"Pathways": A hope-enhancing intervention for patients undergoing treatment for advanced lung cancer.

OBJECTIVE: Observational data suggest hope is associated with the quality of life and survival of people with cancer. This trial examined the feasibility, acceptability, and preliminary outcomes of "Pathways," a hope intervention for people in treatment for advanced lung cancer. METHODS: Between 2020 and 2022, we conducted a single-arm trial of Pathways among participants who were 3-12 weeks into systemic treatment. Pathways consisted of two individual sessions delivered during infusions and three phone calls in which participants discussed their values, goals, and goal strategies with a nurse or occupational therapist. Participants completed standardized measures of hope and goal interference pre- and post-intervention. Feasibility was defined as ≥60% of eligible patients enrolling, ≥70% of participants completing three or more sessions, ≥70% of participants completing post-assessments, and mean acceptability ratings ≥7 out of 10 on intervention relevance, helpfulness, and convenience. Linear regression fixed effects models with covariates modeled pre-post changes in complete case analysis and multiple imputation models. RESULTS: Fifty two participants enrolled: female (59.6%), non-Hispanic White (84.6%), rural (75.0%), and with low educational attainment (51.9% high school degree or less). Except for enrollment (54%), feasibility and acceptability markers were surpassed (77% adherence, 77% retention, acceptability ratings ≥8/10). There was moderate improvement in hope and goal interference from pre-to post-intervention (d = 0.51, p < 0.05 for hope; d = -0.70, p < 0.005 for goal interference). CONCLUSIONS: Strong feasibility, acceptability, and patient-reported outcome data suggest Pathways is a promising intervention to increase hope and reduce cancer-related goal interference during advanced lung cancer treatment.

Seeing is believing: The effect of subtle communication in social media on viewers' beliefs about depression and anxiety symptom trajectories.

OBJECTIVE: One barrier to treatment seeking, uptake, and engagement is the belief that nothing can be done to reduce symptoms. Given the widespread use of social media to disseminate information about important issues, including psychological health, we sought to understand how the influence of social media communication regarding mental health impacts viewers' beliefs about psychopathology recovery. METHOD: Undergraduate participants from a large Midwestern university (N = 322) were randomized to view a series of Tweets characterizing psychopathology from a fixed mindset perspective, a growth mindset perspective, or, in the control condition, Tweets unrelated to psychopathology. Afterward, they completed a series of questionnaires designed to assess beliefs about recovery from depression and anxiety. RESULTS: Participants in the growth mindset condition endorsed less pessimistic beliefs about their ability (i.e., self-efficacy) to alleviate symptoms of depression and anxiety, and they believed these symptoms to be less stable and innate relative to those in the fixed mindset condition. CONCLUSION: Social media communication that characterizes psychopathology from a growth mindset perspective may be a viable intervention for improving beliefs around mental health self-efficacy and the malleable nature of mental illness, particularly depression and anxiety. Clinicians may be able to use social media platforms to promote functional beliefs around mental illness.

Culturally compelled coping and depressive symptoms in Black Americans: Examining the role of psychophysiological regulatory capacity.

Given the culture of racism in the United States, Black Americans are often required to use culturally compelled coping (CCC) styles, such as emotional and behavioral restraint and vigilance. Although CCC is adaptive in the face of pervasive racialized stress, it may still negatively impact mental health outcomes, like depression. Studies have found that Black Americans exhibit higher resting heart rate variability (HRV)-a trait-level biomarker of self-regulatory capacity-than White Americans (Hill et al., 2015), which may reflect the additional resources that Black Americans need to regulate given experiences of racialized stress. Theoretically, this should protect against the development of mental health issues, like depression, given that lower resting HRV is typically observed in psychopathology (Beauchaine & Thayer, 2015). However, the literature is mixed on the buffering effects of greater resting HRV on psychopathology for Black Americans (Keen et al., 2015). Thus, we aimed to understand, with data collected from Black Americans between 2015 and 2018, how individual differences in resting HRV and the use of CCC, particularly restraint and vigilance, related to self-reported depressive symptoms. We found that at higher levels of resting HRV, greater use of CCC was associated with higher depressive symptoms. This suggests that CCC strategies may be detrimental to emotional well-being for those who have the capacity-as indexed by higher resting HRV-to engage in these strategies. Hence, the present study provides preliminary evidence that the ways Black Americans are often compelled to cope with racialized stress may be a path to greater depressive symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Weight loss maintenance following an augmented intervention for early slow weight loss responders: An adaptive trial.

