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Stress-related thinking predicts the cortisol awakening response and somatic symptoms in healthy adults
... Table 1 shows the key characteristics of the included studies. Ultimately, 26 full-text articles were included in the analysis (Amiri et al., 2019;Ashley et al., 2011;Baikie et al., 2012;Burton & King, 2008;Chu et al., 2019;Creswell et al., 2007;Danoff-Burg et al., 2006;Graves et al., 2005;Harvey et al., 2018;King, 2001;King Lichtenthal & Cruess, 2010;Low et al., 2006;Lu et al., 2017;Lumley et al., 2011;Lyubomirsky et al., 2006;McCullough et al., 2006;Norman et al., 2004;O'Connor et al., 2011O'Connor et al., , 2013Segal et al., 2009;Stanton et al., 2002;Zhou & Zhu, 2014). ...
... (Creswell et al., 2007). There was also case in which neither type of writing made any difference to the participants' health (O'Connor et al., 2013). Most data were collected over a period of more than 2 months. ...
Aim:
To evaluate the efficacy of expressive writing (EW) versus positive writing (PW) in different populations focusing on mood, health and writing content and to provide a basis for nurses to carry out the targeted treatment.
Design:
Systematic review and meta-analysis.
Methods:
This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twelve electronic databases and references from articles were searched. All randomized controlled trials (RCTs) comparing EW and PW were included. Statistical analyses were executed using Stata 15.0 software.
Results:
Twenty-four RCTs and a total of 1558 participants were analysed. The results showed that for the general population, PW was more positive on mood than EW and could offer more changes in cognitive mechanisms. Among patients, although PW was more conducive to generating positive emotions, EW could stimulate cognitive changes more. Nursing staff should clarify the mechanism of PW and EW, combine the advantages of both and implement intervention according to the characteristics of different populations.
No patient or public contribution:
It does not apply to your work because this study is an analysis of published studies and does not involve patients or the public.
... For example, 6 months after completing expressive writing, adult caregivers of children with an autism spectrum disorder reported a weaker cortisol awakening response (Da Paz et al., 2018), which has been linked to lower depressive symptoms in some studies (for a review, see Boggero et al., 2017). However, in a trial among emerging adults, expressive writing caused no changes in cortisol awakening response (O'Connor et al., 2013). These mixed effects may be due, in part, to the fact that these studies have measured changes in a marker of the HPA circadian rhythm rather than a marker of total cortisol output. ...
... While there was evidence that expressive writing reduced perceived stress, there was no evidence that expressive writing reduced HPA axis activation. This null finding corroborates evidence from one prior trial that used cortisol waking response as a biomarker of HPA functioning among emerging adults (O'Connor et al., 2013). Thus, while expressive writing has shown efficacy for reducing self-reported perceived stress (e.g., Lewis et al., 2005), there is not yet evidence to suggest that the intervention reduces a biomarker of HPA axis activation. ...
A limited number of studies have examined mechanisms undergirding interventions that mitigate mental health problems or health-risk behaviors that disproportionately burden sexual minorities. A recent trial of expressive writing and self-affirmation writing found that these brief interventions had salubrious effects on mental health and health-risk behaviors; the present research examines the putative mechanisms underlying these effects. Sexual minority emerging adults (N = 108) completed a brief online expressive writing, self-affirmation writing, or neutral control writing intervention and, at baseline and 3-month follow-up, completed measures of mental health, health-risk behaviors, stress, and self-regulation. Expressive writing yielded improvements in mental health and these effects were mediated by reductions in perceived stress. Self-affirmation caused improvements in health-risk behaviors, thoughneither stress nor self-regulation mediated these effects. This finding provides preliminary novel evidence regarding a mechanism underlying a widely used psychological intervention with documented mental health benefits for sexual minorities and other populations disproportionately affected by stress
... Moreover, it has been theorized that the function of the CAR is to prepare the individual for the demands of the upcoming day (Powell & Schlotz 2012). The CAR has been linked with stress and a range of health outcomes, though the pattern of results has been mixed (e.g., Adam et al. 2010, Chida & Steptoe 2009, Clow et al. 2010, Gartland et al. 2014, O'Connor et al. 2013, Steptoe & Serwinski 2016. In terms of psychological stress, a number of studies have found links between stress and increases in the CAR (e.g., De Vugt et al. 2005, Wust et al. 2000. ...
... In terms of psychological stress, a number of studies have found links between stress and increases in the CAR (e.g., De Vugt et al. 2005, Wust et al. 2000. Conversely, other evidence has shown that chronic stress may disrupt HPA axis regulation and lead to a blunted CAR (e.g., Mortensen et al. 2019;O'Connor et al. 2009O'Connor et al. , 2013Steptoe & Serwinski 2016;Thorn et al. 2006). Furthermore, in terms of health outcomes, a comprehensive meta-analysis by Chida & Steptoe (2009) confirmed similar findings and reported that different psychosocial factors are associated with both enhanced and reduced cortisol awakening responses. ...
The cumulative science linking stress to negative health outcomes is vast. Stress can affect health directly, through autonomic and neuroendocrine responses, but also indirectly, through changes in health behaviors. In this review, we present a brief overview of ( a) why we should be interested in stress in the context of health; ( b) the stress response and allostatic load; ( c) some of the key biological mechanisms through which stress impacts health, such as by influencing hypothalamic-pituitary-adrenal axis regulation and cortisol dynamics, the autonomic nervous system, and gene expression; and ( d) evidence of the clinical relevance of stress, exemplified through the risk of infectious diseases. The studies reviewed in this article confirm that stress has an impact on multiple biological systems. Future work ought to consider further the importance of early-life adversity and continue to explore how different biological systems interact in the context of stress and health processes.
Expected final online publication date for the Annual Review of Psychology, Volume 72 is January 4, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... The CAR has also been linked with a range of health outcomes, although the pattern of results has been mixed (e.g., Adam et al., 2006;Chida & Steptoe, 2009;Clow, Hucklebridge, Stalder, Evans, & Thorn, 2010;Gartland et al., 2014;D. B. O'Connor, Walker, Hendrickx, Talbot, & Schaefer, 2013). In terms of psychological stress, a number of studies have found links between stress and increases in the CAR (e.g., De Vugt et al., 2005;Wust, Federenko, Hellhammer, & Kirschbaum, 2000). Conversely, other evidence has shown that chronic stress may disrupt HPA axis regulation and lead to a blunted CAR (e.g., D. B. O'Connor et al., 200 ...
... chanisms underlying the CAR become exhausted, like other cases of hypocortisolism. Empirical evidence is now converging to suggest that repetitive and sustained activation of the HPA axis stress system causes a blunted or reduced cortisol response over time (Fries, Hesse, Hellhammer, & Hellhammer, 2005;Hwang et al., 2014;D. B. O'Connor et al., 2009D. B. O'Connor et al., , 2013. This hypothesis is also in line with Fries et al.'s (2005) account of the development of hypocortisolism, which suggests that the hypocortisolism occurs after a prolonged period of hyperactivity of the HPA axis due to chronic stress. Therefore, it is likely that in individuals who have experienced greater levels of childhood trauma, ov ...
Suicide is a leading cause of mortality worldwide. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, has been identified as 1 potential risk factor. Evidence has indicated that childhood trauma is associated with dysregulated cortisol reactivity to stress in adulthood. The current study investigated for the first time whether childhood trauma and daily stressors and emotions were associated with diurnal cortisol levels over a 7-day study in individuals vulnerable to suicide. One hundred and forty-two participants were categorized according to their suicidal history into 3 groups: suicide attempt, suicidal ideation, or control group. Participants completed questionnaires before commencing a 7-day study. Cortisol samples were provided immediately upon waking, at 15 min, 30 min, 45 min, 3 hr, 6 hr, 9 hr, and 12 hr on 7 consecutive days. Measures of daily stressors, mood, defeat, and entrapment were completed at the end of each day. Participants in the suicide attempt and ideation groups released significantly lower cortisol upon awakening (CAR) and had a tendency toward flatter wake-peak to 12 hr (WP-12) cortisol slopes compared to controls. Childhood trauma was found to be associated with significantly lower CAR and a tendency toward flatter WP-12 cortisol slope. Childhood trauma also had an indirect effect on suicide vulnerability group membership via lower daily CAR levels. Lower CAR was associated with increased suicide ideation at 1 month but not 6 months. Daily stress and emotion measures were not associated with cortisol levels. This is the first 7-day daily diary investigation of naturally fluctuating cortisol levels in individuals vulnerable to suicide. The results indicate that dysregulated HPA axis activity is associated with suicidal ideation and behavior. Childhood trauma appears to be an important distal factor associated with HPA-axis dysregulation.
... The CAR has also been linked with a range of health outcomes, although the pattern of results has been mixed (e.g., Adam et al., 2006;Chida & Steptoe, 2009;Clow, Hucklebridge, Stalder, Evans, & Thorn, 2010;Gartland et al., 2014;D. B. O'Connor, Walker, Hendrickx, Talbot, & Schaefer, 2013). In terms of psychological stress, a number of studies have found links between stress and increases in the CAR (e.g., De Vugt et al., 2005;Wust, Federenko, Hellhammer, & Kirschbaum, 2000). Conversely, other evidence has shown that chronic stress may disrupt HPA axis regulation and lead to a blunted CAR (e.g., D. B. O'Connor et al., 200 ...
... chanisms underlying the CAR become exhausted, like other cases of hypocortisolism. Empirical evidence is now converging to suggest that repetitive and sustained activation of the HPA axis stress system causes a blunted or reduced cortisol response over time (Fries, Hesse, Hellhammer, & Hellhammer, 2005;Hwang et al., 2014;D. B. O'Connor et al., 2009D. B. O'Connor et al., , 2013. This hypothesis is also in line with Fries et al.'s (2005) account of the development of hypocortisolism, which suggests that the hypocortisolism occurs after a prolonged period of hyperactivity of the HPA axis due to chronic stress. Therefore, it is likely that in individuals who have experienced greater levels of childhood trauma, ov ...
Objectives: Suicide is a leading cause of mortality worldwide. Dysregulated hypothalamic-pituitary-adrenal axis activity, as measured by cortisol levels, has been identified as one potential risk factor. Evidence has indicated that childhood trauma is associated with dysregulated cortisol reactivity to stress in adulthood. The current study investigated for the first time whether childhood trauma and daily stressors and emotions were associated with diurnal cortisol levels over a 7-day study in individuals vulnerable to suicide. Methods: 142 participants were categorized according to their suicidal history into three groups: suicide attempt, suicidal ideation or control group. Participants completed questionnaires before commencing a 7-day study. Cortisol samples were provided immediately upon waking, at 15 mins, 30 mins, 45 mins, 3 hours, 6 hours, 9 hours and 12 hours on 7 consecutive days. Measures of daily stressors, mood, defeat and entrapment were completed at the end of each day. Results: Participants in the suicide attempt and ideation groups released significantly lower cortisol upon awakening (CAR) and had a tendency towards flatter wake-peak to 12 hour (WP-12) cortisol slopes compared to controls. Childhood trauma was found to be associated with significantly lower CAR and a tendency towards flatter WP-12 cortisol slope. Childhood trauma also had an indirect effect on suicide vulnerability group membership via lower daily CAR levels. Lower CAR was associated with increased suicide ideation at 1-month but not 6-months. Daily stress and emotion measures were not associated with cortisol levels. Conclusions: This is the first 7-day daily diary investigation of naturally fluctuating cortisol levels in individuals vulnerable to suicide. The results indicate that dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity is associated with suicidal ideation and behavior. Childhood trauma appears to be an important distal factor associated with HPA-axis dysregulation.
... In addition to the resting cortisol level, two area under the curve measures (AUC) were calculated. Using the five sampling time points, the two AUC measures were determined following established procedures (Gartland et al., 2014;O'Connor et al., 2013;Pruessner et al., 2003). Area under the curve with respect to ground (AUCg) is a measure of total cortisol output throughout the stressor and area under the curve with respect to increase (AUCi) captures the sensitivity of the HPA system and is a measure of its ability to change in response to the MAST. ...
