Negative Family Interactions Research Articles

Association between parental phubbing and short-form video addiction: A moderated mediation analysis among Chinese adolescents

BackgroundShort-form video applications have spread rapidly and gained popularity among adolescents for their interactivity, sociality, and personalization. However, excessive and uncontrolled use has also caused some adolescents to develop short-form video addiction (SFVA). Although parental phubbing has been shown to be a risk factor for SFVA in adolescents, its intermediate mechanisms, particularly the emotional mediation mechanisms, remain unclear. Therefore, this study aims to explore the relationships among parental phubbing, SFVA, symptoms of depression and anxiety, and neuroticism in adolescents. MethodsAdolescents aged 13–19 (N = 5785) were recruited from Shandong Province, China, as participants in 2023. Participants were asked to complete five self-report questionnaires, including the Parental Phubbing Behavior Questionnaire (PPBQ), Short-Form Video Addiction (SFVA) Scale, The Center for Epidemiological Studies Depression Scale (CESD20), Generalized Anxiety Disorder 7-item (GAD-7) Scale, and Chinese Big Five Personality Inventory (Brief Version) (CBF-PI-B). ResultsThe results indicate that the influence of parental phubbing on short-form video addiction among adolescents is mediated by symptoms of depression and anxiety. Additionally, neuroticism moderates the association between parental phubbing and symptoms of depression and anxiety. LimitationsCross-sectional design limits causal inferences. Reliance on self-report scales. ConclusionsThese findings contribute to a better understanding of the systemic impact mechanisms of negative family interactions on SFVA. Moreover, prevention and intervention strategies targeting high neuroticism and symptoms of depression and anxiety may help prevent the developmental pathway from parental phubbing to SFVA.

THE MODERATING ROLE OF RACE AND ETHNICITY BETWEEN NEGATIVE FAMILY INTERACTIONS AND MENTAL HEALTH AMONG OLDER ADULTS

Abstract Studies generally show that negative social interactions are detrimental to mental health for older adults. Furthermore, empirical evidence suggests that negative interactions may function differently in relation to mental health across racial/ethnic groups given their unique life circumstances and social conditions. This study examines whether the association between negative family interactions and mental health outcomes varies by race and ethnicity. Samples of older African Americans, Caribbean Blacks, and non-Latino Whites aged 55 and older were drawn from the National Survey of American Life (N = 1,439). Mental health variables included depressive symptoms, any lifetime disorder according to The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and number of lifetime DSM-IV disorders. Regression models were used to test the study aim. Analyses indicated that negative interactions with family were positively associated with all 3 mental health outcomes. Several racial/ethnic differences emerged. The association between negative family interactions and depressive symptoms was stronger among Whites than African Americans. While negative family interactions were positively associated with number of disorders among Caribbean Blacks, negative interactions were unrelated to number of disorders among African Americans. This study demonstrates the racial and ethnic differences in diverse aging populations and the importance of recognizing the heterogeneity of the Black American population in minority research. Clinical practice should focus on reducing negative family interactions, and future research should examine whether psychosocial resources (e.g., stress appraisals, neighborhood social cohesion) can attenuate the association between negative family interactions and mental health for older African Americans.

PRESIDENTIAL SYMPOSIUM: FRAMING, BRIDGING, AND TRAVERSING SOCIAL DETERMINANTS OF HEALTH, DISPARITIES, AND INEQUITIES IN OLDER ADULTS

Abstract In alignment with the theme of this year’s conference, Building Bridges>Catalyzing Research>Empowering All Ages, this symposium focuses on research that frames, bridges, and transverses various constructs of the social determinants of health, intersectional frameworks, and inequities that impact older adults at various times in life from mid to older adulthood through death. We start with a framework for how to consider social and structural conditions in which people live and the cumulative effects that an individual’s life course might impact their trajectory with Alzheimer’s disease and other related dementias and their families. Continuing on with the theme of family, dementia, and caregivers, we delve into the differences in caregiver burden across and within gender and racial/ethnic groups, looking at the linkage with financial, emotional, and physical burdens. From there, we go on to explore whether there is an association between negative family interactions and mental health outcomes and discuss how those outcomes might vary by race and ethnicity. Building upon several concepts in these first three papers, we will discuss how one can evaluate the intersectional impact of race and gender on end-of-life outcomes including pain, anxiety/depression, patient autonomy, and overall care quality. Our last speaker will share intriguing, and somewhat unexpected findings related to social inequities on health from midlife to death and the impact of early exposure to socioeconomic disadvantages might have on disparities. Given the importance of reducing inequities to improve health outcomes, this HS section Presidential Symposium is sure to challenge and enhance our thinking.

