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Poor sleep and different patterns of marital status among Hispanics/Latinos have been documented, yet the extent to which marital status is associated with sleep health and the moderating role of gender in this association among Hispanics/Latinos is poorly understood.Demographic and sleep data were obtained from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL: n= 16,415), an epidemiological cohort study, and the Sueno Study (n= 2,252) that is an ancillary to HCHS/SOL. Sleep duration, insomnia symptoms, daytime sleepiness, napping, and snoring were self-reported and drawn from HCHS/SOL. Sleep efficiency, sleep fragmentation, and inter-day stability were objectively assessed in the Sueno Study.Complex sample analyses indicated that being married or cohabiting was associated with better sleep health in general, including having normal sleep duration, fewer insomnia symptoms, and higher sleep efficiency (F> 2.804, p< .044). These associations were more prominent in objectively measured sleep indices and among females.Findings suggest being in a committed relationship associated with better sleep health in Hispanics/Latinos in the US, a diverse and under-represented population. Findings may have implications for tailoring sleep health interventions to at-risk populations who may less likely to be in a committed relationship.

Cancer patients and their family caregivers have reported various needs that are not met. Recognition of the unmet needs by healthcare professionals may be a first step to adequately and systematically addressing them. Thus, the International Psycho-Oncology Society Survivorship Online Survey was developed to measure healthcare professionals' evaluation about the unmet needs of their patients and family caregivers around the globe.The survey was developed in English and translated to additional 14 different languages. The survey was distributed on the web-based REDCap application to over 50 psycho-oncology societies and their networking platforms as well as social media and to authors who have published in psycho-oncology journals globally.A total of 1472 participants from 36 countries at least partially completed the survey. Healthcare professionals evaluated needs for managing one's emotional distress and patients' medical care and symptoms as the most common concerns for both patients and their family caregivers across all patient age groups. Less than two-thirds of the participating healthcare professionals reported that their institution had services or programs to address the needs of the patients or caregivers.Findings suggest several directions for further analyses to provide more specific information that would be readily translated into clinical practices, research, and policy aimed to enhance the quality of life of cancer patients, survivors, and family caregivers around the globe. In addition, this collaborative effort also hints at the importance of establishing international networks to promote equity in care for people touched by cancer worldwide.

Objectives Obsessive-compulsive disorder (OCD) is a condition marked by recurrent and distressing thoughts, images, and urges accompanied by repetitive physical or mental rituals. An emerging line of work suggests that emotion may be an important consideration when looking at the role of impulsivity across the spectrum of psychopathology, including OCD. The current study examined the relationship between obsessive-compulsive symptomatology (OCS) and impulsive cognitive and behavioural reactions to emotion using a multi-study, multi-method approach. Design Data were collected cross-sectionally online (Study 1) or via an in-person laboratory visit (Study 2). Methods In Study 1, self-report measures of impulsivity and OCS were administered to a large, non-selected community sample (N = 386). Study 2 extended these findings with a young adult sample (N = 107) with clinically elevated OCS using self-report measures, clinical interview, and two behavioural symptom provocation tasks. Results Emotion-related impulsivity, but not non-emotion-related impulsivity, was associated with greater severity of OCS across symptom domains and across all modes of assessment. Impulsive cognitive responses to emotion were associated with greater obsession severity, while impulsive behavioural reactions to emotion were associated with greater compulsions. Emotion-related impulsivity also acted synergistically with a belief in the importance and control of thoughts, such that this established risk factor for OCD was associated with greater OCS severity only when behavioural reactivity to emotion was also present. Conclusions Results highlight the importance of considering emotional context when studying impulsivity in OCD, and point to the potentially differential relationship between OCS and behavioural versus cognitive impulsive reactions to emotion. Practitioner points Emotion-related impulsivity (ERI) reflects a tendency to act impulsively in the context of strong emotions. ERI was associated with greater OCS across symptom domains and type of symptom assessment (self-report, interview, or symptom provocation). ERI also interacted with an established OCS risk factor, a belief in the importance and control of thoughts, to predict symptom severity, suggesting that it may be important to evaluate and address ERI alongside unhelpful beliefs in patients with OCS. Given the present study's cross-sectional nature, we cannot draw conclusions about the directionality of the ERI - OCS relationship, and while our study included individuals with clinically elevated OCS, results should be replicated in a fully clinical sample.

Carver and Scheier's (1990) account of goal striving predicts that unexpectedly fast goal progress leads to reduced effort at that goal (coasting) and to shifting focus toward other goals (shifting). Although these hypotheses are key to this goal-striving account, empirical evidence of coasting and shifting is scarce. Here we demonstrate coasting and shifting in 2 experiments: Participants performed a lexical decision task and were promised a bonus if they delivered a specific number of correct responses (accuracy goal) and a specific number of fast responses (speed goal). After half of the trials, participants received (randomly allocated) feedback on their progress regarding the 2 goals, in which progress toward 1 goal was either above or below the target. In line with hypotheses, better-than-needed progress toward 1 goal led to (a) reduced subsequent progress toward that goal (as reflected in lower goal-related performance; coasting) and (b) a shift of resources toward the alternative goal (as reflected in higher goal-related performance on the alternative goal; shifting). Experiment 1 further demonstrated that positive feedback led to positive affect, and Experiment 2 demonstrated the causal role of affect in coasting and shifting. The implications of the present findings for future research on goal striving are discussed.

