Caring for an autistic child has been linked with poorer prospective memory (PM). However, potential underlying cerebrovascular mechanisms have not been examined. Here we explore whether variations in prefrontal hemodynamic activity, assessed using near-infrared spectroscopy (NIRS), might underlie caregiver related differences in PM failures. A total of 37 participants, of which 19 were caregivers of autistic children and 18 were parents of non-autistic children, completed an objective PM task in the lab. Cerebrovascular activity, measured via oxygenated (Oxy-Hb), deoxygenated (Deoxy-Hb), and total (Total-Hb) haemoglobin, was assessed at baseline and during the PM task. Relative change from baseline was calculated for all indices. Caregivers performed poorer on the PM task, recalling fewer items. However, groups could not be differentiated on cerebrovascular activity. Moreover, cerebrovascular change did not predict PM failures, ruling out mediation effects. Caring for an autistic child was associated with poorer PM. However, caregivers’ poorer PM was not mediated by reduced prefrontal hemodynamic response. Whether caregivers’ PM failures might detrimentally affect quality of provided care should be explored. However, findings reported here should be deemed preliminary, and conclusions from these findings tempered, until consolidated with adequate statistical power.

Gratitude interventions are known to increase subjective wellbeing. However, it has also been suggested that not everyone experiences equivalent benefits of engaging with gratitude activities, and there have been calls to better understand the moderators of such effects. In Study 1, we explored the effects of writing a gratitude letter, relative to a neutral letter, on changes in positive and negative affect, and observed that the effect of gratitude writing on positive affect was exacerbated in participants with elevated life satisfaction. Study 2 sought to replicate the findings of Study 1 whilst minimising demand characteristics, but failed to observe the moderating effect of life satisfaction. In Study 3, we sought to investigate whether these mixed findings could be explained by demand characteristics. We observed that priming participants with information about the benefits of expressing gratitude ameliorated the effect of gratitude writing on positive affect, but life satisfaction did not moderate this priming effect. On the basis of the findings from these three studies, we conclude that life satisfaction does not moderate the effect of gratitude writing on positive affect, but further work should be undertaken to better understand the conditions under which gratitude writing is most effective. Further, we suggest that demand characteristics are an important consideration for both researchers and interventionists delivering gratitude interventions.

Positive expressive writing has been increasingly researched over the past two decades due to its potential to serve as a low-intensity psychological self-help intervention. However, studies are heterogeneous in their methodologies and the health and wellbeing outcomes targeted, and it is unclear which outcomes are most reliably benefited by positive writing techniques. This systematic review aimed to determine the optimal conditions under which positive expressive writing interventions benefit subjective health and wellbeing in non-clinical populations. A systematic search was conducted across four databases (Web of Science, Scopus, PubMed, and ProQuest: APA PsychArticles) identifying peer-reviewed articles written in the English language from 1930 to August 2023. A total of 51 studies were identified and included seven different positive writing techniques: best possible self, positive experiences, gratitude, benefit finding, satisfaction processes, three good things and resource diary. Most consistent benefits were found for wellbeing and positive affect outcomes (e.g., optimism, happiness) whereas less consistent effects were reported for negative affect, psychological health (e.g., stress, anxiety) and physical health outcomes. Best possible self and gratitude interventions revealed most consistent benefits. Several moderators were identified indicating that benefits may depend on individual differences relating to wellbeing, emotional and social factors. While reasonably consistent benefits of positive expressive writing were observed for wellbeing outcomes, the quality of all studies included in the review was assessed to be poor or fair. Thus, it is clear that more rigorous methods, including intention-to-treat analyses and robust reporting of methods and findings are needed. Future work should also aim to replicate the moderation effects reported in the present review, to enable a better understanding of the individual differences which influence the efficacy of positive expressive writing effects.

