Emotion regulation strategies and mental health in dementia caregivers: The moderating role of gender

INTRODUCTION

Providing care for a loved one with dementia can engender intense emotions that contribute to symptoms of anxiety and depression. Caregivers often attempt to regulate their emotions using strategies like cognitive reappraisal (CR; changing how they think about the situation) or expressive suppression (ES; hiding their emotions). However, men and women caregivers may differ in their use of these strategies. The current study examines gender differences in reported CR and ES usage and their associations with depression and anxiety in dementia caregivers.

METHODS

We combined data from three independent studies of informal dementia caregivers (Total N = 460) who reported on their use of CR, ES and symptoms of anxiety and depression.

RESULTS

Women caregivers reported greater use of CR and less use of ES compared to men. Gender moderated the association between CR and depression, such that greater use of CR in women was associated with fewer depressive symptoms, but not for men. Gender did not significantly moderate the association between ES and depression or between either emotion regulation strategy and anxiety.

CONCLUSION

Findings of a unique relationship between greater CR use and less depression among women CGs, although correlational, suggest that utilizing CR may be particularly helpful for reducing depression in women caregivers. These results underscore the need for further research to determine how best to support the mental well-being of dementia caregivers.

Two's company: Biobehavioral research with dyads

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.

Evaluating In-home Assistive Technology for Dementia Caregivers

OBJECTIVES

Dementia caregivers (CGs) are at heightened risk for developing problems with anxiety and depression. Much attention has been directed toward developing and deploying interventions designed to protect CG health, but few have been supported by rigorous empirical evidence. Technology-based interventions that are effective, scalable, and do not add greatly to the CG burden are of particular interest.

METHODS

We conducted a nine-month randomized controlled trial in 63 homes evaluating People Power Caregiver (PPCg), a system of sensors in the home connected to cloud-based software that alerts CGs about worrisome deviations from normal patterns (e.g., falls, wandering).

RESULTS

CGs in the active condition had significantly less anxiety than those in the control condition at the six-month assessment. Greater anxiety reduction in the active condition at the six-month assessment was associated with greater interaction with PPCg via SMS text messages. There were no differences in anxiety at the three-month or nine-month assessments or in depression at any assessment.

CONCLUSIONS

PPCg shows promise for reducing anxiety associated with caring for a =person with dementia.

CLINICAL IMPLICATIONS

Technology-based interventions can help reduce CG anxiety, a major adverse consequence of caregiving that may be difficult to treat due to other demands on caregiver time and energy.

Design and Implementation of a Clinical Science Specialty Clinic for Adults with Neurological Disorders and Their Caregivers

Mental health problems are common for persons with neurological disorders (PWNDs) and their caregivers (CGs) but often are not adequately treated. Despite this growing need, the training of clinical psychologists typically does not include coursework or practicum experience working with these populations. To address this, a team of faculty, supervisors, and doctoral students in UC Berkeley's Clinical Science program undertook a year-long process that consisted of building a training curriculum that integrated coursework and consultation with visiting experts; providing supervised practicum training with PWNDs and CGs and evaluating training and clinical outcomes. We hoped to prepare students to train other mental health professionals to work with these populations in the future. In this article, we describe the Specialty Clinic with special attention given to the training provided, challenges faced and solutions found, clinic operations and logistics, and lessons learned. We also review key clinical issues and report key indicators of client outcomes. Finally, we evaluate the success of the Specialty Clinic and offer recommendations for others interested in providing these kinds of much needed training and clinical services in this important area.

Empathic Accuracy and Shared Depressive Symptoms in Close Relationships

Empathic accuracy, the ability to accurately understand others' emotions, is typically viewed as beneficial for mental health. However, empathic accuracy may be problematic when a close relational partner is depressed because it promotes shared depression. Across two studies, we measured empathic accuracy using laboratory tasks that capture the ability to rate others' emotional valence accurately over time: first, in a sample of 156 neurotypical married couples (Study 1; Total N=312), and then in a sample of 102 informal caregivers of individuals with dementia (Study 2). Across both studies, the association between empathic accuracy and depressive symptoms varied as a function of a partner's level of depressive symptoms. Greater empathic accuracy was associated with (a) fewer depressive symptoms when a partner lacked depressive symptoms, but (b) more depressive symptoms when a partner had high levels of depressive symptoms. Accurately detecting changes in others' emotional valence may underpin shared depressive symptoms.

Cultural differences in caring for people with dementia: a pilot study of concern about losing face and loneliness in Chinese American and European American caregivers

OBJECTIVES

Heavy demands upon dementia caregivers can lead to a number of poor health outcomes including declines in physical, mental, and brain health. Although dementia affects people from all backgrounds, research in the US has largely focused on European American caregivers. This has made providing culturally-competent care more difficult. This study begins to address this issue by empirically examining how culturally-shaped beliefs can influence loneliness in family caregivers of people with dementia.

METHODS

We conducted a preliminary questionnaire study with Chinese American and European American family caregivers of people with dementia (N = 72).

RESULTS

Chinese American caregivers were more concerned than European American caregivers about losing face, which in turn, was associated with greater loneliness. This pattern remained when accounting for caregiver gender, age, and relationship to the person with dementia.

CONCLUSIONS

These preliminary findings highlight the role that cultural beliefs can play in adverse caregiver outcomes, and suggest that addressing concerns about losing face may be an important way for healthcare providers to help reduce loneliness among Chinese American caregivers.

CLINICAL IMPLICATIONS

Understanding how cultural beliefs influence caregiver outcomes is critical as healthcare professionals work to provide culturally-competent care and design culturally-sensitive interventions.

