Affect, Bereavement, Depressive Symptoms, Emotions, Grief
Conditions
Keywords
emotion regulation, bereavement, affective neuroscience, social cognitive neuroscience
Brief summary
This study investigates the underlying mechanisms of a novel emotion regulation intervention among recently bereaved spouses. More specifically, this study examines how thinking about an emotional stimulus in a more adaptive way can affect the relationship between psychological stress, psychophysiological biomarkers of adaptive cardiac response, and brain activity. The emotion regulation strategy targeted is reappraisal, specifically reappraisal-by-distancing (i.e., thinking about a negative situation in a more objective, impartial way) versus reappraisal-by-reinterpretation (i.e., thinking about a better outcome for a negative situation than what initially seemed apparent). The study seeks to determine if relatively brief, focused reappraisal training in bereaved spouses will result in reduction of self-reported negative affect, increases in respiratory sinus arrhythmia (RSA; a measure of heart rate variability reflecting adaptive cardiac vagal tone), reduction in blood-based inflammatory biomarkers, and changes in neural activity over time. Reappraisal-by-distancing is expected to lead to greater changes in these variables relative to reappraisal-by-reinterpretation. Additionally, it is expected that across time decreases in self-reported negative affect, increases in RSA, reductions in blood-based inflammatory biomarker levels, and changes in neural activity will in turn lead to reductions in depressive symptoms and grief rumination. Finally, it is expected that distancing training will lead to reductions in depressive symptoms and grief rumination that are mediated by changes in the targeted neurobiological and behavioral mechanisms.
Detailed description
The objective of this study is to use an experimental medicine approach to evaluate the basic psychological, psychophysiological, and neural mechanisms underlying a novel cognitive emotion regulation intervention aimed at improving psychological outcomes (e.g., reducing depressive symptoms and grief rumination) in recently bereaved spouses. Cognitive reappraisal (i.e. the ability to modify the trajectory of an emotional response by thinking about and appraising emotional information in an alternative, more adaptive way) represents a highly promising target for psychological intervention in bereavement. Reappraisal can be operationalized via two primary tactics: psychological distancing (i.e. appraising an emotional stimulus as an objective, impartial observer) and reinterpretation (i.e. imagining a better outcome than what initially seemed apparent). The current study builds upon promising preliminary work to investigate the effectiveness and underlying neurobiological mechanisms of a novel, five-session cognitive reappraisal intervention in bereaved spouses. Recently bereaved participants (i.e. approximately 6 months post-spousal loss) will be randomly assigned to receive training in either distancing or reinterpretation, with five sessions occurring every 1-3 days, with longitudinal collection of affective, psychophysiological, physiological (i.e., blood draws to assess inflammatory biomarkers) and functional magnetic resonance imaging (fMRI) data. Follow-up questionnaire assessments will occur at one- and two-months post-intervention. The study aims to mechanistically relate changes in psychological, psychophysiological, physiological, and neural function during a novel emotion regulation intervention never before implemented in this stressed, high risk group. This research represents a Phase I, Stage I clinical trial. The primary endpoints are the assessments of the psychological, psychophysiological, physiological, and neural mechanisms mediating behavior change as a function of the cognitive emotion regulation intervention. The secondary endpoint is testing the efficacy of the intervention via assessment of psychological outcomes (i.e., the behavior change, as represented in changes in depressive symptoms, stress, and grief rumination).
Interventions
BEHAVIORALCognitive Emotion Regulation Training
Cognitive emotion regulation training via cognitive reappraisal involves the ability to modify the trajectory of an emotional response by thinking about and appraising emotional information in an alternative, more adaptive way. Reappraisal to down-regulate negative emotion can be operationalized via two tactics: psychological distancing and reinterpretation. The current study will randomly assign participants to receive a brief course of reappraisal training using either psychological distancing or reinterpretation.
Sponsors
National Institute on Aging (NIA)
Bryan Denny
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE
Intervention model description
Participants will be randomized to either the Distancing or Reinterpretation group.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Recent loss of romantic partner within the past 5-7 months * At least 18 years of age * Minimum score of 25 on the Inventory for Complicated Grief * Must be able to speak, read, and write in English * Must be eligible to safely complete MRI scanning
Exclusion criteria
* Death of a second close family member/friend in the past year * Currently receiving psychotherapy * Diagnosed with obstructive pulmonary and/or heart disease, diabetes, liver failure, or kidney failure * Significant visual, auditory, or cognitive impairment * Divorced within the last year * Prior participation in a similar emotion regulation training protocol in Dr. Denny's lab * Any contraindication of MRI scanning (e.g., pregnancy, presence of any non-removable metal on or in the body, implanted medical devices, tattoos, medication patches, orthodontic braces or permanent retainers, hearing aids, history of claustrophobia or breathing disorders)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Perceived Stress | Sessions 1 (baseline/initial session), 2, 3, 4, and 5, which were conducted approximately every 2-3 days over the course of 2 weeks, and at the 1- and 2- month follow-up. | Perceived stress assessed via the Perceived Stress Scale (PSS), consisting of 10 self-reported items asking participants how often they felt or thought a certain way, ranging from 0 (Never) to 4 (Very Often). Total range is 0 to 40, with higher scores indicate higher levels of perceived stress. |
