Everyday stress response targets in the science of behavior change

The effects of childhood trauma on stress-related vulnerability factors and indicators of suicide risk: An ecological momentary assessment study

BACKGROUND

Childhood trauma is experienced by approximately one third of young people in the United Kingdom and has been shown to confer an increased risk for mental health difficulties in adulthood. Understanding the associations between these factors before negative health outcomes manifest in adulthood is imperative to help inform the development of interventions. The aims of this study were two-fold; first, to investigate the effects of childhood trauma on daily stress-related vulnerability factors over a period of 7 days and to test whether any observed relationships were moderated by protective or risk factors. Second, to explore the indirect effects of childhood trauma on reasons for living, optimism, daily suicide ideation, defeat and entrapment through the daily stress-related vulnerability factors.

METHODS

212 participants were recruited to an ecological momentary assessment study to complete three diaries per day for a 7-day period. Participants completed daily measures of stress, hassles, executive functioning, impulsivity, sleep quality (stress-related vulnerability factors) as well as measures of reasons for living, optimism, daily thoughts of suicide, defeat and entrapment. The Childhood Trauma Questionnaire was also completed at baseline.

RESULTS

Analyses found that childhood trauma was significantly associated with higher scores on the daily stress-related vulnerability factors and positively related to each of the daily indicators of suicide risk. The study also uncovered key pathways whereby trauma had indirect effects on reasons for living, optimism, daily thoughts of suicide, defeat and entrapment through executive functioning, impulsivity, sleep quality and stress.

LIMITATIONS

The measures of executive function and sleep were self-reported and future research ought to replicate the current findings using more objective methods.

DISCUSSION

The findings from this study highlight the complexity of childhood trauma and its damaging effects on stress-related vulnerability factors and poorer mental health outcomes. Greater understanding of pathways by which trauma may impact later health outcomes is essential for development of interventions.

The relationship between loneliness and the experiences of everyday stress and stressor-related emotion

Loneliness influences how people experience and respond to stressors, which may account for its role as a risk factor for morbidity and mortality. The present study was motivated by emerging evidence that affective responses to minor daily events have long-term implications for health and well-being. Specifically, we evaluated how individual differences in loneliness relate to the frequency of everyday stressors and stressor-related negative emotions. A diverse community sample of 255 adults (age 25-65 years) completed ecological momentary assessments (EMA), during which they reported recent stressors and current negative affect (NA) five times a day for 14 days. Multilevel logistic analyses indicated that there was a quadratic association between loneliness and likelihood of reporting stressors, controlling for demographics, social isolation, depressive symptoms, and context (current activities, current location). Multilevel regression indicated that loneliness was unrelated to the concurrent effect of stressors on NA but significantly larger lagged stressor effects were observed among individuals in the low and high ranges of loneliness. These findings suggest that individuals with high levels of loneliness are more likely to experience everyday stressors and have prolonged emotional responses following stressors.

Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review

BACKGROUND

Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness.

OBJECTIVE

This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns.

METHODS

In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on.

RESULTS

To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area.

CONCLUSIONS

Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support.

College Students' Day-to-Day Maladaptive Drinking Responses to Stress Severity and Stressor-Related Guilt and Anger

BACKGROUND

Stress is a common part of college students' daily lives that may influence their physical activity (PA) and alcohol use. Understanding features of daily stress processes that predict health behaviors could help identify targets for just-in-time interventions.

PURPOSE

This study used intensive longitudinal data to examine whether prior day stress processes predict current day PA or alcohol use.

METHODS

Participants (N=58, Mage=20.5, 59% women, 70% White) were 18-to-25-year-old students who engaged in binge drinking at least twice monthly and used cannabis or tobacco in the past year. They wore activity (activPAL4) and alcohol (Secure Continuous Remote Alcohol Monitor) monitors for 11 days to assess daily PA (e.g., step counts) and alcohol use (e.g., drinking day), and completed daily surveys about yesterday's stress, including number of stressors (i.e., frequency), stressor intensity (i.e., severity), and frequency of affective states (e.g., guilt). Multilevel models examined prior day stress predicting current day PA or alcohol use.

RESULTS

Participants had higher odds of current day drinking (odds ratio=1.21) and greater area under the curve (B=0.08) when they experienced greater than usual stress severity the prior day. Participants had higher current day peak transdermal alcohol concentration (B=0.12) and area under the curve (B=0.11) when they more frequently experienced guilt due to stressors the prior day.

CONCLUSIONS

College students' unhealthy response of increasing alcohol use due to stress could adversely impact health outcomes. There is a critical need for interventions addressing students' ability to effectively manage and respond to the stress-inducing, daily demands of student life.

Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males

Stress is an established risk factor for negative health outcomes. Salivary cortisol and testosterone concentrations increase in response to acute psychosocial stress. It's crucial to reduce stress for health and well-being through evidence-based interventions. Body-mind interventions such as meditation and Tai Chi have shown reduced cortisol levels but mixed results in testosterone concentration after stress. To address this research gap, we conducted a pilot randomized controlled trial to examine the modulating effects of a short-term (seven 20-minute sessions) mindfulness meditation on testosterone and cortisol in response to acute stress. Using one form of mindfulness meditation - Integrative Body-Mind Training (IBMT) and an active control-relaxation training (RT), we assessed salivary cortisol and testosterone concentrations at three stages of stress intervention - rest, stress, and an additional 20-min IBMT or RT practice. We found increased cortisol and testosterone concentrations after acute stress in both groups, but testosterone rise was not associated with cortisol rise. Moreover, an additional practice immediately after stress produced higher testosterone concentrations in the IBMT group than the RT group, whereas cortisol concentration increased in the RT group than in the IBMT group at the same time point. These findings indicate that brief mindfulness intervention modulates a dual-hormone profile of testosterone and cortisol in response to acute stress presumably via the co-regulation of hypothalamus-pituitary-adrenal and hypothalamus-pituitary-testicular axes.

Breaking the Link Between Negative Emotion and Unhealthy Eating: the Role of Emotion Regulation

Stressful experiences frequently lead to increased consumption of unhealthy foods, high in sugar and fat yet low in nutrients. Can emotion regulation help break this link? In a laboratory experiment (N = 200), participants were encouraged to ruminate on a current, distressing personal problem, followed by instruction to use a specific emotion regulation strategy for managing feelings around that problem (challenge appraisal, relaxation/distraction, imagined social support, no-instruction control). Participants then spent 15 min on an anagram task in which 80% of items were unsolvable-a frustrating situation offering a second, implicit opportunity to use the regulation strategy. During the anagram task they had free access to a snack basket containing various options. Analyses revealed significant differences among regulation conditions in consumption of candy versus healthy snack options; challenge appraisal led to the healthiest snack choices, imagined social support to the least healthy snack choices.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-023-00190-5.

