Your feelings are reasonable: Emotional validation promotes persistence among preschoolers

Persistence is a critical factor that significantly predicts life outcomes. Although individual differences in persistence emerge early in life, the knowledge of effective strategies for cultivating persistence in young children remains limited. Based on these two studies, we suggest that emotional validation, defined as the acceptance of emotions without judgment, is a beneficial technique for promoting persistence in the wake of frustration. Study 1 examined 150 parents of children aged 4-6 years and found that parents' tendency to validate their children's emotions was positively associated with children's trait persistence. We conducted a randomized experiment (N = 93, aged 4-6 years) in Study 2 to establish a causal relationship between emotional validation and persistence in preschoolers. Children who received emotional validation feedback (n = 31) exhibited higher levels of persistence than those who received emotional invalidation (n = 31) and no feedback (baseline, n = 31) on a frustrating task. The persistence between the emotional invalidation and no-feedback conditions was not statistically different. This finding highlights the vital role of emotional validation in promoting persistence in children at trait and state levels. In summary, this study offers a compelling strategy for empowering young children with resilience and determination when they encounter challenges. RESEARCH HIGHLIGHTS: Parental emotional validation predicts the trait-level persistence of children aged 4-6 years. Children who received emotion-validation feedback persisted longer on a task than those who received emotion-invalidation feedback or no feedback. Children in the emotion invalidation condition did not differ from those in the no-feedback condition in terms of persistence. Future studies are required to investigate the mechanisms underlying emotional validation in promoting task persistence in children.

Conversational Chatbot for Cigarette Smoking Cessation: Results From the 11-Step User-Centered Design Development Process and Randomized Controlled Trial

BACKGROUND

Conversational chatbots are an emerging digital intervention for smoking cessation. No studies have reported on the entire development process of a cessation chatbot.

OBJECTIVE

We aim to report results of the user-centered design development process and randomized controlled trial for a novel and comprehensive quit smoking conversational chatbot called QuitBot.

METHODS

The 4 years of formative research for developing QuitBot followed an 11-step process: (1) specifying a conceptual model; (2) conducting content analysis of existing interventions (63 hours of intervention transcripts); (3) assessing user needs; (4) developing the chat's persona ("personality"); (5) prototyping content and persona; (6) developing full functionality; (7) programming the QuitBot; (8) conducting a diary study; (9) conducting a pilot randomized controlled trial (RCT); (10) reviewing results of the RCT; and (11) adding a free-form question and answer (QnA) function, based on user feedback from pilot RCT results. The process of adding a QnA function itself involved a three-step process: (1) generating QnA pairs, (2) fine-tuning large language models (LLMs) on QnA pairs, and (3) evaluating the LLM outputs.

RESULTS

We developed a quit smoking program spanning 42 days of 2- to 3-minute conversations covering topics ranging from motivations to quit, setting a quit date, choosing Food and Drug Administration-approved cessation medications, coping with triggers, and recovering from lapses and relapses. In a pilot RCT with 96% three-month outcome data retention, QuitBot demonstrated high user engagement and promising cessation rates compared to the National Cancer Institute's SmokefreeTXT text messaging program, particularly among those who viewed all 42 days of program content: 30-day, complete-case, point prevalence abstinence rates at 3-month follow-up were 63% (39/62) for QuitBot versus 38.5% (45/117) for SmokefreeTXT (odds ratio 2.58, 95% CI 1.34-4.99; P=.005). However, Facebook Messenger intermittently blocked participants' access to QuitBot, so we transitioned from Facebook Messenger to a stand-alone smartphone app as the communication channel. Participants' frustration with QuitBot's inability to answer their open-ended questions led to us develop a core conversational feature, enabling users to ask open-ended questions about quitting cigarette smoking and for the QuitBot to respond with accurate and professional answers. To support this functionality, we developed a library of 11,000 QnA pairs on topics associated with quitting cigarette smoking. Model testing results showed that Microsoft's Azure-based QnA maker effectively handled questions that matched our library of 11,000 QnA pairs. A fine-tuned, contextualized GPT-3.5 (OpenAI) responds to questions that are not within our library of QnA pairs.

CONCLUSIONS

The development process yielded the first LLM-based quit smoking program delivered as a conversational chatbot. Iterative testing led to significant enhancements, including improvements to the delivery channel. A pivotal addition was the inclusion of a core LLM-supported conversational feature allowing users to ask open-ended questions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03585231; https://clinicaltrials.gov/study/NCT03585231.

Emotional Invalidation and Relationship Quality: A Mediational Model Through a Social Learning Lens

While we know childhood experiences are influential on a child's later socioemotional awareness and behavior, we are still searching for specific mechanisms that influence the transferability of childhood experiences and adult relationship functioning. In this study, we seek to further this area of investigation by examining the interpretation of ambiguous social interactions and perceptions of emotional invalidation as potential mediators of the relationship between perceptions of childhood emotional invalidation and current relationship quality. Participants completed online measures of hostile intent attributions, perceptions of childhood emotional invalidation, and current relationship quality with a significant other. They read emotionally provocative interpersonal scenarios and then reported likely emotionally invalidating reactions from their significant other to measure current perceptions of emotional invalidation. Results supported our hypotheses that perceptions of current emotional invalidation in a close, personal relationship would mediate the relationship between perceptions of childhood maternal emotional invalidation and both current relationship support and relationship conflict. Furthermore, the strength of this mediational pathway outweighed the influence of a more general hostile attribution bias. These findings have implications for prevention and intervention strategies designed to enhance interpersonal functioning.

