Throwing Money at People to Force Them into Health

You may not know it, but some governments have begun to dole out money in an attempt to promote the health behaviors of certain citizen groups.  Good idea?  Bad idea?

First, some context by way of a 2019 Journal of the American Medical Association report (Thirumurthy, et al 2019) entitled "The Uncertain Effect of Financial Incentives to Improve Health Behaviors."  Among other things, the article detailed several relevant studies.  In one, 1503 cardiovascular patients were chosen from three American health care systems. For 12 months, the subjects were entered into a lottery in which they could win more than $1000, if they took their statin medication and lowered their LDL-C cholesterol.  Three other studies focused on HIV positive patients in an attempt to increase their compliance with antiretroviral therapies so as to improve their abilities to suppress the virus.  All three HIV studies provided their participants with financial incentives.  In neither the cardiovascular study nor in any of the HIV studies did monetary rewards produced their desired outcomes.

After noting that some other studies had inferred health compliance benefit from financial inducements, Thirumurthy and his colleagues offered suggestions about how one might pay patients to take better care of their own health.  Among other things, the authors cautioned against what they cited as the "Peanuts Effect" in which patients are paid too little to incentivize them. To quote, "These considerations suggest not being stingy with financial incentives when great value is at stake—or at least not assuming that incentives cannot be effective when small incentives do not succeed."  After addressing several factors regarding patient monetary incentives, the authors subsequently reached the common sense conclusion that the manner in which a financial reward patient program is "designed" is central to its success.

What do you think?  Should some big institution--almost always a government agency--pay people to behave in ways that profit those very same people?  The United States tried paying children to attend school, and that mostly ended with fraud by the administrators and no significantly improved attendance by the students. Nevertheless, there still are pay-to-attend-school crusaders.  Foremost among these is Brentin Mock (2017) who, writing for City Lab-- owned by The Atlantic, one of America's oldest literary magazines--asserted that "We need to pay high school students to go to school. I don’t mean some punk-ass weekly or monthly allowance, or a gift card for Dave & Busters. I’m talking about a deposit of somewhere in the ballpark of $50 to $100, every school day. That’s not for making honor roll; it’s just for making it to school in the morning and staying until the end of the day. Yes, compensated just for showing up. Think Universal Basic Income—but for kids."  Critically evaluate that for a moment: If instituted, the recommendation would cost between $9,000 and $18,000 for each and every student.  Based on 2013-2014 enrollment statistics, for Wyoming, the state with least students, the yearly cost would have ranged from 833 million, 67 thousand dollars at the low end to 1 billion, 666 million, 134 thousand dollars at the high end.  For California, the state with most students, the yearly cost would have ranged from a low of 53 billion, 962 million, 686 thousand dollars at the low end to 107 billion, 925 million, 372 thousand dollars at the high end.  Those new educational expenses, of course, would have to be added to Wyoming's usual pupil yearly expenditures of 1 billion, 560 million,764 thousand dollars, and added to California's usual pupil yearly expenditures of 72 billion, 641 million, 244 thousand dollars.

Just for the moment, set aside the expense.  Instead, be aware that research over the decades has proven that external rewards destroy intrinsic motivation (Ryan & Deci, 2017).  So paying people to force them into physical and mental health easily could backfire.  For instance, studies (Dweck, 2006) have found that when external rewards are withdrawn, those previously rewarded tend to return to their pre-existing behaviors.  And what about those who already had the intrinsic motivation to behave healthfully before financial incentives were offered?  Might they not rebel, demanding to be paid as much, or more, than the slackers in order to continue behaving healthfully?

References

Dweck, C. (2006).  Mindset: The New Psychology of Success.  New York: Random House

Mock, B. (2017). We Will Pay High School Students To Go To School. And We Will Like It.
April 3.  https://www.citylab.com/equity/2017/04/lets-just-pay-high-school-students-to-go-to-school/521694/

Ryan R. M., Deci E. L. (2017). Self-determination theory: Basic Psychological Needs in Motivation Development and Wellness. New York, NY: Guilford Press

Thirumurthy, H., Asch, D., & Volpp, K. (2019) The Uncertain Effect of Financial Incentives to Improve Health Behaviors.  JAMA. 2019;321(15):1451-1452. doi:10.1001/jama.2019.2560

How to drive yourself crazy

Regardless of your current health, wealth, or intelligence, you will die.  Not a particularly pleasant or reassuring thought, but one that incontestably is true. Dwelling about one's mortality is enough to drive anybody insane.

