Healthy or not? The impact of conflicting health-related information on attentional resources.

Despite its ubiquity, little is known about the impact of exposure to conflicting health information on cognitive efficiency. We hypothesized that it would reduce attentional capacity, as evidenced by (1) increased response errors during the Attention Network Test (ANT), (2) decreased efficiency of each ANT system (alerting, orienting, execute control), and (3) increased self-reported workload, (4) nutritional confusion and (5) nutritional backlash. A sample of 184 online participants were assigned randomly to read an article containing either congruent or conflicting health information. Subsequently, they completed the ANT and self-report measures of workload, nutritional confusion, and backlash at nutritional recommendations and research. Participants in the conflicting health information condition made more errors, had overall slower reaction times, and reported greater workload, nutritional confusion, and backlash. No differences were found for individual ANT systems. These findings suggest that exposure to conflicting health information can degrade attentional mechanisms responsible for accurate and prompt responding to incoming information.

Biological causal beliefs and depression stigma: the moderating effects of first- and second-hand experience with depression.

BACKGROUND: Essentialist theory (ET) links biological attributions for mental illnesses to pessimistic prognostic beliefs and stigma. The commonsense model (CSM) provides a nuanced framework for studying illness beliefs as shaped by experience. AIMS: ET-informed hypotheses linking causal and prognostic beliefs and stigmatizing attitudes concerning depression were tested using CSM constructs with a focus on the moderating effects of self-reported experience with this disorder. METHODS: U.S. adults (N = 319) completed online questionnaires assessing depression-related beliefs, attitudes and experience. Multiple regression analysis focused on predictive effects of neurobiological and genetic attributions. Potential mediators (prognosis) and moderators (experience) of the biological attribution-stigma link also were tested. RESULTS: Neurobiological attributions predicted viewing depression as more consequential, longer lasting, and unexpectedly, more treatable. Neurobiological attributions were inversely related to stigma, a link partially mediated by beliefs about depression's consequences and duration. However, both biological attributions' relationships to stigma were moderated by experience. Stronger biological attributions predicted less stigma specifically among participants reporting first- or second-hand experience with depression. CONCLUSION: Experience with depression may shape the relationships of specific causal and prognostic beliefs with depression stigma. Psychoeducation in clinical and public health contexts may be informed by further research using CSM constructs.

Psychosocial predictors of virus and social distancing fears in undergraduate students living in a US COVID-19 "hotspot".

The COVID-19 pandemic is positioned to exact a substantial mental health toll on the global population. Heightened fears of viral contamination and fears of the negative consequences of social distancing (e.g., fears related to home confinement, fears of loneliness and isolation) might contribute to the distress caused by the pandemic. Cross-sectional data were collected from undergraduates (N = 608) residing in a U.S. pandemic "hotspot" at the time of data collection (between 7 April to 9 May, 2020). Outcome variables included viral contamination fears and social distancing fears. Predictor variables included biological sex, underlying medical vulnerability, number of recent viral symptoms, presence of positive COVID-19 test in social network, anxiety, depression, stress, emotion dysregulation, intolerance of uncertainty, body vigilance, and health anxiety. Female sex, anxiety severity, intolerance of uncertainty, and health anxiety uniquely predicted fears of viral contamination. Female sex and depression severity uniquely predicted fears of social distancing. Multiple anxiety-related vulnerabilities are potential intervention targets for reducing viral contamination fears. Depression is a potential intervention target for social distancing fears. Females might be at greater risk for both types of fears.

Dispositional Optimism and Cardiovascular Reactivity Accompanying Anger and Sadness in Young Adults.

BACKGROUND: Dispositional optimism, a generalized expectation for positive outcomes, appears to promote physical health and well-being, including positive effects on cardiovascular disease outcomes. Mechanisms may involve adaptive responses to psychological stressors that dampen their physiological impact. PURPOSE: This study investigated (i) whether individual differences in optimism are associated with attenuated cardiovascular reactivity (CVR); (ii) whether the CVR moderating effect of optimism differs for two stress emotions, anger and sadness; and (iii) whether separate measures of optimism and pessimism, and the more commonly used measure that combines them, differ in their relationships with CVR. METHODS: The Life Orientation Test-Revised (LOT-R) was used to provide an overall dispositional optimism score and subscale scores separately assessing optimism and pessimism. These predictors were examined in relation to cardiovascular responses evoked by a stressful autobiographical recall task. Task instructions were manipulated within subjects to produce anger and sadness. CVR measures were systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR). RESULTS: Dispositional optimism was inversely associated with SBP and HR (but not DBP) elevations while participants related both anger- and sadness-inducing events. There was some indication that these associations were stronger for sadness than for anger, and that the LOT-R optimism subscale was a better predictor of CVR than its pessimism subscale. CONCLUSIONS: These findings add to the understanding of health-promoting effects of dispositional optimism by addressing relationships of optimism and pessimism with cardiovascular concomitants of anger and sadness that are thought to contribute to heart disease.

