"We are Human too.": The Challenges of Being an End-of-Life Doula.

End-of-life (EOL) doulas are emerging professionals who provide an intimate approach to the death process by focusing on the psychological, social, spiritual, and emotional needs of dying individuals. EOL doula work is stressful; it exposes individuals to recurring stressors such as suffering and grief. Trained professionals are needed to help advocate for the dying individual and their families. Despite the growing literature on EOL doulas, information regarding the challenges of being an EOL doula is underrepresented in the literature. This paper is one of the first to address this concept. Twelve in-depth, semi-structured interviews regarding the EOL doula experience were conducted as a part of a larger exploratory study. Three overarching themes emerged from the larger project: motivations to become an EOL doula, roles of an EOL doula, and challenges of an EOL doula. In this article, only challenges of EOL are discussed, along with subsequent subordinate themes.

Coordination in interpersonal systems.

Coordinated group behaviour can result in conflict or social cohesion. Thus having a better understanding of coordination in social groups could help us tackle some of our most challenging social problems. Historically, the most common way to study group behaviour is to break it down into sub-processes, such as cognition and emotion, then ideally manipulate them in a social context in order to predict some behaviour such as liking versus distrusting a target person. This approach has gotten us partway to understanding many important collective behaviours, but I argue that making major changes in the world will require a more integrated approach. In this review, I introduce dynamic systems theory, with a focus on interpersonal systems, where all the processes we typically study in individuals, such as cognition and emotion, become intertwined between social partners over time. I focus on the concept of coordination, defined as a temporal correlation between interacting components of a system (or systems) arising due to coupling between them. Finally, I show how this perspective could be used to guide investigations of social problems such as polarisation.

Hispanic Ethnic Density May Be Protective for Older Black/African American and Non-Hispanic White Populations for Some Health Conditions: An Exploration of Support and Neighborhood Mechanisms.

BACKGROUND AND PURPOSE: Hispanic ethnic density (HED) is associated with salubrious health outcomes for Hispanics, yet recent research suggests it may also be protective for other groups. The purpose of this study was to test whether HED was protective for other racial-ethnic groups. We tested whether social support or neighborhood social integration mediated the association between high HED and depressive symptoms (CES-D) and physical morbidity 5 years later. Lastly, we tested whether race-ethnicity moderated both main and indirect effects. METHODS: We used Waves 1 (2005-2006), and 2 (2010-2011) from The National Social Life, Health, and Aging Project, a national study of older U.S. adults. Our sample was restricted to Wave 1 adults who returned at Wave 2, did not move from their residence between waves, and self-identified as Hispanic, non-Hispanic White (NHW), or non-Hispanic Black (NHB; n = 1,635). We geo-coded respondents' addresses to a census-tract and overlaid racial-ethnic population data. Moderated-mediation models using multiple imputation (to handle missingness) and bootstrapping were used to estimate indirect effects for all racial-ethnic categories. RESULTS: Depressive symptoms were lower amongst racial-ethnic minorities in ethnically (Hispanic) dense neighborhoods; this effect was not stronger in Hispanics. HED was not associated with physical morbidity. Sensitivity analyses revealed that HED was protective for cardiovascular events in all racial-ethnic groups, but not arthritis, or respiratory disease. Social support and neighborhood social integration were not mediators for the association between HED and outcomes, nor were indirect effects moderated by race-ethnicity. CONCLUSIONS: This study offers some evidence that HED may be protective for some conditions in older adults; however, the phenomena underlying these effects remains a question for future work.

"I feel you": Greater linkage between friends' physiological responses and emotional experience is associated with greater empathic accuracy.