Background Fear of cancer recurrence (FCR) has been associated with cancer screening behaviors among cancer survivors, but to the authors' knowledge, the question of whether the same is true for caregivers is unknown. The current study investigated the extent to which FCR among caregivers predicted their cancer screening behaviors years after their relatives' cancer diagnosis. Methods A total of 813 caregivers (67% of whom were female, mean age of 56 years, and 92% non-Hispanic white) completed surveys 2 years (T1) and 8 years (T2) after their patients' cancer diagnosis. FCR, anxiety (Profile of Mood States-Short Form [POMS-SF]), and general mental health (Medical Outcomes Study 36-Item Short-Form Health Survey [MOS SF-36]) were reported at T1; caregivers' engagement in screening for colorectal, breast, and prostate cancers because of the patients' diagnoses were reported at T2. Results Caregivers were found to engage in cancer screening at rates similar to those of the national average. Controlling for covariates, hierarchical logistic regression modeling for each type of cancer screening demonstrated that greater FCR was linearly related to a higher likelihood of undergoing colorectal cancer screening (odds ratio [OR], 1.15) and maintaining prostate cancer screening (OR, 1.34), but a lower likelihood of maintaining breast cancer screening in an age-appropriate manner (OR, 0.27). Examining curvilinear effects demonstrated that moderate levels of FCR were associated with a higher likelihood of maintaining age-appropriate colorectal cancer screening (OR, 1.48). Conclusions The overall FCR among caregivers uniquely promotes their engagement in cancer screening behaviors. The role of caregivers' FCR in other types of cancer preventive behaviors and ways to channel FCR concerns into promoting healthy lifestyle behaviors should be investigated.

Theory about the conceptual basis of psychiatric disorders has long emphasized negative emotionality. More recent ideas emphasize roles for positive emotionality and impulsivity as well. This article examines impulsive responses to positive and negative emotions, which have been labelled as urgency. Urgency is conceptually and empirically distinct from other forms of impulsivity. A large body of work indicates that Urgency is more robustly related to psychopathology than are other forms of impulsivity. Researchers have considered four neurocognitive models of urgency: excessive emotion generation, poor emotion regulation, risky decision-making, and poor cognitive control. Little evidence supports emotion generation or risky decision-making as the core issues driving urgency. Rather, urgency appears related to dysfunction in key hubs implicated in the integration of cognitive control and emotion regulation (e.g., the orbitofrontal cortex and anterior insula), expressed as response inhibition deficits that emerge most robustly in high arousal contexts. These neurocognitive processes appear remarkably parallel for positive and negative urgency. We provide methodological suggestions and theoretical hypotheses to guide future research.

Purpose/BackgroundAccumulating evidence shows that bereaved family caregivers report elevated distress for an extended period, which compromises their quality of life. A first step in the development of programs to enhance bereaved caregivers’ quality of life should be determining the needs they experience to manage the loss, and the needs that are not being satisfied. Thus, this study aimed to develop a new measure to assess unmet needs among bereaved family caregivers.MethodThe 20-item Needs Assessment of Family Caregivers-Bereaved to Cancer measure was developed and validated with bereaved cancer caregivers 5 (n = 159) and 8 (n = 194) years after the initial cancer diagnosis of the index patient, when stress in providing care to the patient was assessed.ResultsExploratory factor analysis yielded two primary factors: unmet needs for reintegration and unmet needs for managing the loss. Bereaved caregivers who were younger and ethnic minority, and who had greater earlier perceived stress of caregiving, reported their needs were more poorly met (t > 2.33, p < .05). The extent to which bereaved caregivers’ needs to manage the loss were not perceived as being met was a consistent and strong predictor of poor adjustment to bereavement at both 5- and 8-year marks (t > 1.96, p < .05), beyond the effects of a host of demographic and earlier caregiving characteristics.ConclusionFindings support the validity of the Needs Assessment of Family Caregivers-Bereaved to Cancer and suggest that interventions to help bereaved caregivers manage the loss by assisting their transition to re-engagement in daily and social activities will benefit caregivers by mitigating bereavement-related distress years after the loss.

Objectives To review the family caregivers’ unmet needs in the long-term phase of survivorship to identify unique challenges faced by family caregivers. Data Sources Research-based articles and published reports. Conclusion Family caregivers diverge into three distinct groups in the long-term survivorship phase: those remaining in care, those whose patients have survived and where care is no longer needed, and those whose patients have died. Their primary unmet needs vary by the different caregivership trajectories. Implications for Nursing Practice Comprehensive understanding of family caregivers’ unmet needs is required to develop family caregiver care plans in long-term survivorship.

This article considers self and self-concept in bipolar disorder. Bipolar disorder, defined on the basis of manic symptoms, is a highly debilitating psychopathology. It is heavily grounded in biology but symptom course is still very responsive to psychological and social forces in the lives of persons who have the disorder. This review assumes an overall view of the self that is typical of personality psychology: self as traits, self as goals and aspirations, and ongoing efforts to attain those goals. In this review, we will discuss two different facets of self and identity in bipolar disorder. First, we review a body of goal pursuit literature suggesting that persons with bipolar disorder endorse heightened ambitions for attaining goals and recognition from others. Second, we will review multiple findings which suggest that among persons with bipolar disorder, self-worth depends on measurable success in an extreme way. We will consider how the intersection of these two themes may lead to unique identity challenges for people with bipolar disorder, drawing from self-report, behavioral, and neuroscience findings to critically examine this viewpoint.

