Postcards from the Id

Ability to Delay Gratification Leads to Better Health

Yes, I know this is a stunning finding, but nevertheless, I shall link to it.  The gist of the research is that individuals who are better able to focus on larger, long-term payoffs with respect to their choices are typically better off, including in areas related to health.  The study focused on determining whether people were more "present-minded" (i.e. focused on immediate results), or "future-oriented" (i.e. Seeing the longer-term consequences).  From the article:

Daugherty and Brase found that it was possible to predict participants' health behaviours according to whether they were future-minded or present-minded.

For example, they found that "delay discounting and time perspective significantly improved the incremental prediction of tobacco, alcohol, and drug use, exercise frequency, eating breakfast, wearing a safety belt, estimated longevity, health concerns ...".

They also found that participants who gave future-minded answers were more likely to report healthy behaviours.

The findings could shed light on how people deal with negative health behaviours: Brase said they could help people make better health decisions. A person with a present-minded time perspective would find it easier to make changes if they could see the rewards sooner rather than later.

The article also offers suggestions regarding how to improve the decision-making processes of those who are more present-minded.  It is in this vein I chose to link to this article; while the importance of developing the ability to delay gratification is readily apparent in a wide variety of areas, the trick (both in personal efforts as well as in therapy, where this issue comes up in many different clinical goals) is how to go about improving one's ability to delay gratification.  That is, we all know it's important; the question is, how do we do it?

The article suggests that one way to improve decision-making for those who are present-minded is to emphasis the relatively quick pay-offs for the future-oriented behavior.  For example, starting an exercise regimen may be extremely important for a person with high cholesterol levels; however, the benefits may not be readily apparent in that regard.  A more present-oriented person might respond better to the associated weight-loss (or other benefits that occur more quickly), even though the primary goal is lowering cholesterol level.  This is certainly one technique that may be useful in improving an individual's decision-making processes, especially early in therapy where a focus can be on certain basic, behavioral changes.  Over time, a person may develop more future-oriented thinking through practicing in this manner (in addition to utilizing other behavioral techniques), and some cognitive techniques may also help in this regard.  As the process unfolds, the even-larger benefits of better choices made during the initial stages will become apparent, further reinforcing the smarter decisions.   

Negative Emotions Stronger Than Positive Emotions At Fitness Clubs

This article reviews recent research into how people who are clinically overweight view the experience of exercise at fitness clubs, versus individuals whose weight is within the normal range. The research was conducted with the idea of examining why so many individuals who are overweight have difficulty engaging in the very behavior that would best impact the issue (the article notes that only 30% of people considered clinically overweight meet the NIH guidelines for weekly exercise).

According to the research, overweight individuals believed exercise improved appearance and self-image more than individuals with normal weight. However, overweight individuals also reported feeling more embarrassment and intimidation when it came to exercise in general, exercising in front of younger people, and exercising in the presence of fitter individuals. There were no differences between the groups when it came to feelings regarding complicated exercises, exercising in front of members of the opposite sex, boredom with exercise, or intention to exercise.

According to these results, it is not attitude about exercise per se that accounts for differing participation levels:

Writing in the article, the authors state, "One of the most noteworthy findings of this study was that OW [overweight] and NW [normal weight] subjects did not differ in their overall attitude toward exercising at a health club. This similarity in overall attitude of the OW and NW to club exercise is somewhat surprising, in that it is often assumed that OW people do not exercise as much as NW people because the 2 groups have different attitudes about exercise.

The article goes on to point out that it is a positive attitude versus negative attitude issue that needs to be addressed, in order to facilitate more consistent fitness participation, rather than simply assuming overweight individuals do not have positive thoughts regarding exercise.