... In terms of cortisol reactivity to stress, there has been much debate about whether dysregulation related to exposure to chronic stress leads to hypercortisolism (enhanced secretion) or hypocortisolism (blunted secretion; Miller et al., 2007;O'Connor et al., 2009O'Connor et al., , 2016Segerstrom and Miller, 2004). The evidence is now converging to suggest that repetitive and sustained activation of the HPA axis stress system causes a blunted or reduced cortisol response over time (Fries et al., 2005;Hwang et al., 2014;O'Connor et al., 2009O'Connor et al., , 2013. Indeed, this view is also in line with an influential account of the development of hypocortisolism, which suggests that the latter phenomenon occurs after a prolonged period of hyperactivity of the HPA axis due to chronic stress (see Fries et al., 2005, for detailed discussion of precise mechanisms). ...
Objectives: Suicide is a global health issue. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, asmeasured by cortisol levels, has been identified as one potential risk factor for suicide. Recent evidence hasindicated that blunted cortisol reactivity to stress is associated with suicidal behavior. The current study investigatedwhether childhood trauma was associated with blunted cortisol reactivity to a laboratory stressor andresting cortisol levels in suicide attempters and ideators.Methods: 160 Participants were recruited and grouped according to history of previous suicidal attempt, suicidalideation or as control participants. Participants completed background questionnaires, including the ChildhoodTrauma Questionnaire, before completing a laboratory stress task. Cortisol levels were assessed at rest andduring the stress task.Results: The highest levels of childhood trauma were reported in those who had attempted suicide (78.7%),followed by those who thought about suicide (37.7%) and then those with no suicidal history (17.8%).Moreover, regression analyses showed that childhood trauma was a significant predictor of blunted cortisolreactivity to stress and resting cortisol levels, such that higher levels of trauma were associated with lowercortisol levels in those with a suicidal history. Family history of suicide did not interact with the effects ofchildhood trauma on cortisol levels.Conclusions: These results indicate that childhood trauma is associated with blunted HPA axis activity in vulnerablepopulations in adulthood. The challenge for researchers is to elucidate the precise causal mechanismslinking trauma, cortisol and suicide risk and to investigate whether the effects of childhood trauma on cortisollevels are amendable to psychological intervention.
... In addition to the resting cortisol level, two area under the curve measures (AUC) were calculated. Using the five sampling time points, the two AUC measures were determined following established procedures (Gartland et al., 2014;O'Connor et al., 2013;Pruessner et al., 2003). Area under the curve with respect to ground (AUCg) is a measure of total cortisol output throughout the stressor and area under the curve with respect to increase (AUCi) captures the sensitivity of the HPA system and is a measure of its ability to change in response to the MAST. ...
... In terms of cortisol reactivity to stress, there has been much debate about whether dysregulation related to exposure to chronic stress leads to hypercortisolism (enhanced secretion) or hypocortisolism (blunted secretion; Miller et al., 2007;O'Connor et al., 2009O'Connor et al., , 2016Segerstrom and Miller, 2004). The evidence is now converging to suggest that repetitive and sustained activation of the HPA axis stress system causes a blunted or reduced cortisol response over time (Fries et al., 2005;Hwang et al., 2014;O'Connor et al., 2009O'Connor et al., , 2013. Indeed, this view is also in line with an influential account of the development of hypocortisolism, which suggests that the latter phenomenon occurs after a prolonged period of hyperactivity of the HPA axis due to chronic stress (see Fries et al., 2005, for detailed discussion of precise mechanisms). ...
Objectives: Suicide is a global health issue. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, has been identified as one potential risk factor for suicide. Recent evidence has indicated that blunted cortisol reactivity to stress is associated with suicidal behavior. The current study investigated whether childhood trauma was associated with blunted cortisol reactivity to a laboratory stressor and resting cortisol levels in suicide attempters and ideators. Methods: 160 Participants were recruited and grouped according to history of previous suicidal attempt, suicidal ideation or as control participants. Participants completed background questionnaires, including the Childhood Trauma Questionnaire, before completing a laboratory stress task. Cortisol levels were assessed at rest and during the stress task. Results: The highest levels of childhood trauma were reported in those who had attempted suicide (78.7%), followed by those who thought about suicide (37.7%) and then those with no suicidal history (17.8%). Moreover, regression analyses showed that childhood trauma was a significant predictor of blunted cortisol reactivity to stress and resting cortisol levels, such that higher levels of trauma were associated with lower cortisol levels in those with a suicidal history. Family history of suicide did not interact with the effects of childhood trauma on cortisol levels. Conclusions: These results indicate that childhood trauma is associated with blunted HPA axis activity in vulnerable populations adulthood. The challenge for researchers is to elucidate the precise causal mechanisms linking trauma, cortisol and suicide risk and to investigate whether the effects of childhood trauma on cortisol levels are amendable to psychological intervention.
... In addition to the resting cortisol level, two area under the curve measures (AUC) were calculated. Using the five sampling time points, the two AUC measures were determined following established procedures (Gartland et al., 2014;O'Connor et al., 2013;Pruessner et al., 2003). Area under the curve with respect to ground (AUCg) is a measure of total cortisol output throughout the stressor and area under the curve with respect to increase (AUCi) captures the sensitivity of the HPA system and is a measure of its ability to change in response to the MAST. ...
... In terms of cortisol reactivity to stress, there has been much debate about whether dysregulation related to exposure to chronic stress leads to hypercortisolism (enhanced secretion) or hypocortisolism (blunted secretion; Miller et al., 2007;O'Connor et al., 2009O'Connor et al., , 2016Segerstrom and Miller, 2004). The evidence is now converging to suggest that repetitive and sustained activation of the HPA axis stress system causes a blunted or reduced cortisol response over time (Fries et al., 2005;Hwang et al., 2014;O'Connor et al., 2009O'Connor et al., , 2013. Indeed, this view is also in line with an influential account of the development of hypocortisolism, which suggests that the latter phenomenon occurs after a prolonged period of hyperactivity of the HPA axis due to chronic stress (see Fries et al., 2005, for detailed discussion of precise mechanisms). ...
... They also demonstrated that having intrusive thoughts about the event hampered the participants' BP recovery. These authors and others (Davidson et al., 2002;O'Connor, Walker, Hendrickx, Talbot, & Schaefer, 2013) suggest that these elevations in BP and intrusive thoughts are likely to reflect unsuccessful cognitive integration of the stressful experiences. Moreover, it has been argued that a longer initial followup may be required in order for positive improvements to emerge (O'Connor & Ashley, 2008;Wetherell et al., 2005). ...
... Nevertheless, these competing explanations notwithstanding, the current results are also important as they suggest that individual differences in brooding may account for (some of) the mixed and inconsistent findings in past WED research (cf. Frattaroli, 2006;O'Connor et al., 2013;Smyth & Pennebaker, 2008). ...
Written emotional disclosure (WED) has beneficial effects on health outcomes. However, its effectiveness is influenced by a number of variables. This exploratory study tested whether trait rumination, which comprises brooding, a maladaptive component, and reflection, an adaptive component, moderated the effects of WED on ambulatory blood pressure (ABP) in female participants.
Fifty-two participants were randomized to write about their most stressful/traumatic life experience(s) or non-emotive topics, for 20 minutes, on 3 consecutive days. Two weeks and 14 weeks later, ABP was recorded over a single day.
Using hierarchical linear modelling, an effect of condition was found at 2 weeks but not at 14 weeks indicating that higher levels of ABP were observed following WED. There was also a significant condition by brooding interaction at two weeks such that higher ABP was observed in low brooders in the WED condition compared with low brooders in the control condition. However, within the WED condition, the lowest ABP was exhibited by participants high in brooding.
The findings indicated that WED led to short-lived increases in ABP which disappeared in the medium term. Researchers ought to build upon this exploratory study and investigate further the potential moderating role of brooding within WED. Individual differences in brooding may account for (some of) the mixed and inconsistent findings in past WED research.
... The CAR has been a popular topic of recent research, though its function and regulation are not yet fully understood. However, there is growing evidence to suggest that cortisol levels are linked to both stress and health (Bellingrath et al., 2008;Miller et al., 2007;O'Connor et al., 2013;Wirtz et al., 2007), and therefore the dynamics of cortisol secretion could represent important physiological mechanisms involved in the negative impact of stress on health. ...
... Much of the research into the relationships between cortisol, stress and health has focussed on cross-sectional or aggregated data, collected over multiple days. However, recent research has observed that intraindividual day-today variations in the CAR may be associated with daily experiences and state-specific factors (Dahlgren et al., 2009;Hellhammer et al., 2007; for review see Law et al., 2013;O'Connor et al., 2013;Stalder et al., 2009;Thorn et al., 2009). Research has also demonstrated the value of analysing this variability with multi-level modelling (Almeida et al., 2009;van Eck et al., 1996). ...
... Theoretically, the CAR gets people ready for the demands of the day [49]. A variety of studies [50][51][52][53][54] have found mixed links between the CAR and stress and different health outcomes. According to some studies [55][56], stress raises the CAR. ...
... Area Under the Curve with respect to ground (AUCg) was calculated using the formula by Pruessner et al. (2003) and following procedures outlined in previous research (Gartland et al., 2014;O'Connor et al., 2013). AUCg reflects total cortisol response throughout the TSST-g. ...
Stress-related eating has been well documented in previous literature. However, there is limited research investigating the role of cortisol reactivity in daily stress-eating associations in samples of adolescents and young adults. 123 participants completed a baseline questionnaire and the Trier Social Stress Test in groups. Four saliva samples were taken at - 10, + 00, + 10 and + 40 min during the stress-induction task. Following this, participants completed an online daily diary each evening for 14 consecutive days to record daily stress and between-meal snack consumption. Multilevel modelling indicated that daily stress was positively associated with daily snack intake, particularly for ego-threatening and work/academic stressors. Emotional and external eating styles were found to moderate the stress-snacking relationship. Cortisol reactivity also moderated stress-eating associations, such that as cortisol reactivity levels increased from lower to higher levels, the impact of stress on eating decreased. The current findings highlight the importance of cortisol reactivity status and eating styles in understanding the complex relationship between daily stress and eating behavior in adolescents and young adults. Future research should continue investigating stress-eating associations in these groups and explore the role of other aspects of hypothalamic-pituitary-adrenal axis functioning.
... all from 2013, these consequences of the prolonged stress situations were confirmed. Namely, it has been found that the prolonged stress, in this case recalling and writing about strong stress and traumatic experiences led to increased level of cortisol and increased respiratory infection [9]. ...
Living in a global world that is continuously changing while creating the experience of fluidity, we are losing ground and, therefore, stability. It affects mental health across the life span. During the last 12 months from the first WHO notification of the novel coronavirus 2019-nCoV, humanity started to experience a dramatic change in the level of plans, norms, expectations. Besides fear for personal safety and health, the directed distancing increased the gap in everyday quality of possibilities for personal contacts and support. Losing the ground and experience trembling, we were inevitably facing blurred boundaries, insecurity and a direct attack on our will and who we are. Furthermore, a year after, we realize that we are in the fertile ground for the manifestation and experience of anxiety, panic, and numerous psychosomatic disorders. The whole of humanity is suffering. Hence, those coming from helping professions (psychologist, psychotherapists, social workers) dealing with mental health are experiencing the kick even harder. The research we are conducting is checking their wellbeing a year after.
... Surprisingly, only limited research has examined relations between suicide risk and other components of HPA function, such as the cortisol awakening response (CAR). The CAR is defined as the rapid increase in cortisol levels following morning awakening (Clow et al., 2010) and has been found to be influenced by chronic stress, trauma and a range of other negative psychosocial variablesall factors frequently implicated in increased suicide risk (Boggero et al., 2017;Chida and Steptoe, 2009;Clow et al., 2010;Gartland et al., 2014;O'Connor et al., 2013;O'Connor et al., 2021). ...