AI-powered mental health communication: Examining the effects of affection expectations on health behavioral intentions

OBJECTIVES

This study proposed and examined users' expectations of chatbots in mental health communication and compared them with human doctors. Focusing on the affective expectation, we aimed to unveil the impacts of changes in affection on individuals' expectations and behavioral intentions.

METHODS

A 2 (chatbot vs. human doctor) x 2 (affective vs. neutral) online experiment (N = 364) was conducted. Participants were asked about their expectations towards communicating health with chatbots and human doctors, watched pre-recorded conversations, and answered questions about expectancy violation toward affection and willingness to further health actions.

RESULTS

Individuals have higher expectations from human doctors in almost all aspects. Individuals' expectation of online chat with doctors is more likely to be violated compared with chatbots. Significant results are found on individuals' behavioral intentions, with a greater likelihood of switching to online chatbots when chatbots use an affective approach or doctors use a neutral tone. Individual's past experiences with chatbots play a key role in expectancy violations.

CONCLUSION

Individuals have higher expectations of human doctors, but using an affective approach may better meet individuals' expectations toward chatbots and switch their behavioral intentions.

PRACTICE IMPLICATIONS

Chatbots that meet expectations can be designed and applied to address mental health concerns.

Maternal alcohol dependence symptoms, maternal insensitivity to children's distress, and young children's blunted emotional reactivity

Maternal insensitivity to children's emotional distress (e.g., expressions of sadness or fearfulness) is one mechanism through which maternal alcohol dependence may increase children's risk for psychopathology. Although emotion dysregulation is consistently associated with psychopathology, it remains unclear how or why alcohol dependence's effects on caregiving responses to children's distress may impact children's emotion regulation over time, particularly in ways that may engender risks for psychopathology. This study examined longitudinal associations between lifetime maternal alcohol dependence symptoms, mothers' insensitivity to children's emotional distress cues, and children's emotional reactivity among 201 mother-child dyads (Mchild age = 2.14 years; 56% Black; 11% Latino). Structural equation modeling analyses revealed a significant mediational pathway such that maternal alcohol dependence predicted increases in mothers' insensitivity to children's emotional distress across a one-year period (β = .16, p = .013), which subsequently predicted decreases in children's emotional reactivity one year later (β = -.29, p = .009). Results suggest that mothers with alcohol dependence symptoms may struggle to sensitively respond to children's emotional distress, which may prompt children to suppress or hide their emotions as an adaptive, protective strategy. The potential developmental benefits and consequences of early, protective expressive suppression strategies are discussed via developmental psychopathology frameworks.

Development, reach, acceptability and associated clinical changes of a group intervention to improve caregiver-adolescent relationships in the context of adolescent depression

Background

Adolescents with depression often experience relationship problems with their caregivers, which predict poorer treatment outcomes. Personalising interventions by targeting factors associated with poor treatment outcomes may enhance the effectiveness of interventions. We report the development and initial evaluation of an intervention designed to target caregiver-adolescent relationship problems in the context of adolescent depression.

Methods

Following a literature search to identify established caregiver interventions, we developed a new group intervention for caregivers through an iterative process including six rounds of the group with n = 53 caregivers of adolescents age 13-18 in the context of an integrated care pathway for adolescent depression. Caregivers rated their family functioning at the beginning and end of the program and provided anonymous satisfaction ratings. Enrolment and attendance data were examined. Youth with lived experience of depression and their caregivers provided input that was incorporated in the final version of the intervention.

Results

The final intervention consists of 8 weekly, 1.5 h group sessions, delivered face-to-face, addressing: psychoeducation, the cognitive-behavioural model and caregiving, positive caregiving, listening and validation, expressing emotions effectively, and problem solving. Reach (56%), attendance (M = 63%, SD = 31%), and satisfaction (M = 92%; SD = 7%) supported the feasibility of the program. Caregivers reported significant improvements in family functioning, t(21) = 2.68, p = .014, d z = 0.56 [95% CI 0.11-1.0].

Discussion

A group intervention is acceptable to caregivers of adolescents with depression and may be associated with improved family functioning. Further research is needed, including a randomised controlled trial to test effects of the intervention on various dimensions of the caregiver-youth relationship and on youth depression outcomes.

Experiences of communication in women with endometriosis: perceived validation and invalidation in different contexts, and associations with health-related quality of life

Endometriosis, a chronic gynecological disease affecting approximately 10% of women of reproductive age, has a significant impact on physical and mental health. This cross-sectional study aimed to explore experiences of validating and invalidating communication in three contexts (with healthcare providers, employers, and family/friends), and whether this may predict health-related quality of life (HRQoL) in women with endometriosis. Data was collected through a digital survey distributed to women with self-reported endometriosis in Sweden. The survey included measures of validating and invalidating communication, depressive symptoms, anxiety, and HRQoL. A total of 427 women participated. The results indicated that women experienced varying levels of validating and invalidating communication in different contexts, with close family/friends providing the highest level of validation, and healthcare providers the lowest. Furthermore, a combined construct of high levels of validation and low levels of invalidation from healthcare providers and from close family and friends were significant predictors of HRQoL. These findings highlight the importance of supportive communication and understanding from healthcare providers and close social networks in promoting the well-being of women with endometriosis. Future research should further explore the impact of validating communication within healthcare settings and develop interventions to improve communication and support for women with endometriosis.

Facing negative emotions: Evaluation of a brief training in validating communication for contact nurses in cancer care

BACKGROUND

Contact nurses in cancer care (CNCC) often face challenges when communicating with patients and their families. The overall aim was to evaluate a brief digital validation training for CNCC, to test whether it was associated with increased validation and decreased invalidation. Associations between communication skills in validation and markers of work-related stress were also investigated.

