Aging & Mental Health, 2015 Vol. 19, No. 8, 689 697, http://dx.doi.org/10.1080/13607863.2014.962010

Physiological reactivity during autobiographical narratives in older adults: the roles of depression and anxiety Sarah M.C. Robertson*, Rhonda J. Swickert, Kathryn Connelly and Ann Galizio Department of Psychology, College of Charleston, Charleston, SC, USA (Received 30 May 2014; accepted 22 August 2014) Objectives: Physiological reactivity (PR) describes the change in physiological functioning (e.g., heart rate, blood pressure, pulse pressure) that occurs after the induction of a stressful task. This study aims to understand the influence of mental health symptoms on patterns of PR during autobiographical narratives in an older adult sample. Method: Eighty older adults completed self-report measures regarding their symptoms of depression and anxiety. Next, their blood pressure was recorded while they completed two verbal autobiographical narratives. Results: During the positive narrative, anxiety was positively associated with increased PR while depression was negatively associated with PR. During the negative narrative, a significant interaction occurred whereby anxiety was significantly positively associated with PR for those participants low in depression. Discussion: The above results are explained in the context of the Tripartite Model of Depression and Anxiety, which predicts different patterns of PR as a function of mental health symptoms. Limitations and future directions are also discussed. Keywords: physiological reactivity; anxiety; depression; aging

Introduction Physiological reactivity (PR) describes the change in physiological functioning (e.g., heart rate, blood pressure, pulse pressure) that occurs after the induction of a stressful task (Linden, Earle, Gerin, & Christenfeld, 1997). PR has received increasing attention from researchers as more has been discovered about its association with a variety of physical and mental health problems (Evans et al., 2013). Recent research indicates that several factors are important in predicting PR, including both mental health symptoms and age (Neupert, Miller, & Lachman, 2006; Patten et al., 2009; Uchino, Birmingham, & Berg, 2010). This study extends our understanding of these variables by assessing the influences of depression and anxiety on PR in a community-dwelling older adult sample. This study also increases our understanding of potential self-regulatory changes in late life by assessing the applicability of the Tripartite Model of Depression and Anxiety (Clark & Watson, 1991) to patterns of PR in an older adult sample. Primary aims of this study are to (1) assess whether changes in PR occur after the completion of stressful autobiographical narrative tasks in an older adult sample, (2) assess whether potential changes in PR occur as a function of mental health symptoms in an older adult sample, and (3) evaluate the applicability of the Tripartite Model of Anxiety and Depression to patterns of PR in an older adult sample.

The Tripartite Model of Anxiety and Depression Researchers have long noticed that anxiety and depressive disorders often co-occur. The Tripartite Model represents *Corresponding author. Email: [email protected] Ó 2014 Taylor & Francis

an important advancement in clinical psychology because it describes in theoretical terms how depression and anxiety are both similar to and different from one another (Clark & Watson, 1991). According to this model, depression and anxiety are similar in that people with both disorders experience negative affect (NA). NA represents the extent to which a person experiences unpleasant emotions, and people with both anxiety and depressive disorders report experiencing NA (Clark & Watson, 1991). However, there are distinct clinical features that also separate the two disorders. According to the Tripartite Model, depressed people uniquely experience anhedonia, and have difficulty experiencing pleasure in their lives. Anxious people, on the other hand, uniquely experience physiological hyperarousal, which can include the following experiences: shaking, heart racing, shortness of breath, and dizziness (Clark & Watson, 1991). Hyperarousal is a very common feature of anxiety disorders and diagnostic criteria for many anxiety disorders include physiological arousal (American Psychiatric Association, 2013). Despite the fact that anxiety and depressive disorders share some symptoms and often co-occur, there is evidence that they have distinct biological patterns as predicted by the Tripartite Model.