Healthcare workers in the UK report high levels of burnout and poor wellbeing, and interventions are urgently needed to address this issue. Expressive writing, whereby individuals write about emotionally laden thoughts or experiences, is an effective intervention for reducing stress and enhancing wellbeing, and is a potential candidate for use with healthcare workers. However, it is crucial that the preferences of healthcare workers are taken into account in the design of future trials in this area, and that perceived barriers and facilitators to engaging with expressive writing activities are considered. Therefore, the present study aimed to seek healthcare workers' views on expressive writing activities for enhancing wellbeing. We informed 11 UK-based health and social care professionals about current research into the potential wellbeing benefits of expressive writing activities and conducted 1:1 semi-structured interviews to determine their preferences, perceived facilitators and barriers to engaging routinely with expressive writing. Data were analysed using deductive, reflective thematic analysis, with the coding framework informed by the Capability-Opportunity-Motivation-Behaviour (COM-B) Model. Key findings, from the perspective of future trial design, were that participants preferred the three good things (writing down three good things that have happened during the day), written benefit finding (writing about positive emotions, thoughts, feelings and life changes in relation to an unfavourable experience) and gratitude letter (writing a letter of appreciation to someone who has never been properly thanked) activities. Participants expressed preferences for simple, brief activities that could be easily embedded into a daily routine. However, it was clear that support from managers, researchers or friends and family would be needed to promote engagement with the activities. Most notably, participants expressed a preference for flexibility in terms of how, when and where they write.

ABSTRACT Aims There is an emerging literature demonstrating the physical and psychological benefits of cold‐water swimming. The majority of this research, however, is qualitative or assesses effects across several months. As daily changes in mood contribute to overall well‐being, the current study sought to explore more proximal changes by adopting a diary approach to investigate the effects of regular cold‐water swimming. Methods Data were collected from an opportunistic sample of healthy, regular, female swimmers (N = 13) in the United Kingdom. Participants completed online questionnaires twice daily. They reported whether it was a swim day or a non‐swim day and then completed questions assessing state, cognitive and somatic anxiety, self‐confidence (morning and evening) and feelings of wellness and sleep quality the night before (morning only). Analysis of variance was conducted to assess differences between swim and non‐swim days. Results Cold‐water swimming led to significant reductions in anxiety and increases in self‐confidence on the day of a swim and improved self‐reported sleep and lower levels of next‐morning anxiety. Conclusions This exploratory study is the first to utilise a daily diary method to capture proximal changes in regular cold‐water swimmers. These results provide further evidence of the beneficial effects of cold‐water swimming on factors that contribute to psychological well‐being.

BACKGROUND:Research has indicated the potential for multivitamin-mineral (MVM) supplementation to improve aspects of wellbeing and cognitive function in older adults via a range of biological mechanisms. However, outside of cognitive function and mood, this research rarely assesses other outcomes that are pertinent to the daily lives of older adults. The current study aimed to investigate the effectiveness of a MVM supplement on meaningful outcomes of everyday functioning in older adults. METHODS:This randomised, double-blind, placebo-controlled, parallel groups trial investigated the effects of 12-week MVM supplementation on measures of wellbeing, mood, and memory; physical health and activity; and social interaction and loneliness. Outcomes were measured at baseline and after 12 weeks in a sample of 228 (124 female) older adults ( > 70 years). RESULTS:MVM supplementation had no effect on the primary outcome of wellbeing (p = 0.29 in males, p = 0.421 in females), but led to increased feelings of friendliness in females (p = 0.045). In males, following MVM, there were lower levels of prolonged stress reactivity (p = 0.007), lower overall stress reactivity (p = 0.019), and lower emotional loneliness (p = 0.042). CONCLUSION:This study provides novel evidence of increased friendliness and decreased stress reactivity and loneliness following MVM supplementation in older adults. These findings support the exploration of broader functions pertinent to aspects of daily living in older adults. Sex differences in response highlight the importance of exploring effects in men and women separately and support a recommendation for the inclusion of diverse samples in future research that are representative of the population.

