The Role of Daily Positive Emotions During Conjugal Bereavement

Humor: A Grief Trigger and Also a Way to Manage or Live With Your Grief

In 2020-2021, a qualitative study was undertaken using an interpretive description methodology to identify what triggers grief in the first 2 years following the death of a beloved family member, and to gain other helpful insights about grief triggers from bereaved Canadian adult volunteers. In that study, a purposive sampling method was used to select 10 bereaved Canadian adult volunteers for in-depth, semi-structured interviews. This paper reports on the humor findings, as revealed to be a particularly complex grief trigger for many participants, as well as a periodic way for most to manage or live with their grief. Participant quotes and an extended discussion are included to illustrate the importance of these humor findings in relation to grief, and to inform bereaved people, bereavement service providers, and the general public about both helpful aspects and some cautionary considerations about humor.

Exploring the Role of Coping Strategies on the Impact of Client Suicide: A Structural Equation Modeling Approach

Client suicide refers to cases where a mental health practitioner is exposed, affected, or bereaved by a client's suicide and is known to have a profound impact on MHPs. The current study investigated the role of coping styles in understanding short- and long-term impact of client suicide. An international sample of 213 mental health practitioners who experienced a client suicide completed a survey on coping strategies (i.e., Brief-COPE) and the impact of traumatic events (i.e., impact of event scale-revised, long-term emotional impact scale and professional practice impact scale). Results indicate coping strategies explain 51% of the short-term, 64% of the long-term emotional and 55% of the long-term professional differences in impact of client suicide. Moreover, while an Avoidant coping style predicted more impact of client suicide, Positive coping and Humor predicted less impact of client suicide. Social Support coping did not predict impact of client suicide. Implications for both research and clinical practice are discussed.

Posttraumatic Growth, Maladaptive Cognitive Schemas and Psychological Distress in Individuals Involved in Road Traffic Accidents-A Conservation of Resources Theory Perspective

Road traffic accidents can have profound psychological impacts on the individuals involved, encompassing both negative distress and positive growth. This study, guided by the conservation of resources (COR) theory, investigates the intricate relationship between posttraumatic growth (PTG), maladaptive cognitive schemas, and psychological distress in individuals involved in road traffic accidents. PTG reflects an individual's ability to derive positive changes from adversity, while maladaptive schemas represent negative cognitive patterns. Using a 122 sample of individuals involved in road traffic accidents, we examined direct and indirect effects within this complex network. Our findings reveal significant direct effects of PTG on psychological distress (β = 0.101, p = 0.02). Particularly noteworthy are the indirect effects mediated by cognitive schemas, emphasizing the role of impaired autonomy and perceived performance deficiencies (β = 0.102, p = 0.05). This suggests that individuals involved in road traffic accidents experiencing higher PTG levels may indirectly experience greater psychological distress through these maladaptive cognitive schemas. This study not only advances our understanding of the psychological consequences of road traffic accidents but also aligns with self-determination theory, emphasizing autonomy and competence as fundamental needs. Individuals involved in road traffic accidents may undergo profound shifts in perspective following the trauma, which our results support. Recognizing the nuanced relationship between PTG, maladaptive cognitive schemas, and psychological distress is crucial for tailoring interventions and support systems for individuals involved in traffic accidents. As PTG can coexist with distress, interventions should foster adaptive growth while addressing maladaptive schemas to promote resilience in the face of traumatic events.

Introversion and the frequency and intensity of daily uplifts and hassles

OBJECTIVE

There is reason to believe that introversion may relate to different patterns of negative and positive experiences in everyday life ("hassles" and "uplifts"), but there is little evidence for this based on reports made in daily life as events occur. We thus extend the literature by using data from ecological momentary assessments to examine whether introversion is associated with either the frequency or intensity of hassles and uplifts.

METHOD

Participants (N = 242) were community-dwelling adults (63% Black, 24% Hispanic; ages 25-65; 65% women) who completed baseline measures of personality and mental health, followed by reports of hassles and uplifts 5x/day for 14 days. We present associations between introversion and hassles/uplifts both with and without controlling for mood-related factors (neuroticism, recent symptoms of depression, and anxiety).

RESULTS

Introversion was associated with reporting less frequent and less enjoyable uplifts, but not with overall hassle frequency or unpleasantness; exploratory analyses suggest associations with specific types of hassles.

CONCLUSIONS

Our results expand understanding of the role of introversion in everyday experiences, suggesting an overall association between introversion and uplifts (but not hassles, broadly) in daily life. Better understanding of such connections may inform future research to determine mechanisms by which introversion relates to health.

Loneliness and mortality: The moderating effect of positive affect

Although the adverse association of loneliness with health and mortality are well documented, less is known about moderating factors of this relationship. According to the "buffering theory," it is argued that positive affect moderates the negative associations of stressors with health. The current study contributes to the literature by asking: Does positive affect also moderate the relationship between loneliness and mortality? A large population-based sample of middle-aged and older adults in Germany from 2008 was used (N = 4442). Mortality was monitored up to 2020, resulting in a maximum follow-up period of observation of 12 years, in which mortality events could be observed. Loneliness was measured using an adapted German version of the De Jong Gierveld Loneliness Scale, while positive affect was measured with an adapted German version of the Positive and Negative Affect Schedule. Using Cox survival regression, it was found that loneliness significantly predicted increased mortality risk (HR = 1.20; p = .029); conversely, positive affect significantly predicted decreased mortality risk (HR = 0.63; p < .001). Furthermore, a significant interaction emerged between loneliness and positive affect in predicting mortality (HR = 0.70; p = .001): The strength of the association of loneliness with mortality decreased with increasing levels of positive affect. Positive affect attenuates the association between loneliness and mortality, supporting previous empirical research and theories on the buffering effect of positive affect. If replicated in further studies, interventions that promote positive affect might be beneficial to mitigate the negative associations of loneliness with health.

