Psychological flexibility and ostracism: Experiential avoidance rather than cognitive fusion moderates distress from perceived ostracism over time

Psychological inflexibility has been found to moderate psychological distress following perceived ostracism. Two component processes of psychological inflexibility, experiential avoidance and cognitive fusion, are considered key in exacerbating general emotional distress. The present study (n = 286) examined whether both experiential avoidance and cognitive fusion moderate distress from perceived ostracism or whether one of these processes alone underpins the moderation effect of psychological inflexibility. In a structural equation model analysis, when accounting for both factors, experiential avoidance moderated distress from perceived ostracism alone. Thus, it seems that experiential avoidance is a key driver underlying emotional regulation of psychological distress in the context of perceived ostracism

Self-Care Confidence May be More Important than Cognition to Influence Self-Care Behaviors in Adults with Heart Failure: Testing a Mediation Model

Background Cognitive impairment can reduce the self-care abilities of heart failure patients. Theory and preliminary evidence suggest that self-care confidence may mediate the relationship between cognition and self-care, but further study is needed to validate this finding. Objectives The aim of this study was to test the mediating role of self-care confidence between specific cognitive domains and heart failure self-care. Design Secondary analysis of data from a descriptive study. Settings Three out-patient sites in Pennsylvania and Delaware, USA. Participants A sample of 280 adults with chronic heart failure, 62 years old on average and mostly male (64.3%). Methods Data on heart failure self-care and self-care confidence were collected with the Self-Care of Heart Failure Index 6.2. Data on cognition were collected by trained research assistants using a neuropsychological test battery measuring simple and complex attention, processing speed, working memory, and short-term memory. Sociodemographic data were collected by self-report. Clinical information was abstracted from the medical record. Mediation analysis was performed with structural equation modeling and indirect effects were evaluated with bootstrapping. Results Most participants had at least 1 impaired cognitive domain. In mediation models, self-care confidence consistently influenced self-care and totally mediated the relationship between simple attention and self-care and between working memory and self-care (comparative fit index range: .929–.968; root mean squared error of approximation range: .032–.052). Except for short-term memory, which had a direct effect on self-care maintenance, the other cognitive domains were unrelated to self-care. Conclusions Self-care confidence appears to be an important factor influencing heart failure self-care even in patients with impaired cognition. As few studies have successfully improved cognition, interventions addressing confidence should be considered as a way to improve self-care in this population

Patients' health locus of control and preferences about the role that they want to play in the medical decision-making process

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A test of the pathway model of problematic smartphone use.

Problematic smartphone use (PSU) has been described as a growing public health issue. In the current study, we aimed to provide a unique and comprehensive test of the pathway model of PSU. This model posits three distinct developmental pathways leading to PSU: (1) the excessive reassurance pathway, (2) the impulsive pathway and (3) the extraversion pathway. Undergraduate students (n = 795, 69.8% female, mean age = 23.80 years, sd = 3.02) completed online self-report measures of PSU (addictive use, antisocial use and dangerous use) and the psychological features (personality traits and psychopathological symptoms) underlying the three pathways. Bayesian analyses revealed that addictive use is mainly driven by the excessive reassurance pathway and the impulsive pathway, for which candidate etiopathological factors include heightened negative urgency, a hyperactive behavioural inhibition system and symptoms of social anxiety. Dangerous and antisocial use are mainly driven by the impulsive pathway and the extraversion pathway, for which candidate etiopathological factors include specific impulsivity components (lack of premeditation and sensation seeking) and primary psychopathy (inclination to lie, lack of remorse, callousness and manipulativeness). The present study constitutes the first comprehensive test of the pathway model of PSU. We provide robust and original results regarding the psychological dimensions associated with each of the postulated pathways of PSU, which should be taken into account when considering regulation of smartphone use or tailoring prevention protocols to reduce problematic usage patterns

Heterogeneity of smartphone impact on everyday life and its relationship with personality and psychopathology: A latent profile analysis

Background The relationships between problematic smartphone use and psychological factors have been extensively investigated. However, previous studies generally used variable-centered approaches, which hinder an examination of the heterogeneity of smartphone impact on everyday life. Objective In the present study, we capitalized on latent profile analysis to identify various classes of smartphone owners based on the impact associated with smartphone use (e.g., unregulated usage, preference for smartphone-mediated social relationships) and to compare these classes in terms of established psychological risk factors for problematic smartphone use. Method We surveyed 934 young adults with validated psychometric questionnaires to assess the impact of smartphones, psychopathological symptoms, self-esteem and impulsivity traits. Results Smartphone users fall into four latent profiles: users with low smartphone impact, users with average smartphone impact, problematic smartphone users, and users favoring online interactions. Individuals distributed in the problematic smartphone user profile were characterized by heightened psychopathological symptoms (stress, anxiety, depression, obsessive-compulsive tendencies) and impulsivity traits. Moreover, users who preferred online interactions exhibited the highest symptoms of social anxiety and the lowest levels of self-esteem. Conclusions These findings further demonstrate the multidimensionality and heterogeneity of the impact of smartphone use, calling for tailored prevention and intervention strategies

