Psychosocial functioning and physical symptoms in heart failure patients: a within-individual approach

OBJECTIVE: Heart failure (HF) markedly diminishes an individual's quality of life. However, little is known about how psychosocial functioning is related to heart failure physical symptom expression (e.g., chest pain or heaviness, shortness of breath) on a day-to-day basis. METHODS: Fifty-eight HF patients completed daily diaries that evaluated mood, social support, coping, and physical symptoms for 2 weeks. RESULTS: After being prewhitened for serial dependencies, the data were entered into regression analyses to determine the concurrent and lagged relationships among them. Significant concurrent relationships were obtained between physical symptoms and depression, social conflict, positive and negative mood, and symptom-focused coping. Furthermore, negative mood and distraction coping predicted greater physical symptoms the next day, while action/acceptance coping predicted fewer physical symptoms the next day. CONCLUSION: Our data provide evidence for an association between daily psychosocial functioning and HF physical symptoms. Implications for research and clinical work with HF patients are discussed.     

The relation between anger management style, mood and somatic symptoms in anxiety disorders and somatoform disorders

The objective of this study was to examine the relationship between anger management style, depression, anxiety and somatic symptoms in anxiety disorder and somatoform disorder patients. The subjects comprised 71 patients with anxiety disorders and 47 with somatoform disorders. The level of anger expression or anger suppression was assessed by the Anger Expression Scale, the severity of anxiety and depression by the Symptom Checklist-90-Revised (SCL-90-R) anxiety and depression subscales, and the severity of somatic symptoms by the Somatization Rating Scale and the SCL-90-R somatization subscale. The results of path analyses showed that anger suppression had only an indirect effect on somatic symptoms through depression and anxiety in each of the disorders. In addition, only anxiety had a direct effect on somatic symptoms in anxiety disorder patients, whereas both anxiety and depression had direct effects on somatic symptoms in somatoform disorder patients. However, the anxiety disorder group showed a significant negative correlation between anger expression and anger suppression in the path from anger-out to anger-in to depression to anxiety to somatic symptoms, unlike the somatoform disorder group. The results suggest that anger suppression, but not anger expression, is associated with mood, i.e. depression and anxiety, and somatic symptoms characterize anxiety disorder and somatoform disorder patients. Anxiety is likely to be an important source of somatic symptoms in anxiety disorders, whereas both anxiety and depression are likely to be important sources of somatic symptoms in somatoform disorders. In addition, anger suppression preceded by inhibited anger expression is associated with anxiety and somatic symptoms in anxiety disorders.     

Experiential avoidance in idiographic,autobiographical memories: Construct validity and links to social anxiety,depressive, and anger symptoms

Experiential avoidance, or attempts to alter or avoid undesirable thoughts and feelings, has been theorized to be relevant to the development of emotional disturbances, particularly anxiety problems. Prior work has relied on two methodologies: global self-report measures or laboratory manipulations. To better understand links between experiential avoidance and emotional disturbances, we measured experiential avoidance in the context of prominent anxious autobiographical events. Trained raters coded events for emotionality and reliance on experiential avoidance. Our interest was whether experiential avoidance could be measured as a memory characteristic and how it relates to social anxiety, depressive, and anger symptoms. As evidence of construct validity, experiential avoidance ratings were related to more intense negative emotions and coping difficulties during anxious events, memory vividness, and emotion suppression tendencies. Experiential avoidance was positively related to social anxiety and depressive symptoms and predicted an increase in social anxiety over a 3-month period; findings could not be attributed to the emotionality of memories. In contrast, no relations were found with inward or outward expressions of anger, or longitudinal change in depressive or anger symptoms. Results suggest that experiential avoidance is an important dimension of people's life narratives and particularly relevant to social anxiety problems.     

