SBM 2017: Reflections on Science

Throughout my time in graduate school I’ve been to several conferences, but this one was different.  There have been a few big changes over the last year, and these changes may have drastic effects on the scientific community.  As a health psychologist, I can’t help but be troubled by this.

Medicine has come a very long way over the many previous decades and because of research, we are better at both treatment and prevention of chronic and acute illness.  However, this doesn’t mean “mission accomplished, we solved health!”  Health in the United States is not good right now.  

There are many indicators of health, but let’s take a quick look atobesity rates
a few. On the right, the first graph you see is obesity rates in the US over time.  It is projected that by 2030, half of the US population will be obese.  Half of the United States!  While this data is for adults, we are also seeing obesity rates rise in children as well.  In fact, 20% of school aged children are obese, a rate that has tripled since the 1970’s (
1). The californiadiabetessecond chart was presented at SBM.  It illustrates that over half the population of California, often considered a comparatively healthy state, has either diabetes or prediabetes. This is also an extremely frightening number.  Lastly, another theme of this conference was consideration of health disparities.  Even though our country has made great progress, we still have great health disparities due to a multitude of reasons.  In the last graph on the right we can see that, overall, disparitiescaucasian Americans live longer than black Americans.  Health equity should be a nonpartisan issue, and we need to continue to do research to bring optimal health to all.

 

While I make the point that scientific advancement should be imperative for our country, science isn’t perfect.  In my opinion, there are two main skills that we as a scientific community need to keep improving on.  The first is our methodologies.  We need to continue to refine study methods, so we can learn more about the causal mechanisms between treatment, prevention, disease, and many other biopsychosocial principles.  Second, and in my mind perhaps the most important, is to improve dissemination.  Again, this is a skill that has shown great progress but we still have a long way to go.  One of the keynote talks at SBM focused on a call to action, specifically for scientists to make calls to congress.  Unfortunately, congress members are not always aware of the science that is being done!  If health legislation is being passed on unscientific reasoning, then the policies that are put into place have a real potential to not only halt the progress we have made, but also set us back years.

In conclusion, we need science.  Especially recently, we too often see that people disregard scientific evidence and instead base their “facts” on their own opinions and experiences.  This is dangerous thinking, and the scientific community needs to do something. Maybe one reason this is happening is that scientists just have not done a terrific job explaining what we actually do and how science works.  So, we are starting a new series of posts that will delve into what science is, what it isn’t, how we should interpret science, and much more.  Stay tuned!

 

  1. https://www.cdc.gov/healthyschools/obesity/facts.htm

 

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Marriage and Health Part 2: Does Poor Sleep Lead to More Conflict?

You get home from a long day of work, eager to lay down for a quick nap; a nap that will help you recover from a bad night of sleep.  As you get home, you start making your way to the couch to enter dream world, but your partner stops you and tells you to walk the dog because it’s your turn.  You contend that you want to sleep first, you’ll do it later, the dog can wait 30 minutes, and that they can do it.  You’re tired and irritable so you angrily proclaim that you’ll do it later, and before you know it…you’re fighting.

This simple example shows how poor sleep can lead to more relationship conflict.  You may be thinking that this seems obvious, and that psychologists have already established this.  Surprisingly, there have only been a handful of studies looking at how sleep influences relationship functioning.  As my primary research interest here at NDSU is sleep in the marital context, I find this a very exciting and important area.  So why does it happen?  What does the science behind this say?  This post will answer these questions.

In many of my previous posts, I’ve explained how sleep is important for physical and emotional health.  Well, it’s also very important for a number of cognitive processes. For example, poor sleep has been associated with decreases in emotional regulation, problem solving, empathy, and emotional recognition.  On top of this, it also increases negative affect and anger.  All of these are BAD for relationship communication and functioning.  If you’re in a relationship, you know how important communication is.  When a problem arises, you need to effectively express your own concerns, recognize what/how your partner is thinking, and strategize an agreeable resolution.  If your cognitive functioning is limited, it increases risk for conflict.

