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V.M. Westerberg – 10143519 Page 1 of 12
ARTICLE REVIEWS – HEALTH PSYCHOLOGY
Wrosch, C., Schulz, R., Miller, G.E., Lupien, S., & Dunne, E. (2007, May). Physical health
problems, depressive mood, and cortisol secretion in old age: Buffer effects of health
engagement control strategies. Health Psychology, 26 (3), 341-349. doi: 10.1037/0278-
6133.26.3.341
The authors of this article have been doing research on the topic of health engagement psychological
strategies for over 10 years now. They are well known Canadian Psychology scholars who fund their
research from different national Canadian and independent institutions. Their articles have been
published in the major Health Psychology journals.
This is the fourth work of this prolific group of researchers, which is based both on their previous
studies and on the most recent related literature, usually not older than 10 years. To date, this article
has been used as a reference in 18 related works, from books to peer reviewed and journal articles.
In this cross-sectional study, the authors aimed to further evaluate the role of control behaviours in
physical health improvement in a large sample of senior citizens from a biopsychosocial perspective.
They used Health Engagement Control Strategies (HECS) to examine the associations between older
adults' physical health problems, depressive mood, and diurnal cortisol secretion. They used
common, simple, well-known self-reported measures of the variables involved. Results showed that
depressive mood completely mediated the HECS buffer effects on the association between physical
health problems and cortisol secretion. Findings were more significant among women and younger
individuals.
Wrosch et al (2007) offer a sound work evidencing that psychological mechanisms and interventions
affect biological health parameters, and they conclude that the results of this and related studies
contribute to show that effective psychological management of physical stressors can prevent the
negative effects on psychological, biological and physical health of individuals as they age. The next
step could be the implementation and evaluation of this strategy in a community health centre.
However, although the authors controlled for neuroticism, they consistently failed to mention and
then consider how the predominant personality traits of the participants, namely conscienciousness
and extraversion, could be relevant confounds accountable for at least part of the results found.
Further research, preferably a large-scale longitudinal study, should take into account this issue and
consider others like sample matching (no reference is made to ethnicity, of much relevance in
countries like Canada and New Zealand), possible confounds like concurrent use of medication, sleep
pattern, and Hawthorne and placebo effects. Further research in the form of meta-analyses for
external validity evaluation, like generalization across age-groups of stress management
intervention effects, could compare this study with those by Urizar and Muñoz (2011) and White-
Traut et al (2009).
V.M. Westerberg – 10143519 Page 2 of 12
Dettling, A.C., Parker, S.W., Lane, S., Sebanc, A., & Gunnar, M.R. (2000, November). Quality of
care and temperament determine changes in cortisol concentrations over the day for
young children in childcare. Psychoneuroendocrinology, 25 (8), 819-836.
doi:10.1016/S0306-4530(00)00028-7
The current study was carried out by a young group of American and Swiss Psychology graduates
who put their grants together to fund this work, a work which, up to date, has been cited in 88
studies, but not always as a study reference.
The authors investigated whether patterns of cortisol secretion in a small sample of 21 high
socioeconomic class preschool children in group vs home care were influenced by quality of
attention and stimulation from the childcare provider, and if temperament (negative affectivity and
low effortful control) and separation from parents influenced this relationship. To measure their
constructs, they shortened well-known psychometric tests, but their complicated statistical analysis
makes it difficult to replicate this test.
Their results align with those of previous studies, that is, that young children are sensitive to social
context and that this is mediated by temperament. However, the internal validity of this study should
be questioned on the basis that they used a non-randomized, non-matched convenience sample (any
lower socioeconomic class, ethnic minority, or single-parent children?), they manipulated
questionnaires, the tests and samples were taken by parents, compliance could not be guaranteed,
the samples were mailed days after collection and researchers replaced missing samples with the
media of the existing samples.