Although aggression is related to manic symptoms among those with bipolar disorder, new work suggests that some continue to experience elevations of aggression after remission. This aggression post-remission appears related to a more general tendency to respond impulsively to states of emotion, labelled emotion-related impulsivity. We recently developed the first intervention designed to address aggression in the context of emotion-related impulsivity. Here, we describe feasibility, acceptability, and pilot data on outcomes for 21 persons who received treatment for bipolar disorder and endorsed high levels of aggression and emotion-related impulsivity. As with other interventions for aggression or bipolar disorder, attrition levels were high. Those who completed the intervention showed large changes in aggression using the interview-based Modified Overt Aggression Scale that were sustained through three months and not observed during wait list control. Although they also showed declines in the self-rated Buss-Perry Aggression Questionnaire and in self-rated emotion-related impulsivity as assessed with the Feelings Trigger Action Scale, these self-ratings also declined during the waitlist control. Despite the limitations, the findings provide the first evidence that a brief, easily disseminated intervention could have promise for reducing aggression among those with bipolar disorder.

OBJECTIVE The experience of cancer elicits not only turmoil but also resilience in the family, which has been related to psychological adjustment and physical health of family caregivers. The biological pathways linking family cancer caregiving to health, however, remain poorly understood. This study examined the extent to which psychological risk and resilience factors related to a proinflammatory gene expression profile (conserved transcriptional response to adversity, or CTRA) among caregivers during the first-year postdiagnosis of a patient with colorectal cancer. METHODS A total of 41 caregivers (mean age = 54 years, 74% female, 40% Hispanic) provided psychological data and peripheral blood samples around 4 and 12 months after diagnosis. Mixed regression models controlling for demographic and biometric factors were used to test the associations of caregiver CTRA gene expression with caregiving stress, loneliness, and lack of social support (risk factors), as well as benefit finding and meaning (resilience factors). RESULTS When individually tested, all but benefit finding were significantly related to CTRA (R2 ≥ 0.112, p < .045). When adjusted for other factors in either the risk or resilience group, loneliness, social support, and meaning effects remained significant (R2 ≥ 0.120, p < .041). When all study factors were simultaneously adjusted (R2 = 0.139), only loneliness remained significant (p = .034). CONCLUSIONS Findings suggest that caregiving-related transcriptional effects seem to be most pronounced when caregivers experience low social support and loneliness, as well as little meaning or purpose in their caregiving. These findings suggest that the development of new intervention strategies that prioritize reductions in caregiver loneliness may favorably impact biological mechanisms related to caregiver health.

BACKGROUND. Identifying and addressing the caregivers’ unmet needs have been suggested as a mean of reducing their distress and improving quality of life. However, needs of family cancer caregivers are complex in the period of long-term survivorship in particular, as the needs may diverge as does the patients’ survivorship trajectory, which this study investigated. METHODS. Family cancer caregivers completed a prospective longitudinal surveys at 2, 5, and 8 years post-diagnosis (n=633). Early caregiving characteristics and demographics were measured at 2 years. Caregiver status (former caregivers-remission, current caregivers, and bereaved caregivers) and unmet needs were measured at three assessments. RESULTS. Caregivers’ unmet needs at 8 years were attributable to the passages of the caregiving status as their patients’ illness trajectory diverges from being initially a care recipient. Specifically, either prolonged caregiving or having a break from caregiving followed by bereavement during the long-term survivorship was related to various domains of unmet needs at 8 years (t> 2.35, p 2.50, p 37.51, p

OBJECTIVE: To investigate the extent to which age and specific sources of caregiving stress are associated with cancer caregivers’ health. METHODS: New colorectal cancer caregivers (n= 88; age M= 49) reported caregiving stress (i.e., disrupted schedule, lacking family support, financial strain) and mental and physical health, and collected saliva samples assayed for neuroendocrine biomarkers (cortisol and α-amylase). RESULTS: Disrupted daily schedule due to caregiving was associated with poorer self-reported mental health across all ages (B= −4.19, 95% CI: −6.59- −1.80, p

BACKGROUND: Social comparisons (SCs) are common among cancer patients, but their prospective associations are not well understood. This study examined concurrent and prospective relationships of SCs with health-related quality of life (HRQOL) and depressive symptoms during the first year of breast cancer treatment. METHODS: Non-metastatic breast cancer patients (N=240) enrolled in a larger intervention trial reported on the frequencies of SCs post-surgery (T1) and 6 months later (T2). Health-related quality of life (HRQOL) and depressive symptoms were assessed at T1, T2, and 12 months after T1 (T3). Path analysis via structural equation modeling was used to assess three models relating SCs to HRQOL and depressive symptoms from T1-T2, T1-T3, and T2-T3, controlling for stage of disease, intervention condition, and dispositional optimism. RESULTS: Upward contrast SCs were associated with poorer concurrent HRQOL at T1 and T2, and with more concurrent depressive symptoms at T2. However, upward contrast SC at T1 predicted better T2 and T3 HRQOL. Upward identification SC at T1 predicted more T2 depressive symptoms, and at T2 was associated with poorer concurrent HRQOL and more concurrent depressive symptoms. Downward identification SCs at T1 were associated with poorer concurrent HRQOL. Downward identification SCs at T2 predicted poorer T3 HRQOL. CONCLUSIONS: Upward SCs were related to compromised concurrent psychosocial well-being, but prospective effects varied by the interpretation of the comparison (i.e., contrast vs. identification). Findings have implications for the development and deployment of group-based psychosocial interventions during the early phases of survivorship, during which opportunities for SC are prevalent.

