Does Self-Affirmation, Cognitive Processing, or Discovery of Meaning Explain Cancer-Related Health Benefits of Expressive Writing?

Self-Affirmation and Image/Performance Enhancing Drug Use in Recreational Exercise

Objectives: The use of image and performance enhancement drugs (IPEDs) in recreational sport represents an emerging public health and societal problem. The present study investigated whether self-affirmation changed exercisers' intentions to use IPEDs, via the effects of mental construal and message acceptance. Method: Sixty-eight exercisers who self-reported IPEDs use participated in the study and were randomly assigned to either a self-affirmation or a control group. All participants read a health-related message about the 10 consequences of IPEDs and subsequently completed a survey measuring message acceptance, mental construal, doping intentions and IPEDs-related social cognitive variables. Results: There were no significant differences between the self-affirmed and the control groups. Hierarchical linear regression analysis further showed that message acceptance, subjective norms, and situational temptation were significantly associated with intentions to use IPEDs. Conclusion: Our findings raise the possibility that for recreational exercisers IPED's use is seen mostly as a health-related matter than a socio-moral transgression.

Efficacy of expressive writing versus positive writing in different populations: Systematic review and meta-analysis

AIM

To evaluate the efficacy of expressive writing (EW) versus positive writing (PW) in different populations focusing on mood, health and writing content and to provide a basis for nurses to carry out the targeted treatment.

DESIGN

Systematic review and meta-analysis.

METHODS

This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twelve electronic databases and references from articles were searched. All randomized controlled trials (RCTs) comparing EW and PW were included. Statistical analyses were executed using Stata 15.0 software.

RESULTS

Twenty-four RCTs and a total of 1558 participants were analysed. The results showed that for the general population, PW was more positive on mood than EW and could offer more changes in cognitive mechanisms. Among patients, although PW was more conducive to generating positive emotions, EW could stimulate cognitive changes more. Nursing staff should clarify the mechanism of PW and EW, combine the advantages of both and implement intervention according to the characteristics of different populations.

NO PATIENT OR PUBLIC CONTRIBUTION

It does not apply to your work because this study is an analysis of published studies and does not involve patients or the public.

The effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery. A randomized controlled trial

BACKGROUND

Self-affirmations help one focus on positive outcomes and adapt to new situations both psychologically and physiologically by the repetition of positive affirmation sentences. This method, which has promising results in symptom management, is predicted to have effective results in the management of pain and discomfort in patients undergoing open-heart surgery.

AIM

To investigate the effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery.

METHODS

This study adopted a randomized controlled pretest-posttest follow-up research design. The study was conducted at a public training and research hospital (Istanbul, Turkey) specialized in thoracic and cardiovascular surgery. The sample consisted of 61 patients randomized into two groups: intervention (n = 34) and control (n = 27). The participants of the intervention group listened to a self-affirmation audio recording for three days after surgery. Anxiety levels and perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured daily. The State Trait Anxiety Inventory (STAI) was used to measure the level of anxiety, meanwhile perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured by a 0 to 10 Numeric Rating Scale (NRS).

RESULTS

The control group had significantly higher anxiety than the intervention group three days after surgery (P < 0.001). The intervention group had less pain (P < 0.01), dyspnoea (P < 0.01), palpitations (P < 0.01), fatigue (P < 0.001) and nausea (P < 0.01) than the control group.

CONCLUSIONS

Positive self-affirmation helped reduce anxiety and perceived discomfort in patients who underwent open-heart surgery.

CLINICALTRIALS

gov Identifier: NCT05487430.

Research on Expressive Writing in Psychology: A Forty-year Bibliometric Analysis and Visualization of Current Status and Research Trends

This study offers a systematic review of global academic publications of studies on expressive writing in psychology to date. By using two visualization tools VOSviewer and CiteSpace, we analyzed 1,429 articles on expressive writing from the Web of Science (WoS) Core Collection database. This study might be the first attempt at providing a visualized analysis of the existing expressive writing research. It discusses the results from the following three aspects: (1) the descriptive analysis of general results based on publications, (2) the content analysis based on highly cited articles and keyword analysis, (3) the thematic evolution based on co-word analysis and bursts detection. It is found that the application of expressive writing to minority ethnic groups might be one of the future research interests. The study proposes the necessity of conducting research in the context of positive psychology, argues for a combined use of creative and expressive writing in future studies, and suggests the potential of second/foreign language expressive writing research. The study can be used to enhance researchers’ understanding of expressive writing research and provide insights into future research opportunities in this area.

Cancer and aging: Reflections for elders- Expressive writing intervention: A pilot study

OBJECTIVES

The Cancer and Aging: Reflections for Elders Expressive Writing Intervention (CARE-Express) was developed to enhance coping and minimize psychological distress in older adults with cancer. The aim of the current study is to evaluate the feasibility and initial efficacy of CARE-Express.

MATERIALS AND METHODS

Seventy-one distressed older adults (≥70) with cancer were assigned to CARE-Express (n = 41) or the Enhanced Social Work Control (ESWC) arm (n = 30). Participants completed five telephone sessions over seven weeks and were assessed on psychosocial variables at baseline, post-intervention, and four months post study enrollment. Feasibility was assessed by examining rates of eligibility, acceptance, retention, assessment, and fidelity. Initial efficacy was evaluated using standardized effect sizes.

