Emotion dysregulation is thought to be critical to the development of negative psychological outcomes. Gross (1998b) conceptualized the timing of regulation strategies as key to this relationship, with response-focused strategies, such as expressive suppression, as less effective and more detrimental compared to antecedent-focused ones, such as cognitive reappraisal. In the current study, we examined the relationship between reappraisal and expressive suppression and measures of psychopathology, particularly for stress-related reactions, in both undergraduate and trauma-exposed community samples of women. Generally, expressive suppression was associated with higher, and reappraisal with lower, self-reported stress-related symptoms. In particular, expressive suppression was associated with PTSD, anxiety, and depression symptoms in the trauma-exposed community sample, with rumination partially mediating this association. Finally, based on factor analysis, expressive suppression and cognitive reappraisal appear to be independent constructs. Overall, expressive suppression, much more so than cognitive reappraisal, may play an important role in the experience of stress-related symptoms. Further, given their independence, there are potentially relevant clinical implications, as interventions that shift one of these emotion regulation strategies may not lead to changes in the other.
Does trauma exposure impair retrieval of autobiographical memories? Many theorists have suggested that the reduced ability to access specific memories of life events, termed overgenerality, is a protective mechanism helping attenuate painful emotions associated with trauma. The authors addressed this question by reviewing 24 studies that assessed trauma exposure and overgenerality, examining samples with posttraumatic stress disorder, acute stress disorder, depression, traumatic event exposure, and other clinical disorders. Limitations are discussed, including variations in assessment of events, depression, and overgenerality and the need for additional comparison groups. Across studies, there was no consistent association between trauma exposure and overgenerality, suggesting that trauma exposure is unlikely to be the primary mechanism leading to overgenerality. Instead, psychopathology factors such as depression and posttraumatic stress appear to be more consistently associated with overgenerality. Alternative overgenerality theories may help identify key overgenerality mechanisms, improving current understanding of autobiographical memory processes underlying psychopathology.
ObjectiveTo evaluate the efficacy of the Patient Reporting and Action for a Safe Environment intervention.DesignA multicentre cluster randomised controlled trial.SettingClusters were 33 hospital wards within five hospitals in the UK.ParticipantsAll patients able to give informed consent were eligible to take part. Wards were allocated to the intervention or control condition.InterventionThe ward-level intervention comprised two tools: (1) a questionnaire that asked patients about factors contributing to safety (patient measure of safety (PMOS)) and (2) a proforma for patients to report both safety concerns and positive experiences (patient incident reporting tool). Feedback was considered in multidisciplinary action planning meetings.MeasurementsPrimary outcomes were routinely collected ward-level harm-free care (HFC) scores and patient-level feedback on safety (PMOS).ResultsIntervention uptake and retention of wards was 100% and patient participation was high (86%). We found no significant effect of the intervention on any outcomes at 6 or 12 months. However, for new harms (ie, those for which the wards were directly accountable) intervention wards did show greater, though non-significant, improvement compared with control wards. Analyses also indicated that improvements were largest for wards that showed the greatest compliance with the intervention.LimitationsAdherence to the intervention, particularly the implementation of action plans, was poor. Patient safety outcomes may represent too blunt a measure.ConclusionsPatients are willing to provide feedback about the safety of their care. However, we were unable to demonstrate any overall effect of this intervention on either measure of patient safety and therefore cannot recommend this intervention for wider uptake. Findings indicate promise for increasing HFC where wards implement ≥75% of the intervention components.Trial registration numberISRCTN07689702; pre-results.
Findings suggest that for some patients, phase I trials fulfil a need to try everything in their fight against cancer. The study also suggests that being on treatment allows some patients to construct their lives meaningfully by providing a supportive structure and enabling hope. Implications for nursing practice and further research are discussed.
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