Last Post: Intergroup, Geopolitical, & Stress Management II

Over the last two and a half months our graduate course, Emotion, Health, and Stress, has examined how humans deal with stressors (acute and chronic). Our readings helped us engage on biological stress responses as well as decisions we personally make to handle stress (e.g., fight or flight). We were able to explore how technology, dieting, diseases, and post-traumatic stress disorder all have important roles when understanding stress and health. Most importantly, we were able to discuss how stress effects humans directly and indirectly, as well as what can be done to properly deal with those stressors. In this post, I will discuss those three topics – intergroup stress, geopolitical stress, and stress management II.

To begin, we’ll review how group differences during intergroup interactions can increase stress and lead to biased decision making within the social health care domain. Sapolsky (2004) emphasizes how people in poverty and members of minority groups may experience greater risks of illnesses (e.g., Latinos with stomach cancer) and may have the most difficult times when trying to receive proper care. For instance, Major et al. (2013) showed that Black patients were less likely to be recommended appropriate treatment compared to White patients and Sapolsky (2004) emphasized how paramedics may be less likely to revive a poorer person on the way to the hospital (compared to a wealthier individual). This becomes a vicious cycle as minority group members (e.g., Black individuals) who have low expectations of procedural justice (being treated fairly) may shorten their telomeres – which is linked to increased risk of stress related illnesses (Lucas et al., 2017). While these attitudes and behaviors from Whites or people in positions of power may be due to implicit racial biases (Major et al., 2013), it may also be due to the fear of being perceived as prejudice which could affect decision making abilities in highly emotional situations. Trawalter et al. (2012) showed that Whites who do not want to be perceived as prejudice (high on external motivation to respond without prejudice), tend to be anxious, avoid contact, and stressed both during interracial contacts and overtime. This is important because if some minority groups (e.g., Blacks) are being perceived as less warm and friendly, and interacting with them increases your stress, then professional decisions may be influenced by your willingness to end the interaction as soon as possible – in order to reduce your own stress – leaving the patient with less than recommended services.

In the event that one group explicitly emphasizes their dislike for another group then thoughts of a realistic threats (e.g., terrorist attacks) may be concerning. Strand et al., 2016 showed that after the 2011 Norway terrorist attack individuals had increased risks of suicides, heart attacks, respiratory problems, cardiovascular problems, and post-traumatic stress disorder. While this study examined the entire population of Norway it is important to note that researchers had relatively low statistical power, no measurement for stress, and hospitalizations/clinical events were relatively low. Generally, individuals have low direct exposure to terrorist attacks or other realistic threats (Strand et al., 2016). However, symbolic threats seem to be frequent during presidential elections. From Obama representing the potential fall of the White hierarchy to Trump representing the rebirth of explicit prejudice. Trawalter et al. (2011) showed that individuals high in social dominance orientation – a personality trait associated to the preference of hierarchy and anti-egalitarianism – had extremely higher cortisol and testosterone levels than individuals low in social dominance orientation. The emergence of a Black president increased stress, negative mood, and triggered a “fight-back” mentality to maintain a White social hierarchy for individuals high in SDO. On the other hand, Majumder et al. (2017) showed that democratic participants reported higher levels of (perceived) stress and anxiety months after the election, especially for women. It is important to note that Majumder et al. (2017) did not control for political views (liberal v conservative), which Trawalter et al. (2011) showed to be a significant variable related to post-election stress and anxiety. Additionally, Majumder et al. (2017) describes increased levels of stress for participants, but actually measures perceived stress.

Nonetheless, this collection of research studies emphasizes how interactions, culturally/economically shifting events, and terrorist’s attacks can all lead to increased stress and its negative health effects. One of the most important tools in reducing stress and anxiety is having an effect stress management. Evers et al., 2006 showed how using a TTM intervention, a national sample of adults were more likely to be actively improving their behaviors and healthy activities over a course of 18 months. However, it is unclear how exactly participants were instructed to complete each phase of the intervention. Other interventions primarily focus on attentional control and awareness of your own attitudes – mindfulness. The mindfulness-based cognitive therapy (MBCT) has shown that mindfulness based cognitive therapy can decrease depression, anxiety, stress, and fatigue in some physical conditions (Alsubaie et al., 2017). Mindfulness is also used in some meditation and yoga courses. That said, exercising tends to blunt your stress-responses for a few hours, decrease the risk of various metabolic and cardiovascular diseases, and simply make you feel good – by causing a secretion of beta-endorphin (Sapolsky, 2004). In Haaren et al., 2015, researchers showed that individuals participating in a 20-week aerobic running training course had lower negative affect compared to the control group and showed lower emotional stress reactivity compared to their baseline. Overall, the three of the most essential stress management methods are being mindful (awareness), being active (exercise), and willing to receive outside support (therapy).

Overall, it’s important to realize that as America becomes more diverse, people are going to feel uncomfortable at first and that’s okay. These readings have taught me that regardless of who I interact with or what news I hear/watch, I may feel stressed and those stressors can cause or escalate illnesses. The biggest take away is that people have to stride to being mindful (of each other and oneself) and that more resources are needed to provide individuals, especially from low socioeconomic communities, with the knowledge and tools to manage stress effectively.


