The stories we tell: how age, gender, and forgiveness affect the emotional content of autobiographical narratives.

OBJECTIVES: Researchers have been attempting to understand the variables that predict differences in autobiographical narratives, given that these differences often reveal important information about the psychological characteristics of the person providing the narrative. METHOD: A sample of young adults (n = 80) and older adults (n = 80) completed a battery of self-report measures in addition to an autobiographical narrative task in which they described a negative emotional experience. These narratives were transcribed and entered into a text analysis program. RESULTS: Results indicated a significant three-way interaction (age × gender × forgiveness) for negative emotion words. Results also indicated two significant two-way interactions (age × forgiveness and gender × forgiveness) and one significant main effect for anger words. There were no significant findings related to anxiety or sad words. DISCUSSION: Results are discussed in the context of Socioemotional Selectivity Theory, which asserts that social and emotional goals shift throughout the lifespan such that older adults are more motivated to regulate their emotions than young adults. Clinical applications and future directions are discussed.

Physiological reactivity during autobiographical narratives in older adults: the roles of depression and anxiety.

OBJECTIVES: Physiological reactivity (PR) describes the change in physiological functioning (e.g., heart rate, blood pressure, pulse pressure) that occurs after the induction of a stressful task. This study aims to understand the influence of mental health symptoms on patterns of PR during autobiographical narratives in an older adult sample. METHOD: Eighty older adults completed self-report measures regarding their symptoms of depression and anxiety. Next, their blood pressure was recorded while they completed two verbal autobiographical narratives. RESULTS: During the positive narrative, anxiety was positively associated with increased PR while depression was negatively associated with PR. During the negative narrative, a significant interaction occurred whereby anxiety was significantly positively associated with PR for those participants low in depression. DISCUSSION: The above results are explained in the context of the Tripartite Model of Depression and Anxiety, which predicts different patterns of PR as a function of mental health symptoms. Limitations and future directions are also discussed.

Randomized controlled trial assessing the efficacy of expressive writing in reducing anxiety in first-year college students: the role of linguistic features.

OBJECTIVE: Meta-analyses assessing the efficacy of expressive writing (EW) interventions have produced mixed results. The current study aimed to assess the efficacy of an EW intervention in the reduction of anxiety symptoms in first-year college students. In an effort to understand more about moderating variables that influence EW outcomes, the current study also assessed the role of linguistic features in symptom reduction. DESIGN AND MEASURES: Ninety participants were assigned to complete either an EW intervention or a non-emotional writing intervention. Participants completed 3 consecutive days of writing and two follow-up visits. Anxiety was measured at each study visit with the Beck Anxiety Inventory, and linguistic features were assessed with the LIWC software program. RESULTS: Results indicated that all participants demonstrated significant decreases in anxiety over time. Participants in the EW group who demonstrated the greatest decreases in anxiety utilized more first-person singular pronouns and fewer affect words. CONCLUSIONS: Results are explained in the context of two prominent theories regarding the therapeutic mechanisms of EW: cognitive processing theory and exposure theory. Exposure theory received more support than cognitive processing theory.

Experiential avoidance: a moderator of the relationship between age and emotional expression.

OBJECTIVES: Experiential avoidance (EA) is the unwillingness to remain in contact with particular private experiences, and higher levels of EA are associated with increased psychopathology. This study explored relationships between EA, age, and the use of emotion words in positive and negative autobiographical narratives. METHOD: Participants included younger (n = 60) and older adults (n = 60) who completed a measure of EA and described a positive and negative autobiographical narrative. RESULTS: In the positive autobiographical narrative, there was a significant interaction between age and EA whereby among low EA participants, younger adults used more emotion words than older adults. In the negative autobiographical narrative, there was a main effect of age in which older adults utilized fewer emotional words and a significant interaction whereby among high EA participants, younger adults used more emotion words than older adults. CONCLUSION: Results are explained in the developmental context of Socioemotional Selectivity Theory (Carstensen, 1991), which posits that older adults may be more likely to verbally communicate in a style characterized by emotion regulation. Research and clinical implications are discussed.

Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: randomized trial.

OBJECTIVE: Major depression is the most common psychiatric disorder among breast cancer patients and is associated with substantial impairment. Although some research has explored the utility of psychotherapy with breast cancer patients, only 2 small trials have investigated the potential benefits of behavior therapy among patients with well-diagnosed depression. METHOD: In a primarily Caucasian, well-educated sample of women (age = 55.4 years, SD = 11.9) diagnosed with breast cancer and major depression (n = 80), this study was a randomized clinical trial testing the efficacy of 8 sessions of behavioral activation treatment for depression (BATD) compared to problem-solving therapy. Primary outcome measures assessed depression, environmental reward, anxiety, quality of life, social support, and medical outcomes. RESULTS: Across both treatments, results revealed strong treatment integrity, excellent patient satisfaction with treatment protocols, and low patient attrition (19%). Intent-to-treat analyses suggested both treatments were efficacious, with both evidencing significant pre-post treatment gains across all outcome measures. Across both treatments, gains were associated with strong effect sizes, and based on response and remission criteria, a reliable change index, and numbers-needed-to-treat analyses, approximately ¾ of patients exhibited clinically significant improvement. No significant group differences were found at posttreatment. Treatment gains were maintained at 12-month follow-up, with some support for stronger maintenance of gains in the BATD group. CONCLUSIONS: BATD and problem-solving interventions represent practical interventions that may improve psychological outcomes and quality of life among depressed breast cancer patients. Study limitations and future research directions are discussed.

Sudden gains in depressed cancer patients treated with behavioral activation therapy.

Many patients who receive cognitive-behavioral therapy experience sudden gains that are associated with improved treatment response and decreased risk of relapse. Extending prior research, this study examined sudden gains among depressed cancer patients receiving brief (9-session) behavioral activation therapy. Fifty percent of patients experienced sudden gains of large magnitude (M=11.8 BDI-II points), with sudden gains associated with improved treatment response and maintenance of gains at 3-month follow-up. Relative to those without sudden gains, at pretreatment assessment, cancer patients with sudden gains were more likely to present with less severe depression, less somatic anxiety, fewer coexistent anxiety disorders, as well as less bodily pain, better overall physical functioning, and fewer problems with daily activities as a result of emotional problems. These findings provide increasing support for behavioral activation with a difficult-to-treat population but raise important questions regarding mechanism of change. Clinical implications for treating depressed cancer patients are discussed.

The phenomenology and screening of clinical depression in cancer patients.

Clinical depression is the most common psychiatric disorder among cancer patients and is associated with significant functional impairment. Unfortunately, depression in cancer patients is often under- diagnosed and untreated, and studies examining the predictive utility of assessment instruments in detecting clinically depressed cancer patients are sparse. Using a structured interview, thirty-three patients with various cancer types were diagnosed as having major depression (n = 24) or no psychiatric diagnosis (n = 9). All patients were administered the Beck Depression Inventory-II (BDI-II), the Center for Epidemiological Studies in Depression Scale (CES-D), Hamilton Rating Scale for Depression (HRSD), Quality of Life Inventory (QOLI), a medical and psychosocial functioning questionnaire (SF-36), and given co-morbidity of depression with anxiety disorders, the Beck Anxiety Inventory (BAI). Depressed and non-depressed cancer patients were compared and contrasted across all assessment measures and accuracy of instruments was based on evaluating their sensitivity, specificity, and positive predictive values. Depressed cancer patients exhibited more severe depressive symptoms and poorer quality of life, increased anxiety and bodily pain, and decreased vitality and social functioning. All instruments exhibited strong predictive properties, with the CES-D and BDI-II considered most feasible given their time efficiency, administrative simplicity, and strong psychometric properties.