Impulsiveness has been studied as an aspect of personality and psychopathology for generations. There are longstanding disagreements about how to define it and whether it should be viewed as one construct or several. This article begins by briefly reviewing some earlier and some more recent work on impulsiveness. Several approaches have recently converged to focus on a distinction between impulsive reactions to emotion and impulsive properties that are not initiated by emotion. From this review, we turn to psychopathology. It is well known that impulsiveness is related to externalizing psychopathology, but some have concluded that a similar relation does not exist for internalizing psychopathology. A recent literature is described that challenges the latter conclusion, linking impulsive reactivity to emotion to both externalizing and internalizing aspects of psychopathology. Discussion then turns to emotion-related impulsiveness and other constructs to which it is conceptually and empirically related, reexamining whether other conceptual targets should be added to the discussion. The article closes with a consideration of how important it is to continue to remain open to new conceptual perspectives. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Objective Cognitive-behavioral stress management (CBSM) improves adaptation to primary treatment for breast cancer (BCa), evidenced as reductions in distress and increases in positive affect. Because not all BCa patients may need psychosocial intervention, identifying those most likely to benefit is important. A secondary analysis of a previous randomized trial tested whether baseline level of cancer-specific distress moderated CBSM effects on adaptation over 12 months. We hypothesized that patients experiencing the greatest cancer-specific distress in the weeks after surgery would show the greatest CBSM-related effects on distress and affect. Methods Stages 0-III BCa patients (N = 240) were enrolled 2–8 weeks after surgery and randomized to either a 10-week group CBSM intervention or a 1-day psychoeducational (PE) control group. They completed the Impact of Event Scale (IES) and Affect Balance Scale (ABS) at study entry, and at 6- and 12- month follow-ups. Results Latent Growth Curve Modeling across the 12-month interval showed that CBSM interacted with initial cancer-related distress to influence distress and affect. Follow-up analyses showed that those with higher initial distress were significantly improved by CBSM compared to control treatment. No differential improvement in affect or intrusive thoughts occurred among low-distress women. Conclusion CBSM decreased negative affect and intrusive thoughts and increases positive affect among post-surgical BCa patients presenting with elevated cancer-specific distress after surgery, but did not show similar effects in women with low levels of cancer-specific distress. Identifying patients most in need of intervention in the period after surgery may optimize cost-effective cancer care.

Acetaminophen has been shown to influence cognitive and affective behavior possibly via alterations in serotonin function. This study builds upon this previous work by examining the relationship between acetaminophen and dual-learning systems, comprising reflective (rule-based) and reflexive (information-integration) processing. In a double-blind, placebo-controlled study, a sample of community-recruited adults (N = 87) were randomly administered acetaminophen (1000 mg) or placebo and then completed reflective-optimal and reflexive-optimal category learning tasks. For the reflective-optimal category learning task, acetaminophen compared to placebo was associated with enhanced accuracy prior to the first rule switch (but not overall accuracy), with needing fewer trials to reach criterion and with a faster learning rate. Acetaminophen modestly attenuated performance on the reflexive-optimal category learning task compared to placebo. These findings indirectly support two positions that have been proposed elsewhere. First, they are consistent with the view that acetaminophen has an influence on the serotonergic system. Second, the findings are consistent with a proposed link between elevated serotonin function and relative dominance of effortful, rule-based processing.

PURPOSE: This study tested a theory linking a marker of low serotonergic function to both depression and impulsivity in a sample of advanced breast cancer patients, among whom elevated depressive symptoms and difficulty regulating emotions are commonly reported. METHODS: A total of 95 patients provided blood samples for serotonin transporter polymorphic region of the gene (5-HTTLPR) and completed questionnaires that measured depressive symptoms and emotional impulsivity. RESULTS: Structural equation modeling revealed that the s allele of 5-HTTLPR was related to greater depressive symptoms (β = .20, p < .042) but only marginally to greater emotional impulsivity (β = .19, p < .068). Depressive symptoms and emotional impulsivity were positively related (β = .33, p < .003). Further tests explored possible mediation from genotype to one psychological variable via the other. Results suggest that depressive symptoms, particularly perceived interpersonal rejection, may be a pathway linking genotype to emotional impulsivity. CONCLUSIONS: Findings provide the first evidence that low serotonergic function contributes to both depression and impulsivity within a clinically meaningful sample. Furthermore, the link of s allele of 5-HTTLPR to emotional impulsivity was mediated by depressive symptoms, particularly perceptions of social rejection. Findings have implications for advanced breast cancer patients’ treatment decision.

