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Positive affect promotes well-being and alleviates depression: The mediating effect of attentional bias
Psychiatry Research 228 (2015) 482–487
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Psychiatry Research journal homepage: www.elsevier.com/locate/psychres
Positive affect promotes well-being and alleviates depression: The mediating effect of attentional bias Yuanyuan Xu, Yongju Yu, Yuanjun Xie, Li Peng, Botao Liu, Junrun Xie, Chen Bian, Min Li n Department of Military Psychology, College of Psychology, Third Military Medical University, Chongqing, China
art ic l e i nf o
a b s t r a c t
Article history: Received 16 March 2015 Received in revised form 8 June 2015 Accepted 17 June 2015 Available online 25 June 2015
The present study tested whether the relationships among positive affect, psychological well-being, life satisfaction and depression could be explained by positive and negative attentional bias. Structural equation modeling and mediation analyses were conducted based on 565 medical freshmen in China. The model of attentional bias as a mediator between positive affect promoting well-being and decreasing depression fit the data. Finding showed positive affect significantly related to positive and negative attentional biases. People who had higher level of positive affect held more positive attentional bias and less negative attentional bias, and reported higher levels of psychological well-being, life satisfaction and lower levels of depression. The utility of the attentional bias as the mechanism through which positive affect enhances well-being and alleviates depression was supported. Applications in cultivating positive affect and regulating attentional bias in counseling and education are discussed. & 2015 Elsevier Ireland Ltd. All rights reserved.
Keywords: Positive affect Attentional bias well-being medical freshmen
1. Introduction There is a long history in psychological research which has examined the relationship between positive affect and well-being. Numerous studies have provided evidence for the positive relationship between positive affect and well-being (Kuppens et al., 2008; Layous et al., 2014; Lyubomirsky et al., 2005; Mauss et al., 2011). For example, In a meta-analysis of 225 studies of positive affect and success in life, Lyubomirsky and his colleagues concluded that positive affect is valuable for more than just feeling good, it can foster successful outcomes in a variety of life domains, including relatively better job satisfaction (show superior performance and productivity, get more income and less likely to show “job withdrawal”), enhanced social relationships (have more friends, stronger social support networks and show more marital satisfaction), and better mental and physical health (Lyubomirsky et al., 2005). Consistently, based on data from 46 countries, Kuppens's research clearly showed that the positive correlation between positive affect and life satisfaction processes a transnational congruence (Kuppens et al., 2008). On the other hand, evidence suggested that happy people were relatively less likely to engage in rumination (Lyubomirsky et al., 2011), and the novel ideas and actions (e.g., the urge to play and explore) brought by the broadened mindsets have been approved n
Corresponding author. Fax: þ86 23 68752360/68752925. E-mail address: [email protected] (M. Li).
http://dx.doi.org/10.1016/j.psychres.2015.06.011 0165-1781/& 2015 Elsevier Ireland Ltd. All rights reserved.
to alleviate depression, since the relatively higher levels of approach-oriented motivation are associated with less severe depression and a greater likelihood of recovery (Sin et al., 2011). Recent research confirmed that army wives who experienced more positive affect during deployment likely experienced fewer depressive symptoms during reunion. That is, individuals who experience positive affect have access to a larger repertoire of coping resources that they can use in creative and flexible ways, which lends to better stress management (Dolphin et al., 2015). Beyond this, the undoing hypothesis of positive affect proposed that positive affect can serve as particularly efficient antidotes for the lingering effects of negative emotions, it might “correct” or “undo” the aftereffects of negative emotions (Fredrickson, 2013). From the research of Fredrickson (Fredrickson and Levenson, 1998), when viewed against the backdrop of pronounced negative emotional arousal, the positive affect clearly stood out in their ability to “undo” lingering cardiovascular activation. That is to say, the difference in positive emotionality accounts for their increased ability to bounce back from adversity, avoid depression, and thrive (Garland et al., 2010). Although the significant relationships among positive affect, well-being and depression have been approved by large empirical literature, few of them have directly tied these variables together to examine the possible intermediary processes. The broaden-andbuild model suggest that positive affect can broaden an individual's thought-action repertoire, thereby promoting the expansion of attention and encouraging play and exploration. In
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turn, these broadening behaviors build lasting resources and heightened well-being (Fredrickson and Branigan, 2005). Based on this model, Wadlinger and his colleagues further confirmed that induced positive mood is indeed related to attentional broadening, but only for positive and neutral stimuli. Thus, it appears that individuals with induced positive mood states generally pay more attention to positive stimuli (Wadlinger and Isaacowitz, 2006). Consistently, Segerstrom indicated that individuals with high level of positive affect are often characterized with a greater attentional bias for positive stimuli relative to negative stimuli (Segerstrom, 2001). Tamir and Robinson found that the induction of positive moods resulted in attentional bias toward positive, rewarding words in a dot probe task (Tamir and Robinson, 2007). Whereas unhappy people appear to be relatively more sensitive to information carrying hedonic stakes, especially unpleasant ones (Lyubomirsky et al., 2011). What we attend to can shape our experiences. Attention is a most valuable instrument that serves as a telescope through which we select, bring into focus, and magnify the stimuli we experience in our world (Wallace, 1999). Carstensen's research about why emotional well-being increase as people get older suggested that older adults emphasize more on emotional goals that directs their attention away from negative information, and this attentional bias is linked to older adults' generally tendency to remember negative less well than positive information and their better emotional well-being (Mather and Carstensen, 2003). Wadlinger and Isaacowitz (2010) further specifically proposed that the experience of positive affect itself may increase individuals' selective attention preferences for positive information, and these broadened attention towards positive information may facilitate emotion regulation by helping individuals to attend to opportunities for reward in their environment. Individuals with such a positive view of the world enjoyed better life satisfaction and psychological well-being, including purpose in life, environmental mastery, and self-acceptance (Feist et al., 1995; Mak et al., 2011). It enlightens us that the attentional process may be the potential mechanism by which positive affect promote well-being. According to the cognitive model of depression, depressed people often possess a biased attention, biased processing, biased thoughts, rumination, biased memory, dysfunctional attitudes and schemas (Beck, 1987), they show selective attention to negative aspects