The tendency to anticipate our own demise is merely one example of what psychologists call prospective forecasting. That is, our natural human proclivity to imagine what the future has in store for us.  Prospective forecasting is the proverbial double-edged sword - great when it predicts the positive, and dreadful when it does the opposite.  Even when imagining circumstances far less dire than death, negative prospective forecasting poisons our current experiences and aspirations.

We all fall victim to negative prospective forecasting at times.  While awaiting the results of a medical blood workup, most people recall some recently experienced minor or major ailment, wondering whether it signals an impending medical crisis. After submitting the competed exam for a professional license, we remember all the "tough questions" that we fear we answered incorrectly, and forget all the ones we answered confidently.

Psychologists assert that "bad" expectations and perceptions generally are stronger than good ones (Baumeister, et al., 2001), meaning that we usually ascribe greater significance to negative feelings and thoughts. Evolution theorists believe that the natural human tendency toward pessimism kept our ancestors alert to potential dangers and, therefore, promoted their survival.  So, we descendants of survivors all inherited that pessimistic mindset.  As the old saying goes, however, "better safe than sorry."

The negative prospective forecasting bias is burdensome enough.  Unfortunately, it is made more onerous due to counterfactual reasoning, another common thinking style.  This is the "what if" aspect of reflection.  After receiving upsetting news regarding your blood work or licensing exam, you ruminate about what you could have done differently to avoid the outcome you just experienced. Had you eaten more sensibly or studied more diligently, you reason, you would not be in your current predicament.

Counterfactual reasoning focuses us on the past and prospective forecasting focuses us on the future. Together they distract us from the present, and it is only in the present that we can act to remedy past deficiencies and to avoid future ones. Almost everyone by now is familiar with "mindfulness," a mental state in which we focus on the present to the exclusion of all else.  As you probably know, mindfulness typically promotes relaxation and clarity of thought.  There are a host of psychological and medical therapeutic modalities that employ mindfulness as a central curative element.

What healthful insights can we glean by integrating the notions of prospective forecasting, counterfactual reasoning, and mindfulness?  First, be aware that your mind frequently is pulled by one or more of the three. and, second, consider whether you are more vulnerable to one or another.  Prospective forecasting, counterfactual reasoning, and mindfulness can have helpful or detrimental effects, depending on how and how often they are employed.   

Because the future is extraordinarily difficult to predict and the past cannot be changed, too much prospective forecasting and counterfactual reasoning usually predisposes us to problems. Handled properly, however, both can be positive forces. Prospective forecasting and counterfactual reasoning can inform us about ways to change our current thoughts, feelings, or behaviors, thus promoting proactive mindfulness. In such cases, the result most likely will be health-inducing when we not only realistically assess past and current weaknesses and strengths, but also act decisively in the present to make best use of the obtained information.  Although we all will die, we have the potential to live better day to day. Rather than driving yourself crazy, drive yourself healthy.

Reference

Baumeister, Roy F.; Bratslavsky, Ellen; Finkenauer, Catrin; Vohs, Kathleen D. (2001).  Bad is stronger than good.  Review of General Psychology, Vol 5(4), December, 323-370.  doi: http://dx.doi.org/10.1037/1089-2680.5.4.323   

New Book and New Blog

Never in human history have so many professions made influencing the masses their primary or secondary goals. Most of those professionals are motivated by desire for fortune and fame. A few others sincerely believe that they, and they alone, know what is best for society, in general, and for you, in particular. And the professional influencers are not billeted only in America, Russia, China, or Korea. Virtually every country has its own professional influence warriors. All of them train and research tactical strategies, and all employ the latest high tech influence weapons.

