Social support mediates the relationship between dispositional gratitude and psychological distress in caregivers of autistic children.

Grateful caregivers report lower levels of psychological distress. Social support, engendered by gratitude and buffering against stress, might mediate this effect. Here we explored whether the protective psychological effect of dispositional gratitude might be mediated by increased social support. A sample of 126 caregivers of autistic children completed questionnaires assessing dispositional gratitude, social support and psychological distress. Gratitude inversely predicted psychological distress, as did social support after adjusting for gratitude. Gratitude positively predicted social support. Gratitude no longer predicted psychological distress after adjusting for social support. Indirect effects analysis revealed the gratitude-distress relationship occurred indirectly via social support. Grateful caregivers reported higher levels of social support, and this predicted lower psychological distress. Gratitude, relatively stable as a disposition, has a state component that is sensitive to change, and healthcare professionals might do well to recommend gratitude enhancing interventions for caregivers of autistic children.

Elevated levels of hair cortisol concentrations in professional dementia caregivers.

Providing care for people with dementia can be a highly stressful profession. Hair Cortisol Concentration (HCC) levels have been used as a biological marker for HPA axis activity to demonstrate that informal caregivers of people with dementia could be vulnerable to chronic stress. The current study aimed to progress the findings of research conducted with informal caregivers and is the first study to assess HCC as a biological indicator of stress in professional carers of people with dementia. HCC levels were compared between 32 professional dementia caregivers (30 females with a mean age of 45.83 and 2 males with a mean age of 24.50), 45 employees working in higher education settings (42 females with a mean age of 38.66 and 3 males with a mean age of 31.89) and 88 undergraduate students (67 females with a mean age of 24.04 and 21 males with a mean age of 23.91). Analysis of HCC was used to assess HPA axis activity over 1 month. A one-way ANCOVA, with age and gender being included as covariates, revealed that higher levels of HCC were observed in professional dementia carers than people who worked within higher education settings and undergraduate students. The results indicated that professional dementia caregivers may experience stress to the extent of activating biological stress responses at a greater frequency in comparison to people who work in higher education and undergraduate students. However, no significant differences were observed in the perceived stress levels reported across dementia caregivers, professionals working in higher education, and undergraduate students. These findings highlight the requirement to ascertain the extent to which work-related tasks or other factors, specific to the profession of caring for people with dementia, could elicit heightened HPA stress reactivity.

Sceletium tortuosum (Zembrin® ) ameliorates experimentally induced anxiety in healthy volunteers.

OBJECTIVE: To investigate the anxiolytic properties of a standardized extract of Sceletium tortuosum (trademarked-Zembrin® ). METHODS: Two studies utilized a placebo-controlled, double-blind, between-subject experimental design to investigate the effects of a single dose of Sceletium tortuosum (25 mg, Zembrin® ) on laboratory stress/anxiety responding in 20 young healthy volunteers. To elicit feelings of stress/anxiety, participants completed 20 min of the multitasking framework in study 1 and a 5-min simulated public speaking task in study 2. Study 1 measured subjective experiences of mood at baseline, prestress induction, and poststress induction. Study 2 measured subjective experiences of anxiety and physiological indicators of stress (heart rate [HR] and galvanic skin response) at baseline, prestress induction, during stress induction, and poststress induction. RESULTS: A series of analysis of covariances (baseline entered as the covariate) revealed no treatment effect in study 1; however, study 2 revealed subjective anxiety levels to be significantly lower in the Zembrin® group at the prestress induction point and a significant interaction between treatment and time on HR. Taken together, results indicate that a single dose of Zembrin® can ameliorate laboratory stress/anxiety responding in healthy volunteers. CONCLUSION: We provide the first tentative behavioral evidence to support the anxiolytic properties of Sceletium tortuosum (25 mg Zembrin® ).

An experimental investigation into cardiovascular, haemodynamic and salivary alpha amylase reactivity to acute stress in Type D individuals.