More than a dozen recent studies have shown that bipolar disorder and key outcomes within bipolar disorder are related to heightened willingness to pursue extremely ambitious life goals, as measured by the Willingly Approached Set of Statistically Unlikely Pursuits (WASSUP). Although it has been argued that this willingness to pursue difficult lifetime ambitions in bipolar disorder could reflect willingness to expend effort toward reward, this has not been tested to date. In this study, 50 individuals with bipolar I disorder were followed until they achieved remission. They then completed the Effort Expenditure for Rewards Task (EEfRT) and the WASSUP. Scores on the WASSUP Financial Success subscale, but not the Popular Fame subscale, were significantly associated with decision making on the EEfRT, even after controlling for significant effects of reward magnitude, gender, and age. These two indices appear to measure related facets of reward sensitivity.

OBJECTIVE Cancer caregiving burden is known to vary across the survivorship trajectory and has been linked with caregivers' subsequent health impairment. Little is known, however, regarding how risk factors during long-term survivorship relate to vulnerability to caregivers' health during that period. This study examined effects of caregiving status and depressive symptoms on development of physical morbidity by 5 years postdiagnosis. METHOD Family caregivers (N = 491; Mage = 55.78) completed surveys at 2 (Time 1 [T1]) and 5 years (T2) after their care recipients' cancer diagnosis. Demographic and caregiving context variables known to affect caregivers' health were assessed at T1. Self-reported depressive symptoms and a list of physical morbid conditions were assessed at T1 and T2. Caregiving status (former, current, or bereaved) was assessed at T2. RESULTS Hierarchical negative binomial regression revealed that current caregivers at T2 (p = .02), but not those bereaved by T2 (p = .32), developed more physical morbid conditions between T1 and T2 compared with former caregivers, controlling for other variables. Independently, caregivers reporting either newly emerging or chronically elevated depressive symptoms at T2 (ps < .03), but not those whose symptoms remitted at T2 (p = .61), showed greater development of physical morbidity than did those reporting minimal depressive symptoms at both T1 and T2. CONCLUSIONS Results highlight the roles of long-term caregiving demands and depressive symptoms in cancer caregivers' premature physical health decline. Clinical attention through the long-term survivorship trajectory should be emphasized for caregivers of patients with recurrent or prolonged illness and to address caregivers' elevated depressive symptoms. (PsycINFO Database Record

BACKGROUND Cancer caregiving has been associated with worsening health among caregivers themselves, yet demographic and psychosocial predictors of their long-term health decline are less known. This study examines changes in caregivers' physical health 2 to 8 years after their family members' cancer diagnosis and prospective predictors of that change. METHODS Caregivers (n = 664; mean age, 53.2 years) participated in a nationwide study at 2 (T1), 5 (T2), and 8 (T3) years after their family members' cancer diagnosis. Physical health (12-item Medical Outcomes Study Short Form Health Survey Physical Component Scale) was assessed T1 through T3 as outcome. Predictors were self-reported at T1, including caregiver demographics (age, sex, education, income, relationship to patient, and employment status), patient cancer severity (from medical records), and caregiver psychosocial factors (caregiving stress, caregiving esteem, social support, and depressive symptoms). Latent growth modeling tested predictors of caregivers' initial physical health and their physical health change across time. RESULTS At T1, caregivers reported slightly better physical health than the US population (M = 51.22, P = .002), which declined over the following 6 years (Mslope = −0.27, P < .001). All demographic factors, patient cancer severity, and T1 caregiving stress were related to caregivers' initial physical health (P ≤ .03). Higher depressive symptoms were unrelated to caregivers' initial physical health, but were the only significant predictor of caregivers' more rapid physical health decline (B = −0.02, P = .004). CONCLUSION Findings highlight the unique contribution of caregivers' depressive symptoms to their physical health decline. Assessing and addressing depressive symptoms among caregivers early in the cancer survivorship trajectory may help to prevent premature health decline among this important yet vulnerable population. Cancer 2017. © 2017 American Cancer Society.

Objective Evidence regarding post traumatic growth (PTG) as a predictor of future reductions in distress has been inconclusive. The purpose of this study was to examine this relationship in a multiple-observation prospective study, to provide a more rigorous test of prediction over time. This longitudinal study extended previous work by taking into account perceptions of vulnerability and explored the buffering role of PTG on the links between vulnerability and psychological distress. We also explored whether individual differences in demographic and medical characteristics moderate the relationship of interests. Method Participants were 312 Taiwanese women (Mage = 46.7 years) who underwent surgery for breast cancer. Measures of PTG, perceived vulnerability, and distress were assessed at Day 1 and 3, 6, 12, and 24 months after surgery. Hierarchical linear modeling was used to investigate whether PTG and vulnerability and their interaction predicted distress over time. Results A significant direct effect of PTG on distress was found: higher PTG was followed by lower distress. Analysis also yielded a significant buffering effect of PTG on vulnerability leading to distress. However, this effect was moderated by type of surgery. The buffering effect of PTG occurred only among women having mastectomy. Conclusions We conclude that PTG tends to lead to less psychological distress overall but particularly so in a high impact context. (PsycINFO Database Record

