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Affective Well-Being, Rumination, and Positive
Reappraisal among People Living with HIV:
A Measurement-Burst Diary Study
Ewa Gruszczy
nska*
SWPS University of Social Sciences and Humanities, Warsaw, Poland
Marcin Rzeszutek
University of Warsaw, Warsaw, Poland
Background: Changes of affective well-being are usually analysed either as longi-
tudinal processes or as daily fluctuations. We used a three-burst diary study to
combine these perspectives. Method: The participants were 211 patients with a
diagnosis of HIV infection. In three bursts with 6-month intervals, they completed
an online diary for five consecutive days, which gives 15 days of measurements.
They evaluate affective well-being (positive and negative affect), stress associated
with a central hassle, and coping (rumination and positive reappraisal). Results:
Higher daily stress coupled with higher rumination was related to lower well-being.
For positive reappraisal, the picture was more complex. First, its interaction with
daily stress had an effect on negative, but not on positive, affect. Second, this effect
was significant only at the first burst. Conclusions: These results suggest a stable
debilitating effect of daily rumination, but a limited and diminishing beneficial
effect of daily positive reappraisal among people living with HIV. As such, they
do not confirm the view that positive reappraisal sustains affective well-being dur-
ing chronic health conditions. This may inform stress management interventions
for PLWH, which are now increasingly taking the form of mobile applications,
adapted to the daily lives of patients in their natural environment.
Keywords: affect, coping, HIV, measurement-burst diary study, stress
INTRODUCTION
While a general agreement exists that coping matters in the way people deal with
stressful life events, until now no consensus has been reached on how to opera-
tionalise, classify, and assess different ways of coping (see for review Cheng
*Address for correspondence: Ewa Gruszczy
nska, Department of Psychology, SWPS University
of Social Sciences and Humanities, Chodakowska Street 19/31, Room N314, 03-815 Warsaw,
Poland. Email: egruszczynska@swps.edu.pl
APPLIED PSYCHOLOGY: HEALTH AND WELL-BEING, 2020
doi:10.1111/aphw.12198
©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
Sons Ltd on behalf of International Association of Applied Psychology
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial
License, which permits use, distribution and reproduction in any medium, provided the original work
is properly cited and is not used for commercial purposes.
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et al., 2014; Skinner et al., 2003). A large heterogeneous literature on coping
with respect to coping measurements, coping outcomes, and especially conclu-
sions is a serious impediment to aggregate results regarding the same stressor or
domain (Kato, 2013; Stanton et al., 2007). One of the problems in coping studies
is that coping is not a distinctive, easy to report behavior, but rather a multidi-
mensional phenomenon referring to diverse cognitive and behavioral efforts dis-
played by the same individual in various times and contexts. This transactional
aspect of coping was elaborated by Lazarus and Folkman (1984) in stress and
coping model almost 40 years ago, but until recently it has been poorly captured.
The traditional designs have a limited ability to give a comprehensive picture of
coping by a given person in their natural environment (Kato, 2013) due to their
insufficient ecological validity. Specifically, it has been challenging to examine a
process that differs not only between people, but also has its own dynamics
within people over time during their daily lives (Hamaker, 2012). A promising
methodological solution lies in an intensive longitudinal design (Bolger & Lau-
renceau, 2013), where the individual nature of these changes can be depicted
through multiple measurements in the same person. As coping is a within-person
process by definition (Lazarus & Folkman, 1984), the ability to capture this
intrapersonal variability can be regarded a milestone in stress and coping
research.
In this context, two strategies, that is, positive reappraisal and rumination,
deserve special attention because of their well-recognised opposite effects on
affective well-being in spite of some similarities (Aldao et al., 2010; Hu et al.,
2014). Namely, both these strategies being emotion-focused have a cognitive
modality, where the emotional state is to change through a change of appraisal
of the situation (Lazarus & Folkman, 1984; Smith & Alloy, 2009). Also, they
may be especially relevant and preferred in situations with a low level of avail-
able control (Haines et al., 2016; Kamijo & Yukawa, 2018). More specifically,
positive reappraisal refers to cognitive attempts to reinterpret stressful life events
in a positive way, including attempts to find benefits in such situations, and thus
changing their initial meaning (Folkman & Moskowitz, 2000). As a result, the
use of this coping strategy is positively associated with various aspects of psy-
chological well-being (Garnefski et al., 2002), including mostly enhancing posi-
tive affect in the face of vast categories of aversive life events (Folkman, 2008).
Conversely, rumination is defined as thinking about the reasons and conse-
quences of an experienced stressful situation, focusing on the negative contents
only (Nolen-Hoeksema, 1991). There are many findings on its positive associa-
tion with various aspects of psychological distress, including mainly depressive
symptoms (see for review Nolen-Hoeksema et al., 2008).
Recent studies using a within-person perspective have confirmed effects
obtained in studies with a more traditional design only to a certain degree. For
instance, daily positive reappraisal was related to daily positive, but not to daily
negative, affect (Brans et al., 2013; Brockman et al., 2017; Pavani et al., 2016).
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©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
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Additionally, more in-depth analysis showed that for some people lower daily
positive reappraisal was associated with lower negative affect, whereas for others
with higher daily negative affect (Brockman et al., 2017). Daily rumination
results for the same day indicate both an increase in negative affect and a
decrease in positive affect (Brockman et al., 2017). Overall, these findings sug-
gest that the role of positive reappraisal and rumination is less symmetrical in
terms of affect valence than has been assumed hitherto (Aldao et al., 2010).