Depression and physiological reactivity Symptoms of major depressive disorder, as defined in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) include depressed mood, anhedonia, weight loss or gain, sleeping disturbance, psychomotor agitation or

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retardation, fatigue, worthlessness, decreased ability to concentrate, and suicidality (American Psychiatric Association, 2013). Given this symptom profile, it is not surprising that much data have indicated that depressive symptoms are often associated with lower levels of PR. For example, depressed participants demonstrated significantly lower systolic blood pressure and heart rate after the induction of a stressful task when compared to healthy controls (Salomon, Clift, Karlsd
ottir, & Rottenberg, 2009), a finding that has been replicated by other researchers (Carroll, Phillips, Hunt, & Der, 2007). More recent work has also confirmed the idea that depressive symptoms are associated with attenuated patterns of PR. Schwerdtfeger and Rosenkaimer (2011) found that depressive symptoms were negatively associated with blood pressure measurements after the induction of a public speaking task, while other work has demonstrated that depression is associated with decreased reactivity during a mental arithmetic task (Phillips, 2011). Also, when required to complete mirror-tracing tasks and speech tasks, participants with higher scores of depression exhibited less heart rate reactivity (Salomon et al., 2009). However, other research has also shown that depression symptoms have been associated with increased levels of PR. Health psychologists have noted the increased risk for cardiovascular disease and high blood pressure among depressed participants (Patten et al., 2009). Also, participants categorized as having high symptoms of depression demonstrated significantly greater systemic vascular resistance after the initiation of a stressful task (Matthews, Nelesen, & Dimsdale, 2005) and higher systolic and diastolic blood pressure before, during, and after the completion of a stressful speech task (Light, Kothandapani, & Allen, 1998). Researchers have been attempting to reconcile the contradictory findings associated with depression symptoms and PR. One variable that may explain the differences in these findings relates to social context, as recent data have indicated that merely thinking about an important social relationship can increase the PR that occurs during a psychologically stressful task (Cyranowski, Hofkens, Swartz, & Gianaros, 2011). Anxiety and physiological reactivity Much research has also been done to identify potential associations between anxiety symptoms and PR. Hallmark symptoms of many anxiety and trauma-related disorders include physiological hyperarousal (e.g., palpitations and trembling in panic disorder, PR when exposed to traumatic cues in post-traumatic stress disorder). Most findings strongly support the notion that higher levels of anxiety are associated with higher degrees of PR (McTeague & Lang, 2012). For example, normotensive students who were high in social anxiety symptoms demonstrated increased levels of heart rate reactivity after the completion of a speech task when compared to normotensive students who were low in social anxiety symptoms (Gramer, Schild, & Lurz, 2012). Additional work has

demonstrated that among a sample of children, anxiety symptoms were more predictive of psychological arousal after the completion of a stressful task than were depressive symptoms (Dieleman, van der Ende, Verhulst, & Huizink, 2010). Recent work has also indicated that higher levels of PR can be identified in participants with anxiety symptoms as well as their offspring (Jovanovic et al., 2011). Children of abused mothers demonstrated an increased startle response when compared to children whose mothers had not experienced abuse. While previous studies generally support the notion that anxiety is associated with the increased levels of PR and depression is generally associated with decreased levels of PR (especially when one is not required to consider social context), few studies have examined whether these two affective patterns may interact. For example, when considering someone who has high levels of both anxiety and depression, what pattern of PR might be anticipated? A recent study by de Rooij, Schene, Phillips, and Roseboom (2010) found that higher scores of composite depression and anxiety (i.e., total scores on the Hospital Anxiety and Depression Scale) were associated with decreased diastolic blood pressure assessments in a sample of 725 participants. It is important to note that the psychological stressor in this study consisted of several cognitive tasks and one speech task. Given these data, it is proposed that a significant interaction will occur whereby anxiety will be a significant positive predictor of PR for those low in depression, but not a significant predictor of PR for those high in depression. Age and physiological reactivity ‘Normal aging affects all physiological processes’ (Boss & Seegmiller, 1981, p. 434). More specifically, cardiac output decreases, blood pressure increases, lung capacity decreases, and rates of ventilation decrease (Boss & Seegmiller, 1981). What has been less clear in the literature, however, is how aging is related to patterns of PR. While previous work has supported the idea that age is an important factor to consider in the area of PR, it should also be noted that social and emotional contextual factors are also important to consider. Work by Kunzmann and Richter (2009) demonstrated that when participants between 20 70 years of age watched films with ageappropriate losses (e.g., cognitive impairment in the older adult), there were no differences in patterns of PR as a function of age. Other data support the notion that older adults display similar patterns of reactivity as young adults when describing past emotional experiences (Levenson, Carstensen, Friesen, & Ekman, 1991). However, data on this topic have been mixed, and some researchers have reported that age is associated with differences in patterns of PR. For example, after viewing emotionally evocative film clips, older adults demonstrated greater physiological responses than young adults (Seider, Shiota, Whalen, & Levenson, 2011). Importantly, a meta-analysis was conducted to assess the influence of age on PR after the induction of a stressful emotional task (Uchino et al., 2010). Results of this study indicated that there are indeed