Expressed Emotion in Families of Children with Neurodevelopmental Disorders: A Mixed-Method Approach.

Family interaction plays a pivotal role in the overall well-being of each member of a family unit. It is foreseeable that a family caring for an individual with a mental or physical health condition could experience negative family interactions for various reasons. Expressed emotion refers to the family environment based on the relatives' interaction with the individual diagnosed with a specific illness. Expressed emotion in the families of a person with any form of mental condition could pose potential psychological distress and burden to family members, notably the primary caregivers. The current study intends to explore the expressed emotion of the primary caregivers toward children with neurodevelopmental disorders (NDDs). The association between expressed emotion, stress experienced by the caregiver, and the self-sufficiency of the child diagnosed with neurodevelopmental disorders was examined. The Five-Minute Speech Sample (FMSS), Kingston Caregivers' Stress Scale (KCSS), and Waisman Activities of Daily Living (WADL) were used to assess expressed emotion, stress, and a child's self-sufficiency, respectively. The snowball sampling technique was adopted, and data were collected from 35 primary caregivers through telephonic interviews. A mixed-method research design was adopted, and the data were analyzed qualitatively and quantitatively. The findings reveal that there is a significant association between expressed emotion and caregivers' stress, expressed emotion, and the child's self-sufficiency and a significant relationship between the caregivers' stress and the child's self-sufficiency. The qualitative analysis suggests the influence of factors such as future concerns, family factors, and relationship strains contribute to expressed emotion. It can be concluded that those primary caregivers who reported extreme caregivers' stress and low self-sufficiency in their child exhibited high negative expressed emotion and diverse individual and systemic factors influenced the display of high expressed emotion within the family.

Bidirectional associations between family conflict and child behavior problems in families at risk for maltreatment

BackgroundChildren's exposure to family conflict is associated with the development of behavior problems. However, it remains unclear whether this association (1) functions bidirectionally and (2) exists independent of more severe forms of violent victimization. ObjectiveThe present study aimed to examine bidirectional and transactional associations between family conflict and children's behavioral problems, controlling for time-varying violent victimization experiences. Invariance testing examined whether these models differed by gender and by maltreatment status prior to initial recruitment. Participants and settingParticipants were caregiver-child dyads identified prospectively as being at risk for maltreatment and family violence exposure prior to age four (N = 1281; 51.4 % female; 74.6 % persons of color). MethodsCaregivers were interviewed prospectively about family conflict, children's aggressive and delinquent behavior, and children's victimization experiences at child ages 6, 8, and 10. ResultsAfter controlling for prior victimization, significant cross-lagged bidirectional associations were identified between family conflict and child behavior problems. Indirect effects from age 6 to age 10 externalizing problems through age 8 family conflict were not supported. Several bidirectional paths were stronger among boys than girls. Results revealed little evidence for moderation by prerecruitment maltreatment status. ConclusionsFindings support a conceptualization of the family-child relationship that is reciprocal in nature and highlight the importance of non-violent, everyday negative family processes. Interventions aiming to improve child behavior problems by targeting severely dysfunctional family processes should also address non-violent, lower-level patterns of negative family interactions, such as everyday instances of blame, criticism, nonacceptance, and favoritism.

The Longitudinal Association Between Childhood Abuse and Positive and Negative Family Interactions in Midlife and Older Adults: The Role of Mindfulness Meditation and Gender.

Childhood abuse has been linked to problematic familial relationships in adulthood; however, it remains unclear what factors buffer the association. Mindfulness research has demonstrated promise in improving relationships among adults abused during childhood, but research has focused on couples, with fewer studies examining familial relationships. Using a data sample of 2430 adults from the Midlife Development in the United States, the current study examined mindfulness as a moderator of childhood abuse and familial support and strain in adults. Analysis of hierarchical regression revealed that mindfulness was a moderator of childhood abuse and family strain over a 10-year period in women, but not men. However, mindfulness did not moderate childhood abuse and support. This examination of mindfulness in the context of familial relationships may help women more successfully manage negative familial interactions. Results indicate mindfulness-based interventions may be helpful in improving familial relationships among adults abused by family members in childhood.

