One ‘knows’: self-rated health and telomere length among ex-prisoners of war

Abstract

Objective: Ill-health and early mortality are amongst the most significant ramifications of trauma. Furthermore, trauma alters the subjective perception and experience of the body. The aim of this study is to examine the extent to which deteriorations in perceived health among traumatised individuals are associated with cellular health as manifested in telomere length.

Methods: Specifically, 88 former prisoners of war (ex-POWs) evaluated their health (self-rated health; SRH) at 18 (T1), 35 (T2) and 42 (T3) years after the war, and were assessed for telomere length at T3. Health behaviour, BMI, morbidity and PTSD were also examined at T3.

Results: The findings demonstrated that SRH was cross-sectionally correlated with telomere length. Furthermore, a significant sequential indirect effect was found, in which worse SRH in T1 was associated with shorter telomere length at T3, through worse SRH at T2 and at T3.

Conclusions: These findings demonstrate that long-term deteriorations in the subjective evaluations of health are implicated in actual cellular health among individuals exposed to trauma.     

The relationship between positive psychological characteristics and longer telomeres

Objective: Longer telomeres are associated with better health and longevity. This research investigated the relationship between positive psychological dispositional traits and telomere length. Positive traits examined were typical high positive affect, typical low negative affect, life satisfaction, trait mindfulness, trait emotional intelligence, general self-efficacy and optimism.

Design and Measures: One hundred and twenty women and men, with a mean age of 40.92, completed measures of positive characteristics and provided samples for telomere length analysis.

Results: Together the positive dispositional characteristics explained significant variance in telomere length, R = .40. Among the individual characteristics, greater optimism and higher emotional intelligence were associated with longer telomeres after adjustment for age and gender and the association between optimism and telomere length remained significant after adjusting for age and gender as well as the other positive characteristics, with a partial correlation r of .30.

Conclusion: These results in conjunction with previous research findings provide a platform for further exploration of biological pathways connecting positive characteristics such as optimism to telomere length and investigation of the impact of increasing a characteristic such as optimism on telomere functioning.     

It's more than skin‐deep: The relationship between social victimization and telomere length in adolescence

This study examined the relationship between peer victimization and telomere length (TL), an indicator of biological aging that is associated with stressors (Epel, 2009). It was predicted that social victimization would have a greater impact upon TL, as well as the frequency and severity of health complaints than physical victimization. Adolescents (M_age = 15.91 years, SD_age = 1.65) and their parents completed measures of peer victimization and physical health problems; adolescents also submitted a DNA sample for telomere analysis. Greater instances of being socially, but not physically, victimized were associated with shorter telomeres, as well as more frequent and severe health complaints. TL was also negatively related to both the frequency and severity of health problems, even after controlling for BMI, age, and sex of participant. The relationship between social victimization and health complaints via TL held only at higher levels of social victimization. These findings are the first to find an association between peer victimization and shortened telomeres.

     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

The gender affirmative lifespan approach (GALA): A framework for competent clinical care with nonbinary clients

Abstract

Background: The limited research on nonbinary individuals suggests that this community experiences significant health disparities. Compared to binary transgender individuals, research suggests that nonbinary individuals are at elevated risk for discrimination and negative mental health outcomes, including depression, anxiety, traumatic stress, and suicidality. Even mental health providers who work with binary transgender individuals often lack knowledge of and training to work competently with nonbinary individuals.

Methods: The authors of this conceptual article present the Gender Affirmative Lifespan Approach (GALA), a psychotherapy framework based in health disparities theory and research, which asserts that therapeutic interventions combating internalized oppression have the potential to improve mental health symptomatology resulting in improved overall health and well-being for gender diverse clients. GALA’s therapeutic interventions are designed to promote positive gender identity development through five core components: (1) building resiliency; (2) developing gender literacy; (3) moving beyond the binary; 4) promoting positive sexuality; and (5) facilitating empowering connections to medical interventions (if desired).

Results: The core components of the GALA model are individualized to each client’s unique needs, while taking into consideration age and acknowledging developmental shifts in, or fluidity of, gender across the lifespan. This model represents an inclusive, trans-affirmative approach to competent clinical care with nonbinary individuals.

Discussion: Application of the GALA model with nonbinary clients is discussed, including one clinical case vignette.     

An examination of mindfulness skills in terms of affect tolerance among individuals with elevated levels of health anxiety

Background and Objectives: Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty.

Methods: Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; M_age?=?19.53, SD?=?3.16, Range?=?18–45) who completed self-report measures for course credit.