of experiences, negative interpretations, and blocking of positive events and memories (Kellough et al., 2008). Research suggests that this specific bias in attention may result from inability to disengaged from negative stimuli, which also contribute to a ruminative response style that perpetuates negative thoughts about the self, the world and the future. This process instigates a feedback loop within the cognitive system that serves to initiate and maintain an episode of depression (Disner et al., 2011). Besides, Gotlib and colleagues based on the n-back task confirmed that never-disordered people disengaged from happy content significantly more slowly than they did from neutral or sad content, counter to the depressed individuals. Consider that almost 20% of individuals will be diagnosed with depression at least one time in their lifetime, and that these participants reported no lifetime psychopathology, the authors suggest that this “positive effect” may reflect a protective bias that underlies their ability to keep positive information active (Levens and Gotlib, 2010). Thus based on the above research, we speculate that happier individuals may have a dominant positive cognitive tendency of attending to positive information and have relatively impotent negative attention bias, which promotes their well-being, and ameliorates distress. Medical students are repeatedly found to sustain immense pressure. As Shah's research demonstrated, for example, mean perceived stress score (measured by the perceived stress scale,
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PSS-14) of 161 medical students was 30.84, over the cut off value of 28 (Shah et al., 2010). Moreover, beyond the general college experience, the first-year transition can be especially distressing— new living arrangements, greater academic demands, and the navigation of unknown social settings may all pose serious risks to first-years' adjustment and well-being (Ramler, 2014), and because of the poor coping capacity to deal with the new complex environments, medical freshmen are the most stressed (Abdulghani et al., 2011). Although appropriate stress can be salutary, the prolonged stresses and strains may cause emotional problems and deteriorate well-being when they fail to release, and thus resulting in depression or suicide (Mak et al., 2011). Previous studies reported that positive affect is negatively associated with psychological distress, and often predicts positive outcomes such as positive psychological function, effective coping and physical health (Layous et al., 2014; Mauss et al., 2011). Thus in order to protect our medical students, especially those medical freshmen away from the bad effects of the overwhelming stresses, it is meaningful to understand the possible mechanisms through which positive affect cause these positive change. And in the present study, this intermediary process was considered to be the attentional tendencies, and our aim was to test the mediating effect of positive and negative attentional biases between positive affect and wellbeing (both life satisfaction and psychological well-being), and the mediating effect of attentional bias between positive affect and depression.
2. Methods 2.1. Participants and procedure A total of 565 freshmen were recruited from a medical university in Chongqing China through systematic sampling method. Among them, 49% came from countryside, 51% came from urban areas, 54% were the only child in their family, 46% were the kids with siblings. Following the completion of informed consent forms, participants filled in a series of questionnaires including Positive and Negative Affect Schedule (PANAS), Satisfaction with Life Scale (SWLS), Ryff's Psychological Well-being Scales (RPWB), Center for Epidemiological Studies Depression Scale (CES-D), and Attention to Positive and Negative Information Scale (APNIS). Students were assessed collectively on the computer. The uniform instruction was used in the test, and the data were gathered on the spot. Total time for completion of the measures ranged from 40 to 55 min. This study was approved by the Ethics Committee of Third Military Medical University. 2.2. Measures 2.2.1. Positive and negative affect Positive and Negative Affect Schedule (PANAS) (Watson et al., 1988) has 20 adjectives that indicate positive affect and negative affect. This 20-item self-report questionnaire needs participants rate the extent of each mood state that they had experienced during a specified time frame on a five-point Likert scale ranging from 1 (very slightly or not at all) to 5 (very much). The internal consistency coefficient for our sample was 0.90. 2.2.2. Life satisfaction The validated Satisfaction with Life Scale (SWLS) (Diener et al., 1985) comprises 5 items, each item measures response on a sevenpoint Likert scale from 1 (strongly disagree) to 7 (strongly agree). Total scores range from 5 to 35, with higher scores indicating greater perceived life satisfaction. Cronbach alpha value for our
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sample was 0.88. 2.2.3. Psychological well-being The validated Chinese version of Ryff's Scales of Psychological Well-being (RPWB) (Li, 2014) includes 18 questions and covers 6 factors, namely Positive Relations with Others, Environmental Mastery, Self-Acceptance, Purpose in Life, Autonomy, and Personal Growth. Each question measures response on a six-point Likert scale from 1 (strongly disagree) to 6 (strongly agree), total scores ranging from 18 to 108, with higher scores indicating greater psychological well-being. In our sample, Cronbach alpha estimates of the six dimension range from 0.53 to 0.80. 2.2.4. Depression The validated Center for Epidemiological Studies Depression Scale (CES-D) (Rankin and Galbraith, 1993) was used in this study. It is a 20-item scale widely used in studies of the epidemiology of depressive symptomatology in the general population. Participants rate the frequency of occurrence of the symptom on a fourpoint Likert scale from 0 to 3 to measure current level of depressive symptomatology, with emphasis on the affective component, depressed mood. Cronbach alpha estimate for our sample was 0.79. 2.2.5. Attentional bias The Attention to Positive and Negative Information Scale (APNIS) (Noguchi et al., 2006) was used in this study. This scale includes 26 questions. It is administrated to assess an individual's positive and negative attentional tendencies to themselves and others. Each item measures response on a five-point Likert scale from 1 (very untrue of me) to 5 (very true of me). In our sample, Cronbach alpha estimates of the attention to positive information (API) and the attention to negative information (ANI) were 0.77 and 0.70 respectively. 2.3. Statistical analyses Descriptive statistics and correlation analyses of six variables (positive affect, attention to positive information, attention to negative information, life satisfaction, psychological well-being, and depression symptoms) were performed using SPSS 19.0 Software. And in order to diagnose multicollinearity, the variance inflection factor (VIF) was calculated. The mediation model mentioned in the introduction was tested with structural equation modeling by AMOS 17.0 Software to examine the impact of positive affect in the adoption of attentional bias on well-being (both life satisfaction and psychological well-being) and depression. To evaluate the overall model fit, we used indexes including CMIN/DF (a value between 1and 3 indicate acceptable fit between hypothetical model with sample data), adjusted goodness-of-fit
index (AGFI, a value greater than 0.90 indicate acceptable model fit) (Hu and Bentler, 1999), and root-mean-square error of approximation (RMSEA, a value between 0.05 and 0.08 reflects reasonable model fit) (Browne and Cudeck, 1992).