How do people come to know others' feelings? One idea is that affective processes (e.g., physiological responses) play an important role, leading to the prediction that linkage between one's physiological responses and others' emotions relates to one's ability to know how others feel (i.e., empathic accuracy). Participants (N = 96, 48 female friend pairs) completed a stressful speech task and then provided continuous ratings of their own (as "targets") and their friend's (as "perceivers") emotional experience for the video-taped speeches. We measured physiology-physiology linkage (linkage between perceivers' and targets' physiology), physiology-experience linkage (linkage between perceivers' physiology and targets' experience), and empathic accuracy (linkage between perceivers' ratings of targets' experience and targets' ratings of their experience). Physiology-experience (but not physiology-physiology) linkage was associated with greater empathic accuracy even when controlling for key potential confounds (random linkage, targets' and perceivers' emotional reactivity, and relationship closeness). Results suggest that physiological responses play a role in empathic accuracy.

Does the Hispanic Mortality Advantage Vary by Marital Status Among Postmenopausal Women in the Women's Health Initiative?

BACKGROUND: Literature assessing the effect of marital status on mortality has underrepresented, or altogether omitted Hispanics and the potential moderating effect of Hispanic ethnicity on these relationships. Given cultural and network dynamics, marital advantages in older Hispanic women may be greater than other groups given their family-focused, collectivist orientation. PURPOSE: The purpose of this study was to understand whether older Hispanic women exhibited a more pronounced marital advantage as compared with non-Hispanic Whites. METHODS: We used longitudinal data from the Women's Health Initiative (WHI) Observational Study and Clinical Trials (N = 161,808) collected initially from 1993 to 1998 and followed until 2018. Our sample excluded those respondents indicating "other" as their race-ethnicity and those missing marital status and race-ethnicity variables (N = 158,814). We used Cox-proportional hazards models to assess the association between race-ethnicity, marital status, and the interactive effect of race-ethnicity and marital status on survival. RESULTS: After controlling for socioeconomic status (SES) and health controls, we found a Hispanic survival advantage when compared with non-Hispanic Whites and all other racial-ethnic groups with the exception of Asian/Pacific Islander women (all significant HRs < 0.78, all ps ≤ 0.001). Hispanics had a higher rate of divorce when compared with non-Hispanic Whites. The interactive effect of race-ethnicity and marital status was not significant. CONCLUSIONS: U.S. Hispanic, postmenopausal women exhibit a mortality advantage over and above marital status despite their high rates of divorce. Implications and potential explanations are discussed. CLINICAL TRIAL REGISTRATION: NCT00000611.

Mechanisms of Racial Disparities in Cognitive Aging: An Examination of Material and Psychosocial Well-Being.

OBJECTIVES: We tested the hypothesis that education's effect on cognitive aging operates in part through measures of material and psychosocial well-being. METHOD: Our sample was of non-Latino black and white participants of the National Social Life Health and Aging Project who had valid cognitive assessments in Waves 2 and 3 (n = 2,951; age range: 48-95). We used structural equation modeling to test for mediation and moderated mediation by income, assets, perceived stress, social status, and allostatic load on the relationships between race, education, and cognition at two time points. RESULTS: Education consistently mediated the race-cognition relationship, explaining about 20% of the relationship between race and cognition in all models. Income and assets were moderated by race; these factors were associated with cognition for whites but not blacks. Social status mediated the association between race and cognition, and social status and perceived stress mediated the education-cognition pathway. Allostatic load was not a mediator of any relationship. DISCUSSION: Education remains the best explanatory factor for cognitive aging disparities, though material well-being and subjective social status help to explain a portion of the racial disparity in cognitive aging.

An Exploratory Study of Physiological Linkage Among Strangers.

The present study explores physiological linkage (i.e., any form of statistical interdependence between the physiological signals of interacting partners; PL) using data from 65 same-sex, same ethnicity stranger dyads. Participants completed a knot-tying task with either a cooperative or competitive framing while either talking or remaining silent. Autonomic nervous system activity was measured continuously by electrocardiograph for both individuals during the interaction. Using a recently developed R statistical package (i.e., rties), we modeled different oscillatory patterns of coordination between partner's interbeat interval (i.e., the time between consecutive heart beats) over the course of the task. Three patterns of PL emerged, characterized by differences in frequency of oscillation, phase, and damping or amplification. To address gaps in the literature, we explored (a) PL patterns as predictors of affiliation and (b) the interaction between individual differences and experimental condition as predictors of PL patterns. In contrast to prior analyses using this dataset for PL operationalized as covariation, the present analyses showed that oscillatory PL patterns did not predict affiliation, but the interaction of individual differences and condition differentially predicted PL patterns. This study represents a next step toward understanding the roles of individual differences, context, and PL among strangers.