A scoping research literature review to explore bereavement humor

The death of a loved one is extremely impactful. Although much of the focus now on helping people who are experiencing bereavement grief is oriented to distinguishing complicated from non-complicated grief for early pharmaceutical or psychiatric treatment, lay bereavement support comprises a more common and thus highly important but often unrecognized consideration. A wide variety of lay bereavement programs with diverse components have come to exist. This scoping research literature review focused on bereavement humor, one possible component. Humor has long been recognized as an important social attribute. Researchers have found humor is important for lifting the spirits of ill people and for aiding healing or recovery. However, humor does not appear to have been recognized as a technique that could benefit mourners. A multi-database search revealed only 11 English-language research articles have been published in the last 25 years that focused in whole or in part on bereavement humour. Although minimal evidence exists, these studies indicate bereaved people often use humor and for a number of reasons. Unfortunately, no investigations revealed when and why bereavement humor may be inappropriate or unhelpful. Additional research, multi-cultural investigations in particular, are needed to establish humor as a safe and effective bereavement support technique to apply or to use. Bereavement humor could potentially be used more often to support grieving people and bereaved people should perhaps be encouraged to use humor in their daily lives.

Caring for Relatives with Dementia in Times of COVID-19: Impact on Caregivers and Care-recipients

OBJECTIVES

To analyze caregivers' perceived impact of the pandemic in their mental health and the well-being of the care-recipients.

METHODS

Caregivers (N = 88) were asked if they had COVID-19 and about their perceptions of change of care-recipients' health conditions as well as whether their own mental health, conflicts with care-recipients and other relatives, thoughts of giving up caregiving, and feelings of coping well with the situation.

RESULTS

A large percentage of caregivers perceived a worsening of care-recipients' symptoms and of their own negative emotions, an increase in the number of conflicts and thoughts of needing to give up caregiving. Having had COVID-19 and reporting higher levels of distress as well as giving up caregiving were related to perceived worsening in care-recipients well-being. Perceived increases were mainly reported by younger caregivers, those who perceived to have not coped well, and those reporting an increase in conflicts. Some caregivers perceived an increase in positive emotions.

CONCLUSIONS

The pandemic has a negative impact on caregivers' perceptions about the course of their own emotions and care-recipients' well-being.

CLINICAL IMPLICATIONS

Interventions are needed to train caregivers in strategies to cope with the sources of stress caused by the pandemic and to promote social support.

Rumination, worry and negative and positive affect in prolonged grief: A daily diary study

After bereavement, a significant minority experiences severe, persistent, and disabling grief, termed prolonged grief or complicated grief. Prolonged grief treatments may be enhanced by improving understanding of malleable risk factors in post‐loss psychological adaptation. Repetitive negative thought (e.g., rumination, worry) constitutes such a risk factor. Rumination and worry are both theorized to be maladaptive through interrelations with affect, yet this assumption has not been systematically investigated in the bereaved. We aimed to fill this gap in knowledge with a baseline survey and 10‐day daily diary investigation among a bereaved sample. Survey between‐subject analyses (N = 113) demonstrated that trait rumination and worry, trait negative affect and prolonged grief symptoms are positively related to each other and negatively related with trait positive affect. Within‐subject multilevel analyses of diaries (N = 62) demonstrated that trait rumination and trait worry relate positively to daily negative affect and negatively to daily positive affect. Daily rumination and worry showed similar relationships with daily negative and positive affect. A stronger relationship emerged between daily rumination and daily negative affect in people with higher prolonged grief symptom levels. Findings consistently support interrelations between repetitive negative thought, affect, and prolonged grief symptoms. Rumination appears particularly detrimental in people with severe grief reactions. Results align with research demonstrating the effectiveness of targeting repetitive negative thought in prolonged grief treatments. Additionally, our study demonstrates the potential feasibility and usefulness of using daily diaries to study behaviours of relevance to post‐loss adaptation in everyday life.

Coping With COVID-19: The Benefits of Anticipating Future Positive Events and Maintaining Optimism

In early 2020, the COVID-19 pandemic forced a large portion of the world into quarantine, leading to an extensive period of stress making it necessary to explore regulatory techniques that are effective at stimulating long-lasting positive emotion. Previous research has demonstrated that anticipating positive events produces increases in positive emotion during discrete stressors. We hypothesized that state and trait positive anticipation during the COVID-19 pandemic would be associated with increased positive emotions. We assessed how often participants thought about a future positive/negative/neutral event, activity, or goal through a daily reconstruction method that represented a "day in the life" of people in the United States during the early stages of the COVID-19 pandemic. The results of multi-level modeling and mediational analyses demonstrated that higher optimism, one form of trait positive anticipation, was related to higher state positive anticipation, which was in turn related to higher positive emotions during the current episode, which persisted to the next episode. In addition, both optimism and state positive anticipation were related to adaptive responses to the pandemic. These findings suggest that anticipation of future emotional experiences and hopefulness for the future can be a powerful predictor of positive emotions during global pandemics and perhaps other similar chronic stressors.

