Joshua M. Smyth

Written emotional expression: effect sizes, outcome types, and moderating variables.

A research synthesis was conducted to examine the relationship between a written emotional expression task and subsequent health. This writing task was found to lead to significantly improved health outcomes in healthy participants. Health was enhanced in 4 outcome types--reported physical health, psychological well-being, physiological functioning, and general functioning--but health behaviors were not influenced. Writing also increased immediate (pre- to postwriting) distress, which was unrelated to health outcomes. The relation between written emotional expression and health was moderated by a number of variables, including the use of college students as participants, gender, duration of the manipulation, publication status of the study, and specific writing content instructions.

Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments.

PURPOSE Psychosocial and health behaviour treatments and therapies can be extended beyond traditional research or clinical settings by using mobile technology to deliver interventions to individuals as they go about their daily lives. These ecological momentary interventions (EMIs) are treatments that are provided to people during their everyday lives (i.e. in real time) and in natural settings (i.e. real world). The goal of the present review is to synthesize and critique mobile technology-based EMI aimed at improving health behaviours and psychological and physical symptoms. METHODS Twenty-seven interventions using palmtop computers or mobile phones to deliver ambulatory treatment for smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol use, and healthy eating and physical activity were identified. RESULTS There is evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for treating a variety of health behaviours and physical and psychological symptoms. Limitations of the existing literature were identified and recommendations and considerations for research design, sample characteristics, measurement, statistical analyses, and clinical implementation are discussed. CONCLUSIONS Mobile technology-based EMI can be effectively implemented as interventions for a variety of health behaviours and psychological and physical symptoms. Future research should integrate the assessment and intervention capabilities of mobile technology to create dynamically and individually tailored EMI that are ecologically sensitive.

STRESSORS AND MOOD MEASURED ON A MOMENTARY BASIS ARE ASSOCIATED WITH SALIVARY CORTISOL SECRETION

Effects of past, current, and anticipated naturalistic daily stressors and of affect on salivary cortisol levels were examined. Participants (120) reported on stressors and affect 6 x /day in response to a preprogrammed wristwatch. Twenty min after each assessment they took a sample of saliva for cortisol analysis. Both the experience of a current stressor and anticipating a stressor were associated with increased salivary cortisol levels. Average increases in cortisol were relatively low, but inter-individual variability in this response existed. Stressors also were associated with lower positive affect and higher negative affect. Negative affect was associated with higher cortisol levels and positive affect was associated with lower cortisol levels. Daily stressors were not significant predictors of cortisol secretion when affect was controlled. Momentary assessment of daily stressors and of salivary cortisol proved to be a useful tool for examining psychoendocrinological processes in the natural environment.

Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment.

The relation of mood and stress to binge eating and vomiting in the natural environments of patients with bulimia nervosa (BN) was examined using real-time data collection. Women (n = 131; mean age = 25.3 years) with BN carried a palmtop computer for 2 weeks and completed ratings of positive affect (PA), negative affect (NA), anger/hostility (AH), and stress (STRS); they also indicated binge or vomit episodes (BN-events) 6 times each day. Mixed models were used to compare mood and STRS between and within days when BN-events occurred. Between-days analyses indicated that binge and vomit days both showed less PA, higher NA, higher AH, and greater STRS than days with no BN-events. Within-day, decreasing PA, and increasing NA and AH, reliably preceded BN-events. Conversely, PA increased, and NA and AH decreased following BN-events. Demonstration of the temporal sequencing of affect, STRS, and BN-events with a large BN sample may help advance theory and clinical practice, and supports the view that binge and purge events hold negatively reinforcing properties for women with BN.

INDIVIDUAL DIFFERENCES IN THE DIURNAL CYCLE OF CORTISOL

This study investigated individual differences in the diurnal cycle of cortisol and explored their relation to several psychosocial variables and to upper-respiratory symptoms. Cortisol and daily experience were assessed for 2 days in 109 healthy employed and unemployed community residents (mean age = 36.4 +/- 12.1, 69% female); self-report upper respiratory illness (URI) symptoms were assessed for an additional 10 days. Fifty-six (51%) participants showed typical declines in cortisol during both days, 19 (17%) showed no significant diurnal pattern on both days, and 34 (31%) showed different diurnal patterns on the 2 days. Individuals with no cycles did not differ from those with normal or inconsistent cycles on demographic factors, baseline psychological measures, health behaviors, or daily experiences over the two assessment days. Individuals without cortisol cycles, however, reported fewer URI symptoms than the remaining subjects. That 17% of our sample did not exhibit diurnal cycles of cortisol was surprising, given established views of normal endocrine function. Although average daily level of cortisol is related to a number of psychosocial and psychiatric factors (e.g. stress and depression), pattern of diurnal cycle was not related to any demographic or psychosocial measures in this study. The finding that flat cycles were related to fewer reports of URI symptoms suggests that perturbations in cycle may be related to processes associated with symptom susceptibility or symptom expression.