As a psychologist, myself, I am troubled by the ways that psychologists have been deployed in the influence wars. Psychology research too often has facilitated methods of mass manipulation.  Accordingly, I recently published a new book, Justifiably Paranoid: Resisting Intrusive and Malicious Influences, and I also began a new blog, https://resistingintrusivemaliciousinfluences.blogspot.com/ 

Unlike the manipulators, I do not have a self-serving agenda and I do not profess to know what is best for you. I do know that you, and you alone, are qualified to determine the influences that should be accepted and rejected. I expect and encourage you to be as justifiably suspicious of the information that I present in my books and blogs as you would be of that contained in any other. I look forward to your feedback on the new book and blog.   

Stages and Processes of Healthful Change

Virtually all of us seek basic life guidelines whose applications readily promote our health and function. Accordingly, this blog post will describe one approach to helping you in that endeavor.

Although behavioral science has not created any simple, E=mc₂-elegant formulas, it has suggested stages and processes to guide our efforts toward physical and mental health. One of the most well-respected of these is the transtheoretical model of Prochaska, DiClemente, and Norcross (1992).

The Prochaska model attempts to match our healthful lifestyle change interventions to given stages. Five stages have been suggested: precontemplation precedes all of our change efforts; contemplation involves planning to change; preparation has us assembling the resources to act on our healthful intention; action is the period during which we overtly implement our plan; and maintenance is our continuing efforts toward change. Prochaska and his colleagues hoped that their model could be used to guide many health-oriented goals.

The five stages were described in terms of five cognitive-affective processes and five behavioral processes.  The former concerned: gathering information, considering consequences on oneself, experiencing and expressing emotion, evaluating consequences on others, and paying attention to norms of society. The latter included: substituting new behaviors for the old ones,  controlling cues within the environment, rewards to the self and others, taking advantage of social supports, and making a change commitment.  

In theory, every stage could be influenced by the way an individual dealt with the cognitive-affective processes and behavioral processes. Craig S. Rosen (2000) was not convinced, so he set out to test the transtheoretical model to ensure that it could be used to greatest effect.  His research focused on the usefulness of the Prochaska model for persons attempting smoking cessation, diet change, exercise adoption, elimination of substance abuse, and benefit from psychotherapy.

After analyzing forty-seven studies, Rosen concluded that the Prochaska stages worked well across the five targeted health goals.  However, the processes were not the same for all.  Specifically, for smoking cessation, in the early stages of change, cognitive processes were more central than behavioral processes.  For diet change and exercise adoption, the cognitive and behavioral processes worked consistently with each other. And for elimination of substance abuse, and benefit from psychotherapy there was general inconsistency.

Rosen’s research was noteworthy because the Prochaska transtheoretical model is well-respected and frequently employed by health professionals to treat their patients. I, too, regard the model as one that has merit, and that can be used with discretion to help guide healthful lifestyle change. However, the stages do not necessarily proceed smoothly from one to the other, and the processes can assume different value from person to person. My point in writing about the model today is to underscore my perennial advice: You must match any change model to what I call your ego strength—the unique “you” that is a result of interactions among your history, temperament, personality, and environments. Remain open-minded to others’ recommendations, but customize them to fit what you are willing and able to do. In order to perform the customization, tactfully "challenge" whoever is advising you.  That is, you need to let them know at which points their advice seems to align with who you are and where it does not seem to do so. After that, you can carefully observe the advisor's response and decide whether you then have more or less confidence in their recommendations.

    

References

Prochaska, J., DiClemente, C., & Norcross, J. (1992).  In search of how people change:  Applications to addictive behaviors.  American Psychologist 47, 9,1102-1114.

Rosen, C. (2000).  Is the sequencing of change processes by stage consistent across health problems?  A meta-analysis.  Health Psychology, 19, 6, 593-604.  doi: http://dx.doi.org/10.1037/0278-6133.19.6.593 

The Exercising Body Invigorates the Thinking Mind

Big time thinkers, such as Aristotle and Einstein, were said to have used walking as a venue for creative thought. Such anecdotal accounts support the notion that exercise can facilitate subsequent intellectual effort. On the other hand, some psychologists reasonably have suspected that relaxation also might be an especially good precondition for cognitive effort. And since relaxation is the opposite of total body movement, it might be fruitful to compare a group who had relaxed prior to engaging in intellectual effort with a group who had exercised. Is one approach more advantageous than the other?   