REMOTELY MEASURED IN-HOME DISTANCE FROM CARE RECIPIENT PREDICTS DEMENTIA CAREGIVERS’ LONELINESS

Caregivers (CGs) of a family member with dementia often experience increased loneliness, which can result from reduced social interactions and increased physical distancing associated with care recipient’s (CR) disease progression. Through a university-industry collaboration, we developed new technology for measuring physical distance remotely. CGs and CRs wore watches that monitored their location in the home using low-energy Bluetooth technology that enabled long battery life (up to four months). Using measures of proximity of the watches to three plug-in Bluetooth receivers located in the home, we assessed CG-CR physical distance on a second-by-second basis over a six-month period. Participants were 27 CRs diagnosed with dementia or mild cognitive impairment and their co-residing familial CGs. CG loneliness was measured by questionnaire at the beginning and end of the study. Both watches and receivers were remotely installed (by CGs). Results indicated that CG-CR physical distance increased from the first three months to the last three months of the study (t = 20.67, p < 0.001). In addition, greater increases in CG-CR physical distance over the six-month period were associated with greater increases in CG loneliness (r = 0.46, p = 0.03). These results advance our understanding of how increases in physical distancing between CGs and CRs contribute to increased CG loneliness (a well-established risk factor for depression and other mental health symptoms). The study also underscores the value of remote technologies that allow for in-home long-term monitoring for research on interpersonal distance and other social behaviors in CG-CR and other aging dyads.

A mindfulness-based intervention adapted to dementia caregivers: A study protocol for a randomized clinical control trial

Dementia caregiving, besides encompassing various challenges in tandem to the diagnosis of the care recipient, is associated with decreased psychological well-being and mental health. Accordingly, caregivers' wellbeing has an impact on the quality of care they provide and on the relationship quality with the person in their care. The aim of the present study is to examine the effectiveness of a mindfulness-based intervention on relational and psychological wellbeing, tailored to the needs of dementia caregivers. This clinical trial (NCT04977245) will apply a randomized controlled mixed method design. Caregivers will be randomly allocated to either the mindfulness intervention or the active control group. The intervention arm is based on experiential learning and is targeted to promote caregivers' well-being and empowerment. Assessments will include, standardized self-report questionnaires, task performance measures, and qualitative measures. All assessments will be held at three time points (baseline; t0, 0 months, post-intervention; t1, 2 months, and after maintenance; t2, 3 months) focused on three core domains (1. relational well-being, 2. psychological well-being, and 3. dementia patient's lifestyle/activities). The primary outcome will be relational well-being, and data will be analyzed using linear mixed modelling.

EMOTIONAL FUNCTIONING IN PEOPLE WITH DEMENTIA AND CAREGIVER AFFECT DURING DYADIC INTERACTIONS

Dementia caregivers can experience negative affect when interacting with their care recipients. However, few studies have examined the specific factors that predict caregiver negative affect in this dyadic context. We hypothesized that deficits in care recipients’ emotional functioning would be associated with increased intensity of caregivers’ negative affect during interactions with their care recipient. Caregivers (Nf100) reported on two aspects of their care recipients’ emotional functioning: (1) emotion recognition (the ability to recognize other people’s emotions), and (2) negative emotional reactivity (the ability to generate negative emotional responses). Dyads then visited the laboratory and engaged in a 10-minute conversation about an area of conflict in their relationship. Caregivers then watched recordings of their conversation while rating the valence and intensity of their experienced affect using a rating dial. We used these ratings to quantify changes in caregivers’ emotional valence across the course of the conversation. Caregivers of care recipients with greater deficits in emotion recognition demonstrated greater increases in negative affect across the conversation. In contrast, care recipients’ negative emotional reactivity was not related to changes in the valence of caregivers’ affect across the conversation. Findings remained significant even after accounting for caregiver baseline valence ratings, biological sex, and age, as well as the care recipients’ diagnosis and level of cognitive impairment. Results reveal the important role that care recipients’ deficits in emotion recognition play in caregivers’ emotional lives. Caregivers’ negative affect may be more likely to increase when their care recipient has deficits in emotion recognition.

Positivity resonance in long-term married couples: Multimodal characteristics and consequences for health and longevity

The Positivity Resonance Theory of coexperienced positive affect describes moments of interpersonal connection characterized by shared positive affect, caring nonverbal synchrony, and biological synchrony. The construct validity of positivity resonance and its longitudinal associations with health have not been tested. The current longitudinal study examined whether positivity resonance in conflict interactions between 154 married couples predicts health trajectories over 13 years and longevity over 30 years. We used couples' continuous ratings of affect during the interactions to capture coexperienced positive affect and continuous physiological responses to capture biological synchrony between spouses. Video recordings were behaviorally coded for coexpressed positive affect, synchronous nonverbal affiliation cues (SNAC), and behavioral indicators of positivity resonance (BIPR). To evaluate construct validity, we conducted a confirmatory factor analysis to test a latent factor of positivity resonance encompassing coexperienced positive affect, coexpressed positive affect, physiological linkage of interbeat heart intervals, SNAC, and BIPR. The model showed excellent fit. To evaluate associations with health and longevity, we used dyadic latent growth curve modeling and Cox proportional hazards modeling, respectively, and found that greater latent positivity resonance predicted less steep declines in health and increased longevity. Associations were robust when accounting for initial health symptoms, sociodemographic characteristics, health-related behaviors, and individually experienced positive affect. We repeated health and longevity analyses, replacing latent positivity resonance with BIPR, and found consistent results. Findings validate positivity resonance as a multimodal construct, support the utility of the BIPR measure, and provide initial evidence for the characterization of positivity resonance as a positive health behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Diminished Visual Attention to Emotional Faces Is Associated with Poor Emotional Valence Perception in Frontotemporal Dementia

AIM

The current study examined whether visual attention to emotional facial expressions is lower in individuals with frontotemporal dementia (FTD) compared to healthy controls, and whether visual attention to emotional facial expressions is associated with the ability to perceive others' emotional valence accurately.

METHODS

Participants with FTD (n = 17) and healthy controls (n = 23) passively viewed pairs of emotional and neutral faces while their visual attention was measured using eye-tracking. A subsample of participants (n = 28) also completed an emotional valence perception task.

RESULTS

Individuals with FTD spent less time looking at emotional faces than healthy controls. However, there was no difference in the amount of time individuals with FTD spent looking at neutral faces as compared to healthy controls. In the subsample, less time spent looking at emotional faces (but not neutral faces) was associated with a less accurate perception of others' emotional valence.

