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Remainder of Semester

Remainder of Semester. Diary Study Due Dec 11 Final: Dec 17, 12:00 – 3:00 Remaining classes :

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Remainder of Semester

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  1. Remainder of Semester Diary Study Due Dec 11 Final: Dec 17, 12:00 – 3:00 Remaining classes: 12/06: Humor and Health 12/11: Review Session 12/17: Final Exam Instructor Evaluation: http://sakai.rutgers.edu

  2. Band Aid Stigma Extra Credit Findings BandAid Size predicts: People stared at you Avoided looking at you Treated you differently You felt angry Glad when “study” ended Interesting Observations: 1. Reduced eye contact, shorter interactions, more awkward interactions, anger! 2. People who directly asked afterwards seemed more comfortable 3. Kids directly ask; parents scold kids; kids curious, parents freaked 4. Joking about it increases other’s comfort: “I cut myself shaving” says female participant 5. Friends as “social comparison” confirmed differential treatment 6. Reflective laptop to observe being observed (clever!) 7. Ambiguity: were people acting weird out of discomfort, pity, fear? 8. Regional effects? Florida vs New Jersey 9. Hypevisibility + invisbility

  3. Reasons for Non-Adherence Personality / demographics Political, ideological orientation Depression, stress, avoidant coping Creative non-adherence Change dose to preserve med Mix with home remedies Altruism: Polish rescuer HPV vaccine: Prevents genital warts and cervical cancer. Michele Bachmann, GOP Representative, says HPV vaccine can cause mental retardation—based on hearsay. https://www.youtube.com/watch?v=P1mQKAHKs88 Flu vaccine, other vaccines reduce infant mortality. Robt. Kennedy Jr. has led misinformed resistance to vaccines as unsafe.

  4. Patient Contribution to Poor Communication Failure to hear a. 33% can't recall diagnosis after seeing MD 50% don't understand important details b. Reasons for failure to hear * Too anxious * Too embarrassed * Ignorant, uninformed Failure to speak a. Don't say why they're there. b. Wait till last minute, mention problem offhandedly

  5. Improving Adherence: Tips for MDs Care more Basic politeness Greet by name Explain purpose of procedures / meds Don't appear desperate to leave (door handle effect) Say "goodbye" after exam U. Mass 3 points (from Schrof article) 1. Don’t interrupt: MD 18 secs / pat 2.5 min 2. Ask “what were you hoping I could do for you?” 3. Don’t intimidate patient into silence

  6. Addressing Adherence Directly 1. Spend real time in explaining: a. Repeat instructions 2 + times b. Have patient repeat instructions back to you. c. Break complicated treatment into sub-goals 2. Probe for real-world barriers to adherence 3. Obtain verbal commitment 4. Prescribe behavior change like medication. e.g., Don't advise new diet, prescribe it. 5. Tell patient to "Get better." (According to Kent's MD)

  7. Tips for Patients Ask questions at the outset, not at the end Prepare a written list for your visit. • My MD Visit Questions List • Coughing at night • Muscle soreness • Eye twitch • Meds give me cramps • Are fried Twinkies truly bad for me? 1. Helps you remember issues and specifics 2. Makes it hard for MD to leave until all of your items are addressed. Bring friend: Note-taker, listener, support source

  8. Class 24:Humor and Health A good laugh and a long sleep are the best cures in the doctor's book.  Irish Proverb

  9. Norman Cousins’s Cure Cousins: Journalist, fought for nuclear disarmament, truth in journalism Diagnosed with deadly form of arthritis; given months to live Cousins self-prescribes the following medicine: https://www.youtube.com/watch?v=O_fmUYyWSyE Cousins lived decades beyond his diagnosis. He attributed his sustained health to humor, as well as to other psychological resources.

  10. Medical Jokes A man walks into a doctor's office. He has a cucumber up his nose, a carrot in his left ear and a banana in his right ear. "So Doc, what do you think is the matter with me?" he asks. The doctor replies, "You're not eating properly." Things you don't Want to Hear During Your Surgery: Oops! Eww! Gross! Come back with that! Bad Dog! Bad Dog! FIRE! FIRE! Everyone get out! If you remember, I did mention possible side effects.

  11. Whoa! That was a good one! Try it, Hobbs—just poke his brain right where my finger is. Well, I guess it’s not a kidney stone after all!

  12. Why Do People Joke About Illness? Positive reframing—makes things less threatening Increases distance to threat Provides feeling of control Downward social comparison Play with meaning, disengagement from morality; Rebel against “just world”: Note—religiosity inhibits humor—why? Increases feelings of belongingness: We like laughing with others.