Abstract Background Individuals who provide critical emergency care mount rapid psychobiological responses when faced with an incident. These responses are adaptive and ensure resources at time of demand; however, frequent activation with minimal opportunity for recovery can have negative consequences for health and wellbeing. Monitoring individuals in real emergency situations would provide an understanding of their stress responses during the provision of critical care; however, this presents logistical challenges. An alternative is to assess individuals during high-fidelity training scenarios. This is the first comprehensive assessment of psychobiological responding during continuous high-fidelity training in pre-hospital emergency medicine. Methods A sample of doctors and paramedics (N = 27) participated during 10 days of training and a weekend of no activities. Training involved the acquisition of human factors, non-technical and surgical skills, and their application in complex high-fidelity scenarios including road-traffic accidents, firearms incidents, and swift water rescue operations. On each day participants reported levels of state, cognitive, and somatic anxiety, and self-confidence following waking and before sleep, and their anticipated (at wake) and experienced (before sleep) demands of the day. Saliva samples were obtained each day for assessment of diurnal cortisol indices and the Cortisol Awakening Response (CAR). Garmin smartwatches were worn throughout for the collection of heart rate and HRV-derived stress. Results There were significant (p < 0.001) differences across days for state, cognitive, and somatic anxiety; self-confidence; anticipated and experienced demands; aggregated measures of heart rate and HRV-derived stress; levels of cortisol at waking (p = 0.002) and for the CAR (p < 0.001). Measures of psychobiological responding during training were distinct from the weekend and the highest levels of psychobiological responding occurred on days characterised by greater anticipated and experienced demands. Discussion This high-fidelity training is typical of the day-to-day requirements of emergency services and these observations are representative of functioning during real-life critical care emergencies. Increased responding during times of demand is adaptive; however, frequent and sustained responding increases allostatic load and is a contributor to burnout. As burnout is a significant concern in emergency medicine, this study identifies patterns of responding and recovery that may impact upon longer-term health and wellbeing.

Gratitude interventions are known to increase psychological wellbeing. However, it has also been suggested that not everyone experiences equivalent benefits of engaging with gratitude activities, and there have been calls to better understand the moderators of such effects. In Study 1, we explored the effects of writing a gratitude letter, relative to a neutral letter, on changes in positive and negative affect, and observed that the effect of gratitude writing on positive affect was exacerbated in participants with elevated life satisfaction. Study 2 sought to replicate the findings of Study 1 whilst minimising demand characteristics, but failed to observe the moderating effect of life satisfaction. In Study 3, we sought to investigate whether these mixed findings could be explained by demand characteristics. We observed that priming participants with information about the benefits of expressing gratitude ameliorated the effect of gratitude writing on positive affect, but life satisfaction did not moderate this priming effect. On the basis of the findings from these three studies, we conclude that life satisfaction does not moderate the effect of gratitude writing on positive affect, but further work should be undertaken to better understand the conditions under which gratitude writing is most effective. Further, we suggest that demand characteristics are an important consideration for both researchers and interventionists delivering gratitude interventions.

Psychotherapeutic interventions such as cognitive training and psychoeducation tend to be effective for alleviating stress in caregivers of children with autism. However, these interventions are often time consuming and take place outside the home, posing challenges for accessibility. Technology, especially virtual reality (VR) technology, can be used to support a range of digital interventions at home. VR headsets, when used to simulate relaxing experiences, have already been linked with stress relieving effects for some caregiving groups. This study builds on this, exploring whether VR simulated relaxing environments engender positive psychological changes for caregivers of children with autism. A total of 18 caregivers were exposed to VR simulated natural environments (e.g., beach, forest) for 15 min in a single session. State mood, captured with POMS, was measured at baseline and immediately post intervention. Perceived stress (PSS) was captured at baseline and, to explore intervention effectiveness, at three- and seven-days post intervention. POMS scores for tension, anger, depression, fatigue and confusion were lower, and scores for vigour higher, immediately post intervention. PSS scores at three-and seven-days post intervention, while comparable with one another, were lower compared with baseline. Interacting with simulated natural environments in VR seems effective for improving caregivers’ state mood and reducing their perceived stress for up to seven days. Future research should aim to consolidate and expand on these findings with larger samples and longer follow up periods.