CONCLUSION

Individuals with FTD displayed diminished visual attention to emotional facial expressions compared to healthy controls. Reduced attention towards emotional faces was associated with poorer emotional valence perception. Findings point toward diminished visual attention as potentially relevant for understanding oft-observed impairments in socioemotional functioning in FTD.

Shared emotions in shared lives: Moments of co-experienced affect, more than individually experienced affect, linked to relationship quality

Motivated by collective emotions theories that propose emotions shared between individuals predict group-level qualities, we hypothesized that co-experienced affect during interactions is associated with relationship quality, above and beyond the effects of individually experienced affect. Consistent with positivity resonance theory, we also hypothesized that co-experienced positive affect would have a stronger association with relationship quality than would co-experienced negative affect. We tested these hypotheses in 150 married couples across 3 conversational interactions: a conflict, a neutral topic, and a pleasant topic. Spouses continuously rated their individual affective experience during each conversation while watching video-recordings of their interactions. These individual affect ratings were used to determine, for positive and negative affect separately, the number of seconds of co-experienced affect and individually experienced affect during each conversation. In line with hypotheses, results from all 3 conversational topics suggest that more co-experienced positive affect is associated with greater marital quality, whereas more co-experienced negative affect is associated with worse marital quality. Individual level affect factors added little explanatory value beyond co-experienced affect. Comparing co-experienced positive affect and co-experienced negative affect, we found that co-experienced positive affect generally outperformed co-experienced negative affect, although co-experienced negative affect was especially diagnostic during the pleasant conversational topic. Findings suggest that co-experienced positive affect may be an integral component of high-quality relationships and highlight the power of co-experienced affect for individual perceptions of relationship quality. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Incongruences Between Facial Expression and Self-Reported Emotional Reactivity in Frontotemporal Dementia and Related Disorders

OBJECTIVE

Emotional reactivity normally involves a synchronized coordination of subjective experience and facial expression. These aspects of emotional reactivity can be uncoupled by neurological illness and produce adverse consequences for patient and caregiver quality of life because of misunderstandings regarding the patient's presumed internal state. Frontotemporal dementia (FTD) is often associated with altered social and emotional functioning. FTD is a heterogeneous disease, and socioemotional changes in patients could result from altered internal experience, altered facial expressive ability, altered language skills, or other factors. The authors investigated how individuals with FTD subtypes differ from a healthy control group regarding the extent to which their facial expressivity aligns with their self-reported emotional experience.

METHODS

Using a compound measure of emotional reactivity to assess reactions to three emotionally provocative videos, the authors explored potential explanations for differences in alignment of facial expressivity with emotional experience, including parkinsonism, physiological reactivity, and nontarget verbal responses.

RESULTS

Participants with the three main subtypes of FTD all tended to express less emotion on their faces than they did through self-report.

CONCLUSIONS

Exploratory analyses suggest that reasons for this incongruence likely differ not only between but also within diagnostic subgroups.

Pronoun Use among Caregivers of People Living with Dementia: Associations with Dementia Severity Using Text Analysis of a Natural Language Sample

Introduction

Family caregivers of persons living with dementia (PLWDs) have extensive social, physical, emotional, and financial responsibilities. However, less is known about the relationship and interpersonal connection between caregivers and PLWDs. We examined caregiver pronoun use, as an index of the connection between the caregiver and PLWD and its associations with the caregiver's and PLWD's health and well-being.

Methods

Caregivers of PLWDs (N = 320) were asked to describe a recent time they felt connected to the PLWD in their care. Responses were transcribed and coded to quantify pronoun use by category (we-pronouns, I-pronouns, and they-pronouns). Caregivers also reported on their depression, burden, and the PLWD's dementia severity and marital satisfaction. Sixty-eight caregivers repeated the same survey 24 months after the initial survey.

Results

Caregivers used less we-pronouns when the PLWD's dementia was more severe, at both timepoints. Spousal caregivers used more we-pronouns and less I- and they-pronouns than nonspousal caregivers. There was an interaction between spousal relationship and dementia severity, such that spousal caregivers exhibited a stronger negative association between dementia severity and we-pronoun use. There were no associations between pronoun category and caregiver burden or depression.

Discussion

Caregivers may feel increasingly disconnected from the PLWD as their dementia becomes more severe, as reflected by less we-pronoun usage. This study highlights the opportunity to explore relationship connection through text analysis.

Diminished preparatory physiological responses in frontotemporal lobar degeneration syndromes

Researchers typically study physiological responses either after stimulus onset or when the emotional valence of an upcoming stimulus is revealed. Yet, participants may also respond when they are told that an emotional stimulus is about to be presented even without knowing its valence. Increased physiological responding during this time may reflect a 'preparation for action'. The generation of such physiological responses may be supported by frontotemporal regions of the brain that are vulnerable to damage in frontotemporal lobar degeneration. We examined preparatory physiological responses and their structural and functional neural correlate in five frontotemporal lobar degeneration clinical subtypes (behavioural variant frontotemporal dementia, n = 67; semantic variant primary progressive aphasia, n = 35; non-fluent variant primary progressive aphasia, n = 30; corticobasal syndrome, n = 32; progressive supranuclear palsy, n = 30). Comparison groups included patients with Alzheimer's disease (n = 56) and healthy controls (n = 35). Preparatory responses were quantified as cardiac interbeat interval decreases (i.e. heart rate increases) from baseline to an 'instruction period', during which participants were told to watch the upcoming emotional film but not provided the film's valence. Patients' behavioural symptoms (apathy and disinhibition) were also evaluated via a caregiver-reported measure. Compared to healthy controls and Alzheimer's disease, the frontotemporal lobar degeneration group showed significantly smaller preparatory responses. When comparing each frontotemporal lobar degeneration clinical subtype with healthy controls and Alzheimer's disease, significant group differences emerged for behavioural variant frontotemporal dementia and progressive supranuclear palsy. Behavioural analyses revealed that frontotemporal lobar degeneration patients showed greater disinhibition and apathy compared to Alzheimer's disease patients. Further, these group differences in disinhibition (but not apathy) were mediated by patients' smaller preparatory responses. Voxel-based morphometry and resting-state functional MRI analyses revealed that across patients and healthy controls, smaller preparatory responses were associated with smaller volume and lower functional connectivity in a circuit that included the ventromedial prefrontal cortex and cortical and subcortical regions of the salience network. Diminished preparatory physiological responding in frontotemporal lobar degeneration may reflect a lack of preparation for actions that are appropriate for an upcoming situation, such as approaching or withdrawing from emotional stimuli. The ventromedial prefrontal cortex and salience network are critical for evaluating stimuli, thinking about the future, triggering peripheral physiological responses, and processing and interpreting interoceptive signals. Damage to these circuits in frontotemporal lobar degeneration may impair preparatory responses and help explain often-observed clinical symptoms such as disinhibition in these patients.

