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Psychological and physiological pathways from social support exchanges to health: a lifespan perspective

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Psychological and physiological pathways from social support exchanges to health: a lifespan perspective

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Content 1

PSYCHOLOGICAL AND PHYSIOLOGICAL PATHWAYS FROM
SOCIAL SUPPORT EXCHANGES TO HEALTH:
A LIFESPAN PERSPECTIVE

A dissertation presented to the Graduate School of the University of Southern California
in partial fulfillment of the requirements for the degree
Doctor of Philosophy
in Gerontology

by

Diana Wang
Bachelor of Sciences, Brandeis University, 2013

University of Southern California
Los Angeles, California
(August 2018)
2

Table of Contents
ACKNOWLEDGEMENTS
4

ABSTRACT
8

CHAPTER
1:
BACKGROUND
9

HEALTH
CORRELATES
OF
SOCIAL
SUPPORT
GIVING
10

DISTINGUISHING
SUPPORT
GIVING
FROM
CAREGIVING
12

BALANCE
OF
GIVING
AND
RECEIVING
SOCIAL
SUPPORT
13

SUPPORT
IMBALANCE
ACROSS
THE
LIFESPAN
14

COGNITIVE
AND
AFFECTIVE
STATES
ASSOCIATED
WITH
SUPPORT-‐‑GIVING
15

PHYSIOLOGICAL
STATES
ASSOCIATED
WITH
SUPPORT-‐‑GIVING
16

SPECIFIC
GOALS
OF
DISSERTATION
17

CHAPTER
2:
THE
PSYCHOLOGICAL
COSTS
OF
SOCIAL
SUPPORT
IMBALANCE:
VARIATION

ACROSS
RELATIONSHIP
CONTEXT
AND
AGE
18

ABSTRACT
18

INTRODUCTION
18

BENEFITS
OF
RECEIVING
SUPPORT
19

BENEFITS
OF
GIVING
SUPPORT
19

IMBALANCES
IN
SOCIAL
SUPPORT
EXCHANGES
19

LIFE
COURSE
PERSPECTIVE
21

PRESENT
STUDY
22

METHODS
22

SAMPLE
22

MEASURES
23

PERCEPTIONS
OF
SOCIAL
SUPPORT
23

SOCIODEMOGRAPHIC
AND
HEALTH
STATUS
COVARIATES
24

PSYCHOLOGICAL
WELL-‐‑BEING
24

ANALYSES
25

RESULTS
28

DISCUSSION
30

CHAPTER
3:
DAILY
PSYCHOLOGICAL
AND
PHYSICAL
WELL-‐‑BEING
CORRELATES
OF
GIVING

SUPPORT
TO
OTHERS
35

INTRODUCTION
35

METHODS
39

SAMPLE
39

MEASURES
40

ANALYSES
42

RESULTS
44

WITHIN-‐‑PERSON
EFFECTS
48

BETWEEN-‐‑PERSON
EFFECTS
49

CONCLUSIONS
52

3
LIMITATIONS
53

CHAPTER
4:
ACTIVATING
THE
SUPPORT
SCHEMAS
WITHIN:
IDENTIFYING
THE
THOUGHTS

AND
FEELINGS
UNDERLYING
GIVING
AND
RECEIVING
SUPPORT
55

BACKGROUND
55

METHODS
57

SAMPLE
57

EXPERIMENTAL
PROTOCOL
57

COGNITIVE-‐‑AFFECTIVE
STATES
58

ANALYTIC
STRATEGY
60

RESULTS
60

CONCLUSIONS
62

CHAPTER
5:
PHYSIOLOGICAL
AND
PSYCHOLOGICAL
EFFECTS
OF
PERCEIVING
ONESELF
AS
A

GIVER:
A
TEST
OF
DIRECT
AND
STRESS-‐‑BUFFERING
PATHWAYS
65

CHAPTER
6:
DISCUSSION
80

APPENDICES
84

REFERENCES
87

4

Acknowledgements

As I reflect on this journey, I am overwhelmed with gratitude for all of those who have
supported me.
First, none of this work would have been possible if it weren’t for my primary advisor,
Tara Gruenewald. She has provided me with the skills necessary for conducting multi-level
research spanning from population-based studies down to laboratory experiments. She has given
me support in many forms - financial, emotional, career development. Importantly, she provided
a foundation for personal and academic growth, and for all this I am so thankful.
I owe so much gratitude to Mara Mather, who provided me an additional lab home in the
challenging stage of data collection in my fourth study. Her support has shaped my development
as a psychophysiologist and ignited new interests and career directions. I admire her passion and
curiosity, deep intellect, and commitment to the scientific method and am so lucky to have had
the chance to work with her.
Eileen Crimmins has been instrumental in my training throughout these years. I am
grateful for her sharing of wisdom that made my projects stronger and more impactful. She
supported my work financially through the National Institutes on Aging T32 training grant and
provided feedback at many stages of the writing process in seminars. Thank you, Eileen, for
having my back.
I am also so grateful for Liz Zelinski for her guidance in the development of my projects,
and in my career. In academia, there are often hard truths to swallow and even harder questions
to ask yourself, but her humor and candor made it all easier to digest.
I am lucky to have had my Healthy Aging Lab, Molli Grossman and Elizabeth Hagood,
who have really been there for me every step in this journey, enriching my mind, challenging
5
me, and bolstering me in countless ways. Thank you, also to Christine Juang, Carly Roman, and
Jennifer Robinette who also gave me much support in our time together in lab.
Thank you to the Emotion and Cognition lab, who adopted me as one of their own. Thank
you so much, to Allie Ponzio, for being a friend, a true peer mentor, and guiding light. Thank
you to Phil Opitz for your key support in the design of my stimuli, Ringo Huang for your
genuine kindness, Hyun Joo Yoo and Kelly Durbin for your irreverent humor that I will miss so
much, Jungwon Min for daily encouragement as my cubicle-mate, and Kaoru Nashiro for being a
truly amazing project manager. Finally, a big thank you to Briana Kennedy, Sara Gallant, and
Alex Ycaza, for being so present and always so willing to share advice – they are my postdoc
role models, and I aspire to step into my next role with as much grace as they all do.
Thank you to my undergraduate research assistants, notably Manali Begur, Jenna
Giulioni, Cindy Kim, and Ryan Ziltzer – without their help I would not have been able to
conduct my last two studies. I’m indebted to them for all their hard work in recruiting, screening,
scheduling a population that isn’t always the easiest to research. I would also like to thank all our
participants, many of whom volunteered their time and efforts in support of science and USC. In
a city like Los Angeles, just transporting oneself to the lab can be a feat.
I’d like to thank our administrative staff members, Linda Broder, Linda Hall, May Ng,
Kurt Schelin, Natasha Reyes, and Maricela Rodriguez, who have all helped so much in the day-
to-day operations of our department and have been critical to the running of my study. I am so
grateful to our associate dean, Maria Henke, for all the support she gave to me and, the incredible
experience of independently teaching a course I loved.
I would also like to thank Nicolas Rohleder, my undergraduate mentor who first instilled
a passion for research in me, and for continuing to be so supportive. He first encouraged me to
6
submit my first poster years ago at American Psychosomatic Society conference, which
connected me to a community of scientists that has been so enlivening to meet with every year.
Of this APS group, I’m most grateful to Danielle St. Pierre, Alexander Fiksdal, Luke
Hanlin, and Ashley Geiger who, for being wonderful grad student mentors to me when I was an
undergrad. I’m also especially thankful to my virtual cohorts of new colleagues – Allison He,
Amanda Acevedo, Marie Cross, Matt Lehrer, Robert-Paul Juster, Lydia Roos, and Sara Sagui-
Henson who have inspired me with their drive and collaborative spirit. Thank you also to
Meanne Chan, Nancy Sin, Ted Robles, Sally Dickerson, and Sarah Pressman - your presence
throughout the years and especially as I planned for my next steps meant so much to me.
Outside of the lab, I have lovely friends who have been nourishing my soul from the day
we met, until now. I am lucky to have them, and they have made this city my new home:
Giuseppe Martone, Michele Kee, Emily Lamon, Kathryn Cai, Blake Weber, Ardalan Youssefi,
Jonah Price, Deborah Hoe, Yuan Zhang, Kristine Carandang, and Nicole Marcione – thank you
for the adventures, tasty meals, and all the heart-to-hearts. I am also so grateful to Roger Yang
and Tali Smookler. Their constant support and comforting presence from afar made the distance
between Boston in LA almost negligible.
Words may not be enough capture my gratitude to my parents, Jianying Yao and Shanqi
Wang. Through their sacrifices, they gave me so many incredible opportunities in my career and
in life. No one could have taught me better than you how important it is to live with integrity.
Thank you to my maternal grandparents – my grandpa instilled the love of science and the
pursuit of health and well-being, and my grandma showed me early on how rewarding it was to
teach. My grandmother also played an integral role in raising me nurturing led me to take interest
in gerontology in the first place. Thank you to my late paternal grandparents - grandma for her
7
dedication to the pursuit of knowledge as a linguistics researcher, and my grandpa for his
devotion to speaking up and standing firmly by his beliefs. Thank you to my aunt Cathy for
being my sounding board, and uncle Shanping for having taught me many life lessons through
our shared interests.
My family has supported me unconditionally, leading up to, and throughout graduate
school and I hope that I can take what I learn and add to their well-being and health as they age.
8
ABSTRACT
Social relationships are an important factor in health and well-being across the lifespan.
While most of the research on the functions of relationships focus on effects of benefits of
receiving support, there is growing evidence that support-giving may also be linked to health and
well-being (Brown, 2003; Schwartz, 2003). To date, however, there is still a lack of research on
the psychological and physiological pathways through which giving may lead to better health
and well-being, as well as the conditions under which giving is beneficial to the giver. The
proposed set of studies is designed to examine key cognitive-affective and physiological states
that flow from support giving to downstream health and well-being states.
The objective of this dissertation is to compare independent effects of giving and
receiving, investigate the effects of imbalance in giving and receiving, and identify the cognitive-
affective and physiological pathways through which giving social support may be linked to
health and well-being in later life. This dissertation is comprised of four studies, two of which
utilize secondary data from the National Survey of Midlife Development in the United States
(MIDUS), an online experiment, and a laboratory experiment, to investigate these questions.

9
CHAPTER 1: BACKGROUND

The notion that humans have evolved as social beings is age-old. As we are dependent
on our social relationships throughout the lifespan, it is thought that there are psychological and
biological processes that underlie the maintenance of these ties. The benefits of social
integration for health and longevity are well established (Cassel, 1976; Cobb, 1976; House,
Landis, & Umberson, 1988). In a landmark study conducted over three decades ago, it was
found that the effects of social connectedness on mortality are comparable to those of the
traditional health risk factors such as smoking and physical inactivity (Berkman & Syme,
1979). Since that time, hundreds of studies have documented that greater levels of social
integration predict better psychological well-being, cognitive and physical functioning, and
lowered risk of morbidity and mortality (Holt-Lunstad, Smith, & Layton, 2010).
The support that individuals give and receive to others within their social networks has
also been shown to be linked to health and well-being (Holt-Lunstad, Smith, & Layton, 2010;
Uchino, Uno, & Holt-lunstad, 2010). Social support has traditionally been defined from the
perspective of the recipient of support, as the perception or experience that an individual is cared
for and part of a network of mutual assistance, or as the direct receipt of supportive assistance.
Less attention has been given to the provision of support, but social support can also be
examined from the perspective of engaging in supportive acts or the perception of oneself as a
support source. There are several forms of social support that may be given or received. The
two main categories that are most commonly used in research are emotional and instrumental
support. Emotional support refers to the giving of nurturance and reassurance to another person.
Instrumental support involves the giving of tangible assistance, such as services, financial
assistance, and other specific aid or goods. Other, less-examined forms of support include
10
companionship, validation, and informational support. These forms of support can be both given
to and received from a diverse array of social ties, including romantic partners, family members,
friends, coworkers, and other social ties.

Health Correlates of Social Support Giving

Emerging evidence suggests that giving support to others is beneficial to one’s health.
Epidemiological studies have shown that giving support to others predicts psychological well-
being and longevity above and beyond that associated with receiving support (Brown & Brown,
2015). Feeling like one plays a useful, contributory role in the lives of others is also associated
with lower levels of depressive symptomatology and higher levels of mastery and control
(Gruenewald, Karlamangla, Greendale, Singer, & Seeman, 2007), and predicts lower likelihood
of the development of physical disability or risk of mortality with advancing age (Gruenewald,
Karlamangla, Greendale, Singer, & Seeman, 2007; Gruenewald, Liao, & Seeman, 2012).
Persistent feelings of usefulness also predict greater longevity in later life (Gruenewald,
Karlamangla, Greendale, Singer, & Seeman, 2009). However, health correlates of support giving
have not been universally observed with some studies finding no significant associations of
support giving with health and others finding a negative association (Krause, Herzog, & Baker,
1992; Strazdins & Broom, 2007; Thomas, 2010).
The research on social support provision primarily examines emotional and instrumental
support, with some inconsistency in findings of whether each form of giving is beneficial for
well-being. In one study of older adult members of religious congregations, it was found that
helping others was associated with higher levels of mental health, above and beyond benefits of
receiving help (Schwartz, 2003). This study assessed social support using items such as making
others feel loved and cared for, and listening to others’ concerns. In another sample of older
11
adults with comorbid health conditions, providing emotional support predicted greater self-
esteem and control beliefs (Warner, Schüz, Wurm, Ziegelmann, & Tesch-Römer, 2010).
Emotional support was assessed by the frequency in which participants consoled or cheered up
someone else. Another study demonstrated that providing companionship support is linked to
better psychological well-being, while “help” was associated with poorer psychological well-
being (Strazdins & Broom, 2007). In this study, companionship support was measured with
items assessing affection and appreciation, asking about others’ thoughts and feelings, and
spending time with or organizing social occasions for others. “Help” on the other hand, was
assessed by frequency of listening to worries, soothing and calming, giving advice, mediating
conflict or regulating others’ angry behavior (Strazdins & Broom, 2007).
Other investigations utilize assessments of instrumental support. In a study of bereaved
participants who experience high levels of grief, providing instrumental support to others was
associated with a faster decline in depressive symptoms after the death of a spouse (S. L. Brown,
Brown, House, & Smith, 2008). Instrumental support was assessed with items such as help with
transportation, errands, shopping, housework, and child-care for friends, neighbors, and relatives.
Giving instrumental support was found to buffer against the detrimental effects of stress on
psychological well-being and longevity (Brown, Brown, House, & Smith, 2008; Poulin, Brown,
Dillard, & Smith, 2013). Instrumental support was measured by how often participants reported
helping others with transportation, errands, shopping, housework, childcare, and other tasks in
both studies. In a study of parents giving support to adult children, those rewarded by giving had
lower levels of depressive symptoms when giving more tangible (practical and financial)
support, while those stressed by giving had higher levels of depressive symptoms when giving
12
less nontangible (companionship, advice) support (Bangerter, Kim, Zarit, Birditt, & Fingerman,
2014).
Social support is differentially associated with psychological well-being and health based
on the definition of support. Within the studies examining emotional support, most findings
show that those who report giving more emotional support tend to have more favorable
psychological well-being. However, giving emotional support that requires helping others
through negative situations is typically associated with worse psychological well-being.
Instrumental support provision, however, is more consistently associated with better well-being.

Distinguishing support giving from caregiving

It is important to distinguish provision of social support from other types of exchanges,
such as informal caregiving. Unpaid caregiving is often defined as helping others with personal
needs or household chores, or providing for a person with medical conditions or disability.
Caregiving is often viewed as a chronic stressor, as many caregivers report that they had no
choice in taking on the responsibilities (Hounsell et al., 2014). Furthermore, caregiving may be
considered stressful because it often co-occurs with experiencing grief as one takes care of a
family member with worsening health conditions. Research documents that caregiving is linked
to poorer health and well-being (Schulz & Beach, 1999; Vitaliano, Zhang, & Scanlan, 2003).
More recently, it has been suggested that two important boundary conditions which
determine whether an individual benefits from support-giving – the perceptions of the efficacy of
support, and the volitional nature of care (Inagaki & Orehek, 2017). Caregiving is often
perceived as a more obligatory form of support provision and thus that may be one characteristic
that dampens the potential benefits of support provision. The relative balance of support given
and received in a relationship is another factor that may shape associated benefits of support
13
provision and provide one explanation for the limited benefits of support provision in caregiving
relationships.

Balance of Giving and Receiving Social Support

One of the conditions under which it is thought that exchanging support is not beneficial
to the individual is if it is perceived to be in imbalance. Both receiving a lot of support and
failing to reciprocate, or constantly giving without receiving in return, can lead to distress in
relationships. Several theoretical perspectives have been put forth which may explain why
imbalance in support exchanges may be associated with distress and ill-being. Equity theory
suggests that individuals are distressed if the amount given and received deviates either way
from a balanced state, and both are equally distressful (Adams, 1966). The norm of reciprocity
suggests that people are more averse to receiving more than they give out of the desire to
reciprocate in relationships (Gouldner, 1960). In his paper, Gouldner illustrates this sentiment
with a quote from Cicero, “There is no duty more indispensable than that of returning a
kindness” (p. 161). Social exchange theory (SET; Homans, 1958) on the other hand suggests
that individuals are motivated to receive more than they give in social exchanges and are
motivated by self-interest. In summary, while each theory suggests that balance in exchanges is
more favorable than imbalance, they differ in predictions of whether giving more, or receiving
more, is more distressful. This distinction needs to be clarified as we move forward in
understanding the contexts in which giving can lead to positive psychological and physiological
states. Imbalance may be one condition under which giving does not confer benefits, and this
needs to be examined across age groups.