RESULTS

Adequate rates of acceptance (29%), eligibility (66%), retention (90%), assessment (70% at post-intervention, 63% at four month follow-up), and fidelity (97%) were observed. At post-intervention, participants receiving CARE-Express reported less depression compared to ESWC (d = 0.69, p = 0.01) and lower demoralization (d = 0.50, p = 0.06). A small/moderate effect was demonstrated for increased total spirituality scores (d = 0.41, p = 0.07), meaning/peace (d = 0.32, p = 0.20) and faith (d = 0.35, p = 0.07). The CARE-Express group reported greater reductions in behavioral disengagement (d = 0.44, p = 0.06), while ESWC demonstrated a small effect for active coping (d = 0.21, p = 0.31). At four months, differential effects of CARE-Express had attenuated, though small/moderate, effects in favor of CARE-Express remained.

CONCLUSION

Results support the feasibility of CARE-Express and its potential positive impact on psychological well-being.

TRIAL REGISTRATION

Registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT00984321 on September 25, 2009.

Pilot Randomized Trial of an Expressive Writing Intervention to Reduce Sexual HIV-Transmission Risk and Substance Use Among Emerging Adult Gay and Bisexual Men

This pilot randomized controlled trial evaluated the feasibility, acceptability, and preliminary efficacy of expressive writing to reduce HIV-related sexual risk taking and symptoms of drug dependence among emerging adult gay and bisexual men (EAGBM) through linguistic mechanisms involving use of words associated with cognitive processing (e.g., think, cause), positive emotion (e.g., love, nice), and negative emotion (e.g., hurt, shame). Between 2014 and 2015, EAGBM (n = 78; aged 18-29) completed a baseline survey and were randomized to complete three 15-min expressive writing or equivalent control-group writing sessions and follow-up assessments 2 months post-baseline. EAGBM in the expressive writing condition utilized significantly more positive emotion, negative emotion, and cognitive processing words. Path model results indicated the intervention condition resulted in significant reductions in symptoms of drug dependence and frequency of condomless anal sex (CAS) through paths mediated by positive emotion words, and significant increases in CAS through a path mediated by negative emotion words.

How do they grow out of their cancer experience? Korean adolescent and young adult cancer survivors' stories

Objectives: Cancer experiences can bring positive as well as negative impacts. The current literature, however, focuses mainly on the negative impacts. This qualitative study examines Korean childhood cancer survivors' post-traumatic growth, which concerns how they respond positively to the cancer experience and how they change as a result of their experience.Design: In-person or telephone interviews were conducted with 31 adolescent and young adult survivors of childhood cancer post-treatment who were living in Korea.Results: Thematic analysis found that childhood cancer survivors experienced growth by feeling gratitude (being content with the present, making comparisons with worse situations), engaging in self-affirmation ('I am strong'; 'My example can help others'; 'I am ready for new challenges'), deepening faith (communicating with God, trusting God's direction), and finding the social meaning of cancer (becoming a self-advocate, mapping out a career path).Conclusions: The study findings can be used by psychosocial care professionals to support Korean cancer survivors to recognize post-traumatic growth and, thus, achieve improved well-being.

Sustaining the integrity of the threatened self: A cluster-randomised trial among social assistance applicants in the Netherlands

Stereotypes and stigma associated with living on welfare or a low income can be a psychological threat that hampers performance and undermines aspirations. Our paper explores the potential of a novel self-affirmation intervention to mitigate such adverse impacts. The intervention comprises a verbal self-affirmation exercise for applicants during their first meeting with a caseworker. We conduct a cluster-randomised trial among a sample of 174 applicants for social assistance benefits in a Social Services office in Maastricht, the Netherlands. We measure outcomes on feelings of self-worth, stress, societal belonging, job search behaviour self-efficacy and cognitive performance immediately after the meeting. In our full sample, the intervention has a negative impact on feelings of societal belonging, but no effect on other outcomes. Effects, however, vary by subgroups. Our treatment increases negative feelings of self-worth and negatively affects societal belonging, but also improves cognitive performance among the group that had paid work in the previous two years. By contrast, self-affirmation positively impacts job search behaviour self-efficacy and cognitive performance for individuals who face increased challenges to (re)integrate into the labour market, proxied by lower levels of education or social assistance receipt in the previous two years. Since our intervention gives rise to testing more than one null hypothesis, we control the false discovery rate using the Benjamini-Hochberg approach. Our findings are sobering. Effects only remain significant for negative feelings of self-worth and improved cognitive performance for one particular subgroup: individuals with paid work in the past two years. This suggests self-affirmation may have reminded them of the time they still had a job, hence creating a backlash effect on feelings of self-worth. At the same time, they may have felt a need to distinguish themselves from others on social assistance benefits resulting in better cognitive performance. These interpretations are consistent with theory and empirical evidence on social identity and self-categorisation. We discuss the implications of our results and outline avenues for future work.

Follow-up to a randomized controlled trial of the effect of self-affirmation on anxiety during the COVID-19 pandemic

A recent study showed that a brief intervention involving reflection on personal values (T1: 2 February 2020) can buffer the anxiety response one week later (T2: Feb. 9) during the COVID-19 pandemic in China. The present study reported the results from a follow-up two weeks (T3: Feb. 16) and one-month later (T4: Mar. 1). Two hundred and twenty participants were recruited via convenience sampling and randomly assigned either to the value-affirmation condition or to a control condition, with 110 participants in each condition. The results revealed that similar to T2, participants who affirmed their values showed a lower anxiety response than those in the control group at T3, despite the pandemic continuing to increase rapidly during that time. Meanwhile, anxiety decreased in both groups at T4 as the pandemic eased. Findings suggest that self-affirmations can help reduce stress in the face of the COVID-19.