METHODS

This intervention study investigated associations between the training and validation skills using a within-group design with repeated measures (at pre, post, and eight-week follow-up). Additionally, associations between the training and occupational self-efficacy, self-validation, and exhaustion symptoms were explored.

RESULTS

Seventeen CNCCs (all female with relatively long work experience) completed a five-week digital training program. Results indicated a statistically significant increase in validation and a statistically significant decrease in invalidation, showing that the nurses improved their communication skills following the training. No changes were found in markers of work-related stress.

CONCLUSION

The results indicate that digital validation training for CNCCs is potentially beneficial by means of improving communication skills. This study further demonstrates that a brief digital training in validating communication to CNCC is associated with improved person-centered communication regarding strong negative emotions.

Social Verification Theory: A New Way to Conceptualize Validation, Dissonance, and Belonging

ACADEMIC ABSTRACT

In the present review, we propose a theory that seeks to recontextualize various existing theories as functions of people's perceptions of their consistency with those around them. This theory posits that people seek social consistency for both epistemic and relational needs and that social inconsistency is both negative and aversive, similar to the experience of cognitive dissonance. We further posit that the aversive nature of perceiving social inconsistency leads people to engage in various behaviors to mitigate or avoid these inconsistencies. When these behaviors fail, however, people experience chronic social inconsistency, which, much like chronic rejection, is associated with physical and mental health and well-being outcomes. Finally, we describe how mitigation and avoidance of social inconsistency underlie many seemingly unrelated theories, and we provide directions for how future research may expand on this theory.

PUBLIC ABSTRACT

In the present review, we propose that people find inconsistency with those around them to be an unpleasant experience, as it threatens people's core need to belong. Because the threat of reduced belongingness evokes negative feelings, people are motivated to avoid inconsistency with others and to mitigate the negative feelings that are produced when it inevitably does arise. We outline several types of behaviors that can be implemented to avoid or mitigate these inconsistencies (e.g., validation, affirmation, distancing, etc.). When these behaviors cannot be implemented successfully, people experience chronic invalidation, which is associated with reduced physical and mental health and well-being outcomes. We discuss how invalidation may disproportionately affect individuals with minoritized identities. Furthermore, we discuss how belongingness could play a key role in radicalization into extremist groups.

Disclosure of Sexual Victimization: Effects of Invalidation and Shame on Re-Disclosure

Research on disclosure of sexual victimization has consistently demonstrated that the act of disclosure and the disclosure recipient have a synergistic effect in facilitating either positive or negative post-assault outcomes. While negative judgments such as victim blame have been argued to serve a silencing function, experimental investigations of this claim are lacking. The current study investigated whether invalidating feedback in response to self-disclosure of a personally distressing event produced feelings of shame, and whether shame influenced subsequent decisions around re-disclosure. Feedback type (validating, invalidating, no feedback) was manipulated in a sample of 142 college students. Results partially supported the hypothesis that shame resulted from invalidation, however shame was better predicted by individual perceptions of invalidation than the experimental manipulation. Although few participants opted to make changes to the content of their narrative for re-disclosure, those who did had higher levels of state shame. Results suggest that shame may be the affective mechanism by which invalidating judgments silence victims of sexual violence. The present study also supports the distinction previously made between Restore and Protect motivations in managing this shame. This study provides experimental support for the notion that an aversion to being shamed, communicated via an individual's perception of emotional invalidation, features in judgments of re-disclosure. Perceptions of invalidation, however, vary individually. Professionals working with victims of sexual violence should be mindful of the importance of shame attenuation in facilitating and encouraging disclosure.

Coping with Transitions: A Promising Intensive Outpatient DBT Program for Emerging Adults and Their Families

Emerging adulthood is a period of significant exploration, transformation, variability, and growth. Simultaneously, this developmental period presents unique challenges as emerging adults work to achieve developmental milestones including self-identity formation, the establishment of long-term intimate relationships, career advancement, and independence from parents. For those who are vulnerable, this period is also marked by the development of significant mental health problems and associated impairment, which prevents individuals from successfully reaching these developmental milestones. To address the various challenges unique to this developmental period, we created and implemented a multifaceted DBT treatment protocol to specifically address emotional dysregulation within emerging adults. The current study presents an evaluation of a novel, intensive, outpatient DBT program called System for Adult Growth and Emergence-Foundations (SAGE-F). We aim to first introduce the SAGE-F treatment protocol, and then to assess both its short and long-term therapeutic value. Participants enrolled in SAGE-F were administered a testing battery assessing symptom severity, functioning capacities, and coping strategies at intake, upon completion of the program 6-weeks later, and at 3-month follow-up. It was found participants who completed SAGE-F reported significant reductions in depression and anxiety symptoms, as well as non-suicidal self-injurious behaviors. Simultaneously, participants also reported improvements in their daily functioning and coping capacities. Follow-up assessments indicated therapeutic progress remained.

Responding to distressed infants: Does mothers' positive versus negative affect matter for infants' behavior and physiology?

How mothers respond to infants' distress has implications for infants' development of self-regulation and social competence. In a sample of 35 mothers and their 4- to 8-month-old infants, we induced infant distress using an arm restraint task and compared infants' observed affect and physiological responses under two conditions, when mothers were instructed to respond with: 1) positive affect and 2) negative affect. Based on theoretical and empirical support, we empirically evaluated two opposing hypotheses. Based on the Mutual Regulation Model and work on affect matching, we predicted that when mothers respond with negative affect versus positive affect, distressed infants' duration of negative affect would be smaller, negative affect would be less intense, and respiratory sinus arrythmia (RSA) withdrawal would be lower. Based on social referencing theory and research, we expected that when mothers respond with positive affect versus negative affect, distressed infants' duration of negative affect would be smaller, negative affect would be less intense, and RSA withdrawal would be lower. We found that when mothers responded to their distressed infants with negative affect versus positive affect, infants spent significantly more time in negative affect, their intensity of expressed negative affect was greater, and their RSA withdrawal was greater, suggesting that mothers' display of mild positive affect when infants are distressed may be helpful for infants. The current findings add to accumulating evidence that mothers' positive relative to negative affective response to their infants' distress can produce observable differences in infants' duration and intensity of negative affect, as well as their physiology. Findings have the potential to inform future research that investigates how mothers can most effectively reduce their infants' distress and intervention that targets the moment-to-moment behaviors in mother-infant reciprocal interactions.