Let’s go back to the example from the first paragraph.  What if you weren’t sleep deprived? You likely would have approached this situation differently.  Maybe you would have noticed that your partner was also fatigued (your own restless sleep can negatively impact their sleep) and perhaps in a bad mood.  Instead of bluntly saying you’ll walk the dog later, you could effectively communicate how you feel and settle on a neutral agreement.  There are a number of different ways this scenario can play out depending on your cognitive resources.

Psychologists have recently begun empirically testing these ideas.  However, much of the current literature has focused on sleep disorders and how they affect relationship functioning.  For example, how snoring, sleep apnea, and insomnia affect your relationship (hint: it’s not good).  What is missing is how day to day sleep in non-disordered couples affect their functioning.  Fortunately, these ideas are finding their way into the field.

Gordon and Chen (2014) carried out two studies testing these concepts.  In study one, participants recorded their sleep quality and relationship conflict over a two-week period.  Using advanced statistics, they found that poor sleep independently led to more conflict the following day.  This type of statistical test is important because it shows the direction of the relationship.

Study 2 found similar results.  Participants came into the lab and, separate from one another, recorded their sleep quality and top sources of conflict.  They were then placed into the same room and were asked to discuss these sources of conflict. Researchers measured their affect, empathy, and conflict resolution.  Couples who had poorer sleep the previous night had lower levels of positive affect, less empathy towards their partner, and had lower conflict resolution.

These findings are a good first step in this new direction.  It tells us that sleep may in fact impact certain aspects of relationships.  This matters because we cannot just say that poor sleep impairs functioning; we need to know why this happens.  But why is it important to learn more about what generates conflict? Conflict is not only bad for relationship outcomes (i.e. divorce) but it is also detrimental to physical health.  In the next post for this series, I will go into more detail as to how conflict influences health.

 

 

Gordon, A. M., & Chen, S. (2014). The Role of Sleep in Interpersonal Conflict Do Sleepless Nights Mean Worse Fights?. Social Psychological and Personality Science, 5(2), 168-175.

 

Psychology’s Role in Opinions Toward Police Shootings

The shootings of Alton Sterling and Philandro Castile have once again cultivated public outrage towards law enforcement officers. Following the shootings, multiple police officers in Dallas and Baton Rouge were shot and killed, seemingly as retaliation against police violence. If you are on social media, you have no doubt seen the videos and the angry reactions to all of these tragedies. Many people have strong opinions concerning the shootings, and it can often be quite easy to tell who is outraged with law enforcement and who defends law enforcement based on the things they say and share on social media.  So how are these opinions developed and maintained? Today’s post will explain the potential for bias in forming opinions, and why such biases can be problematic.

The first concept we will delve into is confirmation bias. This is the idea that we tend to only select information that is consistent with our preconceptions. How does this relate to opinions towards police shootings? Well, the articles you read and accept as true, and the information you ignore or discount may depend on your pre-set beliefs about police. For instance, if you tend to defend police officers, you may only attend to examples where violent police action was either justifiable or not present while discounting instances of race-based police brutality. On the other hand, if you believe that white officers tend to shoot unarmed black individuals, you may be more likely to follow stories of racial injustice while ignoring instances of positive interactions between black people and white police officers.

Confirmation bias is especially problematic because it doesn’t allow for objective reasoning or entertaining other points of view. If you only seek information that is consistent with what you believe and ignore information that contradicts these beliefs, it is very hard to have a rational conversation with someone of a differing opinion. Rather, this bias only serves to strengthen pre-existing opinions and further polarizes people with differing views.

The second concept is the availability heuristic. This heuristic uses the availability of information about an event to make judgments about the likelihood the event will occur. To illustrate: which is a more likely cause of death – being killed by dog or a shark?  Most people will say that a shark attack is more likely thanks to the media coverage when an attack does happen and the graphic imagery found in movies like Jaws, Deep Blue Sea, and The Shallows. Positive experiences with dogs are much more common, and national media rarely carries stories of deadly dog attacks. However, an average of about 30 people in the US die every year from dog attacks whereas 0-3 die from shark attacks. Because we have such readily available images of shark attacks, we are likely to overestimate the likelihood of such an attack occurring. Because we don’t have very available images of dog attacks, we’re more likely to underestimate the odds of dying due to a dog attack.