14
Support imbalance across the lifespan

The nature of social support exchanges evolves over the life course, and the
psychological correlates of imbalance may vary with age as well. Antonucci and colleagues have
proposed a life-course perspective in considering the balance of social support. The concept of a
‘support bank’ has been used to illustrate that individuals keep track of the amount of support
they give to and receive from others. Social exchanges can be reciprocated in the short- or long-
term, potentially rendering imbalance less harmful in the short-term. Also, given a long-term
perspective in viewing exchanges, benefit can be derived from both the actual support received,
as well as the accumulated record of exchanges between parties (Antonucci, Fuhrer, & Jackson,
1990). Thus, the health and well-being of older adults may be less affected by current imbalances
in support provision and receipt. It has been proposed that the resources in the banks of older
adults allow them to continue to feel positively about unequal immediate relationships, since
they can be rationalized to fall in long-term history of exchanges or a deferred reciprocity from
previous exchanges.
On the other hand, there is evidence that perceived imbalance in social support exchanges
is associated with more psychological distress in older adults (McCulloch, 1990; Roberto &
Scott, 1986; Rook, 1987). Older adults may even be more sensitive to imbalanced exchange; one
study found that an imbalance in the number of emotional support hours exchanged predicted
more distress than balanced social exchange in older adults compared to younger adults (Keyes,
2002). Studies of the effects of support giving in older adults show that receiving support is
associated with psychological distress, while providing support to others is psychologically
beneficial (S. L. Brown et al., 2003; Krause & Shaw, 2000; Liang, Krause, & Bennett, 2001;
Silverstein, Chen, & Heller, 1996), although younger individuals were not included in such
15
investigations for direct examination of the potential moderating effect of age. Thus, there is a
need for further exploration of associations between imbalance in supportive exchanges and
health and well-being across the lifespan.

Cognitive and affective states associated with support-giving

As the links between support-giving and health outcomes become established, it is
important to identify the psychological pathways that underlie these associations. Several
candidates have emerged. We may draw from existing evidence of the cognitions and affective
states that prosocial or altruistic behavior is thought to elicit, as well as a handful of experimental
studies in which support-giving is manipulated. There is evidence that support-giving may
increase levels of positive affect, in addition to feelings of self-worth and social connectedness
(Grossman, Wang, & Gruenewald, 2017; Pressman, Kraft, & Cross, 2014). Giving to others may
improve a sense of social well-being, such that it makes the givers feel more connected with
others. In addition, giving may improve one’s perceptions of the self by increasing levels of self-
efficacy. Finally, altruistic behaviors have been linked to a ‘warm glow’ in which giving may
improve positive affect. Furthermore, these potential cognitive-affective pathways – improved
sense of affective and social well-being and self-enhancement have been shown to independently
mediate associations between giving to others and psychological well-being (Martela & Ryan,
2016). To date, however, there have not been studies that compare the unique psychological
states that may underlie the receipt and provision of support on health.

16
Physiological states associated with support-giving

There is beginning to be evidence for potential stress-buffering effects of support-giving.
Engaging in prosocial behavior can lead to release of oxytocin and vasopressin, which can
potentially contribute to the regulation of the hypothalamic pituitary adrenal (HPA) axis. In one
study, helping others was found to reduce HPA activity by regulating the cortisol response to
stress (S. L. Brown et al., 2008). In other studies, it was found that generosity was linked to
greater parasympathetic and lower sympathetic nervous system activity (Miller, Kahle, &
Hastings, 2015). These findings have begun to be supported by laboratory manipulation studies
in which support-giving is associated with reduced sympathetic responses to stress (Inagaki &
Eisenberger, 2015). Specifically, neuroimaging studies have demonstrated that giving support
reduces activation of stress and threat-related regions in the brain, including the dorsal anterieor
cingulate cortex, the amygdala, and the anterior insula in response to a social stressor (Inagaki et
al., 2016). Direct physiological effects of giving to others have also been demonstrated. For
example, in one study, those who were assigned to give money to others as opposed to spending
on oneself, had lower resting blood pressure following the intervention (Sandstrom, Dickerson,
& Madden, 2016). These findings show that giving may reduce stress responses or have direct
effects on stress-related regulatory systems under non-stressful conditions. The body of research
on the potential attenuation of physiological stress responses is still in its infancy, and has not
been examined in middle-aged and older adults. However, given the mounting correlational work
demonstrating longevity and well-being in those who give more in midlife and beyond, it is
necessary to examine the physiological pathways through which support-giving may benefit this
subpopulation.

17
Specific goals of dissertation

This dissertation aims to fill the gaps in our knowledge of links between support-giving
and health through four studies. In the first study, the independent associations of support-giving
and receiving, as well as the balance of the two, with psychological well-being were examined.
These associations were compared across various types of relationships, and across different age
groups from early adulthood to late life. This study uses cross-sectional data from the second
wave of the Survey of Midlife in the US. Study 2 utilizes daily interview data to examine same-
day and next-day associations between instrumental and emotional support-giving and physical
and psychological well-being and physiological functioning. This study capitalizes on available
daily diary data in a subsample of the MIDUS participants to examine how psychological and
physical well-being fluctuates with social support behaviors within and between people. In
addition, the associations between support-giving and well-being/physiological functioning were
examined on the same day and on the lagged day. The third study utilized an online experimental
writing protocol to compare the cognitive-affective states elicited by perceiving oneself as a
giver or receiver of support in midlife and beyond. This study aimed to elucidate the unique
thoughts and feelings that are associated with perceiving oneself to be a giver or a receiver of
support. This also served as a pilot study to test a support schema activation manipulation for the
final study. The fourth study examined physiological effects of perceiving oneself as a giver of
support in the laboratory, including whether perceptions of oneself as a giver had direct or stress-
buffering effects on cardiovascular and autonomic function. Together, these studies build on
growing work to identify the psychological and physiological pathways through which support-
giving influences health across the lifespan, and the contexts in which giving is beneficial or
distressful.
18
CHAPTER 2: THE PSYCHOLOGICAL COSTS OF SOCIAL SUPPORT IMBALANCE:
VARIATION ACROSS RELATIONSHIP CONTEXT AND AGE

(Accepted author version, published in Health Psychology)

Abstract

Psychological well-being benefits of receiving social support are well-established.
Growing evidence also suggests parallel benefits of giving support. However, much less attention
has been given to understanding the psychological correlates of imbalance in giving and receiving
social support. We examined associations between social support (given, received, and imbalance)
and psychological well-being in multiple relationship types (friends, family, and spouse). Greater
levels of both receiving and giving social support were independently associated with more
favorable psychological well-being, while imbalance in the ratio of support given and received
was associated with poorer psychological well-being. Findings varied between relationship types
and across age.
Introduction

While most research on the links between social support and well-being has focused on the
positive effects of receiving support from others, recent studies suggest that there are comparable
and independent benefits of giving support (Konrath and Brown, 2013). Despite evidence that both
giving and receiving support are linked to greater well-being, there has not been extensive research
on the well-being correlates of the balance of support given and received. Furthermore, there is
limited knowledge regarding how these associations vary by relationship type and across the life
course. This study aims to investigate the psychological well-being correlates of under-benefiting
and over-benefiting from social support in multiple relationships across the life course.
19

Benefits of receiving support

There is a substantial amount of evidence that receiving social support is associated with
better physical and psychological health (Uchino et al., 2012). Higher levels of social support are
associated with lower levels of depression and stress and higher levels of positive affect (Cohen,
1988; Uchino et al., 2012). Receiving social support not only directly improves psychological
well-being under non-stressful conditions but also attenuates negative psychological experiences
under stressful conditions. Receiving support may benefit health and well-being by enhancing an
individual’s coping ability (Thoits, 2011). Perceiving the availability of support can also buffer
the effect of stress on psychological distress, anxiety, and depression, often by reducing negative
appraisals of a stressor (Cohen and Wills, 1985; Kawachi and Berkman, 2001).
Benefits of giving support

There is also growing evidence that giving support to others is beneficial to one’s own
health and psychological well-being. Giving has been associated with greater psychological well-
being (Bangerter et al., 2014; Brown et al., 2008) and longevity (Poulin et al., 2013, Brown et al.,
2003). Feeling like one plays a useful, contributory role in the lives of others is associated with
lower levels of depression and higher levels of mastery and control (Gruenewald et al., 2007) and
predicts lower likelihood of the development of physical disability or risk of mortality with
advancing age (Gruenewald et al., 2007, 2012). These findings suggest that supporting others may
promote more positive states of one’s own mental and physical well-being.
Imbalances in social support exchanges

A sizable body of research indicates that balance in social exchanges contributes to
relationship satisfaction (Buunk and Mutsaers, 1999; Buunk and Van Yperen, 1991; Rook, 1987;
Traupmann et al., 1981). However, less is known regarding associations between the balance in
20
support receipt and provision and psychological well-being. Several theories posit that
psychological well-being may be linked to the relative balance of support given and received.
Equity theory posits that individuals experience distress when one’s ratio of inputs and
outputs is unequal to another’s (Adams, 1966). Equity theory suggests that both over-benefiting
(receiving more than giving) and under-benefiting (giving more than receiving) in social
exchanges are equally distressful. In contrast, the norm of reciprocity suggests that people are more
averse to over-benefiting since they are motivated by internalized moral beliefs to reciprocate in
social exchanges (Gouldner, 1960). Social exchange theory (SET; Homans, 1958) on the other
hand suggests that individuals are more motivated to over-benefit from social exchanges due to
self-interest, but that people also abide by norms of reciprocity. Because individuals act to
minimize losses in exchanges, SET suggests that people may be more distressed by under-
benefiting. In summary, while each theory suggests that balance in exchanges is more favorable
than imbalance, they differ in predicting whether over- or under-benefiting is less favorable.
The majority of studies of the effects of imbalanced exchanges on psychological well-
being have not distinguished between over-benefiting and under-benefiting (Buunk et al., 1993;
Davey and Eggebeen, 1998). Studies that have directly compared under- and over-benefiting
resulted in mixed findings. Under-benefiting is associated with worse relationship well-being
than over-benefiting in couples (Grote and Clark, 2001; Sprecher, 2013). However, over-
benefiting was associated with less favorable affective well-being, while under-benefiting was
unrelated to well-being, in a sample of older adults (Keyes, 2002). Thus, it remains unclear
whether over- or under-benefiting is associated with better psychological well-being and how
such links might vary by relationship type and age.
21
Psychological well-being correlates of imbalance may vary across multiple relationship
types (spouse, family, or friend). However, this difference has not been investigated thoroughly.
Relationships with friends tend to be more balanced than with family (Li et al., 2011). Since
friendships are more voluntary, individuals unsatisfied with imbalance in friendships can end them
(Li et al., 2011). In familial relationships, however, individuals who are dissatisfied with imbalance
may not have the choice to end the relationship. It is possible that imbalance in compulsory
relationships with family members and spouses may be more distressful because individuals are not
able to end them at will.
Life course perspective

The nature of social support exchanges evolves over the life course; the psychological
correlates of imbalance may vary with age, as well. The concept of a “support bank” has been used
to illustrate that individuals keep track of the support they exchange with others (Antonucci and
Jackson, 1986). Social exchanges can be reciprocated both in the short-term and the long-term,
potentially reducing the negative effects of imbalance in later life (Antonucci et al., 1990). Older
adults may not be as distressed by imbalance since they draw from a longer banking history of
giving or receiving in the past. However, studies of older adults demonstrated that greater
imbalance in perceptions as well as number of hours of support exchanged are associated with
more psychological distress (Rook, 1987) and greater levels of negative affect (Keyes, 2002).
More research is needed to compare the imbalance—well-being link across different stages of the
life course.
22
Present study

There has yet to be an investigation comparing the psychological well-being correlates of
under- and over-benefiting in different relationships. This study aims to address this gap by
comparing the psychological well-being correlates of giving and receiving support, as well as under-
and over-benefiting in relationships with spouses, friends, and family members. We predict greater
levels of psychological well-being among those who report higher levels of support given and
received. We hypothesize that under- and over-benefiting will both be associated with less favorable
psychological well-being, and that these associations will vary by relationship type. We aim to add
to a growing body of evidence for independent psychological benefits of support-giving, as well as
to resolve mixed findings in imbalance by directly comparing under- and over-benefiting in specific
relationships and across the ages.
Methods

Sample

The data in this study are from the Biomarker Substudy (n = 1255) of the second wave of
the Study of Midlife in the United States (MIDUS; Brim et al., 2004). Two waves of data have
been collected from participants in the parent MIDUS via telephone and mail surveys. In addition,
surveys and health assessments were collected via an in-person visit in the substudy. The first wave
(1994–1995) of 7108 participants were drawn from a main sample from a random digit dialing
(RDD) procedure, oversamples from five US cities, siblings of the RDD sample, and a sample of
twin pairs. A 10-year follow-up (2004–2006) re-surveyed approximately 83 percent (n = 4963
telephone; n = 4032 mail). An additional subsample (n = 592) of African-American participants
from Milwaukee, WI was added at this wave. The substudy collected medical history, health status,
and biomarker data on a subset (n = 1255) of MIDUS II participants. Substudy participants had
23
comparable demographics and health to the larger MIDUS II cohort, with the exception that the
substudy participants had higher educational attainment (42.1% college degree or higher in
substudy; 34.5% in MIDUS II). The analytic sample used in this study is limited to those who had
data on psychological well-being and social support measures (n = 1231). A smaller analytic
sample (n = 819) is utilized in analyses of social support within married participants.

Measures

Perceptions of social support

Participants reported perceptions of support given to family, friends, and spouse in
response to “How much can your family rely on you for help with a serious problem? How much
can your family open up to you if they need to talk about their worries?” Perceptions of support
received from family, friends, and spouse were measured by the converse of the previous
questions. Separate mean scores were calculated for each social target (family, friends, spouse)
which ranged from 1 (not at all) to 4 (a lot; Walen and Lachman, 2000). Higher scores signify a
higher level of perceived support given or received. Cronbach’s alpha (a) internal reliability
coefficients for all social support measures were good: support to family a = .65, to friends
a = .71, and to spouse a = .78, perceived support from family a = .84, from friends a = .88, and
from spouse a = .90.
A ratio of support given to support received was calculated by dividing the perceived
support given to each target by the support received by each target. Ratio scores were then
categorized into three groups: “giving more than receiving” (ratio cutoff score = 1 standard
deviation (SD) above the mean), “balanced exchange” (ratio cutoff score = within 1 SD above and
below the mean), and “giving less than receiving” (ratio cutoff score = 1 SD below the mean).
24
Analyses of support balance employed a categorical support balance variable representing over-
benefiting, balance, and under-benefiting in each relationship.
Sociodemographic and health status covariates
Sociodemographic covariates included age (in years), sex (male; female), educational
attainment (high school diploma or less; some college or more), and race/ethnicity (White; non-
White). A health condition burden score was calculated as the sum of lifetime diagnosis of lung
problems, high blood pressure, diabetes, transient ischemic attack (TIA)/stroke, cancer, heart
disease, circulation problems, and blood clots (scores range from 0 to 8).
Psychological well-being

Perceived stress was assessed with the Perceived Stress Scale (PSS; Cohen et al., 1983).
The PSS is a measure of perceived frequency (1 = never to 5 = very often in past month) of stress
or strain over the last month (“felt difficulties were piling up so high that you couldn’t overcome
them”). A summary score is computed by summing frequency ratings (possible composite score
range is from 10 to 50). The scale exhibits good internal reliability (a = .86; Cohen et al., 1983).
Depression was measured with Center for Epidemiologic Studies Depression Scale
(CESD; Radloff, 1977). Respondents rate the frequency (0 = rarely or none of the time to 3 = most
or all the time) of 20 symptoms of depression over the past week (“during the past week, I had
crying spells.”). This scale exhibits good internal reliability (a = .89).
Distress-anxiety and positive affect were measured by subscales of the Mood and Symptom
Questionnaire (MASQ; Clark and Watson, 1991). The MASQ was used to assess the degree of
experience (1 = not at all to 5 = extremely) that respondents experienced symptoms of anxiety (e.g.
“felt on edge”) and positive affect (e.g. “felt really up or lively”) during the past week. The distress-
25
anxious and positive affect symptoms’ subscales exhibit adequate to good internal reliability
(a = .82) and (a = .93), respectively.
Analyses

Complete data for the measures in the models were available for 1231 participants for
friend and family support data and 819 participants for analyses of spousal support. For each social
target (friend, family, spouse), the association between level of support given to and received by
respondents and psychological well-being outcomes (perceived stress, anxiety, depression,
positive affect) was examined in regression models controlling for sociodemographic and health
status covariates. The moderation of age was tested with the interaction of centered age and
centered continuous variables for giving and receiving social support. Associations between
patterns of support imbalance and psychological well-being were examined in analysis of
covariance (ANCOVA) models that assessed the mean

26
Table 1. Sociodemographic, psychological, and social exchange behavior characteristics of study sample (n = 1228); MIDUS II
(2004–2006).
% Mean (SD) Range
Socio-demographic covariates
Age (years) 54.51 34–85
Gender
Male (referent) 43.4
Female 56.6
Race/ethnicity
White (referent) 77.8
Non-White 22.2
Education
College degree or more (referent) 72.3
High school degree 27.7
Health covariate
Major health conditions 1.06 (1.11)
Social support variables
Give to family 3.78 (0.44) 0–4
Receive from family 3.61 (0.54) 1–4
Equity of exchange with family 72.7
Give more to family than receive 12.7
Give less to family than receive 14.0
Give to friends 3.74 (0.43) 1–4
Receive from friends 3.26 (0.79) 1–4
Equity of exchange with friends 79.5
Give more to friends than receive 10.1
Give less to friends than receive 9.1
Give to spouse 3.85 (0.35) 1–4
Receive from spouse 3.62 (0.62) 1–4
Equity of exchange with spouse 79.8
Give more to spouse than receive 5.9
Give less to spouse than receive 8.5
Mental health outcomes
Depression 8.73 (8.16) 0–54
Anxiety 16.73 (4.92) 11–47
Perceived stress 22.24 (6.32) 10–48
Positive affect 44.50 (10.21) 14–70
SD: standard deviation; MIDUS: Study of Midlife in the United States.

