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Evidence for a causal-mechanistic role for positive appraisal style in stress resilience
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Abstract
Stress resilience is the maintenance of mental health despite adversity. We have predicted that a tendency to appraise stressors in a realistic to slightly unrealistically positive fashion (positive appraisal style, PAS) is prospectively associated with more resilient outcomes; that PAS is a proximal and integrative resilience factor, mediating the pro-resilience effects of other protective factors (e.g., social support); and that PAS is modifiable, with changes in PAS leading to corresponding changes in resilience. In two independent observational samples (N=132 and N=1034), we find PAS to predict resilience over three and more years and to mediate the positive effects of social support. Analyzing the effects of a multi-component intervention (N=232) that targets a broad set of resilience factors, we find that the intervention increases PAS and that this prospectively mediates the intervention-induced increases in resilience. This establishes PAS as a proximal and plastic resilience factor with likely causal effects on resilience.
... Second, the app could serve as an add-on to the therapy as usual when therapists notice high perceived stress or deficits in PCR use. Mastering PCR, improving flexibility to switch between PCR tactics, and raising awareness for domains and severity of stressors could be crucial for successful emotion regulation in patients and increased stress resilience (Petri-Romão et al., 2024). ...
This study investigates the role of positive cognitive reappraisal (PCR) flexibility and variability in mental health in response to real-life stressors among college students. We employed ecological momentary assessment and intervention through ReApp, a mobile app designed to train and promote PCR. We analyzed data from the intervention groups across three randomized trials with a total of 163 participants who used ReApp for either one or three weeks. Stressors due to health problems, uncomfortable environment (e.g., rainy weather, crowded buses, etc.), and lack of time were reported most frequently. Stressors related to the war in Ukraine, fear of the future, exams, and COVID-19 were reported as the most severe. To reappraise these stressors, the participants used mostly acceptance and learning tactics. A key finding is the role of emotional demand–dependent PCR flexibility in mental health. Specifically, the flexible adaptation of PCR tactics in response to stressor severity was associated with a more substantial decline in perceived stress over the study period among participants reporting low tendency to use PCR at the study’s baseline (B = -0.963, p = .016, Cohen’s f = 0.26). In contrast, stressor domain–dependent flexibility and contextually independent between-tactic variability had no moderating effect on stress, depression, and anxiety symptoms. This study contributes to the field of emotion regulation flexibility by highlighting the adaptive role of emotional demand–dependent PCR flexibility in mental well-being among young adults navigating real-life stressors and underscores the importance of tailoring interventions based on the emotional demands of stressors.
People with Parkinson’s disease (PD) are sensitive to effects of long-term stress, but might differ in stress resilience, i.e. the ability to maintain mental health despite adversity. It is unclear whether stress resilience in PD is predominantly determined by dopamine deficiency, psychosocial factors, or both. In PD animal models, chronic stressors accelerate disease progression, but evidence in humans is lacking. Our objectives were to (1) distinguish stressor-reactive from resilient PD patients, (2) identify resilience factors, and (3) compare symptom progression between stressor-reactive and resilient patients. We conducted a longitudinal survey in Personalized Parkinson Project participants ( N = 350 PD). We used the COVID-19 pandemic as a model of a stressor, aligned in time for the entire cohort. COVID-19-related stressors, perceived stress, and PD symptoms were assessed at 11 timepoints (April-October 2020). Both pre-COVID and in-COVID clinical assessments were available. We quantified stressor-reactivity as the residual between actual and predicted perceived stress relative to COVID-19-related stressors, and modeled trajectories of stressor-reactivity across timepoints. We explored pre-COVID predictors of 6-month average stressor-reactivity, and tested whether stressor-reactivity was prospectively associated with one-year clinical progression rates. Latent class trajectory models distinguished patients with high ( N = 123) or low ( N = 227) stressor-reactivity. Pre-existing anxiety, rumination and non-motor symptom severity predicted high stressor-reactivity (risk factors), whereas quality of life, social support, positive appraisal style and cognitive abilities predicted low stressor-reactivity (resilience factors). PD-specific factors, e.g. disease duration, motor severity, and levodopa use, did not predict stressor-reactivity. The COVID-19 pandemic did not accelerate disease progression, but worsened depressive symptoms in stressor-reactive PD patients.
Positive Appraisal Style Theory of Resilience posits that a person’s general style of evaluating stressors plays a central role in mental health and resilience. Specifically, a tendency to appraise stressors positively (positive appraisal style; PAS) is theorized to be protective of mental health and thus a key resilience factor. To this date no measures of PAS exist. Here, we present two scales that measure perceived positive appraisal style, one focusing on cognitive processes that lead to positive appraisals in stressful situations (PASS-process), and the other focusing on the appraisal contents (PASS-content). For PASS-process, the items of the existing questionnaires Brief COPE and CERQ-short were analyzed in exploratory and confirmatory factor analyses (EFA, CFA) in independent samples (N = 1157 and N = 1704). The resulting 10-item questionnaire was internally consistent (α = .78, 95% CI [.86, .87]) and showed good convergent and discriminant validity in comparisons with self-report measures of trait optimism, neuroticism, urgency, and spontaneity. For PASS-content, a newly generated item pool of 29 items across stressor appraisal content dimensions (probability, magnitude, and coping potential) were subjected to EFA and CFA in two independent samples (N = 1174 and N = 1611). The resulting 14-item scale showed good internal consistency (α = .87, 95% CI [.86, .87]), as well as good convergent and discriminant validity within the nomological network. The two scales are a new and reliable way to assess self-perceived positive appraisal style in large-scale studies, which could offer key insights into mechanisms of resilience.
Background: Major life events can lead to depression in adulthood. However, as predicted by several depression theories, not only the mere occurrence of major life events but also the way people perceive them determines the onset of a depression.
Methods: Based on a systematic literature search, we identified 276 studies (Ntotal = 89,600) that examined the relationship between the perception of major life events and depression. We provide an overview of how this relationship has been examined. Furthermore, we meta-analytically integrated 420 effect sizes (172 studies) on the association between the perception of major life events and depression.
Results: Most studies relied on college student samples, were cross-sectional, and were conducted in the United States. A more negative perception of events was significantly associated with higher levels of depressive symptoms (r = .28). This association was robust across several design and sample characteristics. Furthermore, the perception of major life events and depression were also longitudinally associated with each other (event perception predicting later depressive symptoms: r = .26; depressive symptoms predicting later event perception: r = .17).
Limitations: Longitudinal research on the relationship between depression and the perception of major life events was relatively rare impairing definite conclusions on whether the perception of life events can predict changes in depressive symptoms over time.
Conclusion: The perception of major life events is related to depression. However, further longitudinal research considering a range of different perceived event characteristics and using non-Western heterogeneous samples is needed to better understand their relationship.
Introduction
Although the COVID-19 pandemic has severely affected wellbeing of at-risk groups, most research on resilience employed convenience samples. We investigated psychosocial resilience and risk factors (RFs) for the wellbeing of psychotherapists and other mental health practitioners, an under-researched population that provides essential support for other at-risk groups and was uniquely burdened by the pandemic.
