Impact of a Mindfulness-Based Stress Reduction Program on Psychological Well-Being, Cortisol, and Inflammation in Women Veterans.

BACKGROUND: Women veterans experience higher levels of stress-related symptoms than their civilian counterparts. Psychological stress is associated with greater inflammation and may increase risk for cardiovascular disease (CVD). Mindfulness-based stress reduction (MBSR) has been found to improve psychological well-being in other populations but no randomized controlled trials (RCT) have been conducted examining the impact of MBSR on well-being and inflammation in women veterans at risk for CVD. OBJECTIVE: Determine the effectiveness of MBSR in improving psychological well-being, cortisol, and inflammation associated with CVD in women veterans. DESIGN: The design is a RCT comparing MBSR to an active control condition (ACC) consisting of a health education program. PARTICIPANTS: Women veterans (N=164) with risk factors for CVD from the Chicagoland area participated in the study. INTERVENTION: An 8-week MBSR program with weekly 2.5-h classes was compared to an ACC consisting of an 8-week health promotion education program with weekly 2.5-h classes. MAIN MEASURES: The outcomes were psychological well-being [perceived stress, depressive symptoms, loneliness, and post-traumatic stress disorder (PTSD)] symptoms and stress-related markers, including diurnal salivary cortisol and cytokines interleukin-6 (IL-6) and interferon gamma (IFN-γ). Data were collected at baseline, 4 weeks (mid-point of intervention), 8 weeks (completion of intervention), and 6 months after completion of MBSR or ACC. KEY RESULTS: Compared to the ACC, women who participated in MBSR reported less perceived stress, loneliness, and symptoms of PTSD. Although there were no significant differences between groups or changes over time in IL-6 or IFN-γ, participants in the MBSR program demonstrated a more rapid decline in diurnal salivary cortisol as compared to those in the ACC. CONCLUSIONS: MBSR was found to improve psychological well-being and decrease diurnal salivary cortisol in women veterans at risk for CVD. Health care providers may consider MBSR for women veterans as a means by which to improve their psychological well-being.

A Multi-level Longitudinal Model of Risk Factors for Generalized and Separation Anxiety Symptoms in a Community Sample of 6-year-olds.

The current longitudinal study examined the relations between variables in four domains-contextual (SES, family conflict, stress), parent (caretaker depression), parenting (support hostility, autonomy granting), and child (negative affect, effortful control, sensory regulation, attachment)-and both the presence of generalized and separation anxiety symptoms at age 6 in a community sample of 796 children and the change in these anxiety symptoms from ages 4 to 6. Anxiety was highly stable over time. Specific results revealed both direct and indirect pathways between age 4 and age 5 variables, and age 6 anxiety. Caretaker depression and the child variables of attachment, effortful control, negative affect, and sensory regulation were directly related to anxiety symptoms at age 6. Contextual variables (SES) at age 4 were indirectly related to age 6 anxiety through parent depression at age 5. Parent depression was indirectly related to age 6 anxiety through age 5 child negative affect. Child negative affect at age 4 was indirectly related to age 6 anxiety through age 5 effortful control and age 4 effortful control was indirectly related to age 6 anxiety through age 5 negative affect. With the exception of attachment, there was a reduction in the impact of other variables when initial levels of anxiety symptoms were included in the model. Implications of results for early intervention and further study are discussed.

Gratitude as a Mediator of the Effects of Savoring on Positive Adjustment to Aging.

We extended the previous experimental work with older adults by testing mediating variables through which savoring valuable "life lessons" improves attitudes toward aging and boosts well-being. A sample of 202 adults aged 65 or older were randomly assigned to either an experimental condition (in which they reflected on important lessons life had taught them) or a control condition (in which they reflected on their typical morning routine). Contemplating life lessons increased feelings of gratitude, which in turn boosted positive attitudes toward aging, life satisfaction, state hope, and state self-esteem. Additional analyses supported a three-path mediational model, in which reflecting on life lessons increased levels of savoring, which led to greater gratitude, which in turn predicted stronger positive attitudes toward aging, life satisfaction, and hope. We discuss implications of these findings for future research on savoring interventions for older adults and suggest future directions designed to advance understanding of these experimental effects.

