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Gad D, Wells JL, Piechota A, Feeney B, Birditt KS, Marottoli RA, Gaugler JE, Vranceanu AM, Monin JK. Positive affect expression during a play interaction and psychological health among older adults living with cognitive impairment and their adult children. Aging Ment Health 2024:1-9. [PMID: 38795364 DOI: 10.1080/13607863.2024.2358096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/16/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVES We examined the extent to which positive affect expression in play interactions between adult children and their parents living with cognitive impairment was associated with lower depressive symptoms and mental health difficulties for both dyad members. Gender differences in positive affect expression were also examined. METHOD Dyads (N = 126) self-reported their depressive symptoms and mental health difficulties. Dyad members later engaged in a video-recorded play interaction together, and their positive affect expression was observationally coded by trained coders in terms of 'enjoyment', 'laughter', and 'positive affect towards partner'. RESULTS Findings from mixed models using the Actor Partner Interdependence Model showed that one's partner's positive affect was associated with one's own lower depressive symptoms. There were no significant actor effects or effects of role (parent vs. child). Results also revealed that women expressed more positive affect and had greater mental health difficulties, but not depressive symptoms. We found that one's partner's positive affect expressions were more associated with women's mental health than men's mental health. CONCLUSION Positive affect expression may be a useful indicator of psychological health in parent-child relationships in which the parent has cognitive impairment. Positive affect may be useful to target in supportive, dyadic, psychosocial interventions.
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Affiliation(s)
- Dustin Gad
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Jenna L Wells
- Department of Psychology, Cornell University, Ithaca, NY, USA
| | - Amanda Piechota
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Brooke Feeney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Kira S Birditt
- The Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Richard A Marottoli
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Joan K Monin
- Yale School of Public Health, Yale University, New Haven, CT, USA
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Levenson RW. Two's company: Biobehavioral research with dyads. Biol Psychol 2024; 185:108719. [PMID: 37939868 DOI: 10.1016/j.biopsycho.2023.108719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/28/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
The development of paradigms for studying dyadic interaction in the laboratory and methods and analytics for dealing with dyadic data is described. These are illustrated with research findings from the author and others with particular focus on dyadic measures of linkage or synchrony in physiology, expressive behavior, and subjective affective experience.
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Sideman AB, Merrilees J, Dulaney S, Kiekhofer R, Braley T, Lee K, Chiong W, Miller B, Bonasera SJ, Possin KL. "Out of the clear blue sky she tells me she loves me": Connection experiences between caregivers and people with dementia. J Am Geriatr Soc 2023; 71:2172-2183. [PMID: 36917135 PMCID: PMC10500033 DOI: 10.1111/jgs.18297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Dementia can impede the relationship and connection between the person with dementia (PWD) and their caregiver. Yet, caregiving in dementia also offers opportunities for connection, which has implications for caregiver and PWD well-being. In this qualitative study, we describe and characterize ways caregivers felt connected to the person with dementia they care for. METHODS We conducted a telephone-based survey with caregivers of people with dementia. For this paper, we analyzed responses to an open-ended question focused on when caregivers feel most connected to the person they are caring for. Responses were analyzed and coded and themes were identified through an iterative process involving a multidisciplinary team of researchers and clinicians. RESULTS 437 caregivers participated in this study. We identified two domains of connection: activity-based and emotion-based connections. Within activity-based connections, the following themes emerged: everyday activities; reminiscing; activities of caregiving; novel experiences; and time with family and friends. Within emotional connections, the following themes emerged: expressions of love, appreciation, and gratitude; physical affection; sharing an emotion or emotional experience; and times when the PWD seems like "themself" again. CONCLUSIONS Findings provide insights into ways caregivers experience a sense of connection with the person they care for. There is a call to shift away from focusing on reducing stress and toward optimizing positive experiences as a way to better support caregivers' health and well-being. Interventions that leverage these insights to foster caregiver - PWD connection could lead to better health and well-being for both members of the dyad. The amplification of a positive experience may be particularly important for caregivers who are struggling with limited support or respite. Clinicians may be interested in using a question about connection as a way to more fully understand a caregiver's current experience.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Sarah Dulaney