Daily Stress Reactivity Across the Life span: Longitudinal and Cross-Sectional Effects of Age

OBJECTIVE

Exploration of development requires the use of research designs and process-oriented methodologies that can capture daily fluctuations within individuals, systematic changes within individuals, and differences between individuals. We examine the stress-affect relationship in this way to assess how the relationship between daily stress and negative affect (NA) as well as the relationship between daily stress and positive affect (PA) differs between individuals and changes over time depending on age and stress differences.

METHOD

Participants (N = 966) completed daily "burst" assessments of stress, NA, and PA. Three-level multilevel models depicted how cross-sectional age, within-person age changes, and global stress differences impact the daily stress-affect relationship.

RESULTS

Findings illustrate that cross-sectional age and the aging process uniquely buffer the stress-NA relationship whereas global stress exacerbates it. Furthermore, older adults as well as adults with low global stress experience a weaker relationship between daily stress and PA as they age, but midlife adults and adults with high global stress experience a stronger relationship.

DISCUSSION

These results depict differences in aging trajectories for both midlife and older adults and thus inform intervention and preventative care strategies aimed toward promoting stress regulation.

Effects of Pain Reduction by Self-Natural Posture Exercise on Affective Complexity in Women: The Moderating Effect of Self-Regulation

This study aimed to investigate the effects of pain reduction and self-regulation efficacy on affective complexity in female patients with chronic pain after participation in an exercise therapy program—Self-Natural Posture Exercise (SNPE)—within the theoretical framework of the Dynamic Model of Affect. A 12-week SNPE program (thrice a week, 70 min per session) was conducted with 101 women with chronic pain lasting longer than 6 months. Pre- versus post-SNPE difference in the correlation between positive affect (PA) and negative affect (NA) was examined through Fisher’s z test, and the moderation effect was confirmed through hierarchical regression analysis. Upon completion of the program, participants experienced pain [M_pre = 5.68 (SD_pre = 1.96) vs. M_post = 3.12 (SD_post = 2.16)] and stress reduction [M_pre = 2.92 (SD_pre = 0.95) vs. M_post = 2.62 (SD_post = 0.86)], higher satisfaction with life [M_pre = 4.25 (SD_pre = 1.20) vs. M_post = 4.80 (SD_post = 1.15)], and decreases in the negative correlation between PA and NA (r_pre = −0.541 vs. r_post = −0.379). Furthermore, participation in the SNPE program neutralized the impact of PA_post on NA_post (β = −0.03) in participants with high self-regulation and pain reduction. These results suggest that self-regulation helps to increase SNPE adherence, which would induce pain reduction and restore affective complexity. Based on the strength model of self-control, to increase the pain reduction through exercise therapy, the instructor should ensure that the participants are not being ego depleted.

Positive Emotions Experienced on Days of Stress are Associated with Less Same Day and Next Day Negative Emotion

Positive emotions help us during times of stress. They serve to replenish resources and provide relief from stressful experiences. Positive emotions may be particularly beneficial during times of stress by dampening negative emotional reactivity and quickening recovery from stressful events. In this study, we used a daily diary design to examine how positive emotions experienced on days with minor stressful events are associated with same day and next day stressor-related negative emotions. We combined data from the National Study of Daily Experiences II (NSDE II) and the Midlife in the United States survey (MIDUS II), resulting in 1,588 participants who answered questions about daily stressors and emotion across 8 consecutive days. On days when people experienced a stressor and had higher than their average level of positive emotion, they experienced less of a same day increase in negative emotion. Additionally, they experienced less subsequent negative emotion the following day and were less likely to experience a stressor the next day. Results held when adjusting for trait measures of positive and negative emotion. These results suggest that daily positive emotions experienced on days of stress help regulate our negative emotion during times of stress.

Positive Affect as a Buffer between Chronic Stress and Symptom Severity of Emotional Disorders

Research has demonstrated that stressors play a critical role in the development of generalized anxiety disorder (GAD), social anxiety disorder (SAD), and major depressive disorder (MDD). Separately, deficits in positive affect (PA) have been identified in GAD, SAD, and MDD. While previous research has linked the buffering effects of PA in chronic illness, such effects have yet to be investigated for chronic stressors and emotional disorder-related symptom severity. The purpose of the present study was to examine PA as a moderator of chronic interpersonal and non-interpersonal stress on GAD, SAD, and MDD symptom severity. Using a multilevel statistical approach with a sample of adolescents and young adults (N=463), PA was found to significantly moderate the relationship between chronic interpersonal stress and symptom severity for MDD and SAD. Findings suggest that in times of chronic interpersonal stress, higher PA may serve as a buffer from development of SAD and MDD symptoms.

