Biopsychosocial Correlates and Individual Differences for Eliciting Moral Elevation in Veterans With PTSD: An Experimental Case Series.

ABSTRACT: A promising approach to enhancing trauma-focused treatment is moral elevation-feeling inspired by witnessing a virtuous act. This study explored potential links between eliciting elevation and relevant outcomes in a series of case examples. Veterans with probable posttraumatic stress disorder completed experimental tasks including a written trauma narrative exercise and watching elevation-eliciting videos. Participants also completed baseline assessments, repeated measures of trauma-related cognitions, emotions, elevation, and saliva sample collection. Four cases were identified and reviewed: two positive responders (high elevation after videos) and two nonresponders (restricted elevation response). Positive responder cases reported decreased cognitions, emotions, and moral injury distress from after the trauma narrative to after elevation exercises, whereas nonresponders reported minimal to no changes. Positive responders also demonstrated decreases in cortisol, whereas nonresponders demonstrated increases in cortisol. Future work should examine whether elevation contributes to changes in biopsychosocial outcomes and identify individual factors that indicate who might benefit from elevation-based interventions.

Exploring the trajectory and correlates of social isolation for veterans across a 6-month period during COVID-19.

Social isolation is a relevant problem for veterans who are at risk for disengaging from others as a function of transition stress from military life to civilian life, and given high rates of exposure to trauma and psychological distress. Few researchers have examined social isolation in veterans over time, particularly during COVID-19 that led to significant barriers and restrictions on social interactions. The purpose of this longitudinal study was to assess veterans' experience of social isolation and its mental health and social functioning correlates during a 6-month period of the COVID-19 pandemic. Participants were 188 United States veterans of the Iraq and Afghanistan wars. A total of four assessments were administered: one every two months for a total duration of six months. The average number of completed assessments across all participants was 3.70 (SD = 0.75) with 159 participants (84.13%) completing all four timepoints. Surveys included measures of global mental health and social functioning as indicated by perceived emotional support, quality of marriage, and couple satisfaction. Multilevel modeling was used to assess 1) growth models to determine whether social isolation changed over time and the trajectory of that change (i.e., linear or quadratic); and 2) whether social isolation was related to both concurrent and prospective indicators of mental health and social functioning. All analyses included person mean centered and grand mean centered isolation to assess for within-and between-person effects. Veterans reported a quadratic trajectory in social isolation that decreased slightly and stabilized over time. Findings indicate that higher social isolation, at both the within- and between-person level, was negatively associated with concurrent emotional support, mental health, quality of marriage, and couple satisfaction. However, all prospective effects were nonsignificant at the within-person level. Results suggest although isolation may decrease over time, veterans report worse mental health and social functioning during times when they report higher levels of social isolation compared to themselves and others. Future work is needed to determine if interventions can be applied during those times to prevent or target those negative associations.

Moral Elevation Online Intervention for Veterans Experiencing Distress Related to Posttraumatic Stress Disorder and Moral Injury (MOVED): Pilot Trial of a 4-Week Positive Psychology Web-Based Intervention.