In the last couple weeks, there been highly publicized cases of police violence against unarmed black men and deadly retaliation against police officers by black men. This has resulted in extreme scrutiny and hatred directed toward both police officers and the black lives matter movement. However, the deliberate targeting of police officers is very rare, and according to the Washington Post, unarmed black men made up just 4% of the people killed by police officers in 2015. It is important to recognize that it is often the few bad eggs and extremists that get the media attention. The easily available information about these atypical people unfortunately leads to the misperception that they represent their particular group and that other members of their group are likely to preform similar actions. This is not the case, rather it is an example of the availability heuristic.

As an additional note, it is also important to consider the dangers of underestimating event likelihood. National media does not typically feature stories of positive interactions between white officers and black people, nor do they show stories of racial profiling by police. Just because these events may not be as readily available in people’s minds does not mean that they do not happen.

As you can see, there are reasons that people form and maintain their opinions. But what do the statistics say? Unfortunately, there is not a rich data set examining the characteristics of police shootings. However, the Washington Post is starting to compile this information. Using a collection of different sources, they are collecting data on victim race and mental health, circumstances leading up to the shooting, and about 10 other types of information. Data is still being collected for 2016, but here is the gist of what they have found for 2015. Of the nearly 1,000 people killed by police officers, 50% were white and 26% were black. At face value, this statistic seems to indicate that police are more likely to kill white people than black. However, the 2009 US census data shows that the population is approximately 62% white and 13% black. Now this tells us that a black person is twice as likely to be killed by a police officer than a white person. But, there is still one more statistic – blacks are charged with more than 50% of the murders and robberies in major US cities, thus increasing their contact with police officers.

So how do statistics factor into what we believe? Although statistics are substantially more grounded in reality than opinion, they’re not always the straightforward, definitive truth we want them to be. First, most people struggle to understand statistics. What seems like a simple statistic at face value can often require complex thinking that factors in elements such as base rates and population distribution. The average person is more likely to accept whatever statistic is presented than they are to do the research and math required to properly interpret it. Second, there is still room for bias in the interpretation of statistics. In the previous paragraph, there were three different interpretations offered for one statistic. Due to confirmation bias, people are often motivated to select the interpretation that best fits their opinion. Third, statistics can sometimes gloss over deeper systemic issues. In essence, statistics such as the ones previously described are good at telling us that something happened, but not so good at explaining why it happened.

We may like to think that we’re rational beings, but we aren’t. The world we live in is often too complex to fully consider every single detail, and so we develop biases and heuristics as a way to simplify this complexity. Often, these biases and heuristics are quite useful. For instance, confirmation bias can prevent us from pursuing irrelevant pieces of information when making decisions, and availability heuristics can prevent us from worrying too much about seldom occurring events.  However, as previously noted, these biases and heuristics can also be quite dangerous.

Biases and heuristics are quite difficult to avoid, but as you’re reading articles and discussing your opinions, take a moment to reflect. Are you ignoring information because it contradicts your own opinion? Is your fear or anger based mainly on media coverage? It helps to keep in mind the following two pieces of advice. First, be respectful of others and listen to what they have to say, even if you don’t agree with them. You may still disagree with them afterwards, but they may also be able to introduce a perspective you hadn’t previously considered. Second, recognize that you don’t necessarily have to pick a side, nor do you have to defend everything a person/group you support does. For instance, you can support police officers while still being upset with the ones who kill unarmed black men.

Between the social unrest and the current political situation, you’re going to be seeing a lot of people sharing pictures, videos, statistics, and articles that support their particular views. So as you’re scrolling through Facebook or sharing your own opinion, just be aware of the potential for bias and availability heuristics to influence the way you think.

Sleep Recommendations For Children

I wanted to write a very quick, yet important post while I’m home on vacation.  This topic may not seem incredibly important, but it serves as an important building block for lifelong health.  Growing up, my parents always tried to instill healthy habits such as brushing my teeth, staying active, and many others.  One under looked health habit in children is sleep.  Sleep needs vary across the lifespan, and many may wonder just how much sleep is needed from birth throughout the teenage years.