Early slow weight loss during treatment is associated with less weight loss overall. The impact of an augmented intervention designed for early slow weight loss responders compared with a standard diabetes prevention intervention was evaluated following 12 months of treatment and 6 months of no contact. The impact of standard vs. augmented intervention sequences on weight and glycemia also was determined. Adults were ≥21 years old with overweight or obesity and prediabetes (n = 174). Slow responders were stratified to augmented treatment if they failed to achieve >2.5% weight loss (%WL) at Week 5. Matched within-sex pairs of participants were created based on %WL at Month 5 following the intensive intervention phase, and each person within the pair was randomly assigned to treatment for Months 5-12 during the extended intervention phase. Both 12-month interventions included a ≥7%WL goal. Mean 12-month %WL was 5.29% (95% CI: 4.27%-6.31%; P < .0001) and 18-month %WL was 3.34% (95% CI: 2.01%-4.66%; P < .0001) overall. %WL was greater for the standard (9.55%) than the augmented (4.0%) intervention (P = .0001); no differences occurred in weight regain between early and slow responders (P = .9476). No differences occurred in mean %WL at 12 months between the standard and augmented groups after controlling for %WL at Week 5 and sex (P = .23) nor in the change in glycemia (all P > .05). WL following the first month of treatment predicted 12- and 18-month WL success regardless of intervention sequence; however, even early slow responders achieved significant WL during treatment. Further research is needed to support effective WL maintenance for people with prediabetes.

Weight loss is a primary strategy for risk reduction in adults with prediabetes, and early weight loss may indicate weight loss success long-term. Early slow weight loss responders during behavioral treatment may benefit from alternate treatment compared with remaining in a standard diabetes prevention program. An intervention augmented with training in goal setting and problem-solving was implemented among slow weight loss responders following the first month of treatment in the current study. The change in percent weight loss observed in the augmented intervention compared with the standard diabetes prevention intervention was determined at 12 and 18 months from baseline. Both the standard and augmented interventions facilitated significant weight loss at 12 months. Participants who lost more than 2.5% of their weight during the first month of treatment (early responders) lost more weight overall during the study compared with people who were slower to respond. Percent weight loss following the first month of lifestyle intervention and sex predicted percent weight loss at 12 months. Participants regained some weight at 18 months regardless of the treatment group but weighed less than their baseline weight. Both early and slow weight loss responders may benefit from ongoing support following 12 months of treatment to achieve weight loss maintenance.

Protective factors in borderline personality disorder: A multi-study analysis of conscientiousness, distress tolerance, and self-compassion.

BACKGROUND: Despite a growing literature characterizing risk factors associated with the development and maintenance of borderline personality disorder (BPD), substantially less is known about potentially protective factors in BPD. METHODS: In a sample of online (N = 272) participants with likely BPD, major depressive disorder (MDD), or no disorder (ND) and an independent sample of in-person (N = 90) participants diagnosed with BPD, MDD, or ND, we tested the cross-sectional and longitudinal associations among BPD features and three putatively protective personality, cognitive, and affective-behavioral factors: conscientiousness, self-compassion, and distress tolerance. RESULTS: Only conscientiousness was significantly lower in BPD than MDD (ds: .67-.73) across both studies and more strongly related to BPD features (rs: -.68 to -.59) than MDD symptoms (rs: -.49 to -.43) in dimensional analyses across both studies. However, in a multiple regression analysis including all three factors in Study 1, only self-compassion predicted decreases in BPD features (ß = -.28) and MDD symptoms (ß = -.21) over one month. LIMITATIONS: Study 1 participants completed all measures online and exhibited some differential attrition at one month follow-up. Study 2 participants were all diagnosed by one trained assessor and the smaller sample size limited our power to detect effects. CONCLUSIONS: Low conscientiousness may be most strongly related to BPD, whereas self-compassion may be a prospective transdiagnostic protective factor.

Sex Differences in Early Weight Loss Success During a Diabetes Prevention Intervention.

