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RESEARCH ARTICLE |
1 Department of Psychology, University of Notre Dame, Indiana.
2 Department of Psychology, University of New Hampshire, Durham.
Address correspondence to Anthony D. Ong, 118 Haggar Hall, Department of Psychology, University of Notre Dame, Notre Dame, IN 46556. E-mail: aong{at}nd.edu
| Abstract |
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The loss of a spouse is generally regarded as one of the most stressful life events, particularly for older adults (Gallagher, Breckenridge, Thompson, & Peterson, 1983
; Holmes & Rahe, 1967
). Among older Americans, conjugal loss is three times more likely to occur in those over the age of 65 (U.S. Bureau of the Census, 1997
). The resulting conjugal bereavement is associated with an increased risk of depressive symptoms, major depressive episodes (Byrne & Raphael, 1997
; Reynolds et al., 1999
), and anxiety-related symptoms and disorders (Jacobs et al., 1990
; Turvey, Carney, Arndt, Wallace, & Herzog, 1999
). Symptoms related to anxiety and depression, in turn, are highly comorbid (Clark & Watson, 1991
; Mineka, Watson, & Clark, 1998
), showing marked intraindividual variation in the months immediately following conjugal loss (Byrne & Raphael, 1999
; Harlow, Goldberg, & Comstock, 1991
).
Despite the substantial documentation of negative emotions following loss (see Bonanno & Kaltman, 1999
; Stroebe & Schut, 2001
for reviews), little is known about how positive emotions counteract the upending experience of daily stress and negative emotions during the bereavement process. This is despite evidence that positive emotions co-occur with distress in bereaved individuals, often with surprising regularity (Folkman, 1997
; Moskowtiz, Folkman, Collette, & Vittinghoff, 1996; Stein, Folkman, Trabasso, & Richards, 1997
). In a study of AIDS-related caregiving and bereavement, for example, Folkman (1997)
reported that, with the exception of the period immediately before and after their partner's death, the positive emotion scores of men whose partners had died of AIDS did not reliably differ from their negative emotion scores, and at 3 months postloss the scores had returned to their prebereavement level.
Although the finding that people can experience positive emotions with great frequency even in the most difficult of circumstances is surprising, it raises more questions than it answers. Exactly how do daily positive emotions influence and shape the experience of stress and negative emotions during bereavement? Do positive emotions on days in which a stressful event is present function to maximize resistance (Potter, Zautra, & Reich, 2000
; Reich, Zautra, & Potter, 2001), interrupting the experience of bereavement-related anxiety and depression? How do certain bereaved spouses, in the face of daily stress, maintain emotional resilience? Are the benefits of positive emotions during bereavement attached to underlying individual difference variables, such as general positive affectivity and humor, which may be largely immutable? Or do the real benefits of positive emotions take place closer to actual moments of change (cf. Fredrickson & Levenson, 1998
; Zautra, Smith, Affleck, & Tennen, 2001
), such that there exists significant opportunity for grieving individuals to continually recruit personal resources to generate and sustain positive emotions as they cope with loss?
We addressed these questions in a daily diary study of widows coping with the recent death of a spouse. In addition to providing a framework in which to study inherently intraindividual (within-person) questions (Tennen, Affleck, Armeli, & Carney, 2000
), daily diary studies confer specific methodological advantages for the study of conjugal bereavement. Daily diary assessments allow bereaved spouses to report their behavior and experiences over the range of situational circumstances encountered in everyday life. They allow for statistical modeling of bereavement-related stress and emotion over time. Daily diaries also have the potential for greater validity, because the shorter lag between experience and reporting minimizes recall biases (cf. Lazarus & Folkman, 1984
; Stone, Shiffman, & DeVries, 1999
). Although daily process studies have been applied successfully to study an array of psychological phenomena (for reviews, see Bolger, Davis, & Rafaeli, 2003
; Tennen & Affleck, 2002
), relatively less work has been directed at using daily diaries to track the adaptational processes of widows as they unfold over fairly short time intervals. That is, comparatively few published studies have examined the unfolding day-to-day concomitant relationships between stress and emotions in widowhood.
The Adaptive Functions of Positive Emotions During Stress
The larger literature on daily stress and mood reveals that negative emotions are not always present in the same degree each time a person experiences stress (cf. Affleck, Tennen, Urrows, & Higgins, 1994
; Zautra, Berkhof, & Nicolson, 2002
). One psychological resource that has been directly linked to effective regulation of negative emotions is the presence of positive emotions (Fredrickson, Mancuso, Branigan, & Tugade, 2000
). In addition to enhancing psychological coping and well-being, positive emotions have been posited to serve a protective function, guarding individuals from negative emotions as well as "undoing" the aftereffects of such emotions (cf. Fredrickson, 2001
; Fredrickson & Levenson, 1998
).