Defining pain-validation: The importance of validation in reducing the stresses of chronic pain

Purpose

To validate an individual's feelings or behaviour is to sanction their thoughts or actions as worthy of social acceptance and support. In contrast, rejection of the individual's communicated experience indicates a denial of social acceptance, representing a potential survival threat. Pain-invalidation, though ill-defined, appears to be a fundamental component of psychosocial stress for people with chronic pain. As such, the aim of this paper was to define pain-validation and outline its importance for those with chronic pain.

Methods

The pain-validation construct was defined using themes inherent in the narratives of those with chronic pain, as identified in a previously published systematic search and thematic analysis, together with examination of additional literature on pain-validation in the clinical context.

Results

We present a construct definition, proposing that pain-validation must necessarily include: (i) belief that the pain experience is true for the individual, (ii) acceptability of the individual's expressions of pain, and (iii) communication of belief and acceptability to the individual experiencing pain. Further, we outline the importance of pain-validation as a protective factor and means of reducing many of the psychosocial stresses of chronic pain; for example, by indicating social support for pain-coping, buffering negative emotions, and re-enforcing unity and shared identity.

Implications

The role of pain-validation in the current era of pain management intervention is discussed. Adhering to interventions that involve cognitive and behavioural change is often difficult. Acknowledging and validating the acceptability of the patient's pain experience in the early stages of pain management may, therefore, be a key component of intervention that encourages compliance to the treatment plan and achieving therapeutic goals.

The Effect of a Brief Physician-Delivered Neurobiologically Oriented, Cognitive Behavioural Therapy (Brief-CBT) Intervention on Chronic Pain Acceptance in Youth with Chronic Pain-A Randomized Controlled Trial

At the Stollery Children’s Chronic Pain Clinic, new referrals are assessed by an interdisciplinary team. The final part of the intake assessment typically involves an explanation and compassionate validation of the etiology of chronic pain and an invitation to the youth to attend the group outpatient Cognitive Behavioural Therapy (CBT) program, called Pain 101, or to individual outpatient CBT. It was hypothesized that a brief physician-delivered CBT (brief-CBT) intervention at first point of contact improves subsequent pain acceptance. Using a randomized double blinded methodology, 26 participants received a standard intake assessment and 26 the standard assessment plus the brief-CBT intervention. Measures were taken at three points: pre and post-intake assessment and after Pain 101 or individual CBT (or day 30 post-assessment for those attending neither). The primary outcome measure was the Chronic Pain Acceptance Questionnaire—Adolescent version (CPAQ-A). Comparing pre and post-intake measures, there was a significant (p = 0.002) increase in the CPAQ-A scores—four-fold more in the brief-CBT intervention group (p = 0.045). Anxiety (RCADS-T Score) was significantly reduced post-intake and significantly more reduced in the intervention group compared to the control group (p = 0.024). CPAQ-A scores were significantly increased (p < 0.001) (N = 28) and anxiety (RCADs-T) was significantly reduced by the end of Pain 101 (p < 0.003) (N = 29) as was fear of pain as measured by the Tampa Scale for Kinesiophobia (p = 0.021). A physician-delivered brief-CBT intervention significantly and meaningfully increased CPAQ-A scores and reduced anxiety in youth with chronic pain. Furthermore, CBT through Pain 101 is effective at increasing acceptance, as well as reducing anxiety and fear of movement.

Responding to Teenagers’ Emotional Meltdowns: How Outward Bound Instructors Facilitate Development of Anxiety Management Skills

Rates of intense anxiety among teenagers have risen dramatically, a major concern. Outward Bound (OB), a wilderness expedition program that promotes learning through challenge experiences, is found to help youth decrease anxiety. To understand how program staff support this learning, we asked 30 OB instructors to describe their successful work with a youth following an intense anxiety episode (a “meltdown”). Using grounded theory analyses we identified eight practices OB instructors employed that facilitated the youth’s emotional learning. Examples include: helping them open up to examine their emotions, providing tools for detecting and regulating rising anxiety, and instructor-youth co-planning to manage upcoming anxiety-inducing situations. The analyses also revealed the intentionality in each practice: when it was used, its goals, strategies employed, and how each facilitated youth’s active emotional learning. Youth’s learning processes across practices evolved from being instructor-initiated to youth-driven. The skills youth learned progressed from understanding emotions, to controlling imminent anxiety, to controlling anxiety about future situations, to taking responsibility for the impact of their emotions on others. These OB practices, we suggest, can be flexibly adapted to other youth development settings to help teens build competencies to manage anxiety, including when taking on new demanding challenges.

The who and what of validation: an experimental examination of validation and invalidation of specific emotions and the moderating effect of emotion dysregulation

BACKGROUND

Theory and research indicate that validation is associated with reductions in negative emotions, whereas invalidation is associated with escalation of negative emotions. However, it remains unclear whether these effects are consistent across emotions, and/or moderated by an individual's levels of emotion dysregulation. The present study experimentally examines the effects of validation and invalidation across emotions and as moderated by emotion dysregulation.

