When the enemy is invisible... Implicit biases against women in hiring

Photo by NASA on Unsplash

We live in a #HeForShe world of #WonderWoman and #girlpower. Today, more women hold positions of leadership and power than ever before in U.S. history and society is the direct recipient of those changes. Yet, there are still industries where women with the same qualifications as their male colleagues are not given the same opportunities. You could support that statement with factoids, such as the fact that more than 825 men have won a Nobel Prize compared to only 47 women. Or, you could support this statement with science. 

In 2013, Dr. Corinne Moss-Racusin and her colleagues at Yale University published a study testing the question: 

Are scientists biased against female applicants to jobs? 

If so, this may explain the imbalance of male and female scientists. To test this question, they recruited  127 professors in Biology, Chemistry, and Physics at 6 research-intensive universities; 3 were public and 3 were private. These professors were asked to provide feedback on the application materials of an undergraduate science student who wanted to pursue a Ph.D. in their field. What's important is that each faculty member believed that they were providing feedback on a real student who wanted to pursue their career path, and that the student would receive this feedback in order to aid them in reaching this goal. 

The professors were then randomly assigned to receive one of two sets of application materials. These two sets of application materials were identical, in that they included the same exact details of a highly competitive student with some ambiguity with regard to their competence to do independent research. This is by far the most common type of application we get as professors, and is also the type of student whose eventual success will depend largely upon whether a professor is willing to mentor and train them. The difference between the two applications was that one of the applicants was named Jennifer, or a presumably female applicant, and the other was named John, a presumably male applicant. 

The professors were asked to rate the applicant's competence, the likelihood that they would be interested in hiring the student, estimate an annual starting salary of the applicant, and report the amount of mentoring they would provide to the applicant. At the end of the study, these professors were debriefed about the study and none of them knew that the application materials they reviewed were not of a real student. 

From this data, they wanted to test several hypotheses, including the following:  

1) That applications with the name John would be rated as more competent and more likely to be mentored and hired, at higher salaries than the applications with the name Jennifer. 

2) That #1 would not depend on whether the professor rating the applicant was male or female. 

They found that applications for John were rated as significantly more competent,and professors indicated that they were more likely to hire and provide more mentoring to John. Professors also indicated that the starting salary for John should be between $29,000 and $31,000 per year whereas Jennifer's should be between $25,500 and $27,500. This pattern did not vary based on whether the professor rating the applications was male or female, whether they were old or young, nor whether the professor already had tenure. 

Photo by Samantha Sophia on Unsplash

The conclusion from the study was that there is an implicit bias against women applying to positions in science that keeps very competent women from getting entry-level positions. In general, this comes down to the question of whether our society cultivates the perception that women are inherently less competent that men, despite having the same experiences and accomplishments. If so, how to we cultivate a different perception? 

In psychology, we like to drill down into problems like this to determine where they come from and how we can fix them. One way to do this is to test whether and to what degree individuals have an automatic, or implicit bias to associate women with positions of subordinance. It's possible that just knowing that you have such a bias is enough to change your behavior enough to make a difference. 

This is important because there are many ways that a social narrative that women are better suited for positions of subordinance can lead women to behave subordinately and men to treat women as subordinants. The ways women perpetuate this review is expertly outlined in books like Sheryl Sandberg's Lean In. 

If you're interested in knowing whether you are implicitly biased in this particular way, spend just a few minutes to take this test. Knowledge is power people!  If you find that you do, there may be some small ways you can combat these types of bias, especially if you ever operate as a gatekeeper to opportunities for training and jobs. The truth is, only we suffer by biases like this. If we want to solve the problems of the universe, we need the best minds to do it. 

Moss-Racusin, C. A., Dovidio, J. F., Brescoll, V. L., Graham, M. J., & Handelsman, J. (2012). Science faculty’s subtle gender biases favor male students. Proceedings of the National Academy of Sciences, 109(41), 16474-16479.

In defense of humor.

Do you love to laugh? For decades, psychologists have studied the role of positive emotions in health and well-being. So far, it’s pretty clear that positive emotional experiences, including those that make you laugh, are related to better emotional and physical health. Yet, very few of those studies can make causal claims. In other words, they don’t really tell us whether healthier people seek out humor or whether laughter causes better health. Recently, Sarah Wellenzohn, University of Zurich, and colleagues set out to test the causal role of humor in the emotional health of individuals. In short, they designed an experiment to answer the question:  

Does humor increase happiness and decrease symptoms of depression?

To do this, they randomly assigned 632 adults to 1 of 6 interventions to complete daily for 1 week. The interventions were:  

Three funny things: Write down the 3 funniest things you experienced during the day and your feelings during those experiences.

Collecting funny things: Remember 1 of the funniest things you have experienced in the past, write it down with the most possible detail.

Counting funny things: Count all of the funny things that happen throughout the day and write down the number.

Applying humor: Notice the humor experienced throughout the day and add new humorous activities, such as reading comics, telling jokes, watching funny movies.

Solving stressful situations in a humorous way: Think about a stressful experience today and think about how it was or could have been solved in a funny way.

Early memories (placebo control): Write about early memories.

Before starting the intervention, participants completed questionnaires measuring their authentic happiness and symptoms of depression. Authentic happiness is measured using participant agreement to 24 statements such as “My life is filled with joy.”  Depressive symptoms include sad or low mood, loss of interest or pleasure, appetite and weight change, sleep problems, worry, difficulty concentrating, or feelings of hopelessness. Participants also received training in the intervention and were instructed to do their intervention activity each day for one week.

At the end of the 1-week intervention, and then 1-, 3-, and 6-months after completing the intervention, participants again completed the happiness and depression questionnaires. This enabled the research team to look at whether humor interventions led to increases in happiness and declines in depressive symptoms, and also look at how durable those effects are over time.

At the end of 1 week, all of the humor-based interventions were associated with increases in happiness and decreases in depressive symptoms compared to the placebo group. So one important take home message is that humor helps, no matter how you incorporate it into your life.

With respect to increasing happiness, Counting funny things and Applying humor were the most effective, and those effects lasted for up to 6 months! The effects of the Three funny things intervention also lasted through the 6-month time period, but were not as robust. There are a number of reasons that these humor-based interventions had such long-lasting effects on happiness. Most likely, it was because participants continued to engage in the behaviors for longer than just the initial week. Positive emotions are addictive in the same way food and drugs are. So it’s possible that these 1-week interventions were enough to promote a humor-addiction, so to speak.