Self-rated health is associated with the length of stay at the intensive care unit and hospital following cardiac surgery.

BACKGROUND: Recently, a considerable amount of evidence suggested that anxiety, depression and other psychosocial variables might influence the outcomes of cardiac surgery. This study investigated the relationship between length of stay at the intensive care unit (ICU) and hospital after surgery and different psychosocial variables (e.g. depression, anxiety, self rated health, happiness, satisfaction). METHODS: We enrolled prospective patients who were waiting for elective cardiac surgery (N = 267) and consented to take part in the study. We collected data of sociodemographic, medical and perioperative factors as well as psychosocial questionnaires completed 1.56 days (standard deviation [SD] = 0.7) before surgery. The primary clinical endpoint was an ICU stay of at least 3 days and the secondary was hospital stay of at least 10 days. RESULTS: Two hundred sixty-seven patients participated in this study. Four patients (1.5%) died in the hospital and 38 patients (14.5%) spent more than 3 days in the ICU and 62 patients (23.2%) spent more than 10 days in the hospital. After controlling for medical and sociodemographic factors, lower self rated health (Adjusted Odds Ratio [AOR]: 0.51, 95% confidence interval [CI]: 0.28-0.95; p = 0.03), lower rate of happiness (AOR: 0.76, 95% CI: 0.59-0.97, p = 0.03), postoperative cardiac failure (AOR: 7.09, 95% CI:1.21-41.54; p = 0.03) and postoperative complications (AOR: 9.52, 95% CI: 3.76-24.11; p < 0.001) were associated with longer ICU stay. More than 10 days of hospital stay was associated with higher occurrence of COPD (AOR 4.56, CI: 1.95-10.67, p < 0.001), NYHA stage (AOR 6.76, CI: 2.57-17.79, p < 0.001), operation time (AOR 1.45, CI: 1.19-1.76, p < 0.001), female gender (AOR 2.16, CI: 1.06-4.40, p = 0.034) and lower self-rated health (AOR 0.63, CI: 0.41-0.99, p = 0.044). CONCLUSIONS: Lower happiness and self-rated health may influence the outcome of cardiac surgery. Therefore, these variables should be assessed in patients.

College students' perceptions of concussion: Illness beliefs and masculinity norms predict stigma and willingness to seek treatment.

College students' beliefs and attitudes concerning concussion, and masculinity norms, were examined in relation to stigma and willingness to seek treatment for possible concussion. Beliefs were measured using a revised Illness Perception Questionnaire (IPQ). Participants: Participants were 631 undergraduates at a Northeastern university, most of whom were nonathletes with no concussion. Methods: Data were collected online. Regression analysis were performed to identify predictors of stigma and treatment willingness. Results: Beliefs that concussion symptoms reflect malingering, are controllable, and have psychological causes were related to more stigmatizing attitudes, as was endorsement of masculinity norms regarding winning and risk-taking. Believing that concussion symptoms are long-lasting and endorsing competitiveness, pain discounting, and self-reliance predicted willingness to seek treatment. Preliminary structural models showed adequate fit. Conclusions: In addition to beliefs assessed by the IPQ, traditional conceptions of masculinity warrant greater attention in the study of concussion-related stigma and willingness to seek treatment.

Associations between the late positive potential and PTSD, anxiety, and depressive symptoms among trauma-exposed undergraduates.