Sometimes you just can't: within-person variation in working memory capacity moderates negative affect reactivity to stressor exposure

The executive hypothesis of self-regulation places cognitive information processing at the center of self-regulatory success/failure. While the hypothesis is well supported by cross-sectional studies, no study has tested its primary prediction, that temporary lapses in executive control underlie moments of self-regulatory failure. Here, we conducted a naturalistic experiment investigating whether short-term variation in executive control is associated with momentary self-regulatory outcomes, indicated by negative affect reactivity to everyday stressors. We assessed working memory capacity (WMC) through ultra-brief, ambulatory assessments on smart phones five times per day in a 7-day ecological momentary assessment (EMA) study involving college-aged adults. We found that participants exhibited more negative affect reactivity to stressor exposures during moments when they exhibited lower than usual WMC. Contrary to previous findings, we found no between-person association between WMC and average stress reactivity. We interpret these findings as reflecting the role of executive control in determining one's effective capacity to self-regulate.

Stress buffering after physical activity engagement: An experience sampling study

OBJECTIVES

While encountering daily hassles is a normative experience, it poses a threat to individuals' daily affective well-being. However, physical activity engagement may help to reduce the current stress-related impact on affective well-being (i.e. stress buffering), which we investigate in this study. Furthermore, we examined the possible moderating role of people's global stress context (i.e. exposure to major life events and chronic stress) on this within-person stress-buffering effect.

DESIGN

We approached these ideas using six-times-a-day experience sampling assessments over a period of 22 days.

METHODS

Drawing on a broad national sample of 156 middle-aged adults from the EE-SOEP-IS study, we aimed to elucidate the naturally occurring within-person dynamics of current stress, physical activity engagement, and momentary affect within individuals' everyday lives. Major life events and chronic stress were measured as between-person variables.

RESULTS

Multilevel analyses revealed significant within-person associations of current stress and physical activity engagement with momentary affect. Stress-related negative affect was lower when individuals engaged in physical activity, in accordance with the idea of a within-person stress-buffering effect of physical activity engagement. For individuals exposed to more severe major life events, the stress-buffering effect of physical activity engagement for negative affect was lower. Chronic stress did not moderate the within-person stress-buffering effect.

CONCLUSIONS

Overall, results add to the existing literature that links physical activity to increased stress resilience and emphasizes the need for taking the global between-person stress context into account.

Evaluation of Health Pattern and Stress Levels among Patients Undergoing Alcohol Addiction Treatment-A Cross Sectional Study

Alcohol consumption is linked to over 200 diseases and injuries. It is also classified as a risk factor for several types of neoplasms as well as infectious diseases (i.e., HIV and tuberculosis). In 2019, among people aged 25 to 49, alcohol use was the leading risk factor for attributable burden of disease. There are many factors that affect alcohol drinking patterns such as social and economic status, social norms, cultural customs, availability of alcohol, etc. Stress also plays a significant role in the process of developing alcohol addiction. The aim of our study was to examine health patterns and stress levels among patients undergoing alcohol addiction treatment. The study sample consisted of 104 patients who were treated in a hospital ward due to alcohol dependence. Three standardized questionnaire tools were used to measure the sense of coherence and the level of stress among those patients. The main results suggest that the level of perceived stress correlated negatively with all dimensions of sense of coherence and all indicators of health behaviors, however, age was positively correlated with positive mental attitude, proper eating habits, and health behaviors. In conclusion, it is worth noting that developing patterns for positive health behaviors will make it possible to avoid alcohol dependence or reinforce the treatment results if alcohol dependence syndrome occurs.

Daily Stress Processes as Potential Intervention Targets to Reduce Gender Differences and Improve Mental Health Outcomes in Mid- and Later Life

The current study examines daily stress processes as risk factors for comprised mental health in midlife and later life, specifically for gender differences in depression risk. Using data from the Midlife in the United States (MIDUS) study and the National Study of Daily Experiences (NSDE), we examine (1) gender differences in depression; (2) the prospective effects of differential exposure and affective responses on 10-year depression status; (3) gender differences in daily stress-depression links. Furthermore, we explore whether the protective factor of help-seeking behavior moderates the effects of daily stress on depression. Participants included 1289 (mage = 55; SD = 12; range = 34-83; 56% female) individuals who completed the second waves of MIDUS and the 8-day NSDE daily diary protocol and participated in the third wave of MIDUS approximately 10 years later. Respondents completed assessments of depression and their seeking assistance from a psychiatrist, mental health professional, counselor, or religious leader. Covariate-adjusted logistic regression analyses revealed increased odds of depression among women compared to men, but no significant gender difference after taking daily stress into account. Higher levels of stressor exposure, negative affect, and affective reactivity were associated with increased odds of depression for both men and women. Compared to those who did not engage in help-seeking behavior, those who did had significantly greater odds of depression, and there were asymmetric patterns of daily stress effects across groups. These findings highlight differential exposure, negative affect, and affective responses to daily stress as potentially accessible intervention targets for reducing stress in daily life and mitigating longer-term depression risk during mid- and later life.

Affective Reactions to daily interpersonal stressors: Moderation by family involvement and gender

The goal of this study was to examine whether family involvement and gender moderated daily changes in affect associated with interpersonal stressors. Adults (N = 2022; M _age = 56.25, Median = 56, SD = 12.20, Range = 33-84) from the second wave of the National Study of Daily Experiences participated in eight consecutive daily diaries. Each day they reported whether a daily interpersonal stressor occurred, whether family was involved, and their positive and negative affect. Results from multilevel models indicated that family involvement did not significantly moderate daily interpersonal stressor-affect associations; however, gender was a significant moderator in some instances. Women showed greater increases in negative affective reactivity to arguments and avoided arguments compared to men. Further, compared to men, women reported larger decreases in positive affective reactivity, but only for avoided arguments. Neither family involvement, gender, nor the interaction between family involvement and gender predicted affective residue. Gender differences in daily interpersonal stressors and affective reactivity may be attributable to overarching gender norms and roles that are still salient in the U.S. Our results suggest that daily interpersonal stressors may be detrimental to affective well-being, regardless of family involvement. Future work should explore associations between daily interpersonal stressors and family involvement by specific relationship roles, such as mother or spouse, for a more comprehensive understanding of what stressor characteristics impact daily affective well-being.

Association of daily hassles, daily uplifts, coping styles and stress-related symptoms among women exposed to sexual abuse-A cross-sectional study

BACKGROUND

Women who experience physical or sexual violence report poor self-perceived health. Knowledge of daily hassles, daily uplifts and coping styles, as well as how these factors can affect health and well-being among survivors of sexual abuse, is important for healthcare professionals to understand and target their needs.

AIM

The aim of the current study was to explore the association of daily hassles, daily uplifts, coping strategies and stress-related symptoms among female survivors of sexual abuse.

METHODS

A group of women (n = 57), exposed to sexual abuse, were recruited from nine support centres in Norway. Participants completed a questionnaire that addressed demographics, socioeconomic conditions, trauma history, daily hassles, daily uplifts, coping styles and stress-related symptoms. Two groups of participants were compared: one group that had above-median scores on uplifts and adaptive coping styles and one group that had above-median scores on daily hassles and maladaptive coping styles.

RESULTS

Results indicate that women who experienced more daily hassles and used maladaptive coping styles reported significantly more stress-related symptoms, and particularly emotional symptoms, than women who experienced more daily uplifts and used adaptive coping styles. There were few differences between the two groups related to socioeconomic conditions and trauma history.

