the stimulus intervals of 20 s and 120 s used in these tasks. The findings suggest that even simple instructor commands given during high mental task load had a strong impact and can considerably influence measures of cardiovascular reactivity. The effects of paced stimuli should be considered when interpreting cardiovascular responses to task conditions with constant stimulus intervals.

The Appraisal Rebound Effect: Cognitive Appraisals on the Rebound

Although there have been many demonstrations of ironic thought processes, no demonstration to date has examined the effect of suppressing appraisals. Ironic phenomena in this domain have tremendous theoretical and practical importance to person perception, trait attribution, and social cognition in general. The authors propose the appraisal rebound hypothesis, which states that the suppression of an appraisal paradoxically activates it. Appraisal rebound was demonstrated across three studies with three different appraisals: unfairness, agency-others, and perceived control. The appraisal rebound effect was also found to be specific only to the suppressed appraisal. These results add to the growing literature on the many ways in which ironic mental processes affect daily thinking and feeling. Specifically, the findings are discussed with regard to emotion regulation, normal chronic emotionality, and psychopathology.

Undergraduate nursing students' level of assertiveness in Greece: a questionnaire survey

BACKGROUND

A number of studies of nursing and midwifery have found stress and bullying to be frequent problems. Those suffering from bullying and stress need to have high levels of assertiveness to resist and to cope successfully. Hence, it was considered vital to assess the assertiveness level of nursing students throughout their training curriculum.

METHODS

The study population was composed of nursing students in different semesters at one school in Central Greece (n=298) who agreed to complete a questionnaire on assertiveness level assessment, which had been translated into Greek and adapted to this population. All students present in class completed the questionnaire, representing 80% of the total population of active students. Mean assertiveness scores between semesters were compared by ANOVA and comparisons between the responses of the first semester students and responses of advanced semester students were done by Pearson's chi square.

RESULTS

The main finding of this study was that the assertiveness levels displayed by students increase slightly in advanced semesters by comparison to those displayed by first-semester students.

CONCLUSIONS

Assertive behavior should be encouraged through learning methods. Nurses should preferably obtain this training throughout their studies. Instructors have an essential role in the improvement and achievement of assertiveness training curriculums for undergraduate nursing students.

Future orientation in times of threat and challenge: How resilient adolescents construct their future

Drawing on the importance of future orientation for adolescent development this analysis presents a model describing how future orientation is affected by high challenge (or resilience) in the face of political violence. The analysis consists of three parts. The first two present future orientation conceptualization and the psychological processes underlying threat and challenge/resilience, respectively. Consequently, the third part outlines an integrated model positing that the effect of challenge/resilience on future orientation is mediated by hope and moderated by four factors: cultural orientations, developmental period, interpersonal relationships, and intrapersonal characteristics.

Hostility, emotional expression, and hemodynamic responses to laboratory stressors: reactivity attenuating effects of a tendency to express emotion interpersonally

The present study examined the interactive effects of hostility and a predisposition towards emotional expression or suppression in interpersonal situations. We also attempted to partially replicate findings from a recent investigation which provided evidence of lower myocardial and greater vascular responses in high-hostile relative to low-hostile individuals. Undergraduate students (n=99) participated in a protocol consisting of rest periods, speech preparation and presentation, a social-evaluative mental arithmetic task, and a stress interview. After classifying participants into high/low hostility by high/low interpersonal emotional expression groups using median-splits, high-hostile individuals showed lower HR and SBP responses to speech preparation and reported greater threat appraisal and negative affect than low-hostile participants. High-hostile interpersonal expressors and male interpersonal expressors displayed lower DBP and TPR reactivity, respectively, than high-hostile or male suppressors. High-hostile expressors also reported lower levels of positive affect than high-hostile suppressors, and expressors reported lower threat appraisals than suppressors, irrespective of hostility. Findings are discussed in terms of an absence of conflict or ambivalence over interpersonal emotional expression for high-hostile expressors and are suggestive of potential health benefits of expressing emotion interpersonally for at-risk groups.

