Positive Psychological Functioning and the Biology of Health

Most research considers both psychological and physical health with a disease perspective by focusing on poor psychological functioning or disease outcomes. However, identifying attributes that support adaptive functioning may inform approaches to achieving health beyond what we learn from studying risk factors that accelerate deterioration. Recent evidence suggests that positive psychological functioning contributes to attaining optimal physical health. We evaluate the current state of knowledge on the relationship between positive psychological functioning and physical health, defining health beyond solely the absence of disease. We further consider when positive psychological functioning begins to exert effects on health, whether it has direct effects on biological processes or serves primarily to buffer the effects of stress, and whether it is associated with health outcomes and biological processes beyond those that reflect the absence of deterioration and disease. We propose some key directions for future research including the assessment of positive psychological functioning, positive biological functioning, and optimal health, the value of multi‐system measures, and the potential of “omics” to provide novel insights into biological mechanisms underlying associations between positive psychological functioning and physical health.     

Health-related quality of life in chronic fatigue syndrome: predictors of physical functioning and psychological distress

This study investigated health-related quality of life (HRQoL; physical functioning and psychological distress) in an Australian chronic fatigue syndrome (CFS) population. The aims of the study were to compare HRQoL in those with CFS to the normal population, and to investigate the extent to which sociodemographic (age, gender, partner status, education), illness-related (illness duration, symptom frequency), and fatigue severity (physical, mental) variables predicted HRQoL. A total of 139 people meeting CFS criteria completed questionnaires. HRQoL was assessed using standardised measures of distress and physical functioning. Compared with norms, those with CFS obtained significantly lower scores on all physical functioning areas, whereas 63% of participants reported clinically significant psychological distress. Hierarchical regression analyses indicated that physical fatigue severity and symptom frequency were the strongest predictors of deficits in physical domain HRQoL. Physical HRQoL outcomes were also predicted by mental fatigue severity, older age, and female gender. All predictors were unrelated to psychological distress apart from weak positive associations with physical fatigue and symptom frequency. Results identify a potent set of predictors of HRQoL and show that CFS has a pervasive negative impact on quality of life, particularly physical and psychological functioning.     

Followup of psychoanalysis five to ten years after termination: I. Stability of change

Seven out of 17 patients interviewed in a long-term followup of psychoanalysis showed either improvement in psychological functioning or a retention of psychological gains they had made during the course of psychoanalysis. Six patients deteriorated in their psychological functioning, but their gains were restored with subsequent treatment. Four patients deteriorated in psychological functioning without restoration, whether or not treatment was reentered. Neither analysts' assessments at the time of termination nor patients' assessments of themselves or assessments based on psychological tests one year after termination predicted which patients would improve or retain psychological change. No causal generalizations about factors related to psychological change can be made from these data. Different factors in interaction are suggested to account for the stability and instability of psychological change.     

Relational and psychological mediators of change in low‐income couples' perceived health

Experimental tests of the association between relationship functioning and physical health are limited. Although associations are hypothesized to be partially mediated through improved psychological functioning, tests are mostly limited to lab‐based studies. The present study evaluated relational and psychological mediators of change in perceived health in a sample of 742 low‐income couples (1,484 individuals) who participated in a randomized controlled trial of two online relationship education programs and a waitlist control group. Results partially supported the Strengths and Strains Model of Relationships and Physical Health. Relationship functioning and some psychological functioning were mediators of change in perceived health. Future research is needed to understand how relationship functioning improved perceived health through mediators other than psychological functioning tested here.     

Effect of levels of exercise on psychological mood states, physical fitness, and plasma beta-endorphin

Aerobic exercise which resulted in a significant improvement in cardiovascular functioning had no more effect on psychological mood states than did the placebo control of participation in nonaerobic recreational games or no exercise and sport at all (N = 430 college students). Beta-endorphin levels with the 41 depressed subjects were not a biochemical link that might explain the possible influence of physical activity on depression.     