CONCLUSION

The results indicate that women in both groups struggle with stress-related physical, emotional, cognitive and target group-specific symptoms. However, high incidence of daily hassles and the use of maladaptive coping styles were associated with an increase in stress-related symptoms. Novell's findings indicate that despite severe traumatic experiences, adaptive coping styles and favourable perceptions of stress in everyday life were associated with a lower frequency of stress-related symptoms. It may therefore be helpful to focus on altering maladaptive coping styles to reduce stress-related symptoms among sexual abuse survivors.

Testing the Associations Between State and Trait Anxiety, Anger, Sadness, and Ambulatory Blood Pressure and Whether Race Impacts These Relationships

BACKGROUND

Anxiety, anger, and sadness are related to elevated ambulatory blood pressure (ABP), yet it is unclear whether each emotion exerts unique effects. Moreover, an understanding of who might be most susceptible to the negative effects of these emotions is limited, with the trait tendency to experience them or one's race as potential moderators.

PURPOSE

The study examined the potential for differential effects of momentary anxiety, anger, and sadness on ABP. The study assessed whether a trait tendency to experience these negative emotions and/or race (Black vs. non-Black) would moderate these relationships.

METHODS

Participants (n = 153) completed trait anxiety, anger, and depressive symptoms measures at baseline. ABP was collected over two 24-hour periods 3-4 months apart. Momentary measures of anxiety, anger, and sadness were assessed via ecological momentary assessment (EMA) after each ABP reading.

RESULTS

Momentary anxiety consistently predicted diastolic blood pressure but not systolic blood pressure. Momentary anger and sadness did not predict blood pressure (BP). Conditional effects were found with momentary anxiety and anger predicting elevated BP in those individuals with trait anxiety/anger at its mean. Trait anxiety and depression consistently predicted heightened BP in Black participants. Trait anger did not moderate the relationships between negative emotions and ABP.

CONCLUSIONS

Findings suggest that momentary anxiety and anger should be given attention as potential risk factors for hypertension and highlight the unique perspective of EMA methods. Black participants who were more anxious and depressed experienced heightened BP, with anxiety and depression providing possible intervention targets in improving racial disparities in cardiovascular health.

Computing Components of Everyday Stress Responses: Exploring Conceptual Challenges and New Opportunities

Repeated assessments in everyday life enables collecting ecologically valid data on dynamic, within-persons processes. These methods have widespread utility and application and have been extensively used for the study of stressors and stress responses. Enhanced conceptual sophistication of characterizing intraindividual stress responses in everyday life would help advance the field. This article provides a pragmatic overview of approaches, opportunities, and challenges when intensive ambulatory methods are applied to study everyday stress responses in "real time." We distinguish between three stress-response components (i.e., reactivity, recovery, and pileup) and focus on several fundamental questions: (a) What is the appropriate stress-free resting state (or "baseline") for an individual in everyday life? (b) How does one index the magnitude of the initial response to a stressor (reactivity)? (c) Following a stressor, how can recovery be identified (e.g., when the stress response has completed)? and (d) Because stressors may not occur in isolation, how can one capture the temporal clustering of stressors and/or stress responses (pileup)? We also present initial ideas on applying this approach to intervention research. Although we focus on stress responses, these issues may inform many other dynamic intraindividual constructs and behaviors (e.g., physical activity, physiological processes, other subjective states) captured in ambulatory assessment.

Blunted reward responsiveness prospectively predicts emotional distress when exposed to a naturalistic stressor

Both stress and blunted reward responsiveness have been identified as core risk factors of depression. Whether blunted reward responsiveness increases psychological vulnerability to real-life stress from a dynamic perspective (from stress reactivity to recovery) has not been investigated. By utilizing a real-world stressful event (i.e. the final examination), this study aimed to explore the role of reward responsiveness in the stress-emotional distress relationship during stress reactivity and recovery phases. We followed 57 undergraduates with three assessments, from six weeks before examination weeks (T1, baseline), one day before the examinations (T2) to two weeks after the examinations (T3), therefore, covering stress reactivity (T1 to T2) and recovery (T2 to T3) phases. At baseline, reward responsiveness was measured as the Reward Positivity (RewP) in the doors task. Stress and emotional distress (anxiety and depression) were reported at T1, T2 and T3 to capture their dynamic changes. Results showed that self-report stress levels significantly increased from T1 to T2 (stress reactivity phase) and decreased from T2 to T3 (stress recovery phase). Furthermore, blunted reward responsiveness at baseline prospectively predicted emotional distress during the stress reactivity phase but not the recovery phase. Specifically, during the stress reactivity phase, higher perceived stress was associated with greater anxiety and depression only in participants with relatively smaller residual RewP amplitudes but not in participants with relatively larger residual RewP amplitudes. Our study demonstrated that a blunted reward responsiveness is a vulnerable factor of depression, especially when exposed to stress. Our findings provide insights into prevention and intervention for stress-related disturbance.

Physiological stress reactivity and recovery: Some laboratory results transfer to daily life

Stress is a prevalent theme in our daily lives and is related to numerous negative health outcomes. Laboratory research has studied the physiological stress response extensively with objective measures such as vagally-mediated heart rate variability (vmHRV). Recently, the vagal tank theory emerged as a promising approach to predicting adaptive vmHRV levels around stressful events. This study aimed to investigate whether the predictions of the vagal tank theory about vmHRV during stress reactivity and recovery translate into naturalistic stressful events in daily life. Sixty-seven students wore an EcgMove 4 sensor for 4 days to measure vmHRV. Through a combination of device-based and self-report assessment, vmHRV data were segmented into before, during, and after stressful events. VmHRV segments were analyzed with multilevel modeling, accounting for physiological and psychological covariates. VmHRV before stressful events predicted more adaptive vmHRV during the event but not vmHRV recovery afterwards. The results therefore partially support the vagal tank theory's predictions with data from daily life and allow recommendations for future studies of real-world stress reactivity and recovery. The value of intraindividual variations in vmHRV as predictors of adaptive stress response is underscored by these findings and could inform future interventions that seek to increase momentary vmHRV.

Relationships between daily stress responses in everyday life and nightly sleep

Stress and sleep are related, but the nature and time course of this relation is not well understood. We explored the within-person associations of three components of emotional responses to everyday stressors, indexed by negative affect, reactivity (initial response to a stressor), recovery (persistence of the post-stressor response), and pile-up (accumulation of stress episodes), with sleep indicators. We conducted coordinated analyses of data in several studies employing ecological momentary assessments, which captured naturally occurring, self-reported stress and sleep. We defined proximal reactivity as the emotional response to the stressor moment in question compared to an immediate pre-stressor state, and distal reactivity as the emotional response to the stressor moment in question compared to a typical stressor-free state for that person. Results in two of three studies showed that people reported significantly lower sleep quality following days on which they experienced higher levels of distal reactivity to stressors. Days with greater distal reactivity also predicted significantly more difficulty falling asleep in one of two studies. There was no clear association between proximal reactivity and subsequent sleep. Associations of recovery or pile-up with subsequent sleep emerged only in single studies. Poorer sleep quality was significantly related to higher next day levels of negative affect in all three studies, but there were no consistent relations between sleep and next day stress reactivity, recovery, or pile-up. These exploratory analyses suggest that distal reactivity is associated with a heightened risk of experiencing poor sleep quality the following night, and as such the former may serve as a candidate for potential targets for the remediation of the negative effects of stress on sleep.