BACKGROUND: The late positive potential (LPP) is a neural marker of attention to emotional stimuli; dysregulations in those attentional processes might contribute to trauma-related psychopathology. Although higher LPP amplitudes to negative images have been found to be associated with anxiety symptoms, results have been mixed regarding depressive and PTSD symptoms, especially among trauma-exposed populations. Further, the relationships between the LPP to positive and neutral images and psychopathology symptoms have been underexamined. The purpose of the current study was to test the effects of image valence, and PTSD, anxiety, and depressive symptoms on LPP amplitude among trauma-exposed undergraduates. METHOD: Seventy-three trauma-exposed undergraduates viewed a series of negative, positive, and neutral images while LPPs were recorded. Self-report measures were used to assess recent PTSD, anxiety, and depressive symptoms. Hierarchical linear modeling tested valence and symptom main effects, as well as Valence by Symptom interactions on LPP amplitude. RESULTS: We found a main effect of valence such that individuals exhibited higher LPP amplitudes to negative images compared to neutral images. We also found a Valence by Depressive Symptoms interaction such that there was an inverse relationship between depressive symptoms and the LPP to neutral images but no associations between depressive symptoms and the LPP for positive or negative images. We found no main effects or interactions for anxiety and PTSD symptoms. CONCLUSION: Depressive symptoms might be related to diminished attention to neutral stimuli among trauma-exposed undergraduates. Further investigation of the relationship between the LPP and psychopathology is needed.

Exposure to conflicting COVID-19 information in undergraduates: Implications for pandemic-related information-seeking and concern, attention, and cognitive workload.

Objectives: To examine college students' conflicting COVID-19 information exposure, information-seeking, concern, and cognitive functioning. Participants: 179 undergraduates were recruited in March-April 2020, and 220 in September 2020 (Samples 1 and 2, respectively). Methods: Students completed the Attention Network Test, NASA Task Load Index, and COVID-related questions. Results: In Sample 1, exposure to conflicting information predicted poorer attentional performance and greater COVID-related information-seeking and concern; concern was correlated with workload. In Sample 2, conflicting information was associated with information-seeking. In Sample 1, but not Sample 2, cognitive effects of conflicting information were mediated by information-seeking and virus-related concern. Conclusions: Conflicting COVID-19 information may undermine students' cognitive functions, bearing implications for health, academic performance, and stress. Strategies for countering these effects include enhancing the clarity of institutional messaging, and tailoring course curricula and offering workshops to students, faculty, administrators, and counseling staff to augment students' capacity to comprehend and utilize COVID-related communications.

Lay beliefs about the causes and treatment of depression: Tests of measurement models and associations.

BACKGROUND: There is reason to expect beliefs about depression's causes and treatment to influence use of psychotherapy, but the literature is marked by theoretical, methodological, and empirical inconsistencies. This study assessed the factorial validity of measures of beliefs about depression's causes and formal treatment versus self-management. It also tested the links of causal attributions to general treatment/self-management beliefs and endorsement of specific interventions. METHODS: The revised Illness Perception Questionnaire (IPQ-R) adapted for depression was administered online to a non-patient, U.S. sample (N = 319). RESULTS: Confirmatory factor analyses yielded three causal dimensions, Environmental Stressors, Biological Factors, and Personal Attributes, and two control dimensions, (Formal) Treatment and Personal. Both models fit irrespective of whether respondents believed they had ever experienced depression. A structural equation model (SEM) showed a positive relationship for Environmental and Biological attributions, and an inverse relationship for Personal attributions, in predicting general preferences for Formal Treatment. A second SEM, focusing on specific interventions, linked Environmental causation to endorsement of psychotherapy, dietary changes, and self-help, and Biological causation to endorsement of medication and exercise, with Personal causation inversely associated with endorsement of psychotherapy. LIMITATIONS: A cross-sectional, correlational design precludes causal inferences. Potential sociocultural influences were not assessed. CONCLUSIONS: Modifications to the IPQ-R suggested by this study improved its psychometric properties, validated its distinction between Treatment and Personal Control beliefs, and supported examination of both general and specific beliefs about ways to deal with depression. Relationships linking cause and treatment beliefs warrant further investigation as potential intervention targets to increase treatment utilization.

Pathways from exposure to racial/ethnic discrimination to depression: Testing a social-cognitive model.

