Positive affect expression during a play interaction and psychological health among older adults living with cognitive impairment and their adult children.

OBJECTIVES: We examined the extent to which positive affect expression in play interactions between adult children and their parents living with cognitive impairment was associated with lower depressive symptoms and mental health difficulties for both dyad members. Gender differences in positive affect expression were also examined. METHOD: Dyads (N = 126) self-reported their depressive symptoms and mental health difficulties. Dyad members later engaged in a video-recorded play interaction together, and their positive affect expression was observationally coded by trained coders in terms of 'enjoyment', 'laughter', and 'positive affect towards partner'. RESULTS: Findings from mixed models using the Actor Partner Interdependence Model showed that one's partner's positive affect was associated with one's own lower depressive symptoms. There were no significant actor effects or effects of role (parent vs. child). Results also revealed that women expressed more positive affect and had greater mental health difficulties, but not depressive symptoms. We found that one's partner's positive affect expressions were more associated with women's mental health than men's mental health. CONCLUSION: Positive affect expression may be a useful indicator of psychological health in parent-child relationships in which the parent has cognitive impairment. Positive affect may be useful to target in supportive, dyadic, psychosocial interventions.

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

OBJECTIVE: To test the hypothesis that a functional polymorphism of the serotonin transporter gene (serotonin-transporter-linked polymorphic region [5-HTTLPR]), which is thought to be associated with differential environmental sensitivity, moderates the association between low levels of empathic accuracy (i.e., ability to recognize emotions in others) in patients with neurodegenerative disease and caregivers' well-being. METHODS: Participants were 54 patients with neurodegenerative disease and their caregivers. Patients' empathic accuracy was measured using a dynamic tracking task in which they continuously rated the emotions of a character in a film; accuracy was determined by comparing patient ratings with those made by an expert panel. Caregivers provided a saliva sample for genotyping. Caregivers' well-being was measured as a latent construct indicated by validated measures of depression, anxiety, and negative affect. RESULTS: Lower levels of patients' empathic accuracy were associated with lower levels of caregivers' well-being. Importantly, caregivers' 5-HTTLPR genotype moderated this association such that lower empathic accuracy in patients predicted lower well-being for caregivers with the short/short genotype (standardized ß = 0.66), but not for caregivers with the short/long (standardized ß = 0.05) or long/long genotypes (standardized ß = -0.21). CONCLUSION: Consistent with previous findings that the short/short variant of 5-HTTLPR is associated with greater sensitivity to environmental influences, caregivers with the short/short variant manifest lower well-being when caring for a patient with low levels of empathic accuracy than caregivers with the other variants. This finding contributes to the authors' understanding of biological factors associated with individual differences in caregiver vulnerability and resilience.

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

BACKGROUND: Caregivers of patients with neurodegenerative diseases are at heightened risk for serious health problems, but health differences between individual caregivers abound. AIMS: To determine whether atrophy in patient brains could be used to identify caregivers at heightened risk for health problems and which patient variables mediate this relationship. METHODS: In 162 patient-caregiver dyads, we assessed patient atrophy using structural MRI, caregiver health, and patient behavior and cognitive symptoms. RESULTS: Patient atrophy in the right insula and medial frontal gyrus was associated with worse caregiver health; this relationship was partially mediated by patient neuropsychiatric symptoms, and assessing atrophy in these regions improved predictions of poor caregiver health above and beyond patient behavioral symptoms. CONCLUSIONS: This study shows the value of patients' brain data in identifying caregivers at risk for becoming sick themselves.

Greater Experience of Negative Non-Target Emotions by Patients with Neurodegenerative Diseases Is Related to Lower Emotional Well-Being in Caregivers.