Suicide is a global health issue. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, has been identified as one potential risk factor. Evidence is emerging to suggest that different psychological factors may be associated with increased resilience and vulnerability in this context. The current study investigated whether trait resilience, social support, socially prescribed perfectionism, trait worry and trait impulsivity influenced the cortisol awakening response (CAR) over a 7-day study in individuals vulnerable to suicide. 142 participants with a history of suicidal attempt or ideation (suicide vulnerability group; n = 95) and with no suicide risk history (control group; n = 47) were recruited. Participants completed baseline questionnaires before commencing a 7-day study where they provided cortisol samples immediately upon waking, at 15 min, 30 min and 45 min on 7 consecutive days. Higher worry, socially prescribed perfectionism and impulsivity, lower resilience and social support were found in the suicide vulnerability group compared to the control group. Lower levels of resilience, higher levels of socially prescribed perfectionism, worry and impulsivity were associated with significantly lower total CAR. Suicide group membership was also found to have an indirect effect on total CAR via trait worry. The current findings show for the first time, that these well-known psychological risk factors for suicide are associated with smaller total cortisol awakening responses. Researchers ought to elucidate the precise causal mechanisms linking these traits, CAR and suicide risk in order to develop interventions to help build resilience in vulnerable populations.
... Finally, we were interested in testing whether these variables together explain unique variance in addition to more established drivers of poor well-being and burnout in working populations, such as worry and rumination (Brosschot et al., 2006;Flaxman et al., 2012;O'Connor et al., 2021O'Connor et al., , 2013. In this study, we were interested in investigating work-related worry and rumination (work-related WR), defined as perseverative 'thought or thoughts directed to issues relating to work' (Cropley & Zijlstra, 2011, p. 6). ...
Poor wellbeing and burnout are significant issues among health-care professionals (HCPs) and may contribute to unsafe practice. In this exploratory study, we aimed to: provide the first investigation of the combined and unique influences of these psychological factors in predicting safe practice; confirm the role played by mindfulness in relation to wellbeing, burnout and safe practice; and investigate whether values and self-compassion predict additional variability above and beyond mindfulness skills. Ninety-eight NHS staff completed measures of wellbeing, burnout, perceived safety of practice, mindfulness, values and self-compassion. Practitioners with higher perceived safety of practice reported higher levels of mindfulness, but not values or self-compassion, particularly lower experiential avoidance and nonjudgmental attitude toward difficult thoughts. Mindfulness explained significant variability in psychological distress (20%), emotional exhaustion (8%), cognitive weariness (10%), patient safety related to oneself (7%), and related to work (8%). Values (obstruction) added unique variance for psychological distress (12%) and physical fatigue (10%). Moreover, self-compassion explained a small yet significant portion of variability in emotional exhaustion. These preliminary findings suggest that mindfulness processes may be associated with perceived safety of practice. The results also indicate that mindfulness-based interventions for HCPs may benefit from the inclusion of values-based action components and self-compassion practices.
... Aggregated effects of daily stress over several days may have a lasting impact on health (Leger, Charles, Turiano, & Almeida, 2016). Research with crosssectional and longitudinal designs have consistently shown that stress is related to mental and physical health (O'Connor, Walker, Hendrickx, Talbot, & Schaefer, 2013;Schat, Kelloway, & Desmarais, 2005) and these associations also depend on individual differences (e.g., Zunhammer, Eberle, Eichhammer, & Busch, 2013). Recently, an increasing amount of research has adopted diary methods to delineate the association of daily stressors to health and well-being. ...
The current study adopted a daily diary design to examine the impact of exposure to daily stressors, daily resilience, and trait aggression on somatic symptoms, and the moderation of aggression on the associations of exposure to daily stressors and resilience on somatic symptoms. College students completed baseline and seven-day daily assessments. The results indicated that a greater exposure to daily stressors and high levels of trait aggression predicted more daily somatic symptoms. Trait aggression moderated the influence of daily resilience on somatic symptoms, in which higher levels of resilience was associated with fewer somatic symptoms only for those with high levels of aggression but not for those with medium or low levels of aggression. The findings suggest the importance of considering daily stressor and trait aggression in screening for clinic visits for somatic symptoms. The findings also underscore the importance of aggression being a marker in prevention programs and enhancing resilience, particularly for aggressive individuals in preventing somatic symptoms.
Link to the full article: https://authors.elsevier.com/a/1b9qDheKdkCB9
... It is probable to argue that two kinds of higher-order thinking, NAT and worry, could be considered as mediators for the effectiveness of expressive writing procedures. O'Connor, Walker, Hendrickx, Talbot, and Schaefer (2013), in this respect, indicated that the reason for their findings showing no effectiveness of writing protocol might be individuals' propensity to engage in perseverative thinking about stressful events. Indeed, Gortner, Rude, and Pennebaker (2006) found that the effectiveness of expressive writing on the levels of depression is mediated by brooding. ...
The aim of the present study is to provide additional knowledge about the mediatory processes through which language contributes to the symptoms of mental illness. Although recent studies have provided insight about the relationship between language and the indicators of mental illness, the role of intervening variables in this connection has been ignored. The present investigation tested a structural equation model in which the need for the absolute truth about self and worry mediated the relationship of the gap between inner psychological experience and language with anxiety and depression. The results have provided support for the model and showed that the gap predicts both the need for absolute truth and worry which, in turn, predict the levels of anxiety and depression. The results have been discussed in the light of previous research, and implications for future research have also been considered.
... In 2006, Brosschot, Gerin, and Thayer introduced the perseverative cognition hypothesis (PCH), which suggested that worry and/or repetitive thinking may lead to disease by prolonging stress-related physiological activation by amplifying short-term responses, delaying recovery, or reactivating responses after a stressor has been experienced. In the last decade, a number of important reviews and papers have been published clearly demonstrating that perseverative cognition is associated with somatic outcomes (e.g., O'Connor et al., 2013;. ...
Perseverative cognition is defined as the repetitive or sustained activation of cognitive representations of past stressful events or feared events in the future and even at non-clinical levels it causes a “fight-or-flight” action tendency, followed by a cascade of biological events, starting in the brain and ending as peripheral stress responses. In the past decade, such persistent physiological activation has proven to impact individuals’ health, potentially leading to somatic disease. As such, perseverative cognition has recently been proposed as the missing piece in the relationships between stress, psychopathology, and risk for health. Perseverative cognition is indeed a hallmark of conditions such as anxiety and mood disorders that are at increased -though still unexplained- cardiovascular risk. Although the pivotal role of ruminative and worrisome thoughts in determining the onset and maintenance of psychopathological disorders has been acknowledged for a long time, its effects on the body via reciprocal influences between mental processes and the body’s physiology have been neglected. Moreover, perseverative cognition is definitely not restricted to psychopathology, it is extremely common and likely even omnipresent, pervading daily life. The objective of the Research Topic is to provide an interdisciplinary examination of cutting-edge neuroscientific research on brain-body signatures of perseverative cognition in both healthy and psychopathological individuals. Despite the evident role of the brain in repetitive thinking and the assumption that our mind is embodied, bran-body pathways from perseverative cognition to health risk have remained largely unexplored.
... In addition, previous work also demonstrates that somatic disturbance in depressed individuals is associated with higher neuroendocrine hyperreactivity (O'Connor et al., 2013) that, in turn, is related to higher coerciveness in parenting practices (Sturge-Apple et al., 2011). Consistent with these findings, it is possible that nonspecific somatic symptoms may be related to an increased overreactivity in parenting practices, beyond the effect of depression symptoms. ...
Background: Both depressive and somatic symptoms are significant predictors of parenting and coparenting problems. However, despite clear evidence of their co-occurrence, no study to date has examined the association between depressive-somatic symptoms clusters and parenting and coparenting. The current research sought to identify and cross-validate clusters of cognitive-affective depressive symptoms and nonspecific somatic symptoms, as well as to test whether clusters would differ on parenting and coparenting problems across three independent samples of mothers.
Method: Participants in Studies 1 and 3 consisted of 409 and 652 community mothers, respectively. Participants in Study 2 consisted of 162 mothers exposed to intimate partner violence. All participants prospectively completed self-report measures of depressive and nonspecific somatic symptoms and parenting (Studies 1 and 2) or coparenting (Study 3).
Results: Across studies, three depression-somatic symptoms clusters were identified: no symptoms, high depression and low nonspecific somatic symptoms, and high depression and nonspecific somatic symptoms. The high depression-somatic symptoms cluster was associated with the highest levels of child physical maltreatment risk (Study 1) and overt-conflict coparenting (Study 3). No differences in perceived maternal competence (Study 2) and cooperative and undermining coparenting (Study 3) were found between the high depression and low somatic symptoms cluster and the high depression-somatic symptoms cluster.
Conclusions: The results provide novel evidence for the strong associations between clusters of depression and nonspecific somatic symptoms and specific parenting and coparenting problems. Cluster stability across three independent samples suggest that they may be generalizable. The results inform preventive approaches and evidence-based psychotherapeutic treatments.
... In 2006, Brosschot, Gerin, and Thayer introduced the perseverative cognition hypothesis (PCH), which suggested that worry and/or repetitive thinking may lead to disease by prolonging stress-related physiological activation by amplifying short-term responses, delaying recovery, or reactivating responses after a stressor has been experienced. In the last decade, a number of important reviews and papers have been published clearly demonstrating that perseverative cognition is associated with somatic outcomes (e.g., Brosschot et al., 2005;Verkuil et al., 2010;O'Connor et al., 2013;Ottaviani et al., 2015). ...
Recent developments in stress theory have emphasized the significance of perseverative cognition (worry and rumination) in furthering our understanding of stress-disease relationships. Substantial evidence has shown that perseverative cognition (PC) is associated with somatic outcomes and numerous physiological concomitants have been identified (i.e., cardiovascular, autonomic, and endocrine nervous system activity parameters). However, there has been no synthesis of the evidence regarding the association between PC and health behaviors. This is important given such behaviors may also directly and/or indirectly influence health and disease outcomes (triggered by PC). Therefore, the aim of the current review was to synthesize available studies that have explored the relationship between worry and rumination and health behaviors (health risk: behaviors which, if performed, would be detrimental to health; health promoting: behaviors which, if performed, would be beneficial for health). A systematic review and meta-analyses of the literature were conducted. Studies were included in the review if they reported the association between PC and health behavior. Studies identified in MEDLINE or PsycINFO (k = 7504) were screened, of which 19 studies met the eligibility criteria. Random-effects meta-analyses suggested increased PC was generally associated with increased health risk behaviors but not health promoting behaviors. Further analyses indicated that increases in rumination (r = 0.122), but not reflection (r = −0.080), or worry (r = 0.048) were associated with health risk behaviors. In conclusion, these results showed that increases in PC are associated with increases in health risk behaviors (substance use, alcohol consumption, unhealthy eating, and smoking) that are driven primarily through rumination. These findings provide partial support for our hypothesis that in Brosschot et al.'s (2006) original perseverative cognition hypothesis, there may be scope for additional routes to pathogenic disease via poorer health behaviors.
... In addition to the cortisol levels at each time point, two measures of area under the curve were calculated. Using the five sampling time points, the two AUC measures were determined following established procedures (Gartland et al., 2014;O'Connor et al., 2013;Pruessner et al., 2003). Area under the curve with respect to ground (AUCg) is a measure of total cortisol output throughout the stressor and area under the curve with respect to increase (AUCi) captures the sensitivity of the HPA axis system and is a measure of its ability to change in response to the MAST. ...