Fabien D. Legrand and his colleagues (2018) addressed the topic head-on. Initially, 101 student subjects were asked how energetic they felt.  Next, they completed two related tests. The first, called Trail Making A, required the students to sequentially connect, as fast as they could, scrambled numbered dots, proceeding from number 1 to number 2, until reaching number 25. The second, called Trail Making B, also required the same students to sequentially connect scrambled dots, as fast as they could.  However, for Trail Making B, half the dots contained an alphabet letter, from A to L and half contained a numeral, from 1 to 12.  Under the Trail Making B condition, students had to connect dot A to dot 1, dot B to dot 2, and then to proceed throughout the array alternating letter to number until finishing with L12.

After completing Trails A and B, half the students jogged around campus for 15 minutes, and half participated in group relaxation.  Approximately two minutes after the jog or relaxation, all students reported again on their energy levels.  They then all redid Trails A and B.

  

Not surprisingly, those who had jogged felt more invigorated than did those who had relaxed. Moreover, the joggers performed significantly better on their second completion of Trails A, although not on Trails B.  By contrast, the relaxers experienced no change in energy after relaxing, nor did their performance change on either Trails A or B.  The Legrand group suggested that it probably was the full body exercise that accounted for the joggers’ improved Trails A performance.

I’m not surprised if you are not impressed by the aforementioned study. You might have concluded that  it is another psychological study showing the obvious.  One noteworthy feature of the Legrand work that might not have escaped you, however, is that the more cognitively demanding Trails B task did not improve in the joggers group.  Perhaps full body exercise is not all that it is cracked up to be.

If you do feel that way, consider the Hsu, et al. (2018) study of the role of aerobic activity in cognitive performance. The investigation involved elderly patients.  In phase one, half of the group had had moderate-intensity aerobic training, and half did not.  In phase two, all patients rapidly were flashed a succession of geometric figures, each pointed in a given direction.  After the target figure faded away, in a multiple-choice format, the patients had to select which of four figures corresponded direction-wise to the previously flashed figure.  Both before and after the test, all patients received a functional MRI (fMRI). The investigators suggested that the figure flashing and identification task involved both attention and cognitive processing in terms of visual orientation. 

The fMRI results disclosed that those who had completed the aerobic training performed the visual orientation task significantly better than those who had not had the training.  Moreover, the imaging also revealed that the aerobic training group fMRI results (reduced activation in the left lateral occipital cortex and right superior temporal gyrus) were the very ones that previous research had found to be associated with improved cognitive functioning.

If you believe the two studies just reported, you reasonably can conclude that full body exercise might be just the thing to both invigorate your cognitive effort and to facilitate your cognitive processing.     

References

                

Legrand, Fabien D., et al.  Brief aerobic exercise immediately enhances visual attentional control and perceptual speed. Testing the mediating role of feelings of energy.  Acta Psychologica, November 2018, Volume 191. 

Hsu , Chun Liang, et al.  Aerobic exercise promotes executive functions and impacts functional neural activity among older adults with vascular cognitive impairment.  British Journal of Sports Medicine, February, 2018, Volume 52, Issue 3.

Free Time, Social Media, and User Emotion

Most of you undoubtedly remember vividly when people spoke fondly about their intention to “curl up with a good book.”  That volitional media use was firmly associated with positive emotion.  The prospective reader expected a leisurely, relaxed experience.  After reading, one would be better prepared to move forward, whether that meant going to bed or tackling a project.

Today, many people volitionally read as little as possible.  Rather than pick up a book, when having free time, they are inclined to grab a smart phone or computer.  And when they do, they devote much of that electronic media time to social media.  Accordingly, psychologists have investigated whether self-selected volitional social media activity promotes or impairs emotional well-being.  Since Facebook is the social media gold standard, it overwhelmingly has been the focus of most relevant research.  So, let’s consider two recent studies.

Yuen and colleagues (2018) wanted to know how Facebook engagement influenced the mood of early adults.  To do so, they selected 312 undergraduates, randomly assigning them to one of four 20-minute on-line activities.  During the first phase, some browsed the Internet, some passively browsed other people’s Facebook profiles, some actively produced Facebook messages or posts to communicate with someone, and some updated their own Facebook profile.  During the second phase, all filled-out questionnaires designed to assess their overall mood, the extent of their envy, and the amount of meaningfulness they ascribed to the time they had spent online.  After analyzing the data, the psychologists concluded that, when compared with mere Internet browsing, engagement with Facebook worsened their subjects’ moods.  Moreover, passive Facebook browsing had the most deleterious effect.