Type D personality is characterized by increased social inhibition and negative affectivity. Research demonstrates associations between Type D and poor physical health. Maladaptive sympathetic arousal is suggested as a potential mechanism, however, findings are inconsistent and studies mainly focus on basic cardiovascular parameters. The current study examines cardiovascular and haemodynamic parameters in addition to salivary alpha amylase (sAA) as markers of sympathetic stress reactivity in Type D individuals. Healthy adults (N = 75; 33 Type D; aged 18-42; 64% female) completed a multitasking stressor while continuous beat-to-beat cardiovascular function was measured. Saliva samples were obtained at baseline, pre-task, post-task, +10 min and +20 min post-task. Type Ds exhibited dysfunctional cardiovascular reactivity, characterized by blunted total peripheral resistance, slower stroke volume recovery and potentially unhealthy changes in haemodynamic profile. Alpha amylase reactivity was evident, but group differences were not significant. Findings indicate dysregulated sympathetic reactivity in Type D individuals, exemplified by a maladaptive haemodynamic profile.

Affiliate stigma, perceived social support and perceived stress in caregivers of children with autism spectrum disorder: A multiple mediation study.

BACKGROUND: Affiliate stigma negatively predicts social support, and positively predicts psychological distress, in caregivers of children with ASD. Whether the affiliate stigma-distress relationship occurs indirectly via social support however has not been explored. METHODS: A correlational design was used. A sample of n = 124 caregivers of children with ASD completed an online survey assessing affiliate stigma, perceived support from family, friends and significant others, and perceived stress. RESULTS: The relationship between greater affiliate stigma and increased perceived stress occurred indirectly via lower perceived support from family, but not from friends or significant others. CONCLUSIONS: These findings underscore the importance of increasing caregivers' perceived family support. Whether interventions that alleviate affiliate stigma are beneficial for reducing perceived stress, and whether this effect is mediated by increased perceived availability of support, might be the subject of future research.

The relationship between Type D personality and physical health complaints is mediated by perceived stress and anxiety but not diurnal cortisol secretion.

Type D personality has been associated with minor health complaints in the general population and dysregulation of basal cortisol secretion in coronary patients. The aims of the present study were to investigate (i) whether there is an association between Type D personality and basal cortisol secretion in the general population, and (ii) whether subjective measures of stress and anxiety, as well as indices of basal cortisol secretion, mediate the relationship between Type D personality and self-reported physical symptoms in this group. Self-report measures of stress, trait anxiety and physical symptoms were provided by 101 individuals aged 18-45 years. Saliva samples were also provided over two consecutive "typical" days, to enable indices of the cortisol awakening response and diurnal cortisol profile to be determined. There was a significant relationship between Type D personality and self-reported physical symptoms, which was fully mediated by subjective stress and anxiety. However, there were no significant relationships between Type D personality and the basal cortisol indices. These findings suggest that the association between Type D personality and minor health complaints in the general population can be explained by feelings of stress and anxiety, but a precise biological mechanism for this link is yet to be elucidated.

Anticipated next-day demand affects the magnitude of the cortisol awakening response, but not subjective or objective sleep.

Whilst the association between sleep and stress is well established, few studies have examined the effects of an anticipated stressor upon sleep and relevant physiological markers. The aim of the present study was to examine whether an anticipated stressor in the form of next-day demand affects subjective and objective sleep, and multiple indices of the cortisol awakening response. Subjective and objective sleep and the cortisol awakening response were measured over three consecutive nights in 40 healthy adults in a sleep laboratory. During their second night, participants were informed that they would either be required to complete a series of demanding cognitive tasks, in a competition format, during the next day (anticipation condition; n = 22), or were given no instruction (sedentary condition; n = 18). Sleep was measured subjectively using sleep diaries, objectively using polysomnography, and saliva was measured at awakening, +15, +30, +45 and +60 min each morning, from which cortisol awakening response measurement indices were derived: awakening cortisol levels, the mean increase in cortisol levels and total cortisol secretion. There were no between-group differences in subjective or objective sleep in the night preceding the anticipated demand; however, compared with the sedentary condition, those in the anticipation group displayed a larger mean increase in cortisol levels, representing the cortisol awakening response magnitude, on the morning of the anticipated demand. Overall, the results suggest that whilst anticipated stress affected the subsequent cortisol awakening response, subjective and objective sleep remained undisturbed. It is possible that the timing of an anticipated stressor, rather than its expected duration, may influence subsequent sleep disruption.

The effects of an anticipated challenge on diurnal cortisol secretion.