Lower activity linkage between caregivers and persons with neurodegenerative diseases is associated with greater caregiver anxiety

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.

Physiological linkage during shared positive and shared negative emotion

Physiological linkage refers to the degree to which peoples' physiological responses change in coordinated ways. Here, we examine whether and how physiological linkage relates to incidents of shared emotion, distinguished by valence. Past research has used an "overall average" approach and characterized how physiological linkage over relatively long time periods (e.g., 10-15 min) reflects psychological and social processes (e.g., marital satisfaction, empathy). Here, we used a "momentary" approach and characterized whether physiological linkage over relatively short time periods (i.e., 15 s) reflects shared positive emotion, shared negative emotion, or both, and whether linkage during shared emotions relates to relational functioning. Married couples (156 dyads) had a 15-min conflict conversation in the laboratory. Using behavioral coding, each second of conversation was classified into 1 of 4 emotion categories: shared positive emotion, shared negative emotion, shared neutral emotion, or unshared emotion. Using a composite of 3 peripheral physiological measures (i.e., heart rate, skin conductance, finger pulse amplitude), we computed momentary in-phase and antiphase linkage to represent coordinated changes in the same or opposite direction, respectively. We found that shared positive emotion was associated with higher in-phase and lower antiphase linkage, relative to the other 3 emotion categories. Greater in-phase physiological linkage during shared positive emotion was also consistently associated with higher-quality interactions and relationships, both concurrently and longitudinally (i.e., 5 to 6 years later). These findings advance our understanding of the nature of physiological linkage, the emotional conditions under which it occurs, and its possible associations with relational functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The rise of affectivism

Research over the past decades has demonstrated the explanatory power of emotions, feelings, motivations, moods, and other affective processes when trying to understand and predict how we think and behave. In this consensus article, we ask: has the increasingly recognized impact of affective phenomena ushered in a new era, the era of affectivism?

Emotional and Cognitive Empathy in Caregivers of Persons with Neurodegenerative Disease: Relationships with Caregiver Mental Health

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.

Emotion Recognition and Reactivity in Persons With Neurodegenerative Disease Are Differentially Associated With Caregiver Health

BACKGROUND AND OBJECTIVES

Motivated by the high rates of health problems found among caregivers of persons with neurodegenerative disease, we examined associations between deficits in two aspects of care recipients' socioemotional functioning and their caregivers' health.

RESEARCH DESIGN AND METHODS

In 2 studies with independent samples (N = 171 and 73 dyads), caregivers reported on care recipients' emotion recognition and emotional reactivity. Caregiver health was assessed using both self-report measures (Studies 1 and 2) and autonomic nervous system indices (Study 2).

RESULTS

Lower emotion recognition in care recipients was linearly associated with worse self-reported health, faster resting heart rate, and greater physiological reactivity to an acoustic startle stimulus in caregivers. These effects held after accounting for a variety of risk factors for poor caregiver health, including care recipients' neuropsychiatric symptoms. Emotional reactivity showed a quadratic association with health, such that the lowest and highest levels of emotional reactivity in care recipients were associated with lower self-reported health in caregivers.

DISCUSSION AND IMPLICATIONS

Results shed light on the unique associations between two aspects of care recipients' emotional functioning and caregivers' health. Findings suggest potential ways to identify and help caregivers at heightened risk for adverse health outcomes.

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Smaller Volume in Left-Lateralized Brain Structures Correlates with Greater Experience of Negative Non-target Emotions in Neurodegenerative Diseases

Subjective emotional experience that is congruent with a given situation (i.e., target emotions) is critical for human survival (e.g., feeling disgusted in response to contaminated food motivates withdrawal behaviors). Neurodegenerative diseases including frontotemporal dementia and Alzheimer's disease affect brain regions critical for cognitive and emotional functioning, resulting in increased experience of emotions incongruent with the situation (i.e., non-target emotions, such as feeling happy when seeing someone grieving). We examined neuroanatomical correlates of subjective experience of non-target emotions in 147 patients with neurodegenerative diseases and 26 healthy individuals. Participants watched three films intended to elicit particular target emotions and rated their experience of negative and positive target and non-target emotions after watching each film. We found that smaller volume in left hemisphere regions (e.g., caudate, putamen, and dorsal anterior insula) was associated with greater experience of negative non-target emotions. Follow-up analyses confirmed that these effects were left-lateralized. No correlates emerged for positive non-target emotions. These findings suggest that volume loss in left-hemisphere regions produces a more diffuse, incongruent experience of non-target emotions. These findings provide a potential neuroanatomical basis for understanding how subjective emotional experience is constructed in the brain and how this can be disrupted in neurodegenerative disease.

Comparing two facets of emotion perception across multiple neurodegenerative diseases

Deficits in emotion perception (the ability to infer others' emotions accurately) can occur as a result of neurodegeneration. It remains unclear how different neurodegenerative diseases affect different forms of emotion perception. The present study compares performance on a dynamic tracking task of emotion perception (where participants track the changing valence of a film character's emotions) with performance on an emotion category labeling task (where participants label specific emotions portrayed by film characters) across seven diagnostic groups (N = 178) including Alzheimer's disease (AD), behavioral variant frontotemporal dementia (bvFTD), semantic variant primary progressive aphasia (svPPA), non-fluent variant primary progressive aphasia (nfvPPA), progressive supranuclear palsy (PSP), corticobasal syndrome and healthy controls. Consistent with hypotheses, compared to controls, the bvFTD group was impaired on both tasks. The svPPA group was impaired on the emotion labeling task, whereas the nfvPPA, PSP and AD groups were impaired on the dynamic tracking task. Smaller volumes in bilateral frontal and left insular regions were associated with worse labeling, whereas smaller volumes in bilateral medial frontal, temporal and right insular regions were associated with worse tracking. Findings suggest labeling and tracking facets of emotion perception are differentially affected across neurodegenerative diseases due to their unique neuroanatomical correlates.