Stress Management II

In last’s readings, we learned about how people may unfortunately cope with stress by abusing substances (e.g., alcohol, illicit drugs). This week, we learn about “good” coping/stress management strategies people can use to reduce physical and psychological stressors. Personally, I love to dance salsa and use that as an outlet whenever I feel overwhelmed with work, research, or just life in general. When I dance it’s both active exercising, but also an environment where everyone is smiling, laughing, and having a good time. I would definitely recommend people to take salsa classes to reduce stress. At first the classes may seem stressful, especially if you are new to salsa, but the atmosphere is amazing and full of supportive and caring people. That being said there are classes every week in Allston and Cambridge at Salsa y Control studios – just in case you’re looking for a new outlet to reduce stress.

Although the readings didn’t use salsa dancing as an example of stress management, Sapolsky (2004) emphasized the value of exercising and meditation. For example, exercising and meditation can decrease the risk of various metabolic and cardiovascular diseases by decreasing glucocorticoid levels and your sympathetic tone (Sapolsky, 2004). Additionally, it makes you feel good by causing a secretion of beta-endorphins. However, it is important to recognize that using exercise as a stress management tool is only beneficial if it’s something you want to do. If it’s forced, then your health can worsen. Haaren et al. (2015) described how active people may be protected against stress-induced rumination. More importantly, their research found that a 20-week aerobic training course (intervention condition) lowered negative affect (compared to the control group), reduced emotional stress reactivity (compared to their baseline), and may buffer stress-induced health risks (Haaren et al., 2015).

When people meditate or take aerobic courses, an important element of these activities are being mindful. Mindfulness is typically defined as paying attention on purpose to the present moment non-judgmentally (Alsubaie et al., 2017). In mindfulness types of therapy, there are three components researchers typically focus on: control, intention of attentional control, and attitudes that are being trained. For the Mindfulness-Based Cognitive Therapy (MBCT) researchers found that participants had reduced symptoms of depression, anxiety, and fatigue in some physical conditions; however, much of these findings had small to medium effect sizes (Alsubaie et al., 2017). Unfortunately, there has been less attention given on why there are small effect sizes and what mechanisms might change through MBCT when comparing physical and psychological stressors. In an extensive literature review, Alsubaie et al. (2017) found that potential mediators of MBCT were mindfulness and decentering – which mediated the effects of perceived stress, post-traumatic avoidance and anxiety disorders. This was shown to be mediators for both physical and psychological conditions; however, some of these findings were inconsistent in the literature review.

On the other hand, looking at the Transtheoretical Model (TTM) – which we briefly reviewed in last week’s readings, participants typically report having more effective stress management compared to when not using this treatment model (Evers et al., 2006). In a nationally representative study, researchers showed that participants with a history of stress related symptoms (e.g., problems sleeping) and not practicing effective stress management, ended up feeling less stressed, depressed, and were more likely to be in the action and maintenance phases compared to control groups (Evers et al., 2006). This is important because it shows how treatment applied stress-management techniques can produce significant findings (e.g., reduced perceived stress).

Overall, it’s important to understand that not every stress-management treatment/intervention will work for your situation. If you don’t like the gym, then forcing yourself to go when you’re stressed may not be the best solution. More importantly, it starts how much effort you’re willing to put into a stress management system as well as how much support you have around you. That being said, I’m curious on what kind of outlets and management systems people have to deal with their weekly stressors?

Stress Management #1

This week’s articles were really meaningful for me because I had the opportunity to learn how exactly substance use/dependence is related to stress. I grew up with my dad being an alcoholic and my family living paycheck to paycheck. My brother started smoking cigarettes at the age of 13 when he joined a gang. While my two closest friends (Jesus and Marcos) would use drugs on a daily basis recently they stopped using marijuana, Xanax, and Adderall and are trying to stay sober. Similar to me, all my friends grew up in dysfunctional families, low-income communities, and living paycheck to paycheck- all which most likely led to higher levels of stress. Unfortunately, stressful events are shown to increase the likelihood of substance abuse (Hoffman, 2016).

While I was blessed with a great social support system, not everybody has that resource. My brother learned from some of his mistakes and taught me growing up why I shouldn’t use drugs or care about what other people say. While this week’s readings didn’t emphasize the role of social support on stress and substance use/dependency, Hoffman (2016) describes how adolescences typically turn to substance use as a coping strategy since they tend to have insufficient coping skills to manage stressful events. In fact, this research showed how cumulative stress was associated with an increase from early to late adolescence in binge alcohol and substance use (Hoffman, 2016). Additionally, adolescents with higher levels of cumulative stress had substance use increase relatively steady throughout adolescence (Hoffman, 2016). Unfortunately, researchers were not able to find evidence of substance use declining as an adolescent entered their adulthood – which would potentially increase responsibilities and reduce delinquent peers.