3. Results 3.1. Descriptive statistics and intercorrelations Table 1 shows means, standard deviations, and correlations for all variables. Attention to negative information (negative attentional bias) was positively correlated with depression, while negatively correlated with positive affect, psychological well-being and life satisfaction. On the contrary, attention to positive information (positive attentional bias) was negatively correlated with depression and positively correlated with positive affect, psychological well-being and life satisfaction. Besides, positive affect was negatively correlated with depression and positively correlated with psychological well-being and life satisfaction. The significance of the multicollinearity problems among main study variables was checked. The results showed that VIFs varied from 1.354 to 2.285, well below the cut-off VIF value of 10 as recommended (Neter et al., 1985). The above findings approved the hypothesized relations and allowed for further analyses to examine the hypothesized mediation model. 3.2. Mediation model of attentional bias on positive affect promoting well-being and relieving depression Results of structural equation modeling showed that the overall model yielded a satisfactory fit, CMIN/DF ¼2.960, AGFI¼0.964, RMSEA¼ 0.059. All specific indirect effects via the attentional tendencies on Psychological well-being, life satisfaction and depression were significant (see Fig. 1). Particularly, negative attentional bias partially mediates the relationship between positive affect and life satisfaction (unstandardized indirect effect ¼0.10, standardized indirect effect ¼0.10, po 0.001), psychological wellbeing (unstandardized indirect effect ¼0.09, standardized indirect effect ¼ 0.06, p o0.001), and depression (unstandardized indirect effect ¼ 0.10, standardized indirect effect ¼ 0.11, p o0.001). The indirect effect of negative attentional bias accounted for 17.13% of the total effect of positive affect on life satisfaction, 20.44% of the total effect of positive affect on depression, and 9.07% of the total effect of positive affect on psychological well-being. On the other hand, positive attentional bias partially mediates the relationship between positive affect and life satisfaction (unstandardized indirect effect ¼0.14, standardized indirect effect ¼0.14, po 0.001), psychological well-being (unstandardized indirect effect ¼ 0.30, standardized indirect effect ¼0.20, p o0.001), and depression
Table 1 Means, standard deviations, and correlations for all variables (n¼ 565).
1. Attention to negative information 2. Attention to positive information 3. Depression 4. Positive affect 5. Negative affect 6. Psychological well-being 7. Life satisfaction M SD Note: M—means. SD—standard deviation. nnn
Significant at 0.001 level.
1
2
– 0.205nnn 0.485nnn 0.402nnn 0.521nnn 0.396nnn 0.459nnn 29.29 6.12
– 0.431nnn 0.552nnn 0.434nnn 0.621nnn 0.507nnn 67.36 5.53
3
4
5
6
7
– 0.620nnn 0.670nnn 0.530nnn 0.684nnn 4.14 5.39
– 0.512nnn 0.660nnn 0.607nnn 39.27 6.1
– 0.474nnn 0.551nnn 14.81 4.36
– 0.592 89.73 8.77
– 26.66 6.12
Y. Xu et al. / Psychiatry Research 228 (2015) 482–487
485 .47
SWLS
e1
-.26 .25 .36
e4
-.40
ANI
.28
.46
-.43
PA .55
e5
-.41
.16
.30
e2
CESD
.15
-.13
API
-.16
.37 .39
.55 RPWB
e3
Fig. 1. Attentional bias mediates the association between positive affect and life satisfaction, psychological well-being, as well as depression. Standardized path coefficients are shown, and all of them are significant at the 0.001 level. PA— Positive Affect; ANI—Attention to Negative Information; API—Attention to Positive Information; SWLS— Satisfaction with Life Scale; RPWB—Ryff's Psychological Well-being Scale; CESD—Center for Epidemiological Studies Depression Scale. Table 2 Unstandardized and standardized loadings for the hypothesized structural model. Parameter estimate
Unstandardized
Standardized
PA-API PA-ANI API-SWLS API-RPWB API-CES-D ANI-SWLS ANI-RPWB ANI-CES-D
0.500(0.032)nnn 0.403(0.039)nnn 0.281(0.040)nnn 0.591(0.054)nnn 0.131(0.036)nnn 0.262(0.033)nnn 0.234(0.044)nnn 0.250(0.030)nnn
0.552nnn 0.402nnn 0.255nnn 0.373nnn 0.134nnn 0.263nnn 0.163nnn 0.283nnn
Note:nnn
Significant at 0.001 level.
(unstandardized indirect effect ¼ 0.07, standardized indirect effect ¼ 0.07, p o0.001). The indirect effect of positive attentional bias accounted for 22.65% of the total effect of positive affect on life satisfaction, 13.05% of the total effect of positive affect on depression, and 30.83% of the total effect of positive affect on psychological well-being. Unstandardized and standardized loadings for the hypothesized structural model are shown in Table 2.
