As the U.S. population ages the number of family caregivers is expected to rise. Family caregivers are a valuable source of informal healthcare services for patients and the public, in terms of reducing healthcare costs. However, research suggests family caregiving is not only financially costly for individuals, but associated with a number of medical and mental health risks, with spouses at higher risk for negative outcomes compared to other family members. Traditional evidence-based therapies for stress in family caregivers have been shown to be minimally efficacious with spouses. No therapies take into account the existential nature of spouse caregiver stress, including the potential nonconscious role of loss of life meaning/purpose and death anxiety. This study of multiple baseline design preliminarily explored the effects of a novel 8-week Terror Management Theory integrated existential psychotherapy (TIE) on stress and nonconscious mechanisms believed to function as buffers for existential anxiety, in five women with spouses receiving cancer treatment. Methods included ecological momentary assessment (EMA) of anxiety and self-esteem states via text message sent three times daily – and intermittent assessment of death anxiety, self-compassion, meaning in life, and quality of life at baseline, intervention, immediate post, and 1-month follow-up. Visual and statistical analyses indicated significant between-phase trend changes in anxiety and self-esteem within participants, although direction of changes varied across participants. Additionally, changes in death anxiety, self-compassion, meaning in life, and quality of life between phases varied across participants in directions inconsistent with intervention aims and participants’ subjective impressions of intervention-related changes. Mixed findings point to the complexity of spouse caregiver psychology and highlight the need for more effective therapies with this population. Results may also guide future research and development of existentially-informed therapies.

abstract: Research provides increasing support of self-worth, non-physical motives, and body image for predicting physical activity in women. However, no empirical tests of these associations have been conducted. Ecological momentary assessment (EMA) has been recognized as useful for understanding correlates of physical activity. This study tested the feasibility of a novel EMA protocol and explored temporal relationships between daily self-worth and physical activity in middle-aged women. Women aged 35-64 years (N=63; M age=49.2±8.2 years) received text message prompts to an Internet-based mobile survey three times daily for 28 days. The survey assessed momentary activity, self-worth (knowledge, emotional, social, physical, general), and self-efficacy. Women concurrently wore an accelerometer on their non-dominant wrist. Feasibility was assessed via accelerometer wear-time estimates, survey completion rates, and participant feedback. Multilevel models examined the predictive influence of self-worth on daily activity counts. Self-efficacy was also tested due to known relationships with self-worth and physical activity in women. Wear time was high (952.92 ± 100.99 min per day), with only 141 observations lost to non-wear. However, 449 were lost to accelerometer malfunction. Women completed 80.8% of surveys. After excluding missing physical activity data, 67.5% of observations (N=3573) were analyzed. Although women thought the survey was easy to complete, perceptions of the accelerometer were mixed. Approximately 34% of the variance in daily counts was within individuals (ICC=0.66). Average self-efficacy (&#946;=0.005, p=0.009), daily fluctuations in self-efficacy (&#946;=0.001, p<0.001), and daily fluctuations in general self-worth (&#946;=0.04, p=0.003) predicted daily activity. There were significant individual differences in relationships between daily fluctuations in emotional (&#946;=0.006, p=0.02) and general self-worth (&#946;=0.005, p=0.02) and daily activity. The use of text message prompts and an Internet-based mobile survey was feasible for conducting EMA in middle-aged women. Research identifying optimal methods of behavior monitoring in longitudinal studies is needed. Results provide support for small but significant associations among daily fluctuations in self-efficacy and general self-worth and daily activity in middle-aged women. The impact of emotional self-worth may differ across women. Further research examining the transient natures of self-efficacy and general self-worth, improving self-worth scales, and testing momentary strategies to increase women's self-worth and physical activity is warranted. / Dissertation/Thesis / Doctoral Dissertation Exercise and Wellness 2014