Results: Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity.

Conclusions: These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.     

The effects of yoga on stress and psychological health among employees: an 8- and 16-week intervention study

Background: The stresses of modern work life necessitate effective coping strategies that are accessible and affordable to the general public. Yoga has been found to reduce stress in clinical samples, but studies are needed to examine standard gym yoga classes among functional individuals.

Objectives: This study investigated the effects of 8- and 16-week gym yoga on stress and psychological health.

Design and Method: Ninety individuals reporting moderate-to-high stress were randomly assigned to 16 consecutive weeks of yoga, or to a waitlist crossover group who did not practice yoga for 8 weeks then practiced yoga for 8 weeks. Stress and psychological health variables were assessed at baseline, 8 weeks, and 16 weeks.

Results: Significant reductions in stress and all psychological health measures were found within the Yoga group over 16 weeks. When compared to the control group, yoga practitioners showed significant decreases in stress, anxiety, and general psychological health, and significant increases in well-being. The group who did not practice yoga showed significant decreases in stress, anxiety, depression, and insomnia after they crossed over and practiced yoga for 8 weeks.

Conclusions: Gym yoga appears to be effective for stress amelioration and promotion of psychological health among workers experiencing stress.     

Understanding associations between negatively biased attention and depression and social anxiety: positively biased attention is key

ABSTRACT

Background and objectives: Although research supports the premise that depressed and socially anxious individuals direct attention preferentially toward negative emotional cues, little is known about how attention to positive emotional cues might modulate this negative attention bias risk process. The purpose of this study was to determine if associations between attention biases to sad and angry faces and depression and social anxiety symptoms, respectively, would be strongest in individuals who also show biased attention away from happy faces.

Methods: Young adults (N?=?151; 79% female; M?=?19.63 years) completed self-report measures of depression and social anxiety symptoms and a dot probe task to assess attention biases to happy, sad, and angry facial expressions.

Results: Attention bias to happy faces moderated associations between attention to negatively valenced faces and psychopathology symptoms. However, attention bias toward sad faces was positively and significantly related to depression symptoms only for individuals who also selectively attended toward happy faces. Similarly, attention bias toward angry faces was positively and significantly associated with social anxiety symptoms only for individuals who also selectively attended toward happy faces.

Conclusions: These findings suggest that individuals with high levels of depression or social anxiety symptoms attend preferentially to emotional stimuli across valences.     

从端粒和端粒酶探析冥想对压力的缓解作用

冥想是一种维持自我注意的身心调节技术,是缓解因压力所致的抑郁、焦虑等消极情绪的有效方法。端粒是维持染色体稳定和完整的DNA片段,大量有关冥想对端粒及端粒酶活性影响的研究阐明,通常情况下压力人群经过冥想训练能提高端粒长度并增加端粒酶活性,这种改变与压力缓解密切相关。这一积极效果主要得益于皮质醇和炎症等生物因素及心理和环境等非生物因素。未来可以通过对比不同冥想练习的效果、增加追踪研究、多学科联合及扩大样本等找到最有利于提高端粒长度和端粒酶活性的冥想方式。     

Comorbid interpretation and expectancy bias in social anxiety and alcohol use

Background: In two studies, the present research examined whether being high in both social anxiety and alcohol use disorder symptoms is associated with a comorbid interpretation and expectancy bias that reflects their bidirectional relationship.

Design: Cross-sectional, quantitative surveys.

Methods: Measures of social anxiety and alcohol use disorder symptoms, as well as an interpretation and expectancy bias task assessing biases for social anxiety, drinking, and comorbid social anxiety and drinking.

Results: In Study 1 (N?=?447), individuals high (vs. low) in social anxiety had stronger social threat bias and individuals high (vs. low) in alcohol use disorder symptoms had stronger drinking bias. Those high in both social anxiety and alcohol use disorder symptoms endorsed interpretations and expectancies linking social interaction with alcohol use. Comorbid bias predicted membership into the high social anxiety/drinking group, even after taking into account single-disorder biases. In Study 2 (N?=?325), alcohol use disorder symptoms predicted drinking bias and social anxiety symptoms predicted social anxiety bias. Alcohol use disorder symptoms, social anxiety symptoms, and their interaction predicted comorbid interpretation and expectancy bias.

Conclusion: Results indicate unique cognitive vulnerability markers for persons with comorbid social anxiety and alcohol use disorder symptoms, which may improve detection and treatment of this serious comorbidity.     