Advancing the Study of Resilience to Daily Stressors

Historically, studies of childhood and adult resilience have typically focused on adaptation to chronic life adversities, such as poverty and maltreatment, or isolated and potentially traumatic events, such as bereavement and serious illness. Here, we present a complementary view and suggest that stressors experienced in daily life may also forecast individual health and well-being. We argue that daily process approaches that incorporate intensive sampling of individuals in natural settings can provide powerful insights into unfolding adaptational processes. In making this argument, we review studies that link intraindividual dynamics with diverse health-related phenomena. Findings from this research provide support for a multiple-levels-analysis perspective that embraces greater unity in pivotal resilience constructs invoked across childhood and adult literatures. Drawing on insights and principles derived from life-span theory, we conclude by outlining promising directions for future work and considering their broader implications for the field of resilience.

Effects of Persistent Exposure to COVID-19 on Mental Health Outcomes Among Trainees: a Longitudinal Survey Study

BACKGROUND

The rapid spread of the coronavirus disease 2019 (COVID-19) has created considerable strain on the physical and mental health of healthcare workers around the world. The effects have been acute for physician trainees-a unique group functioning simultaneously as learners and care providers with limited autonomy.

OBJECTIVE

To investigate the longitudinal effects of physician trainee exposure to patients being tested for COVID-19 on stress, anxiety, depression, and burnout using three surveys conducted during the early phase of the pandemic.

DESIGN

Longitudinal survey study.

PARTICIPANTS

All physician trainees (N = 1375) at an academic medical center.

MAIN MEASURE

Assess the relationship between repeated exposure to patients being tested for COVID-19 and stress, anxiety, depression, and burnout.

KEY RESULTS

Three hundred eighty-nine trainees completed the baseline survey (28.3%). Of these, 191 and 136 completed the ensuing surveys. Mean stress, anxiety, and burnout decreased by 21% (95% confidence interval (CI): - 28 to - 12%; P < 0.001), 25% (95% CI: - 36 to - 11%; P < 0.001), and 13% (95% CI: - 18 to - 7%; P < 0.001), respectively, per survey. However, for each survey time point, there was mean increase in stress, anxiety, and burnout per additional exposure: stress [24% (95% CI: + 12 to + 38%; P < 0.001)], anxiety [22% (95% CI: + 2 to + 46%; P = 0.026)], and burnout [18% (95% CI: + 10 to + 28%; P < 0.001)]. For depression, the association between exposure was strongest for the third survey, where mean depression scores increased by 33% per additional exposure (95% CI: + 18 to + 50%; P < 0.001).

CONCLUSIONS

Training programs should adapt to address the detrimental effects of the "pileup" of distress associated with persistent exposure through adaptive programs that allow flexibility for time off and recovery.

Quit Stage and Intervention Type Differences in the Momentary Within-Person Association Between Negative Affect and Smoking Urges

Background

Smoking urges and negative affect play important roles in daily cigarette smoking and smoking lapse during a cessation attempt. Traditionally, laboratory research has considered negative affect as a potential cause of smoking urges. A deeper understanding of momentary associations between negative affect and smoking urges during a smoking cessation attempt can inform treatment development efforts. This study examined whether the within-person association between negative affect and smoking urges differed before and after a quit attempt, and by intervention type.

Methods

Data are from a pilot randomized controlled trial comparing 3 smoking cessation interventions. Participants were randomly assigned to: (1) a novel, smartphone-based just-in-time adaptive intervention that tailored treatment content in real-time (Smart-T2; n = 24), (2) the National Cancer Institute QuitGuide app (n = 25), or (3) a clinic-based tobacco cessation program (TTRP; n = 23) that followed Clinical Practice Guidelines. All participants received up to 12 weeks of nicotine replacement therapy and completed up to 5 assessments per day (M PreQuit = 25.8 assessments, SD = 6.0; M PostQuit = 107.7 assessments, SD = 37.1) of their negative affect and smoking urges during the 7 days (M = 6.6 days, SD = 1.0) prior to their quit-date and the 29 days (M = 25.8 days, SD = 6.4) after their quit-date. Prior to analysis, repeated measures of smoking urges were decomposed into between-person and within-person components.

Results

After accounting for baseline nicotine dependence, Bayesian multilevel models indicated that the extent of within-person association between negative affect and smoking urges was stronger in the post-quit stage of the intervention than the pre-quit stage. Results also indicated that in the post-quit stage of the intervention, the within-person association between negative affect and smoking urges was weaker for those in the Smart-T2 and TTRP groups compared with those in the QuitGuide group. The extent of this within-person association did not differ between those in the Smart-T2 and TTRP groups.

Conclusions

These findings offer preliminary evidence that the momentary within-person association between negative affect and smoking urges increases following a quit attempt, and that the TTRP and Smart-T2 interventions may weaken this association. Research is needed to replicate and expand upon current findings in a fully powered randomized controlled trial.

Clinical Trial Registration

ClinicalTrials.gov NCT02930200; https://clinicaltrials.gov/show/NCT02930200.

A Pilot Study of Temporal Associations Between Psychological Stress and Cardiovascular Response

Psychological stress (PS) in daily life can trigger acute changes in cardiovascular function and may lead to increased risk of cardiovascular problems. Prior laboratory-based studies provide little evidence on temporal changes in the associations between PS and cardiovascular responses in natural settings. We hypothesized that daily PS would be associated with higher heart rate (HR) and lower heart rate variability (HRV). Using smartphones, ten participants (four females, 21.1±1.1 years) completed ecological momentary assessment (EMA) 6 times a day for two weeks regarding their current affective state. Participants rated levels of PS, as well as 3 high-arousal negative affect (HNA: Anxious, Annoyed, and Upset), and 3 low-arousal negative affect (LNA: Sluggish, Bored, and Sad) states. They also wore a chest-mounted heart-rate monitor and a wrist accelerometer to monitor cardiovascular response and physical activity, respectively. HR and HRV variables in the time intervals (5, 30, 60 min) before and after EMA were used as indicators of cardiovascular response. Multilevel modeling was used to examine the association between affect and HR/HRV, controlling for physical activity. Higher HR and lower HRV were related to subsequent greater feelings of stress at the 5 and 30-min time intervals. No significant associations were observed between cardiovascular parameters and subsequent affective states, suggesting that the acute exaggerated cardiovascular responses occurred due to PS. Higher LNA was related to antecedent/subsequent lower HR or higher HRV within 2 hours, while HNA was unrelated to HR or HRV for all time intervals, suggesting that both high/low arousal NA were not related to exaggerated cardiovascular response. Understanding psychological feelings of stress and LNA may be helpful in the management of daily cardiovascular health.

Horizontal Collectivism Moderates the Relationship Between in-the-Moment Social Connections and Well-Being Among Latino/a College Students

Sleep problems and poorer well-being may be particularly salient for Latino/a college students as they tend to experience sociocultural adjustments during this transitory time. Social connections, a correlate of health, change moment-to-moment for college students and may be experienced differently for people who more strongly endorse horizontal collectivist cultural values. We used ecological momentary assessment (EMA) to examine how in-the-moment social connections influence in-the-moment health, and how horizontal collectivism moderates the moment-to-moment associations. Self-identified Latino/a college students (n = 221) completed a demographic information and cultural values questionnaire and then responded to EMA measures on their social connections, affective and subjective well-being, and sleep for 14 consecutive days. Better in-the-moment social connections associated with better health. Horizontal collectivism moderated some, but not all associations between social connections and health. Social connections are multidimensional and differently predict in-the-moment health among Latino/a college students who more strongly endorse horizontal collectivistic values. We discuss implications for identifying vulnerable well-being moments among this understudied population.