Racial-ethnic differences in social networks and perceived support: Measurement considerations and implications for disparities research.

OBJECTIVES: Racial-ethnic differences in physical/mental health are well documented as being associated with disparities; however, emerging conceptual models increasingly suggest that group differences in social functioning and organization contribute to these relationships. There is little work examining whether racial-ethnic groups respond similarly to classic measures of social networks and perceived support and whether there are significant between-groups differences on these measures. METHOD: A multisite, cross-sectional study of 2,793 non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic participants was conducted using common measures of social networks and perceived support. A confirmatory factor analytic model was used to test for the invariance of factor covariance and mean structures in a three latent constructs model including social network, social provisions, and interpersonal support. Between-group differences in structural and functional support were assessed. RESULTS: We established measurement invariance of the latent representations of these measures suggesting that racial-ethnic groups responded comparably. In direct comparisons, Hispanics and NHWs demonstrated similar levels of network structure and support. In contrast, NHWs reported support advantages on a majority of measures compared with NHBs. CONCLUSIONS: Findings support the use of these measures across groups and provide initial support for potential differences in this hypothesized mediator of racial-ethnic health disparities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Quantifying Interpersonal Dynamics for Studying Socio-Emotional Processes and Adverse Health Behaviors.

OBJECTIVE: We introduce a new statistical software R package, rties, that simplifies the use of dynamic models for investigating interpersonal emotional processes. We demonstrate the package by using it to test whether emotional dynamics in romantic couples can predict, or are predicted by, shared unhealthy behaviors (SUBs). METHODS: We use data from 74 romantic couples discussing their health behaviors. The conversations were videotaped and rated for evidence that the couples engaged in unhealthy behaviors that benefitted the relationship in some way (e.g., increasing closeness). Participants also provided video-prompted continuous recall of their emotional experience during the conversation. We use the rties package to estimate the parameters for inertia-coordination and coupled-oscillator models of the couples' emotional experience. Those parameter estimates are then used as predictors and outcomes of the couple's SUB. RESULTS: The coupled-oscillator model accounted for 17% of the variance in unhealthy behavior, with both partner's amplification predicting higher unhealthy behavior (women: B = 0.95, SE = 0.31, t(63) = 3.06, p = .003, 95% confidence interval = 0.25-1.45; men: B = 0.9, SE = 0.29, t(63) = 3.09, p = .003, 95% confidence interval = 0.32-1.47). These results suggest that co-dysregulation, an unstable interpersonal pattern of amplified emotional oscillations is associated with more SUBs. In contrast, the dynamics assessed with inertia coordination were not associated with behavior. CONCLUSIONS: The new rties package provides a set of relatively easy-to-use statistical models for representing and testing theories about interpersonal emotional dynamics. Our results suggest that emotional co-dysregulation may be a particularly detrimental pattern for health.

"Eavesdropping on Happiness" Revisited: A Pooled, Multisample Replication of the Association Between Life Satisfaction and Observed Daily Conversation Quantity and Quality.

In the present study, we aimed to replicate and extend findings by Mehl, Vazire, Holleran, and Clark (2010) that individuals with higher well-being tend to spend less time alone and more time interacting with others (e.g., greater conversation quantity) and engage in less small talk and more substantive conversations (e.g., greater conversation quality). To test the robustness of these effects in a larger and more diverse sample, we used Bayesian integrative data analysis to pool data on subjective life satisfaction and observed daily conversations from three heterogeneous adult samples, in addition to the original sample ( N = 486). We found moderate associations between life satisfaction and amount of alone time, conversation time, and substantive conversations, but no reliable association with small talk. Personality did not substantially moderate these associations. The failure to replicate the original small-talk effect is theoretically and practically important, as it has garnered considerable scientific and lay interest.

