Being Well

Kevin Lewis

November 26, 2020

Beliefs About Self-Compassion: Implications for Coping and Self-Improvement
Christina Chwyl, Patricia Chen & Jamil Zaki
Personality and Social Psychology Bulletin, forthcoming


Self-compassion — treating oneself with care and understanding during difficult times — promotes adaptive coping and self-improvement. Nonetheless, many people are not self-compassionate. We examined a key barrier people face to treating themselves self-compassionately: their negative beliefs about self-compassion (i.e., that it leads to complacency, indulgence, or irresponsibility). Across three studies, the more people held these negative beliefs, the less self-compassionately they reported responding to a real-world event (Study 2) and hypothetical emotional challenges (Studies 1 and 3). Self-compassionate responding, in turn, predicted adaptive coping strategies and intentions for self-improvement. Experimentally inducing people to hold positive, as opposed to negative, beliefs about self-compassion predicted self-compassionate responding 5 to 7 days later (Study 3). By recognizing and targeting peoples’ beliefs, our findings highlight the importance of reducing such beliefs that are barriers to practicing self-compassion, as a means to improve the way people respond to difficult times.

Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial
Alan Davis et al.
JAMA Psychiatry, forthcoming

Design, Setting, and Participants: This randomized, waiting list–controlled clinical trial was conducted at the Center for Psychedelic and Consciousness Research at Johns Hopkins Bayview Medical Center in Baltimore, Maryland. Adults aged 21 to 75 years with an MDD diagnosis, not currently using antidepressant medications, and without histories of psychotic disorder, serious suicide attempt, or hospitalization were eligible to participate. Enrollment occurred between August 2017 and April 2019, and the 4-week primary outcome assessments were completed in July 2019. A total of 27 participants were randomized to an immediate treatment condition group (n = 15) or delayed treatment condition group (waiting list control condition; n = 12). Data analysis was conducted from July 1, 2019, to July 31, 2020, and included participants who completed the intervention (evaluable population).

Interventions: Two psilocybin sessions (session 1: 20 mg/70 kg; session 2: 30 mg/70 kg) were given (administered in opaque gelatin capsules with approximately 100 mL of water) in the context of supportive psychotherapy (approximately 11 hours). Participants were randomized to begin treatment immediately or after an 8-week delay.

Results: Of the randomized participants, 24 of 27 (89%) completed the intervention and the week 1 and week 4 postsession assessments. This population had a mean (SD) age of 39.8 (12.2) years, was composed of 16 women (67%), and had a mean (SD) baseline GRID-HAMD score of 22.8 (3.9). The mean (SD) GRID-HAMD scores at weeks 1 and 4 (8.0 [7.1] and 8.5 [5.7]) in the immediate treatment group were statistically significantly lower than the scores at the comparable time points of weeks 5 and 8 (23.8 [5.4] and 23.5 [6.0]) in the delayed treatment group. The effect sizes were large at week 5 (Cohen d = 2.2; 95% CI, 1.4-3.0; P < .001) and week 8 (Cohen d = 2.6; 95% CI, 1.7-3.6; P < .001). The QIDS-SR documented a rapid decrease in mean (SD) depression score from baseline to day 1 after session 1 (16.7 [3.5] vs 6.3 [4.4]; Cohen d = 3.0; 95% CI, 1.9-4.0; P < .001), which remained statistically significantly reduced through the week 4 follow-up (6.0 [5.7]; Cohen d = 3.1; 95% CI, 1.9-4.2; P < .001). In the overall sample, 16 participants (67%) at week 1 and 17 (71%) at week 4 had a clinically significant response to the intervention (≥50% reduction in GRID-HAMD score), and 14 participants (58%) at week 1 and 13 participants (54%) at week 4 were in remission (≤7 GRID-HAMD score).

Yoga is effective in treating symptoms of Gulf War illness: A randomized clinical trial
Peter Bayley et al.
Journal of Psychiatric Research, forthcoming


Many Veterans of the 1990-1991 Gulf War report symptoms of Gulf War Illness, a condition involving numerous chronic symptoms including pain, fatigue, and mood/cognition symptoms. Little is known about this condition’s etiology and treatment. This study reports outcomes from a randomized controlled single-blind trial comparing yoga to cognitive behavioral therapy for chronic pain and other symptoms of Gulf War Illness. Participants were Veterans with symptoms of GWI: chronic pain, fatigue and cognition-mood symptoms. Seventy-five Veterans were randomized to treatment via selection of envelopes from a bag (39 yoga, 36 cognitive behavioral therapy), which consisted of ten weekly group sessions. The primary outcomes of pain severity and interference improved in the yoga condition (Cohen’s d=.35, p=.002 and d=.69, p < .001, respectively) but not in the cognitive behavioral therapy condition (d=.10, p=.59 and d=.25 p=.23). However, the differences between groups were not statistically significant (d=.25, p=.25; d=.43, p=.076), though the difference in an a-priori-defined experimental outcome variable which combines these two variables into a total pain variable (d=.47, p=.047) was significant. Fatigue, as indicated by a measure of functional exercise capacity (6-minute walk test) was reduced significantly more in the yoga group than in the CBT group (between-group d=.27, p=.044). Other secondary outcomes of depression, wellbeing, and self-reported autonomic nervous system symptoms did not differ between groups. No adverse events due to treatment were reported. Yoga may be an effective treatment for core Gulf War Illness symptoms of pain and fatigue, making it one of few treatments with empirical support for GWI. Results support further evaluation of yoga for treating veterans with Gulf War Illness.