Living with Hereditary Haemorrhagic Telangiectasia: stigma,coping with unpredictable symptoms,and self-advocacy

Abstract

Objective: Hereditary Haemorrhagic Telangiectasia (HHT) is a genetic condition causing frequent nose bleeds, skin lesions (telangiectasia) and arteriovenous malformations. Approximately, 50% of people experience life-threatening HHT symptoms including haemorrhages in the brain, lungs and liver. This study aimed to gain a qualitative understanding of the psychosocial impact of HHT over time. Design: Using a phenomenological framework, a rigorous narrative analysis was performed on 20 semi-structured interviews with individuals with HHT aged 20s–60s. Main outcome measures: Qualitative themes explaining life experiences prior to and following a clinical diagnosis of HHT. Results: Narratives highlighted four psychosocial themes: (i) the psychological impact of visible symptoms was significant and related to experiences of social stigma, (ii) individuals struggled to identify triggers of symptoms in order to reduce unpredictability, (iii) an illness identity was rejected by minimising HHT when talking about the present self, and by positive reframing as ‘lucky’ and (iv) self-advocacy was necessitated due to lack of expert coordinated care. Conclusion: HHT has a demanding impact on social, physical and psychological well-being. These findings have significant implications for health care, as narratives about interactions with health professionals often used the terms ‘frustrating’ and ‘not being heard’.     

Perfectionistic concerns predict increases in adolescents’ anxiety symptoms: a three-wave longitudinal study

Background and Objectives: Although perfectionism has been proposed to be a risk factor for the development of anxiety, research on perfectionism and anxiety symptoms in adolescents is scarce and inconclusive. The aim of the present study was to investigate whether the two higher-order dimensions of perfectionism – perfectionistic strivings and perfectionistic concerns – predict the development and maintenance of anxiety symptoms. An additional aim of the present study was to examine potential reciprocal effects of anxiety symptoms predicting increases in perfectionism.

Design: The study used a longitudinal design with three waves spaced 4–5 months apart.

Methods: A non-clinical sample of 489 adolescents aged 12–19 years completed a paper-and-pencil questionnaire.

Results: As expected, results showed a positive effect from perfectionistic concerns to anxiety symptoms, but the effect was restricted to middle-to-late adolescents (16–19 years old): Perfectionistic concerns predicted longitudinal increases in adolescents’ anxiety symptoms, whereas perfectionistic strivings did not. Furthermore, anxiety symptoms did not predict increases in perfectionism.

Conclusions: Implications for the understanding of the relationship between perfectionism and anxiety symptoms are discussed.     

Effects of exercise on anxiety: A review

Abstract

The focus of this review is physical exercise and its possible effectiveness as a means of reducing anxiety. This review is based on English language literature and covers the time period from 1958 to 1988. It provides an overview of the results of research studies carried out in the area of physical fitness and psychological health, more specifically anxiety. In doing so, it draws attention to methodological limitations associated with a number of these research studies. In addition, it describes the level of exercise considered necessary to achieve improved cardio-respiratory fitness (training effect). Conclusions are made which suggest mild support for the positive effect of exercise with some individuals for reducing anxiety. Some speculative explanations as to why exercise may be effective in reducing levels of state anxiety are discussed.     

Panning for the gold in health research: Incorporating studies’ methodological quality in meta-analysis

Background: Systematic reviews now routinely assess methodological quality to gauge the validity of the included studies and of the synthesis as a whole. Although trends from higher quality studies should be clearer, it is uncertain how often meta-analyses incorporate methodological quality in models of study results either as predictors, or, more interestingly, in interactions with theoretical moderators.

Objective and methods: We survey 200 meta-analyses in three health promotion domains to examine when and how meta-analyses incorporate methodological quality.

Results: Although methodological quality assessments commonly appear in contemporary meta-analyses (usually as scales), they are rarely incorporated in analyses, and still more rarely analysed in interaction with theoretical determinants of the success of health promotions. The few meta-analyses (2.5%) that did include such an interaction analysis showed that moderator results remained significant in higher quality studies or were present only among higher quality studies. We describe how to model quality interactively with theoretically derived moderators and discuss strengths and weaknesses of this approach and in relation to current meta-analytic practice.

Conclusions: In large literatures exhibiting heterogeneous effects, meta-analyses can incorporate methodological quality and generate conclusions that enable greater confidence not only about the substantive phenomenon but also about the role that methodological quality itself plays.     