The Role of Family of Origin in Current Lifestyle Choices: A Qualitative Secondary Data Analysis of Interracial and Same-Race Couples.

Many Americans are in poor health. This is acute for racial/ethnic minorities compared with the Non-Hispanic white population. A grounded theory approach was used to analyze semistructured qualitative interviews to identify perceptions of family-of-origin lifestyle choices in same-race and interracial couples. Several central themes emerged from the data including influence of family-of-origin eating patterns, lack of family-of-origin importance for physical activity, and romantic partner influence in eating and exercise. Findings provide evidence for the socialization of family of origin on lifestyle choices into adulthood and also suggest promising changes due to romantic partner.

Longitudinal assessment of daily activity patterns on weight change after involuntary job loss: the ADAPT study protocol.

BACKGROUND: The World Health Organization has identified obesity as one of the most visible and neglected public health problems worldwide. Meta-analytic studies suggest that insufficient sleep increases the risk of developing obesity and related serious medical conditions. Unfortunately, the nationwide average sleep duration has steadily declined over the last two decades with 25% of U.S. adults reporting insufficient sleep. Stress is also an important indirect factor in obesity, and chronic stress and laboratory-induced stress negatively impact sleep. Despite what we know from basic sciences about (a) stress and sleep and (b) sleep and obesity, we know very little about how these factors actually manifest in a natural environment. The Assessing Daily Activity Patterns Through Occupational Transitions (ADAPT) study tests whether sleep disruption plays a key role in the development of obesity for individuals exposed to involuntary job loss, a life event that is often stressful and disrupting to an individual's daily routine. METHODS: This is an 18-month closed, cohort research design examining social rhythms, sleep, dietary intake, energy expenditure, waist circumference, and weight gain over 18 months in individuals who have sustained involuntary job loss. Approximately 332 participants who lost their job within the last 3 months are recruited from flyers within the Arizona Department of Economic Security (AZDES) Unemployment Insurance Administration application packets and other related postings. Multivariate growth curve modeling will be used to investigate the temporal precedence of changes in social rhythms, sleep, and weight gain. DISCUSSION: It is hypothesized that: (1) unemployed individuals with less consistent social rhythms and worse sleep will have steeper weight gain trajectories over 18 months than unemployed individuals with stable social rhythms and better sleep; (2) disrupted sleep will mediate the relationship between social rhythm disruption and weight gain; and (3) reemployment will be associated with a reversal in the negative trajectories outlined above. Positive findings will provide support for the development of obesity prevention campaigns targeting sleep and social rhythms in an accessible subgroup of vulnerable individuals.

Emotions are temporal interpersonal systems.

Several characteristics of emotions are that they: first, evolve dynamically over time, second, extend beyond the individual to incorporate multiple people, and third, function as a system. In other words, emotions can be seen as temporal interpersonal systems. This review summarizes current models for temporal interpersonal emotion systems (TIES), evidence they matter beyond levels of emotional responding, their connections with relationship quality and interpersonal regulation, and some of the challenges for studying them. Important directions for future research include distinguishing between different patterns of interpersonal emotional dynamics and extending theory and experimental work to uncover mechanisms for altering harmful TIES and promoting beneficial ones.

Dyadic coping and salivary interleukin-6 responses to interpersonal stress.

