Although the results from this study are based on cross-sectional data, the study gives some support for the importance of positive affect in coping with stress. Among those who reported high frequency of positive states of mind the association between stress and depression, anxiety, and perceived health were diminished. On the other hand, among those with lower frequency of positive states of mind, perceived stress was highly related with increased depression, anxiety, and decreased perceived health. Thus, it seems like higher frequency of positive states of mind make individuals more capable of handling stress without negative consequences for psychological and physical functioning such as depression, anxiety and perceived health. At low levels of stress, this added benefit of positive states of mind is not needed and as a consequence we find no difference in depression, anxiety, or perceived health among these individuals. These results emphasize the importance of considering positive affect in our understanding of the coping process and have implications for the development of stress management interventions.
In this study we use depression, anxiety, and perceived health as outcomes. These measures are conceptually quite distinct but in particular the distinction between anxiety and depression has been discussed considerably (Clark and Watson 1990). In the current study we were interested in examining the differential associations between perceived stress and measures of anxiety, depression, and perceived health. This similarity in findings between these three outcomes is likely the result of both: a) a comparable process in which positive states of mind reduce the impact of stress on all three of these outcomes; b) an overlap between measures of anxiety, depression, and perceived health.
Several previous studies have given support for the importance of positive affect in predicting health outcomes such as morbidity (Ostir et al. 2001) and mortality (Moskowitz 2003; Moskowitz et al. 2008). But the mechanisms behind these associations are not well understood. This study gives some indication of the role of positive states of mind in increasing resilience against stressful events and in strengthening coping ability. There are several possible pathways through which positive emotions and cognitions might influence psychological functioning (Folkman 2008). Positive emotion could increase sustained efforts of cope with stressful situations. Positive states of mind could also give a needed break to restore resourses and alter perceptions of stressful events and situations as more of a challenge than harm or threat.
Future studies of coping with stress should employ longitudinal design and the use of multiple data sources (e.g. diagnostic interviews), and include measures of positive affective states to enable to examine the causal links through which positive emotion and cognitions might lead to increased psychological well-being and perceived health. The study also highlights the possible beneficial effect of including strategies to increase positive affect during stressful conditions, or of using such strategies to prevent poor outcomes following a major stressful event. Such training might strengthen people’s ability to experience high levels of stress without suffering negative psychological and physical health consequences. A recently published pilot study examining the effect of a multiple-component intervention to promote increased positive emotion in individuals experiencing health-related stress, showed promising results in both increasing positive affect and decreasing negative affect (Moskowitz et al. 2011). Future treatment or prevention studies could be designed to experimentally test the influence of strategies and techniques to promote positive affect, and how this relate to changes in well-being and health for people experiencing stress.
While this study contributes to our understanding of individual differences in our reactions to stress, there are several limitations. First, the fact that we used a sample from Sweden reduces our ability to generalize our finding to other countries. Further, we have a substantial selection bias in our recruitment, skewing our sample towards more highly educated women, which further reduces our ability to generalize our findings to the total population. Nonetheless, the study is based on a fairly large community-based sample. This study also suffers from the limitations associated with self-report, including common method variance and socially desirable responding. However, the test for common method variance did not indicate that a substantial amount of common method variance was present in our sample. As with any cross-sectional study, the design of this study limits our ability to make any conclusions regarding causality. The main aim of the current study was to examine the importance of positive affect as a moderator of the association between perceived stress and negative mental and physical outcomes, but the results would have been strengthened if we could have included measures of negative mood in the analyses. We were unable to compare the relative strength of influence of positive vs. negative mood in coping with stress. A further limitation was the self-assessed measure of perceived health, and future studies are needed to understand the impact of positive states of mind on other measures of health e.g. number or severity of physical symptoms.
It is worth noting that the measure of positive experiences used in the current study assesses experiences of Positive States of Mind, this is broader construct than frequency of positive emotions more often used in studies of the influence of positive affect. The limitation of using a measure of Positive States of Mind is that it takes into account a mix of both emotional and cognitive experience, making it difficult to assess the differential influence of the emotional and cognitive content of the positive experiences and its association with other variables. On the other hand, the measure of Positive States of Mind might partly tap into a valuable aspect of positive affect, and is it a very short and easily disseminated measure. Further studies could more in detail examine potential differences in using various measures of positive experiences to evaluate what aspect that is of particular importance for health outcomes.
A key finding of this study is the indication that perceived stress seems to be differentially related to psychological factors at different levels of positive states of mind. Among people experiencing a high frequency of positive states of mind, perceived stress seems to have a low correspondence with depression, anxiety, and perceived health. But among those reporting a low frequency of positive states of mind, perceived stress was more strongly related and depression, anxiety, and perceived health suggesting a buffering effect of positive states of mind against the negative influence of stress. However, to more fully understand the influence of positive emotional experience as a moderator of stress there is a need to replicate this research, and future studies should use a prospective study design and well validated measures of both positive and negative affect and additional measures of health outcome such as number or severity of physical symptoms.