Multidomain risk factors in early childhood and depression symptoms in 6-year-olds: A longitudinal pathway model.

This study examined effects of risk factors in multiple domains measured in preschool and kindergarten on age 6 depression symptoms, and on changes in symptom levels between ages 4 and 6. Two models were examined in a large, diverse (N = 796) community sample of children and parents. Risk variables included SES, stress, conflict, parental depression, parental hostility, support, scaffolding, child negative affect (NA), effortful control (EC), sensory regulation (SR), and attachment security. Model 1 included effects of risk factors at ages 4 and 5 on child depression symptoms at age 6. Model 2 also included depression symptoms at all three ages to examine changes in these symptoms. Model 1 revealed that age 4 and 5 parental depression, NA, EC, and SR predicted age 6 child depression levels, Several age 4 variables had indirect pathways to age 6 depression via age 5 EC. Model 2 revealed that preschool depression was the only age 4 variable, and EC and SR were the only age 5 variables that significantly predicted increases in age 6 depression. These findings highlight the role of self-regulation in child depression and suggest that targeting self-regulation may be an effective prevention and intervention strategy.

Associations of trait positive emotion regulation with everyday emotions: An experience sampling approach.

Positive emotion regulation is important for enhancing psychological well-being. Previous studies have adopted a cross-sectional design to examine the relationships between positive emotion regulation strategies and psychological functioning. Relatively little is known about the role of positive emotion regulation strategies in positive and negative emotions in everyday life. This study examines associations between perceived capability of savoring and trait positive rumination and everyday emotions. Among 300 Hong Kong Chinese (age 18-77 years), perceived capability of savoring the moment and positive rumination predicted higher positive emotions during positive-valenced events. Perceived capability of savoring the moment predicted lower negative emotions during positive-valenced events and higher positive emotions during negative-valenced events. Positive links between positive valence ratings of events and positive emotions were stronger among individuals who reported higher levels of perceived capability of savoring through reminiscence and greater trait emotion-focused rumination. Positive links between negative valence ratings of events and negative emotions were significant only among individuals who reported low/medium levels of perceived capability of savoring through anticipation. These findings suggest that: (a) perceived capability of savoring and trait positive rumination are key mechanisms for increasing positive emotions and (b) perceived capability of savoring fosters adaptive adjustment to stress during negative events.

Age 4 Predictors of Oppositional Defiant Disorder in Early Grammar School.

Our ability to predict which children will exhibit oppositional defiant disorder (ODD) at the time of entry into grammar school at age 6 lags behind our understanding of the risk factors for ODD. This study examined how well a set of multidomain risk factors for ODD assessed in 4-year-old children predicted age 6 ODD diagnostic status. Participants were a diverse sample of 796 4-year-old children (391 boys).The sample was 54% White, non-Hispanic; 16.8% African American, 20.4% Hispanic; 2.4% Asian; and 4.4% Other or mixed race. The classification accuracy of two models of multidomain risk factors, using either a measure of overall ODD symptoms or dimensions of ODD obtained at age 4, were compared to one another, to chance, and to a parsimonious model based solely on parent-reported ODD using Automated Classification Tree Analysis. Effect Strength for Sensitivity (ESS), a measure of classification accuracy, indicated a multidomain model including a general measure of ODD symptoms at age 4 yielded a large effect (56.29%), a 13.7% increase over the ESS for the parsimonious model (ESS = 42.9%). The ESS (51.23%) for a model including two ODD dimensions (behavior and negative affect) was smaller than that for the model including a measure of overall ODD symptoms. The Classification Tree Analysis approach showed a small but distinct advantage that would be useful in screening for which children would most likely meet criteria for age 6 ODD.

Enhancing positive perceptions of aging by savoring life lessons.