Personally, I see the value in this research, as I think this is the same issue everyone tends to deal with, but with perhaps a stronger "negative" thinking pattern to overcome. Many people, regardless of fitness level and motivation, tend to run into periods in their life where the negative thoughts begin to outweigh the positive with respect to exercise, and many fitness books and magazines (not to mention more formal therapeutic efforts) will devote some writing to strategies designed to overcome creeping negativity, such as scheduling workouts with a fitness partner in order to overcome thinking that might otherwise lead to skipping a workout. In the case of individuals with weight issues, it is important to recognize the additional issues that contribute to negative thinking about exercise (especially in a gym or club), and enact strategies designed to overcome these additional issues (i.e. the negative thoughts about exercising in front of fitter individuals).

Impact of Domestic Abuse on Women's Health

Here is an article discussing new research into the impact of domestic abuse on the health of women.  The study examined the responses and medical records of over 3,000 women.  From the article:

Many of these health problems are not commonly understood as being associated with violence, such as abdominal pain, chest pain, headaches, acid reflux, urinary tract infections, and menstrual disorders.

"Roughly half of the diagnoses we examined were more common in abused women than in other women," said Amy Bonomi, lead author of the study and associate professor of human development and family science at Ohio State University.

There was also this:

Compared with never-abused women, victims had an almost six-fold increase in clinically identified substance abuse, a more than three-fold increase in receiving a depression diagnosis, a three-fold increase in sexually transmitted diseases and a two-fold increase in lacerations.

The article also notes this is the first time the data were gathered from medical records, rather than relying on subjects' self-report.  This gives the diagnostic information more credibility.  The authors pointed out that as these diagnoses become more present in a patient, they should serve as a cue to formally screen for abuse, as many women will not spontaneously volunteer this information. 

PTSD May Contribute to Heart Disease, Early Death

This article reviews new research suggesting that those suffering from PTSD may be up to two times more likely to die from heart disease than others. In addition, the more serious the PTSD, the more one is at risk. From the article:

PTSD causes the body to release stress hormones, which leads to the inflammation and damage to the arteries and cardiovascular system damage. Stress hormones also tend to reduce the amount of inflammation-reducing cortisol in the body--though researchers aren't sure why.

"Increased levels of stress hormones and less cortisol from PTSD are a bad combination," Dr. Boscarino explained. "Basically, PTSD just cooks your arteries in this situation."

The researchers examined over 4000 Vietnam veterans. They found the association between PTSD and heart disease by examining Vietnam veterans who were diagnosed with PTSD verses those who had not been. The researchers also noted. The more generalized association between PTSD and negative health indicators:

Dr. Boscarino previously found that people with PTSD had dramatically higher rates of chronic health problems such as psoriasis, arthritis and other inflammatory diseases.

"The science is conclusively showing that if you suffer psychological trauma, it's going to take a toll on your physical health," Dr. Boscarino said. "Getting counseling today is critical to avoiding a related problem tomorrow."

I was very much encouraged to read that last paragraph. In particular, effective therapy for PTSD will include teaching the client how to both reducing and manage the physiological response to their trauma history. This will include building skills that aid the client in reducing physical symptoms as they arise, as well as reduce the frequency and intensity of physical arousal in response to triggers. As noted above, it is the increased levels of stress hormones that has been implicated in the development of the chronic health problems. It would appear that effective treatment of PTSD, including the addressing of the physical symptoms that characterize this disorder, what helped to reduce the likelihood of developing such health problems.

Another Study Touting the “Mind-Body” Connection

This study examines the benefits of a telephone counseling program offered to women recovering from treatment for cervical cancer. The article indicates not only did the patients quality of life improve as a result of participation, but that there was a benefit to their immune systems due to the positive impact on the stress levels associated with their condition. From the article:

"Cervical cancer survivors frequently experience profound and long-lasting quality of life issues, yet they often do not avail themselves of cancer support resources and are in desperate need of psychosocial interventions that work for them," said Lari Wenzel, associate professor of medicine and public health at UC Irvine and co-lead author of the study. "This telephone-counseling strategy provided broad access to help women manage the stressors associated with cancer and its treatment."