The Moderating Role of Race and Ethnicity in the Relationship Between Negative Family Interactions and Mental Health Among Older Adults.

Studies generally show that negative social interactions are detrimental to mental health for older adults. Furthermore, empirical evidence suggests that negative interactions may function differently in relation to mental health across racial/ethnic groups given their unique life circumstances and social conditions. This study examines whether the association between negative family interactions and mental health outcomes varies by race and ethnicity. Samples of older African Americans, Caribbean Blacks, and non-Latino Whites aged 55 and older were drawn from the National Survey of American Life (N = 1,439). Mental health variables included depressive symptoms, any lifetime disorder according to The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and number of lifetime DSM-IV disorders. Regression models were used to test the study aim. Analyses indicated that negative interactions with family were positively associated with all 3 mental health outcomes. Several racial/ethnic differences emerged. The association between negative family interactions and depressive symptoms was stronger among Whites than African Americans. While negative family interactions were positively associated with number of disorders among Caribbean Blacks, negative interactions were unrelated to number of disorders among African Americans. This study demonstrates the racial and ethnic differences in diverse aging populations and the importance of recognizing the heterogeneity of the Black American population in minority research. Clinical practice should focus on reducing negative family interactions, and future research should examine whether psychosocial resources (e.g., stress appraisals, neighborhood social cohesion, and religious practices) can attenuate the association between negative family interactions and mental health for older African Americans.

Family Factors Related to Three Major Mental Health Issues Among Asian-Americans Nationwide.

Asian-Americans (AAs) constitute the fastest growing minority group in the USA. AAs share a common emphasis on collective cultural strengths, especially family values. Using the National Latino and Asian American Study (NLAAS) data, this study investigated the roles of family cohesiveness, along with other cultural strength factors and negative family interactions in three psychiatric disorders. Supporting the study's hypotheses, multivariate analyses showed that family cohesiveness was associated with a lower incidence of general anxiety disorder (GAD), while regular religious attendance was linked with a lower likelihood of having substance use disorder (SUD). Conversely, negative family interactions increased the likelihood of experiencing major depression disorder (MDD) and SUD. Whereas perceived discrimination was related to higher odds of all diagnoses, family cohesiveness moderated the relationship between discrimination and GAD. These findings suggest that family relationships play a critical role in AAs' mental health and should be further explored through a prospective design.

Correlates of Loneliness in Older Korean Americans: Interactive Effects of Negative Family Interactions

This study examined factors affecting the feelings of loneliness among older Korean Americans. Data were drawn from a survey with older Korean Americans aged 60 or over (N = 2,150) in five states (California, New York, Texas, Hawaii, and Florida), conducted during 2017−2018. In hierarchical multiple regression models, loneliness was regressed on five blocks of variables: (1) demographic/health (age, gender, education, financial status, chronic conditions, and physical disabilities); (2) immigration-related (length of stay in the U.S., and acculturation); (3) social engagement (having meals alone, family network, friend network, activity participation, and community engagement); (4) negative family interactions; and (5) interactions of negative family interactions with social engagement variables. A significant interaction was found in the relationship between friend network and negative family interactions: the impact of negative family interactions on loneliness was buffered by friend network. Implications of findings were discussed regarding working with older immigrants with limited social networks.

Understanding Mental Health, Vulnerabilities, and Coping in Older Koreans and Older Korean Americans

Although significant progress has been made in understanding mental health issues, racial/ethnic minorities are disadvantaged in terms of knowledge, attitude/stigma toward mental illness, and access to treatment. Older Koreans and Korean Americans are high-risk groups with great prevalence of stigma and limited access to mental services. The two groups share similarities as well as differences. For example, Older Korean Americans, a first-generation immigrant group, tend to share traditional values and beliefs with older Koreans. However, differences in social and cultural contexts, availability of social networks and resources, and access to health care systems present unique challenges and strategies. The purpose of this symposium is to enhance the understanding of critical issues in mental health among older Koreans and Korean Americans and identify challenges and strategies to promote mental health and well-being. Five studies conducted in Korea and the US will explore a variety of personal, social, and cultural factors related with mental health, based on quantitative and qualitative approaches. The diverse topics cover the mediating role of self-esteem in the relationship of stigma to emotional well-being, the effect of stress and coping on well-being, loneliness and negative family interactions, the relationship of life stressors and social capital on mental distress among older Korean Americans compared with other older Asian Americans, and community leaders’ attitude toward depression. The issues of vulnerabilities and resources will be discussed from the cultural perspectives as well as implications for future research and practice.