OBJECTIVES: This study examined the effects of savoring valuable life lessons on perceptions of aging and on well-being among older adults. METHOD: A total of 303 adults (mean age = 68.12 years) were randomly assigned to one of three experimental conditions: savoring life lessons (n = 95), reflecting on negative aspects of aging (n = 129), or untreated-control condition (n = 79). Participants in the savoring condition wrote about a valuable lesson they had learned in growing older, whereas participants in the negative-aging condition wrote about physical losses they had experienced in aging. RESULTS: After controlling for baseline happiness, health, gender, and age, participants who savored valuable life lessons reported greater positive perceptions of aging and life satisfaction, compared to participants in the negative-aging and untreated-control conditions. There were no differences across conditions in negative perceptions of aging or in anxiety. CONCLUSION: These findings suggest that savoring valuable life lessons could be an effective addition to psychoeducational programs designed to improve perceptions of aging.

The Meaning of Aggression Varies Across Culture: Testing the Measurement Invariance of the Refined Aggression Questionnaire in Samples From Spain, the United States, and Hong Kong.

Cultural differences in aggression are still poorly understood. The purpose of this article is to assess whether a tool for measuring aggression has the same meaning across cultures. Analyzing samples from Spain (n = 262), the United States (n = 344), and Hong Kong (n = 645), we used confirmatory factor analysis to investigate measurement invariance of the refined version of the Aggression Questionnaire (Bryant & Smith, 2001 ). The measurement of aggression was more equivalent between the Chinese and Spanish versions than between these two and the U.S. version. Aggression does not show invariance at the cultural level. Cultural variables such as affective autonomy or individualism could influence the meaning of aggression. Aggressive behavior models can be improved by incorporating cultural variables.

Perceived discrimination is associated with the inflammatory response to acute laboratory stress in women at risk for cardiovascular disease.

Cardiovascular disease (CVD) is the leading cause of death in the United States and exacts a disproportionate toll on minorities. Growing evidence demonstrates that perceived discrimination is a significant contributing factor to psychological distress, chronic low-grade inflammation, and cardiovascular health. However, little is known regarding the extent to which perceived discrimination contributes to the inflammatory response to acute stress. Therefore, the purpose of this study was to examine the influence of perceived discrimination on the inflammatory response to a laboratory acute stress paradigm in women at risk for CVD. A cross-sectional sample of 99 postmenopausal women (50 African American and 49 non-Hispanic White) (mean age 60.2 years) with at least two risk factors for CVD underwent the Trier Social Stress Test (TSST). Subjects completed the Detroit Area Study Discrimination Scale (DAS-DS) Everyday Discrimination subscale and provided blood and saliva samples prior to the TSST and every 15 min up to 90 min post-TSST to measure a pro-inflammatory cytokine, interleukin-6 (IL-6). Perceived discrimination was significantly associated with the salivary IL-6 response to the TSST (b = 0.49, SE = 0.13, p = <0.001) controlling for age, race, marital status, household income, BMI, statin use, childhood maltreatment, depressive symptoms, and subjective social status. Women who reported higher levels of perceived discrimination had higher levels of salivary IL-6 at baseline and following the TSST as compared to women who reported lower levels of perceived discrimination. Results suggest that higher levels of perceived discrimination, regardless of race and socioeconomic status, may heighten levels of inflammation, prior to and following an acute stress exposure. The circulating Il-6 response was associated with BMI only and did not correlate with salivary IL-6. These data suggest that perceived discrimination may contribute to the salivary-IL-6 acute stress response. However, more research is needed to help clarify the complex relationships among stress and salivary proinflammatory cytokines.

Development of the Professional Self-Care Scale.

