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This study investigated the effects of a character strength focused positive psychology course on student well-being. The Values in Action character strengths were each presented as ways to increase both individual and community well-being. There were 112 undergraduate students in the positive psychology course and a comparison group of 176 undergraduates who took other psychology courses. They all completed the PERMA-Profiler (Butler and Kern in Int J Wellbeing 6:1–48, 2016) during the first and last week of the semester. This questionnaire assessed the five elements of positive emotion, engagement, relationships, meaning, accomplishment (PERMA) plus happiness, health, loneliness, and negative emotion. The hypotheses were that (1) the positive psychology students would have significant improvements in each of the measures during the semester and (2) these changes would be significantly greater in the desired direction than the changes for the students in other psychology courses. The first hypothesis was supported in that the positive psychology students had significant improvements in all of the measures, including the total PERMA score. The second hypothesis was also strongly supported in that these improvements were significantly greater relative to the students taking other psychology courses. The effect sizes for the difference between the groups were large for the total PERMA score (d = .846) and the element of meaning; medium-to-large for positive emotion and relationships; medium for happiness, accomplishment, and negative emotion (decrease); and small-to-medium for engagement, health, and loneliness (decrease).

Latinos comprise a sizeable and growing population that experiences unmet health needs and health inequities. Mindfulness-based interventions may be a cost-effective way to address mental health problems in primary care. We sought to adapt a mindfulness-based intervention to better serve and improve the mental health of Latinos in the primary care setting. The authors employed a unique set of adaptations to increase retention and engagement of Latinos in a mindfulness-based stress reduction (MBSR) intervention. These adaptations included (1) group motivational interviewing, (2) problem-solving barriers to retention, (3) a testimonial by a prior Latino MBSR participant, and (4) modifications to increase perceived applicability of MBSR for Latinos. Thirty Latino participants were recruited for an 8-week mindfulness intervention adapted (MBSR-A) specifically for Latino populations. Twenty-six out of thirty (87%) participants completed at least five of the eight sessions, which was significantly greater than in previous studies targeting Latino participants (60–66%). Of those who completed and provided pre- and post-data, there were decreases in anxiety and depression, and increases in measures of general mental health and physical health. The adaptations utilized in this pilot study may increase retention and engagement of Latinos in mindfulness-based interventions and may be a cost-effective way to reduce mental health problems in this growing population.

The purpose of this study was to test the hypotheses that mindfulness would be related to reduced reactivity to daily stress in urban firefighters. Participants were 78 members from an urban fire department who completed an initial questionnaire and a 21-day daily diary. Mindfulness was assessed at baseline using the Mindful Attention and Awareness Scale. The daily diary included measures of stress (total stress, work stress, partner stress) and measures of negative affect, positive affect, and loneliness. Multilevel analyses adjusting for the dependent variable on the previous day were used to test the hypotheses. Higher daily total, partner, and work stress were associated with increased negative affect. Higher daily, total, and partner stress were associated with increased loneliness and decreased positive affect. Mindfulness appeared to buffer against stress reactivity as higher baseline mindfulness was related to (a) less negative affect on days of greater total stress, (b) more positive affect on days of greater total, work, and partner stress, and (c) less loneliness on days of greater total, work, and partner stress. Mindfulness may improve the health and wellbeing of urban firefighters by reducing reactivity to daily stress, especially in relation to positive affect and loneliness. Future research should determine whether mindfulness-based interventions may be enhanced by focusing more closely on reducing reactivity to stress, especially in fire service populations.

A sample of 718 Brazilians completed self-reports on perceived stress, depressive and anxious symptomatology, social support and individual resilience. The sample comprised two age groups: a sample of adults aged 60 or older (The relationship between individual resilience resources and depressive or anxiety symptomatology was found to take place exclusively through stressfulness appraisal. On the other hand, social resilience resources showed a direct and indirect effect on emotional symptoms. This pattern of relationships was found to be invariant across age groups.Our findings suggest that both individual and social resilience resources are negatively related to both depressive and anxiety symptoms in adults regardless of age, thus opening the way to future research analysing how interventions may build resilience resources to minimise the influence of stressful and traumatic events across the lifespan.

This study examined the effects of a mindful eating intervention on health-related outcomes. Thirty-six obese, post-menopausal women were randomized to a 6-week mindful eating and living (MEAL) intervention or an active control group (CONT), consisting of nutritional counseling, goal setting, and group support. Additionally, there were ten monthly refreshers. Weight, body mass index (BMI), waist-hip ratio (WHR), binge eating, interleukin-6 (IL-6), and C-reactive protein (CRP) were assessed at baseline and four follow-up periods up to 1 year. Multilevel analyses showed that the MEAL group had reductions in weight, BMI, WHR, binge eating, IL-6, and CRP, and the CONT group had reductions in weight, BMI, and binge eating. The reductions in IL-6 and CRP were greater for the MEAL as compared with the CONT group. This study suggests that a mindfulness-based eating intervention may have various health benefits in post-menopausal women who are obese.

BackgroundMindfulness-based interventions, Tai Chi/Qigong, and Yoga (defined here as meditative cancer interventions [MCIs]) have demonstrated small to medium effects on psychosocial outcomes in female breast cancer patients. However, no summary exists of how effective these interventions are for men with cancer.PurposeA meta-analysis was performed to determine the effectiveness of MCIs on psychosocial outcomes (e.g., quality of life, depression, and posttraumatic growth) for men with cancer.MethodsA literature search yielded 17 randomized controlled trials (N = 666) meeting study inclusion criteria. The authors were contacted to request data for male participants in the study when not reported.ResultsWith the removal of one outlier, there was a small effect found in favor of MCIs across all psychosocial outcomes immediately postintervention (g = .23, 95% confidence interval [CI] 0.02 to 0.44). Studies using a usual care control arm demonstrated a small effect in favor of MCIs (g = .26, 95% CI 0.10 to 0.42). However, there was insufficient evidence of a superior effect for MCIs when compared to an active control group, including attention control. Few studies examined both short-term and long-term outcomes.ConclusionsThere is evidence for MCIs improving psychosocial outcomes in male cancer survivors. However, this effect is not demonstrated when limited to studies that used active controls. The effect size found in this meta-analysis is smaller than those reported in MCI studies of mixed gender and female cancer patient populations. More rigorously designed randomized trials are needed that include active control groups, which control for attention, and long-term follow-up. There may be unique challenges for addressing the psychosocial needs of male cancer patients that future interventions should consider.