Family Functioning and Mental Health Changes Following a Family Therapy Intervention in Kenya: a Pilot Trial.

Family-based interventions offer a promising avenue for addressing chronic negative family interactions that contribute to lasting consequences, including family violence and the onset and maintenance of mental health disorders. The purpose of this study was to conduct a mixed-methods, single group pre-post pilot trial of a family therapy intervention (N = 10) delivered by lay counselors in Kenya. Results show that both caregivers and children reported reductions in family dysfunction and improved mental health after the intervention. Point estimates represent change of more than two standard deviations from baseline for the majority of primary outcomes. Treated families also reported a decrease in harsh discipline, intimate partner violence, and alcohol-related problems. These results were corroborated by findings from an observational measure of family functioning and in-depth qualitative interviews. This study presents preliminary evidence of pre-post improvements following a family therapy intervention consisting of streamlined, evidence-informed family therapy strategies to target family dysfunction and mental health.

Relationships of Family Emotional Support and Negative Family Interactions with the Quality of Life among Chinese People with Mental Illness and the Mediating Effect of Internalized Stigma.

This study aimed to investigate the relationships of family emotional support and negative family interactions with the quality of life among Chinese people with mental illness. Furthermore, it examined the mediating role of internalized stigma in these relationships. One hundred and twenty-five Chinese adults with mental illness were recruited from community mental health service centers in Hong Kong. The results show that both family emotional support and negative family interactions were related to the quality of life. Negative family interactions had a stronger effect on the quality of life compared to family emotional support. Internalized stigma partially mediated the relationship between negative family interactions and the quality of life. These findings suggest that, for Chinese people with mental illness, interventions aimed at promoting quality of life should consider enhancing family emotional support and reducing negative family interactions. In addition, mental health service providers could consider using family approaches to address internalized stigma in the effort of improving the quality of life for their service users.

Vulnerable Youth and the COVID-19 Pandemic.

* Abbreviations: COVID-19 — : coronavirus disease of 2019 LGBTQ — : lesbian, gay, bisexual, transgender, queer, and/or questioning Vulnerable pediatric populations (including youth who are lesbian, gay, bisexual, transgender, queer, and/or questioning [LGBTQ]; homeless; maltreated; in foster care; and struggling with substance use disorders) warrant particular consideration during the coronavirus disease of 2019 (COVID-19) pandemic. It is likely that stay-at-home orders, combined with increased economic instability and family pressures, will increase their risks for harm and, in some cases, may make it untenable (and potentially dangerous) for them to shelter in place. Simultaneously, safety nets that protect youth (child protective services, medical and mental health providers, and educators) have fewer staff available or are inaccessible because of the COVID-19 crisis. These conditions highlight how morbidity and mortality in vulnerable pediatric populations will likely extend beyond the pandemic itself. For some children and youth, home can be isolating and, in some cases, dangerous. Adverse childhood experiences, including physical abuse, sexual abuse, and neglect, are common, with an estimated 678 000 children and adolescents experiencing maltreatment in 2018, and young children are at highest risk for serious harm.1 These risks increase for specific populations. Indeed, LGBTQ and gender nonconforming youth (up to 16% of all youth) are at far higher risk of experiencing physical and sexual abuse, with the level of gender nonconformity predictive of … Address correspondence to Rachel I. Silliman Cohen, MD, Child Abuse Research Education and Service Institute, School of Osteopathic Medicine, Rowan University, 42 E Laurel Rd, Stratford, NJ 08084. E-mail: sillimancohen{at}rowan.edu

Family interactions and the involvement of adolescents in bullying situations from a bioecological perspective

Abstract Exposure to school bullying is a situation experienced in children and adolescents’ routine and a few bullying complex conditions have not yet been sufficiently explored. Thus, this study’s objective aimed at synthesizing empirical evidence concerning the relationship between bullying and family variables in a theoretical model. Adopting a mixed design, the total sample included 2,354 students from 11 public schools who participated in the quantitative stage study. Data were collected using two scales. In the quantitative stage 55 students were randomly selected for semi-structured interviews. The results revealed that positive family interactions have a protective power in relation to bullying and victimization, while negative family interactions increase the risk of students becoming involved in such situations. The factors that influence students’ involvement in school bullying belonged to the analytical components of the Bioecological Model. The outcome helped a better understanding of bullying and provided empirical support for family inclusion in the issue.