For the first time, the American Academy of Sleep Medicine has released their recommendations. These come from a yearlong project completed by 13 of the nation’s top sleep experts.  Here they are below:

4-12 months old: 12-16 hours per 24-hour period (including naps)

1-2 years old: 11-14 hours per 24-hour period (including naps)

3-5 years old: 10-13 hours per 24-hour period (including naps)

6-12 years old: 9-12 hours per 24-hour period

13-18 years old: 8-10 hours per 24-hour period

 

Healthy sleep is more than just getting the right number of hours though.  In future posts I will talk more about sleep health in infants and children!

Is Fitbit’s New Feature Fit For Healthy Sleep?

I want to start this post by saying that I am a fan and avid user of Fitbit. For my personal use, I have had both the Fitbit Charge HR and Fitbit Blaze, and have been a member for over a year. We also have a large inventory of Fitbits in our lab that we use for research. Fitbits are great in helping motivate people to live more active lives. I’m not alone in thinking this. As of August 2015, Fitbit had 9.5 million active users, with a total of 19 million registered users. All of this being said, I fear that this new feature may encourage poor sleep habits.

In case you missed it, Fitbit recently implemented a new feature that will set a sleep schedule for you that will help optimize your sleep. Here’s how it works. It averages your total sleep time, wake up time, and bedtime over the last month and using this information makes a recommendation for you to set a rigid schedule. I played around with mine, and it told me that averaged about 8 hours of sleep, like to go to sleep around 11:00pm, and wake up at 7:30am. Once this schedule is set up, it tells me to start getting ready for bed at 10:30pm and sets an alarm for 7:30am. Essentially, Fitbit is trying to motivate me to stick to a strict sleep schedule.

At first glance this seems great, right? As we know, sleep is important for health. So, if their app is helping to optimize our sleep, this should in turn make us healthier? This is a great idea! There is one problem though. This rationale does not completely align with the current sleep literature.

Sleep timing regularity is important for our sleep and physical health because it synchronizes our physiological sleep drive and our circadian rhythms1. Having more sleep variability is associated with more sleep problems and daytime fatigue2. So yes, regularity is important. But…the current sleep medicine therapies only target regularity for wake up times3. This contradicts some popular media sleep hygiene recommendations that propose regularity for both bed and wake time (I’m guessing this is what Fitbit based their app feature off of).

So why do sleep medicine therapies (i.e. Cognitive Behavioral Therapy for Insomnia) only target wake up times? The answer is simple. You should only try to sleep when you’re tired! Imagine yourself in this scenario. You fear that you are suffering from insomnia; you are having trouble falling and maintaining sleep and are struggling with bad daytime fatigue. Your therapist suggests setting a rigid sleep schedule for both your bedtime and wake time (let’s say 11:00pm and 8:00am). So the following night you try to implement this. You start getting ready for bed around 10:30 and get into bed at 11:00. But then you realize you aren’t tired! What then? You’re tossing and turning in bed, worrying that the longer you stay awake, the closer you get to your scheduled wake up time. Then you worry some more that you won’t fall asleep, and you worry some more. See this potentially disastrous cycle?

Each day is different, and you may not be tired at the same time every night.  Trying to sleep when you’re not tired may not only buffer treatment effects, but could also lead to worse sleep.  Due to this, targeting only wake up times may be efficacious and does not have as much potential to disrupt sleep. Trying to sleep when you’re not tired is also a poor sleep habit, because over time it associates your bed as a place where you cannot sleep (click here for more information).

In sum, I believe that this new feature by Fitbit is misleading and may potentially create unhealthy sleep habits. However, the current literature on this topic still needs A LOT more work. My lab has a few ongoing projects that will hopefully shed some light on this topic, so stay tuned in the next few years for updates on sleep schedule regularity!

 

  1. Dijk, D. J., & Czeisler, C. A. (1995). Contribution of the circadian pacemaker and the sleep homeostat to sleep propensity, sleep structure, electroencephalographic slow waves, and sleep spindle activity in humans. The Journal of neuroscience, 15(5), 3526-3538.
  2. Dijk, D. J., & Lockley, S. W. (2002). Invited Review: Integration of human sleep-wake regulation and circadian rhythmicity. Journal of applied physiology, 92(2), 852-862.2. Dijk, D. J., & Lockley, S. W. (2002). Invited Review: Integration of human sleep-wake regulation and circadian rhythmicity. Journal of applied physiology, 92(2), 852-862.
  3. Morin, C. M. (2011). Psychological and behavioral treatments for insomnia I: approaches and efficacy. In Principles and practice of sleep medicine (pp. 866-883). Elsevier Saunders, St. Louis, MO.

