Vanessa L. Burrows
Stress has not always been accepted as a legitimate medical condition. The biomedical concept stress grew from tangled roots of varied psychosomatic theories of health that examined (a) the relationship between the mind and the body, (b) the relationship between an individual and his or her environment, (c) the capacity for human adaptation, and (d) biochemical mechanisms of self-preservation, and how these functions are altered during acute shock or chronic exposure to harmful agents. From disparate 19th-century origins in the fields of neurology, psychiatry, and evolutionary biology, a biological disease model of stress was originally conceived in the mid-1930s by Canadian endocrinologist Hans Selye, who correlated adrenocortical functions with the regulation of chronic disease.
At the same time, the mid-20th-century epidemiological transition signaled the emergence of a pluricausal perspective of degenerative, chronic diseases such as cancer, heart disease, and arthritis that were not produced not by a specific etiological agent, but by a complex combination of multiple factors which contributed to a process of maladaptation that occurred over time due to the conditioning influence of multiple risk factors. The mass awareness of the therapeutic impact of adrenocortical hormones in the treatment of these prevalent diseases offered greater cultural currency to the biological disease model of stress.
By the end of the Second World War, military neuropsychiatric research on combat fatigue promoted cultural acceptance of a dynamic and universal concept of mental illness that normalized the phenomenon of mental stress. This cultural shift encouraged the medicalization of anxiety which stimulated the emergence of a market for anxiolytic drugs in the 1950s and helped to link psychological and physiological health. By the 1960s, a growing psychosomatic paradigm of stress focused on behavioral interventions and encouraged the belief that individuals could control their own health through responsible decision-making. The implication that mental power can affect one’s physical health reinforced the psycho-socio-biological ambiguity that has been an enduring legacy of stress ever since.
This article examines the medicalization of stress—that is, the historical process by which stress became medically defined. It spans from the mid-19th century to the mid-20th century, focusing on these nine distinct phases:
1. 19th-century psychosomatic antecedent disease concepts
2. The emergence of shell-shock as a medical diagnosis during World War I
3. Hans Selye’s theorization of the General Adapation Syndrome in the 1930s
4. neuropsychiatric research on combat stress during World War II
5. contemporaneous military research on stress hormones during World War II
6. the emergence of a risk factor model of disease in the post-World War II era
7. the development of a professional cadre of stress researchers in the 1940s and 50s
8. the medicalization of anxiety in the early post–World War II era
9. The popularization of stress in the 1950s and pharmaceutical treatments for stress, marked by the cultural assimilation of paradigmatic stress behaviors and deterrence strategies, as well pharmaceutical treatments for stress.
Igor Grossmann and Franki Kung
The concept of wisdom is ancient and deeply embedded in the cultural history of humanity. However, only since 1980s have psychologists begun to study it scientifically. Taking a culturally and philosophically informed perspective, this article integrates insights from the quantitative science of wisdom. Analysis of epistemological traditions and research on folk theories of wisdom suggest cultural similarities in the domain of cognition (e.g., wisdom as reasoning ability and knowledge). These similarities can be contrasted with cultural differences concerning folk-theoretical affective and prosocial themes of wisdom, as well as expression of various wisdom-related themes, rooted in distinct sociocultural and ecological environments. Empirical evidence indicates that wisdom is an individually and culturally malleable construct, consistent with an emerging constructionist account of wisdom and its development. Future research can benefit from integration of ecological and cultural-historical factors for the meaning of wisdom and its expression.
As technology advances and offers enjoyable sedentary alternatives to sport, active recreation, and transportation, there is a growing need to understand and harness the drivers of physical activity and exercise among children and adolescents. Determining how youth perceive their physical capabilities and their opportunities and what motivates them to be physically active can provide essential information for teachers, coaches, youth leaders, and program planners who are interested in promoting physical activity. Several well-established and also more recently developed behavioral theories offer numerous avenues to gaining a better understanding of the perceptions and motivation of youth with respect to physical activity and exercise behavior, including the social ecological model, social cognitive theory, self-determination theory, habit theory, dual-process theory, and nudge theory, among others.
Children and adolescents have individual characteristics that influence their perceptions, motivations, and behavior. They also exist within a multilayered ecological context that helps to shape those perceptions, motivations, and behavior. For youth to be sufficiently physically active and thereby help to reach their full potential, the environment must be conducive to consistent routines of physical activity. Such an environment can be designed to provide easily accessible and enjoyable opportunities for youth to fulfill their basic psychological needs for autonomy, relatedness, and competence to be physically active. There is potential for technology to contribute positively toward the design of conducive environments, and toward fostering motivation and enjoyment of exercise and physical activity among children and adolescents.
Shauna Shapiro and Elli Weisbaum
Mindfulness practice and protocols—often referred to as mindfulness-based interventions (MBIs)—have become increasingly popular in every sector of society, including healthcare, education, business, and government. Due to this exponential growth, thoughtful reflection is needed to understand the implications of, and interactions between, the historical context of mindfulness (insights and traditions that have been cultivated over the past 25 centuries) and its recent history (the adaptation and applications within healthcare, therapeutic and modern culture, primarily since the 1980s).