In Bowen, De Boer, and Bergman (2017) the reader is able to understand the relationship between stress and substance use – although this research narrows in on individuals with PTSD. The researchers provided further evidence on how PTSD symptoms (which is associated to stress) and problematic substance use have a bidirectional relationship, that is mediated by some facets of mindfulness. This means that PTSD symptoms are positively associated with severity of substance dependency – with awareness and nonjudging facets of mindfulness increasing substance use dependence (Bowen et al., 2017). However, describe, awareness, and nonjudging facets of mindfulness also increase PTSD symptoms – thus, bidirectional effects. Basically, this research illustrates how training in mindfulness may disrupt the relationship between PTSD symptoms (stress-associated) and substance use dependence.

In Sapolsky (2004) we get to understand the underlying process of addictive behaviors with substance use. Substance use increase the release of dopamine which relates to the anticipation of pleasure and energizing oneself (Sapolsky, 2004). Sapolsky talked about addictive measures in five ways – atypical low amounts of dopamine, perceptions of the substance, length of substance effects, stress, and environment. Individuals with low amounts of dopamine may thrive more on stress and risk-taking as those events/situations typically increase levels of dopamine. When you take drugs they release more dopamine than ordinary events (e.g., eating when you’re starving). Unfortunately, this excessive release of dopamine has a severe impact on your neurons and receptions which make you less sensitive over time to the drug. This means you’re going to need more of it to have that “feel good pleasure” all over again. Initially, that’s all you associate the drug to, pleasure. But, as time goes on you perceive yourself as weak and low on pleasure without the drug – making it addictive. People are stressed become dependent on substance use because it can decrease the extent of your sympathetic nervous system arousal and dampen your CRH-mediated anxiety – which causes you to not remember why you were stressed to begin with (Sapolsky, 2004). Drugs do wear off, and when they do you’re back to reality. You recognize why you’re stressed again and the same drugs that made you forget temporarily, will increase/generate anxiety – which may just lead you to take more drugs and numb the pain.

Some ways to reduce illicit behaviors, especially if they are multiple health risk behaviors are interventions such as the Transtheoretical Model (TTM) and interviewing (MI). Lipschitz et al. (2015) provided evidence showing that these types of interventions were able to positively change illicit behaviors for primary care patients, parents of high school students, community-based patients, and coronary heart disease patients. In general, the researchers found that poor stress management promotes risky behaviors, individuals with high levels of mental distress were more likely to engage in multiple health risk behaviors, and that stress management was associated to depression management (Lipschitz et al., 2015).

Coming back to my real life example in the beginning, I’m curious on how social support effects stress management and health risk behaviors for adolescences. Additionally, I’m curious on how the perception of the substance effects the addictiveness and stress related symptoms. For example, marijuana has become legalized in multiple states. That being said, the public perception of the drug is shifting, potentially from being a bad thing to something that might be normalized in our community now. Does this shift in perception change how and when people use the substance and perceived pleasure? If the substance is illegal then using it would be associated with risky behavior which may increase the release of dopamine. But if it is legal and perceived as “not bad” from the public, does that change the levels of dopamine releasing?

Geopolitical World & Stress

In the last presidential election, I remember going to sleep while Trump was in the lead for electoral college votes – hoping that when I woke up, Clinton somehow came away with the victory. I woke up in disbelief that a racist and politically uneducated individual could represent the country I was probably to be a part of. I was frustrated and didn’t know how to go about my day knowing this was real. Majumder et al. (2017) emphasizes that I wasn’t the only person to feel this away as both Democrats and voters that were concerned about Trump’s moral values and presidential capabilities reported having more stress and anxiety after the election. However, not too long ago some people felt a similar way when Obama became president in 2008. It represented Republican v. Democrat, Black v. White, and paving a new history v. maintaining a White history. Trawalter et al. (2011) showed that after the 2008 election, Republicans, conservatives, and individuals high in social dominance orientation exhibited physiological responses the day of and days after the presidential election. While Republicans showed increased levels of cortisol and decreased levels of testosterone, different patterns were shown for individuals high in social dominance orientation. These individuals showed extremely higher levels (compared to low SDO participants) in cortisol and testosterone. Researchers discussed how higher levels of testosterone may be linked with willingness to fight back to regain dominance. Real life examples have showed this to be true with Tea party members protesting Obama for “moving the USA towards socialism” quickly after his election.

Revisiting Majumder et al. (2017) on the 2016 presidential election, much of their results are open for debate. Unlike timelines like Trawalter et al. (2011) where participants completed a survey the week prior and of the election, Majumder et al. (2017) had participants complete a survey two weeks before and two months after the election day. In addition, their “post-election” survey was on the day of the presidential inauguration – which could be a potential confound on people’s anxiety and perceptions of the election and president. Most importantly, this experiment used two separate samples for the pre-and-post survey. That being said, their experiment offered great insight on how elections can lead to increase stress and anxiety simply on how you perceive the presidential-elect and not solely based on your political affiliation. One of the key concerns that predicted increased stress and anxiety was international policy. This is important because with frequent terrorist attacks across multiple countries, citizens of a nation need to trust that their leader will keep their country safe.