Background Mild to moderate depressive symptoms are common during treatment for non-metastatic breast cancer. The goal of this secondary analysis was to determine if depressive symptoms predict clinical outcomes at long-term follow-up. Methods From 1998 to 2005, we interviewed 231 women with the Hamilton Rating Scale for Depression who were participating in a psychosocial study 2–10weeks post-surgery for non-metastatic breast cancer (Stage 0-IIIb). We conducted Kaplan Meier (K-M) curves and Cox proportional hazards (PH) models to examine associations between depressive symptoms, overall survival, and disease-free survival at 8–15-year follow-up. Results A total of 95 women (41.1%) scored in the mild-moderately depressed range. Non-depressed women had longer overall survival ( M =13.56years; SE =0.26) than those in the mild/moderate depressed group ( M =11.45years; SE =0.40), Log-rank χ 2 (1)=4.41, p =0.036. Cox PH models, adjusting for covariates, showed comparable results: mild/moderate depressive symptoms hazard ratio=2.56, [95% CI, 1.11 to 5.91], p =0.027. Similar results were observed in a subsample with invasive disease (n=191). Depression category did not predict disease-free survival in the overall or invasive sample. Conclusions Screening and referrals for treatment of depressive symptoms, even at subclinical levels, is important early in treatment. A randomized trial is warranted to determine effects of depressive symptoms on clinical outcomes.

This chapter addresses goal dysregulation in the mood disorders and schizophrenia. A large body of basic research has considered goal regulation mechanisms that support the pursuit of reward. This chapter outlines some components of goal regulation, their relevance for emotion, and some ways in which goal regulation can go awry. It begins by providing an overview of normative goal regulation processes and how these relate to emotion. Then, we discuss models and evidence concerning goal dysregulation across psychopathologies (depression, mania, and schizophrenia). The chapter concludes with a discussion of clinical implications of this work, unaddressed issues, and future directions.

In this issue, Colin DeYoung and Robert Krueger (hereafter DK) suggest that cybernetic principles can provide a grounding for a general theory of psychopathology, and they propose one such theory. ...

This chapter describes a set of ideas bearing on the structure of action and emotion and how they are regulated. Some of the ideas are associated with the terms feedback control and cybernetics. Those ideas have roots in many sources, including the concept of homeostasis and the creation of mechanical devices to serve as governors for engines. With respect to motivation, the ideas yield a viewpoint in which action is goal directed and reflects a hierarchy of control processes. The creation and reduction of affect are seen as reflecting another set of feedback processes. The portion of the model devoted to affect is of particular interest because it generates two predictions that differ substantially from those deriving from other theories. The first prediction is that both approach and avoidance can give rise to both positive and negative feelings; the second is that positive affect leads to coasting, a reduction in effort regarding the pursued goal. The latter suggests a way in which positive affect is involved in priority management when many goals are in play concurrently. Recent interest in dual process models, which distinguish between top-down guidance of goal pursuit and reflexive responses to cues of the moment, has caused a reexamination of some previous assumptions and consideration of the possibility that behavior emerges in two distinct ways. This line of thought has also recently been applied to conceptualizing diverse types of psychopathology. The chapter closes with brief consideration of how the ideas considered here might be compatible with other viewpoints on motivation.

Exposure to adverse environments during childhood is robustly linked to future aggressive behavior. In this study we tested a model of emotional and neurocognitive mechanisms related to aggressive behavior in the context of childhood adversity. More specifically, we used path analysis to assess the distal contribution of childhood adversity and the more proximal contributions of emotion-related and non-emotion-related forms of impulsivity, and behavioral response inhibition to aggressive behavior. Participants were 180 undergraduates who completed well-validated self-report measures and an emotional version of the Go/No-Go task. The structural equation model was a poor fit for the data (χ2(3) = 23.023, p

In this study, we characterized the genetic/environmental commonality and heterogeneity of impulsivity facets and tested the hypothesis that goal-management is central to their common variance. 764 young-adult twins completed the UPPS-P Impulsive Behavior Scale and measures of goal management, personality, and psychopathology. We found common genetic influences across all impulsivity facets except sensation seeking. These impulsivity genetic influences explained 40.0% of variance in goal-management ability. Other results supported three hypotheses concerning heterogeneity: that sensation seeking is independent of other facets, that urgency is more related to psychopathology than lack of premeditation, and that lack of perseverance is more similar to urgency than lack of premeditation. Thus, impulsivity facets show considerable heterogeneity in addition to common variation related to goal-management abilities.

PURPOSE. To identify demographic and caregiving characteristics associated with caregivers’ unmet needs and to examine associations of caregivers’ unmet needs with their quality of life at 2 and 5 years since their patients’ initial diagnosis. METHODS. Family cancer caregivers completed a prospective longitudinal surveys at 2 (T1) and 5 years (T2) post-diagnosis. Demographic and caregiving characteristics were measured at T1. Unmet needs and quality of life were measured at T1 and T2. RESULTS. Younger and spousal caregivers reported greater unmet needs (B > 2.03, p < .05). Independent of demographic characteristics, caregivers’ perception that providing care to their relative with cancer was overwhelming was consistently associated with unfulfillment of their needs in various domains, concurrently and prospectively (B > 2.50, p < .05), across the long-term survivorship phases. CONCLUSIONS. Findings highlight the contribution of earlier subjective caregiving stress to family caregivers’ needs not being met both currently and years later, which in turn related to poorer quality of life across different family caregivership trajectories. Findings suggest identifying at-risk subgroups of family caregivers based on demographics and assessing caregiving stress as a priority in psycho-oncology research and clinical practices. IMPLICATIONS FOR CANCER SURVIVORS. Family caregivers’ quality of life is affected by cancer survivors’ illness trajectory many years after the initial cancer diagnosis, so are the caregivers’ needs. Cancer survivorship care plan should take careful consideration of the nuanced long-term contributions of caregivers’ unmet needs to their specific aspects of quality of life.