BACKGROUND: Veterans with posttraumatic stress disorder (PTSD) and moral injury can encounter several barriers to treatment, including limited access to care and low engagement with therapy. Furthermore, most treatment approaches focus on alleviating distress rather than cultivating positive experiences that could facilitate trauma recovery. A potential way to address these issues is through moral elevation: feeling uplifted and inspired by others' virtuous actions. OBJECTIVE: This study aimed to examine the feasibility and acceptability of a novel, web-based moral elevation intervention for veterans with PTSD symptoms and moral injury distress (Moral Elevation Online Intervention for Veterans Experiencing Distress Related to PTSD and Moral Injury [MOVED]). This mixed methods study also examined potential changes in PTSD symptoms, moral injury distress, quality of life, and prosocial behavior. METHODS: In this pilot trial, 48 participants were randomized to a MOVED or control condition (24 participants per condition). Both conditions included 8 sessions and lasted 1 month. The MOVED intervention and all survey components across both conditions were administered online. Participants completed self-report measures that assessed PTSD symptoms, moral injury distress, quality of life, and prosocial behavior at baseline and follow-up. Veterans in the MOVED condition also completed individual qualitative interviews at follow-up. We coded qualitative responses to interviews and identified emergent themes. RESULTS: Findings suggest the MOVED intervention was largely feasible, with evidence for moderate-to-high levels of participation, engagement, and retention in MOVED sessions. Both quantitative and qualitative results suggest veterans found MOVED to be acceptable and satisfactory at the overall treatment level. Furthermore, participants reported high scores for helpfulness and engagement at the session level. Veterans who completed MOVED reported large within-person decreases in PTSD symptoms (Cohen d=1.44), approximately twice that of veterans in the control condition (Cohen d=0.78). Those in MOVED also reported medium-sized increases in physical (Cohen d=0.71) and psychological domains of quality of life (Cohen d=0.74), compared with no meaningful changes in the control condition. Unexpectedly, MOVED veterans reported no decrease in moral injury distress, whereas veterans in the control condition endorsed a medium-sized decrease in the total score. There were no changes in prosociality for either condition. Qualitative feedback further supported high levels of perceived acceptability and satisfaction and positive treatment outcomes across a range of domains, including behaviors, cognitions, emotions, and social functioning. Veterans also recommended adaptations to enhance engagement and maximize the impact of intervention content. CONCLUSIONS: Overall, findings indicate that veterans with PTSD and moral injury distress were interested in an intervention based on exposure to and engagement with experiences of moral elevation. After further research and refinement guided by future trials, veterans may benefit from this novel approach, which may enhance treatment outcomes and increase treatment accessibility for those in need of additional trauma-focused care.

Commending rather than condemning: Moral elevation and stigma for male veterans with military sexual trauma.

BACKGROUND: Using an experimental study, we examined the link between state moral elevation and stigmatic beliefs surrounding male veterans with military sexual trauma (MST). METHODS: Undergraduate students were presented with a video or written narrative of a male veteran self-disclosing how they struggled with and overcame MST (n = 292). Participants completed measures regarding trait and demographic characteristics at baseline, then measures immediately after the disclosure stimulus to assess immediate elevation and stigma-related reactions. RESULTS: Results suggest state-level elevation in response to a veteran self-disclosing their experience with MST was negatively correlated with harmful stigmatic beliefs about MST. A greater predisposition to experience elevation and PTSD symptoms were linked with stronger elevation responses to the stimulus. CONCLUSION: Findings support the need for further exploration of elevation and its potential to impact public stigma for male veterans with MST.

Development and Validation of the State Moral Elevation Scale: Assessing State-Level Elevation Across Nonclinical and Clinical Samples.

Research on moral elevation has steadily increased and identified several psychosocial benefits that bear relevance to both the general population and people with psychological distress. However, elevation measurement is inconsistent, and few state-level measures have been created and critically evaluated to date. To address this gap, the State Moral Elevation Scale (SMES) was developed and tested using an online sample (N = 930) including subsamples of general participants (nonclinical) and those who screened positive for mental health symptoms (clinical). Factor analysis indicated a single factor structure with nine items that demonstrated excellent reliability. Multigroup confirmatory factor analysis indicated good fit statistics and strict measurement invariance across clinical and nonclinical subsamples. Lastly, correlational analyses with related constructs provided evidence of construct validity for both subsamples. Thus, the SMES is a psychometrically valid and reliable assessment tool for state-level elevation which can be used in both general and clinical populations. Supplementary Information: The online version contains supplementary material available at 10.1007/s10902-022-00533-2.

Changes in Trauma-Related Cognitions and Emotions After Eliciting Moral Elevation: Examining the Effects of Viewing Others' Virtuous Behavior on Veterans with PTSD.

