A Pilot Project to Integrate Individualized Measurement Into Measurement-Based Care in a Child Partial Hospitalization Program.

Measurement-based care (MBC), or the regular use of progress measures to inform clinical decision-making, improves quality of care and clinical outcomes. MBC typically focuses on standardized rather than individualized outcome measurement. In this pilot study, we examined the clinical utility of integrating individualized measurement with existing standardized outcome monitoring in a children's partial hospitalization program. Participants were 48 youth (M age 10.13 ±â€¯1.39; 54.2% male, 41.7% female, 4.2% transgender or nonbinary). Comorbidity was common; 83.4% of youth had more than one diagnosis at intake. Using the Youth Top Problems for individualized outcome measurement, we examined Top Problem content and clinical improvement over time. Finally, we examined completion rates and describe implementation issues. Top Problems were heterogeneous and sensitive to change. Of the 144 problems, 107 (74%) had a focus consistent with measures used in program, while 37 (26%) were not captured by standardized measures used in program. Effect sizes from admission to final measurement ranged from Cohen's d = .75 - 1.00. Initial adoption of the MBC was strong, but sustained use of the system over the treatment course was challenging. Individualized outcome measurement in children's partial hospitalization programs is feasible to administer and sensitive to clinical change that is unique from change captured in standardized measures. Parents were able to self-identify clinically meaningful, highly individualized Top Problems. Challenges of implementation and clinical assessment in acute settings and potential strategies for improving implementation are discussed.

"You okay, honey?": Marital quality and mental health as correlates to couples' compassion.

Compassion is an inherently interpersonal emotion that motivates caretaking behavior. Yet, couples' expressions of compassion have been largely overlooked by researchers. We capitalized on a unique archive of naturalistic recordings to assess the frequency with which married couples (N = 30) verbally expressed compassion to one another in daily life and tested associations with partners' ratings of marital quality, depression, and neuroticism. A keyword search of hundreds of hours of recordings flagged potential expressions; human coders examined the interpersonal context in each instance to identify the cases that were actual expressions of compassion. The data showed that verbal expressions of compassion were common: Couples were observed offering compassion on average twice per hour. Actor-partner interdependence models (APIMs) tested how the rate at which compassion was expressed to a spouse was linked to the partners' reports of marital quality, depression, and neuroticism. There was evidence for a hypothesized partner effect: husbands offered more compassion to wives who reported more depressive symptoms. An unexpected pattern emerged indicating that husbands' personal distress was associated with more frequent compassion expressions. In particular, husbands who perceived their marriages as lower quality and husbands who reported more neuroticism offered more compassion. Our findings highlight the distinction between the internal emotional experience versus verbal expressions of compassion and suggest that some partner compassion behaviors may reflect hypervigilance and compulsive caretaking triggered by distress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Increases in positive emotions as precursors to therapeutic change.

Increases in positive emotions may not only be indicators of progress in therapy but also precursors to that improvement. Conducted in a psychology training clinic, this naturalistic, repeated-measures study tracked changes over the course of therapy in 34 clients' emotional experience and two of the primary targets of clinical interventions, symptom distress and relationship functioning. During treatment, positive emotions increased, negative emotions decreased, and improvements were seen in therapeutic outcomes. Positive and negative emotions were correlated, as were changes in positive and negative emotions. However, despite this association, increases in positive emotions were a significant predictor of concurrent improvements in symptom distress and relationship functioning, even when decreases in negative emotions were included in the same model. Additionally, positive emotions not only predicted change in these treatment outcomes over the same time period, but they also predicted future change. This study contributes to research on the critical role positive emotions play in psychotherapy and may encourage the development of interventions focusing on increasing positive emotions. These findings highlight the distinct functioning of positive emotions separate from negative and the value of attending to positive emotions during therapy.

Everyday emotions: Naturalistic observation of specific positive emotions in daily family life.

With technological advances rapidly expanding our ability to collect continuous streams of passive recordings, new techniques for processing and analyzing data of this type are needed. This article presents a feasible, reliable, and valid language-based methodology for scanning large quantities of naturalistic recordings to study specific positive emotions in families. Detailing a keyword approach to identifying and coding verbal expressions of compassion, gratitude, pride, and amusement in video transcripts, this study demonstrates one way of locating phenomena, such as emotion, that arise across many different situations in family life. Transcripts of over 350 hr of video recordings obtained from 32 families interacting in their homes and communities were coded to describe the rates per hour at which mothers, fathers, and school-age children verbally expressed 4 positive emotions. Parents expressed compassion, gratitude, and pride more often than children did, but they expressed amusement at similar rates. Gender comparisons revealed that mothers expressed compassion and gratitude more frequently than fathers, and girls expressed these emotions more often than boys. The specific emotion approach allowed us to probe the association between parental and child-expressed positivity: Mothers' expressions of compassion were the most powerful predictor, explaining over half the variance in children's expressions of positive emotion. This study describes a promising approach to analyzing large volumes of passive data; the results show how families differ with respect to the landscape of 4 specific positive emotions and suggest how and why these emotions should be differentiated in studies of daily family life. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Awe and humility.