The Psychology Behind Irritable Bowel Syndrome

 

This post is written by a friend and colleague, Jessica Naftaly! She is currently a second year graduate student in a Clinical Psychology PhD program.

 

The Brain Gut Relationship in IBS

Approximately 11% of the population is affected by irritable bowel syndrome (IBS), a common functional gastrointestinal disorder that can significantly affect a patient’s quality of life.1 Functional gastrointestinal disorders can be difficult to diagnose as medical tests like blood tests and imaging scans cannot detect IBS.2 In fact, a diagnosis of IBS is IBS in textcommonly given when diseases that cause inflammation such as inflammatory bowel disease (IBD) are ruled out. IBS is thus mainly diagnosed through ruling out other diseases, and through physician use of specific diagnostic criteria called the Rome criteria.2 Since the diagnostic process can be somewhat subjective, patients with IBS tend to have high health care utilization and usually see multiple doctors before receiving a diagnosis. 3 The long process of receiving a diagnosis of IBS can be a frustrating experience for patients, on top struggling with a debilitating illness.

 

Psychology and IBS

Since IBS is difficult to diagnose, there is a limited understanding of how the brain and body interact in IBS (aka the mind-body connection). Research shows that stress makes IBS symptoms (e.g., abdominal pain, constipation, diarrhea) worse.4 Additionally, it is common for patients with IBS to also be diagnosed with anxiety and depressive disorders.1

 

Patients with IBS tend to report more frequent stressful events and have an increased reactivity to stress compared to people without IBS.4 For example, a patient with IBS who plans on going to a concert where there is little access to bathrooms, may be stressed and thus experience abdominal pain. This stressful event, however, may not be considered stressful for someone who does not have IBS.3 A patient with IBS may avoid going to the concert completely due to the fear of not having access to a bathroom. Although the patient knows that he/she is always able to find a bathroom when he/she goes out, this fear persists despite evidence that there will be bathroom access. This anxiety may even exacerbate IBS symptoms. Avoidance of attending the concert is an example of how a patient may cope with the abdominal pain and stress of going to the concert. Furthermore, avoiding the concert can contribute to depressive symptoms, feelings of social isolation, and guilt.3

 

The Brain and IBS

Researchers believe that there is a relationship between IBS and the brain, specifically through serotonin. Serotonin is an important neurotransmitter that is involved in mood regulation, sleep, pain, and motility in the GI system. Although some serotonin is located in the brain, guess where a majority of serotonin is located? You guessed right-the digestive tract.5 Research shows that patients with IBS may have different amounts of serotonin compared to healthy people, This could be why patients with IBS commonly also have anxiety disorders.5

 

Psychological Treatment and IBS

Medications like antidepressants are starting to be used as one form of treatment for IBS. Antidepressants can change the amount of serotonin in the body leading to a decrease in IBS in text twoIBS symptoms. Additionally, cognitive behavioral therapy (CBT) is a short-term treatment that involves the client and therapist (psychologist, counselor, social worker, etc) working together to address distorted thoughts and behaviors. Talking about these thoughts and behaviors can be helpful for patients with IBS.

 

We can use the example mentioned earlier (the patient with IBS avoiding the concert) as an example of how CBT can be used. In that example, the patient may have a cognitive distortion such as “I can’t go to the concert because I won’t make it to the bathroom.” The therapist would talk with the client about what evidence the client has that makes this thought true. Although many patients with IBS may have trouble making it to the bathroom, the therapist may find out that the client actually does make it to the bathroom on time but is constantly worried about not making it. The therapist may then have the client use thought records to help the client keep track of the accuracy of these thoughts. The therapist may also teach the client relaxation strategies, give the client homework, and help the client become more aware of inaccurate beliefs. Although talking with a complete stranger may seem scary, research shows that CBT is effective in decreasing IBS symptoms by improving patients’ coping strategies to manage stress and change cognitive distortions.3

 

Take home message: Although stress does not appear to cause IBS, there is a significant psychological component to IBS symptoms. Treatments like CBT and medications can be used to help decrease IBS symptoms. For more information on CBT please visit http://www.abct.org/Help/?m=mFindHelp&fa=WhatIsCBTpublic.