Dynamic Stress Responses and Real-Time Symptoms in Binge-Eating Disorder

BACKGROUND

Stress is a dynamic construct that predicts a range of health behaviors and conditions, including binge eating and excess weight. Thus far, there have been limited and inconsistent findings regarding stress responses in binge-eating disorder (BED) and insufficient consideration of temporal patterns of stress responses across the weight spectrum.

PURPOSE

The present study used ecological momentary assessment (EMA) to examine stress reactivity (i.e., the magnitude of the initial stress response), recovery (i.e., how long the stress response lasts before returning to baseline), and pileup (i.e., accumulation of repeated experiences of stressors and responses over time) as predictors of binge-eating symptoms (BES) and food craving in BED.

METHODS

Adults with BED (N = 115) completed a 7 day EMA protocol assessing stressful events, perceived stress, binge eating, and food craving prior to being randomized to a behavioral intervention.

RESULTS

Generalized estimating equations indicated that moments of greater stress pileup predicted greater subsequent BES (within-person effect). Participants with higher perceived stress and pileup reported greater overall BES and craving, and those with better recovery reported higher overall craving (between-person effects).

CONCLUSIONS

Findings highlight the importance of considering the dynamic nature of stress responses and, particularly, that the accumulation of stress over the day is an important trigger for BES.

Naturally Occurring Consecutive Sleep Loss and Day-to-Day Trajectories of Affective and Physical Well-Being

BACKGROUND

Experimental studies have shown that just 1 night of sleep loss impairs next-day performance, mood, and energy. Yet, little is known about the effects of consecutive sleep loss on daily well-being in participants' own settings.

PURPOSE

This study examined whether and how naturally occurring consecutive sleep loss is associated with day-to-day trajectories of affective and physical well-being.

METHODS

Participants were adults (N = 1,958) from the Midlife in the United States Study who provided daily diary data for eight consecutive days. Consecutive sleep loss was operationalized as the within-person number of consecutive nights with <6 hr of sleep. Multilevel models evaluated the linear, quadratic, and cubic effects of consecutive sleep loss on daily well-being, after controlling for sociodemographic, health, and daily covariates.

RESULTS

Daily negative affect increased and positive affect decreased in curvilinear fashion as the number of consecutive sleep loss increased. For example, daily negative affect increased (linear), but the rate of increase decelerated as the number of consecutive sleep loss increased (quadratic). Results were consistent for the number and severity of physical symptoms. For negative affect and the severity of physical symptoms, cubic effect was also significant such that the rate of increase accelerated again in the days most distal to baseline (no sleep loss).

CONCLUSIONS

Consecutive sleep loss was associated with degraded trajectories of daily affective and physical well-being. Making efforts to break the vicious cycle of sleep loss may protect daily well-being in adults whose sleep time is often compromised.

Emotional Responses to Stressors in Everyday Life Predict Long-Term Trajectories of Depressive Symptoms

BACKGROUND

Individuals' emotional responses to stressors in everyday life are associated with long-term physical and mental health. Among many possible risk factors, the stressor-related emotional responses may play an important role in future development of depressive symptoms.

PURPOSE

The current study examined how individuals' positive and negative emotional responses to everyday stressors predicted their subsequent changes in depressive symptoms over 18 months.

METHODS

Using an ecological momentary assessment approach, participants (n = 176) reported stressor exposure, positive affect (PA), and negative affect (NA) five times a day for 1 week (n = 5,483 observations) and provided longitudinal reports of depressive symptoms over the subsequent 18 months. A multivariate multilevel latent growth curve model was used to directly link the fluctuations in emotions in response to momentary stressors in everyday life with the long-term trajectory of depressive symptoms.

RESULTS

Adults who demonstrated a greater difference in stressor-related PA (i.e., relatively lower PA on stressor vs. nonstressor moments) reported larger increases in depressive symptoms over 18 months. Those with greater NA responses to everyday stressors (i.e., relatively higher NA on stressor vs. nonstressor moments), however, did not exhibit differential long-term changes in depressive symptoms.

CONCLUSIONS

Adults showed a pattern consistent with both PA and NA responses to stressors in everyday life, but only the stressor-related changes in PA (but not in NA) predicted the growth of depressive symptoms over time. These findings highlight the important-but often overlooked-role of positive emotional responses to everyday stressors in long-term mental health.

Effects of Aerobic Exercise Training on Daily Psychological Processes in Family Caregivers: Secondary Analyses of a Randomized Controlled Trial

The aim of this study was to examine the effects of a 24-week aerobic exercise training program on daily psychological processes and occurrence of stressors in a group of previously physically underactive family caregivers of patients with dementia. As part of the Fitness, Aging, and STress (FAST) randomized controlled trial, 68 participants (F = 55; M = 13) were randomized to either a staff-supported, 24-week aerobic training (N = 34) program or waitlist control (N = 34) group. Approximately 2 weeks prior to randomization, ecological momentary assessments were completed 6 times per day for 7 days and again in the 24th week of the trial to assess exposure to levels of momentary positive affect, negative affect, rumination, control, and the occurrence of stressors throughout the day. These secondary analyses with data from 56 of the participants revealed that the intervention group showed a significantly larger increase in daily positive affect and perceptions of control compared to control participants over the course of the intervention. A treatment effect was also found for negative affect and rumination, whereby both decreased to a greater extent in the intervention group when compared with participants in the control condition. The 24-week aerobic training program had significant impacts on daily psychological processes in family caregivers, deepening our understanding of the robust effects of exercise on mental health.

A Little Autonomy Support Goes a Long Way: Daily Autonomy-Supportive Parenting, Child Well-Being, Parental Need Fulfillment, and Change in Child, Family, and Parent Adjustment Across the Adaptation to the COVID-19 Pandemic

This study examined the effects of daily parental autonomy support on changes in child behavior, family environment, and parental well‐being across 3 weeks during the COVID‐19 pandemic in Germany. Day‐to‐day associations among autonomy‐supportive parenting, parental need fulfillment, and child well‐being were also assessed. Parents (longitudinal N = 469; M_age = 42.93, SD_age = 6.40) of school children (6–19 years) reported on adjustment measures at two measurement occasions and completed up to 21 daily online questionnaires in the weeks between these assessments. Results from dynamic structural equation models suggested reciprocal positive relations among autonomy‐supportive parenting and parental need fulfillment. Daily parental autonomy support, parental need fulfillment, and child well‐being partially predicted change in adjustment measures highlighting the central role of daily parenting for children’s adjustment during the pandemic.

