Affect regulation is important to mental health. A deficit in one’s ability to identify and express emotions (alexithymia), cognitive styles of regulating emotional conflict (defenses), and the capacity for integrative and complex self-other understanding (ego strength or maturity) need to be studied to understand how they relate to each other as well as to mental health and well-being. A sample of 415 community-dwelling adults from a major metropolitan area in the Midwest U.S., stratified for gender, age, and ethnicity, completed three methodologically different measures of affect regulation along with measures of well-being and depression. Six years later, 49% of the sample again reported their well-being and depression. At baseline, ego strength and the defenses of principalization and reversal correlated negatively with alexithymia and the other defenses (turning against self, turning against object and projection), even after controlling for negative affect. Cross-sectionally, relationships were largely as hypothesized, with low alexithymia, use of mature defenses, and greater ego strength correlating with less depression and greater well-being, although some of these relationships were attenuated after controlling for negative affect. Prospectively, each of the affect regulation measures predicted hypothesized changes in well-being after 6 years, after controlling for baseline well-being, but affect regulation did not predict changes in depression. These findings illuminate similarities and differences among these affect regulation constructs, suggest the importance of differentiating well-being from depression, and reveal that affect regulation uniquely predicts changes in long-term well-being.

Background and objectives The US Centers for Medicare and Medicaid Services have mandated reducing early (30-day) hospital readmissions to improve patient care and reduce costs. Patients with ESKD have elevated early readmission rates, due in part to complex medical regimens but also cognitive impairment, literacy difficulties, low social support, and mood problems. We developed a brief family consultation intervention to address these risk factors and tested whether it would reduce early readmissions.Design, setting, participants, & measurements One hundred twenty hospitalized adults with ESKD (mean age=58 years; 50% men; 86% black, 14% white) were recruited from an urban, inpatient nephrology unit. Patients were randomized to the family consultation (n=60) or treatment-as-usual control (n=60) condition. Family consultations, conducted before discharge at bedside or via telephone, educated the family about the patient's cognitive and behavioral risk factors for readmission, particularly cognitive impairment, and how to compensate for them. Blinded medical record reviews were conducted 30 days later to determine readmission status (primary outcome) and any hospital return visit (readmission, emergency department, or observation; secondary outcome). Logistic regressions tested the effects of the consultation versus control on these outcomes.Results Primary analyses were intent-to-treat. The risk of a 30-day readmission after family consultation (n=12, 20%) was 0.54 compared with treatment-as-usual controls (n=19, 32%), although this effect was not statistically significant (odds ratio, 0.54; 95% confidence interval, 0.23 to 1.24; P=0.15). A similar magnitude, nonsignificant result was observed for any 30-day hospital return visit: family consultation (n=19, 32%) versus controls (n=28, 47%; odds ratio, 0.53; 95% confidence interval, 0.25 to 1.1; P=0.09). Per protocol analyses (excluding three patients who did not receive the assigned consultation) revealed similar results.Conclusions A brief consultation with family members about the patient's cognitive and psychosocial risk factors had no significant effect on 30-day hospital readmission in patients with ESKD.

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Background Research links people’s lifetime frequency of traumatic events to chronic pain. Attempts to suppress intrusive thoughts about trauma can paradoxically increase rumination, distress, and pain. Moreover, trauma-exposed individuals may experience social constraints against disclosure about their trauma, which might amplify thought suppression’s effect on pain. Purpose This study extends previous research on chronic pain by examining thought suppression and social constraints as mechanisms through which trauma might influence pain severity, pain interference, and depressive symptoms. Methods 292 adults with chronic low back, recruited from local pain clinics, completed self-report surveys. Mediation and conditional process analyses were conducted to examine associations among trauma, thought suppression, social constraints, and pain-related outcomes. Results Consistent with hypotheses, moderated-mediation analyses indicated that experiencing more traumatic life events was associated with greater suppression of intrusive thoughts, which in turn was associated with greater pain severity, pain interference, and depressive symptoms. Further, elevated levels of social constraints on emotional expression interacted with the indirect effect of thought suppression to augment pain severity and interference. Depressive symptoms were independently predicted by trauma, thought suppression, and social constraints. Conclusions We conclude that the combination of trauma, suppressing one’s thoughts, and social constraints against disclosure can be particularly deleterious for pain patients. Providing social environments that support the expression of trauma-related thoughts and feelings might improve pain outcomes.