Significantly, and most certainly for ethical reasons, childcare providers were assessed for
competence but parents were not, making it difficult to predict whether the lack of stress, measured
as the expected circadian pattern of cortisol levels, shown by children in quality childcare actually
reflects separation relief instead of care benefits. The results of this study correlate with those of
Urizar and Muñoz (2011), White-Traut et al (2009), and Pawlow and Jones (2002) in that an
enhanced environment and quality of care have measurable biological outcomes influencing overall
health.
Further research should consider increasing the power of the study with a larger, representative
sample, an improved internal validity as detailed above, an improved external validity with
generalization across participants (socioeconomic class, age, culture) and across operational
definitions (results show that an enhanced environment decrease stress, but not how a deprived one
influences it), and an ethical but realistic approach to the effect of family context in children’s
biological, psychological and social health.
V.M. Westerberg – 10143519 Page 3 of 12
Urizar, G.G, & Muñoz, R.F. (2011). Impact of a prenatal cognitive-behavioral stress
management intervention on salivary cortisol levels in low-income mothers and their
infants. Psychoneuroendocrinology (in press, corrected proof).
doi:10.1016/j.psyneuen.2011.04.002
Urizar and Muñoz are two California-based Hispanic Clinical Psychology professors and researchers
who funded this study with grants from their own PhD grants and others coming from national and
private sources. Their field of interest is a cross-cultural biopsychosocial perspective of materno-
filial conditions associated with stress and their psychosocial management.
This comprehensive, well-structured article describes their innovative research of pregnant, low
socioeconomic status, Hispanic women who volunteered to be taught cognitive-behavioural stress
management (CBSM) techniques at least 12 weeks pre-partum. Although their results showed that
the intervention was effective in reducing cortisol and self-reported stress levels among mothers and
children for up to 18 months post-partum, parenting responsibilities and socioeconomic problems
nullified the effects of the therapy after that time. It was also noted that the effects were larger and
more long-lasting in younger, more inexperienced mothers.
This pilot study has a few limitations which should be addressed in further research like how
previous history of depression may be predictive of poorer CBSM outcomes, how to improve internal
validity even further by avoiding threats like drop-outs (18% in this study) and non-compliance,
how to improve external validity evaluating generalisation across age-groups, socioeconomic classes
and cultures. For that purpose, findings in this study could be related to those of White-Traut et al
(2009), Dettling et al (2000) and Pawlow and Jones (2002) in that behavioural modification have
measurable biological consequences, some of which irreversible.
It would be interesting to conduct further longitudinal research of participants, should this
intervention be adopted in a community health centre. It should not be very difficult in terms of
human and material requirements as the intervention could be run in pre-existing midwife offices or
in the maternity department of a hospital or clinic by doctoral fellows or advanced doctoral students
who could do it at no charge provided they were allowed to use the results for their study.
CBSM is an easy, inexpensive, effective, contraindications-free therapy, and therefore, probably
doomed, as interventions that provide benefits (health improvement) to deprived, underserved
populations, but no benefits (revenue) to institutions are difficult to implement, especially in the
context of a hard-core neoliberal country like the USA, where social policies leave a lot to be desired.
V.M. Westerberg – 10143519 Page 4 of 12
Heaney, J. L., Ginty, A.T., Carroll, D., & Phillips, A.C. (2011, February). Preliminary evidence
that exercise dependence is associated with blunted cardiac and cortisol reactions to
acute psychological stress. International Journal of Psychophysiology, 79 (2), 323-32.
doi:10.1016/j.ijpsycho.2010.11.010
This study was conducted by two influential British scholars, Douglas Carroll and Anna Phillips, and
their respective female doctoral students. It took place on the premises of the School of Sport and
Exercise Sciences of the University of Birmingham and was funded by the Department of Education.
Heaney et al (2011) approached addiction and its consequences from a dubious psychophysiological
perspective, theorising and concluding that just like smoking and tobacco, exercise dependence
causes blunted cardiovascular (CV) and cortisol reactions to acute psychological stress, the result of
which is far from benign according to the authors, leading to motivational dysregulation.
