Interleukin-6 and Depressive Mood Symptoms: Mediators of the Association Between Childhood Abuse and Cognitive Performance in Middle-Aged Adults.

Background: Childhood abuse is a risk factor for the development of cognitive deficits in adulthood, a relation that is likely mediated by stress-sensitive psychological and physiological indicators. Purpose: To evaluate whether the link between exposure to childhood abuse and cognitive function in middle adulthood is mediated by interleukin-6 (IL-6), metabolic risk, and depressive mood symptoms. Methods: Participants were 770 adults aged 40-65 recruited from the community, who completed the following: (i) a questionnaire assessing exposure to abuse prior to age 18, (ii) a phone interview assessing current depressive mood symptoms, and (iii) a home visit that included blood sampling for evaluation of IL-6 and assessment of metabolic risk indices. A follow-up telephone assessment evaluating cognitive function was completed by 555 of the participants. Structural equation modeling was used to test study hypotheses. Results: Childhood abuse predicted higher levels of IL-6, depressive mood symptoms, and metabolic risk scores (p < .05). The relation between childhood abuse and poorer cognitive performance was mediated by IL-6 (p = .046) and depressive mood symptoms (p = .023), but not metabolic risk. IL-6 and depressive mood symptoms significantly mediated the relation between childhood abuse and adult cognitive function. Conclusions: Exposure to early abuse conveys enduring physiological and psychological effects, which may contribute to cognitive deficits that are evident by middle adulthood. Increased vulnerability for cognitive decline among adults with a history of early trauma and the mediating roles of IL-6 and depressive mood symptoms point to the potential value of interventions that address inflammation or depression, singly or together, to prevent cognitive decline in this at-risk population.

Sharing Positive Experiences Boosts Resilient Thinking: Everyday Benefits of Social Connection and Positive Emotion in a Community Sample.

The influence of shared enjoyment and positive affect (PA) on resilient thinking was examined in 191 middle-aged adults (40-65 years), participating in a study of resilience. Participants completed diaries assessing positive events, shared enjoyment, PA, and resilient cognitions (RC). Multilevel structural equation modeling was utilized to examine when and who engages in RC. Participants reported more RC on days they experienced more positive experiences. This relationship was explained by shared enjoyment and PA. Level-1 proportional reduction of variance (PRV) for shared enjoyment, PA, and RC was 9%, 10%, and 35%, respectively. Individuals reporting more positive experiences trended toward a more resilient mindset; PA accounted for this relationship. Shared enjoyment mediated the relationship between interpersonal events and PA. These findings suggest PA is integral to having a resilient mindset, and shared enjoyment is a potential mechanism that may influence PA. Level-2 PRV for shared enjoyment, PA, and RC was 22%, 21%, and 55%, respectively. RC were associated with less depression and anxiety; and greater well-being, vitality, and physical functioning at follow-up.

Emodiversity and biomarkers of inflammation.

There is growing evidence that inflammatory responses may help to explain how emotions get "under the skin" to influence disease susceptibility. Moving beyond examination of individuals' average level of emotion, this study examined how the breadth and relative abundance of emotions that individuals experience-emodiversity-is related to systemic inflammation. Using diary data from 175 adults aged 40 to 65 who provided end-of-day reports of their positive and negative emotions over 30 days, we found that greater diversity in day-to-day positive emotions was associated with lower circulating levels of inflammation (indicated by IL-6, CRP, fibrinogen), independent of mean levels of positive and negative emotions, body mass index, anti-inflammatory medications, medical conditions, personality, and demographics. No significant associations were observed between global or negative emodiversity and inflammation. These findings highlight the unique role daily positive emotions play in biological health. (PsycINFO Database Record

Inter- and Intra-Individual Variation in Emotional Complexity: Methodological Considerations and Theoretical Implications.

The degree of relationship between positive and negative emotional states or emotional complexity is a topic of ongoing methodological and theoretical debate. At issue is whether positive and negative emotions are opposite ends of a bipolar continuum or independent dimensions in a bivariate distribution with little degree of overlap. In this review, we summarize a body of work suggesting that the distinction between positive and negative emotions varies both between and within individuals over time as a function of cognition and changes in informational demands, a perspective called the Dynamic Model of Affect (DMA). In addition to providing a unifying theoretical model that specifies the conditions under which both bivariate and bipolar models of affect may be valid, the DMA offers an integrative, multidimensional affective framework through which models of resilience and stress adaptation may be articulated. Future work should continue to explore the contextual factors, especially those that have relevance for the complexity of information processing, as potential moderators of the dynamic interplay between positive and negative emotions.