However, these studies were based on one set of intensive measurements,
which do not allow for assessment of stability of the obtained results within
longer periods of time. Also, because they concentrated on affect regulation
more than on coping, they did not control for stress source and intensity.
Finally, they included healthy participants, from the general population. Sur-
prisingly, research on the link between positive reappraisal and rumination
with regard to various aspects of daily psychosocial functioning in clinical
populations is still relatively scarce (e.g. Gruszczy
nska & Knoll, 2015; Kir-
canski et al., 2015).
Concerning people living with HIV (PLWH), it should first be underscored
that studies on the psychosocial aspects of living with HIV are dominated by a
focus on the negative consequences. This stems from some kind of implicit
assumption that the person’s life is preoccupied with HIV-related distress associ-
ated with being diagnosed with a life-threatening virus (see for review Bennett
et al., 2016; Leserman, 2008; Machtinger et al., 2012). However, due to the sub-
stantial progress in antiretroviral treatment, the average life expectancy of PLWH
has become similar to the general population (Deeks et al., 2013). Therefore,
currently many people experience their HIV infection more as a chronic, man-
ageable health condition rather than a fatal disease, meaning their health status is
still an important, but not necessarily predominant, source of their everyday dis-
tress (Carricco, 2019). Therefore, in spite of the same source of chronic stress
(i.e. HIV infection) the stress level of PLWH may fluctuate day by day, leading
to significant individual differences in psychological adaptation (Farmer et al.,
2017). According to stress and coping theory, these differences should also be
explained by ways of coping with daily stress. However, to complicate matters,
the literature on struggling with HIV infection, although massive, is very hetero-
geneous with respect to coping assessment and conclusions (e.g. Armon &
Lichtenstein, 2012; Gray & Hedge, 2010; Rzeszutek et al., 2017; Sikkema et al.,
2006). The meta-analysis by Moskowitz et al. (2009) showed that among PLWH
positive reappraisal was related to higher positive and lower negative affect,
although the first effect was stronger. Interestingly, there were no identified stud-
ies at that time that assessed the association between rumination and positive
affect among PLWH, thus only its relationship with negative affect was con-
firmed. Furthermore, newer studies (Nightingale et al., 2010) include rumination
rather in the context of posttraumatic growth among PLWH, without analysis of
within-person daily processes.
DAILY WELL-BEING AMONG PEOPLE WITH HIV 3
©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
Sons Ltd on behalf of International Association of Applied Psychology
Current Study
Considering the aforementioned research gaps, the aim of our study was to
examine stable between-person differences as well as intraindividual changes
and daily fluctuations in the relation among affective well-being (positive and
negative affect at the end of the day), stress associated with daily hassles, and
coping (rumination and positive reappraisal). We used a measurement-burst
diary study to identify these effects (Sliwinski et al., 2009), with three diaries
separated by 6-month intervals and repeated in the same group of PLWH. Thus,
the aim of the study is not only assessing daily fluctuations but also verifying the
stability of these processes during a longer period of time (i.e. intraindividual
change) (Nesselroade, 1991; Stawski et al., 2015). Thus, with the same sample,
we would like to confirm that results obtained in single set of daily diaries are
not accidental, but persist over time. We formulated three hypotheses based on
the results of previous stress and coping studies carried out in a within-person
framework, taking into account the specific context of living with HIV.
Hypothesis 1. There is a relationship between affective well-being and daily
stress: lower positive affect and higher negative affect relate to higher daily stress
after controlling for weekly and overall stress reported by a person. This effect is
stable within time of the study.
With regard to the association of negative and positive affect with daily stress,
this hypothesis remains intuitively obvious and well documented in the studies on
the general population, including with the within-person model (e.g. Bolger et al.,
1989; Dunkley et al., 2017). However, to date, no research with such a method-
ological design has been conducted among PLWH. Moreover, the burst-diary
design allows verification of whether within-person coupling of daily stress and
affect changes across follow-up. Sliwinski et al. (2009) conceptualised it as changes
in reactivity, that is, how strongly a person reacts emotionally to a given stress
level, which could be related to aging or other developmental processes (R€
ocke &
Brose, 2013). However, taking into account the relatively short time covered by
our study and the effectiveness of medical treatment of HIV infection, on average
we expect a quite stable value of this slope across all the measurement bursts.
Hypothesis 2. There is a relationship between affective well-being and daily cop-
ing in terms of rumination and positive reappraisal. Specifically, higher daily
rumination is related to lower positive affect and higher negative affect. The
opposite relationships are expected for positive reappraisal. These effects are
stable within time of the study.
Based on classical stress and coping theory (Lazarus & Folkman, 1984), we
assumed that the effects of coping on affective well-being should be observed
after controlling for the stress effects described in the previous hypothesis. As
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Sons Ltd on behalf of International Association of Applied Psychology
presented in the introduction, within-person relationships between these coping
strategies and both affect valences are ambiguous, especially for positive reap-
praisal, thus they can be sample and context specific. However, in previous stud-
ies they regarded daily fluctuations only; now we will also examine their
intraindividual stability over time.
Hypothesis 3. There is a significant stress 9coping relationship at the daily
level, with rumination and positive reappraisal moderating the impact of stress on
well-being. This effect is stable within time of the study.