Passive Facebook browsing also was a central focus of Scherr, et al. (2018).  That research specifically looked at how depression affected an individual’s predilection toward “surveillance,” meaning browsing a friend’s Facebook postings on occasions, and not leaving any indication of having done so.  The research considered the browser’s emotional status on two occasions, with a one-year separation between the two.   The data suggested that, on both occasions, depressed persons performed more surveillance and evidenced more envy than did their non-depressed peers. Greater envy, also, was associated with increased Facebook surveillance.

The two aforementioned studies did not tell us whether social media was the cause or the effect of emotion.  However, both suggested that Facebook use with little or no interpersonal interaction was associated with negative affect.  Passive Facebook browsing was associated with more dysphoric mood.  And surveillance Facebook browsing was associated with more envy. 

Social comparison theory posits that people regularly compare themselves with others, a kind of interpersonal score-keeping.  Sometimes the comparison is downward, leading us reassuringly to conclude that we are better off than those with whom we are comparing ourselves.  Other times, the comparison is upward, meaning that we look at another and dishearteningly conclude that she/he is better off than we.  The more time we spend on Facebook, the more we reinforce an external social comparison attitude, and the more emotionally influential that attitude becomes. When Facebook becomes the major determinant of our emotions, we have become a pawn in the social game of life.  When you have free time, do yourself a favor: read a book, talk to a friend, visit a loved one, or find some other positive, engrossing activity to fill the void.  Rather than comparing yourself to others, compare your current self with the self toward which you aspire.       

References:

Scherr, S., Toma, C. L., & Schuster, B. (2018). Depression as a predictor of Facebook surveillance and envy: Longitudinal evidence from a cross-lagged panel study in Germany. Journal of Media Psychology: Theories, Methods, and Applications. Advance online publication.

http://dx.doi.org/10.1027/1864-1105/a000247

Yuen, E. K., Koterba, E. A., Stasio, M. J., Patrick, R. B., Gangi, C., Ash, P., . . . Mansour, B. (2018). The effects of Facebook on mood in emerging adults. Psychology of Popular Media Culture. Advance online publication. http://dx.doi.org/10.1037/ppm0000178

Women and Men, Influence and Health

Everyone  recognizes  that  a  proper  level  of  self-assertion  is  critical  for  health  and  success. We  often  are  told  to  “speak  up”  and  to  “express  your  opinion.” Therefore,  despite  the  persistence  of  gender  bias  in  our  21st  century,  no  sensible  person  would  discourage  a  woman  from  asserting  herself  whenever  she  feels  that  such  action  is  appropriate.

According  to  the  Merriam-Webster  dictionary,  self-assertion  is  “the  act  of  expressing  or  defending  your  rights,  claims,  or  opinions  in  a  confident  or  forceful  way.” So, self-assertion implies at least  a  modicum  of  passion. Moreover,  some  situations  virtually  demand  passion  beyond  the  minimal  emotional  threshold  necessary  to  satisfy  the  definition. One  could  reasonably  “argue”  then,  that  persons  serving  on  juries  that  determine  guilt  or  innocence  in  capital  crimes  have  an obligation  to  self-assertively  express  their  opinions.

During  jury  deliberation,  self-assertion  implies  that  jurists  not  only  express  their  opinions,  but  also  try  to  influence  the  other  members  to  accept  their  rationales.  Given  the  importance  of  jurist  self-assertion,  psychologists  should  and  do  direct  their  expertise  to  studying  how  women  and  men  jurors  can  maximally  contribute during deliberations.