Positive emotions may be most beneficial, however, when they are present at the time of stress. Zautra and colleagues (Zautra, Reich, & Guarnaccia, 1990
; Zautra et al, 2001
) recently introduced the dynamic affect (DA) model to account for how positive emotions influence negative emotions during stressful periods. In contrast to most models of stress and coping, which view well-being entirely in terms of regulating and minimizing psychological distress, the DA model takes into account both negative and positive emotions in the stress process. (For discussions of the role of positive emotions in coping, see Folkman & Moskowitz, 2000
, and Park & Folkman, 1997
.) The model characterizes adaptation to stress as the successful uncoupling of negative and positive emotions. Across a number of studies, Zautra and colleagues (Potter et al., 2001; Reich et al., 2001; Zautra et al., 2001
, 2002
) demonstrated that the capacity for preserving separate, relatively independent emotion systems during stressful periods functions to maximize emotional resilience and hasten psychological recovery. The construct of emotional complexity emphasized in the DA model is also congruent with a number of life-span theories (e.g., Baltes & Staudinger, 2000
; Carstensen, Pasupathi, Mayr, & Nesselroade, 2000; Labouvie-Vief & Medler, 2002
) and cognitivedevelopmental models (Mayer & Salovey, 1997
; Linville, 1987
; Saarni, 1999
), suggesting that differentiated representations of emotional experience that include both positive and negative emotions may be a hallmark of optimal psychological functioning.
In addition to giving a better understanding of how bereaved spouses respond emotionally to ongoing stressors on a daily basis, studying bereavement as a daily process also provides a rich context in which to examine the differential effects of daily positive emotions on anxiety and depression. One provocative hypothesis is that, although anxiety and depression share a general, nonspecific factor with negative emotions, it is ahedonia or the absence of positive emotions, which is a characteristic emotional feature of depression, that distinguishes it from anxiety (Clark & Watson, 1991
; Watson, Clark, & Carey, 1988
; Watson & Kendall, 1989
). Evidence supporting this hypothesis ranges from neuropsychological studies of brain activity (e.g., Henriques & Davidson, 1991
; Sutton & Davidson, 1997
) to cognitivebehavioral interventions (e.g., Gortner, Gollan, Dobson, & Jacobson, 1998
; Lewinsohn & Gotlib, 1995
). Modeling processes of intraindividual variability, thus, can help to clarify how positive emotions differentially influence the occurrence of depression- and anxiety-related symptoms during conjugal bereavement.
The Role of Humor in the Stress Process
Just as there are variations within a person in the experience of emotions and stress, so too there are differences between individuals in the use of emotions to cope with stress (Feldman-Barrett, Gross, Christensen, & Benvenuto, 2001
; Salovey, Stroud, Woolery, & Epel, 2002
). Considerable efforts have focused on humor as a moderator of stressful life events (for a review, see Lefcourt, 2002
; but see Martin, 2001
). Comparatively fewer studies have examined humor as a mechanism by which positive emotions can be both instigated and enhanced in the midst of stress (Kuiper, Martin, & Dance, 1992
; Kuiper, Martin, & Olinger, 1993
). Those who use humor as a coping mechanism may, for example, be more adept at harnessing the benefits of positive emotions to regulate their negative emotions during times of stress (Folkman & Moskowitz, 2000
). Similarly, those who have higher average levels of positive affect should be less vulnerable to experiencing negative emotions during stressful periods (Hobfoll, 1989
). From this perspective, compared with those low in humor and positive affectivity, the daily positive and negative emotions of those high on these traits should be inversely coupled during periods of stress, exhibiting a significant degree of bipolarity.
In contrast to the hypothesis that humor may represent a coping resource that can be deployed as a buffer during stressful times, an alternative hypothesis is that those who engage in humor coping during bereavement may show greater emotional resilience or the capacity to keep their positive emotions separate from negative emotions in the midst of stress. Consistent with this prediction, several investigators have reported that those who are able to engage in coping styles marked by the use of humor are better able to distance themselves from stressful events (Kuiper et al., 1992
, 1993
; Lefcourt, Davidson, Shepherd, Phillips, Prkachin, & Mills, 1995
). Kuiper and colleagues (1992)
, for example, reported that, in the presence of increasing negative life events, those with a good sense of humor were able to maintain and even increase their levels of positive emotions. Keltner and Bonanno (1997)
similarly reported that the occurrence of Duchenne laughter during the course of bereavement was correlated with verbal autonomic response dissociation, indicating that those who engaged in full-laughter displays were better able to emotionally dissociate or distance themselves from feelings of grief and dysphoria. To the extent that a similar resilience mechanism may underlie individual differences in humor coping during conjugal bereavement, it follows that the daily positive and negative emotions of those high in humor coping should be relatively independent, displaying a significant degree of bivalency.