In healthy, non-challenged individuals, the secretion of cortisol typically follows a diurnal profile characterized by a peak in the period following waking (cortisol awakening response) and a gradual decline throughout the day. In addition, cortisol secretion is increased in response to acutely stressful stimuli, particularly stressors involving social evaluation. The current study is the first to assess the impact of an anticipated acute laboratory stressor upon the typical diurnal pattern of HPA activation and relationship to acute cortisol secretion. A sample of 23 healthy young adults provided salivary cortisol samples at four time points (immediately upon awakening, 30-min post-awakening, 1200 h and before bed) on 2 consecutive days. On the second day, participants attended the laboratory and undertook an anticipated acute socially evaluative stressor immediately following provision of their 1200 h saliva sample. Heart rate, blood pressure and mood were recorded immediately before and after the stressor and at 10 and 20 min post-stressor along with additional salivary cortisol samples. Typical patterns of cortisol secretion were observed on both days and exposure to the laboratory stressor was associated with the expected increases in cortisol, heart rate, blood pressure and negative mood. However, significant differences in diurnal cortisol secretion were observed between the two days with greater secretion, in particular, during the period following awakening, evident on the day of the anticipated laboratory stressor. Furthermore, secretion of cortisol during the period following awakening was positively related to secretion during the acute reactivity periods. This is the first study to integrate a laboratory stressor into a typical day and assess its impact on indices of diurnal cortisol secretion in an ambulatory setting. The current findings support the notion that the cortisol awakening response is associated with anticipation of the upcoming day and the subsequent demands required of the individual.

MDMA, cortisol, and heightened stress in recreational ecstasy users.

Stress develops when an organism requires additional metabolic resources to cope with demanding situations. This review will debate how recreational 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') can increase some aspects of acute and chronic stress in humans. Laboratory studies on the acute effects of MDMA on cortisol release and neurohormone levels in drug-free regular ecstasy/MDMA users have been reviewed, and the role of the hypothalamic-pituitary-adrenal (HPA) axis in chronic changes in anxiety, stress, and cognitive coping is debated. In the laboratory, acute ecstasy/MDMA use can increase cortisol levels by 100-200%, whereas ecstasy/MDMA-using dance clubbers experience an 800% increase in cortisol levels, because of the combined effects of the stimulant drug and dancing. Three-month hair samples of abstinent users revealed cortisol levels 400% higher than those in controls. Chronic users show heightened cortisol release in stressful environments and deficits in complex neurocognitive tasks. Event-related evoked response potential studies show altered patterns of brain activation, suggestive of increased mental effort, during basic information processing. Chronic mood deficits include more daily stress and higher depression in susceptible individuals. We conclude that ecstasy/MDMA increases cortisol levels acutely and subchronically and that changes in the HPA axis may explain why recreational ecstasy/MDMA users show various aspects of neuropsychobiological stress.

Psychophysiological responses in experienced firefighters undertaking repeated self-contained breathing apparatus tasks.

In order to safely and effectively extinguish fires and rescue life, firefighters are required to routinely wear self-contained breathing apparatus (SCBA), yet little is known about the specific physiological and psychological demands associated with repeated exposure to tasks that require SCBA. A total of 12 experienced firefighters took part in a series of commonly encountered SCBA activities: free search, guideline search and live firefighting tasks under room temperature (∼20°C) and extreme heat (∼180°C) conditions to assess changes in heart rate, blood pressure, mood, perceived workload and air usage. Findings demonstrate that live firefighting is associated with greater perceived exhaustion than free search or guideline exercises; however, all tasks lead to high cardiovascular demand regardless of the presence of heat. No significant impact of task upon mood and no significant differences between the perceived demands of guideline, free search and live firefighting exercises were found.

Seeing it my way: A perspective taking intervention alleviates psychological distress in caregivers of autistic children.