Effects of social anxiety and evaluative threat on cardiovascular responses to active performance situations

This study investigated the joint influence of trait social anxiety and evaluative threat on psychological and cardiovascular responses to active coping situations. Fifty-two normotensive female students characterized as either high or low in trait social anxiety performed a mental arithmetic task and a speech task requiring persuasive behavior in a context of high or low evaluative threat. Trait social anxiety exerted a substantial influence on cardiovascular reactivity. High socially anxious individuals overall exhibited greater heart rate reactivity. For systolic and diastolic blood pressure enhanced reactivity of socially anxious individuals was confined to low evaluative threat. At high levels of evaluative threat no group differences were observed due to somewhat attenuated reactivity in high compared to low socially anxious individuals. Cognitive appraisals and affective arousal were not found to mediate the effects of social anxiety on cardiovascular reactivity. Results were attributed to differences in effort expenditure rather than experienced anxiety.

The psychobiology of PTSD: coping with trauma

Posttraumatic stress disorder (PTSD) is one of the few psychiatric conditions where a specific psychosocial stressor is explicitly tied to etiology. Although a majority of people experience a traumatic event in their life, most of them will not develop PTSD or other mental health problems such as depressive or anxiety disorders. Emotional and neurobiological responses to psychosocial stressors show striking individual variation. In this paper cognitive appraisal and coping factors are explored as potential sources of individual differences in the neuroendocrinological stress response, and subsequently in mental health outcome. Continued study of the psychobiology of trauma and PTSD will enhance our understanding of adaptation to psychosocial stressors and support efforts to treat associated psychological and biological sequelae.

Behavioral indices of threat and challenge in Hispanic adolescents and hemodynamic responses to a speech stressor

Behavioral ratings of performance and nervousness during a speech were used to divide participants (n=54) into threat and challenge groups. Comparisons on cardiac output, Heather index, heart rate, vascular resistance, and blood pressure reactivity indicated greater myocardial responses for the challenge group. This study extends the threat-challenge literature by employing behavioral definitions of constructs and examining a Hispanic adolescent sample.

Effects of appraisal and coping on the neuroendocrine response to extreme stress

Although many people are exposed to extreme stress, only some of them develop psychobiological disturbances that can lead to posttraumatic stress disorder (PTSD) or other posttrauma psychopathology. This paper examines the effects of different types of appraisal and coping to find clues to how individuals differ in their neuroendocrine responses to extreme stress. It proposes a conceptual model for components of the adult response to stressors. Threat appraisal and defensive coping may play crucial roles in determining the neuroendocrine response to trauma with potential mental health consequences, particularly PTSD.

Comportamento assertivo e sua relação com ansiedade, locus de controle e auto-estima em estudantes universitários

Foram estudados o comportamento assertivo e sua relação com ansiedade, locus de controle e auto-estima. Participou da pesquisa uma amostra aleatória de 135 universitários, de ambos os sexos, com idade média de 25 anos. Foram aplicadas as escalas de assertividade de Rathus, locus de controle de Levenson, auto-estima de Dela Coleta e a escala de ansiedade IDATE-traço. Os resultados indicaram que os estudantes da área de ciências exatas apresentaram escores mais elevados de assertividade e de auto-estima e escores menos elevados de ansiedade do que os de ciências humanas. Não houve diferença significativa de gênero. Os resultados mostraram uma correlação positiva significativa entre os escores de assertividade e o grau de internalidade (r=0,23) e de auto-estima (r=0,54). Constatou-se ainda uma correlação negativa significativa entre assertividade e grau de ansiedade (r=-0,55). Esses resultados confirmam dados da literatura, indicando que o comportamento assertivo está relacionado à baixa ansiedade e à alta internalidade e à alta auto-estima, com implicações para o treinamento do comportamento assertivo.