In recent years, there has been an increased emphasis on the importance of self-care for psychologists and other mental health professionals. With the growth of positive psychology and preventive medicine, self-care is an emerging topic, promulgated as a means of avoiding the adverse effects of stress and promoting professional functioning and well-being. However, the research on self-care is limited because of the lack of an empirically based, psychometrically sound measure of this construct. Thus, the purpose of this project was to develop a measure of professional self-care. Professional psychologists were the focus of study, with the goal being to develop a measure that can be used in this population and similar groups of professionals. Based on expert feedback and a preliminary study of 422 licensed psychologists in Illinois, a 5-factor, 21-item scale was created. Factor analysis identified the following self-care factors: Professional Support, Professional Development, Life Balance, Cognitive Awareness, and Daily Balance. Preliminary analyses provided initial support for the validity of the 5 factors. A follow-up study was conducted with a second sample of clinical psychologists. The 5-factor structure provided a good fit to the data with the second sample. Thus, based on factor analysis and validity data, a 5-factor, 21-item Professional Self-Care Scale was established for further study and use in future research. (PsycINFO Database Record

A multidomain cascade model of early childhood risk factors associated with oppositional defiant disorder symptoms in a community sample of 6-year-olds.

The present study examined a cascade model of age 4 and 5 contextual, parent, parenting, and child factors on symptoms of oppositional defiant disorder (ODD) at age 6 in a diverse community sample of 796 children. Contextual factors include socioeconomic status, family stress, and conflict; parent factors included parental depression; parenting factors included parental hostility, support, and scaffolding skills; child factors included child effortful control (EC), negative affect (NA), and sensory regulation. Direct effects of age 5 conflict, hostility, scaffolding, EC, and NA were found. Significant indirect, cascading effects on age 6 ODD symptom levels were noted for age 4 socioeconomic status via age 5 conflict and scaffolding skills; age 4 parental depression via age 5 child NA; age 4 parental hostility and support via age 5 EC; age 4 support via age 5 EC; and age 4 attachment via age 5 EC. Parenting contributed to EC, and the age 5 EC effects on subsequent ODD symptom levels were distinct from age 5 parental contributions. Scaffolding and ODD symptoms may have a reciprocal relationship. These results highlight the importance of using a multidomain model to examine factors associated with ODD symptoms early in the child's grammar school years.

Multi-domain Predictors of Attention Deficit/Hyperactivity Disorder Symptoms in Preschool Children: Cross-informant Differences.

Numerous studies indicated that agreement between parent and teacher ratings of symptoms of attention-deficit/hyperactivity disorder in children of all ages is poor, but few studies have examined the factors that may be associated with rater differences. The present study examined the contextual, parent, parenting, and child factors associated with rater differences in a community sample of 4-year-old children. Parents and teachers of 344 4-year-olds recruited from preschools and pediatric practices completed the preschool versions of the Child Symptom Inventory. Measures of socioeconomic status, family stress and conflict, caretaker depression, parental hostility, support-engagement, and scaffolding skills, and child negative affect (NA), sensory regulation (SR), effortful control (EC), inhibitory control, and attachment security were obtained either by parental report or observational measures. χ 2 difference tests indicated that child factors of EC and SR, and contextual factor of stress and conflict, contributed more to parent-ratings of ADHD-I and ADHD-HI than to teacher-ratings of those same types of symptoms. Two factors contributed more to teacher-than to parent-rated ADHD-I, NA and caretaker depression. Results indicate there are differences in factors associated with ADHD symptoms at home and school, and have implications for models of ADHD.

The Benefits of Savoring Life: Savoring as a Moderator of the Relationship Between Health and Life Satisfaction in Older Adults.

We investigated the protective impact of savoring capacity on the relationship between physical health and psychological well-being among older adults. A total of 266 adults over 55 years old ( Mean = 73.4 years) completed measures of savoring ability, self-reported health, and life satisfaction. Savoring ability moderated the relationship between health and life satisfaction in older adults. Among people with less savoring ability, poor health was associated with lower life satisfaction. In contrast, people with greater savoring ability maintained higher life satisfaction, regardless of their level of health. These effects were consistent across a variety of different aspects of health, including general health, pain, limitations due to physical health, energy, and social functioning. These findings have direct implications for developing positive interventions to support the psychological well-being of older adults.

Development and validation of the Patriarchal Beliefs Scale.