METHODS

One hundred twenty-six participants completed a measure of emotion dysregulation, and then listened to a rejection-themed imagery script after which they reported the intensity of several emotions. Participants were then presented with either validating or invalidating feedback about their most intense self-reported emotion, depending on their counterbalancing order. They then repeated the procedure for the other condition. Self-reported negative emotions via continuous rating dial, heart rate (HR), and skin conductance level (SCL) were monitored throughout.

RESULTS

Higher emotion dysregulation was associated with greater increases in self-reported positive emotion when shame or sadness was validated and lesser increases when fear was validated. There were no significant moderating effects of emotion dysregulation in response to invalidation for any emotion on any index.

CONCLUSIONS

The effects of validation appear emotion specific and dependent on levels of emotion dysregulation. These findings may help inform more strategic use of validation in psychotherapeutic interventions.

Parenting Intervention for Psychological Flexibility and Emotion Regulation: Clinical Protocol and an Evidence-Based Case Study

Psychological flexibility has been found as a protective factor for several psychological problems, including the field of parenting. The present study aims to illustrate a clinical protocol, session by session, for the promotion of parental psychological flexibility and emotion regulation in a case study. The clinical protocol is based on third-wave behavior therapy in a brief intervention of four sessions. The intervention is presented in a clinical case of a mother with a child diagnosed with Oppositional Defiant Disorder. Both mother and child experienced problems with emotional regulation and psychological flexibility. The results show clinically significant improvements in psychological flexibility, emotional regulation, and stress parenting in the mother both after the intervention and at follow-up. In the child, emotional perspective-taking skills, acceptance, and valued actions improved. The case illustrates in detail the application of different strategies of acceptance, mindfulness, emotion regulation, and emotional defusion applicable to parenting. Clinical implications are discussed.

Shame Mediates the Relationship Between Pain Invalidation and Depression

The experience of pain is subjective, yet many people have their pain invalidated or not believed. Pain invalidation is associated with poor mental health, including depression and lower well-being. Qualitative investigations of invalidating experiences identify themes of depression, but also social withdrawal, self-criticism, and lower self-worth, all of which are core components of shame. Despite this, no studies have quantitatively assessed the interrelationship between pain invalidation, shame, and depression. To explore this relationship, participants recounted the frequency of experienced pain invalidation from family, friends, and medical professionals, as well as their feelings of internalized shame and depressive symptoms. As shame has been shown to be a precursor for depression, we further explored the role of shame as a mediator between pain invalidation and depressive symptoms. All sources of pain invalidation were positively associated with shame and depressive symptoms, and shame fully mediated the relationship between each source of pain invalidation and depression. Relative to other sources, pain invalidation from family was most closely tied to shame and depression. Overall, findings indicate that one mechanism by which pain invalidation may facilitate depression is via the experience of shame. Future research may explore shame as a potential upstream precursor to depression in the context of pain. Findings provide more insight into the harmful influence of pain invalidation on mental health and highlight the impact of interpersonal treatment on the experiences of people in pain.

Race, social pain minimization, and mental health

People often believe Black individuals experience less social pain and require less social support to cope with distress than White individuals (e.g., Deska, Kunstman, Lloyd, et al., 2020). However, researchers have not tested whether biases in third-person pain judgments translate to first-person experiences with social pain minimization. For example, do Black individuals feel their social pain is underrecognized to a greater extent than White individuals? The current work tested whether Black individuals felt their social pain was minimized more than White individuals and if the experience of social pain minimization was related to worse mental health and greater life stress. Data from two cross-sectional, correlational studies provide initial support for these predictions ( Ntotal = 1,501). Black participants felt their social pain was minimized more than White participants and this race difference in social pain minimization was associated with worse mental health and greater life stress. These results suggest that Black individuals feel their pain is underrecognized and this experience of social pain minimization is related to worse mental health outcomes.

How Do I Help My Partner in Pain? Partners' Helping Behaviors Are Linked to Lower Pain and Greater Perceived Validation During an Experimental Pain Task

BACKGROUND

Observers' responses to people with illness are important predictors of quality of life, yet findings are mixed regarding the types of responses that affect illness-related suffering.

PURPOSE

The purpose of this study was to examine whether perspective taking positively affects observers' responses to their romantic partner experiencing experimentally induced pain and whether responses based in Self-Determination Theory and communication models of illness are related to perceived validation and pain outcomes.

METHODS

Undergraduate romantic couples (N = 122) completed baseline questionnaires; then one partner was randomly assigned to complete the cold pressor task, whereas the other partner observed. Couples were randomly assigned to one of two groups: a perspective-taking group in which observers were privately instructed to take the perspective of the pain participant or a control group. Afterward, both partners completed surveys, and pain participants completed a video recall task in which they recalled partner behaviors that were coded by trained raters using a theoretically derived manual.

RESULTS

Pain participants in the perspective-taking group identified significantly less invalidating communication from their partners, fewer behaviors that thwarted their competence, and more behaviors that supported their autonomy. Across groups, pain participants who received more normalizing communication that supported their competence felt more validated by their partners, had lower pain intensity, and exhibited greater pain tolerance, whereas those who received more invalidation showed worse outcomes.

CONCLUSIONS

The results from this study suggest that attention to different types of partner behaviors is essential when developing behavioral medicine treatments for pain and illness.

