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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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

Later Weekday Bedtimes May Be an Independent Risk Factor for Obesity

In one of my previous posts I detailed how eating close to bedtime impairs your sleep quality, which may confer risk for obesity. Similarly, this week we look at a recent finding that having a consistent later bedtime can lead to increases in BMI over time.

It is important to view obesity from a developmental perspective; in many cases obesity starts in childhood and can progress into adulthood.  In fact, the current childhood obesity rates are alarming.  In 2012 data, 17% of children 2-19 were obese. While this number is down from recent years, this is still far too high.

 When looking at this data, one of the questions is always “why is this happening?’  One potential explanation may simply be how late you decide to go to bed.  A 2015 study by Asarnow and colleagues found that no matter how long participants slept, later weekday bedtimes were associated with increases in BMI over time.  This study not only controlled for sleep duration, but also fast food consumption and exercise frequency.  So, regardless of how long you long you sleep, how infrequently you exercise, or how much fast food you consume, going to bed at a later time can be a risk factor for obesity.

 This is pretty amazing.  This could also help explain why obesity rates in children are so high.  Surveys have shown that around 40% of teens prefer later bedtimes, and onset of puberty delays a night owl’s sleep period even more.  In another study of high school upperclassmen, 60% of them stated that they also prefer staying up late.

 But why is this happening?  Late bedtimes, which can desynchronize your internal and external biological clocks, have been shown to lead to metabolic disturbances such as disturbed glucose and insulin metabolism (my next post will explain how poor sleep is a risk factor for Type 2 Diabetes).  These disturbed process are then what contribute to the physiological changes that lead to increases in BMI.

This has important implications for public health and intervention research.  If future studies are able to replicate this effect, bed times can be a target for prevention and treatment for obesity. This is a very hot topic right now, and it will be exciting to see what comes out in the following years!

Asarnow, L. D., McGlinchey, E., & Harvey, A. G. (2015). Evidence for a Possible Link between Bedtime and Change in Body Mass Index. Sleep.

For statistics on childhood obesity: http://www.cdc.gov/obesity/data/childhood.html

The Interplay of Sleep, Food Intake, and Obesity

The field of public health has labeled a number of epidemics that are currently affecting the United States, with one of the most relevant of these being obesity. Current obesity rates are troubling, with almost 70% of the adults in the U.S. considered to be overweight or obese. Further, almost 7% of the population is considered to have extreme obesity.

Although not yet recognized by all public health officials, there is also a sleep epidemic in the U.S., and it’s also troubling. Compared to 50 years ago, Americans have been getting almost two hours less of sleep per night. According to the National Sleep Foundation, adults need 7-9 hours of sleep per night, but 40% of our population is not attaining this goal. Short sleep duration has been associated with increased morbidity and mortality, metabolic syndrome, type 2 diabetes, cardiovascular disease, and hypertension.

Many researchers do not think that the rise in obesity and decreased sleep time are coincidental. In fact, sleep and obesity has received a lot of research attention over the years. In psychology, and many other scientific fields, we like to perform what is called a “meta analysis.” This is basically a fancy word for taking all the studies done on a particular topic, and combining the results to see if there are consistent findings.

In 2008, there was a meta analysis done on sleep duration and obesity. This meta analyses was the first of its kind, because it looked at populations all over the world and also all ages. The results showed consistent odds that, if you are a short sleeper, you are also more likely to be obese.

However, directionality could not be drawn from this specific study. There are some suggested mechanisms behind this relationship though. Short sleep may lead to some hormonal responses, which then increase appetite. More specifically, short sleep associated with changes in leptin and ghrelin, which increase appetite. There is also potential for some behavioral snowball effects. Short sleep makes you more fatigued, which decreases your chance of exercising, which can lead to weight gain, which can lead to poor sleep….