PURPOSE: Cross-sectional research suggests that thinking about multiple ways to reach goals (hope pathways) and the belief that one can reach them (hope agency) may be adaptive for lung cancer patients. We examined the between-person and within-person associations among aspects of hope agency and pathways thinking, daily fatigue, pain, and functional concerns (e.g., sense of independence, usefulness) among lung cancer patients during active treatment. METHODS: Data from a daily diary study were used to examine relations among hope agency, hope pathways, fatigue, pain, and functional concern in 50 patients with advanced lung cancer. Participants were accrued from one outpatient cancer center and completed the study between2014 - 2015. RESULTS: Adjusting for covariates and the previous day’s symptoms or concern, patients who engaged in higher pathways thinking reported lower daily symptoms, whereas those who engaged in higher agency thinking reported less functional concern. Within-person increases in pathways thinking were associated with less daily fatigue, pain, and functional concern; within-person increases in agency thinking were associated with less daily fatigue and pain. Models examining symptoms and concerns as predictors of hope suggested within-person increases in functional concern and fatigue and pain were related to lower agency and pathways thinking the same day. Patients with higher fatigue and pain did not report lower agency or pathways thinking, but patients with more functional concern did. CONCLUSIONS: Increases in hope pathways thinking are associated with lower symptoms and better functioning in lung cancer patients. This suggests that it is important to determine the efficacy of interventions that emphasize the pathways the component of hope.

Clergy fulfill vital societal functions as meaning makers and community builders. Partly because of their important roles, clergy frequently encounter stressful situations. Further, studies suggest that clergy experience high rates of depression. Despite this, few studies have examined protective factors for clergy that may increase their positive mental health. We invited all United Methodist clergy in North Carolina to participate in a survey. Of church-serving clergy, 85 percent responded (n = 1,476). Hierarchical multiple regression was used to assess the predictors of three positive and four negative mental health outcomes. The three sets of predictors were: demographics, which explained 2–10 percent of the variances; variables typically related to mental health (social support, social isolation, and financial stress), which explained 14–41 percent of the variances; and clergy-specific variables, which explained 14–20 percent of the variances, indicating the importance of measuring occupation-specific variables. Some variables (e.g., congregation demands) significantly related to both positive and negative mental health, whereas others (e.g., positive congregations, congregation support) significantly related primarily to positive mental health. In addition to their intervention implications, these findings support separate consideration for negative versus positive mental health.

Objective Previous work suggests that the perception of pain is subjective and dependent on individual differences in physiological, emotional, and cognitive states. Functional magnetic resonance imaging (FMRI) studies have used both stimulus-related (nociceptive properties) and percept-related (subjective experience of pain) models to identify the brain networks associated with pain. Our objective was to identify the network involved in processing subjective pain during cold stimuli. Methods The current FMRI study directly contrasted a stimulus-related model with a percept-related model during blocks of cold pain stimuli in healthy adults. Specifically, neuronal activation was modelled as a function of changes in stimulus intensity vs as a function of increasing/decreasing levels of subjective pain corresponding to changes in pain ratings. In addition, functional connectivity analyses were conducted to examine intrinsic correlations between three proposed subnetworks (sensory/discriminative, affective/motivational, and cognitive/evaluative) involved in pain processing. Results The percept-related model captured more extensive activation than the stimulus-related model and demonstrated an association between higher subjective pain and activation in expected cortical (dorsolateral prefrontal cortex, ventrolateral prefrontal cortex, insula, dorsal anterior cingulate cortex [dACC] extending into pre-supplementary motor area) and subcortical (thalamus, striatum) areas. Moreover, connectivity results supported the posited roles of dACC and insula as key relay sites during neural processing of subjective pain. In particular, anterior insula appeared to link sensory/discriminative regions with regions in the other subnetworks, and dACC appeared to serve as a hub for affective/motivational, cognitive/evaluative, and motor subnetworks. Conclusions Using a percept-related model, brain regions involved in the processing of subjective pain during the application of cold stimuli were identified. Connectivity analyses identified linkages between key subnetworks involved in processing subjective pain.

This parallel-group, randomized controlled pilot study examined daily meditation in a diverse sample of older adults with postherpetic neuralgia. Block randomization was used to allocate participants to a treatment group (n = 13) or control group (n = 14). In addition to usual care, the treatment group practiced daily meditation for six weeks. All participants completed questionnaires at enrollment in the study, two weeks later, and six weeks after that, at the study's end. Participants recorded daily pain and fatigue levels in a diary, and treatment participants also noted meditation practice. Results at the 0.10 level indicated improvement in neuropathic, affective, and total pain scores for the treatment group, whereas affective pain worsened for the control group. Participants were able to adhere to the daily diary and meditation requirements in this feasibility pilot study.