RATIONALE AND OBJECTIVE: Interpersonal racial/ethnic discrimination is a risk factor for depression across the lifespan in minoritized racial/ethnic groups. This study tests a model proposing that social cognitive processes, including relational schemas, mediate the link between discrimination and depression. Relational schemas enable individuals to form mental representations of others, reflecting prior social learning and generating expectations about future social relations. Racism-related relational schemas include, among others, concerns about being rejected or invalidated, concerns about confirming negative stereotypes held by others, and cynical mistrust of others. Prior studies have typically examined the mediating role of one or two relational schemas in the association between discrimination and depression; less is known about the unique and combined effects of multiple dimensions of racism-related social cognition. METHODS: The model was tested in a convenience sample of ethnically diverse, non-white participants recruited from two sites, a community medical center (N = 136; Mage = 38, SD = 13.0) and a private university (N = 120; Mage = 19.4, SD = 1.3), yielding a consolidated sample of 256 participants (64% women). Data were collected between September 2016 and April 2018. Participants completed paper-and-pencil self-report measures of exposure to interpersonal discrimination, depressive symptoms, and eight measures of relational schemas. RESULTS: Confirmatory factor analysis indicated that the eight relational schemas defined three primary dimensions: concerns about rejection and invalidation, social vigilance, and mistrust. A structural equation model in which the association between exposure to discrimination and depressive symptoms operates through latent factors representing three social-cognitive dimensions demonstrated adequate fit (CFI = 0.96, RMSEA = 0.06, SRMR = 0.04). A significant mediational effect was found only for concerns about rejection and invalidation. CONCLUSION: The conceptual model supported by this study may help inform psychological interventions aimed at mitigating the detrimental effects of racial/ethnic discrimination on mental health.

Depressive symptoms, trait aggression, and cardiovascular reactivity to a laboratory stressor.

BACKGROUND: Depression and anger/aggression-related traits are thought to promote coronary disease, at least in part, through their associations with stress-related cardiovascular processes. It is unclear whether the effects of these factors on cardiovascular reactivity (CVR) are redundant, additive, or synergistic. PURPOSE: The main goal of this study was to examine the independent and interactive effects of depressive symptoms and anger/aggression-related traits in promoting CVR. METHODS: Participants were 63 healthy females who completed the Beck Depression Inventory and Buss-Perry Aggression Questionnaire and performed a stressful speaking task. Systolic and diastolic blood pressure (SBP and DBP) and heart rate were recorded. RESULTS: Significant interaction effects indicated that depressive symptoms were positively associated with SBP and DBP reactivity among women high in verbal aggression but not among those low in verbal aggression. CONCLUSIONS: Depressive symptoms and verbal aggression may interact to promote exaggerated blood pressure responses to stressors, a possible marker for mechanisms that contribute to heart disease.

Trait hostility and ambulatory blood pressure among traffic enforcement agents: the effects of stressful social interactions.

This study investigated the hypothesis that trait hostility is associated with heightened cardiovascular reactivity to potentially stressful social interactions but not to nonsocial activities in the workplace. Participants were 73 (39 women) New York City traffic enforcement agents (TEAs) who patrol the streets and issue summonses for vehicular and parking violations. During their patrols, TEAs face potentially stressful interactions when they encounter motorists and pedestrians who may be angry about receiving summonses. Mood and ambulatory blood pressure were initially measured when TEAs were recently hired and attending classes at the training academy (Time 1), and were subsequently assessed again once the TEAs began independently patrolling the city streets (Time 2). Random effects regression models yielded a significant interaction of hostility and work activity on ambulatory systolic blood pressure at Time 2. For those high in hostility, but not for those low in hostility, systolic blood pressure levels were higher while interacting with members of the public than during nonsocial work activities. The findings support the notion that situational factors affect the association of hostility to cardiovascular reactivity, and that interpersonal stressors in the workplace elicit cardiovascular activation among those high in hostility.

Psychosocial factors in heart surgery: presurgical vulnerability and postsurgical recovery.

OBJECTIVE: Distress and low perceived social support were examined as indicators of psychosocial vulnerability in patients about to undergo heart surgery. DESIGN: A total of 550 study patients underwent heart surgeries, including bypass grafting and valve procedures. Psychosocial interviews were conducted about five days before surgery, and biomedical data were obtained from hospital records. MAIN OUTCOME MEASURES: Sociodemographic, personality, religious, and biomedical factors were evaluated as predictors of psychosocial vulnerability, and all five sets of variables were evaluated as contributors to hospital length of stay (LOS). RESULTS: Patients scoring higher on one or more indicator of presurgical psychosocial vulnerability were younger, more likely to be female, less likely to be married, less well educated, lower in dispositional optimism, higher in trait anger, and lower in religiousness. Older age, depression, low support, and low trait anger each showed an independent, prospective association with greater LOS, and several other predictors had prospective relationships with LOS that were statistically mediated by depression or perceived support. CONCLUSION: Evidence that multiple psychosocial factors may influence adaptation to heart surgery has implications for understanding and ameliorating presurgical distress and for improving postsurgical recovery.