Exploring rates of transgender individuals and mental health concerns in an online sample

Background: Prevalence estimates of adults identifying as transgender are scarce, particularly in the United States. Method: The current study endeavored to estimate the prevalence of individuals identifying as transgender in a large online sample of adult U.S. residents (n = 6,727) and compare the prevalence of common mental health disorders (depression, anxiety, attention-deficit/hyperactivity disorder) and the age of onset for individuals identifying as men or women versus those identifying as transgender. Results: The prevalence estimate of individuals identifying as transgender was 0.8%. Individuals identifying as transgender were significantly more likely than individuals identifying as men or women to report having had a single diagnosis or co-occurring diagnoses for all three disorders examined. Additionally, transgender individuals were more likely than individuals identifying as men or women to receive a diagnosis of anxiety or depression at a younger age. Conclusion: Given the prevalence of transgender individuals and the associations with common mental health conditions, clinicians must be informed and competent to care for their clinical needs. This study introduces online crowdsourcing resources as a potentially fruitful option for reaching and researching gender diversity.     

Computerized attention retraining for individuals with elevated health anxiety

Background and Objectives: Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information. Design: This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words. Methods: Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18). Results: Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outperform ACC in reducing HA and other relevant emotional symptoms. However, both AMP and ACC evidenced overall significant symptom reduction in most of the outcome measures, including overall HA, anxiety sensitivity, general depression and anxiety, and somatic complaints. Conclusions: Further research is needed to better understand the effects and mechanisms of AMP as a possible cognitive intervention for HA.     

The role of centrality to self-concept in moderating the associations between injury perceptions and outcomes

Abstract

Objectives: To test the centrality of injury to self-concept as a moderator of the associations between injury perceptions and outcomes.

Methods: Two concurrent studies on samples of injured individuals.

Measures: The centrality of injury to one’s self concept was measured by the degree of self-injury separation (PRISM); injury perceptions were measured by the injury perception questionnaire; and outcomes by standard scales of self-assessed health, physical, emotional and social functioning, vitality, depression, anxiety and somatisation. Regression analyses examined the significance of adding the interactions between injury centrality and injury perceptions to explained outcome variance, beyond their separate contributions.

Results: Both injury centrality and injury perceptions significantly explained variance in patients’ functioning and well-being. Injury centrality moderated the associations between various injury perceptions and outcomes, especially pronounced for emotional representations of the injury. As hypothesised, the effects of injury perceptions on outcomes were stronger among patients for whom the injury was central to their self-concept compared to patients who perceived the injury as peripheral to their self-concept.

Conclusions: ‘Centrality to the self’ is a moderator of the impact of perceptions on outcomes of injuries. The findings suggest ways to tailor interventions to sub-groups of injured patients based on injury centrality to their self-concept.     

Identifying repressors: A methodological issue for health psychology

Abstract

The majority of studies in health psychology use self-report measures. However, there is a growing body of evidence indicating that this methodology may be problematic for a significant minority of the population: individuals who possess a repressive coping style (repressors). Repressors, who fail to report negative affect, answer many self-report measures in a positive fashion. Research has identified an association between repressors, who are identified by low trait anxiety scores and high defensiveness scores, and adverse health outcomes. Therefore, repressors are an important group for health psychologists to investigate. Health psychology research should use more than one method of data collection in an attempt to unravel this difficult methodological problem.     

Effects of emotion regulation strategies on anxiety during job interviews in Chinese college students

Background and objectives: Few studies related to the impact of different emotion regulation strategies on anxiety have used externally and ecologically valid emotion-eliciting stimuli or Eastern populations. The present study compares the effects of reappraisal, suppression, and acceptance on anxiety induced by a simulated job interview in a Chinese sample. Methods: Eighty-two subjects were randomly assigned to one of four instructions: reappraisal, suppression, acceptance, or no-regulation strategies during a simulated job interview. Anxiety was assessed with an observer-based behavior rating scale during the interview and the State Anxiety Inventory before, during, and after the interview. Results: A repeated-measures MANOVA indicated a significantly greater reduction in anxiety in the reappraisal and acceptance groups compared to the control group during the interview (reappraisal: d = 1.42; acceptance: d = 1.30; each p < .001), but not during the recovery stage. The suppression and control group did not differ in any stage. Suppression led to a higher (p_max < .04) anxiety than reappraisal/acceptance in the anticipation (d = 0.65/0.68), interview (d = 0.87/0.79), and recovery stages (d = 0.94/1.03). No significant differences were found between reappraisal and acceptance. Conclusions: In Chinese students reappraisal and acceptance seem to be more effective anxiety regulation strategies than suppression.