Fusing Biodiversity Metrics into Investigations of Daily Life: Illustrations and Recommendations With Emodiversity.

Objectives: Functionalist emotion and ecological systems theories suggest emodiversity-the variety and relative abundance of individuals' emotion experiences-is beneficial for psychological and physical health and may change with age. This paper examines and provides recommendations for operationalization of diversity-type intraindividual variability (IIV) constructs using intensive longitudinal data, and demonstrates the utility of emodiversity by examining its links to physical health moderated by mean levels of emotion and age. Method: Using data from a daily diary study of 138 adults (age 40 to 65 years), we consider how item selection, response scale, choice of diversity index, and number of occasions enable/constrain mapping to theory, measurement reliability, and empirical inquiry. Results: Item selection and response scale had limited influence on rank-order differences in diversity. Reliable measurement (r ≥ .8) required a minimum of 6 to 12 occasions depending on choice of index, theoretical conception, study design, and distribution of diversity scores. The empirical findings suggest mean level of negative affect, rather than age, moderates the relation between negative emodiversity and health. Discussion: This study provides recommendations for the calculation of diversity-type IIV constructs and illustrates the potential for study of emodiversity to contribute to understanding of successful aging.

Predictors and social consequences of daily pain expectancy among adults with chronic pain.

Previous research suggests that for people living with chronic pain, pain expectancy can undermine access to adaptive resources and functioning. We tested and replicated the unique effect of pain expectancy on subsequent pain through 2 daily diary studies. We also extended previous findings by examining cognitive and affective antecedents of pain expectancy and the consequences of pain expectancy for daily social enjoyment and stress. In study 1, 231 individuals with rheumatoid arthritis completed 30 end-of-day diaries. Results of multilevel structural equation model showed that controlling for today's pain, pain expectancy predicted next day pain. In study 2, diary assessments of affective, cognitive, and social factors were collected during the morning, afternoon, and evening for 21 days from a sample of 220 individuals with fibromyalgia. Results showed that both positive affect and the extent to which pain interfered with daily activities in the afternoon predicted evening pain expectancy in the expected direction. However, negative affect and pain coping efficacy were not associated with pain expectancy. Consistent with study 1, more than usual evening pain expectancy was related to greater next morning pain. We also found that next morning pain predicted next afternoon social enjoyment but not social stress. The findings of these 2 studies point to the importance of promoting positive affect and reducing pain expectancy as a way of decreasing the detrimental effect of chronic pain on enjoyable social experiences.

Relations between adaptive and maladaptive pain cognitions and within-day pain exacerbations in individuals with fibromyalgia.

The objectives of this study were to assess within-person hypotheses regarding temporal cognition-pain associations: (1) do morning pain flares predict changes in two afternoon adaptive and maladaptive pain-related cognitions, and (2) do these changes in afternoon cognitions predict changes in end-of-day pain reports, which in turn, carry over to predict next morning pain in individuals with fibromyalgia. Two hundred twenty individuals with fibromyalgia completed electronic assessments of pain intensity, pain catastrophizing, and pain coping efficacy three times a day for three weeks. Multilevel structural equation modeling established that afternoon catastrophizing and coping efficacy were parallel mediators linking late morning with end-of-day pain reports (controlling for afternoon pain), in line with prediction. Catastrophizing was a stronger mediator than coping efficacy. Moreover, afternoon cognitions and end-of-day pain reports served as sequential mediators of the relation between same-day and next-day morning pain. These findings align with assertions of cognitive-behavioral theories of pain that pain flares predict changes in pain both adaptive and maladaptive cognitions, which in turn, predict further changes in pain.

Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways.

In addition to recurrent pain, fatigue, and increased rates of physical disability, individuals with rheumatoid arthritis (RA) have an increased prevalence of some mental health disorders, particularly those involving affective or mood disturbances. This narrative Review provides an overview of mental health comorbidities in RA, and discusses how these comorbidities interact with disease processes, including dysregulation of inflammatory responses, prolonged difficulties with pain and fatigue, and the development of cognitive and behavioural responses that could exacerbate the physical and psychological difficulties associated with RA. This article describes how the social context of individuals with RA affects both their coping strategies and their psychological responses to the disease, and can also impair responses to treatment through disruption of patient-physician relationships and treatment adherence. Evidence from the literature on chronic pain suggests that the resulting alterations in neural pathways of reward processing could yield new insights into the connections between disease processes in RA and psychological distress. Finally, the role of psychological interventions in the effective and comprehensive treatment of RA is discussed.