Dysregulated immune responses to stress are a potential pathway linking close relationship processes to health, and couples' abilities to cope with stress together (dyadic coping) likely impact such immune responses. Most stress research has focused on immune reactivity, whereas knowledge of immune recovery remains limited. The present study examined how acute interpersonal stress affects immune reactivity and recovery, as well as whether dyadic coping moderates these effects. Healthy couples (N = 24) completed the Dyadic Coping Inventory and provided saliva samples 4 times each day for 5 days, including 2 days before a laboratory dyadic stressor (discussing an area of disagreement), the day of, and 2 days after. Four additional saliva samples were taken throughout the laboratory stressor. Saliva samples were assayed for interleukin (IL)-6. Multilevel models that adjusted for demographic and health variables indicated that partners low in dyadic coping showed immune reactivity to the stressor whereas partners high in dyadic coping did not. Dyadic coping did not moderate immune recovery, which had occurred by 5 hr poststressor across all participants. Results suggest that partners low in dyadic coping show increased reactivity of immune responses to interpersonal stress. Enhancing dyadic coping in couples may impact not only their mental health and relationship quality, but also their risk of stress-related immune disorders. (PsycINFO Database Record

Emotional acceptance, inflammation, and sickness symptoms across the first two years following breast cancer diagnosis.

PURPOSE: Breast cancer diagnosis and treatment are associated with increased inflammatory activity, which can induce sickness symptoms. We examined whether emotional acceptance moderates the association between proinflammatory cytokines and self-reported sickness symptoms in women recently diagnosed with breast cancer. METHODS: Women (N=136) diagnosed with stage 0-III breast cancer within the previous 6months provided plasma samples and completed the FACT: Physical Well-Being Scale, as well as the Acceptance of Emotion Scale every 3months for 2years. At each time point, we quantified interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α using a high sensitivity multiplex assay. RESULTS: Higher within-subject mean TNF-α across all time-points predicted higher mean sickness symptoms. At individual time-points, higher IL-6 and IL-8 levels were associated with higher sickness symptoms. Mean emotional acceptance across all time-points moderated the relationship between mean IL-8 and sickness symptoms, with sickness symptoms remaining persistently high in women with low emotional acceptance even when IL-8 levels were low. At individual time-points, emotional acceptance positively moderated the correlations of IL-8 and TNF-α with sickness symptoms, such that the associations between higher levels of these proinflammatory cytokines and higher sickness symptoms were attenuated when emotional acceptance was high. CONCLUSION: Emotional acceptance was shown for the first time to moderate the associations of cytokines with sickness symptoms in breast cancer patients over time following diagnosis and treatment. The association between emotional acceptance and sickness symptoms was significantly different from zero but relatively small in comparison to the range of sickness symptoms. Results suggest that targeting emotion regulation may help to break the cycle between inflammation and sickness symptoms in women with breast cancer.

The interplay of couple's shared time, women's intimacy, and intradyadic stress.

Theoretically, spending time together should be central for couples to build intimacy and should be associated with less relationship stress; however, few empirical studies have examined these links. The present study used 14 days of diary data from 92 women to investigate the interplay between the amount of time they spent with their partner (shared time), intimacy, and daily stress originating inside the relationship (intradyadic stress) on a within- and between-personal level. Multilevel analyses revealed moderation patterns: For example, when women spent more time with their partners than usual on a weekday with low levels of intradyadic stress, they reported higher intimacy. These associations varied substantially between women and were weaker on the weekend or on days with high levels of intradyadic stress. At the between-person level, higher average shared time appeared to buffer the negative association between intradyadic stress and intimacy. Our results suggest that daily fluctuations in intradyadic stress, intimacy, and shared time may have different implications compared with aggregated amounts of those variables. Spending more time together on a weekday with low intimacy might be linked to more intradyadic stress, but aggregated over the long run, spending more time together may provide opportunities for stress resolution and help couples to maintain their intimacy.

Distinguishing emotional coregulation from codysregulation: an investigation of emotional dynamics and body weight in romantic couples.