Death of a close friend: Short and long-term impacts on physical, psychological and social well-being

This paper reports the impact of a major life event-death-on the physical, psychological and social well-being of the deceased's close friends. We utilised data from a large longitudinal survey covering a period of 14 years (2002-2015) consisting a cohort of 26,515 individuals in Australia, of whom 9,586 had experienced the death of at least one close friend. This longitudinal cohort dataset comprises responses to the SF-36 (health related quality of life measure) and allowed for analysis of the short and longer-term impacts of bereavement. In order to manage the heterogeneity of the socio-demographics of respondents who did/not experience a death event, we use a new and robust approach known as the Entropy Balancing method to construct a set of weights applied to the bereaved group and the control group (the group that did not experience death). This approach enables us to match the two groups so that the distribution of socio-demographic variables between the two groups are balanced. These variables included gender, age, marital status, ethnicity, personality traits, religion, relative socio-economic disadvantage, economic resources, and education and occupation and where they resided. The data show, for the first time, a range of negative and enduring consequences experienced by people following the death of a close friend. Significant adverse physical and psychological well-being, poorer mental health and social functioning occur up to four years following bereavement. Bereaved females experienced a sharper fall in vitality, suffered greater deterioration in mental health, impaired emotional and social functioning than the male counterparts up to four years after the death. The data show that the level of social connectedness plays an important role in bereavement outcomes. Specifically, we found that less socially active respondents experienced a longer deterioration in physical and psychological health. Finally, we found evidence that the death of a close friend lowered the respondent's satisfaction with their health. Since death of friends is a universal phenomenon, we conclude the paper by reflecting on the need to recognise the death of a close friend as a substantial experience, and to offer support and services to address this disenfranchised grief. Recognising bereaved friends as a group experiencing adverse outcomes can be used internationally to prompt health and psychological services to assist this specific group, noting that there may be substantial longevity to the negative sequelae of the death of a friend. Facilitating bereaved people's support networks may be a fruitful approach to minimising these negative outcomes.

Formal volunteering as a protector of health in the context of social losses

This study aims to examine the effect of the death of a family member or friend on psychological well-being, specifically the moderating effects of first-time volunteering and social network. With the sample of 354 volunteers from the Experience Corps® (EC) programs, Analysis of covariance (ANCOVA) estimated the differences in psychological well-being. Among volunteers who had experienced the death of a family member or friend, new volunteers showed significant improvement in positive affect compared to experienced volunteers. EC members gained additional social contacts through volunteering. Formal volunteering has a salutatory effect on older adults' health after the loss of family members.

Overview of measurement-based positive psychiatry

BACKGROUND

Psychiatry has traditionally focused on studying psychopathology and treating mental illnesses to relieve symptoms and prevent relapse. Positive psychiatry seeks to expand the scope of psychiatry to broader aspects of mental health and well-being among individuals with or without mental illnesses. Positive psychosocial factors such as well-being, resilience, optimism, wisdom, and social support are central to positive psychiatry.

AIM

To summarize the emerging science of positive psychiatry, emphasizing the use of measures of positive characteristics and outcomes relevant to mental health.

METHODS

Overview of recent research in positive psychiatry, focusing on measurements.

RESULTS

Positive psychosocial factors are associated with better mental and physical health in diverse populations. Among individuals with serious mental illnesses, levels of these factors vary considerably, but positive psychiatry interventions can improve well-being and rates of recovery in at least subsets of the patients. A number of measures of positive factors and outcomes are available; most of them are based on self-reports, which have advantages as well as limitations.

CONCLUSIONS

Positive psychiatry has the potential to improve the health and well-being of individuals with or without mental illnesses. Further research is needed to provide clinicians and investigators with a full tool-box of validated measures for positive psychosocial factors and outcomes. These measures should be subjected to rigorous psychometric evaluation across populations to help clarify mechanisms underlying positive factors, evaluate their longitudinal trajectories, and examine the impact of interventions on health and well-being over the lifespan in different clinical groups.

Resilience Among Nepali Widows After the Death of a Spouse: "That Was My Past and Now I Have to See My Present"

Responses to the death of a spouse vary; although some are at increased risk of poorer physical and mental health outcomes, others have more resilient responses. In light of the limited scope of research on widows' experiences in Nepal, a setting where widows are often marginalized, we explore themes of resilience in Nepali widows' lives. Drawing from a larger qualitative study of grief and widowhood, a thematic narrative analysis was performed on narratives from four widows that reflected resilient outcomes. Individual assets and social resources contributed to these widows' resilient outcomes. Forgetting, acceptance, and moving forward were complemented by confidence and strength. Social support and social participation were key to widows' resilient outcomes. These four narratives reflect the sociocultural context that shape widows' resilient outcomes in Nepal. Future studies on the emergent themes from this exploratory study will help identify how best to encourage resilient outcomes among widows.

Social Support and Resilience as Mediators Between Stress and Life Satisfaction Among People With Substance Use Disorder in China

This study investigated the potential mediating roles of resilience and social support in the relationship between stress and life satisfaction. A total of 426 individuals, who have substance use disorder, from the Shifosi and Dalianshan rehabilitation facilities in China participated in the study. They were tested using the Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale, and Satisfaction with Life Scale. Results showed that the serial multiple mediation of social support and resilience in the relationship between stress and life satisfaction was significant. Furthermore, the findings corroborate the important roles of perceived social support and resilience in alleviating stress. Finally, we discussed ways to enhance the life satisfaction for individuals who have substance use disorder and analyzed the limitations of this study.

Caregivers' positive emotional expression and children's psychological functioning after parental loss

The death of a loved one, particularly a parent, has been identified as not only the most common, but also the most distressing form of adversity youth may experience in their lifetime. Surviving caregivers' communication with their children may play a critical role in shaping bereaved children's psychological functioning. However, few studies have examined the specific content (e.g., word usage) of caregivers' verbal communication as a predictor of psychological functioning in bereaved youth. In a sample of 39 parentally-bereaved children and their surviving caregivers, we investigated whether the frequency of caregivers' use of positive emotion words (e.g., "love", "happy", "hope") during a reminiscing task about the deceased was associated with children's psychological functioning and coping. In a cross-sectional analysis, we specifically examined whether these associations were moderated by the amount of time passed since children lost their parents. The Linguistic Inquiry and Word Count Program (LIWC) was used to code and evaluate the percentage of positive emotion words caregivers used during the discussion. When caregivers used more positive emotion words, children were less likely to experience depression, anxiety, and avoidant coping. Those associations were present for children who had experienced parental loss at least 105 days prior to the study. Our findings have implications for how caregivers can support their children and help to alleviate psychological distress in the aftermath of parental loss.