... Brosschot, Gerin, and Thayer (2006), in their perseverative cognition hypothesis (PCH), have suggested that worry or repetitive thinking may lead to disease by prolonging stress-related physiological activation, amplifying short-term responses, delaying recovery, or reactivating responses after a stressor has been experienced. There is a growing body of evidence that has demonstrated that perseverative cognition is associated with somatic outcomes both crosssectionally, prospectively, and using daily diary methods (see O'Connor, Walker, Hendrickx, & Schaefer, 2013;Verkuil, Brosschot, Meerman, & Thayer, 2012;Verkuil, Brosschot, Gebhardt, & Thayer, 2010 for a review). This suggests that research on appraisals needs to include indices of rumination in relation to stress appraisal processes. ...
... To note, although most individuals have the audacity to dream for success, only a handful would actually try to make the first step of achieving it. A majority of people would dwell on the conceptualization stage (O'Connor et al., 2013). In order to compare the two metaphors more fluidly, a common ground for analysis is needed. ...
This paper looks at the Aminuddin Baki's Torch Movement Speech 2 from the metaphorical perspective. The objective of the study is to identify the type of metaphors employed and how the metaphors are conveyed in the Speech. Numerous studies have been done on the biographical portion of Aminuddin Baki but none on all his Torch Movement speeches that he had made on the progression of the natives in Malaysia at that time. This study used a qualitative method through Neo-Aristotelian Criticism perspective in the analysis of speech. This study demonstrates the relevance of ancient Malay metaphor in modern day communication interaction.
... Our study highlights that gender differences in perseverative thoughts may contribute the well-known gender differences in syndromes characterised by medically unexplained symptoms (Kroenke & Spitzer, 1998). Perseverative thoughts – such as worry and rumination – have been consistently linked to depressive and/or anxious symptoms or psychopathology in adults (see Aldao, Nolen-Hoeksema, & Schweizer, 2010; Nolen-Hoeksema et al., 2008) and in adolescents (e.g. Calvete, Orue, & Hankin, 2013; Michl, McLaughlin, Shepherd, & Nolen-Hoeksema, 2013) as well. ...
Abstract Stable tendency to perseverative thoughts such as trait rumination and worry can influence somatic health. The purpose of the study was to investigate the relationship between perseverative thoughts and somatic complaints, and the possible mediating effects of perceived stress, negative and positive affectivity in adolescence. Having an acute or a chronic condition were also assessed to be controlled for and to reveal their effects on symptom reporting. Three hundred and six adolescents from 7th to 12th grade with mean age of 16.33 (SD=1.29) participated in the study. Mediation analysis suggested that impact of trait-like perseverative thoughts on complaints were mediated by perceived stress and negative affectivity. Having an acute condition had also an effect on symptom-reporting through increased negative affectivity. Our results highlight that rumination or worry as stable intrapersonal characteristics are relevant processes in health and can be potential targets in prevention programs in adolescence.
... Indeed, a useful next step might be to develop a SMS tool that links stressful situations with more adaptive emotional regulation strategies. Similarly, researchers ought to investigate the role of cortisol, perseverative cognition and stress appraisals within the context of developing interventions to reduce stress-induced eating[52][53][54]. There are a number of shortcomings with the current study that require additional comment. ...
Background:
Stress may indirectly contribute to disease (e.g. cardiovascular disease, cancer) by producing deleterious changes to diet.
Purpose:
The purpose of this study was to test the effectiveness of a stress management support (SMS) tool to reduce stress-related unhealthy snacking and to promote stress-related healthy snacking.
Methods:
Participants were randomized to complete a SMS tool with instruction to link stressful situations with healthy snack alternatives (experimental) or a SMS tool without a linking instruction (control). On-line daily reports of stressors and snacking were completed for 7 days.
Results:
Daily stressors were associated with unhealthy snack consumption in the control condition but not in the experimental condition. Participants highly motivated towards healthy eating consumed a greater number of healthy snacks in the experimental condition on stressful days compared to participants in the experimental condition with low and mean levels of motivation.
Conclusions:
This tool is an effective, theory driven, intervention that helps to protect against stress-induced high-calorie snack consumption.
... Female gender and non-white race, as well as excessive consumption of coffee and/or alcohol, or certain physical problems like chronic kidney disease may also increase the risk of incident insomnia in the general population [17]. Empirical evidence suggests that biological factors such as cytokines [18,19], genetic and metabolic disorders [20] and cortisol awaking response [19,21] can contribute to the disruption of the sleep cycle. ...
Background:
The aims of this study were:
1) to assess the frequency of insomnia among patients during admission in a Palliative Care Unit (PCU); 2) to study the association between emotional distress and insomnia, taking physical, environmental and other psychological factors into account.
Methods:
Prospective observational study including patients consecutively admitted to a PCU during eight months, excluding those with severe cognitive problems or too low performance status. Insomnia was assessed by asking a single question and by using the Sleep Disturbance Scale (SDS), and emotional distress using the Hospital Anxiety and Depression Scale (HADS). Physical, environmental and other psychological factors potentially interfering with sleep quality were evaluated. Association between insomnia and the factors evaluated was studied using univariate and multivariate regression analyses.
Results:
61 patients were included (mean age 71.5 years; 95% with oncological disease); 38 (62%) answered "yes" to the insomnia single question and 29 (47%) showed moderate to severe insomnia according to the SDS. 65% showed clinically significant emotional distress and 79% had nocturnal rumination. The physical symptoms most often mentioned as interfering with sleep quality were pain (69%) and dyspnoea (36%). 77% reported at least one environmental disturbance. In the univariate analysis, answering "yes" to the insomnia single question was significantly associated with higher HADS score, anxiety, nocturnal rumination, clear knowledge of the diagnosis, higher performance status and dyspnoea; moderate to severe insomnia was significantly associated with nocturnal rumination, higher performance status, environmental disturbances and daytime sleepiness. In the multivariate regression analysis, answering "yes" to the single question was associated with dyspnoea (OR 7.2 [1.65-31.27]; p = 0.009), nocturnal rumination (OR 5.5 [1.05-28.49]; p = 0.04) and higher performance status (OR 14.3 [1.62-125.43]; p = 0.017), and moderate to severe insomnia with nocturnal rumination (OR 5.6 [1.1-29.1]; p = 0.041), and inversely associated with daytime sleepiness (OR 0.25 [0.07-0.9]; p = 0.043).
Conclusions:
Insomnia was highly frequent. Several physical, psychological and environmental factors seemed to influence insomnia. Within the multimodal management of insomnia, the assessment of nocturnal rumination may be of particular interest, irrespective of emotional distress. Further studies with larger sample sizes could confirm this result.
... Recent research has begun to assess the potential relationships between C and cortisol (Nater et al., 2010). This is a promising new direction for this area of research, as cortisol is a hormone which has a diurnal secretory rhythm, can be measured with minimum disruption to participants, is a marker of hypothalamic-pituitary-adrenocortical axis function, and has been suggested as an indicator of well-being and health (Clow, Thorn, Evans, & Hucklebridge, 2004;O'Connor, Walker, Hendrickx, Talbot, & Schaefer, 2013). Furthermore, evidence indicates that cortisol varies with positive affect and has been suggested as a potential mediator between positive affect and health (Brummett, Boyle, Kuhn, Siegler, & Williams, 2009;Dockray & Steptoe, 2010). ...
Objectives:
Higher conscientiousness (C) predicts better health outcomes. Recent research suggests that stress may play an important role in explaining this relationship. The current study aimed to establish whether C moderates the relationship between daily hassle appraisals, daily affect, and physical symptoms.
Design and methods:
A daily diary design was used, where participants (N = 103) completed a baseline measure of C followed by a 14-day daily diary, providing daily details of hassles (primary and secondary appraisals) experienced as well as positive and negative affect and physical symptoms.
Results:
Hierarchical linear modelling revealed that Total C (as well as two facets of C: Order and Industriousness) moderated the relationship between stress appraisals and positive affect. Specifically, the negative association between the daily appraisal of hassles as stressful (i.e., where perceived demands outweighed perceived resources) and positive affect was stronger for lower and average levels of C, Order, and Industriousness. No significant moderated effects were found for negative affect or physical symptoms. The Order facet was also found to be an important factor predicting attrition.
Conclusions:
The current study provided evidence that C and two of its facets can moderate the relationship between hassle appraisal and positive affect. C may exert part of its influence on health by modifying the effects of daily stressors.
Statement of contribution:
What is already known on this subject? Conscientiousness has a significant positive effect on longevity and health status. While the performance of health behaviours may partially account for this relationship, evidence suggests that it does not fully mediate the effect. Research has begun to look at stress as a possible additional explanatory variable, and there is evidence that Conscientiousness moderates the relationship between stress and health behaviours. What does this study add? Shows that Conscientiousness and two of its facets (Order and Industriousness) moderate the relationship between hassle appraisal and positive affect. Highlights the importance of studying lower order facets of personality in health research. Suggests that Conscientiousness may exert part of its influence on health by modifying the effects of daily stressors.
Objective
Poor respiratory health outcomes have been associated with poorer physical health and higher psychological distress. The aim of this study was to investigate whether illness worry, alexithymia or low sense of coherence predict i) the onset of new respiratory disease, ii) respiratory symptoms or iii) lung function among the working-age population, independently of comorbidity mood-, anxiety, or alcohol abuse disorders.
Methods
The study was conducted among a nationally representative sample of the Finnish population (BRIF8901) aged 30–54 years (N = 2310) in 2000–2001 and was followed up in 2011. Individuals with a diagnosed respiratory disease or a severe psychiatric disorder at baseline were excluded. Lung function was measured by a spirometry test and psychiatric disorders were diagnosed using a structured clinical interview. Structured questionnaires were used to measure self-reported respiratory symptoms and diseases, illness worry, alexithymia, and sense of coherence.
Results
High illness worry predicted an 11-year incidence of asthma (OR 1.47, 95% CI 1.09–1.99, p = 0.01). Alexithymia predicted shortness of breath (OR 1.32, 95% CI 1.13–1.53, p < 0.01) and 11-year incidence of COPD (OR 2.84, 95% CI 1.37–5.88, p < 0.01), even after several adjustments for physical and mental health. Psychological dispositions did not associate with lung function in 2011.
Conclusions
In the general population, psychological factors that modify health behaviour predicted adverse respiratory health outcomes independently of lung function after 11 years of follow-up. This indicates that considering them part of personalized treatment planning is important for promoting health-related behaviour among the working-age population.
The circadian system induces oscillations in most physiological variables, with periods close to 24 hours. Dysfunctions in clock-controlled body functions, such as sleep disorders, as well as deregulation of clock gene expression or glucocorticoid levels have been observed in cancer patients. Moreover, these disorders have been associated with a poor prognosis or worse response to treatment. This work explored the circadian rhythms at behavioral and molecular levels in a murine melanoma model induced by subcutaneous inoculation of B16 tumoral cells. We observed that the presence of the tumors induced a decrease in the robustness of the locomotor activity rhythms and in the amount of nighttime activity, together with a delay in the acrophase and in the activity onset. Moreover, these differences were more marked when the tumor size was larger than in the initial stages of the tumorigenesis protocol. In addition, serum glucocorticoids, which exhibit strong clock-controlled rhythms, lost their circadian patterns. Similarly, the rhythmic expression of the clock genes Bmal1 and Cry1 in the hypothalamic Suprachiasmatic Nuclei (SCN) were also deregulated in mice carrying tumors. Altogether, these results suggest that tumor-secreted molecules could modulate the function of the central circadian pacemaker (SCN). This could account for the worsening of the peripheral biological rhythms such as locomotor activity or serum glucocorticoids. Since disruption of the circadian rhythms might accelerate tumorigenesis, monitoring circadian patterns in cancer patients could offer a new tool to get a better prognosis for this disease.
Objective:
Evidence suggests that perseverative cognition (PC), the cognitive representation of past stressful events (rumination) or feared future events (worry), mediates the relationship between stress and physical disease. However, the experimental evidence testing methods to influence PC and the subsequent relationship with health outcomes has not been synthesized. Therefore, the current review addressed these gaps.