The effects of these interventions on depressive symptoms were not as durable. Despite all of the humor-based interventions being leading to reductions in depressive symptoms at the end of the 1-week intervention compared with the placebo group, none of these effects remained 3-months after the intervention. This finding isn’t too surprising since there were no individuals with depression in this study. In fact, 250 people were excluded from the study for having elevated symptoms of depression at the baseline assessment. This means that there was very little range in depressive symptoms in the sample to begin with, and thus very little chance that the intervention could have an effect at all. That being said, humor on its own is unlikely to be an effective treatment for depression. Depression is an illness; often initiated in the wake of a major life stressor. With the exception of Solving stressful situations in a funny way, none of the humor-based interventions offered skills that help manage the source of that life stress.

The authors argue that one of the important, active ingredients in humor is the focus on increasing positive emotions in the present moment. Each intervention, particularly the durable ones, accomplished that through increasing daily experiences that involved humor but also increasing individuals’ attention to those experiences over time. You can imagine that just a few days of Counting funny things would cause you to pay more attention to, and enjoy, when funny things are occurring.

Until next time, keep on laughing! Here’s a compilation of funny videos of kids learning about physics: https://youtu.be/-TjtoP6-mcQ

Wellenzohn, S., Proyer, R. T., & Ruch, W. (2016). Humor-based online positive psychology interventions: A randomized placebo-controlled long-term trial. The Journal of Positive Psychology, 11(6), 584-594.

*Many thanks to Unsplash.com for the gorgeous photos. 

Who does the cleaning in your house? And why it matters.

With all of the #LeanIn and #HeForShe movements going on lately, division of housework has become a common topic of conversation. The typical family in the United States is comprised of two working adults, averaging about 91 paid hours (combined) per week. So, at the end of the work day, both adults are tasked with recovering from the work day, managing their home, and often caring for their children. Moreso than for any other generation, the division of housework matters. 

In 1965, women spent 30 hours per week devoted to housework while men spent about 5 hours per week. In the year 2000, the National Survey of Families and Households found that women spent about 18 hours per week doing housework while men spend about 10. This suggests a lot of things. First, the amount of hours the average family is spending on housework has declined by 20% since 1965, perhaps due to the introduction of time-saving technology such as microwaves, dishwashers, and washing machines into most American homes. It also says that as women have increasingly joined the work-force, men have increasingly participated in more housework. Yet, among households where both adults work full-time, men still report spending significantly more time "relaxing" and doing leisure activities after work, while women report spending more time doing housework and care-giving.  

Unfortunately, I find conversations about the division of housework to be mostly limited to issues of who does what and seldom about the potential consequences for health, wealth, and well-being. To me, the fact that men and women spend their time doing different activities is obvious and not very interesting. Whether the activities men and women engage in after work have implications for physical and psychological well-being interests me very much. Luckily these are empirical questions that psychologists care about and are actively trying to answer. 

In particular, Dr. Darby Saxbe, University of Southern California, and her colleagues asked the question: 

Does the division of labor in a household have implications for physical health in either partner? 

To answer this question, the research team recruited 30 healthy couples, both members working full-time, who own their own home, have a mortgage, and have at least one child between 8-10 years of age. With these participants, the research team tried to capture a "week in the life" of these couples by tracking their behaviors for 4 days from around 6:30-8:30am and then again from about 4pm to whenever the participants went to bed. Their goal was to capture what participants did before work, and after work. Tracking in this study constituted a research staff member recording each member of the household's location (e.g., kitchen, living room) and activity (e.g., cooking, watching TV) every 10 minutes into a handheld computer. Compared with previous studies that had used self-report assessments of how people spend their time at home, these observations allowed the research team to have a more objective measure of what participants' time at home looked like. 

Participants in this study also provided saliva samples on 3 days at waking, in the late morning (at work before lunch), afternoon (before leaving work), and right before bed. Saliva samples were used to measure the concentration of cortisol. Cortisol is final product of the body's physiological stress response system.* Cortisol in the body should be high in the morning and decline throughout the day. Not showing a steep decline in cortisol throughout the evening has been associated with poor sleep, several diseases, and is a predictor of mortality. In fact, many researchers see dysregulated cortisol as a pathway through which chronic stress leads to illness. The research team was interested in understanding whether the day-to-day activities of men and women at home were related to their body's ability to down-regulate this stress hormone in the evenings. 

They found that women were doing housework in 30.5% of observations, whereas men were doing housework in 20% of observations. In contrast, women were engaging in leisure activity in 10.6% of observations, whereas men were engaging in leisure activities in 19.4% of observations. Surprisingly, perhaps only for me, men and women were both engaging in communication in about 18% of observations. 

They then looked at whether activities at home predicted physiological stress in the evening. They found that both men and women who spend more time doing housework, have higher cortisol in the evenings. Perhaps more interesting, the amount of housework a wife does had no association with their husband's cortisol in the evening. In contrast, husbands observed doing more housework had wives with lower cortisol in the evening. 

When it came to leisure, husbands had lower cortisol in the evening when they spent more time doing leisure activities, especially when their wives were NOT engaging in leisure. In contrast, how much time women spent doing leisure activities was not related to their cortisol in the evening. 

So what does it all mean? The research team concluded creating a true division of labor at home may have real physiological benefits for wives, and suggested that these benefits (or the lack of them) can add up over time.         

So what's the solution? Perhaps it's that wives should make an executive decision to do less housework. A lot of households can accomplish this by making a decision to invest in their health by outsourcing housework to robots and third parties. My favorite examples of this are Roomba and Fluff-and-Fold laundry services. Perhaps it's that husbands need to make an effort to jump in when they see their wife doing housework. This includes, but is not limited to, cooking, vacuuming, doing laundry, dishes, changing sheets, and regularly scanning the house for stray belongings (read: socks). The good news is that many of these solutions are small but still make a big difference. 