In this article, we examine the question of how daily stress, positive emotions, trait humor coping, and positive affectivity each influence the daily experience of anxiety- and depression-related symptoms following the loss of a spouse. Using a multilevel daily process design, we tested predictions that positive emotions may be most beneficial when present at the time of stress (Zautra et al., 2001
, 2002
). We also tested whether the "undoing" effects of daily positive emotions, in the context of conjugal bereavement, are specific to symptoms of depression rather than anxiety. Further, we tested but made no prediction as to whether individual differences in positive affectivity would alter the ongoing daily relationships between positive emotions, anxiety, and depression. Finally, we examined the degree to which within-person relationships between positive and negative emotions (i.e., anxiety and depression) are influenced by individual differences in humor coping.
| METHODS |
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Procedure
At the onset of the project, we identified 266 recently widowed women on the basis of information included in newspaper death notices from a midsized Northern Indiana city as well as surrounding areas. At approximately 7 days following the death of their spouse, we sent these women a letter describing the purpose of the study. We followed up the letter with a telephone call. Of the 266 women, we corresponded with 217 of them. Seventy-one widows expressed interest in participating in the study; however, 11 canceled before the initial interview took place. This resulted in a sample of 60 widows who participated in the initial interview between 18 and 42 days following the death of their spouse (M = 28.60, SD = 6.41). Five of the 60 women who were enrolled in the study had too much missing data to be included in the present study, and 21 women did not take part in the daily assessments. Therefore, the data set being used is composed of 34 recently widowed women (see Appendix, Note 1).
Thirty-four participants received a battery of self-report questionnaires approximately 1 month postloss (M = 28 days, SD = 6). Participants then took part in a daily diary study of emotions and stress. We dated each daily packet and mailed it to the widows in bimonthly intervals. If a participant missed a day, she was instructed to leave that day's response sheet blank. We gave the first set to the participants at the initial interview, and the set included a self-addressed, postage-paid envelope to return surveys. We instructed the participants to complete response sheets in the evening and return diaries by mail every 2 weeks. To remind participants to mail the packet of daily assessments, we made phone calls to them every 3 weeks. These conversations were also a way to keep in touch with the widows over the 3-month project. Widows received $50.00 in return for participation.
Trait-Level Measures
Humor coping
We measured humor coping by using a subscale of the Multidimensional Sense of Humor Scale (Thorson & Powell, 1993
). The scale consists of seven items that assess the degree to which individuals use humor in response to a difficult or stressful situation. Examples of items are "Humor helps me cope," "Coping by using humor is an elegant way of adapting," and "Humor is a lousy coping mechanism" (reverse coded). Participants were asked to indicate the extent to which they believe each item was true on a 4-point scale from 1 (not at all true) to 4 (completely true). Cronbach's
=.87.
Perceived stress
We assessed perceived stress by using the 14-item Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983
). Widely used in studies of both mental and physical health (cf. Cohen, Doyle, & Skoner, 1999
; Cohen, Tyrrell, & Smith, 1993
), the Perceived Stress Scale was designed to assess the degree to which individuals appraise the situations in their lives as stressful. Participants respond to items such as "In the past month, how often have you felt that you were unable to control the important things in your life?" Participants respond on a 4-point scale (from 1, never, to 4, always). Cronbach's
=.86.
Day-Level Measures
Positive emotions and anxietydepression symptomatology
We measured daily positive emotions, anxiety symptoms, and depressive symptoms by using the subscales of the Mental Health Inventory (MHI; Veit & Ware, 1983
). We assessed participants each day for 98 days on positive emotional states as well as symptom-specific indicators of anxiety and depression. In addition to being one of the most widely used mental health assessment inventories, the MHI is sensitive to intraindividual change (for reviews, see McHorney, Ware, Rogers, Anastasia, & Lu, 1992
; Ware & Gandek, 1994
). In the current study, participants were asked to indicate on a 4-point scale (from 1, not at all true, to 4, completely true) the extent to which they had experienced positive emotions and depression or anxiety symptoms on a daily basis. We measured positive emotions by using the 11-item subscale of the MHI (Veit & Ware, 1983
). Example positive items are "Today I felt cheerful, lighthearted," "Today, I felt calm and peaceful," and "Today, I was a happy person." We assessed anxiety and depressive symptoms by using the 9-item anxiety and 4-item depression subscales of the MHI (Veit & Ware, 1983
). Example items assessing anxiety are "Today, I was a very nervous person," "Today, I was anxious and worried," and "I had difficulty trying to calm down." Example items measuring depression are "Today, I felt downhearted and blue," "Today, I felt depressed," and "Today, I had low or very low spirits."