Method:
Studies randomly assigning participants to treatment and control groups, measuring PC and a physical and/or behavioral health outcome after exposure to a nonpharmacological intervention, were included in a systematic review. Key terms were searched in Medline, PsycINFO and CINAHL databases. Of the screened studies (k = 10,703), 36 met the eligibility criteria.
Results:
Random-effects meta-analyses revealed the interventions, relative to comparison groups, on average produced medium-sized effects on rumination (g = -.58), small-to-medium sized effects on worry (g = -.41) and health behaviors (g = .31), and small-sized effects on physical health outcomes (g = .23). Effect sizes for PC were negatively associated with effect sizes for health behaviors. (following outlier removal). Effect sizes for PC were significantly larger when interventions were delivered by health care professionals than when delivered via all other methods. No specific intervention type (when directly compared against other types) was associated with larger effect sizes for PC.
Conclusions:
Psychological interventions can influence PC. Medium-sized (negative) effect sizes for PC correspond with small (but positive) health behavior effect sizes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Objectives. Written benefit finding is known to improve psychological and physical health in a range of patient groups. Here, we tested the efficacy of written benefit finding, delivered online during the Covid-19 pandemic lockdown, on mood and physical symptoms. We also investigated perseverative thinking as a moderator of these effects. Design. A quantitative longitudinal design was employed. Main Outcome Measures. Participants (n = 91) completed self-report measures of anxiety, depression, stress and physical symptoms at baseline, and two weeks after being randomised to complete three consecutive days of writing about the positive thoughts and feelings they experienced during the pandemic (written benefit finding) or to unemotively describe the events of the previous day (control). State anxiety was measured immediately before and after writing. Perseverative thinking was measured at baseline. Results. Anxiety and depression symptoms decreased between baseline and the two week follow-up, but did not differ significantly between the two conditions. Perseverative thinking was negatively associated with changes in symptoms of anxiety, depression and stress, but did not moderate any writing effects. There was a significant reduction in state anxiety in the written benefit finding condition. Conclusions. Written benefit finding may be a useful intervention for short-term improvements in wellbeing.
Due to their work activities, emergency physicians are regularly exposed to exceptional mental and physical situations. In order to prevent stress-related illnesses, the triggers of hormonal and subjectively perceived stress must be understood better. On a sample of emergency physicians from two air rescue services (N = 80), the cortisol awakening response (CAR) was determined on flight rescue days, clinic days, and days off. Pearson correlations showed significant connections between the CAR on flight rescue days and individual scales of the Trier Inventory for Chronic Stress (TICS) and the Perceived Stress Scale (PSS). The results indicate that a lower subjective stress level is associated with higher levels of hormonal stress. Stepwise regression analyses showed a significant influence of the number of professional years, subjectively perceived stress, pressure to succeed, and social isolation. The results suggest that the hormonal stress burden of emergency physicians is in a complex relationship with perceived strain.
People in this modern era now live in a stressful environment and in a civilization full of competition to such an extent that their bodies, minds, and souls have contracted to incompleteness. The aims of this study are to improve and identify ways to cope with this condition, by following the process of “question—main factor—coping strategy—case study—research challenge.” The main factors listed are (1) prioritizing mind-body dualism, especially the material body, (2) active sympathetic nerves as a norm, and (3) dominant left brain activity inhibiting the right brain. The coping strategies are (1) transformation through meditation, (2) surrender and self-inquiry on the consciousness of oneness, and (3) spiritual covenant. The case studies analyzed are (1) We’ll app and (2) Corporate Mandala. Following a literature review and reviewing case studies, this study proposes 6 preliminary dimensions and 12 hypotheses aimed to improve the increasing problems in creativity limitation and depression.
It is really difficult to live in a society in which the human contact is decreasing each day, and where stressful situations become unavoidable. In order to be healthy and have a healthy lifestyle, the coping style plays a huge role.
Witnessing this situation every day, the aim of this research is to investigate the connection among psychosomatic tendencies, different coping styles and locus of control in young adults, aged from 24 to 34 years, in the Republic of North Macedonia.
The evaluated sample consists of 187 (M=47; F=140) participants, randomly selected, who accepted to be the part of the research by filling in the on-line questionnaires, delivered through Google forms. The short demographic questionnaire and three psychological instruments were used: Cybernetic Battery of Conjunctive tests KON-6, CISS-21 (Coping Inventory for Stressful Situations), and Internal-External Locus of Control Scale (I-E).
Spearman’s correlation was used in order to check and approve the connectedness among psychosomatic tendencies, coping styles and locus of control.
The obtained results confirm that there is a significant correlation among tendencies towards psychosomatic reaction, coping styles and locus of control among young adults in the Republic of North Macedonia.
Studies show teaching is a highly stressful profession and that chronic work stress is associated with adverse health outcomes. This study analysed physiological markers of stress and self-reported emotion regulation strategies in a group of middle school teachers over 1 year. Chronic physiological stress was assessed with diurnal cortisol measures at three time points over 1 year (fall, spring, fall). The aim of this longitudinal study was to investigate the changes in educators' physiological level of stress. Results indicate that compared to those in the fall, cortisol awakening responses were blunted in the spring. Further, this effect was ameliorated by the summer break. Additionally, self-reported use of the emotion regulation strategy reappraisal buffered the observed blunting that occurred in the spring.
Objectives: The Hostile-World Scenario (HWS) denotes a personal belief system regarding threats to one’s physical and mental integrity. We examined whether the HWS predicted health among older adults.
Methods: The Israeli branch of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) provided data on 1286 participants, aged 50+, interviewed in two waves four years apart. A special measure assembled items pertinent to the HWS throughout the SHARE survey. Nine outcomes indicated physical health (e.g., activities of daily living, medical conditions) and mental health (e.g., depressive symptoms, satisfaction with life).
Results: The HWS at Wave 1 predicted all physical and mental outcomes at Wave 2, except cognitive functioning, beyond effects of sociodemographics and the respective outcome’s baseline at Wave 1. This predictive effect was stronger among older participants.
Discussion: The results support the conception of the HWS as a psychological monitor that senses approaching functional declines in later life.
Repetitive negative thinking processes like worry are essential maintaining transdiagnostic factors of psychopathology. The article reviews basic concepts and therapeutic techniques addressing worry processes.
This article summarizes the physical and psychological problems that can befall performing artists and aims to provide an insight into their prevention.
Writing expressively about distressing experiences has been found to have beneficial health effects. This study examined the effects of written emotional disclosure (WED) interventions on the self-reported health and job satisfaction of school teachers, and compared standard WED instructions with two commonly used more prescriptive variants. The study also controlled and measured the between-condition comparability of participants' post-writing benefit expectations. Teachers (final N = 77) were randomized to a control writing condition or one of three WED conditions that varied the number and/or type of experiences participants wrote about. All teachers wrote for 20 min on three consecutive days at home. Psychological health, physical health, and job satisfaction were assessed at baseline, two weeks, two months, and six months post-intervention. Participants' expectations of benefit following writing were equivalent across conditions. There was no significant effect of any of the three WED interventions, compared to control writing, on psychological or physical health or job satisfaction. There was, however, a significant and sizeable improvement in physical health across writing conditions from baseline to two-month follow-up, and this was maintained at six months. The findings show that control writing can produce comparable expectations of benefit to WED, and are consistent with the possibility that benefit expectancies can effect health improvements following disclosure or control writing. Most previous studies have examined WED with students or patient groups, and the findings also raise an important question about the feasibility of multi-session writing interventions for mid-life working samples. Further studies with occupational groups are warranted, as is further investigation into the role of positive expectancies in WED effects.
Perseverative cognition, such as worry and rumination, is a common reaction to stressful events. In this review, we present a self-regulation perspective on perseverative cognition and propose that it forms part of the default response to threat, novelty and ambiguity. This default response is enhanced in chronic worriers who show difficulties in recognizing signals of safety, due to excessive goal commitment and the use of perseverative cognition as a strategy to cope with perceived threats to goal attainment. It is proposed that worrying about stressful events increases the total amount of time that stress has a 'wear and tear' effect on the human body. Studies supporting this perseverative cognition hypothesis are reviewed. Moreover, we provide preliminary evidence that unconscious forms of perseverative cognition have substantial somatic health effects as well. In conclusion, a focus on perseverative cognition is warranted when investigating links between stressful events and somatic health.
This study investigated 3 broad classes of individual-differences variables (job-search motives, competencies, and constraints) as predictors of job-search intensity among 292 unemployed job seekers. Also assessed was the relationship between job-search intensity and reemployment success in a longitudinal context. Results show significant relationships between the predictors employment commitment, financial hardship, job-search self-efficacy, and motivation control and the outcome job-search intensity. Support was not found for a relationship between perceived job-search constraints and job-search intensity. Motivation control was highlighted as the only lagged predictor of job-search intensity over time for those who were continuously unemployed. Job-search intensity predicted Time 2 reemployment status for the sample as a whole, but not reemployment quality for those who found jobs over the study's duration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Occupational stress, in particular 'high strain' (defined as high psychological job demands and low job control; Karasek, 1979) has been found to be associated with coronary heart disease and hypertensive risk in a number of occupations. However, despite the large number of studies of GP stress, none have extended this model to British GPs. It was hypothesized that 'high strain' GPs would exhibit heightened levels of cardiovascular arousal compared to 'low strain' GPs, with a carry-over effect into the non-work day. Twenty low strain GPs were compared with seven high strain GPs on ambulatory blood pressure during a work day, work day evening, non-work day and non-work day evening. Work day and non-work day monitoring was counterbalanced. Levels of mental health and job satisfaction were also assessed. High strain GPs' systolic blood pressure and diastolic blood pressure was generally elevated, in particular during the non-work day, compared to their low strain counterparts. No gender differences were found for any of the BP variables. Levels of depression, anxiety and job dissatisfaction were found to be significantly greater for high strain GPs. In terms of GP stress research, these findings are novel; however replication is required with a larger sample.
This study investigated whether emotional expression of traumatic experiences influenced the immune response to a hepatitis B vaccination program. Forty medical students who tested negative for hepatitis B antibodies were randomly assigned to write about personal traumatic events or control topics during 4 consecutive daily sessions. The day after completion of the writing, participants were given their first hepatitis B vaccination, with booster injections at 1 and 4 months after the writing. Blood was collected before each vaccination and at a 6-month follow-up. Compared with the control group, participants in the emotional expression group showed significantly higher antibody levels against hepatitis B at the 4 and 6-month follow-up periods. Other immune changes evident immediately after writing were significantly lower numbers of circulating
T helper lymphocytes and basophils in the treatment group. The finding that a writing intervention influences immune response provides further support for a link between emotional disclosure and health. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The concept of stress has a long and perhaps foundational history in health psychology. However, it is also not without its detractors, who point out imprecise and simplistic use of the concept. Four challenges for stress research in health psychology delineate the nuanced and contextualised future. First, 'stress' can be located in the environment, in appraisal or in response (e.g., emotions or physiology). Careful conceptualisation and assessment can differentiate among these locales, as well as reveal interactions among them. Second, coping refers to the transaction between stress and the affected person. Understanding exactly why coping moderates the effects of stress is a major challenge for coping research. Third, stress happens to different people with different personalities and temperaments and at different stages of their lives. People may even be different from themselves at different life stages. These individual differences can impact all manner of stress and coping. Fourth, stress is dynamic. Minor events come and go, and major events create a cascade of changes in the individual's life. Understanding how stress, coping and health change over time within individuals (i.e., in a multi-level framework) will be a major advance for the field.