Genuine Smiles by Patients During Marital Interactions are Associated with Better Caregiver Mental Health

OBJECTIVE

Providing care for a spouse with dementia is associated with an increased risk for poor mental health. To determine whether this vulnerability in caregivers is related to the expression of positive emotion, we examined 57 patients with Alzheimer's disease and behavioral variant frontotemporal dementia and their spouses as they discussed a marital conflict.

METHOD

Facial behavior during the discussion was objectively coded to identify Duchenne (i.e., genuine) smiles and non-Duchenne (i.e., polite) smiles. Caregiver mental health was measured using the Medical Outcomes Survey.

RESULTS

Greater expression of Duchenne smiles by patients was associated with better caregiver mental health, even when accounting for covariates (i.e., diagnosis, patient cognitive functioning, and caregiver marital satisfaction). Greater expression of non-Duchenne smiles by patients was associated with worse caregiver health, but only when covariates were entered in the model. Expression of Duchenne and non-Duchenne smiles by caregivers was not associated with caregiver mental health.

DISCUSSION

Patients' expression of Duchenne and non-Duchenne smiles may reveal important aspects of the emotional quality of the patient-caregiver relationship that influence caregiver burden and mental health.

Poor Disgust Suppression Is Associated with Increased Anxiety in Caregivers of People with Neurodegenerative Disease

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.

Age-related changes in emotional behavior: Evidence from a 13-year longitudinal study of long-term married couples

We examined age-related changes in emotional behavior in a sample of middle-aged and older long-term married couples over a 13-year period. Data were collected at 3 waves, each occurring 5 to 6 years apart. For the present study, only couples who participated in all 3 waves were examined (n = 87). Couples were either in the middle-aged group (40-50 years old, married at least 15 years) or the older group (60-70 years old, married at least 35 years). At each wave, couples engaged in 15-min unrehearsed conversations about an area of disagreement in their marriage. Emotional behaviors during the conversation were objectively coded using the Specific Affect Coding System. Latent growth curve analyses revealed that, for both husbands and wives, negative emotional behavior (primarily belligerence, defensiveness, fear/tension, and whining) decreased and positive emotional behavior (primarily humor, enthusiasm, and validation) increased with age. Findings generalized across middle-aged and older cohorts and levels of marital satisfaction. These findings support theories that suggest that positive emotion increases and negative emotion decreases with age, expanding upon previous findings by examining objectively coded emotional behaviors longitudinally in an interpersonal context. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Pronoun Use during Patient-Caregiver Interactions: Associations with Caregiver Well-Being

INTRODUCTION

Caring for a spouse with dementia can be extremely challenging. Many caregivers experience profound declines in well-being; however, others remain healthy.

OBJECTIVE

This study determined whether the personal pronouns used in interactions between persons with dementia (PWDs) and their spousal caregivers were associated with caregiver well-being.

METHODS

Fifty-eight PWDs and their spousal caregivers engaged in a 10-min conversation about an area of disagreement in a laboratory setting. Verbatim transcripts of the conversation were coded using text analysis software, and caregivers and PWDs each received scores for (a) I-pronouns, (b) you-pronouns, and (c) we-pronouns. Caregivers' well-being was assessed using a composite measure of depression, anxiety, burden, and strain.

RESULTS

Results revealed that less use of we-pronouns by caregivers and PWDs and greater use of I-pronouns by PWDs were -associated with lower caregiver well-being.

CONCLUSIONS

These findings indicate that less use of pronouns that refer to the couple (we-pronouns used by either partner) and greater use of pronouns that refer to the PWD (I-pronouns used by the PWD) are indicative of caregivers at heightened risk for lower well-being.

Physiological, behavioral and subjective sadness reactivity in frontotemporal dementia subtypes

Frontotemporal dementia (FTD), a neurodegenerative disease broadly characterized by socioemotional impairments, includes three clinical subtypes: behavioral variant FTD (bvFTD), semantic variant primary progressive aphasia (svPPA) and non-fluent variant primary progressive aphasia (nfvPPA). Emerging evidence has shown emotional reactivity impairments in bvFTD and svPPA, whereas emotional reactivity in nfvPPA is far less studied. In 105 patients with FTD (49 bvFTD, 31 svPPA and 25 nfvPPA) and 27 healthy controls, we examined three aspects of emotional reactivity (physiology, facial behavior and subjective experience) in response to a sad film. In a subset of the sample, we also examined the neural correlates of diminished aspects of reactivity using voxel-based morphometry. Results indicated that all three subtypes of FTD showed diminished physiological responding in respiration rate and diastolic blood pressure; patients with bvFTD and svPPA also showed diminished subjective experience, and no subtypes showed diminished facial behavior. Moreover, there were differences among the clinical subtypes in brain regions where smaller volumes were associated with diminished sadness reactivity. These results show that emotion impairments extend to sadness reactivity in FTD and underscore the importance of considering different aspects of sadness reactivity in multiple clinical subtypes for characterizing emotional deficits and associated neurodegeneration in FTD.