Active Coping and Perceived Social Support Mediate the Relationship Between Physical Health and Resilience in Liver Transplant Candidates

Without a transplant, end-stage liver disease is associated with significant morbidity and mortality. Transplant candidates endure physical and psychological stress while awaiting surgery, yet little is known about the relationship between physical health and psychological resilience during the wait-list period. This study examined predictors of psychological resilience and mediators of the relationship between physical health and psychological resilience in liver transplant candidates. Wait-listed candidates (N?=?120) from a single Northeast transplant center completed assessments of physical functioning, coping, perceived social support, and resilience. Findings revealed that physical functioning, active coping, and perceived social support were positively associated with resilience; maladaptive coping was negatively associated with resilience. Perceived social support and active coping partially mediated the relationship between physical functioning and resilience. Transplant center care providers should promote active coping skills and reinforce the importance of effective social support networks. These interventions could increase psychological resilience among liver transplant candidates.     

Do the core self-evaluations moderate the relationship between subjective well-being and physical and psychological health?

This study investigates the role that core self-evaluations (CSE) plays on the relationship between subjective well-being (SWB) and health functioning. The findings from a sample of 160 undergraduate students revealed that CSE explains incremental variance in physical and psychological health functioning, above and beyond the effect of SWB. The results also revealed that CSE moderated the relationship of two indicators of SWB (PA/NA and satisfaction with life) with physical functioning, suggesting that individuals who have positive emotions and/or are satisfied with their lives and simultaneously are high CSE are more likely to demonstrate good physical health functioning. Contrary to expectations, the results revealed that CSE did not moderate the relationship between SWB and psychological health functioning. The findings are discussed in the context of the importance of CSE on health psychology, while implications for practice and directions for future research are proposed.     

The mediating and moderating effects of differentiation of self on body mass index and depressive symptomatology among an American college sample

Differentiation of self – a core construct of Bowen's (Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson) family systems theory – was examined as a possible predictor of psychological health and physical health and as a mediator and moderator of the relation between overall functioning and psychological health and physical health. A total of 818 American college students participated (mean age?=?23.72, SD?=?4.79) in this study. Differentiation of self was correlated and was predictive of psychological health, as measured by the Beck depression inventory, and physical health, as measured by body mass index (BMI). A multivariate multiple regression model revealed that differentiation of self partially mediated the effects of overall functioning on depressive symptomatology and on BMI. Results from a hierarchical regression model showed that differentiation of self moderated the relation between overall functioning and depressive symptomatology but did not moderate the relation between overall functioning and BMI. Taken together, these preliminary findings provide initial evidence of the importance of the associations between family systemic factors (differentiation of self) and psychological and physical health factors among American college populations.     

Understanding and Treating Children Who Experience Interpersonal Maltreatment: Empirical Findings

Child maltreatment (CM) is a major health problem in U.S. society, with 872,000 substantiated cases reported in 2004 and unofficial rates ranging from 2 to 10 million cases per year. Depending on the severity, CM can negatively affect a child's physical, emotional, and psychological functioning and development immediately following an abuse incident or incidents; in severe cases, it can affect adult functioning. The author examines the empirically supported research related to the incidence, consequences, treatment effectiveness, and models of treatment for CM.     

Expressive writing promotes self‐reported physical,social and psychological health among Chinese undergraduates

The present study examines the efficacy of expressive writing among Chinese undergraduates. The sample comprised of 74 undergraduates enrolled in a 9‐week intervention (35 in experimental class vs. 39 in control class). The writing exercises were well‐embedded in an elective course for the two classes. The 46‐item simplified Chinese Self‐Rated Health Measurement Scale, which assesses psychological, physical and social health, was adopted to measure the outcome of this study. Baseline (second week) and post‐test (ninth week) scores were obtained during the classes. After the intervention on the eighth week, the self‐reported psychological, social and physical health of the experimental class improved. Psychological health obtained the maximum degree of improvement, followed by social and physical health. Furthermore, female participants gained more psychological improvement than males. These results demonstrated that the expressive writing approach could improve the physical, social and psychological health of Chinese undergraduates, and the method can be applied in university psychological consulting settings in Mainland China.     