Terrorist attacks have shown to have severe mental and physical health consequences for both individuals with direct and indirect exposure. In general, Garfin and Holman (2016) discuss how terrorist attacks can increase risk of PTSD, cardiovascular and respiratory problems, incidences of schizophrenia, and anxiety, stress, and fear. However, they also mention that there are some positive outcomes from these horrific events. People were more likely to appreciate their life, change priorities, have more meaningful personal relationships, richer spiritual life, and increased resilience (Garfin & Holman, 2016). In Strand et al. (2016) researchers focus on a specific terrorist attack that occurred in Norway in 2011. It was noted that one in four Norwegians personally knew someone who was affected by either the bombings or shootings. Although Strand et al. (2016) is one of the first articles to show the effects of a terrorist attack on a population’s health, I am not convinced by their data. Their analyses showed that days and weeks after the event there was an increase in hospitalizations for: schizophrenia and psychosis, suicide attempts, heart attacks, and births. However, their results were relatively low on statistical power and had no statistical significant findings. These results show descriptive analyses (percentage change) rather than significant differences in hospitalization/incident ratios from the predefined time windows and prior years. In addition, there was no measurement for stress. Most importantly, their data showed low clinical events after the terrorist attack. While I do believe that terrorist attacks may have severe affects on mental and physical health I do not believe that the researchers were able to provide concrete evidence on the effects of this terrorist attack. The fact that there were low clinical events should speak to the low effect from this incident.

Technology & Stress

In this week’s readings, I learned about the use of technology, more specifically social networking sites, on individual well-being and mental-health. In three articles, researchers found that geographically-explicit ecological momentary assessments (GEMA) through cell phones can detect real-time reports of movements and well-being of our population (Kirchner & Shiffman, 2016); information and communication technologies (ICTs) may develop and enhance ongoing stressors in the workplace (Ayyagari, Grover, & Purvis, 2011); and how the use of social networking sites (i.e. Facebook) are associated with mental health (i.e. addition, anxiety, etc.) (Frost & Rickwood, 2017). This research is valuable because as our society develops new technological devices, it is important to recognize how it effects our mental health and productivity in both social and work environments.

Over the past couple of years it has become obvious that our society is dependent on both technological devices (i.e. mobile phones & computers) and the applications that are vastly used within those devices (i.e. Facebook). For the most part it seems as if these devices and applications – social networking sites are beneficial to connect and with old and new friends/associates. However, recent research has explored the potential consequences from our technological advancements. Frost and Rickwood (2017) emphasize that the use of Facebook can have horrific effects on an individual’s well-being from dissatisfaction in a relationship to lower self-esteem to anxiety to depressive symptoms. Most importantly, the researchers illustrate how these effects may vary on culture – as Korean participants reported lower body satisfaction than American participants after viewing a Facebook profile and comments either promoting or discouraging to be thin to an underweight or overweight individual (Frost & Rickwood, 2017). They make it clear to us that this is not simply about labeling social networking sites good or bad, because participating in these networks can potentially be helpful for your mental health. For example, researchers showed that participants who had a psychiatrist on their Facebook friend list benefited therapeutically, as they perceived having more social support and reassurance from a health professional (Frost & Rickwood, 2017).

In Ayyagari et al. (2011), it was further supported that technology can lead to stress and increased stress in the work place (technostress) through a variety of stressors, such as: work-home conflict, invasion of privacy, work overload, role ambiguity, and job insecurity. The study showed that constant changes in technology in the workplace leads to stress as individuals that are not as technology savvy may worry about their job security. Ironically, this is exactly what I mentioned in last week’s post as my mother was stressed about a new computer program at her job which eventually led to depression, since she was scared to go to work and be embarrassed about not knowing how to work the new program. That being said, Ayyagari et al. (2011) described how technostress lowers productivity and job satisfaction.

Interestingly, after reading these articles I started reflecting on my own use of social media and some of the potential stressors that are associated with technology. I realized that I check all my social media applications (i.e. Facebook, Instagram, and Snapchat) nearly 15-20 times an hour. While this may vary depending on how busy I am, it looks like I am addicted to social media. However, I’ve noticed that over the past two years the amount of social media content I produce (i.e. posting and sharing pictures) have significantly reduced. I tend to now use social media as a news site and to keep up with my friends rather than express my own beliefs or likings. This makes me interested in exploring how does technology impact stress levels on individuals who use social media to “keep up with the world” or “try to pass time” rather than as an outlet to express their beliefs or life events.