There was also this paragraph, discussing the improvement in the immune system:

Blood tests on the women who completed the counseling program showed a shift in the immune system, specifically with a class of T-helper immune cells, toward the type of immune response that seeks out and destroys tumor cells. Dr. Edward Nelson, UCI oncologist, tumor immunologist and co-lead author on the study, said the shift in these biomarkers was associated with the quality of life improvements that resulted from the telephone-counseling sessions helping participants address and relieve stress.

Now, the study only examined 50 participants, so larger, more in-depth research is necessary in order to ascertain the benefits of this sort of program, as well as the mechanism. But it seems clear the trends being observed in recent research suggest addressing the mental health aspects of various medical conditions and their treatment improve the recovery efforts, as well as the associated quality of life issues.

Exercise May Cut Risk of Mild Cognitive Impairment

Not to beat a dead horse (and man, is my blog ever a dead horse!), but here is yet more research demonstrating not only the general link between mental and physical health, but the specific impact fitness has in warding off both the physical and mental aspects of aging. Without going on and on, it is becoming increasingly clear that one of the main efforts to address the health care issues facing us as our population ages is to significantly increase the amount of physical activity older adults engage in. The benefits - financial, psychological, medical - are simply too great. I’m not sure how this can be impacted on a macro level, but again, whether you are an older adult, you have parents who are older adults, or you work with older adults in the health care field, the development and implementation of fitness plans will increase both the quality and quantity of this groups’ lives. Continue to do whatever yo can to increase the activity level of all older adults in your life.

Psychologist Develops a Post-Operative Care Program for Heart Patients

Here is an article that briefly discusses the role of a psychologist in developing a program designed to help patients with issues resulting from having a heart defibrillator surgically implanted.  According to the article, heart patients in Bermuda are unable to have the procedure completed there, so they come to the U.S.  However, upon return, there are no post-procedure care services in place to help with the physical or psychological issues that often crop up:

"This treatment can often be lifesaving but the psychological effects of the implant on the patient can be wide-ranging in both symptom and severity. Initial fears of the surgery, what patients can and can't do following the operation, and fears about the physical effects of the implant delivering a shock - which can result in unconsciousness and cause incontinence - can all impact on the patient's well-being."

The authors note, for example, that approximately 16% of people who undergo this procedure will develop agoraphobia, which can seriously impair one's quality of life.  This program appears designed to be preventive in nature, and address these issues as they arise, rather than waiting until a difficulty is full blown.  I would like to note this is another example of the increasing role psychologists can (and will) play in the area of health psychology, as the significant interface between medical issues and mental health continues to be recognized and documented.  Some of my more recent posts, particularly the geriatric-themed posts, are all areas where mental health professionals can not only offer services that improve quality of life, but in fact directly impact people's medical status.

Many Moms Still Using Alcohol, Cigarettes, Marijuana While Pregnant; Dads Worse

According to this article, some women reduce their use of alcohol, cigarettes, and marijuana while pregnant.  However, many continue to use at least sporadically, and a sizable number don't change their habits at all.  The numbers:

* 77 percent of women cigarette smokers and 50 percent of the women who smoked marijuana used those substances at some time during pregnancy.

* 38 percent of women cigarette smokers and 24 percent of marijuana users reported using those substances throughout their pregnancies.

* While overall rates of cigarette and marijuana use and binge drinking for women declined during pregnancy, those rates began rising again during the first six months following the birth of a baby.

The study also found that fathers were not changing their habits appreciably.  The explanation for this was that public service announcements and other information provided to prospective parents focused on the mother's use of these drugs, and did not speak to the behavior of the men.  However, as the article notes, having another person in the house who is using a substance you already may crave will make quitting all that much harder.

The article suggests two strategies for combating this trend.  First, there is an urging toward health care providers to talk with prospective parents about health care issues such as drug use even more, especially towards fathers who might traditionally be left out of that conversation.  Second the authors suggest there needs to be a shift in the popular conventional wisdom regarding the use of drugs, especially marijuana, during pregnancy.  "We also need to change the way society presently looks at the social norms of using these drugs. Right now there is little discussion about marijuana use during pregnancy, although it may be a relatively prevalent problem," according to Karl Hill, one of the authors of the study.