Method
We examined 18 psychosocial factors for their association with resilience, of which four were chosen due to their likely relevance specifically for therapists, in a cross-sectional multi-national sample ( N = 569) surveyed between June and September 2020. Resilience was operationalized dimensionally and outcome-based as lower stressor reactivity (SR), meaning fewer mental health problems than predicted given a participant’s levels of stressor exposure. General SR (SR G ) scores expressed reactivity in terms of general internalizing problems, while profession-specific SR (SR S ) scores expressed reactivity in terms of burnout and secondary trauma, typical problems of mental health practitioners.
Results
Factors previously identified as RFs in other populations, including perceived social support, optimism and self-compassion, were almost all significant in the study population (SR G : 18/18 RFs, absolute βs = 0.16–0.40; SR S : 15/18 RFs, absolute βs = 0.19–0.39 all P s < 0.001). Compassion satisfaction emerged as uniquely relevant for mental health practitioners in regularized regression.
Discussion
Our work identifies psychosocial RFs for mental health practitioners’ wellbeing during crisis. Most identified factors are general, in that they are associated with resilience to a wider range of mental health problems, and global, in that they have also been observed in other populations and stressor constellations.
Background
Cross-sectional relationships between psychosocial resilience factors (RFs) and resilience, operationalized as the outcome of low mental health reactivity to stressor exposure (low “stressor reactivity” [SR]), were reported during the first wave of the COVID-19 pandemic in 2020.
Objective
Extending these findings, we here examined prospective relationships and weekly dynamics between the same RFs and SR in a longitudinal sample during the aftermath of the first wave in several European countries.
Methods
Over 5 weeks of app-based assessments, participants reported weekly stressor exposure, mental health problems, RFs, and demographic data in 1 of 6 different languages. As (partly) preregistered, hypotheses were tested cross-sectionally at baseline (N=558), and longitudinally (n=200), using mixed effects models and mediation analyses.
Results
RFs at baseline, including positive appraisal style (PAS), optimism (OPT), general self-efficacy (GSE), perceived good stress recovery (REC), and perceived social support (PSS), were negatively associated with SR scores, not only cross-sectionally (baseline SR scores; all P<.001) but also prospectively (average SR scores across subsequent weeks; positive appraisal (PA), P=.008; OPT, P<.001; GSE, P=.01; REC, P<.001; and PSS, P=.002). In both associations, PAS mediated the effects of PSS on SR (cross-sectionally: 95% CI –0.064 to –0.013; prospectively: 95% CI –0.074 to –0.0008). In the analyses of weekly RF-SR dynamics, the RFs PA of stressors generally and specifically related to the COVID-19 pandemic, and GSE were negatively associated with SR in a contemporaneous fashion (PA, P<.001; PAC,P=.03; and GSE, P<.001), but not in a lagged fashion (PA, P=.36; PAC, P=.52; and GSE, P=.06).
Conclusions
We identified psychological RFs that prospectively predict resilience and cofluctuate with weekly SR within individuals. These prospective results endorse that the previously reported RF-SR associations do not exclusively reflect mood congruency or other temporal bias effects. We further confirm the important role of PA in resilience.
There is increasing evidence that resilience in youth may have a neurobiological basis. However, the existing literature lacks a consistent way of operationalizing resilience, often relying on arbitrary judgments or narrow definitions (e.g., not developing PTSD) to classify individuals as resilient. Therefore, this study used data-driven, continuous resilience scores based on adversity and psychopathology to investigate associations between resilience and brain structure in youth. Structural MRI data from 298 youth aged 9-18 years (Mage = 13.51; 51% female) who participated in the European multisite FemNAT-CD study were preprocessed using SPM12 and analyzed using voxel-based morphometry. Resilience scores were derived by regressing data on adversity exposure against current/lifetime psychopathology and quantifying each individual's distance from the regression line. General linear models tested for associations between resilience and gray matter volume (GMV) and examined whether associations between resilience and GMV differed by sex. Resilience was positively correlated with GMV in the right inferior frontal and medial frontal gyri. Sex-by-resilience interactions were observed in the middle temporal and middle frontal gyri. These findings demonstrate that resilience in youth is associated with volume in brain regions implicated in executive functioning, emotion regulation, and attention. Our results also provide evidence for sex differences in the neurobiology of resilience.
Background
Evidence-based mental health interventions to support healthcare workers (HCWs) in crisis settings are scarce.
Objective
To evaluate the capacity of a mental health intervention in reducing anxiety and depression symptoms in HCWs, relative to enhanced care as usual (eCAU), amidst the COVID-19 pandemic.
Methods
We conducted an analyst-blind, parallel, multicentre, randomised controlled trial. We recruited HCWs with psychological distress from Madrid and Catalonia (Spain). The intervention arm received a stepped-care programme consisting of two WHO-developed interventions adapted for HCWs: Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+). Each intervention lasted 5 weeks and was delivered remotely by non-specialist mental health providers. HCWs reporting psychological distress after DWM completion were invited to continue to PM+. The primary endpoint was self-reported anxiety/depression symptoms (Patient Health Questionnaire-Anxiety and Depression Scale) at week 21.
Findings
Between 3 November 2021 and 31 March 2022, 115 participants were randomised to stepped care and 117 to eCAU (86% women, mean age 37.5). The intervention showed a greater decrease in anxiety/depression symptoms compared with eCAU at the primary endpoint (baseline-adjusted difference 4.4, 95% CI 2.1 to 6.7; standardised effect size 0.8, 95% CI 0.4 to 1.2). No serious adverse events occurred.
Conclusions
Brief stepped-care psychological interventions reduce anxiety and depression during a period of stress among HCWs.
Clinical implications
Our results can inform policies and actions to protect the mental health of HCWs during major health crises and are potentially rapidly replicable in other settings where workers are affected by global emergencies.
Trial registration number
NCT04980326 .
Emotion regulation is essential to survive in a world full of challenges with rapidly changing contextual demands. The ability to flexibly shift between different emotional control strategies is critical to successfully deal with these demands. Recently, decision neuroscience has shown the importance of monitoring alternative control strategies. However, this insight has not been incorporated into current neurocognitive models of emotional control. Here, we integrate insights from decision and affective sciences into a novel viewpoint on emotion control, the Flexible Emotion Control Theory (FECT). This theory explains how an individual can flexibly change emotion‐regulatory behavior to adapt to varying goals and contextual demands. Crucially, FECT proposes that rapid switching between alternative emotional control strategies requires concurrent evaluation of current as well as alternative (unchosen) options. The neural implementation of FECT relies on the involvement of distinct prefrontal structures, including the lateral frontal pole (FPl) and its connections with other cortical (prefrontal, parietal, motor) and subcortical systems. This novel account of emotion control integrates insights from decision sciences, clinical research, as well as meta‐analytic evidence for the consistent FPl involvement during emotional control when monitoring of alternative emotional control strategies is required. Moreover, it provides novel, neurocognitively grounded starting points for interventions to improve emotion control in affective disorders, such as anxiety and aggression.