4. Discussion Previous research has reported the strong relationships of positive affect with well-being and depression (Fredrickson, 2013; Garland et al., 2010; Kuppens et al., 2008; Layous et al., 2014; Lyubomirsky et al., 2005; Mauss et al., 2011). Yet few studies have directly examined their relationships with an explicit attempt to tie them together, and further analyze the potential mediating role of attentional bias. Our findings together demonstrated the possible attentional mechanism by which positive affect promotes well-being (both life satisfaction and psychological well-being) and alleviates depression. On the one hand, positive affect is positively related to attentional bias to positive information, and by enhancing the positive attentional tendency to the self and others, positive affect may contribute to improve individuals' life satisfaction and psychological well-being. This is consistent with previous studies reporting that happier people are often characterized with a greater attentional bias for positive stimuli (Segerstrom, 2001; Tamir and Robinson, 2007). Since what we attend to can shape what we experience in the world, the broaden attention towards positive
information can help people to see more opportunities of reward in their environment (Wadlinger and Isaacowitz, 2010), solicit external support from others and adopt more active coping strategies to face the adversity instead of treat it as threatening (Mak et al., 2011), which enable individuals to enjoy better subjective and psychological well-being, experience less depression (Feist et al., 1995; Mak et al., 2011). On the other hand, since the undoing hypothesis of positive affect suggested that positive affect can serve as particularly efficient antidotes for the lingering effects of negative emotions, might “correct” or “undo” the aftereffects of negative emotions (Fredrickson, 2000), we speculated that positive affect could reduce the negative cognitive bias induced by negative affect, thus contribute to alleviated psychological distress, and improve the life satisfaction and psychological well-being. The results confirmed the viewpoint that the decrease of individuals' negative attentional bias indeed partially mediated the effects of between positive affect on subjective well-being and psychological well-being. The inability to allocate attention to appropriate emotional cues is central to the negative cognitive model. People with depression are prone to selectively attend to mood-congruent stimuli (Kellough et al., 2008), which facilitate the biased processing and biased memory for emotional internal or external stimuli (Disner et al., 2011), and lead to the repeated experience of sadness and trigger the downward spirals to mental disorder (Garland et al., 2010). Therefore, with the decrease of negative attentional bias, more positive information will be brought into processing and memory, thus change the original cognitive model, and improve depression. The resulting relief of depressive symptoms will then prevent the reinforcement of the self-referential schema, and in turn impact individual's belief in its depressive elements. This virtuous circle could contribute to counter the downward spirals of negativity and trigger upward spirals toward greater well-being. Additionally, according to the Structural Equation Model, it is found that there is a very small mediating effect of negative attentional bias between positive affect and psychological wellbeing (The indirect effect of negative attentional bias accounted for 9.07% of the total effect of positive affect on psychological wellbeing). It seems that the decrease of negative attentional bias has very little contribute to the promotion of psychological well-being. This could be explained when we gain an insight into the definition of psychological well-being. Psychological well-being has a deep philosophical roots which could date back to the ancient
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Greeks, and resided in Aristotle’s formulation of the highest human good, namely, eudaimonia (Ryff, 2013). According to eudaimonia, well-being does not simply refers to happiness, feeling good or satisfying (i.e. subjective well-being). It is about the realization of self-potential and value (Ryff and Singer, 2006). Thus, the decrease of negative attentional bias may not play a relatively important role in enhancing psychological well-being. It is easier for medical freshmen to fall into psychological distress and impair their well-being in the face of tremendous pressure from environmental maladaptation, heavy academic stress, and unreasonable expectations from parents (Abdulghani et al., 2011). As Layous has suggested that the cultivation of positive affect can moderate these detrimental effects and often predict positive outcomes, a mountain of research have developed numerous interventions to increase positive affect (Gander et al., 2013; Jazaieri et al., 2013). Since the present study revealed that positive and negative attentional bias play an crucial mediating role in the effect of positive affect on depression and well-being, it is important for our counselors and educators to take the regulation of attentional bias into account during their counseling service and classes. The various attentional bias training had been successfully applied to prevent depression and improve well-being (Baert et al., 2010; Wadlinger and Isaacowitz, 2010; Wells and Beevers, 2010). For example, Wells and Beevers (2010) have investigated a 4-session attentional retraining in dysphoric students with mild to moderate symptom severity, and after the 2-week training, participants in the training condition reported significantly less depressive symptoms compares to the no-training condition immediately after training as well as at follow-up 2 weeks later. In addition, various meditation practice have been reported possess the most potential effect on maladaptive rumination as well as modifying a broad range of emotion regulation (Wadlinger and Isaacowitz, 2010). These interventions may act as the preventive strategies that can protect our students against various mental disorder, promote positive psychosomatic development. Thus based on the current results, we suggest our counselors and educators focus on the regulation of attentional bias when we equip our medical students with more positive affect to prevent they burn out due to the tremendous psychological stress. However, there were several limitations of the present study should be noted. One point of concern is the use of a specific sample. This study based on the data of 565 Chinese medical freshmen, so a much more complex sampling is needed across different countries to examine the attentional mechanism by which positive affect promotes well-being and alleviates depression in future studies. Second, the use of all self-reported measures make the present research inevitably possess definite subjectivity. Further research should rely on some other assessment methods, such as peer-reports, objective outcomes and so on. Finally, since the data is collected at the same time, the present research fail to infer that the change of the attentional bias could causally lead to the latter improvement of well-being and depression. A better research design that allows causal influence should be taken into careful consideration in the following research.
Acknowledgments The authors sincerely thank Renhau li for providing us with original shorter Chinese version of Ryff's psychological well-being scale. we also thank all the participants for their cooperation. this study was financially supported by National Natural Science Foundation of China (No. 31170994), National Social Science Foundation of China (No. 14CSH072) and Military Mental Health Research Foundation of PLA (Nos. 12XLZ212 and CWS11J049).