27
Table 2. Associations between perceived support exchanges (giving and receiving; imbalance) and psychological well-being
across relationship types.
Relationship type Social support Psychological well-being
Positive affect B (b) Anxiety B (b) Depression B (b) Stress B (b)
Spouse Giving 2.49 (.084)* -0.38 (-.029) -2.53 (-.115)** -3.39 (-.184)***
Receiving 2.12 (.132)*** -0.71 (-.099)** -1.80 (-.151)*** -1.32 (-.132)***
Friends Giving 2.55 (.106)*** -0.12 (-.011) -0.97 (-.051) -1.36 (-.092)**
Receiving 2.53 (.197)*** -0.69 (-.112)*** -2.23 (-.215)*** -1.38 (-.172)***
Family Giving 1.31 (.056) -0.28 (-.025) -1.20 (-.064)* -1.49 (-.103)***
Receiving 3.51 (.189)*** -1.13 (-.129)*** -3.25 (-.217)*** -1.92 (-.166)***
Positive affect M Anxiety M Depression M Stress M
Spouse Balance 45.27 16.21 6.99 21.21
Over-benefit 43.98 16.87 9.38
a
23.96
a

Under-benefit 42.51
b
17.75
b
10.82
b
24.09
b

Friends Balance 44.99 16.57 8.25 21.92
Over-benefit 45.39
c
16.34
c
8.02
c
22.18
c

Under-benefit 41.26
b,c
17.91
b,c
12.68
b,c
24.47
b,c

Family Balance 45.69 16.44 7.85 21.60
Over-benefit 42.97
a,c
17.02 9.70
a,c
23.65
a,c

Under-benefit 40.15
b,c
17.64
b
12.51
b,c
24.25
b,c

OLS: ordinary least squares; ANCOVA: analysis of covariance.
Shaded rows indicate results from OLS regression. Unstandardized regression coefficients are presented, with standardized coefficients in
parentheses. Covariates include age, gender, education, chronic and health burden. Unshaded rows indicate results from ANCOVA models using
categorical predictors of support balance. Covariates include age, gender, education, chronic health burden. Estimated means of psychological
measures in each group are presented, with superscripts indicating significant (p < .01) mean difference between each group.
a
Estimated effect of over-benefiting varies from that of balanced.
b
Estimated effect of under-benefiting varies from that of balanced.
c
Estimated effect of under-benefiting varies from that of over-benefiting.
*p < .05; **p < .01; ***p < .001.

28
levels of each psychological well-being measure as a function of a categorical independent variable
reflecting over-benefiting, under-benefiting, or a balanced ratio of perceived support. Using
Hayes’ PROCESS macro, a continuous measure of age and a dichotomous indicator of sex were
tested as moderators of the associations between giving, receiving, and imbalance in each
relationship type and each form of psychological well-being (Hayes and Matthes, 2009). All
statistical analyses were conducted in SPSS (v. 22).
Results

The sample was primarily White, well-educated (72.3% had some college or greater), and
aged 34–85 years, with a mean age of 55 years (Table 1). Perceptions of support given and
received were generally favorable. Over-benefiting was more commonly reported in familial and
spousal relationships, while under-benefiting was more frequently reported in friendships.
Greater perceptions of the receipt of support significantly predicted more favorable levels
of all measures of psychological well-being (see Table 2). Likewise, greater perceptions of giving
support also generally predicted more favorable psychological well-being for all measures except
anxiety, although the association was in the expected direction. These results demonstrate that
there are significant associations between degree of support provision and psychological well-
being, even when controlling for the effects of received support.
Age moderated the associations between giving support and all forms of psychological
well-being except anxiety, although the results varied by relationship type. The Johnson–Neyman
technique within the Hayes’ PROCESS macro was used to identify regions of significance within
significant interactions. Analyses indicated that greater support provision was associated with
lower levels of depression within familial relationships in those aged 37–57 years and within
spousal relationships for those aged 40–63 years. Greater support provision was also associated
29
with lower levels of perceived stress in middle-aged individuals (association significant for those
between ages 40 and 70 years). Greater perceptions of support provision were also linked to higher
levels of positive affect in friendships for those aged 47–86 years and in spousal relationships for
those aged 50–60 years. The patterns of age moderation for associations between receiving support
and psychological well-being were similar with associations typically significant for young and
middle-aged, but not older adult participants. Greater perceived support receipt was associated
with lower levels of depression in familial (under age 78 years) and spousal (under age 65 years)
relationships, lower levels of perceived stress in familial (under age 70 years) and spousal (ages
37–70 years) relationships, and higher positive affect in spousal relationships (ages 40–65 years).
Higher perceptions of support receipt were also linked to lower levels of anxiety in those under
age 65 years for all relationship types. Among the associations between giving and receiving and
psychological well-being, sex only significantly moderates the link between giving support to
family and depressive symptoms: among females, giving more support was not associated with
depression, whereas among males, giving more support was associated with lower levels of
depressive symptoms (b = -2.55; p = .0005). The associations between giving or receiving support
and other measures of well-being did not vary by sex.
Those who under-benefit have poorer psychological well-being, as indicated by higher
levels of stress, anxiety, and depression and lower levels of positive affect, compared to those who
have balanced relationships (Supplemental Figure 1(a) to (d)). Those who over-benefit in familial
and spousal relationships also had greater levels of stress and depression compared to those who
had balanced relationships. Over-benefiting in friendships was not associated with poorer
psychological well-being. When comparing both forms of imbalance, we find that those who
under-benefit have greater levels of stress, depression, and anxiety and lower levels of positive
30
affect than those who over-benefit in relationships with friends and family. This difference is not
found within spousal relationships.
Age moderated the associations between imbalance and distress, but the significance of
moderation depended on the form of distress and relationship type. The Johnson–Neyman
technique was again used to identify regions of significance within each interaction. Age
moderated the association between over-benefiting in families and stress, but over-benefiting was
only associated with higher stress in participants aged 63 years and younger (p
int
< .01). There was
also a significant interaction of age and under-benefiting in family and friends (p
int
< .01; p
int
< .05)
on anxiety, with under-benefiting associated with greater anxiety in those younger than 57 years.
Age also moderated the association between under-benefiting and greater depressive symptom
experience in spouses (p
int
< .05), but only among those aged 60 years and younger. These
associations between imbalance in support exchanged and psychological well-being did not vary
by sex.
Discussion

We found that both perceptions of giving and receiving support from others are
independently predictive of more favorable psychological well-being. Greater levels of perceived
support were associated with greater levels of all forms of psychological well-being examined
(higher positive affect, lower anxiety, depression, and perceived stress) in all relationships. Greater
perceived provision of support was also associated with greater levels of most forms of psychological
well-being, apart from anxiety, which was not significantly associated with perceived levels of
giving to others. Overall, the magnitude of associations between support-receiving and
psychological well-being was higher than those for support-giving.
31
Under-benefiting in social exchanges predicts less favorable well-being compared to balance
in all relationships. Compared to balanced relationships, over-benefiting was also associated with
lower levels of some forms of psychological well-being in spousal and familial relationships, but not
friendships. While both forms of imbalance were associated with poorer psychological well-being
compared to balanced support states, under-benefiting tends to be associated with significantly
higher levels of distress than over-benefiting in friendships and familial relationships.
Different imbalance-related theories are supported in each relationship type (Adams, 1966;
Homans, 1958; Walster et al., 1976). Our findings of spousal relationships support equity theory,
in which under-benefiting and over-benefiting are equally distressful. We find support for SET in
our findings of familial and friendship relationships, in which it is more distressful to under-benefit
than over-benefit (Homans, 1958), albeit greater distress is found in those who over-benefit in
familial relationships while distress is unrelated to over-benefiting in friendships. This latter
finding aligns with the hypothesis that imbalance in compulsory relationships (i.e. family, spousal
relationships) may be more distressing than in non-compulsory friendships. It is possible that
individuals are more likely to end friendships in which they received unsolicited support that
contribute to over-benefiting. Or, it is possible that over-benefiting does not elicit distress, because
it is more normative to receive more support from friends. More research is needed to understand
why over-benefiting is not associated with greater distress in friendships; the length of the
friendship may explain more of the variation in these associations and is an important aspect to
examine in the future.
Age moderates a few associations between imbalance in some relationships and some
domains of psychological distress. Imbalance was associated with greater distress in young and
middle-aged adults, but not older adults, which supports the notion of a “support bank” (Antonucci
32
and Jackson, 1986); older adults may be less distressed with either form of imbalance because it
can more easily be rationalized as repayment for numerous instances of previously exchanged
support. Our findings vary from the other study comparing effects of imbalance across the life
course (Keyes, 2002), in which it was found that imbalance in support was associated with worse
affect in older but not younger adults. This discrepancy may be due to the use of the number of
hours rather than perceptions of support. Additionally, the perceptions of support investigated in
this study refer to emotional support, rather than instrumental support. Findings from past research
indicate that receiving more than giving is distressful to older adults as it may indicate dependency
(Dunbar et al., 1998; Zunzunegui et al., 2001). However, this prior research operationalizes social
support as instrumental rather than emotional. Thus, more research is needed to further understand
age differences in the support imbalance—distress connection across different types of social
support.
Apart from a significant association between greater giving and lower depressive symptoms
among males but not females, we do not find any sex differences in other giving/receiving or over-
/under-benefiting and psychological well-being associations. There have been mixed findings with
regard to sex differences in associations between imbalance and well-being. In one study of couples,
wives who over-benefit are less satisfied with their marriages, while husbands’ perceived imbalance
was not associated with satisfaction (Goodman, 1999). In another, it was found that while women
receive more support than men, there are no differences in the reported imbalance in support, nor are
there differences in associations between imbalance and happiness (Antonucci and Akiyama, 1987).
More research is needed to clarify these mixed findings in the role of sex as a moderator of the
relationship between social support imbalance and psychological well-being.
33
An important limitation of this study is the cross-sectional analysis of associations between
forms of social support exchange and well-being, due to the availability of all the variables of
interest in only wave II of the MIDUS. Longitudinal data are needed to investigate how changes
in the perceptions of support predict changes in well-being. Strengths of this study include the
comparisons between specific types of relationships, efforts to distinguish between effects of over-
benefiting and under-benefiting, and examination of age as a moderator of these associations.
Since most previous research does not directly compare under- and over-benefiting or the effects
of imbalance across different relationships, our findings help clarify some of the previously
conflicting support for different theories of social support inequity (Buunk et al., 1993; Rook,
1987; Väänänen et al., 2005).
Other inter-individual differences, such as personality factors, may moderate the links
between imbalance and well-being. Those who are more extraverted receive and perceive higher
levels of support (Asendorpf and Van Aken, 2003; Swickert et al., 2002), have larger social
networks (Cutrona et al., 1997), and are less likely to feel burdened, frustrated, or dependent as a
function of support provision or receipt (Lu, 1997). Additionally, it has been proposed that
individuals differ in levels of exchange orientation, or the degree to which they are oriented toward
direct and immediate reciprocity (Murstein et al., 1977). A greater exchange orientation is linked
to greater levels of stress and loneliness (Buunk et al., 1993; Buunk and Prins, 1998). Our findings
of age differences may be explained by change in exchange orientation or personality traits over
the life course. Thus, personality trait moderation of associations observed in the present analyses
between support imbalance and psychological well-being is an important focus for future research.
In summary, we find that psychological well-being is consistently greater in those who perceive
balanced support exchanges compared to both the under- and over-benefited. Under-benefiting is
34
more strongly associated with poor well-being than is over-benefiting in familial relationships.
Under-benefiting is the only form of imbalance associated with poorer well-being in friendships,
while both forms of imbalance are equally linked to greater distress in spousal relationships. The
strength of association between imbalance and poorer psychological well-being also appears to fade
with age. Considerable progress has been made in the social support and health field in the
identification of health correlates of receiving support, and more recently, in the identification of the
potential benefits of giving support. The present findings further contribute to our understanding of
the psychological well-being correlates of the balance in giving and receiving in different
relationship types across the life course.

35
CHAPTER 3: DAILY PSYCHOLOGICAL AND PHYSICAL WELL-BEING
CORRELATES OF GIVING SUPPORT TO OTHERS

Introduction

The benefits of social integration on health and longevity are well established (House,
Landis, & Umberson, 1988). A voluminous literature indicates psychological well-being benefits
of receiving social support (Holt-Lunstad et al., 2010; Uchino, 2009; Uchino, Bowen, Carlisle, &
Birmingham, 2012). A small, but growing body of research, likewise indicates benefits of giving
support to others on health outcomes (Inagaki & Orehek, 2017; Konrath & Brown, 2013).
Multiple investigations indicate links between giving behavior and indicators of better physical
well-being. Giving to others is associated greater longevity, fewer health conditions, lower
blood pressure and lower viral loads (Piferi & Lawler, 2006; Schwartz, 2003). The associations
between support-giving and psychological health is less consistent. While several
epidemiological studies have shown associations with positive psychological outcomes, such as
less loneliness, increased happiness, and self-esteem (Gierveld & Dykstra, 2008; Krause &
Shaw, 2000), providing support to others can also be distressful or lead to a sense of burden and
frustration (Cichy, Stawski, & Almeida, 2013; Strazdins & Broom, 2007). In one study, no
relationship was found between support-giving and depression (Liang, Krause, & Bennett,
2001).
There is also a lack of clarity in our knowledge as to the cognitive and affective pathways
through which providing social support to others may be linked to psychological and physical
health. Experimental manipulations of support-giving, such as giving money to others
consistently demonstrate higher levels of positive affect following giving experiences (Aknin et
al., 2013; Pressman et al., 2014). Investigations of the neural underpinnings of support-giving
36
also demonstrate activation of reward-related regions such as the ventral striatum during the
provision of support (Inagaki & Eisenberger, 2012). The effects of support-giving on negative
affect are more mixed, with some demonstrating lower levels of negative affect and depression
(Field, Hernandez-Reif, Quintino, Schanberg, & Kuhn, 1998; Pressman et al., 2014) and others
which demonstrate no significant difference in negative affect and anxiety (Abelson et al., 2014;
Inagaki & Eisenberger, 2015). Recently, we have demonstrated varying associations between
supportive behavior and psychological states. Specifically, giving more emotional support on a
certain day is associated with lower levels of positive affect, while informal help and
volunteering is associated with greater self-enhancement and sense of connectedness on the same
day (Grossman et al., 2017). These findings demonstrate that there are direct effects of support-
giving on affective well-being, and that a potential reason for the mixed pattern of affective
correlates of support provision may be due to a lack of comparison between differing forms of
supportive behavior. These studies have only examined one form of support under controlled
conditions. However, the giving of social support in naturalistic settings occurring under
circumstances when individuals are presented with opportunities to provide different forms of
support, including those which may be more emotionally meaningful to support providers. It is
thus important to understand the correlates of naturally occurring instances of support-giving and
distinguish between different types of support.
Evidence is also emerging that giving may buffer against the negative effects of stressor
experience. Support-giving reduces stress-related neural activity in the amygdala, the dorsal
anterior cingulate cortex, and the anterior insula and reduces sympathetic nervous system
responses to a social stressor (Inagaki et al., 2016; Inagaki & Eisenberger, 2012). Furthermore,
37
feeling that one is generative has also been shown to buffer the negative associations between
caregiving and levels of depression and negative affect (Grossman & Gruenewald, 2017).
While these studies point to the possibility of both direct and stress-buffering effects of
support-giving, most studies which have experimentally manipulated support only manipulate
one form of support, and these forms of support and stressors may not be ecologically valid or
personally relevant. Thus, it is important to understand how natural instances of giving of
support are related to psychological well-being, and how it may interact with stressors in real
life. There have been many studies which use ecological momentary assessment to link the
experience of stressors on a given day with higher blood pressure, levels of cortisol, greater
experiences of physical symptoms, and more psychological distress on the same day (Almeida,
2005; Almeida, Piazza, & Stawski, 2009; Smith, Birmingham, & Uchino, 2012). Furthermore,
the lingering effects of stressors on psychological outcomes on the following day has been
associated with greater number of chronic conditions and poorer physical functioning a decade
later (Leger, Charles, & Almeida, 2018). The use of daily diary designs to examine effects of
social support on well-being has shed light on temporal nuances. For example, in one study,
individuals who received emotional support experienced greater levels of depressed mood on the
same day, and lower levels on the following day (Bolger, Zuckerman, & Kessler, 2000). The
investigators have since ascribed this pattern to the phenomenon that individuals find emotional
support most helpful when it is invisible. A follow-up study found that the same pattern was not
found when individuals received practical or instrumental support, such that those who received
emotional support had greater levels of anxiety, depression, fatigue, and lower levels of vigor,
while those who received instrumental support had greater levels of vigor and lower levels of
fatigue on the days following support. This methodology has allowed for better understanding of
38
the trajectories of receiving support and shined light on the importance of looking at same day
and lagged day associations between supportive exchanges and mood. Daily studies have been
used to examine the between-person associations between giving support and physiological well-
being (Piferi & Lawler, 2006), and found that those who characteristically give support
experience better physiological well-being. However, how well-being may covary with giving
behavior from day-to-day has not been examined. Delving into such daily associations may
provide greater understanding of the temporal patterns of connection between support provision
and various psychological, physical, and physiological correlates of giving to others.
This study uses the National Survey of Daily Experiences, a sub-study of the MIDUS
Study. These data allow for examination of the proximal effects of social support exchanges.
Many past investigations utilize surveys in which participants recall qualities or quantities of
support exchanged over a long period (i.e. over the past month or year), or laboratory
manipulations. A benefit of using daily experience sampling data is the reduction of bias in
recalling aspects of social exchanges over longer periods of time. Furthermore, the ability to
understand same day and lagged affective, physical, and physiological states associated with
social support giving provides a window through which to view the pathways linking support to
longer-term health outcomes. Investigating the lagged effects of providing support to others can
help clarify the dynamic trajectories through which support may be associated with well-being.
Finally, these data allow us to investigate the effects of social exchanges in a real-world setting.
The aims of this study are two-fold. Utilizing repeated daily measurements of
instrumental and emotional support given, affective states, physical symptoms, and physiological
function, we examine whether:
39
1) More support-giving is associated with higher same-day and next-day well-being
(indicated by higher positive and lower negative affect, lower experience and severity
of symptoms, and a healthier profile of diurnal cortisol). Analyses will explore
whether patterns of association with well-being variables are the same for provision
of both instrumental and emotional support.
2) Support-giving will interact with stressor experience such that on days when
individuals experience a stressor, if they also give more than usual they will have
greater levels of well-being.
3) Associations between greater support given on one day are also hypothesized to
persist and be linked with affective, physical, and physiological well-being on the
following day.
Methods