Of course you do everything you can, but this is a tough nut to crack.  The optimist in me will look at the changing habits of smoking over the last few decades and believe this trend can also be reversed.  However, this group has resisted the smoking trend (they are still smoking), so this are likely less amenable to change.  In addition, several decades is a long time to shift something like this, because every baby born in the meantime by a couple who was using during the pregnancy is more susceptible to future problems, including the types of problems that perpetuate this problem (i.e. poor frustration tolerance, distractibility, etc.).  Who knows?  Maybe some other solution is out there, just waiting to be invented...

Lifetime Risk for Dementia - 1 in 6 for Women, 1 in 10 for Men

This article reviews the recent finding that the lifetime risk for developing Alzheimer's Disease is 1 in 6 for women, and 1 in 10 for men.  For women, the lifetime risk of any dementia or stroke is 1 in 3, which is higher than cardiopulmonary difficulties.  Women are at a higher lifetime risk due to their longer average lifespan.

With the wealth of recent information regarding the possible successful interfaces between psychology and the health sciences, and our rapidly aging population, I wonder if, 10-20 years down the line, there will be a major shortage in mental health professionals with a geriatric bent.  When I first entered my doctoral program, my plan was to specialize in geriatric psychology, and much of my graduate work (including research) was oriented to that area.  It is a huge area now, and will only become more widely needed as the boomers enter their retirement years.  The ability to assess dementia, as well as to help families cope with the myriad issues around caring for a loved one with dementia and other elderly medical problems is going to be something our society will desperately need in the not too distant future.  When I talk with younger people who are entering (or considering entering) the behavioral sciences, one area of specialty I identify as a future high-demand area is geriatrics.  Even in forensic psychology, we see this issue come up with older defendants who may or may not be suffering level of cognitive decline.  I think the numbers in this article demonstrate just how prevalent this problem is, and will be for the foreseeable future.

Cognitve Therapy Effective in Treatment of Self-Harming Behaviors

This is an interesting summary of a recent research study that found a 12-week course of cognitive-behavioral therapy (CBT) was effective in significantly reducing self-harming behaviors in individuals who engage in this type of behavior.  A couple of personal observations...

First, as the article notes, this type of behavior is on the rise, especially among teens.  The authors also note that the actual issues being addressed are depression and associated features.  These two aspects of the article, I imagine, are related - depression is on the rise, so it stands to reason that self-harm (a manifestation of depression), is on the rise.

Self-harming behaviors are not suicidal in nature, but very often people who engage in self-harming behaviors will end up with suicidal thinking at some point.  Self-harming behavior is actually a coping mechanism (albeit a very poor one), in which an individual is engaging in creating a sensation of pain in order to overcome a sense of "numbness."  This is a very difficult concept to understand in a "I get where you're coming from" way, as pain, for most of us, has a serious, built-in "avoid at all cost" response mechanism.  However, for individuals who are experiencing a certain combination of symptoms (to include depression, hopelessness, powerlessness, and a very low sense of self-efficacy, among other things), self-harm (such as cutting, burning, etc.) provides temporary relief.  However, the relief is often soon followed by even more depression, hopelessness, etc., as the relief is temporary, and the individual negatively judges them self for having engaged in the self-harming behavior (much like an alcoholic may drink to feel better, but feels worse the next day when they realize they got drunk again).

As a therapist, I can tell you that treating self-harming clients can be difficult.  As the article notes, it is important to acknowledge the individual's difficulties, without being judgmental, yet also promote the idea that there are better ways to handle their experiences.  Increased self-efficacy is crucial - basically, "Okay, you are feeling particularly bad right now - what can you do to provide relief that does not involve self-harm?"  As alternatives are developed, the individual improves their outlook and confidence in themselves, but it can take time, because the self-harm is quick and easy, while healthier solutions can take longer - not always an easy transition for an individual in crisis.