Objectives: Males often lose more weight than females during treatment, and early weight loss predicts weight loss longer-term. Yet, mechanisms for sex differences in early weight loss are unknown and were examined in this study.Methods: Adults≥21 years old with overweight or obesity and prediabetes (N=206) participated in a lifestyle intervention and completed baseline psychosocial questionnaires. Percent weight loss, session attendance, and number of days participants self-monitored dietary intake and weight were determined at week 5. Principal components, regression, and mediation analyses were conducted to determine whether weight loss differed by sex and potential mediators of weight change. Results: Mean (±SD) weight loss was greater for males (2.59±1.62%) than females (2.05±1.54%; p=.02). Attendance, self-monitoring, and beliefs regarding disease risk were independent predictors of weight loss (all p<.05) but did not explain sex differences. The association between attendance and weight loss was stronger for males than females (p<.05). Conclusions: Additional research is needed to identify mechanisms that explain sex differences in early weight loss. However, strengthening risk beliefs, attendance, and self-monitoring may promote greater early weight loss for all participants.

Goal-Focused Emotion-Regulation Therapy (GET) in Young Adult Testicular Cancer Survivors: A Randomized Pilot Study.

BACKGROUND: Young adult testicular cancer survivors experience adverse impacts after treatment. We developed Goal-focused Emotion-regulation Therapy (GET) to improve distress symptoms, emotion regulation, and goal navigation skills. PURPOSE: This pilot study examined GET versus an active control intervention in young adult survivors of testicular cancer. METHODS: Seventy-five eligible survivors treated with chemotherapy were randomized to receive GET or Individual Supportive Listening (ISL). Study acceptability, engagement, and tolerability were examined, and intervention fidelity and therapeutic alliance were compared between arms. Preliminary efficacy was evaluated by effect sizes for between-group changes in primary (anxiety and depressive symptoms) and secondary (career confusion, goal navigation, and emotion regulation) outcomes from baseline to immediately and 3-month post-intervention. RESULTS: Among the 38 men randomized to GET, 81.1% completed all study sessions compared with 82.4% of the 37 men assigned to ISL. Fidelity to the intervention was 87% in GET. Therapeutic alliance wassignificantly higher among those receiving GET versus ISL. Participants exhibited a medium group-by-time effect size with greater reductions in depressive (d = 0.45) and anxiety (d = 0.29) symptoms for those in GET versus ISL, with a similar pattern at 3 months for depressive (d = 0.46) and anxiety (d = 0.46) symptoms. CONCLUSIONS: GET is a feasible and acceptable intervention for reducing adverse outcomes after testicular cancer for young adults. Observed effect sizes preliminarily suggest meaningful change, though should be interpreted with caution in small samples. GET may be a developmentally-matched behavioral approach to improve psychosocial function in this cancer group. CLINICAL TRIAL INFORMATION: Clinicaltrials.gov, NCT04150848. Registered on October 28, 2019.

Young adult testicular cancer survivors experience adverse impacts after treatment. Goal-focused Emotion-regulation Therapy (GET) was developed to improve distress symptoms, emotion regulation, and goal navigation skills. The aim of this pilot study was to examine GET versus a control intervention in young adult survivors of testicular cancer. Seventy-five survivors were randomly assigned to GET or Individual Supportive Listening (ISL). Indictors of acceptability, engagement, and tolerability were examined, and intervention fidelity and therapeutic alliance were compared between groups. Between-group changes in primary (anxiety and depressive symptoms) and secondary (career confusion, goal navigation, and emotion regulation) outcomes from baseline to immediately and 3-month post-intervention were examined. Among GET participants, 81.1% completed all study sessions compared with 82.4% of those receiving ISL. Fidelity to the intervention was 87% in GET. Therapeutic alliance scores were significantly higher among those receiving GET. Participants exhibited greater reductions in depressive and anxiety symptoms for those in the GET versus ISL, with a similar pattern observed for changes at 3 months for depressive and anxiety symptoms. GET is a feasible and acceptable intervention for reducing adverse outcomes after testicular cancer for young adults.

Less is more: Decreasing the frequency of maladaptive coping predicts improvements in DBT more consistently than increasing the frequency of adaptive coping.

It is well-established that participation in dialectical behavior therapy (DBT) results in patients using adaptive coping strategies more frequently. Although coping skill instruction may be necessary to promote decreases in symptoms and behavioral targets in DBT, it is unclear if the frequency with which patients use adaptive coping skills leads to these outcomes. Alternatively, it is possible that DBT also leads patients to use maladaptive strategies less frequently and that these reductions more consistently predict improvements in treatment. We recruited 87 participants with elevated emotion dysregulation (Mage = 30.56; 83.9% female; 75.9% White) to participate in a 6-month course of full-model DBT delivered by advanced graduate students. Participants completed measures of adaptive and maladaptive strategy use, emotion dysregulation, interpersonal problems, distress tolerance, and mindfulness at baseline and after three DBT skills training modules. Both within- and between-person maladaptive strategy use significantly predicted module-to-module changes in all outcomes whereas adaptive strategy use significantly predicted changes in emotion dysregulation and distress tolerance, although the size of these effects did not significantly differ between adaptive and maladaptive strategy use. We discuss the limitations and implications of these results for optimizing DBT.