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<p>Social dysfunction is a hallmark of schizophrenia and leads to significant disability and distress. Decreased positive and increased negative affect predict poorer social functioning in those with schizophrenia. Social functioning and affect have traditionally been measured in the laboratory; yet, these methods are limited. Experience sampling methods (ESM) offer more immediate, ecologically valid assessments of these constructs. The purpose of this study was to examine social functioning and affect in schizophrenia using a novel form of ESM that passively collects audio data. The two primary hypotheses were: 1) clinical status (schizophrenia versus control) will predict social functioning, level of positive affect, and level of negative affect; and 2) the relationship between clinical status and affect will be moderated by context (social versus non-social). Additional exploratory aims tested the convergent validity between traditional, laboratory-based assessments of social functioning and this novel ESM. Data was collected from 38 people with schizophrenia and 36 control participants; Results partially supported the hypotheses. As expected, laboratory measures of social functioning revealed that those with schizophrenia performed worse than controls. ESM measures of social functioning found that the schizophrenia group interacted with others at the same rate as the control group but did not exhibit as much social engagement. ESM measures of affect revealed the schizophrenia group reported more negative affect than controls, but no differences in positive affect were found. Social context did not moderate the relationship between clinical status and affect. Lastly, correlations between laboratory measures and ESM measures of social functioning were significant for the schizophrenia group but not the control group. Results further our understanding of social functioning and affect in those with schizophrenia and yield important implications for future work.</p>

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Background: Few studies have focused on the contextual influences that impact negative affect (NA) and risk for mood disorders in young adults. Research using ecological momentary assessment (EMA) methods has shown that neurotypical adults with elevated social anxiety may be more sensitive to their social environment. To date, little is known about how types of social interactions impact autistic adults, who may show varying levels of social anxiety and social motivation. Aim: Our goal was to examine the heterogeneity in daily social experiences for autistic and socially anxious adults. Method: Using EMA surveys, we tracked daily self-reported face-to-face interactions and examined how these interactions influenced daily affect. We likewise examined how social anxiety (using the Liebowitz Social Anxiety Scale) and autism traits (using the Autism Spectrum Quotient) influenced day-to-day social experiences while controlling for potential covariates (age and biological sex). Participants consisted of 88 young adults who participated in a mental health longitudinal study. We used a multilevel model approach (MLM) to examine predictors of NA. Results: MLM analysis showed that a model with face-to-face interactions and social anxiety predictors best explained outcomes in NA. AQ scores, age, and sex covariates did not improve model fit. Social anxiety was a significant negative predictor of NA after controlling for face-to-face interaction. Conclusion: These findings highlight that autism traits do not predict NA after controlling for social anxiety, and that social anxiety interventions may improve overall moods by addressing types of interactions.

Suicide continues to be a critical concern for society as one of the leading causes of death in the United States, increasing from 10.4 to 13.5 per 100,000 from 2000 to 2016. This risk is further increased up to 8 times for individuals with Autism Spectrum Disorder. Suicidal thoughts and behaviors have been difficult to predict on a moment-by-moment basis, in part due to technological challenges. Suicidal ideation has been identified as an important indicator of suicidal behavior and an important measurement for predicting suicide in both neurotypical individuals and individuals with autism spectrum disorder. In particular, sleep disturbances are one risk factor for suicidal behavior. Important aims of this study include identifying personalized predictors of leading up to suicidal ideation, including how sleep activity patterns affect suicidal ideation, and how these risk factors differ between those with autism spectrum, socially anxious groups. This will give further insight into predictors of suicidal ideation, providing a better understanding for predicting changes in suicidal ideation, with aims to bring more clarity in this at-risk population and improve treatment options. To observe predictors of both long-term and short-term changes in suicidal ideation, I will analyze longitudinal data. The data includes daily phone questionnaires and actigraphy data tracking using GENEActiv wearable devices that includes sleep from individuals with autism spectrum and social anxiety with a history of suicidal ideation, and neurotypical individuals who are tracked over 24-36 weeks. Results of analysis indicate that sleep duration is not a significant predictor of suicidal ideation intensity, and that there is no difference between the autism spectrum and social anxiety groups in the predictive ability of sleep. Limitations of this study include local convenience sampling which includes a large majority of white participants, part of the study and data collected occurring during the COVID-19 pandemic, and potential response bias for such a sensitive topic. This study shows overall that there is a working model for this type of analysis, however many more features of sleep including movement during sleep and waking during sleep need to be analyzed to see if there is any predictive power in information from actigraphy, which would be a low invasive method for detecting increases in suicidal ideation risk.