Aging & Mental Health differences in PR as a function of age. More specifically, after analyzing 31 individual studies, age was associated with decreased heart rate reactivity and increased systolic blood pressure reactivity. It is proposed, given the Tripartite Model of Depression and Anxiety, that some of the inconsistency in findings related to PR and age can be explained by the presence of depression and anxiety symptoms. This study uniquely adds to the literature by assessing the influence of mental health symptoms on patterns of PR during autobiographical narratives in community-dwelling older adults.

Autobiographical narratives Although there is not a clear definition of an autobiographical narrative in the literature, it is widely accepted that narratives ‘place events in the larger context of one’s life, they relate events in a meaningful order, and most importantly, they provide evaluations of events that express their importance and personal significance’ (Bohanek, Fivush, & Walker, 2005, p. 51). The autobiographical narrative was chosen as a psychological stressor for this study because (1) it is highly ecologically valid and (2) meaningful information may be imperceptibly obtained that might be more readily avoided and less reliably assessed when using more direct assessment methods. Older adults are known to often share unstructured stories with other people in their everyday lives, which enhances the ecological validity of this task (Alea, Bluck, & Semegon, 2004). Also, utilizing narratives as a mechanism for assessing verbal emotionality is perhaps more accurate than asking people to rate how often they use emotional words. Quantifying emotional word during narratives eliminates some of the demand characteristics associated with a self-report measure of verbal emotionality. While a considerable amount of work has been focused on narrative expression and associated psychological constructs (e.g., identity formation, cognitive capacities, etc.), there has not been an equivalent focus on understanding physiological reactions during the expression of a personal story (Heilmann, Miller, & Nockerts, 2010; Ibarra & Barbulescu, 2010; Keddell, 2009; Robertson & Hopko, 2013; Watson, 2009). Some important work has begun in this area that will be reviewed here. Lawler et al. (2003) explored the relationship between forgiveness and PR during narratives. Results indicated that participants demonstrating trait forgiveness experienced lower diastolic blood pressure, while those showing state forgiveness had lower blood pressure (both diastolic and systolic) and heart rate. Lawler-Row, Karremans, Scott, Edlis-Matityahou, and Edwards (2008) also used narratives to assess whether or not reductions in anger (i.e., becoming less angry about a negative experience) had beneficial effects on physiological arousal or if complete forgiveness had significantly greater physiological benefits than only decreased anger. Findings from this study showed that forgiveness, not a decrease in anger, has a beneficial impact on physiological responding. This study builds upon this work by assessing the roles of mental health variables in patterns of PR during autobiographical narratives in a community-dwelling older adult sample.