 

 

  1. Canavan, C., West, J., & Card, T. (2014). The epidemiology of irritable bowel syndrome. Clinical Epidemiology, 6, 71–80.
  2. Dalton, C. (n.d). UNC center for functional GI & motility disorders: Ask the expert: Question what is a functional GI disorder. Retrieved from https://www.med.unc.edu/ibs.
  3. Naliboff, B.D., Fresé, M.P., & Rapgay, L. (2008). Mind/body psychological treatments for irritable bowel syndrome. eCAM, 5(1), 41-50.
  4. Drossman, D.A., Camilleri, M., Mayer, E.A., & Whitehead, W.E. (2002). AGA technical review on irritable bowel syndrome. Gastroenterology, 123(6), 2108-2131.
  5. McLean, P.G., Borman, R.A., & Lee, K. (2006). 5-HT in the enteric nervous system: gut function and neuropharmacology. Trends in Neuroscience, 30(1), 9-13.

Pictures from: http://www.healthywomen.org/sites/default/files/ibs_0.jpg and http://www.gutfulofadhd.com/wp-content/uploads/2014/04/images.jpg

Postpartum Depression: What about the Dad?

There are several different forms of depression (i.e. major depressive disorder, bipolar disorder, seasonal affective disorder), but one that is not talked about as often is postpartum depression (PPD). PPD is diagnosed when there is an onset of major or minor depression during pregnancy or within the first 12 months after giving birth, and affects 1 in 7 new moms (14.5%). There is not a clear cause of PPD, but it is believed to be caused by physiological changes, a previous history of depression, poor sleep, or the burden of childcare.

No matter the cause, it is a disorder with extreme consequences. Beyond the depression in the mother and marital conflict, it also impairs family functioning and child development. For instance, a mother with PPD may not attend to the child’s needs as much, impairing child health and growth. It may also influence the child’s psychopathology later in life, increasing their risk for anxiety, depression, or emotion disorders.

A large portion of the current research has focused on PPD in mothers, but it is missing something important: the father. Men can also suffer from PPD, and it affects approximately 10% of new dads. This compares to a depression incidence of 5% in men in the general population (not new dads), revealing just how serious of an issue this is.

What causes PPD in men? This is a very new area of study, and one can only formulate educated guesses as to why men also suffer from PPD. According to Family Systems Theory, a family member’s emotions influence the emotions of those in their household, so it is possible that men develop PPD if their wife also has PPD. In fact, PPD in men and PPD in women are positively correlated, such that the father is at higher risk for PPD if the mother also develops it. An explanation for this relationship has to do with social support. A male’s strongest source of support is his wife, and if she has PPD she may not be as emotionally available to help him with the stress of being a new father.

While not yet shown with any empirical data, I would hypothesize that poor sleep also influences PPD in men. Following birth, sleep schedules in both parents are drastically changed and impaired sleep is a risk factor for the onset of depression. Further, more dads now than ever are stay at home dads, thus embodying the role of the infant’s primary care taker.

We know that research on PPD is important because it influences the physical and mental health of both the infant and the parents. Dads may be a particularly important group to learn more about in relation to PPD. A 1998 study found that a non-depressed father may buffer the negative effects of the relationship between a mom with PPD and child development. In other words, the dad may compensate for the mother’s PPD and take a larger role in caring for the infant. Overall, PPD research in both new mothers and fathers is extremely important, and future investigations need to learn more about PPD etiology, prevention, and treatment.

 

Goodman, J. H. (2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advance Nursing, 45 (1), 26-35.

Grace, S. L., Evindar, A., & Stewart, D. E. (2003). The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Archives of Women’s Mental Health, 6 (4), 263-274.

Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA, 303 (19), 1961-1969.