Will the glass be half full or half empty? Brain potentials and emotional expectations

Brainwave responses to words in context depend on semantic and world-knowledge expectations. Using the N400 component of event-related potentials as an index of word expectation, we explored brain responses to negatively and positively biased sentence frames randomly presented with their emotionally matched highly expected outcome or with violations that included switches to unexpected emotionally opposite outcomes or nonsense. Nonsense elicited large N400 responses regardless of the bias of the preceding sentence frame. Unexpected emotionally opposite outcomes elicited smaller than nonsense N400 responses and subsequent post-N400 frontal positivities, both unaffected by sentence frame bias. Over a midline-posterior scalp region, expected positive outcomes elicited larger N400 responses than negative ones, despite a high and matched word probability. Our study reveals that brains respond to unexpected emotional outcomes regardless of the direction of the emotional switch and hints at the possibility that the strength of positive and negative expectations may be adjusted before experiencing unexpected events.     

Mood and Attitude Predict Pain Outcomes Following Arthroscopic Knee Surgery

Background  Decreased pain represents a clinically important outcome following arthroscopic knee surgery. However, little is known about preoperative mood and attitudinal factors and their potential relationship with pain outcomes. Purpose  This prospective, longitudinal study investigated the influence of preoperative depression, stress, and optimism on pain severity and interference with functioning, controlling for relevant demographic and clinical factors 1 year postoperatively. Methods  Participants (N = 180, mean age = 48.2 years) completed scales assessing pain severity and interference both preoperatively and postoperatively. Demographics, depression, stress, optimism, and body mass index were assessed preoperatively. Physicians assessed extent of knee osteoarthritis during surgery. Results  Hierarchical regression analyses controlling for relevant demographic and clinical variables revealed that optimism and stress were significant predictors of pain severity at 1 year but not pain interference. Extent of osteoarthritis predicted pain interference. Conclusions  These findings support that optimism and stress are important predictors of patient-rated pain severity. They do not, however, predict the extent to which pain interferes with daily functioning.     

Further evidence for individual differences in placebo responding: an interactionist perspective

OBJECTIVE: A prior investigation found that individuals low in optimism are more likely to follow a negative placebo (nocebo) expectation. The present study tested the hypothesis that individuals high in optimism are more likely to follow a positive placebo expectation. METHODS: Individuals (N=56) varying in their level of optimism were randomly assigned to one of three conditions. In the first condition, participants were given the expectation that a placebo sleep treatment would improve their sleep quality (placebo expectation condition). In the second condition, participants engaged in the same sleep treatment activity but were not given the positive placebo expectation (treatment control condition). Finally, a third group did not receive the positive placebo expectation and also did not engage in the placebo sleep treatment (no-placebo control condition). RESULTS: Optimism was positively associated with better sleep quality in the placebo expectation condition (r=.48, P<.05). Optimism scores were not associated with better sleep quality in either the treatment control condition (r=-.17, P=.46) or the no-placebo control condition (r=-.24, P=.35). CONCLUSION: Dispositional optimism relates to placebo responding. This relationship, however, is not manifested in a simple increase or decrease in all types of placebo responding. Rather, it appears that, as optimism increases, response to the positive placebo expectation increases, whereas response to nocebo expectation decreases. It is recommended that future research on personality and placebo effects consider the interaction between situational and dispositional variables.     

Human Optimal Functioning: The Genetics of Positive Orientation Towards Self,Life, and the Future

Certain personality characteristics such as self-esteem, life satisfaction, and optimism are fundamental components of positive mental health status and well-being. There is consistent evidence that these traits tend to be substantially correlated in individuals. However, no previous studies have investigated the origin of such correlation. This research used the twin method to unravel the genetic and environmental architecture of self-esteem, life satisfaction, and optimism, along with their mutual interplay. The sample was derived from the population-based Italian Twin Register, and included 428 twin pairs, aged 23–24 years. Multivariate genetic modeling showed that genes influencing self-esteem, life satisfaction, and optimism are largely overlapping. Furthermore, results indicated that the environmental components of the traits may overlap only modestly, and suggested that a sizeable amount of variance in the traits may be explained by environmental effects specific to each of them. An erratum to this article can be found at     

Measurement and predictors of resilience among community-dwelling older women

Background

Resilience, the ability to adapt positively to adversity, may be an important factor in successful aging. However, the assessment and correlates of resilience in elderly individuals have not received adequate attention.

