Diversity of Activities, Emotions, and Pleasant Events and Their Associations With Mental and Cognitive Health

The COVID-19 pandemic dramatically changed the structure of our daily lives. One of the most significant changes is a limited opportunity to engage in face-to-face social interactions and enjoy diverse daily activities. This raises a public health concern, because diverse experiences are critical sources of health by increasing social integration, cognitive reserve, and psychological resources. Recently, two lines of research have consistently shown that activity diversity or emodiversity is associated with multiple health outcomes. However, still more integrated efforts are needed to better understand diversity of daily experiences in various aspects and their contributions to health. This symposium brings together different endeavors towards understanding how diversity of daily experiences – activity diversity, emodiversity, and variety in positive experiences – are associated with health and well-being across adulthood. The topic of this symposium is timely to discuss potential prevention approaches to protect population well-being as the pandemic evolves. Paper 1 examines activity diversity (breadth and evenness of daily activity participation) and how it is related to positive and negative emodiversity (rich and balanced emotional experiences) differently by age groups. Paper 2 investigates the longitudinal relationship between activity variety across cognitive, physical, and social domains and cognitive functioning. Paper 3 examines variety in pleasant events and its associations with mental health outcomes. Paper 4 examines whether and how negative emodiversity is associated with mental illness during COVID-19. The discussant, Dr. David Almeida will integrate key findings from these studies, discuss their theoretical and methodological contributions, and consider opportunities for future research.

Associations between pleasant events, activity restriction, stressors, and blood pressure in caregivers of persons with dementia

Objectives: Caring for a relative with dementia is associated with adverse consequences for cardiovascular health. Cognitive and behavioral factors, such as high perceived activity restriction and low frequency of pleasant events have been found to be associated with higher levels of blood pressure, but the role these variables play in the stress and coping process remains understudied. The objective of this study is to analyze the associations between behavioral and psychological symptoms of dementia, activity restriction, frequency of pleasant events, and mean arterial pressure. Design: Face-to-face interviews and cross-sectional analyses. Setting: Social services, healthcare centers, and adult day services of Comunidad de Madrid, Spain. Participants: One hundred and two family caregivers of a spouse or parent with dementia. Measurements: Apart from various sociodemographic and health-related variables, behavioral and psychological symptoms of dementia, activity restriction, and frequency of leisure activities were assessed. In addition, measurement of blood pressure levels was conducted through an electronic sphygmomanometer. Results: The obtained model suggests that there is a significant indirect association between behavioral and psychological symptoms of dementia and mean arterial pressure through activity restriction and frequency of pleasant events. Conclusions: The findings of this study provide preliminary support for a potential indirect effect between behavioral and psychological symptoms of dementia and blood pressure, through the effects of behavioral and psychological symptoms of dementia on the caregivers’ levels of activity restriction and frequency of pleasant activities. Our manuscript provides additional support for the pleasant events and activity restriction model (Mausbach et al., 2011; Chattillion et al., 2013), by highlighting the importance of considering caregiving stressors as a source of caregivers’ activity restriction in the theoretical framework of the model.

Session 3: Noticing Slips and Falls

The main focus of the current session is to help participants see the connection between their cognitive slip-ups (which they were asked to track in the prior week’s homework) and the emotional reactions they have to those slip-ups (i.e., “falls,” as in “slips and falls”). Homework is reviewed to provide material for this discussion. This segues into providing psychoeducation on the hierarchy of attention, and Focused Attention mindfulness is again reinforced as a way to decrease slip-ups. Participants are introduced to the first of two Mindful Yoga series as another way to experience present-moment awareness, and as a complement to sitting meditation practice. Tracking pleasant events is also assigned for homework as a way to make the bridge between mindfulness practice and daily activities and life experiences.

Session 3: Noticing Slips and Falls

The main focus of the current session is to introduce you to the connection between your cognitive slip-ups (which you were asked to track in the prior week’s homework) and the emotional reactions you have to those slip-ups (i.e., “falls”, as in “slips and falls”). You will have a chance to discuss your experience with the homework and what you learned about the kinds of slip-ups you experience and how that is related to your mood. Building on this, you will learn about the hierarchy of attention, and how Focused Attention mindfulness can help you decrease slip-ups. You will also be introduced to the first of two Mindful Yoga series as another way to experience present-moment awareness, and as a complement to sitting meditation practice. Tracking pleasant events is also assigned for homework as a way to make the bridge between mindfulness practice and daily activities and life experiences.

Risk Area 3: Caregiver Emotional Well-Being

This chapter describes one of the five risk areas, namely, caregiver emotional well-being. Caregiving for a person with dementia often is associated with increased levels of depression, stress, anxiety, and anger. This chapter focuses on two strategies designed to improve caregiver emotional well-being: relaxation to reduce stress and increasing engagement in pleasant events. Clinicians are given instructions to teach caregivers the Signal Breath technique, a deep breathing skill to help increase alertness and reduce stress. The chapter also includes worksheets designed to be filled out with the caregiver in order to identify and plan pleasant events for both the caregiver and the person with dementia.

Effects of Psychosocial Interventions and Caregiving Stress on Cardiovascular Biomarkers in Family Dementia Caregivers: The UCSD Pleasant Events Program (PEP) Randomized Controlled Trial

Background This study examined whether biological mechanisms linking dementia caregiving with an increased risk of coronary heart disease can be modified by psychosocial interventions and which caregivers might benefit the most from an intervention. Methods Spousal dementia caregivers were randomized to 12-week treatment with either a behavioral activation intervention (ie, Pleasant Events Program [PEP]; n = 60), or an active control Information and Support (IS; n = 63) condition. Indicators of caregiving stress were assessed pretreatment and circulating cardiovascular biomarkers were measured pre- and posttreatment. Results There were no significant changes in biomarker levels from pre- to posttreatment both by treatment condition and across all caregivers. Regardless of the treatment condition, exploratory regression analysis revealed that caregivers were more likely to show significant decreases in C-reactive protein (CRP) and D-dimer when their spouse had severe functional impairment; in interleukin (IL)-6 and CRP when they had greater distress due to care recipient’s problem behaviors; in tumor necrosis factor (TNF)-α when they had higher levels of negative affect; and in IL-6, CRP, TNF-α, and D-dimer when they had higher personal mastery. Within the PEP group, caregivers with higher negative affect and those with higher positive affect were more likely to show a reduction in von Willebrand factor and D-dimer, respectively. Within the IS group, caregivers whose spouse had severe functional impairment were more likely to show a decrease in IL-6. Conclusions Unlike the average caregiver, caregivers high in burden/distress and resources might benefit from psychosocial interventions to improve cardiovascular risk, although these observations need confirmation.