Humility is a foundational virtue that counters selfish inclinations such as entitlement, arrogance, and narcissism (Tangney, 2000). We hypothesize that experiences of awe promote greater humility. Guided by an appraisal-tendency framework of emotion, we propose that when individuals encounter an entity that is vast and challenges their worldview, they feel awe, which leads to self-diminishment and subsequently humility. In support of these claims, awe-prone individuals were rated as more humble by friends (Study 1) and reported greater humility across a 2-week period (Study 2), controlling for other positive emotions. Inducing awe led participants to present a more balanced view of their strengths and weaknesses to others (Study 3) and acknowledge, to a greater degree, the contribution of outside forces in their own personal accomplishments (Study 4), compared with neutral and positive control conditions. Finally, an awe-inducing expansive view elicited greater reported humility than a neutral view (Study 5). We also elucidated the process by which awe leads to humility. Feelings of awe mediated the relationship between appraisals (perceptions of vastness and a challenge to one's world view) and humility (Study 4), and self-diminishment mediated the relationship between awe and humility (Study 5). Taken together, these results reveal that awe offers one path to greater humility. (PsycINFO Database Record

Awe, the diminished self, and collective engagement: Universals and cultural variations in the small self.

Awe has been theorized as a collective emotion, one that enables individuals to integrate into social collectives. In keeping with this theorizing, we propose that awe diminishes the sense of self and shifts attention away from individual interests and concerns. In testing this hypothesis across 6 studies (N = 2137), we first validate pictorial and verbal measures of the small self; we then document that daily, in vivo, and lab experiences of awe, but not other positive emotions, diminish the sense of the self. These findings were observed across collectivist and individualistic cultures, but also varied across cultures in magnitude and content. Evidence from the last 2 studies showed that the influence of awe upon the small self accounted for increases in collective engagement, fitting with claims that awe promotes integration into social groups. Discussion focused on how the small self might mediate the effects of awe on collective cognition and behavior, the need to study more negatively valenced varieties of awe, and other potential cultural variations of the small self. (PsycINFO Database Record

The dark side of the sublime: Distinguishing a threat-based variant of awe.

Theoretical conceptualizations of awe suggest this emotion can be more positive or negative depending on specific appraisal processes. However, the emergent scientific study of awe rarely emphasizes its negative side, classifying it instead as a positive emotion. In the present research we tested whether there is a more negative variant of awe that arises in response to vast, complex stimuli that are threatening (e.g., tornadoes, terrorist attack, wrathful god). We discovered people do experience this type of awe with regularity (Studies 1 & 4) and that it differs from other variants of awe in terms of its underlying appraisals, subjective experience, physiological correlates, and consequences for well-being. Specifically, threat-based awe experiences were appraised as lower in self-control and certainty and higher in situational control than other awe experiences, and were characterized by greater feelings of fear (Studies 2a & 2b). Threat-based awe was associated with physiological indicators of increased sympathetic autonomic arousal, whereas positive awe was associated with indicators of increased parasympathetic arousal (Study 3). Positive awe experiences in daily life (Study 4) and in the lab (Study 5) led to greater momentary well-being (compared with no awe experience), whereas threat-based awe experiences did not. This effect was partially mediated by increased feelings of powerlessness during threat-based awe experiences. Together, these findings highlight a darker side of awe. (PsycINFO Database Record

Positive affect and markers of inflammation: discrete positive emotions predict lower levels of inflammatory cytokines.

Negative emotions are reliably associated with poorer health (e.g., Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002), but only recently has research begun to acknowledge the important role of positive emotions for our physical health (Fredrickson, 2003). We examine the link between dispositional positive affect and one potential biological pathway between positive emotions and health-proinflammatory cytokines, specifically levels of interleukin-6 (IL-6). We hypothesized that greater trait positive affect would be associated with lower levels of IL-6 in a healthy sample. We found support for this hypothesis across two studies. We also explored the relationship between discrete positive emotions and IL-6 levels, finding that awe, measured in two different ways, was the strongest predictor of lower levels of proinflammatory cytokines. These effects held when controlling for relevant personality and health variables. This work suggests a potential biological pathway between positive emotions and health through proinflammatory cytokines.