Recently, I watched an episode of Black Mirror (S3 E1 – Nosedive) which depicts technological anxieties in the workplace. In this futuristic world, somewhere in England, social media is directly associated to real life benefits and decision-making. Rather than receiving likes on a social media post, viewers rate one another’s posts/pictures out of five stars. The average amount of stars an individual receives is what they are represented as in life – so that an individual with a certain star average will be able to receive a loan, rent a car, get into specific restaurants, etc. While technology is exciting, this illustrates the extreme case of addiction to technology – to which a society use it to develop social statuses. In addition, this creates an environment where individuals are constantly stressed on how people perceive them and their social media posts. After watching this episode and reading these articles, I became interested in understanding how technology can potentially be used as a tool to control who we are rather than a platform of expression. We’ve seen this already in some cases with jobs and schools checking applicant’s social media profiles when evaluating their application. However, do you think it’ll ever come to a point where social media sites or certain technological devices will be required in our society in order to keep surveillance on the population?

Intergroup Context

Reading the articles this week really hit home – especially growing up as a Latino in a low SES community, raised by a single mom (who was recently diagnosed with bipolar disorder), and a brother involved with gangs. Sapolsky (2004) couldn’t have said it better when he said being poor brings more psychological and physical stressors – and often poorer people can’t cope with these stressors efficiently. I say that because I’ve seen first-hand what these stressors have done to my mom over the years. From being emotionally abused by my father to being the only parent with a job to being in credit card debt to living paycheck by paycheck to becoming a citizen – she’s had to somehow figure things out. The irony in this week’s articles is that my mom works at a university medical center, but felt too stressed when workers were required to learn new computer programs (as she barely knows how to work a computer), so she decided to stop going to work each morning to avoid the embarrassment and stress that came along with working on a computer. She would sleep all day not wanting to do anything. After months of missing multiple workdays, my family (especially her sisters) talked her into going to a therapist, in which they went with her each week. She was then diagnosed with bipolar disorder, and while she still has her moments – she’s doing a lot better. I wanted to share this story because I think this example adds on a feature of stress for groups of people that the articles didn’t particularly mention. In this age of technology, many workers who grew up in low SES communities or migrated from another country for greater opportunities (as my mom did) didn’t have the opportunity or resources to learn how to use some technological devices. The fear of losing a job, due to the lack of skills required on a computer or other technological devices may develop chronic stress – as some of these workers may be working solely to provide for their family. This may not be just an issue for poorer people, but for older people as well. It might be the case that older people are less interested in adapting with newer times, which could potentially backfire if their company advances their technological tools.

In Major et al. (2013) we learn how severe of an issue health disparities are in the United States, as Latino men are 63% and women 150% more risk of stomach cancer compared to their White counterparts. These disparities have been shown to be horrific for numerous disadvantaged social groups (e.g. race, sex, SES). Similar to my earlier example, Major et al. (2013) explains that when disadvantaged groups of people are threatened they feel defeated and powerless – which over time will turn into disengagement, where there is no attempt being made for coping with the problem. Major et al. (2013) emphasizes that people may cope through compensation (i.e. working extra hard), suppressing activated negative group stereotypes (i.e. attempting to disprove stereotypes by your work ethic/academic performance), and by using avoidance – like what my mom did. Unfortunately, each of these coping strategies come with consequences that may increase the risk of diseases and illnesses. For example, avoidance coping strategies may lead to more risky behaviors like smoking, substance abuse, drinking and comfort eating – which have all been linked to increased risks of depression, cardiovascular disease, and autoimmune diseases. Nonetheless, regardless if you cope or not, disadvantaged social groups are still at risk of health issues by simply living and interacting with people of different races and statuses. On the other hand, when people from these groups attempt to seek help they find themselves even more disadvantaged based on stereotypes related to their group. Major et al. (2013) reviewed how physicians reported spending less time treating obese patients, and were less likely to recommend appropriate medical treatments to Black patients after reading a vignette. This then leads disadvantaged groups of people to become more suspicious that they are being mistreated due to prejudicial attitudes from health professionals – which predicts the likeliness of Blacks scheduling and attending appointments with White physicians and minority women pursuing recommended tests and preventive services (Major et al., 2013). Also, White physicians who scored high in implicit racial bias perceived Blacks as less warm and friendly – which could explain their lack of medical recommendations towards Blacks. That being said, Lucas et al. (2017) discussed how low expectations of procedural justice may negatively affect coping strategies regarding health.

While Major et al. (2013) described the intergroup structure and individual dynamics of the health care system and how it facilitates both explicit and implicit biases towards patients, Trawalter et al. (2012) evaluated how everyday (non-physicians) advantaged people may also experience stress while interacting with individuals of another race. More specifically, this research examined how Whites who are externally motivated (EM) to respond to others without prejudice become more anxious and attempt to avoid contact. In the first experiment, Trawalter et al. (2012) found that after having an interracial interactions Whites had increased levels of stress via nonverbal anxiety and cortisol levels during the interaction. In the second, the researchers discovered that Whites with high-EM who had more interracial interactions throughout a school year had a flatter cortisol slope – and this pattern has been associated with chronic stress exposure and negative health outcomes (Trawalter et al., 2012). After reading this article I became interested in understanding how much of an increase of cortisol levels will Whites with high-EM have after having an interracial interaction with a discussion about race issues in America. In addition, I am curious on how stress levels will change depending on how the discussion is framed – either as a topic of White privilege or Black disadvantages.