Best practices in research mentoring in clinical science

The growth of clinical science as a field depends on the work of engaged mentors nurturing future generations of scientists. Effective research mentoring has been shown to predict positive outcomes, including greater scholarly productivity, reduced attrition, and increased satisfaction with training and/or employment, which ultimately may enhance the quality of the clinical-science research enterprise. Barriers to effective research mentoring, however, pose significant challenges for both mentees and mentors, as well as for labs, training programs, and/or departments. We discuss some key issues as they apply to clinical-science mentoring and note how they are affected across different developmental levels (undergraduate, postbaccalaureate, doctoral, internship, postdoctoral associates, and early career faculty). Although we do not proclaim expertise on these issues-and have struggled with them in our own careers-we believe an open discussion around best mentoring practices will enhance our collective effectiveness and help mentees and our field to flourish. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neuroanatomy of expressive suppression: The role of the insula

Expressive suppression is a response-focused regulatory strategy aimed at concealing the outward expression of emotion that is already underway. Expressive suppression requires the integration of interoception, proprioception, and social awareness to guide behavior in alignment with personal and interpersonal goals-all processes known to involve the insular cortex. Frontotemporal dementia (FTD) provides a useful patient model for studying the insula's role in socioemotional regulation. The insula is a key target of early atrophy in FTD, causing patients to lose the ability to represent the salience of internal and external conditions and to use these representations to guide behavior. We examined a sample of 59 patients with FTD, 52 patients with Alzheimer's disease (AD), and 38 neurologically healthy controls. Subjects viewed 2 disgust-eliciting films in the laboratory. During the first film, subjects were instructed to simply watch (emotional reactivity trial); during the second, they were instructed to hide their emotions (expressive suppression trial). Structural images from a subsample of participants (n = 42; 11 FTD patients, 11 AD patients, and 20 controls) were examined in conjunction with behavior. FreeSurfer was used to quantify regional gray matter volume in 41 empirically derived neural regions in both hemispheres. Of the 3 groups studied, FTD patients showed the least expressive suppression and had the smallest insula volumes, even after controlling for age, gender, and emotional reactivity. Among the brain regions examined, the insula was the only significant predictor of expressive suppression ability, with lower insula gray matter volume in both hemispheres predicting less expressive suppression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Emotion recognition in objects in patients with neurological disease

OBJECTIVE

Considerable research indicates that individuals with dementia have deficits in the ability to recognize emotion in other people. The present study examined ability to detect emotional qualities of objects.

METHOD

Fifty-two patients with frontotemporal dementia (FTD), 20 patients with Alzheimer's disease (AD), 18 patients awaiting surgery for intractable epilepsy, and 159 healthy controls completed a newly developed test of ability to recognize emotional qualities of art (music and paintings), and pleasantness in simple sensory stimuli (tactile, olfactory, auditory), and to make aesthetic judgments (geometric shapes, room décor). A subset of participants also completed a test of ability to recognize emotions in other people.

RESULTS

Patients with FTD showed a marked deficit in ability to recognize the emotions conveyed in art, compared with both healthy individuals and patients with AD (relative to controls, deficits in patients with AD only approached significance). This deficit remained robust after controlling for FTD patients' ability to recognize pleasantness in simple sensory stimuli, make aesthetic judgments, identify odors, and identify emotions in other people. Neither FTD nor AD patients showed deficits in recognizing pleasant sensory stimuli or making aesthetic judgments. Exploratory analysis of patients with epilepsy revealed no deficits in any of these domains.

CONCLUSION

Patients with FTD (but not AD) showed a significant, specific deficit in ability to interpret emotional messages in art, echoing FTD-related deficits in recognizing emotions in other people. This finding adds to our understanding of the impact these diseases have on the lives of patients and their caregivers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neurodegenerative Disease Caregivers' 5-HTTLPR Genotype Moderates the Effect of Patients' Empathic Accuracy Deficits on Caregivers' Well-Being

OBJECTIVE

To test the hypothesis that a functional polymorphism of the serotonin transporter gene (serotonin-transporter-linked polymorphic region [5-HTTLPR]), which is thought to be associated with differential environmental sensitivity, moderates the association between low levels of empathic accuracy (i.e., ability to recognize emotions in others) in patients with neurodegenerative disease and caregivers' well-being.

METHODS

Participants were 54 patients with neurodegenerative disease and their caregivers. Patients' empathic accuracy was measured using a dynamic tracking task in which they continuously rated the emotions of a character in a film; accuracy was determined by comparing patient ratings with those made by an expert panel. Caregivers provided a saliva sample for genotyping. Caregivers' well-being was measured as a latent construct indicated by validated measures of depression, anxiety, and negative affect.

RESULTS

Lower levels of patients' empathic accuracy were associated with lower levels of caregivers' well-being. Importantly, caregivers' 5-HTTLPR genotype moderated this association such that lower empathic accuracy in patients predicted lower well-being for caregivers with the short/short genotype (standardized β = 0.66), but not for caregivers with the short/long (standardized β = 0.05) or long/long genotypes (standardized β = -0.21).

CONCLUSION

Consistent with previous findings that the short/short variant of 5-HTTLPR is associated with greater sensitivity to environmental influences, caregivers with the short/short variant manifest lower well-being when caring for a patient with low levels of empathic accuracy than caregivers with the other variants. This finding contributes to the authors' understanding of biological factors associated with individual differences in caregiver vulnerability and resilience.

Stress and Illness: A Role for Specific Emotions

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.

Behavioral indices of positivity resonance associated with long-term marital satisfaction

Positivity resonance-defined as a synthesis of shared positive affect, mutual care and concern, plus behavioral and biological synchrony-is theorized to contribute to a host of positive outcomes, including relationship satisfaction. The current study examined whether, in long-term married couples, behavioral indices of positivity resonance (rated using a new behavioral coding system) are associated with concurrent shared positive affect using a well-established dyadic-level behavioral coding system (i.e., Specific Affect Coding System: SPAFF), and whether positivity resonance predicts concurrent marital satisfaction independently from other affective indices. Long-term married couples completed a self-report inventory assessing marital satisfaction and were then brought into the laboratory to participate in a conversation about an area of marital disagreement while being videotaped for subsequent behavioral coding. Interrater reliability for positivity resonance behavioral coding was high (intraclass correlation coefficient: 0.8). Results indicated that positivity resonance is associated with frequency of shared positive affect using SPAFF. No associations were found between positivity resonance and frequencies of SPAFF-coded individual-level positive affect or shared negative affect. Additionally, positivity resonance predicted marital satisfaction independently from frequencies of SPAFF-coded shared positive affect and individual-level positive affect alone. The effect of positivity resonance on marital satisfaction also remained significant after controlling for overall affective tone of conflict conversation. These findings provide preliminary construct and predictive validity for positivity resonance behavioral coding, and highlight the possible role positivity resonance may play in building relationship satisfaction in married couples. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Interpersonal prosodic correlation in frontotemporal dementia

Communication accommodation describes how individuals adjust their communicative style to that of their conversational partner. We predicted that interpersonal prosodic correlation related to pitch and timing would be decreased in behavioral variant frontotemporal dementia (bvFTD). We predicted that the interpersonal correlation in a timing measure and a pitch measure would be increased in right temporal FTD (rtFTD) due to sparing of the neural substrate for speech timing and pitch modulation but loss of social semantics. We found no significant effects in bvFTD, but conversations including rtFTD demonstrated higher interpersonal correlations in speech rate than healthy controls.

