abstract: Experiencing poor, unrefreshing sleep is a common occurrence for individuals with chronic pain. Sleep disturbance predicts not only greater pain and disability, but also heightened negative affect and reduced positive affect in individuals with chronic pain. Such fluctuations in affect have been linked with more negative and fewer positive social events. For those with chronic pain, negative social relations can exacerbate pain, whereas positive social interactions can help decrease disability. Thus, exploring the sleep‒social functioning process in chronic pain may be one way to improve daily functioning and quality of life. The current study examined positive and negative affect as two parallel mediators of the within-day relations between sleep quality and positive and negative social events in individuals with chronic pain. For 21 days, electronic daily diary reports were collected from 220 individuals with fibromyalgia, a condition characterized by widespread chronic pain. Within-person relations among reports of last night’s sleep quality, afternoon affects and pain, and evening social events were estimated via multilevel structural equation modeling. Findings showed that positive affect mediated both the sleep quality‒positive social events and sleep quality‒negative social events relations. That is, greater than usual sleep disturbance last night predicted afternoon reports of lower than usual positive affect. Low positive affect, in turn, predicted evening reports of fewer than usual positive social events and more than usual negative social events that day, controlling for the effects of afternoon pain. In addition, negative affect mediated the sleep quality‒negative social events link. That is, greater than usual sleep disturbance last night predicted afternoon reports of higher than usual negative affect, which, in turn, predicted evening reports of more than usual negative social events that day, controlling for the effects of afternoon pain. Of the three significant mediated paths, the sleep quality‒positive affect‒positive social events path was the strongest in magnitude. Thus, a night of poor sleep can have an impact on social events the next day in those with chronic pain by dysregulating affect. Further, findings highlight the key role of positive affect in the sleep‒social functioning process and potential socio-affective benefits of sleep interventions in chronic pain. / Dissertation/Thesis / Doctoral Dissertation Psychology 2019

Indiana University-Purdue University Indianapolis (IUPUI) / Objective: Social functioning encompasses interactions with people across situations of varying complexity. Given the frequency of observed social impairments in individuals with schizophrenia, there is a need to identify mechanisms that influence social functioning impairments. One proposed mechanism is metacognition, a mental process that enables the integration and interpretation of mental states and experiences. Impaired metacognition can inhibit one’s ability to engage and navigate through our social world. In individuals with schizophrenia, both social functioning and metacognitive deficits are profound. This study examined three hypotheses. Following Metacognitive Reflection and Insight Therapy (MERIT), (1) individuals will show improvements in social functioning; (2) individuals will show improvements in metacognitive abilities; and (3) improvements in social functioning will be associated with improved metacognitive abilities. Method: Using secondary data from a MERIT therapy feasibility study, data collected from the active condition groups (e.g., individuals with schizophrenia, n =16) at pre-and post-assessment were analyzed using paired samples t-tests for primary outcomes and hierarchical linear regressions to assess metacognition as an underlying mechanism of change. Results: Paired samples t-tests found no significant improvement in social functioning or metacognition. In contrast to the hypothesis, metacognitive abilities significantly declined. When subscales were examined, two subscales (self-reflectivity and awareness of others) significantly decreased. The post-hoc analysis found significant improvements in overall symptoms and disorganization. Lastly, metacognition did not significantly predict post-intervention social functioning. Conclusions: Measurement modality and the length of intervention may help explain the null findings observed in this study. The improvement in overall and disorganized symptoms could indicate that symptom reductions precede social functioning and metacognition changes. Given that the results from this trial were not aligned with previous studies, further research is needed to determine the effectiveness of MERIT on social functioning and metacognition in schizophrenia.

Indiana University-Purdue University Indianapolis (IUPUI) / 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.

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