Physical fitness and enhanced psychological health

A great deal of attention has been given to the association between physical fitness and psychological health. The purpose of this view is to examine recent developments in the burgeoning exercise and psychological health literature and to explore avenues for future research. The current review focuses on research that has examined enhancement of psychological health and well-being among nonclinical populations since 1980. Four areas of psychological functioning are reviewed: (1) psychological well-being and mood, (2) personality and self-concept, (3) physiological stress responsivity and (4) cognition. Exercise appears to improve mood and psychological well-being as well as enhancing self-concept and self-esteem. Exercise appears to do little for personality functioning. Furthermore, mixed empirical support exists to suggest that exercise influences stress responsivity and cognitive functioning. However better research designs and procedures are still needed. Theories regarding the connection between exercise and psychological functioning as well as suggestions for future research are offered.     

Predicting Potentially Harmful Psychological and Physical Behaviours by Parental Caregivers toward Children with Autism Spectrum Disorder

Mistreatment of dementia patients by spousal care providers is fairly common. Caregivers’ characteristics, particularly their psychosocial, physical and cognitive functioning, and coping behaviours, predict reports of elder mistreatment. Parental caregivers of children with autism spectrum disorder (ASD) however, despite the similarities they share with dementia caregivers, have not been studied in this context. A sample of N?=?95 caregivers of children with ASD completed an online survey assessing: (a) psychosocial, physical and cognitive functioning, and (b) coping behaviours. Caregivers also: (c) rated the extent to which they used potentially harmful psychological (e.g., screamed at the child) and physical (e.g., slapped the child) behaviours to cope with caregiving challenges over the last 12 months. Rates of potentially harmful psychological and physical behaviours were extremely low. However, 95% of caregivers reported using at least one potentially harmful psychological behaviour at some point in the last 12 months, and almost 38% reported using at least one potentially harmful physical behaviour. Mediation analysis yielded an indirect effect of psychological distress on potentially harmful psychological behaviours through disengaged coping. In conclusion, rates of potentially harmful behaviours appear to be low in the context of caring for a child with ASD. Caregivers reporting increased psychological distress were more likely to use potentially harmful psychological behaviours, and this effect was partially mediated by greater use of disengaged coping.     

Optimism as an indicator of psychological health: using psychological assessment wisely.

Healthy aspects of psychological functioning are often overlooked in traditional psychological assessment. When this happens, the client may become discouraged with his or her testing results, or perhaps worse, may feel that the assessor was not interested in obtaining a complete picture of who he or she is. Assessing healthy aspects of psychological functioning can be problematic, however; adding new instruments that only speak to one aspect of psychological functioning is not practical. A system is proposed in which one aspect of healthy psychological functioning--optimism--can be assessed using a standard projective test. Use of this scale can aid the assessor in conceptualizing the client's functioning and can also be a helpful tool to draw on in the course of treatment.     

Optimism as an Indicator of Psychological Health: Using Psychological Assessment Wisely

Healthy aspects of psychological functioning are often overlooked in traditional psychological assessment. When this happens, the client may become discouraged with his or her testing results, or perhaps worse, may feel that the assessor was not interested in obtaining a complete picture of who he or she is. Assessing healthy aspects of psychological functioning can be problematic, however; adding new instruments that only speak to one aspect of psychological functioning is not practical. A system is proposed in which one aspect of healthy psychological functioning--optimism--can be assessed using a standard projective test. Use of this scale can aid the assessor in conceptualizing the client's functioning and can also be a helpful tool to draw on in the course of treatment.     