| Neural Activity | Sessions 1 (baseline/initial session) and 5, which were conducted approximately 2 weeks apart. | Picture Induced Negative Emotion Signature (PINES) is an independently-defined, validated whole-brain neural pattern map for negative appraisal, with positive weights for areas like the amygdala and insula. PINES Correspondence Scores (PCS) are correlation coefficients derived for each trial type (Look Neutral, Look Negative, Reappraise Negative) per participant by correlating each participant's whole-brain pattern during the task to PINES. PCS correlation coefficients range from -1 to 1, and higher values reflect greater correlation to PINES and thus greater negative affect. |
| Grief Rumination | Sessions 1 (baseline/initial session) and 5, which were conducted approximately 2 weeks apart, and at the 1- and 2-month follow-ups. | Grief rumination assessed via Utrecht Grief Rumination Scale (UGRS) and the Inventory for Complicated Grief (ICG). UGRS items are rated from 1 (never) to 5 (very often). Scores range from 15 to 75; higher numbers represent higher grief rumination. These are summed from 3-item subscales Reactions, Injustice, Counterfactuals, Meaning, and Relationships, which all have score ranges of 3-15. Higher scores represent greater grief rumination. The ICG assesses grief via 19 first-person statements on a scale of 0 (Never) to 4 (Always) with a range from 0-76. Higher numbers reflect greater grief. |
| Depressive Symptoms | Sessions 1 (baseline/initial session) and 5, which were conducted approximately 2 weeks apart, and at the 1- and 2-month follow-ups. | Symptoms of depression assessed via the Center for Epidemiological Studies Depression (CES-D) scale, which asks participants to rate how often in the past week they have experience symptoms of depression, ranging from 0 (Rarely or none of the time) to 3 (Most of the time). Scores range from 0 to 60, with higher scores indicating higher levels of depressive symptoms. |
| Self-reported Negative Affect | Sessions 1 (baseline/initial session), 2, 3, 4, and 5, which were conducted approximately every 2-3 days over the course of 2 weeks. | Self-reported negative affect data collected during the emotion regulation task on a 1-4 scale, with 1 meaning not negative at all and 4 meaning very negative. |
| Respiratory Sinus Arrhythmia | Sessions 1 (baseline/initial session), 2, 3, 4, and 5, which were conducted approximately every 2-3 days over the course of 2 weeks. | Heart rate variability, or variability in time intervals between heart beats, as measured by the log of the root mean square of the successive RR interval differences (ln(RMSSD)). RR intervals are interbeat intervals between consecutive heartbeats. Average ranges for ln(RMSSD) for 30 to over 75 years of age range from 3.2 to 3.9 for women and 3.2 to 3.8 for men. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Physical Health | Sessions 1 (baseline/initial session) and 5, which were conducted approximately 2 weeks apart, and at the 1- and 2-month follow-ups. | Physical health and quality of life assessed via the RAND 36-Item Short Form Health Survey (SF-36) which assesses 8 subscales: physical functioning, social functioning, role limitations due to physical health problems, body pain, role limitations due to personal or emotional problems, emotional well-being, energy/fatigue, and general health perceptions. Each subscale ranges from 0 to 100, higher scores referring to more adaptive health outcomes. |
| Inflammatory Biomarkers | Sessions 0 and 6, which were conducted approximately 2-3 weeks apart. | Inflammatory biomarkers (e.g., serum IL-6, sIL-6R, IL-10, and TNF- α) measured via blood draw |
| Frequency of Reappraisal Usage | Sessions 1 (baseline/initial session) and 5, which were conducted approximately 2 weeks apart, and at the 1- and 2-month follow-ups. | Overall reappraisal usage frequency assessed via the Emotion Regulation Questionnaire Reappraisal facet score. Participants report using a 7-point Likert-type scale ranging from 1 (strongly disagree) to 7 (strongly agree). Reappraisal facet scores may range from 6-42. Higher scores represent greater habitual reappraisal usage. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Distancing Participants will receive structured cognitive emotion regulation training from an experimenter during an approximately 10-minute interaction in which detailed instructions for implementation of the distancing strategy is explained (i.e. appraising an emotional stimulus as an objective, impartial observer).
Cognitive Emotion Regulation Training: Cognitive emotion regulation training via cognitive reappraisal involves the ability to modify the trajectory of an emotional response by thinking about and appraising emotional information in an alternative, more adaptive way. Reappraisal to down-regulate negative emotion can be operationalized via two tactics: psychological distancing and reinterpretation. The current study will randomly assign participants to receive a brief course of reappraisal training using either psychological distancing or reinterpretation. | 29 |
| Reinterpretation Participants will receive structured cognitive emotion regulation training from an experimenter during an approximately 10-minute interaction in which detailed instructions for implementation of the reinterpretation strategy is explained (i.e. imagining a better outcome than what initially seemed apparent).