Daily positive events and diurnal cortisol rhythms: Examination of between-person differences and within-person variation

Growing evidence from field studies has linked daily stressors to dysregulated patterns of diurnal cortisol. Less is known about whether naturally-occurring positive events in everyday life are associated with diurnal cortisol. The objectives of this study were to evaluate daily positive events as predictors of between-person differences and within-person (day-to-day) variations in diurnal cortisol parameters, in addition to daily positive events as buffers against the associations between daily stressors and cortisol. In the National Study of Daily Experiences, 1657 adults ages 33-84 (57% female) reported daily experiences during telephone interviews on 8 consecutive evenings. Saliva samples were collected 4 times per day on 4 interview days and assayed for cortisol. Multilevel models were used to estimate associations of daily positive events with cortisol awakening response (CAR), diurnal cortisol slope, and area under the curve (AUC). At the between-person level, people who experienced more frequent positive events exhibited a steeper diurnal cortisol slope, controlling for daily stressors, daily affect, and other covariates. At the within-person level, positive events in the morning (but not prior-night or afternoon/evening events) predicted steeper decline in cortisol across that day; positive events were also marginally associated with lower same-day AUC. Associations were not mediated by daily positive affect, and positive events did not buffer against stressor-related cortisol alterations. These findings indicate that individual differences and day-to-day variations in daily positive events are associated with diurnal cortisol patterns, independent of stressors and affect.

Age differences in negative emotional responses to daily stressors depend on time since event

Research on age differences in the experience of negative emotional states have produced inconsistent results, particularly when emotion is examined in the context of daily stress. Strength and vulnerability integration (SAVI; Charles, 2010) theory postulates that age differences in emotional states are contingent upon whether a stressor occurred, and whether sufficient time has passed since the stressor to allow older adults to benefit from theorized strengths. The present study uses an ecological momentary assessment design to examine how timing of daily stressors relates to age differences in negative emotional responses. Participants (N = 199, aged 25-65) completed mobile surveys up to 5 times daily for 14 days. They reported current mood and stressor exposure, as well as how long ago the stressor occurred. As expected, no age differences were observed in current negative affect (NA) for stressors which occurred in the previous 0-10 min. As predicted, older age was associated with less of a stressor-related increase in NA when a greater time had passed (i.e., 10 min to 2.5 hours) since stressor exposure. Consistent with previous results, there were no age differences in the effects of more distal stressors that occurred 2.5 to 5 hr ago, although NA remained significantly elevated. The present findings are consistent with SAVI's predictions and advance understanding age differences in the time course relating everyday stressors to emotional responses. (PsycINFO Database Record

Inter- and Intra-Individual Variation in Emotional Complexity: Methodological Considerations and Theoretical Implications

The degree of relationship between positive and negative emotional states or emotional complexity is a topic of ongoing methodological and theoretical debate. At issue is whether positive and negative emotions are opposite ends of a bipolar continuum or independent dimensions in a bivariate distribution with little degree of overlap. In this review, we summarize a body of work suggesting that the distinction between positive and negative emotions varies both between and within individuals over time as a function of cognition and changes in informational demands, a perspective called the Dynamic Model of Affect (DMA). In addition to providing a unifying theoretical model that specifies the conditions under which both bivariate and bipolar models of affect may be valid, the DMA offers an integrative, multidimensional affective framework through which models of resilience and stress adaptation may be articulated. Future work should continue to explore the contextual factors, especially those that have relevance for the complexity of information processing, as potential moderators of the dynamic interplay between positive and negative emotions.

Older people’s views and experiences of engagement in standardised patient simulation

Background

The last two decades have witnessed initiatives aimed at improving the care of older people, including educating nurses so that they are equipped with the skills to care for older people with frailty and complex multimorbidities. It has been suggested that involvement of older service users in nurse education can facilitate the development of nurses’ caring skills by promoting understanding of the reality of older people’s situations. One method of involving older service users is standardised patient simulation (SPS). While some recent studies have acknowledged the importance of considering standardised patients’ experiences and perceptions of simulation, to date few have focused specifically on the experiences of older people.

Methods

In this qualitative study, data were collected via focus groups, whereby older people were invited to discuss their views and experiences of involvement in SPS. Data were analysed using open coding.

Findings

Four themes emerged from the data, demonstrating that involving older people in SPS may be beneficial for their well-being. The four themes were: ‘using personal experiences to improve care’, ‘having a sense of purpose’, ‘preparation and support for SPS’ and ‘feeling appreciated’.

Discussion

While most participants reported that they enjoyed the SPS activities, engagement appeared to have had a much deeper significance for them. Many participants’ responses suggested that involvement assisted them to ‘make sense’ of their experiences of illness and healthcare, and also gave a sense of purpose, of belonging and of being valued.

Conclusion

Findings support the need for nurse educators to consider developing SPS programmes that involve older people.

Relationships Among Nightly Sleep Quality, Daily Stress, and Daily Affect

Objectives.