Effects of trait dominance on psychological and cardiovascular responses to social influence attempts: the role of gender and partner dominance

This study investigated the influence of trait dominance on cardiovascular reactivity to and recovery from a dyadic interaction task requiring active social influence attempts. Thirty-six male and 36 female normotensive high-school students characterized as either high or low in trait dominance engaged in a mixed-gender discussion with a high or low dominant partner. Trait dominance substantially influenced cardiovascular reactivity to the interpersonal stressor. High dominant participants displayed higher increases in systolic blood pressure (SBP) and pulse pressure (PP), but lower diastolic elevations than low dominant participants. The difference in diastolic reactivity was particularly pronounced in females. Recovery from stress was influenced by level of partner dominance. Participants interacting with a dominant partner showed delayed diastolic recovery. The observed cardiovascular effects seem to reflect greater task engagement and efficient coping in dominant subjects. Group differences in cognitive task appraisals and affective experiences are consistent with this interpretation. Differences in psychological responding were not found to mediate the relation between trait dominance and cardiovascular responses, however.

Irish nursing students' changing levels of assertiveness during their pre-registration programme

BACKGROUND

Stress and bullying have been found to be common problems in a number of studies of Irish nursing and midwifery. Victims of bullying need high levels of assertiveness to enable them to withstand the stress of victimization. It was deemed important to measure nursing students' level of assertiveness prior to, and near completion of, their pre-registration education programme. Aim. To ascertain nursing students' perceived levels of assertiveness prior to, and nearing the completion of, their three-year pre-registration programme.

METHODS

Ethical approval was given. The students commencing general nurse education programmes in two schools in Southern Ireland agreed to take part (n=72). A questionnaire adapted from a number of assertiveness scales, and tested for validity and reliability in this population, was used to collect data.

RESULTS

In general, students' reported assertiveness levels rose as they approached completion of their three-year education programme.

DISCUSSION

The resource constrained health service of the 21st century requires nurses who are assertive to meet the needs of its users. Nursing students' assertiveness skills could be augmented through concentrated efforts from nurse educationalists and clinicians to reduce the communication theory practice gap in nurse education today. To address the multi-dimensional nature of assertiveness, strategies to increase assertiveness should operate at the individual, interface and organisational level.

CONCLUSIONS

The students in this study reported an increase in levels of assertiveness as they approached completion of their three-year education programme. To function as effective, safe practitioners registered nurses need to be assertive, therefore education in assertiveness should be an integral part of their preparation. The precise composition and mode of delivery of this education requires exploration and evaluation.

The robust nature of the biopsychosocial model challenge and threat: a reply to Wright and Kirby

This article responds to Wright and Kirby's (this issue) critique of our biopsychosocial (BPS) analysis of challenge and threat motivation. We counter their arguments by reviewing the current state of our theory as well as supporting data, then turn to their specific criticisms. We believe that Wright and Kirby failed to accurately represent the corpus of our work, including both our theoretical model and its supporting data. They critiqued our model from a contextual, rational-economic perspective that ignores the complexity and subjectivity of person-person and person-environmental interactions as well as nonconscious influences. Finally, they provided criticisms regarding possible underspecificity of antecedent components of our model that do not so much indicate theoretical flaws as provide important and interesting questions for future research. We conclude by affirming that our BPS model of challenge and threat is an evolving, generative theory directed toward understanding the complexity of personality and social psychological factors underlying challenge and threat states.

Cardiovascular correlates of challenge and threat appraisals: a critical examination of the biopsychosocial analysis

In this article we examine critically the biopsychosocial (BPS) challenge versus threat analysis proposed by Blascovich and his coworkers. We conclude that the BPS analysis should be viewed with considerable caution. We conclude this in part because the analysis is associated with notable problems, including (a) its conception of demand, (b) its definitions of goal-relevant and evaluative situations, (c) its assertion regarding primary and secondary appraisal determinants of challenge and threat, and (d) its cardiovascular (CV) predictions. We conclude this as well because BPS analysis studies have not made a compelling empirical case. BPS analysis studies are unpersuasive because (a) their CV results are only partially consistent with BPS analysis predictions, (b) they have compared CV responses of groups bearing an uncertain relationship to the primary and secondary appraisal criteria specified for the production of challenge and threat effects, (c) they have not compared challenge and threat appraisals between challenge and threat groups, and (d) they provided data that are incomplete. Theoretical modifications and additional research could make a better case for the BPS view.