  13. Humor and Coping: Survey Studies What would be a prime difficulty in studying effects of humor on coping? Measuring humor. What is humor? What is a good vs. bad sense of humor? What is using humor a lot vs. using humor a little? Psychology of humor struggles with these issues. • Coping With Humor Scale: Martin & Lefcourt, 1983 • I lose my sense of humor when I’m having problems. • I find my problems are greatly reduced by finding humor in them. • I look for something funny to say in tense situations. • My life would be easier if I had more of a sense of humor. • If I’m in a situation where I have to cry or laugh, its better to laugh. • I can usually find something to laugh or joke about even in trying situations. • It has been my experience that humor is a very effective way of coping with problems.

  14. Humor and Hardiness Overholser, 1992 People who score higher on “Coping Humor Scale”, and on humor appreciation and humor creativity show: 1. Less loneliness 2. Less depression 3. Greater self-esteem How might these effects be relevant to health? Loneliness = low perceived social support  health risk Depression  hippocampus atrophy, cardiac illness Self-esteem  less stress  greater health OK, fine, but does humor actually relate to health outcomes?

  15. Humor, Stressors, and Moods Martin & Lefcourt, 1983 Stress has what affect on health? Major health risk. How might humor affect stress? Reduce stress If humor reduces stress, how should it affect health? Improve it. Martin & Lefcourt test 2nd proposition: humor reduces stress. Method: Ss Coping with Humor Scale. Also complete measures of: Stressful Life Events survey Mood States survey Because all measures taken at same time, this a: Cross-sectional OR longitudinal survey?

  16. Humor, Stressors, and Moods: Results Martin & Lefcourt, 1983 Negative Mood

  17. Humor, Stressors, and Moods: A Prospective Study Nezu, Nezu, & Blissett, 1988 • Causality unclear: • Humor  Low stress • Low stress  humor • Hidden variable affects stress and humor Martin & Lefcourt, 1983, used a cross sectional design. Problems? Nezu et al. use prospective design Method: Ss complete Coping with Humor Scale and Stress Scaleat Time 1, Depression at Time 2. How does this design improve on 1983 cross sectional design? If Time 1 Humor and Stressors predict Time 2 Depression, then there is better evidence that humor effects depression.

  18. Humor, Stressors, and Depression: Results Nezu et al., 1988 Time 2 Depression OK, evidence that humor does affect psychological coping. But what about physical symptoms?

  19. Does Laughter Increase Pain Tolerance? Dunbar et al., 2011 Norman Cousins hypothesized that laughter would release endorphins, which are leading to reduced pain. endogenous opioids If laughter has this effect, it should increase / decrease pain tolerance. • Dunbar et al. tested this prediction in a series of studies. • Does viewing comedy video vs. neutral video increase pain tolerance? • Does viewing in groups vs. alone make a difference re. pain tolerance? • Is it really comedy, or just positive affect?

  20. Change in Pain Tolerance Due to Comedy Video vs. Neutral Video Dunbar et al., 2011 Change in Pain Tolerance

  21. Changes in Pain Threshold: Comedy, Group Setting, & Gender Dunbar et al., 2011 People do not laugh at even funniest events when alone. Laughter 30 times more likely to occur in social contexts vs. alone 1. Would group vs. alone conds. moderate analgesic effect of laughter? 2. Would gender moderate group effect? Males Females

  22. Changes in Pain Threshold: Laughter vs. Positive Affect Dunbar et al., 2011 Is benefit of laughter actual laughter, or just change in mood? Ss watch neutral vs comedy vid, rate change in mood. Wear mics to record laughter DV: BP cuff pressure Neutral Vid. Pos. Affect Rating Amount Laughed

  23. Mirthful Laughter and Cardiovascular Health Miller & Fry, 2009 “Mirthful Laughter”: Unifying, enhances rapport, communication, and harmony Laughter is universal: All humans laugh. What is evolutionary reason? “Mirthful Laughter” involves many biologic systems: Respiratory, muscular, cardiovascular Laughter increases arterial blood pressure (like strenuous exercise) “Extravagance of laughter”  intense increases in BP. Isn’t this a threat? Rare occasions, intense laughter  vascular hemorrhage But very rare. Enigma—how come heavy laughter doesn’t kill us? Clues: 1. Arteries aren’t “passive tubes”; instead respond to materials conveyed 2. Endothelial Cells: line all blood vessels, filter materials, inhibit clotting 3. Endothelium excretes nitric oxide (NO): NO is cardio-protective: a. Vasodilation b. Reduced platelet aggregation (cholesterol buildup) c. Reduced vascular inflammation.