Objective Given its lethality, associated stigma, and symptom burden, a lung cancer diagnosis poses a substantial challenge for patients. The goal of this study was to examine how daily hope, defined as goal-directed effort and planning to meet goals, and daily stigma were related to same- and next-day functioning in lung cancer patients receiving cancer treatment. Methods Fifty lung cancer patients (39 non-small-cell stages IIIa-IV; 11 limited and extensive small cell) completed a baseline questionnaire and 21 daily diaries (n = 1,042) assessing hope, stigma, physical symptoms, treatment factors, and functioning. Hypotheses were tested in same- and next-day models with multilevel modeling. Results Patients who reported more daily hope reported higher social and role functioning in same- and next-day models. On days that patients reported more hope than usual (compared with their own across-day average), they had higher social, role, and physical functioning; this effect did not carry into the next day. Treatment days were associated with lower social and role functioning when patients reported lower hope and associated with higher functioning when patients reported higher hope. Within-person hope was not predicted by disease symptoms. On days that patients reported more stigma than usual, they reported lower social and role functioning. Conclusions Hope is associated with functioning in lung cancer patients, regardless of physical symptoms from disease and treatment. Hope and stigma may therefore be appropriate intervention targets to support daily social and role functioning during lung cancer treatment. (PsycINFO Database Record

Background High rates of posttraumatic stress disorder (PTSD) and depressive symptoms have been observed in earthquake survivors from less developed areas of the world. This study, conducted three years after the 2005 Pakistan earthquake, aimed to identify potentially protective psychosocial factors associated with lower PTSD and depressive symptom levels. Methods Adult earthquake survivors (N=200) were recruited from affected areas in Northwestern Pakistan and completed self-report questionnaires measuring PTSD and depressive symptoms, positive and negative affect, and four psychosocial variables (purpose in life, positive and negative religious coping, and social support). Results Sixty five percent of participants met criteria for probable PTSD. Purpose in life was associated with lower symptom levels and higher positive emotions. A form of negative religious coping (feeling punished by God for one’s sins or lack of spirituality) was associated with higher symptom levels and negative emotions. Higher perceived social support was associated with higher positive emotions. Other significant relationships were also identified. Limitations Limitations include the recruitment of a sample of convenience, a modest sample size, and the cross-sectional nature of the study. Conclusions Findings suggest that some psychosocial factors may be protective across cultures, and that the use of negative religious coping is associated with poorer mental health outcomes in earthquake survivors. This study can inform preventive and treatment interventions for earthquake survivors in Pakistan and other less industrialized countries as they develop mental health care services.

Background Generalized social phobia (GSP) and generalized anxiety disorder (GAD) are both associated with emotion dysregulation. Research implicates dorsal anterior cingulate cortex in both explicit emotion regulation (EER) and top-down attentional control (TAC). Although studies have examined these processes in GSP or GAD, no work compares findings across the two disorders or examines functioning in cases comorbid for both disorders (GSP/GAD). Here we compare the neural correlates of EER and TAC in GSP, GAD, and GSP/GAD. Methods Medication-free adults with GSP (EER n = 19; TAC n = 18), GAD (EER n = 17; TAC n = 17), GSP/GAD (EER n = 17; TAC n = 15), and no psychopathology (EER n = 18; TAC n = 18) participated. During EER, individuals alternatively viewed and upregulated and downregulated responses to emotional pictures. During TAC, they performed an emotional Stroop task. Results For both tasks, significant group × condition interactions emerged in dorsal anterior cingulate cortex and parietal cortices. Healthy adults showed significantly increased recruitment during emotion regulation, relative to emotion-picture viewing. GAD, GSP, and GSP/GAD subjects showed no such increases, with all groups differing from healthy adults but not from each other. Evidence of emotion-related disorder-specificity emerged in medial prefrontal cortex and amygdala. This disorder-specific responding varied as a function of emotion content but not emotion-regulatory demands. Conclusions GSP and GAD both involve reduced capacity for engaging emotion-regulation brain networks, whether explicitly or via TAC. A reduced ability to recruit regions implicated in top-down attention might represent a general risk factor for anxiety disorders.

Objective This study investigated the association between mindfulness, other resilience resources, and several measures of health in 124 urban firefighters. Method Participants completed health measures of posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, physical symptoms, and alcohol problems and measures of resilience resources including mindfulness, optimism, personal mastery, and social support. The Mindful Awareness and Attention Scale (MAAS; Brown & Ryan, 2003) was used to assess mindfulness. Participants also completed measures of firefighter stress, number of calls, and years as a firefighter as control variables. Hierarchical multiple regressions were conducted with the health measures as the dependent variables with 3 levels of independent variables: (a) demographic characteristics, (b) firefighter variables, and (c) resilience resources. Results The results showed that mindfulness was associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems when controlling for the other study variables. Personal mastery and social support were also related to fewer depressive symptoms, firefighter stress was related to more PTSD symptoms and alcohol problems, and years as a firefighter were related to fewer alcohol problems. Conclusions Mindfulness may be important to consider and include in models of stress, coping, and resilience in firefighters. Future studies should examine the prospective relationship between mindfulness and health in firefighters and others in high-stress occupations.

Few studies have assessed the results of multiple exposures to disaster. Our objective was to examine the effect of experiencing Hurricane Gustav on mental health of women previously exposed to Hurricane Katrina. A total of 102 women from Southern Louisiana were interviewed by telephone. Experience of the hurricanes was assessed with questions about injury, danger and damage, while depression was assessed with the Edinburgh Depression Scale and post-traumatic stress disorder using the Post-Traumatic Checklist. Minor stressors, social support, trait resilience and perceived benefit had been measured previously. Mental health was examined with linear and log-linear models. Women who had a severe experience of both Gustav and Katrina scored higher on the mental health scales, but finding new ways to cope after Katrina or feeling more prepared was not protective. About half the population had better mental health scores after Gustav than at previous measures. Improvement was more likely among those who reported high social support or low levels of minor stressors, or were younger. Trait resilience mitigated the effect of hurricane exposure. Multiple disaster experiences are associated with worse mental health overall, although many women are resilient. Perceiving benefit after the first disaster was not protective.