The Double-Edged Sword of Reflective Pondering: The Role of State and Trait Reflective Pondering in Predicting Depressive Symptoms Among Women With Breast Cancer

BACKGROUND AND PURPOSE

Prior research has debated whether reflective pondering is a more constructive form of rumination than brooding, which is generally considered maladaptive. This study sought to investigate whether reflective pondering predicts depressive symptoms and whether reflective pondering is adaptive under certain conditions. We predicted that the effectiveness of reflective pondering could depend on concurrent coping strategies and the trait-state distinction.

METHOD

Women with breast cancer (N = 309; M age = 47.5) were assessed at four waves over 2 years. A time-lagged design was applied, with rumination (i.e., brooding and reflective pondering) and coping (i.e., engagement and disengagement) measured from T1 to T3, predicting depressive symptoms assessed from T2 to T4. These variables were measured by the Ruminative Response Scale, the Brief COPE, and the Hospital Anxiety and Depression Scale.

RESULTS

Using hierarchical linear modeling, brooding, but not reflective pondering, predicted elevated depressive symptoms at both between- and within-person levels. The relationship between reflective pondering and depression was moderated by the coping strategies. Individual differences in reflective pondering predicted worse depressive symptoms, but higher use of engagement coping mitigated the detrimental effect. Within individuals, the co-occurrence of reflective pondering and disengagement coping predicted a subsequent decrease in depressive symptoms.

CONCLUSIONS

The emerging role of reflective pondering in the face of breast cancer-related stress appears to be a double-edged sword. Its impact on depression may depend on concurrent coping strategies and whether reflective pondering is assessed at state and trait levels.

Association of Spontaneous and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile App: Randomized Controlled Trial

Background

Most smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats.

Objective

This study examines whether self-affirmation is associated with smoking cessation in the context of a cessation app. Two types of self-affirmation are examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publicly available smoking cessation app (Smoke-Free Quit Smoking Now). In addition, this study explores whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predict smoking cessation.

Methods

All users who met the inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to 1 of 4 conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half of the participants were randomly assigned to receive self-affirming text notifications during their quit attempt or to receive conventional notifications. The induction and the text notifications were fully automated, and all data were collected through self-assessments in the app. Self-reported smoking cessation was assessed 1 month and 3 months following study entry.

Results

The study enrolled 7899 participants; 647 completed the 1-month follow-up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% (569/7899) of participants self-reported not smoking in the previous week and 6.4% (503/7899) self-reported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted a greater likelihood of cessation (P<.001) at 1 month after controlling for smoking-related variables. Neither self-affirmation induction influenced cessation. In addition, spontaneous self-affirmation did not moderate the relationship between self-affirmation inductions and cessation. Greater baseline sadness was associated with a lower likelihood of reporting successful cessation. Optimism predicted past-week cessation at the 1-month follow-up, and both happiness and anger predicted past-month cessation at the 1-month follow-up; however, none of these potential predictors moderated the relationship between self-affirmation conditions and successful cessation.

Conclusions

Spontaneous self-affirmation may be an important psychological resource for managing threats to self-concept during the smoking cessation process. Sadness may hinder quit attempts. Future research can explicate how spontaneous versus induced self-affirmation can promote smoking cessation and examine boundary conditions for the effectiveness of disseminated self-affirmation interventions.

Trial Registration

ISRCTN Registry 56646695; https://www.isrctn.com/ISRCTN56646695

Greater benefit of self-affirmation for prevention-focused individuals prior to threatening health messages

OBJECTIVE

Individuals are often defensive toward health messages that suggest they are putting their health at risk because such messages threaten their self-competence and integrity. Although self-affirmation can facilitate prevention behaviors in response to health messages, effects are variable. We examined whether disease prevention focus might strengthen self-affirmation's effects in response to disease prevention messages, given that prevention-focused individuals are likeliest to be persuaded by those messages after self-affirmation attenuates defensiveness.

DESIGN

In Study 1, participants were self-affirmed before a message about sexually transmitted infections. In Studies 2 and 3, individuals were self-affirmed prior to a message about alcohol and cancer risk.

MAIN OUTCOME MEASURES

Studies assessed intentions to use condoms, intentions to reduce alcohol, and willingness to drink alcohol in specific scenarios.

RESULTS

In Study 1, self-affirmation facilitated condom use intentions among those higher in prevention focus. In Studies 2 and 3, self-affirmation facilitated lower willingness to consume alcohol among those high in prevention focus. A meta-analysis across the three studies indicated that self-affirmation improved intentions and willingness under high, but not low, prevention focus (d = 0.20, p = .003).

CONCLUSION

These findings demonstrate that health prevention-focus can strengthen self-affirmation's effects, thereby improving responsiveness to health communications about behaviors that increase disease risk.

Emotional approach coping in older adults as predictor of physical and mental health

Emotional approach coping involves active attempts at emotional expression and processing in response to stressful circumstances. This study tested whether dispositional emotional approach coping processes predict changes in physical and mental health in community-dwelling older adults, particularly within the context of higher perceived stress. To test this, older adults (N = 150) completed assessments of emotional expression and emotional processing at study entry. They also completed measures of perceived stress, depressive symptoms, and ill-health (a composite of subjective and objective physical health indicators, which included blood draw for collection of biomarkers), every 6 months over 4.5 years. Emotional processing and emotional expression were not related significantly to ill-health at study entry. However, emotional processing (but not emotional expression) significantly predicted changes in ill-health. At higher levels of emotional processing, ill-health remained low and stable; at lower levels of emotional processing, ill-health increased over time. However, when perceived stress was high, higher emotional processing and emotional expression were related to lower depressive symptoms at study entry, but higher emotional processing was associated with increasing depressive symptoms over time. Emotional approach coping processes evidence prospective relations with health outcomes, which are partially conditioned by stress perceptions. Emotional processing appears to have a protective impact against declining physical health. Predictive relationships for depressive symptoms are more complex. Older adults with chronically high perceived stress might benefit from interventions that target emotion-regulating coping processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Using the theory of self-affirmation and self-regulation strategies of mental contrasting and forming implementation intentions to reduce social anxiety symptoms

