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BackgroundInsecure attachment is predictive of depression and emotion regulation is largely recognized as a mediator of such association. Despite the ability to refer to the social context to regulate emotions can be considered as a key aspect of depressive dynamics, most studies focused on intrapersonal forms of emotion regulation neglecting its interpersonal forms. In the present study, we investigated the role of interpersonal emotion regulation (IER) as mediator of the association between attachment insecurity and depression.MethodsData were collected from 630 adults using scales assessing individual differences in the use of IER strategies, IER difficulties, attachment orientations, and depression symptoms. We tested the correlations between the considered variables and, additionally, a latent structural equation model was tested to determine the mediating role of IER in the relationship between attachment (anxiety and avoidance) and depression.ResultsPositive associations between the use of IER and anxious attachment, and negative associations with avoidant attachment were found. Depression symptoms were significantly predicted by difficulties in IER (Venting and Reassurance-Seek), but not by IER strategies. The mediation analyses showed that attachment insecurity statistically predicted depression, mediated by IER difficulties.ConclusionsThese results account for increasing risk of depression due to a vicious cycle in which anxious attached individuals use venting and reassurance-seek with the aim of decreasing their negative emotions, but reach the opposite result of exacerbating negative moods.

India has adopted the Indo-Pacific concept with uncharacteristic speed. This article examines India’s Indo-Pacific strategy, which evolved out of its earlier ‘Look East’ and ‘Act East’ policies but is much more focused on strategic concerns than on trade or connectivity. As such, the strategy is subset of its China policy, and includes contradictory elements of balancing China by building partnerships with the United States as well as with regional powers, while simultaneously pursuing a reassurance strategy to convince Beijing that India is not really balancing China. The combination of these contradictory elements is characterized as evasive balancing, which is a more useful concept than either pure balancing or hedging for understanding the policies of India and of many other countries in the region that are trying to manage China’s rise. However, reassurance strategies rarely work and the combination of balancing and reassurance is even less likely to be viable.

There is considerable evidence that self-criticism plays a major role in the vulnerability to and recovery from psychopathology. Methods to measure this process, and its change over time, are therefore important for research in psychopathology and well-being. This study examined the factor structure of a widely used measure, the Forms of Self-Criticising/Attacking & Self-Reassuring Scale in thirteen nonclinical samples (N = 7510) from twelve different countries: Australia (N = 319), Canada (N = 383), Switzerland (N = 230), Israel (N = 476), Italy (N = 389), Japan (N = 264), the Netherlands (N = 360), Portugal (N = 764), Slovakia (N = 1326), Taiwan (N = 417), the United Kingdom 1 (N = 1570), the United Kingdom 2 (N = 883), and USA (N = 331). This study used more advanced analyses than prior reports: a bifactor item-response theory model, a two-tier item-response theory model, and a non-parametric item-response theory (Mokken) scale analysis. Although the original three-factor solution for the FSCRS (distinguishing between Inadequate-Self, Hated-Self, and Reassured-Self) had an acceptable fit, two-tier models, with two general factors (Self-criticism and Self-reassurance) demonstrated the best fit across all samples. This study provides preliminary evidence suggesting that this two-factor structure can be used in a range of nonclinical contexts across countries and cultures. Inadequate-Self and Hated-Self might not by distinct factors in nonclinical samples. Future work may benefit from distinguishing between self-correction versus shame-based self-criticism.

