ذهن آگاهی به عنوان یک تعدیل کننده ارتباط بین آندروسترون و علایم جسمی گزارش شده

The present study tested the hypothesis that mindfulness leads to greater concordance between physiological functioning (dehydroepiandrosterone; DHEA) and the psychological experience of that functioning (physical symptoms). Participants completed the mindful Attention Awareness Scale (Brown & Ryan, 2003) and a questionnaire assessing the severity of recent physical symptoms. In addition, each participant provided a saliva sample that allowed for the measurement of DHEA. It was found that those higher in mindfulness had a stronger negative relationship between DHEA and symptoms than those lower in mindfulness. Healthcare providers can use mindfulness to predict which patients are likely to have greater insight into their physiological health. The results also provide further validation of the mindfulness construct as an important predictor of internal concordance.

A person’s health is a multifaceted experience that includes at least three components: physiological activity, awareness of symptoms, and illness-related behavior (Davison & Pennebaker, 1996). Measures of these facets are only moderately correlated with each other (c.f., Pennebaker, 1982). The current investigation will attempt to identify those individuals who show a stronger correlation or concordance between their physiological activity (their levels of salivary dehydroepiandrosterone) and their symptom awareness. It is expected that those who are high on mindfulness (Brown & Ryan, 2003) will show a greater concordance between these health-related measures. 1.1. Dehydroepiandrosterone Dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) are two of the most abundant steroids in the human body; only cholesterol is present in greater amounts (Labrie et al., 2005). The majority of DHEA is produced by the adrenal glands; but it is also produced by the gonads, adipose tissue, and brain (Pieper & Lobocki, 2000). DHEA plays an important role in the onset of puberty and the development of secondary sex characteristics (Grumbach, 2002). As such, DHEA levels are generally low in early life, begin to increase rapidly in the years preceding the onset of puberty (between ages 7 and 9), continue to increase until early adulthood, and then begin to decline (Kroboth, Salek, Pittenger, Fabian, & Frye, 1999). It has been found that at ages 70−80, DHEA concentrations are approximately 20% and 30% for men and women, respectively, of the corresponding levels at ages 20–30 (Labrie, Bélanger, Cusan, Gomez, & Caridas, 1997). In addition to regulating sexual development, DHEA is related to physical health and immune functioning. In animal studies, high levels of DHEA have been linked to protection from a number of viral and bacterial infections in mice (Padgett, Sheridan, & Loria, 1995). In humans, low levels have been linked to a wide variety of physical ailments such as diabetes, obesity, and rheumatoid arthritis (c.f., Celec and Starka, 2003, Ernestam et al., 2007 and Labrie et al., 2005). Additionally, DHEA plays a role in the course of HIV. People with lower levels of DHEA are likely to have lower CD4 cell counts and more likely to have progressed from HIV infection to AIDS (Christeff et al., 1996). In a recent review of studies investigating the link between DHEA (and DHEAS) and coronary heart disease, the majority of studies found that those with lower levels of either steroid are at an increased risk for heart disease (Alexandersen, Haarbo, & Christiansen, 1997). As noted above, DHEA levels decrease from early adulthood throughout the rest of life. Accordingly, it has been proposed that decreases in DHEA levels are responsible for the general decrease in health with age (c.f., Celec & Starka, 2003). Seemingly contrary to the age-related decline, one study found that the average DHEA level for the 80+ age group was higher than the corresponding average for the 60–80 age group. The investigators suggested that their unexpected finding simply indicates that people high in DHEA live longer than those who are low (Sulcová, Hill, Hampl, & Stárka, 1997). Clearly, there is substantial evidence linking people’s health to their basal DHEA level. Indeed, this link has led some to recommend that DHEA be given as a supplement to help battle the effects of aging (Kroboth et al., 1999 and Labrie et al., 2005), as well as to increase adrenal functioning in patients who have received tumor necrosis factor treatment for rheumatoid arthritis (Ernestam et al., 2007). 