Research has shown that MBIs have significant health benefits including decreased stress, insomnia, anxiety, and panic, along with enhancing personal well-being, perceptual sensitivity, processing speed, empathy, concentration, reaction time, motor skills, and cognitive performance including short- and long-term memory recall and academic performance. As with any adaptation, skillful decisions have to be made about what is included and excluded. Concerns and critiques have been raised by clinicians, researchers, and Buddhist scholars about the potential impact that the decontextualization of mindfulness from its original roots may have on the efficacy, content, focus, and delivery of MBIs. By honoring and reflecting on the insights, intentions, and work from both historical and contemporary perspectives of mindfulness, the field can support the continued development of effective, applicable, and accessible interventions and programs.
Christian von Wagner, Wouter Verstraete, and Sandro Stoffel
Cancer screening aims to detect cancer before the appearance of symptoms. Applying a proactive and systematic approach, cancer screening programs invite every person in the target population automatically. Many countries have established guidelines that define criteria and principles on whether to implement screening programs for specific conditions. Despite the universal coverage of these programs, inequalities have been observed in their uptake based on various sociodemographic factors: gender, age, ethnicity, socioeconomic status (SES), educational level, and marital status. Behavioral science provides key performance indicators of these programs. Psychological factors such as perceived benefits (e.g., ability of the program to diagnose early or even prevent cancer) and barriers (e.g., opportunity costs relating to test attendance or completion), as well as people’s cancer and screening-related beliefs and perceptions of their own susceptibility to cancer, play a crucial role in cancer screening uptake. Furthermore, there is increasing awareness among professional bodies for the need to balance the public health benefits against individual costs, including financial and opportunity costs associated with participation and potential longer-term harms, such as receiving a cancer diagnosis that would never have caused any symptoms or problems). These recent developments have led to stronger emphasis on monitoring patient-reported experiences and ensuring that participation is based on informed choice. In addition, some of these issues have also been addressed by more fundamental changes to the screening paradigm such as more personalized approaches (using additional genetic and epigenetic information) to establishing eligibility criteria. The acceptability of using this information and its implication to offer more or less intensive screening and developing effective ways to understand the ability of the program to communicate this information are key challenges for the clinical, research and policy making community.
Sleep health is understood as a key factor in lifelong health and for social participation, function, and satisfaction. In later life, insomnia and other sleep disturbances are common. Insomnia is experienced as poor, disrupted, or insufficient sleep associated with significant daytime impairments including increased fatigue or reduced energy, impaired cognitive function, and increased mood disturbance. Poor sleep is associated with negative outcomes across a range of dimensions that impair quality of life, increases risk for other diseases, and may interact negatively with the progression and treatment of other disorders. Evidence for effective psychological interventions to improve sleep in later life, specifically cognitive behavioral therapy for insomnia, is robust and well described. Good sleep should be understood as a substrate for psychological health and a reasonable expectation in later life.
Benjamin Gardner and Amanda L. Rebar
Within psychology, the term habit refers to a process whereby contexts prompt action automatically, through activation of mental context–action associations learned through prior performances. Habitual behavior is regulated by an impulsive process, and so can be elicited with minimal cognitive effort, awareness, control, or intention. When an initially goal-directed behavior becomes habitual, action initiation transfers from conscious motivational processes to context-cued impulse-driven mechanisms. Regulation of action becomes detached from motivational or volitional control. Upon encountering the associated context, the urge to enact the habitual behavior is spontaneously triggered and alternative behavioral responses become less cognitively accessible.
By virtue of its cue-dependent automatic nature, theory proposes that habit strength will predict the likelihood of enactment of habitual behavior, and that strong habitual tendencies will tend to dominate over motivational tendencies. Support for these effects has been found for many health-related behaviors, such as healthy eating, physical activity, and medication adherence. This has stimulated interest in habit formation as a behavior change mechanism: It has been argued that adding habit formation components into behavior change interventions should shield new behaviors against motivational lapses, making them more sustainable in the long-term. Interventions based on the habit-formation model differ from non-habit-based interventions in that they include elements that promote reliable context-dependent repetition of the target behavior, with the aim of establishing learned context–action associations that manifest in automatically cued behavioral responses. Interventions may also seek to harness these processes to displace an existing “bad” habit with a “good” habit.
Research around the application of habit formation to health behavior change interventions is reviewed, drawn from two sources: extant theory and evidence regarding how habit forms, and previous interventions that have used habit formation principles and techniques to change behavior. Behavior change techniques that may facilitate movement through discrete phases in the habit formation trajectory are highlighted, and techniques that have been used in previous interventions are explored based on a habit formation framework. Although these interventions have mostly shown promising effects on behavior, the unique impact on behavior of habit-focused components and the longevity of such effects are not yet known. As an intervention strategy, habit formation has been shown to be acceptable to intervention recipients, who report that through repetition, behaviors gradually become routinized. Whether habit formation interventions truly offer a route to long-lasting behavior change, however, remains unclear.
