Kimberly S. Kelly

Placebo/Nocebo Symptom Reporting in a Sham Herbal Supplement Trial

The present study examined reports of placebo and nocebo symptoms in a college sample. The study was presented under the guise of a clinical trial to evaluate the effectiveness of an over-the-counter herbal supplement intended to enhance cognitive performance. Participants were informed they would be receiving either an herbal supplement or a placebo, and each was provided with a mock list of possible beneficial and adverse effects of the “supplement.” In fact, all participants received placebo. Symptoms were endorsed by a significant majority of participants following placebo ingestion. More important, results indicated that the few participants who believed they received an herbal supplement endorsed (via self-report) significantly more symptoms than those who believed they received a placebo. Neither anxiety nor social desirability was significantly related to symptom reporting. Results suggest that beliefs concerning treatment received may subsequently affect the degree of placebo response in a no-treatment group. Implications for clinical trials and future research are discussed.

Psychometric Evaluation of the PSQI in U.S. College Students.

STUDY OBJECTIVES Examine the psychometric properties of the PSQI in two U.S. college samples. METHODS Study I assessed convergent and divergent validity in 866 undergraduates who completed a sleep diary, PSQI, and other sleep and psychosocial measures. Study II assessed PSQI insomnia diagnostic accuracy in a separate sample of 147 healthy undergraduates with and without insomnia. RESULTS The PSQI global score had only moderate convergent validity with sleep diary sleep efficiency (prospective global measure of sleep continuity; r = 0.53), the Insomnia Severity Index (r = 0.63), and fatigue (r = 0.44). The PSQI global score demonstrated good divergent validity with measures of excessive daytime sleepiness (r = 0.18), circadian preference (r = -0.08), alcohol (r = 0.08) and marijuana (r = 0.05) abuse scales, and poor divergent validity with depression (r = 0.48), anxiety (r = 0.40), and perceived stress (r = 0.33). Examination of other analogous PSQI and sleep diary components showed low to moderate convergent validity: sleep latency (r = 0.70), wake after sleep onset (r = 0.37), sleep duration (r = 0.51), and sleep efficiency (r = -0.32). Diagnostic accuracy of the PSQI to detect insomnia was very high (area under the curve = 0.999). Sensitivity and specificity were maximized at a cutoff of 6. CONCLUSIONS The PSQI demonstrated moderate convergent validity compared to measures of insomnia and fatigue and good divergent validity with measures of daytime sleepiness, circadian phase preference, and alcohol and marijuana use. The PSQI demonstrated considerable overlap with depression, anxiety, and perceived stress. Therefore, caution should be used with interpretation.

Role of Parental Stress on Pediatric Feeding Disorders

The study examined the relation between parental anxiety and child feeding progress. Eighteen sets of parent and G-tube-fed child dyads participated. Caloric intake was recorded daily as the outcome measure of treatment progression. Parental anxiety was measured subjectively (self-report questionnaires) and objectively (salivary cortisol). Objective parental anxiety increased significantly (p < .001) when parents went from simply observing to actually feeding the child. There was, however, no direct relation between parental stress and caloric intake. Exploratory analyses of documented behavioral observations during feeding revealed a significant increase (p <. 001) in the childs negative behaviors with parental feeding, as opposed to staff feeding. Based on the results, further research to investigate parent–child dynamics during feeding is warranted.

PHYSIOLOGICAL INDICATORS OF STRESS AND INTELLECTUAL PERFORMANCE AMONG ANXIOUS OLDER ADULTS

The purpose of this study was to gain a better understanding of the relationship between anxiety and cognitive performance in older adults. We asked 27 older adults, self‐selected on the basis of their concerns about decrements in intellectual functioning, to perform a series of cognitive tasks to assess crystallized (Gc) and fluid (Gf) intellectual abilities. Volunteers also completed questionnaires concerning their beliefs about their task performance specific to each ability, as well as measures of both generalized and intellectual self‐efficacy, everyday cognitive failures, and concerns about illness and aging. Cortisol was measured as an indicator of anxiety and Epstein‐Barr virus levels were assessed to determine nonspecific physiological changes. Results indicated that in the self‐selected “anxious” sample, there was a significant negative correlation between cortisol and self‐efficacy related to the most difficult measure of Gf. The only other significant (negative) correlation was between cortiso...

Gains in Fluid Ability Performance and Their Relationship to Cortisol

The present analyses examined the relationship between cortisol and performance gains in crystallized (Gc) and fluid (Gf) ability, as well as the relationship to measures of everyday cognitive functioning in a sample of 73 older adults. The analyses were part of a larger study examining the impact of anxiety-reduction training on everyday tasks. Cortisol was assessed via urine sampling. Results indicated that there was a significant negative correlation between cortisol and performance gains for Gf, replicating earlier findings reported by our laboratory. These findings also extend the relationship to cortisol measured in urine; previous analyses were conducted using serum-based cortisol. Cortisol was also significantly related to performance gains in some measures of everyday cognitive functioning.