Reported fatigue, difficulty, and cardiovascular response to a memory challenge.

Female undergraduates were presented the opportunity to earn a small chance of winning a modest prize by memorizing in 2 min two or six nonsense trigrams (meaningless series of three letters, such as AED). Analysis of cardiovascular measures taken during the work period indicated that systolic blood pressure responses first rose and then fell with self-reported fatigue in the two trigram condition. By contrast, the responses declined with self-reported fatigue in the six trigram condition, starting relatively high and ending low. Whereas systolic blood pressure responses were stronger for Six Trigram participants where fatigue was low, they tended to be stronger for Two Trigram participants where fatigue was moderate and were weak for both trigram groups where fatigue was high. Response patterns for diastolic blood pressure and, especially, mean arterial blood pressure, were similar. The blood pressure findings conceptually replicate and extend previous fatigue study results and provide further support for a recent conceptual analysis of fatigue influence on effort and associated cardiovascular responses.

PERCEIVED RACISM AND NEGATIVE AFFECT: ANALYSES OF TRAIT AND STATE MEASURES OF AFFECT IN A COMMUNITY SAMPLE.

Racism is a significant psychosocial stressor that is hypothesized to have negative psychological and physical health consequences. The Reserve Capacity Model (Gallo & Matthews, 2003) suggests that low socioeconomic status may influence health through its effects on negative affect. We extend this model to study the effects of racism, examining the association of lifetime perceived racism to trait and daily negative affect. A multiethnic sample of 362 American-born Black and Latino adults completed the Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV). Trait negative affect was assessed with the Positive and Negative Affect Schedule (PANAS), and state negative affect was measured using ecological momentary assessments (EMA), in the form of an electronic diary. Analyses revealed a significant relationship of lifetime perceived racism to both daily negative affect and trait negative affect, even when controlling for trait hostility and socioeconomic status. The relationship of perceived racism to negative affect was moderated by education, such that the relationships were strongest for those with less than a high school education. The findings support aspects of the Reserve Capacity Model and identify pathways through which perceived racism may affect health status.

Poincaré plot indices as measures of sympathetic cardiac regulation: Responses to psychological stress and associations with pre-ejection period.

The Poincaré plot is a visual representation of the R-R time series within a Cartesian plane constructed by plotting each R-R interval as a function of the previous one. The plot can be characterized by parameters that quantify the standard deviation (SD) of short- and long-term R-R interval variability (SD1 and SD2, respectively). Claims regarding the use of Poincaré plot analysis as an alternative to conventional time-domain and spectral analytic measures of parasympathetic contributions to heart rate variability (HRV) have been evaluated somewhat extensively. However, its proposed utility for characterizing sympathetic influences on HRV during periods of acute mental stress, using SD2 and the SD1/SD2 ratio, has received minimal attention. In the present study, the electrocardiogram was used to record R-R interval variability in healthy participants during a resting baseline period, while they performed a challenging reaction time task, and then during a recovery period. Simultaneously, the thoracic impedance cardiogram was used to derive the pre-ejection period (PEP), which reflects sympathetic cardiac control. HRV was quantified using time-domain, spectral analytic, and Poincaré plot indices. Task performance elicited significant reductions in HRV and PEP parameters, indicating withdrawal of parasympathetic tone with concomitant sympathetic activation. Following cessation of task performance, all HRV and impedance measures returned to baseline levels, signaling resumption of parasympathetic dominance. Bivariate associations linking SD2 and the SD1/SD2 ratio to PEP were observed; however, these were not large in magnitude, were exceeded in size by associations between the Poincaré metrics and conventional HRV markers of parasympathetic cardiac influences, and were eliminated when the latter were controlled statistically. These observations challenge the proposal that the Poincaré SD2 and SD1/SD2 metrics are suitable markers of sympathetic cardiac regulation in research concerned with mental and physical health.

Course of depressive symptoms in patients undergoing heart surgery: confirmatory analysis of the factor pattern and latent mean structure of the Center for Epidemiologic Studies Depression Scale.