Moral elevation is described as feeling inspired after witnessing someone perform a virtuous act. Past work suggests the features of moral elevation may be contrary to PTSD, yet few studies have directly tested its impact on relevant symptoms. This experimental study assessed changes in trauma-related cognitions and emotions from after a trauma reminder task to after an elevation induction exercise. We hypothesized that higher elevation after the induction exercise would be associated with greater reductions in cognitions and emotions. Veterans with probable PTSD (N = 38) completed measures of trauma-related cognitions and emotions, once after a written trauma narrative exercise (T1) and again after watching two videos designed to elicit elevation (T2). Veterans also completed measures of state elevation after each video. Results suggest veterans experienced small, significant decreases in self-blame (d = 0.36) and negative beliefs about others (d = 0.46), and medium, significant decreases in guilt (d = 0.68), shame (d = 0.60), and negative beliefs about self (d = 0.69) between T1 and T2. As hypothesized, higher elevation was associated with significantly greater reductions in multiple outcomes above and beyond the effects of general positive affect. Specifically, there were medium effects for changes in shame (ß = -0.42, SE = 0.17, p = .019, Δf 2 = 0.25), negative view of others (ß = -0.34, SE = 0.16, p = .044, Δf 2 = 0.20), and a large effect for changes in negative view of self (ß = -0.31, SE = 0.13, p = .019, Δf 2 = 0.54). These findings suggest elevation may be well-suited to target trauma-related symptoms and future research should further examine its clinical utility.

Dispositional gratitude predicts the development of psychopathology and suicidal behaviors: Results from a 7-year population-based study of U.S. military veterans.

BACKGROUND: Dispositional gratitude has been implicated as a psychological characteristic that may modulate risk for mental health outcomes. Using a population-based sample of U.S. military veterans, this study evaluated the association between dispositional gratitude and the development of psychopathology and suicidal behaviors over a 7-year period. METHODS: A nationally representative sample of U.S. veterans was surveyed at four timepoints across seven years. Analyses were restricted to veterans without incident outcomes at baseline. Multivariable analyses were conducted to examine the relation between baseline levels of dispositional gratitude and risk of developing (a) major depressive disorder (MDD), generalized anxiety disorder (GAD), or posttraumatic stress disorder (PTSD); (b) suicidal ideation; and (c) suicide attempts. RESULTS: A total 9.6% of veterans developed MDD, GAD, and/or PTSD, 9.5% developed suicidal ideation, and 2.8% reported having attempted suicide over the 7-year follow-up period. Among veterans with high levels of dispositional gratitude, incidence was lower for MDD/GAD/PTSD (8.0%), suicidal ideation (6.8%), and suicide attempts (1.5%). Conversely, veterans with low dispositional gratitude were at substantially higher risk of developing MDD/GAD/PTSD (27.7%), suicidal ideation (33.6%), and suicide attempts (20.3%). CONCLUSIONS: High dispositional gratitude may help protect against the development of psychopathology and suicidal behaviors in U.S. military veterans, whereas low gratitude may increase risk of developing these outcomes. Collectively, these results support the potential utility of enhancing gratitude as part of primary prevention efforts for veterans, service members, and other populations at heightened risk for adverse mental health outcomes.

Exploring the longitudinal clustering of lifestyle behaviors, social determinants of health, and depression.

Lifestyle behaviors such as exercise, sleep, smoking, diet, and social interaction are associated with depression. This study aimed to model the complex relationships between lifestyle behaviors and depression and among the lifestyle behaviors. Data from three waves of the Midlife in the United States study were used, involving 6898 adults. Network models revealed associations between the lifestyle behaviors and depression, with smoker status being strongly associated with depression. Depression, smoker status, age, time, and exercise were some of the most central components of the networks. Future lifestyle intervention research might prioritize specific behaviors based on these associations and centrality indices.

Resilience predicts posttraumatic cognitions after a trauma reminder task and subsequent positive emotion induction among veterans with PTSD.