The relationship of cortisol to practice-related gains in intelligence among older persons.

Based on data collected from two separate samples of older adults, the present study explored the role of cortisol in mediating practice-related gains in fluid intelligence (Gf) among older adults. Analyses across samples involved treatment group participants who received stress inoculation training in order to reduce anxiety concerning intellectual performance; waiting list control group participants did not receive training until the experiment(s) were completed. Practice effects were examined for both groups. In Study 1, the sample consisted of a heterogeneous (re: concerns about intellectual performance) group of older adults, and Study 2 participants were older adults who self-reported as being at least moderately anxious or concerned about intellectual performance declines. The two samples differed on health (p < .01), with Study 2 participants being healthier (as determined via self-report). Results indicated that practice, but not training, effects were evident for measures of crystallized ability (Gc) and Gf across both studies. The data also suggested that cortisol mediation was different for the two samples in that it was negatively correlated with Gf in the first sample, and, though not significant, positively correlated with Gf in the second. The same directional relationships were evident for the measure of Gc. Comparisons between studies regarding correlations between cortisol and practice-related gains in performance were significant for Gf (p < .01) and approached significance for Gc (p < .07). These data seem to suggest that for some older persons, higher levels of cortisol interfere with the effects of practice on Gf performance, while for others, higher cortisol facilitates such gains in performance.

Expectancy and placebo reporting

dritic cell (DC). These studies aimed to understand how melatonin affects DCs’ differentiation and maturation using an in vitro bone marrow dendritic cells (BMDC) culture system. Since melatonin has also been shown to regulate the stress-induced hormone corticosterone (CORT), CORT was also included in the study. It was found that 24 h pretreatment with melatonin caused dose-responsive enhancement of LPS-induced DC maturation, while CORT, as expected, caused dose-responsive inhibition of DC maturation. Furthermore, DCs exposed to moderate amounts of melatonin greatly increased their IL-12 production. On the other hand, when BM cells were treated with hormones throughout the culture period without LPS stimulation, their development into DCs was not affected by melatonin, but was negatively affected by CORT. Surprisingly, when both hormones were applied, the effects of CORT were dominant in all cases. All together, melatonin positively regulates DCs during immune responses, but does not influence the CORT’s effects on DCs. Continuing studies will help the arising clinical use of DCs.

Comparisons of Urinary Versus Serum Cortisol in Older Persons

The present analysis compared urine- versus serum-based amounts of the stress hormone cortisol in two older adult samples, given that urine as a sample medium is a less expensive and less invasive method of determining cortisol amounts relative to serum. Seventy-three older adults provided urine samples as part of an ongoing study to assess levels of cortisol as a function of intellectual efficacy/performance; these data were compared to serum cortisol levels obtained from 96 older adults in a separate study examining health beliefs and cortisol levels. Analyses indicated that the cortisol levels did not differ across samples, i.e., cortisol amounts measured in serum or urine yielded similar, typical (within normal ranges) results. The data, though preliminary, indicate that urine may provide an alternative to serum when assessing cortisol in older persons.

Is Insomnia a Risk Factor for Decreased Influenza Vaccine Response

Healthy young adult college students (N = 133) with Insomnia (n = 65) or No Insomnia (n = 68) were compared on influenza serum antibody levels pre- and four weeks postvaccination. Volunteers underwent structured clinical interviews for sleep disorders to ensure insomnia diagnoses, as well as psychiatric interviews, physical examinations, and drug testing to ensure comorbid health problems were not potential confounds. There were significant time (both groups had increases in antibody levels pre- to postvaccination) and group (Insomnia group had lower HI antibody levels overall) main effects, but the time × group interaction was nonsignificant. Exploratory analyses did find significant PSQI x Time (p < .001) and Insomnia Status × Time (p = .002) interaction effects. Results indicate insomnia may be a risk factor for lowered immunity to the influenza virus.

68 Anxiety and the placebo effect

for their top three concerns. Parent and youth BASC subscales and FDI scores were clinically elevated and positively correlated at baseline. Eight subjects attended at least one yoga class and completed both the baseline and follow-up measures within 1 month of their last class. They did not differ significantly in age, gender, ethnicity or diagnosis from the sample as a whole. The eight subjects attended an average of 13 yoga classes over 4 months (range 12–41 classes; 3–6 months). Parent report showed significant improvement over time on depression and anxiety subscales, and three of four indexes. Youth report showed a significant interaction effect with subjects who attended more classes showing significantly greater improvement at the .05 level on the BASC somatization subscale and two of the four indexes, and a trend toward significance on the depression and atypicality subscales. Clinically significant, but not statistically significant changes were assessed by the FDI and MASC. The principle obstacle to class attendance was transportation. A shorter, more intensive intervention is recommended to increase adherence.