The disclosure of emotional events to various social intimates (disclosure targets) was measured in 2 samples (soldiers and first responders) at risk for posttraumatic stress disorder (PTSD), as well as a comparison sample of college students. These 3 groups completed survey measures of disclosure, and at risk groups also completed measures of PTSD symptoms and social support. Groups at risk for PTSD were less likely to disclose emotions related to potentially traumatic events than were college students reporting general emotional disclosure. Overall, disclosure of positive emotions was more likely than disclosure of negative emotions. Furthermore, amount of disclosure depended on the person to whom the individual disclosed. Within groups at risk for PTSD, social support was associated with lower levels of PTSD. However, this relationship was

Background The purpose of this study was to develop a model to predict the emotional and behavioral responses to an avian flu outbreak. Methods The participants were 289 university students ranging in age, income, and ethnic backgrounds. They were presented with scenarios describing avian flu outbreaks affecting their community. They reported their anticipated emotional responses (positive emotion, negative emotion) and behavioral responses (helping, avoidance, sacrifice, illegal behavior) as if the scenarios were actually occurring. They also were assessed on individual differences expected to predict their responses. Results Participants were only modestly familiar with the avian flu and anticipated strong emotional and behavioral responses to an outbreak. Path analyses were conducted to test a model for predicting responses. The model showed that age, sex, income, spirituality, resilience, and neuroticism were related to responses. Spirituality, resilience, and income predicted better emotional responses, and neuroticism and female sex predicted worse emotional responses. Age, sex, income, and spirituality had direct effects on behavior. The emotional responses were directly related to each behavior and mediated the effects of individual differences. Conclusion Emotional responses may be important in predicting behavior after an outbreak of avian flu, and personal characteristics may predict both emotional and behavioral responses.

This study examined the role of resilience in habituation to heat and cold pain in healthy women (n = 47). Heat and cold pain thresholds were each assessed across 5 equally spaced trials. Resilience, purpose in life, optimism, social support, and neuroticism were assessed using self-report measures. The hypothesis was that the resilience and the associated resilience factors would be positively related to habituation to heat and cold pain while controlling for neuroticism. Multilevel modeling was used to test the hypothesis. When considering each characteristic separately, resilience and purpose in life predicted greater habituation to heat pain while resilience, purpose in life, optimism, and social support predicted greater habituation to cold pain. When controlling for the other characteristics, both resilience and purpose in life predicted greater habituation to heat and cold pain. Resilience and associated characteristics such as a sense of purpose in life may be related to enhanced habituation to painful stimuli. Future research should further examine the relationship between resilience, purpose in life, and habituation to pain and determine whether psychosocial interventions that target resilience and purpose in life improve habituation and reduce vulnerability to chronic pain. Perspective This article showed that resilience and a sense of purpose in life were both related to the ability to habituate to heat and cold pain in healthy women. These personal characteristics may enhance habituation to pain by providing the confidence and motivation to persist in the face of painful stimuli.

Objective: Despite increased risk for psychiatric disorders after trauma exposure, many people are able to adapt with minimal life disruption, and others eventually recover after a symptomatic period. This study examined psychosocial factors associated with resilience and recovery from psychiatric disorders in a high-risk sample of African American adults exposed to a range of severe traumas, who participated in structured diagnostic interviews. Method: The sample included 259 patients exposed to at least one severe traumatic event, recruited from primary care offices at Howard University and administered the Structured Clinical Interview for DSM-IV Axis I disorders. Multinomial logistic regression was used to identify potential psychosocial factors associated with resilience and recovery, including purpose in life, mastery, and coping strategies. Results: Forty-seven patients had no lifetime psychiatric disorders (resilient), 85 met criteria for at least one past DSM-IV disorder but no current disorders (recovered), and 127 met criteria for at least one current DSM-IV disorder (currently ill). The resilient group was characterized by a significantly lower lifetime trauma load. Female gender was predictive of currently ill status. In the final model, purpose in life emerged as a key factor associated with both resilience and recovery, and mastery was also significantly associated with recovery. Conclusions: The identification of psychosocial factors associated with resistance to severe trauma can inform future studies of preventive and treatment interventions for high-risk populations. Further study is needed to determine which psychosocial factors are consistently associated with resilience and to what extent they can be modified through clinical intervention.

The objective of this pilot study was to compare the effects of two mind-body interventions: mindfulness-based stress reduction (MBSR) and cognitive-behavioral stress reduction (CBSR).Fifty (50) subjects were recruited from the community and took part in MBSR (n = 36) and CBSR (n = 14) courses. Participants self-selected into MBSR or CBSR courses taught at different times. There were no initial differences between the MBSR and CBSR subjects on demographics, including age, gender, education, and income.MBSR was an 8-week course using meditation, gentle yoga, and body scanning exercises to increase mindfulness. CBSR was an 8-week course using cognitive and behavioral techniques to change thinking and reduce distress.Perceived stress, depression, psychological well-being, neuroticism, binge eating, energy, pain, and mindfulness were assessed before and after each course. Pre-post scores for each intervention were compared by using paired t tests. Pre-post scores across interventions were compared by using a general linear model with repeated measures. SETTINGS/LOCATIONS: Weekly meetings for both courses were held in a large room on a university medical center campus.MBSR subjects improved on all eight outcomes, with all of the differences being significant. CBSR subjects improved on six of eight outcomes, with significant improvements on well-being, perceived stress, and depression. Multivariate analyses showed that the MBSR subjects had better outcomes across all variables, when compared with the CBSR subjects. Univariate analyses showed that MBSR subjects had better outcomes with regard to mindfulness, energy, pain, and a trend for binge eating.While MBSR and CBSR may both be effective in reducing perceived stress and depression, MBSR may be more effective in increasing mindfulness and energy and reducing pain. Future studies should continue to examine the differential effects of cognitive behavioral and mindfulness-based interventions and attempt to explain the reasons for the differences.

