Don't Worry About It
Lifestyle Health Wrap #8
The title of this week’s newsletter relates to the research covered in the Stress section. This research tracked the worries of university student with generalized anxiety disorder for 10 days and whether or not their worries came true. The findings suggest we’d be better off not worrying so much, thus the title of this post.
If you haven’t caught on already, I try to make the titles of these posts somewhat click-baity without veering into the realm of misinformation as perhaps most clickbait does. Anyway, we live in the attention economy, and these aren’t 15-second viral videos, so I gotta try to grab your attention somehow.
As I’ve done a couple of times in past posts, I’ve combined two sections into one because the study I chose covers both topics: diet and sleep. An interesting combination indeed. Let’s get right into it…
Diet & Sleep
The association between dietary quality, sleep duration, and depression symptoms in the general population: findings from cross-sectional NHANES study | September 27, 2024
https://doi.org/10.1186/s12889-024-20093-9
N = 19,134 (adults aged 20 years and older)
Cross-sectional
NHANES is a dataset that the CDC collects every two years designed to be a representative sample of the US population.1 This study used the data from the NHANES samples spanning from 2007 to 2014 to look at how dietary quality, sleep duration, and depression symptoms were correlated.
Here are the raw findings from the abstract. I’ll break them down shortly thereafter:
Unhealthy diet (OR: 1.40, 95% CI: 1.18–1.67, p < 0.001) and unhealthy sleep duration (OR: 1.94, 95% CI: 1.63–2.31, p < 0.001) exhibited positive associations with depression symptoms. Individuals who maintained an unhealthy diet but healthy sleep duration (OR: 1.60, 95% CI: 1.20–2.13, p = 0.002), healthy diet but unhealthy sleep duration (OR: 2.50, 95% CI: 1.64–3.80, p < 0.001), or an unhealthy diet and unhealthy sleep duration (OR: 2.91, 95% CI: 2.16–3.92, p < 0.001) were significantly associated with depressive symptoms compared to those with a healthy diet and healthy sleep duration, respectively.
OR stands for Odds Ratio. The equation for an odds ratio is as follows:
a is the number of cases who were exposed
b is the number of cases who were not exposed
c is the number of controls who were exposed
d is the number of controls who were not exposed
In this context, “exposed” just means had an unhealthy diet or had an unhealthy sleep duration.2 This is the silly language of epidemiology, which regardless of topic uses language that makes more sense for talking about viral pathogens.
Anyway, if we look at the ORs from the quoted results above, we can see that it is highest for those who had “an unhealthy diet and unhealthy sleep duration” which means these people had the highest odds of depression, which was expected. The OR of 2.91 here means that in these data, those who had an unhealthy diet and an unhealthy sleep duration had 2.91 times the odds of being depressed as compared to those with a healthy diet and sleep.
What I find most interesting though, is comparing the individuals who maintained an unhealthy diet but healthy sleep duration to those with a healthy diet but unhealthy sleep duration. For the unhealthy diet + healthy sleep group, the OR is 1.60 (95% CI: 1.20–2.133) for the healthy diet + unhealthy sleep group the OR is OR is 2.50 (95% CI: 1.64–3.80).
This means that poor sleep was much more correlated with depression than poor diet. This is also reflected in the ORs for the broader groups of just unhealthy diet (OR: 1.40, 95% CI: 1.18–1.67) and unhealthy sleep OR: 1.94, 95% CI: 1.63–2.31).