Initially, I always thought that post-traumatic stress disorder (PTSD) was only associated with military veterans because of the media and movies I watched. I soon learned that I was wrong. However, I realize that I don’t actually know a lot about PTSD. This week’s list of readings was great in helping me understand what PTSD is, how it can affect you biologically, mentally, and physically, and ways to reduce it’s symptoms.

Post-traumatic stress disorder (PTSD) is a psychological condition triggered by a traumatic event (Hall, Hoerster, & Yancy, 2014). About 6.8% of people in the United States develop PTSD some time in their life, even though 75% of people experience at least one traumatic event in their life (Yehuda & LeDoux, 2007).  PTSD is described to be 3 clusters of symptoms: (1) re-experiencing symptoms (e.g. nightmares of traumatic events), (2) avoidance symptoms (e.g. distancing oneself from the reminders of the event), and (3) hyperarousal symptoms (e.g. overt physiological manifestations – insomnia) (Yehuda & LeDoux, 2007). These symptoms must be severe enough for at least one month to be considered PTSD. While there has been limited neuroscience research on understanding PTSD, Yehuda and LeDoux (2007) describe how PTSD is a condition in which the process of recovery from trauma is impeded by a mechanism (phenotype) and because of the failure to reinstate physiological homeostasis.

Typically, research focuses on White male military veterans, even though Black and Hispanic veterans experience higher rates of chronic PTSD (Hall, Hoerster, & Yancy, 2014). In an extensive literature review of PTSD, physical activity, and eating behavior, researchers discovered that individuals dealing with PTSD are less likely to exercise and more likely to have a poor diet because of their fear of bodily arousal symptoms – like increased heart rates and a shortness of breath (Hall, Hoerster, & Yancy, 2014). However, these behaviors do vary based on demographics. While a decline in exercise over time is associated to PTSD, I found it surprising that veterans had the highest odds of no regular exercise (Hall, Hoerster, & Yancy, 2014). I would assume that veterans would have the lowest odds – as they lived a numerous amount of years in routine of exercise. Women on the other hand showed more PTSD symptoms if they engaged in binge eating. Surprisingly, this extensive literature review revealed that there is barely any research on PTSD, physical activity, and eating behavior in the past 30 years – as the authors site 15 studies that could be appropriately analyzed into these three categories. Unfortunately, the literature currently availability lacks consistency in measurements (e.g. self-reports, clinical interviews, cohort studies). While it’s great to have diverse research methods, the issue here is that it becomes difficult to understand what measures are reliable and valid when they are used in experiments that are distinctly different from one another. And with the lack of replicable and follow-up studies it becomes extremely difficult to believe the arguments much of the research has to offer. For example, Hall, Hoerster, and Yancy (2014) describe how 2 studies showed that adults with PTSD were less likely to engage in regular physical activity, but another two showed no differences.

Due to the lack of research in the current literature, recent research has examined the effects of PTSD on weight gain. Kubzansky et al. (2004) showed that experiencing PTSD symptoms was not only associated with an increased risk of becoming overweight, but also altered people’s BMI trajectories over time. Specifically, this research study found that women with trauma and ongoing symptoms of PTSD had significantly higher odds of being overweight or obese compared to women who did not experience PTSD symptoms (Kubzansky et al., 2014). However, some limitations of this study were how they assessed PTSD as being associated with the “worst event” of someone’s life which could be a misclassification of PTSD as previously noted 75% experience at least one traumatic event. While this research does not offer insight on potential mechanisms that may associate PTSD with increased risk of weight gain, it does push us to explore whether PTSD can also be a risk to cardiometabolic diseases as obesity is a proven mechanism for cardiometabolic diseases (Kubzansky et al., 2014). Building off of this idea, Schnurr (2015) emphasized that more childhood trauma was associated with an elevated likelihood of serious chronic diseases (e.g. CVD).

In Schnurr (2015) we learn about potential mediators between PTSD and chronic diseases and physical health. For example, depression mediates the relationship between PTSD and pain and physical inactivity. Most importantly, a higher allostatic load may be the key mechanism between PTSD and physical health because PTSD is associated with metabolic syndrome (a combination of multiple risk factors – like obesity and hypertension), and multiple risk factors combined is a key feature of allostatic load (Schnurr, 2015). In general, Schnurr (2015) emphasized that when looking at mechanisms associated with PTSD and physical health you must look at everything – biological, psychological, behavioral, and attentional changes.

Immunity, Stress, and Diseases

I remember throughout high school and college I would always have a stuffy nose and a little cough around finals week. I hated it because when the class was quiet and focused on the exam, my sneezing and coughing was constantly disruptive. Turns out that a common cold during a stressful week is more common than I thought. Research has shown that stress is associated with an increased susceptibility of developing a common cold (Cohen et al., 2012; Sapolsky, 2004). In these experiments participants were spritzed up their nose with a rhinovirus (what typically causes the common cold), and researchers found that stressed participants were about three times more liking of getting a cold after being exposed to the virus (Sapolsky, 2004). Follow-up studies have shown that developing a common cold after being exposed to a virus is more susceptibility to chronic stress (compared to acute), especially if the stressful life event was recent (Cohen et al., 2012).