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Rachel Kiekhofer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Tamara Braley
- Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kirby Lee
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
| | - Winston Chiong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Bruce Miller
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Stephen J. Bonasera
- Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Medicine, Division of Geriatrics and Palliative Care, Baystate Health, Springfield, Massachusetts, USA
| | - Katherine L. Possin
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
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Kato K, Yoshimi T, Aimoto K, Sato K, Itoh N, Kondo I. A rise-assisting robot extends life space and improves facial expressions of nursing home residents. BMC Health Serv Res 2022; 22:1588. [PMID: 36575420 PMCID: PMC9794109 DOI: 10.1186/s12913-022-08952-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The introduction of nursing care-support devices using robotic technology is expected to reduce the task burden in long-term care facilities. OBJECTIVE To investigate the use of the rise-assisting robot, Resyone, in extending and improving the life space of nursing home residents with severe care needs. METHODS We performed a feasibility study in which Resyone was used to facilitate visits to additional sites in and around the nursing home as part of the care package of three residents. Two weeks before and four weeks after implementation of the new arrangements, the 30 caregivers involved were asked to record transfer times and destinations, while also checking the residents' facial expressions. RESULTS Before implementation, participants had limited life spaces, but afterwards they regularly visited additional destinations including the garden, home entrance and corridors, which previously they had not visited frequently. The residents' facial expressions became more positive and less negative. This study demonstrates that Resyone can enrich care activities in severely disabled individuals. CONCLUSION These findings suggest that the sustainable use of Resyone would improve the quality of care at care facilities. Moreover, the extension of otherwise limited life space has the potential to improve care receivers' quality of life. TRIAL REGISTRATION UMIN Clinical Trials Registry No. UMIN000039204 (20/01/2020); retrospectively registered; interventional study; parallel, non-randomized, single blinded. URL of trial registry records: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000044709 .
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Affiliation(s)
- Kenji Kato
- grid.419257.c0000 0004 1791 9005Laboratory for Clinical Evaluation with Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi 474-8511 Japan
| | - Tatsuya Yoshimi
- grid.419257.c0000 0004 1791 9005Laboratory for Clinical Evaluation with Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi 474-8511 Japan
| | - Keita Aimoto
- grid.419257.c0000 0004 1791 9005Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi 474-8511 Japan
| | - Kenji Sato
- grid.419257.c0000 0004 1791 9005Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi 474-8511 Japan
| | - Naoki Itoh
- grid.419257.c0000 0004 1791 9005Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi 474-8511 Japan
| | - Izumi Kondo
- grid.419257.c0000 0004 1791 9005Assistive Robot Center, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi 474-8511 Japan
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Ricard JR, Gupta T, Vargas T, Haase CM, Mittal VA. Genuine and non-genuine smiles in individuals meeting criteria for a clinical high-risk syndrome. Early Interv Psychiatry 2022; 16:875-882. [PMID: 34725928 PMCID: PMC9056581 DOI: 10.1111/eip.13233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/21/2021] [Accepted: 10/19/2021] [Indexed: 01/17/2023]
Abstract
AIM Psychosis is characterized by both alterations in emotional functioning and environmental stressors including bullying victimization. Recent evidence suggests that some alterations in emotional functioning (e.g., blunted positive facial expressions) are already present in the psychosis risk period. Yet, some clinically relevant facial emotions have not been investigated such as genuine smiles (thought to reflect genuine positive emotions) and non-genuine smiles (thought to fake positive or mask negative emotions) in individuals meeting criteria for a clinical high-risk (CHR) syndrome. Further, despite a compelling conceptual basis to suggest a link between affective expression and exposure to environmental stress, to date, no investigations have sought to examine this association. Here, we aim to assess differences between a sample of CHR (N = 65) and control (N = 67) individuals in genuine and non-genuine smiles and associations with bullying victimization. METHODS Smiles (i.e., genuine; non-genuine) were objectively coded on a second-by-second basis using the Facial Action Coding System during a digitally recorded clinical interview segment. Bullying victimization was measured via parent report. RESULTS Findings revealed that the CHR group (1) showed blunted genuine (but not non-genuine) smiles compared to controls. Moreover, (2) bullying victimization was related to blunted genuine smiles, but not non-genuine smiles. CONCLUSION These findings expand our understanding of emotional alterations in this group with implications for diagnosis (highlighting blunted genuine smiles as a specific marker) and etiology (underscoring the role of bullying victimization in the etiology of emotional dysfunction).