Finally, since coping strategies are undertaken to alleviate stress, daily well-be-
ing in the face of stress could be a proxy for coping effectiveness, especially
when emotion-focused strategies are considered (Lazarus, 2000). Therefore, we
expect that an interaction of daily stress and daily coping should be noted. Specif-
ically, higher stress when accompanied by higher rumination (comparing to
lower) would be related to lower affective well-being (Genet & Siemer, 2012),
whereas for positive reappraisal the opposite effect would be noted. Also, this
daily stress 9daily coping relationship is expected to be stable across bursts.
METHOD
Participants and Procedure
This study is a part of a larger project on well-being and quality of life among
PLWH undergoing antiretroviral treatment. All the patients had a medically con-
firmed diagnosis of HIV and were recruited from a specialised outpatient clinic
where they received antiretroviral treatment in schemas according to current
medical guidelines The additional inclusion criteria encompassed a lack of HIV-
related cognitive disorders, no current diagnosis of substance use, as well as
access to the internet. Out of 770 eligible patients, 217 agreed to take part in the
repeated diary study and provided their email address and phone number. These
patients were contacted approximately 1 week before the first diary to confirm
their willingness to participate and verify the correctness of their contact data.
Their final informed consent was obtained on the first day of the first diary. No
one resigned at this stage; however, six people had missing data for all three
bursts. Thus, they were excluded from the analyses. For the remaining partici-
pants, mean values of missing days was 7.46 (SD =4.39) with 70 per cent pro-
viding more than four measurement days. Thus, the final sample included 211
patients (17% women) and 1,574 measurement points.
Each burst consists of repeated sequences of daily measurements. For five
consecutive days (from Monday to Friday), the participants filled out online
questionnaires, which were sent via hyperlinks to their email boxes each evening
to evaluate their affective well-being (positive and negative affect), followed by
DAILY WELL-BEING AMONG PEOPLE WITH HIV 5
©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
Sons Ltd on behalf of International Association of Applied Psychology
stress associated with a central hassle on a given day and coping strategies (rumi-
nation and positive reappraisal) related to this hassle. A single online diary sur-
vey took approximately 3 to 5 minutes to complete. The items assessing
affective state and coping were shuffled within to avoid habitual answering, and
automatic notifications prompted participants to answer every question. Daily
access was restricted to a limited time after which the link was deactivated and
the survey could not be entered. Thus, the participants had no access to the pre-
vious answers for review. The online diaries were accessible from internet-con-
nected PCs, smartphones, and tablets. This procedure constitutes a gold standard
in diary studies (Masumi et al., 2012).
In total, the study protocol consists of three bursts of such 5-day diaries, sepa-
rated by a 6-month interval, which equaled 15 potential measurement days for
each person through the 12 months of the study. During completion of the dia-
ries, three trained research assistants, supervised by the authors, were available
to the participants via email and phone to provide technical support and to
answer their questions. The participants received a diary day automatic reminder
4 hours after the survey link was sent if the survey had not been completed, a
thank you message after completing each survey, and a longer message when
each burst was finished. Participants did not receive compensation for their par-
ticipation. The study protocol was accepted by the institutional ethics committee.
Measures
The end-of-day affective well-being was evaluated using 12 items from the
PANAS-X by Watson et al. (1988): six items measuring negative affect (e.g.
tired, unhappy, and upset) and six items evaluating positive affect (e.g. calm,
excited, and satisfied). The participants assessed how they felt at the end of each
day and provided their answers on a 5-point scale from 1 =very slightly or not
at all to 5 =strongly. The raw values for a given day were added and averaged
separately for each subscale. The multilevel reliability was assessed by omega
coefficient (Geldhof et al., 2014). The coefficient values were high at the within-
and between-person levels, respectively, for both negative (x
w
=.81; x
b
=.97)
and positive affect (x
w
=.82; x
b
=.96).
The stress intensity due to central hassles was assessed using a modification of
the operationalisation by Dunkley et al. (2003). The participants chose the most
central hassle on a particular day and then described event-related stress intensity,
controllability, and importance. In this study, only data on stress intensity were
used. Participants answered the question How stressful was this event or issue to
you? and rated their stress level from 1 =not at all to 5 =very much.
Coping was assessed with two items taken from Brief COPE (Carver, 1997)
for positive reappraisal (I’ve been trying to see it in a different light, to make it
seem more positive. I’ve been looking for something good in what is happening),
and two items taken from Response Styles Questionnaire (Treynor et al., 2003)
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Sons Ltd on behalf of International Association of Applied Psychology
for rumination (I’ve been thinking what I am doing to deserve this. I’ve been
thinking why I have problems other people don’t have). They were rephrased to
match daily evaluation. Participants were instructed to provide their answers on
a 5-point scale from 1 =I haven’t been doing this at all to 5 =I’ve been doing
this a lot, keeping in mind their coping with a central hassle. The raw values for
a given day were added and averaged for each strategy. Thus, two indicators
were obtained, with higher values indicating higher intensities of rumination and
positive reappraisal, respectively. The reliability of the measurement was satis-
factory, with lower values for within-person omega coefficient (x
w
=.59;
x
b
=.97 for positive reappraisal; x
w
=.63; x
b
=.98 for rumination).
Data Analysis
In general, we followed the pattern of data analysis proposed by Sliwinski et al.