1.2. Physical symptoms People do not have access to their DHEA levels, but they do have some access to another indicator of health – physical symptoms. The symptoms that people feel (or report) can be defined as “subjective perceptions of physiological processes” (Davison & Pennebaker, 1996, p. 107). Reported symptoms include headaches, coughs, upset stomachs, etc. Unfortunately, they are not a perfect predictor of a person’s current physiological health. In a review of the literature, Pennebaker (1982) looked at the average correlation between physical states and people’s perceptions of those states. The resulting relations ranged from .21 (for the relation between actual and perceived heart rate) to .33 (for the relation between actual and perceived finger temperature). Since a specific physiological state (e.g., heart rate) and the perception of that state are more similar than general health and physical symptoms, it would be expected that the relation between actual health and perceived symptoms would be smaller than those reported above. Clearly, the perception of physical states (and symptom reporting) is influenced by factors other than the physiological process to which they refer. One factor that influences symptom reporting is a person’s affective state. People high in negative affect or neuroticism tend to report more symptoms than those who are low (Pennebaker, 2000). One review of the research in this area (Watson & Pennebaker, 1989) found that correlations between negative affect and reported symptoms ranged from .25 to .62 with an average of .33. Because these correlations are so prevalent, it has been recommended that a measure of negative affect or neuroticism be included whenever symptoms are being measured in order to remove this unwanted variance (Davison & Pennebaker, 1996). Another factor that impacts symptom reporting is level of attention (Pennebaker, 2000). People are receiving information about both their internal and external worlds, and information from these two sources often compete for people’s attention. Therefore, the amount of information that a person is receiving from the outside world will affect how much attention they are capable of paying to their internal physiology (Pennebaker, 1982). For example, when a person is engaged in an interesting activity, they are less likely to report physical symptoms than when they are in a “boring” environment (an environment with little external stimulation). However, people in a boring environment are no more accurate at reporting their symptoms than are people in a distracting environment (Pennebaker, 1982). Stated differently, higher attention appears to lead to higher reported symptoms independent of one’s “true” symptom level. Accuracy of symptom reporting may be influenced by other factors. The construct of mindfulness (Brown & Ryan, 2003) may be such a factor. 1.3. Mindfulness Mindfulness represents an open prereflexive state where one is aware of their behavior, experiences, and the stimuli around them (Brown & Ryan, 2003). Mindfulness has been found to be positively related to stronger concordance between implicit and explicit experience. Specifically, Brown and Ryan (2003) reported that those higher in mindfulness had a stronger relation between their implicit (as measured by the implicit associations task; Greenwald, McGhee, & Schwartz, 1998) and explicit affect (based on Diener & Emmons, 1984). The authors attributed these results to the increased awareness that people high in mindfulness have for their internal experiences. The greater awareness allowed greater access to implicit affect, resulting in greater concordance with explicit affect. Of particular importance to the present study, Brown and Ryan (2003) argued that the greater awareness of mindful people applies not just to psychological states, but also to physiological experiences. In addition to greater concordance between implicit and explicit affect, mindfulness appears related to improved health. Specifically, mindfulness has been shown to predict fewer reported stress-related symptoms in cancer patients (including disturbances of the cardiopulmonary, central nervous, and gastrointestinal systems; Carlson & Brown, 2005). This finding points to an important distinction between attention and mindfulness. Whereas greater attention leads to greater symptom reporting (Pennebaker, 2000), mindfulness results in the opposite. What remains to be seen, however, is whether in addition to its relation to less symptom reporting, mindfulness also moderates the relation between actual physiological state and reported symptoms.

This study found that while there is little overall agreement between physiological and psychological experience of health, some people show greater concordance than others. Those more aware of their current situation (i.e., more mindful) reported levels of symptoms more in line with a physiological measure of health (DHEA). We suggest that people who are more accurate at assessing their health are better able to take care of themselves. However, it remains to be seen whether more mindful people show greater concordance between symptom reporting and seeking medical help.