This study exemplifies bias. First, although many researchers use convenience samples, like
undergraduate students, this one was comprised of exclusively Caucasian undergraduate women,
with only one exception (an Indian woman). The reason given is that “exercise dependence is
reasonably well characterized in women and is rarer in men” (Heaney et al, 2011), citing a former
University of Birmingham PhD student as a reference. Second, they based their research mainly on a
made-to-order, non-revised scale they called Exercise Attitudes and Beliefs Questionnaire (EABQ)
and on the Exercise Dependence Questionnaire (EDQ).
The EABQ scale cannot even be critiqued because no mention is made or link is offered to the
development of the test, like how did they design factor analysis, how did they determine face and
underlying dimensions of data, how did they manage data clustering sorting, and more importantly,
where are the validity and reliability analyses?. The EDQ scale is a more widely used test with just
enough construct validity flaws to render it useless in this context, as items assess mainly attitudes
and social aspects of exercise instead of dependence (Hausenblas & Symons-Downs, 2002), there is
no set cut-off point, it measures far more secondary than primary exercise dependence, it does not
disqualify participants with eating disorders (bulimia and anorexia), it fails to measure tolerance and
lack of control, and, despite its name, the EDQ has only been validated against the EAT (Eating
Attitudes Test) and POMS (Profile of Mood States) (Ogden, Veale, & Summers, 1997) .
Finally, this article raises issues worth exploring: Why was a design, observer, measurement,
sampling, and procedurally biased study allowed to be run and published? How do studies like these
contribute to health promotion? Note for the Quality Control Departments of the University of
Birmingham and the International Journal of Psychophysiology (peer reviewers): anybody home?
V.M. Westerberg – 10143519 Page 5 of 12
Laura A. Pawlow, Gary E. Jones. The impact of abbreviated progressive muscle relaxation on
salivary cortisol Biological Psychology, Volume 60, Issue 1, July 2002, Pages 1-16
doi:10.1016/S0301-0511(02)00010-8
The current study was carried out by a PhD student and her supervisor of the University of Southern
Mississippi. The source of funding was not mentioned and could not be found.
In this study, Pawlow and Jones (2002) matched and randomised sample participants on the
variables of age and sex, but no reference was made to ethnicity, nationality, or socioeconomic class.
Likewise, they did not control for participants’ conditions that could potentially influence the two
biological variables used to show stress management, that is heart rate and finger pulse volume, like
previous habits (smoking, exercising), diet or personality types.
They claim that given that results evidenced significant behavioural manipulation of the
hypothalamus-pituitary axis (HPA), the doors to further research on immune-enhancement, as a
consequence of the endocrinological change are opened. However, knowing that maintained high
levels of cortisol have detrimental effects on the immune system does not mean that the opposite
situation, that is, that lower levels of cortisol would enhance immune function, and this warrants
further research in this line.
Additionally, further research may include meta-analyses. The present study could be compared
with related ones, like that by Healey et al (2011) on exercise and stress, to show if or how the
degree of muscular activity relates to cortisol levels and health outcomes. However, only Pawlow and
Jones (2002) produced a sound, well-structured, relevant psychobiological research with particular
emphasis on avoiding the internal validity problems noted in the related literature, which is
particularly remarkable in Heaney et al (2011), but which did not keep it from being published in the
prestigious International Journal of Psychophysiology.
The authors concluded that “the implications for possible uses of relaxation as an inexpensive,
effective means of improving people’s health are enormous” (Pawlow & Jones, 2002). However, they
face the same barriers as fellow American researchers Urizar and Muñoz (2011) in that the United
States’ social policy is not a world reference. It is quite discouraging that the translation of effective
studies like these into sustainable clinical and patient-service improvements, if it ever happens, may
take up to 20 years according to the U.S. Department of Health and Human Services (2011). This
remains a substantial obstacle to the improvement of healthcare, which is necessary for the
elimination of health disparities that disproportionately affect population minorities. Maybe if
research institutions, like universities, took the initiative and, for example, established academic-
based health centres, a small but firm forward step would be taken in the direction of health
promotion.