This research study definitely doesn't provide all of the answers, and probably introduces more questions than it answers (as all good research does). For example, this study focused on heterosexual couples and therefore the role of "wife" vs "husband" is somewhat confounded with "male" vs "female." It's possible that women have higher physiological stress in the evenings than men, independent of housework. More studies looking at a more diverse sample of couples that include homosexual couples would help us understand how to disentangle the male-female differences from the role of housework-leisure behaviors. Also, this study only included couples where both parent works full-time. While this represents the average American family today, this study doesn't tell us much families with stay-at-home moms or dads.   

*Click here for past articles about/related to cortisol. 

Saxbe, D. E., Repetti, R. L., & Graesch, A. P. (2011). Time spent in housework and leisure: links with parents' physiological recovery from work. Journal of Family Psychology, 25(2), 271.

Many thanks to unsplash for the photos!

At risk for diabetes? Here's how to prevent it.

Psychology holds a strange position in modern medicine because we live in a time when everyone believes there is a pill that can solve their problems, and yet many common illnesses in medicine (e.g., pain, depression) are treated more effectively with behavioral medicine than pharmaceuticals. This week, I would like to share with you one of the original studies that showed us just how profound an impact psychologists and other mental health professionals can have on medical problems, specifically diabetes. 

American Diabetes Association

According to the CDC, 30 million people in the United States have diabetes. For more on diabetes from the CDC click here.  

In 2002, the Diabetes Prevention Program Research Group published the results of a 5 year study examining treatment outcomes for people at risk for diabetes. They asked the questions can you prevent diabetes? And what works: drugs or lifestyle change?

To answer these questions, they recruited 3,234 individuals who were at risk of diabetes based on their fasting glucose levels. These individuals were about 51 years old, 68% female, 45% belonged to an ethnic minority group, and the average BMI was 34 (BMI > 30 is considered obese). 

Each participant was then randomly assigned to 1 of 3 groups: placebo, Metformin, or Lifestyle change. The placebo group took 2 pills per day for the duration of the study. Metformin is the most commonly prescribed, 1st line treatment for Type 2 Diabetes. Participants in the Metformin group took an 850mg pill of Metformin twice daily for the duration of the study. 

Participants in the Lifestyle change group were assigned to a mental health professional who guided them through a 16-lesson curriculum in weekly, one-on-one meetings for 24 weeks. The goals of this program were to help the participant maintain 150 minutes of physical activity per week and reduce their body weight by 7%. By the end of the 24 week curriculum, 50% of participants had maintained the 7% weight loss and 74% of participants had maintained their physical activity regimen. After 24 weeks, participants continued to meet with their behavioral therapist monthly for the duration of the study in order to review and reinforce these lifestyle changes. 

To determine the effectiveness of these treatments, each participant was tested annually for diabetes using an oral glucose tolerance test. Over the next 5 years, the incidence of diabetes was 11% in the placebo group, 7.8% in the Metformin group, and 4.8% in the Lifestyle change group. In other words, Metformin was effective in reducing the incidence of diabetes by 31% whereas the behavioral Lifestyle change program was effective in reducing diabetes by 58%. 

Needless to say, these results caught the medical world by storm. First, no one really expected that behavioral medicine could be more effective than the gold standard medical treatment. Second, the world hadn't really considered how to leverage the power of mental health professionals in healthcare. Luckily, this was almost 15 years ago, and integrated primary care is becoming more commonplace. 

The WHO defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity," but we still have a long way to go. It seems as though many people still believe working with a mental health professional is only meant for extreme cases. Yet, these data are pretty clear that working with an expert in behavioral medicine, such as clinical psychologists, can be extremely effectively in maintaining health goals that going far beyond depression and anxiety. 

Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl j Med, 2002(346), 393-403.

What works: Anxiety and Depression Treatments

Depression and anxiety are emotional disorders that reduce quality of life, increase suffering, impair our relationships, and endanger our long-term health. What's worse is that they are also extremely common. Depression and anxiety are known to affect 19 and 29% of individuals, respectively, not to mention that depression and anxiety co-occur at a rate of almost 50%. These statistics are particularly astonishing to me as a clinical psychologist because our field has developed a number of effective, non-invasive treatments that just don't seem to get into the lives of the people who need them most. In fact, a large national study recently found that most people suffer with anxiety and depression for about 10 years before they get treatment. A decade of unnecessary suffering. 

There are many reasons for this: some people don't live close enough to mental health providers, many people don't believe they have a problem (after all anything that sticks around for 10 years would just become the new normal), many people don't believe that seeing a psychologist would help, and many people can't afford the time or money it would cost. Luckily, how to effectively treat anxiety and depression is an active area of research, including questions such as what works for whom, and how can these effective treatments be delivered. 

An older approach to treating anxiety and depression was to identify which problem was more pressing and severe, and then treat the disorders sequentially. However, basic psychological science research suggests that underlying brain structures, symptoms, and behaviors for depression and anxiety are the same. This means that they can likely be treated with the same interventions. With this realization, clinical psychological scientists began to test the effectiveness of depression treatments on anxiety disorders, and anxiety treatments on depressive disorders. What emerged from these studies were "transdiagnostic" treatments for depression and anxiety. The transdiagnostic approach to treating emotional disorders is to identify and address the common maladaptive psychological, behavioral, and interpersonal processes that underlie psychological distress and impede well-being. But the million dollar question is, "Do they work?" 

Last year Dr. Jill Newby at the University of New South Wales and her colleagues published a meta-analysis examining the effectiveness across all of the existing clinical trials using transdiagnostic treatments for depression and anxiety. After scouring the published literature, they identified 47 studies that examined the effectiveness of transdiagnostic treatments for depression, anxiety, and quality of life for adults. The 47 studies varied in the type of treatment used (e.g., mindfulness vs cognitive behavioral therapy (CBT)), size (e.g., group vs individual), and delivery (e.g., internet-based vs face-to-face). The results of this meta-analysis represent effectiveness for transdiagnostic treatment for 1,109 patients compared to 992 controls. 

They found that transdiagnostic treatments had a large and significant overall effect on decreasing depression and anxiety symptoms as well as increasing quality of life. They also found that these benefits were maintained for up to 6 months following treatment completion. They also examined delivery characteristics for treatments and found that anxiety symptoms improved the most when treatment was delivered individually or over the internet compared with in a group format. Depression symptoms were most effectively treated over the internet, followed by face-to-face and group formats. They also looked at whether the content and approach to therapy influenced patient outcomes. They found that anxiety symptoms improved more in CBT-based treatments, while there was no difference in effectiveness between CBT- and mindfulness-based treatments for depression symptoms. In other words, both work just as effectively for treating depressive symptoms. 