Sample
Using data from the National Study of Daily Experiences (NSDE) in the second wave of
the Survey of Midlife Development in the US (MIDUS), associations between the daily levels of
giving and receiving support and well-being (physical, physiological, and affective) were tested.
The sample includes 2,022 adults aged 35 to 85. A random sample of the respondents from the
MIDUS II were selected to participate in the NSDE II, also known as the National Study of
Daily Experiences. These respondents include those who participated in the second wave of the
MIDUS main study, as well as a sample of African American respondents from Milwaukee (n =
180). Respondents in the NSDE are a representative subsample of the MIDUS study.
These respondents participated in 8 consecutive days of interviews in which they were
contacted via telephone each evening and asked to report on daily exchanges of social support,
daily affect, and experiences of physical symptoms. Respondents were also asked to provide
40
multiple daily samples of salivary cortisol on 4 of the 8 days in order to assess the diurnal rhythm
of cortisol as an indicator of physiological function on each day.
Participants completed an average of 7.2 of the 8 daily interviews. 1,374 participants
completed all 8 days of telephone interviews. The number of missing data increased slightly
throughout the 8 days of data collection, with .10% completing interviews the first day of the
NSDE study, and 10.29% finishing the last day of interviews (Table 1). The highest amount of
missingness over the 8 days was 11.03% missing on the 7
th
day.
Table 1. Missing cases
Day Missing Percent
Missing
1 2 0.10
2 146 7.22
3 165 8.16
4 151 7.47
5 187 9.25
6 215 10.63
7 223 11.03
8 208 10.29

Measures

Daily emotional support. Each day, respondents were asked to report the number of hours
which they gave or received emotional (listening to problems, gave advice, or comforted others)
and instrumental (transportation, shopping, helping with child care) support to others. If a
participant responded “yes”, a follow-up question was asked for the total number of hours and
minutes of emotional support provided to others was queried. It was specified that participants
should not count support that they might provide as part of their jobs. Conversely, respondents
41
were asked about emotional support received from anyone or any organization, and were
instructed not to include counseling that one pays for.
Affective well-being. Each day, respondents were asked about their affective states, using
the Positive and Negative Affect Schedule survey (Mroczek & Kolarz, 1998). The PANAS is
comprised of the positive affect subscale and negative affect subscale. The positive affect
subscale consists of 13 questions: “How much of the time today did you feel…cheerful, calm
and peaceful etc…?” (13-item alpha: 0.96). The negative affect subscale consists of 14
questions: “How much of the time today did you feel…hopeless, and lonely etc…?” (14-item
alpha: 0.89) Participants responded on a 0-4 scale, 0 – “none of the time,” to 4 – “all of the
time.” Positive and negative affect are understood to be unique constructs, that both contribute to
health differentially and may be affected differentially by experiences (Pressman & Cohen,
2005), so the average of each subscale are used in separate models.
Physical Symptom Experience Severity. Each day, respondents were asked whether they
experienced any physical symptoms (e.g. headache, fatigue, nausea, hot flashes…). For each
physical symptom experienced, respondents were asked to rate the severity of the symptom from
a scale of 1 - very mild to 10 – very severe. A composite symptom experience severity score was
calculated by multiplying the number of symptoms experienced by the average reported
symptom severity (Seltzer et al., 2009).
Cortisol. Respondents received a Home Saliva Collection Kit in the mail. On days two
through five, respondents provided four saliva samples per day that were later assayed for
cortisol. Respondents took samples using salivettes (a device consisting of a cotton swab and
plastic receptacle) by placing the swab in their mouths, chewing on it for approximately 30 s, and
placing it in the plastic tube, which respondents stored at room temperature until they were
42
returned to the clinic. Saliva was collected immediately upon waking, 30 min after waking,
before lunch, and before bed. Data on the exact time respondents provided each saliva sample
was obtained from the nightly telephone interviews as well as on a paper pencil log sent with the
collection kit. The slopes from wake to lunch-time and lunch-time to bed-time were calculated
with a simple difference score, and area under the curve with respect to ground (AUCg) was
calculated (Pruessner, Kirschbaum, Meinlschmid, & Hellhammer, 2003).
Demographic Covariates. Covariates in analytic models included age, gender (male,
female), race (white, nonwhite), and educational attainment (high school or below, completed
some college or more) and whether the collection occurred on a weekend or weekday.
Analyses

Associations between daily support giving and receiving of the two support forms, and
daily psychological and physical well-being were examined using multilevel models. Models
examined same-day and lagged-day associations of support and well-being. The total number of
hours giving and receiving support (continuous variable) were included in the model. The
within-person (Level 1) variable was created by subtracting the mean amount of support an
individual gives to others over the 8 days from the amount of support given on a specific day.
The between-person (Level 2) variable was created by subtracting the mean amount of support
given of the sample from the 8-day average support given of the individual.
Equations representing the assessment of day-to-day variations within individuals and
variations between individuals in the study in associations between support behavior and well-
being are detailed below:
43
Level 1 Equation:

(1) Well-being
di
= β
0i
+ β
1i
(Support Given
di
– 𝑆𝑢𝑝𝑝𝑜𝑟𝑡
𝐺𝑖𝑣𝑒𝑛
-
) + β
2i
(Support Received
di
–
𝑆𝑢𝑝𝑝𝑜𝑟𝑡
𝑅𝑒𝑐𝑒𝑖𝑣𝑒𝑑
-
) + β
2i
(Stressor severity
di
– 𝑆𝑡𝑟𝑒𝑠𝑠𝑜𝑟
𝑠𝑒𝑣𝑒𝑟𝑖𝑡𝑦
-
) + e
di

Level 2 Equations:

Intercept
(2) β
0i
= δ
00
+ δ
01
(Sociodemographics) + δ
02
(Stressor severity) + δ
03
(Support Provided
i
–
𝑆𝑢𝑝𝑝𝑜𝑟𝑡
𝑃𝑟𝑜𝑣𝑖𝑑𝑒𝑑
45678
) + δ
04
(Support Received
i
– 𝑆𝑢𝑝𝑝𝑜𝑟𝑡
𝑅𝑒𝑐𝑒𝑖𝑣𝑒𝑑
45678
) + U
0i

Within person support provision
(3) β
1i
= δ
10

Composite equation

𝑊𝑒𝑙𝑙−𝑏𝑒𝑖𝑛𝑔
>-
=
δ
AA

+
δ
AC
(𝑆𝑜𝑐𝑖𝑜𝑑𝑒𝑚𝑜𝑔𝑟𝑎𝑝ℎ𝑖𝑐𝑠)
+δ
AI
(𝑆𝑢𝑝𝑝𝑜𝑟𝑡
𝑃𝑟𝑜𝑣𝚤𝑑𝑒𝑑
K
–
𝑆𝑢𝑝𝑝𝑜𝑟𝑡
𝑃𝑟𝑜𝑣𝚤𝑑𝑒𝑑
45678
)

+
δ
CA
(𝑆𝑢𝑝𝑝𝑜𝑟𝑡
𝑃𝑟𝑜𝑣𝚤𝑑𝑒𝑑
K
–
𝑆𝑢𝑝𝑝𝑜𝑟𝑡
𝑃𝑟𝑜𝑣𝚤𝑑𝑒𝑑
45678
)
+
𝑈
A-
+
𝑒
N-

In the level-1 equation (daily, within-person), well-being

is the reported affective and
physical well-being on Day
d
for Person
i
. Support given
di
indicates the number of hours of
instrumental or emotional support the respondent reported giving to others on a given Day
d
by
Person
i
.
𝑆𝑢𝑝𝑝𝑜𝑟𝑡
𝑔𝑖𝑣𝑒𝑛
-
refers to the average hours of emotional support for Person
i
over the 8
days, and e
di
is the residual variance. β
0i
is the intercept indicating Person
i
’s level of affective
and physical well-being on days when Support exchange = 0. Edi is the residual variance.
In level-2 equations, 𝑆𝑢𝑝𝑝𝑜𝑟𝑡
𝑔𝑖𝑣𝑒𝑛
45678
is the average number of hours of support
given by the sample of respondents. β
1i
represents the association between person
i
’s deviation in
support exchanged on a certain day from in general, and well-being on that day. δ
10
and δ
11
are
the average within-person intercept and daily support provision effects (fixed effects), and U
0i
is
44
the person-specific variation from the intercept (random effect). δ
01
and δ
11
are the Level 2
effects and reflect sociodemographic differences in the average levels of affect and within-person
daily support provision effects.
We also examined diurnal cortisol trajectories using several indicators, including the area
under the curve (AUC), slope of increase (from wake to lunch), and slope of decline (from lunch
to bedtime). The AUC is calculated using formulas derived from the trapezoidal rule (Pruessner
et al., 2003). All models control for the occurrence and severity of stressors.
Interaction terms for support-giving and receiving (both instrumental and emotional) and
stressor experience were created by calculating the product of the continuous variable of support
given or received, and stressor severity.

Results

Descriptive statistics are included in table 1. In this sample, there were more females
(57%) than males, the sample was highly educated with 69% having completed some college or
more. The sample was 83% white, and the mean age was 56, ranging from 33 to 83.
Participants reported giving around 20 minutes of support to others (both instrumental and
emotional) each day, on average, and reported receiving on average 10 minutes of emotional
support and 3 minutes of instrumental support. Individuals’ stressor severity experience was 0.93
(SD=1.52) indicating an average experience of very mild (0-3). Average daily positive affect was
2.74 (range - 0-4, SD=.79) indicating that individuals experienced positive emotional states
between some of the time and most of the time. Average daily negative affect was 0.19 (range - 0-
4, SD=.32) indicating that individuals typically experienced negative emotional states between
none of the time and a little of the time. The average physical symptom composite score of the
symptom severity of this sample across the measurement days is 7.39.
45

Table 1. Descriptive Statistics for Sociodemographic, Social support provision, and Well-being
factors

(N=2,022) Mean St Dev

Sociodemographic Factors

Gender
Male 42.80%
Female 57.20%
Education
High school degree or below 31.10%
Some college or more 68.90%
Race
White 83.30%
Nonwhite 16.70%
Age 56.24 11.25

Social Support exchanges
Hours of emotional support given
Hours of instrumental support given
Hours of emotional support received
Hours of instrumental support received

Stressor severity

0.34
0.35
0.17
0.05

0.93
0
0
0
0

1.52

Well-Being
Physical Symptom Severity 7.39 11.25
Positive Affect 2.74 0.79
Negative Affect 0.19 0.32

Results from the multilevel regression model analyses testing within- and between-person
associations between support exchanges and well-being are included in Table 2.

46
Table 2. Associations between emotional support giving and well-being
Physical Symptom Severity
Same-Day Next-Day
Within-person
Support given
Support received
Between-person
Support given
Support received

0.53
1.03

1.40
2.33

***
***

***
***

-0.60
-0.58

0.17
0.61

**
*

-
-

Positive Affect
Same-Day Next-Day
Within-person
Support given
Support received
Between-person
Support given
Support received

0.00
-0.01

-0.04
0.02

-
-

-
-

0.00
0.00

-0.01
-0.02

-
-

-
-

Negative Affect
Same-Day Next-Day
Within-person
Support given
Support received
Between-person
Support given
Support received

0.01
0.03

0.01
0.05

-
***

-
***

0.01
0.00

0.01
0.03

*
-

-
**
Cortisol slope from lunch to bedtime
Same-Day Next-Day
Within-person
Support given
Support received
Between-person
Support given
Support received

-1.01
-0.06

-2.83
-1.33

-
-

-
-

0.22
-2.32

-2.20
-1.90

-
-

-
-

47
Table 3. Associations between instrumental support giving and well-being
Physical Symptom Severity
Same-Day Next-Day
Within-person
Support given
Support received
Between-person
Support given
Support received

-0.02
0.61

0.73
2.91

-
*

**
***

-0.08
-0.64

0.26
1.12

-
-

-
-

Positive Affect
Same-Day Next-Day
Within-person
Support given
Support received
Between-person
Support given
Support received

0.01
-0.02

-0.01
-0.06

***
-

-
-

-0.01
0.02

0.00
-0.03

-
-

-
-

Negative Affect
Same-Day Next-Day
Within-person
Support given
Support received
Between-person
Support given
Support received

0.00
0.00

0.00
0.07

-
-

-
***

0.00
-0.01

0.00
0.04

-
-

-
***

Cortisol slope from lunch to bedtime
Same-Day Next-Day
Within-person
Support given
Support received
Between-person
Support given
Support received

-0.96
0.38

-2.87
-1.08

-
*

-
-

0.42
-2.32

-1.07
-0.14

-
-

-
-

48
Within-person effects

Emotional support and same-day well-being. On days when individuals gave more
support to others than their average giving level they experienced greater levels of symptom
severity on the same day (B=0.53; p<.001). Reports of symptom severity were also higher on
days when individuals received more support than usual (B=1.03; p<.001). There were no
significant differences in levels of positive affect in relation to those who gave or received more
support than average. There were no associations between giving more and negative affect on the
same day. However, receiving more emotional support was associated with greater levels of
negative affect on that day (B=.03; p<.001). There were no associations between giving or
receiving more emotional support on a given day and the cortisol awakening response (wake to
lunchtime), area under the curve, or decline (lunch to bedtime).
Instrumental support and same-day well-being. Giving greater amounts of instrumental
support than average was associated with greater levels of positive affect (B=.01; p<.001). No
significant associations were found between the giving of instrumental support and negative
affect, symptom experience or cortisol patterns. Receiving more support than average was
associated with greater levels of symptom severity (B=.61; p<.05) and cortisol slope from lunch
to bedtime (B=.38; p<.05). There was no association between receiving more support than one’s
average and positive or negative affect.
Emotional support and next-day well-being. Those who gave and received more support
from others than their own average experienced lower levels of symptom severity on the
following day (giving: B=-.60; p<.01, receiving: B=-.58, p<.05). Those who gave more support
than average experienced lower levels of negative affect the next day (B=-.01; p<.05), while
those who received more support than average experienced higher negative affect the next day.
49
There were no next-day associations between support receiving and positive or negative affect
on the following day. There were no significant associations between emotional support giving
and positive affect or cortisol on the following day.
Instrumental support and next-day well-being. There are no significant associations
between instrumental support-giving and well-being on the following day. Receiving more
instrumental support than average was associated with greater levels of negative affect on the
following day.
Between-person effects