[Correction Notice: An Erratum for this article was reported in Vol 14(S1) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2022-45004-002). In the article (https://doi.org/10.1037/tra0001143), the Supplemental materials link was missing from the title page. All versions of this article have been corrected.] Objective: Posttraumatic stress disorder (PTSD) is a common problem for veterans. Resilience, the tendency to bounce back from difficult circumstances, is negatively associated with posttraumatic cognitions (PTCs) among individuals with a history of trauma, and it may be important to understand responses to trauma reminders. METHOD: Using a quasi-experimental design, we examined the association between trait resilience and state PTCs in veterans with PTSD (n = 47, Mage = 48.60, 91.8% male) at two points: following a written trauma narrative exposure (Time 1 [T1]), and following a subsequent positive distraction task (i.e., brief, positive video; Time 2 [T2]). RESULTS: After controlling for PTSD symptom severity and combat exposure, resilience was negatively associated with PTCs at T1 (ΔR2 = .19) and T2 (ΔR2 = .13). However, resilience was a poor predictor of change in PTCs from T1 to T2. We also examined the relationship between resilience and subtypes of PTCs: resilience was associated with negative views of the self (T1, ΔR2 = .24) but not negative views of the world or self-blame (T1, ΔR2s ≤ .07); these results were consistent at T2. CONCLUSIONS: Thus, resilience may attenuate negative trauma-related cognitions after trauma recall; however, this study was not designed to test causal pathways. Future research could examine whether resilience-building exercises reduce negative PTCs after trauma reminders among veterans. Additional research is needed to generalize to other trauma-exposed populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social Interaction Within a Trauma-Exposed Population During the Early Phase of COVID-19.

The novel coronavirus (COVID-19) has led to significant stressors and shifts in social life, yet social interactions experienced by people with trauma exposure during the COVID pandemic is largely unknown. This study assessed frequency of interactions, social support given and received, and prosocial behavior using online survey methods (N=1049). We examined differences in experiences across three groups: no trauma exposure, trauma-exposed with low PTSD symptoms, and trauma-exposed with high PTSD symptoms. We also explored correlations between social interactions and PTSD symptom clusters. Results indicated significant differences across groups and the high PTSD group reported stronger associations between social interaction variables and symptom clusters, on average.

Dispositional gratitude and mental health in the U.S. veteran population: Results from the National Health and Resilience Veterans Study.

Dispositional gratitude may be linked to positive mental health outcomes, yet population-based data on this association are lacking. Military veterans are an ideal population in which to examine this question given high rates of psychiatric morbidities and efforts to promote psychological resilience in this population. Data were analyzed from a nationally representative sample of 3151 U.S. veterans. Veterans were separated into three groups based on an assessment of level of dispositional gratitude: high gratitude (weighted 79.8%), moderate gratitude (9.6%), and low gratitude (10.5%). Multivariable analyses examined the associations between level of dispositional gratitude, and measures of mental health and psychosocial variables. A "dose-response" association was observed between levels of dispositional gratitude and odds of psychiatric morbidities. Higher dispositional gratitude was associated with decreased risk for lifetime history of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), social phobia, nicotine dependence, and suicide attempts, and decreased risk for current PTSD, MDD, generalized anxiety disorder, and suicidal ideation (odds ratio range = 0.16-0.65). Higher dispositional gratitude was additionally associated with resilience-promoting characteristics such as optimism, curiosity, purpose in life, perceived social support, and religiosity/spirituality (Cohen's d range = 0.11-0.73). Dispositional gratitude is prevalent in U.S. veterans, is negatively associated with psychiatric morbidities, and may help promote psychosocial factors linked to resilience in this population. Stratification of veterans with low, moderate, and high dispositional gratitude may help identify those who are at increased risk for psychiatric illness and in need of additional support.

Examining the Link Between Intolerance of Uncertainty and Positive and Negative Urgency in Veterans With Comorbid Posttraumatic Stress Disorder and Substance Use Disorders.

Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are highly comorbid among the veteran population. Impulsivity, particularly negative and positive urgency, are prevalent within this dual-diagnosis population and associated with negative outcomes. One possible correlate of negative/positive urgency is intolerance of uncertainty (IU). IU is associated with exacerbated PTSD symptom severity and increased risk for substance use. However, few studies have examined the link between IU and negative/positive urgency in dual-diagnosis populations. This study aimed to examine whether there was a significant association between trait IU and baseline negative and positive urgency in veterans seeking treatment for both PTSD and SUD. In a sample of 114 veterans from a 6-week residential treatment program, IU was significantly associated with higher negative and positive urgency. Further research is warranted to extend these findings and examine whether IU plays an important role in negative/positive urgency for dual-diagnosis populations.

Pre- to Posttreatment Changes in Trauma-Cued Negative Emotion Mediate Improvement in Posttraumatic Stress Disorder, Depression, and Impulsivity.

Posttraumatic stress disorder (PTSD) is characterized by strong negative emotions, often in response to trauma cues or reminders. Subsequent emotion regulation strategies impact the maintenance of PTSD symptoms and other trauma-related outcomes (depression, substance use). This study aimed to examine a range of trauma-cued emotions to enhance our understanding of changes following treatment and their potential role in improving relevant outcomes. Participants included 67 veterans diagnosed with PTSD and a substance use disorder who completed a dual diagnosis residential program that used cognitive processing therapy. At pre- and posttreatment, we measured 8 negative emotions following a trauma recall and PTSD symptoms, depressive symptoms, and negative urgency (impulsivity following negative emotions) as treatment outcomes. We used t-tests to assess changes at posttreatment and a within-subjects mediational analysis to test whether changes in trauma-cued emotions mediated treatment outcomes. Participants reported moderate, significant decreases for 5 emotions at posttreatment: anger at self, disgust at self, fear, guilt, and sadness (d ≥ 0.50), whereas nonsignificant changes were found for anger at others, disgust at others, and shame. Mediation analyses indicated greater reductions in trauma-cued sadness had a significant indirect effect on improvement in PTSD symptoms, depressive symptoms, and negative urgency. Reductions in disgust at self and fear also demonstrated a significant indirect effect on depressive symptom improvement. In this dual diagnosis program, veterans reported a significant reduction in some, but not all, trauma-cued emotions, and improvements in only select emotions accounted for a significant portion of improvement in relevant treatment outcomes.

SOCIAL ENGAGEMENT EARLY IN THE U.S. COVID-19 CRISIS: EXPLORING SOCIAL SUPPORT AND PROSOCIAL BEHAVIOR BETWEEN THOSE WITH AND WITHOUT DEPRESSION OR ANXIETY IN AN ONLINE SAMPLE.

INTRODUCTION: Social distancing and sheltering-in-place mitigate the physical health risks of the novel coronavirus (COVID-19); however, there are concerns about the impact on mental health and social engagement. METHODS: We used data from a U.S.-based online survey (March 2020) to examine patterns of social support and prosocial behavior, explore differences between people with and without depression or anxiety, and explore correlates of social engagement in both groups, including symptom severity in the clinical group. RESULTS: The clinical group reported greater social engagement. In both groups, social engagement was positively associated with COVID-19-related worry and trait moral elevation; mindfulness was positively associated with all outcomes for the clinical group only. Social interaction frequency had little influence on outcomes. Depressive symptom severity was positively associated with all outcomes, whereas anxiety was negatively associated with prosocial behavior. DISCUSSION: These findings highlight how social engagement was experienced early in the U.S. COVID-19 crisis.

Direct and Indirect Effects of Trait and State Gratitude on Health-Related Quality of Life in a Prospective Design.