The current study used event-related fMRI to examine BOLD responses associated with two factors that behaviorally determine speed of lexical decision: frequency and emotion. Thirteen healthy adults performed a visual lexical decision task, discriminating between words and orthographically and phonologically legal nonwords. The study involved a 2 (Frequency: high and low) × 3 (Emotional arousal: highly negative, mildly negative, and neutral words) design with word categories matched for number of letters and concreteness. There were significant main effects for both frequency and emotion in lexical decision reaction times but no significant interaction. Negative word lexical decisions were associated with increased activation in bilateral amygdala and middle temporal cortex as well as rostral anterior and posterior cingulate cortex. Low-frequency word lexical decisions, relative to high-frequency word lexical decisions, were associated with increased bilateral activity in inferior frontal cortex. Inferior frontal cortex activation was particularly low during lexical decision for high-frequency emotional words but significant for high-frequency neutral emotional words. We suggest that this is because the semantic representation of high-frequency emotional words may receive sufficient additional augmentation via the reciprocal activation from the amygdala such that selective augmentation by inferior frontal cortex to achieve lexical decision is unnecessary.

Objectives: This study examines the impact of controlled-release oxycodone (OxyContin®) on cognitive-behavioral indicators of efficacy beliefs and coping efforts in patients with osteoarthritis who experience persistent pain. Methods: This was a double-blind, placebo-controlled study of 104 male and female patients with osteoarthritis who experienced moderate to severe pain. Pain assessment, arthritis helplessness, and coping efforts were assessed before and after for treatment and placebo control groups. Results: Examination of differences between treatment and control groups after 2 weeks revealed significant reductions in reported pain, improvements in coping efficacy, and reductions in helplessness and passive coping in response to controlled-release oxycodone treatment compared to placebo. Changes in pain partially mediated the effects on coping in subsequent assessments. Discussion: The findings indicate that controlled-release oxycodone treatment accounted for improvements in coping with pain beyond that of placebo controls. This medication may be most beneficial to osteoarthritis patients when incorporated as part of a multidisciplinary approach to pain management.

This study examined the role of a sense of purpose in life (PIL) in recovery from knee replacement surgery in 64 surgery patients. Each of the surgery patients had been diagnosed with severe osteoarthritis of the knee. Regression analyses were conducted predicting changes in health 6 months after surgery. When considered alone, PIL was related to less anxiety, depression, negative affect, functional disability, stiffness, and more positive affect. When optimism, pessimism, and emotionality were controlled, PIL was still related to less negative affect, depression, and anxiety, and more positive affect. The results suggest that PIL may be an important positive personal characteristic and target for interventions.

The influence of depression and interpersonal stress on immune function was examined in older women with rheumatoid arthritis (RA) and osteoarthritis (OA). The participants were examined during a week of low disease activity and low interpersonal stress (baseline), a week of high interpersonal stress (stress), and during the following week (stress+1). Measures of depressive symptoms, circulating stress hormones and immune cells, and a clinician's global ratings of disease activity were obtained. RA patients, and depressed patients with either RA or OA. In addition, RA patients who were depressed had higher levels of CD4 (T helper) and lower levels of CD8 (T suppressor) lymphocytes than OA patients and non-depressed individuals, suggesting a possible pathway for the influence of stress and depression on disease activity.

The role of personality in the stress process was examined in older women with rheumatoid arthritis (RA) and osteoarthritis (OA) and in healthy controls (HCs). Reactivity was examined in relation to arthritis disease activity and negative affect. Interpersonal sensitivity and neuroticism were measured in questionnaires, and interpersonal stress, negative affect, and disease activity were assessed weekly for 12 weeks. Interpersonal sensitivity was defined as an excessive sensitivity to the behavior and feelings of others. Regarding exposure, neuroticism was related to interpersonal stress for all groups. Regarding reactivity, interpersonal sensitivity interacted with interpersonal stress to predicted elevations in negative affect in all groups and elevations in disease activity in the arthritis groups. There were no significant differences in the effects.

Objective The purpose of this study was to examine the role of depressive symptoms in reactivity to stress and pain in older women with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods Participants were 188 older women with RA (N = 87) and OA (N = 101). They were initially assessed for depressive symptoms and interviewed weekly for 12 to 20 weeks regarding interpersonal stress, arthritis pain, and negative affect. Results Hierarchical linear modeling (HLM) revealed that depressive symptoms were related to weekly elevations in arthritis pain, negative events, perceived stress, and negative affect for RA respondents and elevations in arthritis pain and negative affect for OA respondents. HLM analyses also indicated that depressive symptoms were related to increased reactivity to perceived stress and arthritis pain in people with RA, but not those with OA. Conclusions Depression may be related to elevations in pain for people with RA and OA and to elevations in stress and increased reactivity to stress and pain for those with RA.

Two studies of the relationship between pain and negative affect are presented in this article: a study of weekly fluctuations in pain and negative affect among those with arthritis and a study of daily fluctuations in pain and negative affect for participants with fibromyalgia. The roles of positive affect and mood clarity (or the ability to distinguish between different emotions) in modifying the size of the relationship between pain and negative affect were examined in both studies as a means of testing the predictions of a dynamic model of affect regulation. In both studies, the presence of positive affect reduced the size of the relationship between pain and negative affect. Also, for arthritis participants with greater mood clarity, there was less overlap in ratings of negative and positive affective states.

This study used the Conservation of Resources stress model to examine the role of psychosocial resource loss in the aftermath of Midwest flooding. Questionnaires were distributed through churches and completed by 131 adults in flood-affected communities 6 weeks and 6 months after the flood's crest. Frequent psychosocial losses included losses of routine, sense of control, sense of optimism, accomplishing goals, and time with loved ones. Path analysis revealed that psychosocial resource loss mediated the effects of flood exposure on both psychological distress and physical symptoms at 6 months post-flood. The findings suggest that interventions designed to prevent psychosocial resource loss may reduce the long-term effects of disasters.