Cognitive Emotion Regulation Training: Cognitive emotion regulation training via cognitive reappraisal involves the ability to modify the trajectory of an emotional response by thinking about and appraising emotional information in an alternative, more adaptive way. Reappraisal to down-regulate negative emotion can be operationalized via two tactics: psychological distancing and reinterpretation. The current study will randomly assign participants to receive a brief course of reappraisal training using either psychological distancing or reinterpretation. | 32 |
| Total | 61 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 5 | 7 |
| Overall Study | Technical issues with MR scanner | 1 | 0 |
| Overall Study | Withdrawal by Subject | 5 | 4 |
Baseline characteristics
| Characteristic | Distancing | Total | Reinterpretation |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 18 Participants | 39 Participants | 21 Participants |
| Age, Categorical Between 18 and 65 years | 11 Participants | 22 Participants | 11 Participants |
| Age, Continuous | 67.90 years STANDARD_DEVIATION 13.48 | 67.54 years STANDARD_DEVIATION 11.68 | 67.22 years STANDARD_DEVIATION 9.98 |
| Depressive Symptoms | 26 score on a scale STANDARD_DEVIATION 8.45 | 24.7 score on a scale STANDARD_DEVIATION 9.47 | 23.5 score on a scale STANDARD_DEVIATION 10.29 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4 Participants | 9 Participants | 5 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 24 Participants | 49 Participants | 25 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 3 Participants | 2 Participants |
| Grief Rumination Inventory for Complicated Grief (ICG) | 27.93 score on a scale STANDARD_DEVIATION 9.36 | 29.70 score on a scale STANDARD_DEVIATION 10.93 | 31.31 score on a scale STANDARD_DEVIATION 12.1 |
| Grief Rumination Utrecht Grief Rumination Scale (UGRS) Composite score | 41.34 score on a scale STANDARD_DEVIATION 10.54 | 41.34 score on a scale STANDARD_DEVIATION 10.73 | 41.34 score on a scale STANDARD_DEVIATION 11.07 |
| Grief Rumination Utrecht Grief Rumination Scale (UGRS) Counterfactuals Subscale | 7.41 score on a scale STANDARD_DEVIATION 4 | 7.33 score on a scale STANDARD_DEVIATION 3.74 | 7.25 score on a scale STANDARD_DEVIATION 3.55 |
| Grief Rumination Utrecht Grief Rumination Scale (UGRS) Injustice Subscale | 6.79 score on a scale STANDARD_DEVIATION 3.17 | 6.59 score on a scale STANDARD_DEVIATION 3.32 | 6.41 score on a scale STANDARD_DEVIATION 3.5 |
| Grief Rumination Utrecht Grief Rumination Scale (UGRS) Meaning Subscale | 11.17 score on a scale STANDARD_DEVIATION 2.96 | 11.85 score on a scale STANDARD_DEVIATION 2.78 | 12.47 score on a scale STANDARD_DEVIATION 2.49 |
| Grief Rumination Utrecht Grief Rumination Scale (UGRS) Reactions Subscale | 9.10 score on a scale STANDARD_DEVIATION 3 | 9.16 score on a scale STANDARD_DEVIATION 2.92 | 9.22 score on a scale STANDARD_DEVIATION 2.89 |
| Grief Rumination Utrecht Grief Rumination Scale (UGRS) Relationships Subscale | 6.86 score on a scale STANDARD_DEVIATION 3.37 | 6.41 score on a scale STANDARD_DEVIATION 3.2 | 6.00 score on a scale STANDARD_DEVIATION 3.03 |
| Neural Activity Composite Score | 0.11 units on a scale STANDARD_DEVIATION 0.03 | 0.11 units on a scale STANDARD_DEVIATION 0.04 | 0.11 units on a scale STANDARD_DEVIATION 0.04 |
| Neural Activity Look Negative Trials | 0.12 units on a scale STANDARD_DEVIATION 0.03 | 0.13 units on a scale STANDARD_DEVIATION 0.03 | 0.13 units on a scale STANDARD_DEVIATION 0.03 |
| Neural Activity Look Neutral Trials | 0.09 units on a scale STANDARD_DEVIATION 0.03 | 0.10 units on a scale STANDARD_DEVIATION 0.03 | 0.10 units on a scale STANDARD_DEVIATION 0.03 |
| Neural Activity Reappraise Negative Trials | 0.12 units on a scale STANDARD_DEVIATION 0.03 | 0.12 units on a scale STANDARD_DEVIATION 0.04 | 0.12 units on a scale STANDARD_DEVIATION 0.04 |
| Perceived Stress | 17.7 score on a scale STANDARD_DEVIATION 5.74 | 16.8 score on a scale STANDARD_DEVIATION 6.72 | 15.9 score on a scale STANDARD_DEVIATION 7.48 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 4 Participants | 6 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 3 Participants | 4 Participants | 1 Participants |
| Race (NIH/OMB) White | 21 Participants | 49 Participants | 28 Participants |
| Region of Enrollment United States | 29 participants | 61 participants | 32 participants |
| Respiratory Sinus Arrhythmia | 3.04 ln(ms) STANDARD_DEVIATION 0.78 | 3.01 ln(ms) STANDARD_DEVIATION 0.769 | 2.99 ln(ms) STANDARD_DEVIATION 0.78 |
| Self-reported Negative Affect | 1.98 units on a scale STANDARD_DEVIATION 0.45 | 2.02 units on a scale STANDARD_DEVIATION 0.46 | 2.05 units on a scale STANDARD_DEVIATION 0.49 |
| Sex: Female, Male Female | 20 Participants | 41 Participants | 21 Participants |
| Sex: Female, Male Male | 9 Participants | 20 Participants | 11 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 38 | 0 / 37 |
| other Total, other adverse events | 0 / 38 | 0 / 37 |
| serious Total, serious adverse events | 0 / 38 | 0 / 37 |
Outcome results
Primary
Depressive Symptoms
Symptoms of depression assessed via the Center for Epidemiological Studies Depression (CES-D) scale, which asks participants to rate how often in the past week they have experience symptoms of depression, ranging from 0 (Rarely or none of the time) to 3 (Most of the time). Scores range from 0 to 60, with higher scores indicating higher levels of depressive symptoms.
Time frame: Sessions 1 (baseline/initial session) and 5, which were conducted approximately 2 weeks apart, and at the 1- and 2-month follow-ups.
Population: Participants either dropped out or stopped responding during the follow-ups, leading to attrition that lowered our participant number during the 1 and 2 month follow-ups.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Distancing | Depressive Symptoms | Center for Epidemiological Studies Depression scale Session 5 | 21.59 score on a scale | Standard Error 2.04 |
| Distancing | Depressive Symptoms | Center for Epidemiological Studies Depression scale 1 month follow up | 18.96 score on a scale | Standard Error 1.63 |
| Distancing | Depressive Symptoms | Center for Epidemiological Studies Depression scale 2 month follow up | 16.77 score on a scale | Standard Error 1.86 |
| Reinterpretation | Depressive Symptoms | Center for Epidemiological Studies Depression scale Session 5 | 21.78 score on a scale | Standard Error 1.9 |
| Reinterpretation | Depressive Symptoms | Center for Epidemiological Studies Depression scale 1 month follow up | 20.75 score on a scale | Standard Error 1.93 |
| Reinterpretation | Depressive Symptoms | Center for Epidemiological Studies Depression scale 2 month follow up | 18.70 score on a scale | Standard Error 2.07 |
Comparison: Null hypothesis: no difference between groupsp-value: 0.092Mixed Models Analysis
Primary
Grief Rumination
Grief rumination assessed via Utrecht Grief Rumination Scale (UGRS) and the Inventory for Complicated Grief (ICG). UGRS items are rated from 1 (never) to 5 (very often). Scores range from 15 to 75; higher numbers represent higher grief rumination. These are summed from 3-item subscales Reactions, Injustice, Counterfactuals, Meaning, and Relationships, which all have score ranges of 3-15. Higher scores represent greater grief rumination. The ICG assesses grief via 19 first-person statements on a scale of 0 (Never) to 4 (Always) with a range from 0-76. Higher numbers reflect greater grief.