Gratitude has been consistently linked to well-being, but its influence on health-related functioning is not well understood. Furthermore, research suggests the need to differentiate between-person and within-person effects of personality characteristics, and research on gratitude and health has not typically done so. This prospective study aimed to (1) differentiate the unique effects of trait and state gratitude on health-related quality of life (HRQoL) and (2) test state gratitude as a mediator between baseline trait gratitude and subsequent HRQoL. Undergraduate participants (N = 141) completed a trait gratitude measure at baseline and then repeated measures of weekly state gratitude and HRQoL over eight weeks. Multilevel models examined baseline trait gratitude, state gratitude averaged across the study (person aggregate) as between-person individual differences, and within-person variability in state gratitude (person-centered) as predictors of HRQoL, as well as the indirect effect of trait gratitude on HRQoL via state gratitude. Greater aggregate and person-centered state gratitude each predicted higher HRQoL. Baseline trait gratitude did not have a significant direct effect but prospectively predicted higher HRQoL via higher weekly state gratitude. Results suggest that understanding effects of gratitude on health-related perceptions requires accounting for both between-person individual differences and within-person fluctuation in state gratitude.

A cognitive processing therapy-based treatment program for veterans diagnosed with co-occurring posttraumatic stress disorder and substance use disorder: The relationship between trauma-related cognitions and outcomes of a 6-week treatment program.

Dysfunctional trauma-related cognitions are important in the emergence and maintenance of posttraumatic stress disorder (PTSD) and the modification of such cognitions is a proposed mechanism of trauma treatment. However, the authors are not aware of any research examining trauma-related cognitions as a treatment mechanism in a sample of individuals with comorbid PTSD and substance use disorder (SUD). Accordingly, the present study sought to address this gap in the literature and examined the relationship between trauma-related cognitions and treatment outcomes within a sample of seventy-two veterans diagnosed with PTSD and SUD. Veterans completed a 6-week day CPT-based treatment program that included cognitive processing therapy as a central component. Measures of trauma-related cognitions, PTSD symptoms, depressive symptoms, and trauma-cued substance craving were completed at pre- and post-treatment. As expected, trauma-related cognitions were associated with several PTSD-related variables prior to treatment. Furthermore, results of a within-subjects mediational analysis indicated that maladaptive trauma-related cognitions decreased during the treatment program and accounted for a significant portion of the variance in the reduction of PTSD and depressive symptoms at post-treatment. This study provides support for the position that attempts to modify dysfunctional trauma-related cognitions among veterans with co-occurring PTSD and SUD can lead to desirable treatment outcomes.

Social Support Moderates Effects of Natural Disaster Exposure on Depression and Posttraumatic Stress Disorder Symptoms: Effects for Displaced and Nondisplaced Residents.

Social support is a known protective factor against the negative psychological impact of natural disasters. Most past research has examined how the effects of exposure to traumatic events influences whether someone meets diagnostic criteria for depression and posttraumatic stress disorder (PTSD); it has also suggested sequelae of disaster exposure depends on whether survivors are displaced from their homes. To capture the full range of the psychological impact of natural disasters, we examined the buffering effects of social support on depressive symptoms and cluster-specific PTSD symptoms, with consideration of displacement status. In a survey conducted 18 to 24 months after Hurricane Katrina, 810 adults exposed to the disaster reported the number of Katrina-related traumatic events experienced, perceived social support 2 months post-Katrina, and cluster-specific PTSD and depressive symptoms experienced since Katrina. Analyses assessed the moderating effects of social support and displacement and the conditional effects of displacement status. Social support significantly buffered the negative effect of Katrina-related traumatic events on depressive symptoms, B = -0.10, p = .001, and avoidance and arousal PTSD symptoms, B = -0.02, p = .035 and B = -0.02, p = .042, respectively. Three-way interactions were nonsignificant. Conditional effects indicated social support buffered development of depressive symptoms across all residents; however, the moderating effects of support on avoidance and arousal symptoms only appeared significant for nondisplaced residents. Results highlight the protective effects of disaster-related social support among nondisplaced individuals, and suggest displaced individuals may require more formal supports for PTSD symptom reduction following a natural disaster.

Increased Resilience is Associated with Positive Treatment Outcomes for Veterans with Comorbid PTSD and Substance Use Disorders.