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Affiliation(s)
- Jordyn R Ricard
- School of Education and Social Policy, Northwestern University, Evanston, Illinois, USA
| | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Teresa Vargas
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Claudia M Haase
- School of Education and Social Policy and (by courtesy) Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Vijay A Mittal
- Department of Psychology, Department of Psychiatry, Institute for Policy Research (IPR), Department of Medical Social Sciences, and Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston, Illinois, USA
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Chen KH, Casey JJ, Connelly DE, Merrilees J, Yang CM, Miller BL, Levenson RW. Lower activity linkage between caregivers and persons with neurodegenerative diseases is associated with greater caregiver anxiety. Psychophysiology 2022; 59:e14040. [PMID: 35315937 DOI: 10.1111/psyp.14040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/24/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
Physiological linkage refers to the degree to which two individuals' central/peripheral physiological activities change in coordinated ways. Previous research has focused primarily on linkage in the autonomic nervous system in laboratory settings, particularly examining how linkage is associated with social behavior and relationship quality. In this study, we examined how linkage in couples' daily somatic activity (e.g., synchronized movement measured from wrist sensors)-another important aspect of peripheral physiology-was associated with relationship quality and mental health. We focused on persons with neurodegenerative diseases (PWNDs) and their spousal caregivers, whose linkage might have direct implications for the PWND-caregiver relationship and caregiver's health. Twenty-two PWNDs and their caregivers wore wristwatch actigraphy devices that provided continuous measurement of activity over 7 days at home. PWND-caregiver activity linkage was quantified by the degree to which activity was "in-phase" or "anti-phase" linked (i.e., coordinated changes in the same or opposite direction) during waking hours, computed by correlating minute-by-minute activity levels averaged using a 10-min rolling window. Caregivers completed well-validated surveys that assessed their mental health (including anxiety and depression) and relationship quality with the PWND. We found that lower in-phase activity linkage, but not anti-phase linkage, was associated with higher caregiver anxiety. These dyad-level effects were robust, remaining significant after adjusting for somatic activity at the individual level. No effects were found for caregiver depression or relationship quality. These findings suggest activity linkage and wearables may be useful for day-by-day monitoring of vulnerable populations such as family caregivers. We offered several possible explanations for our findings.
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Affiliation(s)
- Kuan-Hua Chen
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - James J Casey
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Dyan E Connelly
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Jennifer Merrilees
- Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Chien-Ming Yang
- Department of Psychology/The Research Center for Mind, Brain & Leaning, National Chengchi University, Taipei, Taiwan
| | - Bruce L Miller
- Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Robert W Levenson
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
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Wolff JL, Benge JF, Cassel CK, Monin JK, Reuben DB. Emerging topics in dementia care and services. J Am Geriatr Soc 2021; 69:1763-1773. [PMID: 34245585 DOI: 10.1111/jgs.17341] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND The National Institute on Aging (NIA), in conjunction with the Department of Health and Human Services as part of the National Alzheimer's Project Act (NAPA), convened a 2020 Dementia Care, Caregiving, and Services Research Summit Virtual Meeting Series. This review article summarizes three areas of emerging science that are likely to grow in importance given advances in measurement, technologies, and diagnostic tests that were presented at the Summit. RESULTS Dr. Cassel discussed novel ethical considerations that have resulted from scientific advances that have enabled early diagnosis of pre-clinical dementia. Dr. Monin then summarized issues regarding emotional experiences in persons with dementia and their caregivers and care partners, including the protective impact of positive emotion and heterogeneity of differences in emotion by dementia type and individual characteristics that affect emotional processes with disease progression. Finally, Dr. Jared Benge provided an overview of the role of technologies in buffering the impact of cognitive change on real-world functioning and their utility in safety and monitoring of function and treatment adherence, facilitating communication and transportation, and increasing access to specialists in underserved or remote areas. CONCLUSIONS National policy initiatives, supported by strong advocacy and increased federal investments, have accelerated the pace of scientific inquiry and innovation related to dementia care and services but have raised some new concerns regarding ethics, disparities, and attending to individual needs, capabilities, and preferences.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jared F Benge
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Christine K Cassel
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Joan K Monin
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - David B Reuben
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Hua AY, Wells JL, Brown CL, Levenson RW. Emotional and Cognitive Empathy in Caregivers of Persons with Neurodegenerative Disease: Relationships with Caregiver Mental Health. Clin Psychol Sci 2021; 9:449-466. [PMID: 34194871 PMCID: PMC8240761 DOI: 10.1177/2167702620974368] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Caregiving for a person with dementia or neurodegenerative disease (PWD) is associated with increased rates of depression and anxiety. As the population ages and dementia prevalence increases worldwide, mental health problems related to dementia caregiving will become an even more pressing public health concern. The present study assessed emotional empathy (physiological, behavioral, and self-reported emotional responses to a film depicting others suffering) and two measures of cognitive empathy (identifying the primary emotion experienced by another person; providing continuous ratings of the valence of another person's changing emotions) in relation to mental health (standard questionnaires) in 78 caregivers of PWDs. Greater emotional empathy (self-reported emotional responses) was associated with worse mental health, even after accounting for known risk factors. Neither measure of cognitive empathy was associated with mental health. A relationship between high levels of emotional empathy and poor mental health in caregivers suggests possible risk indicators and intervention targets.
