Individual differences in the intensity (e.g., emotional reactivity and mean affect), variety (e.g., emodiversity and range of emotions), and specificity (e.g., emotional granularity and alexithymia) of self-reported emotion experiences throughout daily life are important indicators of mental health and well-being. As commonly measured, these constructs reflect differences in how individuals employ emotion concept words to report their feelings. Here, we examined how emotion fluency (the number of emotion concept words one can readily access) relates to the intensity, variety, and specificity of individuals' reported emotion experiences using both retrospective self-report questionnaires and measures derived from emotion experience ratings over a 6-week experience sampling protocol. Those higher in emotion fluency reported experiencing more intense emotions, particularly negative emotions, and a wider variety of emotions over time (e.g., greater emodiversity) even when controlling general verbal fluency. However, emotion fluency was not related to measures associated with the specificity or precision with which one uses emotion concepts to report their experiences (e.g., emotional granularity and alexithymia). Findings suggest that having ready access to many emotion concepts may enable a person to use a lot of different emotion concepts when reporting feelings, but that greater emotion fluency does not necessarily result in using those concepts in more specific, context-dependent ways. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Abstract The existing literature on naturalistic thoughts has offered insights into the general patterns of thoughts common across large groups of participants. However, little is known about individual variability in thoughts. One approach to understanding variation within individuals is precision experience sampling, an idiographic approach that involves sampling inner experiences across multiple sessions and/or timepoints. This creates a comprehensive portrayal of an individual’s thoughts across time and context, which in turn facilitates person-specific predictions of their thoughts. The current study therefore used precision experience sampling to examine individual variations in naturalistic thoughts as a function of ongoing task. We implemented 7 sessions per participant (n = 7, idiographic group), resulting in 49 datasets. We verified that the descriptives of thoughts and task-modulatory effects of thoughts in this group were comparable to a larger cohort of participants (n = 49, nomothetic group) who each completed one session. Both groups were asked to complete whatever task they wished on the laboratory computer and to occasionally report their current task and numerous thought dimensions. Our results revealed considerable individual differences in the modulatory effects of task on thought dimensions, such that individuals engaged in different types of thoughts under different task contexts, underscoring the importance of considering both individual and contextual factors. They also indicated that patterns observed at the group level did not always accurately represent individual level patterns. Furthermore, applying machine learning algorithms on reports of the task-at-hand reliably detected all thought dimensions, with superior classification performance in the idiographic compared to nomothetic group. Overall, our study demonstrates the idiosyncratic effects of task on naturalistic thoughts and highlights the value of precision experience sampling in improving person-specific predictions of thoughts, which has important methodological and clinical implications.

Standard practice for collecting and analyzing cardiac activity data involves establishing a baseline of cardiac activity and assessing deviations from this baseline. However, empirical data on how these baseline measurements may vary within individuals over time and across contexts remains sparse. Here, we assess resting baseline measures of interbeat interval (IBI) and high-frequency heartrate variability (HF-HRV) for 124 participants during four separate 5-minute baseline sessions over a 6-week period. Analyses suggest that only about half of the variance in the data for each measure was attributable to between-subject differences (IBI=59.86%; HF-HRV: 51.49%) and a third or more of the variance was attributable to between-session differences (IBI: 35.93%; HF-HRV: 30.36%). Minute-to-minute variability was minimal (IBI: 4.20%; HF-HRV: 18.14%), particularly for IBI which did not change significantly over the course of the 5-minute baselines on average; HF-HRV was significantly higher in the first minute of the baseline than the others on average. Investigation of sources of person-level and session-level variability revealed that both IBI and HF-HRV were significantly higher during the first session than latter sessions, and HF-HRV was significantly higher when the baseline was collected after instead of before a 20-minute task. Older age, higher BMI, and less reported weekly exercise were also associated with lower HF-HRV at the between-subjects level. Other person- and session-level variables examined (e.g., experimenter characteristics, weather, time of day) did not significantly account for any observed variability. Methodological implications are discussed.