Middle-aged adults are a central pillar of society because they comprise large segments of the workforce and bridge younger and older generations. Given the significant role that middle-aged adults play for the greater good of society, more research is warranted to evaluate in which ways adversity could accumulate or pile-up to impact pertinent outcomes. We used data from a sample of middle-aged adults (n = 317, age 50–65 at baseline, 55% women) who were assessed monthly for a period of 2 years to examine whether the accumulation of adversity was predictive of depressive symptoms, life satisfaction, and character strengths (generativity, gratitude, the presence of meaning, and search for meaning). Greater accumulation of adversity was associated with reporting more depressive symptoms, lower life satisfaction, and the lower presence of meaning and the effects remained for depressive symptoms when accounting for concurrent adversity. More concurrent adversity was associated with reporting more depressive symptoms and lower life satisfaction and lower levels of generativity, gratitude, and the presence of meaning. Analyses that targeted specific domains of adversity showed that the accumulation of adversity associated with close family members (i.e., spouse/partner, children, and parents), and financial, and work domains showed the strongest (negative) associations across each outcome. Our findings demonstrate that monthly adversity take its toll on pertinent midlife outcomes and points to future research targeting mechanisms underlying our findings as well as resources that promote positive outcomes.
The COVID-19 pandemic has resulted in a major societal disruption, raising the question of how people can maintain or quickly regain their mental health (i.e., be resilient) during such times. Researchers have used the pandemic as a use case for studying resilience in response to a global, synchronously starting, and chronic set of stressors on the individual and societal level. Our review of this recent literature reveals that mental distress trajectories during the pandemic largely resemble mental distress responses to individual-level macro-stressors, except for a lower prevalence of recovery trajectories. Results suggest more resilient responses in older adults, but trajectories are less consistent for younger and older ages compared with middle-aged adults. We call for more research integrating state-of-the-art operationalizations of resilience and using these to study resilience over the lifespan.
Background and aims
The coronavirus disease 2019 pandemic has challenged health services worldwide, with a worsening of healthcare workers’ mental health within initial pandemic hotspots. In early 2022, the Omicron variant is spreading rapidly around the world. This study explores the effectiveness and cost-effectiveness of a stepped-care programme of scalable, internet-based psychological interventions for distressed health workers on self-reported anxiety and depression symptoms.
Methods
We present the study protocol for a multicentre (two sites), parallel-group (1:1 allocation ratio), analyst-blinded, superiority, randomised controlled trial. Healthcare workers with psychological distress will be allocated either to care as usual only or to care as usual plus a stepped-care programme that includes two scalable psychological interventions developed by the World Health Organization: A guided self-help stress management guide (Doing What Matters in Times of Stress) and a five-session cognitive behavioural intervention (Problem Management Plus). All participants will receive a single-session emotional support intervention, namely psychological first aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire – Anxiety and Depression Scale summary score at 21 weeks from baseline. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, cost impact and cost-effectiveness.
Conclusions
This study is the first randomised trial that combines two World Health Organization psychological interventions tailored for health workers into one stepped-care programme. Results will inform occupational and mental health prevention, treatment, and recovery strategies.
Registration details
ClinicalTrials.gov Identifier: NCT04980326.
Background
Healthcare workers (HCWs) from COVID-19 hotspots worldwide have reported poor mental health outcomes since the pandemic's beginning. The virulence of the initial COVID-19 surge in Spain and the urgency for rapid evidence constrained early studies in their capacity to inform mental health programs accurately. Here, we used a qualitative research design to describe relevant mental health problems among frontline HCWs and explore their association with determinants and consequences and their implications for the design and implementation of mental health programs.
Materials and methods
Following the Programme Design, Implementation, Monitoring, and Evaluation (DIME) protocol, we used a two-step qualitative research design to interview frontline HCWs, mental health experts, administrators, and service planners in Spain. We used Free List (FL) interviews to identify problems experienced by frontline HCWs and Key informant (KI) interviews to describe them and explore their determinants and consequences, as well as the strategies considered useful to overcome these problems. We used a thematic analysis approach to analyze the interview outputs and framed our results into a five-level social-ecological model (intrapersonal, interpersonal, organizational, community, and public health).
Results
We recruited 75 FL and 22 KI interviewees, roughly balanced in age and gender. We detected 56 themes during the FL interviews and explored the following themes in the KI interviews: fear of infection, psychological distress, stress, moral distress, and interpersonal conflicts among coworkers. We found that interviewees reported perceived causes and consequences across problems at all levels (intrapersonal to public health). Although several mental health strategies were implemented (especially at an intrapersonal and interpersonal level), most mental health needs remained unmet, especially at the organizational, community, and public policy levels.
Conclusions
In keeping with available quantitative evidence, our findings show that mental health problems are still relevant for frontline HCWs 1 year after the COVID-19 pandemic and that many reported causes of these problems are modifiable. Based on this, we offer specific recommendations to design and implement mental health strategies and recommend using transdiagnostic, low-intensity, scalable psychological interventions contextually adapted and tailored for HCWs.
Background
Resilience is broadly defined as the ability to maintain or regain functioning in the face of adversity. Recent work to harmonise the quantification and definition of resilience quantifies resilience as the residual variance in psychosocial functioning that remains after accounting for adversity exposure. However, there have been no published studies that have formally investigated the validity of this approach. Considering this, we examine the construct and predictive validity of the residuals approach using participants from the Avon Longitudinal Study of Parents and Children (ALSPAC), a multigenerational, longitudinal cohort study.
Methods
We regressed exposures of adolescent adversity on adolescent psychopathology scores using the Strength and Difficulties Questionnaire and obtained the residual variance. We investigated construct validity by analysing whether previously identified demographic and resilience factors significantly predicted resilience. Predictive validity of resilience was investigated by comparing the predictive power of resilience with other determinants of psychosocial functioning on two developmental outcomes: depressive symptoms at 18 years, measured by the Short Moods and Feelings Questionnaire, and NEET (Not in Employment, Education or Training) status at 17 and 23 years. The associations between depressive symptoms at 18, resilience, ACEs and covariates were tested using multiple linear regression. NEET status at 17 and 23 were run as separate binary multiple logistic regression models to test associations with resilience and known demographics previously associated with NEET status.
Results
Seven previously identified protective factors, including self-esteem, positive sibling relationship, temperament, and positive perception of school, significantly predicted resilience to adolescent psychopathology, thus providing strong construct validity. Resilience significantly predicted a reduction in depressive symptoms at 18 years, and significantly decreased the likelihood of having NEET status at both 17 years and 23 years, even after taking into account early childhood adversity and other risk factors. None of the socioeconomic factors were significantly associated with resilience.
Conclusions
Our study demonstrates that the residuals method of operationalising resilience has good construct and predictive validity yet recommend replication studies. It has the potential to advance research into the mechanisms and modifiability of resilience.
Trial Registration: Not applicable.