Sayaka Aritake-Okada and Sunao Uchida
Research indicates that both acute and chronic physical activity improve sleep. Effects on sleep include prolongation of total sleep time, slow wave sleep increase, rapid eye movement sleep decrease, wake after sleep onset reduction, and shortened sleep latency. However, detailed biological mechanisms of these effects have not been well elucidated.
Past studies strongly suggest that the sleep-promoting effect of exercise could be multifactorial. Increase of slow wave sleep, which has been repeatedly reported, strongly suggests physical activity effects on central nervous system function. Physical activity also elevates body temperature, alters glucose, and impacts other metabolic regulations. Habitual exercise also alters autonomic nervous system predominance measured by heart rate variability.
Nadeeka N. Dissanayaka
Progressive neurological disorders are incurable disorders with gradual deterioration and impacting patients for life. Two common progressive neurological disorders found in late life are Parkinson’s disease (PD) and motor neuron disease (MND). Psychological complications such as depression and anxiety are prevalent in people living with PD and MND, yet they are underdiagnosed and poorly treated.
PD is classified a Movement Disorder and predominantly characterized by motor symptoms such as tremor, bradykinesia, gait problems and postural instability; however, neuropsychiatric complications such as anxiety and depression are common and contribute poorly to quality of life, even more so than motor disability. The average prevalence of depression in PD suggest 35% and anxiety in PD reports 31%. Depression and anxiety often coexist. Symptoms of depression and anxiety overlap with symptoms of PD, making it difficult to recognize. In PD, daily fluctuations in anxiety and mood disturbances are observed with clear synchronized relationships to wearing off of PD medication in some individuals. Such unique characteristics must be addressed when treating PD depression and anxiety. There is an increase in the evidence base for psychotherapeutic approaches such as cognitive behavior therapy to treat depression and anxiety in PD.
Motor neuron disease (MND) is classified a neuromuscular disease and is characterized by progressive degeneration of upper and lower motor neurons is the primary characteristic of MND. The most common form of MND is Amyotrophic lateral sclerosis (ALS) and the terms ALS and MND are simultaneously used in the literature. Given the short life expectancy (average 4 years), rapid deterioration, paralysis, nonmotor dysfunctions, and resulting incapacity, psychological factors clearly play a major role in MND. Depression and suicide are common psychological concerns in persons with MND. While there is an ALS-specific instrument to assess depression, evaluation of anxiety is poorly studied; although emerging studies suggesting that anxiety is highly prevalent in MND. Unfortunately, there is no substantial evidence-base for the treatment of anxiety and depression in MND.
Caregivers play a major role in the management of progressive neurological diseases. Therefore, evaluating caregiver burden and caregiver psychological health are essential to improve quality of care provided to the patient, as well as to improve quality of life for carers. In progressive neurological diseases, caregiving is often provided by family members and spouses, with professional care at advanced disease. Psychological interventions for PD carers addressing unique characteristics of PD and care needs is required. Heterogeneous clinical features, rapid functional decline, and short trajectory of MND suggest a multidisciplinary framework of carer services including psychological interventions to mitigate MND. A Supportive Care Needs Framework has been recently proposed encompassing practical, informational, social, psychological, physical, emotional, and spiritual needs of both MND patients and carers.
Carolyn M. Aldwin and Ritwik Nath
Erythocyte sedimentation rate (ESR) is one of the oldest measures of inflammation. It is used extensively in clinical medicine and has shown some utility in biomedical research. It is a nonspecific inflammation assay, and although it is less sensitive than more modern measures such as C-reactive protein, it is a useful measure in chronic illnesses.
In general, ESR increases with age and appears to be a biomarker of aging in general. It predicts both cardiovascular disease (CVD) and cancer and is elevated in autoimmune disorders such as rheumatoid arthritis. Further, it predicts mortality both in the general population and in those with chronic illnesses such as CVD and cancer, independent of other indicators of illness severity.
Interestingly, ESR is not associated with anxiety or general measures of distress but is consistently associated with measures of depression and suicidal ideation. Further, the effect of depressive symptoms on mortality appears to be mediated through increases in ESR.
Studies of the relationship between stress and ESR have been less consistent, primarily because early studies were largely cross-sectional and in small samples. Studies using more modern, longitudinal analyses in larger samples may show more consistent results, especially if multilevel modeling was used that examined within-person changes in ESR in response to stress. Given that other large, longitudinal studies, such as the Baltimore Longitudinal Study on Aging, the Rotterdam Study, The Reykjavik Cohort Study, and Women’s Healthy Ageing Study have included ESR in their biomedical assays, it should be possible to analyze existing data to examine how psychosocial factors influence inflamm-aging in humans.