Individual differences in people’s tolerance for uncertainty are associated with mental health and well-being. However, much of the literature on responses to uncertainty has relied on retrospective self-report measures of how one believes they tend to act in uncertain contexts or has inferred how people feel about uncertainty based on their behavior in decision-making tasks. Here, we piloted a novel experiential uncertainty task in which participants were asked to insert their hands into an opaque box and feel an unknown object, and we assessed subjective affective reactions and physiological reactivity in anticipation of completing the task. Across both exploratory studies, we found participants higher in intolerance of uncertainty (IU) demonstrated less parasympathetic nervous system reactivity during uncertainty compared to those lower in IU. In Study 2, we found that this association was disrupted by presentation of biofeedback during the task, particularly false biofeedback indicating a rapid heart rate. Additionally, we found participants high in IU reported heightened experiences of several negative emotions (i.e., nervousness, worry, and stress) during experiential uncertainty (Study 2). Taken together, these findings suggest that individuals high in IU not only maintain unfavorable attitudes toward uncertainty in broad retrospective self-report measures, but they also experience instances of uncertainty differently than individuals lower in IU in the moment, both subjectively and physiologically.

BACKGROUND:Buprenorphine is an underused opioid therapy for patients with serious illnesses. Using the principles of implementation science, we developed, distributed, and tested a Buprenorphine Pocket Card and Tool Kit (Bupe PC&TK). OBJECTIVES:We conducted an online survey to assess buprenorphine learning needs, confidence, and knowledge. We then tested the impact of the Bupe PC&TK using a pre-/poststudy design. SETTING/SUBJECTS:Palliative care clinicians located throughout the United States. MEASUREMENT:Investigator-initiated online mixed-methods survey at baseline and six weeks following distribution of a Bupe PC&TK. RESULTS:Among the 179 baseline participants, most were physicians (n = 114) with more than six years of opioid prescribing experience (n = 99). The majority rated buprenorphine prescribing as an important skill, but only 15 participants reported they were very confident in prescribing or managing buprenorphine, and inaccurate knowledge was common. Participants reported that information on buprenorphine dosing and initiation would be most helpful in a Bupe PC&TK. Fifty-six participants completed the follow-up survey; the majority were physicians (n = 33). Most participants used the Bupe PC&TK (n = 47) and rated it as helpful or very helpful (n = 45). A paired samples t-test revealed that participants were significantly more confident after receiving the Bupe PC&TK (p < 0.001). Knowledge accuracy improved for buccal buprenorphine (p = 0.003) and formulations for opioid use disorder (p < 0.001). CONCLUSION:Palliative care clinicians ascribe a large degree of importance to prescribing buprenorphine but have knowledge and confidence gaps. The Bupe PC&TK can be readily implemented to increase clinician confidence and knowledge in prescribing buprenorphine to patients with serious illness.

OBJECTIVES:Specialty care coordination is particularly challenging across health systems. The Veterans Health Administration (VHA) has implemented several measures to support coordination between VHA and VHA-paid community care. The objective of this study is to examine how within-system specialty care coordination compares with cross-system coordination with an array of organizational supports in place. STUDY DESIGN:Cross-sectional online survey of VHA primary care providers (PCPs) who placed referrals for specialty care. METHODS:We administered the Coordination of Specialty Care-Primary Care Provider survey, which comprises 1 item about overall coordination (0 [worst] to 10 [best]) and 6 multi-item scales measuring coordination subdomains: relationships and collaboration, communication, data transfer, role clarity, role agreement, and making referrals. RESULTS:Responses were from 351 PCPs about within-system and 226 PCPs about cross-system specialty care coordination. Overall coordination was higher for within-system than cross-system care (mean [SD] score, 7.01 [2.33] vs 6.22 [2.64]; P = .002). All scale scores were higher for within-system care. Cross-system respondents commonly lacked experience directly interacting with specialists. In both settings, the strongest association with overall coordination was with relationships and collaboration (within-system: standardized beta coefficient [β] = 0.45; P < .0001; cross-system: β = 0.69; P < .0001). Relationships and collaboration was a greater contributor to overall coordination for cross-system than within-system care. CONCLUSIONS:Specialty care coordination is worse in cross-system care than in within-system care, even with significant organizational investment in structures and processes to coordinate across systems. Strategies to support direct clinician-clinician interactions could be particularly impactful for cross-system care.