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Hypotheses When considering the extant literatures on PR, depression, anxiety, and aging, it seems clear that anxiety is generally associated with increased PR, while the findings related to depression and PR have been mixed. It is proposed that depression will be associated with decreased PR in this study, given that the majority of data supports this proposition and the fact that social context was not a specific requirement of the task in this study. It is also proposed that anxiety and depression will interact (i.e., anxiety will predict PR for those low in depression, but not those high in depression). In this study, participants will complete two autobiographical narratives (one about a positive emotional experience and one about a negative emotional experience), and their systolic blood pressure will be assessed during their verbal description of emotional events. Systolic blood pressure is defined as the pressure in the arteries when the heart beats (as opposed to diastolic blood pressure which is the pressure in the arteries when the heart rests) and is utilized as the dependent variable in this study because it is more strongly related to psychological stressors in the laboratory and is also relatively more important than diastolic reactivity in predicting medical outcomes (Everson et al., 2001; Uchino et al., 2010). Both positive and negative narratives will be assessed because recent research suggests that emotional complexity (experiencing NA and positive affect simultaneously) increases in late life (Carstensen et al., 2011), and assessing both negatively and positively valenced stories allows the opportunity to comprehensively capture both congruent and non-congruent emotions. The following hypotheses will be tested within an older adult sample: (1) It is predicted that participating in autobiographical narrative tasks will result in a significant increase in systolic blood pressure when compared to a relaxation phase and a non-word reading phase. (2) It is predicted that anxiety will be positively associated with systolic blood pressure reactivity, while depression symptoms will be negatively associated with systolic blood pressure reactivity. (3) It is predicted that a significant interaction will occur whereby anxiety will be a significant positive predictor of PR for those low in depression, but not a significant predictor of PR for those high in depression.

Method Participants Older adult participants (ages 59 91) were recruited through an advertisement in the local newspaper (n D 80). Participants were not eligible for the study if they were currently being treated with medications known to alter physiological status (e.g., beta-blockers, anti-depressants, anti-inflammatory medications) or if they were under 55 years of age. Demographic characteristics of the sample are presented in Table 1.

Measures Beck Depression Inventory (BDI), second edition: the BDI is a 21-item scale that assesses affective,

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Table 1. Demographic descriptive statistics. Older adults (N D 80) Age (mean, SD) Years of education (mean, SD) Gender (women) Ethnicity Caucasian African-American Latino Asian Marital status Single Married Separated Divorced Widowed Occupational status Employed full-time Employed part-time Unemployed-seeking employment Unemployed-not seeking employment

72.64 (7.54) 15.28 (2.15) 52 (65.00%) 77 (96.25%) 1 (1.25%) 1 (1.25%) 1 (1.25%) 7 (8.75%) 47 (58.75%) 2 (2.50%) 11 (13.75%) 13 (16.25%) 8 (10.00%) 9 (11.25%) 2 (2.50%) 61 (76.25%)

physiological, and cognitive symptoms of depression (Beck, Steer, & Brown, 1996). Each question is measured on a 4-point Likert-type scale, with higher total scores representing higher levels of depression. In the current sample, internal consistency was strong (a D .91). Beck Anxiety Inventory (BAI): the BAI is a 21-item questionnaire designed to assess cognitive and physiological symptoms of anxiety (Beck & Steer, 1993). Each question is measured on a 4-point Likert-type scale, and higher total scores on the BAI represent higher levels of anxiety. In the current sample, internal consistency was strong (a D .92). Linguistic Inquiry Word Count (LIWC; Pennebaker, Booth, & Francis, 2007): this computer program analyzes the linguistic content of narratives. Researchers were responsible for transcribing all narratives immediately after the data were collected. A second member of the research team reviewed the transcription for accuracy and data were then entered into the LIWC software program. This program has good psychometric properties and has been utilized by several narrative researchers in previous studies (Fivush, Edwards, & Mennuti-Washburn, 2003; Pennebaker et al., 2007; Smith, Anderson-Hanley, Langrock, & Compas, 2005). All data, as is consistent with the LIWC program, are expressed as percentages of total words utilized. The Total Affect variable is analyzed for this study, and computes the percentage of all affective words within a narrative (e.g., happy, cried, abandon). More specifically, both NA and positive affect words are captured by this variable. Total Affect was selected (rather than only NA words or only positive affect words) given the literature that suggests emotional complexity increases in late life (Carstensen et al., 2011). Physiological Assessment: all blood pressure recordings were conducted with a General Electric Carescape