Emotional state and coping style among gynecologic patients undergoing surgery

The aim of the present study was to investigate changes in emotional state and the relationship between emotional state and demographic/clinical factors and coping style among gynecologic patients undergoing surgery. Using the Japanese version of the Profile of Mood States (POMS), 90 patients (benign disease: 32, malignancy: 58) were examined on three occasions: before surgery, before discharge, and 3 months after discharge. They were also examined using the Coping Inventory for Stressful Situations (CISS) on one occasion before discharge. The scores for the subscales depression, anger, and confusion were the highest after discharge while those for anxiety were the highest before surgery. The average scores of the POMS subscales for all subjects were within the normal range. With regard to the relationship between these emotional states and other factors, multiple regressions showed that the principal determinants of anxiety before surgery were religious belief, psychological symptoms during hospitalization and emotion-oriented (E) coping style; further, it was found that depression after discharge could be explained by chemotherapy, duration of hospitalization, and E coping style. The principal determinants of anger after discharge and vigor before surgery were length of education and E coping style, and severity of disease, chemotherapy, E coping style and task-oriented coping style, respectively. Those of post-discharge fatigue and confusion were length of education, psychological symptoms, and E coping style. In summary it is suggested that the following should be taken into account in patients undergoing gynecologic surgery: anxiety before surgery, depression, anger, and confusion after surgery, including coping styles.     

Adolescent vulnerability and the distress of rejection: Associations of adjustment problems and gender with control,emotions, and coping

We examined adjustment problems as risks for patterns of emotions, appraisals, and coping with rejection, and explored whether these processes could account for sex (boy/girl) differences in coping. Young adolescents (N = 669, grades 6–8) completed questionnaires, which assessed responses to peer rejection threat with two short scenarios. Using structural equation modeling to test a multivariate process model, adolescents with heightened social anxiety had the most maladaptive responses to rejection threat, including elevated emotional reactions, more self-blame, and coping using more social isolation, rumination and opposition. Adolescents reporting more depressive symptoms felt less control and anticipated using less adaptive coping (less support seeking, distraction, and negotiation), whereas aggressive adolescents responded with more anger and coped via opposition. Moreover, as anticipated, sex differences in coping, symptoms, emotions, and appraisals were found. However, coping differences between boys and girls were mostly nonsignificant after accounting for symptoms, aggression, emotional reactions, and appraisals.     

Coping style and psychological health among adolescent prisoners: a study of young and juvenile offenders

The current study explores the role of coping styles as a predictor of poor psychological health among adolescent offenders. It presents the first study to compare young and juvenile offenders. Two hundred and three male offenders took part: 108 young (18-21 years) and 95 juvenile (15-17 years) offenders. All completed the General Health Questionnaire (GHQ-28) and a revised version of the Coping Styles Questionnaire (CSQ-3). Young offenders reported using emotional, avoidant and detached coping styles more than juveniles. They also reported more overall psychological distress than juveniles, with a trend to report increased depression, anxiety and insomnia. For both young and juvenile offenders, emotional coping predicted increased psychological distress. This was consistent across different symptoms (i.e. somatic, anxiety and insomnia, social dysfunction and severe depression). For young offenders, rational coping predicted a decrease in overall distress and was found across all symptoms. For juveniles, although detached coping predicted a decrease in overall psychological distress, across symptoms it only predicted social dysfunction. Increased rational coping was also found to predict decreased depression for juveniles. The study highlights differences between young and juvenile offenders regarding coping styles and how this relates to psychological distress. It highlights the complexities of trying to understand the coping-health relationship in a prison setting and asks if such settings are increasing the potential for adolescents to over-use coping styles that may not be the most effective.     

The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization

This study examined the relationships between experiential avoidance in general (and thought suppression in particular), posttraumatic stress symptom severity, and symptoms of depression, anxiety, and somatization among a sample of individuals exposed to multiple potentially traumatic events. Although experiential avoidance was not associated with severity of posttraumatic stress symptoms beyond their shared relationship with general psychiatric symptom severity, it was associated with symptoms of depression, anxiety, and somatization when controlling for posttraumatic stress symptom severity. Thought suppression, on the other hand, was associated with severity of posttraumatic stress symptoms when controlling for their shared relationship with general psychiatric symptom severity. No significant relationships were found between thought suppression and the presence of depression, anxiety, and somatization symptoms when controlling for posttraumatic stress symptom severity. Results suggest the importance of separately examining the influence of different forms of experiential avoidance on posttraumatic psychopathology.     