Background and Objectives: Based on the results of past research on emotion regulation and positive behavioral change via self-affirmation, it was hypothesized that self-affirmation should help socially anxious individuals to reduce social anxiety symptoms. The effectiveness of a brief self-affirmation intervention framed in terms of implementation intentions (if-then plans with self-affirming cognitions) was compared against forming non-affirming implementation intentions (with distraction as a way of coping) and inactive control condition. Additionally, it was tested whether mental contrasting can augment the impact of the self-affirmation intervention. Design/Methods: Participants (N = 198, aged 18-45) were randomly assigned to one of three intervention conditions (self-affirming implementation intention, mental contrasting with self-affirming implementation intention, or non-affirming implementation intention) or an inactive control-group. Social anxiety symptoms were assessed at baseline and at one-week post-intervention. Results: The difference between the interventions and the control group was substantial. However, there were no differences in the reduction of overall social anxiety levels between the interventions. Each of the interventions produced a statistically significant reduction in social anxiety (Cohen's ds from -.40 to -.50). Conclusions: The results indicate no advantage for self-affirming over non-affirming implementation intentions in reducing social anxiety symptoms. Moreover, no superiority of mental contrasting was found.

User Experiences of Social Support From Companion Chatbots in Everyday Contexts: Thematic Analysis

BACKGROUND

Previous research suggests that artificial agents may be a promising source of social support for humans. However, the bulk of this research has been conducted in the context of social support interventions that specifically address stressful situations or health improvements. Little research has examined social support received from artificial agents in everyday contexts.

OBJECTIVE

Considering that social support manifests in not only crises but also everyday situations and that everyday social support forms the basis of support received during more stressful events, we aimed to investigate the types of everyday social support that can be received from artificial agents.

METHODS

In Study 1, we examined publicly available user reviews (N=1854) of Replika, a popular companion chatbot. In Study 2, a sample (n=66) of Replika users provided detailed open-ended responses regarding their experiences of using Replika. We conducted thematic analysis on both datasets to gain insight into the kind of everyday social support that users receive through interactions with Replika.

RESULTS

Replika provides some level of companionship that can help curtail loneliness, provide a "safe space" in which users can discuss any topic without the fear of judgment or retaliation, increase positive affect through uplifting and nurturing messages, and provide helpful information/advice when normal sources of informational support are not available.

CONCLUSIONS

Artificial agents may be a promising source of everyday social support, particularly companionship, emotional, informational, and appraisal support, but not as tangible support. Future studies are needed to determine who might benefit from these types of everyday social support the most and why. These results could potentially be used to help address global health issues or other crises early on in everyday situations before they potentially manifest into larger issues.

The Language of LGBTQ+ Minority Stress Experiences on Social Media

LGBTQ+ (lesbian, gay, bisexual, transgender, queer) individuals are at significantly higher risk for mental health challenges than the general population. Social media and online communities provide avenues for LGBTQ+ individuals to have safe, candid, semi-anonymous discussions about their struggles and experiences. We study minority stress through the language of disclosures and self-experiences on the r/lgbt Reddit community. Drawing on Meyer's minority stress theory, and adopting a combined qualitative and computational approach, we make three primary contributions, 1) a theoretically grounded codebook to identify minority stressors across three types of minority stress-prejudice events, perceived stigma, and internalized LGBTphobia, 2) a machine learning classifier to scalably identify social media posts describing minority stress experiences, that achieves an AUC of 0.80, and 3) a lexicon of linguistic markers, along with their contextualization in the minority stress theory. Our results bear implications to influence public health policy and contribute to improving knowledge relating to the mental health disparities of LGBTQ+ populations. We also discuss the potential of our approach to enable designing online tools sensitive to the needs of LGBTQ+ individuals.

Values of cancer survivors and the supportive role of recreational video games

Value-affirming activities have been linked to positive health outcomes and improved ability to cope. For cancer survivors who regularly play video games, might the games have potential to affirm values? We surveyed gameplaying survivors and included an open-ended question asking about values and the extent to which they perceived gameplaying as supporting values. A content analysis of responses (N = 533) using Schwartz's value typology revealed that a majority perceived gameplaying as supporting values or offering other benefits. Self-transcendence followed by openness to change were the most frequently coded higher-order categories. The results contribute to a richer understanding of survivors who gameplay.

Autobiographical recall of mastery experiences is a mechanism of self-affirming under social identity threat

Autobiographical memories are relevant to many areas of psychological functioning. So far, however, there is no evidence whether personal memories can also be instrumental for self-affirmation. We conducted two experiments, varying national identity threat among U.S. Americans recruited through MTurk. In Study 1, participants spontaneously recalled autobiographical memories after being exposed to varying levels of threat. When the threat was identity-relevant, those who spontaneously recalled mastery autobiographical memories had higher collective self-esteem than those who did not. In Study 2, we instructed participants to recall either mastery autobiographical memories or routine memories. When the threat was identity-relevant, collective self-esteem was again higher for mastery recall compared to routine recall, moderated by national identification and self-esteem. We also found a general, self-affirmative effect of autobiographical memories, regardless of threat relevance or recall content. Findings provide a first empirical demonstration that autobiographical recall can enhance self-affirmation in identity threat situations.