Emotion regulation via visual avoidance: Insights from neurological patients

Visual avoidance of unpleasant stimuli (i.e., strategic positioning of eyes, head and torso away from an environmental stimulus) is a common attentional control behavior that may down-regulate emotion by reducing visual input. Despite its ubiquity, relatively little is known about how visual avoidance is affected by neurological diseases that impact neural circuits involved in emotional functioning. We examined visual avoidance in 56 behavioral variant frontotemporal dementia (bvFTD) patients, 43 Alzheimer's disease (AD) patients, and 34 healthy controls. Participants came to our laboratory and viewed an extremely disgusting film clip while visual avoidance was measured using behavioral coding of head, body, and eye position. Controlling for differences in cognitive functioning, bvFTD patients were less likely to engage in visual avoidance behaviors than both AD patients and healthy controls. Additional analyses revealed that diminished visual avoidance in this task was associated with lower levels of real-world emotion regulation but not with emotion reactivity as reported by the primary caregiver.

Coherence between subjective experience and physiology in emotion: Individual differences and implications for well-being

Emotion theorists have characterized emotions as involving coherent responding across various emotion response systems (e.g., covariation of subjective experience and physiology). Greater response system coherence has been theorized to promote well-being, yet very little research has tested this assumption. The current study examined whether individuals with greater coherence between physiology and subjective experience of emotion report greater well-being. We also examined factors that may predict the magnitude of coherence, such as emotion intensity, cognitive reappraisal, and expressive suppression. Participants (N = 63) completed self-report measures of well-being, expressive suppression, and cognitive reappraisal. They then watched a series of emotionally evocative film clips designed to elicit positive and negative emotion. During the films, participants continuously rated their emotional experience using a rating dial, and their autonomic physiological responses were recorded. Time-lagged cross-correlations were used to calculate within-participant coherence between intensity of emotional experience (ranging from neutral to very negative or very positive) and physiology (composite of cardiac interbeat interval, skin conductance, ear pulse transit time, finger pulse transit time and amplitude, systolic and diastolic blood pressure). Results indicated that individuals with greater coherence reported greater well-being. Coherence was highest during the most emotionally intense film and among individuals who reported lower expressive suppression. However, coherence was not associated with reappraisal. These findings provide support for the idea that greater emotion coherence promotes well-being and also shed light on factors that are associated with the magnitude of coherence. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Responding to the emotions of others: Age differences in facial expressions and age-specific associations with relational connectedness

Responding prosocially to the emotion of others may become increasingly important in late life, especially as partners and friends encounter a growing number of losses, challenges, and declines. Facial expressions are important avenues for communicating empathy and concern, and for signaling that help is forthcoming when needed. In a study of young, middle-aged, and older adults, we measured emotional responses (facial expressions, subjective experience, and physiological activation) to a sad, distressing film clip and a happy, uplifting film clip. Results revealed that, relative to younger adults, older adults showed more sadness and confusion/concern facial expressions during the distressing film clip. Moreover, for older adults only, more sadness and fewer disgust facial expressions during the distressing film clip were associated with higher levels of relational connectedness. These findings remained stable when accounting for subjective emotional experience, physiological activation, and trait empathy in response to the film clip. When examining the uplifting film clip, older adults showed more happiness facial expressions relative to younger adults at trend levels. More facial expressions of happiness were associated with higher levels of relational connectedness, but unlike the effect of sadness expressions, this was not moderated by age. These findings underscore an important adaptive social function of facial expressions-particularly in response to the distress of others-in late life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Reflections on 30 years of Cognition & Emotion

The publication of the first issue of Cognition & Emotion in 1987 helped open the floodgates to what has become a golden age of emotion research in the social and biological sciences. In this article, I describe the intellectual landscape of that era and trace key developments that helped foster the growth of the field of affective science. Looking back from a present-day perspective, I offer some thoughts on the major changes that have occurred over the past three decades, the opportunities and challenges that lie ahead, and my own personal journey toward becoming an affective scientist (which largely occurred during this period). Finally, I offer three considerations that might be helpful for young researchers who are already in the field of affective science or are considering entering it.

Evaluating Patient Brain and Behavior Pathways to Caregiver Health in Neurodegenerative Diseases

BACKGROUND

Caregivers of patients with neurodegenerative diseases are at heightened risk for serious health problems, but health differences between individual caregivers abound.

AIMS

To determine whether atrophy in patient brains could be used to identify caregivers at heightened risk for health problems and which patient variables mediate this relationship.

METHODS

In 162 patient-caregiver dyads, we assessed patient atrophy using structural MRI, caregiver health, and patient behavior and cognitive symptoms.

RESULTS

Patient atrophy in the right insula and medial frontal gyrus was associated with worse caregiver health; this relationship was partially mediated by patient neuropsychiatric symptoms, and assessing atrophy in these regions improved predictions of poor caregiver health above and beyond patient behavioral symptoms.

CONCLUSIONS

This study shows the value of patients' brain data in identifying caregivers at risk for becoming sick themselves.