To summarize, patients with anxiety and depression were better off if they received transdiagnostic treatment than if they didn't. Further, internet-based CBT is likely the best bet for how to effectively treat your symptoms. This is good news because internet-based treatments are wiping out many of the common barriers to getting treatment. They are flexibly scheduled, cost-effective, and accessible. It's not surprising then that internet-based treatments for depression and anxiety are becoming a topic of national discussion. We wrote about it at the launch of Maven, the future of health care, and UCLA's Raphael Rose Ph.D. was featured on the topic in Vogue magazine just this month. Based on the national statistics, one in three of you is struggling with depression and/or anxiety. Getting mental health services used to be nearly impossible and quite stigmatizing to navigate. All of that has changed. The only question now is what are you waiting for? 

Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood.Clinical psychology review, 40, 91-110.

Mama Bear: Ever wonder whether breastfeeding changed your behavior?

This week’s article highlights many of the fun things we do in psychology research. Of course, it started with a question:

Does breastfeeding increase aggression?

Many lactating animals (e.g., mice, rats, prairie voles, hamsters, lions, domestic cats, rabbits, squirrels, and domestic sheep) are more aggressive than their non-lactating peers. In animals, lactation increases aggressive behavior, and reduces physiological responses to stress. This makes sense because for many animal, and even humans until 100 years ago, many infants didn't survive. Lactation is a way for the mother's body to know that there is an infant to still take care of. However, humans have built societies and homes, invented seatbelts, and established food protection standards. So, it remains to be documented whether human women become more aggressive after having a baby, and what physiological processes support this change in behavior.

To answer this question, Dr. Jennifer Hahn-Holbrook, now a professor at Chapman University, and her colleagues conducted a very cool experiment to understand whether breastfeeding women are more aggressive, and whether that aggression is accounted for by reduced physiological responses to stress.

To do this, they recruited three groups of women: 20 women with infants between 3-6 months who were exclusively breast-feeding, 20 women with infants between 3-6 months who were feeding their infant a mix of breast milk and formula, and 20 women who had never had a baby. The women came to the laboratory and met what we call a “confederate.” A confederate is a person introduced to the participants as another participant, but in actuality is part of the experiment. The confederate was trained to be rude. Rude behavior involved ignoring the actual participant, chewing gum, and checking their cell phone during the experiment instructions. This was intended to cause the actual participants to make what psychologists call fundamental attribution error, or the tendency to place an undue emphasis on internal characteristics (personality) to explain someone else’s behavior in a given situation rather than considering the situation’s external factors. For example, when you cut someone off you know it’s because you are late and would otherwise miss your exit. When someone else cuts you off, it’s because they are a jerk.

The participants were then instructed to play a game against the other “participant” that involved reaction time. Fastest person to respond wins. The winner of each round got to push a button that released a loud sound at the loser. The participant controlled the volume (up to 150 decibels) and duration (up to 5 seconds) of the sound with their button push. After 8 rounds of the game, participants fed their babies (breastfed, formula fed) or took a break if they were in the non-mother control group. Then, the participants played the game again for another 8 rounds. The mothers’ blood pressure was monitored and recorded throughout the entire procedure.

They found that breastfeeding mothers delivered longer and louder aversive sounds to their rude competitors, compared to both the mixed-feeding mothers and the non-mothers. They also found that breastfeeding women had smaller increases in blood pressure (a measure of stress) while playing the competitive game than women in either of the other groups.

The research team concluded by saying that women who are breastfeeding, not just new moms, were more likely to be aggressive than women who are not. Supporting this idea, they found that there was a significant positive correlation between aggression during the game and the percent of the infant’s diet that was breastmilk (as a measure of how much the mother is lactating). Therefore, they believe that the physiology that supports lactation in new moms supports aggressive behavior that is protective to the infant. And further, lactating mothers show a reduced response to stress, which likely helps facilitate aggression in times of threat and competition.

So, what can we take away from this? I think on a very basic level, knowledge is power. If you or someone you know is breastfeeding, they are likely to be more aggressive than they are usually, and more aggressive than other people. This is normal and adaptive. Don’t hold it against them or yourself. Aggression has many different dimensions. In this study it was the force with which women delivered aversive sounds to competitors, like a punishment. But what might this behavior look like outside of the laboratory? Potentially, it’s perceiving other people as a threat, competing with other moms for no apparent reason, delivering unusually harsh punishments to your partner or older children for potential threats to the new baby. Just remember, increases in aggression are normal, and being driven by the many, many changes to your physiology that allowed you to have the baby and care for it in the first place.

In these modern times, we take for granted all of the physiological changes that come with being able to sustain a pregnancy, have a baby, and breastfeed that have been promoting human survival for thousands of years. As a result, many women don’t learn about these physiological changes until they are going through it, and society doesn’t do much to support them. Don’t be part of that problem.

Hahn-Holbrook, J., Holt-Lunstad, J., Holbrook, C., Coyne, S.M., & Lawson, E.T. (2011). Maternal defense: Breast feeding increases aggression by reducing stress. Psychological Science. DOI: 10.1177/0956797611420729

Invest in Education

ScienceForWomen.org is has two goals which we describe here. The second goal is to promote the education of women in sciences and reinforce young women who have made an investment in their education.

In a past post, I wrote about telomeres. Telomeres are the caps on our chromosomes, which hold all of our DNA. As we age, telomeres shorten, creating vulnerability to disease and contributing to mortality. As a result, there has been a monsoon of research in the past decade examining the lifestyle and psychological factors that predict telomere length.  More recently, I came across an article that underscores our mission to reward those who have invested in their education.

One of my scientific heroes, Dr. Andrew Steptoe, and his colleagues asked the question:

What is a better predictor of telomere length later in life: how much money you have or how much education you completed?