Salerno  and  Peter-Hagene  (2015)  are  two  who  chose  to  address  the  role  of  gender  and  self-assertion  during  capital  crime  jury  deliberation. Their  study  used  a  computer  simulation  in  which  the  subjects  erroneously  believed  that  they  were  involved  in  a  role-play  jury  trial  in  which  all  subjects  were  participating  authentically. No  video  was  involved,  so  no  subject  could  see  any  other. Actually,  five  of  the  jurists  were  scripted  either  to  agree  (4  experimenter  confederates) or  to  disagree  (1  experimenter  confederate)  with  the  subject’s  views.  In  the  first  part  of  the  experiment,  holdouts  were  given  either  female  or  male  names,  and  none  of  them  expressed  significant  emotion  when  disagreeing. Within  that  non-emotional  condition,  the  holdout  did  not  influence  the  subjects. By  contrast,  in  the  second  part,  the  holdout’s  argument  was  conducted  in  an  angry  manner. When  the  angry  communicator  was  male,  he  tended  to  undermine  the  subject’s  confidence  in  their  own  opinion,  but  the  opposite  occurred  when  the  angry  communicator  was  female. Critically,  both  the  angry  male  and  the  angry  female  argued  for  the  very  same  opinion. Only their gender differed. The  investigators  proffered  the  obvious  interpretation  that  male  anger  is  more  likely  to  enhance  their  influence  during  group  decisions,  whereas  female  anger  is  more  likely  to  detract  from  their  influence.

A single study certainly  does  not  prove  anything.  But  it  is  consistent  with  the  stereotypic belief  that  angry  women  are  “bitches”  who  should  be  ignored,  and  that  angry  men  are  “alphas”  who  should  be  heard.  Viewed  from  a  health  perspective,  the  implication  is  that  women  should  swallow  their  anger  and  stew,  whereas  men  can  “get  it  out”  and  move  on. Here,  then,  is  one  more  example  of  ways  that  gender  bias  can  marginalize women and make them sick.

Reference

Salerno, J. M., & Peter-Hagene, L. C. (2015).  One  angry  woman:  Anger  expression  increases  influence  for  men,  but  decreases  influence  for  women,  during  group  deliberation. Law and  Human Behavior,  39(6),  581-592.  http://dx.doi.org/10.1037/lhb0000147

Out of Joint?

Bill Clinton, 42nd United States President, famously, or infamously, confessed to having used marijuana, but claimed that he never had inhaled its smoke.  And Barack Obama, 44th President, all but boasted of having binge smoked marijuana in cars and in a Volkswagen bus with the windows shut tight, so that he and his friends could suck in every last whiff of the burning “weed.”  Only two presidencies and marijuana already had gone from verboten to akzeptabel.

But this is not a political blog.  It is all about you.  The scientific community still argues about the extent to which cannabis is a health hazard.  The people in the white coats will not answer the question definitively any time soon because of the powerful lobbies for and against marijuana.

Since most of what I see in the popular press is pro-pot, let me adopt the anti-pot position.  Most striking to me is the astounding fact that many “highly educated” people whom I know or whose work I read, while vociferously denouncing tobacco and its “profiteers” are most blasé, even supportive of, marijuana sucking.  It is as if they believe that we have two sets of smoke-receiving lungs—one for tobacco and one for what they casually call, “joint”.  But who am I to tell you about cannabis and tobacco? Rather, I should give you the information that I have seen recently, and you will reach you own decision. I’ll mostly confine myself to two respiratory-relevant sources.

The first source is Michael Greger, M.D. FACLM, a physician, who—among other professional activities— has published scientific papers in, Family and Community Health, Critical Reviews in Microbiology, the International Journal of Food Safety, Nutrition, and Public Health, and the American Journal of Preventive Medicine, and who has lectured to the National Institutes of Health, United States Congress, and Conference on World Affairs.  His opinion about cannabis smoking is:

“There is unequivocal evidence that habitual or regular marijuana smoking is not harmless and causes respiratory symptoms and airway inflammation.” If you take biopsies from the airways of those that smoke crack, cannabis, or tobacco, compared to nonsmokers, there is significantly more damage in the lungs of crack smokers, marijuana smokers, and tobacco smokers. And, the levels of damage seemed comparable—especially between the marijuana smokers and tobacco smokers—which is remarkable, since the tobacco smokers were smoking about a pack a day, whereas the marijuana smokers were only smoking about 20 joints a week, rather than 25 cigarettes a day. And those smoking crack were just doing a gram or two a week. So, to see similar rates of damage between marijuana smokers and cigarette smokers suggests each joint is way worse than each cigarette.” (2018)

The second source comes to us from the Alcohol and Drug Abuse Institute of the University of Washington (2018). 