Linking childhood abuse and hypertension: sleep disturbance and inflammation as mediators.

The indirect association of childhood abuse with prevalent hypertension in adulthood through sleep disturbance and pro-inflammatory biomarkers was investigated in 589 community-dwelling, middle-aged adults. Participants completed the Childhood Trauma Questionnaire and self-reported current sleep disturbance and medical diagnoses including hypertension. Blood pressure was taken and blood samples were analyzed for C-reactive protein, interleukin-6, and fibrinogen. Hypertension was present in 41.3 % of the sample. In the full multiple mediation model, tested using structural equation modeling, all hypothesized pathways were significant (p's < 0.05). Childhood abuse was significantly related to both body mass index and sleep disturbance, which, both in turn, were significantly associated with inflammation, which was subsequently associated with hypertension status. The model demonstrated good fit [χ(2) (122) = 352.0, p < 0.001, CFI = 0.918, RMSEA = 0.057] and the indirect effect of all mediators was significant (indirect effect: 0.02, 95 % CI 0.005-0.03, p = 0.001). Sleep disturbance, body mass, and inflammation may be independent, intermediate steps between childhood abuse and subsequent hypertension that may be amenable to biobehavioral interventions.

REMAP-a Resilience Resources Measure for Prediction and Management of Somatic Symptoms.

PURPOSE: Patients with symptoms but without an identified disease are a challenge to primary care providers. A 22-item measure is introduced and evaluated to offer medical care providers with an instrument to assess and discuss possible deficiencies in resilience resources that may contribute to symptoms without identifiable pathology. This instrument highlights psychosocial and lifestyle resources that serve as buffers to life's stressors rather than focusing on stress and its related symptoms. METHODS: The measure included items from five resilience domains-relational engagement, emotional sensibility, meaningful action, awareness of self and others, and physical health behaviors (REMAP). Its structure and function were evaluated using two different samples. RESULTS: Results suggest that scores from the REMAP have reasonable psychometric properties. Higher REMAP scores were predictive of fewer health symptoms in a sample representative of the US population. In a second sample, REMAP was positively associated with perceived resilience, ego strength and mindfulness attention and negatively related to perceived stress, depression, sleep disturbances, and loneliness, providing evidence of convergent and divergent validity. Furthermore, the REMAP scale was sensitive to change following a life style intervention. CONCLUSION: This suggests that REMAP can be a useful tool in practice settings for counseling patients with unexplained symptoms. With insight into the biopsychosocial aspect of their symptoms, patients may become more receptive to cognitive behavioral options to improve their resilience resources and lifestyle choices.

Social pain and physical pain: shared paths to resilience.

Although clinical models have traditionally defined pain by its consequences for the behavior and internal states of the sufferer, recent evidence has highlighted the importance of examining pain in the context of the broader social environment. Neuroscience research has highlighted commonalities of neural pathways connecting the experience of physical and social pain, suggesting a substantial overlap between these phenomena. Further, interpersonal ties, support and aspects of the social environment can impair or promote effective adaptation to chronic pain through changes in pain perception, coping and emotional states. The current paper reviews the role of social factors in extant psychological interventions for chronic pain, and discusses how greater attention to these factors may inform future research and clinical care.

The Psychosocial Context of Financial Stress: Implications for Inflammation and Psychological Health.

OBJECTIVE: Psychological distress may contribute to chronic activation of acute-phase inflammation. The current study investigated how financial stressors influence psychosocial functioning and inflammation. This study examined a) the direct relations between financial stress and inflammation; b) whether the relationships between financial stress and inflammation are mediated in part by negative interpersonal events, psychological distress, and psychological well-being; and c) whether social standing in one's community moderates the relations between financial stress and psychological distress, psychological well-being, and markers of inflammation (interleukin-6 [IL-6] and C-reactive protein). METHODS: Stressful financial and interpersonal events over the previous year, perceived social status, indices of psychological well-being and distress, and levels of IL-6 and C-reactive protein were assessed in a community sample of 680 middle-aged adults (ages 40-65 years). RESULTS: Structural equation modeling analyses revealed significant relations among financial stress, interpersonal stress, and psychological distress and well-being, and complex relationships between these variables and inflammatory markers. Psychological well-being mediated the association between financial stress and IL-6 ([mediation] ab = 0.012, standard error [SE] = 0.006, p = .048). Furthermore, individuals with higher perceived social standing within their communities exhibited a stronger relation between negative financial events and both interpersonal stressors (interaction B = 0.067, SE = 0.017, p < .001) and C-reactive protein (interaction B = 0.051, SE = 0.026, p = .050). CONCLUSIONS: Financial stress demonstrates complex relations with inflammation, due partly to psychological well-being and social perceptions. Findings are discussed with regard to the social context of stress and physiological factors pertinent to stress adaptation and inflammation.