Hope therapy.

Research over the past three decades has established that hope is related to positive outcomes. Hope therapy was originally developed to optimize successful goals pursuits by increasing hopeful thought. Here, we briefly review the current state of hope therapy research and offer directions for future investigations. We note that hope therapy has been adapted to be delivered in different formats, by providers from various professional backgrounds, and to participants presenting with a variety of chronic health conditions. We suggest there is a need to reach a consensus about what characterizes hope therapy. Further, we note the need for well-designed trials to test potential mechanisms of change. We believe that these future directions will result in a more efficacious hope therapy that can be widely disseminated.

Broad strokes or fine points: Are dialectical behavior therapy modules associated with general or domain-specific changes?

Dialectical behavior therapy (DBT) has demonstrated effectiveness for a range of emotional difficulties, and DBT skills training groups may be necessary to produce symptom change. However, it is unclear how skills training groups influence outcomes. Specifically, is participation in DBT skills modules associated with general effects (i.e., changes in multiple domains) or domain-specific effects (i.e., changes in the conceptually relevant domain)? Participants recruited from a university training clinic (n = 87; 75.9% diagnosed with borderline personality disorder) participated in standard DBT for 6 months. We conducted hierarchical linear mixed models to test whether self-reported changes in emotion regulation, interpersonal problems, and distress tolerance were associated with the specific DBT module intended to target that outcome. In 3 models, we regressed end-of-module ratings of each of our measures of interest on (a) premodule ratings of each measure of interest, (b) time, and (c) dummy-coded module completed. Although all modules were associated with similar reductions in emotion dysregulation, the Emotion Regulation module was associated with the greatest improvements in both interpersonal problems and distress tolerance. In contrast, the first skills module completed was unrelated to changes in any of these domains. These results suggest that Emotion Regulation skills are associated with improvements in patient symptoms across relevant domains and offer potential directions for optimizing the delivery of DBT. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Defining the p-factor: an empirical test of five leading theories.

BACKGROUND: Despite statistical evidence of a general factor of psychopathology (i.e., p-factor), there is little agreement about what the p-factor represents. Researchers have proposed five theories: dispositional negative emotionality (neuroticism), impulsive responsivity to emotions (impulsivity), thought dysfunction, low cognitive functioning, and impairment. These theories have primarily been inferred from patterns of loadings of diagnoses on p-factors with different sets of diagnoses included in different studies. Researchers who have directly examined these theories of p have examined a subset of the theories in any single sample, limiting the ability to compare the size of their associations with a p-factor. METHODS: In a sample of adults (N = 1833, Mage = 34.20, 54.4% female, 53.3% white) who completed diagnostic assessments, self-report measures, and cognitive tests, we evaluated statistical p-factor structures across modeling approaches and compared the strength of associations among the p-factor and indicators of each of these five theories. RESULTS: We found consistent evidence of the p-factor's unidimensionality across one-factor and bifactor models. The p-factor was most strongly and similarly associated with neuroticism (r = .88), impairment (r = .88), and impulsivity (r = .87), χ2(1)s < .15, ps > .70, and less strongly associated with thought dysfunction (r = .78), χ2(1)s > 3.92, ps < .05, and cognitive functioning (r = -.25), χ2(1)s > 189.56, ps < .01. CONCLUSIONS: We discuss a tripartite definition of p that involves the transaction of impulsive responses to frequent negative emotions leading to impairment that extends and synthesizes previous theories of psychopathology.

Interpersonal emotion regulation in the context of social networks: A focus on borderline personality disorder.

