Sandy J. Lwi

Poor caregiver mental health predicts mortality of patients with neurodegenerative disease

Significance In this study, we investigated the role that caregiver mental health plays in patient mortality. In 176 patient–caregiver dyads, we found that worse caregiver mental health predicted greater patient mortality even when accounting for key risk factors in patients (i.e., diagnosis, age, sex, dementia severity, and patient mental health). Thus, although providing the best possible care for the large and growing number of individuals with neurodegenerative disease is an important public health priority, our findings suggest that these efforts should also consider caregiver mental health as an important intervention target. These findings represent research at the intersection of psychology, neuroscience, and medical science, and highlight the importance of caring for caregivers as well as patients when attempting to improve patients’ lives. Dementia and other neurodegenerative diseases cause profound declines in functioning; thus, many patients require caregivers for assistance with daily living. Patients differ greatly in how long they live after disease onset, with the nature and severity of the disease playing an important role. Caregiving can also be extremely stressful, and many caregivers experience declines in mental health. In this study, we investigated the role that caregiver mental health plays in patient mortality. In 176 patient–caregiver dyads, we found that worse caregiver mental health predicted greater patient mortality even when accounting for key risk factors in patients (i.e., diagnosis, age, sex, dementia severity, and patient mental health). These findings highlight the importance of caring for caregivers as well as patients when attempting to improve patients’ lives.

Short alleles, bigger smiles? The effect of 5-HTTLPR on positive emotional expressions.

The present research examined the effect of the 5-HTTLPR polymorphism in the serotonin transporter gene on objectively coded positive emotional expressions (i.e., laughing and smiling behavior objectively coded using the Facial Action Coding System). Three studies with independent samples of participants were conducted. Study 1 examined young adults watching still cartoons. Study 2 examined young, middle-aged, and older adults watching a thematically ambiguous yet subtly amusing film clip. Study 3 examined middle-aged and older spouses discussing an area of marital conflict (that typically produces both positive and negative emotion). Aggregating data across studies, results showed that the short allele of 5-HTTLPR predicted heightened positive emotional expressions. Results remained stable when controlling for age, gender, ethnicity, and depressive symptoms. These findings are consistent with the notion that the short allele of 5-HTTLPR functions as an emotion amplifier, which may confer heightened susceptibility to environmental conditions.

An Assessment of Emotional Reactivity to Frustration of Goal Pursuit in Euthymic Bipolar I Disorder

Affective disturbance is a central feature of bipolar disorder. Many investigators have hypothesized that euthymic people with bipolar disorder might display elevated emotional reactivity, but laboratory studies of emotional reactivity have had mixed results. Drawing on theories of bipolar disorder that emphasize dysregulation of goal pursuit, we hypothesized that people with bipolar disorder might be emotionally hyperreactive to frustration of goal pursuit. Forty-seven euthymic participants with bipolar disorder and 43 control participants played a computer game for a monetary reward. To induce frustration, we programmed the game to respond inconsistently to user input during two periods. The frustration induction was successful as measured by self-report, physiological responding, and facial behavior, but contrary to the hypothesis of emotional hyperreactivity in bipolar disorder, the bipolar and control groups were equally reactive to frustration. Future studies will benefit from more specific hypotheses about how emotion might be altered in bipolar disorder.

Positive Urgency and Emotional Reactivity: Evidence for Altered Responding to Positive Stimuli.

Positive urgency, defined as a tendency to become impulsive during positive affective states, has gained support as a form of impulsivity that is particularly important for understanding psychopathology. Despite this, little is known about the emotional mechanisms and correlates of this form of impulsivity. We hypothesized that positive urgency would be related to greater emotional reactivity in response to a positive film clip. Seventy-five undergraduates watched a positive film clip, and a multimodal assessment of emotion was conducted, including subjective emotional experience, physiological activation (i.e., heart rate, respiratory sinus arrhythmia, skin conductance), and facial emotional behavior (i.e., objectively coded using the Facial Action Coding System). Positive urgency was not significantly related to greater positive emotional reactivity but rather a more complex array of emotions expressed in facial behavior, as indexed by similar levels of positive yet greater levels of negative behavior. These findings show that positive urgency may be linked to altered emotionality, but does not appear related to heightened positive emotional reactivity. Potential implications for functional outcomes are discussed.

Increased subjective experience of non-target emotions in patients with frontotemporal dementia and Alzheimer’s disease

Although laboratory procedures are designed to produce specific emotions, participants often experience mixed emotions (i.e., target and non-target emotions). We examined non-target emotions in patients with frontotemporal dementia (FTD), Alzheimers disease (AD), other neurodegenerative diseases, and healthy controls. Participants watched film clips designed to produce three target emotions. Subjective experience of non-target emotions was assessed and emotional facial expressions were coded. Compared to patients with other neurodegenerative diseases and healthy controls, FTD patients reported more positive and negative non-target emotions, whereas AD patients reported more positive non-target emotions. There were no group differences in facial expressions of non-target emotions. We interpret these findings as reflecting deficits in processing interoceptive and contextual information resulting from neurodegeneration in brain regions critical for creating subjective emotional experience.

The cost of believing emotions are uncontrollable: Youths’ beliefs about emotion predict emotion regulation and depressive symptoms

As humans, we have a unique capacity to reflect on our experiences, including emotions. Over time, we develop beliefs about the nature of emotions, and these beliefs are consequential, guiding how we respond to emotions and how we feel as a consequence. One fundamental belief concerns the controllability of emotions: Believing emotions are uncontrollable (entity beliefs) should reduce the likelihood of trying to control emotional experiences using effective regulation strategies like reappraisal; this, in turn, could negatively affect core indices of psychological health, including depressive symptoms. This model holds particular relevance during youth, when emotion-related beliefs first develop and stabilize and when maladaptive beliefs could contribute to emerging risk for depression. In the present investigation, a pilot diary study (N = 223, aged 21–60) demonstrated that entity beliefs were associated with using reappraisal less in everyday life, even when controlling for possible confounds (i.e., self-efficacy, pessimism, stress exposure, stress reactivity). Then, two studies examined whether entity beliefs and associated impairments in reappraisal may set youths on a maladaptive trajectory: In a cross-sectional study (N = 136, aged 14–18), youths with stronger entity beliefs experienced greater depressive symptoms, and this link was mediated by lower reappraisal. This pattern was replicated and extended in a longitudinal study (N = 227, aged 10–18), wherein youth- and parent-reported depressive symptoms were assessed 18 months after assessing beliefs. These results suggest that entity beliefs about emotion constitute a risk factor for depression that acts via reappraisal, adding to the growing literature on emotion beliefs and their consequences for self-regulation and health.