Stress reactivity
In addition to reporting on their daily mood, widows completed a single item on the most stressful event of the day and then rated their perceptions of how stressful the event was on a scale of 1 (very stressful) to 5 (not very stressful).
| RESULTS |
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We developed HLM equations predicting daily anxiety and depressive symptoms to test our hypotheses. There were several common elements in each of our HLM analyses. First, following recommendations by Bryk and Raudenbush (1992)
, we centered all day-level variables on the individuals' mean, and we centered all trait-level variables on sample means. Second, we rescaled variables that did not include a meaningful zero in the original scaling (e.g., day of study) to include zero. Third, we controlled for mean level of positive emotions and trait perceived stress in the prediction of daily anxiety and depressive symptoms to remove trait stability and examine only the state fluctuations. Fourth, we modeled the lower order regression parameters (i.e., Level 1 variables) as random coefficients.
Predicting Daily Anxiety Symptoms
We estimated day-level anxiety by using the following equation:
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In the second portion of the model, we estimated trait-level effects as follows:
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The results of the HLM analyses predicting daily anxiety symptoms are summarized in Table 2. The data indicate that, after we control for current level of depressive symptoms, those reporting high levels of trait perceived stress had a higher intercept for anxiety symptoms than those reporting lower levels of perceived stress (b = 15.362, SE = 1.085, t = 13.657, p <.001). Also evident was a significant effect of time, such that anxiety symptoms showed a significant increase over the course of the study (b =.584, SE =.053, t = 14.362, p <.001). In comparison with those low in trait perceived stress, however, widows who reported high levels of chronic stress had steeper increases in anxiety symptoms over the course of study (b =.335, SE =.064, t = 5.974, p <.05). Table 2 also shows that higher levels of daily stress were associated with greater anxiety symptoms (b =.412, SE =.035, t = 13.854, p <.001), and that the individual slopes of this stress-to-anxiety relationship were predictable from individual differences in trait perceived stress. Among more chronically stressed widows, the link between daily stress and anxiety symptoms was considerably stronger than was the link between daily stress and anxiety for less stressed widows (b =.271, SE =.072, t = 4.325, p <.05). Finally, Table 2 shows that mean level of positive emotion was not associated with either anxiety or the stressanxiety relationship. It is important to note that neither daily positive emotions nor its interaction with daily stress covaried with anxiety symptoms once current levels of depressive symptoms were statistically controlled.
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The results of the HLM analyses predicting daily depressive symptoms are summarized in Table 3. Similar to the anxiety findings, Table 2 shows that, compared with widows who reported relatively low levels of trait stress, chronically stressed widows had higher intercepts (b = 9.542, SE =.087, t = 12.085, p <.001) and slopes for depressive symptoms (b =.388, SE =.075, t = 6.247, p <.05) and stronger daily stressdepression relationships (b =.398, SE =.042, t = 7.985, p <.05). It is important to note that higher levels of daily positive emotions were associated with lower symptom levels of depression, even after we controlled for current levels of anxiety (b = .399, SE =.084, t = 11.624, p <.001). Further, the relationship was strongest among those low in trait humor coping (b =.268, SE =.136, t = 5.325, p <.05). This interaction is depicted in Figure 1. For those high in trait humor coping, changes in positive emotions were not associated with changes in depressive symptoms. In contrast, those low in trait humor coping showed a strong inverse relationship between changes in positive emotions and depression symptoms. Finally, the interaction between daily stress and positive emotions indicated that positive emotions were associated with a weaker relationship between daily stress and depressive symptoms (b = .445, SE =.028, t = 15.618, p <.001). This interaction is depicted in Figure 2. There was a less manifest increase in depressive symptoms on days marked by greater stress when positive emotions were also high. Notably, average positive emotion was not associated with daily depressive symptoms, suggesting that only elevations in positive emotions at the time of stress appear to reduce depression-related symptoms (see Appendix, Note 3).