Familial caregivers typically have more trouble completing fundamental tasks of daily living compared with non-caregivers. The ability to complete tasks of daily living relies on prospective memory (PM). PM, however, is typically poorer in familial caregivers. It would make sense, therefore, that poorer PM would mediate caregivers' greater difficulties completing tasks of daily living. This was explored here. A sample of n = 500 participants (196 caregivers of autistic children and 304 parents of non-autistic children) completed a questionnaire assessing PM failures. An abbreviated version of the Everyday Problems Test (EPT) was used to measure participants' ability to complete tasks of daily living, such as managing medications and paying bills. Caregivers reported more PM failures. EPT scores were lower in caregivers, reflecting fewer problems completing tasks of daily living. PM failures were unrelated to EPT scores, ruling out mediation. Caregivers of autistic children were better at completing basic tasks of daily living despite their poorer PM. Whether quality of life for the autistic child might be related to caregivers' ability to complete tasks of daily living should be the focus of future research.

ObjectiveDepression scores in caregivers of autistic children often fall in the clinical range. The attention of clinically depressed individuals tends to be biased toward negatively toned information. Whether caring for an autistic child might also be characterized by a negative attentional bias was explored here.MethodsA sample of N = 98 (57 caregivers and 41 controls) completed questionnaires assessing depressive symptoms. Orienting attention to (i.e., vigilance), and shifting attention away from (i.e., disengagement), negative information was assessed via an online version of the emotional face dot probe task.ResultsMean depression scores in caregivers, falling in the borderline clinical range, were significantly higher compared with controls. Groups, however, were indistinguishable with respect to vigilance and disengagement, and these attentional indices were unrelated to depression scores.ConclusionCaring for an autistic child, while associated with borderline clinical depression scores, was not characterized by a negative attentional bias. Findings are discussed in the context of methodological shortcomings and recommendations for future research.

Grateful caregivers report lower levels of psychological distress. Social support, engendered by gratitude and buffering against stress, might mediate this effect. Here we explored whether the protective psychological effect of dispositional gratitude might be mediated by increased social support. A sample of 126 caregivers of autistic children completed questionnaires assessing dispositional gratitude, social support and psychological distress. Gratitude inversely predicted psychological distress, as did social support after adjusting for gratitude. Gratitude positively predicted social support. Gratitude no longer predicted psychological distress after adjusting for social support. Indirect effects analysis revealed the gratitude-distress relationship occurred indirectly via social support. Grateful caregivers reported higher levels of social support, and this predicted lower psychological distress. Gratitude, relatively stable as a disposition, has a state component that is sensitive to change, and healthcare professionals might do well to recommend gratitude enhancing interventions for caregivers of autistic children.

Negative emotions are typically high, and typically stay high over time, in caregivers of children with autism. The severity of autism-related symptoms on the other hand tends to improve over time, reducing as the child gets older. Why caregivers’ negative emotions continue to be high at a time when autism symptom severity is improving remains puzzling. This exploratory study asks whether prevalence-induced concept change (PICC) might provide one plausible explanation. A sample of N = 34 participants, of which 17 were caregivers of children with autism and 17 were non-caregiving controls, completed questionnaires assessing negative emotions. PICC was assessed via an online paradigm; participants were shown a face on screen for 500ms and asked, following its disappearance, whether it conveyed a negative (i.e., sad) or a neutral expression. Neutral faces mistaken for sad faces, as our outcome variable of interest, were summed across trials. The prevalence of negative faces was gradually reduced across four experimental blocks (50 trials per block). Mixed ANOVA yielded a significant main effect of block. That is, neutral faces were more likely to be mistaken for sad faces as sad faces became less prevalent across blocks. This pattern of change varied by group; caregivers were more likely to mistake neutral faces for sad faces as sad faces reduced in prevalence across blocks. Errors made by the control group did not vary across blocks. Caregivers’ concept of ‘negative, therefore, seems sensitive to change, redefining its parameters as negative events become less prevalent. PICC might explain why caregivers’ negative emotions remain high when autism symptom severity, as one well-known predictor of those negative emotions, is reducing in prevalence. The implications of these findings for caregivers’ psychological well-being and, by association, care recipient quality of life are considered.