We explored the prospective, microlevel relationship between nightly sleep quality (SQ) and the subsequent day's stress on positive (PA) and negative affect (NA) as well as the moderating relationships between nightly SQ, subsequent stress, and subsequent PA on NA. We investigated whether age moderated these relationships.

Method.

We collected 56 days of sleep, stress, and affect data using daily diary questionnaires (N = 552). We used multilevel modeling to assess relationships at the between- and within-person levels.

Results.

Daily increases in SQ and decreases in stress interacted to predict higher daily PA and lower daily NA. Better SQ in older adults enhanced the benefits of PA on the stress-NA relationship more during times of low stress, whereas better sleep in younger adults enhanced the benefits of PA more during times of high stress. Between-person effects were stronger predictors of well-being outcomes than within-person variability.

Discussion.

The combination of good SQ and higher PA buffered the impact of stress on NA. The moderating impact of age suggests that sleep and stress play different roles across adulthood. Targeting intervention and prevention strategies to improve SQ and enhance PA could disrupt the detrimental relationship between daily stress and NA.

The Effects of Widowhood on Disabled Older Women (The Women's Health and Aging Study)

This study examined the effects of becoming widowed for older women with pre-existing physical disability. Data from three consecutive interviews from the Women's Health and Aging Study (WHAS) were used to compare depression, quality of life, and functional difficulty for widowed and non-widowed women. The two groups of 24 women were matched by age, disability level, domains of disability, and race. Repeated measures of analyses of variance (ANOVAs) revealed that, for both groups, depression scores were low and remained relatively stable and they were satisfied with their quality of life at all three time points (T1 = 0–6 months pre-bereavement, T2 = 0–6 months bereaved, T3 = 6–12 months bereaved), with no significant group by time interaction effects. The two groups were no different on their levels of functional difficulty at T1 and T2 but by T3, surprisingly, the widows reported slightly less difficulty. Overall, the findings show that disabled women who became widows demonstrate a noticeable degree of resiliency and hardiness.

Does Ego-Resilience Impact Friendship Outcomes?

Abstract. The present study examined the relationship between resilience and positive outcomes in friendships of young adults. SEM and bootstrapping analyses were performed to test whether positive emotions mediate the relationship between ego-resilience and enhanced friendship outcomes. Findings revealed indirect effects for friendship closeness, maintenance behaviors, and received social support. Our findings demonstrate the importance of positive emotions and its connection with trait resilience in the realm of friendships.

Affective reactivity to daily stressors is associated with elevated inflammation

OBJECTIVE

Inflammation increases the risk of chronic diseases, but the links between emotional responses to daily events and inflammation are unknown. We examined individual differences in affective reactivity to daily stressors (i.e., changes in positive and negative affect in response to stressors) as predictors of inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP).

METHODS

A cross-sectional sample of 872 adults from the National Study of Daily Experiences (substudy of Midlife in the United States II) reported daily stressors and affect during telephone interviews for 8 days. Blood samples were obtained at a separate clinic visit and assayed for inflammatory markers. Multilevel models estimated trait affective reactivity slopes for each participant, which were inputted into regression models to predict inflammation.

RESULTS

People who experienced greater decreases in positive affect on days when stressors occurred (i.e., positive affect reactivity) had elevated log IL-6, independent of demographic, physical, psychological, and behavioral factors (B = 1.12, SE = 0.45, p = .01). Heightened negative affect reactivity was associated with higher log CRP among women (p = .03) but not men (p = .57); health behaviors accounted for this association in women.

CONCLUSIONS

Adults who fail to maintain positive affect when faced with minor stressors in everyday life appear to have elevated levels of IL-6, a marker of inflammation. Women who experience increased negative affect when faced with minor stressors may be at particular risk of elevated inflammation. These findings add to growing evidence regarding the health implications of affective reactivity to daily stressors.

Reactivity to stressor pile-up in adulthood: effects on daily negative and positive affect

This study used data from a 30-day diary study with 289 adults (age range 18-89 years) to model the effects of stressor pile-up on individuals' daily negative affect (NA) and positive affect (PA) and to test for age differences in these effects. Specifically, we developed a new approach to operationalize and model stressor pile-up and evaluated this approach using generalized mixed models, taking into account the gamma response distribution of the highly skewed daily NA data. Findings showed that pile-up of stressors over a 1-week period was significantly coupled with increases in individuals' daily NA above and beyond the effect of concurrent stressors. Findings also showed that the effects of stressor accumulation and concurrent stress were additive rather than multiplicative. Age interacted significantly with stressor accumulation so that a higher age was associated with less NA reactivity to stressor pile-up. Yet, we did not find such an age-related association for NA reactivity to concurrent daily stressors. Daily PA was not associated with daily stress or with stressor pile-up. The operational definition of stressor pile-up presented in this study contributes to the literature by providing a new approach to model the dynamic effects of stress, and by providing new ways of separating the effects of acute stressors from the effects of stressor pile-up. The age differences found in the present study suggest that older adults develop effective emotion regulation skills for handling stressor pile-up, but that they react to acute daily stressors in a similar way than younger adults.

Empirical study of the influence of a Laughing Qigong Program on long-term care residents

AIM

To determine the psychological and physiological effects of a Laughing Qigong Program on an elderly population in an institutionalized setting.

METHODS

Participants were recruited from a long-term care institution in northern Taiwan. A total of 99 residents were interviewed and 66 enrolled, there were 33 control participants and 33 experimental participants. The participants were matched according to their abilities as measured by the Barthel Index of Activities for Daily Living. Experimental participants attended the Laughing Qigong Program, twice a week for 4 weeks. Comparisons were made on the Mini-Mental State Examination, Faces Scale, Geriatric Depression Scale and cortisol levels.