BACKGROUND: Behavioral symptoms in patients with neurodegenerative diseases can be particularly challenging for caregivers. Previously, we reported that patients with frontotemporal dementia (FTD) and Alzheimer's disease (AD) experienced emotions that were atypical or incongruent with a given situation (i.e., non-target emotions). AIM: We tested the hypothesis that greater experience of non-target emotions by patients is associated with lower caregiver emotional well-being. METHODS: 178 patients with FTD, AD, or other neurodegenerative diseases and 35 healthy individuals watched 3 films designed to induce amusement, sadness, and disgust, and then reported their emotions during the films. Caregivers of the patients reported their own emotional well-being on the Medical Outcomes Study 36-item Short-Form Health Survey. RESULTS: In response to the amusement and sadness (but not disgust) films, greater experience of non-target emotions by patients was related to lower caregiver emotional well-being. These effects were specific to patients' experience of negative non-target emotions (i.e., not found for positive non-target emotions or for negative or positive target emotions). CONCLUSION: The findings reveal a previously unstudied patient behavior that is related to worse caregiver emotional well-being. Future research and clinical assessment may benefit from evaluating non-target emotions in patients.

Empathic Accuracy and Shared Depressive Symptoms in Close Relationships.

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

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

Introduction: Family caregivers of persons living with dementia (PLWDs) have extensive social, physical, emotional, and financial responsibilities. However, less is known about the relationship and interpersonal connection between caregivers and PLWDs. We examined caregiver pronoun use, as an index of the connection between the caregiver and PLWD and its associations with the caregiver's and PLWD's health and well-being. Methods: Caregivers of PLWDs (N = 320) were asked to describe a recent time they felt connected to the PLWD in their care. Responses were transcribed and coded to quantify pronoun use by category (we-pronouns, I-pronouns, and they-pronouns). Caregivers also reported on their depression, burden, and the PLWD's dementia severity and marital satisfaction. Sixty-eight caregivers repeated the same survey 24 months after the initial survey. Results: Caregivers used less we-pronouns when the PLWD's dementia was more severe, at both timepoints. Spousal caregivers used more we-pronouns and less I- and they-pronouns than nonspousal caregivers. There was an interaction between spousal relationship and dementia severity, such that spousal caregivers exhibited a stronger negative association between dementia severity and we-pronoun use. There were no associations between pronoun category and caregiver burden or depression. Discussion: Caregivers may feel increasingly disconnected from the PLWD as their dementia becomes more severe, as reflected by less we-pronoun usage. This study highlights the opportunity to explore relationship connection through text analysis.

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

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

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

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

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

OBJECTIVES: Caregivers of persons with neurodegenerative disease have high rates of mental health problems compared to noncaregiving adults. Emotion regulation may play an important role in preserving caregivers' mental health. We examined the associations between caregivers' emotion regulation measured in several ways (ability, habitual use, and self-ratings) and their mental health symptoms. METHOD: Ninety-one caregivers of persons with neurodegenerative disease participated in a laboratory-based assessment of emotion regulation. In two series of tasks, caregivers were given different instructions (no instruction, suppress) regarding altering their emotional behavioral responses to disgusting films and acoustic startle stimuli. Caregivers' emotional behavior was measured via behavioral coding and caregivers rated "how much emotion" they showed during each task. Anxiety, depression, and habitual use of expressive suppression were measured via questionnaires. RESULTS: Poor emotion regulation in the disgust suppression condition (i.e., greater emotional behavior) was associated with greater anxiety. Associations were not found for the startle suppression condition, depression, or self-report measures of emotion regulation. DISCUSSION: Findings suggest that caregivers who are unable to suppress emotional behavior in response to disgusting stimuli may be at greater risk for anxiety. Given high levels of anxiety in caregivers, it may be useful to evaluate interventions that improve ability to downregulate emotional behavior.

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

Caregiving for a person with dementia or neurodegenerative disease (PWD) is associated with increased rates of depression and anxiety. As the population ages and dementia prevalence increases worldwide, mental health problems related to dementia caregiving will become an even more pressing public health concern. The present study assessed emotional empathy (physiological, behavioral, and self-reported emotional responses to a film depicting others suffering) and two measures of cognitive empathy (identifying the primary emotion experienced by another person; providing continuous ratings of the valence of another person's changing emotions) in relation to mental health (standard questionnaires) in 78 caregivers of PWDs. Greater emotional empathy (self-reported emotional responses) was associated with worse mental health, even after accounting for known risk factors. Neither measure of cognitive empathy was associated with mental health. A relationship between high levels of emotional empathy and poor mental health in caregivers suggests possible risk indicators and intervention targets.

Physiological linkage during shared positive and shared negative emotion.

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

How the Affective Quality of Social Connections May Contribute to Public Health: Prosocial Tendencies Account for the Links Between Positivity Resonance and Behaviors that Reduce the Spread of COVID-19.