Time frame: Sessions 1 (baseline/initial session) and 5, which were conducted approximately 2 weeks apart, and at the 1- and 2-month follow-ups.
Population: Participants either dropped out or stopped responding during the follow-ups, leading to attrition that lowered our participant number during the 1 and 2 month follow-ups.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Meaning Subscale Session 5 | 10.38 score on a scale | Standard Error 0.52 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Relationships Subscale Session 5 | 5.66 score on a scale | Standard Error 0.4 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Counterfactuals Subscale Session 5 | 6.66 score on a scale | Standard Error 0.66 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Injustice Subscale Session 5 | 5.59 score on a scale | Standard Error 0.51 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Reactions Subscale Session 5 | 9.24 score on a scale | Standard Error 0.61 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Composite Score Session 5 | 37.52 score on a scale | Standard Error 1.85 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Meaning Subscale 1 month follow up | 9.42 score on a scale | Standard Error 0.45 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Relationships Subscale 1 month follow up | 6.08 score on a scale | Standard Error 0.46 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Counterfactuals Subscale 1 month follow up | 5.50 score on a scale | Standard Error 0.52 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Injustice Subscale 1 month follow up | 5.13 score on a scale | Standard Error 0.51 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Reactions Subscale 1 month follow up | 8.04 score on a scale | Standard Error 0.43 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Composite Score 1 month follow up | 34.17 score on a scale | Standard Error 1.56 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Meaning Subscale 2 month follow up | 8.77 score on a scale | Standard Error 0.53 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Relationships Subscale 2 month follow up | 5.55 score on a scale | Standard Error 0.59 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Counterfactuals Subscale 2 month follow up | 5.91 score on a scale | Standard Error 0.69 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Injustice Subscale 2 month follow up | 4.05 score on a scale | Standard Error 0.31 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Reactions Subscale 2 month follow up | 6.95 score on a scale | Standard Error 0.7 |
| Distancing | Grief Rumination | Utrecht Grief Rumination Scale Composite Score 2 month follow up | 31.23 score on a scale | Standard Error 2.24 |
| Distancing | Grief Rumination | Inventory for Complicated Grief Session 5 | 25.41 score on a scale | Standard Error 1.69 |
| Distancing | Grief Rumination | Inventory for Complicated Grief 1 month follow up | 23.92 score on a scale | Standard Error 1.77 |
| Distancing | Grief Rumination | Inventory for Complicated Grief 2 month follow up | 21.41 score on a scale | Standard Error 1.83 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Reactions Subscale 1 month follow up | 8.21 score on a scale | Standard Error 0.55 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Meaning Subscale Session 5 | 11.69 score on a scale | Standard Error 0.51 |
| Reinterpretation | Grief Rumination | Inventory for Complicated Grief Session 5 | 29.41 score on a scale | Standard Error 2.24 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Relationships Subscale Session 5 | 5.78 score on a scale | Standard Error 0.48 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Composite Score 1 month follow up | 35.61 score on a scale | Standard Error 1.95 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Counterfactuals Subscale Session 5 | 6.81 score on a scale | Standard Error 0.59 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Reactions Subscale 2 month follow up | 7.39 score on a scale | Standard Error 0.75 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Injustice Subscale Session 5 | 6.59 score on a scale | Standard Error 0.66 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Meaning Subscale 2 month follow up | 10.30 score on a scale | Standard Error 0.71 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Reactions Subscale Session 5 | 9.03 score on a scale | Standard Error 0.51 |
| Reinterpretation | Grief Rumination | Inventory for Complicated Grief 2 month follow up | 27.09 score on a scale | Standard Error 2.55 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Composite Score Session 5 | 39.91 score on a scale | Standard Error 2.05 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Relationships Subscale 2 month follow up | 5.17 score on a scale | Standard Error 0.55 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Meaning Subscale 1 month follow up | 10.61 score on a scale | Standard Error 0.64 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Composite Score 2 month follow up | 34.22 score on a scale | Standard Error 2.89 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Relationships Subscale 1 month follow up | 5.11 score on a scale | Standard Error 0.34 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Counterfactuals Subscale 2 month follow up | 5.48 score on a scale | Standard Error 0.72 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Counterfactuals Subscale 1 month follow up | 6.11 score on a scale | Standard Error 0.57 |
| Reinterpretation | Grief Rumination | Inventory for Complicated Grief 1 month follow up | 27.32 score on a scale | Standard Error 2.41 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Injustice Subscale 1 month follow up | 5.57 score on a scale | Standard Error 0.56 |
| Reinterpretation | Grief Rumination | Utrecht Grief Rumination Scale Injustice Subscale 2 month follow up | 5.87 score on a scale | Standard Error 0.71 |
Comparison: Null hypothesis: no difference between groups. Power analyses of an effect size (d=.70) previously reported for within and between-subjects analyses of questionnaire outcomes (i.e., depressive symptoms, grief rumination, perceived stress, reappraisal usage) indicate over 95% power (α=.05) to detect within-group effects and 90% power (α=0.05) for between-group effects should be achieved with 36 per group.p-value: 0.724Mixed Models Analysis
Comparison: Null hypothesis: no difference between groupsp-value: 0.835Mixed Models Analysis
Comparison: Null hypothesis: no difference between groups.p-value: 0.09Mixed Models Analysis
Comparison: Null hypothesis: no difference between groupsp-value: 0.983Mixed Models Analysis
Comparison: Null hypothesis: no difference between groupsp-value: 0.76Mixed Models Analysis
Comparison: Null hypothesis: no difference between groups.p-value: 0.402Mixed Models Analysis
Primary
Neural Activity
Picture Induced Negative Emotion Signature (PINES) is an independently-defined, validated whole-brain neural pattern map for negative appraisal, with positive weights for areas like the amygdala and insula. PINES Correspondence Scores (PCS) are correlation coefficients derived for each trial type (Look Neutral, Look Negative, Reappraise Negative) per participant by correlating each participant's whole-brain pattern during the task to PINES. PCS correlation coefficients range from -1 to 1, and higher values reflect greater correlation to PINES and thus greater negative affect.