Social-evaluative stressors—experiences when the self could be negatively judged by others—pose a major threat to adolescent health via their effects on internalizing disorders, such as anxiety and depression. Preventative interventions to help adolescents improve their responses to social-evaluative stressors, however, have rarely been effective. Here we show that replicable benefits for adolescents’ stress responses can be achieved with a short (~30-minute), scalable synergistic mindsets intervention. This intervention, which is a self-administered online training module, synergistically targets both growth mindsets (the idea that people’s intelligence can be developed in response to challenge) and stress-can-be-enhancing mindsets (the idea that people’s stress responses can fuel optimal performance). In six double-blind, randomized, controlled experiments conducted with youth in grades 8-12 and in undergraduate education, the synergistic mindsets intervention improved stress-related cognitions—the immediate target of the intervention (Studies 1-2, N = 3,472)—and a cascade of stress-linked outcomes: cardiovascular reactivity (Studies 3, N = 160; Study 4, N = 200), cortisol levels (Study 5, N = 118 students, n = 1,213 observations), psychological well-being (Studies 4-5), course pass rates (Study 5), and anxiety symptoms during the 2020 COVID-19 lockdowns (Study 6, N = 341). Evidence that the two mindsets worked synergistically came from heterogeneity analyses showing stronger effects among participants holding both negative mindsets at baseline (Studies 3, 5, and 6) and from a four-cell experiment that showed stronger effects of the synergistic mindsets intervention relative to changing single mindsets alone (Study 4). Confidence in these conclusions is rooted in a conservative, Bayesian machine-learning statistical method for detecting heterogeneous effects.
The global public health crisis caused by COVID-19 has lasted longer than many of us would have hoped and expected. With its high uncertainty and limited control, the COVID-19 pandemic has undoubtedly asked a lot from all of us. One important central question is: how resilient have we proved in face of the unprecedented and prolonged coronavirus pandemic? There is a vast and rapidly growing literature that has examined the impact of the pandemic on mental health both on the shorter (2020) and longer (2021) term. This not only concerns pandemic-related effects on resilience in the general population, but also how the pandemic has challenged stress resilience and mental health outcomes across more specific vulnerable population groups: patients with a psychiatric disorder, COVID-19 diagnosed patients, health care workers, children and adolescents, pregnant women, and elderly people. It is challenging to keep up to date with, and interpret, this rapidly increasing scientific literature. In this review, we provide a critical overview on how the COVID-19 pandemic has impacted mental health and how human stress resilience has been shaped by the pandemic on the shorter and longer term. The vast literature is dominated by a wealth of data which are, however, not always of the highest quality and heavily depend on online and self-report surveys. Nevertheless, it appears that we have proven surprisingly resilient over time, with fast recovery from COVID-19 measures. Still, vulnerable groups such as adolescents and health care personnel that have been severely impacted by the COVID-19 pandemic do exist. Large interindividual differences exist, and for future pandemics there is a clear need to comprehensively and integratively assess resilience from the start to provide personalized help and interventions tailored to the specific needs for vulnerable groups.
Resilience has been defined as the maintenance or quick recovery of mental health during and after times of adversity. How to operationalize resilience and to determine the factors and processes that lead to good long-term mental health outcomes in stressor-exposed individuals is a matter of ongoing debate and of critical importance for the advancement of the field. One of the biggest challenges for implementing an outcome-based definition of resilience in longitudinal observational study designs lies in the fact that real-life adversity is usually unpredictable and that its substantial qualitative as well as temporal variability between subjects often precludes defining circumscribed time windows of inter-individually comparable stressor exposure relative to which the maintenance or recovery of mental health can be determined. To address this pertinent issue, we propose to frequently and regularly monitor stressor exposure (E) and mental health problems (P) throughout a study's observation period [Frequent Stressor and Mental Health Monitoring (FRESHMO)-paradigm]. On this basis, a subject's deviation at any single monitoring time point from the study sample's normative E–P relationship (the regression residual) can be used to calculate that subject's current mental health reactivity to stressor exposure (“stressor reactivity,” SR). The SR score takes into account the individual extent of experienced adversity and is comparable between and within subjects. Individual SR time courses across monitoring time points reflect intra-individual temporal variability in SR, where periods of under-reactivity (negative SR score) are associated with accumulation of fewer mental health problems than is normal for the sample. If FRESHMO is accompanied by regular measurement of potential resilience factors, temporal changes in resilience factors can be used to predict SR time courses. An increase in a resilience factor measurement explaining a lagged decrease in SR can then be considered to index a process of adaptation to stressor exposure that promotes a resilient outcome (an allostatic resilience process). This design principle allows resilience research to move beyond merely determining baseline predictors of resilience outcomes, which cannot inform about how individuals successfully adjust and adapt when confronted with adversity. Hence, FRESHMO plus regular resilience factor monitoring incorporates a dynamic-systems perspective into resilience research.
In this chapter, the authors show how studying stressor appraisal and resulting adaptive coping potentially provides a parsimonious explanation of psychological resilience. Extra-individual factors such as social support, favorable environmental conditions, or positive cultural influences have all been found to be associated with people maintaining mental health in the face of adversity. It thus appears logical that the inclusion of extra-individual factors into models of psychological resilience will improve our understanding of the concept. However, these multisystemic approaches to resilience sometimes ignore that the presence of adversity is an essential part of the concept of psychological resilience: some individuals stay mentally healthy despite being exposed to significant stressors. As a consequence, extra-individual factors that reduce or limit individuals’ overall exposure to stressors (e.g., material support, healthy living conditions, safe neighborhoods) may be beneficial for their mental health, but they do not, as such, inform about resilience. Classifying these buffers as resilience factors blurs the resilience concept, because by removing stressors they remove a driving force for mental health deteriorations rather than help individuals to not let the stressors drive mental health changes. The authors argue that the primary mechanism for mental health in contexts of stressor exposure remains individual appraisal of difficult situations in a way that produces adaptive stress reactions. These reactions promote coping with the threat but do not overly burden or unnecessarily consume an organism’s resources, thereby containing the deleterious consequences of stressor exposure on mental health.
Abstract The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts on mental health. Although increases in stress-related symptomatology and other adverse psycho-social outcomes, as well as their most important risk factors have been described, hardly anything is known about potential protective factors. Resilience refers to the maintenance of mental health despite adversity. To gain mechanistic insights about the relationship between described psycho-social resilience factors and resilience specifically in the current crisis, we assessed resilience factors, exposure to Corona crisis-specific and general stressors, as well as internalizing symptoms in a cross-sectional online survey conducted in 24 languages during the most intense phase of the lockdown in Europe (22 March to 19 April) in a convenience sample of N = 15,970 adults. Resilience, as an outcome, was conceptualized as good mental health despite stressor exposure and measured as the inverse residual between actual and predicted symptom total score. Preregistered hypotheses (osf.io/r6btn) were tested with multiple regression models and mediation analyses. Results confirmed our primary hypothesis that positive appraisal style (PAS) is positively associated with resilience (p
Resilience is the maintenance and/or quick recovery of mental health during and after periods of adversity. It is conceptualized to result from a dynamic process of successful adaptation to stressors. Up to now, a large number of resilience factors have been proposed, but the mechanisms underlying resilience are not yet understood. To shed light on the complex and time-varying processes of resilience that lead to a positive long-term outcome in the face of adversity, the Longitudinal Resilience Assessment (LORA) study has been established. In this study, 1191 healthy participants are followed up at 3- and 18-month intervals over a course of 4.5 years at two study centers in Germany. Baseline and 18-month visits entail multimodal phenotyping, including the assessment of mental health status, sociodemographic and lifestyle variables, resilience factors, life history, neuropsychological assessments (of proposed resilience mechanisms), and biomaterials (blood for genetic and epigenetic, stool for microbiome, and hair for cortisol analysis). At 3-monthly online assessments, subjects are monitored for subsequent exposure to stressors as well as mental health measures, which allows for a quantitative assessment of stressor-dependent changes in mental health as the main outcome. Descriptive analyses of mental health, number of stressors including major life events, daily hassles, perceived stress, and the ability to recover from stress are here presented for the baseline sample. The LORA study is unique in its design and will pave the way for a better understanding of resilience mechanisms in humans and for further development of interventions to successfully prevent stress-related disorder.