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Positive affect promotes well-being and alleviates depression: The mediating effect of attentional bias Yuanyuan Xu, Yongju Yu, Yuanjun Xie, Li Peng, Botao Liu, Junrun Xie, Chen Bian, Min Li n Department of Military Psychology, College of Psychology, Third Military Medical University, Chongqing, China
art ic l e i nf o
a b s t r a c t
Article history: Received 16 March 2015 Received in revised form 8 June 2015 Accepted 17 June 2015 Available online 25 June 2015
The present study tested whether the relationships among positive affect, psychological well-being, life satisfaction and depression could be explained by positive and negative attentional bias. Structural equation modeling and mediation analyses were conducted based on 565 medical freshmen in China. The model of attentional bias as a mediator between positive affect promoting well-being and decreasing depression fit the data. Finding showed positive affect significantly related to positive and negative attentional biases. People who had higher level of positive affect held more positive attentional bias and less negative attentional bias, and reported higher levels of psychological well-being, life satisfaction and lower levels of depression. The utility of the attentional bias as the mechanism through which positive affect enhances well-being and alleviates depression was supported. Applications in cultivating positive affect and regulating attentional bias in counseling and education are discussed. & 2015 Elsevier Ireland Ltd. All rights reserved.
Keywords: Positive affect Attentional bias well-being medical freshmen
1. Introduction There is a long history in psychological research which has examined the relationship between positive affect and well-being. Numerous studies have provided evidence for the positive relationship between positive affect and well-being (Kuppens et al., 2008; Layous et al., 2014; Lyubomirsky et al., 2005; Mauss et al., 2011). For example, In a meta-analysis of 225 studies of positive affect and success in life, Lyubomirsky and his colleagues concluded that positive affect is valuable for more than just feeling good, it can foster successful outcomes in a variety of life domains, including relatively better job satisfaction (show superior performance and productivity, get more income and less likely to show “job withdrawal”), enhanced social relationships (have more friends, stronger social support networks and show more marital satisfaction), and better mental and physical health (Lyubomirsky et al., 2005). Consistently, based on data from 46 countries, Kuppens's research clearly showed that the positive correlation between positive affect and life satisfaction processes a transnational congruence (Kuppens et al., 2008). On the other hand, evidence suggested that happy people were relatively less likely to engage in rumination (Lyubomirsky et al., 2011), and the novel ideas and actions (e.g., the urge to play and explore) brought by the broadened mindsets have been approved n
Corresponding author. Fax: þ86 23 68752360/68752925. E-mail address: [email protected] (M. Li).
http://dx.doi.org/10.1016/j.psychres.2015.06.011 0165-1781/& 2015 Elsevier Ireland Ltd. All rights reserved.
to alleviate depression, since the relatively higher levels of approach-oriented motivation are associated with less severe depression and a greater likelihood of recovery (Sin et al., 2011). Recent research confirmed that army wives who experienced more positive affect during deployment likely experienced fewer depressive symptoms during reunion. That is, individuals who experience positive affect have access to a larger repertoire of coping resources that they can use in creative and flexible ways, which lends to better stress management (Dolphin et al., 2015). Beyond this, the undoing hypothesis of positive affect proposed that positive affect can serve as particularly efficient antidotes for the lingering effects of negative emotions, it might “correct” or “undo” the aftereffects of negative emotions (Fredrickson, 2013). From the research of Fredrickson (Fredrickson and Levenson, 1998), when viewed against the backdrop of pronounced negative emotional arousal, the positive affect clearly stood out in their ability to “undo” lingering cardiovascular activation. That is to say, the difference in positive emotionality accounts for their increased ability to bounce back from adversity, avoid depression, and thrive (Garland et al., 2010). Although the significant relationships among positive affect, well-being and depression have been approved by large empirical literature, few of them have directly tied these variables together to examine the possible intermediary processes. The broaden-andbuild model suggest that positive affect can broaden an individual's thought-action repertoire, thereby promoting the expansion of attention and encouraging play and exploration. In
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turn, these broadening behaviors build lasting resources and heightened well-being (Fredrickson and Branigan, 2005). Based on this model, Wadlinger and his colleagues further confirmed that induced positive mood is indeed related to attentional broadening, but only for positive and neutral stimuli. Thus, it appears that individuals with induced positive mood states generally pay more attention to positive stimuli (Wadlinger and Isaacowitz, 2006). Consistently, Segerstrom indicated that individuals with high level of positive affect are often characterized with a greater attentional bias for positive stimuli relative to negative stimuli (Segerstrom, 2001). Tamir and Robinson found that the induction of positive moods resulted in attentional bias toward positive, rewarding words in a dot probe task (Tamir and Robinson, 2007). Whereas unhappy people appear to be relatively more sensitive to information carrying hedonic stakes, especially unpleasant ones (Lyubomirsky et al., 2011). What we attend to can shape our experiences. Attention is a most valuable instrument that serves as a telescope through which we select, bring into focus, and magnify the stimuli we experience in our world (Wallace, 1999). Carstensen's research about why emotional well-being increase as people get older suggested that older adults emphasize more on emotional goals that directs their attention away from negative information, and this attentional bias is linked to older adults' generally tendency to remember negative less well than positive information and their better emotional well-being (Mather and Carstensen, 2003). Wadlinger and Isaacowitz (2010) further specifically proposed that the experience of positive affect itself may increase individuals' selective attention preferences for positive information, and these broadened attention towards positive information may facilitate emotion regulation by helping individuals to attend to opportunities for reward in their environment. Individuals with such a positive view of the world enjoyed better life satisfaction and psychological well-being, including purpose in life, environmental mastery, and self-acceptance (Feist et al., 1995; Mak et al., 2011). It enlightens us that the attentional process may be the potential mechanism by which positive affect promote well-being. According to the cognitive model of depression, depressed people often possess a biased attention, biased processing, biased thoughts, rumination, biased memory, dysfunctional attitudes and schemas (Beck, 1987), they show selective attention to negative aspects of experiences, negative interpretations, and blocking of positive events and memories (Kellough et al., 