This study examined the relationship between religious coping by church members and psychological and religious outcomes following the 1993 Midwest flood. Questionnaires were distributed through churches in flood-affected communities in Missouri and Illinois. The first questionnaire was completed by 209 adults 6 weeks after the flood and a follow-up was completed by 131 respondents 6 months after the flood. Correlational analyses revealed that religious dispositions, attributions, and coping activities were related to psychological and religious outcomes. Hierarchical multiple regressions showed that religious attributions and coping activities predicted psychological and religious outcomes at both 6 weeks and 6 months after controlling for flood exposure and demographics. The results also suggest that positive religious coping may mediate the relationship between religious dispositions and psychological and religious outcomes. © 2000 John Wiley & Sons, Inc.

The study reported in this article examined the role of a sense of purpose in life in recovery from total knee-replacement surgery in 59 older people. Participants completed questionnaires two weeks before, four weeks after, and six months after surgery. Regression analyses predicted health at six months from purpose in life, controlling for initial health and age, education, and gender. The results revealed that purpose in life was directly related to better mental health and indirectly related, through active coping, to better physical health. The findings support the efforts of occupational therapists to increase purposeful habits of living.

This study sought patterns underlying a broad range of psychological problems in 248 undergraduates at a private Midwestern university by examining relations among 1) psychological problems significant in undergraduates and 2) potential correlates of psychological problems. Psychological problems examined were anxiety, depression, emotional stress, physical symptoms, amount and consequences of alcohol consumption, eating problems, and psychological traits associated with eating problems. Personal-emotional adjustment was included as the potential opposite of maladjustment. Factor analyses generally found two broad independent patterns constant across genders. Internalized Distress consisted of anxiety; depression; emotional stress; personal maladjustment; physical symptoms; eating problems; and eating traits. Alcohol Abuse consisted of amount and consequences of alcohol consumption. Multiple regression analyses indicated that whereas stressors were correlates of both factors, female gender predicted higher scores on Internalized Distress, while male gender predicted higher scores on Alcohol Abuse.

BACKGROUND: Mixed associations have been observed between various aspects of ‘social support’ and patient pain experiencesOBJECTIVE: To explore the possibility that more basic social factors, namely coresidence patterns, may be associated with variability in patient pain experiences.METHODS: Relationships between coresidence partners and self-reported pain that interferes with activities were examined in a large representative sample of home health care patients (n=11,436; age range 18 to 107 years, mean [± SD] age 66.3±16.1 years; 55% females).RESULTS: After controlling for sex, age and behavioural risks, compared with living alone, coresidence with an intimate affiliate (eg, spouse, relative) predicted greater pain interference (Cohen’s d = 0.10 to 1.72), and coresidence with a less intimate type of affiliate (eg, friend, paid help) predicted lower pain interference (Cohen’s d = −0.21 tö0.83). In general, however, coresidence patterns accounted for small proportions of variance in pain interference, and the magnitudes of these effects varied widely according to patients’ sex, age and diagnosis.DISCUSSION: The findings suggest that fundamental components of patient’s home-living environment may be associated with potential costs and benefits related to clinically relevant pain functioning for some subgroups of patients.CONCLUSION: Further research that incorporates quantitative and qualitative assessments of patient pain functioning is warranted to better understand how objective and subjective characteristics of patients’ home-living environment may inform the development of more individualized pain treatment options for patients with differing social circumstances.

The clergy occupation is unique in its combination of role strains and higher calling, putting clergy mental health at risk. We surveyed all United Methodist clergy in North Carolina, and 95 % (n = 1,726) responded, with 38% responding via phone interview. We compared clergy phone interview depression rates, assessed using the Patient Health Questionnaire (PHQ-9), to those of in-person interviews in a representative United States sample that also used the PHQ-9. The clergy depression prevalence was 8.7 %, significantly higher than the 5.5 % rate of the national sample. We used logistic regression to explain depression, and also anxiety, assessed using the Hospital Anxiety and Depression Scale. As hypothesized by effort-reward imbalance theory, several extrinsic demands (job stress, life unpredictability) and intrinsic demands (guilt about not doing enough work, doubting one’s call to ministry) significantly predicted depression and anxiety, as did rewards such as ministry satisfaction and lack of financial stress. The high rate of clergy depression signals the need for preventive policies and programs for clergy. The extrinsic and intrinsic demands and rewards suggest specific actions to improve clergy mental health.

As semiconductor nanolithography is pushed to smaller dimensions, process yields can suffer from three dimensional sub-wavelength imaging effects. Mask topography can influence the propagating diffracted field causing errors such as pitch dependent defocus and degraded useable depth of focus (UDOF). In this work, the compensation of diffracted phase error is realized through the manipulation of the wavefront in the projection lens pupil. Mask exposure data is presented showing how such manipulation can increase the UDOF for several mask structure types, leading to UDOF improvement between 18% and 83%. An analytical model is presented to understand trends seen in experimental data through pitch. Results also show that an asymmetric wavefront can be tuned to particular geometries, providing a UDOF improvement for line ends under restricted processing conditions.

Summary Objectives The purpose of this study was to pilot a brief (6-week) group curriculum for providing mindfulness training to obese individuals, called Mindful Eating and Living (MEAL). Setting and design Participants were recruited through a local Young Men's Christian Association (YMCA) in spring 2006. Data was collected at three time points: baseline, completion of intervention (6 weeks), and 3-month follow-up (12 weeks). Intervention Six weekly two-hour group classes (with two monthly follow-up classes). Content included training in mindfulness meditation, mindful eating, and group discussion, with emphasis on awareness of body sensations, emotions, and triggers to overeat. Main outcome measures Key variables assessed included changes in weight, body-mass index (BMI), eating behavior, and psychological distress. In addition, physiological markers of cardiovascular risk were evaluated including C-reactive protein (hsCRP), adiponectin, low-density lipoprotein (LDL), and plasminogen activator inhibitor-1 (PAI-1). Results Ten obese patients enrolled with a mean BMI of 36.9kg/m 2 [SD±6.2]. The mean weight was 101kg/m 2 and the mean age was 44 years (SD=8.7; range=31–62). Compared to baseline data, participants showed statistically significant increases in measures of mindfulness and cognitive restraint around eating, and statistically significant decreases in weight, eating disinhibition, binge eating, depression, perceived stress, physical symptoms, negative affect, and C-reactive protein. Conclusions This study provides preliminary evidence that a eating focused mindfulness-based intervention can result in significant changes in weight, eating behavior, and psychological distress in obese individuals.