Cognitively empathic caregivers are able to take the perspective of their autistic child(ren) without experiencing vicarious distressing emotions, and typically report lower psychological distress. Taking the perspective of the autistic child might, through fostering cognitive empathy, might relieve caregivers' psychological distress. Here we explored whether autism perspective taking videos developed by the National Autistic Society (NAS), intended to raise public awareness about autism, might be effective, packaged as an intervention, for increasing caregivers' cognitive empathy and reducing their psychological distress. A sample of 24 caregivers of autistic children completed questionnaires capturing psychological distress and cognitive empathy at baseline. For three consecutive days, for two-three minutes per day, caregivers watched perspective taking videos. Follow up assessments were collected 7, 14, and 21 days post intervention. Psychological distress was lower after seven days, and stayed lower 14 and 21 days post intervention compared with baseline. Cognitive empathy was higher after 14 days, and remained higher 21 days post intervention compared with baseline. Taking the perspective of the autistic child, achieved here with publically available NAS videos, seems to be effective for increasing caregivers' cognitive empathy and reducing their psychological distress for up to three weeks. Future research might use more rigorous methodologies, incorporating control groups and larger samples, to explore moderators of intervention efficacy.

The effect of socially evaluated multitasking stress on typing rhythms.

Individuals have unique typing rhythms characterized by specific keystroke dynamics. Changes in state and cardiovascular responding are well documented manifestations of the fight-flight response to stress. However, as stress also leads to changes in muscle tone and motor control, typing rhythms may also be impacted. We aim to determine which individuals are experiencing stress through their typing rhythms and identify universal keystroke markers of stress. Participants (N = 116) typed 80 repetitions of a 6-word, 30-character phrase before and after 15 min of critically evaluated multitasking stress. Cardiovascular, hemodynamic, and state variables were compared across baseline, stress, and recovery periods and measures of typing rhythm were derived for each period and classified using machine-learning algorithms. Critically evaluated multitasking led to significant changes in all stress measures, demonstrating highly robust stress reactivity. Machine learning algorithms accurately classified stressed typing for each individual based on their typing rhythms; however, no universal keystroke markers of stress were identified. Using typing rhythms. We were able to determine whether an individual was stressed or not, but the markers used for classification differed between individuals. These individual changes may provide opportunities for identifying stressful periods through keystroke monitoring, as well as the potential for early identification of disorders which may impact fine motor control. Typing rhythms could therefore be used to monitor health and well-being in individuals who use keyboards in various situations. This is the first rigorous assessment of stress and typing rhythms and has led to the development of a feasible and highly reproducible research protocol.

Clinically elevated depression scores do not produce negative attentional biases in caregivers of autistic children.

Objective: Depression scores in caregivers of autistic children often fall in the clinical range. The attention of clinically depressed individuals tends to be biased toward negatively toned information. Whether caring for an autistic child might also be characterized by a negative attentional bias was explored here. Methods: A sample of N = 98 (57 caregivers and 41 controls) completed questionnaires assessing depressive symptoms. Orienting attention to (i.e., vigilance), and shifting attention away from (i.e., disengagement), negative information was assessed via an online version of the emotional face dot probe task. Results: Mean depression scores in caregivers, falling in the borderline clinical range, were significantly higher compared with controls. Groups, however, were indistinguishable with respect to vigilance and disengagement, and these attentional indices were unrelated to depression scores. Conclusion: Caring for an autistic child, while associated with borderline clinical depression scores, was not characterized by a negative attentional bias. Findings are discussed in the context of methodological shortcomings and recommendations for future research.

The effects of multitasking on psychological stress reactivity in recreational users of cannabis and MDMA.

BACKGROUND: Cannabis and 3,4-methylenedioxymethamphetamine (MDMA) use is associated with psychobiological and neurocognitive deficits. Assessments of the latter typically include tests of memory and everyday cognitive functioning. However, to date, little attention has been paid to effects of drug use on psychological stress reactivity. We report three studies examining the effects of recreational use of cannabis and MDMA on mood and psychological responses to multitasking using a cognitively demanding laboratory stressor that provides an analogue for everyday situations involving responses to multiple stimuli. METHODS: The effects of the multitasking framework on mood and perceived workload were assessed in cannabis (N=25), younger (N=18) and older (N=20) MDMA users and compared with non-target drug controls. RESULTS: Compared with respective control groups, cannabis users became less alert and content, and both MDMA groups became less calm following acute stress. Unexpectedly, the stressor increased ratings of calm in cannabis users. Users also scored higher than their controls with respect to ratings of resources needed to complete the multitasking framework. CONCLUSIONS: These findings show, for the first time, that recreational use of cannabis and MDMA, beyond the period of intoxication, can negatively influence psychological responses to a multitasking stressor, and this may have implications for real-life situations which place high demands on cognitive resources.