Emotional support and same-day well-being. Individuals who tend to give and receive
more emotional support from others, on average had greater experience and severity of
symptoms (Giving: B=.53; p<.001, Receiving: B=1.03; p<.001). Individuals who received more
hours of emotional support had greater levels of negative affect overall (B=.05; p<.001). There
were no associations between those who gave or received more support on average, and levels of
positive affect or cortisol.
Instrumental support and same-day well-being. Individuals who gave and received more
instrumental support to others experienced greater experience and severity of symptoms (giving:
B=.73; p<.01, receiving: B<2.91; p<.001). Those who received (but not gave) more instrumental
support experienced greater levels of negative affect (B=.07; p<.001). Those who gave more
instrumental support to others experience greater levels of positive affect (B=.01; p<.001).
Interaction effects
Experiencing greater levels of stressor severity is associated with greater symptom
severity on the same day. There were significant interactions in the within-person associations of
emotional support giving and severity of stressors experienced on the same day (B=.20; p=.029).
50
Experiencing high levels of stress and giving a greater amount of support than average is
associated with greater experience and severity of physical symptoms on the same day. There
was a significant interaction between support-giving and stress severity on the experience of
symptoms on the following day (B=-.25; p=.042), such that those who gave more support on
days when they experienced greater levels of stress have lower levels of symptoms on the
following day.
51
Figures 1a and 1b. Interactions between emotional support-giving and stress

2
3
4
5
6
7
8
Low Stressor Severity High Stressor Severity
Same day symptom severity
Emotional support giving interacts with stressor
severity to predict same day symptom
Low
Emotional
Support
Giving
High
Emotional
Support
Giving
0
0.5
1
1.5
2
2.5
3
3.5
4
Low Stressor Severity High Stressor Severity
Next day symptom severity
Emotional support giving interacts with stress to
predict next day symptom
Low
Emotional
Support
Giving
High
Emotional
Support
Giving
52
Conclusions

These findings demonstrate that overall, giving more emotional support than one’s
general daily average is associated with greater distress on the same day, while giving more
instrumental support than one usually does is associated with greater positive affect on the same
day. This demonstrates unique affective correlates between different forms of support on the day
of giving support. It is likely that giving instrumental support may be immediately gratifying,
since the giver sees the effects of their effort, whereas giving a greater amount of emotional
support exposes the giver to the psychosocial issues of the support recipient, but one may not
immediately see the results of the support given.
One of the boundary conditions in which support-giving is thought to be beneficial is the
sense of efficacy in the support given (Inagaki & Orehek, 2017). When one gives emotional
support, it may not be immediately apparent whether the giver’s support was effective in helping
resolve the recipients’ issues. Alternately, when one gives instrumental support, it is immediately
apparent that the task is completed, therefore improving the giver’s sense of efficacy.
Furthermore, there is evidence that the stress experienced by social network members can be a
strain on the individual (Cichy et al., 2013; Rook, 1990).
The next-day associations show an alleviation of the negative effects of emotional
support provision from the previous day. Those who give more than they do on average have
lower levels of negative affect and better physical well-being on the following day. These
findings illustrate the importance of understanding the timing, as well as context, in the
investigations of effects of social exchanges on psychological and physical well-being. These
findings appear to demonstrate a next-day stress-buffering effect, in which support giving seems
to contribute to a lessened experience of symptoms under conditions of stress experience on the
53
previous day. This may be one pathway through which support-giving is linked to better health
over time, as has been observed in epidemiological studies.
Limitations

Although these analyses add to the understanding of social support provision, they are not
without limitations. Missing data from certain days may be due to distressful times that would
be important to account for. For example, it is possible that those days are the ones in which a
participant experienced above-average levels of stress, or was too busy (potentially helping
others), or ill. As a result, the data that are available may not represent the full range of
emotional support provision or well-being in a person. It is also possible that those who
experience stressors are more likely to notice higher levels of support-giving on the day than
those not experiencing stress. Since participants only report the support and well-being at the
end of each day, this may contributes to recall bias. Thus, to thoroughly understand whether
support-giving buffers stress in a natural context, one would need even more temporally granular
measures of supportive instances and stressful events, to understand how one may interact with
another to exacerbate or reduce perceptions of stress, or physiological responses to stress.
Ecological momentary assessment methods can be used to couple repeated measurement burst
assessments of ambulatory measures of physiological data (heart rate, blood pressure, skin
conductance etc.), support exchanges, and experiences of stressors.
These findings demonstrate that emotional support-giving seems to be linked to worse
concurrent affective and physical well-being, but associated with better outcomes in the day
following the act of giving. Instrumental support, on the other hand, may contribute to positive
affect immediately, but have no lingering effects on a person’s well-being. In addition,
instrumental support does not interact with stressor experiences to influence well-being
54
outcomes. The data also lends support for a delayed stress-buffering effect of emotional support-
giving in a real-world context. These findings fill a gap in our knowledge of how naturalistic
instances of providing emotional and instrumental support is linked to well-being.

55
CHAPTER 4: ACTIVATING THE SUPPORT SCHEMAS WITHIN: IDENTIFYING
THE THOUGHTS AND FEELINGS UNDERLYING GIVING AND RECEIVING
SUPPORT

Background

The benefits of social integration have largely been attributed to the effects of receiving
support. Thus, the thoughts and feelings believed to influence health because of social
relationships are largely from the perspective of the support recipient. There are both theoretical
perspectives and empirical evidence to suggest overlapping as well as unique thoughts and
feelings that flow from support-giving compared to receiving. Epidemiological studies have
demonstrated that in midlife and beyond, perceiving oneself as supportive or generative is
associated with psychological well-being and positive health outcomes. For example, feeling like
one plays a useful, contributory role in the lives of others is associated with lower levels of
depressive symptomatology and higher levels of mastery and control (Gruenewald, Karlamangla,
Greendale, Singer, & Seeman, 2007).
Several cognitive-affective pathways through which giving may promote better well-
being have been posited, including improved positive affect, ego enhancement, and increased
sense of connectedness with others. It has been suggested that altruistic acts are motivated by
and elicit a warm glow (Andreoni, 1990; Dunn, Aknin, & Norton, 2014). Indeed, empirical
evidence demonstrates that individuals who give monetary donations have greater levels of
positive emotions, especially in older adulthood (Bjälkebring, Västfjäll, Dickert, & Slovic,
2016). Other experimental manipulations also support this notion that giving increases levels of
positive affect, both self-reported, and behavioral evidence via Duchenne smiles (Dunn et al.,
2014; Pressman et al., 2014).
56
Engagement in altruistic behavior in later life may also enhance one’s sense of self, or
ego. It has been suggested that giving improves perceptions self-efficacy and competence (Post,
2005). Self-determination theory suggests that increases in well-being are mediated by the
satisfaction of the need for a sense of competence, among others (Weinstein & Ryan, 2010).
Specifically, self-esteem has been shown to mediate links between giving behavior and well-
being (Martela & Ryan, 2016).
Finally, a sense of connectedness may be a key pathway through which support-giving is
thought to improve health (Aknin et al., 2013; Martela & Ryan, 2016). Volunteering has been
shown to improve perceptions that one could turn to others for help (Fried et al., 2004;
Greenfield & Marks, 2004). Prosocial behavior is also associated with greater sense of social
belonging (Nelson, Layous, Cole, & Lyubormirsky, 2016).
It is important to understand the unique states that are elicited by support-receipt and
support-giving. So far, the research on social support has overwhelmingly focused on the
benefits from the perspective of the support-receiver. Volunteerism is associated with a sense of
belonging and connectedness (Kahana & Bhatta, 2013). While there is growing work in this
area, there has not been a comprehensive study of specific hypothesized cognitive affective states
that may overlap or differ between support-giving and support-receiving.
Past research has manipulated support-giving behavior through volunteers writing
supportive notes, holding a hand of someone experiencing pain, and random acts of kindness
(Breines & Chen, 2013; T. L. Gruenewald et al., 2015; Inagaki et al., 2016; Inagaki &
Eisenberger, 2015; Pressman et al., 2014). Volunteering interventions may be most relevant to
older adults, but the requirements for a level of physical functioning to engage, and the time
commitment may lead to a selection bias in volunteers. Other forms of manipulating perceptions
57
of support-giving have largely been conducted in younger adult samples. One method, the
activation of a support-giving schema through writing about ways one has given support to
others has been shown to improve levels of self-compassion (Breines & Chen, 2013). A schema
activation paradigm allows for the adaptation of the manipulation to elicit self-perceptions of
giving and receiving, as well as a neutral control condition. This study tested the cognitive-
affective states associated with giving support to others in older adults, and compared them to
those associated with receiving support. The support-giving schema activation manipulation was
piloted in this study to understand the cognitive and affective correlates of giving and to use the
paradigm in a laboratory investigation of the physiological correlates of support provision in
Chapter 4.

Methods

Sample
A total of 324 participants age 55 and over were recruited for this study, entitled the
Autobiographical Memories and Emotional States (AMES) Study. The first group from the
greater Los Angeles area was recruited via the Healthy Minds database by telephone and email,
while the second and third groups were recruited through two widely used online survey
platforms, Qualtrics Panel Services and Amazon’s Mechanical Turk (mTurk) via TurkPrime.
Participants from the Los Angeles sample were compensated with $5.00 gift cards, and
participants from the Qualtrics sample were compensated with either an average of $3.25 or non-
monetary means. The Mechanical Turk sample was compensated with $3.00.
Experimental protocol

Participants participated in the study online. They were given instructions to complete
the study in a quiet location with limited distractions, in one sitting. Participants were randomly
58
assigned to one of three writing prompts, which asked for them to reflect for 2 minutes and write
for 10 minutes about themselves as support-givers, support-receivers, or a neutral condition in
which participants recalled events from the previous day. Following the task, a questionnaire
surveyed hypothesized cognitive-affective states. Sociodemographic information was surveyed
prior to the writing task.
37 participants’ data were excluded from the analytic sample due to their noncompliance
with the written prompt. These included those who wrote about support-giving, even though they
were given the support-receipt prompt, those who wrote about support-receiving, even though
they were given the support-provision prompt, and those who wrote about giving or receiving,
even though they were given the neutral prompt. Additionally, those who wrote about how they
do not give or receive support, in response to the giving or receiving prompt, or whose writings
were otherwise off-topic were excluded. An additional 5 were excluded from the analytic
sample as they failed to complete the study within a timeframe of 15 to 50 minutes. A final
sample of 287 were used for the present analyses. The majority of the sample was white and
female. 91 participants were in support-giving condition, 101 were in the support-receiving
condition, and 95 were in the neutral control condition.
Cognitive-affective states

Three cognitive-affective states of interest were measured immediately following the
writing task, including affect (positive and negative), ego (achievement, self-esteem), and social
well-being (social connectedness, loneliness). Additional exploratory cognitive-affective states
were tested as well, including meaning and purpose, control and mastery, and a sense of
contributions to others. Please see Table 3-1 for items assessing each cognitive-affective state.

59
Table 1. Questions asked after writing task in Study 3
Please rate the extent to which you are feeling ... on a scale of 0-100
Cognitive-affective state Items
Positive Affect Happy, relaxed, content
Negative Affect Depressed/blue, frustrated/annoyed, worried/anxious, stressed
Social Connectedness Supported, like I belong, connected to others
Social Contributions Useful, I'm making a difference
Loneliness There are people I can turn to (reversed), alone
Control/Mastery I can handle whatever comes my way, helpless (reversed), in control, I
can do the things I want to do
Purpose/Meaning Purposeful, like my life is meaningful
Accomplishment Accomplished, proud, I am achieving important goals
Self Esteem/Self-worth Respected, I’m a person of worth, I have a number of good qualities,
inferior (reversed), confident

Participants’ narratives were analyzed using the Linguistic Inquiry and Word Count
(LIWC) text analysis software program designed by Pennebaker and colleagues (2007) to
calculate the degree to which participants written words corresponded to LIWC emotion
categories that were the same, or similar, to the hypothesized cognitive-affective states expected
to flow from support perceptions (positive and negative emotion, social processes and affiliation,
and achievement). Please see figure 2 for examples of words in each construct identified in the
LIWC dictionaries.

Table 2. Words in each linguistic expression category
LIWC Dictionary Example words
Achievement Earn, hero, win
Positive emotion Love, nice, sweet
Negative emotion Hurt, ugly, nasty
Anxiety Worried, nervous
Anger Hate, killed, annoyed
Sadness Crying, grief, sad
Affiliation (social) Ally, friend, social

60
Analytic strategy

ANOVA models were used to compare the mean scores of each cognitive-affective state
between the support-giving, support-receiving, and neutral groups. Outliers were winsorized at
10 and 90%.
Results

Self-reported cognitive-affective states. There were significant group differences in
self-reported mean levels of perceived control (p=.027) and contributions to others (p=.044).
Bonferroni post-hoc tests show that those in the support-giving group had significantly higher
levels of perceived control compared to the support-receiving group, and marginally greater
levels of perceived contributions to others compared to the neutral group. There were no
significant differences in the mean levels of self-reported positive affect, negative affect,
connectedness, meaning and purpose, accomplishment, and self-efficacy.
Cognitive-affective states expressed in written narratives. Analyses of linguistic
expressions in the written narratives show that those in the support-giving group had
significantly less use of positive emotion words, negative emotion (including sad and anxious)
words, and marginally less use of affiliation words compared to the receiving group. However,
the support-giving group had a greater level of achievement-related words than the support-
receiving and neutral groups. The receiving group also had greater levels of positive, negative
(including sad), and affiliation and achievement-related words in their narratives compared to the
neutral group. See figure 3 for results.

61
Table 3. Results from ANOVA models comparing mean self-reported and word usage in
narratives between giving, receiving, and neutral conditions

Self-reported outcomes F p
Affective well-being
Positive affect 1.817 .179
Negative affect 0.318 .573
Social well-being
Contributions to others 3.357 .068
Loneliness 1.012 .315
Connectedness 0.010 .919
Self-enhancement
Accomplishment 0.850 .357
Self-efficacy 2.688 .102
Control 4.261 .040
Meaning/Purpose 0.521 .471

Percentage of words used in narratives F p
Affective well-being
Positive emotion 89.476 .000
Negative emotion 38.443 .000
Social well-being
Affiliation 66.956 .000
Self-enhancement
Achievement 60.434 .000

62
Figures 1a-d. Percentage of words in each LIWC category by experimental condition

Conclusions

This study compared the effects of activating perceptions of oneself as a support-giver or
support-recipient to examine hypothesized cognitive-affective pathways that may lead from
support-giving to health. There were no significant differences between groups in self-reported
levels of positive or negative affect. Those in the support-giving group reported a higher sense
of control compared to the receiving group, and the levels of contributions to others was
marginally higher in those who were assigned to the support-giving group, compared to the
neutral condition. Self-reported measures are only one way to determine the experience of a
cognitive or affective state. It is well-understood that self-reported measures may not accurately
capture individuals cognitive-affective experiences due to response bias and social pressure.
63
In addition to examination of self-report of emotional experience, we also examined
expression of cognitive-affective states within individuals’ narratives of support giving and
receiving experiences. Linguistic inquiry and word count text analyses provide another valuable
lens through which to understand cognitive-affective states associated with social support
experiences. We found variation in the categories of words used, with the giving group using a
greater percentage of achievement-related words in their narratives compared to the receiving
group. While support-giving group used significantly greater percentage of positive emotion
words compared to the neutral condition, they also used more negative emotion words as well.
Linguistic text analyses have often been used to identify emotion in language use. The
LIWC program has been validated, with those using more negative and positive emotion words
when asked to write about negative or positive events (Tausczik & Pennebaker, 2010). In
addition, ratings from the LIWC program mapped on to human ratings of the emotional tone of
narratives. In addition, other dimensions of LIWC categories have been linked to attentional
focus and, social relationships (Tausczik & Pennebaker, 2010). This text analysis tool allowed
us to assess cognitive-affective states that may not be in the participant’s conscious awareness or
self-reported. However, it does shed light on what an individual is attending to as they recall
instances of support-giving.
These findings demonstrate the unique blend of thoughts and feelings that are elicited by
thinking of oneself as a giver or recipient of support. When asked to write about ways that
individuals give to others and reflect about how it makes them feel, they are more likely to
express feelings of achievement. From a developmental perspective, it is understood that a
primary developmental goal in midlife and beyond is to contribute to others (Erikson, 1959;
McAdams & de St. Aubin, 1992). Evidence from correlational studies demonstrate that those
64
who feel that they are useful to others enjoy positive health and well-being benefits (Gruenewald
et al., 2012). Those who feel like they fall short of their generative expectations have also been
found to have lower life satisfaction (Grossman & Gruenewald, 2018). The current study found
a more mixed profile of affective states in response to a support-giving or receiving manipulation
This further demonstrates a mixed profile of affective states as shown in the previous study. This
study represents an initial step in examining the efficacy of a support-giving schema activation
that is used in the following chapter.
65
CHAPTER 5: PHYSIOLOGICAL AND PSYCHOLOGICAL EFFECTS OF
PERCEIVING ONESELF AS A GIVER: A TEST OF DIRECT AND STRESS-
BUFFERING PATHWAYS