This study examined posttraumatic growth in 30 male veterans captured and held as prisoners of war during the Vietnam War. Participants were assessed with structured diagnostic interviews administered by trained clinicians as well as with the Posttraumatic Growth Inventory (PTGI) and other questionnaires measuring dispositional optimism, religious coping, social supports, and purpose in life. Mean age (standard deviation-SD) of participants was 66.7 (6.0) years. Mean total PTGI score (SD) was 66.3 (17.5), indicating a moderate degree of posttraumatic growth. The most strongly endorsed items corresponded to the Appreciation of Life and Personal Strength factors. The group as a whole was optimistic and reported moderate use of positive religious coping. Posttraumatic growth did not significantly differ in repatriates with and without psychopathology, but it was significantly positively correlated with dispositional optimism. In the final regression model, length of captivity and optimism were significant predictors of posttraumatic growth. Our findings confirm that it is possible to achieve long-lasting personal growth even in the face of prolonged extreme adversity. Prospective studies are needed to further evaluate whether pre-existing traits such as optimism can predict growth after trauma.

Spirituality is presumed by millions of Americans to be directly relevant to problems of alcohol abuse. We summarize findings regarding the role of religion and spirituality in the prevention and treatment of substance abuse and present a case illustration. We also consider mechanisms responsible for these effects. We offer advice about why, by whom, and how religion and spirituality should be discussed with clients with substance use disorders. In a recent clinical trial, therapists trained in a client-centered approach to facilitate exploration of spirituality fostered clients' use of spiritual practices. We suggest that the therapist's ability to skillfully engage clients in a discussion of spirituality is largely determined by how the therapist balances the dual roles of authoritative expert and evocative facilitator.

This study examined the relationship between trauma, stress and health in 41 women with fibromyalgia (FM) and 44 women who were healthy controls (HC). The participants were assessed for traumatic events, perceived stress and mental and physical health. Perceived stress was related to worse mental and physical health in both groups. Traumatic events were related to worse mental and physical health in the FM group but were unrelated to health in the HC group. Perceived stress partially mediated the effect of traumatic events on mental and physical health in the FM group. Finally, adult abuse partially mediated the effects of child abuse on adult stress and health. Trauma may have lasting effects on stress and health in women with FM. Copyright © 2009 John Wiley & Sons, Ltd.

This study examined posttraumatic growth (PTG) in Non-Hispanic White (NHW; n = 132) and Hispanic (HISP; n = 51) women who had been diagnosed with cervical cancer. Participants completed measures of PTG, spirituality, optimism, stage of cancer, and demographics variables. The results showed that women with cervical cancer reported PTG but at lower levels than in studies of women with breast cancer. Greater spirituality and more advanced cancer stage predicted more PTG, but optimism did not predict PTG. HISP women reported higher levels of PTG than NHW women, and greater spirituality in the HISP women partially accounted for the difference.

Background: While resilience has been defined as resistance to illness, adaptation, and thriving, the ability to bounce back or recover from stress is closest to its original meaning. Previous resilience measures assess resources that may promote resilience rather than recovery, resistance, adaptation, or thriving. Purpose: To test a new brief resilience scale. Method: The brief resilience scale (BRS) was created to assess the ability to bounce back or recover from stress. Its psychometric characteristics were examined in four samples, including two student samples and samples with cardiac and chronic pain patients. Results: The BRS was reliable and measured as a unitary construct. It was predictably related to personal characteristics, social relations, coping, and health in all samples. It was negatively related to anxiety, depression, negative affect, and physical symptoms when other resilience measures and optimism, social support, and Type D personality (high negative affect and high social inhibition) were controlled. There were large differences in BRS scores between cardiac patients with and without Type D and women with and without fibromyalgia. Conclusion: The BRS is a reliable means of assessing resilience as the ability to bounce back or recover from stress and may provide unique and important information about people coping with health-related stressors.

The purpose of this study was to examine differences in habituation to heat and cold pain in women with fibromyalgia (FM; n = 33) and in women who were healthy controls (HC; n = 44). Quantitative sensory testing (QST) was used to assess pain thresholds during five consecutive trials of ascending heat and descending cold stimulation. Anxiety, depression, fatigue, and pain during the previous week were assessed using self-report measures. The overall hypotheses were that there would be differences between groups in pain thresholds and in the rate of habituation to heat and cold pain stimuli. Multilevel modeling was used to test the hypotheses. There were large overall differences in pain thresholds, with the FM group showing greater sensitivity to heat and cold pain stimuli compared with the HC group. While habituation occurred in both of the groups for heat pain, the HC group had stronger habituation across trials than the FM group. Conversely, while the HC group habituated to cold pain stimuli, the FM group showed sensitization and had decreased cold pain thresholds across trials (they felt cold pain at higher temperatures). In addition, anxiety, depression, fatigue, and pain were related to decreased heat and cold pain thresholds in the overall sample. However, when group was controlled, none of these variables were related to thresholds or rates of habituation or sensitization. The differences between women with FM and healthy women in habituation and sensitization may have important implications for the etiology, diagnosis, and treatment of FM and other chronic pain conditions.