Research has shown that patients with somatoform disorders (SFD) have difficulty using medical reassurance (i.e. normal results from diagnostic testing) to revise concerns about being seriously ill. In this brief report, we investigated whether deficits in adequately interpreting the likelihood of a medical disease may contribute to this difficulty, and whether patients' concerns are altered by different likelihood framings. Patients with SFD ( = 60), patients with major depression ( = 32), and healthy volunteers ( = 37) were presented with varying likelihoods for the presence of a serious medical disease and were asked how concerned they are about it. The likelihood itself was varied, as was the format in which it was presented (i.e. negative framing focusing on the presence of a disease v. positive framing emphasizing its absence; use of natural frequencies percentages). Patients with SFD reported significantly more concern than depressed patients and healthy people in response to low likelihoods (i.e. 1: 100 000 to 1:10), while the groups were similarly concerned for likelihoods ⩾1:5. Across samples, the same mathematical likelihood caused significantly different levels of concern depending on how it was framed, with the lowest degree of concern for a positive framing approach and higher concern for natural frequencies (e.g. 1:100) than for percentages (e.g. 1%). The results suggest a specific deficit of patients with SFD in interpreting low likelihoods for the presence of a medical disease. Positive framing approaches and the use of percentages rather than natural frequencies can lower the degree of concern.

People with a history of self-harm are at a far greater risk of suicide than the general population. However, the relationship between self-harm and suicide is complex. To undertake the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm. We conducted a search for prospective cohort studies of populations who had self-harmed. For the review of risk scales we also included studies examining the risk of suicide in people under specialist mental healthcare, in order to broaden the scope of the review and increase the number of studies considered. Differences in predictive accuracy between populations were examined where applicable. Twelve studies on risk factors and 7 studies on risk scales were included. Four risk factors emerged from the meta-analysis, with robust effect sizes that showed little change when adjusted for important potential confounders. These included: previous episodes of self-harm (hazard ratio (HR) = 1.68, 95% CI 1.38-2.05, K = 4), suicidal intent (HR = 2.7, 95% CI 1.91-3.81, K = 3), physical health problems (HR = 1.99, 95% CI 1.16-3.43, K = 3) and male gender (HR = 2.05, 95% CI 1.70-2.46, K = 5). The included studies evaluated only three risk scales (Beck Hopelessness Scale (BHS), Suicide Intent Scale (SIS) and Scale for Suicide Ideation). Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a high heterogeneity was observed. The positive predictive values ranged from 1.3 to 16.7%. The four risk factors that emerged, although of interest, are unlikely to be of much practical use because they are comparatively common in clinical populations. No scales have sufficient evidence to support their use. The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and is, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed.

We explored the differences among 327 lesbian, gay, and/or bisexual (LGB) individuals on the dimensions of the Lesbian, Gay, and Bisexual Positive Identity Measure (LGB-PIM), a recently developed instrument to assess positive facets of LGB identity. We evaluated the relationship between the dimensions of LGB-PIM and self-relating processes (self-criticism, self-hate, and self-reassurance), internalized sexual stigma (ISS), social safeness and well-being, and the distinctive impact of the LGB-PIM dimensions on well-being. Lesbian/gay participants showed significantly higher levels of all five dimensions of positive identity than bisexual people. All LGB-PIM dimensions, except for commitment to social justice, showed correlations with well-being, self-relating processes, ISS, and social safeness. When controlling for other variables, only authenticity showed a significant unique relevance to positive psychological functioning in this population.

Why has U.S. grand strategy persisted since the end of the Cold War? Despite shocks such as the 2008 global financial crisis and the costs of the war in Iraq—circumstances that ought to have stimulated at least a revision—the United States remains committed to a grand strategy of “primacy.” It strives for military preponderance, dominance in key regions, the containment and reassurance of allies, nuclear counterproliferation, and the economic “Open Door.” The habitual ideas of the U.S. foreign policy establishment, or the “Blob,” make U.S. grand strategy hard to change. The United States’ military and economic capabilities enable the U.S. government to pursue primacy, but the embedded assumptions of the Blob make primacy the seemingly natural choice. Thanks to the Blob’s constraining power, alternative grand strategies based on restraint and retrenchment are hardly entertained, and debate is narrowed mostly into questions of execution and implementation. Two cases—the presidency of Bill Clinton and the first year of the presidency of Donald Trump—demonstrate this argument. In each case, candidates promising change were elected in fluid conditions that we would expect to stimulate a reevaluation of the United States’ commitments. In each case, the Blob asserted itself successfully, at least on the grand strategic fundamentals. Change in grand strategy is possible, but it would require shocks large enough to shake the assumptions of the status quo and a president willing to be an agent of change and prepared to absorb the political costs of overhauling Washington’s traditional design.