Many emotion theories suggest that sensations from the body are a critical piece of emotional experience. Here, we examine how subjective awareness of body sensations is associated with emotional experience throughout daily life using ecological momentary assessment (data collected in 2021). Participants (N = 161) completed a 7-day protocol where they rated the intensity with which they were currently experiencing 16 different emotions as well as overall awareness of their body sensations (Nobs = 7,483). Experienced emotional intensity was positively associated with in-the-moment body awareness across 12 of 16 emotion terms. This association was present for both normatively positive and negative emotions, as well as for both normatively high and low arousal emotions. These findings extend prior theories on the role of body sensations in emotional experience and demonstrate that the association between conscious experiences of the body and emotion covaries in the moment within participants across different contexts in daily life. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

BackgroundClinical trials of remote patient monitoring (RPM) technology are well-suited to remote studies, for which patients complete key procedures online. However, remote digital health studies often suffer from low enrollment and retention, threatening the successful achievement of study outcomes and wasting resources and time. Recruiting patients from a large integrated health system offers a greater potential pool of participants for enrollment, which can increase the likelihood of successful study completion. ObjectiveThis study describes enrollment and retention outcomes for a remote digital health study of an RPM device conducted in collaboration with researchers from the Veterans Health Administration (VA). The VA is the largest integrated health system in the United States, with 9 million enrollees who are, as a group, older and with more medical and mental health comorbidities than the civilian population. MethodsWe aimed to enroll 200 VA patients for a clinical study of a cellular-enabled, handheld, multisensor device that captures multiple health parameters and transmits data to a cloud-based dashboard for viewing by clinicians. Eligible patients were hospitalized with COVID-19 within 3-6 months before enrollment and had one of 6 pre-existing medical comorbidities. Potentially eligible patients were identified using the VA Corporate Data Warehouse. Every 3 weeks, up to 1000 potentially eligible patients were mailed a recruitment letter. All study tasks, including obtaining informed consent, device training and troubleshooting, and handling study-related questions, were completed online and by telephone. Device and survey data were combined with VA clinical and utilization data to develop a predictive algorithm for clinical decompensation. The geographic distribution of enrolled patients was mapped by county. Demographic and health characteristics of nonenrolled versus enrolled, and of completers versus noncompleters were compared using t tests and chi-square tests as appropriate. Reasons for noncompletion were summed. Multivariate logistic regression was used to evaluate variables associated with enrolling versus nonenrolling, and completing versus noncompleting. ResultsOf the 7714 who were mailed a study invitation, 560 were screened. Of the screened patients, 203 were enrolled (2.9% enrollment yield) and 166 completed the study (82% retention rate). Enrolled patients were broadly distributed across the United States. Among those enrolled, completers and noncompleters were similar except for a slightly higher proportion of patients with hypertension among completers. The most common reason for noncompletion of the study was that participants were unable to be contacted for study tasks. ConclusionsRemote digital health studies are increasingly common, but inadequate enrollment often results in failed studies. Recruiting patients through the VA enables access to a very large population of potentially eligible patients and can help ensure that clinical trials reach targets for enrollment and completion. Trial RegistrationClinicalTrials.gov NCT05713266; https://clinicaltrials.gov/study/NCT05713266