Although behaviors such as handwashing, mask wearing, and social distancing are known to limit viral spread, early in the COVID-19 pandemic, many individuals in the United States did not adopt them. The positivity resonance theory of co-experienced positive affect (Fredrickson, 2016) holds that shared pleasant states that include the key features of mutual care and a sense of oneness through behavioral synchrony function to build prosocial tendencies (e.g., self-transcendent and other-oriented dispositions of felt unity, empathy, altruism, and general positivity toward humanity). We tested the theory-driven hypothesis that prosocial tendencies are associated with high-quality social connections characterized by the affective state of positivity resonance and, in turn, account for behaviors to slow the spread of COVID-19. We measured perceived positivity resonance at the level of social episodes either during the COVID-19 pandemic (study 1, N = 1059, April-May 2020) or before it (study 2, N = 227, March-November 2019). In both studies, cross-sectionally and prospectively, results suggest that perceived positivity resonance had a positive indirect effect on self-reported hygienic behaviors (e.g., handwashing and mask wearing), which was mediated by a latent measure of prosocial tendencies. Sensitivity analyses confirmed these mediation effects to be independent of competing predictors of prosocial tendencies (e.g., overall positive and negative affect, frequency of social interaction) and competing predictors of health behaviors (e.g., political orientation, high-risk status, illness symptoms). Effects for social distancing were mixed. Overall, findings are consistent with the view that positivity resonance builds self-transcendent prosocial tendencies that motivate behaviors to protect community health. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42761-021-00035-z.

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

BACKGROUND AND OBJECTIVES: Motivated by the high rates of health problems found among caregivers of persons with neurodegenerative disease, we examined associations between deficits in two aspects of care recipients' socioemotional functioning and their caregivers' health. RESEARCH DESIGN AND METHODS: In 2 studies with independent samples (N = 171 and 73 dyads), caregivers reported on care recipients' emotion recognition and emotional reactivity. Caregiver health was assessed using both self-report measures (Studies 1 and 2) and autonomic nervous system indices (Study 2). RESULTS: Lower emotion recognition in care recipients was linearly associated with worse self-reported health, faster resting heart rate, and greater physiological reactivity to an acoustic startle stimulus in caregivers. These effects held after accounting for a variety of risk factors for poor caregiver health, including care recipients' neuropsychiatric symptoms. Emotional reactivity showed a quadratic association with health, such that the lowest and highest levels of emotional reactivity in care recipients were associated with lower self-reported health in caregivers. DISCUSSION AND IMPLICATIONS: Results shed light on the unique associations between two aspects of care recipients' emotional functioning and caregivers' health. Findings suggest potential ways to identify and help caregivers at heightened risk for adverse health outcomes.

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

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

A standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy.

Diabetic polyneuropathy (DPN) is a major cause of neuropathic pain and a frequent target condition in analgesic treatment trials. Differences in the clinical symptoms and signs associated with DPN suggest distinct pathophysiological mechanisms underlying nerve damage and dysfunction that are likely to have therapeutic relevance. The aim of this study was to develop a tool for the bedside assessment of painful neuropathies such as DPN that captures the diversity of phenotypes. Sixty-one patients with type 2 diabetes and painful neuropathy, 19 patients with painless DPN, 25 patients with type 2 diabetes but no clinical evidence of neuropathy, and 20 healthy control subjects completed a structured interview (47 items) and a standardized physical examination (39 items). After analyzing critical features of pain and painless symptoms and examining the outcome of physical tests of sensory function, we determined principal components of the phenotypic variance among patients. Increased sensitivity to mechanical or thermal stimuli and, to a lesser extent, the sensory quality of pain or paresthesia were the most discriminating elements of DPN phenotypes. Correlation patterns of symptoms and signs indicated the involvement of functionally distinct nerve fiber populations. We combined interview questions and physical tests identifying these differences in a shortened assessment protocol that we named Standardized Evaluation of Pain and Somatosensory Function (StEPS). The protocol StEPS generates a phenotypic profile of patients with neuropathy. Separate intensity ratings for spontaneous painful symptoms and pain evoked by standard stimuli support a detailed documentation of neuropathic pain and its response to analgesic treatment.