Studies suggest that sleep disturbance may be an important etiological factor in the development of comorbid anxiety and depressive disorders, whereby anxiety leads to sleep difficulties, which in turn increase the vulnerability for depression. The primary aim of this study was to determine whether the sequential comorbidity patterns observed at the disorder level (i.e., where anxiety disorders most often precede insomnia, and insomnia most often precedes depression) were also present in daily fluctuations of symptoms. The secondary aim was to explore possible moderators of any observed temporal associations. Participants were 15 patients with generalized anxiety disorder (GAD; mean age = 28.9 years, SD = 9.8) and 15 good sleeper controls (mean age = 27.1 years, SD = 8.3) who were comparable in female:male ratio (73% female vs. 67% female). For 14 days, participants wore an actigraph to objectively assess sleep quality (sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency) and completed daily symptom ratings multiple times each day using their smartphones to assess symptoms of anxiety, depressed mood, and subjective sleep quality. Study aims were assessed using multilevel modeling, with daily symptoms nested within individuals. Many of the analyses were lagged such that the time-varying predictor variable preceded the time-varying outcome variable temporally. Consistent with hypotheses, results demonstrated that anxious mood was predictive of later subjective and objective sleep disturbance in individuals with GAD, and this effect was strongest among individuals with higher levels of neuroticism, negative affect, and dysfunctional beliefs about sleep. Anxious mood was not associated with later subsequent sleep disturbance in healthy controls. In the GAD group, subjective and objective sleep disturbance predicted later depressed mood; this effect was moderated by temperament and dysfunctional beliefs about sleep. For the control group, the effect of subjective sleep disturbance on later depressed mood was moderated by neuroticism and the effect of objective sleep disturbance was moderated by dysfunctional beliefs about sleep, suggesting that sleep disturbance may increase vulnerability for depressed mood even in healthy individuals. These results suggest that explicitly targeting sleep disturbance during the treatment of GAD may attenuate the experience of depressive symptoms.

Nonsuicidal self-injury (NSSI; i.e., the deliberate destruction of one’s own bodily tissue without suicidal intent and for reasons not socially sanctioned) is prevalent and associated with clinically serious consequences. There is a need for evidence-based, stand-alone treatments for this behavior as it presents across the full range of psychiatric disorders. Developing time-efficient and cost-effective interventions for NSSI has proven difficult given that the core components of treatment remain largely unknown. The aim of this study was to examine the specific effects on NSSI of mindful emotion awareness training and cognitive reappraisal, two transdiagnostic treatment strategies that directly address the functional processes that often maintain self-injury (i.e., relief or escape from aversive thoughts or feelings). Using a counterbalanced, combined series (multiple baseline and phase change) single-case experimental design, the unique and combined impact of these two four-week interventions was evaluated among diagnostically heterogeneous, self-injuring adults (N = 10; mean age = 21.3, range = 18 to 30 years). Hypotheses were that each intervention would produce clinically meaningful reductions in NSSI; adding the alternative intervention would have additive benefit for those who did not respond to the initial intervention alone; and reductions in NSSI would be maintained over a four-week follow-up phase. Results showed that 8 of 10 participants demonstrated clinically meaningful reductions in NSSI by the follow-up phase; six participants responded to one intervention alone, whereas adding the alternative intervention was associated with additive benefit for two participants. Group-based analyses indicated a statistically significant effect of study phase on NSSI (p < .001), with fewer NSSI urges and acts occurring after the interventions were introduced. The interventions were also associated with moderate to large reductions in anxiety (d = 0.89 – 1.09), depression (d = 0.79 – 1.09), and interference caused by symptoms (d = 0.61), and with improvements in skills-based mechanisms: mindful emotion awareness (d = 1.44) and reappraisal (d = 1.30). The results suggest that increasing mindful emotion awareness and cognitive reappraisal may be two key therapeutic strategies for reducing NSSI. Transdiagnostic, emotion-focused interventions delivered in time-limited formats can serve as practical yet powerful treatment approaches, especially for lower-risk self-injuring individuals.