Background: High-quality goals of care (GOC) discussions should be founded on shared decision-making (SDM) - eliciting patients' values and preferences while providing adequate information for patients to make decisions. One metric that can assess GOC discussion quality is the degree to which patients are adequately informed. Objective: Identify clinician GOC discussion attitudes and behaviors associated with clinician confidence that they conveyed adequate information to patients. Methods: We conducted a secondary analysis of national survey data from Veterans Affairs clinicians assessing attitudes toward and behaviors during GOC discussions about life-sustaining therapy. We used stepwise multivariable logistic regression models to identify factors associated with clinician confidence that they provided patients with adequate information to make informed decisions following discussions. Results: Among the 253 clinician respondents, there was high confidence that they provided adequate information (Mean = 4.09 on a 5-point scale, SD = 0.69, Median = 4.0). Higher confidence was associated with practicing in Geriatrics/Palliative Care in bivariate analyses, but not when controlling for clinician behaviors during GOC discussions. In the final multivariable model, two behaviors were statistically significantly associated with increased confidence: "identify proxy/surrogate" (β = 0.21, P = 0.015) and "suggest decision consistent with patients' values" (β = 0.16, P = 0.045). These behaviors also occurred significantly more often in Geriatrics/Palliative Care compared to other specialties. Conclusion: Specific clinician behaviors in GOC discussions differed across specialties and were significantly associated with clinicians' confidence that they conveyed adequate information. Our findings can inform strategies to enhance communication training across specialties and improve care processes to support clinicians in performing behaviors conducive to high-quality GOC discussions.

Deprescribing, intentional medication discontinuation or dose reduction, can reduce potentially inappropriate medication use and medication-related harms. Engaging patients in deprescribing discussions may increase likelihood of deprescribing and promote shared decision-making. To examine the impact of patient-directed educational brochures on patient engagement and deprescribing discussions with primary care providers (PCPs). We mailed medication-specific brochures 2 weeks prior to each patient’s PCP appointment (4/12/2021–10/7/2022), followed by a mailed survey 2 weeks after scheduled PCP visits. Patients from three Veterans Affairs facilities with scheduled PCP appointments eligible for one of three medication-based cohorts (proton pump inhibitor, gabapentin, diabetes-hypoglycemia risk). Our primary outcome was patient-reported deprescribing discussions with their PCP (yes/no). Descriptive statistics characterized engagement with and reactions to the brochure. Multivariable logistic regression models determined associations of patient characteristics, attitudes, and brochure-engagement with reported deprescribing discussions. Adjusting only for patient characteristics, discussions were less likely if respondents were Black (vs. White: OR 0.47, 95

We examined categorical processing biases in the perception and recognition of facial expressions of emotion across two studies. In both studies, participants first learned to discriminate between two ambiguous facial expressions of emotion selected from the middle of a continuous array of blended expressions (i.e., an array created from morphing images of two facial expressions together, with still images selected in equidistant increments). Participants were then asked to recognize the specific expressions they were trained to discriminate. In Study 1, target expressions labeled with emotion words (e.g., more angry face) during discrimination and recognition tasks were misremembered as more perceptually distinct from one another and therefore more perceptually similar to the stereotypical expression for their labeled emotion category than they were in reality. Critically, in Study 2, these recognition biases were significantly reduced or absent in conditions where the target expressions were not labeled with emotion words (e.g., Face A), demonstrating the role of emotion words in promoting categorical processing biases in emotion recognition. Moreover, in the absence of emotion labels, peoples' beliefs about the nature of emotion categories were related to the extent to which they employed categorical processing during emotion perception and recognition. Specifically, people with more essentialist beliefs about emotion categories-believing emotion categories are more innate, biologically-based, and immutable-exhibited more pronounced categorical processing biases during emotion recognition. Findings shed light on the critical role of language and cognition in constructing emotion and add to empirical findings on categorical processing in emotion perception. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