Can We Learn to Treat One Another Better? A Test of a Social Intelligence Curriculum.

This paper reports on the first test of the value of an online curriculum in social intelligence (SI). Built from current social and cognitive neuroscience research findings, the 50 session SI program was administered, with facilitation in Spanish by classroom instructors, to 207 students from Universidad Rey Juan Carlos in Madrid as part of their undergraduate classes. All materials were translated into Castilian Spanish, including outcome measures of SI that have been used in prior studies to provide valid estimates of two key components of social intelligence: 1) Sensitivity to others and 2) confidence in one's capacity to manage social situations. Pre- and Posttest were administered to participants in the SI training, and also to 87 students in similar classes who did not receive the program who served as the control group. Gender and emotional intelligence levels at pretest also were examined as potential individual differences that might affect the impact of the program on study outcomes. Repeated measures ANOVAs on study outcomes revealed significant increases, from pre to post, in most measures of social intelligence for program participants in comparison to controls, with no effects of gender or age on program effectiveness. Prior scores on emotional intelligence were not a prerequisite for learning from the program. Some findings suggest ways the program may be improved to have stronger effects. Nonetheless, the findings indicate that the SI program tested here shows considerable promise as a means to increase the willingness of young adults to take the perspective of others and enhance their efficacy for initiating and sustaining positive social connections.

Childhood trauma and personal mastery: their influence on emotional reactivity to everyday events in a community sample of middle-aged adults.

Childhood trauma is associated with premature declines in health in midlife and old age. Pathways that have been implicated, but less studied include social-emotional regulation, biological programming, and habitual patterns of thought and action. In this study we focused on childhood trauma's influence via alterations in social-emotional regulation to everyday life events, a pathway that has been linked to subsequent health effects. Data from a 30-day daily diary of community residents who participated in a study of resilience in Midlife (n = 191, Mage = 54, SD = 7.50, 54% women) was used to examine whether self-reports of childhood trauma were associated with daily well-being, as well as reported and emotional reactivity to daily negative and positive events. Childhood trauma reports were associated with reporting lower overall levels of and greater variability in daily well-being. Childhood trauma was linked to greater reports of daily negative events, but not to positive events. Focusing on emotional reactivity to daily events, residents who reported higher levels of childhood trauma showed stronger decreases in well-being when experiencing negative events and also stronger increases in well-being with positive events. For those reporting childhood trauma, higher levels of mastery were associated with stronger decreases in well-being with negative events and stronger increases in well-being with positive events, suggesting that mastery increases sensitivity to daily negative and positive events. Our results suggest that childhood trauma may lead to poorer health in midlife through disturbances in the patterns of everyday life events and responses to those events. Further, our findings indicate that mastery may have a different meaning for those who experienced childhood trauma. We discuss social-emotional regulation as one pathway linking childhood trauma to health, and psychosocial resources to consider when building resilience-promoting interventions for mitigating the detrimental health effects of childhood trauma.

Chronic pain and the adaptive significance of positive emotions.

The February-March 2014 special issue of the American Psychologist featured articles summarizing select contributions from the field of psychology to the assessment and treatment of chronic pain. The articles examined a range of psychosocial and family factors that influence individual adjustment and contribute to disparities in pain care. The reviews also considered the psychological correlates and neurophysiological mechanisms of specific pain treatments, including cognitive-behavioral therapy, hypnosis, acceptance and commitment therapy, mindfulness, and meditation. Although a number of articles emphasized the role that negative states of mind play in pain outcomes, positive emotions were given only brief mention. Here, we provide a rationale for the inclusion of positive emotions in chronic pain research.

Comparison of an Online Mindfulness-based Cognitive Therapy Intervention With Online Pain Management Psychoeducation: A Randomized Controlled Study.