POSITIVE AND NEGATIVE SOCIAL INTERACTIONS ON MENTAL HEALTH IN OLDER KOREAN AMERICANS: GENDER DIFFERENCES

While there is substantial documentation of a positive relationship between objective social engagement and mental health, relatively little is known about how perceived quality of social interactions affects mental health and how men and women differ. Considering the gap, the purpose of this study was to investigate gender difference in how social interactions associate with self-rated mental health in older Korean Americans. Data came from a survey with older Korean Americans aged 60 or over that included 713 men and 1437 women living in five sites (California, New York, Texas, Hawaii, and Florida), conducted during 2017−2018. In multiple regression models run separately for men and women, self-rated mental health on a five-point scale (excellent/very good/good/fair/poor) was regressed on four blocks of variables: socio-demographic characteristics (age, marital status, education, financial status, self-rated health, and region), immigration-related variables (length of stay in the U.S. and acculturation), social engagement (family network, friend network, and activity participation), and perceived quality of social interactions (positive or negative family interactions and negative community interactions). In the final models with all covariates, younger age, more years in education, better physical health, higher levels of acculturation, and more positive family interactions were commonly associated with more positively rated mental health for both men and women. For women, stronger family network and fewer negative family interactions were additional contributors. Results suggest that negative and positive indicators of family interactions differentially affect self-rated mental health for older Korean American men and women.

Parents’ and College Students’ Perceptions of Support and Family Environment

The main objectives of this multimethod exploratory study were to compare parent and college student perceptions of communication patterns, financial/emotional support, family environment, and achieved adulthood during the transition to adulthood while in college. First, focus groups including eight parent figures and 16 students were conducted to provide feedback on important topics as well as on survey instruments. Survey responses from 152 parent figures and their college-age children were then used for the exploratory survey study. Parents reported providing more financial support, more positive family interactions, and less negative family interactions compared to their college-age children. The majority of students as well as parents did not view themselves and their children as having fully completed the transition to adulthood as indicated by the majority using the “in-between” response when asked if their child (or student himself or herself) had reached adulthood.

Church and Family Support Networks and Depressive Symptoms among African Americans: Findings from the National Survey of American Life.

AbstractAims:We examined the associations between informal social support from church members and social support from extended family members and depressive symptoms within a national probability sample of African American adults ranging in age from 18 to 93.Methods:This analysis used data from the National Survey of American Life and accounted for religious service attendance and various demographic variables that have known associations with and are consequential for mental health.Results:Frequency of contact with church and family members and emotional support from family were inversely associated with depressive symptoms, and negative church and family interactions were positively associated with depressive symptoms. Emotional support from church members, however, was unrelated to depressive symptoms.Conclusion:This study underscores the important contributions of church relationships to depressive symptoms among African Americans across the adult life span, and confirms that these associations are independent of family relationship factors and religious service attendance.

The influences of family interaction and spiritual well-being on anxiety and depression among older adults in the United States