Perceived ostracism and paranoia: A test of potential moderating effects of psychological flexibility and inflexibility

Ostracism is known to lead to negative psychological outcomes; however, little is known as to how ostracism may be a predictor of paranoid thoughts. The present paper examined the relationship between perceived ostracism and paranoid thoughts (social reference, persecution) by focusing on the potential moderating roles of psychological flexibility and inflexibility. As expected, data from a sample of 315 internet users (Mage = 31.5 years) showed that perceived ostracism was positively related to both social reference and persecution. Psychological flexibility did not moderate the ostracism-paranoid thought relationships. However, psychological inflexibility was a moderator of the ostracism-social reference relationship, but not for ostracism-persecution. Specifically, at both high and low levels of psychological inflexibility, there was a significant positive relationship between ostracism and social reference. These unexpected findings suggest that future research is needed to elucidate the mechanisms by which perceived ostracism may lead to paranoia

The Acceptance and Action Questionnaire-II (AAQ-II) as a measure of experiential avoidance: Concerns over discriminant validity

Psychological inflexibility and experiential avoidance are key constructs in the Acceptance and Commitment Therapy (ACT) model of behavior change. Wolgast (2014) questioned the construct validity of the Acceptance and Action Questionnaire-II (AAQ-II), the most used self-report instrument to assess the efficacy of ACT interventions. Wolgast suggested that the AAQ-II measured psychological distress rather than psychological inflexibility and experiential avoidance. The current study further examined the construct validity of the AAQ-II by conducting an online cross-sectional survey (n = 524), including separate measures of experiential avoidance and psychological distress. Confirmatory factor analyses indicated that items from the AAQ-II correlated more highly with measures of depression, anxiety, and stress than the Brief Experiential Avoidance Questionnaire (BEAQ). Implications include that, as broad measures of experiential avoidance, the AAQ-II and BEAQ may not measure the same construct. In terms of psychological distress, the BEAQ has greater discriminant validity than the AAQ-II, and perhaps an alternative instrument of psychological inflexibility might be needed to assess core outcomes in ACT intervention research

Profiles of psychological flexibility: A latent class analysis of the Acceptance and Commitment Therapy model

There exists uncertainty for clinicians over how the separate sub-component processes of psychological flexibility, a core construct of the Acceptance and Commitment Therapy model, interact and influence distress experienced. The present study (N = 567) employed latent class analysis to (i) identify potential classes (i.e., subgroups) of psychological flexibility based on responses on measures of key sub-component process, and (ii) to examine whether such classes could reliably differentiate levels of self-reported psychological distress and positive and negative emotionality. We found three distinct classes: (i) High Psychological Flexibility, (ii) Moderate Psychological Flexibility, and (iii) Low Psychological Flexibility. Those in the Low Psychology Flexibility class reported highest levels of psychological distress, whereas those in the High Psychological Flexibility class subgroup reported lowest levels of psychological distress. This study provides a clearer view to clinicians of the profile of the broader spectrum of the psychological flexibility model to facilitate change in clients

第792回 千葉医学会例会・第二内科例会 35.

Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed

Venous thromboembolism secondary to hospitalization for COVID-19: patient management and long-term outcomes

Background: Venous thromboembolism (VTE) is a complication of COVID-19 in hospitalized patients. Little information is available on long-term outcomes of VTE in this population. Objectives: We aimed to compare the characteristics, management strategies, and long-term clinical outcomes between patients with COVID-19-associated VTE and patients with VTE provoked by hospitalization for other acute medical illnesses. Methods: This is an observational cohort study, with a prospective cohort of 278 patients with COVID-19-associated VTE enrolled between 2020 and 2021 and a comparison cohort of 300 patients without COVID-19 enrolled in the ongoing START2-Register between 2018 and 2020. Exclusion criteria included age <18 years, other indications to anticoagulant treatment, active cancer, recent (<3 months) major surgery, trauma, pregnancy, and participation in interventional studies. All patients were followed up for a minimum of 12 months after treatment discontinuation. Primary end point was the occurrence of venous and arterial thrombotic events. Results: Patients with VTE secondary to COVID-19 had more frequent pulmonary embolism without deep vein thrombosis than controls (83.1% vs 46.2%, P <.001), lower prevalence of chronic inflammatory disease (1.4% and 16.3%, P <.001), and history of VTE (5.0% and 19.0%, P <.001). The median duration of anticoagulant treatment (194 and 225 days, P = 0.9) and the proportion of patients who discontinued anticoagulation (78.0% and 75.0%, P = 0.4) were similar between the 2 groups. Thrombotic event rates after discontinuation were 1.5 and 2.6 per 100 patient-years, respectively (P = 0.4). Conclusion: The risk of recurrent thrombotic events in patients with COVID-19-associated VTE is low and similar to the risk observed in patients with VTE secondary to hospitalization for other medical diseases