Moderation of physiological stress responses by personality traits and daily hassles: less flexibility of immune system responses

Previously we demonstrated that stressors varying on the dimension of mental effort and controllability have distinctive effects on cardiovascular, endocrine and immune system responses. The purpose of the present study was to relate individual differences in physiological stress responsivity to task appraisal and stress-induced mood changes (issue 1), trait characteristics (issue 2) and daily hassles (issue 3). Appraisal and mood changes did not mediate the differential effects of the stressors. The trait characteristics, aggression and external locus of control and daily hassles moderated the effect of the stressor on physiological parameters, especially immune parameters. Moreover, the moderation effect was different in the high versus the low effort stress task. High aggression, high external locus of control and more daily hassles were associated with increased reactivity in the low effort condition and decreased reactivity in the high effort condition, which is suggested to reflect less differentiated responding to changing task demands and hence, less flexibility in the immune system.

Cardiovascular correlates of emotional expression and suppression: do content and gender context matter?

Three studies examined cardiovascular (CV) responses during emotional expression with empathically responsive strangers. Study 1 demonstrated that self-relevant emotional expression fostered CV reactivity consistent with challenge. Study 2 manipulated content of discussion by assigning participants to 1 of 4 conditions: emotional, nonemotional, emotional suppression, nonemotional suppression. In same-sex dyads. emotional expression elicited CV challenge reactivity whereas emotional suppression evoked CV threat reactivity, both compared with appropriate control groups. In opposite-sex dyads, however, emotional expression engendered CV threat. Because same- and opposite-sex disclosures differed, Study 3 controlled the content of emotional expression while manipulating gender context. Results confirmed findings from the first 2 studies, indicating that both context and content of emotional expression influenced CV effects. Findings are discussed within a theoretical challenge and threat perspective.

Psychophysiological reactivity in female sexual abuse survivors

This study examined psychophysiological reactivity in 37 female childhood sexual abuse (CSA) survivors. After assessment of posttraumatic stress disorder (PTSD), psychiatric comorbidity, and trauma history, we conducted a psychophysiological assessment of forehead muscle tension, electrodermal activity, and heart rate during a mental arithmetic task and4 script-driven imagery tasks (neutral, consensual sex, pleasant, and trauma). PTSD symptom severity correlated positively with psychophysiologic changes and negative emotions during the trauma imagery task. During mental arithmetic, PTSD symptom severity correlated negatively with autonomic changes and positively with negative emotions. These results extend earlier PTSD research showing trauma-specific increased psychophysiological reactivity related to CSA in women with PTSD. They further suggest a negative association between PTSD severity and autonomic reactions to mental arithmetic.

Perceiver threat in social interactions with stigmatized others

The extent to which stigmatized interaction partners engender perceivers' threat reactions (i.e., stigma-threat hypothesis) was examined. Experiments 1 and 2 included the manipulation of stigma using facial birthmarks. Experiment 3 included manipulations of race and socioeconomic status. Threat responses were measured physiologically, behaviorally, and subjectively. Perceivers interacting with stigmatized partners exhibited cardiovascular reactivity consistent with threat and poorer performance compared with participants interacting with nonstigmatized partners, who exhibited challenge reactivity. In Experiment 3, intergroup contact moderated physiological reactivity such that participants who reported more contact with Black persons exhibited less physiological threat when interacting with them. These results support the stigma-threat hypothesis and suggest the utility of a biopsychosocial approach to the study of stigma and related constructs.