V100 Vital Signs Monitor. A blood pressure cuff was placed on the left arm of all the participants. Procedures All the participants initially completed a consent form and a brief packet of questionnaires, including a demographic form, the BDI, and the BAI. Next, participants viewed a relaxing nature video for 3 minutes (Gross & Levenson, 1995). Blood pressure was recorded at two points during this relaxation phase: once at the beginning and once at the end. Next, participants completed a reading task that required them to read non-words out loud. This list of non-words had been previously developed for the purposes of assessing literacy skills (Good & Kaminski, 2002). Examples of these items include, ‘sed’, ‘tob’, and ‘bil’. The reading task was completed in order to ensure that changes in PR during the narrative phase were not due to the effects of speaking alone. Blood pressure was recorded twice during the reading phase (once at the beginning and once at the end). Then, participants moved to the narrative phase of the study, in which they recalled both a positive and negative story about their lives (the order of narratives was counterbalanced throughout the study). Blood pressure was recorded at two points for both the positive and negative narrative (once at the beginning and once when a prompt was given). Blood pressure was recorded after the prompt from the researcher in order to ensure that all participants were speaking, thereby reducing experimental noise associated with variability in speech production. Including the two readings from the relaxation phase, a total of eight blood pressure measurements were taken. The two readings from each phase were averaged. Specific instructions for the autobiographical narratives were as follows: ‘Today I am interested in hearing about the different experiences that people have in life. Please describe a positive emotional experience that you have been through. Try to imagine the event in your mind and talk continuously about the thoughts and feelings related to the event you are describing. Please try to do this in as much detail as possible. I will record your blood pressure at two different points during your story: once at the beginning and once towards the end. Do you have any questions?’ Participants had up to 10 minutes to complete each narrative. After participants stopped speaking, they were all prompted with the question, ‘Is there anything else you can remember about that event?’ Of the 160 narratives, there were two negative autobiographical narratives that lasted for 10 minutes. Once 10 minutes had elapsed, the researcher asked, ‘Ten minutes have now elapsed. Are you comfortable moving on now?’ Both participants agreed to move on following this prompt. Out of the 640 total readings, 5 were not completed due to errors with the machine. Often, participants moved their arms while discussing their narratives, even when they were instructed to stay as still as possible. Therefore, the blood pressure monitor was unable to attain a reading for these five assessments. There were three incomplete readings during the positive narrative and two

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Table 2. Descriptive statistics for study variables. Older adults (N D 80)

Systolic blood pressure relaxation phase Systolic blood pressure reading phase Systolic blood pressure positive narrative Systolic blood pressure negative narrative BDI-II BAI LIWC (total affect-positive narrative expressed as percentage) LIWC (total affect-negative narrative) expressed as percentage)

N

Mean (SE)

Range

80 80 77 78 80 80 80 80

139.52 (2.33) 137.98 (2.10) 152.72 (2.58) 155.31 (2.69) 5.90 (4.25) 4.29 (4.81) 4.62 (1.97) 4.51 (1.85)

95.50 184.50 103.50 193.00 114.50 209.00 111.50 218.00 0 21 0 24 .95 12.50 0 9.35

Note: There are only 77 participants in the positive narrative and 78 participants in the negative narrative due to errors with the blood pressure machine. See procedures section for more information.

incomplete readings during the negative narrative. All of the incomplete readings were completed by different participants. No incomplete readings occurred during the relaxation or reading phases. Because blood pressure data during the narratives (i.e., the dependent variable) were not available for these five participants, this data was not used when running hierarchical regressions.