The incorporation of causal inference in mediation analysis has led to theoretical and methodological advancements-effect definitions with causal interpretation, clarification of assumptions required for effect identification, and an expanding array of options for effect estimation. However, the literature on these results is fast-growing and complex, which may be confusing to researchers unfamiliar with causal inference or unfamiliar with mediation. The goal of this article is to help ease the understanding and adoption of causal mediation analysis. It starts by highlighting a key difference between the causal inference and traditional approaches to mediation analysis and making a case for the need for explicit causal thinking and the causal inference approach in mediation analysis. It then explains in as-plain-as-possible language existing effect types, paying special attention to motivating these effects with different types of research questions, and using concrete examples for illustration. This presentation differentiates 2 perspectives (or purposes of analysis): the explanatory perspective (aiming to explain the total effect) and the interventional perspective (asking questions about hypothetical interventions on the exposure and mediator, or hypothetically modified exposures). For the latter perspective, the article proposes tapping into a general class of interventional effects that contains as special cases most of the usual effect types-interventional direct and indirect effects, controlled direct effects and also a generalized interventional direct effect type, as well as the total effect and overall effect. This general class allows flexible effect definitions which better match many research questions than the standard interventional direct and indirect effects. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
BACKGROUND:
Many existing scales for microstressor assessment do not differentiate between objective (ie, observable) stressor events and stressful cognitions or concerns. They often mix items assessing objective stressor events with items measuring other aspects of stress, such as perceived stressor severity, the evoked stress reaction, or further consequences on health, which may result in spurious associations in studies that include other questionnaires that measure such constructs. Most scales were developed several decades ago; therefore, modern life stressors may not be represented. Ecological momentary assessment (EMA) allows for sampling of current behaviors and experiences in real time and in the natural habitat, thereby maximizing the generalization of the findings to real-life situations (ie, ecological validity) and minimizing recall bias. However, it has not been used for the validation of microstressor questionnaires so far.
OBJECTIVE:
The aim is to develop a questionnaire that (1) allows for retrospective assessment of microstressors over one week, (2) focuses on objective (ie, observable) microstressors, (3) includes stressors of modern life, and (4) separates stressor occurrence from perceived stressor severity.
METHODS:
Cross-sectional (N=108) and longitudinal studies (N=10 and N=70) were conducted to evaluate the Mainz Inventory of Microstressors (MIMIS). In the longitudinal studies, EMA was used to compare stressor data, which was collected five times per day for 7 or 30 days with retrospective reports (end-of-day, end-of-week). Pearson correlations and multilevel modeling were used in the analyses.
RESULTS:
High correlations were found between end-of-week, end-of-day, and EMA data for microstressor occurrence (counts) (r≥.69 for comparisons per week, r≥.83 for cumulated data) and for mean perceived microstressor severity (r≥.74 for comparisons per week, r≥.85 for cumulated data). The end-of-week questionnaire predicted the EMA assessments sufficiently (counts: beta=.03, 95% CI .02-.03, P<.001; severity: beta=.73, 95% CI .59-.88, P<.001) and the association did not change significantly over four subsequent weeks.
CONCLUSIONS:
Our results provide evidence for the ecological validity of the MIMIS questionnaire.
Resilience is the maintenance or rapid recovery of mental health during and after stressor exposure. It is becoming increasingly clear that resilience results from a complex and dynamic process of adaptation to stressors involving the biological, psychological and social levels. Positive appraisal style theory of resilience (PASTOR) claims that the common final pathway to maintained mental health lies in the non-negative (non-catastrophizing, non- pessimistic) appraisal of potential stressors, permitting the organism to fine-tune stress responses to optimal levels, thus avoiding unnecessary stress, inefficient deployment of resources and concomitant deleterious allostatic load effects. Successful adaptation consists in developing or strengthening a positive appraisal style. Another key element of PASTOR is that a positive appraisal style is strongly determined by the efficacy and efficiency of the neural and cognitive processes that underlie positive stressor appraisal. We here present a combined behavioral and functional magnetic resonance imaging (fMRI) battery designed to assess such processes repeatedly in longitudinal settings. The battery includes tests of stress reactivity and recovery, reward sensitivity, safety learning and memory in the context of fear conditioning and extinction, volitional situation-focused reappraisal, volitional self-focused reappraisal, and emotional interference inhibition, along with structural MRI and resting-state MRI scans. A detailed description of the battery methods is provided. The feasibility of the battery was successfully tested in N=55 healthy subjects; group results of the individual tasks largely replicate existing literature.
Background: Up to half of Western children and adolescents experience at least one type of childhood adversity. Individuals with a history of childhood adversity have an increased risk of psychopathology. Resilience enhancing factors reduce the risk of psychopathology following childhood adversity. A comprehensive overview of empirically supported resilience factors is critically important for interventions aimed to increase resilience in young people. Moreover, such an overview may aid the development of novel resilience theories. Therefore, we conducted the first systematic review of social, emotional, cognitive and/or behavioral resilience factors after childhood adversity.
Methods: We systematically searched Web of Science, PsycINFO, and Scopus (e.g., including MEDLINE) for English, Dutch, and German literature. We included cohort studies that examined whether a resilience factor was a moderator and/or a mediator for the relationship between childhood adversity and psychopathology in young people (mean age 13–24). Therefore, studies were included if the resilience factor was assessed prior to psychopathology, and childhood adversity was assessed no later than the resilience factor. Study data extraction was based on the STROBE report and study quality was assessed with an adapted version of Downs and Black's scale. The preregistered protocol can be found at: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016051978.
Results: The search identified 1969 studies, of which 22 were included (eight nationalities, study sample n range: 59–6780). We found empirical support for 13 of 25 individual-level (e.g., high self-esteem, low rumination), six of 12 family-level (e.g., high family cohesion, high parental involvement), and one of five community-level resilience factors (i.e., high social support), to benefit mental health in young people exposed to childhood adversity. Single vs. multiple resilience factor models supported the notion that resilience factors should not be studied in isolation, and that interrelations between resilience factors should be taken into account when predicting psychopathology after childhood adversity.