The purpose of this research was to develop and validate a conceptually and psychometrically solid measure for patriarchal beliefs in samples of U.S. American adults from diverse demographic and geographic backgrounds. In Study 1, we identified 3 correlated factors of the Patriarchal Beliefs Scale (PBS) in data collected from the Internet (N = 279): Institutional Power of Men, Inferiority of Women, and Gendered Domestic Roles. In Study 2, data collected from the Internet (N = 284) supported both an oblique 3-factor structure and a bifactor structure of the PBS, through confirmatory factor analyses. Construct validity of the PBS was supported in relation to other gender-related measures. The PBS was correlated in expected directions with modern sexism, antifeminist attitudes, and egalitarian attitudes toward women. In Study 3, we examined measurement invariance across gender by using combined data from Study 1 and Study 2. All 3 factors of the oblique 3-factor model indicated measurement invariance, whereas the general factor represented in the bifactor model indicated nonequivalence. Mean differences in patriarchal beliefs were found for such demographic variables as gender, sexual orientation, education, and social class. Recommendations for using the PBS, as well as implications for research and practice, are discussed.

Models of anxiety, depression, somatization, and coping as predictors of abdominal pain in a community sample of school-age children.

OBJECTIVE: To examine whether somatization mediates the relationship of coping styles and internalizing problems with abdominal pain. METHODS: 230 school children (M age = 11.80 years; 43.8% male; 21.3% White) completed measures of coping style, anxiety, and depression early in the school year, and subsequently reported abdominal pain symptoms weekly. RESULTS: The results showed (a) the association of anxiety and depression with abdominal pain may be mediated by somatization; (b) there are similarities and differences in the association of coping styles with pain for models including anxiety versus depression. Significant indirect effects showed higher levels of passive coping were associated with more pain via somatization and either anxiety or depression. For active coping, results differed for models including anxiety versus depression. Accommodative coping showed no independent relationship with abdominal pain. CONCLUSIONS: Somatization may mediate the relationship of internalizing symptoms and coping styles with pain. Treatment implications are discussed.

The effectiveness of savouring interventions on well-being in adult clinical populations: A protocol for a systematic review.

PURPOSE: Savouring interventions aim to amplify the intensity and duration of positive feelings and positive affect. Research has shown that the potential benefits of savouring include the promotion of psychological well-being and diminution of negative affective states. Savouring strategies may be particularly useful amongst clinical populations in changing biobehavioural processes which can strengthen an individual's propensity to exert control over how to develop, intensify and promote psychological well-being, while simultaneously mitigating negative affective states. This paper outlines a protocol for a systematic review that will be used to identify, critically appraise and synthesise findings of studies examining the effectiveness of savouring interventions in adult clinical populations. Savouring interventions will be defined broadly, operationalised as any savouring strategy focusing on past, present or future events or experiences whereby participants are instructed to attend to and amplify positive affect relating to same. The goal of our review is to include the extent of the literature on this topic and contribute to the overall evidence to support savouring interventions. METHODS: This protocol is carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols Guidelines. The protocol has been registered with PROSPERO (CRD42023404857). The databases PsycINFO, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Scopus will be searched alongside a search of grey literature. An examination of the first 200 papers on Google Scholar will also be done to identify relevant papers. Studies describing randomised controlled trials evaluating the effects of savouring interventions as described within this article on adult clinical populations will be included in the review. Outcomes will include well-being, quality of life, depression, anxiety or stress. Study selection and data extraction will be completed by three independent reviewers to reduce risk of bias. Interrater percentage agreement and interrater reliability will be reported on same. The quality of studies will be assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias and the Jadad scale. A narrative synthesis with tables of study characteristics will be provided. Separate considerations of the three time perspectives of savouring interventions (past-focused, present-focused, and future-focused) will also be described. CONCLUSIONS: This systematic review will provide important clinical insights into the potential efficacy of savouring interventions when working with adult clinical samples.

Savoring mediates the mental health benefits of positive coping processes: A prospective population-based analysis.