V.M. Westerberg – 10143519 Page 6 of 12
White-Traut, R.C., Schwertz, D., McFarlin, B., & Kogan, J. (2009, January). Salivary Cortisol and
Behavioral State Responses of Healthy Newborn Infants to Tactile-Only and
Multisensory Interventions. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38 (1),
22–34 DOI: 10.1111/j.1552-6909.2008.00307.x
The current study is the result of a multi-disciplinary collaboration of four professors and research
specialists of the Illinois College of Nursing based on previous animal and human sensory
intervention studies to prevent stress and its implications on health outcomes. Here, the authors
wanted to test if there is any difference between a tactile-only and multisensory approach to
newborn stress control and how the difference, if any, would translate into cortisol levels.
Results showed that any degree of tactile stimulation is distressing for newborn children as shown
by an increase in cortisol levels, whereas the application of a multisensory auditory, tactile, visual
and vestibular (ATVV) intervention resulted in a significant but short-lived decrease in cortisol
levels. Salivary cortisol is considered an acceptable measure of human stress reactivity across ages;
however, additional measures, apart from crying, that reliably quantify infant stress reactivity are
needed.
The article presentation and analysis are reader friendly, directed towards an academic audience
interested in psychobiology, that is, how psychology influences biology as opposed to biopsychology
or how biology affects psychology. The study was well-designed and efforts were done towards a
good level of internal validity, like sample matching and randomization, control for modifiers
(maternal, gestational and infant age, sex, race), extraneous variables (epidural anaesthesia, delivery
mode, medication, maternal and infant health status, separation anxiety, feeding mode and time).
Reliability was shown demonstrating an inter-rater agreement greater than 88%.
Limitations of this study were small saliva sample volumes and loses (contamination), lack of
optimization of saliva collection times in an age-group where the HPA is undergoing development,
lack of research and understanding of the underlying mechanisms of the complex relationship
between the biological parameter (cortisol levels) and the result (organ-system reaction) of stress in
infants (how do hippocampal glucocorticoid cell receptors vary? [in number?, in reactiviry?] ), how is
gene expression altered by behaviour or environmental characteristics?).
Further research with a larger sample addressing the above limitations would be needed to replicate
these findings and to further evaluate the relationship between behavioural state and cortisol level.
Additionally, research is warranted to document whether the ATVV intervention reduces cortisol
levels, how long lasting ATVV effects are, how long-term administration might influence cortisol
levels, and whether the interventions are beneficial for other populations.
V.M. Westerberg – 10143519 Page 7 of 12
Hammerfald, K., Eberle, C., Grau, M., Kinsperger, A., Zimmermann, A., Ehlert, U., & Gaab, J.
(2006, April). Persistent effects of cognitive-behavioral stress management on cortisol
responses to acute stress in healthy subjects — A randomized controlled trial.
Psychoneuroendocrinology, 31 (3), 333-339. doi:10.1016/j.psyneuen.2005.08.007
The study was conducted by a research group of German and Swiss scholars as the continuation of a
series of previous assays of this group on the topic of psychosocial stress management. This time
they aimed to examine the long-term effects and generalisability of cognitive-behavioural stress
management (CBSM) training on cortisol stress responses in healthy undergraduate men and
women who had previously taken a stress-inducing test, the Trier Social Stress Test (TSST).
Findings in this detailed study showed that the previously reported attenuation of cortisol stress
responses through CBSM persisted for at least 4 months after the intervention and did so similarly in
both genders. No prior literature could be found demonstrating persistence of endocrine effects of
CBSM, therefore, results would be ground-breaking if further research replicates results considering
limitations and further increasing the power of the study (larger sample, tighter control of
extraneous variables, further controlling error variance, increase treatment effect).