Results Manipulation checks Prior to the statistical analyses of autobiographical narratives, a manipulation check was performed to determine whether counterbalancing of narratives was successful. There were no significant differences in the PR as a function of narrative task order [average systolic blood pressure during positive narrative F(1,34) D 1.98, p D .17; average systolic blood pressure during negative narrative F(1,35) D .08, p D .78)]. Also, there was not a significant difference between the length of narratives as a function of narrative valence: [F(1,158) D .00, p D 1.00; average negative narrative length: (M D 209.38 seconds, SD D 149.62); average positive narrative length: (M D 194.41 seconds, SD D 148.13)]. Blood pressure data across time A Repeated Measures Analysis of Variance was completed to determine whether systolic blood pressure differed between the relaxation phase, the reading phase, the positive narrative, and the negative narrative. There was a significant difference across the four time points: F(1,75) D 4310.92, p D .00. Post hoc analyses indicated that there was a significant difference between relaxation (M D 139.52, SE D 2.33) and both the positive narrative [(M D 152.72, SE D 2.58), mean difference D 13.20, p D .00) and the negative narrative [(M D 155.31, SE D 2.69), mean difference D 15.79, p D .00]. There was also a significant difference between reading (M D 137.98, SE D 2.10) and both the positive narrative (mean difference D 14.74, p D .00) and the negative narrative (mean difference D 17.33, p D .00). There was not a significant difference between relaxation and reading (mean difference D 1.54, SE D 1.25, p D

.22). In relation to narrative valence, there was not a significant difference between the positive and negative narrative (mean difference D 2.59, SE D 1.43, p D .07). Please see Table 2 for descriptive statistics related to blood pressure data and other dependent measures.

The effects of depression and anxiety on systolic blood pressure Hierarchical linear regression was utilized to assess the ability of anxiety and depression to predict PR during autobiographical narratives after controlling for the influences of (1) PR during the reading task and (2) the percentage of emotional words utilized during the narratives as measured by the LIWC program. This model was chosen to ensure that PR during the autobiographical narratives was not due to the act of speaking alone. This model was also chosen to control the potential influence of the emotional content of the narratives. For example, some participants might have utilized a higher percentage of emotional words in their narrative than other participants, which could influence patterns of PR. Controlling for these potential confounds allows for a clearer understanding of the relationship between mental health symptoms and patterns of PR. Preliminary analyses were conducted to ensure no violation of the assumptions of normality, linearity, multicollinearity, and homoscedasticity. In order to reduce collinearity among variables, anxiety and depression scores were centered prior to forming the product term. Systolic blood pressure during the reading phase and the percentage of emotional word utilized were entered at Step 1. Anxiety and depression were entered at Step 2, and the depression X anxiety interaction was entered at Step 3. Hierarchical linear regressions were completed for both the negative and positive autobiographical narratives. Negative autobiographical narrative. Step 1: Average systolic blood pressure during the reading phase and the percentage of emotional words utilized explained 52.5% of the variance in average systolic blood pressure during the negative autobiographical narrative [Fchange (2,74) D 40.89, p D .00]. Step 2: After entry of depression and anxiety at Step 2 the total variance explained by the model as

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Independent variable Step 1 Reading systolic blood pressure (b) Emotional content (b) DR2 Step 2 Reading systolic blood pressure (b) Emotional content (b) Depression (b) Anxiety (b) DR2 Step 3 Reading systolic blood pressure (b) Emotional content (b) Depression X anxiety interaction (b) DR2 

standardized beta coefficients and R2

Systolic blood pressure: negative narrative

Systolic blood pressure: positive narrative

.73 ¡.03 .53

.77 ¡.22 .62

.72 ¡.03 ¡.12 .19 .02

.76 ¡.21 ¡.20 .28 .04

.70 ¡.03 ¡.25 .03

.75 ¡.21 ¡.14 .01

Significant at .05 level. Significant at .01 level.