BACKGROUND:Identification of transgender and gender diverse (TGD) people has been limited to diagnoses and text rather than self-identified gender identity (SIGI), representing a subset of TGD people. In 2017, the Veterans Health Administration (VHA) implemented SIGI, allowing for precise identification of TGD veterans, including subgroups (transgender man, transgender woman, and nonbinary). OBJECTIVES:Health conditions, adverse social determinants of health (SDOH), and health care utilization were compared among veterans (1) identified by SIGI only, both SIGI and diagnosis/text, diagnosis/text only (ie, without SIGI), and (2) SIGI subgroups. RESEARCH DESIGN:Cross-sectional. SUBJECTS:Twenty thousand seventy-nine TGD VHA patients from 2019 to 2023; SIGI only (n=5523), both SIGI and diagnosis/text (n=4066), and without SIGI (n=10,490). MEASURES:Health conditions, adverse SODH and health care utilization. RESULTS:In adjusted models, SIGI only veterans were less likely to have documentation of depression (32.4% vs. 60.7% vs. 54.8%), post-traumatic stress disorder (PTSD; 23.5% vs. 41.4% vs. 37.5%), housing instability (8.8% vs. 21.5% vs. 16.1%), unemployment/financial problems (10.5% vs. 23.8% vs. 19.0%), and mental health visits (72.5% vs. 97.7% vs. 95.2%) compared with those with both SIGI and diagnosis/text and without SIGI. Health conditions were more similar across the diagnosis groups (i.e. both SIGI and diagnosis/text and without SIGI). Among veterans with SIGI data, we identified 49% transgender women, 38% transgender men, and 14% nonbinary veterans without many differences across subgroups. In adjusted models, more nonbinary veterans than transgender women and transgender men had documentation of alcohol use disorder (10.1% vs. 6.1% vs. 7.5%), depression (62.3% vs. 42.6% vs. 47.0%), PTSD (45.9% vs. 27.4% vs. 33.5%), mental health visits (96.7% vs. 89.1% vs. 91.9%), and experienced unemployment/financial problems (21.3% vs. 16.9% vs. 14.7%). CONCLUSIONS:Without diagnosis, SIGI enables the identification of healthier TGD veterans. Regardless of SIGI, diagnosis signals much higher rates of health concerns. SIGI data facilitates understanding veteran subgroups, informing TGD policy and practice.

Several theories suggest that mood disorders, like depression and anxiety, involve relatively systematic biases in how one imagines and predicts their future feelings. Here, we examine whether affective forecasting errors for mildly evocative, everyday emotional events are associated with differences in depression, anxiety, and somatic symptom severity in a non-clinical sample drawn from the general population. Participants read descriptions of 20 affective pictures which varied in terms of their normative valence (pleasantness/unpleasantness) and arousal (activation/deactivation). Based on the provided descriptions, participants rated their predicted emotional reaction to each picture. One week later, rated their experienced emotion in response to viewing each picture. Depression, anxiety, and somatic symptom severity were assessed using self-report questionnaires. Results revealed that those with greater anxiety or depression symptom severity, but not greater somatic symptom severity, had increased error in predicting their negative emotions for normatively positive future events (e.g., viewing pictures of stereotypically pleasant animals). Supplemental analyses revealed that individuals with greater depression symptom severity tended to over-predict their future negative feelings, while individuals with greater anxiety symptom severity made more errors in general (i.e., they both over- and under-predicted future negative emotions). These findings suggest that biases in predicting one’s future affective feelings, particularly one’s future negative feelings, may play a role in mood disorder symptom severity, and highlight potential differences in how emotional predictions may be biased for those with greater depression and/or anxiety symptomology.

Background/ObjectiveAutism has been investigated through traditional emotion recognition paradigms, merely investigating accuracy, thereby constraining how potential differences across autistic and control individuals may be observed, identified, and described. Moreover, the use of emotional facial expression information for social functioning in autism is of relevance to provide a deeper understanding of the condition.MethodAdult autistic individuals (n = 34) and adult control individuals (n = 34) were assessed with a social perception behavioral paradigm exploring facial expression predictions and their impact on social evaluation.ResultsAutistic individuals held less stereotypical predictions than controls. Importantly, despite such differences in predictions, the use of such predictions for social evaluation did not differ significantly between groups, as autistic individuals relied on their predictions to evaluate others to the same extent as controls.ConclusionsThese results help to understand how autistic individuals perceive social stimuli and evaluate others, revealing a deviation from stereotypicality beyond which social evaluation strategies may be intact.