(2009) when estimating fixed effects. We had the same hierarchical data struc-
ture, with three levels: days (Level 1), nested in bursts (Level 2), nested in per-
sons (Level 3). After obtaining intraclass correlation coefficients via an
unconditional model with random intercepts (Bolger & Laurenceau, 2013), we
started with a model in which daily affective well-being was explained by inter-
cept, time-related parameters (i.e. weekdays and bursts, and gender because of
possible differences between women and men in reporting their emotional states).
Weekdays were coded 0 for Monday and then 1, 2, 3, and 4, respectively, for
consecutive days. Analogically, bursts were coded from 0 to 2. For stress and
coping three indexes were obtained: raw daily level as described in the measures
section, burst level (an average value from all weekdays of a given burst), and
person level (an average value from all the measurement days for each person).
All these values were grand mean centered to facilitate interpretation in absolute
values (Sliwinski et al., 2009). In the second model, stress indicators were added,
followed by coping indicators in the next model and interaction daily stress 9
daily coping in the final one. Simple slopes were obtained using the calculator by
Preacher et al. (2006). All analyses were performed separately for negative affect
and positive affect as well as for rumination and positive reappraisal. Addition-
ally, in all the models we included random effects across individuals and across
bursts as well as autoregressive covariance structure (AR1) at Level 1. All the
analyses were performed using IBM SPSS Statistics Version 25.
RESULTS
Descriptive Statistics
Table 1 presents basic descriptive statistics as well as Pearson’s correlations for
aggregated data in each measurement burst. For negative affect, we noted 53 per
DAILY WELL-BEING AMONG PEOPLE WITH HIV 7
©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
Sons Ltd on behalf of International Association of Applied Psychology
cent of the variance at the daily level, 10 per cent at the burst level, and 37 per-
cent at the between-person level. These proportions were similar for positive
affect: 51 per cent, 9 per cent, and 41 per cent, at daily, burst, and person level,
respectively. Thus, with substantial intrapersonal variability and between-person
differences in affective well-being, we observed relatively small variance due to
intraindividual change.
Preliminary Analysis: Within-Person Changes of
Affective Well-Being
Results for examining within-person time effects on affective well-being are pre-
sented in Model 1 of Tables 2 and 3. As expected, there is no significant change
in well-being during the time of the study. However, a slight improvement
occurs across weekdays with the highest values of negative affect (b=.05,
p<.001) and the lowest values of positive affect (b=.05, p<.001) on Mon-
days. Gender differentiated level of positive affect, with women reporting lower
values than men (b=.29, p<.05). Nevertheless, this effect disappeared in
models including stress and coping.
TABLE 1
Descriptive Statistics and Pearson’s Correlations for Aggregated Diary Data by
Measurement Burst
Variables M SD
Pearson’s correlations
1234
First measurement burst
1. Negative affect 2.08 0.88
2. Positive affect 2.87 0.90 .56
3. Stress 2.87 1.20 .55 .28
4. Rumination 1.92 1.10 .41 .24 .24
5. Positive Reappraisal 2.95 1.08 .17 .30 .02
#
.06
#
Second measurement burst
1. Negative affect 2.11 0.92
2. Positive affect 2.86 0.93 .60
3. Stress 2.86 1.22 .63 .45
4. Rumination 1.85 1.02 .41 .27 .25
5. Positive Reappraisal 2.91 1.07 .08
#
.26 .07
#
.02
#
Third measurement burst
1. Negative affect 2.08 0.88
2. Positive affect 2.92 0.91 .54
3. Stress 2.92 1.22 .60 .42
4. Rumination 1.78 1.04 .52 .32 .35
5. Positive Reappraisal 2.83 1.19 .05
#
.27 .03
#
.10
#
Note:M=mean, SD =standard deviation.
All correlations except those marked with # are significant at p<.05.