Individuals have unique typing rhythms characterized by specific keystroke dynamics. Changes in state and cardiovascular responding are well documented manifestations of the fight-flight response to stress. However, as stress also leads to changes in muscle tone and motor control, typing rhythms may also be impacted. We aim to determine which individuals are experiencing stress through their typing rhythms and identify universal keystroke markers of stress. Participants (N = 116) typed 80 repetitions of a 6-word, 30-character phrase before and after 15 min of critically evaluated multitasking stress. Cardiovascular, hemodynamic, and state variables were compared across baseline, stress, and recovery periods and measures of typing rhythm were derived for each period and classified using machine-learning algorithms. Critically evaluated multitasking led to significant changes in all stress measures, demonstrating highly robust stress reactivity. Machine learning algorithms accurately classified stressed typing for each individual based on their typing rhythms; however, no universal keystroke markers of stress were identified. Using typing rhythms. We were able to determine whether an individual was stressed or not, but the markers used for classification differed between individuals. These individual changes may provide opportunities for identifying stressful periods through keystroke monitoring, as well as the potential for early identification of disorders which may impact fine motor control. Typing rhythms could therefore be used to monitor health and well-being in individuals who use keyboards in various situations. This is the first rigorous assessment of stress and typing rhythms and has led to the development of a feasible and highly reproducible research protocol.

Cognitively empathic caregivers are able to take the perspective of their autistic child(ren) without experiencing vicarious distressing emotions, and typically report lower psychological distress. Taking the perspective of the autistic child might, through fostering cognitive empathy, might relieve caregivers' psychological distress. Here we explored whether autism perspective taking videos developed by the National Autistic Society (NAS), intended to raise public awareness about autism, might be effective, packaged as an intervention, for increasing caregivers' cognitive empathy and reducing their psychological distress. A sample of 24 caregivers of autistic children completed questionnaires capturing psychological distress and cognitive empathy at baseline. For three consecutive days, for two-three minutes per day, caregivers watched perspective taking videos. Follow up assessments were collected 7, 14, and 21 days post intervention. Psychological distress was lower after seven days, and stayed lower 14 and 21 days post intervention compared with baseline. Cognitive empathy was higher after 14 days, and remained higher 21 days post intervention compared with baseline. Taking the perspective of the autistic child, achieved here with publically available NAS videos, seems to be effective for increasing caregivers' cognitive empathy and reducing their psychological distress for up to three weeks. Future research might use more rigorous methodologies, incorporating control groups and larger samples, to explore moderators of intervention efficacy.

Teachers are an occupational group particularly prone to suffering from burnout, a condition caused by chronic stress from work overload. Burnout is a risk factor for adverse psychological and physical health, thus it is important to test the efficacy of tools and techniques for alleviating burnout and enhancing job satisfaction. One potentially suitable technique is positive expressive writing. In the present study, we investigated the effects of a positive writing intervention on burnout, job satisfaction, anxiety, perceived stress and self-reported physical symptoms and compared these effects in teachers and other full-time workers.A group of teachers (n = 35) and a group of non-teachers (n = 31) who worked full-time in other professions were randomly allocated to complete either three consecutive days of positive expressive writing, or writing about a more neutral topic, online, 20 minutes per day, for three consecutive days State anxiety declined to a greater extent for participants in the positive writing condition compared to the neutral writing condition. Positive writing also conferred benefits on some aspects of job satisfaction, but not burnout. There were no specific benefits for teachers compared to non-teachers. The present study is the first to observe that positive expressive writing may be a useful technique for enhancing job satisfaction in full-time workers.

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