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Affiliation(s)
- Alice Y Hua
- Department of Psychology, University of California, Berkeley
| | - Jenna L Wells
- Department of Psychology, University of California, Berkeley
| | - Casey L Brown
- Department of Psychology, University of California, Berkeley
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Wells JL, Hua AY, Levenson RW. Poor Disgust Suppression Is Associated with Increased Anxiety in Caregivers of People with Neurodegenerative Disease. J Gerontol B Psychol Sci Soc Sci 2020; 76:1302-1312. [PMID: 32322886 DOI: 10.1093/geronb/gbaa056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Caregivers of persons with neurodegenerative disease have high rates of mental health problems compared to noncaregiving adults. Emotion regulation may play an important role in preserving caregivers' mental health. We examined the associations between caregivers' emotion regulation measured in several ways (ability, habitual use, and self-ratings) and their mental health symptoms. METHOD Ninety-one caregivers of persons with neurodegenerative disease participated in a laboratory-based assessment of emotion regulation. In two series of tasks, caregivers were given different instructions (no instruction, suppress) regarding altering their emotional behavioral responses to disgusting films and acoustic startle stimuli. Caregivers' emotional behavior was measured via behavioral coding and caregivers rated "how much emotion" they showed during each task. Anxiety, depression, and habitual use of expressive suppression were measured via questionnaires. RESULTS Poor emotion regulation in the disgust suppression condition (i.e., greater emotional behavior) was associated with greater anxiety. Associations were not found for the startle suppression condition, depression, or self-report measures of emotion regulation. DISCUSSION Findings suggest that caregivers who are unable to suppress emotional behavior in response to disgusting stimuli may be at greater risk for anxiety. Given high levels of anxiety in caregivers, it may be useful to evaluate interventions that improve ability to downregulate emotional behavior.
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Affiliation(s)
- Jenna L Wells
- Department of Psychology, University of California, Berkeley
| | - Alice Y Hua
- Department of Psychology, University of California, Berkeley
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Abstract
Research on stress and disease has often afforded an important role to emotion, typically conceptualized in broad categories (e.g., negative emotions), viewed as playing a causal role (e.g., anger contributing to pathophysiology of cardiovascular disease), and measured using self-report inventories. In this article, I argue for the value of evaluating specific emotions, considering bidirectional causal influences, and assessing actual emotional responding when considering the role that emotions play in the stress-disease relationship. In terms of specificity, specific emotions (e.g., anger, sadness, and embarrassment) can be linked with particular health outcomes (e.g., cardiovascular disease and musculoskeletal disease). In terms of bidirectionality, the influences of emotions on disease as well as the influences of disease on emotional functioning can be considered. In terms of assessing actual emotional responding, emotions can be studied in vivo under controlled conditions that allow behavioral, physiological, and subjective responses to be measured during different kinds of emotional functioning (e.g., responding to emotional stimuli, interacting with relationship partners, and downregulating emotional responses). With these considerations in mind, I review early theories and empirical studies in psychosomatic medicine that considered the role of specific emotions and emotion-related behaviors. Studies from our laboratory are presented that illustrate a) differences in patterns of autonomic nervous system responding associated with specific emotions, b) relationships between specific emotions and particular health outcomes in the context of social relationships, c) age as a moderator of the relationship between specific emotions and well-being, d) bidirectional influences (emotions influencing disease and disease influencing emotional functioning), and e) impact of changes in emotional functioning in individuals with neurodegenerative diseases on the health of familial caregivers.
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Affiliation(s)
- Robert W Levenson
- From the Department of Psychology, University of California, Berkeley, Berkeley, California
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