Written benefit finding for improving psychological health during the Covid-19 pandemic first wave lockdown.

Objectives. Written benefit finding is known to improve psychological and physical health in a range of patient groups. Here, we tested the efficacy of written benefit finding, delivered online during the Covid-19 pandemic lockdown, on mood and physical symptoms. We also investigated perseverative thinking as a moderator of these effects. Design. A quantitative longitudinal design was employed. Main Outcome Measures. Participants (n = 91) completed self-report measures of anxiety, depression, stress and physical symptoms at baseline, and two weeks after being randomised to complete three consecutive days of writing about the positive thoughts and feelings they experienced during the pandemic (written benefit finding) or to unemotively describe the events of the previous day (control). State anxiety was measured immediately before and after writing. Perseverative thinking was measured at baseline. Results. Anxiety and depression symptoms decreased between baseline and the two week follow-up, but did not differ significantly between the two conditions. Perseverative thinking was negatively associated with changes in symptoms of anxiety, depression and stress, but did not moderate any writing effects. There was a significant reduction in state anxiety in the written benefit finding condition. Conclusions. Written benefit finding may be a useful intervention for short-term improvements in wellbeing.

Pre-Sleep Cognitive Arousal Is Unrelated to Sleep Misperception in Healthy Sleepers When Unexpected Sounds Are Played during Non-Rapid Eye Movement Sleep: A Polysomnography Study.

BACKGROUND: It is well-established that environmental noise can disrupt sleep, and cause a mismatch between subjective and objective sleep, which is known as "sleep misperception". Naturalistic studies indicate that pre-sleep cognitive arousal and sleep misperception are associated in the context of noise. However, it is not known if this is the case when ecologically valid noises are specifically played during non-rapid eye movement (NREM) sleep, which is susceptible to noise-related disruption. The present study evaluated if pre-sleep cognitive arousal was associated with sleep misperception in healthy normal sleepers, when unexpected ecologically valid common nocturnal noises were played during NREM sleep. METHODS: Eighteen healthy sleepers (Mage = 23.37 years, SDage = 3.21 years) participated. Sleep was measured objectively on three consecutive nights using polysomnography, in a sleep laboratory environment, and subjectively, through participant estimates of total sleep time (TST). Night 1 was a baseline night where no noises were played. On Night 2, noises, which were chosen to be representative of habitual nocturnal noises heard in home environments, were played to participants via in-ear headphones after 5 min of objective sleep. RESULTS: Unexpectedly, habitual pre-sleep cognitive arousal was not associated with subjective-objective TST discrepancy on Night 2. CONCLUSIONS: These results suggest that in healthy sleepers, when ecologically valid noises are played unexpectedly during NREM sleep in an unfamiliar sleep laboratory environment the subjective experience of sleep is not associated with pre-sleep cognitive arousal, or negatively impacted by noise exposure.

Evaluation and update of the expert consensus guidelines for the assessment of the cortisol awakening response (CAR).

The cortisol awakening response (CAR) is frequently assessed in psychobiological (stress) research. Obtaining reliable CAR data, however, requires careful attention to methodological detail. To promote best practice, expert consensus guidelines on the assessment of the CAR were published (Stalder et al., 2016, PNEC). However, it is unclear whether these highly cited guidelines have resulted in actual methodological improvements. To explore this, the PNEC editorial board invited the present authors to conduct a critical evaluation and update of current CAR methodology, which is reported here. (i) A quantitative evaluation of methodological quality of CAR research published in PNEC before and after the guidelines (2013-2015 vs. 2018-2020) was conducted. Disappointingly, results reveal little improvement in the implementation of central recommendations (especially objective time verification) in recent research. (ii) To enable an update of guidelines, evidence on recent developments in CAR assessment is reviewed, which mostly confirms the accuracy of the majority of the original guidelines. Moreover, recent technological advances, particularly regarding methods for the verification of awakening and sampling times, have emerged and may help to reduce costs in future research. (iii) To aid researchers and increase accessibility, an updated and streamlined version of the CAR consensus guidelines is presented. (iv) Finally, the response of the PNEC editorial board to the present results is described: potential authors of future CAR research to be published in PNEC will be required to submit a methodological checklist (based on the current guidelines) alongside their article. This will increase transparency and enable reviewers to readily assess the quality of the respective CAR data. Combined, it is hoped that these steps will assist researchers and reviewers in assuring higher quality CAR assessments in future research, thus yielding more reliable and reproducible results and helping to further advance this field of study.