RESULTS

Psychometric measures for participants in the experimental group improved, whereas those in the control group decreased. The experimental group showed the following changes: improved Mini-Mental State Examination scores (Z=-2.28; P<0.05), improved mood states (Z=-4.47; P<0.001) and decreased Geriatric Depression Scale scores (Z=3.79; P<0.001). There were no significant changes for the experimental group in cortisol levels. By comparison, the control group showed: decreased mood states (Z=2.53; P<0.011), increased Geriatric Depression Scale scores (Z=4.34; P<0.001) and significant increases in cortisol levels (Z=2.62; P<0.009).

CONCLUSIONS

The Laughing Qigong Program has shown to be an effective, cost-effective non-pharmacological therapy for cognitive impairment, mood states and elderly depression.

Using the Dynamic Model of Affect (DMA) to examine leisure time as a stress coping resource: Taking into account stress severity and gender difference

Affective complexity (AC) is a marker of psychological well-being. According to the Dynamic Model of Affect (DMA), stressful experiences reduce AC while positive events increase AC. One type of positive events is leisure, which was also identified as a coping resource. This study extended the DMA and leisure coping research by assessing gender difference in how daily stress severity and leisure time influence AC. Analyzing eight-day diary data, we found that females, compared to males, experienced greater decrease in AC with increase in stress severity but also bigger increase in AC with increase in leisure time. The finding highlights gender difference in affective reactivity to and coping with daily stress, the value of the DMA, and the importance of severity appraisal.

Behavioral activation for pathological grief

The death of a significant other often entails far-reaching changes in individuals' life that can contribute to pathological grief responses. This article reviews 3 prominent theories of grief resolution, highlights common factors proposed to be associated with pathological grief responses, and suggests that behavioral activation (Martell, Addis, & Jacobson, 2001) may address the factors contributing to pathological grieving. Behavioral activation applied to pathological grief may address loss related disruption by engaging bereaved individuals in their social environment and increasing contact with positive reinforcers that maintain sense of self. Two case studies are provided to demonstrate how behavioral activation can be adapted to remediate environmental disengagement, avoidance, and rumination typical of pathological grief responses.

Does Leisure Time as a Stress Coping Resource Increase Affective Complexity? Applying the Dynamic Model of Affect (DMA)

Affective complexity, a manifestation of psychological well-being, refers to the relative independence between positive and negative affect (PA, NA). According to the Dynamic Model of Affect (DMA), stressful situations lead to highly inverse PA-NA relationship, reducing affective complexity. Meanwhile, positive events can sustain affective complexity by restoring PA-NA independence. Leisure, a type of positive events, has been identified as a coping resource. This study used the DMA to assess whether leisure time helps restore affective complexity on stressful days. We found that on days with more leisure time than usual, an individual experienced less negative PA-NA relationship after daily stressful events. The finding demonstrates the value of leisure time as a coping resource and the DMA's contribution to coping research.

Getting straight about grief

Acute grief is emotionally intense, cognitively preoccupying, and disruptive, but grief is not an illness; major depression and anxiety disorders are. Grief and mourning have a purpose. They provide an intense, focused opportunity to reregulate emotion and to engage in a learning process that is aimed at reconfiguring life without the deceased—both the internal life of the mind, and ongoing life in the world. A bereaved person needs to figure out how to find meaning, purpose, joy, and satisfaction in life without someone who has previously been central to these feelings. This reconfiguration is a very natural process that tends to occur in fits and starts as bereaved people move forward and deal with everyday life. Nevertheless, a knowledgeable, empathic and supportive clinician can foster good adjustment. Successful mourning is, however, not a given. For some people, the mourning process is derailed and acute grief is inordinately painful and prolonged. For others, the stress of bereavement triggers the onset or worsening of symptoms of MDD, an anxiety disorder or another psychiatric or medical condition, suicidality or negative health behaviors. Clinicians need to be alert to all of these problematic responses to loss. In the wake of bereavement, we need to both facilitate effective mourning and diagnose and treat co-occurring conditions.

Older adults' response to the loss of a spouse: the function of spirituality in understanding the grieving process

OBJECTIVE

The objective of this study was to examine the role of spirituality in helping older adults grieve the loss of a spouse in the context of a model of group psychotherapy.

METHODS

Twenty-four older adults, ranging in age from 65 to 82, whose spouses had died in the previous year, were assigned, in groups of six, to a 14-week group therapy intervention facilitated by trained, experienced co-therapist social workers. All sessions were audio recorded.

RESULTS

Qualitative analysis of the four therapy groups at beginning, middle and ending sessions yielded salient themes that illustrate associations between spirituality and shifts in self-identity, mourning the loss and social re-engagement.

DISCUSSION

Observed were within process acknowledgement of the role played by spiritual beliefs in mourning the loss of a spouse. Implications for group intervention for older adults grieving the loss of a spouse are discussed.

The Health Significance of Positive Emotions in Adulthood and Later Life

A growing body of literature supports a link between positive emotions and health in older adults. In this article, we review evidence of the effects of positive emotions on downstream biological processes and meaningful clinical endpoints, such as adult morbidity and mortality. We then present relevant predictions from lifespan theories that suggest changes in cognition and motivation may play an important role in explaining how positive emotions are well maintained in old age, despite pervasive declines in cognitive processes. We conclude by discussing how the application of psychological theory can inform greater understanding of the adaptive significance of positive emotions in adulthood and later life.