Positive coping (e.g., self-efficacy and positive reappraisal) and savoring could bear mental health implications under large-scale disasters such as COVID-19. The integrative affect-regulation framework of psychological resilience proposes that evaluative efforts regulate affect, which then predicts positive short-term consequences and better mental health. This two-wave study was done during the prolonged, intensive COVID-19 control rules in Hong Kong and examined (1) the prospective associations of positive coping processes (i.e., self-efficacy and positive reappraisal) (T1, March-August 2021) with subsequent psychiatric symptoms (T2, September 2021-February 2022) and (2) the mediating effect of T2 savoring in the associations. Path analyses revealed that T1 self-efficacy and positive reappraisal were inversely related to T2 psychiatric symptoms. T2 savoring partially mediated the effect of T1 self-efficacy but fully mediated the effect of T1 positive reappraisal. Self-efficacy could have more sustainable direct positive associations with mental health, whereas the benefit of positive reappraisal might need to be catalyzed by savoring over time. Our study offered concrete illustrations of the conceptual tenets of the affect-regulation framework.

Gene × environment effects of serotonin transporter, dopamine receptor D4, and monoamine oxidase A genes with contextual and parenting risk factors on symptoms of oppositional defiant disorder, anxiety, and depression in a community sample of 4-year-old children.

Genetic factors can play a key role in the multiple level of analyses approach to understanding the development of child psychopathology. The present study examined gene-environment correlations and gene × environment interactions for polymorphisms of three target genes, the serotonin transporter gene, the D4 dopamine receptor gene, and the monoamine oxidase A gene in relation to symptoms of anxiety, depression, and oppositional behavior. Saliva samples were collected from 175 non-Hispanic White, 4-year-old children. Psychosocial risk factors included socioeconomic status, life stress, caretaker depression, parental support, hostility, and scaffolding skills. In comparison with the short forms (s/s, s/l) of the serotonin transporter linked polymorphic repeat, the long form (l/l) was associated with greater increases in symptoms of oppositional defiant disorder in interaction with family stress and with greater increases in symptoms of child depression and anxiety in interaction with caretaker depression, family conflict, and socioeconomic status. In boys, low-activity monoamine oxidase A gene was associated with increases in child anxiety and depression in interaction with caretaker depression, hostility, family conflict, and family stress. The results highlight the important of gene-environment interplay in the development of symptoms of child psychopathology in young children.

Effects of coping-skills training in low-income urban African-American adolescents with asthma.

BACKGROUND: Minority teens with asthma are at particular risk for this life-threatening disease due to increased morbidity and mortality rates in addition to the normal challenges of adolescence. OBJECTIVE: The purpose of this randomized controlled trial (n = 137) was to determine the effects of a coping-skills training program (intervention) compared with standard asthma education (attention control) in African-American teens with asthma. METHODS: Adolescents were recruited from five African-American dominant high schools serving low-income areas of Chicago. Data were collected at baseline, 2 months (immediately following the intervention), 6 months, and 12 months. Results. Both groups improved over time, with significant increases in asthma-related quality of life, asthma knowledge, and asthma self-efficacy, accompanied by decreases in symptom days and asthma-related school absences. CONCLUSIONS: Findings suggest that coping-skills training as implemented in this study provided no additional benefit beyond that experienced in the control group. However, group-based interventions delivered in the school setting may be beneficial for low-income, minority teens with asthma.

Reexamining the Factor structure of somatization using the children's somatization inventory (CSI-24) in a community sample.

OBJECTIVE: Pediatric somatization studies have used the 35-item Child Somatization Inventory (CSI-35) or psychometrically refined 24-item CSI (CSI-24). Exploratory factor analysis of the CSI-24 has identified a single factor that did not show good model fit in confirmatory factor analysis (CFA). Further evaluation of the CSI-24 factor structure is needed. METHODS: The present study examined alternative factor structures of the CSI-24 in a community sample (N = 233, ages 8-15). RESULTS: The CFA showed good fit for a single CSI-24 factor, better fit for multiple factor models, and best fit for a single, six-item factor. Construct validity for that factor was found in significant correlations with anxiety, depression, functional disability, and quality of life. CONCLUSIONS: Results are consistent with a single somatization factor, but research is needed to verify the factor structure in different, race/ethnic/demographic, and clinical groups.