Interpersonal emotion regulation (IER) involves modulating one's emotions through social contact. Considering the extensive emotional and interpersonal difficulties associated with borderline personality disorder (BPD), it is particularly relevant to the study of IER. We examined the frequency and efficacy of IER in relation to BPD features, as well as perceived characteristics of the social network partners utilized for IER, among 149 participants. We found that BPD features were unrelated to the frequency of using IER but negatively related to the perceived efficacy of IER and perceived willingness of partners to assist in IER. Furthermore, BPD features attenuated the relation between partner closeness and both the likelihood of being an IER partner (vs. a non-IER partner) and the frequency of going to that partner for IER (partner-IER-frequency). Additionally, there was an inverse relation between relationship quality and frequency of seeking IER from a partner at higher levels of BPD features, whereas there was no association between quality and frequency of IER at lower levels of BPD features. Finally, BPD features attenuated the relation between partner centrality and the likelihood of being an IER partner. Finding that those with elevated BPD features go to less central and close others for IER, even though there is no association between IER frequency and BPD features, bolsters our understanding of the intersection of interpersonal and emotional functioning and may provide future avenues for intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The therapeutic alliance and dropout in cognitive behavioral therapy of depression.

Identifying predictors of dropout is an important step in improving treatment outcomes. The alliance is the most frequently studied psychotherapy process variable, but its relation to dropout in cognitive behavioral therapy (CBT) of depression is not well understood.We evaluated the alliance at session one as reported by clients and therapists as predictors of dropout among 126 clients with major depressive disorder participating in CBT for depression.Over a similar time period, those who dropped out experienced less symptom change than those who did not. Client, but not therapist reported alliance was related to reduced risk for dropout. This relation remained significant even when clients' pre-treatment predictions of the alliance were included as a covariate. Concurrent use of medication did not moderate the alliance-dropout relation.Our findings are consistent with alliance being an important contributor to risk of dropout in CBT for depression. Future research should investigate intervention strategies that might promote the alliance as a means of reducing dropout.

Framing an intervention as focused on one's strength: Does framing enhance therapeutic benefit?

INTRODUCTION: A capitalization approach to enhancing client skills in cognitive behavioral interventions is focused on enhancing skills that represent relative strengths. This approach may bolster outcomes because the targeted skills are those that clients can most effectively use to recover from negative moods. Alternatively, the benefits might be due to client attitudes about these skills, such as their confidence that they can use these skills effectively. METHODS: In an unselected sample of 616 undergraduates, we randomized to one of two brief interventions (a cognitive or mindfulness intervention) and one of two framing conditions (framing the intervention as focusing on a relative strength or a weakness), resulting in four conditions. Participants were then asked to use the skill targeted in their intervention to recover from a sad mood induction. RESULTS: Framing conditions did not differ on expectations of benefit from sustained use of an intervention but did differ on mood recovery. Participants told that the intervention focused on a strength recovered more quickly following the mood induction. There was no difference between the skill interventions. DISCUSSION: Our finding suggests intervention framing positively contributes to the effects of strengths focused treatments, though perhaps not by enhancing treatment expectations.

A longitudinal examination of the reciprocal relationship between borderline personality features and interpersonal relationship quality.

Interpersonal dysfunction is a core characteristic of borderline personality disorder (BPD). Cross-sectional research suggests that higher BPD features are associated with lower relationship quality. Many researchers have examined the associations between interpersonal stressors and short-term increases in emotional reactivity or impulsivity among those with high levels of BPD features. Yet, most research paradigms assume that interpersonal stressors change over time, whereas BPD features remain relatively stable; however, the stability of BPD features in the context of fluctuating interpersonal stressors has yet to be tested longitudinally. In the current study, we examined co-occurring changes in relationship quality and BPD features over time. In Study 1, 126 female, undergraduate participants completed ratings of relationship quality (i.e., conflict, criticism, closeness, satisfaction, and support) with recent interpersonal partners as well as self-reported BPD features at baseline and 1-month follow-up. In Study 2, 50 female participants from the community (n = 27 with BPD; n = 23 without any psychiatric diagnoses) completed the same measures at baseline and 1-, 3-, and 6-month follow-ups. Across both studies, when participants reported decreases in the quality of their interpersonal relationships, they endorsed increases in BPD features. Similarly, when participants endorsed worsening BPD features, their perceptions of relationship quality with all recent interaction partners (in Study 1) or more frequent interaction partners (in Study 2) decreased as well. Even in samples with a wide range of BPD features, these results suggest that the quality of interpersonal relationships and BPD features may influence each other over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Developing pathways, a hope-enhancing intervention for metastatic lung cancer patients receiving cancer treatment.