To measure emotion in daily life, studies often prompt participants to repeatedly rate their feelings on a set of pre-specified terms. This approach has yielded key findings in the psychological literature yet may not represent how people typically describe their experiences. We used an alternative approach, in which participants labeled their current emotion with at least one word of their choosing. In an initial study, estimates of label positivity recapitulated momentary valence ratings and were associated with self-reported mental health. The number of unique emotion words used over time was related to the balance and spread of emotions endorsed in an end-of-day rating task, but not to other measures of emotional functioning. A second study tested and replicated a subset of these findings. Considering the variety and richness of participant responses, a free-label approach appears to be a viable as well as compelling means of studying emotion in everyday life.

Affective feelings exert a powerful influence on decision making, even when the source of those feelings is incidental, i.e., unrelated to the decision at hand. Research on the role of affect in decision making has typically focused on how incidental affect shapes evaluations of an individual target, and thus decisions about how to engage with that target. It is less clear, however, if and how individuals use their incidental affective feelings when evaluating and comparing multiple competing targets and deciding which one to choose. To investigate this, we modified the Affect Misattribution Procedure (AMP) to include two competing targets, presented sequentially, that individuals needed to choose between. In two pre-registered studies (N = 196 and N = 214), participants were presented with pairs of landscape images (e.g., beaches, lakes) and asked to choose which image in the pair they liked more. Each landscape was preceded by an affective prime: a briefly flashed image of a face that was either smiling (a positive prime), scowling (a negative prime), or neutral (a neutral prime). We found that participants were significantly more likely to choose landscapes preceded by primes of more positive valence, and this effect was driven by trials on which the positive prime came second. Our studies demonstrate that decision makers use their incidental affective feelings when making choices among competing alternatives, and introduce a novel methodology for understanding the constructive role of affect in preference formation.

Affect is thought to be a low-dimensional representation of ongoing body activity. Recent studies have demonstrated that individual differences in the ability to objectively detect one's body activity are related to affective experience, particularly the experience of affective arousal. However, less is known about the role of subjective awareness of body sensations in affective experience, a facet of interoception that has been distinguished from objective detection on theoretical and empirical grounds. Moreover, there is a lack of evidence concerning how affective experience relates to the perception of body activity in the moment; that is, how awareness of sensations from the body may covary with affective and emotional experiences in real time. In the present studies, we examine within-person relationships between subjective awareness of body sensations and self-reported affect in real-world settings using ecological momentary assessment (EMA) paradigms. Across two EMA studies with international samples of adults, we found participants reported greater awareness of body sensations in moments where they also reported experiencing heightened arousal and more negatively valenced affect. In Study 1 (N = 109; data collected and analyzed 2022), we found that the associations held across a 4-week EMA protocol. In Study 2 (N = 116; data collected 2020, analyzed 2022), we also derived measures of affective valence from participants' freely generated descriptions of their ongoing thoughts, and we explored the consistency of this relationship with awareness of several individual body sensations (e.g., awareness of one's breathing, awareness of one's heart rate). We conclude that affective experience covaries moment to moment with subjective awareness of the body.

To measure emotion in daily life, studies often prompt participants to repeatedly rate their feelings on a set of pre-specified terms. This approach has yielded key findings in the psychological literature yet may not represent how people typically describe their experiences. We used an alternative approach, in which participants labeled their current emotion with at least one word of their choosing. In an initial study, estimates of label positivity recapitulated momentary valence ratings and were associated with self-reported mental health. The number of unique emotion words used over time was related to the balance and spread of emotions endorsed in an end-of-day rating task, but not to other measures of emotional functioning. A second study tested and replicated a subset of these findings. Considering the variety and richness of participant responses, a free-label approach appears to be a viable as well as compelling means of studying emotion in everyday life.