The quest for genuine care: A qualitative study of the experiences of young people who self-harm in residential care

Levels of self-harm for young people in care are high, and even higher for those in residential care. Recent research highlights the importance of understanding self-harm relationally. Such an approach may be of particular value for understanding the self-harm of young people in care. The aim of this research was to understand the experiences of young people who self-harm whilst living in residential care, with a particular focus on the effect of the care setting on their self-harm. Five young people participated in semi-structured interviews which were analysed using Interpretive Phenomenological Analysis. Four themes emerged: 'The black hole of self-harm', 'Seeking genuine care and containment', 'The cry to be understood' and 'Loss of control to the system.' Young people recognised their need for support with their self-harm, but organisationally driven approaches to managing risk contributed to a perception that the care offered was not genuine, which led to an unwillingness to accept care. The findings highlight the need for a more compassionate, relational response to young people who self-harm in residential care.

The Interplay of Parental Response to Anger, Adolescent Anger Regulation, and Externalizing and Internalizing Problems: A Longitudinal Study

Numerous studies have reported substantive correlations between anger socialization, children’s anger regulation, and internalizing/externalizing problems. However, substantially less is known about the interplay among these constructs during the developmental stage of adolescence, and longitudinal studies on causal relations (i.e., parent-directed, adolescent-directed, or reciprocal effects) are rare. It is also unclear whether the development of internalizing and externalizing problems have similar causal relations. We collected three waves of longitudinal data (Grade 6, Grade 7, Grade 9) from multiple informants. A sample of N = 634 adolescents (mostly 11–12 years at Time 1; 50.6% male) and their parents (predominantly Caucasian with German nationality) completed questionnaires assessing parents’ responses to anger, adolescents’ anger regulation, and adolescents’ internalizing/externalizing problems at each wave. Comparisons of different cross-lagged models revealed reciprocal rather than unidirectional effects. However, we found more parent-directed effects with respect to the development of internalizing problems, whereas relations regarding externalizing problems were more adolescent-directed, i.e., adolescents’ externalizing problems and their anger regulation predicted changes in their parents’ responses to anger across time. Adolescent anger regulation was an important maintaining factor of parents’ responses to anger in later adolescence. Our findings suggest that assumptions regarding bidirectional relations should be emphasized much more in emotion socialization frameworks, particularly for the period of adolescence. Moreover, our study emphasizes the transdiagnostic importance of parents’ responses to anger for both externalizing and internalizing problems and also suggests different underlying mechanisms.

Meaning-Making Activity in the Emotional Experience of Borderline Personalities

This article describes the mereological constitution of contents in the intentional acts of people affected by borderline personality disorder (BPD) or emotionally unstable personality disorder (EUPD) in order to shed light on the origin of the emotional instability characterizing this disorder. The article will first discuss the emotional cycle of people affected by this disorder; second, it will focus on the mereological aspect of the meaning-making<A51_FootRef>1</A51_FootRef> experience in the intentional act; third, it will show how this meaning-making experience usually interacts with axiological<A51_FootRef>2</A51_FootRef> qualities that affect the continuity of their sense of reality. From the investigation, it emerges that the mereological constitution of contents occurs in a way that is disruptive of the continuity of BPD/EUPDs' interaffective lifeworld as it generates intersubjective disturbances on the axiological, logical, and ontological levels. On this basis, as a concluding suggestion, the paper will propose an alternative way to approach the problem, soothe the disturbance, and encourage integration.

Racial discrimination and posttraumatic stress: examining emotion dysregulation as a mediator in an African American community sample

Background: African Americans experience more severe and chronic posttraumatic stress disorder (PTSD) symptoms compared to other racial groups, and thus it is important to examine factors that are relevant for the aetiology of PTSD in this population. Although racial discrimination has been implicated as an exacerbating factor in the development and maintenance of PTSD, relatively less is known about mechanisms through which this process may occur. Objective: The purpose of this study was to examine one such mechanism, emotion dysregulation, in two independent samples of African American adults. Method: Trauma-exposed participants were recruited in a large, urban community hospital setting (initial sample n = 1,841; replication sample n = 294). In the initial sample, participants completed a unidimensional measure of emotion dysregulation and self-reported PTSD symptoms based on the DSM-IV. In the replication sample, participants completed a multidimensional measure of emotion dysregulation and a diagnostic interview of PTSD symptoms based on the DSM-5. Mediation analyses were used to test our hypotheses. Results: Across both samples, results indicated that racial discrimination was indirectly associated with PTSD symptoms through emotion dysregulation (even when trauma load was added as a covariate). Conclusions: Taken together, these results provide strong evidence that the association between racial discrimination and PTSD symptoms may be partially explained by the association between racial discrimination and worse emotion dysregulation. These findings elucidate the impact of racist incidents on mental health and identify modifiable emotion regulatory processes that can be intervened upon to enhance the psychological and social wellbeing of African Americans.

Adolescents' perceptions of maternal response to negative affect predict emotional reactivity during mother-daughter interaction: A multi-modal assessment

Parental socialization of emotion consists of parental behaviors that scaffold child emotional reactivity and regulation. The current study examined whether adolescents' perceptions of their mothers' supportive versus non-supportive responses to negative emotions could predict adolescent emotional reactivity. Thirty adolescent girls (M_age  = 14.41 [1.55]) reported on how their mothers typically respond to their negative emotions and then completed a laboratory-based mother-adolescent interaction task. A multi-modal assessment of adolescent emotional reactivity during the interaction included adolescents' skin conductance levels (SCLs) and state anxiety, and mother-daughter interactions were behaviorally coded to assess how often dyads engaged in both negative and positive escalation (i.e., a pattern of negative or positive behavior of one partner being reciprocated by the other). Adolescents who reported that their mothers used more non-supportive responses to their negative emotion tended to exhibit higher SCL and engage in more negative escalation with their mothers during the interaction task. Furthermore, adolescents' SCL was positively correlated with both their state anxiety levels and negative escalation during the task. Together, these findings suggest that adolescents who perceive their mothers as less supportive of negative emotions are more likely to exhibit greater negative emotionality during parent-adolescent interaction, which may relate to risk for emotional disorders.