Acculturation Moderates the Effects of Expressive Writing on Post-Traumatic Stress Symptoms Among Chinese American Breast Cancer Survivors

BACKGROUND

Previous research indicated that the benefits of expressive writing on cancer patients' physical and psychological well-being may vary across cultures. However, it remains unknown whether the within-ethnicity cultural orientation would also moderate the efficacy of expressive writing. Immigrants are a special population who differ widely in extent of endorsing the home culture and the host culture. We examined the role of acculturation in moderating the effect of expressive writing among Chinese American breast cancer survivors in reducing different post-traumatic stress disorder (PTSD) symptom clusters: re-experiencing, avoidance, and arousal.

METHOD

Ninety-six Chinese American breast cancer survivors were randomly assigned to three groups to write about cancer-related topics: a self-regulation group to write about deepest feelings, stress coping, and finding benefits; an emotional disclosure group to write about deepest feelings; and a cancer-fact group to write about cancer experience objectively. The only examined moderator, acculturation, was assessed at baseline. PTSD symptoms were assessed at baseline and 1-, 3-, and 6-month follow-ups.

RESULTS

Acculturation moderated the effect of expressive writing at 3- and 6-month follow-ups. Among participants with low acculturation, PTSD symptoms were less severe in the self-regulation and cancer-fact groups compared with the emotional disclosure group; in contrast, no group differences in PTSD were found among highly acculturated participants.

CONCLUSIONS

Our findings highlight the important role of sub-ethnic cultural orientation in the efficacy of psychosocial interventions targeting immigrant populations.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03546673.

Increasing Receptivity to Messages about E-Cigarette Risk Using Vicarious-Affirmation

Empirical research has found that self-affirmation that precedes exposure to threatening information can reduce resistance and exert a positive effect on attitudes and beliefs. However, the effortful methods currently used to induce self-affirmation (e.g., writing an essay about an important value) limit its applicability. Informed by narrative persuasion literature, we present an experimental study designed to assess the potential of vicarious-affirmation (i.e., affirmation through a relevant exemplar in a fictional story) to influence perceived risk and behavioral intent among college-age electronic cigarette users (N = 832). Similar to traditional self-affirmation, a story that affirmed its character (by winning an award) before introducing tobacco-related risk information, led to greater perceived risk and increased intentions to stop using electronic-cigarettes. Identification with the character led to more positive self-appraisal, which, in turn, reduced message derogation and enhanced perceived risk. We conclude by discussing the theoretical and applied implications of integrating narrative persuasion with self-affirmation theory.

Effects of expressive writing and use of cognitive words on meaning making and post-traumatic Growth

Expressive writing can enhance cognitive processing and improve stress regulation. Particularly, the use of cognitive words (i.e., insightful and causal words) in writing may be associated with the process of meaning making and promotion of post-traumatic growth (PTG). The aim of the present study was to determine how expressive writing and the use of causal and insightful cognitive words influenced meaning making and PTG during writing. In total, 52 traumatized university students were recruited and randomly assigned to one of two writing conditions involving either an expressive writing task or a neutral writing task. The results showed that participants who engaged in expressive (vs. neutral) writing showed higher scores on the presence of meaning and PTG in the post-writing, self-report questionnaires. Moreover, writing task (expressive or neutral) and frequency of causal and insightful cognitive words were both significant predictors of meaning, which in turn led to high levels of PTG. In conclusion, the use of causal and insightful words might be a fundamental cognitive process for developing meaning in writing, which is essential for our further understanding of meaning making and PTG.

Self-Distancing May Be Harmful: Third-Person Writing Increases Levels of Depressive Symptoms Compared to Traditional Expressive Writing and No Writing

Introduction: The positive effects of expressive writing on both mental and physical health are well documented. However, expressive writing may have the potential to activate negative schemas and facilitate rumination in those at high cognitive risk for depression (Yasinski, Hayes, & Laurenceau, 2016). The current research tested the hypothesis that writing using self-distancing would be more effective than traditional expressive writing in preventing depressive symptoms for those at high cognitive risk for depression.

Method: Two studies using undergraduate samples (n = 104 and n = 80) were conducted to test our hypotheses. Both studies used a two-week daily writing experimental design.

Results: Contrary to hypotheses, Study 1 found that individuals randomly assigned to a self-distancing writing condition reported greater levels of depressive symptoms than those assigned to a traditional expressive writing condition. The results of Study 2 replicated the results of Study 1. Participants randomly assigned to the self-distancing writing condition reported significantly greater levels of depressive symptoms than those in the expressive writing and no-writing control conditions. The effect of writing condition in Study 2 was driven by those with high levels of cognitive vulnerability.

Discussion: Results suggest that writing using self-distancing should not be used for the prevention of depressive symptoms.

Psychological, Relational, and Emotional Effects of Self-Disclosure After Conversations With a Chatbot

Disclosing personal information to another person has beneficial emotional, relational, and psychological outcomes. When disclosers believe they are interacting with a computer instead of another person, such as a chatbot that can simulate human-to-human conversation, outcomes may be undermined, enhanced, or equivalent. Our experiment examined downstream effects after emotional versus factual disclosures in conversations with a supposed chatbot or person. The effects of emotional disclosure were equivalent whether participants thought they were disclosing to a chatbot or to a person. This study advances current understanding of disclosure and whether its impact is altered by technology, providing support for media equivalency as a primary mechanism for the consequences of disclosing to a chatbot.

