Westerberg, VM

Westerberg, VMPage 2 of 81

TABLE OF CONTENTS

1.- ANNOTATED READINGS

1.1.- ANNOTATION I

1.2.- ANNOTATION II

1.3.- ANNOTATION III

1.4.- ANNOTATION IV

1.5.- ANNOTATION V

1.6.- ANNOTATION VI

1.7.- ANNOTATION VII

1.8.- ANNOTATION VIII

1.9.- ANNOTATION IX

1.10.- ANNOTATION X

1.11.- ANNOTATION XI

2.- REFERENCES

3.- APPENDICES

3.1.- APPENDIX 1: ANNOTATION I JOURNAL ARTICLE

3.2.- APPENDIX 2: ANNOTATION II JOURNAL ARTICLE

3.3.- APPENDIX 3: ANNOTATION III JOURNAL ARTICLE

3.4.- APPENDIX 4: ANNOTATION IV JOURNAL ARTICLE

3.5.- APPENDIX 5: ANNOTATION V JOURNAL ARTICLE

3.6.- APPENDIX 6: ANNOTATION VI JOURNAL ARTICLE

3.7.- APPENDIX 7: ANNOTATION VII JOURNAL ARTICLE

3.8.- APPENDIX 8: ANNOTATION VIII JOURNAL ARTICLE

3.9.- APPENDIX 9: ANNOTATION IX JOURNAL ARTICLE

3.10.- APPENDIX 10: ANNOTATION X JOURNAL ARTICLE

3.11.- APPENDIX 11 : ANNOTATION XI JOURNAL ARTICLE

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Westerberg, VMPage 3 of 81

1.- ANNOTATED READINGS

1.1.- ANNOTATION I

Dettling, A.C., Parker, S.W., Lane, S., Sebanc, A., & Gunnar, M.R. (2000). 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 their research, 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 versus 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, 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.

Westerberg, VMPage 4 of 81

1.2.- ANNOTATION II

Dowd, J.B., Ranjit, N., Phuong Do, D., Young, E.A., House, J.S, & Kaplan, G.A. (2011). 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.

Westerberg, VMPage 5 of 81

1.3.- ANNOTATION III

Hammerfald, K., Eberle, C., Grau, M., Kinsperger, A., Zimmermann, A., Ehlert, U., & Gaab, J.

(2006). 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).

The authors are among the pioneers who acknowledge that both persistently high and persistently

low levels of cortisol have health outcomes implications. All previous studies had only focused on the

impact of high cortisol effects on health. This research shows that it is the disturbance of

homeostasis that is accountable for disease, no matter in which direction the alteration goes, up or

down, provided that it is maintained for a long period of time. Further research should be directed

towards determining “how long is too long” an exposure to cortisol imbalance and if high and low

levels have different health implications.

The findings of Hammerfald et al (2006) align with those of Wrosch et al (2007) in that both

research groups found cortisol to be the main mediator of allostatic load (burden of persistent high

levels of cortisol) which leads to increased mortality and decreased cognitive and physical

functioning in the elderly. Further research with functional MRI should address which cerebral areas

are more sensitive to the wear-and-tear effects of cortisol and factor which determine its

progression.

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?

Westerberg, VMPage 6 of 81

1.4.- ANNOTATION IV

Heaney, J. L., Ginty, A.T., Carroll, D., & Phillips, A.C. (2011). 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 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?

Westerberg, VMPage 7 of 81

1.5.- ANNOTATION V

Lam, S., Dickerson, S.S., Zoccola, P.M., & Zaldivar, F. (2009). 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?

Westerberg, VMPage 8 of 81

1.6.- ANNOTATION VI

Pawlow, L.A., & Jones., G.E. (2002). The impact of abbreviated progressive muscle relaxation

on salivary cortisol   Biological Psychology, 60 (1), 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.

Westerberg, VMPage 9 of 81

1.7.- ANNOTATION VII

Reeve, J., & Tseng, C.M.. (2011). Cortisol reactivity to a teacher's motivating style: the biology

of being controlled versus supporting autonomy. Motivation and Emotion, 35 (1), 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.

Westerberg, VMPage 10 of 81

1.8.- ANNOTATION VIII

Tartaro, J., Luecken, L.J., & Gunn, H.E. (2005). Exploring heart and soul: Effects of

religiosity/spirituality and gender on blood pressure and cortisol stress responses.

Journal of Health Psychology, 10 (6), 753-766doi: 10.1177/1359105305057311

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 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: Healthier State.

Westerberg, VMPage 11 of 81

1.9.- ANNOTATION IX

Urizar, G.G., & Muñoz, R.F. (in press). Impact of a prenatal cognitive-behavioral stress

management intervention on salivary cortisol levels in low-income mothers and their

infants. Psychoneuroendocrinology. 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.

Westerberg, VMPage 12 of 81

1.10.- ANNOTATION X

White-Traut, R.C., Schwertz, D., McFarlin, B., & Kogan, J. (2009). 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 reactivity?] ), how is

gene expression altered by behaviour or by 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.

Westerberg, VMPage 13 of 81

1.11.- ANNOTATION XI

Wrosch, C., Schulz, R., Miller, G.E., Lupien, S., & Dunne, E. (2007). 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).

2.- REFERENCES

Westerberg, VMPage 14 of 81

Brandtstadter J., Baltes-Gotz B., Kirschbaurn C., Helihammer D. (1991). 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, 35, 173-185.

Dettling, A.C., Parker, S.W., Lane, S., Sebanc, A., & Gunnar, M.R. (2000). 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

Dowd, J.B., Ranjit, N., Phuong Do, D., Young, E.A., House, J.S, & Kaplan, G.A. (2011). 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

Hammerfald, K., Eberle, C., Grau, M., Kinsperger, A., Zimmermann, A., Ehlert, U., & Gaab, J. (2006).

Persistent effects of cognitive-behavioral stress management on cortisol responses to acute

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3.- APPENDICES (add actual journal articles with continuing page numbers)