Objective Depression and inflammation may independently promote breast cancer (BCa) disease progression and poorer clinical outcomes. Depression has been associated with increased levels of inflammatory markers in medically healthy individuals and patients with cancer. However, inconsistencies in study time frames complicate interpretation of results within specific cancer types. This study examined relationships between depressive symptoms and inflammation in women with early-stage BCa before beginning adjuvant treatment. Methods Women with Stage 0-III BCa were recruited approximately 4 to 8 weeks after surgery. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression, and blood samples were collected to quantify circulating levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor α (TNF-α) by enzyme-linked immunosorbent assay. Analyses of covariance were used to test for group differences (elevated versus low depressive symptoms) in levels of cytokines. Multiple regression analyses were used to examine relationships between continuous severity of depressive symptoms and levels of cytokines adjusting for relevant biobehavioral covariates. Results Thirty-six (40%) of 89 patients showed elevated levels of depressive symptoms and, in adjusted models, had marginally higher levels of IL-1β (mean [M] = 14.49 [95% confidence interval {CI} = 6.11-32.65] versus M = 4.68 [95% CI = 1.96-9.86] and IL-6 [M = 88.74 {95% CI = 33.28-233.96} versus M = 61.52 {95% CI = 27.44-136.40}]) significantly higher levels of TNF-α (M = 17.07 [95% CI = 8.27-34.32] versus M = 6.94 [95% CI = 3.58-12.80]) than did women with low depressive symptoms. Across the spectrum of depressive symptoms, greater magnitude of depressive symptoms was related to greater levels of IL-1β (β = 0.06, p = .006, R = 0.25) and TNF-α (β = 0.06, p = .003, R = 0.27). Conclusions Postsurgery and preadjuvant treatment for early-stage BCa, depressive symptoms covary with elevated levels of multiple proinflammatory cytokines. Findings have implications for psychosocial and biological interventions concurrently focusing on depression and inflammation. Trial registration NCT01422551.

Recent evidence suggests that anger and aggression are of concern even during remission for persons with bipolar I disorder, although there is substantial variability in the degree of anger and aggression across individuals. Little research is available to examine psychological models of anger and aggression for those with remitted bipolar disorder, and that was the goal of this study. Participants were 58 persons diagnosed with bipolar I disorder using the Structured Clinical Interview for DSM-IV, who were followed with monthly symptom severity interviews until they achieved remission, and then assessed using the Aggression-Short Form. We examined traditional predictors of clinical parameters and trauma exposure, and then considered three trait domains that have been shown to be elevated in bipolar disorder and have also been linked to aggression outside of bipolar disorder: emotion-relevant impulsivity, approach motivation, and dominance-related constructs. Emotion-relevant impulsivity was related to anger, hostility, verbal aggression, and physical aggression, even after controlling for clinical variables. Findings extend the importance of emotion-relevant impulsivity to another important clinical outcome and suggest the promise of using psychological models to understand the factors driving aggression and anger problems that persist into remission among persons with bipolar disorder.

Genetic polymorphisms relevant to behavioral approach and behavioral inhibition are examined, using a polygenic approach while also considering the role of early adversity. Undergraduates (N = 343) completed the well-validated Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales and provided blood for genotyping. The BDNF met allele was related to higher BIS scores. OPRM1 status interacted with a measure of early adversity to predict the BAS Reward Responsiveness subscale. Results provide additional support for the validity of the BIS/BAS scales, and suggest combined genetic and environmental influences on the development of these traits.

Trait-like tendencies to respond impulsively to emotion, labelled emotion-related impulsivity, are robustly related to aggression. We developed and tested an online intervention to address emotion-related impulsivity and aggression. The 6-session intervention focused on behavioral techniques shown to decrease arousal and aggression, supplemented with implementation intentions and smartphone prompts to facilitate skills transfer into daily life. First, we piloted the intervention in-person with 4 people. Then, 235 participants were randomly assigned to take the online intervention immediately or after a wait-list period; those in the waitlist were then invited to take part in the intervention. Participants completed the self-rated Feelings Trigger Action Scale to assess emotion-related impulsivity, the interview-based Modified Overt Aggression Scale and the self-rated Buss Perry Aggression Questionnaire. Participants who took part in the treatment completed daily anger logs. Attrition, as with other online programs, was high; however, treatment completers reported high satisfaction, and outcomes changed more rapidly during treatment than waitlist across all key outcome indices. In analyses including all participants who took part in the treatment (immediate or delayed), we observed moderate-to-large treatment gains, which were maintained as of the 3-month follow-up assessment. This work supports the usefulness of an intervention for addressing emotion-related impulsivity and aggression.