Background: Living with anxiety and depression is a very real and palpable experience for many older adults in the modern day. Facing these conditions as an individual on a day to day basis can be overbearing and relentless. Subjectively one can imagine how difficult either of these conditions can be to face as well as seek aid for. The purpose of this study was to examine the influences of past family interactions related to child rearing techniques as well as current experiences of spiritual well-being on the older adults’ anxiety and depression. Methods: This was a cross sectional, descriptive design. Total 448 older adults were recruited from the community in the US. The mean age was 71.33 (SD=7.61). There were 41.1% Male (n=184) and 58.9% Female (n=264). The structured questionnaires were used to do the data collection. The SPSS 23 version was used to do the data analysis. The descriptive data analysis, Pearson Correlation, and Step-wise Multiple Regressions were used to solve the research questions. Results: Older adults whose parents used child monitor (r=-0.211, p=0.000), inductive reasoning (r=-0.116, p=0.015), communication (r=-0.145, p=0.002), involvement (r=-0.169, p=0.000) and positive family interaction (r=-0.210, p=0.000) had lower scores of anxiety. Older adults whose parents used inconsistent discipline (r=0.185, p=0.000), harsh discipline (r=0.245, p=0.000) and negative family interaction (r=0.290, p=0.000) had higher scores of anxiety. Older adults whose parents used child monitor (r=-0.279, p=0.000), inductive reasoning (r=-0.190, p=0.000), communication (r=-0.196, p=0.000), involvement (r=-0.208, p=0.000) and positive family interaction (r=-0.280, p=0.000) had lower scores of depression. Older adults whose parents used inconsistent discipline (r=0.182, p=0.000), harsh discipline (r=0.292, p=0.000) and negative family interaction (r=0.322, p=0.000) had higher scores of depression. Older adults who had higher scores of spiritual wellbeing (r=-0.518, p=0.000), higher scores of faith/belief (r=-0.373, p=0.000), life and self-responsibility (r=-0.418, p=0.000), and higher scores of life satisfaction and self-actualization (r=-0.492, p=0.000) had lower scores of anxiety. Older adults who had higher scores of spiritual well-being (r=-0.597, p=0.000), higher scores of faith/belief (r=-0.434, p=0.000), life and selfresponsibility (r=-0.412, p=0.000), and higher scores of life satisfaction and self-actualization (r=-0.623, p=0.000) had lower scores of depression. There was a statistically significant positive relationship between anxiety and depression (r=0.734, p=0.000). Conclusions: The predictors of older adults’ anxiety were negative family interaction, their parents using a child monitor, their spiritual well-being and faith/belief. The predictors of older adults’ depression were negative family interaction, their parents using a child monitor, their life satisfaction/ self-actualization and life/self-responsibility. Older adults who had higher scores of experienced negative family interaction had higher scores of anxiety and depression. Older adults who had higher scores of spiritual well-being (including life satisfaction/ self-actualization and life/self-responsibility) and higher scores of experienced child monitor had lower scores of anxiety and depression.

Childhood Familial Victimization: An Exploration of Gender and Sexual Identity Using the Scale of Negative Family Interactions.

Familial violence poses a serious public health concern and has therefore received a considerable amount of attention from academics and practitioners alike. Research within this field has found that parent-to-parent and parent-to-child violence often occur simultaneously and are especially prevalent within households that suffer from social and environmental stressors. Sibling violence and its relationship to these other forms of familial violence has received considerably less attention, largely related to the widely held belief that sibling violence is natural, especially for boys. Using the Scale of Negative Family Interactions (SNFI), parent-to-child and sibling-to-sibling violence is investigated. Specifically, the relationship between participants' gender and sexual identities and their reports of familial violence are explored to better understand participants' gendered and sexed experiences. Data suggest that gender and sexual minorities may have a unique experience of familial violence, although further research is needed in this area.

Postpartum Mothers’ Leisure-Time Exercise Behavior is Linked to Positive Emotion During Partner Discussions

ABSTRACTPurpose: Marital dissatisfaction and conflict often increase for couples after the birth of a child and are evident in fewer positive family interactions and more negative family interactions. Because exercise is known to increase positive emotions and decrease negative emotions, the current study examined the extent to which higher levels of mothers’ exercise during the postpartum period were related to more positive and fewer negative emotion-expressive behaviors with their infants’ fathers. Method: Mothers’ (N = 46; M = 8 months postpartum) positive and negative expressive behaviors were coded during couples’ discussions of current conflict and positive family experiences. Mothers self-reported their leisure-time exercise behavior. Results: First-time mothers and mothers with higher levels of leisure-time exercise behavior displayed higher levels of positive expressive behaviors during couples’ discussions. Conclusions: Exercise may be associated with increased positive emotion and, in turn, can have great potential to improve family relationships during the postpartum period when marital stress normatively increases, particularly for mothers with more than 1 child. Future longitudinal studies are needed to understand exercise patterns across the postpartum period to identify the most effective timing and optimal level of exercise that lead to more positive expressive behaviors.