Time frame: Sessions 1 (baseline/initial session) and 5, which were conducted approximately 2 weeks apart.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Distancing | Neural Activity | Look Neutral Trials | 0.09 units on a scale | Standard Error 0.01 |
| Distancing | Neural Activity | Look Negative Trials | 0.13 units on a scale | Standard Error 0.01 |
| Distancing | Neural Activity | Reappraise Negative Trials | 0.11 units on a scale | Standard Error 0.01 |
| Distancing | Neural Activity | Composite Score | 0.11 units on a scale | Standard Error 0.004 |
| Reinterpretation | Neural Activity | Composite Score | 0.12 units on a scale | Standard Error 0.003 |
| Reinterpretation | Neural Activity | Look Neutral Trials | 0.10 units on a scale | Standard Error 0.005 |
| Reinterpretation | Neural Activity | Reappraise Negative Trials | 0.13 units on a scale | Standard Error 0.01 |
| Reinterpretation | Neural Activity | Look Negative Trials | 0.14 units on a scale | Standard Error 0.01 |
Comparison: Null hypothesis: no difference between groups. Power analyses using a within-subject fMRI effect size estimate for right amygdala affective reactivity from a meta-analysis of Human Connectome Project data of approx. d=.70, applying to between-subjects effects as well, indicate over 95% power (α=.05) to detect within-group effects and 90% power (α=0.05) to detect between-group effects should be achieved with 36 participants per group.p-value: 0.021Mixed Models Analysis
Primary
Perceived Stress
Perceived stress assessed via the Perceived Stress Scale (PSS), consisting of 10 self-reported items asking participants how often they felt or thought a certain way, ranging from 0 (Never) to 4 (Very Often). Total range is 0 to 40, with higher scores indicate higher levels of perceived stress.
Time frame: Sessions 1 (baseline/initial session), 2, 3, 4, and 5, which were conducted approximately every 2-3 days over the course of 2 weeks, and at the 1- and 2- month follow-up.
Population: Participants either dropped out or stopped responding during the follow-ups, leading to attrition that lowered our participant number during the 1 and 2 month follow-ups.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Distancing | Perceived Stress | Perceived Stress Scale Session 2 | 16.07 score on a scale | Standard Error 1.16 |
| Distancing | Perceived Stress | Perceived Stress Scale Session 3 | 15.93 score on a scale | Standard Error 1.04 |
| Distancing | Perceived Stress | Perceived Stress Scale Session 4 | 14.52 score on a scale | Standard Error 1.16 |
| Distancing | Perceived Stress | Perceived Stress Scale Session 5 | 14.41 score on a scale | Standard Error 1.17 |
| Distancing | Perceived Stress | Perceived Stress Scale 1 month follow up | 14.29 score on a scale | Standard Error 1.17 |
| Distancing | Perceived Stress | Perceived Stress Scale 2 month follow up | 13.00 score on a scale | Standard Error 1.2 |
| Reinterpretation | Perceived Stress | Perceived Stress Scale 1 month follow up | 14.18 score on a scale | Standard Error 1.41 |
| Reinterpretation | Perceived Stress | Perceived Stress Scale Session 2 | 15.31 score on a scale | Standard Error 1.38 |
| Reinterpretation | Perceived Stress | Perceived Stress Scale Session 5 | 14.28 score on a scale | Standard Error 1.49 |
| Reinterpretation | Perceived Stress | Perceived Stress Scale Session 3 | 15.53 score on a scale | Standard Error 1.45 |
| Reinterpretation | Perceived Stress | Perceived Stress Scale 2 month follow up | 12.91 score on a scale | Standard Error 1.59 |
| Reinterpretation | Perceived Stress | Perceived Stress Scale Session 4 | 14.28 score on a scale | Standard Error 1.35 |
Comparison: Null hypothesis: no difference between groupsp-value: 0.585Mixed Models Analysis
Primary
Respiratory Sinus Arrhythmia
Heart rate variability, or variability in time intervals between heart beats, as measured by the log of the root mean square of the successive RR interval differences (ln(RMSSD)). RR intervals are interbeat intervals between consecutive heartbeats. Average ranges for ln(RMSSD) for 30 to over 75 years of age range from 3.2 to 3.9 for women and 3.2 to 3.8 for men.
Time frame: Sessions 1 (baseline/initial session), 2, 3, 4, and 5, which were conducted approximately every 2-3 days over the course of 2 weeks.