Dispositional optimism is the generalized, relatively stable tendency to expect good outcomes across important life domains. This article provides a representative review of 30 years of research on dispositional optimism and physical well-being. Assessment of optimism is described, along with data regarding its stability. A review of the research linking optimism and physical health is then presented. Included in the review are initial studies suggesting that optimism and physical well-being might be linked as well as more recent, larger scale epidemiological studies that make the point more emphatically. Also considered are potential pathways-behavioral, biological, and social-that might explain these associations. The article concludes with a brief look to the future, describing several issues and questions that still need to be answered. These questions include the relationship of optimism and pessimism to each other (and the implications of that relationship for physical well-being), the origins of optimism and pessimism, and interventions that might be implemented to reduce the negative impact of a pessimistic outlook. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

BackgroundAlthough spirituality has been identified as a psychological resource relevant to coping with caregiving stress, little is known about the differential roles of spirituality’s facets in bereaved caregivers’ adjustment.PurposeThis study examined this question with regard to bereavement-specific and general distress in cancer caregivers.MethodsCancer caregivers provided data at 2 years after their relative’s diagnosis when all the patients were alive (Time 1, preloss) and 3 years later, after the patient had died (Time 2, postloss: N = 128). Demographics and three facets of spirituality (meaning, peace, and faith) were measured at Time 1. Psychological distress and time since the death were measured at Time 2.ResultsYounger age, less education, and being a spousal caregiver of the patient related to greater bereavement-specific and general distress (ts ≥ 2.02, ps < .05, partial η2 ≥ .15). Above and beyond these demographic factors, two preloss spirituality facets related to postloss distress. Specifically, a greater sense of inner peace at preloss was prospectively associated with less bereavement-specific distress (both intrusive thoughts and hyperarousal, ts ≥ 2.24, ps < .05, partial η2 ≥ .41). Greater reliance on faith at preloss was also prospectively associated with lower intrusive thoughts (t = 2.24, p < .05, partial η2 = .34).ConclusionFindings highlight the importance of preloss sense of peace as a predictor of psychological distress during bereavement. Programs and interventions might be designed to help caregivers find inner peace while caregiving, in an effort to augment their resiliency against psychological distress when facing the loss of the patient.

This chapter focuses on emotion-related impulsivity and its relation to mood disorders. We begin with a brief overview of emotion-related impulsivity, in which we discuss theory and measure development. We then review a growing literature on the relevance of emotion-related impulsivity to depression, suicidality, and bipolar disorder. With the mounting evidence that this form of impulsivity is particularly important for understanding these syndromes, we consider newer research on possible mechanisms. We end by considering future directions.

Stressed caregivers are known to have poorer quality of life (mental and physical health) during the caregiving period. Unknown are prospective longitudinal associations of early caregiving stress with quality of life years later, biological pathways of the associations, and ethnic differences in the associations. Family caregivers (n = 64, 49-years-old, 70% female, 56% Hispanic) of colorectal cancer patients provided data around the time of relative’s diagnosis (T1) and one year later (T2), including self-reported caregiving stress at T1, mental and physical health at T2, and saliva samples at T1 where cortisol and DHEA-S were assayed. Caregivers reported moderate levels of caregiving stress, and mental and physical health at 50th percentile and comparable levels of the US norms, respectively. SEM revealed that controlling for age and ethnicity, greater caregiving stress and lower waking cortisol related to poorer mental health at T2 (betas > ∣.22∣, ps .05), and higher waking DHEA-S related to better physical health at T2 (beta=.49, p = .05). When Hispanics vs non–Hispanics are compared, greater caregiving stress related to lower waking DHEA-S and smaller DHEA-S AUG (marginally) among Hispanics, whereas caregiving stress related to higher waking DHEA-S and larger DHEA-S AUG among non–Hispanics (betas > ∣.23∣, ps .08). Findings suggest need for further investigation of biological pathways and more nuanced sociocultural factors that link caregiving stress to longer-term quality of life outcomes differentially by Hispanics vs non–Hispanics with larger samples.

Background A substantial number of family caregivers go through bereavement because of cancer, but little is known about the bereaved caregivers' long-term adjustment. This study aimed to document levels of bereavement outcomes (prolonged grief symptoms, intense emotional reaction to the loss, depressive symptoms, and life satisfaction) among family cancer caregivers 3–5 years post-loss and to investigate how self-rated preparedness for the patient's death predicted those bereavement outcomes. Methods Family members participated in a nationwide survey for cancer caregivers 2 years after the relative's diagnosis (T1). Of those, 109 were identified as bereaved by 5 years post-diagnosis (T2). Of those, 88 continued to participate at 8-year follow-up (T3) and provided valid data for the study variables. Caregivers' distress risk factors were measured at T1, satisfaction with palliative care and preparedness for the death of the patient at T2, and time since death of the patient at T2 or T3. Results Substantial numbers of family members (18% to 48%) displayed heightened levels of bereavement-related psychological distress years after the loss. Hierarchical general linear modeling revealed that perceived preparedness for the death of the patient concurrently and prospectively predicted better adjustment to bereavement, independent of contributions of other factors studied. Conclusions Findings underscore the high prevalence of long-lasting bereavement-related distress among family cancer caregivers and the role of preparedness for the relative's death in the level of that distress. Findings suggest that psychosocial programs among caregivers focus on not only caregiving skills per se but also preparedness for the death of the patient. Copyright © 2015 John Wiley & Sons, Ltd.