The long-term impact of role stress (conflict and ambiguity), cognitive rumination and their interaction were analysed upon morning and evening saliva cortisol secretion. The sample consisted of 52 male and 24 female British white-collars who had participated in a survey study on psychosocial working conditions 3.5 years earlier. Saliva cortisol secretion was measured over seven consecutive days with two measures: in the morning on awakening and at 22.00 hours. Stepwise linear multiple regression analyses was used for the statistical analyses. Role ambiguity at baseline and the interaction between role ambiguity and trait rumination contributed to explaining elevations in morning saliva cortisol secretion 3.5 years later (R(2) = 0.045; F = 4.57; p < 0.05), while role conflict at baseline significantly predicted increases in long-term evening saliva cortisol (R(2) = 0.057; F = 8.99; p < 0.01). The findings support a long-term relationship between chronic stress exposure and saliva cortisol secretion and some support for the assumption of cognitive rumination moderating the stressor-strain relationship. STATEMENT OF RElevance: The study is of interest for ergonomics practice because it demonstrates that work role ambiguity and role conflict, typically associated with organisational downsizing and restructuring, may contribute to long-term psycho-physiological reactivity. This could expose workers to increased health risks. Therefore, stress management programmes should include the concept of role stress, especially at a time where many work organisations are undergoing significant change. Management should also be made aware of the importance of communicating clear goals, objectives and lines of authority as well as providing sufficient training for those in new job roles.
Somatic health complaints are extremely common and are responsible for a large part of human suffering and healthcare costs. It has been recognised that psychosocial stress can affect somatic health. According to the 'perseverative cognition hypothesis', stressful events affect somatic health because people keep on worrying about them. Worry would prolong stress-related physiological activity that can ultimately lead to health problems. In this ambulatory study we tested whether stressful events and worry predict daily somatic complaints, and whether worry mediates the effects of stressful events. In addition, it was tested whether these effects were independent from negative affect. Using electronic diaries, 69 teachers (age 21-60 years) from Dutch primary and secondary schools reported daily stressful events, worry episodes, negative affect and somatic complaints for a period of 6 days. Results showed that worry intensity predicted the number of somatic complaints and mediated the effect of stressful events on somatic complaints. Furthermore, these results were independent from biobehavioural variables and daily negative affect. These findings support the perseverative cognition hypothesis proposing that the negative somatic health effects of stressful events are largely due to the worry; that is, to the prolonged cognitive representation of stressors.
Elevated pre-operative neutrophil: lymphocyte ratio (NLR) has been identified as a predictor of survival in patients with hepatocellular and colorectal cancer. The aim of this study was to examine the prognostic value of an elevated preoperative NLR following resection for oesophageal cancer.
Patients who underwent resection for oesophageal carcinoma from June 1997 to September 2007 were identified from a local cancer database. Data on demographics, conventional prognostic markers, laboratory analyses including blood count results, and histopathology were collected and analysed.
A total of 294 patients were identified with a median age at diagnosis of 65.2 (IQR 59-72) years. The median pre-operative time of blood sample collection was three days (IQR 1-8). The median neutrophil count was 64.2 x 10-9/litre, median lymphocyte count 23.9 x 10-9/litre, whilst the NLR was 2.69 (IQR 1.95-4.02). NLR did not prove to be a significant predictor of number of involved lymph nodes (Cox regression, p = 0.754), disease recurrence (p = 0.288) or death (Cox regression, p = 0.374). Furthermore, survival time was not significantly different between patients with high (>or= 3.5) or low (< 3.5) NLR (p = 0.49).
Preoperative NLR does not appear to offer useful predictive ability for outcome, disease-free and overall survival following oesophageal cancer resection.
In an attempt to eliminate similar item content as an alternative explanation for the relation between depression and rumination, a secondary analysis was conducted using the data from S. Nolen-Hoeksema, J. Larson, and C. Grayson (1999). After constructing a measure of rumination unconfounded with depression content, support for a two factor model of rumination was found. These analyses indicate that the 2 components, reflective pondering and brooding, differentially relate to depression in terms of predictive ability and gender difference mediation. The results presented here support the general premise of Nolen-Hoeksema's Response Styles Theory (S. Nolen-Hoeksema 1987) that rumination can contribute to more depressive symptoms and to the gender difference in depression, but suggest important refinements of the theory. Such refinements include the need to differentiate between the reflective pondering component of rumination and the brooding component in rumination research. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/44342/1/10608_2004_Article_464752.pdf
This study investigated the impact of conscientiousness and its facets on health behaviors and daily hassles (stressors) and the moderating effects of conscientiousness on the hassles-health behavior relationship
Four hundred and twenty-two employees completed daily diaries over 4 weeks. Day-to-day within-person effects of daily hassles on health behaviors were examined, together with the influence of conscientiousness.
Using hierarchical multivariate linear modeling, the results showed that conscientiousness was associated with lower consumption of high-fat snacks and more fruit and higher caffeine intake and smoking (in smokers) across the 28-day study period. Facets of conscientiousness were also found to moderate the effects of daily hassles on vegetable consumption, smoking, and likelihood of exercising each day. Participants with higher levels of order exercised more on days when they experienced daily hassles, whereas participants with lower levels of self-efficacy consumed less vegetables on stressful days. Among smokers, those with higher levels of self-discipline reported smoking more on days when they encountered hassles.
These findings indicate that conscientiousness and its facets may influence health status directly via changes in health behaviors and indirectly through influencing stress-health behavior relations.
On the basis of previous work, freshmen should evidence improved health after writing about their thoughts and feelings associated with entering college. One hundred thirty subjects were assigned to write either about coming to college or about superficial topics for 20 min on 3 days. One fourth of the subjects in each group wrote during the 1st, 5th, 9th, or 14th week of classes. Physician visits for illness in the months after writing were lower for the experimental than for the control subjects. Self-reports of homesickness and anxiety were higher in the experimental group 2-3 months after writing. By year's end, experimental subjects were either superior or similar to control subjects in grade average and in positive moods. No effects emerged as a function of when people wrote, suggesting that the coping process can be accelerated. Implications for comparing insight treatments with catharsis and for distinguishing between objective and self-report indicators of distress are discussed.
Examined whether writing about traumatic events would influence long-term measures of health as well as short-term indicators of physiological arousal and reports of negative moods in 46 introductory psychology students. Also examined were aspects of writing about traumatic events (i.e., cognitive, affective, or both) that were most related to physiological and self-report variables. Ss wrote about either personally traumatic life events or trivial topics on 4 consecutive days. In addition to health center records, physiological measures and self-reported moods and physical symptoms were collected throughout the experiment. Findings indicate that, in general, writing about both the emotions and facts surrounding a traumatic event was associated with relatively higher blood pressure and negative moods following the essays, but fewer health center visits in the 6 mo following the experiment. It is concluded that, although findings should be considered preliminary, they bear directly on issues surrounding catharsis, self-disclosure, and a general theory of psychosomatics based on behavioral inhibition. (24 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Nonpharmacological treatments with little patient cost or risk are useful supplements to pharmacotherapy in the treatment of patients with chronic illness. Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports, well-being, and health care use in healthy individuals.
To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using standardized quantitative outcome measures.
Randomized controlled trial conducted between October 1996 and December 1997.
Outpatient community residents drawn from private and institutional practice.
Volunteer sample of 112 patients with asthma (n = 61) or rheumatoid arthritis (n = 51) received the intervention; 107 completed the study, 58 in the asthma group and 49 in the rheumatoid arthritis group.
Patients were assigned to write either about the most stressful event of their lives (n = 71; 39 asthma, 32 rheumatoid arthritis) or about emotionally neutral topics (n = 41; 22 asthma, 19 rheumatoid arthritis) (the control intervention).
Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinically examined by a rheumatologist. Assessments were conducted at baseline and at 2 weeks and 2 months and 4 months after writing and were done blind to experimental condition.
Of evaluable patients 4 months after treatment, asthma patients in the experimental group showed improvements in lung function (the mean percentage of predicted forced expiratory volume in 1 second [FEV1] improved from 63.9% at baseline to 76.3% at the 4-month follow-up; P<.001), whereas control group patients showed no change. Rheumatoid arthritis patients in the experimental group showed improvements in overall disease activity (a mean reduction in disease severity from 1.65 to 1.19 [28%] on a scale of 0 [asymptomatic] to 4 [very severe] at the 4-month follow-up; P=.001), whereas control group patients did not change. Combining all completing patients, 33 (47.1%) of 70 experimental patients had clinically relevant improvement, whereas 9 (24.3%) of 37 control patients had improvement (P=.001).
Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinically relevant changes in health status at 4 months compared with those in the control group. These gains were beyond those attributable to the standard medical care that all participants were receiving. It remains unknown whether these health improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases.
Psychosocial variables such as major stressful life events/daily stressful events have been associated with health care utilization.
Our aim was to examine the effects of a guided disclosure protocol (GDP) of past traumas on symptoms and clinic visits among frequent clinic attenders.
Forty-one frequent clinic attenders (> or =2 visits/3 months) took part. Patients were randomly assigned individually to either a casual content writing control group (n = 19) or a trauma content writing experimental GDP group (n = 22). GDP patients wrote about an upsetting event chronologically (day 1), verbally described their thoughts and feelings and described the event's impact on life (day 2), and finally wrote about their current perspective on and future coping with the event (day 3). Three months later, patients were reassessed blindly for symptoms and clinic visits, and an average of 15 months later they were assessed blindly for clinic visits again.
Compared with controls, GDP patients reported lower symptom levels at 3 months (2.3 versus 5.2), and made fewer clinic visits during the 3 (1.3 versus 3.0) and 15 month (5.1 versus 9.7) follow-ups. The percentage of GDP patients making > or =10 visits during the 15 month follow-up was smaller (10%) than among controls (33%).
The findings extend previous findings to frequent clinic users, using a new form of written disclosure aimed at shifting trauma from implicit to explicit memory. The GDP may be an inexpensive additional intervention in primary care for reducing symptoms and clinic visits among frequent clinic users.
This article provides a selected overview of 20 years of research on the role of psychosocial factors in susceptibility to upper respiratory infections. We present evidence from our laboratory that psychological stress is associated with increased risk for developing respiratory illness for persons intentionally exposed to a common cold virus, that the longer the duration of the stressor the greater the risk, and that stress association with susceptibility may be mediated by stress-induced disruption of the regulation of proinflammatory cytokines. We further provide evidence that social relationships (social integration and social support) are also associated with risk for respiratory illness: Social integration is associated with reduced risk irrespective of stress level and social support protects persons from the pathogenic influences of stress. Finally, we report recent evidence that lower levels of early childhood socioeconomic status (SES) are associated with greater risk of viral-induced illness during adulthood, independent of adult SES.
Perseverative cognition, as manifested in worry and rumination, is a common response to stress, but biopsychological models of stress and health have largely ignored it. These models have generally focused on physiological activation that occurs during stress and have insufficiently addressed effects that occur in anticipation of, or following, stressful events. We argue that perseverative cognition moderates the health consequences of stressors because it can prolong stress-related affective and physiological activation, both in advance of and following stressors. We review evidence that worry, rumination, and anticipatory stress are associated with enhanced cardiovascular, endocrinological, immunological, and neurovisceral activity. The findings yield preliminary support for our hypothesis, suggesting that perseverative cognition might act directly on somatic disease via enhance activation via the cardiovascular, immune, endocrine, and neurovisceral systems.
Disclosing information, thoughts, and feelings about personal and meaningful topics (experimental disclosure) is purported to have various health and psychological consequences (e.g., J. W. Pennebaker, 1993). Although the results of 2 small meta-analyses (P. G. Frisina, J. C. Borod, & S. J. Lepore, 2004; J. M. Smyth, 1998) suggest that experimental disclosure has a positive and significant effect, both used a fixed effects approach, limiting generalizability. Also, a plethora of studies on experimental disclosure have been completed that were not included in the previous analyses. One hundred forty-six randomized studies of experimental disclosure were collected and included in the present meta-analysis. Results of random effects analyses indicate that experimental disclosure is effective, with a positive and significant average r-effect size of .075. In addition, a number of moderators were identified.