Population: Participants that had low quality data (e.g., motion artifacts), recordings that were too short to analyze (less than 150 seconds), or had no recording files available were excluded from analysis.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Distancing | Respiratory Sinus Arrhythmia | Session 2 | 2.80 ln(ms) | Standard Error 0.12 |
| Distancing | Respiratory Sinus Arrhythmia | Session 3 | 2.90 ln(ms) | Standard Error 0.12 |
| Distancing | Respiratory Sinus Arrhythmia | Session 4 | 3.05 ln(ms) | Standard Error 0.15 |
| Distancing | Respiratory Sinus Arrhythmia | Session 5 | 3.09 ln(ms) | Standard Error 0.16 |
| Reinterpretation | Respiratory Sinus Arrhythmia | Session 5 | 2.84 ln(ms) | Standard Error 0.12 |
| Reinterpretation | Respiratory Sinus Arrhythmia | Session 2 | 2.72 ln(ms) | Standard Error 0.11 |
| Reinterpretation | Respiratory Sinus Arrhythmia | Session 4 | 2.84 ln(ms) | Standard Error 0.13 |
| Reinterpretation | Respiratory Sinus Arrhythmia | Session 3 | 2.95 ln(ms) | Standard Error 0.14 |
Comparison: Null hypothesis: no difference between groups. Power analyses using an approximate effect size (d=.70) previously obtained for within and between-subjects analyses of respiratory sinus arrhythmia data indicate over 95% power (α=.05) to detect within-group effects and 90% power (α=.05) to detect between-group effects should be achieved with 36 per group.p-value: 0.741Mixed Models Analysis
Primary
Self-reported Negative Affect
Self-reported negative affect data collected during the emotion regulation task on a 1-4 scale, with 1 meaning not negative at all and 4 meaning very negative.
Time frame: Sessions 1 (baseline/initial session), 2, 3, 4, and 5, which were conducted approximately every 2-3 days over the course of 2 weeks.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Distancing | Self-reported Negative Affect | Session 2 Negative Affect | 1.88 score on a scale | Standard Error 0.07 |
| Distancing | Self-reported Negative Affect | Session 3 Negative Affect | 1.70 score on a scale | Standard Error 0.06 |
| Distancing | Self-reported Negative Affect | Session 4 Negative Affect | 1.63 score on a scale | Standard Error 0.06 |
| Distancing | Self-reported Negative Affect | Session 5 Negative Affect | 1.63 score on a scale | Standard Error 0.06 |
| Reinterpretation | Self-reported Negative Affect | Session 5 Negative Affect | 1.83 score on a scale | Standard Error 0.06 |
| Reinterpretation | Self-reported Negative Affect | Session 2 Negative Affect | 1.91 score on a scale | Standard Error 0.06 |
| Reinterpretation | Self-reported Negative Affect | Session 4 Negative Affect | 1.85 score on a scale | Standard Error 0.07 |
| Reinterpretation | Self-reported Negative Affect | Session 3 Negative Affect | 1.89 score on a scale | Standard Error 0.06 |
Comparison: Null hypothesis: no difference between groups. Power analyses using an approximate effect size (d=.70) previously reported for within and between-subjects behavioral analyses of longitudinal reappraisal training data indicate over 95% power (α=.05) to detect within-group effects and 90% power (α=.05) to detect between-group effects require 36 per group.p-value: 0.053Mixed Models Analysis
Secondary
Frequency of Reappraisal Usage
Overall reappraisal usage frequency assessed via the Emotion Regulation Questionnaire Reappraisal facet score. Participants report using a 7-point Likert-type scale ranging from 1 (strongly disagree) to 7 (strongly agree). Reappraisal facet scores may range from 6-42. Higher scores represent greater habitual reappraisal usage.
Time frame: Sessions 1 (baseline/initial session) and 5, which were conducted approximately 2 weeks apart, and at the 1- and 2-month follow-ups.
Population: Participants either dropped out or stopped responding during the follow-ups, leading to attrition that lowered our participant number during the 1 and 2 month follow-ups.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Distancing | Frequency of Reappraisal Usage | Emotion Regulation Questionnaire Reappraisal facet score Session 1 | 29.86 score on a scale | Standard Error 1.32 |
| Distancing | Frequency of Reappraisal Usage | Emotion Regulation Questionnaire Reappraisal facet score 1 month follow up | 32.17 score on a scale | Standard Error 1.31 |
| Distancing | Frequency of Reappraisal Usage | Emotion Regulation Questionnaire Reappraisal facet score Session 5 | 31.48 score on a scale | Standard Error 1.08 |
| Distancing | Frequency of Reappraisal Usage | Emotion Regulation Questionnaire Reappraisal facet score 2 month follow up | 31.05 score on a scale | Standard Error 1.46 |
| Reinterpretation | Frequency of Reappraisal Usage | Emotion Regulation Questionnaire Reappraisal facet score Session 5 | 31.69 score on a scale | Standard Error 0.93 |
| Reinterpretation | Frequency of Reappraisal Usage | Emotion Regulation Questionnaire Reappraisal facet score Session 1 | 30.03 score on a scale | Standard Error 1.03 |
| Reinterpretation | Frequency of Reappraisal Usage | Emotion Regulation Questionnaire Reappraisal facet score 2 month follow up | 31.28 score on a scale | Standard Error 1.35 |
| Reinterpretation | Frequency of Reappraisal Usage | Emotion Regulation Questionnaire Reappraisal facet score 1 month follow up | 31.43 score on a scale | Standard Error 1.09 |
Comparison: Null hypothesis: no difference between groupsp-value: 0.7Mixed Models Analysis
Secondary
Inflammatory Biomarkers
Inflammatory biomarkers (e.g., serum IL-6, sIL-6R, IL-10, and TNF- α) measured via blood draw
Time frame: Sessions 0 and 6, which were conducted approximately 2-3 weeks apart.