Study after study after study shows that having low socioeconomic status predicts earlier mortality and greater risk for disease. In fact, some past studies have shown that low SES predicts shortening telomeres which protect the DNA of your cells. Shortening telomeres are a popular marker of biological aging. Yet, socioeconomic status is comprised of many different factors, including household income, occupation, and education. To answer their research question, the team used data from  a large study that followed over 10,000 civil servants living in London between 1985-1988 who were recruited for a longitudinal study on cardiovascular disease risk. Most importantly, recruitment for the study specifically aimed to have participants ranging on socioeconomic background. Among these thousands of individuals, 506 (277 men, 229 women) aged 62.77 years  (range 53–76 years) came to a laboratory between 2006-2008 to provide a blood sample and complete more measures of their current income and occupation.

In this sample,  180 (35.6%) participants had a college/university degree, 153 (30.2%) had obtained "A levels" or an advanced qualification for high school, 132 (26.1%) had obtained "O levels" or a basic qualification in high school, and 41 (8.1%) had no educational qualifications. 

They then looked the association between different education levels and telomere length, and found that as educational attainment increased, so did telomere length. That may not be surprising, but they also found this association after controlling for: age, sex, current occupation, blood pressure, cholesterol, smoking, BMI, physical activity, and current household income. So that means that while it is possible that low educational achievement may contribute negatively to health through lower lifelong income, higher likelihood of smoking, obesity, smoking, and so on, there is still a significant contribution made by educational achievement to the health of your cells, above and beyond those factors.  Even more remarkable was that the association was a gradient, such that there were gains in telomere length with each additional level of educational. 

What might this mean? The authors make two points that warrant further research and consideration. First, it is possible that education sets an individual on a health-promoting trajectory that is more important to late-life health than wealth or occupation when a person is older. It is also possible that education allows an individual to more effectively problem solve around health-related issues. The measures of educational attainment in this study are fairly specific to the UK, whereas educational levels in the United States would likely group the "O"s and "A"s together. Not knowing much about the UK system, I expect that the UK high school qualifications are more highly correlated with IQ than anything else. So, perhaps individuals with higher educational qualifications, have higher IQs, which cause them to seek out and respond to health recommendations and problems differently, resulting in cumulative benefit or damage to the body. 

The take home message here is that investing in a young adult's education will do more for them than increase their potential income, it has the potential to improve their health, reduce their risk for disease, and lengthen their life. Keep in mind that these findings are just correlational, meaning there is no way of knowing whether higher education caused longer telomere lengths for the people in this study. These data are also limited in that they excluded people with heart and inflammatory diseases. These limitations aside, I still can't think of a good reason not to invest in education. 

For more articles on telomeres click here.

Steptoe, A., Hamer, M., Butcher, L., Lin, J., Brydon, L., Kivimäki, M., ... & Erusalimsky, J. D. (2011). Educational attainment but not measures of current socioeconomic circumstances are associated with leukocyte telomere length in healthy older men and women. Brain, behavior, and immunity, 25(7), 1292-1298.

What your body remembers from the first year of life!

Now, normally we cover the work of brilliant psychological scientists from all over the world, but our founder Dr. Kate Ryan Kuhlman's most recent paper was featured last week on the International Society for Traumatic Stress Studies' Trauma Blog so we wanted to share it with you by reposting here. Enjoy!

Exposure to trauma during the first year of life may impair the body’s ability to recover from stress

Childhood adversity exposure has been linked to physical and mental health difficulties, such as asthma, arthritis, cardiovascular disease, depression, and suicidality. These health conditions and/or their risk factors emerge throughout childhood and adolescence, and persist across the lifespan. Research over the past two decades has taught us that exposure to traumatic experiences has the potential to alter the way our body responds to stress. When our body experiences stress, there is a cascade of physiological changes that result in the production of cortisol. Exposure to large quantities of cortisol for extended periods of time has serious negative consequences for our brain and our immune system. More recently, researchers have considered whether there are specific periods of development that are more sensitive to trauma and therefore are more impactful to our long-term health.

In a recent article in the Journal of Traumatic Stress, Dr. Kate Ryan Kuhlman and colleagues in Nestor Lopez-Duran’s laboratory at the University of Michigan conducted a study looking at the way 97 adolescents (ages 9-16) responded to stress in the laboratory, and whether responses to the stressor were different based on when the adolescent was first exposed to trauma. These traumatic experiences were assessed using the Early Trauma Inventory, reported by their parents, and included events that constitute non-intentional traumatic events, sexual, physical, and emotional abuse.

Adolescents in the study who were exposed to trauma before they turned one had a significantly different profile of response to the laboratory stressor. Specifically, adolescents exposed to trauma during their first year of life showed a slower recovery from the acute stressor than their peers who were exposed to the same number of stressors beginning later in childhood.

Several studies have shown that timing of trauma exposure during childhood is linked to distinct alterations in the brain as well as clusters of clinical symptoms. This preliminary finding suggests that exposure to traumatic experiences during infancy may disrupt the physiological capacity to “shut off” the stress response. Thus, the evidence that increased attention to trauma exposure timing is necessary to consider within a developmental framework is growing, and may have profound health implications. Until recently, there were few measures available to reliably gather information regarding the timing of traumatic experiences during youth. Just this year, the Maltreatment and Abuse Chronology of Exposure (MACE; Teicher & Parriger, 2015) was published, and we are excited to use in future studies. More research is needed to identify the cognitive and behavioral symptoms that are associated with delayed recovery from acute stress, how long this pattern of responding lasts, and whether psychosocial and pharmacological interventions can help.

For more insights from the frontlines of science on trauma, check out the ISTSS Trauma Blog.

Kuhlman, K. R., Vargas, I., Geiss, E. G., & Lopez-Duran, N. L. (2015). Age of Trauma Onset and HPA Axis Dysregulation Among Trauma-Exposed Youth. Journal of Traumatic Stress. doi: 10.1002/jts.22054

Teens, Anti-depressants, and a bit of context

Recently, there has been increasing media attention toward use of antidepressant medications to treat depression in adolescents. On August 3, 2015 an article was published in the New York Times arguing that antidepressants are safe and should be used more widely in the treatment of depression in young people (here's the link). On September 16, 2015, an article was published, also in the New York Times, alerting the public that a recent study identified Paxil (an antidepressant) as potentially dangerous for young people based on a re-analysis of an old study (here's the link to that article). 