OBJECTIVE: The purpose of this study was to examine the dimensionality, stability, and course of depressive symptoms over the 12-month period beginning approximately 1 week before heart surgery. METHODS: The Center for Epidemiological Studies Depression Scale (CES-D) was administered to 570 patients before heart surgery and 1, 3.5, 6.5, and 12.5 months later. RESULTS: Confirmatory factor analysis rejected a four-factor model as a result of small variances for two interpersonal items. With their elimination, a three-factor solution (negative affect, low positive affect, somatic/vegetative symptoms) showed good psychometric properties. Except for the somatic/vegetative factor at the 1-month follow up, there was a high degree of stability in the factor pattern over a 12-month period beginning approximately 1 week before heart surgery. Latent mean structure analysis indicated that, apart from elevations in several somatic/vegetative symptoms during the month after surgery, means for all three depressive symptoms declined over time. The recovery of positive affect showed a steeper trajectory toward the end of the follow-up period by comparison with the rates of decline for depressed affect and somatic/vegetative symptoms. CONCLUSIONS: These findings support using 18 CES-D items to measure three depressive symptom dimensions in heart patients and may reflect a normative pattern of adjustment to heart surgery.

Quality of life following cardiac surgery: impact of the severity and course of depressive symptoms.

OBJECTIVES: The purpose of this study was to examine the impact of the severity and course of depressive symptoms on change in quality of life (QOL) 6 months after cardiac surgery. METHODS: Ninety patients were interviewed before heart surgery and 2 and 6 months after surgery. Depressive symptoms were assessed using the Beck Depression Inventory, and QOL was assessed using physical and psychosocial functioning indices derived from the Medical Outcomes Study instrument. Multiple regression examined the effects of the severity and course of depressive symptoms on QOL adjusting for demographic and biomedical predictors. RESULTS: Higher levels of presurgical depressive symptoms predicted poorer physical functioning after cardiac surgery. A similar effect on psychosocial functioning fell short of significance. An increase in depressive symptoms 2 months after surgery was significantly predictive of poorer physical and psychosocial functioning at 6 months. The effect of increased depressive symptoms on psychosocial functioning was significantly stronger in patients with high presurgical Beck Depression Inventory scores. CONCLUSIONS: Both preoperative depressive symptoms and postoperative increases in depressive symptoms seem associated with poorer QOL 6 months after cardiac surgery. Further examination of these associations and the mechanisms they reflect may provide a basis for guiding treatment decisions before and after coronary artery bypass graft surgery.

Integrating affective and cognitive correlates of heart rate variability: A structural equation modeling approach.

High frequency heart rate variability (HRV) is a measure of neurocardiac communication thought to reflect predominantly parasympathetic cardiac regulation. Low HRV has been associated empirically with clinical and subclinical levels of anxiety and depression and, more recently, high levels of HRV have been associated with better performance on some measures of executive functioning (EF). These findings have offered support for theories proposing HRV as an index measure of a broad, self-regulatory capacity underlying aspects of emotion regulation and executive control. This study sought to test that proposition by using a structural equation modeling approach to examine the relationships of HRV to negative affect (NA) and EF in a large sample of U.S. adults ages 30s-80s. HRV was modeled as a predictor of an NA factor (self-reported trait anxiety and depression symptoms) and an EF factor (performance on three neuropsychological tests tapping facets of executive abilities). Alternative models also were tested to determine the utility of HRV for predicting NA and EF, with and without statistical control of demographic and health-related covariates. In the initial structural model, HRV showed a significant positive relationship to EF and a nonsignificant relationship to NA. In a covariate-adjusted model, HRV's associations with both constructs were nonsignificant. Age emerged as the only significant predictor of NA and EF in the final model, showing inverse relationships to both. Findings may reflect population and methodological differences from prior research; they also suggest refinements to the interpretations of earlier findings and theoretical claims regarding HRV.

Why not find out whether religious beliefs predict surgical outcomes? If they do, why not find out why? Reply to Freedland (2004).

In this reply to K. E. Freedland's (see record 2004-13299-002) comments on R. J. Contrada et al. (see record 2004-13299-001), it is shown that the statistical issues he raised, and his preferred interpretation of the findings, were adequately addressed in the original article. It is argued that methodological limitations also were fully characterized and do not differ in kind from those of biomedical studies. Other issues discussed include the merits of focusing on distal versus proximal causation, plausibility of explanatory mechanisms for health effects of religious involvement, and potential practical applications that do not require manipulation of religious involvement. The article is concluded by commenting on subtle aspects of discourse that may unnecessarily polarize discussions of possible physical health effects of religious involvement.