Conclusions: Interventions that improve individual, family, and/or social support resilience factors may reduce the risk of psychopathology following childhood adversity. Future research should scrutinize whether resilience factors function as a complex interrelated system that benefits mental health resilience after childhood adversity.
p>Consistent failure over the past few decades to reduce the high prevalence of stress-related disorders has motivated a search for alternative research strategies. Resilience refers to the phenomenon of many people maintaining mental health despite exposure to psychological or physical adversity. Instead of aiming to understand the pathophysiology of stress-related disorders, resilience research focuses on protective mechanisms that shield people against the development of such disorders and tries to exploit its insights to improve treatment and, in particular, disease prevention. To fully harness the potential of resilience research, a critical appraisal of the current state of the art — in terms of basic concepts and key methods — is needed. We highlight challenges to resilience research and make concrete conceptual and methodological proposals to improve resilience research. Most importantly, we propose to focus research on the dynamic processes of successful adaptation to stressors in prospective longitudinal studies.</p
The coefficient of determination R² quantifies the proportion of variance explained by a statistical model and is an important summary statistic of biological interest. However, estimating R² for generalized linear mixed models (GLMMs) remains challenging. We have previously introduced a version of R² that we called for Poisson and binomial GLMMs, but not for other distributional families. Similarly, we earlier discussed how to estimate intra-class correlation coefficients (ICCs) using Poisson and binomial GLMMs. In this paper, we generalize our methods to all other non-Gaussian distributions, in particular to negative binomial and gamma distributions that are commonly used for modelling biological data. While expanding our approach, we highlight two useful concepts for biologists, Jensen's inequality and the delta method, both of which help us in understanding the properties of GLMMs. Jensen's inequality has important implications for biologically meaningful interpretation of GLMMs, whereas the delta method allows a general derivation of variance associated with non-Gaussian distributions. We also discuss some special considerations for binomial GLMMs with binary or proportion data. We illustrate the implementation of our extension by worked examples from the field of ecology and evolution in the R environment. However, our method can be used across disciplines and regardless of statistical environments.
Background
The prevalence of major depressive disorder (MDD) in Spanish primary care (PC) centres is high. However, MDD is frequently underdiagnosed and consequently only some patients receive the appropriate treatment. The present study aims to determine the utility of the Patient Health Questionnaire-9 (PHQ-9) to identify MDD in a subset of PC patients participating in the large PsicAP study.
Methods
A total of 178 patients completed the full PHQ test, including the depression module (PHQ-9). Also, a Spanish version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was implemented by clinical psychologists that were blinded to the PHQ-9 results. We evaluated the psychometric properties of the PHQ-9 as a screening tool as compared to the SCID-I as a reference standard.
Results
The psychometric properties of the PHQ-9 for a cut-off value of 10 points were as follows: sensitivity, 0.95; specificity, 0.67. Using a cut-off of 12 points, the values were: sensitivity, 0.84; specificity, 0.78. Finally, using the diagnostic algorithm for depression (DSM-IV criteria), the sensitivity was 0.88 and the specificity 0.80.
Conclusions
As a screening instrument, the PHQ-9 performed better with a cut-off value of 12 versus the standard cut-off of 10. However, the best psychometric properties were obtained with the DSM-IV diagnostic algorithm for depression. These findings indicate that the PHQ-9 is a highly satisfactory tool that can be used for screening MDD in the PC setting.
Trial registration
Current Controlled Trials ISRCTN58437086. Registered 20 May 2013.
Mediation analyses abound in social and personality psychology. Current recommendations for assessing power and sample size in mediation models include using a Monte Carlo power analysis simulation and testing the indirect effect with a bootstrapped confidence interval. Unfortunately, these methods have rarely been adopted by researchers due to limited software options and the computational time needed. We propose a new method and convenient tools for determining sample size and power in mediation models. We demonstrate our new method through an easy-to-use application that implements the method. These developments will allow researchers to quickly and easily determine power and sample size for simple and complex mediation models.
Background:
Adolescence is a key time period for the emergence of psychosocial and mental health difficulties. To promote adolescent adaptive ('resilient') psychosocial functioning (PSF), appropriate conceptualisation and quantification of such functioning and its predictors is a crucial first step. Here, we quantify resilient functioning as the degree to which an individual functions better or worse than expected given their self-reported childhood family experiences, and relate this to adolescent family and friendship support.
Method:
We used Principal Component and regression analyses to investigate the relationship between childhood family experiences and PSF (psychiatric symptomatology, personality traits and mental wellbeing) in healthy adolescents (the Neuroscience in Psychiatry Network; N = 2389; ages 14-24). Residuals from the relation between childhood family experiences and PSF reflect resilient functioning; the degree to which an individual is functioning better, or worse, than expected given their childhood family experiences. Next, we relate family and friendship support with resilient functioning both cross-sectionally and 1 year later.
Results:
Friendship and family support were positive predictors of immediate resilient PSF, with friendship support being the strongest predictor. However, whereas friendship support was a significant positive predictor of later resilient functioning, family support had a negative relationship with later resilient PSF.
Conclusions:
We show that friendship support, but not family support, is an important positive predictor of both immediate and later resilient PSF in adolescence and early adulthood. Interventions that promote the skills needed to acquire and sustain adolescent friendships may be crucial in increasing adolescent resilient PSF.
The well-replicated observation that many people maintain mental health despite exposure to severe psychological or physical adversity has ignited interest in the mechanisms that protect against stress-related mental illness. Focusing on resilience rather than pathophysiology in many ways represents a paradigm shift in clinical-psychological and psychiatric research that has great potential for the development of new prevention and treatment strategies. More recently, research into resilience also arrived in the neurobiological community, posing nontrivial questions about ecological validity and translatability. Drawing on concepts and findings from transdiagnostic psychiatry, emotion research, and behavioral and cognitive neuroscience, we propose a unified theoretical framework for the neuroscientific study of general resilience mechanisms. The framework is applicable to both animal and human research and supports the design and interpretation of translational studies. The theory emphasizes the causal role of stimulus appraisal (evaluation) processes in the generation of emotional responses, including responses to potential stressors. On this basis, it posits that a positive (non-negative) appraisal style is the key mechanism that protects against the detrimental effects of stress and mediates the effects of other known resilience factors. Appraisal style is shaped by three classes of cognitive processes – positive situation classification, reappraisal, and interference inhibition – that can be investigated at the neural level. Prospects for the future development of resilience research are discussed.
Psychological resilience has become a popular concept. Owing to that popularity, the word resilience has taken on myriad and often overlapping meanings. To be a useful framework for psychological research and theory, the authors argue, the study of resilience must explicitly reference each of four constituent temporal elements: (a) baseline or preadversity functioning, (b) the actual aversive circumstances, (c) postadversity resilient outcomes, and (d) predictors of resilient outcomes. Using this framework to review the existing literature, the most complete body of evidence is available on individual psychological resilience in children and adults. By contrast, the research on psychological resilience in families and communities is far more limited and lags well behind the rich theoretical perspective available from those literatures. The vast majority of research on resilience in families and communities has focused primarily on only one temporal element, possible predictors of resilient outcomes. Surprisingly, however, almost no scientific evidence is actually available for community or family resilient outcomes. We close by suggesting that there is room for optimism and that existing methods and measures could be relatively easily adapted to help fill these gaps. To that end, we propose a series of steps to guide future research.