The brain is the key organ of the response to stress because it determines what is threatening and, therefore, potentially stressful, as well as the physiological and behavioral responses which can be either adaptive or damaging. Stress involves two-way communication between the brain and the cardiovascular, immune, and other systems via neural and endocrine mechanisms. Beyond the "flight-or-fight" response to acute stress, there are events in daily life that produce a type of chronic stress and lead over time to wear and tear on the body ("allostatic load"). Yet, hormones associated with stress protect the body in the short-run and promote adaptation ("allostasis"). The brain is a target of stress, and the hippocampus was the first brain region, besides the hypothalamus, to be recognized as a target of glucocorticoids. Stress and stress hormones produce both adaptive and maladaptive effects on this brain region throughout the life course. Early life events influence life-long patterns of emotionality and stress responsiveness and alter the rate of brain and body aging. The hippocampus, amygdala, and prefrontal cortex undergo stress-induced structural remodeling, which alters behavioral and physiological responses. As an adjunct to pharmaceutical therapy, social and behavioral interventions such as regular physical activity and social support reduce the chronic stress burden and benefit brain and body health and resilience.
This study examines whether structured writing about receiving a diagnosis and treatment for pediatric cancer reduces distress among highly distressed parents of children with cancer (PCWC). Eight PCWC completed measures of posttraumatic stress symptoms (PTSS) and depressive symptoms at two baselines, and again after writing, with 1-month gaps between assessments. Using a guided disclosure protocol (GDP), parents were asked to write about receiving the diagnosis first in a chronological manner, then to explicitly label their emotions at the time of diagnosis and explain the impact of the child's illness on their life. Finally, they were asked to reflect on current feelings, future coping ability, and personal growth. Although symptoms of distress did not change between baselines, significant reductions were found in PTSS from the first baseline to postwriting, but not in depression. This preliminary study suggests that the GDP may reduce PTSS in distressed PCWC.
Attempting to understand the body’s signals is similar to trying to interpret the noises and sensations of the automobile that we drive. We do not have a computer printout of either the current physiological status of our body or the condition of the various systems of our car. Given this, we are in the position of attempting to understand a large array of ambiguous sensations about which we have at best a modicum of knowledge. Whether we are dealing with human bodies or inanimate cars, the awareness and reporting of symptoms are dependent on psychological or perceptual processes. Throughout this book, a large number of studies have outlined some of the parameters that determine when and why symptoms are reported. Before discussing some of the implications of symptom research, we present the following brief review of our current knowledge about the perception of physical symptoms.
Caregivers have been found to experience high levels of depression and anxiety. This study explored the efficacy of two writing interventions aimed at reducing psychological distress in informal caregivers and examined the moderating effects of alexithymia. Caregivers (N = 150) were randomly assigned to (1) write about the stress related to being a caregiver, (2) write about positive life experiences or (3) write about a control topic for 20 min on 3 days at home. Depression and anxiety symptoms were assessed at baseline, 2 weeks, 2 months and 6 months post-intervention. Analysis of variance for a mixed design revealed no main effects of writing condition on the follow-up measures. However, among caregivers with lower scores on alexithymia, those who wrote about positive experiences reported less anxiety and/or depression on follow-ups at 2 weeks, at 2 months and at 6 months. Moreover, in the control condition, less anxiety was reported by caregivers with lower scores on alexithymia at 2 weeks and at 6 months. No effects of stress disclosure were observed; therefore, writing about caregiver stress should not be encouraged in this vulnerable group. These findings highlight the importance of examining moderating factors, such as individual differences variables as well as exploring the efficacy of alternative writing interventions. Copyright © 2011 John Wiley & Sons, Ltd.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
This study examines whether worry is prospectively associated with somatic complaints and whether a worry reduction intervention can decrease these complaints. One hundred and seventy-one high school students (16–17 years old) kept a log of their worry duration and frequency for 6 days, of whom half were instructed to try to postpone worrying to a special 30-min worry period each day (‘postponers’). Somatic symptoms during ‘the last 3 days’ were assessed before and after the 6 days. At follow-up, postponers reported fewer complaints than controls, controlled for baseline. This reduction appeared to be mediated by worry duration, and pertained to, amongst others, lower back pain, neck pain, coughing/bronchitis, breathing difficulties and stomach pains. Thus, daily worry appears to be prospectively related to a broad set of somatic complaints, and its effect might be reversed by a simple intervention. Possible underlying mechanisms include prolonged physiological activity and illness-related perseverative cognition.
In a variation on Pennebaker’s writing paradigm, a sample of 90 undergraduates were randomly assigned to write about either an intensely positive experience (IPE) (n=48) or a control topic (n=42) for 20min each day for three consecutive days. Mood measures were taken before and after writing. Three months later, measures of health center visits for illness were obtained. Writing about IPEs was associated with enhanced positive mood. Writing about IPEs was also associated with significantly fewer health center visits for illness, compared to controls. Results are interpreted as challenging previously considered mechanisms of the positive benefits of writing.
Health psychology is a rapidly expanding discipline at the interface of psychology and clinical medicine. This new edition is fully reworked and revised, offering an entirely up-to-date, comprehensive, accessible, one-stop resource for clinical psychologists, mental health professionals and specialists in health-related matters. There are two new editors: Susan Ayers from the University of Sussex and Kenneth Wallston from Vanderbilt University Medical Center. The prestigious editorial team and their international, interdisciplinary cast of authors have reconceptualised their much-acclaimed handbook. The book is now in two parts: part I covers psychological aspects of health and illness, assessments, interventions and healthcare practice. Part II covers medical matters listed in alphabetical order. Among the many new topics added are: diet and health, ethnicity and health, clinical inrterviewing, mood assessment, communicating risk, medical interviewing, diagnostic procedures, organ donation, IVF, MMR, HRT, sleep disorders, skin disorders, depression and anxiety disorders.
Background:
White blood cell count is an independent predictor of cardiovascular events and mortality. Neutrophil/lymphocyte ratio (NLR) is a biomarker that can single out individuals at risk for vascular events.
Objective:
To evaluate whether NLR adds additional information beyond that provided by conventional risk factors and biomarkers for coronary artery disease (CAD) severity and adverse outcome, in a large cohort of consecutive patients referred for coronary angiography.
Materials and methods:
NLR was computed from the absolute values of neutrophils and lymphocytes from the complete blood count of 3005 consecutive patients undergoing coronary angiography for various indications. CAD severity was determined by an interventional cardiologist unaware of the study aims. The association between NLR and CAD severity was assessed by logistic regression and the association between NLR and 3-years outcome were analyzed using Cox regression models, adjusting for potential clinical, metabolic, and inflammatory confounders.
Results:
The cohort was divided into 3 groups according to the NLR value (<2, 2-3, and >3). NLR was independently associated with CAD severity and it contributed significantly to the regression models. Patients with NLR >3 had more advanced obstructive CAD (OR = 2.45, CI 95% 1.76-3.42, p < 0.001) and worse prognosis, with a higher rate of major CVD events during up to 3 years of follow-up (HR = 1.55, CI 95% 1.09-2.2, p = 0.01).
Conclusion:
Neutrophil/lymphocyte ratio is independently associated with CAD severity and 3-years outcome. NLR value appears additive to conventional risk factors and commonly used biomarkers.
Neutrophil to lymphocyte ratio (NLR), an index of systemic inflammation, has been associated with worse survival for many types of cancer. The aim of this study is to investigate the clinical significance of the blood NLR as a prognostic factor in non-small cell lung cancer (NSCLC) patients.
Stage IV NSCLC patients diagnosed in our institution between April 2004 and March 2009 were retrospectively reviewed. Potential prognostic factors such as histology, gender, performance status, response to chemotherapy and NLR were analyzed. NLR was assessed baseline and during chemotherapy treatment. Overall survival (OS) and progression free survival (PFS) were calculated by the Kaplan-Meier method.
A total of 171 patients were included in the study and 60 patients (35.1 %) presented a NLR ≥5. Median survival for the entire cohort was 9.3 months. We found that patients with undifferentiated carcinoma and patients with NLR ≥5 had a worse survival. Median PFS of patients with NLR <5 was 5.62 months and in patients with NLR ≥5 was 3.25 months (p = 0.098), and OS was 11.1 versus 5.6 months for patients with NLR<5 and NLR ≥5, respectively (p = 0.017). During the chemotherapy treatment, patients who normalized NLR after one cycle presented better outcomes (OS 8.7 vs. 4.3 months, p = 0.001, for patients who normalized NLR and for patients who remained persistently elevated). After multivariate analysis, histology and NLR remained independent predictors of survival (p < 0.05).
In our analysis, elevated NLR is a predictor of shorter survival in patients with advanced NSCLC and the variation of NLR during the first cycle of treatment predicts survival. NLR is an easily measured, reproducible test that could be considered to be incorporated in the routine practice in NSCLC patients.
This study investigated the extent to which trait anxiety and state anxiety in response to stress are associated with the cortisol awakening response (CAR).Fifty-one healthy participants were recruited. State anxiety measures were taken in anticipation of and during a laboratory stressor. Salivary cortisol levels were measured immediately upon awakening (at 0, 15, 30, and 45 min) on two consecutive mornings. Cortisol awakening response was assessed by the area under the curve with respect to zero (AUCG).The magnitude of the CAR was found to be negatively associated with both trait anxiety and anticipatory anxiety. Moreover, regression analysis showed that the effects of trait anxiety on the AUCG were mediated by anticipatory anxiety.These results suggest that the CAR is influenced by trait anxiety. Moreover, the effect of trait anxiety on the CAR seems to operate by impacting on psychological stress reactivity (i.e., anticipatory anxiety).
The response styles theory (Nolen-Hoeksema, 1991) was proposed to explain the insidious relationship between rumination and depression. We review the aspects of the response styles theory that have been well-supported, including evidence that rumination exacerbates depression, enhances negative thinking, impairs problem solving, interferes with instrumental behavior, and erodes social support. Next, we address contradictory and new findings. Specifically, rumination appears to more consistently predict the onset of depression rather than the duration, but rumination interacts with negative cognitive styles to predict the duration of depressive symptoms. Contrary to original predictions, the use of positive distractions has not consistently been correlated with lower levels of depressive symptoms in correlational studies, although dozens of experimental studies show positive distractions relieve depressed mood. Further, evidence now suggests that rumination is associated with psychopathologies in addition to depression, including anxiety, binge eating, binge drinking, and self-harm. We discuss the relationships between rumination and worry and between rumination and other coping or emotion-regulation strategies. Finally, we highlight recent research on the distinction between rumination and more adaptive forms of self-reflection, on basic cognitive deficits or biases in rumination, on its neural and genetic correlates, and on possible interventions to combat rumination.
© 2008 Association for Psychological Science.
In an earlier study, Roger and Nesshoever (Person. individ. Diff.8, 527–534, 1987) reported the construction and validation of a scale for measuring emotion control entitled the Emotion Control Questionnaire (ECQ). Factor analysis revealed a 4-factor structure comprising Rehearsal, Emotional Inhibition, Aggression Control and Benign Control, which was replicated on an independent sample of subjects. The earlier study also presented the relationships between the ECQ factors and a variety of other personality scales. Subsequent work has shown that one of the ECQ factors in particular (Rehearsal) is significantly related to both heart-rate recovery and urinary cortisol elevations following stress. However, one of the disadvantages of the ECQ was the brevity of the factors, two of which (Emotional Inhibition and Benign Control) comprised just nine items each, and the present study was aimed at extending the range of behaviour sampled by the scale. Factor analyses of an expanded item pool confirmed the structure of the earlier scale and resulted in a new scale comprising 56 items, fourteen in each of the four factors. Other findings for the new scale (ECQ2) indicate that it is psychometrically equivalent to the original, and further data on the concurrent validation of the emotion control construct are presented.