2008). Research suggests that this specific bias in attention may result from inability to disengaged from negative stimuli, which also contribute to a ruminative response style that perpetuates negative thoughts about the self, the world and the future. This process instigates a feedback loop within the cognitive system that serves to initiate and maintain an episode of depression (Disner et al., 2011). Besides, Gotlib and colleagues based on the n-back task confirmed that never-disordered people disengaged from happy content significantly more slowly than they did from neutral or sad content, counter to the depressed individuals. Consider that almost 20% of individuals will be diagnosed with depression at least one time in their lifetime, and that these participants reported no lifetime psychopathology, the authors suggest that this “positive effect” may reflect a protective bias that underlies their ability to keep positive information active (Levens and Gotlib, 2010). Thus based on the above research, we speculate that happier individuals may have a dominant positive cognitive tendency of attending to positive information and have relatively impotent negative attention bias, which promotes their well-being, and ameliorates distress. Medical students are repeatedly found to sustain immense pressure. As Shah's research demonstrated, for example, mean perceived stress score (measured by the perceived stress scale,
483
PSS-14) of 161 medical students was 30.84, over the cut off value of 28 (Shah et al., 2010). Moreover, beyond the general college experience, the first-year transition can be especially distressing— new living arrangements, greater academic demands, and the navigation of unknown social settings may all pose serious risks to first-years' adjustment and well-being (Ramler, 2014), and because of the poor coping capacity to deal with the new complex environments, medical freshmen are the most stressed (Abdulghani et al., 2011). Although appropriate stress can be salutary, the prolonged stresses and strains may cause emotional problems and deteriorate well-being when they fail to release, and thus resulting in depression or suicide (Mak et al., 2011). Previous studies reported that positive affect is negatively associated with psychological distress, and often predicts positive outcomes such as positive psychological function, effective coping and physical health (Layous et al., 2014; Mauss et al., 2011). Thus in order to protect our medical students, especially those medical freshmen away from the bad effects of the overwhelming stresses, it is meaningful to understand the possible mechanisms through which positive affect cause these positive change. And in the present study, this intermediary process was considered to be the attentional tendencies, and our aim was to test the mediating effect of positive and negative attentional biases between positive affect and wellbeing (both life satisfaction and psychological well-being), and the mediating effect of attentional bias between positive affect and depression.
2. Methods 2.1. Participants and procedure A total of 565 freshmen were recruited from a medical university in Chongqing China through systematic sampling method. Among them, 49% came from countryside, 51% came from urban areas, 54% were the only child in their family, 46% were the kids with siblings. Following the completion of informed consent forms, participants filled in a series of questionnaires including Positive and Negative Affect Schedule (PANAS), Satisfaction with Life Scale (SWLS), Ryff's Psychological Well-being Scales (RPWB), Center for Epidemiological Studies Depression Scale (CES-D), and Attention to Positive and Negative Information Scale (APNIS). Students were assessed collectively on the computer. The uniform instruction was used in the test, and the data were gathered on the spot. Total time for completion of the measures ranged from 40 to 55 min. This study was approved by the Ethics Committee of Third Military Medical University. 2.2. Measures 2.2.1. Positive and negative affect Positive and Negative Affect Schedule (PANAS) (Watson et al., 1988) has 20 adjectives that indicate positive affect and negative affect. This 20-item self-report questionnaire needs participants rate the extent of each mood state that they had experienced during a specified time frame on a five-point Likert scale ranging from 1 (very slightly or not at all) to 5 (very much). The internal consistency coefficient for our sample was 0.90. 2.2.2. Life satisfaction The validated Satisfaction with Life Scale (SWLS) (Diener et al., 1985) comprises 5 items, each item measures response on a sevenpoint Likert scale from 1 (strongly disagree) to 7 (strongly agree). Total scores range from 5 to 35, with higher scores indicating greater perceived life satisfaction. Cronbach alpha value for our
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sample was 0.88. 2.2.3. Psychological well-being The validated Chinese version of Ryff's Scales of Psychological Well-being (RPWB) (Li, 2014) includes 18 questions and covers 6 factors, namely Positive Relations with Others, Environmental Mastery, Self-Acceptance, Purpose in Life, Autonomy, and Personal Growth. Each question measures response on a six-point Likert scale from 1 (strongly disagree) to 6 (strongly agree), total scores ranging from 18 to 108, with higher scores indicating greater psychological well-being. In our sample, Cronbach alpha estimates of the six dimension range from 0.53 to 0.80. 2.2.4. Depression The validated Center for Epidemiological Studies Depression Scale (CES-D) (Rankin and Galbraith, 1993) was used in this study. It is a 20-item scale widely used in studies of the epidemiology of depressive symptomatology in the general population. Participants rate the frequency of occurrence of the symptom on a fourpoint Likert scale from 0 to 3 to measure current level of depressive symptomatology, with emphasis on the affective component, depressed mood. Cronbach alpha estimate for our sample was 0.79. 2.2.5. Attentional bias The Attention to Positive and Negative Information Scale (APNIS) (Noguchi et al., 2006) was used in this study. This scale includes 26 questions. It is administrated to assess an individual's positive and negative attentional tendencies to themselves and others. Each item measures response on a five-point Likert scale from 1 (very untrue of me) to 5 (very true of me). In our sample, Cronbach alpha estimates of the attention to positive information (API) and the attention to negative information (ANI) were 0.77 and 0.70 respectively. 2.3. Statistical analyses Descriptive statistics and correlation analyses of six variables (positive affect, attention to positive information, attention to negative information, life satisfaction, psychological well-being, and depression symptoms) were performed using SPSS 19.0 Software. And in order to diagnose multicollinearity, the variance inflection factor (VIF) was calculated. The mediation model mentioned in the introduction was tested with structural equation modeling by AMOS 17.0 Software to examine the impact of positive affect in the adoption of attentional bias on well-being (both life satisfaction and psychological well-being) and depression. To evaluate the overall model fit, we used indexes including CMIN/DF (a value between 1and 3 indicate acceptable fit between hypothetical model with sample data), adjusted goodness-of-fit
index (AGFI, a value greater than 0.90 indicate acceptable model fit) (Hu and Bentler, 1999), and root-mean-square error of approximation (RMSEA, a value between 0.05 and 0.08 reflects reasonable model fit) (Browne and Cudeck, 1992).