The Biobehavioral Family Model: An Evidence-Based Approach to Biopsychosocial Research, Residency Training, and Patient Care

Engel's biopsychosocial model, based in systems theory, assumes the reciprocal influence of biological, psychological, and social factors on one another and on mental and physical health. However, the model's application to scientific study is limited by its lack of specificity, thus constraining its implementation in training and healthcare environments. The Biobehavioral Family Model (BBFM) is one model that can facilitate specification and integration of biopsychosocial conceptualization and treatment of illness. The model identifies specific pathways by which family relationships (i.e., family emotional climate) impact disease activity, through psychobiological mechanisms (i.e., biobehavioral reactivity). Furthermore, it is capable of identifying positive and negative effects of family process in the same model, and can be applied across cultural contexts. The BBFM has been applied to the study of child health outcomes, including pediatric asthma, and adult health, including for underserved primary care patients, minoritized samples, and persons with chronic pain, for example. The BBFM also serves as a guide for training and clinical practice; two such applications are presented, including the use of the BBFM in family medicine residency and child and adolescent psychiatry fellowship programs. Specific teaching and clinical approaches derived from the BBFM are described in both contexts, including the use of didactic lecture, patient interview guides, assessment protocol, and family-oriented care. Future directions for the application of the BBFM include incorporating temporal dynamics and developmental trajectories in the model, extending testable theory of family and individual resilience, examining causes of health disparities, and developing family-based prevention and intervention efforts to ameliorate contributing factors to disease. Ultimately, research and successful applications of the BBFM could inform policy to improve the lives of families, and provide additional support for the value of a biopsychosocial approach to medicine.

Interrelationship of emotional stability, hassles, uplifts, coping and stress-related symptoms in Swedish female and male military veterans

Drawing on previous research, two hypotheses were tested: (1) the higher the frequency of daily uplifts and use of functional coping strategies, and the lower the frequency of daily hassles and use of dysfunctional coping strategies, the lower the prevalence of stress-related symptoms will be, and vice versa; and (2) the direct relationship between the personality dimension emotional stability and stress-related symptoms, will be moderated by daily hassles, daily uplifts and coping processes. A quantitative test of a qualitatively developed model was performed. A questionnaire was sent to all Swedish military veterans who had served in the period 2011-2015 and 1859 individuals (1,614 men and 199 women, 46 individuals did not mark gender) responded (40.5% total response rate). All analyses were made separately for men and women. Comparisons between theoretically favorable and unfavorable profiles across the model variables, daily uplifts, daily hassles, functional coping and dysfunctional coping (based on a cluster analysis), showed considerable differences regarding the prevalence of stress-related symptoms as predicted by the model and supporting the first hypothesis. Regression and moderation analyses yielded limited support for the second hypothesis. As predicted, female veterans reported a higher frequency of physical, emotional and cognitive stress-related symptoms than male veterans. The main conclusion is that the theoretical model stood up well when empirically tested and offers a promising approach to future studies on everyday stress and health. The results contribute with new knowledge of military veterans compared to the main stream PTSD, depression and drug abuse-oriented studies.

A Coordinated Analysis of Variance in Affect in Daily Life

Despite widespread interest in variance in affect, basic questions remain pertaining to the relative proportions of between-person and within-person variance, the contribution of days and moments, and the reliability of these estimates. We addressed these questions by decomposing negative affect and positive affect variance across three levels (person, day, moment), and calculating reliability using a coordinated analysis of seven daily diary, ecological momentary assessment (EMA), and diary-EMA hybrid studies (across studies age = 18-84 years, total Npersons = 2,103, total Nobservations = 45,065). Across studies, within-person variance was sizeable (negative affect: 45% to 66%, positive affect: 25% to 74%); in EMA more within-person variance was attributable to momentary rather than daily level. Reliability was adequate to high at all levels of analysis (within-person: .73-.91; between-person: .96-1.00) despite different items and designs. We discuss the implications of these results for the design of future intensive studies of affect variance.

Psychological stress and cortisol during pregnancy: An ecological momentary assessment (EMA)-Based within- and between-person analysis

BACKGROUND

Although the linkage between psychological stress and cortisol is believed to mediate the association of stress with health outcomes, several studies have been unable to demonstrate this association. We suggest this inability may be a consequence of limitations in the measurement approach and/or reliance on analytic strategies that focus on associations across, rather than within individuals. The link between psychological stress and cortisol is of particular interest in the context of pregnancy and fetal development. Using an ecological momentary assessment (EMA) design, we examined the association between psychological stress and cortisol at the between- and the within-person level.

METHODS

152 participants completed a 4-day long EMA protocol serially in early, mid and late pregnancy to provide momentary stress appraisals (average of 150 measures/subject) and saliva samples (average of 55 samples/subject) for quantification of cortisol. The association between stress and cortisol was estimated using linear mixed models.

RESULTS

After accounting for the effects of key determinants of variation in cortisol, momentary stress was significantly and positively associated with cortisol at the within-person level (B = .030, p = .031), but not at the between-person level. No association was evident for traditional retrospective measures of stress with cortisol at either the between- or the within-person level.

CONCLUSIONS

Our study highlights the value of EMA methods and linear mixed-modeling approaches in linking maternal psychological and physiological states across pregnancy. These findings may have important implications for the development of personalized risk identification and "just-in-time" intervention strategies to optimize maternal and child health.

Change in mental health symptoms during the COVID-19 pandemic: The role of appraisals and daily life experiences

OBJECTIVE

When confronted with major threats, people often experience decline in well-being. The central purpose of this study was to identify mechanisms underlying change of well-being in times of threat, using the example of the COVID-19 pandemic, with a focus on appraisals of the pandemic and affective states, stress, as well as mindfulness in daily life.

METHOD

We conducted a study across 3.5 weeks, including pretest, posttest, and a diary phase in-between. We worked with a sample of 460 adults, pre- and post-test information, as well as 7,189 observations from the diary phase.

RESULTS

Results showed that deterioration in mental health symptoms across the duration of the study was associated with (a) change towards less fortunate appraisals of the pandemic and (b), more negative affect and less mindfulness in daily life. Furthermore, appraisals of the pandemic at pretest predicted experiences in daily life, with more negative appraisals of the pandemic predicting more negative affect and stressor occurrence as well as less mindfulness.

CONCLUSIONS

These findings speak to the dynamic nature of well-being and appraisals in times of threat, and highlight the role of experiences in daily life in changes in well-being.

Sleep duration and affective reactivity to stressors and positive events in daily life

OBJECTIVE

Experimental evidence suggests that inadequate sleep disrupts next-day affective processing and evokes greater stress reactivity. However, less research has focused on whether sleep predicts next-day affective reactivity to naturally occurring stressors and positive events in daily life, as well as the reversed direction of association (i.e., affective reactivity to daily events as predictors of subsequent sleep). The purpose of this study was to evaluate the within-person, bidirectional associations between nightly sleep duration and day-to-day fluctuations in affect related to stressors and positive events.

METHOD

Adults ages 33-84 (N = 1,982, 57% female) in the U.S. National Study of Daily Experiences II reported sociodemographics and chronic conditions at baseline, then completed telephone interviews for 8 consecutive days about their sleep duration, daily stressors, positive events, and affect.

RESULTS

Prior-night sleep duration moderated the link between current-day events and positive affect, but not negative affect. Specifically, nights of shorter-than-usual sleep duration predicted more pronounced decreases in positive affect in response to daily stressors, as well as smaller increases in positive affect in response to daily positive events. Results for the reversed direction of association showed no evidence for affective reactivity to daily events as predictors of subsequent sleep duration. People with more chronic conditions were more reactive to positive events, particularly after nights of longer sleep.