Party identification is central to the study of American political behavior, yet there remains disagreement over whether it is largely instrumental or expressive in nature. We draw on social identity theory to develop the expressive model and conduct four studies to compare it to an instrumental explanation of campaign involvement. We find strong support for the expressive model: a multi-item partisan identity scale better accounts for campaign activity than a strong stance on subjectively important policy issues, the strength of ideological self-placement, or a measure of ideological identity. A series of experiments underscore the power of partisan identity to generate action-oriented emotions that drive campaign activity. Strongly identified partisans feel angrier than weaker partisans when threatened with electoral loss and more positive when reassured of victory. In contrast, those who hold a strong and ideologically consistent position on issues are no more aroused emotionally than others by party threats or reassurances. In addition, threat and reassurance to the party's status arouse greater anger and enthusiasm among partisans than does a threatened loss or victory on central policy issues. Our findings underscore the power of an expressive partisan identity to drive campaign involvement and generate strong emotional reactions to ongoing campaign events.

Background Digital health provides solutions that capture patient-reported outcomes (PROs) and allows symptom monitoring and patient management. Digital therapeutics is the provision to patients of evidence-based therapeutic interventions through software applications aimed at prevention, monitoring, management, and treatment of symptoms and diseases or for treatment optimization. The digital health solutions collecting PROs address many unmet needs, including access to care and reassurance, increase in adherence and treatment efficacy, and decrease in hospitalizations. With current developments in oncology including increased availability of oral drugs and reduced availability of healthcare professionals, these solutions offer an innovative approach to optimize healthcare resource utilization. Design This scoping review clarifies the role and impact of the digital health solutions in oncology supportive care, with a view of the current segmentation according to their technical features (connection to sensors, PRO collection, remote monitoring, self-management in real time…), and identifies evidence from clinical studies published about their benefits and limitations and drivers and barriers to adoption. A qualitative summary is presented. Results Sixty-six studies were identified and included in the qualitative synthesis. Studies supported the use of 38 digital health solutions collecting ePROs and allowing remote monitoring, with benefits to patients regarding symptom reporting and management, reduction in symptom distress, decrease in unplanned hospitalizations and related costs and improved quality of life and survival. Among those 38 solutions 21 provided patient self-management with impactful symptom support, improvement of QoL, usefulness and reassurance. Principal challenges are in developing and implementing digital solutions to suit most patients, while ensuring patient compliance and adaptability for use in different healthcare systems and living environments. Conclusions There is growing evidence that digital health collecting ePROs provide benefits to patients related to clinical and health economic endpoints. These digital solutions can be integrated into routine supportive care in oncology practice to provide improved patient-centered care.

PurposeThere has been limited research conducted on the nature and consequences of excessive reassurance seeking in individuals with social anxiety, who tend to worry about the impression they make in evaluative social contexts. We examined the effects of self-reported trait social anxiety, low self-certainty, and engagement in post-event processing on reassurance seeking behaviours.MethodsThe sample consisted of 399 non-clinical undergraduate participants who completed self-report questionnaires in an online pre-registered correlational study.ResultsPartially consistent with our preregistered hypothesis, hierarchical regression analyses revealed that each predictor variable explained unique variance in reassurance seeking behaviours over and above the others, but interaction effects were non-significant for the main outcome variable measuring overall reassurance-seeking. Ancillary analyses revealed a significant three-way interaction between social anxiety symptoms, self-certainty, and post-event processing on engagement in evaluative threat-related reassurance seeking specifically.ConclusionsFuture prospective, naturalistic, and experimental research is needed to verify that evaluative threat-related reassurance seeking in social anxiety may be driven by heightened self-doubt and engagement in post-event processing, which may hinder socially anxious individuals from receiving high-quality support from those in their social network.