Racial (vs. self) affirmation as a protective mechanism against the effects of racial exclusion on negative affect and substance use vulnerability among black young adults

Affirming one's racial identity may help protect against the harmful effects of racial exclusion on substance use cognitions. This study examined whether racial versus self-affirmation (vs. no affirmation) buffers against the effects of racial exclusion on substance use willingness and substance use word associations in Black young adults. It also examined anger as a potential mediator of these effects. After being included, or racially excluded by White peers, participants were assigned to a writing task: self-affirmation, racial-affirmation, or describing their sleep routine (neutral). Racial exclusion predicted greater perceived discrimination and anger. Excluded participants who engaged in racial-affirmation reported reduced perceived discrimination, anger, and fewer substance use cognitions compared to the neutral writing group. This relation between racial-affirmation and lower substance use willingness was mediated by reduced perceived discrimination and anger. Findings suggest racial-affirmation is protective against racial exclusion and, more generally, that ethnic based approaches to minority substance use prevention may have particular potential.

Can self-affirmation exacerbate adverse reactions to stress under certain conditions?

OBJECTIVE

Self-affirmation has repeatedly been shown to reduce adverse psychological and physiological responses to stress. However, it is plausible that self-affirmation could exacerbate negative reactions to stress under certain conditions. The current research explored whether self-affirmation would increase negative psychological responses to a stressor occurring in a central life domain characterised by low levels of control.

DESIGN

Female participants (Study 1 N = 132; Study 2 N = 141) completed baseline measures of anxiety and mood. They were then randomly allocated to complete a self-affirmation or control task, before reading a narrative documenting a stressful birth and imagining themselves in the place of the woman giving birth. After completing this task, participants again reported their levels of anxiety and positive mood.

MAIN OUTCOME MEASURES

Anxiety and positive mood assessed at follow-up.

RESULTS

Study 1 demonstrated that self-affirmed women experienced increased anxiety and less positive mood at follow-up, compared both to baseline and to women in the control condition. Study 2 revealed that the effect of self-affirmation on outcomes was moderated by fear of childbirth.

CONCLUSION

These results provide preliminary evidence that self-affirmation may worsen negative responses to stressors under certain conditions and for certain individuals.

Spontaneous self-affirmation is associated with psychological well-being: Evidence from a US national adult survey sample

Emerging evidence suggests that individuals spontaneously self-affirm, by reflecting on values and strengths, in response to daily threats. We examined the prevalence and demographic and well-being correlates of spontaneous self-affirmation in the general population. Participants ( n = 3185) completed the cross-sectional, nationally representative 2013 Health Information National Trends Survey (HINTS 4, Cycle 3), and answered questions about spontaneous self-affirmation, demographic factors, well-being, and affect. The majority of the population reported spontaneously self-affirming. Black and Hispanic respondents reported engaging in more spontaneous self-affirmation. Engaging in spontaneous self-affirmation was related to greater happiness, hopefulness, optimism, subjective health, and personal health efficacy, and less anger and sadness.

Involved, United, and Efficacious: Could Self-Affirmation Be the Solution to California's Drought?

Self-affirmation theory posits that thoughts and actions that affirm an important aspect of the self-concept can make people more susceptible to change by casting their self in a positive light. Whereas much of the current literature has been restricted to individual-level concerns, the current study provides longitudinal evidence for behavioral outcomes in the context of the California drought, advancing our theoretical knowledge regarding the underlying processes that lead self-affirmed individuals to address societal risks and collective concerns. The results of a three-wave experimental study (N = 91) indicated that relative to nonaffirmed counterparts, self-affirmed participants reported on higher levels of support for water conservation policies, as well as on reduction of water use that endured for 30 days following the self-affirming manipulation. In both cases, the effects were mediated by collective-efficacy but not by self-efficacy. Relevant explanations are considered and practical and theoretical implications are discussed.

A randomized controlled trial of expressive writing in breast cancer survivors with lymphedema

OBJECTIVE

Breast cancer survivors who develop lymphedema report poorer quality of life (QoL) than those without lymphedema. Expressive writing is a potential intervention to address QoL.

DESIGN

Adult women (N = 107) with breast cancer and chronic Stage II lymphedema were randomised to writing about thoughts and feelings specific to lymphedema and its treatment (intervention) or about daily activities (control) for four, 20-min sessions.

MAIN OUTCOME MEASURES

Outcome measures were several indicators of QoL assessed at baseline, one, three, and six months post-intervention (total scores and subscales of Upper Limb Lymphedema 27 and Functional Assessment of Cancer Therapy-Breast). Hypothesised moderators of change in QoL were dispositional optimism, avoidant behaviours, and time since lymphedema diagnosis.

RESULTS

There was no statistically significant intent-to-treat main effects of expressive writing on QoL. Statistically significant moderating effects on change in different indicators of QoL were observed for all three moderators. Expressive writing was more effective for improving QoL in women who were higher on optimism, lower on avoidance and had less time since a lymphedema diagnosis.

CONCLUSION

These results provide further evidence that there are subsets of individuals for whom expressive writing is more effective. Future research may investigate targeting expressive writing based on identified moderators.

Symptom Management: The Effects of Self-Affirmation on Chemotherapy-Related Symptoms

BACKGROUND

Positive effects of auditory stimulations are common in symptom management. However, the effect of self-affirmations on symptom management is not well known.

OBJECTIVES

The purpose of this study is to investigate the effects of self-affirmations and nature sounds on chemotherapy-related symptoms.

METHODS

This randomized, controlled experimental study was conducted with 140 patients receiving chemotherapy. The first experimental group listened to affirmations, the second listened to nature sounds, and the third listened to both.

FINDINGS

In the affirmation group, pain, tiredness, drowsiness, lack of appetite, depression, anxiety, and lack of well-being scores were lower. In the affirmation and nature sounds group, drowsiness, depression, anxiety, and lack of well-being scores were reduced. In the nature sounds group, tiredness, drowsiness, and lack of well-being scores were reduced. In the control group, tiredness, drowsiness, nausea, and lack of well-being scores were higher.

You Should Know Better: Can Self-Affirmation Facilitate Information-Seeking Behavior and Interpersonal Discussion?