Interesting in further exploring the potential relationship between stress and illness, researchers investigated how physical and psychological stressors could attribute to breast cancer. Research has shown that women frequently attribute their cancer to stress via self-reports. However, research (see: Shoemaker et al., 2016) fail to show scientific evidence of stress and increased risk of cancer. Shoemaker et al. (2016) found that while there was no significant association between breast cancer risk and perceived stress levels, they did discover that risk did increase for participants who lost a mother, not a father, before the age of 20 – excluding mothers with breast cancer. Sapolsky (2014) discusses how popular books in the late 1980s may have contributed to this idea of stress causing cancer, as Siegel (1986) emphasized that people with a lack of love, spirituality, and faith in their lives are more prone to cancer and illness. He quoted in his book (Love, Medicine, and Miracles, 1986) that “there are no incurable diseases, only incurable people.” Ideas like these grabbed people’s attention, especially if they could not afford proper treatment. Siegel went on to found a program called Exceptional Cancer patients where he attempts to relieve people from stress and have them focus on the nature of life and spirituality (Sapolsky, 2004). While his published articles found no significant effects on his techniques and survival time, this movement contributed to the interest in examining well-being and illness and morality.

While it’s still not understood whether stress can affect the risk of cancer or survival time for cancer patients, Sapolsky (2004) describes to the reader that people with fewer social connections have 2.5 times more of a chance dying from an illness. I find this interesting because initially I would assume that the smaller your social connection is the less likely you are to be infected by a virus or stressed in general. However, it emphasizes that with the lack of a social support system you might be more likely to experience risky behaviors (e.g. smoking) or forget to take medicine (Sapolsky, 2004). He does acknowledge that more research is needed to examine whether the lack of social connections causes risk of illness, or does being ill reduce the amount of people you interact with. This is important because in Hodes et al. (2015) we find out that depression alters the brain of an individual and has a physical impact on the body (i.e. not wanting to get out of bed) – which could relate with Sapolsky’s relationship between illness and social connections.

I find it surprising how detrimental stress can be on your health. As a social psychologist, I constantly explore how stress can affect perceptions, attitudes, and behaviors during a variety of events (i.e. intergroup and interracial interactions). Outside of research I really only saw stress as something that made my shoulders tense, changed my mood, and either made me sleep deprived or hungry. I never imagined how constant stressful events can eventually develop autoimmune diseases. While I think that research is necessary, this week’s readings made me recognize that everybody needs to know about the effects of stress – as people are frequently stressed for a variety of reasons.

Depression, Stress, & Eating

Over the years one of my biggest challenges has been boredom eating. When I don’t have any plans or want to procrastinate on doing homework I opt into eating to pass time. Most importantly, during these times of eating they’re typically high-calorie or fat meals – nothing to be proud of. This summer I lived with my two friends back in Chicago, since my sister took over my room. I never realized that my friend Edgar had diabetes until I saw him take his insulin shots. It would always freak me out when he had to inject himself with insulin – I hate needles. I’ve been trying to lose weight over the past two years, but could never stay consistent on my exercising or dieting plans. Although he has Type 1 diabetes he taught me a lot about taking care of my body and not putting myself at risk of Type 2 diabetes. I became scared of gaining more weight and started biking to work every day – even bought a bike in Boston.

Type 1 diabetes deals with the body not having enough insulin, while Type 2 deals with the failure of the cells responding to the insulin (Sapolsky, 2004). That being said, they both respond to chronic stress differently. For Type 1 diabetes, insulin might not initially work well for the body, leading the individual to inject more. Consequently, this leads the cells to become more resistant to the insulin. When stress goes down it’s not clear how the insulin dose goes down since each body part has different insulin sensitivity rates – causing your system to be unbalanced (Sapolsky, 2004). On the other hand, for Type 2 diabetes chronic stress simply just tells your cells that it’s great to be insulin resistant (Sapolsky, 2004).

While reading Magnan, Fennell, and Brady (2017) I realized that I was using the dual-process model over the summer. By seeing my friend Edgar inject insulin in himself, I became motivated to create better health choices – like riding my bike to work every day. Unfortunately, I constantly use the anticipated affect model described in Magnan, Fennell, and Brady (2017), but end up just feeling down on myself. I always tell myself that when I’m in Boston if I lose weight then I’m going to feel good and happy once I get to Chicago, but that seems to never happen and I just end up feeling disappointed with how I look at the beach.

While much of the time I feel stressed I try to sleep it off – trying to escape the reality of my stressors. It’s interesting on how stress-induced eating may make you feel better at the moment, but is much damaging long term. In Finch and Tomiyama (2014) they discuss how the consumption of palatable foods can reduce anxiety and depressive behaviors for both acute and chronic psychosocial stressors. However, we also know that being highly stressed is associated with high-fat diets (Finch & Tomiyama, 2014). While this may develop stress-induced, emotional eating, and comfort eating, it also makes you more vulnerable to Type 2 diabetes. Specifically, Kiecolt-Glaser et al. (2015) emphasized that greater numbers of “prior day stressors” in their study was associated with decreased post-meal energy expenditure – which could potentially lead to 11 pounds of weight increase across a year.