Network Architecture Underlying Basal Autonomic Outflow: Evidence from Frontotemporal Dementia

The salience network is a distributed neural system that maintains homeostasis by regulating autonomic nervous system activity and social-emotional function. Here we examined how within-network connectivity relates to individual differences in human (including males and females) baseline parasympathetic and sympathetic nervous activity. We measured resting autonomic nervous system physiology in 24 healthy controls and 23 patients with behavioral variant frontotemporal dementia (bvFTD), a neurodegenerative disease characterized by baseline autonomic deficits. Participants also underwent structural and task-free fMRI. First, we used voxel-based morphometry to determine whether salience network atrophy was associated with lower baseline respiratory sinus arrhythmia (a parasympathetic measure) and skin conductance level (a sympathetic measure) in bvFTD. Next, we examined whether functional connectivity deficits in 21 autonomic-relevant, salience network node-pairs related to baseline autonomic dysfunction. Lower baseline respiratory sinus arrhythmia was associated with smaller volume in left ventral anterior insula (vAI), weaker connectivity between bilateral vAI and bilateral anterior cingulate cortex (ACC), and stronger connectivity between bilateral ACC and bilateral hypothalamus/amygdala. Lower baseline skin conductance level, in contrast, was associated with smaller volume in inferior temporal gyrus, dorsal mid-insula, and hypothalamus; weaker connectivity between bilateral ACC and right hypothalamus/amygdala; and stronger connectivity between bilateral dorsal anterior insula and periaqueductal gray. Our results suggest that baseline parasympathetic and sympathetic tone depends on the integrity of lateralized salience network hubs (left vAI for parasympathetic and right hypothalamus/amygdala for sympathetic) and highly calibrated ipsilateral and contralateral network connections. In bvFTD, deficits in this system may underlie resting parasympathetic and sympathetic disruption.SIGNIFICANCE STATEMENT The salience network maintains homeostasis and regulates autonomic nervous system activity. Whether within-network connectivity patterns underlie individual differences in resting parasympathetic and sympathetic nervous system activity, however, is not well understood. We measured baseline autonomic nervous system activity in healthy controls and patients with behavioral variant frontotemporal dementia, a neurodegenerative disease characterized by resting autonomic deficits, and probed how salience network dysfunction relates to diminished parasympathetic and sympathetic outflow. Our results indicate that baseline parasympathetic and sympathetic tone are the product of complex, opposing intranetwork nodal interactions and depend on the integrity of highly tuned, lateralized salience network hubs (i.e., left ventral anterior insula for parasympathetic activity and right hypothalamus/amygdala for sympathetic activity).

Neuroanatomy of Shared Conversational Laughter in Neurodegenerative Disease

Perceiving another person's emotional expression often sparks a corresponding signal in the observer. Shared conversational laughter is a familiar example. Prior studies of shared laughter have made use of task-based functional neuroimaging. While these methods offer insight in a controlled setting, the ecological validity of such controlled tasks has limitations. Here, we investigate the neural correlates of shared laughter in patients with one of a variety of neurodegenerative disease syndromes (N = 75), including Alzheimer's disease (AD), behavioral variant frontotemporal dementia (bvFTD), right and left temporal variants of semantic dementia (rtvFTD, svPPA), nonfluent/agrammatic primary progressive aphasia (nfvPPA), corticobasal syndrome (CBS), and progressive supranuclear palsy (PSP). Patients were recorded in a brief unrehearsed conversation with a partner (e.g., a friend or family member). Laughter was manually labeled, and an automated system was used to assess the timing of that laughter relative to the partner's laughter. The probability of each participant with neurodegenerative disease laughing during or shortly after his or her partners' laughter was compared to differences in brain morphology using voxel-based morphometry, thresholded based on cluster size and a permutation method and including age, sex, magnet strength, disease-specific atrophy and total intracranial volumes as covariates. While no significant correlations were found at the critical T value, at a corrected voxelwise threshold of p < 0.005, a cluster in the left posterior cingulate gyrus demonstrated a trend at p = 0.08 (T = 4.54). Exploratory analysis with a voxelwise threshold of p = 0.001 also suggests involvement of the left precuneus (T = 3.91) and right fusiform gyrus (T = 3.86). The precuneus has been previously implicated in the detection of socially complex laughter, and the fusiform gyrus has a well-described role in the recognition and processing of others' emotional cues. This study is limited by a relatively small sample size given the number of covariates. While further investigation is needed, these results support our understanding of the neural underpinnings of shared conversational laughter.

Empathic Accuracy Deficits in Patients with Neurodegenerative Disease: Association with Caregiver Depression

OBJECTIVES

To investigate whether deficits in empathic accuracy (i.e., ability to recognize emotion in others) in patients with neurodegenerative disease are associated with greater depression in their caregivers.

DESIGN

Two cross-sectional studies.

SETTING

Academic medical center and research university.

PARTICIPANTS

Two independent samples (N = 172, N = 63) of patients with a variety of neurodegenerative diseases and their caregivers; comparison group of healthy couples.

MEASUREMENT

Patients' empathic accuracy was assessed in the laboratory using a novel dynamic tracking task (rating another person's changing emotions over time) and more traditional measures (recognizing the emotion expressed in photographs of facial expressions and by characters in films). Caregivers completed self-report inventories of depression.

RESULTS

Lower empathic accuracy in patients was associated with greater depression in caregivers in both studies. In study 1, this association was found when empathic accuracy was measured using the dynamic tracking measure but not when measured using the more traditional photograph and film measures. In study 2, we found preliminary support for our theoretical model wherein lower empathic accuracy in patients is associated with increased caregiver stress (loneliness, strain, and burden), which in turn is associated with greater caregiver depression.

CONCLUSIONS

Caring for a patient with deficits in empathic accuracy is associated with greater loneliness, strain, and burden for caregivers, and increased depression. Caregivers may benefit from interventions designed to compensate for the stress and interpersonal loss associated with patients' declining empathic accuracy.

Clinical Psychology Training: Accreditation and Beyond

Beginning with efforts in the late 1940s to ensure that clinical psychologists were adequately trained to meet the mental health needs of the veterans of World War II, the accreditation of clinical psychologists has largely been the province of the Commission on Accreditation of the American Psychological Association. However, in 2008 the Psychological Clinical Science Accreditation System began accrediting doctoral programs that adhere to the clinical science training model. This review discusses the goals of accreditation and the history of the accreditation of graduate programs in clinical psychology, and provides an overview of the evaluation procedures used by these two systems. Accreditation is viewed against the backdrop of the slow rate of progress in reducing the burden of mental illness and the changes in clinical psychology training that might help improve this situation. The review concludes with a set of five recommendations for improving accreditation.