Psycho-social well-being among the parents of children with autism

This paper reports the results of a study of psycho-social well-being among an Australian sample of parents of children with autism. A variety of independent variables including: sociodemographic information, health and treatment status of the child and coping behaviours were assessed in terms of their effects on parental depression, anxiety and anger. The results of regression analysis indicated that fathers, and those parents who received more social support, had lower scores of depression, anxiety and anger. The age of symptom onset was positively related to depression, but was not significant in terms of anxiety and anger. Parents with older children, females and larger families reported lower scores of anger. These independent variables were not significantly related to depression or anxiety. Neither the type nor the extent of coping behaviours was significantly related to any of the measures of psycho-social well-being used in this study.     

Cross-situational coping with peer and family stressors in adolescent offspring of depressed parents

Offspring of depressed parents are faced with significant interpersonal stress both within their families and in peer relationships. The present study examined parent and self-reports of adolescents' coping in response to family and peer stressors in 73 adolescent children of parents with a history of depression. Correlational analyses indicated that adolescents were moderately consistent in the coping strategies used with peer stress and family stress. Mean levels of coping were similar across situations, as adolescents reported greater use of secondary control coping (i.e., acceptance, distraction) than primary control coping (i.e., problem solving, emotional expression) or disengagement coping (i.e., avoidance) with both types of stress. Regression analyses indicated that fewer symptoms of self-reported anxiety/depression and aggression were related to using secondary control coping strategies in response to family stress and primary control coping in response to peer stress. Implications for understanding the characteristics of effective coping with stress related to living with a depressed parent are highlighted.     

Psychological correlates of myasthenia gravis: a brief report

Myasthenia gravis patients and matched normal controls were assessed on a range of psychological indices; myasthenic patients had higher scores on trait anxiety and suppression of anger. There were no other significant differences between the groups on psychological symptom measures (anxiety, depression or anger) or other trait measures (anger, suppression of anxiety and suppression of depression). It is concluded that trait anxiety and suppression of anger may predispose to myasthenia gravis.     

Negative affect and the experience of chronic pain

Although it is clear from previous research that pain is associated with negative affect, the relative contribution of specific affective dimensions, e.g. depression, anxiety and anger, to the subjective experience of chronic pain is unclear. The literature is also mixed concerning the relative importance of state versus trait influences in the experience of chronic pain. The present study analyzed the ability of anxiety, anger, and depression (as measured by the State-Trait Personality Inventory, State-Trait Anger Expression Inventory, and the Beck Depression Inventory, respectively) to predict self-report of clinical pain as indicated by the McGill Pain Questionnaire (MPQ) in a sample of 60 chronic pain patients. The results of stepwise regression analyses consistently demonstrated that the state measures were more strongly related to MPQ pain ratings than trait measures. These data suggest support for the hypothesis that chronic pain adversely impacts mood rather than the opposing hypothesis that negative mood is a predisposing factor in the development of chronic pain. Furthermore, different aspects of the state emotional experience were found to be related to different components of pain report. The results of this study also suggest that attributional processes could be an important component of the relationship between negative mood and the experience of pain.     

Preliminary evidence for a relationship between prospective memory and PTSD symptoms in the general population

IntroductionPTSD sufferers often have problems with remembering the past, but do they also have trouble remembering tasks to be completed in the future? We argue characteristics of PTSD—such as negative appraisals and maladaptive strategies—might contribute to biased reporting of prospective memory failures among PTSD sufferers—or people with severe PTSD symptoms—within a general population.MethodsMechanical Turk participants completed a questionnaire battery measuring self-report prospective memory, PTSD symptoms, negative appraisals and maladaptive strategies (e.g., suppression), and depression, anxiety and stress symptoms.ResultsPTSD symptom severity positively correlated with self-report prospective memory failures (rs = .42–49). PTSD symptoms affected self-report prospective memory via their influence on negative appraisals and maladaptive strategies.LimitationsOur findings rely on self-report, therefore we do not know if this relationship generalizes to objective prospective memory tasks.ConclusionsOur data provide preliminary evidence for a relationship between PTSD symptomatology and subjective prospective memory in the general population and suggest that the negative appraisals and maladaptive strategies that commonly accompany PTSD might underpin this relationship.     