Perceived stress, common health complaints and diurnal patterns of cortisol secretion in young, otherwise healthy individuals.

Research has frequently linked perceived stress with changes in subjective and objective measures of ill health; however, additional assessment should consider the physiological mechanisms mediating these effects. This study investigated whether differential patterns of cortisol secretion might partially mediate perceived stress related disparities in common health complaints in young, otherwise healthy individuals. To capture the kinds of health complaints commonly reported in this population, the Pennebaker Inventory of Limbic Languidness (PILL) was selected. To capture important parameters of the diurnal profile, cortisol was sampled at waking, 30 minutes post waking, 1200 h and 2200 h on three consecutive weekdays. Results revealed flatter diurnal cortisol slopes and elevated mean diurnal output (characterised by HPA hyperactivity in the evening) for participants in the higher stress group. Participants that reported higher perceived levels of stress also reported experiencing common health complaints with markedly greater frequency; however, these disparities were abolished when mean diurnal output of cortisol was statistically controlled. While dysregulation of basal HPA activity has been implicated in the aetiologies of chronic illness, findings reported here implicated hypersecretion of cortisol as one physiological pathway, partially mediating perceived stress related disparities in the kinds of common health complaints that typically affect young, otherwise healthy individuals.

Sleep disturbances and physical health problems in caregivers of children with ASD.

OBJECTIVES: Caregivers of children with autism spectrum disorder self-report more physical health problems than controls. Sleep disturbances are also more prevalent in caregivers, and are positively associated with physical health problems. The negative impact of caring for a child with ASD on physical health therefore, might occur indirectly via poorer sleep. METHODS: Participants, of which n = 43 were caregivers and n = 17 were controls, completed self-report measures of physical health problems and, to capture objective measures of sleep, wore an actigraphy device. RESULTS: Physical health problems were greater in caregivers, as were subjective reports of disturbed sleep. Objectively, waking after sleep onset (WASO) and average number of awakenings were higher, as was sleep latency, and sleep efficiency was poorer, in caregivers. Total sleep time however, was greater in caregivers, as was time in bed. Physical health problems, while unrelated to actigraphy measures, were positively associated with self-reported sleep disturbances. Caregivers' increased risk for physical health problems occurred indirectly via greater self-reports of disturbed sleep. CONCLUSIONS: Interventions that help alleviate caregivers' sleep disturbances might be effective, by reducing physical health problems, for improving quality of provided care, and this might be explored in future research.

The Effects of COVID-19 Lockdown on Health and Psychosocial Functioning in Older Adults Aged 70 and Over.

The COVID-19 pandemic led to a state-imposed lockdown in the UK; there are many psychosocial consequences of pandemics, with older adults potentially at an increased risk. The current study assessed psychosocial functioning in a sample of older adults in the UK with baseline data collected pre-lockdown and follow-up 12 weeks later during lockdown. Thus, allowing investigation of the effect of COVID-19 and associated lockdown on psychosocial well-being. Thirty-five older adults (Mean age = 76.06, sex = 12 males) participated in this repeated measures study. A final follow-up was then conducted post-lockdown to capture any factors that were viewed as helpful to well-being during lockdown. From pre- to during lockdown, perceived stress, well-being, depressive symptoms, mood disturbance and memory were all significantly worsened. There were significant improvements in self-reported physical health symptoms, social interaction, time spent engaging in physical activity and certain aspects of relationship quality. Follow-up showed that well-being, depression and mood were still negatively affected post-lockdown. Given the sample were all 'healthy' at baseline in comparison to established norms, there may be greater impairment in more vulnerable populations. Support for older populations is needed to mitigate the negative effects shown, particularly in light of the endurance of some of these effects post-lockdown.