Unfortunately, similarities can be found with Heaney et al’s cortisol reactions to exercise dependence
work (2009) in that both research groups developed their own psychometric scales and that neither
rejected women on oral contraceptives, which interfere with cortisol levels. There are significant
differences, though, between the two: First, Hammerfald et al’s test (2006) is used to ethically induce
stress and not to prove their results. Second, unlike Heaney et al (2009), Hammerfald et al (2006)
specifically mention these issues and warrant further research to address these and other
limitations.
The authors suggested that given that stress-induced alterations of the functionality of the HPA axis
are known to be involved in the onset and maintenance of both somatic and psychological
conditions, CBSM or similar interventions could be used for prevention and treatment of detrimental
stress effects. But then again, the translation of reliably-replicated effective studies like this one into
a clinical or social context may take many years. The question is: who should be responsible for the
implementation of such research?
V.M. Westerberg – 10143519 Page 8 of 12
Reeve, J (Reeve, Johnmarshall); Tseng, CM (Tseng, Ching-Mei). (2011, March) Cortisol
reactivity to a teacher's motivating style: the biology of being controlled versus supporting
autonomy. MOTIVATION AND EMOTION Volume: 35 Issue: 1 Pages: 63-74 DOI:
10.1007/s11031-011-9204-2
The present study was funded by the Korean Department of Education and carried out by a Seoul-
based American scholar and researcher and a Korean Iowa University PhD student in the University
of Iowa premises. The authors built up on the extensive prior work of Dr Reeve on psychosocial
motivators, but this time the aim was to link motivational styles (controlling, supportive, neutral)
with salivary cortisol levels and positive functioning using the Controlling Teacher Scale (CTS), the
Learning Climate Questionnaire (LCQ), SOMA cubes (“soma” is not an acronym), the Perceived Self-
Determination scale (PSD), and the Active Feelings States (AFS). The two latter measures were
developed by Prof Reeve 10 and 15 years ago respectively and have been widely used since then.
The authors hypothesised and further found a significant relationship between interpersonal event
response and cortisol reactivity. Using repeated-measures mixed ANCOVA analyses, they concluded
that now that they have confirmed their hypothesis, the study should be replicated by another study
group. Actually, one study could hardly be said to confirm any results. Even after multiple power-
enhanced replications and/or a longitudinal study, researchers would still phrase their conclusions
in a more cautious fashion, especially when the study limitations have not been mentioned. This
raises a few questions about the reliability of the study: How reliable and independent are Korean-
funded researches? Would the Korean authorities have been satisfied if non-conclusive results had
been found, getting no return for investment? How eager (and pressed) were the researchers to
prove their hypothesis?
Indeed, further research is required to see if findings can be replicated in another context, with a
larger sample and with male and female teachers, to see what the long-term consequences of both
controlling and motivational teaching are (longitudinal studies) in terms of academic and even
personal and professional achievements, and to see what the long-term health outcomes of children
in either group are.
Motivational teaching has become the golden standard in Western countries as evidence-based
research and common sense indicate that outcomes are far better for the biopsychosocial health of
children. However, in developing countries and in those with dictatorial regimes, where controlling
styles can be theorized to prevail, the results of this research could have an impact on policy makers,
who would not see it as a Western imposition but as their own initiative to move on to a, literally,
more relaxed teaching style.
V.M. Westerberg – 10143519 Page 9 of 12
Jennifer B. Dowd, Nalini Ranjit, D. Phuong Do, Elizabeth A. Young, James S. House and George
A. Kaplan. Education and Levels of Salivary Cortisol Over the Day in US Adults. Annals of
Behavioral Medicine 41 (1), 13-20. DOI: 10.1007/s12160-010-9224-2
This cross-sectional study was carried out in the city of Chicago (IL) by experts in Public Health,
Demographics, Psychiatry, Sociology and Epidemiology. It was funded by two grants from the
National Institute of Child Health and Human Development. The aim was to elucidate the biological
mechanisms linking socioeconomic status (SES) (measured as low [<12yrs] education), and cortisol
levels in view of the inconsistent and even contradictory previous research. This is the first study to
take into account the pulsatile circadian secretion of cortisol, which requires multiple measures over
several days and specific data analysis. They used multi-level modelling and non-parametric spline
technique for that purpose, and constitute major strengths of this work.