Well-regulated emotions, both within people and between relationship partners, play a key role in facilitating health and well-being. The present study examined 39 heterosexual couples' joint weight status (both partners are healthy-weight, both overweight, 1 healthy-weight, and 1 overweight) as a predictor of 2 interpersonal emotional patterns during a discussion of their shared lifestyle choices. The first pattern, coregulation, is one in which partners' coupled emotions show a dampening pattern over time and ultimately return to homeostatic levels. The second, codysregulation, is one in which partners' coupled emotions are amplified away from homeostatic balance. We demonstrate how a coupled linear oscillator (CLO) model (Butner, Amazeen, & Mulvey, 2005) can be used to distinguish coregulation from codysregulation. As predicted, healthy-weight couples and mixed-weight couples in which the man was heavier than the woman displayed coregulation, but overweight couples and mixed-weight couples in which the woman was heavier showed codysregulation. These results suggest that heterosexual couples in which the woman is overweight may face formidable coregulatory challenges that could undermine both partners' well-being. The results also demonstrate the importance of distinguishing between various interpersonal emotional dynamics for understanding connections between interpersonal emotions and health.

Emotion regulation and the temporal dynamics of emotions: Effects of cognitive reappraisal and expressive suppression on emotional inertia.

The tendency for emotions to be predictable over time, labelled emotional inertia, has been linked to low well-being and is thought to reflect impaired emotion regulation. However, almost no studies have examined how emotion regulation relates to emotional inertia. We examined the effects of cognitive reappraisal and expressive suppression on the inertia of behavioural, subjective and physiological measures of emotion. In Study 1 (N = 111), trait suppression was associated with higher inertia of negative behaviours. We replicated this finding experimentally in Study 2 (N = 186). Furthermore, in Study 2, instructed suppressors and reappraisers both showed higher inertia of positive behaviours, and reappraisers displayed higher inertia of heart rate. Neither suppression nor reappraisal were associated with the inertia of subjective feelings in either study. Thus, the effects of suppression and reappraisal on the temporal dynamics of emotions depend on the valence and emotional response component in question.

Testing the effects of suppression and reappraisal on emotional concordance using a multivariate multilevel model.

In theory, the essence of emotion is coordination across experiential, behavioral, and physiological systems in the service of functional responding to environmental demands. However, people often regulate emotions, which could either reduce or enhance cross-system concordance. The present study tested the effects of two forms of emotion regulation (expressive suppression, positive reappraisal) on concordance of subjective experience (positive-negative valence), expressive behavior (positive and negative), and physiology (inter-beat interval, skin conductance, blood pressure) during conversations between unacquainted young women. As predicted, participants asked to suppress showed reduced concordance for both positive and negative emotions. Reappraisal instructions also reduced concordance for negative emotions, but increased concordance for positive ones. Both regulation strategies had contagious interpersonal effects on average levels of responding. Suppression reduced overall expression for both regulating and uninstructed partners, while reappraisal reduced negative experience. Neither strategy influenced the uninstructed partners' concordance. These results suggest that emotion regulation impacts concordance by altering the temporal coupling of phasic subsystem responses, rather than by having divergent effects on subsystem tonic levels.

Job stress and dyadic synchrony in police marriages: a preliminary investigation.

Despite reports documenting adverse effects of stress on police marriages, few empirical studies focus on actual emotional behaviors of officers and spouses. In this preliminary investigation, 17 male police officers and their nonpolice wives completed daily stress diaries for 1 week and then participated in a laboratory-based discussion about their respective days. Conversations were video-recorded and coded for specific emotional behaviors reflecting hostility and affection, which are strong predictors of marital outcomes. We examined associations between officers' job stress (per diaries and the Police Stress Survey) and couples' emotional behavior (mean levels and behavioral synchrony) using a dyadic repeated measures design capitalizing on the large number of observations available for each couple (1020 observations). When officers reported more job stress, they showed less hostility, less synchrony with their wives' hostility, and more synchrony with their wives' affection; their wives showed greater synchrony with officers' hostility and less synchrony with officers' affection. Therefore, for officers, greater job stress was associated with less behavioral negativity, potentially less attunement to wives' negativity, but potentially greater attunement to wives' affection-perhaps a compensatory strategy or attempt to buffer their marriage from stress. These attempts may be less effective, however, if, as our synchrony findings may suggest, wives are focusing on officers' hostility rather than affection. Although it will be important to replicate these results given the small sample, our findings reveal that patterns of behavioral synchrony may be a key means to better understand how job stress exacts a toll on police marriages.