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Sons Ltd on behalf of International Association of Applied Psychology
TABLE 2
Results of Multilevel Analyses for Stress and Rumination on the End-of-Day Affective Well-Being
Parameters
Negative affect Positive affect
Model 1
Est (SE)
Model 2
Est (SE)
Model 3
Est (SE)
Model 4
Est (SE)
Model 5
Est (SE)
Model 1
Est (SE)
Model 2
Est (SE)
Model 3
Est (SE)
Model 4
Est (SE)
Model 5
Est (SE)
Fixed effects
Intercept 2.39 (.12)*** 2.17 (.09)*** 2.16 (.08)*** 2.14 (.08)*** 2.15 (.08)*** 2.50 (.12)*** 2.66 (.11)*** 2.68 (.11)*** 2.68 (.11)*** 2.68 (.11)***
Burst .02 (.03) .01 (.02) .02 (.02) .02 (.02) .01 (.02) .03 (.03) .02 (.03) .01 (.03) .01 (.03) .01 (.03)
Day .05 (.01)*** .03 (.01)* .02 (.01)* .02 (.01)* .03 (.01)* .05 (.01)*** .03 (.01)** .03 (.01)** .03 (.01)** .03 (.01)**
Gender .19 (.12) .03 (.09) .01 (.08) .02 (.08) .01 (.08) .29 (.14)* .15 (.12) .14 (.11) .14 (.11) .14 (.11)
Stress_day .35 (.03)*** .33 (.03)*** .33 (.03)*** .33 (.03)*** .24 (.03)*** .23 (.03)*** .23 (.03)*** .23 (.03)***
Stress_week .06 (.04) .04 (.04) .05 (.04) .05 (.04) .03 (.05) .04 (.05) .03 (.05) .03 (.05)
Stress_person .14 (.07)* .06 (.07) .06 (.07) .06 (.06) .07 (.08) .01 (.08) .01 (.08) .01 (.08)
Burst x stress_day .01 (.02) .02 (.02) .01 (.02) .01 (.02) .03 (.02) .02 (.02) .03 (.02) .03 (.02)
Burst x stress_person .04 (.04) .05 (.04) .04 (.04) .04 (.04) .04 (.04) .04 (.04) .03 (.04) .03 (.04)
Rumination_day .17 (.03)*** .16 (.03)*** .17 (.03)*** .08 (.03)** .08 (.03)** .08 (.03)**
Rumination_week .04 (.05) .04 (.05) .04 (.05) .08 (.06) .08 (.06) .08 (.06)
Rumination_person .01 (.07) .01 (.07) .02 (.07) .03 (.09) .04 (.08) .04 (.09)
Burst x Rumination_
day
.02 (.03) .01 (.03) .01 (.03) .02 (.03) .02 (.05) .02 (.03)
Burst x Rumination_
person
.01 (.04) .02 (.04) .02 (.04) .03 (.05) .03 (.05) .03 (.05)
Stress_day x
Rumination_day
.07 (.01)*** .05 (.02)** .03 (.01)* .03 (.02)
Burst x Stress_day x
Rumination_day
.02 (.01) .00 (.02)
Random effects
Level 3 (between
person)
Intercept .30 (.04)*** .14 (.02) *** .10 (.02)*** .10 (.02)*** .10 (.02)*** 33 (.05)*** .28 (.04)*** .25 (.04)*** .24 (.04)*** .24 (.04)***
Stress_day .02 (.01)** .02 (.01)** .02 (.00)** .02 (.00)** .03 (.01)*** .03 (.01)*** .03 (.01)*** .03 (.01)***
Rumination_day .01 (.01)* .01 (.01) .01 (.01) .01 (.01) .01 (.01) .01 (.01)
DAILY WELL-BEING AMONG PEOPLE WITH HIV 9
©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
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TABLE 2 (Continued)
Parameters
Negative affect Positive affect
Model 1
Est (SE)
Model 2
Est (SE)
Model 3
Est (SE)
Model 4
Est (SE)
Model 5
Est (SE)
Model 1
Est (SE)
Model 2
Est (SE)
Model 3
Est (SE)
Model 4
Est (SE)
Model 5
Est (SE)
Level 2 (withinperson, across bursts)
Intercept .01 (.03) .02 (.02) .01 (.02) .01 (.02) .01 (.02) .02 (.01) .04 (.02)* .03 (.02) .03 (.02) .03 (.02)
Repeated measures
AR1 diagonal .52 (.03)*** .34 (.02)*** .31 (.02)*** .31 (.02)*** .31 (.02)*** .49 (.02)*** .35 (.02)*** .35 (.02)*** .35 (.02)*** .35 (.02)***
AR1 rho .28 (.04)*** .21 (.04)*** .20 (.05)*** .20 (.05)*** .20 (.05)*** .25 (.04)*** .13 (.05)** .13 (.05)** .13 (.05)** .13 (.05)**
Note:Est =estimate, SE =standard error.
*p<.05.
** p<.01.
*** p<.001.
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©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
Sons Ltd on behalf of International Association of Applied Psychology
TABLE 3
Results of Multilevel Analyses for Stress and Positive Reappraisal on the End-of-Day Affective Well-Being
Parameters
Negative affect Positive affect>
Model 1
Est (SE)
Model 2
Est (SE)
Model 3
Est (SE)
Model 4
Est (SE)
Model 5
Est (SE)
Model 1
Est (SE)
Model 2
Est (SE)
Model 3
Est (SE)
Model 4
Est (SE)
Model 5
Est (ss)
Fixed effects
Intercept 2.39 (.12)*** 2.17 (.09)*** 2.16 (.08)*** 2.20 (.09)*** 2.19 (.09)*** 2.50 (.12)*** 2.66 (.11)*** 2.64 (.10)*** 2.64 (.10)*** 2.65 (.10)***
Burst .02 (.03) .01 (.02) .00 (.02) .01 (.02) .00 (.02) .03 (.03) .02 (.03) .04 (.02) .04 (.02) .04 (.02)
Day .05 (.01)*** .03 (.01
)***
.04 (.01)*** .04 (.01)** .04 (.01)** .05 (.01)*** .03 (.01)** .04 (.01)*** .04 (.01)*** .04 (.01)***
Gender .19 (.12) .03 (.09) .01 (.09) .02 (.09) .02 (.09) .29 (.14)* .15 (.12) .15 (.11) .15 (.11) .14 (.11)
Stress_day .35 (.03)*** .33 (.03)*** .33 (.03)*** .33 (.03)*** .24 (.03)*** .23 (.03)*** .23 (.03)*** .23 (.03)***