Both of these articles were well-written and convey interesting information and interpretations of the science involved in evaluating treatments for mental illness. However, neither article provides the context within which these findings should be interpreted.  As a result, we are being distracted from the real problem: Depression is a life-threatening illness.

Why would antidepressants be unsafe for youth? 

Currently, there is an FDA black box warning on antidepressant medications. This first sentence reads, "Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders." Let's unpack this. This warning was developed following publication of a study that examined changes in suicidal thoughts and behavior for more than 100,000 youth undergoing antidepressant treatment trials for depression across more than 300 studies. They found that 2% of youth taking the placebo medication, but 4% in people taking the antidepressant, reported suicidal thoughts or behaviors. 

There are two important points to be made about the result of this study. First, the term suicidal thinking and behavior is misleading. Thoughts about suicide are common in depression, and more common among young people than the world likes to acknowledge. There were no differences in suicide completions between the two groups, only increases in thoughts related to suicide. Thoughts can be addressed in therapy. The truth is that a person with depression should see a mental health professional once per week during treatment, regardless of whether they are on antidepressants or not. For this reason, the best practices for treating an adolescent with depression include weekly visits with a psychologist, and bi-weekly to monthly visits with a psychiatrist. Unfortunately, among all of the young people with depression today, half of them are receiving no treatment, and those who are receive antidepressant medications from their primary physician, instead of a psychiatrist, which comes with its own set of risks. These risks are best managed by seeking mental health professionals, psychologists and psychiatrists, who specialize in treating children and adolescents.  

The second point to be made is that 4% is still low. This black box warning is quite misleading, as many statistics can be. The results of this study could be presented, accurately, by saying that youth taking antidepressants are twice as likely to have suicidal thoughts than depressed youth taking a placebo medication. Saying it this way is alarming. However, one could also say that 96% of youth taking antidepressant medications did not report suicidal thoughts, which is actually encouraging. In truth, 2% and 4% are statistically different from one another, but both are very small percentages. Yet, as a result of this black box warning, use of antidepressant medications for young people with depression plummeted. 

This brings me to another important point, which is that there are serious risks to not treating depression in young people as well. Like I said before, suicidal thoughts are common among individuals with depression. So common in fact that between 2 and 15% of individuals with untreated depression complete suicide. Yes, I said complete. Thus, we are brought to the second, less often considered sentence of the black box warning which reads, "Anyone considering the use of [Insert established name] or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need." In fact, we can see the unintended negative consequences of this black box warning over time. Between 1990 and 2000 adolescent suicide completion rates were steadily declining, and have been steadily increasing since 2004 when the black box warning was added. Click here for a figure of these suicide rates.  

To summarize, youth with depression are likely already experiencing suicidal ideation, and the risk of the teen completing suicide is highest when untreated. Obviously, treatment decisions are extremely personal and there will always be pros and cons of every treatment decision. However, we know that the most effective way to treat depression is a combination of weekly CBT and antidepressant medication, and risks are most effectively managed by mental health professionals who specialize in child and adolescent mental illness. For more on depression and it's treatment, click here. 

The verdict is in: Coffee is good for you again!

Coffee and I go way back. Some of my earliest memories are of sitting at the kitchen table with my grandmother while she ate grapefruit for breakfast and drank a cup of coffee. I would sip my own cup of what was probably 10% coffee and 90% cream. Coffee even inspired my professional path when I learned as a hospital volunteer that premature babies are prescribed caffeine citrate to catalyze respiratory development. Even today, I spend a good portion of my time either trying to get more coffee, enjoying coffee, or making plans about when I will have coffee next. Luckily, I am not alone. This behavior is well-integrated into my family, American culture, and has been a major part of the human experience since its discovery in Ethiopia around 850 A.D. Despite its ubiquity, somewhere along the way, coffee developed a bad reputation where our physical health is concerned. But, like many trends in health advice, those opinions were based on anecdotes and not evidence, and the tides are turning.

 
This week, I thought I would share what we know about coffee and different health risks and even benefits. Last year, there were two great articles published on this topic. The first reviews what we know about the links between coffee and health by Elvira Gonzalez de Mejia and her colleagues from the University of Illinois Department of Food Science and Human Nutrition.

In the past decade, several studies have consistently shown that drinking coffee is associated with weight loss due to increased metabolism and lipid oxidation, a 7% reduction in risk for Type 2 Diabetes, enhances memory consolidation, and is protective against the development of prostate, colon, liver, and endometrial cancers. However, there are some diseases that may be more likely in people who drink too much coffee, mix caffeine with alcohol, or who have other risk factors. For example, drinking coffee may be related to bone loss and osteoporosis later in life. The authors suggest that this association may be offset by drinking coffee with milk as opposed to black. There are other studies showing that coffee can increase cholesterol and blood pressure, which may increase risk for heart disease. There are other studies suggesting that drinking coffee can worsen pre-existing conditions, such as heart disease or anxiety. What remains to be understood in many of these studies is whether these effects are related to caffeine or specific to coffee. Coffee, compared with other sources of caffeine, actually have a number of health benefits like reducing inflammation that are independent of caffeine, especially when you avoid adding sugar.

The overall conclusion of the article was that drinking coffee can confer more health benefits than risks, but that moderation is critical. But, what is moderation anyway? The authors recommend that adults drink fewer than 400 mg of caffeine per day. A cup of coffee can range from 95-330 mg per cup, while an espresso can range between 50-150 mg. The recommendations for pregnant women and children are a bit different. Pregnant women should limit daily caffeine intake to less than 300 mg, while children and adolescents should limit their daily caffeine intake to less than 2.5 mg/ kg of weight. This means that the average 10 year old in the US, who weighs ~70 lbs or 32 kg, should have less than 80 mg of caffeine per day. Also, it's important to keep in mind that caffeine isn't only found in coffee. There are meaningful doses of caffeine in tea, chocolate, soda, and energy drinks. Kids, unlike adults, generally get caffeine from soda, which also contains high doses of sugar that contribute to risk for Type 2 Diabetes considerably.