Emotional problems figure prominently in many clinical conditions. Recent efforts to explain and treat these conditions have emphasized the role of emotion dysregulation. However, emotional problems are not always the result of emotion dysregulation, and even when emotional problems do arise from emotion dysregulation, it is necessary to specify precisely what type of emotion dysregulation might be operative. In this review, we present an extended process model of emotion regulation, and we use this model to describe key points at which emotion-regulation difficulties can lead to various forms of psychopathology. These difficulties are associated with (a) identification of the need to regulate emotions, (b) selection among available regulatory options, (c) implementation of a selected regulatory tactic, and (d) monitoring of implemented emotion regulation across time. Implications and future directions for basic research, assessment, and intervention are discussed. Expected final online publication date for the Annual Review of Clinical Psychology Volume 11 is March 28, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
How do people flexibly regulate their emotions in order to manage the diverse demands of varying situations? This question assumes particular importance given the central role that emotion regulation (ER) deficits play in many forms of psychopathology. In this review, we propose a translational framework for the study of ER flexibility that is relevant to normative and clinical populations. We also offer a set of computational tools that are useful for work on ER flexibility. We specify how such tools can be used in a variety of settings, such as basic research, experimental psychopathology, and clinical practice. Our goal is to encourage the theoretical and methodological precision that is needed in order to facilitate progress in this important area.
Stress resilience is the phenomenon that some people maintain their mental health despite exposure to adversity or show only temporary impairments followed by quick recovery. Resilience research attempts to unravel the factors and mechanisms that make resilience possible and to harness its insights for the development of preventative interventions in individuals at risk for acquiring stress-related dysfunctions. Biological resilience research has been lagging behind the psychological and social sciences, but has seen a massive surge in recent years. At the same time, progress in this field has been hampered by methodological challenges related to finding suitable operationalizations and study designs, replicating findings, and modeling resilience in animals. We embed a review of behavioral, neuroimaging, neurobiological, and systems-biological findings in adults in a critical methods discussion. We find preliminary evidence that hippocampal-based pattern separation and prefrontal-based cognitive control functions protect against the development of pathological fears in the aftermath of singular, event-type stressors (as found in fear-related disorders, including simpler forms of post-traumatic stress disorder, PTSD), by facilitating the perception of safety. Reward system-based pursuit and savoring of positive reinforcers appear to protect against the development of more generalized dysfunctions of the anxious-depressive spectrum resulting from more severe or longer-lasting stressors (as in depression, generalized or comorbid anxiety, or severe PTSD). Links between preserved functioning of these neural systems under stress and neuroplasticity, immunoregulation, gut microbiome composition, and integrity of the gut barrier and the blood-brain barrier are beginning to emerge. On this basis, avenues for biological interventions are pointed out.
Resilience can be conceptualized as a network of interacting mental-health constructs characterized by weak autoconnections and/or interconnections. We investigated whether positive appraisal style (PAS), the ability to bounce back or recover from stress (BRS), age, education level, and urbanization grade can confer such desirable network properties within a network comprising depression, anxiety, loneliness, and mental well-being. Longitudinal data (five time points during the COVID-19 pandemic) were derived from a sample of older adults ( N = 1,270, 55+). Individuals who were 67 or older, highly educated, or scored high on PAS and BRS exhibited more resilient network dynamics and generally better overall mental-health outcomes. Findings pertaining to urbanization grade and the (subgroup-dependent) dynamics among the mental-health constructs are also discussed. These findings may inform theorizing and interventions aimed at resilience during a challenging life phase.
Disasters cause sweeping damage, hardship, and loss of life. In this article, we first consider the dominant psychological approach to disasters and its narrow focus on psychopathology (e.g., posttraumatic stress disorder). We then review research on a broader approach that has identified heterogeneous, highly replicable trajectories of outcome, the most common being stable mental health or resilience. We review trajectory research for different types of disasters, including the COVID-19 pandemic. Next, we consider correlates of the resilience trajectory and note their paradoxically limited ability to predict future resilient outcomes. Research using machine learning algorithms improved prediction but has not yet illuminated the mechanism behind resilient adaptation. To that end, we propose a more direct psychological explanation for resilience based on research on the motivational and mechanistic components of regulatory flexibility. Finally, we consider how future research might leverage new computational approaches to better capture regulatory flexibility in real time.
Expected final online publication date for the Annual Review of Psychology, Volume 75 is January 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Introduction: Reappraisal is one of the highly modifiable resilience factors and an important emotion regulation strategy. Reappraisal training can be delivered via mobile apps; however, such apps have typically combined reappraisal with other techniques. To address this gap, we developed ReApp, which engages users solely in reappraisal. Methods: For two trials, we invited 40 and 95 young adults with low levels of reappraisal skills. Participants were randomized into either control (CG) or intervention group (IG). The CG had access only to the Ecological Momentary Assessment component of the app, while the IG could also access the reappraisal training. We analyzed the self-report data using linear mixed models.Results: In both trials, adherence was high. Trial 1 revealed that only participants with very low reappraisal skills at baseline benefited from ReApp. This outcome was replicated in Trial 2 but there were no significant differences between the groups in the follow-up in mental health symptoms severity.Discussion: High adherence suggests that participants found it easy to integrate ReApp into their daily routines. Furthermore, ReApp successfully increased reappraisal in individuals with low level of reappraisal skills. Future studies will focus on assessing the efficacy of EMI-delivered reappraisal training on healthy and clinical populations.
Exposure to adversity (e.g., poverty, bereavement) is a robust predictor of disruptions in psychological functioning. However, people vary greatly in their responses to adversity; some experience severe long-term disruptions, others experience minimal disruptions or even improvements . We refer to the latter outcomes—faring better than expected given adversity—as psychological resilience. Understanding what processes explain resilience has critical theoretical and practical implications. Yet, psychology's understanding of resilience is incomplete, for two reasons: ( a) We lack conceptual clarity, and ( b) two major approaches to resilience—the stress and coping approach and the emotion and emotion-regulation approach—have limitations and are relatively isolated from one another. To address these two obstacles, we first discuss conceptual questions about resilience. Next, we offer an integrative affect-regulation framework that capitalizes on complementary strengths of both approaches. This framework advances our understanding of resilience by integrating existing findings, highlighting gaps in knowledge, and guiding future research.
Expected final online publication date for the Annual Review of Psychology, Volume 74 is January 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Introduction:
Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers.
Objective:
We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms.
Methods:
We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme.
Results:
In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training (d = 1.30, 95% CI 0.82-1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; d = 0.85, 95% CI 0.39-1.32) and the PTSD Checklist for DSM-5 (PCL-5; d = 0.68, 95% CI 0.23-1.14), but not for long-term cortisol concentrations (d = 0.25, 95% CI -0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points.