Method

A total of 1395 community-dwelling women over age 60 who were participants at the San Diego Clinical Center of the Women’s Health Initiative completed the Connor-Davidson Resilience Scale (CD-RISC), along with other scales pertinent to successful cognitive aging. Internal consistency and predictors of the CD-RISC were examined, as well as the consistency of its factor structure with published reports.

Results

The mean age of the cohort was 73 (7.2) years and 14% were Hispanic, 76% were non-Hispanic white, and nearly all had completed a high school education (98%). The mean total score on the CD-RISC was 75.7 (sd = 13.0). This scale showed high internal consistency (Cronbach’s alpha = 0.92). Exploratory factor analysis yielded four factors (somewhat different from those previously reported among younger adults) that reflected items involving: (1) personal control and goal orientation, (2) adaptation and tolerance for negative affect, (3) leadership and trust in instincts, and (4) spiritual coping. The strongest predictors of CD-RISC scores in this study were higher emotional well-being, optimism, self-rated successful aging, social engagement, and fewer cognitive complaints.

Conclusions

Our study suggests that the CD-RISC is an internally consistent scale for assessing resilience among older women, and that greater resilience as assessed by the CD-RISC related positively to key components of successful aging.     

Can we predict which head and neck cancer survivors develop fears of recurrence?

Objectives

The objectives of this study were to investigate longitudinal predictors of fear of recurrence in survivors of head and neck cancer (HNC) using Leventhal's Common Sense Model (CSM) as a framework. The research questions were as follows: (a) to what extent do HNC patients report fear of cancer recurrence? (b) To what extent are fears of recurrence manifestations of illness-related anxiety? (c) Are fears of recurrence closely related to current symptoms, disease, and treatment-related factors, or psychological/socio-demographic factors? (d) What factors are predictive of long-term fears of recurrence?

Methods

A prospective repeat measures design was employed whereby a sample of 82 newly diagnosed HNC patients (54 males, 28 females, mean age 60 years) completed measures of fears of recurrence, illness perceptions, coping, and anxiety and depression, prior to treatment and 6-8 months after treatment (fears of recurrence only).

Results

A third of HNC patients at diagnosis reported relatively high levels of fears of recurrence, with 12% still reporting similar levels of fear 6-8 months after treatment. Fears of recurrence were not related to any socio-demographic factor (age, gender, ethnicity, marital status, and educational attainment) or disease, treatment, or symptom-related factors. Path analyses demonstrated that fears of cancer recurrence after treatment were directly predicted by pre-treatment fears and optimism.

Conclusion

Although components of the CSM (cognitive and emotional representations, coping strategies) were associated with fears of recurrence, optimism was found to be the strongest predictor of fear, independent of anxiety and level of fear reported prior to treatment.     

Community involvement and risk perception at personal and societal levels

Some risk perception studies suggest that personal and societal level risk judgements are distinct and largely separate, and people do not necessarily draw personal implications from their general views about society. This study explores the role of community involvement in people's risk judgements at personal and societal levels. Using risk judgements about four health issueswater contaminants, radon, AIDS and heart diseasewe examined if community involvement decreases the discrepancy between personal and societal level risk perceptions. The data were collected through a mail survey of a random sample of 750 upstate New York residents. Across the four issues people tend to have significantly more concern at the societal level than at the personal level. Multiple regression analysis shows that community involvement decreases the difference people have between the personal and societal level risk judgements and that it has a direct impact on people's personal level of concern about AIDS. Compared with men, women tend to have higher levels of societal concern across all four health issues. Interpersonal communication primarily influences personal judgements. These findings have important implications for health education campaigns and deserve more attention from researchers.     