"My child will actually say 'I am upset' … Before all they would do was scream": Teaching parents emotion validation in a social care setting

BACKGROUND

Emotion validation by parents has positive outcomes for children's emotional development, particularly in vulnerable families, but there is a lack of research on supporting health workers to teach emotion validation to parents whose children are open to early help and children's social services. There is also a theoretical debate about how best to conceptualize emotion validation and why it is beneficial to children. The purpose of the study was to test the feasibility of teaching emotion validation skills to parents and family workers in a social care setting and to examine the effects of such teaching on children's emotion awareness and emotion regulation.

METHODS

This small scale qualitative feasibility study involved 11 parents (with children aged 2-5 years) who were receiving early help social services and five family workers. All parents took part in a 4-week course teaching emotionally validating parenting: either in a group class (six parents) or one-one delivery at home via a family worker (five parents). Effects on parents, children, and family workers were assessed using semi-structured interviews.

RESULTS

Six themes were identified in qualitative analysis: (1) parent became more validating, (2) parent's own vulnerability affected their ability to use the skills, (3) child became more aware of emotions, (4) child became calmer and more accepting of negative emotions, (5) child transferred emotion validation to others, and (6) family workers incorporated emotion validation techniques into their professional practice.

CONCLUSION

Results demonstrated the feasibility of teaching emotional validation skills to parents via both delivery methods, with positive outcomes reported for parents and children and positive impact reported on family worker practice. Qualitative analysis suggested that parental acceptance of child's negative emotions may be linked with greater self-awareness of negative emotions in the child.

Effects of (in)validation and plain versus technical language on the experience of experimentally induced pain: A computer controlled simulation paradigm

BACKGROUND AND OBJECTIVES

Amongst social contextual influences on pain, the manner in which pain and painful procedures are communicated to patients is considered an important contributor to the subjective experience of pain. Threatening information, e.g., by the use of technical language, is suggested to increase pain reports. Validation, or communicating understanding towards another person reporting personal experiences, is suggested to reduce pain. The current study examines effects of both information language (technical vs. plain language) and validation (validation vs. invalidation) on the subjective experience of experimentally induced pain.

METHODS

Pain-free participants (N = 132) were randomly assigned to one of four groups as formed by manipulations of validation and information language. After reading a description concerning the upcoming thermal stimulus formulated in technical or plain language, participants engaged in a computer controlled simulation (CCS; based on virtual reality technology). Participants received three thermal stimuli while interacting with an avatar who either validated or invalidated their experience during the CCS. Pain intensity and pain unpleasantness were assessed after each stimulus.

RESULTS

The validation manipulation showed to be effective, but the information language manipulation did not induce differential threat expectancies. Results show no effect of validation or information language on subjective pain reports.

LIMITATIONS

Suboptimality of the information language manipulation and shortcomings of the CCS procedure might account for current findings.

CONCLUSIONS

The study offers an interesting model for the further experimental study of isolated and combined effects of (social) contextual factors on pain. Diverse future research avenues are discussed.

Confirmatory Factor Analysis of the Invalidating Childhood Environment Scale in Spanish (ICES)

Background/Objective: The Invalidating Childhood Environment Scale (ICES) is an instrument designed to assess retrospectively parental invalidation experience, according to Marsha Linehan’s definition of invalidation. The main aim of this paper is to determine the factorial structure of the ICES. Three factor structures: Standard Model, Reduced Model, and 2 Factor Model are examined. Also, the association between invalidating experience and borderline symptoms is studied. Method: Data from a non-clinical, volunteer sample of 274 adults was collected. Participants completed 4 surveys: Demographic surveys, Invalidating Childhood Environment Scale (ICES), Borderline Symptoms List (BSL 23), and Parental Bonding Instrument (PBI). Statistical analyses included confirmatory factor analysis and multiple linear regression. Results: The results of the analysis presented indicate that the ICES is a reliable instrument, and that the 2 Factor Model is good fit and allows for a broader understanding of invalidation and it’s qualities. The results of the linear regression analysis indicated a mild but significant association between invalidation and BPD symptoms. Internal consistency was acceptable for all levels. Conclusion: The outcome of this study shows that the ICES is a useful instrument that can be used to make progress in uncovering the role of childhood invalidation in BPD.

Medical Education: Guidelines for Effective Teaching of Managing Challenging Patient Encounters

Health care providers require strong communication skills to effectively interact with and assist patients on a daily basis. However, medical professionals and trainees are often not equipped with the tools necessary to conduct productive exchanges, especially with challenging patient encounters. Communicating thoughtfully can become extremely challenging when patients exhibit problematic behaviors or attitudes. The following guidelines-inspired by a workshop for medical students at Tufts University School of Medicine (TUSM) and further developed by the authors' interdisciplinary experiences and research-offer comprehensive criteria for medical instructors to lead an experiential seminar on how students can succeed in challenging patient encounters.

Emotion Regulation in Context: Social Connectedness Moderates Concurrent and Prospective Associations With Depressive Symptoms

Introduction: Emotion regulation in healthy functioning and in depression is typically examined as an intrapersonal phenomenon, but growing evidence suggests social factors affect individuals' strategy use and effectiveness. We examined whether the role of emotion regulation in depression—concurrently and over four weeks—depends on social connectedness, predicting that higher social connectedness would dilute effects of one's own strategy use regardless of specific strategy.

Methods: Young adult participants (n = 187) completed measures of perceived social connectedness, depressive symptoms, two avoidant emotion regulation strategies (ruminative brooding and experiential avoidance), and two approach-oriented strategies (positive reappraisal and planning), and depressive symptoms again four weeks later (n = 166).