While there is plenty of research looking at how short sleep time may cause obesity, there is little examining the other part of the relationship; how can food intake effect sleep? A recent study tackled this question, and recruited 52 men and women to participate. It is important to note that these participants were young adults, non-smokers, healthy, non-obese, and good sleepers.

Participants completed a detail record of their diet, and were then invited to spend a night in the sleep laboratory. They were then hooked up to a polysomnograph (the gold standard for sleep research). Researchers found that food intake, primarily at night, was significantly associated with sleep quality. In particular, food intake was associated longer sleep latency (the time it takes to fall asleep), less REM sleep, and more awakenings throughout the night. These findings were even more pronounced for women.

This is an important area of study. Sleep is very influential on daytime behaviors, such as diet, and vice versa. Sleep has significant implications for overall health, and should be seen as an important factor when considering diet and weight. Future research endeavors will hopefully shed light on some of the specific mechanisms in the relationships between sleep and obesity.

Cappuccio, F. P., Taggart, F. M., Kandala, N. B., & Currie, A. (2008). Meta-analysis of short sleep duration and obesity in children and adults. Sleep, 31(5), 619.

Crispim, C. A., Zimberg, I. Z., dos Reis, B. G., Diniz, R. M., Tufik, S., & de Mello, M. T. (2011). Relationship between food intake and sleep pattern in healthy individuals. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 7(6), 659.

Marriage and Health Part 1: Gender Differences in Social Control

It’s well known that marriage has many positive effects on health. Further, social isolation is a huge risk factor for mortality, comparable to the risks given by smoking, high blood pressure, and obesity. There is also a considerable gender difference in the benefits of marriage. For example, non married women have a 50% greater mortality risk compared to married women, while non married men have a 250% greater mortality risk than married men. All these findings are fascinating, but why do we consistently find these? In this new series of posts, we will be guiding you through the different pathways that will demonstrate how this relationship occurs.

This week, we will start by looking at a possible answer as to why men benefit far more from marriage than women. This is through the idea of “health related social control.” This is a little different than social support, which is characterized by positive encouragement. Social control is when a partner tries to persuade or intimidate their partner into changing certain health behaviors.

Social control attempts can be aimed at either health enhancing or health compromising behavior. Health enhancing behaviors are ways to improve health, such as exercising or attaining good sleep each night. Health compromising behaviors are anything that can worsen health, such as smoking or binge drinking. So, a control attempt at a health compromising behavior may sound like this; “Bob, if you don’t quit smoking, you won’t be around to see your grand children.”

So how does this benefit men more than women? Previous research has shown us that women generally have more health related knowledge. Due to this, women are more mindful of their health, and are also less likely to participate in health compromising behaviors. In fact, this finding is so strong that the greatest predictor in preventative health care is gender! Gender roles add to this. Women are not only more likely to monitor their own health, but also the health of others. So, if these roles are taken on during marriage, this can lead to more control attempts.

This sounds great for men, but do women receive control attempts as well? This is where it gets interesting. Contrary to women, men are less likely to monitor their own health and also the health of others. So, they are less likely to engage in social control attempts. However, this is not necessarily a bad thing for women, because they get their support from other sources. When naming their top sources of social control and support, women list family and friends over their spouse. To add credence to this line of research, men name their spouse as their top source.

While these findings are great and interesting, why are they important to know? While attempts to control another’s health behavior may sound like a bad thing, it actually does confer health benefits. It has been shown to lead to greater amounts of exercise, improved diet, and adherence to numerous medical regimes. However, social control attempts have a potential negative side to them as well, which can then lead to marital conflict; marital conflict can then engender a host of negative health outcomes (which we will talk about in later posts). So, it is important for each partner in a relationship to know their roles in the context of each other’s health.

Kiecolt-Glaser, J. K., & Newton, T. L. (2001). Marriage and health: his and hers. Psychological bulletin, 127(4), 472.

Umberson, D. (1992). Gender, marital status and the social control of health behavior. Social science & medicine, 34(8), 907-917.