a whole was 54.3%, which was not significantly higher than the previous model [Fchange (2,72) D 1.42, p D .25]. Step 3: After the entry of the interaction between depression and anxiety at Step 3 the total variance explained by the model as a whole was 57.3%, which was significantly higher than the previous model [Fchange (1,71) D 4.96, p D .03]. Please see Table 3 for a compiled list of beta weights and R2 values. The significant interaction between anxiety and depression was decomposed utilizing procedures described in Bauer and Curran (2005), which describes the application of the Johnson Neyman technique for probing interactions in hierarchical or multilevel models. The Johnson Neyman technique allows for the calculation of a range of values for which there is a significant interaction, rather than the ‘pick-a-point’ approach, which calculates significance of simple slopes at a limited number of values. Results indicated that anxiety was a significant predictor of systolic blood pressure when centered depression scores were less than 3.64. In order to plot this interaction, simple slopes of the lines predicting systolic blood pressure from depression were calculated at conditional values of anxiety that were one standard deviation above and below the mean (Bauer & Curran, 2005). Slope analyses indicated that for participants who were low in depression, there was a significant positive effect of anxiety whereby increased anxiety was associated with increased systolic blood pressure [simple slope D 2.03 (SE D .71), t D 2.86, p D .01]. However, for participants who were high in depression, there was no significant effect of anxiety [simple slope D .91 (SE D .50), t D 1.83, p D .09]. Importantly, these findings were significant even after controlling for the effects of reading and the percentage of emotional words utilized on PR. Please see Figure 1.

Positive autobiographical narrative. Step 1: Average systolic blood pressure during the reading phase and the percentage of emotional words utilized explained 62.2% of the variance in average systolic blood pressure during the positive autobiographical narrative [Fchange (2,72) D 59.29, p D .00]. Step 2: After the entry of depression and anxiety at Step 2 the total variance explained by the model as a whole was 66.3% [Fchange (2,70) D 4.23, p D .02], which was significantly higher than the previous model. Step 3: After the entry of the interaction between depression and anxiety at Step 3 the total variance explained by the model as a whole was 67.3% [Fchange (1,69) D 2.08, p D .15], which was not significantly higher than the previous model. Regression analyses indicated a significant main effect for anxiety [B D .28, t(73) D 2.91, p D .01] whereby increased anxiety was associated with increased systolic blood pressure. There was also a significant main effect of depression [B D ¡.19, t(73) D ¡2.00, p D .04] whereby increased depression was associated with decreased systolic blood pressure. Importantly, these findings were significant even after controlling for the effects of reading and the percentage of emotional words utilized on PR. Discussion Results provided moderate support for study hypotheses, and each hypothesis and the associated data will be discussed. Results of the study were supportive of Hypothesis 1, in that participants demonstrated significant increases in systolic blood pressure after the relaxation phase of the study. Importantly, this increase in PR occurred for both the positive and negative narratives. Speaking of an emotional event is associated with increased PR, regardless of the type of event described.

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Figure 1. Simple slopes of depression at low and high levels of anxiety during negative narrative.

Hypotheses 2 and 3 are important to consider together given that they related to each other. Hypotheses 2 and 3 predicted that (1) anxiety would be positively associated with PR, while depression would be negatively associated with PR and (2) a significant interaction would occur whereby anxiety will be a significant positive predictor of PR for those low in depression, but not a significant predictor of PR for those high in depression. Data from this study provide support for these hypotheses, and the predictions will be discussed separately for each narrative phase. Negative narrative There was a significant interaction whereby anxiety was a positive predictor of PR for those low in depression, but not a significant predictor of PR for those high in depression. An important finding of this study is that participants with higher depression scores did not demonstrate differences in PR as a function of anxiety. While anxiety is typically positively associated with PR, this pattern does not occur among older adults high in depression. It appears that depressive symptoms in the older adult seem to be physiologically overpowering the influence of anxiety symptoms, and leads one to wonder whether depression has a more profound impact on PR during negative narratives than anxiety. In other words, while anxiety is typically positively associated with PR, its effects are weakened when considering older adults with high levels of depression. Previous work has been done on depression and age that could play an important role in explaining this interaction effect. Research has indicated that older adults report more somatic symptoms of depression than young adults, while young adults report more affective