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| DISCUSSION |
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Our findings support the hypothesis that the associations between daily stress and depressive symptoms are weakened when positive emotions are also present. Intraindividual analyses revealed significant reductions in the magnitude of the stressdepression correlation on days in which greater positive emotions were present. The results also support the view that ahedonia or low positive emotionality is specific to depression symptomatology. The results are congruent with the larger literature on positive and negative emotions (Watson et al., 1988
; Watson & Tellegen, 1985
) as well as tripartite models of depression (Clark & Watson, 1991
; Watson et al., 1988
; Watson & Kendall, 1989
), which suggest that, although general negative emotionality encompasses both depression and anxiety, low positive affect is unique to depression. The discriminant validity of daily positive emotions is strongly supported in the present study. The HLM results indicate that on days in which positive emotions were high, the correlation between stress and depressive symptoms was significantly attenuated. Thus, positive emotions appear to play a particular role in the regulation of ongoing depression during conjugal bereavement.
Equally important to explicating the pathways that lead to daily emotional resilience is identifying the psychological factors that contribute to sustaining resilience throughout the bereavement process. How does the ability to find humor in stressful situations promote emotional resilience during bereavement? Our results suggest that those widows low in humor coping showed a strong inverse relationship between changes in positive emotions and depression. These findings are consistent with theories of depression that link ahedonic symptoms of depression to a deficiency in approach motivation or behavioral activation strength (cf. Harmon-Jones & Allen, 1997
; Lewinsohn & Gotlib, 1995
). The results also broaden the scope of such theories by identifying a resilience trait (i.e., humor coping) that influences constructs thought to underlie symptom manifestations of depression during bereavement.
Our findings regarding the unique influence of positive emotions on depressive symptoms have implications for intervention. Clark and Watson (1991)
postulated a theoretical model in which ahedonia was uniquely linked to depression and hyperarousal to anxiety. Cognitive and behavioral interventions for depression (e.g., Lewinsohn & Gotlib, 1995
) often encourage individuals to become involved in activities that will boost their positive emotions (e.g., exercise). The results of the present study suggest that such interventions may derive their efficacy from the emotional changes that take place as a result of significant decreases in depressive symptoms coinciding with increases in positive emotions during times of stress. In contrast to depression, anxiety-related symptoms and disorders are associated with anticipated threat or danger and an overall sense of helplessness (Beck & Emery, 1985
; Brown, Harris, & Eales, 1993
). Thus, helping widows shift their attention to aspects of their lives that they can control may mitigate the manifestation of anxiety-related symptoms during bereavement. Moreover, interventions designed to enhance the experience of both mastery and positive emotions may be necessary to treat bereavement-related syndromes characterized by mixed anxietydepressive states.
Limitations
There are at least three limitations to the current study: causality, a widow sample, and the reliance on self-reports. First, although the daily process design of the study allows us some confidence in the conclusions that we have drawn from the correlations among the variables over time, causal conclusions cannot be made. In addition, the measures were completed at the end of the day, and hours could have passed since the occurrence of the daily stressor. It is possible that negative mood resulted in a distorted recollection and appraisal of events (Marco & Suls, 1993
). Moreover, our measures of anxiety, depression, and positive emotions do not encompass the entire range of measurements within each of these constructs (e.g., Russell, 2003
). Second, the sample for this study consisted of only widows. Whether our conclusions can be generalizable to explain gender differences in bereavement-related depression (e.g., Nolen-Hoeksema, Parker, & Larson, 1994
) is an empirical question. Finally, the analyses of daily emotions and stress relied heavily on self-reports from respondents. It would have been useful to have clinical diagnoses of anxiety and depression for these analyses. Thus, firm conclusions about the relationship between positive emotions and depression during conjugal bereavement await further study.
Conclusions
Although few would question the extraordinary psychological and physical distress that is caused by the death of a spouse, there exist significant opportunities for growth and well-being throughout the grieving process (cf. Bonanno & Kaltman, 1999
; Stroebe & Schut, 2001
). Overall, our results highlight the critical role of daily positive emotions in the months immediately following conjugal loss. It is important that our findings also document the need for identifying theoretical vulnerability and resilience traits that may place certain widows at greater or lesser risk for adaptational difficulties. In particular, higher levels of perceived stress appear to alter the structure of daily emotional responses, leading to less differentiation of daily emotional experiences. In contrast, widows who coped with stress through humor were more likely to capitalize on daily positive emotions, thereby protecting such emotions from the upending experience of daily depression. Understanding how theses relationships unfold and change over longer intervals throughout the bereavement process represents an important area for future research.
| APPENDIX |
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| Acknowledgments |
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| Footnotes |
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Received for publication September 25, 2003. Accepted for publication February 25, 2004.
| References |
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