3. Results 3.1. Descriptive statistics and intercorrelations Table 1 shows means, standard deviations, and correlations for all variables. Attention to negative information (negative attentional bias) was positively correlated with depression, while negatively correlated with positive affect, psychological well-being and life satisfaction. On the contrary, attention to positive information (positive attentional bias) was negatively correlated with depression and positively correlated with positive affect, psychological well-being and life satisfaction. Besides, positive affect was negatively correlated with depression and positively correlated with psychological well-being and life satisfaction. The significance of the multicollinearity problems among main study variables was checked. The results showed that VIFs varied from 1.354 to 2.285, well below the cut-off VIF value of 10 as recommended (Neter et al., 1985). The above findings approved the hypothesized relations and allowed for further analyses to examine the hypothesized mediation model. 3.2. Mediation model of attentional bias on positive affect promoting well-being and relieving depression Results of structural equation modeling showed that the overall model yielded a satisfactory fit, CMIN/DF ¼2.960, AGFI¼0.964, RMSEA¼ 0.059. All specific indirect effects via the attentional tendencies on Psychological well-being, life satisfaction and depression were significant (see Fig. 1). Particularly, negative attentional bias partially mediates the relationship between positive affect and life satisfaction (unstandardized indirect effect ¼0.10, standardized indirect effect ¼0.10, po 0.001), psychological wellbeing (unstandardized indirect effect ¼0.09, standardized indirect effect ¼ 0.06, p o0.001), and depression (unstandardized indirect effect ¼ 0.10, standardized indirect effect ¼ 0.11, p o0.001). The indirect effect of negative attentional bias accounted for 17.13% of the total effect of positive affect on life satisfaction, 20.44% of the total effect of positive affect on depression, and 9.07% of the total effect of positive affect on psychological well-being. On the other hand, positive attentional bias partially mediates the relationship between positive affect and life satisfaction (unstandardized indirect effect ¼0.14, standardized indirect effect ¼0.14, po 0.001), psychological well-being (unstandardized indirect effect ¼ 0.30, standardized indirect effect ¼0.20, p o0.001), and depression
Table 1 Means, standard deviations, and correlations for all variables (n¼ 565).
1. Attention to negative information 2. Attention to positive information 3. Depression 4. Positive affect 5. Negative affect 6. Psychological well-being 7. Life satisfaction M SD Note: M—means. SD—standard deviation. nnn
Significant at 0.001 level.
1
2
– 0.205nnn 0.485nnn 0.402nnn 0.521nnn 0.396nnn 0.459nnn 29.29 6.12
– 0.431nnn 0.552nnn 0.434nnn 0.621nnn 0.507nnn 67.36 5.53
3
4
5
6
7
– 0.620nnn 0.670nnn 0.530nnn 0.684nnn 4.14 5.39
– 0.512nnn 0.660nnn 0.607nnn 39.27 6.1
– 0.474nnn 0.551nnn 14.81 4.36
– 0.592 89.73 8.77
– 26.66 6.12
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485 .47
SWLS
e1
-.26 .25 .36
e4
-.40
ANI
.28
.46
-.43
PA .55
e5
-.41
.16
.30
e2
CESD
.15
-.13
API
-.16
.37 .39
.55 RPWB
e3
Fig. 1. Attentional bias mediates the association between positive affect and life satisfaction, psychological well-being, as well as depression. Standardized path coefficients are shown, and all of them are significant at the 0.001 level. PA— Positive Affect; ANI—Attention to Negative Information; API—Attention to Positive Information; SWLS— Satisfaction with Life Scale; RPWB—Ryff's Psychological Well-being Scale; CESD—Center for Epidemiological Studies Depression Scale. Table 2 Unstandardized and standardized loadings for the hypothesized structural model. Parameter estimate
Unstandardized
Standardized
PA-API PA-ANI API-SWLS API-RPWB API-CES-D ANI-SWLS ANI-RPWB ANI-CES-D
0.500(0.032)nnn 0.403(0.039)nnn 0.281(0.040)nnn 0.591(0.054)nnn 0.131(0.036)nnn 0.262(0.033)nnn 0.234(0.044)nnn 0.250(0.030)nnn
0.552nnn 0.402nnn 0.255nnn 0.373nnn 0.134nnn 0.263nnn 0.163nnn 0.283nnn
Note:nnn
Significant at 0.001 level.
(unstandardized indirect effect ¼ 0.07, standardized indirect effect ¼ 0.07, p o0.001). The indirect effect of positive attentional bias accounted for 22.65% of the total effect of positive affect on life satisfaction, 13.05% of the total effect of positive affect on depression, and 30.83% of the total effect of positive affect on psychological well-being. Unstandardized and standardized loadings for the hypothesized structural model are shown in Table 2.