symptoms than older adults (Fiske, Wetherell, & Gatz, 2009). If older adults experience more of the somatic symptoms of depression, it might require a relatively greater amount of anxiety to induce PR, given that depression symptoms are often associated with dampened patterns of PR. Data from this study supports this notion, as higher levels of depression were associated with attenuated patterns of PR. The implications of this finding are important for older adults and clinicians alike. Struggling with depression as an older adult will often be associated with significant changes in an older adult’s physiological functioning, and somatic symptoms of depression like lethargy and sleep disturbances can become especially pronounced. It is important for clinicians to inquire about the status of somatic symptoms in the depressed older adult population and potentially address these symptoms by implementing an empirically supported treatment aimed at improving somatic symptoms of depression (i.e., behavioral activation; Hopko et al., 2011). It is also possible that depression could be serving to influence the schema of an older adult in such a way that priming could play an important role. Beck et al. have described a depressive schema as an interconnected system of thoughts that allows for a negative internal representation of the self (Beck, Rush, Shaw, & Emery, 1979). When an older adult describes a negative emotional experience, it is possible that this narrative description activates underlying negative schemata. In other words, talking about a negative event can serve as a primer for the activation of negative internal representations. If a depressive schema is activated, an older adult might not demonstrate equivalent physiological arousal, given that depression is so often associated with the dampened patterns of the PR. Further

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exploration of the potential role of cognitive schemata on patterns of the PR is indicated. Positive narrative Anxiety was significantly positively associated with PR during the positive narrative, and depression was significantly negatively associated with PR during the positive narrative. There was not a significant interaction between anxiety and depression during the positive narrative. While the main effects of anxiety and depression were predicted, it is interesting that the anticipated interaction did not occur as it did with the negative autobiographical narrative. There seems to be a difference in the role of depression and anxiety symptoms as a function of narrative valence. Anxiety was positively associated with patterns of PR during the positive narrative for all participants, not just those who were low in depression as occurred in the negative narrative. Perhaps recounting a negative life story is relatively more stressful than recounting a positive life story. The task of recounting a negative story might be so emotionally taxing that PR becomes less influenced by anxiety given that the depressive symptoms are potentially more activated in this specific type of task. This would explain why participants high in depression did not demonstrate differences in PR as a function of anxiety during the negative narrative. Likewise, when given a relatively easier task to complete (i.e., recounting a positive story), anxiety symptoms become more important to consider given that the depression symptoms are not as activated as they would have been when recounting a negative story. In future work, it will be important to empirically measure the subjective distress one experiences during these tasks to further understand its potential role in influencing patterns of PR. There are several limitations to address with this study. First, this study only included older adults. Ideally, one would like to have access to a variety of age groups to understand how potential differences occur across the lifespan. Second, physiological measurement is ideally done in a continuous manner. However, in situations where this level of equipment is unavailable, non-continuous assessment has also been supported in the literature (Lawler et al., 2003). Replication of this work utilizing a continuous method of measurement will help to strengthen the results presented here. Third, it is important to note the sample obtained for this study is predominantly Caucasian and replication of this work in minority groups is greatly needed. Fourth, it is important to note that the LIWC program does not rate the intensity of words utilized. Using the word ‘upset’, ‘sad’, and ‘furious’ would all be categorized in the Total Affect category. Future work that examines the potential function of the intensity of these words is needed. Also, it should be noted that the majority of the sample was composed of women (n D 52, 65.00%), and additional study is needed to understand how gender might influence patterns of PR in older adults. Finally, the older adults in this study covered a large range of ages (from 59 to 91). It is quite possible that variability in patterns of PR could occur within this range, and future work

that examines PR in young old, old, and old old categories will be helpful. In sum, data from this study provide moderate support for the Tripartite Model of Anxiety and Depression. During the negative autobiographical narrative, a significant interaction occurred whereby anxiety was significantly positively associated with PR for participants low in depression. During the positive autobiographical narrative, there were two significant main effects that occurred. Anxiety was positively associated with PR, while depression was negatively associated with PR. It will be important for future work to address how these patterns of PR might be similar to or different from patterns of PR in young and middle aged adults. Having data from several different age groups would allow researchers and clinicians to more comprehensively understand self-regulatory processes across the lifespan.

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