Stress_week .06 (.04) .06 (.04) .07 (.04) .07 (.04) .03 (.05) .02 (.04) .01 (.04) .01 (.04)
Stress_person .14 (.07)* .14 (.06)* .13 (.06)* .13 (.06)* .07 (.08) .08 (.07) .07 (.07) .07 (.07)
Burst x stress_day .01 (.02) .00 (.02) .01 (.02) .00 (.02) .03 (.02) .03 (.02) .02 (.02) .02 (.02)
Burst x stress_person .04 (.04) .02 (.04) .02 (.04) .02 (.04) .04 (.04) .02 (.04) .03 (.04) .02 (.04)
PReapprasial_day .11 (.03)*** .11 (.03)*** .10 (.03)*** .10 (.03)** .10 (.03)** .10 (.03)**
PReapprasial_week .11 (.05)* .11 (.05)* .11 (.05)* .20 (.05)*** .20 (.05)*** .20 (.05)***
PReapprasial_person .08 (.07) .07 (.07) .06 (.07) .09 (.07) .09 (.08) .09 (.08)
Burst x PReapprasial_day .04 (.02) .03 (.02) .03 (.02) .00 (.02) .00 (.03) .00 (.03)
Burst x
PReapprasial_person
.08 (.04)* .08 (.04)* .08 (.04)* .09 (.04)* .09 (.04)* .09 (.04)*
Stress_day x
PReapprasial_day
.03 (.01)* .05 (.02)** .01 (.01) .02 (.02)
Burst x Stress_day x
PReapprasial_day
.03 (.01)* .01 (.02)
Random effects
Level 3 (betweenperson)
Intercept .30 (.04)*** .14 (.02) *** .14 (.02)*** .14 (.02)*** .14 (.02)*** 33 (.05)*** .28 (.04)*** .22 (.03)*** .22 (.03)*** .22 (.03)***
Stress_day .02 (.01)** .01 (.01)** .02 (.02)** .02 (.01)** .03 (.01)*** .03 (.01)*** .03 (.01)*** .03 (.01)***
PReapprasial_day .02 (.01)* .02 (.01)* .01 (.01)* .01 (.01) .01 (.01) .01 (.01)
DAILY WELL-BEING AMONG PEOPLE WITH HIV 11
©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
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TABLE 3 (Continued)
Parameters
Negative affect Positive affect>
Model 1
Est (SE)
Model 2
Est (SE)
Model 3
Est (SE)
Model 4
Est (SE)
Model 5
Est (SE)
Model 1
Est (SE)
Model 2
Est (SE)
Model 3
Est (SE)
Model 4
Est (SE)
Model 5
Est (ss)
Level 2 (withinperson,
across bursts)
Intercept .01 (.03) .02 (.02) .01 (.02) .00 (.01) .01 (.02) .02 (.01) .04 (.02)* .01 (.02) .01 (.02) .01 (.02)
Repeated measures
AR1 diagonal .52 (.03)*** .34 (.02)*** .33 (.02)*** .32 (.02)*** .32 (.02)*** .49 (.02)*** .35 (.02)*** .34 (.02)*** .34 (.02)*** .34 (.02)***
AR1 rho .28 (.04)*** .21 (.04)*** .20 (.05)*** .19 (.05)*** .19 (.05)*** .25 (.04)*** .13 (.05)** .13 (.05)** .11 (.05)* .11 (.05)**
Note:Est =estimate, SE =standard error, PReappraisal =positive reappraisal.
*p<.05.
** p<.01.
*** p<.001.
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Hypothesis 1: Relationship between Affective
Well-Being and Stress
The next stage of analysis is presented in Model 2. Results for negative and posi-
tive affect are highly similar. Namely, higher negative affect and lower positive
affect are related to higher daily stress (b=.35 and b=.24, p<.001, respec-
tively) and there is no incremental effect of the week-stress level. Also, a lack of
burst effect showed within-person stability of these relationships during the time
of the study. Additionally, there is a significant between-person stress effect,
noted only for negative affect (b=.14, p<.05), in that participants reporting
higher stress in general, also had higher negative affect.
Hypothesis 2: Relationship between Affective
Well-Being and Coping after Controlling for Stress
Results for each kind of coping are described separately. For rumination (Model
3 of Table 2), there is a significant positive relationship at the daily level for neg-
ative affect (b=.18, p<.001) and a negative relationship for positive affect
(b=.08, p<.01). Thus, on days with higher use of rumination, worse affec-
tive well-being is also noted. Also, the within-person slope of the relationship
between rumination and daily well-being did not change across bursts, and rumi-
native coping at the person level did not modify intraindividual change in well-
being.
For positive reappraisal (Model 3 of Table 3), although the pattern of results
is more complex, similar results are seen for both negative and positive affect.
Specifically, there is a significant relationship of affective well-being with daily
use of positive reappraisal strategies (b=.11, p<.001, and b=.10, p<.05)
as well as weekly use of these strategies (b=.11, p<.05, and b=.20,
p<.001). No main effect of between-person differences in positive reappraisal
was noted; nevertheless, this effect changes longitudinally. Specifically, with
each burst, a higher average of positive reappraisal reported by participants is
coupled with a decrease of positive affect (b=.09, p<.05) and an increase
of negative affect (b=.08, p<.05), and thus with worsening of affective well-
being.