4. Discussion Previous research has reported the strong relationships of positive affect with well-being and depression (Fredrickson, 2013; Garland et al., 2010; Kuppens et al., 2008; Layous et al., 2014; Lyubomirsky et al., 2005; Mauss et al., 2011). Yet few studies have directly examined their relationships with an explicit attempt to tie them together, and further analyze the potential mediating role of attentional bias. Our findings together demonstrated the possible attentional mechanism by which positive affect promotes well-being (both life satisfaction and psychological well-being) and alleviates depression. On the one hand, positive affect is positively related to attentional bias to positive information, and by enhancing the positive attentional tendency to the self and others, positive affect may contribute to improve individuals' life satisfaction and psychological well-being. This is consistent with previous studies reporting that happier people are often characterized with a greater attentional bias for positive stimuli (Segerstrom, 2001; Tamir and Robinson, 2007). Since what we attend to can shape what we experience in the world, the broaden attention towards positive
information can help people to see more opportunities of reward in their environment (Wadlinger and Isaacowitz, 2010), solicit external support from others and adopt more active coping strategies to face the adversity instead of treat it as threatening (Mak et al., 2011), which enable individuals to enjoy better subjective and psychological well-being, experience less depression (Feist et al., 1995; Mak et al., 2011). On the other hand, since the undoing hypothesis of positive affect suggested that positive affect can serve as particularly efficient antidotes for the lingering effects of negative emotions, might “correct” or “undo” the aftereffects of negative emotions (Fredrickson, 2000), we speculated that positive affect could reduce the negative cognitive bias induced by negative affect, thus contribute to alleviated psychological distress, and improve the life satisfaction and psychological well-being. The results confirmed the viewpoint that the decrease of individuals' negative attentional bias indeed partially mediated the effects of between positive affect on subjective well-being and psychological well-being. The inability to allocate attention to appropriate emotional cues is central to the negative cognitive model. People with depression are prone to selectively attend to mood-congruent stimuli (Kellough et al., 2008), which facilitate the biased processing and biased memory for emotional internal or external stimuli (Disner et al., 2011), and lead to the repeated experience of sadness and trigger the downward spirals to mental disorder (Garland et al., 2010). Therefore, with the decrease of negative attentional bias, more positive information will be brought into processing and memory, thus change the original cognitive model, and improve depression. The resulting relief of depressive symptoms will then prevent the reinforcement of the self-referential schema, and in turn impact individual's belief in its depressive elements. This virtuous circle could contribute to counter the downward spirals of negativity and trigger upward spirals toward greater well-being. Additionally, according to the Structural Equation Model, it is found that there is a very small mediating effect of negative attentional bias between positive affect and psychological wellbeing (The indirect effect of negative attentional bias accounted for 9.07% of the total effect of positive affect on psychological wellbeing). It seems that the decrease of negative attentional bias has very little contribute to the promotion of psychological well-being. This could be explained when we gain an insight into the definition of psychological well-being. Psychological well-being has a deep philosophical roots which could date back to the ancient
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Greeks, and resided in Aristotle’s formulation of the highest human good, namely, eudaimonia (Ryff, 2013). According to eudaimonia, well-being does not simply refers to happiness, feeling good or satisfying (i.e. subjective well-being). It is about the realization of self-potential and value (Ryff and Singer, 2006). Thus, the decrease of negative attentional bias may not play a relatively important role in enhancing psychological well-being. It is easier for medical freshmen to fall into psychological distress and impair their well-being in the face of tremendous pressure from environmental maladaptation, heavy academic stress, and unreasonable expectations from parents (Abdulghani et al., 2011). As Layous has suggested that the cultivation of positive affect can moderate these detrimental effects and often predict positive outcomes, a mountain of research have developed numerous interventions to increase positive affect (Gander et al., 2013; Jazaieri et al., 2013). Since the present study revealed that positive and negative attentional bias play an crucial mediating role in the effect of positive affect on depression and well-being, it is important for our counselors and educators to take the regulation of attentional bias into account during their counseling service and classes. The various attentional bias training had been successfully applied to prevent depression and improve well-being (Baert et al., 2010; Wadlinger and Isaacowitz, 2010; Wells and Beevers, 2010). For example, Wells and Beevers (2010) have investigated a 4-session attentional retraining in dysphoric students with mild to moderate symptom severity, and after the 2-week training, participants in the training condition reported significantly less depressive symptoms compares to the no-training condition immediately after training as well as at follow-up 2 weeks later. In addition, various meditation practice have been reported possess the most potential effect on maladaptive rumination as well as modifying a broad range of emotion regulation (Wadlinger and Isaacowitz, 2010). These interventions may act as the preventive strategies that can protect our students against various mental disorder, promote positive psychosomatic development. Thus based on the current results, we suggest our counselors and educators focus on the regulation of attentional bias when we equip our medical students with more positive affect to prevent they burn out due to the tremendous psychological stress. However, there were several limitations of the present study should be noted. One point of concern is the use of a specific sample. This study based on the data of 565 Chinese medical freshmen, so a much more complex sampling is needed across different countries to examine the attentional mechanism by which positive affect promotes well-being and alleviates depression in future studies. Second, the use of all self-reported measures make the present research inevitably possess definite subjectivity. Further research should rely on some other assessment methods, such as peer-reports, objective outcomes and so on. Finally, since the data is collected at the same time, the present research fail to infer that the change of the attentional bias could causally lead to the latter improvement of well-being and depression. A better research design that allows causal influence should be taken into careful consideration in the following research.
Acknowledgments The authors sincerely thank Renhau li for providing us with original shorter Chinese version of Ryff's psychological well-being scale. we also thank all the participants for their cooperation. this study was financially supported by National Natural Science Foundation of China (No. 31170994), National Social Science Foundation of China (No. 14CSH072) and Military Mental Health Research Foundation of PLA (Nos. 12XLZ212 and CWS11J049).
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