Population: Blood biomarkers were a later, secondary addition to the study outcome measures and thus there was not biomarker data collected from each participant. Additionally, attrition from the study accounts for differing participant counts as well.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Distancing | Inflammatory Biomarkers | sIL-6R Session 6 | 5931.06 pg/mL | Standard Error 473.53 |
| Distancing | Inflammatory Biomarkers | IL-10 Session 0 | 16.60 pg/mL | Standard Error 5.19 |
| Distancing | Inflammatory Biomarkers | Serum IL-6 Session 0 | 5.10 pg/mL | Standard Error 2.24 |
| Distancing | Inflammatory Biomarkers | TNF- α Session 0 | 21.02 pg/mL | Standard Error 2.27 |
| Distancing | Inflammatory Biomarkers | sIL-6R Session 0 | 6050.37 pg/mL | Standard Error 424.24 |
| Distancing | Inflammatory Biomarkers | Serum IL-6 Session 6 | 5.60 pg/mL | Standard Error 1.79 |
| Distancing | Inflammatory Biomarkers | TNF- α Session 6 | 23.97 pg/mL | Standard Error 2.45 |
| Reinterpretation | Inflammatory Biomarkers | sIL-6R Session 6 | 5494.27 pg/mL | Standard Error 378.9 |
| Reinterpretation | Inflammatory Biomarkers | sIL-6R Session 0 | 5387.61 pg/mL | Standard Error 309.64 |
| Reinterpretation | Inflammatory Biomarkers | IL-10 Session 0 | 12.60 pg/mL | Standard Error 4.94 |
| Reinterpretation | Inflammatory Biomarkers | TNF- α Session 6 | 29.05 pg/mL | Standard Error 4.24 |
| Reinterpretation | Inflammatory Biomarkers | Serum IL-6 Session 0 | 10.34 pg/mL | Standard Error 3.44 |
| Reinterpretation | Inflammatory Biomarkers | Serum IL-6 Session 6 | 6.11 pg/mL | Standard Error 1.63 |
| Reinterpretation | Inflammatory Biomarkers | TNF- α Session 0 | 33.53 pg/mL | Standard Error 5.01 |
Comparison: Null hypothesis: no difference between groupsp-value: 0.422ANCOVA
Comparison: Null hypothesis: no difference between groupsp-value: 0.438ANCOVA
Secondary
Physical Health
Physical health and quality of life assessed via the RAND 36-Item Short Form Health Survey (SF-36) which assesses 8 subscales: physical functioning, social functioning, role limitations due to physical health problems, body pain, role limitations due to personal or emotional problems, emotional well-being, energy/fatigue, and general health perceptions. Each subscale ranges from 0 to 100, higher scores referring to more adaptive health outcomes.
Time frame: Sessions 1 (baseline/initial session) and 5, which were conducted approximately 2 weeks apart, and at the 1- and 2-month follow-ups.
Population: Participants either dropped out or stopped responding during the follow-ups, leading to attrition that lowered our participant number during the 1 and 2 month follow-ups.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Distancing | Physical Health | Physical Function score Session 1 | 77.93 score on a scale | Standard Error 5.16 |
| Distancing | Physical Health | Physical Health score Session 1 | 59.48 score on a scale | Standard Error 7.17 |
| Distancing | Physical Health | Emotional Problems score Session 1 | 51.72 score on a scale | Standard Error 7.51 |
| Distancing | Physical Health | Energy score Session 1 | 48.45 score on a scale | Standard Error 4.23 |
| Distancing | Physical Health | Emotional Wellbeing score Session 1 | 62.07 score on a scale | Standard Error 3.43 |
| Distancing | Physical Health | Social Function score Session 1 | 68.97 score on a scale | Standard Error 4.58 |
| Distancing | Physical Health | Energy score Session 5 | 49.71 score on a scale | Standard Error 4.74 |
| Distancing | Physical Health | Pain score Session 1 | 76.47 score on a scale | Standard Error 4.39 |
| Distancing | Physical Health | Health Perceptions score Session 1 | 71.55 score on a scale | Standard Error 4.21 |
| Distancing | Physical Health | Physical Function score Session 5 | 80.34 score on a scale | Standard Error 4.39 |
| Distancing | Physical Health | Physical Health score Session 5 | 65.52 score on a scale | Standard Error 7.59 |
| Distancing | Physical Health | Emotional Problems score Session 5 | 57.47 score on a scale | Standard Error 7 |
| Distancing | Physical Health | Emotional Wellbeing score Session 5 | 63.17 score on a scale | Standard Error 3.54 |
| Distancing | Physical Health | Social Function score Session 5 | 70.69 score on a scale | Standard Error 4.49 |
| Distancing | Physical Health | Pain score Session 5 | 78.88 score on a scale | Standard Error 4.02 |
| Distancing | Physical Health | Health Perceptions score Session 5 | 71.21 score on a scale | Standard Error 4.04 |
| Distancing | Physical Health | Physical Function score 1 month follow up | 78.75 score on a scale | Standard Error 4.57 |
| Distancing | Physical Health | Physical Health Physical Health score 1 month follow up | 62.50 score on a scale | Standard Error 8.64 |
| Distancing | Physical Health | Emotional Problems score 1 month follow up | 68.06 score on a scale | Standard Error 7.89 |
| Distancing | Physical Health | Energy score 1 month follow up | 57.71 score on a scale | Standard Error 3.91 |
| Distancing | Physical Health | Emotional Wellbeing score 1 month follow up | 68.17 score on a scale | Standard Error 2.84 |
| Distancing | Physical Health | Social Function score 1 month follow up | 81.77 score on a scale | Standard Error 3.36 |
| Distancing | Physical Health | Pain score 1 month follow up | 75.63 score on a scale | Standard Error 4.46 |
| Distancing | Physical Health | Health Perceptions score 1 month follow up | 75.00 score on a scale | Standard Error 4.13 |
| Distancing | Physical Health | Physical Function score 2 month follow up | 79.77 score on a scale | Standard Error 5.06 |