The effect of maternal psychopathology on parent–child agreement of child anxiety symptoms: A hierarchical linear modeling approach

The current study examined the effects of maternal anxiety, worry, depression, child age and gender on mother and child reports of child anxiety using hierarchical linear modeling. Participants were 73 mother–child dyads with children between the ages of 7 and 10 years. Reports of child anxiety symptoms, including symptoms of specific disorders (e.g., social phobia) were obtained using concordant versions of the Screen for Anxiety and Related Emotional Disorders (SCARED). Children reported significantly higher levels of anxiety symptoms relative to their mothers. Maternal worry and depression predicted for significantly lower levels of maternal-reported child anxiety and increasing discrepant reports. Maternal anxiety predicted for higher levels of maternal-reported child anxiety and decreasing discrepant reports. Maternal depression was associated with increased child-reported child anxiety symptoms. No significant effect of child age or gender was observed. Findings may inform inconsistencies in previous studies on reporter discrepancies. Implications and future directions are discussed.     

Contrast avoidance prospectively mediates effects of fear of emotional responding,negative problem orientation,and sensitivity to low perceived control on generalized anxiety disorder symptoms

The Contrast Avoidance Model (CAM; Newman & Llera, 2011) has been well established in the literature on the etiology and maintenance of generalized anxiety disorder (GAD). Research has investigated other factors that may also characterize GAD, such as fear of emotional responding, negative problem orientation (NPO), and negative beliefs about control; however, these have yet to be explored within the context of the CAM regarding maintenance of GAD symptoms. The purpose of this study was to explore the predictive relationship between the above-mentioned factors and GAD symptoms, mediated by contrast avoidance. Participants (N = 99, 49.5% of whom scored in the upper range on GAD symptoms) completed a series of questionnaires across three time points, each one week apart. Results indicated that fear of emotional responding, NPO, and sensitivity to low perceived control predicted CA tendencies a week later. CA tendencies then mediated the relationship between each predictor and GAD symptoms in the following week. Findings suggested that known vulnerabilities for GAD predict coping with distressing internal responses via sustained negative emotionality (such as through chronic worry) as a way to avoid negative emotional contrasts. However, this coping mechanism itself may maintain GAD symptoms over time.     

Hoarding and emotional reactivity: The link between negative emotional reactions and hoarding symptomatology

Hoarding disorder (HD) is characterized by difficulty discarding, clutter, and frequently excessive acquiring. Theories have pointed to intense negative emotional reactions (e.g., sadness) as one factor that may play a critical role in HD's etiology. Preliminary work with an analogue sample indicated that more intense negative emotions following emotional films were linked with greater hoarding symptoms. Symptom provocation imaging studies with HD patients have also found evidence for excessive activation in brain regions implicated in processing emotions. The current study utilized a sample with self-reported serious hoarding difficulties to examine how hoarding symptoms related to both general and hoarding-related emotional reactivity, taking into account the specificity of these relationships. We also examined how two cognitive factors, fear of decision-making and confidence in memory, modified this relationship. 628 participants with self-identified hoarding difficulties completed questionnaires about general emotional reactivity, depression, anxiety, decision-making, and confidence in memory. To assess hoarding-related emotional reactivity, participants reported their emotional reactions when imagining discarding various items. Heightened general emotional reactivity and more intense emotional reactions to imagined discarding were associated with both difficulty discarding and acquisition, but not clutter, controlling for age, gender, and co-occurring mood and anxiety symptoms. Fear of decision-making and confidence in memory interacted with general emotional reactivity to predict hoarding symptoms. These findings provide support for cognitive-behavioral models of hoarding. Experimental research should be conducted to discover whether emotional reactivity increases vulnerability for HD. Future work should also examine whether emotional reactivity should be targeted in interventions for hoarding.     