Financial Strain and Suicide Attempts in a Nationally Representative Sample of US Adults
Eric Elbogen et al.
American Journal of Epidemiology, November 2020, Pages 1266–1274


Although research has identified many suicide risk factors, the relationship between financial strain and suicide has received less attention. Using data representative of the US adult population (n = 34,653) from wave 1 (2001–2002) and wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions, we investigated the association between financial strain — financial debt/crisis, unemployment, past homelessness, and lower income — and subsequent suicide attempts and suicidal ideation. Multivariable logistic regression controlling for demographic and clinical covariates showed that cumulative financial strain was predictive of suicide attempts between waves 1 and 2 (odds ratio (OR) = 1.53, 95% confidence interval (CI): 1.32, 1.77). Wave 1 financial debt/crisis (OR = 1.58, 95% CI: 1.06, 2.34), unemployment (OR = 1.52, 95% CI: 1.10, 2.10), past homelessness (OR = 1.50, 95% CI: 1.03, 2.17), and lower income (OR = 1.51, 95% CI: 1.01, 2.25) were each associated with subsequent suicide attempts. Respondents endorsing these 4 financial-strain variables had 20 times higher predicted probability of attempting suicide compared with respondents endorsing none of these variables. Analyses yielded similar results examining suicidal ideation. Financial strain accumulated from multiple sources (debt, housing instability, unemployment, and low income) should be considered for optimal assessment, management, and prevention of suicide.

The Impact of Diagnostic Uncertainty on Mental Health: Evidence from Rheumatoid Arthritis Patients
Lauren Blumberg
University of Georgia Working Paper, November 2020


This paper explores the impact of diagnostic uncertainty on mental health diagnosis and treatment. I exploit results from a set of blood tests as a plausibly exogenous source of variation in diagnostic certainty during the search for a rheumatoid arthritis (RA) diagnosis. Using administrative claims data, I estimate two-way fixed effects difference-in-differences models, combined with coarsened exact matching, comparing mental health outcomes of those with positive blood test results (and hence, increased diagnostic certainty) to those with negative blood test results. I find increased diagnostic certainty leads to a decrease in adverse mental health outcomes. The estimates suggest a 13 percent and 19 percent decline in anxiety and depression diagnoses, respectively, and an 11.5 percent decline in anti-anxiety prescription utilization for individuals whose blood test results lead to further diagnostic certainty compared to individuals whose blood test results do not. The improvements in mental health are driven by females, who make up the majority of RA patients. The results imply that uncertainty during the diagnostic search process and the receipt of new medical information can have important effects on anxiety and mental health more broadly.

Counterfactual thinking and facial expressions among Olympic medalists: A conceptual replication of Medvec, Madey, and Gilovich’s (1995) findings
William Hedgcock, Andrea Luangrath & Raelyn Webster
Journal of Experimental Psychology: General, forthcoming


Counterfactual thinking, or contemplation of “what could have been,” influences facial expressions of Olympic medalists. Medvec, Madey, and Gilovich (1995) revealed that bronze medalists appeared happier than silver medalists after competition in Olympic events. Two prominent explanations for this phenomenon exist: the formation of (a) category-based counterfactuals and (b) expectation-based counterfactuals. First, Medvec et al. (1995) demonstrated that silver medalists formed an upward comparison to the gold medalist with thoughts of “I almost won Gold” while bronze medalists formed a downward comparison to a fourth place finisher with thoughts of “at least I won a medal.” A second explanation suggests that medalists form expectation-based counterfactuals in which silver medalists are more disappointed since their prior expectations for performance were higher than bronze medalists (McGraw, Mellers, & Tetlock, 2005). To test these 2 explanations, we compiled a large dataset of medal stand photographs from the Olympic Multimedia Library and Getty Images for the 2000–2016 Olympic games as well as Sports Illustrated’s predictions. Using automated facial expression encoding, we conducted a conceptual replication of prior work and found evidence supporting both category-based and expectation-based counterfactual accounts of Olympic medalists’ expressions.

Interoceptive cardiac signals selectively enhance fear memories
Sarah Garfinkel et al.
Journal of Experimental Psychology: General, forthcoming


Fear is coupled to states of physiological arousal. We tested how learning and memory of threat, specifically conditioned fear, is influenced by interoceptive signals. Forty healthy individuals were exposed to two threat (conditioned stimuli [CS+], paired with electrocutaneous shocks) and two safety (CS−) stimuli, time-locked to either cardiac ventricular systole (when arterial baroreceptors signal cardiovascular arousal to brainstem), or diastole (when these afferent signals are quiescent). Threat learning was indexed objectively using skin conductance responses (SCRs). During acquisition of threat contingencies, cardiac effects dominated: Stimuli (both CS+ and CS−) presented at systole evoked greater SCR responses, relative to stimuli (both CS+ and CS−) presented at diastole. This difference was amplified in more anxious individuals. Learning of conditioned fear was established by the end of the acquisition phase, which was followed by an extinction phase when unpaired CSs were presented at either the same or switched cardiac contingencies. One day later, electrocutaneous shocks triggered the reinstatement of fear responses. Subsequent presentation of stimuli previously encoded at systole evoked higher SCRs. Moreover, only those participants for whom stimuli had the same cardiac-contingency over both acquisition and extinction phases retained conditioned fear memory (i.e., CS+ > CS−). Our findings reveal two important cardiac afferent effects on threat learning and memory: 1) Cardiac signals bias processing toward threat; and 2) cardiac signals are a context for fear memory; altering this context can disrupt the memory. These observations suggest how threat reactivity may be reinforced and maintained by both acute and enduring states of cardiac arousal.


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