  24. Nitric Oxide (NO) Notes • Nitric Oxide IS NOT nitrous oxide (aka laughing gas) • Benefits of NO • Helps memory by transmitting neural signals • Assists immune system; battles tumors, bacteria • Dilates arteries • Reduces inflammation • Improves sleep • Increases endurance and strength • Improves metabolism • Improves sense of smell Viagra works by improving NO production vasodilation  erection How to increase NO production (other than the blue pill) a. Exercise b. Diet -- amino acids: Nuts, fruits, garlic, soy, meats, dairy

  25. How Mirthful Laughter Might Be Cardioprotective Miller & Fry, 2009 Funny Things Releases Endorphins Vessel Dilation Endothlium Reduced Platelet Aggregation μ-3 receptor activation by endorphins increases nitric oxide production Reduced Vascular Inflammation Nitric Oxide

  26. Test of Mirthful Laugher / Heart Protective Hypothesis Miller & Fry, 2009 Subs. view funny scene (SNL) then disturbing scene (Private Ryan), or vice versa. Subs. undergo Brachial Artery Reactivity Test (BART), Measures vaso-reactivity. Higher score = more dilation Percentage Change in Vasodilation Vasodilation Change

  27. Sense of Humor and Survival Among Patients with Terminal Renal Disease Svebak, 2006 Subjects: 41 patients receiving dialysis for terminal renal disease Subjects report: 1. Demographics (age, gender, education) 2. Illness facts (duration, # treatments per week, co- morbidity) 3. Psycho-social: Sense of humor, Quality of Life Results at 2 years: 1. 19 patients die (46%) 2. Older patients die sooner 3. Illness facts not predictive 4. Sense of humor strongly predicts survival

  28. “Institutionalized” Humor Therapy: Patch Adams https://www.youtube.com/watch?annotation_id=annotation_817711&feature=iv&list=PL7A9200584AE4CFC1&src_vid=eQ87hBFrS_I&v=byPJ22JDFjI Hunter Doherty “Gesundheit Institute” 1971 Introduces humor into Medical Training and service

  29. Sick Humor, Coping, and Religion Saroglou & Anciaux, 2004 Hey everybody! Look at me! I’m a cowboy! Howdy Howdy Howdy! It’s still hungry. And I’ve been stuffing worms into it all day!

  30. Death Disability Disgust “Sick Humor” jokes based on “3-Ds”: AND Neutral humor jokes Subs. 1. Rate jokes 0= not funny, 5 = very funny 2. Complete coping styles measure 3. Complete measure of religiosity Sick humor is related to “Emotional Coping” -- Disclosing, venting, getting emotional support, negatively related to religiosity. Who benefits more from sick humor? ___ Men ___ Women Neutral humor is related to “Active Coping” –planning, active responses, not disengaging, not using substances, unrelated to religiosity. Perhaps people who like sick humor are less inhibited, more freely engage with taboo topics. What is benefit of being less inhibited? X Free disclosure  immunocompetence

  31. Laughter Therapy Let us take a dose of medicine https://www.youtube.com/watch?v=QEZkb97rRtI Laughter Clubs: Cancer Treatment Centers of America (CTCA) 1. Laughter clubs adjunct to regular treatment 2. Not based on humor or jokes, instead laughter as exercise 3. Patients in circle, fingertips on cheek, chest, abdomen 4. All make “hee hee” or “ha ha” sounds 5. Pats. say: first time laughed in months, mind off cancer

  32. More Research is Needed!

  33. Environmental Cues and Health: Ellen Langer’s Odd Study Subjects: 8 men in 70s. Procedure: Live in monastery converted to look like 1950’s apartment: Music, TV, books, magazines from 1950s—BUT NO MIRRORS Men told to live like they had 20 years earlier; be as active, self-reliant told to talk about 1950s events as if they were current events Outcome: Relative to 8 men in control condition (stayed in “normal” monastery) Better manual dexterity; sat taller; looked younger to “blind” judges AND Better Eye-sight!

  34. You Feel as Good as You Look? Hair and Blood Pressure Subjects: Women at salon for hair styling or hair coloring. Procedure: BP recorded, hair styled, complete “satisfaction” survey, BP recorded Outcome: Women who reported looking younger after hair style had lower BP

  35. Attitude About Activity Affects Benefits of Activity Hsu, Chung, &Langer, 2010 Work is exercise mindset Daily required work mindset Subjects: Maids at hotels told to regard work as exercise—more than Surgeon General recommends. Or not given this mindset Outcome: “Work is Exercise” maids lost weight, better Body Mass Index (BMI) better Hip to Waist ratio.

  36. Uniforms and Health Hsu, Chung, &Langer, 2010 Question: Does wearing a uniform improve health? If income low, uniform is related to worse health If income middle-range or higher, uniform  greater longevity Why? Clothing implies social status, and ability. Professional garb is an equalizer; Look the same at 70 as at 30, in terms of clothing. “Clothing makes the man (or woman)”

  37. LET THERE BE LIGHT https://www.youtube.com/watch?v=uiD6bnqpJDE

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