| Distancing | Physical Health | Physical Health score 2 month follow up | 70.45 score on a scale | Standard Error 8.8 |
| Distancing | Physical Health | Emotional Problems score 2 month follow up | 80.30 score on a scale | Standard Error 6.45 |
| Distancing | Physical Health | Energy score 2 month follow up | 55.23 score on a scale | Standard Error 5.07 |
| Distancing | Physical Health | Emotional Wellbeing score 2 month follow up | 72.36 score on a scale | Standard Error 3.36 |
| Distancing | Physical Health | Social Function score 2 month follow up | 81.82 score on a scale | Standard Error 4.17 |
| Distancing | Physical Health | Pain score 2 month follow up | 76.70 score on a scale | Standard Error 4.97 |
| Distancing | Physical Health | Health Perceptions Score 2 month follow up | 73.41 score on a scale | Standard Error 3.93 |
| Reinterpretation | Physical Health | Health Perceptions Score 2 month follow up | 73.04 score on a scale | Standard Error 4.26 |
| Reinterpretation | Physical Health | Physical Function score Session 1 | 83.71 score on a scale | Standard Error 4.21 |
| Reinterpretation | Physical Health | Physical Function score 1 month follow up | 85.36 score on a scale | Standard Error 3.66 |
| Reinterpretation | Physical Health | Physical Health score Session 1 | 67.74 score on a scale | Standard Error 6.58 |
| Reinterpretation | Physical Health | Physical Function score 2 month follow up | 84.78 score on a scale | Standard Error 4.75 |
| Reinterpretation | Physical Health | Emotional Problems score Session 1 | 46.24 score on a scale | Standard Error 7.98 |
| Reinterpretation | Physical Health | Physical Health Physical Health score 1 month follow up | 66.07 score on a scale | Standard Error 7.84 |
| Reinterpretation | Physical Health | Energy score Session 1 | 49.68 score on a scale | Standard Error 3.67 |
| Reinterpretation | Physical Health | Emotional Wellbeing score 2 month follow up | 69.74 score on a scale | Standard Error 3.51 |
| Reinterpretation | Physical Health | Emotional Wellbeing score Session 1 | 64.65 score on a scale | Standard Error 3.37 |
| Reinterpretation | Physical Health | Emotional Problems score 1 month follow up | 48.81 score on a scale | Standard Error 7.76 |
| Reinterpretation | Physical Health | Physical Health score 2 month follow up | 66.30 score on a scale | Standard Error 8.11 |
| Reinterpretation | Physical Health | Social Function score Session 1 | 78.63 score on a scale | Standard Error 4.61 |
| Reinterpretation | Physical Health | Energy score 1 month follow up | 55.54 score on a scale | Standard Error 3.94 |
| Reinterpretation | Physical Health | Pain score Session 1 | 71.53 score on a scale | Standard Error 4.05 |
| Reinterpretation | Physical Health | Pain score 2 month follow up | 76.96 score on a scale | Standard Error 4.69 |
| Reinterpretation | Physical Health | Health Perceptions score Session 1 | 71.94 score on a scale | Standard Error 3.19 |
| Reinterpretation | Physical Health | Emotional Wellbeing score 1 month follow up | 68.57 score on a scale | Standard Error 3.82 |
| Reinterpretation | Physical Health | Physical Function score Session 5 | 83.44 score on a scale | Standard Error 4.14 |
| Reinterpretation | Physical Health | Emotional Problems score 2 month follow up | 65.22 score on a scale | Standard Error 7.97 |
| Reinterpretation | Physical Health | Physical Health score Session 5 | 71.09 score on a scale | Standard Error 5.84 |
| Reinterpretation | Physical Health | Social Function score 1 month follow up | 77.68 score on a scale | Standard Error 4.56 |
| Reinterpretation | Physical Health | Emotional Problems score Session 5 | 45.83 score on a scale | Standard Error 7.14 |
| Reinterpretation | Physical Health | Energy score Session 5 | 52.50 score on a scale | Standard Error 4.07 |
| Reinterpretation | Physical Health | Social Function score 2 month follow up | 80.43 score on a scale | Standard Error 4.43 |
| Reinterpretation | Physical Health | Emotional Wellbeing score Session 5 | 64.88 score on a scale | Standard Error 3.46 |
| Reinterpretation | Physical Health | Pain score 1 month follow up | 78.13 score on a scale | Standard Error 3.97 |
| Reinterpretation | Physical Health | Social Function score Session 5 | 75.39 score on a scale | Standard Error 4.58 |
| Reinterpretation | Physical Health | Energy score 2 month follow up | 57.83 score on a scale | Standard Error 4.47 |
| Reinterpretation | Physical Health | Pain score Session 5 | 75.70 score on a scale | Standard Error 4.43 |
| Reinterpretation | Physical Health | Health Perceptions score 1 month follow up | 72.32 score on a scale | Standard Error 3.38 |
| Reinterpretation | Physical Health | Health Perceptions score Session 5 | 73.59 score on a scale | Standard Error 3.49 |
Comparison: Null hypothesis: no difference between groupsp-value: 0.452Mixed Models Analysis
Comparison: Null hypothesis: no difference between groupsp-value: 0.65Mixed Models Analysis
Comparison: Null hypothesis: no difference between groupsp-value: 0.224Mixed Models Analysis
Comparison: Null hypothesis: no difference between groups.p-value: 0.696Mixed Models Analysis
Comparison: Null hypothesis: no difference in groupsp-value: 0.256Mixed Models Analysis
Comparison: Null hypothesis: no difference between groupsp-value: 0.984Mixed Models Analysis
Comparison: Null hypothesis: no difference between groupsp-value: 0.363Mixed Models Analysis
Comparison: Null hypothesis: no difference between groupsp-value: 0.045Mixed Models Analysis