The second article I found was a meta-analysis conducted by Alessio Crippa and colleagues at the Institute of Environmental Medicine at the Karolinska Institute in Sweden. The purpose of this study was to aggregate all of the studies that have looked at the association between coffee consumption (measured in number of cups per day) and mortality between 1966 and 2013. This ultimately included data from 997,464 individuals, 120,915 of whom had passed away. They divided their findings up into studies that examined all-cause mortality, cardiovascular disease, and cancer. They found that drinking coffee was associated with lower all-cause mortality risk compared with individuals who drank none, but the mortality related benefits of drinking coffee stopped increasing after about 4 cups per day. With respect to cardiovascular disease, similar results were observed. Specifically, mortality risk was highest among individuals who did not drink any coffee, lowest for individuals who drink 3 cups per day, and the benefits of drinking coffee taper off and even begin to reverse after 4 cups per day. Unfortunately, the same pattern was not observed for cancer, and drinking coffee was not related to any differences in cancer-related mortality.

One limitation of everything I've just shared with you is that I am unapologetically biased. It would take an enormous amount of evidence to convince me to quit drinking coffee, however I have learned quite a lot from reading these articles. Before now, I assumed that coffee was good for my own health because I enjoy it so much, and because walking to get coffee constitutes much of my daily exercise. However, these data speak to additional health-benefits that I wasn't aware of. Now obviously the most important limitation of these studies is the lack of causal associations. The only way we would know that caffeine prevents disease or causes anything is by randomly assigning one group of humans to drink coffee daily and one group to drink something else. But then we would have to follow them for the rest of their lives, and alas we are only guaranteed one life to live. In the absence of good causal data, these are enough to reassure us coffee-drinkers that if we keep our enjoyment below 400 mg per day, with some exceptions, we not harming ourselves and can continue as T.S. Eliot and measure out our lives with coffee spoons.

Crippa, A., Discacciati, A., Larsson, S. C., Wolk, A., & Orsini, N. (2014). Coffee consumption and mortality from all causes, cardiovascular disease, and cancer: a dose-response meta-analysis. American Journal of Epidemiology, kwu194.

de Mejia, E. G., & Ramirez-Mares, M. V. (2014). Impact of caffeine and coffee on our health. Trends in Endocrinology & Metabolism, 25(10), 489-492.

I hate exercise too.

Photo credit: https://unsplash.com/

I shouldn’t admit this because I am a health professional, but I don’t like exercise. Don’t get me wrong, I enjoy being active. I love living in a city because you can walk everywhere, hiking in the canyons with my dog, and I will usually take the stairs over the elevator to get from Point A to Point B. Despite generally enjoying living an active life, I really hate structured, overt exercise. I’m talking about the kind that requires you to buy a new wardrobe of workout clothes and visit a gym several times a week where you are strapped into machines that contort your muscles to-and-fro while someone who runs ultramarathons for fun yells “imagine carving out that panty line” and “get that leg a little higher” at you while you try not to cry or vomit. For me, all of this feels and seems completely ridiculous. That being said, the data consistently shows that engaging in 30 minutes of aerobic exercise at least 3 times per week will, literally, save your life. If you do that, you will live longer, get injured and sick less, spend less money on medical bills, look younger, feel happier, and sleep more restfully. As far as investments go, exercise is a safe bet. So, professionally, I make recommendations that people exercise, like I did here, and I also participate 2 hours per week in the Los Angeles cult that is CardioBarre. For better or for worse, it is the nearest to my house.

But sometimes, despite this laundry list of benefits, I find it difficult to muster up the motivation to engage in overt exercise activities. There are so many hours in the day, and just under a million other things I could be doing instead that would feel more productive or that I would actually enjoy. If there is anyone out there who thinks and feels the same way, this post is directed at you. In fact, only 26% of people in the United States actually meet the recommended weekly exercise dose, so this is directed at most of you.

In 2008, Hillman, Erickson, and Kramer published a review of what we know about the effects of exercise on the brain. While they reviewed the results of many findings, I will limit my explanation to 3 findings that are particularly motivating for me. First and foremost, exercise creates new brain cells. If you have two cages of rodents, one cage with a running wheel, and one cage without, the rodents in the cage with the running wheel will run on it and create new neurons. Throughout your life, you are creating and losing neurons, with an imbalance toward creating in the first half of life and an imbalance toward losing in the second half. However, exercise promotes the creation of new neurons, thus allowing for more learning early in life, and less deterioration in later life. Second, exercise makes daily tasks less difficult. If you have older adults (ages 60-85) participate in aerobic training multiple times per week over several months, they will process information more quickly, have better spatial reasoning, and have much better executive functioning than people who did not participate in the exercise program. Executive functioning skills most robustly improved compared with the control group as a result of exercise, which include complex thinking such as planning, problem solving, holding multiple pieces of information in memory, and switching between tasks. These results are actually so convincing that researchers are looking into whether exercise interventions can prevent or even reverse the effects of Alzheimer’s Disease. Stay tuned for more on that in the future. Finally, exercise makes you smarter. These effects can even be intergenerational. For example, mothers who exercise during their pregnancy have offspring with more brain cells in the parts of their brain responsible for learning and memory (hippocampus & dentate gyrus). As children continue to develop, kids who engage in more physical activity have higher IQs, better achievement scores in both verbal and math assessments, and have better memories.

So there you have it, even if it’s silly and feels like a sweaty, waste of time and money, exercising with regularity will put you in a better mood, help you think more clearly while you work, and will continue to promote your ability to learn (whatever you want) throughout your life. When you put it in perspective like that, 30 minutes every couple of days isn’t so bad.


Hillman, C. H., Erickson, K. I., & Kramer, A. F. (2008). Be smart, exercise your heart: exercise effects on brain and cognition. Nature reviews neuroscience,9(1), 58-65.

There’s an app for that?!?! How your social network influences important healthcare decisions.

There are tens of thousands of people around the world who conduct research on developing treatments for illnesses, including me. These range from publicly funded to private sector investigations, on illnesses from depression to multiple sclerosis, from behavioral interventions to surgery techniques. In the past century, we have tested countless interventions for their ability to effectively reduce symptoms, morbidity, and mortality. To do this we recruit samples of people with the illness we want to treat, randomly assign half of them to the treatment we are testing, and the others get an appropriate control (either a placebo, waitlist condition, or a competing treatment). If the treatment turns out to effectively reduce the impact of the illness on the participants, we call it an Evidence Based Practice or EBP for short.