CONCLUSION

Affective reactivity to daily stressors and positive events vary based upon sleep duration, such that sleep loss may amplify loss of positive affect on days with stressors, as well as reduce positive affective responsiveness to positive events. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Daily Mood Reactivity to Stress during Childhood Predicts Internalizing Problems Three Years Later

The mental health toll of common school problems that many children encounter every day is not well understood. This study examined individual differences in mood reactivity to naturally occurring school problems using daily diaries, and assessed their prospective associations with youth mental health, three years later. At baseline, 47 children ages 8 to 13 years described common problems at school and mood on a daily basis, for 8 weeks. Thirty-three youth returned for follow-up three years later at ages 11 to 17 years. Children and parents also completed one-time questionnaires about youth mental health at baseline and follow-up. There were individual differences in the within-person associations between school problems and same-day and next-day mood. A greater tendency to react to school problems with more negative mood or less positive mood on the same day predicted more parent-rated internalizing and externalizing problems and child ratings of depression symptoms three years later, relative to baseline levels of symptoms. Daily diaries can help to identify specific targets of psychosocial interventions in real world settings.

Annual Research Review: Ecological momentary assessment studies in child psychology and psychiatry

BACKGROUND

Enhancements in mobile phone technology allow the study of children and adolescents' everyday lives like never before. Ecological momentary assessment (EMA) uses these advancements to allow in-depth measurements of links between context, behavior, and physiology in youths' everyday lives.

FINDINGS

A large and diverse literature now exists on using EMA to study mental and behavioral health among youth. Modern EMA methods are built on a rich tradition of idiographic inquiry focused on the intensive study of individuals. Studies of child and adolescent mental and behavioral health have used EMA to characterize lived experience, document naturalistic within-person processes and individual differences in these processes, measure familiar constructs in novel ways, and examine temporal order and dynamics in youths' everyday lives.

CONCLUSIONS

Ecological momentary assessment is feasible and reliable for studying the daily lives of youth. EMA can inform the development and augmentation of traditional and momentary intervention. Continued research and technological development in mobile intervention design and implementation, EMA-sensor integration, and complex real-time data analysis are needed to realize the potential of just-in-time adaptive intervention, which may allow researchers to reach high-risk youth with intervention content when and where it is needed most.

Memory lapses in daily life among breast cancer survivors and women without cancer history

OBJECTIVE

Cancer-associated cognitive decline is a concern among cancer survivors. Survivors' memory lapses (eg, location of keys, names, and reason entered room) may negatively impact quality of life. This study used smartphone-based surveys to compare cancer survivors to those without cancer history on frequency of, severity of, and affective response to daily memory lapses.

METHODS

For 14 evenings, breast cancer survivors (N = 47, M age = 52.9) and women without a cancer history (N = 105, M age = 51.8) completed smartphone-based surveys on memory lapse occurrence and severity and negative and positive affect.

RESULTS

Survivors were nearly three times more likely to report a daily memory lapse but did not differ from comparison group on memory lapse severity. Negative affect was significantly higher on days with memory lapses associated with doing something in the future (eg, appointments) but this did not differ across groups. Positive affect was not significantly related to survivorship status or the occurrence of daily memory lapses.

CONCLUSION

Survivors may be at-risk for more frequent memory lapses. Both survivors and women without a history of cancer reported greater negative affect on days when memory lapses occurred, suggesting that daily cognitive functioning may have important implications for quality of life.

Everyday stress components and physical activity: examining reactivity, recovery and pileup

The experience of naturally-occurring stress in daily life has been linked with lower physical activity levels. However, most of this evidence comes from general and static reports of stress. Less is known how different temporal components of everyday stress interfere with physical activity. In a coordinated secondary analysis of data from two studies of adults, we used intensive, micro-longitudinal assessments (ecological momentary assessments, EMA) to investigate how distinct components of everyday stress, that is, reactivity to stressor events, recovery from stressor events, and pileup of stressor events and responses predict physical activity. Results showed that components of everyday stress predicted subsequent physical activity especially for indicators of stress pileup. In both studies, the accumulation of stress responses over the previous 12 h was more predictive of subsequent physical activity than current stress reactivity or recovery responses. Results are compared to the effects of general measures of perceived stress that showed an opposite pattern of results. The novel everyday stress approach used here may be fruitful for generating new insights into physical activity specifically and health behaviors in general.

Does Cardiorespiratory Fitness Buffer Stress Reactivity and Stress Recovery in Police Officers? A Real-Life Study

High levels of cardiorespiratory fitness have the potential to buffer against physical and mental health impairments, which can result from exposure to occupational stress. Police officers are especially at risk of high psychosocial stress; therefore, effective intervention strategies are warranted. Given this background, the purpose of the present study was to examine whether police officers with different levels of cardiorespiratory fitness differ with regard to their (a) physiological stress reactivity during acute real-life stress situations, and (b) physiological recovery related to acute and chronic work stress. In total, 201 police officers took part in this study (M = 38.6 years, SD = 10.1, 35.8% females). Officers were contacted eight times on a smartphone during their workday, and asked to report their current level of positive and negative affect, as well as feelings of stress and anger. Physiological stress responses and recovery (heart rate variability) were assessed using Movisens EcgMove3 devices. The Åstrand bicycle ergometer test was used to assess participants' cardiorespiratory fitness. Chronic work stress was assessed using the effort-reward imbalance model and the job strain model. Multilevel modeling was used to test buffering effects of cardiorespiratory fitness on physiological stress reactivity. Linear regression was applied to test stress-buffering effects of cardiorespiratory fitness on physiological recovery. Results showed lowered physiological stress reactivity to acute work stress in officers with higher levels of cardiorespiratory fitness. However, these results were not consistent, with no effects occurring for feelings of anger, positive affect, and negative affect. Chronic work stress (effort-reward imbalance) was related to lower physiological recovery. Cardiorespiratory fitness was positively related to physiological recovery. Data did not support interactions between work stress and cardiorespiratory fitness on physiological recovery. To some extent, cardiorespiratory fitness seems to have the potential to buffer stress reactivity in police officers in acute stress situations. Therefore, we encourage promoting fitness programs which aim to enhance cardiorespiratory fitness in stressful occupations such as law enforcement. Improvements in cardiorespiratory fitness might further enhance physiological recovery from chronic work stress, which is thought to improve cardiovascular health.

Health behaviour change in cardiovascular disease prevention and management: meta-review of behaviour change techniques to affect self-regulation

Self-regulation processes assume a major role in health behaviour theory and are postulated as important mechanisms of action in behavioural interventions to improve health prevention and management. The need to better understand mechanisms of behaviour change interventions for cardiovascular diseases (CVD) called for conducting a meta-review of meta-analyses for interventions targeting self-regulation processes. The protocol, preregistered on Open Science Framework (OSF), found 15 eligible meta-analyses, published between 2006 and August 2019, which quantitatively assessed the role of self-regulatory mechanisms and behaviour change techniques (BCTs). Quality of the meta-analyses varied widely according to AMSTAR-2 criteria. Several BCTs, assumed to engage self-regulatory mechanisms, were unevenly represented in CVD meta-analytic reviews. Self-monitoring, the most frequently studied self-regulatory BCT, seemed to improve health behaviour change and health outcomes but these results merit cautious interpretation. Findings for other self-regulatory BCTs were less promising. No studies in the CVD domain directly tested engagement of self-regulation processes. A general challenge for this area stems from reliance on post-hoc tests of the effects of BCTs in multiple-component interventions. Recent advances in BCT taxonomies and the experimental medicine approach to engaging self-regulation mechanisms, however, provide opportunities to improve CVD prevention and management behavioural interventions.