Exercise
Behavioral change interventions, theories, and techniques to reduce physical inactivity and sedentary behavior in the general population: a scoping review | August 3, 2024
https://doi.org/10.1186/s12889-024-19600-9
N = 29 studies
Scoping Review4
This review highlights the shortcomings of research on behavioral interventions focused on reducing physical inactivity and sedentary behavior. Changing people’s behaviors is difficult to do. We are all creatures of habit and habits are powerful. Understanding how to change them is even more powerful, thus the importance of this research. Here’s the concluding section of this study’s abstract:
Our review suggests the need to develop systemic and complementary interventions that entail the micro-, meso- and macro-level barriers to behavioral changes. Theory informed [behavior change interventions] BCIs need to integrate synergistic [behavior change techniques] BCTs into models that use micro-, meso- and macro-level theories to determine behavioral change. Future interventions need to appropriately use a mix of behavioral theories and BCTs to address the systemic nature of behavioral change as well as the heterogeneity of contexts and targeted populations.
Macro-level: “environmental restructuring”
Meso-level: “social and peer pressure”
Micro-level: “activating intrapersonal and interpersonal mechanisms of change”
In more straightforward speech: effective interventions for behavior change must integrate theories and techniques that take into account one’s environment, one’s social setting and relationships, and one’s mental state.
Stress
“85% of the things we worry about never happen” stated a recent post on Pubity’s Instagram account. Their caption attributed this claim to a Cornell University study without actually citing the study. It went on to say, “Even when worries did come true, 79% of participants handled the situation better than expected or learned something valuable.”
So I searched for these claims and found nothing other than other blogs repeating the same fabricated claim about a Cornell study with none of them citing an actual study.
With the help of the AI tool Perplexity, I did manage to find a study that came out of Pennsylvania State University that is similar, but doesn’t provide strong evidence for the claim that “85% of the things we worry about never happen.” Nevertheless, it does support the notion that much of what we worry about doesn’t come true.
A Brief Ecological Momentary Intervention for Generalized Anxiety Disorder: A Randomized Controlled Trial of the Worry Outcome Journal
April 7, 2016
https://doi.org/10.1002/da.22507
N = 51 undergraduate students (43 females) with generalized anxiety disorder
Randomized Controlled Trial
Even though this was a randomized controlled trial, the gold standard of experimental research, it’s a pretty weak one. All the participants were undergraduate students with generalized anxiety disorder (GAD) and most of them were females. Granted, females do have a higher rate of GAD than males5 but this sample did not come close to correctly portraying that difference in prevalence and is not a representative sample of any population other than perhaps the students at that school at that time who had GAD.
Despite these shortcomings of the study design, the goal of the study was to assess the effectiveness of this technique for journalling about worries called the Worry Ourcome Journal (WOJ).
Participants were assigned either to the WOJ technique (the treatment group) or to the Thought Log (TL) technique (the control group). In both cases, the participants were instructed to journal about either their worries, in the case of the WOJ group, or their thoughts, in the case of the TL group, when they received text reminders to journal, four times a day for 10 days. These journal notes were then entered online each night and reviewed 20 days after the 10 days, making for a 30-day study.
In the WOJ group, participants “recorded the content of their worries as concrete, specific predictions about the future.” For each worry, they rated how distressing it was, noted how much time was wasted worrying, how likely they thought it was that their worries would come true, and how likely the most rational person in the world would say their worry would come true. When transcribing their journal notes onto the computer, they were asked to not which worries came true or not and to rate whether these outcomes were “as bad as, worse than, or better than expected.”
Essentially, they were being trained in a form of cognitive behavioral therapy.
Participants first underwent a scripted training session for use of the WOJ in groups led by study personnel. They were given the following rationale: “Many people who regularly worry believe their worry is useful to them. As you pay attention to how upsetting, disrupting, and costly your worries are, and as you see clear evidence in your life that the things you worry about actually do not happen, you will recognize the uselessness of worrying and begin to engage in it less. Without these anxious thoughts in your life, your anxiety should also lessen.”
Unlike the WOJ group, who were given a definition of worry6 to keep in mind, the TL group just took notes about their thoughts throughout the day.
The researchers found that the Worry Ourcome Journal (WOJ) method decreased worrying at the end of the 30-day study as compared to the Thought Log (TL) group.