Once we have evidence that a treatment works, we try to find ways to get it into the hands of professionals and patients in the community who could benefit from it. You’d think that everything that comes before this step would be the hard part; that once we had strong, repeated evidence that we have developed a treatment that worked, the people who are sick would embrace the treatment with open arms. Unfortunately, that’s not the case. Getting new EBPs out into the community is next to impossible in almost every field of health care, from psychology to cardiac surgery. As a result of this problem, researchers spend some of their time conducting studies that help us understand what leads patients to choose non-EBPs instead of EBPs. A great example of this is a study by Katherine Pickard and Dr. Brooke Ingersoll about what predicts use of EBPs for the treatment of autism.

Roughly 1 in 68 children have an Autism Spectrum Disorder (ASD). Since ASD affects all ethnic, racial and socioeconomic groups we thought it would be an important topic to address. Individuals with ASD often struggle with emotional, social, and communication skills. They can be resistant to change and engage in repetitive behaviors. The signs of ASD typically start during early childhood and will last through out the lifespan. The most effective treatment for the symptoms and difficulties related to ASD is behavioral intervention for between 15 to 30 hours per week, of which there are many to choose from depending on the age of the patient, community availability, and symptom severity. Children with ASD who are treated with EBPs grow up to have more friends, complete more formal education, have higher IQs, among many other positive outcomes. So, you can imagine why we are enthusiastic about getting more kids into treatment with EBPs. Pickard and Brooke were too. Specifically, they asked:

“How do social networks contribute to decisions about the use of EBPs for the treatment of Autism Spectrum Disorders?”

To answer this question, the sent a survey out to the members of the Interactive Autism Network (IAN), an online community of 43,000 families created to connect parents of children with ASD to research. They recruited 244 parents of a child with ASD. The children were about 6 years old, but ranged between 2 and 17 years of age. The parents provided demographic information and ASD symptom severity of their children. Parents then made a list of all of the people they had received advice from about their child’s care, their profession and personal role in the child’s like, listed what that advice was, and whether they followed through on it. Parents then saw a list of 54 services commonly provided among treatment programs for autism. Of these, 24 were EBPs, 24 were non-EBPs, and 6 were supplemental services. They were asked to “mark which ones you’ve heard of, and which ones you’ve used in the past 6 months.”

The research team then combed through the parent reports of their social networks to mark which members of the parents’ network were “formal ties” vs “informal ties.” Formal ties were teachers, therapists, & other intervention providers. They hypothesized that formal ties would lead to greater use of EBPs because professionals are part of scientifically integrated professional organizations, thus increasing the chances of their patients hearing about new, effective treatments. In contrast, informal ties tend to have more limited social ties, and mostly share information amongst themselves, thus decreasing the likelihood that new information will infiltrate the network.

They found that parents of children with ASD in this sample were using between 1 and 35 types of services, with an average of about 6. Parents of children with ASD also reported seeking advice from an average of 6 people in the past 6 months. The good news was that 94% of the sample were using at least one EBP, but 58% of the sample were also using at least one non-EBP. This means that more than half of the sample was spending time and money on services for their children despite there being little evidence that it would help. What’s a bit more concerning was that only 58% of parents reported that their primary intervention for their child was an EBP... The rest of the article explained how a parent’s social network determined use of EBPs to help their child.

They found that about 15% of the use of EBPs was explained by social network size and composition. Further, social network variables predict parental EBP use above income, education, and severity of the ASD symptoms in their child. Having a larger social network, or wider net cast for advice, predicted a higher likelihood of using EBPs. They also found that people reporting more formal ties in their network were more likely to use EBPs as their primary source of intervention and had more hours of EBP intervention.

The EBPs were, not surprising, being recommended by professionals such as teachers, speech-language pathologists, social workers, respite care providers, psychologists, neurologists, early intervention providers, counselors, case managers, and behavioral specialists. Non-EBPs were being recommended by parents of children with autism, the internet, friends, family, colleagues, tutors, and physical therapists. Important to keep in mind here is that not all professionals give good advice, and not all other parents with ASD will recommend non-EBPs. What is important to note is the theory behind why larger networks lead to use of more effective treatments: professionals have contact with larger groups of other professionals so new information about treatments that are effective can reach their patients.

But how do you change your social network? 

The truth is that parents of children with ASD need more help that they are getting. The most common source of advice these parents reported was family members, then teachers, then other parents. They are reaching out to the people nearby because it’s expensive and time-consuming to seek professional advice, and difficult to change your social network. Or at least it used to be. Which leads me to the title of this article, “There’s an app for that?”

Recently, a company called Maven decided to revolutionize health care access. The first thing you see on their website is, “You have ten places to be, and a waiting room isn’t one of them.” They realized that when you have a child, there are a million questions that come up regarding how to manage health-related issues for your child. So, they created an app that allows you to choose from a list of healthcare professionals including a pediatrician, nurse practitioner, nutritionist, lactation consultant, OB/GYN, a doula, psychologists, and social workers. Then you can choose an appointment time that works for you, even later that day. Then you can have a video appointment with them for consultation on your issue, from the privacy of your own phone, wherever that may be. There is flat fee per appointment that’s comparable to a common co-pay with no need for hassles with health insurance. For example, it’s $18 for a 10 minute conversation with a nurse practitioner. Easy, convenient, and inexpensive. With services like Maven, parents can easily double check the latest fads with a professional, before spending time and money on something that won’t help.

If you want to sign up, and why wouldn’t you, use the promo code SCIENCE to get $10 off your first visit, and get help that will actually help.

Before you go, one limitation of this study is that participants in this study were all part of the IAN, which is for families who are interested in contributing to and accessing the most recent innovations in treatments and resources for ASD. Therefore, this sample is likely an over-estimating use of EBPs in the community. Related to that point, the sample was also 90% white with 80% male children with ASD. ASD is twice as common in males as females, but a sample with more diversity would certainly help us understand how social networks influence decisions about health care in more communities.

Pickard, K. E., & Ingersoll, B. R. (2014). From Research Settings to Parents The Role of Parent Social Networks in the Choices Parents Make About Services for Their Child With Autism Spectrum Disorder. Clinical Psychological Science, 3(2), 256-269. doi: 10.1177/2167702614534240