The story that these authors and researchers were trying to tell is that depression and stress promote obesity (Kiecolt-Glaser et al., 2015) because during stressful events we consume high fat/calorie/sugar meals with low protein to reduce stress (Finch & Tomiyama, 2014). By constantly having acute or chronic stressful events that induce eating will lead to Type 2 diabetes and increase your risks of cardiovascular disease (Sapolsky, 2004). Although you might be depressed, stressed, and eating, Magnan et al. (2017) wants you to know that there are models designed to improve health behaviors, create health-protective interventions, and to understand how you perceive health threat information.

However, after reading all of this I’ve became even more curious in understanding the effects of boredom eating. How does it effect your chances of diabetes? Does it create risks of cardiovascular disease? Is it as common as stress-induced eating?

CVD (Readings #2)

Over the summer, I was a research assistant at the University of Chicago Booth School of Business where I ran experiments on judgements and decision making. One of those experiments explored the 10/5 rule – one of many hospitality principles. This rule suggests that when you’re 10 feet away from someone you smile and make direct eye contact. And when you’re 5 feet away from someone you offer a greeting (i.e. waving your hand) gesture. This experiment split the 10/5 rule in half and examined the amount of interactions participants made depending on whether they used eye contact and smiled at 10 feet or eye contact and used a greeting gesture at 5 feet. This made me think about real-life implications. If I walk around smiling at everyone that crosses my path, am I going to be happier? Are they going to be happier? Are we going to put out a positive energy into the world? Maybe the reaction to seeing someone smile makes you happy and unconsciously smile back? This made me think – well can the opposite happen? What if we see someone and have a face that’s indifferent with emotions as we make eye contact – could that make them feel indifferent or angry? Did our indifferent expressions just let out a negative energy into the world?

It turns out that our emotional expressions do have a significant role on our well-being – more than you’d think. The act of smiling can reduce risk of cardiovascular disease by lowering physiological arousal, increasing heart rate variability, and lowering concentrations of inflammatory markers (Tucker et al., 2017). Although Tucker et al. (2017) showed us that the skill of expressing a positive emotion (i.e. happiness) was associated with lower cardiovascular risk (CVD) scores –their sample was relatively low in CVD risk factors to begin with. This leaves us to wonder if positive emotional expressions can have the same power (impact) for people with poorer health and at a greater risk with CVD. While research tries to dissect our everyday life and experiences, the isolation of an individual in a lab and expressing emotions at a computer monitor is completely different from a human being. For example, if I smile at a stranger (expressing joy/happiness) and they respond to me negatively, then I might not be in a joyful mood anymore. I might feel angry now because of their reaction.

While expressing happiness may have positive associations with lowering heart risks, anger and hostility actually increase the risk – specifically in ischemic heart disease (Newman et al., 2011). Patients who were observed as expressing hostility, by interviewers, were associated with an increased risk of IHD (Newman et al., 2011). This research suggests that hospitals should use interviewer based methods when coding for hostile behavior in patients, rather than asking a patient to self-report their emotions. However, in the attempt to prove that observing hostility was the superior method, Whooley and Wong (2011) refuted that if 90% of their patients observed hostility, how can they make an equal comparison and analysis to self-reporting systems when determining IHD risks. More importantly Whooley and Wong (2011) emphasize that Newman et al. (2011) were too focused on the differences of methods in understanding hostility that they did not explore what potential mechanisms could link hostility with heart disease.

As we can see, researchers are constantly trying to understand how our emotional expressions and experiences can affect our risk to heart disease, but it can be difficult to determine at times what’s the most appropriate method and how much external validity the experiment will have. In Why Zebras Don’t Get Ulcers, by Sapolsky (2004), the author explores the basic functions of our cardiovascular system and parasympathetic nervous system in relation to heart disease. Tying in similar topics as Tuck et al. (2017) and Newman et al. (2011), Sapolsky highlights that experiencing extreme joy or extreme stress can have similarly large demands on your heart which could make you more vulnerable to heart disease (Sapolsky, 2004). Constantly having chronic stress or extreme moments of joy can affect your parasympathetic nervous system to the point that it’s harder for your heartbeat to slow down (minimal variability) – which can gradually damage your system and make it more sensitive to acute stressors (Sapolsky, 2004). As acute stressors can potentially cause more harm on a damaged system, wear-and-tear become a greater concern. If acute stressors are causing greater harm than before then it forces your body to constantly work harder. In that process the amount and force of blood constantly returning to your heart may lead to a left ventricular hypertrophy – which is the single best predictor of cardiac risk (Sapolsky, 2004).

Returning to my original point, as social beings we are constantly experiencing and expressing a variety of emotions either initiated by us or as a reaction to another person or event. It is important to understand that these emotional experiences and expressions very much have a significant role in the well-being of our heart and bodily functions.