This study explores whether self-affirmation has the capacity not merely to reduce the perceived threat associated with health-related information but also to facilitate interpersonal discussion and affect health information-seeking behavior. The context for the study is the ongoing California drought, which serves as suitable context to examine the intersection of self-affirmation and information-seeking behavior because it involves a threatening message (the destructive consequences of the drought) and highlights discrepancies between actual (water waste) and prosocial (water conservation) behavior. Results of a month-long longitudinal panel study demonstrate significant effects of self-affirmation on interpersonal discussion, information seeking, knowledge, and water-conserving behavior across time. Implications for theorizing longer term effects of self-affirmation and practical implications for promoting behavioral change through the enhancement of knowledge and self-esteem are considered.

Implicit loneliness, emotion regulation, and depressive symptoms in breast cancer survivors

Among individuals coping with cancer, emotional approach coping-expressing and processing emotions following negative events-has been identified as a potentially adaptive form of emotion regulation. However, its mental health benefits may depend on social-cognitive factors and on how it is implemented. This study examined loneliness as a determinant of emotion regulation associations with depressive symptoms in women with breast cancer. Loneliness was examined as an implicit social-cognitive phenomenon (i.e., automatic views of oneself as lonely), and emotional expression and processing were examined as both explicit and implicit processes. Approximately 11 months after diagnosis, 390 women completed explicit measures of coping through cancer-related emotional expression and processing; an implicit measure of expression and processing (an essay-writing task submitted to linguistic analysis); and an implicit association test measuring loneliness. Depressive symptoms were assessed 3 months later. Regardless of implicit loneliness, self-reported emotional expression (but not emotional processing) predicted fewer depressive symptoms, whereas implicit expression of negative emotion during essay-writing predicted more symptoms. Only among women high in implicit loneliness, less positive emotional expression and more causal processing during the writing task predicted more depressive symptoms. Results suggest that explicit and implicit breast cancer-related emotion regulation have distinct relations with depressive symptoms, and implicit loneliness moderates effects of implicit emotional approach. Findings support implicit processes as influential mechanisms of emotion regulation and suggest targets for intervention among breast cancer survivors.

Optimism and Spontaneous Self-affirmation are Associated with Lower Likelihood of Cognitive Impairment and Greater Positive Affect among Cancer Survivors

BACKGROUND

Optimism and self-affirmation promote adaptive coping, goal achievement, and better health.

PURPOSE

The aim of this study is to examine the associations of optimism and spontaneous self-affirmation (SSA) with physical, mental, and cognitive health and information seeking among cancer survivors.

METHODS

Cancer survivors (n = 326) completed the Health Information National Trends Survey 2013, a national survey of US adults. Participants reported optimism, SSA, cognitive and physical impairment, affect, health status, and information seeking.

RESULTS

Participants higher in optimism reported better health on nearly all indices examined, even when controlling for SSA. Participants higher in SSA reported lower likelihood of cognitive impairment, greater happiness and hopefulness, and greater likelihood of cancer information seeking. SSA remained significantly associated with greater hopefulness and cancer information seeking when controlling for optimism.

CONCLUSIONS

Optimism and SSA may be associated with beneficial health-related outcomes among cancer survivors. Given the demonstrated malleability of self-affirmation, these findings represent important avenues for future research.

The Power of Affirming Group Values: Group Affirmation Buffers the Self-Esteem of Women Exposed to Blatant Sexism

Extending the group affirmation literature to the domain of prejudice, this study investigated whether group affirmation buffers the self-esteem of women exposed to blatant sexism. In accordance with Self-Affirmation Theory (Steele, 1988) and group affirmation research (Sherman et al., 2007), we hypothesized that when one aspect of the collective self is threatened (gender identity), self-esteem can be maintained via the affirmation of an alternative aspect of the collective self. In a 2×2 between-participants design, female students were randomly assigned to read about discrimination directed toward women or a non-self-relevant disadvantaged group (the Inuit). All then participated in a (fictitious) second study, in which half completed a group affirmation manipulation (wrote about the top three values of a self-defining group) and half completed a control writing exercise. The self-esteem of women who were threatened by sexism, but group affirmed, was protected from the negative effects of perceiving sexism.

Posttraumatic Growth in Psychosis

OBJECTIVE

Recent research has shown high rates of exposure to trauma among people with serious mental illness (SMI). In addition, studies suggest that psychosis and mental illness-related experiences can be extremely traumatic. While some individuals develop full blown PTSD related to these experiences, it has been noted that some may also experience posttraumatic growth (PTG). However, few studies have examined PTG as a possible outcome in people who have experienced psychosis.

METHOD

To further understand the relationships between psychosis and PTG, 121 participants were recruited from community mental health rehabilitation centers and administered trauma and psychiatric questionnaires.

RESULTS

High levels of traumatic exposure were found in the sample. Regarding our main focus of study, we observed that people who endured psychosis can experience PTG, and that PTG is mediated by meaning making and coping self-efficacy (CSE) appraisal. Psychotic symptoms were found to be a major obstacle to meaning making, CSE, and PTG, whereas negative symptoms were found to be significantly related to PTG when mediated by meaning making and CSE.

CONCLUSION

The current research provides preliminary evidence for potential role of meaning making and CSE as mediators of PTG in the clinical, highly traumatized population of people with SMI who have experienced psychosis. This may have both research as well as clinical practice relevance for the field of psychiatric rehabilitation.

Associations of spontaneous self-affirmation with health care experiences and health information seeking in a national survey of US adults

OBJECTIVE

Self-affirming--such as by reflecting on one's strengths and values--reduces defensiveness to threatening information, reduces negative effects of stereotype threat and promotes prosociality. These outcomes may promote physical health, highlighting a need to examine the role of self-affirmation in medical and health contexts.