“Based on the current scientific research, there is no definitively proven "safe" way of inhaling marijuana (smoke or vapor).

Inhaling marijuana smoke in the long-term is likely to result in damage to the respiratory tract.

Smoking both marijuana and tobacco increases the risk of damage from both substances.

While marijuana smoke contains carcinogens, research about the association between marijuana smoking and cancer is limited and conflicting. The same is true for other lung-related diseases.

Marijuana smoking does appear to increase cough, sputum production, airway inflammation, and wheeze.

Using a water pipe or bong does nothing to reduce exposure to tar and carcinogens in marijuana smoke; using a vaporizer may reduce the harm associated with smoking marijuana, however vaporizers may carry their own risks and more research is needed.”

Please recall that the aforementioned discussion is deliberately limited to a direct comparison of the respiratory effects of cannabis versus tobacco.  You, no doubt, have heard that marijuana also has been implicated in a host of other unhealthful conditions, such as accelerated heart rate, nausea, vomiting, and pregnancy risks.  Neurological and psychological problems also are common, such as: time distortion, mood change, in-coordination, confusion, memory deficits, irritability, sleeplessness, anorexia, cravings, and anxiety.

Therefore, if you plan to run for the United States Presidency or aspire to any other occupation, I suggest that you think at least twice about whether to smoke pot, with or without inhaling.

References

Gregor, M. (2018).  Effects of Smoking Marijuana on the Lungs.  https://drgreger.org/pages/about-us

University of Washington (2018)  Learn about marijuana.  http://adai.uw.edu/marijuana/factsheets/respiratoryeffects.htm

Taking Control

We often are advised to take control.  So, the question naturally arises: take control of what?  Where do we look to promote our well-being?   Since I discussed this issue at length in my Conversation: Thriving, Surviving, and Thriving book, I will address it only briefly here.

There are four critical sources of tension that we target for improvement, and that determine our physical and mental well-being: body, environment, thoughts, and feelings (BETF).   These four elements are always interacting, and always affecting us to some extent. A change in any single element of the BETF system can produce a change in any of the others, although not necessarily at the same order of magnitude.  Most often when we seek health, we desire to change BETF to a more optimal level.  Imagine the four as housed within a vehicle that is the self and that has four functional steering wheels. Any individual BETF element or combination of elements can steer the self while the remaining one or ones go along for the ride.

Each BETF element exists both as trait and state tension, but, to simplify our discussion, let's illustrate by talking only in terms of the body. Trait body tension refers to our modal level of physiologic tension --- our usual resting level. Trait body tension differs from person to person, much as blood pressure does. For instance, a person who always seems "uptight" is high in trait body tension while a "laid back" person is low in trait body tension. Like blood pressure, however, body tension is not completely static for any single person. State body tension describes an individual's tension fluctuations within his trait-circumscribed range, temporary peaks or valleys soon replaced by his modal, resting level.

A resting level of trait tension represents a readiness that permits us to quickly respond to everyday circumstances of life. An individual's resting level of trait tension can be subjectively comfortable or uncomfortable. In the latter case, the uncomfortable condition could be due such factors as physical pain, noxious environment, disturbing thought, or dysfunctional mood.

Regardless of the comfort or discomfort of the trait condition, our physical and mental selves periodically are roused from the complacency of this relatively stable, resting, trait level and moved into a changed state. Physical change is perceived by us when it exceeds a given biological threshold. The change can be caused by alterations in the internal milieu, such as when blood sugar or hormonal levels drop precipitously. Or it could be caused by an external source as when a cold blast of air chills our skin. Mental change is perceived by us when thoughts or feelings occur that are qualitatively or quantitatively different from the extant trait baseline. When any one of the constants deviates from its trait baseline significantly, the foregrounding of that factor amounts to increased "press" (pressure to seize our attention and/or to influence our behavior) prompting us to seek satisfaction of the fore- grounded constant. 