OBJECTIVE: Between 40% and 65% of lung cancer patients report concern about maintaining valued activities and roles, yet few interventions address this concern. Hope, a patient's perceived ability to generate goals and identify ways to pursue them, may be a promising intervention target to support function among lung cancer patients. The goal of this study was to assess metastatic non-small cell lung cancer (mNSCLC) patient interest and preferences for a hope-enhancing intervention. METHODS: We conducted a sequential mixed-methods (survey followed by semi-structured interviews) study with patients with mNSCLC. Surveys assessed patient interest in, perceived helpfulness of, and preferences for a hope intervention. A subset of 12 patients (and caregivers, when present) completed semi-structured interviews to elicit feedback on proposed intervention content and procedures. RESULTS: Survey data from 60 patients (40% male; Mean age = 62.5; SD = 9.3) suggested high perceived importance of pursuing personal goals during cancer treatment, moderate perceived helpfulness in discussing personal goals, and preference for a nurse-led intervention. Based on these data, a 5-session, nurse-led intervention protocol was drafted and reviewed with 12 patients. Interviewed patients and caregivers agreed working towards goals was beneficial, liked the intervention concept, and thought prompts and rating scales on handouts would facilitate discussion. The majority preferred nurse delivery during infusions. CONCLUSIONS: A nurse-led hope-enhancing intervention delivered primarily during infusions may be acceptable to mNSCLC patients. Future work should test feasibility and identify ways to incorporate caregivers and oncology providers into hope interventions.

On what do therapists agree? Assessing therapist evaluations of emotion regulation strategy effectiveness.

OBJECTIVE: To develop more unified, process-based, and disseminable psychotherapy treatments, it is important to determine whether there is consensus among therapists regarding intervention strategies. DESIGN: Because emotion regulation is a cornerstone of modern treatments and a thriving area of clinical research, we assessed therapists' ratings of the effectiveness of commonly studied emotion regulation strategies. METHODS: Therapists (n = 582) read eleven vignettes describing stressful scenarios and rated the effectiveness of ten emotion regulation strategies in each scenario. RESULTS: Across therapists, we found general consensus regarding the most (i.e., problem-solving) and least (i.e., concealing emotions) effective strategies. Cognitive/behavioural/third-wave therapists rated acceptance and distraction as more effective, and emotional expression and gathering information as less effective, than other therapists, Fs> 4.20, ps < .05, whereas hours of clinical experience were generally unrelated to strategy effectiveness ratings. CONCLUSIONS: We discuss what these points of agreement and relative disagreement among therapists reveal about a more unified, process-based treatment approach and how these results can guide emotion regulation research. PRACTITIONER POINTS: There is general consensus among practising therapists that problem-solving is the most effective emotion regulation strategy and expressive suppression is the least effective. However, CBT-oriented therapists rated acceptance and distraction as more effective than non-CBT-oriented therapists. Non-CBT-oriented therapists rated emotional expression and gathering information as more effective than CBT-oriented therapists. Years of experience were unrelated to ratings of emotion regulation strategy effectiveness.

Hope attenuates the negative impact of general psychological distress on goal progress.

OBJECTIVE: Symptoms of general psychological distress disrupt goal pursuit; however, not everyone is equally impacted by distress when pursuing goals. We tested whether hope, self-efficacy, and/or grit buffered the impact of symptoms of general psychological distress on longitudinal goal progress. METHOD: Undergraduate students reported on these constructs and, 2 months later, their progress toward five personal goals (N = 117). RESULTS: Although greater levels of baseline psychological distress predicted less goal progress, the impact of psychological distress on goal progress was moderated by hope, ß = .20, SE = 0.07, p < .01. More specifically, at higher hope, participants reported similar goal progress regardless of baseline distress symptoms, while at lower hope, baseline distress was negatively associated with goal progress. CONCLUSION: Hope may function as a buffer against the association between general psychological distress and impaired goal progress.

More (of the right strategies) is better: disaggregating the naturalistic between- and within-person structure and effects of emotion regulation strategies.

Although people often use multiple strategies to regulate their emotions, it is unclear if using more strategies effectively changes emotional outcomes. This may be because there is no clear, data-driven structure to organise which strategies people use together, so strategies with opposing impacts are modelled together. We first conducted a multilevel factor analysis of negative- and positive-emotion regulation strategies among undergraduates (n = 92) completing ecological momentary assessment three times per day for 10 days. Solutions including 3-within/3-between factors were most interpretable. Using more between-person Adaptive Engagement strategies and within-person Adaptive Engagement, Enhancement, and Behavioural strategies predicted improved mood, whereas using more between-person Aversive Cognitive and within-person Aversive Cognitive and Disengagement strategies predicted worse mood, ps < .05. Using a greater quantity of strategies may thus promote better, or worse, emotional outcomes, depending on the class of strategies used.