Transactions among adolescent trait and state emotion and diurnal and momentary cortisol activity in naturalistic settings

In a community sample of 52 adolescents, multilevel growth curve modeling was utilized to examine whether within-person changes in momentary mood states, and individual differences in trait emotional functioning, were related to adolescent cortisol levels in naturalistic settings. Salivary cortisol levels were measured seven times a day on two typical weekdays in conjunction with diary reports of adolescent mood states. Questionnaire reports of trait emotional functioning (depression, anxiety, and anger) were obtained, as were reports of demographic, developmental, and health control variables. After accounting for the effects of time of day and a wide range of control variables, within-person increases in state negative mood (worry/stress and anger/frustration) were significantly associated with within-person increases in cortisol. When examining trait emotional functioning, adolescents with higher levels of depressive symptoms had slightly lower basal cortisol levels, and adolescents with higher levels of trait anger had a significantly stronger cortisol response to awakening. Several developmental effects were found-adolescents at higher stages of pubertal development had daytime basal cortisol curves that were more elevated, had a steeper diurnal decline, and showed a lesser cortisol awakening response, and cortisol responses to worry/stress increased with age. Cortisol levels were also higher at moments adolescents were alone rather than with others, an effect that declined significantly with age. Cortisol levels were also higher at moments adolescents were alone rather than with others, an effect that declined significantly with age. Results suggest that ongoing transactions occur between adolescents' everyday emotional experiences and their cortisol levels, and that adolescent cortisol activity is modified by age/pubertal stage and by trait emotional functioning.     

Structured group intervention model for AIDS patients

We have gathered and analyzed data on 50 gay men with AIDS before and after a ten-week structured group intervention aimed at reducing psychological distress and improving coping skills. Among the major findings have been information relating coping strategies to depression and anxiety, information about the support networks of people with AIDS, and the relationships between coping strategies, support networks and psychological mood states. We have also found that structured group interventions comprised of problem solving techniques, health education, relaxation training and emotional support are helpful in reducing anxiety and depression and in teaching people more positive ways of coping with their illness.     

A clinical electrophysiological study of emotional lability in patients with systemic lupus erythematosus

Neuropsychiatric symptoms are well recognized in systemic lupus erythematosus (SLE), with depression and anxiety often reported. The authors' clinical observations suggested emotional lability might also be a noteworthy symptom. In a consecutive series of systemic lupus erythematosus clinic attendees the authors therefore measured depression, anxiety, and emotional lability. Additionally, based on reports linking emotional reactivity and transient mood changes to alterations in early attentional processes, the authors investigated event-related potential indices of preattentive and early orienting responses to auditory stimuli (N1, MMN, P3a and P3b). The authors observed that 15 of 32 participants with systemic lupus erythematosus had high lability scores and, comparing event-related potential measures between the high and low lability subgroups, noted that those with greater emotional lability demonstrated reduced response latencies in N1 and MMN paradigms.     

Specific coping behaviors in relation to adolescent depression and suicidal ideation

The coping strategies used by adolescents to deal with stress may have implications for the development of depression and suicidal ideation. This study examined coping categories and specific coping behaviors used by adolescents to assess the relation of coping to depression and suicidal ideation. In hierarchical regression models, the specific coping behaviors of behavioral disengagement and self-blame were predictive of higher levels of depression; depression and using emotional support were predictive of suicidal ideation. Results suggest that specific behaviors within the broad coping categories of emotion-focused coping (e.g., self-blame) and avoidant coping (e.g., behavioral disengagement) account for these categories’ associations with depression and suicidal ideation. Specific problem-focused coping strategies did not independently predict lower levels of depression or suicidal ideation. It may be beneficial for interventions to focus on eliminating maladaptive coping behaviors in addition to introducing or enhancing positive coping behaviors.