Research has frequently linked perceived stress with changes in subjective and objective measures of ill health; however, additional assessment should consider the physiological mechanisms mediating these effects. This study investigated whether differential patterns of cortisol secretion might partially mediate perceived stress related disparities in common health complaints in young, otherwise healthy individuals. To capture the kinds of health complaints commonly reported in this population, the Pennebaker Inventory of Limbic Languidness (PILL) was selected. To capture important parameters of the diurnal profile, cortisol was sampled at waking, 30 minutes post waking, 1200 h and 2200 h on three consecutive weekdays. Results revealed flatter diurnal cortisol slopes and elevated mean diurnal output (characterised by HPA hyperactivity in the evening) for participants in the higher stress group. Participants that reported higher perceived levels of stress also reported experiencing common health complaints with markedly greater frequency; however, these disparities were abolished when mean diurnal output of cortisol was statistically controlled. While dysregulation of basal HPA activity has been implicated in the aetiologies of chronic illness, findings reported here implicated hypersecretion of cortisol as one physiological pathway, partially mediating perceived stress related disparities in the kinds of common health complaints that typically affect young, otherwise healthy individuals.
Negative body image has a significant impact on self-esteem, disordered eating, and general health. Writing about distressing events and experiences has been found to have beneficial effects on psychological and physical health outcomes. This study investigated whether a written self-disclosure intervention, compared to a writing about body image success stories (WSS) intervention, had beneficial effects on self-esteem and body image.
One hundred and fifty-eight women (aged 18-22 years) were allocated to either: written emotional disclosure (WED); WSS; or a control, non-emotional writing condition. All measures were completed at baseline and at follow-up 4 weeks later.
A condition by time interaction was observed for implicit self-esteem, such that levels of self-esteem were improved 4 weeks later in the WED condition. Implicit self-esteem was also found to be greater following WED compared to the control condition, but not following WSS.
This is the first study to demonstrate that WED has beneficial effects on implicit outcome measures such as self-esteem indicating that the positive effects of expressive writing may initially operate by influencing automatically activated attitudes towards the self. The impact of WED on implicit self-esteem may have implications for future health.
Perseverative cognition (i.e., rumination, worry) may amplify or maintain cortisol stress responses. The present study examined the effects of trait and state perseverative cognition (PC) on the cortisol awakening response (CAR). We hypothesized that trait PC and state (prior day's) PC would be associated with greater CARs. Undergraduates scoring high (N=77) and low (N=42) on trait PC were included. Participants reported worries about upcoming events and ruminations on past events that occurred throughout the day as a measure of state PC. The next morning, saliva samples were collected 0, 30, 45, and 60min after awakening to assess the CAR. Area under the curve (AUC) and 30-min increase (30-min Inc) were calculated to capture the salivary cortisol total output and increase relative to baseline in the hour after awakening. There was no effect of trait PC on the CAR. In contrast, reports of worrying and/or ruminating the night before predicted greater increases in cortisol concentration and total cortisol output compared to those who neither ruminated nor worried the night before. These effects were not accounted for by depressed mood, anxiety, sleep, or recent stressors. Findings suggest differential effects of trait and state PC on the CAR and highlight the importance of using proximal measures in examining individual differences in the CAR.
In most healthy people morning awakening is associated with a burst of cortisol secretion: the cortisol awakening response (CAR). It is argued that the CAR is subject to a range physiological regulatory influences that facilitate this rapid increase in cortisol secretion. Evidence is presented for reduced adrenal sensitivity to rising levels of ACTH in the pre-awakening period, mediated by an extra-pituitary pathway to the adrenal from the suprachiasmatic nucleus (SCN). A role for the hippocampus in this pre-awakening regulation of cortisol secretion is considered. Attainment of consciousness is associated with 'flip-flop' switching of regional brain activation, which, it is argued, initiates a combination of processes: (1) activation of the hypothalamic pituitary adrenal (HPA) axis; (2) release of pre-awakening reduced adrenal sensitivity to ACTH; (3) increased post-awakening adrenal sensitivity to ACTH in response to light, mediated by a SCN extra-pituitary pathway. An association between the CAR and the ending of sleep inertia is discussed.
The cortisol awakening rise (CAR) is defined as cortisol secretory activity in the first 45-60 min immediately post-awakening. It has been suggested that psychological factors may disrupt the normal awakening rise. Recent research has shown that psychological stress may influence the magnitude of the CAR, however the findings have been mixed. This study examined the impact of stress on the CAR and the diurnal mean in a sample of middle-aged women.
One hundred and eighteen healthy female participants who reported experiencing high or low stress were recruited. Salivary cortisol levels were measured immediately upon awakening (at 0, 15, 30, and 45 min) and at 3, 6, 9 and 12 h on two consecutive days. A number of metabolic and inflammatory biomarkers were also assessed together with measures of mood disturbance and health behaviour.
The magnitude of the CAR, assessed by the area under the response curve (AURC) estimate, was significantly lower in the high stress group compared to the low stress group indicating that participants who experienced high stress secreted lower levels of cortisol. The effect was largely accounted for by differences 30 min after waking. The diurnal mean was also lower for the high stress group. Although participants in the high stress group had a slightly worse inflammatory profile, only low-density lipoprotein levels were found to be significantly higher, compared to the low stress group. Lifestyle indicators and mood were also found to be significantly poorer in the high stress group.
The results suggest that psychological stress may be associated with a smaller cortisol awakening rise, a lower diurnal mean, poor lifestyle choices and high levels of psychological distress. These findings may have broader implications for future health risk and for an individual's ability to cope with imminent daily stressors and demands.
In humans, the secretion of cortisol from the adrenal glands follows a diurnal cycle with a profound increase after awakening. This increase after awakening, a phenomenon termed the cortisol awakening response (CAR), appears to be a distinct feature of the hypothalamus-pituitary-adrenal (HPA) axis, superimposing the circadian rhythmicity of cortisol secretion. Several studies point towards an important role of the hippocampus and, additionally, other brain structures (e. g. amygdala, prefrontal cortex, suprachiasmatic nucleus) in the regulation of the CAR. There is increasing knowledge that the CAR is influenced by a variety of factors such as gender, health status, and health behavior or stress perception. However, the exact function of the profound cortisol increase after awakening is still not clarified. We hypothesize that the anticipation of the upcoming day is of major relevance for the magnitude of the CAR. The present paper reviews the current knowledge on the neural regulation of the CAR and factors influencing this phenomenon and considerations are addressed concerning the exact function of the CAR.
We tested the hypothesis that impaired social problem solving in depression is a consequence of state-oriented rumination, which can be ameliorated by improving awareness of mental processes. 32 currently depressed, 26 recovered depressed, and 26 never depressed participants completed the Means Ends Problem Solving Test while randomly allocated to no questions, state-oriented ruminative questions, (e.g. focusing on why you have a problem) or process-focused questions (e.g. focusing on how you decide to solve a problem). In the no question condition, the currently depressed group was significantly impaired at problem solving compared to the never depressed and recovered depressed groups, which did not differ from each other. As predicted, the process-focused questions significantly improved social problem solving in depressed patients, compared to no questions and state-oriented questions, which did not differ from each other. As predicted, compared to the process-focused questions, the state-oriented questions significantly impaired social problem solving in the recovered depressed group. These results are consistent with recent theories and treatment developments which suggest that increased awareness of mental processes can shift people away from ruminative thinking, thereby, reducing depressive relapse.
Study protocols in endocrinological research and the neurosciences often employ repeated measurements over time to record changes in physiological or endocrinological variables. While it is desirable to acquire repeated measurements for finding individual and group differences with regard to response time and duration, the amount of data gathered often represents a problem for the statistical analysis. When trying to detect possible associations between repeated measures and other variables, the area under the curve (AUC) is routinely used to incorporate multiple time points. However, formulas for computation of the AUC are not standardized across laboratories, and existing differences are usually not presented when discussing results, thus causing possible variability, or incompatibility of findings between research groups. In this paper, two formulas for calculation of the area under the curve are presented, which are derived from the trapezoid formula. These formulas are termed 'Area under the curve with respect to increase' (AUCI) and 'Area under the curve with respect to ground' (AUCG). The different information that can be derived from repeated measurements with these two formulas is exemplified using artificial and real data from recent studies of the authors. It is shown that depending on which formula is used, different associations with other variables may emerge. Consequently, it is recommended to employ both formulas when analyzing data sets with repeated measures.
Objectives. We undertook this study to clarify the operative mechanisms that account for the relationship between emotional disclosure and health. We hypothesized that emotional disclosure via writing was a form of exposure‐based therapy and that exposure was the active therapeutic component.
Design and method. A group of 129 male and female undergraduates were randomly assigned to three writing groups: (1) a trauma disclosure writing group; (2) a positive emotion writing group to control for affect arousal; and (3) a neutral writing group to control for any affect arousal ‐ either positive or negative. Process measures were taken before and after each 3‐day, 20‐minute writing session. All participantscompleted questionnaires that assessed psychological and physical functioning at both the baseline and the end of the semester (approximately 9 weeks later).
Results. Groups reported differential affective arousal as well as disclosure themes in accord with our predictions. We did not replicate the findings of Pennebaker and his colleagues (e.g. Pennebaker & Beall, 1986). In our study, physical health outcome measures did not differ between groups by the end of the semester, nor did psychological measures change from baseline to follow‐up.
Conclusions. We found only limited support for the hypothesis that exposure best explains the effects of written self‐disclosure. Implications for future research in this area are discussed.
To determine whether writing about emotional topics compared with writing about neutral topics could affect CD4+ lymphocyte count and human immunodeficiency virus (HIV) viral load among HIV-infected patients.
Thirty-seven HIV-infected patients were randomly allocated to 2 writing conditions focusing on emotional or control topics. Participants wrote for 4 days, 30 minutes per day. The CD4+ lymphocyte count and HIV viral load were measured at baseline and at 2 weeks, 3 months, and 6 months after writing.
The emotional writing participants rated their essays as more personal, valuable, and emotional than those in the control condition. Relative to the drop in HIV viral load, CD4+ lymphocyte counts increased after the intervention for participants in the emotional writing condition compared with control writing participants.
The results are consistent with those of previous studies using emotional writing in other patient groups. Based on the self-reports of the value of writing and the preliminary laboratory findings, the results suggest that emotional writing may provide benefit for patients with HIV infection.
The awakening cortisol response (ACR) is a discrete and distinctive part of the cortisol circadian cycle. In healthy adults salivary free cortisol concentrations increase by between 50 and 160% in the first 30 min immediately post-awakening (approximate average increase of 9 nmol/l, range 4-15 nmol/l, estimated to be equivalent to about three secretory episodes). However there are no agreed norms for the absolute concentrations of free cortisol in saliva either immediately post-awakening (range of 4.7-18.5 nmol/l) or 30 min post-awakening (range of 8.6-21.9 nmol/l). This review explores reasons for these discrepancies in normative data including confounding factors such as gender, age, awakening time, light and participant adherence. Although the physiological role of the ACR has not been clearly defined evidence is discussed that suggests it is under a distinct regulatory influence, different from the rest of the diurnal cortisol secretory cycle. Despite the difficulties associated with its measurement a range of studies have demonstrated an association between the ACR and psychosocial variables, stress and health. However it remains unclear whether positive affect and good health are consistently associated with larger or smaller awakening responses. It is early days in the search for the role and significance of the ACR. Its putative role in the regulation of physiological function across the day (e.g. the immune system) and its sensitivity to psychosocial variables make it a prime candidate as an intermediary linking mind and health.
This article reviews a program of research on alexithymia, emotional disclosure, and health. The article first describes two lines of research and then outlines current work attempting to integrate these lines. The first research line involves basic correlational studies on alexithymia's link to health problems; these studies suggest that alexithymia is a potential risk factor for symptoms and illness behavior, although not necessarily organic disease. The second research line involves experimental studies of the health effects of emotional disclosure via expressive writing or talking; these studies suggest that disclosure improves health on average, but that the effects are not that robust and that various moderators likely are involved. The next section of the article describes recent attempts to integrate the two research lines by examining how baseline levels of alexithymia influence the effects of emotional disclosure; these analyses suggest that alexithymia interferes with or attenuates the health benefits of disclosure. Finally, the article describes initial forays into research on interventions with the alexithymic patients. This evolving program of research demonstrates the value of integrating emotion, personality, and health, and highlights the bidirectional relationship between clinical problems and basic research.