With regard to the measure of SES, the authors, quite rightly, considered that low education
determines lower grade employment and that it is the best available parameter of lifelong SES, better
than income.
Researchers stated that the discrepancies in the literature on the relationship between SES and
cortisol stem from inconsistencies in participants’ compliance, sample collection, data analysis, intra-
individual cortisol secretion patterns and beliefs relating SES, chronic illness and cortisol secretion.
With the risk of the above inconsistencies in mind among others, most of the previous research had
theorised and shown that given that cortisol is “the stress hormone”, longstanding hardship
associated with a low SES would evidence higher morning, evening and baseline levels. Additionally,
it was believed that only higher-than-normal cortisol levels led to poor health outcomes.
The current study aligns with, and confirms, the results obtained by Brandtstadter et al in Germany
in 1991, which are that excessive chronic exposure to cortisol (as biological marker) or to stress (as
a sociopsychological marker) leads to tolerance and to a permanently blunted response by the
secreting organ-system, the HPA axis. Additionally, the authors evidenced that both high and low
cortisol levels are damaging to health, something that had been suggested in just one previous study,
that by Brandtstadter et al (1991).
Further longitudinal research in this line is warranted to better outline how much/little cortisol and
how long an exposure to it are required to cause HPA axis blunting and to characterize stress-related
health conditions prior and after that point. Moreover, further clarification of the biopsychosocial
markers and mechanisms linking SES and health outcomes is required to build up knowledge that
could potentially turn into the development and implementation of sustainable health promotion
strategies.
V.M. Westerberg – 10143519 Page 10 of 12
Jessica Tartaro, Linda J. Luecken, Heather E. Gunn. Exploring Heart and Soul: Effects of
Religiosity/Spirituality and Gender on Blood Pressure and Cortisol Stress Responses . doi:
10.1177/1359105305057311 J Health Psychol December 2005 vol. 10 no. 6 753-766
This study was carried out by three Arizona University Health Psychology researchers based on
previous literature linking positive psychobiological health outcomes with religiousness/spirituality
(RS). Their novel contribution is that for the first time, a biological marker of stress (cortisol) was
obtained to demonstrate those benefits.
Previous work linked the effects of RS to cardiovascular and immune system function enhancement
which was suggested to explain reduced overall mortality of individuals involved in RS practices
regardless of degree of public or private commitment and of depth of belief. Benefits were found to
be independent of socioeconomic position, culture, ethnicity, age and sex. The present study
substantiates those results and suggests additional mechanisms by which RS may contribute to
health improvement, like the enhancement of social and coping resources, and the promotion of
healthy behaviours like forgiveness and of positive emotions like hope. A further positive emotion to
be considered would be meaning in life.
The RS construct was measured using the Brief Multidimensional Measurement of Religiousness /
Spirituality (BMMRS). Two possible flaws of this tool, and therefore of the study are: First, that the
BMMRS may not be culturally sensitive, based on the non-significant results observed for meditation
on cortisol levels. The current sample characteristics are those of the typical Western society: Mostly
Christian Caucasians. Meditation, instead, is characteristic of Eastern societies where Buddhism and
Hinduism predominate. Second, the way items exploring meditation are phrased in the BMMRS, like:
“Within your RS traditions, how often do you meditate?” . Christianism, Judaism and Islam
recommend evaluating one’s conduct to ensure better eternal-life outcomes, whereas Buddhism and
Hinduism prescribe meditation to attain enlightening to ensure better re-incarnation outcomes (La
Fave, 2004).
It is doubtful that further research with either a revised culturally sensitive version of the BMMS or
with another questionnaire would make a difference in the mediation-cortisol levels relationship
results of this study because respondents’ characteristics would be the similar in the same context.