BACKGROUND: This study tested the effectiveness of a computerized mindfulness-based cognitive therapy intervention compared with computerized pain management psychoeducation in a randomized study. METHODS: Using an intention-to-treat approach, 124 adult participants who reported experiencing pain that was unrelated to cancer and of at least 6 months duration were randomly assigned to computerized mindfulness-based cognitive therapy ("Mindfulness in Action" [MIA]) or pain management psychoeducation programs. Data were collected before and after the intervention and at 6-month follow-up. RESULTS: Participants in both groups showed equivalent change and significant improvements on measures of pain interference, pain acceptance, and catastrophizing from pretreatment to posttreatment and the improvements were maintained at follow-up. Average pain intensity also reduced from baseline to posttreatment for both groups, but was not maintained at follow-up. Participants in both groups reported increases in subjective well-being, these were more pronounced in the MIA than the pain management psychoeducation group. Participants in the MIA group also reported a greater reduction in pain "right now," and increases in their ability to manage emotions, manage stress, and enjoy pleasant events on completion of the intervention. The changes in ability to manage emotions and stressful events were maintained at follow-up. CONCLUSIONS: The results of the study provide evidence that although there were equivalent changes across outcomes of interest for participants in both conditions over time, the MIA program showed a number of unique benefits. However, the level of participant attrition in the study highlighted a need for further attention to participant engagement with online chronic pain programs.

Mindfulness and cognitive-behavioral interventions for chronic pain: differential effects on daily pain reactivity and stress reactivity.

OBJECTIVE: This study compared the impact of cognitive-behavioral therapy for pain (CBT-P), mindful awareness and acceptance treatment (M), and arthritis education (E) on day-to-day pain- and stress-related changes in cognitions, symptoms, and affect among adults with rheumatoid arthritis (RA). METHOD: One hundred forty-three RA patients were randomized to 1 of the 3 treatment conditions. CBT-P targeted pain-coping skills; M targeted awareness and acceptance of current experience to enhance coping with a range of aversive experiences; E provided information regarding RA pain and its management. At pre- and posttreatment, participants completed 30 consecutive evening diaries assessing that day's pain, fatigue, pain-related catastrophizing and perceived control, morning disability, and serene and anxious affects. RESULTS: Multilevel models compared groups in the magnitude of within-person change in daily pain and stress reactivity from pre- to posttreatment. M yielded greater reductions than did CBT-P and E in daily pain-related catastrophizing, morning disability, and fatigue and greater reductions in daily stress-related anxious affect. CBT-P yielded less pronounced declines in daily pain-related perceived control than did M and E. CONCLUSIONS: For individuals with RA, M produces the broadest improvements in daily pain and stress reactivity relative to CBT-P and E. These findings also highlight the utility of a diary-based approach to evaluating the treatment-related changes in responses to daily life.

Associations between financial stress and interpersonal events: a daily diary study of middle-aged adults and their life circumstances.

This study examined the relationships between daily negative financial events and positive and negative interpersonal events, as well as the moderating effects of life circumstances, for a sample of 182 adults between the age of 40 and 65 providing 30 days of diary data collected between 2008 and 2011. There was a significant and positive relationship between daily negative interpersonal events and daily levels of both negative interpersonal events and positive interpersonal events; these relationships varied by income, employment status, parenting roles, and the experience of major financial challenges over the previous year. The moderating effect of income was nonlinear but its effect disappeared when the interaction between major financial challenges over the previous year and daily negative financial events was entered into the model. The results were interpreted in the context of the stress proliferation and resource mobilization theoretical models and directions for future studies were delineated with respect to individual- and community-level factors that influence the role of financial events on the daily social worlds of middle-aged adults.

Stress-related clinical pain and mood in women with chronic pain: moderating effects of depression and positive mood induction.

BACKGROUND: Chronic pain with comorbid depression is characterized by poor mood regulation and stress-related pain. PURPOSE: This study aims to compare depressed and non-depressed pain patients in mood and pain stress reactivity and recovery, and test whether a post-stress positive mood induction moderates pain recovery. METHODS: Women with fibromyalgia and/or osteoarthritis (N = 110) underwent interpersonal stress and were then randomly assigned by pain condition and depression status, assessed via the Center for Epidemiological Studies-Depression scale, to positive versus neutral mood induction. RESULTS: Depression did not predict stress-related reactivity in despondency, joviality, or clinical pain. However, depression × mood condition predicted recovery in joviality and clinical pain; depressed women recovered only in the positive mood condition, whereas non-depressed women recovered in both mood conditions. CONCLUSIONS: Depression does not alter pain and mood stress reactivity, but does impair recovery. Boosting post-stress jovial mood ameliorates pain recovery deficits in depressed patients, a finding relevant to chronic pain interventions.