Potential benefits of integrating ecological momentary assessment data into mHealth care systems

The advancement of wearable/ambulatory technologies has brought a huge change to data collection frameworks in recent decades. Mobile health (mHealth) care platforms, which utilize ambulatory devices to collect naturalistic and often intensively sampled data, produce innovative information of potential clinical relevance. For example, such data can inform clinical study design, recruitment approach, data analysis, and delivery of both "traditional" and novel (e.g., mHealth) interventions. We provide a conceptual overview of how data measured continuously or repeatedly via mobile devices (e.g., smartphone and body sensors) in daily life could be fruitfully used within a mHealth care system. We highlight the potential benefits of integrating ecological momentary assessment (EMA) into mHealth platforms for collecting, processing, and modeling data, and delivering and evaluating novel interventions in everyday life. Although the data obtained from EMA and related approaches may hold great potential benefits for mHealth care system, there are also implementation challenges; we briefly discuss the challenges to integrating EMA into mHealth care system.

Understanding stress reports in daily life: a coordinated analysis of factors associated with the frequency of reporting stress

Although stress is a common experience in everyday life, a clear understanding of how often an individual experiences and reports stress is lacking. Notably, there is little information regarding factors that may influence how frequently stress is reported, including which stress dimension is measured (i.e., stressors-did an event happen, subjective stress-how stressed do you feel, conditional stress-how stressful a stressor was) and the temporal features of that assessment (i.e., time of day, day of study, weekday vs. weekend day). The purpose of the present study was to conduct a coordinated analysis of five independent ecological momentary assessment studies utilizing varied stress reporting dimensions and temporal features. Results indicated that, within days, stress was reported at different frequencies depending on the stress dimension. Stressors were reported on 15-32% of momentary reports made within a day; across days, the frequency ranged from 42 to 76% of days. Depending on the cutoff, subjective stress was reported more frequently ranging about 8-56% of all moments within days, and 40-90% of days. Likewise, conditional stress ranged from just 3% of moments to 22%, and 11-69% of days. For the temporal features, stress was reported more frequently on weekdays (compared to weekend days) and on days earlier in the study (relative to days later in the study); time of day was inconsistently related to stress reports. In sum, stress report frequency depends in part on how stress is assessed. As such, researchers may wish to measure stress in multiple ways and, in the case of subjective and conditional stress with multiple operational definitions, to thoroughly characterize the frequency of stress reporting.

Additive Effects of Forecasted and Reported Stressors on Negative Affect

Objectives

Many studies of daily life have framed stressors as unpredictable disruptions. We tested age differences in whether individuals forecast upcoming stressors, whether individuals show anticipatory stress responses prior to stressors, and whether having previously forecasted any stressors moderates stressor exposure on negative affect.

Method

Adults (n = 237; age 25-65) completed surveys five times daily for 14 days on current negative affect, stressor exposure, and stressor forecasts.

Results

Older age was associated with slightly greater likelihood of reported stressors but unrelated to forecasted stressors. Following forecasted stressors, individuals were four times more likely to report a stressor had occurred; age did not moderate this effect. Even prior to stressors, current negative affect was significantly higher when individuals forecasted stressors compared to when no stressors were forecast. No support was found for forecasts buffering effects of stressors on negative affect and age did not moderate this interaction. Instead, the effects were additive.

Discussion

In an age-heterogeneous sample, individuals showed early and persistent affective responses in advance of stressors. Anticipatory stress responses may be a mechanism for chronic stress.

Daily Stress Processes as Contributors to and Targets for Promoting Cognitive Health in Later Life

OBJECTIVE

The aim of this study was to test the hypothesis that daily stress processes, including exposure and emotional reactivity to daily stressors, are associated with response time inconsistency (RTI), an indicator of processing efficiency and cognitive health. Furthermore, we considered daily stress-cognitive health associations at the level of individual differences and within-persons over time.

METHODS

Participants were 111 older adults (mean = 80 years, range = 66-95 years) enrolled in a measurement burst study where assessments of response time-based cognitive performance, stressful experiences, and affect were administered on each of 6 days for a 2-week period. This protocol was repeated every 6 months for 2.5 years. Multilevel modeling was used to examine frequency of stressor exposure, nonstressor affect, and affect reactivity to daily stressors as individual difference and time-varying predictors of RTI.

RESULTS

Between-persons, higher levels of nonstressor negative affect (b = 0.41, 95% confidence interval [CI] = -0.01 to 0.83, p = .055) and negative affect reactivity (b = 0.80, 95% CI = 0.18 to 1.42, p = .012) were associated with greater RTI. Within-persons over time, higher levels of negative affect (b = 0.20, 95% CI = 0.06 to 0.34, p = .006) and negative affect reactivity (b = 0.13, 95% CI = 0.02 to 0.24, p = .018) were associated with increased RTI among the oldest portion of the sample, whereas higher levels of positive affect (b = -0.11, 95% CI = -0.21 to -0.02, p = .019) were associated with reduced RTI.

CONCLUSIONS

Negative affect reactions to daily stressors are associated with compromised RTI both between and within-persons. Findings suggest that emotional reactions to daily stressors contribute to compromise older adults' cognitive health, whereas increased positive affect may be beneficial.

Age differences in everyday stressor-related negative affect: A coordinated analysis

Advancing age is often characterized by preserved or even enhanced emotion regulation, which is thought to manifest in terms of age-related reductions in the within-person association between stressors and negative affect. Existing research from ecological momentary assessment and end-of-day daily diary studies examining such age-related benefits have yielded mixed results, potentially due to differences in samples, design, and measurement of everyday stressors and negative affect. We conducted a coordinated analysis of 5 ecological momentary assessments and 2 end-of-day daily diary studies to examine adult age differences in the within-person association between everyday stressors and negative affect. Reported stressor occurrences are robustly associated with higher negative affect, regardless of study design and sample characteristics. Across studies, interactions between age and everyday stressors predicting negative affect revealed a pattern of age-related decreases in the stressor-negative affect association, but this interaction was only significant for 2 studies. Further, examination of statistical power of the included studies suggests that, despite differences in the number of repeated assessments, power to detect within-person stressor-negative affect associations is quite good. In contrast, despite possessing wider age ranges, observed age differences were relatively small in magnitude, and studies are potentially underpowered to detect age differences in these within-person associations. We discuss the importance of study design, interval of repeated assessments and number of participants for examining age differences in everyday stressors and negative affect, as well as the virtue of coordinated analyses for detecting consistent direction of associations, but inconsistent patterns of statistical significance. (PsycINFO Database Record (c) 2019 APA, all rights reserved).