However, it would be enlightening to conduct a similar research with an adapted questionnaire in a
traditionally Budhist or Hinduist country to see how the subset of meditation influences the
relationship RS - health outcomes. This work is another step forward towards the demonstration
that psychology, that is, thoughts, behaviours and beliefs, influences biology at least as much as
biology influences psychology. The relationship is a two-way road. Destination: Healthy State.
V.M. Westerberg – 10143519 Page 11 of 12
Lam, S., Dickerson, S.S., Zoccola, P.M., Zaldivar, F. (2009, October). Emotion regulation and
cortisol reactivity to a social-evaluative speech task. Psychoneurendocrinology, 34 (9), 1355-
1362. doi:10.1016/j.psyneuen.2009.04.006
This multicultural group of California-based scholars dedicated to psychosocial research, aimed to
cover a gap in literature regarding trait forms of emotion regulation and cortisol responses in a
realistic social context. Lam et al (2009) suggest that it is possible to predict cortisol reactivity to an
acute stressor and that this can be moderated by emotion regulation strategies, like suppression and
reappraisal (SA).
Previous laboratory studies had found a relationship between emotion regulation strategies such as
repressive coping, emotional intelligence, suppression, reappraisal and cardiovascular reactivity, but
a biological marker, like cortisol, had never been used to quantify or predict cortisol reactivity to
stress. Additionally, previous studies had shown no mundane realism as they had all used non-social
emotion induction techniques (watching videos, pictures, cards). Here, the authors employed a
social-evaluative speech task in the form of a modified version of the Trier Social Stress Test (TSST),
and suppression and reappraisal were assessed with the Emotion Regulation Questionnaire (ERQ).
The study showed that suppression and reappraisal, both independently and combined, predicted
exaggerated cortisol responses to the speech task. Significance of results is enhanced by the fact that
Lam et al (2009) controlled for the effects of trait and state anxiety, health conditions, medication,
diet, exercise, and demographic variables. With regard to demographics, this study is relevant for the
New Zealand Maori population in that the majority of participants (>52%) were Asia-Pacific
islanders.
Limitations of the current study are those of the participants’ characteristics, which raise questions
about generalisation: Can results be generalised across age-groups (undergraduate-other), across
ethnicities (Asia-Pacific-other), across socioeconomic positions (high-low) and across personality
types?
Possible questions that future research could address are: Does negative emotion regulation of
stressful situations through suppression and appraisal require effortful processing, enhanced
attention and/or self control? Can negative emotion regulation be generalised to the management of
other stressors different from social interaction? Do suppression and re-appraisal enhance social
interaction, and if so, what effect does it have on behaviour, bodily processes and health outcomes?
What are the consequences of persistent negative emotion regulation on social, psychological and
physical outcomes?
V.M. Westerberg – 10143519 Page 12 of 12
Callahan, TL., Caughey, A.B., Heffner, L.J. (2004). Blueprints Obstetrics & Gynecology (3rd Ed.). Malden
,MA: Blackwell Publishing.
Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen,
Campus Ring 1, 28759 Bremen, Germany
Psychology, Department of Clinical and Physiological Psychology, University of Trier, Johanniterufer
15, 54290 Trier, Germany
c Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, J5, 68159
Mannheim, Germany
REFERENCES
Brandtstadter J, Baltes-Gotz B, Kirschbaurn C, Helihammer D. Developmental and personality
correlates of adrenocortical activity as indexed by salivary cortisol: Observations in the age range
of35 to 65 years. Journal of Psychosomatic Research 1991;35:173—85.
La Fave, S. (2004). Comparing Eastern and Western Religions. West Valley College: Author.
Ogden, J., Veale, D., & Summers, Z. (1997). The development and validation of the exercise
dependence questionnaire. Addiction Research, 5(4), 343-356.
Hausenblas, H., & Symons-Downs, D. (2002). Exercise dependence: a systematic review. Psychology
of Sport and Exercise 3(2), 89-123.
U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality (2011)
http://www.ahrq.gov/
APPENDICES