However, I think the more interesting findings come from the secondary analysis of these data, which ties back into the fabricated “Cornell” study I mentioned at the onset. Here’s the secondary study, which only analyzed data from the WOJ group:
Exposing Worry’s Deceit: Percentage of Untrue Worries in Generalized Anxiety Disorder Treatment
July 17, 2019 | https://doi.org/10.1016/j.beth.2019.07.003
N = 29 undergraduate students (26 females) with generalized anxiety disorder7
In this secondary study, which simply used the data collected from the previous study, found that “91.4% of worry predictions did not come true.” Also, “the most common percentage of untrue worries per person was 100%.”
The researchers came to the obvious conclusion that “worries in those with GAD were mostly inaccurate.”
So although these results come from a small group of anxious college students at a state school in Pennsylvania, it makes you wonder: what percentage of my worries don’t come true? Perhaps you ought to test out the worry outcome journal technique for yourself and see what you find.
Connection
The impact of social participation on the quality of life among older adults in China: a chain mediation analysis of loneliness, depression, and anxiety | September 24, 2024
https://doi.org/10.3389/fpubh.2024.1473657
N = 508 (aged ≥ 60; 56.5% women)
Cross-sectional
This study examined how social participation impacts the quality of life among older adults in China. The results indicated significant negative associations between social participation and loneliness, depression, and anxiety, and a positive association between social participation8 and quality of life (QOL). Loneliness and depression were found to mediate the link between social participation and QOL, while anxiety did not. Meaning that lack of social participation seems to decrease quality of life via loneliness and depression but not via anxiety. The findings underscore the importance of social engagement for enhancing psychological well-being and quality of life in older adults.9
Other
I listened to Andrew Huberman’s podcast about microplastics this week and recommend giving it a listen.
The research isn’t quite there yet, but I have a strong feeling that there's going to be some sort of societal reckoning about the impact that plastics are having on human health.
What we know now is that they are everywhere you look (literally everywhere) and that they can disrupt biological processes, particularly, they can interfere with endocrine (hormone) signaling. We just don’t know how much of an impact they’re having or how much microplastics in the body it takes for them to have negative impacts. There’s sure to be a ton more research that comes out in the coming years about this.
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Thanks for reading!
As always, let me know if you find any mistakes, have any questions, or have any feedback!
Disclaimer: This newsletter provides health information and research for educational purposes only. It is not a substitute for professional medical advice. We are not medical professionals.
Longer description from ChatGPT: “The National Health and Nutrition Examination Survey (NHANES) is a long-standing research program conducted by the Centers for Disease Control and Prevention (CDC), specifically its National Center for Health Statistics (NCHS). NHANES collects a wide range of health and nutritional data from a representative sample of the U.S. population to assess the health and wellness of Americans over time.”
The abstract of the study mentions how they defined unhealthy/healthy diets and sleep duration btw, if you want to check it out.
95% CI means 95% confidence interval, which translates to: we can be 95% confident that the true value lies between these two values.
A scoping review is a sort of exploratory academic review that identifies key concepts, gaps, and the scope of existing research on a particular topic without detailed/critical analyses.
“… they were provided a definition of worry—“a repetitive anxious thought that an event in the future will turn out badly . . . apprehensive expectation . . . repetitive and hard to control in your mind”—and were given several examples. They were also taught that “a worry is not just a fleeting concern about the future”—that it must “forecast a negative outcome”—and were given examples of thoughts that are not worries. Participants were asked to only record specific, concrete, testable worries that they could be sure either occurred or did not occur within the 30 days of the study and were given good and bad examples”
this was the treatment group from the previous study
From the study: “Social participation is defined as an individual’s involvement in activities that facilitate interaction with others in society or the community, expressing interpersonal interactions outside the home (6–9). This includes active engagement in small social circles, such as friendships, as well as larger societal contexts, like workplace interactions (10), and the satisfaction derived from these engagements (11).”
ChatGPT helped write this section