Conclusions:
Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches.
Objectives: Spousal loss is a significant life event that can negatively affect multiple facets of mental and physical health. Social support and engagement are generally found to improve adjustment following adversity, but much less is known regarding which facet of social support and engagement is most predictive of adjustment following spousal loss. This study examined changes in mental health and well-being following spousal loss and which facets of social support and engagement are associated with positive adjustment following spousal loss. Method: Latent growth curve modeling was applied to longitudinal data from 265 individuals who became widowed from the Changing Lives of Older Couples Study to examine: (1) adjustment following spousal loss in depressive symptoms, anxiety and well-being and (2) whether different facets of social support and engagement predict positive adjustment. Results: Depressive symptoms increased following spousal loss, whereas anxiety and well-being remained relatively stable before and after spousal loss. Receiving more instrumental support was associated with lower levels of depressive symptoms and anxiety 6-months following spousal loss. Higher levels of emotional support from one’s spouse at baseline was associated with more depressive symptoms and anxiety 6-months following spousal loss. Conclusion: Instrumental support received was the most beneficial facet of social support and engagement. The discussion focuses on how these findings fit into the larger literature of the ways through which social support and engagement lead to adjustment following adversity. © 2019
Consistent with its recommendations for stress management interventions1, the World Health Organization (WHO) has developed a new psychological intervention for managing stress and coping with adversity. This new intervention is intended to be relevant for coping with any type of adversity, including chronic poverty, endemic community and gender‐based violence, long‐term armed conflict, and displacement. It is especially targeted towards places with enormous needs but limited humanitarian access, such as Syria and South Sudan.
Objective:
We examine the reliability and validity of the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS)-which combines the nine-item Patient Health Questionnaire depression scale and seven-item Generalized Anxiety Disorder scale-as a composite measure of depression and anxiety.
Methods:
Baseline data from 896 patients enrolled in two primary-care based trials of chronic pain and one oncology-practice-based trial of depression and pain were analyzed. The internal reliability, standard error of measurement, and convergent, construct, and factor structure validity, as well as sensitivity to change of the PHQ-ADS were examined.
Results:
The PHQ-ADS demonstrated high internal reliability (Cronbach α values of .8 to .9) in all three trials. PHQ-ADS scores can range from 0 to 48 (with higher scores indicating more severe depression/anxiety), and the estimated standard error of measurement was approximately 3 to 4 points. The PHQ-ADS showed strong convergent (most correlations, 0.7-0.8 range) and construct (most correlations, 0.4-0.6 range) validity when examining its association with other mental health, quality of life, and disability measures. PHQ-ADS cutpoints of 10, 20, and 30 indicated mild, moderate, and severe levels of depression/anxiety, respectively. Bifactor analysis showed sufficient unidimensionality of the PHQ-ADS score. PHQ-ADS change scores at 3 months differentiated (p < .0001) between individuals classified as worse, stable, or improved by a reference measure, providing preliminary evidence for sensitivity to change.
Conclusions:
The PHQ-ADS may be a reliable and valid composite measure of depression and anxiety which, if validated in other populations, could be useful as a single measure for jointly assessing two of the most common psychological conditions in clinical practice and research.
Trial registration:
Clinicaltrials.gov Identifier: NCT00926588 (SCOPE); NCT00386243 (ESCAPE); NCT00313573 (INCPAD).
One of the most salient attributes of information is valence: whether a piece of news is good or bad. Contrary to classic learning theories, which implicitly assume beliefs are adjusted similarly regardless of valence, we review evidence suggesting that different rules and mechanisms underlie learning from desirable and undesirable information. For self-relevant beliefs this asymmetry generates a positive bias, with significant implications for individuals and society. We discuss the boundaries of this asymmetry, characterize the neural system supporting it, and describe how changes in this circuit are related to individual differences in behavior.
Mental disorders are significant contributors to the global burden of disease (1). While they occur across all levels of socio-economic status, the majority of populations in low- and middle-income countries (LMICs) do not have access to effective psychological and pharmacological interventions (2). Key barriers to sustainable delivery of psychological therapies in LMICs include limited mental health funding and infrastructure, chronic shortage of mental health professionals, lack of treatments adapted to the local context, and challenges associated with training and supervision. Implementation of low-intensity psychological interventions by trained para-professionals is one potential solution to this problem (3,4) which is receiving significant attention as part of global mental health research agendas (e.g.,(5)).
A number of low-intensity interventions have demonstrated clinical benefit and utility in high-income settings. For example, early analyses of the UK’s Improving Access to Psychological Therapies programme (IAPT,(6)) found a substantial reduction in depression and anxiety in people who attended at least two sessions of low-intensity interventions. Additionally, a recent meta-analysis challenged conventional thinking and provided support for low-intensity interventions as an effective treatment even for individuals with symptoms of severe depression (7).
Evidence for the applicability of psychological interventions by non-specialists in LMICs is mounting (8,9). For instance, group interpersonal psychotherapy facilitated by local para-professionals has been shown to be effective in rural Uganda among depressed adults compared to usual care at six month follow-up (10). In rural Pakistan, Rahman et al (11) found that local community health workers could effectively deliver a locally adapted cognitive-behavioural intervention for perinatal depression. Mothers receiving the treatment demonstrated significant clinical improvement on depression symptoms, showed less disability and better overall and social functioning. Finally, a comparatively more intensive transdiagnostic intervention, the Common Elements Treatment Approach (CETA), has shown promising results for the treatment of symptoms of depression, anxiety and post-traumatic stress in Burmese refugees when delivered by para-professionals (12).
To fill the gap between mental health needs and access to quality care, and extend the current research on low-intensity interventions in LMICs, the World Health Organization (WHO) – as part of its Mental Health Gap Action Programme (mhGAP) – has begun to develop and test low-intensity psychological interventions. The current paper focuses on one such intervention, named Problem Management Plus (PM+).
We argue that social psychology has unique potential for advancing understanding of resilience. An exciting development that illustrates this is the emergence of
social-psychological interventions
– brief, stealthy, and psychologically precise interventions – that can yield broad and lasting benefits by targeting key resilience mechanisms. Such interventions provide a causal test of resilience mechanisms and bring about positive change in people's lives.
Recent advances in the causal inference literature on mediation have extended traditional approaches to direct and indirect effects to settings that allow for interactions and non-linearities. In this paper, these approaches from causal inference are further extended to settings in which multiple mediators may be of interest. Two analytic approaches, one based on regression and one based on weighting are proposed to estimate the effect mediated through multiple mediators and the effects through other pathways. The approaches proposed here accommodate exposure-mediator interactions and, to a certain extent, mediator-mediator interactions as well. The methods handle binary or continuous mediators and binary, continuous or count outcomes. When the mediators affect one another, the strategy of trying to assess direct and indirect effects one mediator at a time will in general fail; the approach given in this paper can still be used. A characterization is moreover given as to when the sum of the mediated effects for multiple mediators considered separately will be equal to the mediated effect of all of the mediators considered jointly. The approach proposed in this paper is robust to unmeasured common causes of two or more mediators.