DESIGN

Data were collected as part of the nationally representative, cross-sectional, 2013 Health Information National Trends Survey. Items were completed by 2731 respondents.

MAIN OUTCOME MEASURES

Respondents answered questions about spontaneous self-affirmation tendencies, perceptions of providers and health care, involvement in medical appointments, health information seeking and engagement in medical research.

RESULTS

Spontaneous self-affirmation was associated with more positive perceptions of communication with one's provider, better perceived quality of care, greater likelihood of asking questions in a medical appointment, greater information seeking for oneself and multiple indices of surrogate information seeking (i.e. seeking information for others). Four of eight significant associations remained significant when controlling for optimism. The associations of self-affirmation with aspects of the patient-provider relationship were not modified by factors likely to be associated with stereotype threat (e.g. race or BMI).

CONCLUSION

Spontaneous self-affirmation was related to positive outcomes in health contexts. Experimental research is needed to further explore the causal nature of these associations.

Self-Esteem and the Acute Effect of Anxiety on Ambulatory Blood Pressure

OBJECTIVES

Recent research suggests that self-esteem may be associated with improved parasympathetic nervous system functioning. This study tested whether high self-esteem is associated with decreased ambulatory systolic blood pressure (ASBP) reactivity to anxiety in healthy adults during the waking hours of a normal day.

METHODS

Each of 858 participants completed a short version of the Rosenberg Self-Esteem Scale and then wore an ABP monitor that took two blood pressure readings per hour for 24 hours. Immediately after each blood pressure reading, participants completed an electronic diary report that included an anxiety rating on a 100-point visual analog scale. Using multilevel models, we assessed the association of momentary anxiety, high trait self-esteem, and their interaction on momentary ASBP, with adjustment for age, sex, race, ethnicity, and body mass index. Sensitivity analyses were conducted examining psychological factors associated with self-esteem: sense of mastery, optimism, social support, and depressive symptoms.

RESULTS

On average, a 1-point increase in cube root-transformed anxiety was associated with a 0.80-mm Hg (standard error = 0.09, p < .001) increase in ASBP, and the interaction of high self-esteem and momentary anxiety was significant, such that this effect was 0.48 (standard error = 0.20, p = .015) less in individuals with high self-esteem compared with all others. Results for self-esteem remained significant when adjusting for sex and psychological factors.

CONCLUSIONS

Momentary increases in anxiety are associated with acute increases in ASBP, and high self-esteem buffers the effect of momentary anxiety on blood pressure. Thus, high self-esteem may confer cardiovascular benefit by reducing the acute effects of anxiety on systolic blood pressure.

Distinguishing Intrapsychic From Interpersonal Motives in Psychological Theory and Research

Many psychological phenomena have been explained primarily in terms of intrapsychic motives to maintain particular cognitive or affective states—such as motives for consistency, self-esteem, and authenticity—whereas other phenomena have been explained in terms of interpersonal motives to obtain tangible resources, reactions, or outcomes from other people. In this article, we describe and contrast intrapsychic and interpersonal motives, and we review evidence showing that these two distinct sets of motives are sometimes conflated and confused in ways that undermine the viability of motivational theories. Explanations that invoke motives to maintain certain intrapsychic states offer a dramatically different view of the psychological foundations of human behavior than those that posit motives to obtain desired interpersonal outcomes. Several phenomena are examined as exemplars of instances in which interpersonal and intrapsychic motives have been inadequately distinguished, if not directly confounded, including cognitive dissonance, the self-esteem motive, biases in judgment and decision making, posttransgression accounts, authenticity, and self-conscious emotions. Our analysis of the literature suggests that theorists and researchers should consider the relative importance of intrapsychic versus interpersonal motives in the phenomena they study and that they should make a concerted effort to deconfound intrapsychic and interpersonal influences in their research.

Health and writing: meaning-making processes in the narratives of parents of children with leukemia

There is literary evidence stating that expressive writing affects health outcomes. Nevertheless, the processes underlying its benefits remain unclear. In our previous article, we described the benefits of writing; in this article, we investigate the meaning-making processes underlying the traumatic experiences of parents of children with leukemia in off-therapy. We collected the writings of 23 parents and grouped them according to the parents' psychological outcome (low/good/high) with respect to anxiety, as assessed during a follow-up. We qualitatively analyzed the texts written by parents with good psychological outcomes to highlight their main meaning-making processes, that is, how they put into words the shattering experience, reordered the events, connected their emotions and the events, reevaluated the event, and reconstructed the time process. We found that parents with low/high outcomes articulated these processes differently. Furthermore, we discussed the uses and functions of written narration for each group.

Writing content predicts benefit from written expressive disclosure: Evidence for repeated exposure and self-affirmation

Expressive disclosure regarding a stressful event improves psychological and physical health, yet predictors of these effects are not well established. The current study assessed exposure, narrative structure, affect word use, self-affirmation and discovery of meaning as predictors of anxiety, depressive and physical symptoms following expressive writing. Participants (N = 50) wrote on four occasions about a stressful event and completed self-report measures before writing and three months later. Essays were coded for stressor exposure (level of detail and whether participants remained on topic), narrative structure, self-affirmation and discovery of meaning. Linguistic Inquiry and Word Count software was used to quantify positive and negative affect word use. Controlling for baseline anxiety, more self-affirmation and detail about the event predicted lower anxiety symptoms, and more negative affect words (very high use) and more discovery of meaning predicted higher anxiety symptoms three months after writing. Findings highlight the importance of self-affirmation and exposure as predictors of benefit from expressive writing.