Increasing Optimism Protects Against Pain-Induced Impairment in Task-Shifting Performance

Persistent pain can lead to difficulties in executive task performance. Three core executive functions that are often postulated are inhibition, updating, and shifting. Optimism, the tendency to expect that good things happen in the future, has been shown to protect against pain-induced performance deterioration in executive function updating. This study tested whether this protective effect of a temporary optimistic state by means of a writing and visualization exercise extended to executive function shifting. A 2 (optimism: optimism vs no optimism) × 2 (pain: pain vs no pain) mixed factorial design was conducted. Participants (N = 61) completed a shifting task once with and once without concurrent painful heat stimulation after an optimism or neutral manipulation. Results showed that shifting performance was impaired when experimental heat pain was applied during task execution, and that optimism counteracted pain-induced deterioration in task-shifting performance.

Predictors of depression and life satisfaction in visually impaired people

Background: Visual impairment can lead loss of functional ability, necessity of accommodations and assistive technologies or having to rely on others for help. This can bring about feelings of sadness, dependency, inadequacy, and fear, which can put a person at risk for depression and affect one’s satisfaction with life.

Purpose: The aim of this study was to examine the effects of socio-demographic factors, disability-related factors, optimism, pessimism, self-esteem and social support on depression, and life satisfaction in visually impaired people.

Methods: A total of 94 visually impaired people completed the measures of socio-demographic and disability-related characteristics, optimism and pessimism, self-esteem, social support, depression and life satisfaction, administered by the authors. Correlational and hierarchical regression analysis was used to examine the relations and test the model for predicting depression and life satisfaction.

Results: The results have shown that depression was negatively related to the level of education, optimism, self-liking, self-competence, support from friends, family and coworkers, and positively related to comorbidity and pessimism. Life satisfaction was positively related to education, socio-economic status, optimism, self-liking, self-competence and support from friends, family and coworkers, and negatively to pessimism. Results have further shown that depression levels were predicted by education, comorbidity, optimism and self-liking, and that self-liking mediated the relationship between optimism and depression. Life satisfaction was predicted by optimism, pessimism, self-liking, friends’ support, and depression. Further analysis suggested that the path from optimism to life satisfaction goes through self-liking, friends’ support, and depression. Pessimism showed indirect effects through self-liking but also had direct effects on life satisfaction.

Conclusions: Focusing on optimism, pessimism, self-esteem, and social functioning of visually impaired is important in preventing depression and promoting life satisfaction, and should be a part of rehabilitation practices.

• Implications for Rehabilitation

• Screening for depression and mental health problems should be a part of rehabilitation process.

• Changes in the perception of future outcomes should be monitored and addressed throughout rehabilitation process in order to boost realistic optimism and prevent discouragement and hopelessness.

• Frequent feedback and positive reinforcement about a persons’ progress and ability should be given throughout rehabilitation process in order to promote positive view of oneself and prevent self-esteem problems.

• Visually impaired people should be encouraged to socialise outside of their families and participate in social activities. This can be integrated in rehabilitation process as a part of everyday homework.

     

Assessment of the sunk-cost effect in clinical decision-making

Despite the current push toward the practice of evidence-based medicine and comparative effectiveness research, clinicians' decisions may be influenced not only by evidence, but also by cognitive biases. A cognitive bias describes a tendency to make systematic errors in certain circumstances based on cognitive factors rather than evidence. Though health care providers have been shown in several studies to be susceptible to a variety of types of cognitive biases, research on the role of the sunk-cost bias in clinical decision-making is extremely limited. The sunk-cost bias is the tendency to pursue a course of action, even after it has proved to be suboptimal, because resources have been invested in that course of action. This study explores whether health care providers' medical treatment recommendations are affected by prior investments in a course of treatment. Specifically, we surveyed 389 health care providers in a large urban medical center in the United States during August 2009. We asked participants to make a treatment recommendation based on one of four hypothetical clinical scenarios that varied in the source and type of prior investment described. By comparing recommendations across scenarios, we found that providers did not demonstrate a sunk-cost effect; rather, they demonstrated a significant tendency to over-compensate for the effect. In addition, we found that more than one in ten health care providers recommended continuation of an ineffective treatment.