Hypothesis 3: Interaction between Daily Stress and
Daily Coping
Finally, an interaction between daily stress and daily coping was added in Model
4 (Tables 2 and 3). It revealed that higher daily stress when accompanied by
higher rumination has a stable dampening effect on affective well-being as
shown in Figure 1. Namely, for higher daily rumination, the relationship
between daily stress and negative affect was twice as strong as for lower daily
DAILY WELL-BEING AMONG PEOPLE WITH HIV 13
©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
Sons Ltd on behalf of International Association of Applied Psychology
rumination (b
low
=.26, p<.001 vs. b
high
=.54, p<.001). Region of signifi-
cance for simple slopes indicates that for all the participants in our sample this
slope was positive and significant. Similarly, the negative relationship between
positive affect and daily stress was stronger for higher than for lower daily rumi-
nation, although this effect was less pronounced (b
low
=.20, p<.001 vs.
b
high
=.32, p<.001). Region of significance for simple slopes indicates that
for all the participants in our sample these slopes had the same negative sign and
were significant.
For positive reappraisal, there is an opposite effect but only for negative
affect: together with higher daily stress, a higher daily level of these strategies
was related to lower negative affect (b=.03, p<.05). However, this effect is
burst-related (b=.03, p<.05). Namely, for the first set of diaries it is equal to
b=.06, and significant at p=.001, whereas for the second b=.003 and
for the last b=.01, both insignificant. The simple slopes were thus probed only
(a)
(b)
1
2
3
4
5
lower higher
Daily stress
lower higher
Daily stress
Negative affect
Daily rumination
lower higher
1
2
3
4
5
Positive affect
Daily rumination
lower higher
FIGURE 1. Simple slopes for interaction between daily stress and daily rumina-
tion on negative (a) and positive affect (b).
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for the first burst, for which the positive relationship between daily stress and
negative affect is getting weaker with higher use of positive reappraisal
(b
low
=.48., p<.001 vs. b
high
=.20, p<.001), turning insignificant at a value
of around three standard deviations above the mean. However, it is outside the
range of reported daily positive reappraisal in our study; thus although different
in magnitude, this slope is significant for all the participants.
Summing up, for rumination the hypothesis was supported, whereas for posi-
tive reappraisal the positive effect was noted only for negative affect and disap-
peared with time.
DISCUSSION
The results of our study were in line with our expectations regarding the time
effects for daily affective well-being among our participants. Namely, as
expected affective well-being was longitudinally stable but a significant day
effect was noted (i.e. participants reported the highest negative affect and the
lowest positive affect on Monday with linear improvement across weekdays).
Some authors have already observed an adaptation and stability of well-being,
especially over the long term, when patients were not newly diagnosed and
when HIV is adequately controlled by the treatment (Ironson & Hayward,
2008; Tsevat et al., 2009); notably, both of these circumstances were fulfilled
among our participants. It would suggest that living with HIV, at least for
some people, might be subject to the same adaptation processes as others
described by subjective well-being theory (Lyubomirsky, 2011). Also, day-
by-day across week fluctuations were observed, which were noted earlier in
nonclinical populations. Taken together, it may suggest a high similarity of
processes underlying affective well-being among highly functional PLWH on
antiretroviral treatment to those without any diagnosis of chronic illness.
To some extent, this is also illustrated by the verification of the first
hypothesis that higher daily stress was related both to negative affect (posi-
tively) and positive affect (negatively), but at the same time no effect for
week-level stress or burst effect of stress for either positive and negative
affect has been found. With regard to the association of affect with daily
stress, this result remains intuitively obvious and well documented in the
studies on the general population (e.g. Bolger et al., 1989; Dunkley et al.,
2017). However, only very few studies with such a methodological design
have been conducted, so it may contribute to both the HIV/AIDS and affec-
tive well-being literature. The null finding regarding the link between daily
stress and affective well-being in a longitudinal perspective may again be a
sign that among PLWH short-term affective fluctuations in the aftermath of
various stressors do not necessarily translate into long-term changes in how
stress disturbs well-being (Rendina et al., 2018; Tsevat et al., 2009). Finally,
interestingly, higher reported stress at the person level had an effect only on
DAILY WELL-BEING AMONG PEOPLE WITH HIV 15
©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
Sons Ltd on behalf of International Association of Applied Psychology
negative affect and not on positive affect among our participants. This may
support a differential effect of perceived chronic stress on affective well-be-
ing with a more reactive negative affect-related system even when dealing
with relatively small stressors, such as daily hassles (Larsen & Prizmic,
2008).
When coping was added to the models, we observed some differences
between the result patterns for rumination and positive reappraisal. As
expected, higher daily rumination was related to worse affective well-being,
after controlling for stress effects, and was not modified by burst. Thus, this
was stable across time, which can be also interpreted as time-invariant. As
such, it supports this relationship more strongly than in the existing studies
(Nolen-Hoeksema et al., 2008) and those among PLWH (Kraaij et al., 2008;
Nightingale et al., 2010), since it was repeated during the time of the study
(i.e. observed at each set of diaries). However, we did not find that between-
person differences understood as a proxy of coping styles (Parker & Endler,
1992) are related to affective well-being, which is inconsistent with existing
results concerning ruminative style (Nolen-Hoeksema, 1991, 2000) and posi-
tive reappraising style (Mauss et al., 2007; Memedovic et al., 2010) as well
as studies using the diary approach (Gunaydin et al., 2016), although data on
the latter are very scarce. Nonetheless, in our study, we confirmed the
expected relationship of affective well-being with daily coping strategies and,
additionally, failed to observe it for coping styles.