Social support,social integration,and health-related quality of life over time: Results from the Fitness and Arthritis in Seniors Trial (FAST)

The present study tested whether baseline perceived social support and social integration predicted baseline and follow-up measures of health-related quality of life for 364 older adults with osteoarthritis. The findings are secondary analyses of a randomized controlled trial of an exercise intervention. Multiple regression analyses indicate that perceived social support was related to baseline measures of functioning in psychological (depressive symptoms, social functioning, and life satisfaction) and physical domains (self-rated disability, observed physical function, and perceived health), after accounting for demographic and clinical status factors. At 18-month follow-up (additionally controlling for exercise intervention and baseline outcomes), social support significantly predicted changes in psychosocial functioning, but was unrelated to changes in self-reported and observed physical health. The findings indicate that social support is an important predictor of long-term psychosocial outcomes, but is less important than baseline clinical status for physical health endpoints in this cohort of older adults. In contrast, social integration was not a consistent predictor of outcomes.     

Homeostatic interactions: a longitudinal study of biological, psychosocial and family variables in children with cystic fibrosis

A two-Year longitudinal study of thirty-five children used data gathered from pulmonary function tests, clinical measurements and standardized tests of depression, self-esteem and family environment to illustrate homeostatic interactions among biological and psychosocial adaptation to cystic fibrosis. Despite physical deterioration over the course of the study, children with cystic fibrosis reported lower depression and higher self-esteem than population norms, and improvements in psychological functioning. Decline in biological indicators of health was associated with increases on an index based on Family Environmental Scales (FES), subscales of cohesion, expressiveness and organization, and maintenance of high self-esteem and low depression. Presence of additional major life stressors was associated with deterioration in pulmonary function, higher levels of depression and poorer scores on the FES. These findings suggest that homeostatic interactions between children's health status and family functioning may moderate the physical and psychological sequelae of cystic fibrosis.     

The effects of rational-emotive therapy and relaxation training on premenstrual syndrome: A preliminary study

Six female subjects who were between 31 and 44 years of age attended a premenstrual syndrome (PMS) clinic and participated in a group therapy program designed to alleviate their premenstrual symptoms. Rational-emotive therapy (RET) and relaxation training were offered in addition to ongoing progesterone treatment in an effort to alleviate severe psychological symptoms thought to be occasioned by the hormonal changes occurring during the premenstrual week. Pre-treatment assessments were carried out using Moos' Menstrual Distress Questionnaire, Broadbent's Cognitive Failures Questionnaire, and Eysenck's Personality Questionnaire. Additionally, levels of self-reported psychological and physical menstrual distress symptoms were estimated by the subjects at each premenstruum throughout the ten-week therapy program. At the end of the ten week therapy program hormone treatment was discontinued. Significant pre-test to post-test differences were found in a number of psychological and physical symptoms of menstrual distress, in cognitive functioning and neuroticism, following the combined group treatment. Improvements in psychological functioning during premenstruum were observed at a one-year follow-up. RET and relaxation together with hormonal therapy produced a substantial reduction in PMS symptoms in comparison with drug treatment alone.     

A longitudinal analysis of the course of depressive symptomatology in geriatric patients with cancer of the breast, colon, lung, or prostate.

This study mapped the trajectory of depression and its components (depressive mood, somatic expression of depression, and lack of positive affect) for 1 year after an initial cancer diagnosis, revealing the complex nature of the psychological response to the cancer experience. The analysis was based on 4 waves of panel data from 860 older patients with incident breast, colon, lung, or prostate cancer. Predictors of depressive symptoms included cancer site; stage; comorbidities; sociodemographic characteristics; and indicators of physical functioning, symptom severity, and treatment. Patients' overall depressive symptoms declined, especially depressive mood and somatic indicators. By contrast, the sense of well-being did not recover; in fact, it would have deteriorated without improvements in physical functioning and physical symptoms. The present findings show the importance of psychological assessments and symptom management during cancer treatment.