Results: Cross-sectional associations of emotion regulation with symptoms were moderated by social connectedness: effects of both avoidant and approach strategies were weaker among more connected individuals. Prospectively, social connectedness moderated effects of approach strategies, but not avoidant strategies. Among more socially connected individuals, using approach strategies—which are typically adaptive—was associated with higher symptoms over time.

Discussion: Results partially replicate previous research and support the role of social factors as important contexts of intraper-sonal emotion regulation and dysregulation in depression. Findings suggest that social resources can dilute intrapersonal effects regardless of strategy type—more in the shorter term than in the longer term—and can even lead seemingly adaptive strategies to backfire over time. Implications for research integrating emotion regulation, relationships, and depressive psychopathology are discussed.

Invalidation of chronic pain: a thematic analysis of pain narratives

PURPOSE

Many people with chronic pain report feeling disbelieved or disparaged by others regarding their pain symptoms. Given the widely documented relationship between stress and pain, the importance of identifying psychosocial stressors such as pain-invalidation is apparent. This study was designed to identify and illustrate using first-person narratives, the effects of pain-invalidation by the self, family, friends, and healthcare professionals, toward individuals with chronic pain.

METHOD

A systematic search of five databases was performed using a search strategy consisting of terms related to pain-invalidation. A review of 431 peer-reviewed journal articles, containing narratives from a pool of over 7770 study participants with a wide range of pain conditions, was conducted, followed by a thematic analysis to establish themes of invalidation experienced by those with chronic pain.

FINDINGS

Five major pain-invalidation themes were revealed: Not being believed, lack of compassion, lack of pain awareness/understanding, feeling stigmatized, and critical self-judgement. Themes additional to pain-invalidation included: Threats to Self-Image, Loss of Identity, and Isolation.

CONCLUSION

Themes were largely interrelated and, together, build a picture of how levels of perceived social unacceptability of pain symptoms can impact on the emotional state and self-image of those with chronic pain. As such, pain-invalidation may potentially impede help-seeking or the effectiveness of therapeutic interventions.IMPLICATIONS FOR REHABILITATIONPain-invalidation can occur at the level of the self, social others, or healthcare professionals.Pain-invalidation can arise through a lack of understanding by others in the social network about having chronic pain.Pain-invalidation may be a barrier to seeking therapy for pain management and rehabilitation, and thus, efforts to identify and acknowledge invalidation experiences may be beneficial in the rehabilitation process.

Social influences on cognitive processing in enacted social support: effects on receivers' cognitive appraisals, emotion, and affiliation

Background and objectives. Social support is linked with psychological health, but its mechanisms are unclear. We examined supporters' influence on recipients' cognitive processing as a mechanism of effects of support on outcomes associated with depression. Design/methods. 2 × 2 between-subjects experiment. 147 participants (1) experienced a negative event (false feedback); (2) received social support modeling one of two contrasting cognitive processing modes (abstract/evaluative or concrete/experiential); (3) generated explanations for the event, later coded for processing mode and internal/external causal attribution; and (4) reported on emotion, perceptions of self and future, and social affiliation. To examine relational effects, half of participants were led to perceive the supporter as similar to themselves via a shared birthday manipulation. Results. Support condition influenced participants' processing mode and causal attributions as predicted. Abstract/evaluative support led to more positive emotion and self-perceptions, and less pessimistic expectancies for the future than concrete/experiential support. Perceived similarity moderated effects on beliefs about an upcoming social interaction, magnifying positive affiliation outcomes of abstract/evaluative versus concrete/experiential support. Conclusions. Processing modes that are generally maladaptive at the intrapersonal level may be adaptive (and vice versa) when they are interpersonally influenced, and perceived similarity may facilitate interpersonal effects of processing mode on affiliation.

Behind the doors of home hospice patients: A secondary qualitative analysis of hospice nurse communication with patients and families

OBJECTIVE

Hospice nurses frequently encounter patients and families under tremendous emotional distress, yet the communication techniques they use in emotionally charged situations have rarely been investigated. In this study, researchers sought to examine hospice nurses' use of validation communication techniques, which have been shown in prior research to be effective in supporting individuals experiencing emotional distress.

METHOD

Researchers performed a directed content analysis of audiorecordings of 65 hospice nurses' home visits by identifying instances when nurses used validation communication techniques and rating the level of complexity of those techniques.

RESULT

All nurses used validation communication techniques at least once during their home visits. Use of lower level (i.e., more basic) techniques was more common than use of higher level (i.e., more complex) techniques.

SIGNIFICANCE OF RESULTS

Although hospice nurses appear to use basic validation techniques naturally, benefit may be found in the use of higher level techniques, which have been shown to result in improved clinical outcomes in other settings.

Biological and Behavioral Mechanisms of Identity Pathology Development: An Integrative Review

Although identity disturbance is a transdiagnostic mental health problem, modern explanatory models for its emergence are limited. To date, the social, developmental, clinical, and neuropsychological literatures exploring identity processes are also largely disconnected. Existing theories have laid the foundation for understanding important components of identity pathology, yet many overlook biological, behavioral, and interactive processes by which these difficulties may emerge. In this integrative review, we explore how broad transdiagnostic vulnerabilities for psychopathology and more specific risky behavioral processes may reciprocally interact and be refined over time into an identity disturbance profile. Our primary purpose is to review behavioral and biosocial theories and derive a testable conceptual framework for how identity disturbance emerges over the course of development. We aim to describe and integrate several disparate lines of theory and research in order to illuminate potential etiological pathways to identity pathology.

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.