The changed tone of the constant sometimes evolves slowly over time, as when people become less aggressive with age. Or the changed tone sometimes erupts into our consciousness, as when we are jolted by a leg cramp, surprised to see a sky that abruptly turns black and foreboding, alarmed to precipitously realize that we forgot to turn off the oven, or overwhelmed by an unanticipated emotion. Moreover, the constants interactively influence each other. Sometimes there is conflict among them, as when, through our thoughts, we "talk ourselves" into engaging in overly strenuous physical exercise, pitting thought against body. But more often the constants achieve a harmonious amalgamation appropriate to an individual in her milieu. For instance, happy thoughts typically occur in a context of relatively happy feelings, happy bodily conditions, and a happy environmental setting,

When a changed state occurs from our current trait baseline, we habituate to it and establish a new trait-circumscribed baseline. We then perceive subsequent changes as deviations from this, habituate to the new condition, establish a new trait-circumscribed baseline, and so the dynamic process continues.  

How about a concrete example to simplify the admittedly abstract ideas above?  For instance, as I walk along the beach, I may be totally absorbed in and conscious of vacation-related ideas, and oblivious to my reddening skin, the roar of the surf, and my serene mood. At this point my conscious physical and mental life is steered by my thoughts. However, in the next second, I could slash my toe on a sharp seashell, instantly foreground my bodily self, background the heretofore engrossing vacation-related thoughts, and direct myself to restoring my body-oriented integrity. My previous thoughts can be lost forever. Instead, I function at a reactive level of state arousal, become attentive to my bodily self, and direct my activities toward my injury, comfort, and safety. Subsequently, I habituate to the "shock" of my injury, establish a new trait-circumscribed resting level of bodily tension, background the concern about my toe, and foreground some other BETF element. In short, mental life can effortlessly move back and forth among BETF elements.

The more you can control  each of your BETF elements, then, the more you can take control of your overall physical and mental health.

Reference:

Peter J. McCusker (2003).  Conversation: Striving, Surviving, and Thriving: Searching for Messages and Relationships.  Bloomington, IN:Iuniverse.

Do You Know What You Want?

Every day you are besieged by people who think they know better than you.  That conviction is especially strong among marketers, and others intent on selling you an item or service.  Three leaders of the most powerful companies on earth subscribe to that “we know them better than they know themselves" attitude.  One was the late Steve Jobs of Apple who in a 1998 Business Week interview said, “A lot of times, people don't know what they want until you show it to them.”  The others are Eric Schmidt and  Jonathan Rosenberg of Google who, in their 2014 book, How Google Works, wrote,  “Giving the customer what he wants is less important than is giving him what he doesn’t yet know he wants.”

Obviously all three of the aforementioned technology titans are correct to a point: one certainly cannot want something until she/he becomes aware of it.  Moreover, marketers, and others who sell, sometimes must presume that they know what you will want, otherwise they never would invest the time, money and other resources to develop innovations. 

This blog, however, is not so much about marketers, and others intent on selling you an item or service, as it is about you. and your awareness of what you want.  More specifically, it is about what you must want to become healthier.

Let's suppose for the moment that Jobs', Schmidt's, and Rosenberg's beliefs can be applied to your health-namely, that you actually do not know what you want health-wise.  Now, of course, you know in a very general sense.  For instance, you would like to have an optimal weight, blood pressure, and blood sugar level.  But to achieve and maintain health, you must know more than those health dimensions, and know how to fight continually to maintain a comprehensively healthful lifestyle.  That stance, in turn, requires you to know which specific health obstacles impact you, personally.  If you are content to laze about, over-eat, and over-work, you do not truly know with sufficient specificity what you need to be healthy.

Presuming that you know clearly enough what you want, you then can turn you attention to what Jobs, Schmidt, and Rosenberg types presume that you want.  More important than those three, of course, are the marketers and sellers of "junk foods," edible and inedible.  Junk food can come in many forms, such as mindless television programs that keep you sitting on the couch for hours, or rabble-rousing politicians who add to your stress.  You need to know how to resist the junk food in all its manifestations.

So, you should strive to know as precisely as possible what you, personally, have to know and do to be healthy. With that secure base, you can prioritize your goals and be more discriminating when marketers and others, intent on selling you an item or service, try to exert their influence on you.  You then will know whether what they offer will contribute to your health or will undermine it.