The placebo and the therapeutic uses of faith

The holistic movement in modern medicine has raised questions concerning the very character of the religion-medicine dialogue. A truly mutual interaction between theology and medicine must require of the theologian a serious interest in and understanding of medicine if the notion of the body-mind unity is to be taken seriously from the point of view of pastoral care. This paper suggests that this discussion may be enriched by a theological analysis of the placebo, which has lately been the subject of controversy within medical circles. Finally, it is suggested that the value of the placebo reposes in its serving as a symbol of the dynamics of faith in medical care.     

Immediate antecedents of cigarette smoking: an analysis of unrestricted smoking patterns

Theory suggests that cigarette smoking is under stimulus control and that affect is a key trigger for smoking. A previous study (S. Shiftman et al., 2002) showed little relationship between affect and smoking, but this relationship could have been suppressed by the impact of smoking restrictions. The study evaluated these associations in a 1988 sample that was subject to few smoking restrictions. Smokers (N = 28) not seeking treatment used palmtop computers to record context and affect prior to smoking (n = 2217 observations) and also at random times when not smoking (n = 2,380). Comparisons showed little relationship between smoking and affect. Smoking was associated with particular activities and locations. Urge to smoke was the strongest predictor of smoking. The results replicated the findings of S. Shiffman et al. (2002).     

Psychosocial Stress and Cardiovascular Risk: What is the Role of Daily Experience?

We describe an ecological momentary assessment (EMA) protocol designed to measure daily life experiences along several psychosocial dimensions (Social Conflict, Task Demand, Decisional Control, Negative Affect, and Arousal) hypothesized to be relevant for cardiovascular disease risk. In a large community sample, these assessments have been administered in conjunction with ambulatory blood pressure (ABP) monitoring and measures of subclinical cardiovascular disease. Several results have emerged that support the promise of this approach. First of all, each of these dimensions of experience appears to be a trigger for cardiovascular activation, with movement on each scale being associated with significant within-person changes in heart rate and blood pressure in the natural environment. Second, there appear to be individual differences in physiological responsiveness to these dimensions of daily experience, with such differences being associated in some cases with laboratory-based assessments of cardiovascular reactivity, as might be expected. Third, EMA ratings are associated in several instances with (between-person) stable individual differences in ABP readings. And finally, we have found that some of the characteristics defined by our EMA ratings are related to measures of subclinical atherosclerosis. Such effects appear to be mediated, in part, by ABP. The advantages of using EMA measures for capturing the effects of psychosocial stressors are highlighted by comparing the predictive validity of these daily life assessments to traditional global self-reports. We conclude by describing future plans for use of this type of assessment protocol for helping us to characterize psychosocial characteristics relevant to cardiovascular disease risk. Personality and social processes during daily living may have an important impact not only on psychological functioning but also on physical health and disease. In this article we review our recent work involving the assessment of daily experience as a means of better understanding the role of psychosocial stress in cardiovascular disease risk. First, we outline the rationale for our interest in daily experience sampling for examining these processes, and we describe the methods we have adopted for this purpose. Next, we review findings from a recent study in which we have used these approaches to examine the role of psychosocial stress on ABP and atherosclerosis in a community-dwelling sample. We compare our approach to more traditional (global self-report and laboratory-observation) methods for examining these relationships in humans, and we discuss potential future directions for use of daily experience sampling in studies of health and behavior.     

In the aftermath of September 11: group interventions with traumatized children revisited

The terrorist attacks of September 11, 2001, affected thousands of children psychologically, necessitating the mobilization of multifaceted mental health interventions in an ecological context. This paper reviews the major role of large and small group modalities in this challenging effort, with many of them based on earlier group work with child-victims of trauma.     

Why is cross-sex-role behavior more approved for girls than for boys? A status characteristic approach

Previous research has found that cross-sex-role behavior is less approved for boys than for girls in contemporary American culture. The investigation reported in this paper developed a general theory of the effects of status variables on evaluation of role behavior performance. Several propositions in the specific area of sex roles were tested empirically and all were confirmed. Subjects were 169 college students who responded to either a measure of disapproval of cross-sex-role behavior or a measure of disapproval of appropriate sex-role behavior. The results indicated that male-role behavior was more approved for both male and female actors, but that this difference was greater for boys than for girls. In addition, the results indicated that the cost in disapproval is greater for males who engage in cross-sex-role behavior than for females. Finally, the difference by sex of actor in approval-disapproval of female-role behaviors was larger than that for male-role behaviors. These results were discussed within the context of sex as a status variable. The general applicability of the propositions developed in the study was discussed. Also found were sex differences among subjects in response to cross-sex-role behavior and appropriate sex-role behavior.The author would like to thank Irv Gray, Barbara Wylie, and Gene Adams for their help in data processing and analysis. The comments received from those who read the earlier work of this author are greatly appreciated. Address correspondence to the author at Department of Sociology, University of Wyoming, Box 3293, University Station, Laramie, Wyoming 82071.     

Smoking patterns and dependence: contrasting chippers and heavy smokers

The authors used ecological momentary assessment to contrast smoking patterns among chippers (CHs; n = 26)--smokers who smoke despite an apparent absence of tobacco dependence--with those seen in heavy smokers (HSs; n = 28). Smoking and nonsmoking settings (activity, mood, etc.) were assessed by means of electronic diary. CHs were not social smokers; like HSs, they smoked half their cigarettes while alone. When smoking, CHs' urge levels equaled those of HSs; between cigarettes, CHs had few urges, whereas HSs reported moderate urges. CHs' smoking was particularly associated with indulgent activities: relaxation, socializing, eating, and drinking alcohol. Outside of these indulgent settings, CHs' (but not HSs') smoking was associated with negative affect. In idiographic analyses, CHs' smoking was under much stronger stimulus control than was that of HSs. The authors propose that the disappearance of stimulus control over use is a characteristic of dependence.