Ecological Momentary Assessment Research in Behavioral medicine

Behavioral medicine research often seeks to examine relatively complex theoretical models and clinical processes. Traditional designs, based on retrospective self-report in the natural environment or laboratory-based studies, cannot assess complex and temporally dynamic psychological, behavioral, and physiological processes in the natural environment. An alternate research approach, Ecological Momentary Assessment (EMA), provides a method to collect such data. This research approach and these data allow investigation of a number of research questions not amenable to other data collection methods. Examples of research questions uniquely suited for EMA data include, but are not limited to: (1) the comparison of retrospective data to momentary data; (2) evaluation of physiological and psychosocial processes in the natural environment; (3) the relation of symptoms and other disease processes to characteristics of the natural environment; and (4) examination of dynamic changes in psychosocial variables that may mediate improvement following treatment. Despite the strengths of EMA data, a number of challenges exist – including logistic, analytic, and interpretation problems – to the easy implementation of EMA approaches in behavioral medicine.

Anger toward God: social-cognitive predictors, prevalence, and links with adjustment to bereavement and cancer.

Many people see themselves as being in a relationship with God and see this bond as comforting. Yet, perceived relationships with God also carry the potential for experiencing anger toward God, as shown here in studies with the U.S. population (Study 1), undergraduates (Studies 2 and 3), bereaved individuals (Study 4), and cancer survivors (Study 5). These studies addressed 3 fundamental issues regarding anger toward God: perceptions and attributions that predict anger toward God, its prevalence, and its associations with adjustment. Social-cognitive predictors of anger toward God paralleled predictors of interpersonal anger and included holding God responsible for severe harm, attributions of cruelty, difficulty finding meaning, and seeing oneself as a victim. Anger toward God was frequently reported in response to negative events, although positive feelings predominated. Anger and positive feelings toward God showed moderate negative associations. Religiosity and age correlated negatively with anger toward God. Reports of anger toward God were slightly lower among Protestants and African Americans in comparison with other groups (Study 1). Some atheists and agnostics reported anger involving God, particularly on measures emphasizing past experiences (Study 2) and images of a hypothetical God (Study 3). Anger toward God was associated with poorer adjustment to bereavement (Study 4) and cancer (Study 5), particularly when anger remained unresolved over a 1-year period (Study 5). Taken together, these studies suggest that anger toward God is an important dimension of religious and spiritual experience, one that is measurable, widespread, and related to adjustment across various contexts and populations.

Reported Exposure and Emotional Reactivity to Daily Stressors: The Roles of Adult-Age and Global Perceived Stress

A central goal of daily stress research is to identify resilience and vulnerability factors associated with exposure and reactivity to daily stressors. The present study examined how age differences and global perceptions of stress relate to exposure and emotional reactivity to daily stressors. Sixty-seven younger (M age = 20) and 116 older (M age = 80) adults completed a daily stress diary and measures of positive and negative affect on 6 days over a 14-day period. Participants also completed a measure of global perceived stress. Results revealed that reported exposure to daily stressors is reduced in old age but that emotional reactivity to daily stressors did not differ between younger and older adults. Global perceived stress was associated with greater reported exposure to daily stressors in older adults and greater stress-related increases in negative affect in younger adults. Furthermore, across days on which daily stressors were reported, intraindividual variability in the number and severity of stressors reported was associated with increased negative affect, but only among younger adults.

Intraindividual coupling of daily stress and cognition.

Most psychological theories predict associations among processes that transpire within individuals. However, these theories are often tested by examining relationships at the between-persons (BP) rather than the within-persons (WP) level. The authors examined the WP and BP relationships between daily stress and daily variability in cognitive performance. Daily stress and cognitive performance were assessed on 6 occasions in 108 older adults and 68 young adults. WP variability in stress predicted WP variability in response times (RTs) on a 2-back working memory task in both younger and older adults. That is, RTs were slower on high-stress days compared with low-stress days. There was evidence of an amplified WP stress effect in the older adults on a serial attention task. There was no evidence of stress effects on simple versions of these tasks that placed minimal demands on working memory. These results are consistent with theories that postulate that stress-related cognitive interference competes for attentional resources.

An Evaluation of Affect and Binge Eating

The affect regulation model of binge eating suggests that binge eating occurs because it provides momentary relief from negative affect. The purpose of this study was to evaluate change in affect during binge eating to evaluate the merits of this model. Participants were young adult women from a midwestern university. Binge eaters recorded their level of pleasantness using the affect grid at 2-minute intervals before, during, and after binge eating episodes and regular meals. Controls recorded in a similar manner during meals. The results showed a different pattern of affect for binge eaters during binge eating episodes and normal meals and for binge eaters and controls at normal meals. The results support the affect regulation model of binge eating and suggest that binge eating is negatively reinforced because it produces momentary relief from negative affect.