Introduction
There are striking benefits associated with social integration on health and longevity
(House et al., 1988). Individuals who have larger social networks have better health outcomes as
well as a lower risk of mortality (Holt-Lunstad et al., 2010). In addition, feeling lonely or
disconnected with one’s network has been linked to compromised health (Cacioppo et al., 2002;
Steptoe, Shankar, Demakakos, & Wardle, 2013). As part of a social network, someone can both
receive and give social support. Most research on the effects of social relationships has focused
on identifying pathways through which receiving support from others is beneficial to the health
of the recipient (Uchino, 2006). However, a small but growing body of research reveals benefits
of giving support to others on health outcomes (Konrath & Brown, 2013). Indeed, as reviewed
below, some studies suggest that giving support to others may benefit one’s well-being and
health as much as receiving support from others.
Population-based studies indicate that those who tend to give more to others have lower
risk of experiencing cognitive decline and live longer (Brown, Nesse, Vinokur, & Smith, 2003).
Likewise, self-perceptions that one is making useful contributions to others’ lives is associated
with these same positive health outcomes (Gruenewald et al., 2012). The pathways from giving
to positive health outcomes remain unclear, but there is growing evidence that giving may buffer
the negative effects of stress on physiology. Giving has been associated with increased neural
activity in reward-related regions such as the ventral striatum (Telzer, Masten, Berkman,
Lieberman, & Andrew, 2011), as well as decreased activity in threat-related regions, which
include the amygdala, dorsal anterior cingulate cortex, and anterior insula (Inagaki &
66
Eisenberger, 2012). Furthermore, giving has been shown to reduce the sympathetic nervous
system responses to a stressor, as indicated by lower systolic blood pressure reactivity (Inagaki,
2016). These findings suggest that giving reduces stress-related physiological activity. However,
more research is needed to understand the mechanisms that underlie the links between support-
giving and health outcomes.
One of the key regulatory systems involved in stress responses is the autonomic nervous
system (ANS). ANS output influences heart rate variability (HRV), or the variation in time
between consecutive heart beats. High frequency heart rate variability (HF-HRV) provides an
index of the engagement of the parasympathetic nervous system. Under stressful circumstances,
HF-HRV decreases, as activity in the parasympathetic branch of the ANS becomes less
dominant. Higher levels of heart rate variability are understood to reflect greater capacity for
social engagement, psychological flexibility, and ability for one’s system to appropriately
respond to environmental demands (Kemp, Koenig, & Thayer, 2017). Autonomic dysregulation
has been linked to worse psychological well-being, physiological functioning and increased risk
of mortality (Thayer & Lane, 2007). Acute stress elicits parasympathetic withdrawal and
sympathetic dominance, reflected by a reduction in HF-HRV (Castaldo et al., 2015; Egizio et al.,
2008; Hjortskov et al., 2004). Individuals differ in autonomic responses to acute stress, with a
faster recovery from acute stress in the laboratory predicting lower risk for cardiovascular
disease (Mezzacappa, Kelsey, Katkin, & Sloan, 2001).
Several theoretical perspectives may contribute to our understanding of the possible
pathways through which support-giving contributes to health. Feeling like we can provide for
others may fulfill a psychological need for social connectedness, which promotes a feeling of
safety and inhibits the activation of stress-related physiological responses. The General Unsafety
67
Theory of Stress (GUTS) posits that by default, the stress response may be always turned “on”
due to generalized, unconscious perceptions of the lack of safety (Brosschot, Verkuil, & Thayer,
2018). This perspective offers an alternative view of the traditional theories on stress, in which
the exposure to acute stressors activate the physiological responses that can lead to prolonged
activity leading to dysregulation. GUTS proposes that certain situations, like loneliness, low
social status, and early life adversity, can lead to the unconscious, generalized perceptions of
‘unsafety’, which are reflected by chronic disinhibition of the stress response.
A large component of feeling safe is feeling socially integrated (Hawkley & Cacioppo,
2010). Alternately, isolation leads to feeling unsafe and threatened, and this state is thought to
underlie the chronic activation of stress-related systems. Indeed, individuals who feel lonely have
physiological profiles that indicate greater vigilance for threat, indicated by high total peripheral
resistance and low cardiac output, as well as lower heart rate variability and greater risk for
cardiovascular diseases and mortality (Cacioppo, Hawkley, Norman, & Berntson, 2011; Seery,
2011). GUTS highlights the importance of states such as social connectedness in the inhibition of
subcortical structures involved in stress-related autonomic activity.
Feeling as though one can provide for others may also be a key factor that contributes to
the health and well-being correlates of social integration. Self-determination theory (SDT)
suggests that giving to others satisfies the need for competence when individuals feel effective in
helping, a feeling of connectedness with others, and enhances autonomy, which are key to one’s
psychological well-being (Weinstein & Ryan, 2010). Indeed, empirical evidence supports this
theory and demonstrates that individuals’ sense of autonomy, connectedness, and competence
independently improve following acts of giving to others (Grossman et al., 2017; Martela &
Ryan, 2016; Nelson et al., 2016; Pressman et al., 2014). Furthermore, there has been evidence of
68
bidirectional effects between social connectedness and the capacity of the parasympathetic
nervous system to adapt to changes in the environment (Kok & Fredrickson, 2010; Porges,
2007).
Thus far, most of the research on support-giving and health outcomes has been limited to
correlational studies that demonstrate links between typical giving behavior and health outcomes,
as well as experiments in which individuals are assigned to give to others. Furthermore
epidemiological investigations have largely been conducted in middle-aged and older adults
(Brown et al., 2003; Konrath & Brown, 2013), while laboratory studies of the stress-buffering
effects of giving have only been conducted in younger adults. Thus, it remains unclear whether
the perception of oneself as a giver has direct effects on physiological processes thought to
underlie positive health outcomes. Given the theoretical and empirical evidence that giving may
enhance multiple indicators of psychosocial well-being and reduce physiological responses to
stress, we examined the physiological correlates of support giving in a lab setting in a sample of
adults in midlife and older. Specifically, we hypothesized that those who are assigned to activate
perceptions of oneself as a support-giver will have dampened physiological (cardiovascular and
autonomic) reactivity or greater recovery to an acute stressor. We also examined whether
perceptions of oneself as support-giving elicited cognitive-affective states of social
connectedness, positive affect, and self-enhancement.
Methods
Participants were randomly assigned to one of two conditions: support-giving or neutral.
In the support-giving condition, they were asked to write about the experience of being a source
of support for others (see Appendix 1 for writing prompts). In the neutral condition participants
69
were asked to recount the details of the previous day. They were then exposed to an acute
laboratory stressor (Stroop task and Paced Auditory Serial Addition Task – PASAT).
Throughout this laboratory session, we monitored and recorded cardiovascular measures
(blood pressure was taken periodically throughout the study) and autonomic functioning (heart
rate was recorded continuously throughout the study). If participants’ blood pressure exceeded a
certain threshold during the baseline resting period (above 180/100) or during the stress task
(above 210/110), the session was terminated. Heart rate variability indices were derived in 4-
minute epochs during the end of the baseline period, in each of the stressors, and during the first
four minutes of the recovery period.
Measures
Cognitive-affective pathways. Brief measures of the experience of cognitive-affective
states were administered following the stressor protocol. Three cognitive-affective states of
interest were measured immediately following the writing task: positive affect, self-
enhancement, and social connectedness. Positive affect. A subset of items from the Positive and
Negative Affect Schedule (PANAS) “happy, relaxed, content (a= .93)” were administered. Self-
enhancement. Self-esteem (a= .834) “confident, respected, I’m a person of worth” and
accomplishment (a=.883) “accomplished, proud” were assessed. Connectedness (a=.821) was
measured with items such as “like I belong, connected to others.”
Additional exploratory cognitive-affective states were tested, including negative affect,
sense of control and mastery, and generativity/social contributions. Negative affect (a=.877) was
measured using a subset of PANAS items “depressed/blue, worried/anxious” were administered.
Sense of control/mastery (a=.87) was measured with items such as “I can handle whatever
70
comes my way, in control.” Contributions (a=.876) was measured with items such as “useful,
I’m making a difference.”
In addition to the self-reported levels of cognitive-affective states, Linguistic Inquiry and
Word Count software (Tausczik & Pennebaker, 2010) was used to examine the percentage of
words used in the text of the responses to experimental writing prompts. Perceptions of stress
were surveyed immediately after the baseline period, after the writing manipulation, between the
two stressors, immediately after the second stressor, and after the recovery period.
Physiological function
Cardiovascular and autonomic function. ECG electrodes were placed on the left and
right clavicles, as well as the left lower quadrant. The ECG waveform was submitted to a R-
wave detection routine, resulting in RR interval series. Errors in marking R waves were corrected
by visual inspection. HRV modules from Mindware Technologies (Gahanna, OH) were used to
edit and score the physiological parameters of interest. Four-minute epochs (minutes 6-9 of
baseline, 2-5 of the experimental writing manipulation, 2-5 of PASAT task, 2-5 of STROOP
task, and 2-5 of the recovery period) were cleaned and averaged. Measures of blood pressure
were taken immediately after the initial resting period, immediately after the writing task, in
between the two stressors, and immediately after and 30 minutes after the stressor. High
frequency heart rate variability (0.15 – 0.40 Hz) was computed based on 4-minute epochs, using
an interval method for computing Fourier transforms recommended by the European Task force
(Malik, Bigger, Camm, & Kleiger, 1996)
Laboratory support manipulation. All participants were instructed to write about some
aspect of their autobiographical memory. Those in the support-giving condition were instructed
to recall their experiences in which they were supportive of others. This task served to prime the
71
perception of oneself as a support-giver. Those in the neutral condition were instructed to recall
the events of the previous day. Writing manipulations have been widely used to evoke self-
perceptions of various forms and have been shown to elicit changes in cognitive and affective
and physiological states (Barber, Opitz, Martins, Sakaki, & Mather, 2016; Breines & Chen,
2013; Creaven & Hughes, 2012).
Analytic strategy
Repeated measures ANOVAs were conducted to examine the responses to stress in
cardiovascular (BP) and autonomic (HF-HRV) measures during the baseline, writing, stressor,
and recovery phases. In addition, difference scores were calculated, and ANCOVAs were used to
examine reactivity and recovery from the stressor when controlling for baseline values. T-tests
were used to examine differences between groups in mean levels of self-reported cognitive-
affective states as well as those expressed in written narratives. Race/ethnicity, age, and gender
were included as covariates, as autonomic activity differs based on these demographic factors
(Hill et al., 2015; Koenig & Thayer, 2016).
A total of 74 participants completed the study. Those who did not comply with the
writing task or explicitly mentioned caregiving roles (4 participants) were excluded from all
analyses. Additionally, 3 participants had arrhythmias throughout each segment of the
experiment, and were excluded from the heart rate variability analyses. Five participants with
HRV values during certain segments greater than 2 standard deviations were excluded from the
models. No participants had outlier blood pressure data. Forty-seven percent were female, forty-
eight percent identified as white/Caucasian, and the mean age was 60.
72
Results
Self-reported cognitive-affective states. There were no significant differences in self-
reported levels of positive or negative affect when controlling for self-reported affective states at
baseline. There were also no differences in levels of social well-being (social contributions,
connectedness) or self-enhancement (self-efficacy and accomplishment).
Linguistic inquiry and word count. T-tests were conducted to compare group (support-
giving vs. control) differences in use of each hypothesized cognitive-affective state (positive and
negative affect, social affiliation, achievement). There were significant differences in several
categories of words used in narrative responses to the writing prompts as shown in figure 4-2.
Those in the support-giving schema group used greater percentage of positive emotion words
(p<.001) but no difference in the use of negative emotion words (p=.205). They also had greater
use of social affiliation words (p<.001), and greater use of achievement words (p=.003).
Self-reported perceptions of stress. Repeated measures ANOVAs were conducted to
examine trajectories of self-reported stress levels throughout the study, immediately after the
baseline period, after the writing task, after each stressor, and after the recovery period. There
was a significant effect of time, such that levels of stress were significantly greater than baseline,
indicating an increase in stress following the exposure to the stressor tasks. There was also a
significant quadratic time x condition effect, (F=4.367, p=.042), such that both the increase in
levels of stress from baseline to peak stress, and the decrease in between peak stress are greater
in the support-giving group compared to the neutral group.
Cardiovascular function. Repeated measures ANCOVAs were used to examine patterns
of systolic and diastolic blood pressure in responses to stress. There were no significant
differences in the blood pressure responses of the two groups.
73
Autonomic function. Repeated measures ANCOVAs were used to test differences in
patterns of high frequency heart rate variability differences from the baseline resting period to
the stressor period between the two groups. When controlling for the baseline HF-HRV value,
there was a significant difference between the support-giving and neutral group in their reactivity
delta scores with lower reactivity in the support-giving as compared to control group (mean
support-giving reactivity delta=-.120, SE=.107, mean neutral reactivity delta=-.317, SE=.114;
p=.007).
In post-hoc analyses, we examined demographic variables (race, sex, age) as potential
moderating variables and found no significant interactions between the covariates and the main
effects of the experimental condition.
Conclusions
The findings in this study reveal stress-buffering effects of giving support to others.
Parasympathetic nervous system reactivity and self-reported stress level responses to an acute
stressor significantly differed between the support-giving group and the control group, indicating
stress-buffering effects of perceiving oneself as a giver. The support-giving group showed less of
a decline in high frequency heart rate variability following stress exposure. Both the reactivity
and recovery in levels of perceived stress in response to the acute stressor were greater in the
support-giving group, indicating that while support-giving may increase reported stress,
perceiving oneself as a support-giver is also linked to a robust recovery from stress.
Furthermore, our analysis of the written text suggests that feeling supportive to others
may contribute to a sense of social embeddedness. Those who were primed to perceive
themselves as support-givers used a greater percentage of positive affect, social affiliation, and
achievement words in their written responses. Social connectedness has been linked to
74
perceptions of safety, which inhibit feelings of threat activity in the subcortical regions of the
brain, including the amygdala (Brosschot et al., 2018). It has been proposed that several neural
structures, which are referred to as the central autonomic network (CAN) allows for the
inhibition of subcortical structures by the prefrontal cortex (Thayer, 2006). This inhibitory
network may underlie the link between supportiveness to others and a reduced autonomic
response to stress. Further work may be able to elucidate this through observation of neural
activity as individuals activate perceptions of themselves as givers and measures of social
embeddedness.
In our study, self-reported levels of cognitive-affective states did not differ significantly
between experimental and control groups. These findings are not surprising; some studies found
that self-reported cognitive-affective states, like stress, negative affect, and levels of anxiety did
not change in response to a support-giving manipulation (Abelson et al., 2014; Inagaki &
Eisenberger, 2015), although others report that giving did reduce negative affect or increase
positive affect (Dunn et al., 2014; Field et al., 1998; Pressman et al., 2014). More research is
needed to identify the self-reported and expressed cognitive-affective states that occur alongside
perceptions of oneself as a support giver in middle-age and older age groups.
A growing body of literature demonstrates that short interventions which increase
feelings of gratefulness to others have similar psychological and physiological outcomes as
interventions to increase people’s perceptions of themselves as support givers. Thus, feeling
grateful and feel like a support giver may have overlapping psychological and neurological
pathways. In gratitude interventions, participants are asked to reflect on ways they are grateful to
other people, or to write a note of gratitude to other people. These short writing interventions
elicit cognitions like closeness to others, relationship formation, and perceived support from
75
others (Wood, Joseph, & Linley, 2007). Furthermore, gratitude has been shown to reduce
perceptions of stress (Killen & Macaskill, 2014), increase high frequency heart rate variability
(Redwine et al., 2016), and activate the medial prefrontal cortex (Fox, Kaplan, Damasio, &
Damasio, 2015) which plays an important role in inhibiting stress-related activity. Further, the
medial prefrontal cortex, which on the amygdala and autonomic output (Thayer, Yamamoto, &
Brosschot, 2010). A common aspect of gratitude and support-giving may be that they both
contribute to feelings of social connectedness and safety, which in turn contributes to reduced
autonomic reactivity.
One limitation of this study is the possibility that in some individuals, being asked to
recall instances of support may have triggered thoughts that they give inadequate amounts of
support. However, we examined group differences with and without individuals whose narratives
explicitly stated that they did not feel as though they gave enough, and results were largely the
same. In addition, it is possible that individuals recalled stressful or burdensome situations that
required their support. Furthermore, the written responses reflected a variety of types of support
that individuals gave to others, including emotional, instrumental, and financial support. Future
work that aims to examine effects of support-giving might benefit from prompting more specific
types of support to determine effects of each type.
Taken together, these findings represent an important step towards understanding the
potential stress-buffering effects that are elicited by perceiving oneself as a support-giver in
midlife and beyond. This study adds to a growing body of work demonstrating that perceiving
ourselves as providing for others is important for health. Often, this side of the social support
exchange is overlooked in the examination of the salubrious effects of social relationships.
76
Understanding these mechanisms can help contribute to non-pharmaceutical interventions that
can improve resilience against daily stressors and health outcomes in later life.