OBJECTIVE: Resilience has been associated with less severe psychiatric symptomatology and better treatment outcomes among individuals with posttraumatic stress disorder (PTSD) and substance use disorders. However, it remains unknown whether resilience increases during psychotherapy within the comorbid PTSD and substance use disorder population with unique features of dual diagnosis, including trauma cue-related cravings. We tested whether veterans seeking psychotherapy for comorbid PTSD and substance use disorder reported increased resilience from pre- to posttreatment. We also tested whether increased resilience was associated with greater decreases in posttreatment PTSD and substance use disorder symptoms. METHODS: Participants were 29 male veterans (Mage = 49.07 years, SD = 11.24 years) receiving six-week residential day treatment including cognitive processing therapy for PTSD and cognitive behavioral therapy for substance use disorder. Resilience, PTSD symptoms, and trauma cue-related cravings were assessed at pre- and posttreatment. RESULTS: Veterans reported a large, significant increase in resilience posttreatment (Mdiff = 14.24, t = -4.22, p < .001, d = 0.74). Greater increases in resilience were significantly associated with fewer PTSD symptoms (ß = -0.37, p = .049, sr = -.36) and trauma-cued cravings (ß = -0.39, p = .006, sr = -.38) posttreatment when controlling for pretreatment scores and baseline depressive symptoms. CONCLUSIONS: Results suggest that evidence-based psychotherapy for comorbid PTSD and substance use disorder may facilitate strength-based psychological growth, which may further promote sustained recovery.

Mediators of compassionate goal intervention effects on human neuroendocrine responses to the Trier Social Stress Test.

OBJECTIVES: The hypothalamic-pituitary-adrenal (HPA) axis is thought to mediate the effects of stress on illness. Research has identified a limited number of psychological variables that modulate human HPA responses to stressors (e.g. perceived control and social support). Prosocial goals can reduce subjective stress, but have not been carefully examined in experimental settings where pathways of impact on biological stress markers may be traced. Recent work demonstrated that coaching individuals to strive to help others reduced HPA responses to the Trier Social Stress Test (TSST) relative to other cognitive interventions. However, identification of mediational pathways, which were not examined in the original study, is necessary to determine whether the HPA buffering effects were due to helping motivations (compassionate goals; CGs) rather than via previously identified variables such as control or support. METHODS: In this new analysis, we combined the original cortisol data with novel observer ratings of interpersonal behavior and psychological variables during the stress task, and conducted new, theory-driven analyses to determine psychological mediators for the intervention's effect on cortisol responses (N = 54; 21 females, 33 males; 486 cortisol samples). RESULTS: Control, support, and task ego-threat failed to account for the effects of the intervention. As hypothesized, self and observer-rated CGs, as well as observer-rated perceptions of participants' interpersonal behavior as morally desirable (but not as dominant or affiliative) were significant mediators of neuroendocrine responses. CONCLUSIONS: The findings suggest that stress-reduction interventions based on prosocial behavior should target particular motivational and interpersonal features.

Somatic Symptoms Mediate the Relationship Between Health Anxiety and Health-Related Quality of Life over Eight Weeks.

Previous research has indicated that at clinical levels, health anxiety is cross-sectionally correlated with both somatic symptoms and health-related quality of life (HRQOL). However, research has not tested mediational models of how health anxiety may lead to diminished HRQOL prospectively, and more broadly outside of clinical contexts. In the context of an eight-week prospective diary study of 118 subclinical adults, we examined whether somatic symptoms mediate the relationship between health anxiety and both same-week HRQOL and week-to-week change in HRQOL. Multilevel modelling indicated that somatic symptoms fully mediated the relationship between HA and HRQOL concurrently and over time. Even after accounting for depressive symptoms, individuals who were predisposed to experience illness preoccupation and oversensitivity to bodily sensations were at risk for higher somatic symptoms and thereby poorer levels of perceived health. Thus, both health anxiety and somatic symptoms may be an important target for interventions seeking to improve HRQOL in subclinical populations. Copyright © 2016 John Wiley & Sons, Ltd.