Spousal loss predicts alterations in diurnal cortisol activity through prospective changes in positive emotion

OBJECTIVE

The objective of this study was to examine the role of spousal bereavement and positive emotion in naturally occurring levels of daily cortisol.

METHODS

Analyses were conducted using data from the Midlife in the United States survey and the National Study of Daily Experiences. Baseline assessments of extraversion, neuroticism, trait positive emotion, and trait negative emotion were obtained, as were reports of demographic and health behavior covariates. Salivary cortisol levels were measured at wakeup, 30 min after awakening, before lunch, and at bedtime on each of 4 successive days.

RESULTS

Multilevel growth curve analyses indicated that independent of age, gender, education, extraversion, neuroticism, negative emotion, medication use, and smoking, spousal bereavement was associated with lower levels of cortisol at wakeup and a flattening of the diurnal cortisol rhythm. Mediation analyses revealed that prospective changes in positive emotion accounted for the impact of bereavement on diurnal cortisol slopes.

CONCLUSION

The current prospective study is among the first to provide evidence for a role for positive emotion as a mechanism by which bereavement influences hypothalamic-pituitary-adrenal axis dysregulation in older adults.

Psychological resilience predicts decreases in pain catastrophizing through positive emotions

The study used a daily process design to examine the role of psychological resilience and positive emotions in the day-to-day experience of pain catastrophizing. A sample of 95 men and women with chronic pain completed initial assessments of neuroticism, psychological resilience, and demographic data, and then completed short diaries regarding pain intensity, pain catastrophizing, and positive and negative emotions every day for 14 consecutive days. Multilevel modeling analyses indicated that independent of level of neuroticism, negative emotions, pain intensity, income, and age, high-resilient individuals reported greater positive emotions and exhibited lower day-to-day pain catastrophizing compared with low-resilient individuals. Mediation analyses revealed that psychologically resilient individuals rebound from daily pain catastrophizing through experiences of positive emotion. Implications for research on psychological resilience, pain catastrophizing, and positive emotions are discussed.

Length of caregiving and well-being among older widowers: implications for the dual process model of bereavement

The intent of this study was to examine if length of caregiving was associated with older widowers' adjustment to bereavement and to identify factors, based on principles underlying the Dual Process Model of Bereavement, that might mitigate the potential adverse effects of time spent caring. Two-hundred men over the age of 60 and in the second year of bereavement were identified from death records of older women who had died within a 12-month period. Interviews lasted about 2 hours and focused on widowers' experiences surrounding their wives' deaths along with questions about social support, health, retirement, and other demographic information. The Bradburn Affect Scale was used to measure positive and negative affect. Restoration-oriented coping, such as starting new relationships and activities were measured. These variables included extent of family contact, number of friends, having a confidante, involvement with neighbors, and participation in sports and clubs. Time since death and demographic variables were used as controls. Hierarchical linear regression was conducted on positive and negative affect after which potentially moderating effects were analyzed. Results indicated that the most important influences on negative affect were time since death, ethnicity, and participation in clubs while for positive affect the most significant factors included length of caregiving, number of friends, and having a confidante. Although no interaction effects were significant, patterns emerged. Implications for applying the DPM with older bereaved men are made.

Experiences and early coping of bereaved spouses/partners in an intervention based on the dual process model (dpm)

This study was designed to test the effectiveness of the Dual Process Model (DPM) of coping with bereavement. The sample consisted of 298 recently widowed women (61%) and men age 50+ who participated in 14 weekly intervention sessions and also completed before (O1) and after (O2) self-administered questionnaires. While the study also includes two additional follow-up assessments (O3 and O4) that cover up to 14-16 months bereaved, this article examines only O1 and O2 assessments. Based on random assignment, 128 persons attended traditional grief groups that focused on loss-orientation (LO) in the model and 170 persons participated in groups receiving both the LO and restoration-orientation (RO) coping (learning daily life skills). As expected, participants in DPM groups showed slightly higher use of RO coping initially, but compared with LO group participants they improved at similar levels and reported similar high degrees of satisfaction with their participation (i.e., having their needs met and 98-100% indicating they were glad they participated. Even though DPM participants had six fewer LO sessions, they showed similar levels of LO improvement. Qualitative data indicate that the RO component of the DPM might be more effective if it is tailored and delivered individually.

A Tale of Two Counties:Bereavement in Socio-Demographically Diverse Places

The "Living After Loss" study was designed to test the effectiveness of the dual process model (DPM) of coping with bereavement. In order to obtain a larger and more diverse sample we studied 328 recently widowed men and women (61%) age 50+ in two counties, Salt Lake (n=197) and San Francisco (n=131) in two states, Utah and California. This paper does not report on the effects of the intervention but focuses on a comparison of the bereaved spouses/partners in these two cites. First, the only socio-demographic differences we found between those in SF and SL were that those in San Francisco were more racially, ethnically and religiously diverse, higher in education, had slightly fewer years in their relationship to the deceased and were two weeks longer in their grief process. Second, there were far more similarities than differences between SF and SL regarding nearly all of the study variables. Third, we found that those in SF had more positive qualitative features in their friendship support networks and that for bereaved in both counties, we found strong associations with having highly supportive friend-based networks and more positive bereavement adjustments (especially experiencing lower levels of loneliness and depression). Limitations and suggestions for future research are described.