77

Figure 1. High frequency heart rate variability responses to acute stress

Figure 2. Self-reported stress level responses to acute stress

3.500
4.000
4.500
5.000
5.500
Baseline Stressor Recovery
High
Frequency
Heart
Rate

Variability
HF
HRV
responses
to
acute
stress
Giving Control
0
1
2
3
4
5
6
Baseline Stressor Recovery
Self-‐‑reported
stress
levels
(1-‐‑10)
Perceived
stress
levels
78
Table 1 – Demographics

Age 41-90 (mean 60.14; SD 12.863)
Race
Asian/Pacific Islander
Black/African American
Native Hawaiian/Pacific Islander
White/Caucasian
Other
Mixed/Biracial
Do not wish to answer
Education
No formal education
High school/equivalent
Some college
Bachelor’s
Post graduate
Other
Sex
Female
Male

7 (9.2%)
21(27.6%)
1(1.3%)
34(44.7%)
3(3.9%)
4(5.3%)
2(2.6%)

1(1.3%)
6(7.9%)
19(25%)
22(28.9%)
21(27.6%)
3(3.9%)

34(44.7%)
38(50.0%)

Table 2–Mean differences in cognitive-affective states and linguistic expressions between groups

Giving Control
Mean Mean p
Cognitive affective states
Connectedness 75.31 71.38 .526
Control 56.74 59.34 .518
Meaning and Purpose 75.76 76.10 .957
Sense of accomplishment 67.10 73.50 .293
Self-efficacy 81.66 82.64 .844
Contributions to others 76.56 78.60 .723
Loneliness 27.93 27.48 .951

LIWC results
Achievement 2.09 .80 .004
Positive emotion 5.80 1.36 .000
Negative emotion .72 .49 .213
Social affiliation 4.68 .80 .000

79
Table 3 – Mean differences in autonomic function between groups
Giving Control
Cardiovascular system
Systolic blood pressure
Baseline
Post-writing task
Peak stressor
Recovery 1 minute post stress
Recovery 5 minutes post stress
F=.157, p=.694

Diastolic blood pressure
Baseline
Post-writing task
Peak stressor
Recovery 1 minute post stress
Recovery 5 minutes post stress
rmANOVA F= .001, p=.975

Autonomic nervous system
High frequency heart rate variability
Baseline
Stressor
(maximum change from baseline)
Recovery
Reactivity delta
Recovery delta
ANCOVA (covariate: baseline lnHF)
Reactivity F=6.120 p=.016
Recovery F=2.321 p=.133

117.41
120.96
134.75
121.55
125.21

68.73
71.59
77.23
70.82
72.84

4.84
4.95

5.34
-.111
.394

120.84
123.04
136.10
125.56
127.80

68.73
69.08
78.60
72.28
72.98

4.73
4.43

5.00
.306
.574

80
CHAPTER 6: DISCUSSION

Given our understanding of the potent effects of social networks on health and longevity,
it is necessary to reach a more nuanced understanding about different aspects of social support,
including the giving, receiving, and balance of support exchanges and associations with
psychological and physical well-being. The current findings help deepen our understanding of
conditions under which giving support to others may protect our health and well-being across the
lifespan, as well as the potential cognitive-affective and physiological mechanisms through
which feeling as though one is a giver benefits the individual. This set of studies utilized large,
population datasets to examine associations between the balance of support giving and receiving
and links with psychological well-being, as well as same-day and next-day associations between
two forms of giving and physical and affective health. The cognitive-affective and physiological
mechanisms through which feeling like a support-giver influences health was examined in an
online and in a lab experiments. This mixture of secondary data analysis and laboratory
manipulations allows us to contribute to our understanding from multiple levels. From the
MIDUS dataset, we could draw conclusions about a large sample of Americans across several
age groups, as well as examine ecologically valid instances of support-giving. In our
experiments, we could examine immediate psychological and physiological changes following
the manipulation of perceptions of oneself as a giving individual under controlled conditions.
Together, these findings add to a growing body of research defining support-giving as an
important aspect of social relationships that confers health benefits.
While relationships with others have been understood as crucial for surviving and
thriving from birth to later life, a large assumption in the field has been that receiving support is
the primary way through which relationships benefit us. However, the exchanges of support that
81
make up a relationship flow in both directions, and the act of giving itself, as well as feeling as
though one is providing for others in a meaningful way can act just as powerfully in protecting
our health and well-being. While there have been several epidemiological studies demonstrating
this association between giving and health outcomes, the pathways and conditions remain
unknown.
Study 1 contributes to our growing knowledge of the well-being correlates of giving, and
provides a better understanding of the well-being correlates of over-benefiting and under-
benefitting in specific relationship types. The age-comparisons in this study allow us to begin to
understand how the effects of support giving and the balance of giving and receiving may differ
at various life stages. Greater perceived levels of support-giving and receiving were
independently associated with indices of psychological well-being. However, those who felt that
they were giving more than they received, or receiving more than they gave had lower levels of
psychological well-being. Support-giving was more strongly associated with well-being in
middle age, and receiving was associated more strongly with well-being in younger and middle
ages. Imbalance in support given and received was more strongly associated with greater well-
being only in younger and middle ages. These findings demonstrate important age-related
differences in the associations between support exchanges and well-being, and that balance is an
important boundary condition within which giving may benefit the giver.
Chapter 2 contributes to our understanding of day-to-day variations in associations
between different forms of support-giving and psychological, physiological and physical
functioning. Giving more emotional support than one usually does was associated with greater
levels of negative affect and symptom severity on the same day, but lower levels on the day
after. In addition, emotional support-giving interacts with stressor severity, such that those who
82
give more support and experience greater levels of stress than average report even higher levels
of symptoms. Giving more instrumental support, however, is associated with greater levels of
positive affect on the same day, and not associated with well-being on the following day. These
findings point to different profiles of patterns for each form of support, with emotional support
potentially having a same-day exacerbation, and a next-day buffering of the effects of stress on
the experience of physical symptoms. These findings demonstrate the importance of
distinguishing between forms of support, and the reversal of symptom experience from one day
to the next shows a unique trajectory for the potential effects of support-giving, that will need to
be clarified further with additional research.
Data collected in Study 3 allows for a finer assessment of the specific cognitive-affective
pathways through which giving and receiving may be linked to health and well-being in older
adults. Findings demonstrate that although self-reported cognitive-affective states do not differ
between support-giving and support-receiving there is significantly greater usage of words used
in the narratives that are parallel to the hypothesized cognitive-affective states.
Study 4 examined whether support-giving has direct and stress-buffering effects on
physiological function in middle aged and older adults. We find some evidence that support-
giving attenuates psychological responses to stress. Specifically, those who perceive of
themselves as support-givers had greater autonomic recovery from stress, and they report a lower
magnitude of increase in perceived stress. We also found that those in the support-giving group
used greater percentages of words in achievement, social affiliation, and positive affect.
However, we did not find any direct or stress-buffering effects of the manipulation on
cardiovascular activity, or differences between groups in autonomic function during the schema
activation.
83
The last several decades of research on social relationships and health have identified
social integration as a health-promoting factor, with the assumption that receiving support is a
primary way through which individuals benefit from integration. While there is growing
recognition of the importance of giving, as well as a healthy balance in giving and receiving,
research on the well-being correlates and pathways are still scarce. Findings from these studies
can fill these considerable gaps in our knowledge of the contexts (balance, certain age ranges) in
which support-giving is beneficial, clarifies the timeline through which different forms of
support (instrumental and emotional) are associated with physical and affective well-being, and
examines the potential direct and stress-buffering effects of perceiving oneself as a giver on
cognitions and affective states, as well as physiological functioning. As we understand the
mechanisms through which giving influences health, as well as the contexts, we can leverage this
knowledge to improve the quality of interpersonal relationships across the lifespan and optimally
design volunteer and other engagement opportunities for those in midlife and beyond.
84
APPENDICES

GIVING SUPPORT – Writing prompt in Chapter 5
The next task is an autobiographical writing exercise. You are asked to write about a topic which
many people view as an important aspect of their lives – their connections to others. Specifically,
we would like you to share the ways in which you play a helpful and supportive role in the lives
of others. In your essay, please describe:
1. The ways in which you help and provide support to others. This can include, but is not
limited to, helping your family members, friends, community members, and even
strangers.
2. How does it make you feel to help and support others?
3. How important is it to you that you play a supportive role in the lives of others?
Please try to be as detailed as is possible in recounting how you help others, how it makes you
feel to help others, and how important it is for you to be a source of support to others. We will
ask you questions about your memory for things you shared in your essay and we find that
memory for autobiographical details is enhanced when individuals share personally meaningful
information in their essays.

You will have 10 minutes to write. Please continue writing for the whole time that you have,
even if you feel like you are being repetitive.

85
NEUTRAL CONDITION – writing prompt in Chapter 4
The next task is an autobiographical writing exercise. You are asked to write about a
topic which we believe you should have good memory of – what you did. Specifically, we
would like you to share details about the inanimate objects that you interacted with (e.g., alarm
clock, dishes, computer, vehicle) in your daily activities yesterday. In your essay, please
describe:
What you did yesterday from the time you got up until the time you went to bed. Try to
give a lot of detail about what you did and the objects that you interacted with. For example, you
might start when your alarm went off and you got out of bed:
“I woke up at 6:05 AM, and turned off my alarm by pressing the rectangular button on
the top of the clock. The alarm clock is digital, and the display is red and flashes. I put on my
slippers and walked to the bathroom. My slippers are made of microfiber, are light blue and
slightly worn on the soles and dusty on the sides. I took my medication out of the medicine
cabinet, and drank a glass of cold water to wash down the white pills. I walked to the kitchen,
boiled two eggs, rinsed some fresh strawberries and made a cup of coffee. My coffee was
slightly burnt, and I drank it out of a red and gold mug…”
Please describe the objects that you interacted with as accurately and objectively as
possible. Please try to be as detailed as is possible in recounting your activities and their
associated objects. We will ask you questions about your memory for activities you shared in
your essay and we find that memory for autobiographical details is enhanced when individuals
share detailed information about objects they interacted with in their activities in their essays.

86
You will have 10 minutes to write. Please continue writing for the whole time that you have,
even if you feel like you are being repetitive.