Finally, we also noted a significant interaction of daily stress with daily cop-
ing. As expected in Hypothesis 3, higher daily stress when coupled with higher
rumination was related to lower affective well-being. In general, however, the
picture for positive reappraisal is more complex than for rumination. First, when
we analysed positive reappraisal at the person level, we observed worsening
affective well-being with each burst for those who reported that they generally
use this coping more intensively in the time covered by the study. Secondly, at
the level of daily coping, we noted that the beneficial effect of positive reap-
praisal strategies in the face of higher stress in terms of reducing negative affect,
present in the first diary data collection, was erased in the second and third.
Taken together, we found a stable debilitating effect of daily rumination on both
valences of affective well-being, but a disappearing beneficial effect of daily
positive reappraisal, and limited to negative affect only.
The aforementioned findings are relatively difficult to interpret as until now
no studies with such a design including coping have been conducted either
among PLWH or in other samples. However, they correspond with a large effect
for rumination and only a small to medium effect for positive reappraisal in
depression and anxiety as illustrated by meta-analyses on emotion-regulation
across psychopathology (Aldao et al., 2010). This weaker effect of positive reap-
praisal could be explained by significant between-person variability; Brockman
et al. (2017) found that for some people higher daily reappraisal was related to
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©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
Sons Ltd on behalf of International Association of Applied Psychology
lower negative affect, whereas for others it was related to higher negative affect.
Thus, in real life outcomes of positive appraisal are not necessarily so unified
and beneficial as assumed (McMahon & Naragon-Gainey, 2018), not only at the
daily level, but also at the person level. Kuppens et al. (2012) showed a signifi-
cant cross-sectional as well as a predictive effect of emotional inertia on depres-
sion. Interestingly, this deleterious carry-over was noted for both negative and
positive emotions, which suggests a crucial role of the flexibility of emotional
responses (note that a positive autoregressive correlation was indicated for both
positive and negative affect in our study). Therefore, the lack of this flexibility
could be reflected in a diminishing beneficial effect of adaptive strategies and an
increasing debilitating effect of maladaptive strategies. The former was noted in
our study; however, how it translates into escalation of symptomology requires
observation of trajectories within longer periods of time (Kuppens et al., 2012;
Pavani et al., 2017).
Nonetheless, we still have to keep in mind that in our study on average we
observed neither an increase of negative affect nor a decrease of positive affect
across bursts, so the aforementioned effects do not have a profound impact on
affective well-being. Rather, the findings support the stability of affective well-
being and may also explain how it is regulated to maintain this stability. It is also
worth noting that person-related stability assumes that interindividual differences
in well-being exist as indicated by significant random intercepts and the afore-
mentioned time-related effect of overall use of positive reappraisal. Additionally,
their sources other than time, gender, stress, and coping were not accounted for
in our study.
Still, this study has several strengths. To the best of our knowledge, it is
the first study using three bursts of daily diaries with this particular set of
study variables and with a relatively large sample size of participants. The
added value of our research lies also in the analysis of long-term usual daily
functioning of PLWH when dealing with different hassles, a topic greatly
neglected in the HIV/AIDS literature. Nevertheless, some limitations should
also be underscored. First, in this study, we did not control for several
sociodemographic and clinical variables which may be related to the obtained
pattern of findings, particularly as our sample should be regarded as highly
functional and with well-controlled medical symptoms. Future studies should
concentrate on more heterogeneous samples of PLWH with regard to their
socioeconomic status and HIV infection progression. Second, all the variables
were assessed by self-description and only one item was used for stress
assessment. Thus, future studies in that area could focus on a more compre-
hensive assessment of stress related to daily hassles. Finally, our study shares
shortcomings typical of all diary studies, including a highly demanding proto-
col for participants, which could influence the results in many ways. In our
case, of special importance is sample-selection bias, the percentage of missing
data and the potential intervening impact of repeated measures (Bolger &
DAILY WELL-BEING AMONG PEOPLE WITH HIV 17
©2020 The Authors. Applied Psychology: Health and Well-Being published by John Wiley &
Sons Ltd on behalf of International Association of Applied Psychology
Laurenceau, 2013). However, no significant intraindividual change was
observed (Newcomb et al., 2018), suggesting the limited nature of measure-
ment reactivity (Shrout et al., 2018). Even if the observed time-related inter-
action effect is suspected to be a result of attenuation, still it would be
intriguing to discover why this effect was noted only for positive reappraisal.
Verification of this finding requires further research.
Despite these limitations, we revealed a debilitating effect of high daily
rumination on affective well-being, especially when coupled with high stress,
and a beneficial effect of daily positive reappraisal, especially when coupled
with high stress, but only for negative affect. Additionally, a completely new
result is that we found stability of the stress 9rumination effect and a fading
of the stress 9positive reappraisal effect. Thus, we identified possible short-
comings of using a single set of diaries, which is a diary design dominating
contemporary research on the daily life of PLWH (e.g. Fazeli et al., 2017;
Rendina et al., 2018), and showed the potential of using a burst design. This
study illustrates that although we are still quite far from “capturing life as it
is lived”(Bolger et al., 2003), we are equipped with tools to make more a
reliable approximation of these real-life processes. Hopefully, it would lead to
more effective stress management interventions, which are now increasingly
taking the form of mobile applications, tailored to the everyday lives of
patients with chronic medical conditions in their natural environment (Barroso
et al., 2019).
ACKNOWLEDGEMENTS
This study was founded by the National Science Center, Poland, research project
no. 2016/23/D/HS6/02943.
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