Generalized social phobia involves fear/avoidance, specifically of social situations, whereas generalized anxiety disorder involves intrusive worry about diverse circumstances. It remains unclear the degree to which these two, often comorbid, conditions represent distinct disorders or alternative presentations of a single, core underlying pathology. Functional magnetic resonance imaging assessed the neural response to facial expressions in generalized social phobia and generalized anxiety disorder.Individuals matched on age, IQ, and gender with generalized social phobia without generalized anxiety disorder (N=17), generalized anxiety disorder (N=17), or no psychopathology (N=17) viewed neutral, fearful, and angry expressions while ostensibly making a simple gender judgment.The patients with generalized social phobia without generalized anxiety disorder showed increased activation to fearful relative to neutral expressions in several regions, including the amygdala, compared to healthy individuals. This increased amygdala response related to self-reported anxiety in patients with generalized social phobia without generalized anxiety disorder. In contrast, patients with generalized anxiety disorder showed significantly less activation to fearful relative to neutral faces compared to the healthy individuals. They did show significantly increased response to angry expressions relative to healthy individuals in a lateral region of the middle frontal gyrus. This increased lateral frontal response related to self-reported anxiety in patients with generalized anxiety disorder.These results suggest that neural circuitry dysfunctions differ in generalized social phobia and generalized anxiety disorder.

This study examined the effects of anxiety and depression on pain in women with rheumatoid arthritis (RA; n = 82) or osteoarthritis (OA; n = 88). Anxiety and depression symptoms were assessed at the beginning of the study. Arthritis pain, interpersonal stress, negative affect, and positive affect were assessed weekly for 11 consecutive weeks. Multilevel analyses were conducted to investigate direct, indirect, and interactive effects of anxiety and depression on weekly changes in pain. When entered separately into the prediction equations, anxiety and depression were both related to elevations in current and next week pain, although the effects were nearly twice as large for anxiety. In addition, both anxiety and depression were indirectly related to current pain through negative and positive affect and depression interacted with stress to predict current pain in the RA group. When entered together into the prediction equations, anxiety alone was still related to elevations in current and next week pain. In addition, anxiety alone was indirectly related to current pain through negative affect and depression alone was indirectly related to current pain through positive affect. These results highlight the need for careful study of the differential effects of anxiety and depression and treatments that target their unique mechanisms.

Understanding the role of emotional states is critical for predicting the kind of decisions people will make in risky situations. Currently, there is little understanding as to how emotion influences decision-making in situations such as terrorist attacks, natural disasters, pandemics, and combat. To help address this, we used behavioral and neuroimaging methods to examine how emotion states and traits influence decisions. Specifically, this study used a wheel of fortune behavioral task and functional magnetic resonance imaging (fMRI) to examine the effects of emotional states and traits on decision-making pertaining to the degree of risk people are willing to make in specific situations. The behavioral results are reported here. The neural data requires additional time to analyze and will be reported at a future date. Biases caused by emotion states and traits were found regarding the likelihood of making risky decisions. The behavioral results will help provide a solid empirical foundation for modeling the effects of emotion on decision in risky situations.

We describe a program of research examining how the relationship between positive and negative affect varies both between individuals and within individuals over time. This Dynamic Model of Affect (DMA) proposes that under conditions that promote maximal information processing, positive and negative affective systems function relatively independently. In contrast, under conditions characterized by uncertainty, including pain and stress, the affects become strongly inversely related. Included in our consideration are potential individual differences in the ability to sustain affective differentiation during pain and other stressors, and the implications of this model for perceptions of social relations and for interventions to improve well-being among the chronically ill.

We review empirical evidence from two field studies for the role of stressful life events in disease flare-ups among patients with rheumatoid arthritis (RA). RA patients were expected to be more vulnerable psychologically, and physiologically, to stressful events in their everyday lives than other arthritis patients without an autoimmune disease. Findings from two studies are reviewed both for their substantive contribution, but also to provide guidance on measurement issues in future field research of this kind. One study included 41 patients with RA, who were interviewed weekly and called to a clinic for blood work and joint examinations when their levels of interpersonal stress increased significantly. A second study used a similar design but included comparison samples of patients with osteoarthritis (OA) and healthy controls of similar age and the same gender as the RA sample. The findings provided support for the proposition that interpersonal stressors are predictive of increases in disease activity. Not all RA patients, however, showed these relationships, and there was evidence that some participants with OA who were depressed also showed higher disease activity following interpersonal stressors. Significant individual differences in the stress-disease relationship were uncovered that deserve greater attention in future studies. Important improvements in the assessment of stressful events and refinements in panel study design are also presented as guides to research on the role of stress in disease processes.

The use of attenuated phase-shift masking materials is being considered as one of the key resolution enhancement techniques for sub-0.18 micrometers lithography. In addition to proper optical performance, films for use at DUV and 193 nm wavelengths require suitable plasma etch characteristics and stability at mask exposure levels of pulse excimer lasers. This may limit practical materials to those which allow suitably volatile etch bi-products and possess stable stoichiometric composition. Several film families have been produced which can deliver a (pi) phase shift and 4 - 15% transmission within a single films thickness including Al/AlN, MoSiO, TaSiO, Zr/ZrN, SixNy, and TaN/Si3N4. Of these materials, TaSiO, SixNy, and TaN/Si3N4, allow for adequate plasma etch performance with selectivity to fused silica and resist. Excimer laser 193 nm exposure at fluences corresponding to mask exposure levels show some degree of optical degradation of materials prone to oxidation.© (1997) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

A 193nm excimer laser microstepper has been developed for deep UV photolithography research at this wavelength. The system incorporates a x10, 0.5NA, 4mm field diameter, high-resolution imaging lens of either all-refractive or catadioptric design. An all-fused silica refractive lens has been used in the results reported here to carry out exposures in polymethylmethacrylate and polyvinylphenol photoresists. Well-resolved images of 0.2micrometers dense lines and spaces and 0.35micrometers diameter contact holes have been produced in PMMA and polyvinylphenol resists.

A simple null modulation-polarization method of measuring optical constants of metals has been adapted for operation with a KrF 248 nm excimer laser. The approach requires only 3 optical components to extract the real and imaginary parts of the index of refraction (n,k). Experimental results will show good agreement to reference values for several metals (Cr, Au, Al) and Si.