87
REFERENCES

Abelson, J. L., Erickson, T. M., Mayer, S. E., Crocker, J., Briggs, H., Lopez-Duran, N. L., &
Liberzon, I. (2014). Brief cognitive intervention can modulate neuroendocrine stress
responses to the Trier Social Stress Test: Buffering effects of a compassionate goal
orientation. Psychoneuroendocrinology, 44, 60–70.
http://doi.org/10.1016/j.psyneuen.2014.02.016
Aknin, L. B., Barrington-Leigh, C. P., Dunn, E. W., Helliwell, J. F., Burns, J., Biswas-Diener,
R., … Norton, M. I. (2013). Prosocial spending and well-being: cross-cultural evidence for
a psychological universal. Journal of Personality and Social Psychology, 104(4), 635–52.
http://doi.org/10.1037/a0031578
Almeida, D. M. (2005). Resilience and Vulnerability to Daily Stressors Assessed via Diary
Methods, 14(2), 64–68.
Almeida, D. M., Piazza, J. R., & Stawski, R. S. (2009). Interindividual differences and
intraindividual variability in the cortisol awakening response: an examination of age and
gender. Psychology and Aging, 24(4), 819–27. http://doi.org/10.1037/a0017910
Andreoni, J. (1990). Impure Altruism and Donations to Public Goods : A Theory of Warm-Glow
Giving Author ( s ): James Andreoni Published by : Wiley on behalf of the Royal Economic
Society Stable URL : http://www.jstor.org/stable/2234133 Accessed : 02-03-2016 06 : 35
UTC Your. The Economic Journal, 100(401), 464–477.
Bangerter, L. R., Kim, K., Zarit, S. H., Birditt, K. S., & Fingerman, K. L. (2014). Perceptions of
Giving Support and Depressive Symptoms in Late Life. The Gerontologist, 1–10.
http://doi.org/10.1093/geront/gnt210
Barber, S. J., Opitz, P. C., Martins, B., Sakaki, M., & Mather, M. (2016). Thinking about a
limited future enhances the positivity of younger and older adults’ recall: Support for
socioemotional selectivity theory. Memory and Cognition, 44(6), 869–882.
http://doi.org/10.3758/s13421-016-0612-0
Bjälkebring, P., Västfjäll, D., Dickert, S., & Slovic, P. (2016). Greater emotional gain from
giving in older adults: Age-related positivity bias in charitable giving. Frontiers in
Psychology, 7(JUN), 1–8. http://doi.org/10.3389/fpsyg.2016.00846
Bolger, N., Zuckerman, A., & Kessler, R. C. (2000). Invisible support and adjustment to stress.
Journal of Personality and Social Psychology, 79(6), 953–961. http://doi.org/10.1037/0022-
3514.79.6.953
Breines, J. G., & Chen, S. (2013). Activating the inner caregiver: The role of support-giving
schemas in increasing state self-compassion. Journal of Experimental Social Psychology,
49(1), 58–64. http://doi.org/10.1016/j.jesp.2012.07.015
Brosschot, J. F., Verkuil, B., & Thayer, J. F. (2018). Generalized unsafety theory of stress:
Unsafe environments and conditions, and the default stress response. International Journal
of Environmental Research and Public Health. http://doi.org/10.3390/ijerph15030464
Brown, S. L., & Brown, R. M. (2015). Connecting prosocial behavior to improved physical
health: Contributions from the neurobiology of parenting. Neuroscience and Biobehavioral
Reviews, 55, 1–17. http://doi.org/10.1016/j.neubiorev.2015.04.004
Brown, S. L., Brown, R. M., House, J. S., & Smith, D. M. (2008). Coping With Spousal Loss:
Potential Buffering Effects of Self-Reported Helping Behavior. Personality and Social
Psychology Bulletin, 34(6), 849–861. http://doi.org/10.1177/0146167208314972
Brown, S. L., Nesse, R. M., Vinokur, A. D., & Smith, D. M. (2003). Providing social support
88
may be more beneficial than receiving it: results from a prospective study of mortality.
Psychological Science : A Journal of the American Psychological Society / APS, 14(4),
320–327.
Cacioppo, J. T., Hawkley, L. C., Crawford, L. E., Ernst, J. M., Burleson, M. H., Kowalewski, R.
B., … Berntson, G. G. (2002). Loneliness and health: potential mechanisms. Psychosomatic
Medicine, 64(3), 407–17. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12021415
Cacioppo, J. T., Hawkley, L. C., Norman, G. J., & Berntson, G. G. (2011). Social isolation.
Annals of the New York Academy of Sciences, 1231(1), 17–22.
http://doi.org/10.1111/j.1749-6632.2011.06028.x
Castaldo, R., Melillo, P., Bracale, U., Caserta, M., Triassi, M., & Pecchia, L. (2015). Acute
mental stress assessment via short term HRV analysis in healthy adults: A systematic
review with meta-analysis. Biomedical Signal Processing and Control, 18, 370–377.
http://doi.org/10.1016/j.bspc.2015.02.012
Cichy, K. E., Stawski, R. S., & Almeida, D. M. (2013). A Double-Edged Sword: Race, Daily
Family Support Exchanges, and Daily Well-Being. Journal of Family Issues, 1(22).
http://doi.org/10.1177/0192513X13479595
Creaven, A. M., & Hughes, B. M. (2012). Cardiovascular responses to mental activation of
social support schemas. International Journal of Psychophysiology, 84(2), 113–119.
http://doi.org/10.1016/j.ijpsycho.2012.01.018
Dunn, E. W., Aknin, L. B., & Norton, M. I. (2014). Prosocial Spending and Happiness: Using
Money to Benefit Others Pays Off. Current Directions in Psychological Science, 23(1), 41–
47. http://doi.org/10.1177/0963721413512503
Egizio, V. B., Jennings, J. R., Christie, I. C., Sheu, L. K., Matthews, K. a, & Gianaros, P. J.
(2008). Cardiac vagal activity during psychological stress varies with social functioning in
older women. Psychophysiology, 45(6), 1046–54. http://doi.org/10.1111/j.1469-
8986.2008.00698.x
Erikson, E. H. (1959). Identity and the life cycle: Psychological issues. New York: Int. Univ.
Press (trad. it.: I cicli della vita. Continuità e mutamenti. Roma: Armando, 1991).
Field, T. M., Hernandez-Reif, M., Quintino, O., Schanberg, S., & Kuhn, C. (1998). Elder Retired
Volunteers Benefit From Giving Massage Therapy to Infants. Journal of Applied
Gerontology, 17(2), 229–239. http://doi.org/10.1177/073346489801700210
Fox, G. R., Kaplan, J., Damasio, H., & Damasio, A. (2015). Neural correlates of gratitude.
Frontiers in Psychology, 6(September). http://doi.org/10.3389/fpsyg.2015.01491
Fried, L. P., Carlson, M. C., Freedman, M., Frick, K. D., Glass, T. A., Hill, J., … Zeger, S.
(2004). A Social Model for Health Promotion for an Aging Population : Initial Evidence on
the Experience Corps Model, 81(1), 64–78.
Gierveld, J. D. E. J., & Dykstra, P. A. (2008). Virtue is its own reward ? Support-giving in the
family and loneliness in middle and old age, 271–287.
http://doi.org/10.1017/S0144686X07006629
Greenfield, E. A., & Marks, N. F. (2004). Formal Volunteering as a Protective Factor for Older
Adults ’ Psychological Well-Being. Journals of Gerontology - Series B Psychological
Sciences and Social Sciences, 59(5), 258–264.
Grossman, M. R., & Gruenewald, T. L. (2017). Caregiving and Perceived Generativity : A
Positive and Protective Aspect of. Clinical Gerontologist, 0, 0–13.
Grossman, M. R., Wang, D., & Gruenewald, T. L. (2017). Variations in Daily Cognitive
Affective States as a Function of Variations in Daily Generative Activity. Journal of
89
Happiness Studies. http://doi.org/10.1007/s10902-017-9935-1
Gruenewald, T. L., Karlamangla, A. S., Greendale, G. A., Singer, B. H., & Seeman, T. E. (2009).
Increased mortality risk in older adults with persistently low or declining feelings of
usefulness to others. Journal of Aging and Health, 21(2), 398–425.
http://doi.org/10.1177/0898264308329023
Gruenewald, T. L., Karlamangla, A. S., Greendale, G. a, Singer, B. H., & Seeman, T. E. (2007).
Feelings of Usefulness to Others, Disability, and Mortality in Older Adults: the MacArthur
Study of Successful Aging. The Journals of Gerontology. Series B, Psychological Sciences
and Social Sciences, 62(1), P28–P37.
Gruenewald, T. L., Liao, D. H., & Seeman, T. E. (2012). Contributing to others, contributing to
oneself: perceptions of generativity and health in later life. The Journals of Gerontology.
Series B, Psychological Sciences and Social Sciences, 67(6), 660–5.
http://doi.org/10.1093/geronb/gbs034
Gruenewald, T. L., Tanner, E. K., Fried, L. P., Carlson, M. C., Xue, Q.-L., Parisi, J. M., …
Seeman, T. E. (2015). The Baltimore Experience Corps Trial: Enhancing Generativity via
Intergenerational Activity Engagement in Later Life. The Journals of Gerontology Series B:
Psychological Sciences and Social Sciences, 1–10. http://doi.org/10.1093/geronb/gbv005
Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: A theoretical and empirical
review of consequences and mechanisms. Annals of Behavioral Medicine, 40(2), 218–227.
http://doi.org/10.1007/s12160-010-9210-8
Hill, L. K., Hu, D., Koenig, J., Sollers III, J., Kapuku, G., Wang, X., … Thayer, J. (2015). Ethnic
Differences in Resting Heart Rate Variability: A Systematic Review and Meta-Analysis.
Psychosom Med, 77(1), 16–25. http://doi.org/10.1097/PSY.0000000000000133.Ethnic
Hjortskov, N., Rissén, D., Blangsted, A. K., Fallentin, N., Lundberg, U., & Søgaard, K. (2004).
The effect of mental stress on heart rate variability and blood pressure during computer
work. European Journal of Applied Physiology, 92(1–2), 84–9.
http://doi.org/10.1007/s00421-004-1055-z
Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: a
meta-analytic review. PLoS Medicine, 7(7), e1000316.
http://doi.org/10.1371/journal.pmed.1000316
Hounsell, C., Jed Johnson, W., Seals Carol Levine, E., Stein, R., Vuckovic, N., Donna Wagner,
I., … Ari Houser, M. (2014). Caregiving in the U.S. – AARP 2015 Report, (June).
House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science
(New York, N.Y.), 241(4865), 540–5. http://doi.org/10.1126/science.3399889
Inagaki, T. K., Bryne Haltom, K. E., Suzuki, S., Jevtic, I., Hornstein, E., Bower, J. E., &
Eisenberger, N. I. (2016). The Neurobiology of Giving Versus Receiving Support.
Psychosomatic Medicine, 1. http://doi.org/10.1097/PSY.0000000000000302
Inagaki, T. K., & Eisenberger, N. I. (2012). Neural Correlates of Giving Support to a Loved One.
Psychosomatic Medicine, 74(1), 3–7. http://doi.org/10.1097/PSY.0b013e3182359335
Inagaki, T. K., & Eisenberger, N. I. (2015). Giving support to others reduces sympathetic
nervous system-related responses to stress. Psychophysiology, 00, n/a-n/a.
http://doi.org/10.1111/psyp.12578
Inagaki, T. K., & Orehek, E. (2017). On the Benefits of Giving Social Support. Current
Directions in Psychological Science, 26(2), 109–113.
http://doi.org/10.1177/0963721416686212
Kahana, E., & Bhatta, T. (2013). Altruism, Helping, and Volunteering: Pathways to Well-Being
90
in Late Life. Journal of Aging and …, 25(1), 1–24.
http://doi.org/10.1177/0898264312469665.Altruism
Kemp, A. H., Koenig, J., & Thayer, J. F. (2017). From psychological moments to mortality: A
multidisciplinary synthesis on heart rate variability spanning the continuum of time.
Neuroscience and Biobehavioral Reviews. Elsevier.
http://doi.org/10.1016/j.neubiorev.2017.09.006
Killen, A., & Macaskill, A. (2014). Using a Gratitude Intervention to Enhance Well-Being in
Older Adults. Journal of Happiness Studies, 947–964. http://doi.org/10.1007/s10902-014-
9542-3
Koenig, J., & Thayer, J. F. (2016). Sex differences in healthy human heart rate variability: A
meta-analysis. Neuroscience and Biobehavioral Reviews, 64, 288–310.
http://doi.org/10.1016/j.neubiorev.2016.03.007
Kok, B. E., & Fredrickson, B. L. (2010). Upward spirals of the heart : Autonomic flexibility , as
indexed by vagal tone , reciprocally and prospectively predicts positive emotions and social
connectedness. Biological Psychology, 85(3), 432–436.
http://doi.org/10.1016/j.biopsycho.2010.09.005
Konrath, S., & Brown, S. (2013). The effects of giving on givers. Health and Social
Relationships: The Good, the Bad, and the Complicated., 39–64.
http://doi.org/10.1037/14036-003
Krause, N., Herzog, A., & Baker, E. (1992). Providing support to others and well-being in later
life. Journal of Gerontology, 47(5), 300–311.
http://doi.org/10.1093/geront/32.Special_Issue_I.1\r10.1093/geronj/47.5.P300
Krause, N., & Shaw, B. a. (2000). Giving social support to others, socioeconomic status, and
changes in self-esteem in late life. The Journals of Gerontology. Series B, Psychological
Sciences and Social Sciences, 55(6), S323–S333.
Leger, K. A., Charles, S. T., & Almeida, D. M. (2018). Let It Go: Lingering Negative Affect in
Response to Daily Stressors Is Associated With Physical Health Years Later. Psychological
Science, 095679761876309. http://doi.org/10.1177/0956797618763097
Liang, J., Krause, N. M., & Bennett, J. M. (2001). Social exchange and well-being: is giving
better than receiving? Psychology and Aging, 16(3), 511–523.
Malik, M., Bigger, J., Camm, A., & Kleiger, R. (1996). Heart rate variability. Standards of
measurement, physiological interpretation, and clinical use. Task Force of the European
Society of Cardiology and the North American Society of Pacing and Electrophysiology.
European Heart Journal, 17, 354–381. http://doi.org/0195-668X/96/030354 + 28 $18.00/0
Martela, F., & Ryan, R. M. (2016). The Benefits of Benevolence: Basic Psychological Needs,
Beneficence, and the Enhancement of Well-Being. Journal of Personality, 84(6), 750–764.
http://doi.org/10.1111/jopy.12215
McAdams, D. P., & de St. Aubin, E. (1992). A theory of generativity and its assessment through
self-report, behavioral acts, and narrative themes in autobiography. Journal of Personality
and Social Psychology. http://doi.org/10.1037/0022-3514.62.6.1003
Mezzacappa, E. S., Kelsey, R. M., Katkin, E. S., & Sloan, R. P. (2001). Vagal rebound and
recovery from psychological stress. Psychosomatic Medicine, 63, 650–657.
http://doi.org/10.1097/00006842-200107000-00018
Miller, J. G., Kahle, S., & Hastings, P. D. (2015). Roots and Benefits of Costly Giving: Children
Who Are More Altruistic Have Greater Autonomic Flexibility and Less Family Wealth.
Psychological Science, 26(7), 1038–1045. http://doi.org/10.1177/0956797615578476
91
Nelson, K., Layous, K., Cole, S., & Lyubormirsky, S. (2016). Do Unto Others or Treat Yourself?
The Effects of Prosocial and Self-Focused Behavior on Psychological Flourishing. Emotion,
(February). http://doi.org/10.1037/emo0000178
Piferi, R. L., & Lawler, K. A. (2006). Social support and ambulatory blood pressure: an
examination of both receiving and giving. International Journal of Psychophysiology :
Official Journal of the International Organization of Psychophysiology, 62(2), 328–336.
http://doi.org/10.1016/j.ijpsycho.2006.06.002
Porges, S. W. (2007). The Polyvagal Perspetive. Biological Psychology, 74(2), 116–143.
http://doi.org/10.1016/j.biopsycho.2006.06.009
Post, S. G. (2005). Altruism, happiness, and health: it’s good to be good. International Journal of
Behavioral Medicine, 12(2), 66–77. http://doi.org/10.1207/s15327558ijbm1202_4
Poulin, M. J., Brown, S. L., Dillard, A. J., & Smith, D. M. (2013). Giving to others and the
association between stress and mortality. American Journal of Public Health, 103(9), 1649–
55. http://doi.org/10.2105/AJPH.2012.300876
Pressman, S. D., & Cohen, S. (2005). Does positive affect influence health? Psychological
Bulletin, 131(6), 925–971. http://doi.org/10.1037/0033-2909.131.6.925
Pressman, S. D., Kraft, T. L., & Cross, M. P. (2014). It’s good to do good and receive good: The
impact of a ‘pay it forward’ style kindness intervention on giver and receiver well-being.
The Journal of Positive Psychology, 9760(4), 293–302.
http://doi.org/10.1080/17439760.2014.965269
Pruessner, J. C., Kirschbaum, C., Meinlschmid, G., & Hellhammer, D. H. (2003). Two formulas
for computation of the area under the curve represent measures of total hormone
concentration versus time-dependent change. Psychoneuroendocrinology, 28(7), 916–931.
http://doi.org/10.1016/S0306-4530(02)00108-7
Redwine, L., Henry, B. L., Pung, M. A., Wilson, K., Chinh, K., Knight, B., … Mills, P. J.
(2016). A pilot randomized study of a gratitude journaling intervention on HRV and
inflammatory biomarkers in Stage B heart faillure patients. Psychosom Med, 78(6), 667–
676. http://doi.org/10.1097/PSY.0000000000000316.A
Rook, K. S. (1990). Parallels in the study of social support and social strain. Journal of Social
and Clinical Psychology, 9(1), 118–132.
Sandstrom, G. M., Dickerson, S., & Madden, K. M. (2016). Is spending money on others good
for your heart? Ashley V. Whillans. Health Psychology, 35(February 2016), 574–583.
http://doi.org/10.1037/hea0000332
Schulz, R., & Beach, S. R. (1999). Caregiving as a Risk Factor for Mortality. Jama, 282(23),
2215. http://doi.org/10.1001/jama.282.23.2215
Schwartz, C. (2003). Altruistic Social Interest Behaviors Are Associated With Better Mental
Health. Psychosomatic Medicine, 65(5), 778–785.
http://doi.org/10.1097/01.PSY.0000079378.39062.D4
Seery, M. D. (2011). Challenge or threat? Cardiovascular indexes of resilience and vulnerability
to potential stress in humans. Neuroscience and Biobehavioral Reviews, 35(7), 1603–1610.
http://doi.org/10.1016/j.neubiorev.2011.03.003
Smith, T. W., Birmingham, W., & Uchino, B. N. (2012). Evaluative threat and ambulatory blood
pressure: Cardiovascular effects of social stress in daily experience. Health Psychology,
31(6), 763–766. http://doi.org/10.1037/a0026947
Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and
all-cause mortality in older men and women. Pnas, 2013(15), 1–5.
92
http://doi.org/10.1073/pnas.1219686110
Strazdins, L., & Broom, D. H. (2007). The mental health costs and benefits of giving social
support. International Journal of Stress Management. http://doi.org/10.1037/1072-
5245.14.4.370
Tausczik, Y. R., & Pennebaker, J. W. (2010). The Psychological Meaning of Words: LIWC and
Computerized Text Analysis Methods. Journal of Language and Social Psychology, 29(1),
24–54. http://doi.org/10.1177/0261927X09351676
Telzer, E. H., Masten, C. L., Berkman, E. T., Lieberman, M. D., & Andrew, J. (2011). Gaining
while giving: An fMRI study of the rewards of family assistance among White and Latino
youth, 5, 508–518. http://doi.org/10.1080/17470911003687913.Gaining
Thayer, J. F., & Lane, R. D. (2007). The role of vagal function in the risk for cardiovascular
disease and mortality. Biological Psychology, 74, 224–242.
http://doi.org/10.1016/j.biopsycho.2005.11.013
Thayer, J. F., Yamamoto, S. S., & Brosschot, J. F. (2010). The relationship of autonomic
imbalance, heart rate variability and cardiovascular disease risk factors. International
Journal of Cardiology, 141(2), 122–31. http://doi.org/10.1016/j.ijcard.2009.09.543
Thomas, P. a. (2010). Is it better to give or to receive? Social support and the well-being of older
adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences,
65B(3), 351–357. http://doi.org/10.1093/geronb/gbp113.Advance
Uchino, B. N. (2006). Social support and health: a review of physiological processes potentially
underlying links to disease outcomes. Journal of Behavioral Medicine, 29(4), 377–387.
http://doi.org/10.1007/s10865-006-9056-5
Uchino, B. N. (2009). Understanding the Links Between Social Support and Physical Health.
Perspectives on Psychological Science, 4(3), 236–255.
Uchino, B. N., Bowen, K., Carlisle, M., & Birmingham, W. (2012). Psychological pathways
linking social support to health outcomes: A visit with the “ghosts” of research past,
present, and future. Social Science & Medicine, 74(7), 949–957.
http://doi.org/10.1016/j.socscimed.2011.11.023
Uchino, B. N., Uno, D., & Holt-lunstad, J. (2010). Social Support, Physiological and Health
Processes. Psychological Science, 8(5), 145–148.
Vitaliano, P. P., Zhang, J., & Scanlan, J. M. (2003). Is Caregiving Hazardous to One’s Physical
Health? A Meta-Analysis. Psychological Bulletin, 129(6), 946–972.
http://doi.org/10.1037/0033-2909.129.6.946
Warner, L. M., Schüz, B., Wurm, S., Ziegelmann, J. P., & Tesch-Römer, C. (2010). Giving and
taking--differential effects of providing, receiving and anticipating emotional support on
quality of life in adults with multiple illnesses. Journal of Health Psychology, 15(5), 660–
670. http://doi.org/10.1177/1359105310368186
Weinstein, N., & Ryan, R. M. (2010). When helping helps: Autonomous motivation for prosocial
behavior and its influence on well-being for the helper and recipient. Journal of Personality
and Social Psychology, 98(2), 222–244. http://doi.org/10.1037/a0016984
Wood, A. M., Joseph, S., & Linley, P. A. (2007). Coping style as a psychological resource of
grateful people. Journal of Social and Clinical Psychology, 26(9), 1076–1093.
http://doi.org/10.1521/jscp.2007.26.9.1076

Abstract (if available)

Abstract Social relationships are an important factor in health and well-being across the lifespan. While most of the research on the functions of relationships focus on effects of benefits of receiving support, there is growing evidence that support-giving may also be linked to health and well-being (Brown, 2003

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Asset Metadata

Creator Wang, Diana (author)

Core Title Psychological and physiological pathways from social support exchanges to health: a lifespan perspective

School Leonard Davis School of Gerontology

Degree Doctor of Philosophy

Degree Program Gerontology

Publication Date 08/14/2020

Defense Date 04/12/2018

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag aging,autonomic stress reactivity,daily diary,generativity,OAI-PMH Harvest,social support

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Mather, Mara (committee chair), Crimmins, Eileen (committee member), Gruenewald, Tara (committee member), Zelinski, Elizabeth (committee member)

Creator Email diana.wang.1@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-69859

Unique identifier UC11672155

Identifier etd-WangDiana-6744.pdf (filename),usctheses-c89-69859 (legacy record id)

Legacy Identifier etd-WangDiana-6744.pdf

Dmrecord 69859

Document Type Dissertation

Format application/pdf (imt)

Rights Wang, Diana

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA